Homeless Sue, a 35-year-old female, has been diagnosed with Schizophrenia Disorder exhibiting delusions and hallucinations. In addition, she has

Homeless Sue, a 35-year-old female, has been diagnosed with Schizophrenia Disorder exhibiting
delusions and hallucinations. In addition, she has problems with social environment, occupational
problems, housing problems, and economic problems.
Sue is an Iraq War veteran. She served as a liaison to human resources and then as a paramedic. Sue
was honorably discharged in 2009. Before she served, she received a degree in medical technology at
a local community college. Her father was a veteran and she grew up on army bases. She attended
five high schools in four years. Her mother was a secretary and a teacher. She has not seen her family
for two years; she lived with them after her return from Iraq, but both parents and Sue could not find
a peaceful way to live together.
Sue can often be seen walking to and from the downtown area and the local grocery store. She
spends most of her days on the streets. A case manager working downtown saw her walking through
the rain and called a friend working for a shelter. She asked if she could refer Sue. The outreach team
located Sue during one of her walks the next week.
The outreach worker learned that Sue cleaned up several local businesses late at night. She slept in
the places she cleaned. She appeared sober but complained of hearing voices. She believed that she
was in danger from wild animals most of the time. She feared for her life; she thought her parents
would find her and kill her. Sue had never been arrested. Sue indicated she didn’t want to live in a
house and she did not want to live with anybody around. People scared her; noises scared her. She
had trouble sleeping.
The outreach worker referred Sue to a local homeless shelter providing comprehensive care.
Reluctantly, Sue agreed to come to an initial interview. She asked if the interviewer (who was also a
case manager) if they could meet on the streets for the interview. The case manager agreed. After the
initial screening, the case manager asked Sue if she would be willing to participate in additional in-
depth interviews. She declined, but when each week the case manager encouraged her, she
reluctantly said “yes.”
Mental health assessments concluded with a diagnosis of schizophrenia. Sue refused medication. She
continues to hear voices, rejects offered housing, but occasionally meets the case manager on the
streets. She was willing to be placed on the agency service roles. The service plan for Sue continues to


1. You are meeting with Sue to talk about a service plan. How might you focus on strengths to

engage Sue in case management?
2. Describe how you would use motivational interviewing to help Sue change her present

3. By focusing on strengths, what would you hope to accomplish in each of the three case

management phases?
4. What additional information would you like to have about Sue that would facilitate a

strengths-based approach?
5. What resources do you think are available for Sue? How would you find out?

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