Case management/Service Coordination

Case Management
Activities which bring services , agencies, resources, or people together within a planned framework of action toward the achievement of established goals. it may involve liaison activities and collateral contacts.
Services and Resources
The goal of case management as a social service discipline
is to help those in need obtain the services and resources that can facilitate and support their recovery.
Case managers can help ensure that all therapeutic and supportive activities are
1. structured and sequenced to facilitate seamless transitions to progressive levels of care
2. avoid gaps in service
3. and be responsive to events that increase the potential for relapse or dropping out.
engagement, assessment, planning, linkage, monitoring, advocacy, and disengagement
The seven social service core functions comprising case management——remain intact regardless of the specific practice model employedor the goals of the case management intervention.
broker/generalist
In _____________models the case manager identifies the clients’ needs and then helps them access either clinical services or community resources to address these needs.
strengths-based perspective
The model emphasizes: (a) encouraging and then supporting clients to assert direct control over their search for resources, such as housing and employment; and (b) having clients identify their own strengths and assets as the vehicle for resource acquisition.
Clinical/rehabilitation
___________approaches to case management combine clinical and resource acquisition activities.The clinical rehabilitation approach has been most widely used for the treatment of persons diagnosed with both substance abuse and severe psychiatric problems.
Assertive Community Treatment
This is the most intensive case management model and is most appropriate for use with the least intact client such as those suffering from severe substance abuse problems and severe mental illness requiring daily doses of medication. The mentally ill, substance-abusing, homeless, HIV-infected individual who is taking multiple medications might exemplify persons in need of this practice model.
assertive community treatment model:
Very intensive case management practice model typically used for multiply challenged persons.
broker/generalist model:
Practice of case management service delivery which strives to help the client obtain services and resources.
case management:
A set of social service functions typically including assessment, planning,
linkage, monitoring, and disengagement having the goal of helping human services clients obtain the resources they need.
clinical/rehabilitation model:
Practice model of case management services in which the case
manager provides both clinical and case management services.
settlement houses and neighborhood centers:
Late nineteenth Century/early twentieth century social work institutions established to assist those arriving in the United States.
strengths-based model:
More intensive service delivery model which helps clients identify their own strengths and mobilize them to acquire the services of resources they need.
Linkage
is “hooking up” the client with an agency/program that can provide the needed service or resource.
linkage
may entail the case manager simply identifying the agency, perhaps initiating contact, or perhaps even accompanying the client to the agency and advocating for the client to obtain the needed service or resource
Monitoring
involves the case manager keeping track of the client’s progress through the case management plan. It may focus on the treatment continuum, ensuring that a seamless transition is made from service level to service level. It also entails evaluating the client’s success in obtaining the services and resources outlined in the plan that can sustain the recovery process.
Advocacy:
the case manager morally represents the client and assertively helps him or her obtain the services or resources they are entitled to.
Assessment
provides the professional with a clear understanding of a client’s needs, existing resources, and perceived barriers to meeting these needs.
Examples of coordination
include giving or receiving information regarding specific clients,
keeping another agency informed about the client’s treatment process, obtaining or receiving information from another agency, and communicating with other agencies in planning aftercare
the five main functions of case management:
• Assessment. Identify clients’ strengths, weaknesses, and needs.
• Planning. Negotiate what the client wants and develop a plan for achieving it.
• Linking. Help clients obtain required services by referring or transferring clients to services in the formal and informal care-giving systems.
• Advocacy. Intercede on behalf of the client to obtain needed resources.
• Monitoring. Evaluate progress continuously and take action if needed.
community-based, culturally sensitive, pragmatic, and client-driven
Case management consolidates client care to a single point of responsibility, and is always ________________________________
Phases
case finding and pretreatment, primary
treatment, aftercare, and disengagement
Disengagement.
Ideally, can take place over time. The case
manager and client can discuss what the client learned from interacting with different service providers and be encouraged to continue accessing the resources the client needs in life.
Aftercare
sometimes called continuing care, follows discharge. At this
phase, case managers help clients transition out of treatment and take
responsibility for their lives. The client may need housing, a source of income, or a social support system.
Counselors need to be personally familiar with the resources in the local community. This includes _____
knowing something about the resources’ treatment
philosophies, personnel, and logistics, such as costs and hours of operation.
women
Culturally sensitive case management is particularly important when working with ________ for several reasons.
Examples of entries related to case management activities are:
properly completed release forms to share information with other treatment providers and notes of counselors’ efforts to advocate for clients, such as “met with school guidance counselor to ensure support for client’s treatment” Entries should indicate what the counselor coordinated, with whom, when, and why.
Information about effectiveness can be gathered through
Interviews with clients, collateral interviews, and interviews with professionals who worked with the client.
Examples of information that can be collected include
Frequency of client relapses based on self reports and collateral reports, urine screen results, and case manager observations of the client’s behavior.
Evaluating Case Management Effectiveness
Some programs report quarterly the percent of clients who relapsed, were arrested, who linked with the recommended support systems, or who made progress toward their educational or vocational goals.