“The landlord calls to say that Bill has been suggesting he would like to have a barbeque in the hallway of his large apartment building. The landlord demands to know if Bill has caused fires in the past (The client hasn’t; the barbeque comment is most likely an awkward attempt at conversation). He will be evicted unless there is a response. The paranoid client refuses to give permission for staff to talk with the landlord.
The Question: Do you tell the landlord the client is not a safety concern?”
This clinical vignette is found in a wonderful teaching tool authored by Garside and Maher in their 2006 paper Assertive Community Treatment (ACT): 23 Cases (click to open pdf – JEMH_V1N1_analysis_23ACTCases)
The scenarios will ring true to all ACT clinicians. I particularly admire that the authors don’t just pose the questions but also, for some, clearly state their yes or no or maybe answer.
I suggest not giving out the whole paper but rather taking 3 or 4 of the cases and using it during a team education session – which we should be doing regularly. Copy just the case and the question, divide the team into groups of 3 or 4 and send them off to discuss for a bit. Bring everyone back to the table and get them to share their thoughts. After some more discussion share the authors’ comments and discuss further.
Try it. The process is challenging, at times controversial and fun!