Growing up with Mental Illness in the Foster Care System

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  • #299

    Jenn_Smith
    Participant

    The details of this case have been altered to protect the anonymity of those involved.

    Katie is a new social worker for the child welfare government office. She is assigned to work on the permanent care team, which works with clients who are already in the foster care system. She has been on the team for a month and is struggling to identify what supports she can provide for a particular client.

    Peter is a nineteen year old ward of the department. He has been in care for the better part of a decade. He has had over a dozen foster placements, all of which ended due to unpredictable and violent behavior. Peter came into care at a young age after it was discovered that his father was selling drugs and using them with his children; his father died from an overdose a few years after Peter had entered care.

    Peter has struggled with substance abuse but remains sober at the present time. Peter was diagnosed with schizophrenia recently. He also suffers from severe anxiety and agoraphobia.  Even as a pre-teen, Peter had incidents where he would steal from stores because he said “the demons inside me told me to.” Peter has had a hard time leaving his home in the past, and will frequently not leave for weeks at a time. Peter is inconsistent taking his medication due to the mental “fog” he experiences.

    Peter has a serious on again/ off again relationship with Bailey, a woman who has been a support system for Peter for many years. Bailey has borderline personality disorder and is at times quite volatile. Peter has been evicted from six different apartments due to incidents between him and Bailey, including an incident where they threw a chair out of a large glass window. Peter has a history of causing property damage, including punching walls, doors, throwing objects at windows, and smoking indoors. He and Bailey have a toddler who lives with the maternal aunt due to the department of community service’s involvement with Peter and Bailey. Peter has been homeless for almost a year, and has been sleeping on various couches throughout that time. The worker has struggled to find a place for Peter to live due to his criminal record, poor tenancy history, and minimal housing budget ($650 a month for rent and utilities). Peter is often unable to work due to his mental illness, but was unable to receive disability support program income for many years due to delays in receiving a diagnosis of schizophrenia. Peter also has trouble focusing enough to fill out the paperwork required for most applications, and frequently misses deadlines because of it. Peter must find somewhere to live in the next month as the friend he is staying with is moving out of province.  Peter has severe anxiety and often begins to ramble incoherently when attending appointments. Peter is very polite and engaging when he is not having a hard time, and presents as likeable. Previously Peter has done well when he owned a cat, though he was unable to afford medication and veterinary care for the cat and could not afford to keep the cat when he was evicted and forced to move to a new residence. Peter identifies that he has trouble managing his anger, and appears quite remorseful when reflecting on past incidents.

    Katie is struggling to find a place for Peter to live due to his history; they have applied to over 30 properties in the past year, all of which were not approved. Peter ages out of the system within the next few months and is quite anxious about what will happen when he no longer has the support of the agency. Katie is unsure exactly how she should proceed.

    Questions:
    1. What can Katie do within the next few months to assist Peter?
    2. What are structural barriers that impact Peter?
    3. What are alternative resources that may be helpful to Peter?
    4 Is this more of an individual or systemic challenge (or neither)?
    5. Should Katie fill out Peter’s rental applications (as he struggles to fill them
    out correctly and apply by the deadlines)? If she does, should she mention Peter’s
    tenancy history?

    • This topic was modified 4 months, 1 week ago by  Jenn_Smith.
    • This topic was modified 4 months, 1 week ago by  Jenn_Smith.
    • This topic was modified 4 months, 1 week ago by  Jenn_Smith.
    #305

    kathleenleaman
    Participant

    1. What can Katie do within the next few months to assist Peter?

    Katie can continue to advocate for Peter and to help him boost his own self advocacy skills. She can keep looking for housing, reach out to different organizations, such as Schizophrenia Society of Nova Scotia to inquire about programming and housing opportunities. She can assist him in applications for disability assistance to give him more of an income.
    2. What are structural barriers that impact Peter?

    Mental health stigma, trauma, being in care, hisory of abuse, history of addiction, poverty.

    3. What are alternative resources that may be helpful to Peter?

    Organizations that can work with him to find housing and employment, such as Reachability or Schizophrenia Society of Nova Scotia. Programs such as Laing House, or Connections. Getting a cat again could be a way of coping.

    4 Is this more of an individual or systemic challenge (or neither)?

    It is both. Mental health issues compounded with poverty, abuse, addiction and precarious housing.

    5. Should Katie fill out Peter’s rental applications (as he struggles to fill them
    out correctly and apply by the deadlines)? If she does, should she mention Peter’s
    tenancy history?

    Katie can fill out, and/or help him to fill out his rental application. People of all walks of life get help in doing things they don’t excel at. I don’t see this as an ethical issue.

    This topic was modified 1

    #306

    kscott12
    Participant

    Question 1: I feel Katie should seek the assistance of adult programs that could be a support for peter and help in his transition. Katie can continue to advocate and work with Peter to set goals and guidelines in how peter can achieve these goals. Katie could also look into second stage housing options within Phoenix and Shelter Nova Scotia. Katie could also look into MOSH housing first, and MOSH street health team to have a continuous support for Peter when Katie can no longer work with him. There are also options within Phoenix employability and learning centre that Katie can set up for Peter and they can continue helping peter with forms.

    Question 2: Structural barriers that affect peter are mental health and addictions stigmas, lack of mental health and trauma services, poverty, and a lack of transitional systems for youth leaving the foster care system.

    Question 3: I have already mentioned in question 1, alternative resources that could be available to peter that Katie could look into for him so he can have a better transition out of the system. Another resources could be setting up a trustee to help budget, setting up food banks, and finding a housing program that could work with peter long term.

    Question 4: The challenges peter is facing are both individual and systemic issues. His mental health should have more services offered by the system, the lack of transition is no fault of peters and is an system issue. Peter’s trauma is not his fault and he used unhealthy coping mechanisms to help because of the lack of services available to him.

    Question 5: Katie should continue to help Peter fill out his rental applications until she no longer can. Rental history is a barrier for lots of folks trying to obtain new housing. Having references from other professionals, and a trustee in place could help mitigate the issue of his poor rental history.

    Thank you for sharing, I feel this example is great to show the relationship between the individual and system issues, as well as how the system can fail.

    #307

    RachaelJacklin
    Participant

    1. What can Katie do within the next few months to assist Peter?
    There is obviously a priority on finding Peter a safe and stable place to live. Katie should reach out to local organizations that specialize in supportive housing for people struggling with severe mental illness to start. New Dawn Enterpirses is a Cape Breton based organization that looks to seek out apartments for people suffering from mental illness. If this is not an option then it is also a priority to maximize Peter’s income potential through disability in order for him to afford an apartment traditionally.
    2. What are structural barriers that impact Peter?
    Peter is dealing with mental illness and a substance abuse problem which obviously makes him marginalized and facing stigma, however he is also facing a lifetime history of feeling or being powerless within the child welfare system, both as a child in care and now as a parent of a child in care.
    3. What are alternative resources that may be helpful to Peter?
    I mentioned the supportive housing for people suffering from mental disabilities. Peter is also in a tumultuous relationship with the mother of his child, it may bring peace to his life if they attend relationship building.Also, Peter is involved in many social services like child welfare, addictions services, mental health services. There should be one person in charge of assisting him and bringing all of those arenas together , making sure to look after the whole package that is Peter.
    4 Is this more of an individual or systemic challenge (or neither)?
    Both, Peter faces many individual marginalization and vulnerabilities but one major thing that is bring all of these issues to a crux is the fact that he is “aging out of the system”. The fact that Peter has multiple vulnerabilities that he needs assistance but will not be receiving it because of a timeline/deadline is an example of how the system is failing him and possibility escalating his problems.
    5. Should Katie fill out Peter’s rental applications (as he struggles to fill them
    out correctly and apply by the deadlines)? If she does, should she mention Peter’s
    tenancy history?
    yes, Katie should fill out Peter’s applications. I think it would be more un-ethical to expect him to do it himself knowing his history and challenges. Any person relies on people within their support system to help where they can. Katie may not be family but she is a major part of his support system. She should lie on the applications but she should set up supports for peter that she can discuss with landlords as being in place to help Peter be successful in his tenancy.

    #310

    knearing
    Participant

    1. What can Katie do within the next few months to assist Peter?
    Katie must look at her priorities with Peter. If I was Peter’s Social Worker I would want to focus on finding Peter a stable and safe place to live and working to proactively address his transition from the child care system to the adult assistance program. It is important to address this transition because finding him a place to live must fit within the guidelines of budgetary concerns (how much for rent), social concerns and employment concerns of the adult system he will be entering. This should be articulated to Peter so he knows that he is not the only one who feels anxious about this transition. By combating this anxiety and finding him a place to live the transition will be more comfortable for Peter.

    2. Structural Barriers that affect Peter are the paper trail that follows him regarding his mental illness, his previous renting history, his involvement in the foster care system and his involvement with child protection regarding his own child. This paper trail is preventing him from finding a safe place to live. The allowed budget of 650$ a month is also a structural barrier.This budget does not allow for options for Peter so that he has a better chance of getting a stable place to live. He also may not be able to find a place that is considered safe with a low budget. He also faces structural barriers of history of abuse and poverty. These would be considered trauma.

    3. Alternate resources could be organizations for mental health, mental illness and schizophrenia specifically. He could access organizations that provide employment for individuals living with disabilities. Peter could also reach out to the SPCA to see if he could volunteer his time with the cats in the shelters as this would provide him time with cats which has proved to give him solace in the past. Ideally, he could eventually work towards the goal of owning a cat.

    4. I believe that there is a systematic challenge that the individual is subjectively experiencing, there for there is both. Peter is dealing with individual challenges of being placed into child protection systems as a child and that has systematically created challenges such as trauma and experiences in the foster care system. Peter has individually experienced challenges maintaining a stable place to live but he is systematically facing the challenge of stigma and fear of renting to him. The system always affects the individual.

    5. Katie should guide and help in areas that Peter needs on his rental applications. Ethically, she should not lie on applications but she should only provide necessary information. This is important as social workers to work with the grey areas allowed within ethics and rules.

    #330

    B00678457
    Participant

    1. What can Katie do within the next few months to assist Peter?

    Katie should take a number of approaches to assist Peter in the coming months. I think, foremost, she should talk with Peter about helping him find an apartment and, with his permission, attend his apartment showings with him. I think in doing so Katie could assist with Peters’ housing as a whole as he attempts to navigate the sparsely-available housing within his budget. Katie could also provide Peter a degree of advocacy as a clinician, potentially being able to provide support to Peter by discussing his need for affordable housing to landlords, explaining his situation, and, if needed, addressing some of the symptoms that he often presents with during apartment showings. Katie could also assist Peter in filling out housing paperwork and applications for additional funding, which would help address his difficulties concentrating when trying to fill out such forms.

    In the meantime, Katie could connect Peter with Phoenix youth shelter (which serves youth up to age 24) to see if they have any short-term or long-term beds available for Peter, so as to help with his housing situation in the interim.

    If Katie and Peter, together, were able to locate housing for Peter, Katie may also want to talk to Peter about some of the programs available through the SPCA that allow people to foster cats for short periods of time or to adopt older cats. Many of these programs offer ongoing support for foster/adoptive care providers, including free vet care if needed. As noted in the case, a cat has provided Peter with considerable support for his anxiety in the past; connecting him with a foster cat or an older animal with ongoing support from the SPCA or another organization would therefore benefit his symptoms and provide a client-centered intervention based on Peter’s self-identified needs.

    I also think that Katie could work with community mental health to put in a self-referral for Peter (again with his permission), so as to potentially connect him with a long-term clinician for support with his schizophrenia. Another service that Peter could also potentially benefit from is the Early Psychosis Program through the NSHA: given that his diagnosis of schizophrenia is recent, the team at Early Psychosis may be able to help him identify coping, self-care, and recovery-oriented strategies for the betterment of his mental health. They could also help address the ‘fog’ that he experiences, and strategies to help him deal with the voices that tell him to do things. Additionally, Katie could explain the role of the Mobile Crisis Team to Peter, and that he can call the service to connect with a clinician during times he has difficulty coping.

    Lastly, it might also be worth it for Katie to have a discussion with Peter to gain insight into his perspective on his relationship with Bailey, including if, and how, he feels that the relationship is affecting his situation. Katie would have to approach this conversation cautiously to ensure she did not impose any biases that she holds onto Peter and his relationship. However, I believe it is a conversation that is worth having to help understand Peter’s viewpoint and what he intends to do moving forward in the relationship given how it has impacted his housing situation.

    2. What are structural barriers that impact Peter?

    A number of structural barriers are impacting Peter. Foremost is the lack of affordable housing readily available for people with disabilities. Indeed, the fact that he has not been approved for housing based on his budget and his disability is indicative of a structural barrier regarding a lack of affordable and/or accessible housing in his area.

    A second structural barrier is the stigma associated with his mental illness. Such stigma may be impacting his ability to access housing, especially given that he often presents with psychosis-based symptoms during apartment viewings. Should the landlords that he interacts with hold biases and stereotypes concerning mental health, Peter would therefore be negatively impacted by such stigma.

    Another structural barrier is his rental history, which is impacting his capacity to seek out a new place to live. Especially given his history of damaging property, Peter is implicated in a low likelihood of approval from landlords.

    Assuming this interaction occurred in Nova Scotia, another structural barrier that may be interplaying within Peter’s situation is the lack of readily-available mental health services to help him with his schizophrenia. Long wait-times and a lack of clinicians for proactive support currently plague the province, leaving those experiencing mental illness without access to services for lengthy periods. Hence, this structural barrier may be perpetuating Peter’s situation insofar as leaving him without mental health support.

    3. What are alternative resources that may be helpful to Peter?

    I have noted a number of alternative resources that may be helpful to Peter in my answer to question one. In addition to these resources, Peter may also be able to access Out of the Cold emergency housing for a short-term bed to keep him off the street. Peter may also be able to connect with Metro Community Housing for additional housing resources and connections to government-based affordable housing. Laing House (a non-profit mental health agency serving youth age 16- 29) may also be able to provide Peter with ongoing support in which he could connect with peers and engage in client-centered activities based on his self-identified interests and needs.

    4. Is this more of an individual or systemic challenge (or neither)?

    I don’t believe that any challenge faced by a client is purely individual or systemic-based. In Peter’s case, I believe that there are certainly some individual factors impacting his situation—namely, his difficulty concentrating, his history, his relationship with Bailey, and his symptoms—but I also think that these factors make up only small percentage of the larger context of his situation. Additional factors that are undoubtedly interplaying to perpetuate Peter’s situation are the above-noted structural barriers that I have discussed. These factors, I believe, serve to interplay within his situation to render him without readily-available solutions to the issues that he is facing. They also serve to perpetuate and amplify some of his individual-based factors including his symptomology by leaving him with this overall lack of solutions and support. As a whole, then, I think Peter is caught in a cycle in which systemic forces of oppression and his individual factors are interplaying with one another to foster and perpetuate the situation that he is currently in, and that interventions are needed to address these forces in their entirety.

    5. Should Katie fill out Peter’s rental applications (as he struggles to fill them
    out correctly and apply by the deadlines)? If she does, should she mention Peter’s
    tenancy history?

    I believe that Katie should not take full ownership of filling out Peter’s rental applications, but rather that she should help him in completing the applications. I think that Katie could work with, and support, Peter in filling out the applications by filling out the forms together and helping him with his concentration. Doing so, I think, would be a much more client-centered intervention that would ensure Peter still has agency over the forms and his situation as a whole.

    Mentioning Peter’s tenancy history within his rental application is a much more difficult ethical question. I think, personally, she has an obligation to fill out the forms truthfully, without holding back information that is being requested. That said, I think I would personally leave out information not explicitly necessary to include within the application, and to only highlight aspects of Peter’s rental history that are required as part of these forms. Withholding such information, I think, could cause more issues for Peter in the future, and potentially implicate both him and myself in the law. I would therefore work to ensure that the information I include is truthful and acknowledges Peter’s history, but also that any unnecessary information or any information not explicitly requested is left out of the application.

    Jordan Z

    #333

    LRSLWK4010
    Participant

    What can Katie do within the next few months to assist Peter?
    I think it’s important for Katie to sit with Peter and see what his goals are, and using motivational interviewing Katie can help him to see the changes he has the power to make in his own life. While providing support and resources Katie can assist Peter for the next phase of his life.

    What are structural barriers that impact Peter?
    There are many structural issues that Peter is being oppressed by.
    – The healthcare system and its lack of resources specific with Mental Health. As well as caring service providers that understand trauma informed care.
    – Stigma is something that affects people both inside and outside the health care system. Peter has to deal with people stigmatizing him from the general public to housing authority to doctors.
    – While being a child of the system Peter missed out of having a supportive adult teach him living basics like laundry, cooking, and how to live on your own successfully. Whereas many children that grow up in their primary care provider are taught skills from a young age about how to be a successful adult, even from just watching the supportive adults modeling the behaviour.
    – Lack of affordable housing is a large structural issue. Due to the fact that Peter’s record keep following him he will continue to be passed over.

    What are alternative resources that may be helpful to Peter?
    It is really important to know about the community resources that are more in the nonprofit sector. REsources in Halifax could be Laing House, Heartwood Community Youth Development, Phoenix Youth Services.
    Is this more of an individual or systemic challenge (or neither)?
    Peter’s issues are both in the micro and macro levels.
    Should Katie fill out Peter’s rental applications (as he struggles to fill them
    out correctly and apply by the deadlines)? If she does, should she mention Peter’s
    tenancy history?
    There is nothing wrong with Katie sitting with Peter and helping him fill out the rental agreements. This is a why for Katie to model professional behaviours for Peter and teach him how to do it. As for if she should disclose it really is Peter’s decision. Katie should help Peter to understand the consequences of his actions and help him make an informed decision.

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