Case Management Sarah Himmelheber, LCSW

In todays discussion... Defining case management Defining case management Reviewing models of case management Reviewing models of case management Process of rapport building Process of rapport building Developing case plans Developing case plans Working the case Working the case Successfully partnering with clients Successfully partnering with clients Discharge process Discharge process Confidentiality issues Confidentiality issues Supervision Supervision Self-care strategies Self-care strategies Case examples Case examples

What is Case Management? Type of service to clients Type of service to clients coordinating and therapeutic function for clients receiving services coordinating and therapeutic function for clients receiving services Defining the case Defining the case Goals of the working relationship Goals of the working relationship Objectives and interventions Objectives and interventions Timeline/ boundaries of the relationship Timeline/ boundaries of the relationship

Models of Case Management The Broker The Broker The primary function is to link the client to needed, usually external, resources. This model limits the role of the case manager/ client relationship. The main task is to identify what the client needs and then to facilitate the referral so the client is connected to the service provider. The primary function is to link the client to needed, usually external, resources. This model limits the role of the case manager/ client relationship. The main task is to identify what the client needs and then to facilitate the referral so the client is connected to the service provider. The Rehabilitationist The Rehabilitationist The Rehabilitation model identifies strengths and deficits of the client and attempts to remedy a wide array of problems and barriers that may include medical, mental health, vocational and housing issues. The case managers role is to assist the client in overcoming barriers that prevent independent functioning in the community. When barriers have been addressed, the relationship between the case manager and the client is reduced or terminated. The Rehabilitation model identifies strengths and deficits of the client and attempts to remedy a wide array of problems and barriers that may include medical, mental health, vocational and housing issues. The case managers role is to assist the client in overcoming barriers that prevent independent functioning in the community. When barriers have been addressed, the relationship between the case manager and the client is reduced or terminated.

Models of Case Management The Full Support The Full Support By using an integrated team of providers including case managers, outreach workers, rehabilitation specialists, and medical professionals, this model relies less on outside referrals and provides the client with in-house service delivery. In this model the case manager not only coordinates care but also provides clinical support and life skills training. By using an integrated team of providers including case managers, outreach workers, rehabilitation specialists, and medical professionals, this model relies less on outside referrals and provides the client with in-house service delivery. In this model the case manager not only coordinates care but also provides clinical support and life skills training. Full Support models have been effective in reducing inpatient psychiatric hospitalizations and are generally used with clients who have long-term care needs. The relationship between client and the treatment team is open-ended and ongoing rather than limited to specific goals (Draine, 1997). Determining when to terminate services can be challenging when using this model. Full Support models have been effective in reducing inpatient psychiatric hospitalizations and are generally used with clients who have long-term care needs. The relationship between client and the treatment team is open-ended and ongoing rather than limited to specific goals (Draine, 1997). Determining when to terminate services can be challenging when using this model.

Models of Case Management The Strengths Model The Strengths Model As implied in the name, the Strengths model avoids assessing client needs in terms of pathology or deficits. The focus is exclusively on strengths. Self-determination of the client and assisting with client-specific goals are the task of the case manager. This model places strong emphasis on case manager- client relationships. The efficacy of this model relies on intensive outreach and follow up (Standard, 1999, Rapp, 1998). As implied in the name, the Strengths model avoids assessing client needs in terms of pathology or deficits. The focus is exclusively on strengths. Self-determination of the client and assisting with client-specific goals are the task of the case manager. This model places strong emphasis on case manager- client relationships. The efficacy of this model relies on intensive outreach and follow up (Standard, 1999, Rapp, 1998). Fliesher, P. and Henrickson, M. (2002). Fliesher, P. and Henrickson, M. (2002). Towards a Typology of Case Management. Retrieved from: f%20Case%20Management.pdf

Building the Trust Relationship Living social work values Living social work values Using active listening skills Using active listening skills Task-centered trust development Task-centered trust development

Social Work Values Service Service Social justice Social justice Dignity and worth of the person Dignity and worth of the person Importance of human relationships Importance of human relationships Integrity Integrity Competence Competence

Active Listening Skills Reflecting Reflecting Paraphrasing Paraphrasing Clarifying Clarifying Summarizing Summarizing

Active Listening Exercise Partner up, with each person playing the client once Partner up, with each person playing the client once Refer to active listening scenario handout Refer to active listening scenario handout Comments? Comments? Limitations to active listening Limitations to active listening Serves as a starting point Serves as a starting point

Task-Centered Trust Development Method for building relationships with apprehensive clients Method for building relationships with apprehensive clients Cleaning Cleaning Food inventory/ meal planning/ grocery shopping Food inventory/ meal planning/ grocery shopping Public transportation assistance Public transportation assistance Side-by-side linking Side-by-side linking Community-based or office-based Community-based or office-based

Moving towards... Developing a Case Plan Example cases? Example cases? Realism Realism In goal formulation In goal formulation The role of you/ your agency The role of you/ your agency Resources Resources

Developing the Case Plan Intake process Intake process Review example form Review example form Goal and objective formulation Goal and objective formulation Keeping a time frame Keeping a time frame Schedule towards the goal Schedule towards the goal Interventions: what you can do Interventions: what you can do Dealing with challenges Dealing with challenges

Working the Plan…. Knowing your local resources Knowing your local resources Coalitions Coalitions Staff time to attend meetings Staff time to attend meetings Organizational strategies Organizational strategies Post-meeting notes Post-meeting notes Scheduled office time Scheduled office time Jointly monitoring and reviewing goals Jointly monitoring and reviewing goals Celebrating progress Celebrating progress

Whose Case Is This? Idea of progressive client control Idea of progressive client control May be related to length of case plan May be related to length of case plan Boundaries Boundaries What type are appropriate? What type are appropriate? Strategies for handling challenges Strategies for handling challenges Avoiding us/them Avoiding us/them Modeling Modeling Responsibility Responsibility Acceptance Acceptance Understanding Understanding Expectations for the working relationship Expectations for the working relationship

Dealing with Challenges Strategies for improving the relationship Strategies for improving the relationship Back to assessment Back to assessment Highlighting changes Highlighting changes The importance of documentation The importance of documentation

The Discharge Process May vary by service provider Connected to goals Start from the first session What ought to be included Medicare defines discharge planning this way: A process used to decide what a patient needs for a smooth move from one level of care to another. Review example form

Confidentiality Issues Within agencies Within agencies Employees & volunteers Employees & volunteers Review example volunteer form Review example volunteer form With other agencies With other agencies Review example Release of Information form Review example Release of Information form

Supervision Formal versus informal Formal versus informal What to cover What to cover

Stress and Self-Care Being mindful of stress Being mindful of stress - Signs of stress? Strategies for stress reduction... Strategies for stress reduction... How to ask for a break... How to ask for a break... "We learned that it was not the clients themselves who were causing the major portion of the stress, but the work environment itself," said Tracy Whitaker, director of the Center. "The primary stress social workers face is that they don't have enough time to do their jobs, and related to that, have too heavy a workload. This was true across practice areas.

Wrapping Up… Case Examples? Case Examples? Questions & Ideas? Questions & Ideas?

Thank you! Contact information: Sarah Himmelheber, LCSW