On the career road.

So I received some really bad news in the last few weeks that has put a bit of a wrench in my career aspirations.    The education liason representative  of Ontario Art Therapy Association responded to my yearly query email,  with a different and less than hopeful tone.   She recommended that I not continue to wait for the Art Therapy Certificate program that I had finished all but less 2 art credits to be developed into a Masters program.   She suggested I would be better off returning and getting my Masters in Social Work.  She said after over 10 years of trying to make the Masters program in Art Therapy a reality,  it would likely not happen at UWO.    Since I have a growing family,  I will have to wait to attend Wayne State University in the States,  or Concordia University in Montreal.    The other programs are in Alberta at Stephen’s College and University of British Columbia.   I really don’t want to shelve these aspirations any longer.  I have wanted to become an Art Therapist for the last 20 years and always seem to hit hiccups on this road.   

I have decided since my long term goals involve a Masters degree,  to bite the bullet and finish my Masters of Social Work.   I will always be able to utilize art in the counseling process.     I have also decided due to my current carreer path,  that I would like to concentrate some focus of studies into Thanatology and Palliative Care.    King's College at UWO also has an amazing post degree certificate program in Thanatology.   So again,   in the next few years I will commence this challenge and I believe one has 5 years to complete the Thanatology program.   Thankfully there is a program at work that will allow for me to do this.     My long term goals after all involve working with children diagnosed with CANCER  utilizing art therapy.  

I am currently a Case Manager for CCAC,  and I have been in this role working with adults for the last year.  Prior to that I worked for 1 year and a half as a Case Manager for CCAC in School Health Support Services as a Paediatric Case Manager.    I love aspects of  both roles for different reasons.  There are other parts of this job that really challenge me.  .  I would love to return to working with a Paediatric caseload,  as this is my comfort zone,  but am challenged to seek out new avenues for myself.  

These are all stepping stones to help have my long term goals realized.   More recently my discomfort with power differentials has been surfacing in my role.  I usually either fight tooth and nail,  or run for the hills when this happens.    I see my role very much as a system navigator,  and resource to families and at times an advocate.  I have recently become more aware of how much power families and individuals believe I have.   I am not very comfortable with this.    Among many of the roles played by a Case Manager,  including assessment of health care needs,  implementing a service plan,  we are responsible for distributing health care supports according to the needs.   We are also responsible for determining eligibility for Long Term Care Homes and assisting individuals through the process of getting on waitlists,  and prioritizing needs.   Well,  last week,  one individual identified to me the belief and real fear and anxiety that I was going to “put them in a home”.   I always make an effort to make my role very clear to individuals,  that yes I do have to assess one’s capacity to be able to make their own decision for Long Term Care.  But I see my role as more of advocating and ensuring that “no one gets “put into a home against their wishes,  and if someones wish is to get into a home providing them the information and means to do so.   Most seniors that I have had to tell that aren’t “eligible” for admission to a Nursing Home ( LTC facility)  love this information and are relieved.   These decisions are based upon the individuals health status,  and their ability to manage on their own plain and simple.  Family members often very well meaning think this is in someones best interest,  but in reality most people are better off in their own homes,  with the appropriate health care supports in place.      I would assess whether someone can still make a safe decision to live on their own,  with these supports in place  and have to determine whether they are aware of all the consequences of these decisions.        There are very few people that I have ever determined as incapable of making a decision for or against Long Term Care.   Its when dementia,  or alzheimers  or other issues have affected an individuals judgement to the point where their decisions in the moment would be deemed unsafe.   Where they would not know what to do in the case of a fire,  or other safety emergency,   where they are making decisions to continue to live at home,  and are refusing supports and do not seem to be aware of the consequences of these decisions.      Definitely not a favourite part of my job.    Families wanting their loved one in Long Term Care don’t seem to get why their loved one can’t go on a waiting list without their informed consent.    This is all to protect an individuals rights.   While I am happy to be an advocate for an individuals rights in this instance,  it can be a pretty uncomfortable place to be with well meaning and caring, passionate family members challenging you.    CCAC has received some unsavoury media attention recently,  and  it raised this reflection within me.     These articles talk about how as Case Managers we were required to take cost containment measures,  such as a waitlist strategy for services that were not assessed as a high priority need.   These were difficult but necessary decisions at the time to ensure that those with the most intensive needs received the services as quickly as they needed it.  Yes,  as Case Managers we do find it necessary to decrease services for some,  but these decisions,  at least for me are not based upon “cost containment” pressures”  but on the facts of the individual, their    families strengths and the individuals current  health care and home care support  needs. 

While I don’t believe in flaggerantly giving out service,  I believe in addressing a family  and individual where they are at,  and developing a service plan that works for them and their strengths and needs.   I believe in assisting families access community supports that are already available to also help address their needs.  I believe in empowering families and individuals to maximize their independence.   This to me means,  that I should never give someone more hours of support than I see there is a need for.  This also means that if the family has supports in place that are already doing an amazing job,  their service plan would look very different from someone having similar needs,  but very few natural supports.    Providing people with more supports than is necessary  only develops dependence,  and misunderstandings,  and individuals that could have eventually managed on their own,  not doing so.   I also rely heavily on liason with the service providers such as the Occupational Therapists,  Nurses, Physiotherapists to assist in the assessment process.   What functional limitations does one have,  and what kind of plan can help support an individual regaining their independence?   Most individuals I have worked together with to develop service plans to meet their needs agree that they do not want to have anyone do more than what they cannot physically manage themselves. 

Is this a job I want to be doing for the next 20 years,  likely not.   I see myself moving either back into a Paediatric Case Management role,  or one on a Support Care Resource Team,  supporting individuals and families through their last breathes.       As I noted before…these are all steping stones to my long term goal,  that I fear I won’t get to until I am retired….but as long as I get there …and have an interesting journey in the process I will be fine.   I feel blessed to have a job that provides me the opportunity to help support people in the health care needs.  While not everyone is happy with the decisions I have had to make,  I’m not here to make people happy ,  I am here to ensure those that need the support get it,  and have the information they need to make decisions, and about resources they can access .