A Day in the Life of an Outreach Drug Counsellor

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By Linda Stewart

Outreach workers are familiar with the avoidant tactics of the hard to reach groups. Groups that include people with mental health issues, those engaged in illegal activities (substance use and street prostitution) and those experiencing homelessness. Outreach services provide the only contact with support services for people who live in isolated circumstances whether by choice or financial hardship.

As an outreach worker I do not control the environment in which I meet parents who access our service but I do understand that engaging mums and dads can only be described at times like a dance. The concept is one of process because as we take a “step” towards a parent we never know whether or not they will step away or engage. We cannot predict what situations we will walk into when that door opens, we simply go with it and we do that in the belief that everyone has strengths with which to work.

Crisis or not there is always a way forward.

The parents who do engage with services and experience the most positive outcomes tend to be those prepared to learn how to lead, who have the ability to build a new self-concept. One that promotes autonomy in a welfare system that disempowers by its culture; personality-drive judgement that withholds resources from some while providing others with support.

Tuesday 26 May 2015
9am – 12pm

The day started with an interagency meeting at which the guest speakers were leading a forum on men’s health issues. Lots of statistics and facts about why men do/do not seek help and ways in which we can break down those barriers.  The number of fathers who access our drug and alcohol outreach counselling service has increased and I am thinking here is an opportunity to provide information in an informal (outreach) setting about issues that are male specific.  One in four men are primary carers for either their children or their partners.  I have a number on my caseload who care for elderly parents and have little respite or support.  Also raised is the matter of the increasing number of men who are victims of domestic violence yet there are no services for these men.

These gatherings are great networking opportunities and on the very rare occasions the guest speakers are less engaging the morning teas alone are worth the effort.

12 – 12.30pm
Travel to the office

12.30 – 2.45pm
In between phone calls and clearing eight voicemail messages I catch up with a staff member who has returned from a three week camping trip to the Red Centre (envious). One of the phone calls is a lengthy discussion with a mental health service provider as we arrange a case conference with other services involved with a mutual client. We identify a framework within which to work and I make the phone call to the client advising her of details for the combined visit (which she has known about for some time).

The next half hour is spent using DBT (Dialectic Behaviour Therapy) to assist the same client manage her emotions and encouraging her to reflect on the mindfulness techniques taught during our last visit. Today is not a listening day.  She wants to talk. So I listen and reflect back to her what she has told me. She tells me again what she has already told me, several times. I do not discount her anxieties but try to bring her back to the present and what is happening now: what can you do today to help? Can you think of a time when you were able to be assertive, what worked well then … 

I have a scheduled visit and request we continue the conversation with the other services at the case conference reminding her that it will be her time to set her expectations on the table.  I encourage her to take time to write notes for the meeting. 

The next phone call is from probation and parole officer who is assessing one of my clients – a father – for home detention. I advocate for home detention advising our service will remain involved with the family as long as the father engages with the service. The officer is pleased I am accompanying this father to criminal court in a fortnight’s time as I will be seen as a ‘good support’ (thank you …).

The boss wants to know when I will be phoning clients to complete their follow up health surveys. The phone rings (Hallelujah, thank you God). It is an intake referral and assessment which takes twenty minutes with lots of questions and a brief drug history as well as what the client hopes to achieve with our service.  By the time I out the phone down the boss has moved on.

2.45pm
Leave the office and travel to a client visit. The GPS gets us lost (am I the only one it does that to?) but I manage to arrive at one minute to three.

3.00pm
I have been working as Kelly’s outreach counsellor helping support her to remain abstinent from illicit substances and alcohol. When Kelly was referred to our service in December last year she was homeless and her newborn son had been removed at birth – eleven days prior to her referral to our service. Her other five children were also in out of home care (fostercare).

The child protection worker who made the referral was disrespectful and judgemental of Kelly and I had the impression she was moving as quickly as possible through a checklist before closing the door on the case. There was little drug history, she had no idea which services were involved with the family and told me it didn’t matter what Kelly did ‘she will never see those children again.’ I was left wondering about the employment pathway to a job that wields so much control over people’s lives.

Kelly is in her new home; a three-bedroom house because she is in the process of having her two youngest children restored to her care. The children will spend the next two nights with Kelly – the first time she’s been allowed to parent with no supervision – and if that goes well the overnight stays will be increased. The case returns to court in June for assessment of the restoration plan.

We have completed a gamut of relapse prevention work. Identified high risk people, places and situations, formulated crisis plans for many and more hypothetical events that may sabotage her goal to remain abstinent from all substances. She has a list of emergency numbers to call and knows who her support people are. Kelly has worked hard, she has given herself wholeheartedly to the task of having her children restored to her care. The court process has been arduous and in itself one of the biggest high risk events that she may possibly face. She has come through beautifully utilising newly identified strategies putting to practice her new behaviours.

When I enter the six-month old baby is propped up in some kind of safety ring and happily fixated on the cartoons on TV. The 17-month old toddler is unpacking the kitchen cupboards and has several open packets of kiddy snacks strewn about the floor. The double mattress is the only ‘furniture’ in the living room and the carpet is covered in toys and wet wipes that have been pulled from their packet. A few small framed pictures hang on the walls.

Kelly is clearly overwhelmed. I have not seen her in this state before but then she has not had children in her care while I have been working with her. Having her children home is everything we had been working towards but today reality hits hard.

Our relationship has been built on small steps.    In the early stages I lead and Kelly followed. Now Kelly leads and I follow in the role of cheer leader, advocate while she accesses my network of possible services to support her.

The children were dropped off after breakfast this morning. It is now 3.15pm and Kelly states she has tried to get both children down for day time naps without success. The baby looks exhausted and the toddler tired and scratchy. I realise that I need to take the lead at this point and allow Kelly to follow; this is a new situation for her and one for which she is unprepared.  She is nervous that neither child will settle.

Her anxiety level has escalated and signs of stress are evident as she paces and twirls her hair – signs I have come to recognise. We have worked on strategies to manage feelings of being overwhelmed and stressed out. As we know little prepares us for parenthood. Similarly nothing could have prepared Kelly to know what to do with two children that she has only had two-hourly visits with until today.  We take time to recap those strategies and do some breathing exercises.

The cupboards are well-stocked with baby formula, bottled baby food so we feed the children and they settle. The baby fall asleep in my arms while the toddler is happy to lie on the bed with her bottle. Kelly is able to relax while we talk about the stressors and how things can be different next time the children come to stay. Kelly makes a plan for bed time and we figure out an afternoon routine.

Before scheduling our next visit for two week’s time we find two boxes and sort the toys into them and place them in a corner of the living room. We always set homework and this fortnight Kelly’s homework is to register for a self esteem course at a women’s centre and do something pleasurable for herself – a bubble bath, watch a DVD or take time to do her nails – ‘me time’.

Kelly will ring if she requires assistance before the next visit or if she wants to talk. She is calmer and thanks me for the support. No relapse prevention today, just parenting support; going with the flow, meeting the need at that time.

4.30pm

Check in with the office and notify the counsellor on call that I have completed my last client visit of the day.

I think about how the system has failed this mum and her children. The hoops they required her to jump through, her achievements so her children can return home and yet in all that court work no one has thought to put in place family support.  Not one other professional has thought to help Kelly with the routine for the first time the children came to spend a night with her.

This mother’s only experience of parenting was when substance affected. She has no idea how to parent while being chemical free. Without intensive support in the home there is little likelihood the children can remain in Kelly’s care .

While we have been focussing on the court’s requirement that Kelly undergo intensive relapse prevention work and substance counselling, other supports have not been set in place by child protection services. In my opinion, the system has dropped the ball big time; it has failed Kelly and her children.

Follow Up Work for Tomorrow
In between other client visits I will contact the child protection worker and have a discussion about referring the family to an intensive family support service. This is a service that comes into the home to help parents set routines: from mealtimes, house chores, sleeping routines for the children and sometimes even routines for the parents.

General Reflection
I feel sure we are not the only service who does more leg work for statutory bodies than they do themselves, but it concerns me that if statutory bodies do not fulfil their mandated obligations then other (non-government) services must do so. If we want a more equitable and socially just community those of us who can must and those who should but don’t need to be held accountable.

It starts with me and today I can make a difference … in one person’s life. Soon after her referral Kelly and I met with the manager of the statutory body whose worker referred Kelly to our service. Consequently, Kelly has a new child protection worker with whom she has a good relationship. This case worker is supportive of Kelly and I am confident we can work together to set in place more services for the family.  I do understand workers carry heavy case loads what I do not understand is why funding continues to be cut when the demand for services continues to increase.

Footnote: Kelly’s partner – and the father of her two youngest children – recently relapsed to ice use. She separated from him last week and is seeking sole custody of the two children. Child protection services are supporting this.

7 thoughts on “A Day in the Life of an Outreach Drug Counsellor

  1. Pingback: Lake St Clair | Catch Us Camping

  2. Wow, this was fascinating. To be taken into your work life and go through a day with you was a real eye opener. I am instinctively impressed with people who provide outreach services, and this detailed post told me why I’ve had that feeling. Thank you for the work you do.

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    • Thanx Janet for your kind words. No two days are ever the same and stepping into someone’s world is a humbling experience. I feel privileged to be able to journey along side them for a season 🙂 Linda

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  3. Seems like it was a long day – a long fruitful one. The good thing about our work as counselors and therapists is that we get to help others while we earn. Two birds with one stone.

    Liked by 1 person

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