The role of case management Page last updated: Case management is one of the major types of community aftercare that is used to provide ongoing management of chronic or recurring illness. Active case management is especially important for people who have been repeatedly hospitalised for mental illness.
Kzenon Definition Case management assigns the administration of care for an outpatient individual with a serious mental illness to Case management functions single person or team ; this includes coordinating all necessary medical and mental health care, along with associated supportive services.
Purpose Case management tries to enhance access to care and improve the continuity and efficiency of services.
Depending on the specific setting and locale, case managers are responsible for a variety of tasks, ranging from linking clients to services to actually providing intensive clinical or rehabilitative services themselves.
Other core functions include outreach to engage clients in services, assessing individual needs, arranging requisite support services such as housing, benefit programs, job trainingmonitoring medication and use of services, and advocating for client rights and entitlements.
Case management is not a time-limited service, but is intended to be ongoing, providing Case management functions whatever they need whenever they need it, for as long as necessary.
Historical background Over the past 50 years, there have been fundamental changes in the system of mental health care in America.
In the s, mental health care for persons with severe and persistent mental illnesses like schizophreniabipolar disordersevere depression, and schizoaffective disorder was provided almost exclusively by large public mental hospitals. Created as part of a reform movement, these state hospitals provided a wide range of basic life supports in addition to mental health treatment, including housing, meals, clothing and laundry services, and varying degrees of social and vocational rehabilitation.
During the latter half of the same decade, the introduction of neuroleptic medication provided symptomatic management of seriously disabling psychoses. This breakthrough, and other subsequent reforms in mental health policy including the introduction of Medicare and Medicaid in and the Supplemental Security Income [SSI] program inprovided incentives for policy makers to discharge patients to the community and transfer state mental health expenditures to the federal government.
These advances—coupled with new procedural safeguards for involuntary patients, court decisions establishing the right to treatment in the least restrictive setting, and changed philosophies of care—led to widespread deinstitutionalization.
In there werepersons in state hospitals; bythat number had dropped toAccording to the most recent data from the U. Center for Mental Health Services, while the number of mental health organizations providing hour services hospital inpatient and residential treatment more than doubled in the United States from tothe number of psychiatric beds provided by these organizations decreased by half.
As a result of deinstitutionalization policies, the number of patients discharged from hospitals has risen, and the average length of stay for newly admitted patients has decreased. An increasing number of patients are never admitted at all, but are diverted to a more complex and decentralized system of community-based care.
Case management was designed to remedy the confusion created by multiple care providers in different settings, and to assure accessibility, continuity of care, and accountability for individuals with long-term disabling mental illnesses.
Models of case management The two models of case management mentioned most often in the mental health literature are assertive community treatment ACT and intensive case management.
A third model, clinical case management, refers to a program where the case manager assigned to a client also functions as their primary therapist. The program's architects, Arnold Marx, M. ACT uses multidisciplinary teams, low client-to-staff ratios, an emphasis on assertive outreach, provision of in-vivo services in the client's own settingan emphasis on assisting the client in managing their illness, assistance with ADL activities of daily living skills, emphasis on relationship building, and emotional support, crisis intervention as necessary and an orientation, whenever possible, towards providing clients with services rather than linking them to other providers.
Compared to other psychosocial interventions the program has a remarkably strong evidence base. Twenty-five randomized controlled clinical trials have demonstrated that these programs reduce hospitalizationhomelessnessand inappropriate hospitalization; increase housing stability; control psychiatric symptoms; and improve quality of life, especially among individuals who are high users of mental health services.
The ACT model has been implemented in 33 states. Intensive case management Intensive case management practices are typically targeted to individuals with the greatest service needs, including individuals with a history of multiple hospitalizations, persons dually diagnosed with substance abuse problems, individuals with mental illness who have been involved with the criminal justice system, and individuals who are both homeless and severely mentally ill.
A recent mail survey of 22 experts found that while intensive case management shares many critical ingredients with ACT programs, its elements are not as clearly articulated. Another distinction between intensive case management and ACT appears to be that the latter relies more heavily on a team versus individual approach.
In addition, intensive case managers are more likely to "broker" treatment and rehabilitation services rather than provide them directly. Finally, intensive case management programs are more likely to focus on client strengths, empowering clients to fully participate in all treatment decisions.
Clinical case management A meta-analytic study comparing ACT and clinical case management found that while the generic approach resulted in increased hospital admissions, it significantly decreased the length of stay.
This suggests that the overall impact of clinical case management is positive. Consistent with prior research, the study concluded that both ACT and high-quality clinical case management should be essential features of any mental health service system.
One of the greatest tragedies of deinstitutionalization has been that most families, without any training or support, often become de facto case managers for their family members.
Case management for children and adolescents Case management is also used to coordinate care for children with serious emotional disturbances—diagnosed mental health problems that substantially disrupt a child's ability to function socially, academically, and emotionally.
Although not a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders DSMthe handbook published by the American Psychiatric Association used by mental health professionals to diagnose mental disorders, the term "serious emotional disturbance" is commonly used by states and the federal government to identify children with the greatest service needs.
While the limited research on case management for children and youth with serious emotional disturbances has been primarily focused on service use rather than clinical outcomes, there is growing evidence that case management is an effective intervention for this population.
Case management models used for children vary considerably. One model, called "wraparound," helps families develop a plan to address the child's individual needs across multiple life domains home and school, for example.
Research on the effectiveness of this model is still in an early stage.
Another model, known as the children and youth intensive case management or expanded broker model had been evaluated in two controlled studies. Conclusion In recent years, many case management programs have expanded their teams to successfully utilize consumers as peer counselors and family members as outreach workers.CASE and COALESCE.
Perhaps the most commonly used function, which is classified as a system function, is CASE. There are two general uses of CASE. 1 Introduction The Practice Guide. This practice guide is a companion document to the Case Management Practice Policy and is designed to support and guide case managers working in Community Access.
Social Work Best Practice Healthcare Case Management Standards Introduction Currently, the term Case Management has varied meanings within the context of its use by. Most case management programs in mental health, however, typically involve a single case manager working with a consumer.
The role of the case manager is to undertake assessment, monitoring, planning, advocacy and linking of the consumer with rehabilitation and support services (Intagliata, ). table of contents executive summary ix the role of case management in the drug court process: an overview 1 case management: history and models 5 the key functions of case management: adaptation to the drug court setting 9 the engagement process 25 other unique demands of drug court case management 27 the art of case management: principles, knowledge, and skills.
EXTERNAL VERSION 1 - 4/18/08 Enclosure A Technical Assistance Tool Optional State Plan Case Management [CMSIFC] BASIC PROVISIONS OF SECTION OF THE DRA.