Case Study – Relationship Building – Mrs A’s story

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Mrs A – A case study from Stoke-on-Trent City Council
Ms A is 61 years of age and was referred to social care by the police following an allegation that she was being financially abused.  She had no family or friends to offer her support.  She had been known to services (mental health, district nurses and social care) for about 15 years.  Her presenting needs were:
 
• Concerns she was self-neglecting
• Reluctance to engage with professionals or services thus placing her health at serious risk
• She had legs ulcers which were badly infected but she declined to let health professionals treat them
• She was diagnosed as having a ‘personality disorder’, OCD and displayed previous suicidal intent.   She was viewed as having an overreliance on morphine based medication
• She was in significant debt and unable to maintain her property which was in an extremely poor state as a result.
• She was also vulnerable due to being targeted by local youths.
• She was labelled as ‘non-compliant’ ‘difficult’ and ‘antisocial’, with organisations arguing ‘she’s not our responsibility’ and ‘she refuses our help anyway’ so quickly closing her case. 
 
What we did
 
The social worker visited Ms A on numerous occasions. This was not always easy; Ms A would often refuse to answer the door immediately leaving the social worker on the door step for up to 40 minutes. But, the social worker spent time building a relationship with Ms A, getting to know her as an individual and things that mattered to her.  Sometimes this involved taking her to the shop or helping her in some other practical way. She came to recognise Ms A’s strengths; ‘caring, resilient, articulate and funny’.  With Ms A’s consent her social worker was able to share this understanding with the MDT, allowing the development of strategies that could support her in a way she would accept. One of these strategies involved the social worker, as the person who Ms A trusted, supporting District and Tissue viability nurses when they visited her to treat her leg ulcers. This meant that the social worker had to commit a significant amount of her time for a period but the result was that a relationship started to build with the nursing team and Ms A’s legs started to improve.
 
The difference we made – Impact and Outcomes
 
The social worker continued to work with Ms A for a number of months, supporting her to identify the outcomes she wished to achieve, assisting her to take small steps that would help her achieve these, pulling in other services and professionals as required. Ms A remains in control of her life, making her own choices but she now has the information to make more informed choices, is safer as she takes steps towards fully achieving her outcomes and has support as she requires it. 
 
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