In this enquiry you will: Read the case scenarios and consider the following points: In what ways might the assessment be more complex than for other client groups? How would you go about finding out the strengths and aspirations of the person with intellectual disability? What is particularly challenging for this group? What are different types of knowledge you might need to draw on? What strategies might you use to map the person’s social network? In what sorts of circumstance might you consider the need for an independent advocate, apart from those who already know the person? How can you be sure the person with mild intellectually disability is making their own informed choices? If a person has no friends, what strategies might you think about in order to extend their social networks? What principles should inform an assessment and plan with a person with intellectual disability? What are the hidden processes or tasks that must occur in making plans with people with intellectual disability? What may compromise a person’s rights and choices when you are working on a plan for support? You will then use an identified framework or theoretical perspective to: Identify the presenting problem/s Describe your case formulation Develop an intervention plan Analyse the empirical and theoretical knowledge about the client’s situation. You might draw on the particular ethical or other tensions What you need to submit An individual paper of 2500 words (excluding the case scenario). In this paper you will approach the task from the perspective of the role identified with the case scenario you have chosen, and you will: Identify the presenting problem and describe a case formulation and intervention plan. Discuss the rationale for using the theoretical perspectives you have chosen and consider a possible alternative approach you could have adopted. Discuss the sources of empirical and theoretical knowledge you have drawn on in your assessment of this case. Discuss the particular ethical or other challenges you may encounter in working with this client and their family. Case Scenarios James James is 40 years old, and is assessed as having a moderate intellectual disability. He has always lived at home with his mother and had little contact with anyone else in the family. James spent most of his time in the company of his mother but once a week went to a dance club specifically for people with intellectual disability. On Saturday mornings he has been attending a (disability specific) art group and on Sundays, with his mother, goes to the same church he has been attending since his childhood days. James receives a disability support pension and his mother a carer’s pension. Last week his mother died suddenly and James was there with her. He had called for help from his neighbours and police had made contact with an aunt of James who had not seen him for three years. In consultation with her a place is short term respite care was found for James in a local disability support service. James had gone with his aunt to his mother’s funeral service but does not appear to understand what has happened. His is usually an out-going and friendly man but is now very anxious and missing his mother. The aunt is willing to take some legal responsibility for James as far as being identified as his next of kin but appears unwilling to have any regular contact with him. The respite facility is unable to offer any ongoing accommodation for James and suggest that he needs long term accommodation support either in the family home that he has inherited from his mother or in a group home. Your role: You work as a social worker/case manager in the disability support service that manages the respite care facility where James has been staying. You have sought an appointment with the NDIA for a review of his plan and have the task of working with James to prepare for this meeting. Joe Joe has intellectual disability and has been living alone in his parents’ home since his mother died several years ago. He continues to attend a supported employment service he has been going to for many years. He is an NDIS participant and receives a small amount of funding for drop in support with daily living tasks to enable him to manage his household. This is coordinated by a disability organisation. His brother, who lives interstate rings regularly to make sure everything is ok. Joe’s brother was horrified to learn that a friend of Joe’s from work, who is much younger and less intellectually impaired than he, has moved in to share with him. Joe is talking about getting married. His brother rang the Office of the Public Advocate and the supported employment service and asked them to put a stop this situation, as he thinks Joe is being sexually exploited and his substantial inheritance may be in danger from this woman. Your role: You are a social worker with the Office of Public Advocate and have been asked to follow up this referral and determine what action if any should be taken. Michael Michael is 54 he has lived in a group home with the same 4 other people for the past 20 years, since they moved out of a large institution. They have all got on very well together and done many things together. Another resident, Fred was diagnosed with Alzheimer’s disease 4 years ago and a year ago Michael was also diagnosed with Alzheimer’s. Michael’s sister says she thinks he is aware that things are changing for him but is not sure he fully understands. The atmosphere of the house has changed over the past two years and the other residents are finding it difficult to tolerate the significant changes to Michael and Fred’s behaviour. They have become more quarrelsome, Fred has been walking around the house at night waking people up and taking food out of the fridge. Last night Michael wandered down the road and was picked up by the police. As a result, life for the other residents is becoming more restrictive, the house is now to be locked at all times, and a gate is being built to restrict access to the kitchen. They are not getting out to their individual evening activities, as neither Michael nor Fred can be left alone. Both Michael and Fred have been assessed as eligible for residential aged care, and the social worker in the agency that manages the group home has been asked to make recommendations about whether Michael should move. Michael’s sister is adamant that Michael should not have to move but should be able to age in place. The service is concerned about the cost of adapting the environment of the house and staffing to adapt to his needs, and the impact he and Fred are having on other residents. Your role: You are a social worker /case manager in the non-government agency that manages Michael’s group home and have been asked to assess Michael’s situation and recommend what action would be taken. Betty Betty is 45; she has moderate intellectual disability and a hearing impairment. She lives at home with her widowed mother who is aged 80 years. She has attended an Adult Training and Support Service for many years. When Betty’s mother was admitted to hospital, an urgent request for service was made by Betty’s married sister to her NDIS support coordinator seeking emergency accommodation as well as long term supported accommodation for Betty. Emergency respite was organised by her care coordinator who contacted the NDIS about the need to review Betty’s plan given the change in her circumstances. Contrary to expectation Mrs Smith made a good recovery and returned home. She wished to continue caring for Betty and declined the offer from Betty’s support coordinator to help investigate and prepare a request to revise her plan seeking regular out of home respite and in home support. In the support coordinator’s view Mrs Smith is just managing her own health care and that of Betty and their situation is extremely fragile. Mrs Smith is not sure that she needs any additional help from the support coordinator or the NDIS and thinks she and Betty will manage fine for another few years. Your role: You work as Betty’s support coordinator in a non- government disability service, funded by the NDIS as part of Betty’s plan. The senior manager has asked you to provide her with advice about what if any action the service should take in regard to Betty’s situation. Beattie Beattie, a young woman with intellectual disability. Although Beattie is in her mid-twenties she still lives at home with her mother who is in her mid-50s. Beattie attend has attended the local Adult training and support services (ATSS) since she left school. Beattie likes living at home with her mother but there have been some tensions recently. For example, at the ATSS Beattie has learnt to be quite an effective cook. However, when she tried it at home the different oven confused her and the experiment was not a success. Her mother felt this simply confirmed her view that it was not safe for Beattie to use the cooker. Two years ago, Beattie joined a local self-advocacy group, and her attitude to living at home have shifted a bit. She has told her mum that she likes the idea of leaving home and living somewhere with a few friends. So far there have been no obvious opportunities for this to happen and Beattie has not said anything to her mum. However, Beattie is due for an NDIS planning sessions soon, and the case manager at the ATSS is helping her to prepare for this. During a meeting with the case manager Betty confided that she wants to marry her boyfriend, George, who also goes to the centre but is worried about what her mother will say and whether she will be able to get support to live with George as part of her NDIS plan. Beattie is worried about conflict with her mother. On the one hand, she and her fellow members of the self-advocacy group have talked about relationships and have decided that they have as much right to get married as anybody else. On the other, Beattie loves her mother, finds it difficult to imagine managing without her support, and does not want to upset her. Your role: You work as a case manager for a non-government service that manages the ATSS and are tasked with preparing for Betty’s initial planning session with the NDIS and helping her work out what support she needs and set in place a plan to meet her needs. 6.Jake Fenn Jake is aged 35 years and has mild/moderate intellectual disability. For the first 22 years of his life, he lived at home with his parents out of touch with disability services. His first contact with services was 12 years ago when he was placed in respite care during his mother’s illness. His mother died and Jake spent the next 5 years living in various institutions around the State. In recent years he has been living, with another client, in a privately rented unit in the Northern Region supported by an Outreach Worker with whom he has weekly contact. Jake does not wish to attend a day program. At times, his behaviour is socially unacceptable and assaultive to others. He is beginning to drink considerable quantities of alcohol. Although his brother administers his affairs, Jake’s contact with his family is minimal and often conflictual. The Outreach Worker found out that Jake and his co resident had been assaulted a few weeks ago and thought it was important that Jake was helped to seek compensation but also that he needed more support to establish social connections find meaningful things to do with his time. The outreach worker has asked the social worker at his agency to review Jake’s support needs with a view to requesting a new NDIS plan. Your role: You work as a social worker in the agency that provides outreach support to Jake and are following up on the request to review Jake’s needs. John Wheatley John is a 60 year old man, who uses a wheel chair for mobility. At the age of five John moved to a large residential institution. Two years ago he moved out of the institution to a new group home is the community that he shares with 4 other residents. John likes living there, particularly being able to have a room to himself. He understands much of what goes on around him but has only a very few words to communicate his views on the world. One of his chief interests in football and he has been following the Hawthorn team for many years. He also loves to eat and is a bit overweight. John does a minimal amount of exercise following a program prepared before he left the institution. John has limited movement in his arms and his reliance on a wheelchair makes participation in domestic chores difficult. Anyway, the kitchen benches are too high to be accessible to anyone in a wheelchair. He gets around independently in an electric wheelchair and can transfer himself to and from his chair. He requires assistance with all personal care tasks but with modified plates and cutlery he can feed himself. John’s mother, lives in a country town, a two hour drive from the house. She visited him regularly whilst he was in the institution and has continued to be very involved in his life. However, her vision problems mean she can no longer drive, and is reliant on staying in touch by phone now. John is an only child and his father is dead. For the last two years John has attended an arts and drama program for people with intellectual disabilities which is based in a community college. Here he participates in drawing, cooking, watching videos, and in two drama performances a year. In the two years since John moved all the staff in the house have changed. The first house supervisor, created a spotless well cared for home, and mothered all the residents. She left after a year, to be followed by a series of short term staff. The new house supervisor has a very different approach much more focused on building each individual’s life than the state of the house. He has some very definite views about the rights of people with disabilities to retire, just like everyone else. Your role: You are an independent planner and have been assigned to work with John for 30 hours to prepare a retirement plan to form the basis of a request for an individual support package which will enable him to retire from the day program. Alex Alex is a woman with an intellectual disability who has lived in a group home for the last 5 years. When she was young she was in foster care and after foster care she lived by herself with some outreach support, but she had a lot of problems living on her own and looking after herself. She is not able to talk very clearly as she has Cerebral Palsy. She walks with a limp and one of her arms is partially paralysed. Over the years her speech and her physical agility have got worse but she is still able to dress herself and do some things around the house. Alex has never had much control over her life, she doesn’t make many decisions and is very unsure of herself. Currently the staff in her house support her to do things like go to the doctors and she has an administrator looking after her money. The house staff have also been the main people involved in any planning of her programs and supports. Recently the house staff have found that Alex has been very quiet overall but she has periods of extreme emotional outbursts where she will cry and scream. When they ask her what is wrong she will not respond. They are really concerned about her and have taken her to the Doctor on a couple of occasions. On one of these visits the Doctor asked whether the house staff thought anything had happened to Alex recently, as when she went to do a physical examination of Alex she turned away and curled up so the Doctor couldn’t touch her. The Doctor was just checking for possible areas where she might have been tender. When the Doctor asked her if she was OK Alex shook her head but wouldn’t say anymore. The Doctor thinks there is a need to do some further investigating and has raised the question of possible sexual abuse. The house staff did not think this was possible as Alex never spends time by herself in the community or goes out with people on her own. The Doctor said the abuse could have happened at the house or at her day placement. Your role: You are a social worker in the non-government service that manages the house where Alex lives and she has been referred to you to by the residential services manager to follow up these allegations.