Case Management

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Case Management

• Sarah Himmelheber, LCSW

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In todays discussion...

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

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What is Case Management?

• Type of service to clients
• coordinating and therapeutic function for clients
  receiving services
• Defining the case
• Goals of the working relationship
• Objectives and interventions
• Timeline/ boundaries of the relationship

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Models of Case Management

• 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 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.

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Models of Case Management

• 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.
• 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.

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Models of Case Management

• 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).
• Fliesher, P. and Henrickson, M. (2002). Towards a
  Typology of Case Management.
• Retrieved from http//www.hawaii.edu/hivandaids/T
  owards20a20Typology20of20Case20Management.pdf
  

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Building the Trust Relationship

• Living social work values
• Using active listening skills
• Task-centered trust development

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Social Work Values

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

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Active Listening Skills

• Reflecting
• Paraphrasing
• Clarifying
• Summarizing

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Active Listening Exercise

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

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Task-Centered Trust Development

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

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Moving towards...Developing a Case Plan

• Example cases?
• Realism
• In goal formulation
• The role of you/ your agency
• Resources

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Developing the Case Plan

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

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Working the Plan.

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

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Whose Case Is This?

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

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Dealing with Challenges

• Strategies for improving the relationship
• Back to assessment
• Highlighting changes
• The importance of documentation

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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

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Confidentiality Issues

• Within agencies
• Employees volunteers
• Review example volunteer form
• With other agencies
• Review example Release of Information form

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Supervision

• Formal versus informal
• What to cover

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Stress and Self-Care

• Being mindful of stress
• - Signs of stress?
• Strategies for stress reduction ...
• 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.
• http//www.naswdc.org/pubs/news/2008/11/self-care.
  asp

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Wrapping Up

• Case Examples?
• Questions Ideas?

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Thank you!

• Contact information
• Sarah Himmelheber, LCSW
• sarah.himmelheber_at_gmail.com