For over 27 years as an addiction treatment professional I have applied various treatment approaches in various communities. In helping my clients find success I have learned that treatment approaches should vary not only by community, but also by client experience and milieu. Many clients find success as a member of a community mental health team. Homebound clients are not only mobility challenged they experience uncontrolled and unexpected occurrences that negatively impact long-term success. Their case specific needs require different treatment approaches to support long term recovery. In this article we will explore various reasons for this lack of success and posit some suggestions about the best way to engage homebound clients.
I have been fortunate enough to support client success in many environments, but I find additional compassion for the homebound and concern for their long term success. Most of my homebound clients are unable to make it appointments outside of their home due to conditions such as chronic illness, a lack of social/familial support, diffuse mental health problems, lack of transportation or clinician resistance. A focused team of health and social welfare clinicians can coordinate client specific treatment approaches.
As clinicians we can be easy become set in our ways and become numb to the strife of others. We travel from place to place being creatures of habit. It takes conscious effort and new situations requiring our attention to change. Out of the items I mentioned above the last two items (lack of transportation or clinician resistance) can be overcome by education and community research to assist a homebound client.
The lack of personal or immediate access to transportation need not be a limitation to treatment for homebound clients. Many communities have numerous community transportation programs. In Seattle clients have options such as Access Transportation, Hopelink, Community Transportation, Taxi Script, or even subsidized bus passes. The surrounding cities also have transportation assistance for community members. I would also recommend checking with an area’s Chamber of Commerce. Some of these programs require that a medical practitioner verify that a client is disabled by completing an assessment and signing a form that a client can being to a transportation provider.
Visiting a client at their residence or at a community site can be very helpful, especially when a lack of transportation is a result of conditions beyond his or her control. The idea of having a private and personal visit can instill not only client investment, but also a sense of control. Many homebound clients are mentally ill and have manifestations which make it impossible for them to leave their home. For example, schizophrenic clients can be plagued with command hallucinations that tell them to jump off a bridge or in front of traffic. These clients stay home because the outside world is not safe.
Home visits can be very beneficial to health and social well-being when handled properly. Providing clinical work at the client’s place of residence or a community site can be accomplished by hiring a counselor that specifically completes visits out of the agency, or by setting aside a percentage of a clinician’s time for travel and home visits.
Assuming homebound clients are resistant because they do not want to leave home misses the point and suggests this the counselor does not understand mental illness and sees everything as a manifestation of chemical dependency, without considering any outside source or etiology.
As a clinician working one-on-one with homebound clients it may be difficult to recognize resistance; this is where a well-informed team of health and social care providers can be beneficial. A well informed counselor of homebound client’s can be taught to realize that clients are not resistant because they are unable to make it to group, rather, they have very real, concrete and specific illnesses which prevent them from fully participating in treatment and in life.
Ultimately, working with homebound clients that have limits beyond their control can be very rewarding. It’s an opportunity to reap very personal and professional benefits in an environment you may never have the opportunity to experience again. The efforts made by chronically ill and significantly challenged homebound clients should be recognized for what they are and celebrated as small successes. It is important to remember that recovery looks different for everybody.