Identifying Strengths and Barriers in the case of Carla

• To apply the experience and learning from the readings and discussions to real-life situations related to the empowerment-oriented case management process

The main course outcomes covered by this assignment are:

• 4. Develop empowerment strategies to assist in recovery and building resiliency.
• 5. Apply empowerment-oriented, strengths-based, case management practices.
• 8. Apply techniques to aid in the development of supportive social networks.
• 9. Develop options to support independence and build friendships in the community.
• 11. Describe options for effective collaboration between nonprofessional and professional supports.

Review the case of Carla and answer the questions

Part A – Identifying Strengths

Part B – Identifying Barriers

Part C – Mutual Review

Assume Carla has a goal to learn to make pottery; she has found a local pottery class and she’d like Maria to take it with her. Carla’s said she would look up costs and ask Maria to join the class with her. When you meet with Carla next, she has found out the costs, but hasn’t asked Maria yet because she is afraid if Maria can’t do it then she (Carla) might get mad and yell at Maria – and she doesn’t want to upset Maria since she is her friend. (See sample table you can use for your response below.)

Part D – Membership and Empowerment

Carla feels she is ready to be on her own without your direct support. You and Carla decide to have a planning meeting and to invite people from the many different circles of her life to set up a system to support her once you are no longer her case manager.

Answer the following question:

• Not including you and Carla, list three non-professionals (e.g., family, friends, co-workers, community members – NOTE: at least one must be a non-family member) and three professionals (e.g. service providers, people from institutions or community services) – so six people total – you would want to invite and for each explain why (i.e. what their unique contribution is, how they can help support Carla – minimum of 20 words for each person).

Part E – Self Reflection

Reflect on your experience of completing this assignment; provide a response to the following questions

1. What were some interesting or surprising things you experience while completing this assignment (could be about your own self and how you worked, or about how easy/hard certain things were, or about the case itself)?
2. What are some things you have learned about working with someone who has complex needs like Carla in terms of identifying strengths and barriers?
3. What were some challenges you had in completing this assignment and what could you do differently when working on the next assignment to address this?

Carla DiFrancesco is a 40-year-old woman – she has a mild developmental delay and also has a diagnosis of schizophrenia. For the past three years, she has lived in the basement of her family’s home in a self-contained apartment. She has regular contact with her parents, father Giovanni (72) and mother Gabriella (70), who live upstairs. Carla states that she lives by herself. Her parents describe the living situation as difficult and report they are ‘fed up’ with trying to help Carla.

Carla has worked sporadically in an animal shelter for the past five years. She enjoys TV, music, working on basic math and has a goal to learn to read. She does not identify any friends except her mother and her cousin Maria.

The police were recently called to the house due to an altercation that occurred when Mr. DiFrancesco tried to stop her from leaving the house when she was naked. Carla threatened her father with a knife and physically assaulted him. Her mother called the police. Carla was arrested and charged with assault with a deadly weapon. She was sent to the hospital for treatment via the mental health court; she was hospitalized for ten days. She was released to the custody of her mother.

Learning Outcomes

As a child, Carla attended a special needs class in a local public school. She then attended high school for 2 years in a special needs class, but at age fifteen Carla was caught naked with a boy at school and Mrs. Di Francesco made the decision to remove her daughter from school. She felt is was unsafe and was angry that program officials did not intervene and that the other participant involved was not expelled. No one ever documented Carla’s side of the story.

Over the years, the family has been involved with several treatment agencies. Previous referrals were initiated by Carla’s workers, to seek assistance for her behaviours that were extremely difficult to manage. Mrs. DiFrancesco describes being involved with various agencies and workers as a “waste of time” and feels they were unsympathetic; past teachers, workers and other professionals they had met with either blamed Carla or the parents for her problems. Mrs. DiFrancesco describes her daughter as being ‘different’ but not ‘slow’ or ‘disabled’. As a consequence of their negative experiences with helpers in the past, Carla’s parents decided to manage her on their own.

Jenna was assigned as the case manager following Carla’s arrest and recent hospitalization; she visited the family home several times, but was only been able to meet with Carla and her mother. She tried to meet with Mr. DiFrancesco, but he has made it clear through his wife that he is not interested in his daughter and only allows her to live in the home because her social assistance helps cover the rent.

Carla has two brothers: Mario (35) lives in a neighbouring town and Luciano (37) lives out of province. Ten years ago, Luciano ‘came out’ to the family as being gay. Mario is married and has two children – Franca (8) and Tullio (5) – who have never met Carla. Both brothers have regular contact with Mrs.

DiFrancesco, but only Luciano keeps in contact with Carla. Carla talks about missing Luciano and doesn’t understand why Mario won’t see her or why she cannot visit her niece and nephew.

Carla, when not angered, can effectively communicate her desires and wishes. However, if she doesn’t get her way, she screams for what she wants and uses physical threats; her parents generally give in, as they find it easier to comply with her wishes than to deal with her behaviours. She has been known to be non-compliant with medication, to avoid completing activities of daily living, and have had seemingly unprovoked episodes of verbal and physical hostility. There have been several incidents where she swore at the neighbours and she has been known to disrobing in public.

Carla’s episodes of verbal and physical aggression, public disrobing, the decline in her self-care and her hostility towards Mr. DiFrancesco, friends and helpers are increasing in frequency and intensity. Frustration tolerance, motivation and social skills were identified as problematic by past programs and workers. Carla has not been involved in any programs since her parents removed her from school. However, she has had numerous hospitalizations which have temporarily stabilized her behaviours.