North Carolina TASC Clinical Series Training Module Eleven: Care Management Planning

Quality Standards Care Management Planning is a logical process Care Management Planning starts with an initial set of long and short term goals, with the short-term goals developed to meet the long-term goals Short-term goals should be realistic and attainable Goals should be documented according to SOP standards, including at a minimum: – date goal is set – estimated goal completion date – actual goal – person goal assigned to Care Management Planning is a logical process Care Management Planning starts with an initial set of long and short term goals, with the short-term goals developed to meet the long-term goals Short-term goals should be realistic and attainable Goals should be documented according to SOP standards, including at a minimum: – date goal is set – estimated goal completion date – actual goal – person goal assigned to

Care Management Planning Functions Client-centered goals based on client needs Client-centered goals that focus on where the client is in the stage of change Strength-based or asset-focused Map/guideline for client and care manager Specific objectives with timelines for completion & review Realistic and meaningful Attainable goals Anticipatory, proactive plans On-going process Client-centered goals based on client needs Client-centered goals that focus on where the client is in the stage of change Strength-based or asset-focused Map/guideline for client and care manager Specific objectives with timelines for completion & review Realistic and meaningful Attainable goals Anticipatory, proactive plans On-going process

Encouraging Client Involvement Pay attention to the relationship building process Involve the client from the beginning Pace the development of the Care Management Plan Plan in parts Emphasize client strengths rather than problems/weaknesses Set goals that reflect the client Make the plan client-centered Anticipate the possibility of failure or relapse Pay attention to the relationship building process Involve the client from the beginning Pace the development of the Care Management Plan Plan in parts Emphasize client strengths rather than problems/weaknesses Set goals that reflect the client Make the plan client-centered Anticipate the possibility of failure or relapse

Obstacles to Client Involvement Spouse or Significant Other Children Family Members Work Schedule Health Education Spirituality/Religion Spouse or Significant Other Children Family Members Work Schedule Health Education Spirituality/Religion

Care Management Planning Standards Goals must be meaningful and compatible with the client’s values The Care Management Plan relies upon a strength- based approach The process requires sincere input from the client and written in the client’s own words whenever possible Goals and activities must be measurable and achievable A good plan will also have contingency plans for obstacles and setback Goals must be meaningful and compatible with the client’s values The Care Management Plan relies upon a strength- based approach The process requires sincere input from the client and written in the client’s own words whenever possible Goals and activities must be measurable and achievable A good plan will also have contingency plans for obstacles and setback

Care Management Planning Prerequisites Knowledge Relapse signs and symptoms Interventions Goals of Program Community Resources Recovery Process Standards for Documentation Counseling Theories Stages of Change Knowledge Relapse signs and symptoms Interventions Goals of Program Community Resources Recovery Process Standards for Documentation Counseling Theories Stages of Change Skills Write measurable objectives Use short-term goals to meet long-term goals Engage client in process Develop consulting role with client Teach, coach Move client from one stage of change to the next

Precontemplation: Staff Role at this Stage Establish rapport, ask permission to address the topic of change, and build trust Elicit, listen to, and acknowledge the aspects of substance use the client enjoys Evoke doubts or concerns in the client about substance use Explore the meaning of the events that brought the client to treatment or the results of previous treatment Obtain the client’s perceptions of the problem Offer factual information about the risks of substance use Provide personalized feedback about assessment findings Examine discrepancies between the client’s and other’s perceptions of the problem behavior Express concern and keep the door open Establish rapport, ask permission to address the topic of change, and build trust Elicit, listen to, and acknowledge the aspects of substance use the client enjoys Evoke doubts or concerns in the client about substance use Explore the meaning of the events that brought the client to treatment or the results of previous treatment Obtain the client’s perceptions of the problem Offer factual information about the risks of substance use Provide personalized feedback about assessment findings Examine discrepancies between the client’s and other’s perceptions of the problem behavior Express concern and keep the door open

Contemplation: Staff Role at this Stage Demonstrating genuine interest in the client’s dilemma Non-judgmental discussion Reassurance over doubts and ambivalence Revisiting material from assessment and earlier experiences Reframe a client’s negative statement about a perceived coercion by re-expressing the statement with a positive spin Summarize the client’s concerns Explore specific pros & cons of substance use behavior Normalize the client’s ambivalence Examine the client’s understanding of change and expectations of treatment Re-explore the client’s values in relation to change Demonstrating genuine interest in the client’s dilemma Non-judgmental discussion Reassurance over doubts and ambivalence Revisiting material from assessment and earlier experiences Reframe a client’s negative statement about a perceived coercion by re-expressing the statement with a positive spin Summarize the client’s concerns Explore specific pros & cons of substance use behavior Normalize the client’s ambivalence Examine the client’s understanding of change and expectations of treatment Re-explore the client’s values in relation to change

Preparation: Staff Role at this Stage Discuss options and help clarify goals Offer advice if requested and aid in the overcoming of barriers Help identify and enlist social supports Care Management Planning Encourage success via incremental steps Acknowledge and validate difficulties Recognize that non-compliance may be continuing ambivalence Always review expectations for client, TASC, treatment and CJS Discuss options and help clarify goals Offer advice if requested and aid in the overcoming of barriers Help identify and enlist social supports Care Management Planning Encourage success via incremental steps Acknowledge and validate difficulties Recognize that non-compliance may be continuing ambivalence Always review expectations for client, TASC, treatment and CJS

Action: Staff Role at this Stage Develop a nurturing rapport with clients Induct clients into their role in the Care Management Planning process Support a realistic view of change through small steps Explore what client expects from TASC and treatment and determine discrepancies Acknowledge difficulties for clients in early stages of change Investigate and resolve barriers to treatment and a sober existence Increase congruence between intrinsic and extrinsic motivation Examine noncompliant behavior in the context of ambivalence Develop a nurturing rapport with clients Induct clients into their role in the Care Management Planning process Support a realistic view of change through small steps Explore what client expects from TASC and treatment and determine discrepancies Acknowledge difficulties for clients in early stages of change Investigate and resolve barriers to treatment and a sober existence Increase congruence between intrinsic and extrinsic motivation Examine noncompliant behavior in the context of ambivalence

Maintenance: Staff Role at this Stage Help the client identify high-risk situations and develop coping strategies Assist client in finding new reinforcers of positive change Help the client identify and sample substance-free sources of pleasure - i.e. new reinforcers Support lifestyle changes Affirm the client’s resolve and self-efficacy Help the client practice and use new coping strategies to avoid a return to substance use Maintain supportive contact Help the client identify high-risk situations and develop coping strategies Assist client in finding new reinforcers of positive change Help the client identify and sample substance-free sources of pleasure - i.e. new reinforcers Support lifestyle changes Affirm the client’s resolve and self-efficacy Help the client practice and use new coping strategies to avoid a return to substance use Maintain supportive contact