Case Studies

Case 1
Promoting safety, coping, and community reintegration

A case manager from a rural community service contacted Diverge seeking assistance with one of her clients whose problematic behaviours were causing concern among community members.

The client was a 50-year-old woman who had suffered a stroke approximately 10 years ago. After a brief stint in rehabilitation in Melbourne, she returned to her own home in her local community where she had since lived. She lived alone, and typically managed quite well with regular visits from council services. Over recent months, however, her presentation deteriorated: she was irritable with council helpers and often refused them entry into her home; she appeared at the local shops unkempt where she often lingered and begged for money; she sometimes wandered unsafely on local roads. She was unsafe in public, becoming a nuisance, and the police had recently become involved. It was unclear how to manage the situation.

Assessment

A psychologist from Diverge and the case manager visited the client in her home. It was apparent she was not coping by such things as the rancid smell in the house, the collection of unpaid bills, and the fridge with very out-of-date food. It became apparent that she had had regular support from a sister in a neighbouring town, who had died approximately a year ago. Further conversation with the client and the local council staff suggested the following had occurred: Without her sister’s moderating influence, council helpers were not able to access the house. The client then had no family or paid support, and she was unable to manage household chores, daily living activities, and finances by herself. As a result, her personal care and presentation deteriorated, she did not have access to money, and she had little structured activity to keep her busy.

Intervention

An occupational therapy assessment was organised through a rural community health service. This identified that the client had sufficient skills to live at home with daily support. Council services were reinstated but staff were restricted to the two women the client got on well with and would let into her house. Photos of them were placed on the client’s fridge along with their names and visiting days so that the client was regularly aware of pending visits. Staff assisted the client with routine household chores. A small funding package was acquired through the Department of Human Services to pay for additional support through an community agency. Every other day, a worker would visit, prompt the client to bathe and change, and they would then go into the community together to access money, shop, and return home safely. Once per week, the local social group associated with the aged care facility would collect the client for a social event, and return her home. A neighbour was enlisted as an informal support who would check in on the client every other day.


Case 2
Managing aggression and adjusting after release from prison

A family support worker contacted Diverge for assistance with a client was behaving aggressively. The behaviour included verbal and physical threats towards his partner, and property damage (e.g., holes punched in wall); these were occurring in the presence of their two young children. The client had recently been released from prison, was drinking excessive amounts of alcohol, refused to work with the family support worker, and was at risk of losing contact with his partner and children.

Assessment

Consideration of the client’s history showed previous charges for aggressive behaviour, and a number of restraining orders having been taken out against him. He was a member of a gang prior to his brain injury, and had acquired injury from an assault in a gang fight. He had been involved in petty crime for many years prior to his injury, and it appeared that his injury had made him less able to successfully avoid detection and capture by police. His neuropsychological assessment indicated that he retained reasonable ability to learn new information, and that he had a considerable degree of insight into his difficulties (i.e., poor memory, slowed thinking, poor planning), and the consequences of his actions. He appeared to have developed depressed mood since leaving prison because he was struggling to cope with the complexities of an unstructured life; he realised that his life was not as he wanted, and he could generate few solutions for resolving his problems. He claimed that he drank because it “made the problems go away” (i.e., self medication).

Intervention

Psychiatric opinion was obtained regarding the client’s mood, which resulted in the introduction of a small dose of an antidepressant medication. This was considered a short-term intervention that provided a window of opportunity in which to progress other interventions. The client was coached in a controlled drinking approach in which his total daily intake of alcohol was reduced by half – this was reinforced with shopping vouchers, which eased the burden of financial responsibility he felt. Two key activities were introduced to provide structure to his day, and displace opportunities for other unwanted behaviours: he commenced workouts in the gym, which he greatly enjoyed, and he was introduced to a local men’s shed where he could interact with other men, and work with his hands. In addition, he was taught basic anger management strategies by a Diverge psychologist, and used a CD recording backup, and received weekly evaluation and feedback. A consequence card was added to his wallet, reminding him that prison is not a place to return to.
His wife was assisted to devise a safety plan (e.g., escape options, police quick dial) to employ if her husband became very aggressive. was coached in the use of a daily timetable to promote structure and predictability in the family’s activities. She was introduced to an employment support agency so that she could pursue work, which not only provided an income, but gave her respite from the house.
The family support worker was re-engaged to work with the family once much of the intensity had been removed from the situation, and daily life was running more smoothly.