CMCT01_Case_Studies 2015

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CMCT01 CASE MANAGEMENT (NATIONAL CERTIFICATION) COMPETENCY TRAINING CASE STUDIES

C A S E M A N A G E M E N T S O C I E T Y O F A U S T R A L I A & N E W Z E A L A N D 1 9 9 6

THIS IS THE PROPERTYOF THE CMSAAND IS NOT TO BE REMOVED FROM TRAINING – PLEASE RETURN TO TRAINER

ethical | enabling | challenging | sustainable

CONTENTS

Case Study 1 David

Mental Health (Torres Strait Islander)...................................................................... 1

Case Study 2 Tom

CDC Level 2................................................................................................................ 2

Case Study 3 Mary

Aged Care (National Respite Carers Program). ....................................................... 3

Case Study 4 Sarah

Disabilities.................................................................................................................. 4

Case Study 5 Tammy

Youth – Alcohol Tobacco Other Drugs / Homelessness .......................................... 5

Case Study 6 John

Mental Health (Cultural / Indigenous)..................................................................... 6

Case Study 7 Avril

Alcohol Tobacco Other Drugs / HIV.......................................................................... 7

Case Study 8 Paul

Child Safety (Residential) ......................................................................................... 8

Case Study 9 Mohammad Nabi

Immigration (Asylum Seeker)................................................................................... 9

Case Study 10 Molly

Juvenile Justice / Homelessness. ............................................................................. 10

Case Study 11 Chan

Immigration............................................................................................................. 11

Case Study 12 Natalie

Domestic Violence / Shelter.................................................................................... 12

Case Study 13 Trevor

Hospital (surgical).................................................................................................... 13

Case Study 14 Emily

Disability (Downs Syndrome / new baby). ............................................................. 14

Case Study 15 Joe

HACC (Home Care Level 4 referral)........................................................................ 15

Case Study 16 Elena

HACC (Dementia). ................................................................................................... 16

Case Study 17 Glenys

HACC (Hoarding)..................................................................................................... 17

Case Study 18 Steven

HACC to Residential Care........................................................................................ 18

Case Study 19 Valerie

CDC Level 4.............................................................................................................. 19

Case Study 20 Katrina

Workplace Injury..................................................................................................... 21

Case Study 21 Elizabeth

WorkCover............................................................................................................... 22

CASE STUDY 1 – DAVID

David is a 50 year old Torres Strait Islander man with a history of mental illness and is an insulin dependent diabetic. During his younger years David spent many years confined to a mental health facility and since that time has been in and out of inpatient units. David has moderate cognitive impairment and has trouble managing his finances. He is also receiving reduced payment from Centrelink because he is not confident enough to sort out the problem.

David has been estranged from his family (two sons and a daughter) for many years and has been living in a hostel.

David experiences paranoid thoughts and finds that “quiet time” is the only thing that allows him to effectively manage them. David’s accommodation does not assist with this process and so he spends hours each day locked in his room with his head under a pillow.

David has low self esteem and lacks confidence.

David will not use public transport and so is limited to places that he can walk to.

David has a dream that one day his children will want to talk to him and that he might have his own house so that they would come and visit him there and even stay for a few days. David has recently become friendly with Joe, another resident who has a significant drug and alcohol problem. Shane, who boards in a room next door, to David, tells you that Joe spends a lot of time in David’s room and sometimes takes other friends there too. This resident adds that Joe is taking money from David to buy his own drink and drugs and that when he is drunk he becomes angry and aggressive and has hit David. Joe is also giving David confectionary fully aware that David has a medical condition. The manager of the hostel confirms Shane’s story about a recent friendship between David and Joe however states that she has not witnessed any violent or aggressive behaviour and vehemently denies that any alcohol and drugs are being consumed onsite. She confirms that David is eating confectionary these days but says “a little bit of sugar never hurt anyone”. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of David? (i.e. his individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for David’s rights? (including developing David’s strengths to advocate for himself) C. Addressing David’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for David? (i.e. balances David’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with David, the Hostel Manager and all other Key Stakeholders Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 2 – TOM

CDC is a way of delivering services that allows consumers to have greater control over their own lives by allowing them to make choices about the types of care and services they access and the delivery of those services, including who will deliver the services and when. Under a CDC approach, consumers are encouraged to identify goals, which could include independence, wellness and re-ablement. The consumer on a CDC package decides the level of involvement they wish to have in managing their package, which could range from involvement in all aspects of the package, including co-ordination of care and services, to a less active role in decision- making and management of the package. The key principles of Consumer Directed Care are; Consumer choice and control; Consumer rights; respectful and balanced partnerships; participation, wellness and transparency (including financial). Please consider the CDC philosophy and requirements/guidelines when reading and responding to this case study. Tom is a 78 year old alcoholic who lives in a ground floor unit close to the beach. He has had 8 admissions to hospital in the last 6 months, usually as a result of falls whilst he is intoxicated or because he has been found semi- conscious by the police. Tom has a diagnosis of gout and hypertension. He often has injuries from his falls and has some chronic ulcers on his legs. Tom’s toenails are overgrown and causing him some pain. He has been referred to your service by the local ACAT team and discharge planner from the local hospital for a Consumer Directed Care Level 2 with a view to Consumer Directed Care Level 4 package in the future. When you visit Tom you find the front door is unlocked and there is a younger man living in one of the bedrooms. There is no telephone connected, no food in the fridge and only some cans of food in the pantry. The house is relatively clean but there is no electricity connected and very little furniture or household appliances. ►► Tom later reveals that he usually shoplifts his tinned food and tells you the best places to undertake this activity. He has been in gaol for petty crimes and not paying fines. Tom has not been incarcerated for many years yet he very vivid memories of this time that causes him great anxiety and distress. ►► Tom has refused further residential respite as it “felt too much like gaol” last time he was there. ►► Tom confides in you that his flat mate pays no rent and has taken the main bedroom but he is OK with this as the second room is warmer in winter and if someone breaks in then the flatmate can protect him. ►► Tom later confides in you that the flatmate has also borrowed money from him and not paid him back. ►► Tom usually leaves the unit by 11.00AM so that he can go to the early opener. ►► Tom has never voluntarily visited a local doctor and has only been examined by a medical practitioner during his recent hospital admissions. Instructions: 1. Please answer each of the questions overleaf utilising the CDC philosophy 2. Please complete this activity with reference to the resource materials provided. Please document and report your findings back to the group. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Tom? (i.e. his individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Tom’s rights? (including developing Tom’s strengths to advocate for himself) C. Addressing Tom’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Tom? (i.e. balances Tom’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Tom and other Key Stakeholders) Additional information ►► Tom has tried MOW but due to the times of delivery and his dislike of strangers he doesn’t really want to use this service again.

CASE STUDY 3 – MARY

Mary has been referred to your service under the National Respite for Carers Program. Mary’s mother Clare has a formal diagnosis of dementia and Mary has been her primary carer for the past 3 years. Mary has full time employment as a legal secretary and her workplace is situated close to home. This is the first time she has accessed any services, is quite fearful of accepting help and tells you this at your first meeting. Clare has had a recent psychogeriatric assessment and this reveals a moderate to severe dementia with the likelihood that the symptoms will start to escalate. Clare has just started to become incontinent and Mary has bought some ‘nappies’ at Aldi for her mum to wear. She was referred by the Dementia Advisory Service who have been visiting for about a month. Mary states she was very fond of Kathy who works there. Mary informs you that under no circumstances will she admit her mother into care as she has promised her mother she will care for her at home until she dies. During your visit you notice that Mary answers all the questions that are directed to Clare and that Mary presents as agitated and stoic.

Additional Information:

►► Mary has not told anyone at her work that her mother has developed dementia. ►► Mary has a mortgage on the unit and cannot afford to cease her paid employment.

►► Mary leaves Clare unsupervised at home five days a week in order to continue her employment, returning home during her morning tea, lunch and afternoon tea break to check on her mother. During Mary’s absence, Clare is restrained in a lounge chair with a sheet tied loosely twice around her waist, wears an incontinence pad and can access food and reading materials on a table positioned close to the lounge chair. ►► Mary no longer dates nor socialises with her friends, or work colleagues, as she is either too tired or broke to do so. She goes to extreme lengths to keep her mother’s medical condition hidden from everyone, fearful of the shame and embarrassment this may cause her and her mother. ►► Mary cannot afford to pay for any home care services as she has reached the maximum limit of her income and credit.

Instructions: 1.

Please answer each of the questions below.

2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Mary? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Mary’s rights? (including developing Mary’s strengths to advocate for herself) C. Addressing Mary’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Mary? (i.e. balances Mary’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Mary, Clare and other Key Stakeholders)

CASE STUDY 4 – SARAH

Sarah is a 38 year old woman with serious physical disabilities and an acquired brain injury sustained through a motor vehicle accident seven years ago. Sarah was treated for depression prior to her MVA however these symptoms are exacerbated now due to her ABI and physical disabilities. Sarah lives at home with her mother and a menagerie of pets, including 2 cats, 3 dogs and 2 cockatiels, and is dependant on her mother’s daily support as her primary carer to facilitate her access to ongoing clinical health support. Sarah is estranged from her only sibling (an older brother) who resides overseas in the United Kingdom and her father is deceased, having passed away from lung cancer 10 years ago. Sarah has an 8 year old daughter who is currently living with her ex-partner, Lisa (her legal guardian) although due to a ‘falling out’ Sarah has not seen either of them now for 18 months. Until recently Sarah had an on/off relationship with Lisa who lives locally. Sarahwas previously employed as a chartered accountant and no longer has any contact with her friends or work colleagues due to repeated outbursts and inappropriate sexualised behaviour. Consequently Sarah has become increasingly socially isolated, angry and withdrawn. Sarah’s mother was rushed to the hospital by ambulance this morning with complications arising from her stage 4 breast cancer. Sarah has been urgently referred to you by the hospital social worker who says Sarah has arrived on the ward inappropriately attired, is uncooperative and verbally abusive towards nursing staff. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Sarah? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Sarah’s rights? (including developing Sarah’s strengths to advocate for herself) C. Addressing Sarah’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Sarah? (i.e. balances Sarah’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Sarah, the Hospital Social Worker and all other Key Stakeholders) Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 5 – TAMMY

A local homeless shelter has contacted you to report Tammy’s attempts to enter the adult shelter with a 28 year old Caucasian male this evening. Tammy is a 14 year old indigenous female with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and an intellectual impairment. Tammy has a history of chronic alcohol and substance misuse and involvement with chroming. She regularly displays sexualised behaviour such as exposing herself and masturbating in public whilst intoxicated and engages in prostitution with older men in exchange for food and volatile substances. Tammy has resided in youth shelters, residential care facilities and on and off the streets for 18 months now and is 8 months pregnant. Tammy is unable to maintain her accommodation due her challenging behaviours and will regularly abscond in order to obtain paint and to engage in chroming. Tammy is prone to escalations of aggression and has been known to be physically violent and aggressive towards staff. On one occasion Tammy broke a youth workers arm and damaged property during her attempts to recover paint that had been confiscated and locked in a store room. Tammy has an estranged relationship with her mother who also has a history of chronic substance abuse (chroming), alcoholism, domestic violence and transience. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Tammy? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Tammy’s rights? (including developing Tammy’s strengths to advocate for herself) C. Addressing Tammy’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Tammy? (i.e. balances Tammy’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Tammy and all other Key Stakeholders) Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 6 – JOHN

John is a 15 year old Aboriginal boy who lives in a remote Aboriginal community.

The community has a population of approximately 2000 people, with high unemployment, fly in/fly out service provision and during the wet season is ‘cut off’ and only accessible by air. The community has a total ban on alcohol consumption.

John’s home life is chaotic and overcrowded with extended family, regular domestic violence and gunja (cannabis) abuse.

John has not attended school since the age of 12 and spends most of his time hanging out with his mates and getting into trouble with the local police. John’s older brother was recently arrested for murder and is now incarcerated thousands of miles away. You are contacted by the local police sergeant who tells you that John has spent the night in lock up after being found in the early hours of the morning in a ‘clearly psychotic state’ wandering around the bush yelling out his father’s name. He tells you John needs to be seen by a psychiatrist, detained and flown out to the regional psychiatric hospital as “he’s clearly off the planet”. On John’s arrival you gain his permission to speak with him. He is quiet, slightly withdrawn, dishevelled and smells of stale alcohol. In the course of the interview he advises you that his father committed suicide by hanging himself 2 months ago. He says that he misses his dad badly and that last night after consuming copious amounts of alcohol he went into the bush “to call out to his father’s spirit”. He tells you he wanted his father’s spirit to enter his body he would be a mighty elder like his father. With no eye contact you observe John as he sits beside you. He is tearful and restless however there is no evidence of psychosis. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of John? (i.e. his individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for John’s rights? (including developing John’s strengths to advocate for himself) C. Addressing John’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for John? (i.e. balances John’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with John and all other Key Stakeholders) Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 7 – AVRIL

Avril has walked into your service off the street for some help and advice. She tells you she has not slept for 48 hours and presents as agitated, dishevelled and incoherent.

Avril is a 20 year old single Caucasian woman who shares a 1 bedroom flat with her boyfriend Dave (28 years old).

Avril and Dave started using heroin 4 years ago on a daily basis and are estranged from their families. At 14 years old Avril started drinking and smoking marijuana. At 15 she dropped out of school and at 16 left home and moved in with Dave who introduced her to heroin. Avril refuses to have anything to do with her family and suffers from PTSD. When Avril was 10 years old her father committed suicide after being reported for sexually interfering with Avril and her disabled younger brother (cerebral palsy). Both Avril and Dave are unemployed and to support their heroin habit Avril works the streets at night. Six months ago Avril contracted HIV and fearful of losing her clients she has not disclosed this information to Dave or anyone. She continues to have unprotected sex.

Avril usually drinks 5 or 6 beers before going out to work and if she can’t score she will use benzodiazepines.

Avril is 12 weeks pregnant and her friend who works with her at night has told her not to stop using whilst she is pregnant as it’s worse for the baby than to keep using.

Avril has not told Dave about the baby as she is worried he won’t agree to keeping it.

Avril and Dave are 4 months behind with their rent and have received an eviction notice accompanied by verbal threats from the landlord.

Instructions: 1.

Please answer each of the questions below.

2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Avril? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Avril’s rights? (including developing Avril’s strengths to advocate for herself) C. Addressing Avril’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Avril? (i.e. balances Avril’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Avril and all other Key Stakeholders)

CASE STUDY 8 – PAUL

Paul is 12 years old, is in the care of the Department of Child Safety and has entered a residential accommodation (remote setting) for children with complex to extreme behavioural needs. Paul previously resided with his father who is on disability pension suffering from multiple co- morbidities and his elderly Polish grandmother who speaks very little English. Paul doesn’t remember his mother as she left when he was 6 months old.

Paul has been the subject of bullying and ridicule by his peers for most of his life and finds it difficult to make friends.

Paul has made numerous attempts on his life and cuts himself daily.

Paul has been expelled from 2 schools for being in the possession of illegal substances and pornographic materials.

Paul’s grandmother is presently recovering from a fractured neck of femur (NOF) as a result of being violently assaulted by Paul (with little or no provocation).

Paul is refusing to comply with staff and today has tortured and maimed 3 domesticated chickens on the premises.

Instructions: 1.

Please answer each of the questions below.

2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Paul? (i.e. his individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Paul’s rights? (including developing Paul’s strengths to advocate for himself) C. Addressing Paul’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Paul? (i.e. balances Paul’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Paul and all other Key Stakeholders

CASE STUDY 9 – MOHAMMAD NABI

Mohammad Nabi is a 33 year old Afghani male who has recently been released from a detention centre into the community. Mohammad Nabi does not speak English. Whilst in detention, Mohammad Nabi had a psychiatric assessment and you learn through medical reports that he has a formal diagnosis of schizophrenia with some aspects of violence psychosis. There are also identified issues of torture and trauma. After 2 weeks living in the community, the friend telephones your service distressed and seeking urgent assistance. He claims that Mohammad Nabi is no longer taking his medication and his behaviour is frightening him and his family. He begs you to come and take Mohammad Nabi away as he has concerns for the safety of his wife and children. He says Mohammad Nabi describes hearing voices, some of which scream and others whisper. All are derogatory in nature. Mohammad Nabi has also become increasingly paranoid and suspicious and believes that he is receiving messages from the television screen. His friend tell you he confronted Mohammad Nabi about his behaviour 2 days ago and offered to take him to see a doctor but Mohammad Nabi got angry and pushed him away yelling at him that he has no problem with his head “as madness does not affect his people”. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Mohammad Nabi? (i.e. his individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Mohammad Nabi’s rights? (including developing Mohammad Nabi’s strengths to advocate for himself) C. Addressing Mohammad Nabi’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Mohammad Nabi? (i.e. balances Mohammad Nabi’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Mohammad Nabi and all other Key Stakeholders) Mohammad Nabi is currently staying with a friend but this arrangement is short term (maximum 4 weeks). Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 10 – MOLLY

Molly is a 15 year old girl who has experienced learning difficulties throughout her primary and high school years as a result of an intellectual disability. 12 months ago Molly started hanging out with a new circle of friends and began experimenting with alcohol and drugs. 8 months ago Molly ran away from home and has been living on the streets with intermittent periods of short term access to accommodation at the local girl’s shelter. Molly has been seen intoxicated and in the company of a large group of homeless men and her family are fearful for her safety. Molly’s parents, both professional people, have tried unsuccessfully to obtain support and assistance from government services to bring their daughter home. Desperate for help Molly’s parents have lobbied their local member for parliament and ombudsman for assistance and regularly visit the police station begging for some intervention and assistance. Molly has been brought to your service after being charged with malicious damage, following a series of arrests for a break in to a local chemist, in addition to damage and graffiti to public buildings. Molly has just disclosed to you that she was sexually assaulted 4 months ago and thinks she might be pregnant. She says she wants to keep the baby but wants nothing to do with her parents or family. Reception staff have just told you that Molly’s parents have telephoned having heard Molly is here and are on their way to the service. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Molly? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Molly’s rights? (including developing Molly’s strengths to advocate for herself) C. Addressing Molly’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Molly? (i.e. balances Molly’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Molly, her parents and all other Key Stakeholders) Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 11 – CHAN

Chan is a 42 year old women who came to Australia on a student visa 4 years ago and met her Australian (Caucasian) partner, Simon, 1 year later. 3 months later Chan moved into Simon’s rental property in the suburbs. Chan and Simon separated 2 months ago when Chan was 7 months pregnant at which time she moved in with a girlfriend until the husband told her to leave.

Simon has since relocated interstate and Chan does not know of his whereabouts.

Chan is currently staying in a Women’s Shelter but will not be eligible for this accommodation once the baby is born.

Chan has been referred to you by the Department of Immigration and Citizenship who have told you her Student Visa has expired. Chan is to be deported back to Cambodia once the baby is born and both parties are deemed medically fit to travel. As Chan contracted polio as a child she will require a caesarean and will not be medically fit to travel for a minimum of 6 weeks post delivery.

Chan has no Medicare entitlements and no income or savings.

Chan (and baby) require temporary accommodation until she is deported. The Department of Immigration and Citizenship are yet to provide a tentative deportation date.

Instructions: 1.

Please answer each of the questions below.

2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Chan? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Chan’s rights? (including developing Chan’s strengths to advocate for herself) C. Addressing Chan’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Chan? (i.e. balances Chan’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Chan and all other Key Stakeholders)

CASE STUDY 12 – NATALIE

Natalie is a 31 year old married women with 2 sons, James (6 years old) and Aiden (10 years old), residing in emergency accommodation (Women’s Shelter) for 7 days in an undisclosed location. Natalie has 2 broken ribs and a broken right arm (in plaster) following a domestic dispute with her husband, Bruce of 11 years. James and Aiden have both witnessed incidences of domestic violence on more than one occasion and are exhibiting behavioural and psychological symptoms consistent with trauma. James has started wetting the bed and Aiden is waking up with night terrors. Both children are not attending classes at school as the family home is situated directly opposite the educational facility. Furthermore, both boys are missing the company of their friends and participating in extracurricular activities. Bruce is constantly calling Natalie’s mobile phone demanding they come home and making verbal threats against her and the children.

Natalie has intense episodes of anxiety and is experiencing persistent panic attacks.

Natalie has no funds as Bruce has withdrawn all savings from both joint bank accounts and reported their credit card as stolen.

Natalie has been referred to you by the Women’s Shelter for case management services.

Instructions: 1.

Please answer each of the questions below.

2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Natalie? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Natalie’s rights? (including developing Natalie’s strengths to advocate for herself) C. Addressing Natalie’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Natalie? (i.e. balances Natalie’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Natalie and all other Key Stakeholders)

CASE STUDY 13 – TREVOR

Trevor is a 45 year old single caucasian male hospitalised for 4 days following a drive by shooting, whilst travelling at full speed on his Harley Davidson motorcycle on the freeway. Trevor has multiple injuries including a gun shot wound to his left shoulder, second degree burns to his abdomen and a broken left tibia and fibula. Trevor is a heavy smoker and is receiving frequent visitors, all of whom are members of the same motorcycle club. These visitors are intimidating nursing staff and removing Trevor off the ward for extended periods of time. Upon returning to the ward, staff suspect Trevor is under the influence of other drugs. Swabs from his left shoulder have indicated staphylococcus aureus and Trevor frequently interferes with the dressings to his abdomen.

Trevor and his visitors are increasingly derogatory and abusive to hospital and medical staff, other patients and visitors.

Hospital security is under resourced and unable to effectively support ward staff and respond quickly to all incidences.

You have been called to a multidisciplinary meeting as nursing staff are now refusing to be assigned Trevor.

Trevor lives alone and is not medically fit to be discharged.

Instructions: 1.

Please answer each of the questions below.

2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Trevor? (i.e. his individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Trevor’s rights? (including developing Trevor’s strengths to advocate for himself) C. Addressing Trevor’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Trevor? (i.e. balances Trevor’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Trevor and all other Key Stakeholders)

CASE STUDY 14 – EMILY

Emily is a 19 year old patient with Down Syndrome who is a new mother to a 2 day old infant male. She resides in supported accommodation (1 bedroom unit) with her 20 year old boyfriend Bennie who also has Downs Syndrome. Until recently Emily worked with Bennie at the Endeavour Foundation travelling daily to/from the workplace by public transport. Emily’s parents who live in a small rural community are presently on an extended overseas holiday and unaware of either their daughter’s pregnancy or childbirth. Bennie’s parents are both deceased. Both Emily and Bennie have a case worker who has been unsupportive of the pregnancy. All attempts to contact their case worker by phone or email have been unsuccessful. In conversation you learn that the couple have no baby supplies or equipment and thought that the hospital would give this to them. Both Emily and Bennie have not attended any antenatal classes and appear to have no understanding of how to care for a baby. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Emily? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Emily’s rights? (including developing Emily’s strengths to advocate for herself) C. Addressing Emily’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Emily? (i.e. balances Emily’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Emily and all other Key Stakeholders) Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 15 – JOE

Joe is a thickset 70 year old gentleman who resides at home with his 65 year old wife, Maria, a gaunt, small statured women and his full time carer since he suffered a stroke 2 years ago. Joe has dense hemiplegia of his dominant right side, severe dysphasia and an ileostomy. Fully dependant on Maria for all aspects of his care, including feeding, hygiene, toileting, mobility and communication, Joe was recently discharged from the local hospital following a 6 day admission arising from an untreated urinary tract infection. His recent hospitalisation follows a routine admission the month prior when paramedics were urgently called to the home to lift Joe from the tiled floor of the shower cubicle. Maria reports that she lost her balance when transferring Joe out of the shower however she is adamant this has never happened previously despite transferring Joe (190cm) solo from the bed to chair (vice versa) at least four times daily. Both Joe and Maria have been waiting for a Home Care Level 4 package since the decision to bring Joe home almost 18 months ago. Currently Maria receives 2 hours per fortnight from the local Shire Council and 3 hours per fortnight in home respite from the Carer Respite Centre. Maria’s caring role for Joe is starting to impact on her health and she has recently been diagnosed with hypertension and depression. Her general practitioner has warned her that she will not be able to continue to care for Joe without additional support. Maria receives a carer’s pension and a carer allowance and supplements the family income from the sale of fruit from the small orchard she maintains on their 1 acre retirement property. Contact with family is infrequent as their only son is overseas on his seventh tour of duty in Afghanistan and their daughter-in-law and 4 grandchildren live busy lives in a major capital city 12 hours away by rail. Joe has a strict daily regime and Maria is insistent that any support you provide must be in accordance with his existing daily routine. Maria tells you Joe is an early riser and gets out of bed for his shower at 5.00am each day. He returns to bed at 12.15pm for 2.5 hours in the afternoon prior to having his afternoon shower and changing his clothes for dinner. Joe will have 1-2 glasses of wine with his evening meal and watches the late news at 10.30pm before being assisted with his hygiene and toileting prior to retiring to bed. ►► Maria is fixated on the huge responsibility of maintaining a large property in addition to caring for Joe. She has indicated that she does not want to accept any extra services other than lawn mowing/gardener; that this will solve her problems. ►► Maria has refused in the past to consider residential respite for Joe. ►► Maria manages the finances well but struggles with finding time to ensure all accounts are paid. ►► Maria has to leave Joe home alone to do shopping and run errands and is reliant on public transport to/from the shopping district. The bus trip takes an hour each way and Joe is left at home unattended for a minimum of 3 hours on each occasion. ►► Maria and Joe struggle to attend medical appointments due to Joe’s extremely limited mobility. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Joe? (i.e. individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Joe’s rights? (including developing Joe strengths to advocate for himself) C. Addressing Joe’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Joe? (i.e. balances Joe’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Joe, Maria and other Key Stakeholders) Additional information Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 16 – ELENA

Elena is an 83 year old woman from the Baltic region who resides alone in a 3 bedroom home after being widowed 10 years ago. She has increasing memory loss and loves animals. Elena has always housed many pets, including strays, birds and a little dog “Rex”. Elena speaks very good English but has never learnt to read English. She has 2 supportive daughters, Natalie and Rebeccah, who visit weekly however both are not local to the area and must travel 1 hour by car to see their mother. Elena is currently receiving minimal services (fortnightly cleaning). Both Elena’s daughters independently report of increasing changes to their mothers behaviour and her health. On visiting they observe there is little to no food in the home and Elena appears to have lost a significant amount of weight in recent months. Furniture and other items are frequently moved about and/or misplaced. Elena has become suspicious of visitors, accusing them of stealing her belongings, including her jewellery. Elena no longer answers the telephone nor understands its purpose, recently pulling it from the wall in her endeavours to investigate what the noise was. A neighbour has telephoned Natalie concerned that Elena has taken to watering her front garden at all hours of the day and night wearing only a singlet and underpants. Furthermore, they have disclosed that Elena will often take her dog Rex for numerous walks during the day and observed her leave one evening, a little after 10.00pm, not returning home until well after midnight. There have been several incidents in the past 2 months where the same neighbour has called the fire brigade to the home as Elena, having taken off with Rex, had left a kettle boiling on the electric stove. You learn that both Natalie and Rebeccah are supportive of Elena’s wish to remain living at home but are increasingly frustrated and troubled by Elena’s erratic behaviour. On visiting 12 weeks ago Rebeccah arrived to witness her mother reversing her car straight into the front fence. Rebeccah immediately coaxed her mother to give her the car keys and took them with her when leaving to prevent Elena from driving. Last week, another neighbour telephoned Natalie requesting her urgent attendance at the home. Elena was hysterical and inconsolable claiming that her car had been stolen out of the driveway. Further investigation revealed that Elena had found a spare set of keys and had driven the car to the local supermarket, before abandoning the car (unlocked) and walking home. Elena has hidden the spare set of keys to the car and refuses to hand them over to her daughters. ►► Elena has started to mix up the pet food, feeding the bird’s dog food and Rex the bird seed. ►► Soiled clothing is often found placed in the dishwasher by the HACC worker who visits fortnightly for cleaning. The worker has also found what appears to be medication on the lounge room carpet. ►► Elena has not attended her regular hairdressing appointment for several weeks. This is very out of character for her as she has visited the same hairdresser at the same time each week, for a wash and blow dry, for 20 years. She is often seen wearing the same items of clothing. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Elena? (i.e. her individual, diverse and special needs, including his aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Elena’s rights? (including developing Elena’s strengths to advocate for herself) C. Addressing Elena’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Elena? (i.e. balances Elena’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Elena, her daughters and other Key Stakeholders Additional information Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

CASE STUDY 17 – GLENYS

Glenys is an active 67 year old caucasian woman who lives alone in a small 2 bedroom unit within a 6 unit complex. Glenys moved into the rental property over 12 months ago after being evicted from her previous residence. She does not speak to her neighbours and keeps to herself. Glenys is an avid collector and regularly goes through the local bins in the area and is seen walking the streets during the council’s hard rubbish collection days in search of more treasures to bring home. Glenys’ neighbours have made formal complaints about the amount of items she has accumulated in piles around her unit, including broken bicycles frames, old garden chairs and boxes containing magazines, newspapers, stuffed toys and other items. There has also been complaints by local residents of an infestation of rodents and the complex being frequented regularly by stray dogs. The landlord has informed Glenys that her tenancy is in jeopardy and she will face eviction if she does not clean up “her filthy mess”. When you visit the property you initially observe Glenys through the glass panels in the front door watching as she steps over a number of items to reach the front entrance. Glenys refuses to let you in and holds tightly onto the door frame with her other hand continually scratching her skin, hair and clothing. Glenys is dishevelled in her appearance, refuses to meet your gaze and her eyes dart left and right over your shoulder. Through the partially opened door you note that her living area is piled almost shoulder height with belongings. Your attention is drawn to the right where flies in their multitudes fill the air above an open saucepan. The area is strewn with pots and pans and newspapers and the floor is covered with plastic bags, papers, bottles and cans. In addition to the strong odour you deduce is coming from the kitchen area, you note the overwhelming presence of another smell which you suspect is urine. The referral documentation for Glenys indicates previous involvement with a service provider and provides a summary of actions taken to manage the clutter. A final record refers to Glenys detainment in hospital whilst workers cleaned and removed rubbish from the home. This included the removal of 5 skip bins of waste. Upon Glenys’ discharge from hospital, she refused to engage with the service provider and exited from the program. Three months later the landlord served her with an eviction notice.

Additional information

►► You can see evidence of bruising on Glenys arms consistent with a fall. ►► Glenys clothing is soiled and her personal hygiene is extremely poor. She tells you that she has no hot water in the bathroom. ►► Glenys has a gas stove and uses matches to light the gas.

Instructions: 1.

Please answer each of the questions below.

2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Glenys? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Glenys rights? (including developing Glenys strengths to advocate for himself) C. Addressing Glenys needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Glenys? (i.e. balances Glenys needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Glenys and other Key Stakeholders

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