Special Populations University of Phoenix Darla Roberts BSHS 402 Jocelyn Besse May 7, 2011 Many populations in and outside of human services can utilize the skills and services of a case manager, however, there are many special populations in the realm of human services that require a case manager. Populations that were determined to need a case manager were the elderly, poverty stricken, mental/emotional disabilities, speech pathology, and drug exposed infants.
Though each of these populations needs a multitude of services and a case manager, those with mental and emotional disabilities can benefit exponentially with the aid and expertise of a case manager to ensure that needs are met for those clients that cannot or do not understand what needs should be met. How and why have you selected this population? How was this area of interest formed? My interest in the human service field and case management of mental and emotional disabilities was nurtured through personal experience.
Throughout my adolescence and early adulthood as I watched two sisters struggle with Bipolar Disorder (BD), Borderline Personality Disorder (BPD), and Manic Depressive Disorder (MDD). My younger brother also battled with mental and emotional disorders such as Shaken Baby Syndrome (SBS), Obsessive Compulsive Disorder (OCD), and various other disorders that prevented learning at an average pace or milestone achievements.
Watching my siblings battle these obstacles and the upheaval that each episode brought into our family life made for a constant barrage of dramatic psych ward admissions, suicide attempts, frustration, stress, and emotional exhaustion for both the individual experiencing the episode and the rest of the family watching with our breath held as to the outcome. Growing up in this environment first began to affect me negatively with rebellious acting out. However as I aged and matured, these episodes fostered empathy and an undeniable desire to help others suffering as my siblings had.
In the last eight years, I have lost both my sisters to suicide. My older sister overdosed on prescription medication in January of 2003 at the age of 22, and my younger sister overdosed on her prescription medication this past February at the age of 24. Not only do I wish to help those individuals who suffer with these same afflictions, but I would also like to help and support those individuals who are constantly exposed to the effects and aftermath of these disabilities. What do you bring to the field of helping that would benefit this specific population?
The largest contribution I bring to the field of case managing is experience. Living with siblings combating so many struggles and obstacles, not only have I seen firsthand what these episodes can entail, but I also know how these episodes can affect the other individuals living in the home. Watching my siblings suffer through these illnesses, I felt helpless, distraught, anxious, and when younger, resentment. The child suffering from the illness is given so much attention that other children in the home without afflictions are forgotten, bypassed, or simply unnoticed.
Though being teased at school, not understanding homework, or normal teenage issues pales in comparison to illnesses such as BPD, OCD, MDD, and other illness, the child dealing with the average issues of every adolescent still feels they need guidance, help, and support. However, the parents, schools, doctors, and other family members are so concerned and concentrated on the child with mental issues, that the other children are left to overcome obstacles of everyday life with no support or guidance except what may be found elsewhere.
This can lead to drugs, sex, legal trouble, acting out, problems in school, and a number of other undesirable effects. Though some, like me, may experiment mildly with these behaviors and outgrow them, others are not so lucky and end up with severe issues of their own. One other effect of living with individuals affected with these kinds of disorders is to eventually learn that some disorders, such as BD, are genetic. As a mother of two girls, I can only pray that my girls will not suffer as my sister’s did.
This in itself is a harrowing feeling. I would like to help others realize that simply because disorders are genetic, does not automatically mean that their children will suffer the same. There are benefits to living with individuals battling these illnesses. One benefit is recognizing normal and abnormal patterns of behavior. An individual that has personal experience living with a disorder such as BD will know what kind of displays of behavior to watch for and whether fits of temper are simply normal ehavior or could be something else. An individual who has no concept of BD may not realize that their child needs professional attention and assume that the child is spoiled or ill tempered. I also bring personally developed ideas to this field. Since I have lived with and seen firsthand episodes stemming from severe mental and emotional disorders, I gained valuable insight and familiarity with treatments as well as their success rates not only on a medical level, but on a personal level according to the individual taking them.
For instance, in order to mitigate the effects of Bipolar Disorder in my younger sister, a plethora of drugs were tried over the course of many years. While some drugs like Lithium can help reduce the mania and manic episodes of BD, one of the side effects of this drug is severe weight gain. While my sister’s mental stability was improved, her self-esteem and confidence plummeted due to the massive weight gain. She was still depressed, irritable, and quickly offended.
While the doctors and my parents believed this is simply as good control as BD can have, I realized her emotional feelings about the weight gain were being displayed, not symptoms of her mental state. Another idea came after a year of having her medication constantly switched. My sister seemed to be switching medicine every few months. Not only did this cause severe weight fluctuations which inhibit and disrupt any individuals mental, emotional, and physical wellbeing, but I believe the constant switching of medications kept her mental state from stabilizing at all during that year leading to many outbursts.
I think the doctors need to try harder to find a custom medication combination according to symptoms, personality, and dominating traits during episodes instead of which drugs are most commonly used to treat the condition or trial and error methods. How would you use case management to help this population? I would use case management to help those individuals suffering from the disorders themselves, as well as those individuals suffering from living with an individual with the disorder to provide many services that are needed, but as of yet, not always included.
One of these services is a nutritionist. The client may need to see a nutritionist to help combat weight fluctuations since many studies have linked sever weight fluctuations to instability in mood and many medications used to treat BD have rapid weight loss or gain as side effects. As a case manager, I would help clients receive constant medical care and therapy for each member of the family. As a case manager I would ensure that group therapy and individual therapy is provided for support to each member of the household.
Many services focus solely on the individual suffering from the disorder, but disorders such as BD affect everyone in the household. I would also educate the individual extensively on their illness. In my sisters’ cases, my mother was guardian for both, though they both reached ages over 18. In instances such as these, doctors and others assigned to the case tend to direct all questions, treatment plans, and instructions to the guardian. I believe this impedes the individual’s ability to monitor their own condition and allows a passive attitude in determining treatments and controlling disorders.
Whether an individual has someone to help or not, each individual needs to be aware, active, and educated on their illness, treatments, and goals. What limitations and strengths do you bring to this chosen field? How would you use the strengths and overcome the limitations? In this field the greatest strength and most limiting weakness I bring is personal experience. Even though individuals may suffer from the same mental or emotional illness, no two cases are the same. Each case cannot be identically compared to my sisters’ cases, though they provide a good foundation to begin from.
Simply basing actions off what I believe would help the client the most without hearing the differences between their cases and my own experiences could complicate the case more. Since I do have personal experience with these types of illnesses, I know that each case can quickly become a matter of life and death with absolutely no warning. One day a client may be well adjusted, and the next day try to commit suicide. And, in my experience, both individuals have succumbed to suicide.
This could cause a sense of overly exaggerated pressure for me in evaluating a client’s progress. I know that not all individuals feel suicidal at every mishap or setback that occurs, but using my personal experience, I may easily fail to remember this. To overcome this limitation, I will have to trust that I am judging the client based on their own case and not solely my own experiences. Listening to the client, reading body language and facial expressions, and asking pertinent questions will allow me to make a better judgment for the client than going off my own experience.
In order to best serve the client, I would put my own experiences in the background and only use that experience when relevant. By treating each case individually and uniquely I can ensure that I am guiding the client down the best road for that client. Are there likely to be multicultural issues to be addressed as you work with this population? How would you address those? Mental and emotional disabilities affect individuals from every race, creed, sex, and ethnicity.
Case managing clients in this population will most definitely bring in a plethora of clients from all different backgrounds. There are some groups who may resist medicine on religious grounds, such as the Amish. Others may live in an area that does not have access to services needed, such as underdeveloped countries. There may even be male clients that resist the diagnosis of diseases simply because women are statistically more prone to the disorder or vice versa. In these instances, I would try every avenue to secure treatment for the individual.
Whether that means enrolling the client in services that can help attain services in their area or travel as needed to a location that provides services, or strongly advocating the necessity of the medication. What local resources did you find in your Internet search for this population? The only local resource I found on the internet for this population was a dictionary search to ensure the correct spelling of lithium. Otherwise, this is entirely my own extensive experience and thoughts on case managing mental and emotional disorders.