George Vs Nostrand Risks of Normalcy Response For this assignment follow the instructions. You are a job coach providing services to the disabled.Describe

George Vs Nostrand Risks of Normalcy Response For this assignment follow the instructions. You are a job coach providing services to the disabled.Describe at least five areas and the changes you can make to improve your interactions with the people with whom you work. your response should be 300 words.Please describe the 5 areas. Please keep your answer relevant to the assignment. Do not write about articles or journals . The resource is to help guide you. Provide relevant answer thanks:Assignment:You have read George Nostrand’s presentation on normalcy. Think about how you behave when you are with the people to whom you provide job-related services. Relative to George’s normalcy presentation, where do you think you have room for improvement? Describe at least five areas and the changes you can make to improve your interactions with the people with whom you work. Remember that your goal is normalcy! attached is a article on normacy The Risks of Normalcy?
Providing Real People with Real Opportunities
Presenter:
George V. Nostrand, Employment Counselor
Vocational Opportunity Works! (VOW)
Rutland Mental Heath Services (RMHS)
Rutland, VT 05701
phone: (802) 786-4935/ fax: (802) 775-3307
vow@sover.net
This presentation came about when last fall, I asked my boss if I
could talk to my peers because I had some concerns and
observations I wanted to share. I had noticed that often times the
way we both treated and interacted with the clients we worked with
was not normal.
My thoughts at the time were that if our goal was for people to be
treated normally in the community, how could we ask others to do
this if we didn’t? I also thought, “How can we expect clients to
behave and live normally if we don’t treat them normally?”
The topic of this presentation is normalcy, which is a broad concept
and an abstract word. What is normal anyway? For the purpose of
this presentation, I would like to look at normalcy as something
closer to an accepted standard of living. When I refer to a “normal”
life I mean one where the person’s basic needs are met in a way that
is comfortable and/or over which he/she has some control.
The truth is that most of our clients are not what most people or
society would call normal by any definition. They are different for
various reasons and they cannot always function at healthy levels.
That’s why they need our help.
Although we get new clients all the time, there are people we have
worked with over longer periods. We get to know these people well,
forming various opinions and images of them. These images often
define the clients for us and shape how we interact with them. I’d
like to present a quick case study of one client to help illustrate a
few of the points I want to make. This person has been a client of
my agency for around five years.
Case Study
• 1991
Hospitalized for Major Depression
• 1992
Hospitalized for Major Depression
• 1993
Hospitalized for Major Depression
• 1995
Hospitalized twice for Mania
• 1996
Hospitalized for both Mania and Major
Depression
Medications: Imipramine, Desipramine, Thorazine,
Zoloft, Nardil, Lithium, Depakote, Wellbutrin
among others.
Additionally this person…
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Took a major overdose
Had many ECT treatments
Escaped from the hospital
Was handcuffed and taken away by the police on several
occasions
Was unable to hold down a job
Was evicted from an apartment
Lived in a half-way house
Spent and owed large sums of money
Etc., etc.
As you can see, this client has had multiple hospitalizations and been
on a number of different medications. Additionally this person has
quite a past…. In looking at the history of this person, one could
easily say he or she is pretty sick. It would stand to reason by looking
at his or her past, that without a miracle or positive intervention, he/
she would continue along a similar path. In the years listed, this
person had many charts, assessments, evaluations, etc. and was
treated by a variety of people from different disciplines. There are
people who may only remember that person based on that period of
time, those records, and the problems he/ she had.
But here is where that person is today.
Today
• Employment Counselor for Rutland Mental Health
• Group Leader for Choices Workshop series
• Editorial Board Member and writer for CounterPoint,
a quarterly Newspaper
• Former Board Member of NAMI-VT
• Public Speaker & Writer
• Professional-Amateur Musician
Additionally…
This person also has:
• his own apartment
• a car
• a meager income
• a girlfriend of over 5 years
• friends
• hobbies
• hopes, dreams, and opportunities…
All of which are normal expectations!
How does this tie into the concept of normalcy? Most of the
people I deal with these days only know the person on the last two
slides. They treat me as coworkers or peers should. But how would
they have dealt with me if they knew me during the time on the
first two slides?
Same Person?
Then:
• 7 Hospitalizations
in 6 years
• Fired/ quit five jobs in
two years
• Had a legal Guardian/
Payee
• Once thrown out of a
bank, bar, & supermarket
in a matter of hours
Now:
• Has lived independently
for over 6 years
• Has held the same job
for almost 5 years
• Can almost balance his
checkbook
• Occasionally still gets
speeding tickets
Well, it so happens that I’ve had different experiences that showed
how differently someone like myself can been treated.
One is with my current coworker Kirsten. Kirsten was a worker at
a community care home or half-way house when I was a client
there. Although she has admitted that it was a challenge initially,
she has been able to see past the client I was, and deals with the
person I am today. My hope and belief is that she can see the
person I am today in the clients she works with now.
On the other hand when VOW was looking for new staff
recently, Kirsten tried to recruit one of her former coworkers at
the same half-way house. We’ll call her Jane. When Jane found
out that she would be working with me, she said that she would
not apply for the job. Kirsten suggested that if she was willing
to talk with me, Jane would see that I was not the same person
as I was six years ago. She refused. Her loss.
Honestly, Jane knew a pretty sick young man six years ago. She
couldn’t get past my history. It is easy to judge clients by their
history. Although we must take the past into account in
treatment, we need to deal with clients based on who they are
today.
It’s In The Past
Goal: to treat people based on who
they are today, considering their
history without letting that history
overshadow their abilities,
interests, and goals.
There is a lot of shame and stigma attached to having a mental
illness and for many people, myself included, much of it lies in the
past. So instead of focusing on that past, we need to look to what
we can do today and in the future. We can’t let a client’s history
hinder movement forward in life. People who do not know my past
might not find it surprising that I have achieved what I have, but
more than once my parents were told: “He probably won’t get
much better, and will most likely only get worse.”
On one of the earlier slides I mentioned that I was a group
leader for the Choices Workshop. Participating in the workshop
required a willingness to participate in a study with the purpose
to look at why people (especially with mental illness) rarely
returned to work after being approved for Social Security
Disability Insurance benefits. Since I had been a Social
Security recipient and had successfully returned to work,
eliminating those my benefits; since I filled out the same form
as the rest of the participants in the workshop; since I was a
“consumer” and also an employment counselor; and, since I
was helping to teach the class, I was interviewed as part of the
study. After more than an hour and a half on the phone with a
woman in Oregon, and many questions, she finally asked,
“Why do you think people with mental illness rarely returned to
work after being approved for some kind of cash benefits?”
She had asked me all kinds of questions relating to fears about
losing benefits, different work incentives, and other benefitrelated questions. She also asked me about medications, side
effects, treatment, and a variety of other things.
My answer was something that she hadn’t mentioned, but
something that really encompassed all of these things. I told her
I thought the biggest barrier keeping people from returning to
work is low self-esteem.
Self-Esteem
E
S
E
L F
s
t
e e m
SUCCESS
I could easily do a whole presentation on both the importance
of, and lack of, focus around self-esteem in most forms of
treatment.
Without healthy self-esteem, it is hard to accomplish
anything. Healthy self-esteem is something that must be built
or rebuilt by achieving success. The reason I am an
employment counselor is because I believe that work is the
most effective way to address self-esteem.
Work Works!
Work is why I am here today and no longer wasting my days
away at some day center – drinking coffee, smoking cigarettes
and pacing back and forth. Work made me feel worthwhile
because I could see I was accomplishing something,
contributing to my community and I had a purpose.
There was a time when I did spend my days at a day center drinking coffee, smoking cigarettes and pacing. At the time,
that was all that was expected of me. Fortunately my parents
had higher expectations for me.
Expectations
From the root Expect, which
implies looking forward to and
confidently believing, with good
reason, that something will occur,
even to the extent of imagining or
picturing it.
We all need to have expectations if we want something to
occur. We need to confidently believe and even picture what
our goals are and be able not only verbalize them, but also to
make plans that incorporate progress, no matter how small.
In my case, my parents wanted me to be more active and do
something … anything. I began doing some volunteer carpentry
work at a local recycling center. I liked carpentry, I had done it
before, and it didn’t take long for me to start feeling better
about myself. My parents had good reason to believe and didn’t
have a problem imagining me working because they had seen
me do it before. But the people at the mental health center only
saw the sick young man that came to them from the hospital.
At the center, their expectations were only that I follow the bare
minimum of a treatment plan; maintain stability by taking meds,
making appointments, following the rules at the community care
home, and attending the day center.
My first job with the agency where I work now was at a similar
day center and many of the clients had similar goals. They drank
coffee, smoked cigarettes, and paced all day, every day. I know I
may be preaching to the choir here, but many of these people
could have and should have been working. But there were no
expectations for them. When the day center closed, some of the
people, who staff never imagined working, went to work.
As employment counselors we need to ask why. Why can’t
they work? We can and need to challenge the mentality that
people with disabilities can’t work. If there are no
expectations, there will be no progress, no real recovery.
•
There are normal, or natural milestones that we all strive for
in life, and these should not be out of reach to our clients. We
should not limit opportunity for an individual just because he
or she has a disability.
We need to look at creative ways of helping clients achieve
their goals, and reach the milestones they strive for, in
attainable, appropriate time frames. This entails a number of
things. We must honestly look at the goals we develop with
our clients and we must ask our clients and ourselves a
number of questions including:
Effective Goal Setting
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Are our goals the client’s goals?
Is the client invested in these goals?
Are the goals individualized?
Are we providing the services that the client needs and
wants?
• Are the goals worded so that they address problems
through building on the strengths, abilities, interests,
and preferences of the client?
• Have we taken the time and thought to develop these
goals so that they are appropriate to where the person
is in his/her recovery?
• Does the client understand the goals?
Effective Goal Setting 2
• Are we collaborating with others (ex – family,
community, state, advocacy, and other organizations) to
provide the best treatment?
• What are the specific services & time frames?
• Are there ways of measuring progress & success?
• Have the goals been broken down into smaller, more
achievable steps?
• Is there a plan for frequent review &/ or potential
revision of the goals?
• Are these goals normalizing?
• Does the person have his/her own copy of the goals?
Creating client-centered goals is not a new idea. But it is
important that when we develop these goals with clients, it is
a genuine process and not something just to write down for
documentation purposes. We must ask our clients and
ourselves what they really need and want, and how we can
facilitate and empower them to achieve the goals we create
together.
Inherent in achieving goals and striving for self-advancement
is the fact that people must take risks. Risk should not be a
four-letter word. We should encourage our clients to take
healthy risks that will allow them to grow and provide
opportunities for them to better themselves and their
situations.
Healthy Risk Taking
Risk is the bridge we must cross to
reach success.
Small calculated risks help to lay the
foundation for a healthy self-esteem.
Risk is not a four-letter word!
Taking risks doesn’t mean we encourage people to be reckless
or jeopardize their treatment. It can be a process of starting
with small risks and building upon successes. Working
towards normalized goals related to independent living,
financial stability, real skill building, and employment are all
aspirations for which people can strive. Again, this is a process
that can sometimes seem overwhelming for clients and for us,
however, if we break everything down into small achievable
steps with specific parameters, then goal attainment will seem
more feasible.
Having something to look forward to, as well as the hope that
things can get better, is crucial to successful recovery.
Oftentimes, hopelessness can be more debilitating than mental
illness itself. We need to show people that they have more to
gain by taking small risks, than they do to lose.
We also need to show clients that there is no such thing as
failure.
When clients start talking about failure, I often reach over and
take the following list off my wall…
There’s No Such Thing As Failure!
JOBS BETWEEN 1991 – 1998
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Drove a delivery truck – 3 months
McDonald’s – 3 months
Warehouse – 9 months
Grill Cook – 1 month
Hotel job – 3 weeks
Warehouse – 4 months
Cafeteria – 6 months
Corner Store – 6 months
Airbrusher – 4 months
Telemarketer – 3 months
Dishwasher – 6 months
Counselor at Child Center – 1 month
Telemarketer – 7 months
Carpenter – 8 months
One-to-one Counselor – 6 months
16. Employment Counselor
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
Quit due to mental illness
Quit
Quit due to mental illness
Fired
Fired
Quit
Quit
Quit
Let go
Quit
Quit due to mental illness
Fired
Quit
Quit
Took another job
* 4+ years & going strong!
They generally read over it quietly until they get to the bottom
when they say, “It’s you!” Again, the past isn’t always the best
predictor of the future. As you can see, before this job, I’ve
never held a job for more than a year. I’ve often joked with
people that the reason I am an employment counselor is that
I’ve had so much experience finding (and losing) jobs of my
own.
Failure is an idea we have to get out of people’s heads, because
it is tied in with the word fear, which keeps people from taking
risks. Eliminating the risk of failure or the fear of failure is
essential for people to realize their full potentials. This all ties
into the self-esteem piece I mentioned earlier. Employment
counseling is a process of walking side-by-side with a person
through the risks involved in finding, getting and keeping a
job. It involves ongoing development and reassessment of
goals and expectations. Throughout the process, a main focus
should be on helping people to strengthen their self-esteem.
Personally, I only received employment counseling for a brief
period of time. Though I don’t access many direct services, I
have a number of natural supports…
Natural Supports
Goal: Encourage and help clients develop
natural supports, so that they are not reliant
only on us to help solve all their problems
and meet all their needs.
If we educate our clients about natural supports, it will not
only mean less work for us, but also one more normalized
piece in the lives of our clients. If there is a way for them to
access or meet their needs more naturally, we should be
promoting and supporting this. Clients need to be involved in
activities and relationships that lead to socializing, learning,
and experiences outside of the mental health or other
treatment, medical, and rehabilitation systems.
For me, a key part of developing natural supports has been
my willingness to disclose. While this may not be as relevant
for some disabilities, it is a big issue for most people with
mental illness. (In my case, I am not only willing to share that
I have a mental illness, some days I actually get paid to.)
On another level, being open with people has allowed me to create a
natural support network that is more normal than if I were reliant on
service providers. Fortunately, I haven’t needed much professional
support recently, but I feel confident that my friends, family,
coworkers, and others in the community would reach out if I were
in a time of need. They would not be as surprised or confused
because I have been open about the reality that I have bipolar
illness.
Natural supports in the work place are essential for success. If
people don’t feel welcome, wanted, and supported at the workplace
all the coaching in the world won’t keep them there. The best
placements I have made have been at places where I had an
established relationship with one or more people, a relationship that
was both trusting and friendly, and a relationship that assured me
that the client would be in good hands. Developing natural supports,
just like many of the things we do, needs to be an ongoing process
and something that you do with the client and on your own.
It is also only natural to work with families.
As I’ve said, if it wasn’t for the support,
involvement, and advocacy of my family I
honestly wouldn’t be here today. Here’s a
quote from the president of NAMI-VT.
Families Members
“Ideally, treatment is a team approach with
consumer, providers and family member all
contributing a perspective. The family members
offer day-to-day experience of being with
someone who suffers from mental illness. Often
the family members can tell providers about
changes in patterns of behavior: taking
medication, sleeping, eating, agitation, depression,
using /abusing drug and alcohol etc. While the
provider often sees the consumer for a brief period
of time, the family member has both a day-to-day
an historical perspective.”
–Claire Munat, President of NAMI-VT
I’m currently working with the a young man’s family
who wants the best for their son. It’s interesting being
on the other side. I know my family was labeled
“difficult” and “pushy” when they were advocating
for me. Last summer when my younger brother was
hospitalized, I was considered me to be difficult and
overly assertive. Dealing with family members can be
trying and seem like very hard work, but family
members can also be important allies.
Working with Families
• Although we may know more about the
illness, treatment, and how to help people
with mental illness, families still know
the person best.
• Families may not always be easy to work
with, but if the client wants them to be
included and they are willing, they should
be considered part of the treatment team.
• Believe it or not, often family members
carry more weight with clients than we do.
Make them your allies.
When we challenge clients to take risks, explore
natural supports, and work on goals, it is only
reasonable to expect that they are going to
struggle. I believe another key component to
naturalizing or normalizing our system is
allowing for natural consequences.
Natural Consequences
Allow clients the freedom to fall, so
that they can …
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