Mapping a preliminary case management taxonomy to ICHI Sue Lukersmith, Ana Fernandez, Michael Millington, Brain injury case management nominal group, Nicola Fortune, Luis Salvador-Carulla I am presenting this poster on behalf of my colleagues at the University of Sydney. The poster presents work led by Sue Lukersmith on the development of a preliminary taxonomy of case management for people with brain injury. As part of the development process the preliminary taxonomy was mapped to the 2013 Alpha2 version of ICHI. This led to proposals of changes to ICHI Actions, and also helped to refine the case management taxonomy. Faculty of Health Sciences

Community-based case management Makes a unique contribution towards functioning and participation Involves a number of health interventions Multiple components and variations Need for clarity and a common language Development of a preliminary taxonomy Community-based case management is person-centred, and makes a unique contribution towards the improved functioning and participation of a person with a complex health condition such as brain injury, spinal cord injury, mental health conditions, or dementia. Community-based case management needs to be distinguished from case management delivered from the perspective of the services, rather than the person with their individual goals and needs— For example, we are not talking about the kind of ‘case management’ that often happens in a hospital setting where the purpose is to coordinate services for a patient along a clinical pathway or prior to discharge; or about brokerage of community services where there is little or no contact between the case manager and the person. Community-based case management involves a variety of interventions for assessing, planning, coordinating and reviewing the options and services required to meet the person’s health-related needs. It has multiple components and variations depending on the context in which it is delivered, and the population to which it is addressed. The need for greater clarity and a common language about what is and what is not community-based case management is evident from reviewing the case management literature, and was the impetus for developing a preliminary taxonomy on case management for people with brain injury and spinal cord injury.

Systematic review of literature Development of case management taxonomy for brain injury (BICM-PT): methods Phase 1 Systematic review of literature Extract information on components, activities and descriptors of CM Phase 2 Critical review of appropriate frameworks - ICHI (International classification of health Interventions) - DESDE-LTC (Evaluation & classification of services for long term care in Europe) BICM-PT Beta 1 12 actions >50 components Phase 3 Nominal group: discussion – consensus – refinement 13 actions 37 components Phase 4 Mapping to ICHI BICM-PT Beta 2 9 actions 25 components This slide outlines the method used to develop the preliminary taxonomy. The literature review identified the component activities of case management and how they are described. A review of potentially relevant frameworks identified ICHI and the DESDE-LTC, a mental health services classification. DESDE-LTC was used to map the nature of services (episodic vs non-episodic, etc) ICHI was used to map case-management Actions Sue Lukersmith developed the Beta1 version of the taxonomy, which was then refined through a consensus process by a ‘Nominal group’ of 15 experts, which included case managers from various sectors with experience working with children and adults in different service contexts. The 4th phase of the development process involved mapping case management components to ICHI Actions; this led to further refinement of the taxonomy with input again from the nominal group.

BICM-PT Beta 2 Table 1 Main actions in the BICM-PT taxonomy tree* 1. Engage with the client 2. Holistic assessment 3. Planning 4. Education 5. Training & skills development 6. Emotional & motivational support 7. Advising 8. Coordination 9. Monitoring *A further 25 components sit under these main actions in complete taxonomy tree Alignment between ICHI Actions and BICM-PT Education, Monitoring and Preparation as separate actions Revised definition of Training (includes ‘developing skills’) Addition of new ICHI Action Advising Revised titles: Personal support to Emotional support Care giving to Task performed by another Personal assistance to Practical support Development to date has resulted in a Beta-2 version of the taxonomy. Components of case management are organized into a tree structure with 3 hierarchical levels. The 9 Main Actions are listed here; 25 components sit under these Main Actions. There is good alignment between the taxonomy and ICHI for the Actions listed here (bottom section of slide): Education, Monitoring and Preparation are separate Actions in ICHI and components of the taxonomy Refinement of the ICHI Actions axis over the past 12 months has included modifications of existing Actions and their definitions, and some new Actions have been added—in the current 2014 updated version of Alpha2, Training, Advising, Emotional Support, Task performed by another, and Practical support map to components in the case management taxonomy.

Proposed inclusions to ICHI Table 2 Proposed inclusions to ICHI Proposed new actions Coordination ‘Navigating and facilitating the access, management and cohesion of services and supports for the client’ Planning   ‘Support the client to develop their individualised plan including setting client goals and priorities, actions, responsibilities to achieve the goals and identify the supports needed (services and resources)’. Includes: Managing risks - (taken by the client) weighing up the potential benefits and likelihood of something happening, the impact or harms, respecting and supporting client choice and recognising acceptable risk is part of everyday life, for the development of strategies to manage unacceptable risks Inclusion to actions Emotional & motivational support Inclusion: engaging and building a partnership between the client and service provider Inclusions to titles Training Training and skill development Emotional support Emotional and motivational support This final slide presents proposals that were submitted to the ICHI Functioning Technical Working Group in June 2014. They have not been adopted in the current version of ICHI. However, they may receive further consideration in the next phase of ICHI development and in the course of pilot testing. To conclude: Many of the actions and components of case management do map to the revised ICHI Alpha 2, though some gaps remain, notably the BICM-PT actions ‘Coordination’ and ‘Planning’. The mapping exercise, and the dialogue between the BICM-PT and ICHI teams, has been valuable in contributing to the development of both the Case management preliminary taxonomy and ICHI.