SSW 255 – Case Management Advocacy
Case Summaries
Case 1: Brianna
Brianna is a 27 year-old woman who gave birth to a boy “baby Jake”, two months ago. This is her first child. He was briefly apprehended by the Children’s Aid Society (CAS) as he tested positive for cocaine at birth in the hospital. Brianna used cocaine intravenously for two years but claims she hadn’t used since she found out she was pregnant seven months ago. She informs you that she had a “slip” two days prior to giving birth. Brianna is distraught by the CAS intervention. While Jake is home now, CAS sent a worker to visit weekly. Brianna has heard recently learned that there will be an up-coming court case with the CAS. She has been informed by her CAS worker that their plan is to make her child a Society Ward, thus removing some of her rights as his mother, and she fears placing him on a fast track for adoption. In order to fight CAS’ plan, Brianna needs to come up with her own plan to address her
issues. Although she maintains that she hasn’t used since the last slip, you notice that she is wearing long sleeves and long pants despite the 35 degree heat.
SSW 255 – Case Management Advocacy
She looks very thin and her hygiene is poor. Based on your conversation with Brianna, you know that she is an only child. She never knew her father. She was raised by her mother who was an “alcoholic and mentally unstable”. She states that her mother would have “really incredible mood swings” and could spend “weeks in bed”. Although she says she has some good memories of her mother, she describes her youth as unstable. She explains that they moved every six months, either because they got evicted or because they couldn’t afford the rent. Furthermore, she says that her mother “wasn’t strict at all” and recalls getting drunk for the first time with her mother at the age of 11. She more or less quit school in the middle of Grade 9, because it interfered with her social life. Brianna explains that she has been really depressed most of her life and also finds herself unable to get out of bed some days. She tells you that her mother died 10 years ago and that she’s been on her own ever since. Brianna has worked as a waitress on and off for the past eight years.
SSW 255 – Case Management Advocacy
She has never been on a payroll, explaining that she didn’t want anything interfering with her social assistance. However, when she isn’t working as a waitress, she says she sometimes gets paid for sex to make ends meet. She claims she’s never been arrested for this before. Brianna lives in subsidized housing in a low-income area. However, she has received several notices of eviction due to non-payment of rent. The most recent notice was delivered yesterday. They have set the date for her eviction for the 21st of this November. Brianna explains that there’s never been a stable male role model in her life and that, as a result, she’s never been able to have “successful” relationships. Brianna recounts having been involved with numerous abusive men throughout her life. Her recent boyfriend is a well-known drug dealer who has had numerous interactions with the law, but she is quick to point out that he is very loving and supportive. Her son is the result of sex work and she has no idea who the father is.
SSW 255 – Case Management Advocacy
Case 2: Gareth
Gareth is a 26-year-old young man who resides in a CAMH ward meant primarily for people with diagnoses of some form of psychosis. Gareth has been diagnosed with Schizophrenia since he was 18. He was tested cognitively in elementary school and found to have low-average intelligence and so received a school board designation of Mild Intellectual Disability (Important- not to be confused with an actual mental health diagnosis of Intellectual Disability –Mild) and attended special remedial classes. His Schizophrenia started with several negative symptoms around the time that he was smoking a lot of marijuana in the park across from his high school. He liked the drug but primarily engaged in the smoking to be around popular kids. The kids supplied him with weed and alcohol
because Gareth entertained them. They could get him to do ‘crazy things’ including to shop-lift snacks from a nearby convenience store for them because he was so desperate to have friends.
SSW 255 – Case Management Advocacy
Over the years he has been also diagnosed with intermittent high anxiety of some sort as he can become somewhat preoccupied with personal belongings that he hopes to one-day purchase. In truth he is becoming very fed up with living in a hospital where he does not receive his full ODSP pension and therefore cannot buy the things he likes.
For the past three years Gareth has lived on the ward because his mother and stepfather will not accept him at their home, and the mental health agency in his hometown had him kicked out of their supportive housing complex when he last lived there. They respected his right to privacy as a strong example of the empowerment philosophy of the agency. Given his rights, Gareth usually refused to allow the onsite staff to come into his unit to speak to him about his occasional loud yelling (i.e., likely at voices he was experiencing) and did not wish their help with his trouble with the law such as frequent police involvement.
SSW 255 – Case Management Advocacy
Just before his current (i.e., three years ago) admission he had arrived home late and says he was stoned, drunk and delusional. He recalls being very upset that the staff would not open the agency housing entrance door for him. All he wanted to do was go to his unit and go to bed. Eventually the police arrived and escorted him to hospital, as in fact, he was found trying to kick down a door of a home owned by a family down the street from where he thought he was. Gareth is at times persistent when he wants something (that is when not acutely ill with his delusions) and enjoys having his own possession such as a TV and Walkman. He is close to his aging grandmother who speaks to him on the phone every few days when Gareth calls to check in. He plans on staying away from drugs and alcohol because he has realized it makes his anti-psychotic medication work less well. Gareth is not overly motivated to find a job or a romantic partner at present. He is seeking to move to some new Ontario community setting away from his hometown.
SSW 255 – Case Management Advocacy
Case 3: Alice
Alice is 23 and has two children, three-year-old Mona and seven-year-old Jessi. She left high school earlier than she had planned when she has pregnant with Jessi. Her boyfriend had her move in with his mother and him but after a few weeks she was told to leave by the mother and the boyfriend didn’t want to see her or sleep with her when her pregnant abdomen started to become obvious. Alice is living in a social housing unit and receives Ontario Works funding with top ups for each of her children. She has a current boyfriend of seven months who is living with her most of the time. He has started to become increasingly demanding and doesn’t let her hang out with old friends in the neighbourhood who also have young kids. Alice used to like hanging out and singing for fun with a couple of friends but generally stayed away when her friends got into serious partying with drugs and alcohol. Alice is really
devoted to Mona and Jessi and used to take them to the public library sometimes, though she never felt like she fit in with the rich mothers or their nannies, or at the park where her kids could swing and play on the slides all they wanted for free.
SSW 255 – Case Management Advocacy
She is thankful that the school board provides a bus to pick up Jessi each morning to take him to the special school outside of their neighbourhood where he gets concentrated help learning to read and write.
Alice’s life got worse she says when her current boyfriend started hitting her at times and when Jessi told a teacher about the terrifying loud arguments between Alice and the boyfriend. Now the CAS is visiting and wants her to have a plan for keeping the kids safer. The problem is that in the past few months she has less and less energy to do things. She thinks she is ‘down’ about her new pregnancy because she can’t imagine how she can manage a third child but would never consider abortion or giving up her baby for adoption. Last week the doctor at the emergency department’s walk in clinic told her that she was not pregnant like she thought. The Psychiatry resident she saw a
while later that day at Emerg said she was likely suffering from a depression and told her she would send some recommendations to her family doctor including suggestions on what medications to prescribe. Alice doesn’t think she could afford medications and decided not to follow any of the advice to see her family doctor.
SSW 255 – Case Management Advocacy
Case 4: Margareta
Margareta is a 75-year-old woman originally from another country. Margareta immigrated to Montreal from abroad and lived there for a few years and later moved to Ontario where she has lived since the 1960s. Margareta was sexually abused as a child by two of her uncles at different time periods, before leaving her home country. After completing a year of high school in Montreal, Margareta lived with her mother until she was married as a young woman. Thereafter she resided with her spouse for several decades until his untimely death that she thinks is not due to the cancer he was diagnosed with but instead due to poisons he breathed in at the many construction sites at
which he worked.
SSW 255 – Case Management Advocacy
Margareta worked most of her life with varying work roles which included cleaning homes and later cleaning office buildings and for the longest period, with a crew cleaning banks in the evenings. Margareta gave birth to and raised her three children who are now in their late 40’s and early 50s. Two of her children reside in Ontario while one moved three years ago to Vancouver. In recent years all of the offspring have steadily become more involved in their own work or families and have increasingly resisted Margareta’s entreaties to visit her. This estrangement has
been progressive and almost complete in recent years. Margareta is bewildered by her children’s refusal to visit and believes that they are not respectful of her role as a mother and grandmother. She finds them to be very self-centered and stubborn. She has recently stopped contacting them altogether. She was especially upset that her children have in recent years tried to get her to give up her home and live with a much younger sister of hers that she used to be close to. She especially misses her eldest daughter Elaine’s children who she helped raise for many years when Elaine and granddaughter lived with her.
SSW 255 – Case Management Advocacy
Margareta still resides in the small bungalow that she lived in for over 30 years after saving up a small down payment for years with her husband. Over the years she has often been accused by two of her children of drinking incessantly and excessively and causing her to either become belligerent and what they called ‘obnoxious’. Her son Jim did not mind the drinking and even encouraged it as he would join in and the two would become happily inebriated. Margareta enjoys reading books when she is able and watching her favourite soap operas on TV most afternoons. She has one friend Donna, a woman who lives nearby and while Donna is a teetotaler, Donna does enjoy joining her a few times a month to watch soaps on Margareta’s big screen TV. Lately, Donna has become increasingly concerned with Margareta’s drinking which has seemed to increase markedly in recent months. As well, on several occasions Donna has phoned to say hello and encountered Margareta being almost incomprehensible on the telephone. While visiting the last few times, Donna has found Margareta to be “talking crazy” and worries that she has caught Schizophrenia from someone.
SSW 255 – Case Management Advocacy
Case 5: Ayonne
Ayonne is a 28-year-old mother of one young daughter. This shocks her even now as she doesn’t even like men but got pregnant after the only time she ever chose to have sex with one. Her toddler resides in a temporary foster care placement. Ayonne is very upset with the CAS workers and has a long history of becoming very angry at service providers and most people she has had close to her in her life. She has had no contact with any family members for several years and there is a notation on her doctor’s file that she had been regularly abused sexually as a child by a male extended-family member during a portion of her childhood.
Ayonne has no close female or male friends because as she says, “they are too stuck up and full of themselves”. Ayonne knows she is of Mohawk heritage but was raised in North Bay by foster parents since around the age of 2 years old and has no contact with them or any connection to any indigenous people. She has been called racist names before and felt justified in assaulting her peers at times as a result. Ayonne has always fallen in love very quickly. In recent years, Ayonne has had many new short romantic relationships always ending in break-ups that have been quite conflictual. Sometimes these breakup periods have been short with a subsequent reunification and then a further break up. She complains that most of her partners have lied to her and later become violent or are plainly unstable. She has seldom been alone / single and prefers to have someone with whom she is romantically involved.
SSW 255 – Case Management Advocacy
Ayonne has tried to end her life on at least three occasions known to past service providers and has a history of cutting herself at times. She recalls being diagnosed once in the past with a some kind of personality disorder, ‘Borderline’ she thinks, but did not follow through with any suggested treatments and can’t recall who the professional was she saw. She does not believe most doctors know “what the fuck they are talking about”. Her main concern now is that she definitely wants CAS “the fuck off her back” and is self-aware in knowing that she has anger issues that have concerned members of the public, such as the workers at her daughter’s day care centre.
Ayonne presently lives in a public housing apartment with her new partner of two months. Her partner has issues with criminal court and might “get custody time”.
Ayonne is supported through the Ontario Works program. She disclosed that she had an introduction as a teenager to substance use; using cannabis leading to alcohol and cocaine over a few month time period. She shared that she has sometimes used substances in order to mask the pain after a break up or when she is reminiscing too much about her past experiences of childhood abuse. At present she is tired of all the relationship ups and downs and can’t see ever being able to trust a new partner. She just wants her current relationship to work out. She is emphatic when she shares that she doesn’t know how she could go on if her current partner leaves her or gets incarcerated.
SSW 255 – Case Management Advocacy
Case 6: Ali
Ali is a 36-year-old man who resides in a detached house with his father and mother. Both parents immigrated to Canada in 1975 and proceeded to have and raise their three offspring. Ali was diagnosed, by a psychiatrist, as a child with the diagnosis of Autism Spectrum Disorder (ASD) of the high functioning or mild type that used to be labeled Asperger’s Disorder. Ali’s father is now in his late 70s. Ali’s mother struggles with her chronic mental illness that keeps her housebound and needing her husband’s help. Ali has high anxiety and repetitive thoughts on topics of extreme interest to him. Ali craves social friendships and at times experiences intense romantic interest in women. Due to his ASD, he often forgets that other people like their personal space respected. He often walks up to young
women that he finds attractive and tries to speak with them. Such women have reported that his large physical size, his lack of respecting common understandings of personal space and his repeated and personal questions (e.g., Where do you live? Do you live near here? Is it nice there?) often make them feel uncomfortable or afraid of him. He has often accidently frightened other people he tries to greet or speak with as well and he is sad that he has never made a true friend.
SSW 255 – Case Management Advocacy
Ali wishes to live in his own apartment and earn his own money. He does not currently know how to pay his bills on his own though his ODSP cheque provides the funds. He frequently angers his parents because at night he randomly calls people on the telephone “just to chat” and this behaviour has resulted in costly long-distance telephone charges for his parents. He has never received any case management services or significant ongoing day supports, or respite staff supports. Up until recent years his parents could help him with many things but their involvement has decreased, and their frustrations with his frequent social conflicts have increased. While Ali intermittently has had the help of staff from a local developmental services agency he still frequently breaks rules, can seldom sit still for more than 15 minutes at a time, and has many times been suspended from attending day programs for various reasons. He has never been physically violent toward others however. He often expresses his loneliness and distress for not fitting in anywhere by keeping busy walking or at times breaking bottles he finds in the parking lot behind a strip mall near his home.
SSW 255 – Case Management Advocacy
Most afternoons Ali takes city buses and subways for hours at a time, often out of boredom. Due to his sometimes repetitive questioning (and the personal nature of his questions) of commuters Ali has been ordered off of buses by drivers and suspended from using public transportation services and the public library at times. Mental health clinicians have assessed him in the past and even prescribed medicines for anxiety, which he refuses, due to his dislike of previously-experienced side effects. In the past (i.e., at least 10 years ago), clinicians have provided various therapies and at times they have intervened with authorities to advocate for him on his behalf. Use APA referencing style.