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Part A: Identifying strengths

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

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.

Part B: Identifying barriers

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.

Part A: Identifying strengths


Strength 1

Strength 2

Interpersonal relationships

Carla lives in her family home with her parents.

Her mum, her cousin Maria are her good friends who visit her and spend quality time with her.


When she is not mad at someone, she can effectively express her desires and wishes.

She is able to talk to her therapist, and speak out vividly about what goes through her mind.


To silence the voices in her head, she takes pills that she believes to silence those voices and make her behave well.

She sometimes rejects the voices in her head. At one instance she rejected the idea of beating up a seven-year-old girl.

Cognitive skills

She has the ability to work on basic mathematics, and has the goal to learn how to read.

For the past five years, she has been working at an animal shelter, cleaning, feeding and taking care of the animals and people around.


She enjoys going out to places in a car with her mum, Maria, Luciano and Jenna. She also enjoys music and watching television.

She has a goal to learn how to read.

Previous successes

At one time, she rejected the voice in her head to beat up a seven-year-old girl.

Sometimes she takes her drugs because she believes they silence the voices in her head and do not make her extremely mad.

Education and vocational achievements

She attended a special needs class for both her lower and high school.

She has been working in an animal shelter occasionally for the past five years.



Current status

Individual barriers

Societal barriers


Meet her brother Mario and her two nephews

Mario lives out of the province and never visits her. He does not allow her to meet his two children.

Her state of sadness and anger may make her not receptive to her two nephews and Mario.

Mario and his family may not be comfortable meeting her in her schizophrenic state.


Live in her own apartment

Lives in the basement of her family home where her mum and dad can step in.

She may not be having enough money to afford a good apartment as her job pays very little.

Many housing agencies and owners may not accommodate her due to her mental and psychological disorder.


Get her blood sugar levels on a healthy check

She was currently diagnosed with borderline diabetes.

Eating chips and pop may elevate her blood sugar, making her condition progress which will necessitate her to take more pills.

Restaurant and other food joints may not be aware of her condition and will therefore offer her anything she demands.


Earn more money

Her job pays her very little money that she keeps asking for money from her mum.

Her limited ability to read coupled up with her verbal and physical aggression may lower her chances of getting a better job.

Companies and various employers may have very little confidence on her ability to deliver well at the work place.

Education and vocation

Acquire the ability to read

She has limited ability to read and must ask others to read for her.

Her restlessness and aggression may make her less patient to the thought processes involved when mastering words and concepts.

Many tutors and teachers may fear taking her through sessions of learning how to read due to her state of physical and verbal aggression.


Go out to places in the car

She is taken out to places occasionally by her mum, cousin Maria, brother Luciano and Doctor Jenna.

She is likely to eat junk foods such as chips and pop that may cause a hazardous surge in her blood sugar.

Due to her state of restlessness and aggression, hotels, parks of other visiting sites may not accommodate her.

Empowering statements I would say to Carla


Her success in finding out the costs of taking the pottery class

“Congratulations Carla, you are an initiative person and I am sure you will do well in the course.”

This statement will make her feel good about herself. It will motivate her and encourage her to give her very best and focus throughout the course. It will boost her self-confidence and courage.

Her telling me that she did not tell Maria about it yet

“I am sure Maria will consider taking the course with you if all circumstances will allow her. If at all she will be limited by circumstances, she will be glad you have done all this for her. Just go ahead and request her.”

This will again boost her self-confidence and courage. She will have the energy to tell Maria about it and not expect her to agree definitely. If Maria will decline and explain herself, Carla will have the capacity to understand this.

Next steps in terms of asking Maria

“please relax and tell her when you are calmer and relaxed. Call her on the phone and tell her as soon as you can.”

This will put her in a relaxed state, where she will confidently tell Maria about the pottery lessons. She will properly articulate her idea where Maria will understand very well. Simply, this will enhance their communication.

People who would offer great support to Carla in place of her case manager include her Mum, her cousin Maria and the cop who frequents the surrounding of her house every day. These are non-professionals who would make a positive impact in Carla’s condition. Professionals who would make impact include her doctor in charge of monitoring her blood sugar at the hospital, her psychotherapists at the hospital and a community therapist from a psychiatric agency. These people would play different roles to ensure Carla’s well-being.

Carla’s mum would ensure she feels loved and valued from her unconditional motherly love and natural commitment towards her daughter. Maria would give her company and listen to her concerns with unconditional positive regard. She will ensure that she is available for Carla in case she needs medical attention. The cop would ensure he can track Carla’s where-about at any time. He will protect her from any harm that is likely to befall her. The doctor in charge of monitoring her blood sugar levels would make sure she keeps her sugar levels on check. She will make sure she eats healthy and whole foods that will improve her condition. Her psychotherapist at the hospital will construct a counselling plan that will work towards her psychological improvement. She will offer technical support every time Carla is presented at the hospital. Finally, her community therapist will visit Carla at least thrice in a week to offer well-planned and effective counselling sessions. This therapist will observe professional ethics even when she establishes a closer and intimate therapeutic relationship with Carla.

Carla’s case is shocking. Working on this assignment made me think about the many individuals in our homes or on the streets, who are suffering from similar psychological disorders, but are simply referred to as ‘mad people.’ These people are neglected by the society and end up being engulfed by their own state of mind. When working with people like Carla, it is important to treat them with oneness and kindness. We should not treat them with exceptionalism, rather, we should show them that they are just like normal people, with a small mental alignment. When working on this assignment, I encountered challenges such as limited practical knowledge on Carla’s condition, as such conditions present themselves differently in different people. On my next assignment, I will ensure I visit medical practitioners to enquire more about such psychological conditions.

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