From a fake problem to a real one.
I work mostly with substance abuse cases in my new position. Since I have substance abuse treatment experience, my supervisor lets me make treatment decisions and offers help only when I ask. I kind of like it that way. So in our last meetings I mention a difficult case I have. The client should really at a minimum, complete an intensive outpatient program. She has many years of polysubstance abuse and no treatment history. She’s a single mother in a rural area, works far from home at a low paying job and has little family support. She has medical insurance through her job and pays for her own apartment. Those in social service know that things that seem good, like private medical insurance, often disqualify low income clients from services.
The client will lose her job if she does not follow the recommended treatment. The client is not particularly dedicated to her job and may quit her job if treatment expectations are too intensive. She’s not dedicated to sobriety either and has continued to use drugs even after testing positive at work.
So what to recommend? I think an introduction to treatment, some education is better than none. Recommend a combination of self pay group counseling, some individual counseling sessions paid for by the employer and self support groups like NA. Sounds similar to an IOP but offers more flexibility and lower cost.
My supervisor says no. If she needs IOP, recommend IOP. A hospital about a half hour from the client offers IOP services. I understand where my supervisor is coming from. The environmental circumstances don’t change the fact that she needs intensive services. I explained the “some is better than none” theory and my supervisor disagrees. She says it is not our problem if she cannot complete services, we are bound to make a recommendation strictly based on her presenting symptoms/use.
I have to make a recommendation this week. I’ve been “given my orders” but like I said, unless I bring up an issue in a case, my supervisor doesn’t notice what I do.