Working in the NASEAU PROJECT

The Naseau Project was named after Marguerite Naseau (1594-1633) who died before The Daughters of Charity were even founded; in France, she cared for the sick and poor in the Confraternities of Charity with St. Vincent de Paul and St. Louise de Marillac. St. Vincent thought she was “an ideal daughter of charity.”

The Naseau Project was a five-year pilot program located at the St. Mary’s Family Practice Center, a residency program of the Medical College of Wisconsin. The project’s mission was to develop and implement high-quality low-cost health care for the inner-city poor. We specifically targeted two of the most-needy cohorts coming to the clinic: the frail elderly and mothers with new babies.

The Naseau Project clinical team was comprised of a clinical director, a social worker and a family nurse practitioner. We worked under two principle investigators, one from the Medical College and one from St, Mary’s.

I was told that though I was a social worker and this clinic served a very needy population, I was not to act as a social worker but as a researcher. The idea was we needed to identify and develop long-term solutions rather than fill in the gaps or adopt a band-aid approach to patient care.

It was the use of students that gave us the manpower to serve these patients and conduct our research. All educational programs are looking for ways to teach their student so we reached out to the Medical College’s family practice residents and various medical students on monthly rotations.

Combine this with Marquette University College of Nursing who assigned faculty to incorporate our activities into a community health course. I became a field supervisor for the Helen Bader School of Social Welfare at UWM and this activity was part of their assignment.

We became an Area Health Education Center (AHEC) site.  AHEC has been a leading provider of continuing education for healthcare professionals since 1988. One day a week these students came together and were assigned in pairs, mixing up the disciplines, to visit one of the clinic’s elderly patients in their homes. Each team was required to write an assessment note of their findings and a plan of care.

Writing that note was probably where students learned the most. Trying to put both perspectives into the same note was a challenge. And learning to speak up as a representative of a discipline with a different viewpoint was one of the most important lessons.

This program highlighted, for students of all disciplines, the strengths and weaknesses we all bring. A stark reminder that doctors and nurses usually focus on labs and other definitive results while social work deals with more vague and less easily defined issues. I remember a nursing student saying to me that she’d considered becoming a social worker but decided it was too hard.

After lunch a staff meeting was held where the clinic Medical Director presented a topic germane to the care of the frail elderly and then each team presented their case for discussion and questions. These case notes were then added to the patient’s medical record.

In our work with mothers with new babies we focused on completion of vaccinations. Social work students provided case management services to ensure proper post-natal care with attention to the accomplishment of such milestones as weight gain.

To further improve outcomes and build relationships, we scheduled a monthly meeting held at a church in the neighborhood. Called, Lunch Breaks, the program offered educational sessions on subjects chosen by participants, a medical check and lunch. What was the most gratifying was when these women began to show up and leave with each other. Our goal of improving their social relationships was being met.

Our basic finding from this project was reasserting previous conclusions that case management works. The special attention mothers with new babies received resulted in a 100% compliance in the vaccination schedule, acceptable weight gain and reaching other important milestones. For the frail elderly, our work resulted in less use of the emergency room, fewer rehospitalizations and a longer time between hospitalizations.

An equally important finding was the value and efficiency of the inter-disciplinary team. The doctor cannot and should not be expected to do it all. They say hindsight is twenty-twenty and that applies here. Throughout the project’s five years, we were seen as an outsider. That we were judging the established system and represented radical change. Perhaps if clinic leadership had been part of the research team, we could have had an easier time.

The Naseau Project didn’t change the medical delivery system much. Maybe not at all.  Our findings were lost in the hustle bustle of twelve-minute doctor visits. We had to be satisfied that our work added to other studies with similar findings and might someday support real change.

But for me, this was one of the best jobs of my entire career. A chance to develop and test new things.  And being given the time and money to accomplish that. I came away with a new understanding of how to design,  implement and evaluate effective programs. I didn’t know then how this experience would lead to and prepare me for the next step in my career.

my career.

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Working in Gogebic County

It wasn’t until eight years after finishing my bachelor’s degree that I began my first job in social work at the Gogebic County Department of Social Services in Bessemer, Michigan.

When I socially met the Director of the local county office, he was interested in me since I had a college degree which qualified me for a social work job in his office.

Michigan is a civil service state so I had to take a written test and designate which counties I’d be willing to work in. The only one checked was Gogebic County. Then I got onto a list and waited. When I got the call with the offer I realized my life was about to change forever; the beginning of what would turn out to be my long and rewarding career in social work was actually happening.

My first assignment involved managing a caseload of over one hundred adults, elderly, disabled or mentally ill, who lived in the community; it was my job to keep them there. I’d arrange and pay for support services so a person could avoid being placed outside their home.

I was required to see each client once every quarter. Or whenever there was an emergency. And there were many. Often, a crisis was needed to convince someone they needed more help than they could get at home. These were difficult and emotional tasks.

Some of these people will be embedded into my memory forever. Often, I was the only social visitor they had.  Some insisted on having coffee or tea and several baked just for my visit. I now realize, for many, my visit was seen a test; they had to prove to me they could manage in their home on a day to day basis.

I vividly remember standing in the living room of a woman who described, in great detail,  each of the decorative plates on her wall. Her daughter later informed me her mother was blind but wanted to hide that fact, lest I suggest she go to a nursing home.

I also recall a ninety-year old man who didn’t want to let me in because I was from the welfare. He woudn’t believe me when I told him his social security wasn’t welfare, that he’d earned that from his many years working in the mine.

I also went to the Lac Vieux Desert Indian reservation once a month. I asked one of our staff to accompany me. She was an Ottawa Indian woman who worked in our office as a homemaker aide. Looking back, I’m surprised I knew enough to do that; because she spoke the language and was an Indian, she got me into their homes.

After some time, I switched to family services. These were cases that didn’t meet child protection criteria but the family still needed some short-term help. After that, I also had an assignment in foster care and doing on-call child protection.

This type of work was difficult but especially so in this economically depressed and isolated area. With limited resources it was often not possible to get families and individuals what they needed to manage their health and other family issues. Their resiliency was impressive.

This was a good start for my future career. I became familiar with working in a government bureaucracy. That’s important for all social workers, no matter what area you work in, to understand how the government system works in order to get your clients what they need.

Then the unbelievable happened. I was laid off. As the last hired, I was the first fired. That’s how the government works. The Governor of the State of Michigan and the Director of Social Services disagreed; the Governor froze the budget which resulted in a huge statewide layoff. My office lost two and every county in the state lost at least one position. So much for the security of a government job.

Drug of Choice

While on a three-day riverboat trip, I wandered up to the top level and found that the concessions also had alcoholic beverages for sale. I wanted a brandy Manhattan and through the clerk’s questions I realized he was a professional bartender. He made me a very good drink.

Priscilla, my traveling companion, is a photographer. She was interested in him as a subject. Over six feet tall with grey hair, long, almost to his shoulders, with an earring on both sides, a baseball hat worn backwards. But what intrigued Priscilla were his tattoos.

Both arms were covered down to the wrists. When he stood in the doorway of the concession stand and reached up to the top of the door, tattoos could be seen that covered the entire underside of his arms. Joyce and Mary, our dinner and drinks new friends, joined me and Priscilla in getting pictures and in general conversation.

He was friendly and talkative and seemed okay with having his picture taken. In fact, he said he’d wear shorts the next day so we could see the tattoos on his legs. Sure enough, next day there he was. And there they were.

His thighs were covered with long, thin tattoos. He commented these were hard since he had to sit in a twisted position while the tattooist did his art. At first, I’d been hesitant about this. I wasn’t sure if we were embarrassing him or making his day. We decided he was having as much fun as we were.

Then I noticed a tattoo peeking out from the collar of his shirt. So, there must be more. I wasn’t sure about this but I asked: why do people get tattoos?  Turned out he wasn’t bothered at all and instead told his story:

It’s my drug of choice. I don’t do drugs and don’t drink anymore. When I started, I wasn’t going to go below the elbow but then I did. It’s just what I do.

I probed further as I pointed to his collar: so, there are others that we haven’t seen? He grinned and shook his head, then told us about the full back tattoo of a waterfall. But it wasn’t colored in yet, he said. I should have asked what he would do when he ran out of body.

We probably could have gone on talking but the call for dinner came so that was the end of our interaction. I still don’t understand it. While tattoos are fairly common, there’s a lot of judgement that goes along with it.

This guy was very nice but is probably misjudged due to his looks. He told us he works the boat in the summer and is a full-time bartender the rest of the year. So, who am I to judge? And maybe that’s the lesson. About judging someone before we know them.

Finding My People

The Spirit 27 rrcopy (2)

Three days on a riverboat with over one hundred strangers. Well, not quite. I knew my traveling companion, Priscilla, of course. I knew the travel agent, Barb. I knew the bus driver, Lynn. But that was pretty much it.

This conglomerate of humanity would spend these three days being cordial to each other. At each meal we’d sit with other strangers and make small talk. Where are you from? Have you ever been on a trip like this before? Just the type of superficial chat that’s required in polite company. But on this trip, we’d be fortunate to find some like-minded folks to spend quality time with.

It started the first night, once we’d arrived at our hotel after a full day of activity. We’d just found out the hotel had no restaurant. Or a bar. I was standing in the lobby trying to decide what to do when another traveler declared I want a drink. I responded, I do too. And we were bonded.

Throughout the trip we’d run into each other and have passing conversations, a few laughs and be separated once again. After arriving at the Pere Marquette Lodge late in the evening and hearing they had a winery, Priscilla and I headed there for a nightcap. The I want a drink gal and her traveling companion were already there and invited us to join them.

As with most short, chance encounters, I’m not even sure what their names were.  I think it might have been Mary and Joyce. But that’s just a guess.  We laughed a lot that night and the next day connected even more with the conversation and picture taking of the boat’s multi-tattooed bartender. We made plans for dinner and drinks at our last stop in St. Louis.

That night, again, we laughed a lot but also got kind of serious in our talk about lost children, worries about an aging mother, the foibles of family dysfunction we all experience on some level. Mary and Joyce told of how they became friends after years of being only neighbors. It was pretty personal.  And a great time.

I’m sure everyone has experienced such encounters, connecting with a stranger on a deep level and then going your own way, never to meet again. In this frantic mixed up world we live in, it’s those chance encounters that add depth to our lives and replenish our faith in the goodness of people.

 

 

 

 

Three Days on a Riverboat

August 23-27, 2019
Bus departs from Wauwatosa City Hall
Anderson Gardens, Japanese Tea Garden, Rockford, Ill.
Lodging, Peoria, Ill.
Board the Spirit of Peoria, down the Illinois River
Lodging at President Abraham Lincoln Hotel, Springfield, Ill.
Abraham Lincoln Museum and Library, Springfield, Ill.
Starved Rock State Park, Utica, Ill.
Lodging at Pere Marquette Lodge, Grafton, Ill
Enter the Mississippi
Lodging at Red Lion Hotel, St. Louis, Mo.
Bus ride home from St. Louis

Our journey began with a stop at the Japanese Tea Garden in Rockford Ill. Established in 1978 by Rockford businessman, John Anderson, as “a Japanese garden in his swampy backyard” it has grown into a twelve acre, meticulously landscaped series of winding pathways, streams and waterfalls. Highlight was seeing the colorful koi and the ducks frolicking together and fighting over the seeds thrown into the water by visitors.

Then lunch and a mid-afternoon arrival at a hotel in Peoria. Next day, we boarded the Spirit of Peoria, a three-tiered paddle boat that replicated riverboats of times gone by. The lower level was where food was served. The middle level was for entertainment and the top level was open air. Each level had indoor and outdoor seating.

For the next three days we had most meals on the boat. Astounding was the efficiency of the food service crew. Before we had hardly finished, they were setting up the buffet table in the middle of the room for the next meal. The food was varied, plentiful and very tasty. Including dessert!

Entertainment was on the second level. Morning and afternoon, a guitar player/singer and a honky-tonk piano man regaled us with old songs. Perhaps they were playing to the crowd, mostly seniors. As he strummed his beautiful dobro guitar, the guitar player/singer told the story of the dobro’s history I’d never heard before.

We were also delighted by the story teller, most entertaining with yarns of the river and pointing out landmarks as we went. His use of sound effects added to the drama of his tales. He gave us a first-class narration of river activity as we went through several locks and helped us understand the hold-up when barges needed the right of way. Most memorable point: saying “Mississippi River” is redundant.  The name Mississippi is derived from the Ojibwe word misi-ziibi(“Great River”) or gichi-ziibi (“Big River”). So, it’s more correct to just say Mississippi.

The Abraham Lincoln Presidential Library and Museum established in 2005 in Springfield, Ill. included two dramatic films that depicted both Lincoln’s admirers and detractors. Separate exhibits included a replica of his log cabin early life, his pre-presidential years and his White House years.

Starved Rock State Park in Utica, Ill. was a short stop to enjoy the trails. The park’s name was derived from a Native American legend of injustice surrounding the death of Pontiac, chief of the Ottawa tribe. When he was slain by a member of another tribe, a battle ensued resulting in that tribe taking refuge on a 125-foot sandstone butte; they were trapped there until they died of starvation. Hence, the name “Starved Rock.”

Each night we left the boat and stayed in hotels. Memorable were the Abraham Lincoln Hotel in Springfield, Ill and the Pere Marquette Lodge in Grafton Ill. Both were beautiful. The Red Lion Hotel in St. Louis was a place that has seen better days. I had a room that was like a one-bedroom apartment without a kitchen. Two separate rooms with a TV in each. Though everything worked, it was well-worn and in a part of town that was questionable.

Our group consisted of four buses. Ours had about twenty-five. A bus from Green Bay had about twenty-five. A bus from southern Missouri had an unknown number. And the Spirit of Peoria also had a bus of an unknown number.  We were all starting and ending the tour at different places and times.

I’d describe the crew as jack of all trades. The captain and owner of the boat loaded our luggage the first day. Various crew members did their job as bartender, entertainer or wait staff then assisted in launching and docking the boat or showing up at our hotel to help with luggage and directions. At every arrival and departure there were two crew members at the end and beginning of each ramp to help travelers.

Thanks to each crew member who were so helpful and accommodating:
Alex (Captain, boat owner, luggage handler);
Barry (guitar player, singer, bartender, luggage handler);
Ted (piano player, singer, bartender, guide);
Brian (storyteller, historian, guide);
Roger (bartender, boat launcher and docker);
Rita (waitress, cook,);
Nameless young man who looks like Trevor Noah (waiter, luggage handler, guide).

All in all, it was a great trip. We were off the grid with no wi-fi, or TV, and I often asked someone what day it was.  The river was relaxing and each day slowly blended in with the next. I now fully understand the enticement of riverboat travel so richly documented by Mark Twain.

Umbrella

Shield the wind
Stop the drops
Shade the sun
Statement of fashion
Close up like a capsule
Forget on the train

 

Soccer (Nonet)

(Nonet: nine lines, nine to one syllable)

 

At the park across the street they run
and screech and yell and cheer as their
families sit in chairs and
visit and cheer along
as coaches cajole
I get to watch
with no thought
of the
win.

 

 

 

Karin’s Group (at Rogers Hospital

The first thing I did before starting my group was attend “big group,” an open-ended process group that included all the patients currently in the program. The primary therapists (PsyDs and PhDs) rotated leading the group so it was a little different each day. I knew right away I didn’t want to duplicate “big group.” I noticed time was often used up by a few of the more talkative or controlling patients while the shy ones hid in the bushes hoping not to be called on.

Most of the kids returned home and I wanted them to be better equipped to handle the issues that had resulted in their hospitalization. Surely, these same issues awaited them. So, my focus was on social skill building, improving communication and decision making.

My first group session was a disaster. I was fresh meat and they chewed me up and spit me out. Out of control, disruptive and disrespectful. Luckily, later that day, the head of the rec-therapy department showed up at my office door and gave me a short tutorial on getting control of this mob of manipulative kids.

Basically, this is what he said: next time in group, the first time someone acts out, even if it’s just flicking an eyebrow, you stop the group and give that patient negative behavior points and have them taken back to the unit. As they are leaving, go back to whatever you were doing so they can see life goes on without them. And best of all, the whole group sees that you are in charge.

When I did this, everything changed. Once back in charge, I began introducing a topic for each group, discussion topics and activities that promoted group cohesion and support. Whatever the discussion was, at the end there was a go-around and each patient was expected to contribute.

For example, one day the topic was heroes. First, an open discussion. What does it mean to be a hero, how does someone become a hero? At the end, I asked the group to identify a personal hero of their own.  I modeled by identifying and talking about one of my own heroes. Then I asked for volunteers to do the same and we worked our way around the room until everyone had spoken.

It was amazing what came out of this exercise. Touching stories of a parent, a foster parent, older brother, valued friend or teacher who was looked up to and why. Group members learned important things about each other and felt less alone. This was what I was going for.

And I especially liked hearing from everyone. I’d chuckle as we headed down the stairs to the group room; They were so nervous, knowing they’d have to talk. I’d be bombarded with anxious questions of what are we talking about today?  Of course, I never told them.

I developed a rotation of topics that I used and re-used since this was a short-term program. But I also changed things if there was a certain issue that needed discussion. For example, I’d noticed a time when there was a higher than usual amount of swearing. So, I announced that for one session we’d have a no swearing group.

After the grumbling and complaining, I explained by saying: okay. I’m not being a goody two shoes. Hell, I swear sometimes too. But, damn it, once you go home, you’ll be in situations where you need to ask for something or bargain for something and swearing will make a bad impression. Swearing at your principal is not a good idea. I just want you to have some practice at expressing yourself without depending on swear words.

They got it. We had a productive group and though this was just one session, for weeks afterwards, kids would point out to me with pride when they hadn’t sworn, not even once, in group that day.

The adolescent program was treated differently than other patient groups. An example was the Florida Room, a beautifully decorated room off the main lobby. It was used for special parties and meetings and occasionally some of the adult programs used it for group. Why not us, I asked. We shouldn’t be second-class citizens.

I approached the chief medical officer, Dr. Otto, and he very reluctantly gave permission. Then I prepped the group saying I’d stuck my neck out and they needed to be on their best behavior. No feet on the furniture or leaving a mess of any kind.

They were great and I made sure Dr. Otto knew that. In all the time I spent at Rogers the kids always surprised me with their potential. Except for one time. During a group, a fifteen-year-old young man was disruptive. I asked him to settle down and when he didn’t, I gave him negative points. He continued. I warned of more points.

Instead of complying, he stood, took the wooden chair he’d been sitting in, hoisted it over his head and threw it. It hit and left a permanent gouge on the wall between me and the patient I was sitting next to. He ran out of the room, followed by an aide. The group was quiet and in shock so I sent them back to the unit and sat for a few minutes alone in the room.  I knew I had to go up to the unit and make an appearance because that’s what I always did after group. And I did.

Such incidents require a special staffing to be scheduled, attended by the entire program team right up to the chief medical officer. At the special staffing the next day, this young man showed no remorse. In fact, when asked if he’d meant to hit me, he said:  if I’d meant to hit her, I would have. I have no idea what he was trying to say but he was discharged that day.

I learned so much from my time at Rogers and especially in this group experience. Perhaps my most valuable lesson was from that helpful rec-therapist who’d taught me something that I carried throughout my career: it’s more important to be respected than to be liked; in fact, if you’re liked you’re probably not doing your job.

 

 

 

Nick of Time

An instrumental version of the song
brought the memory back of that day.
We were driving to a meeting.
She had a cassette.
The song Nick of Time was playing.
She rewound it to a few certain lyrics
Over and over.
She was nervous.

You came along and showed me I could leave it all behind.
You opened up my heart again, then to my surprise.
Love in the nick of time.
I didn’t know her well
though we worked together.
I knew, from office gossip, she was having an affair with
a man we worked with.

When did the choices get so hard?
With so much more at stake.
She was married and had three children,
One, a new infant.
He was recently divorced.

I sat quietly,
had no idea if or what to respond.
I felt invisible, an observer of her pain.
She wasn’t asking anything of me
and I gave nothing.
We arrived and went to our meeting.

She stayed with her husband.
Her paramour went on to chaotic relationships
including an unhappy and short marriage
So much for
Love in the nick of time.

 

 

 

Working at Rogers Hospital

First day at my new job, I’d parked in the back lot; as I walked toward the main building and the door I was instructed to enter, there were screams coming from one of the top floors. A woman was letting out screeches of help me, as if she were being tortured. This was my introduction to my new job at Rogers Memorial Hospital in Oconomowoc. I wondered if this was a sign.

With trepidation, I went inside and found my supervisor. The advertisement had said MSW required. I didn’t have that but applied anyway and was hired as a psychiatric social worker at this private acute care psychiatric hospital.  I was assigned to an adult addiction program.

I hadn’t been too keen on working in addictions (been there, done that) but took the offer as my ticket to relocate close to a graduate school.  Then, within two weeks my supervisor told me the director of the inpatient adolescent-pre-adolescent program wanted to “steal me away” to work in his program.

He’d looked at my resume and felt I had the skills to develop some new programming he had in mind. We had an interview and I was happy to sign on. The in-patient program, housed at the hospital, was run by an out-patient counseling organization, Institute for Motivational Development (IMD).

Referrals for in-patient treatment came from IMD and also from the courts, schools and other counseling services. The typical patients were adolescents with learning disabilities, or ones who’d been expelled from or were failing in school, or had had a first-time encounter with police and/or juvenile court. Then there were the usual drug and alcohol issues, depression and suicide attempts.

Admission was voluntary; the hospital had no locked doors and did not use restraints of any kind. So, the typical patient was not your severe juvenile delinquents or out of control, violent adolescents.

Most often we had kids who were having a tough time that often was short term. The usual length of stay was thirty days but more if insurance allowed. And it often did. Over 95% of them returned home after treatment,

This was my first time working with only private insurance since the hospital did not take Medicaid. It was eye-opening to see these well-heeled kids haul in their boom boxes, fancy clothes and high-tech, expensive items. At admission, they were followed by equally well-heeled parents. Having worked only in the public sector, I was surprised, shouldn’t have been, that these families had the same problems.

The IMD inpatient staff included four PsyDs and two PhDs who were the primary therapists. The hospital program staff included one psychiatric social worker, an addiction counselor, two school teachers, three recreation therapists, various psychiatric nurses and aides.

The program operated on a milieu therapy model, a therapeutic community where patients are encouraged to take responsibility for themselves and others. There is a hierarchy based on achieving levels where peer relationships and peer pressure plays a primary role. The main motivators are positive and negative behavior points and earning privileges.

Any program staff could impose a restriction or reward. Because this was a closed system, we could use more provocative tactics. For example, we sometimes prescribed the symptom.  A patient using not feeling well as an excuse to not participate is made to use a wheelchair and exhibit and explain symptoms of a specific illness. Their frustration quickly rises and they’re usually “cured” in a day or two.

For me, this was a steep learning curve and I was clearly over my head at the beginning. The hospital operated strictly by the medical model so having a lowly social worker actually work with patients was unheard of. I knew I had to prove myself.

Rogers Hospital had been established in 1907 by Dr. Arthur Rogers, a British psychiatrist. Then his protégé, Dr. Owen Otto became the owner and chief medical officer. I worked there in the 1980s and it was experiencing some hard times. Then, in the 1990s, an influential member of the hospital’s board would take charge and bring it to the success it enjoys today.

A Goggle search shows a sprawling campus that is a far cry from the old brick hospital with a few dilapidated out-buildings of my experience. I’m sure that fourth floor locked unit (the only locks there) where I heard those screams on my first day, is no more. And those mentally ill, private pay members of wealthy families are long gone too.

My time at Rogers Hospital was challenging and unforgettable, an opportunity to develop new skills and broaden my resume. While abiding by the institutional structure, I was also given complete freedom when designing programming.

Besides doing psycho-social histories on new admissions and wrangling with insurance companies when an extension was needed, I developed a group with the adolescents two afternoons a week and a parent’s group on Saturdays.

 

Later, I did lectures and groups for other programs within the hospital. An unexpected benefit was that all my hours counted toward licensure.  All in all, this was an invaluable experience that prepared me for graduate school and a rewarding future career.

 

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