Programs are measured on the records of their achievements, and the IRC and Intensive Case Management programs are no different. During the intake process, our clients create a list of goals they have for their time enrolled in our program. These goals vary from learning English, to getting a job, to making connections with other people in their community, to navigating the healthcare system. While this goal-setting process could be seen as “What do I want to be done for me?” it’s really more of a “What skills do I need to (re)learn to survive in this new place and culture?”
How do we measure success and completion of these goals? After intake, our program completes a three month, six month and close-out assessment with the client to measure their progress. A numerical scale is used which ranges from safe to very vulnerable. It is common for a client to start at a one or two and move up one value during their twelve-month enrollment period. Does that seem like progress to you?
Yesterday, I spent almost two hours with a client coaching them on using the phone interpreter through their health insurance to schedule a medical appointment. This client does not speak English so the first step is navigating the automated menu in English because the only other language option is in Spanish. Once the client got connected to an operator they had to repeat “No English, Dari!” while the operator asked them in English to repeat themselves and spell the language. After connecting to an interpreter, the insurance refused to schedule the appointment until I intervened and said that insurance is required to provide language services to their members so that they can readily access healthcare services.
We then tried to schedule an appointment with the provider information that the insurance had on file, which ended up having an incorrect phone number, which we discovered after calling the clinic twice. Eventually, the client was able to schedule an appointment for himself! We smiled, applauded, and let out deep sighs and laughs. We laughed even though we had spent two stressful hours on the phone, even though we didn’t speak the same language, and even though we both knew that this was only the first hurdle for this client to receive the appropriate physical and mental healthcare services. That phone call will not move the client up a number on our assessment form, and we will probably have another coaching system in the next few weeks to solidify the skill, but those two hours on the phone were progress.
Will our clients ever fully reach their goals? I hope so. Will all the goals be achieved fully during the course of our program? Probably not. Progress is slow because change is slow and building up people’s confidence is slow. Additionally, some of these goals will not be achieved because of systemic constraints within the healthcare system such as language and cultural barriers causing health disparities, the education system, lack of access to quality mental health services to address trauma and the current political climate with its prejudice, and the lack of welcome towards refugees.
I would be proud to have a fraction of the resilience I see from our clients, many of whom have experienced great trauma. For example, some share stories of a wife patrolling the house while the husband slept to protect him from Taliban bombings as well as the loss of family members left behind in Afghanistan. One of the goals a client shared for their child was that they hoped that their child would “grow up in a safe, secure and peaceful place with access to healthcare and education so that they could pursue their own goals.” So, I will continue to define progress as making difficult phone calls to insurance and building self-confidence to complete other tasks. These are the first steps to helping our clients make their goals for themselves and their children a reality.
Disclaimer: The views expressed in this blog post are mine alone and are not affiliated with the views of the IRC or ICM program.