Panel: StrengthsBased Treatment: From Case Management to Family Therapy

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Panel Strengths-Based Treatment From Case
Management to Family Therapy

• Discussant Jerry Flanzer, PHD
• Services Research Branch, DESPR, NIDA
• 20005 Joint mtg on Adolescent TX Effectiveness
• March 21, 20005 Omni Shoreham Hotel,
  Washington,DC

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Core and Comprehensive Drug Abuse Treatment
Services
Core Treatment
Behavioral Therapy
Core Treatment
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CM does everything
Case Manager
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CM Activities at NIDA

• According to 2/5/2005 CRISP search 318 active
  grants, contracts, training have a component
  devoted to case management

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Case Management Models Practice
What works?

• Vanderplasschen et al. review - 17 case
  management studies for substance use disorders
• Three outcome criteria
• Treatment access, participation, retention
• Use of services
• Drug-related outcomes (drug use and crime)
• Specific case management models have advantages
  for certain goals, clientele
• Implementation is key

Vanderplasschen, Rapp, et al., Psychiatric
Services 55(8), 2004
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Core Functions of Case Management

• Engagement
• Assessment
• Planning
• Linkage
• Monitoring
• Advocacy
• Disengagement

Create positive working relationship with the
client.
Determine clients proximal needs, resources, and
barriers.
Develop feasible, concrete plan to obtain
services or resources goal, action steps,
contact, timeframe.
Connect client with agency/program that provides
needed service or resource.
Track progress in plan track success in
obtaining needed services and resources.
Represent the client and assertively help obtain
services and resources client is entitled to.
End professional relationship with client a
process.
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Improving Case Management
Research findings case management is improved
with

• Fidelity to the model of case management
• Formal agreements and protocols between case
  managers and other service providers re
• Tasks
• Responsibilities
• Authority
• Use of assessment and planning tools
• Exchange and management of client information

Vanderplasschen, Rapp, et al., Psychiatric
Services 55(8), 2004
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Improving Case Management
Research findings case management is improved
by

• Case manager knowledge of program quality and
  service availability effectiveness of referrals
• Housing case management in the treatment facility
  service utilization increases
• Ability of case manager to pay for services
  improves access, utilization, retention

Vanderplasschen, Rapp, et al., Psychiatric
Services 55(8), 2004
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Findings

• CM when implemented in DAT programs has a
  positive impact on treatment retention, substance
  use and health outcomes (Evans et al, 1998
  McLellan et al, 1999)
• CM DAT are strong independent predictors of
  outpt medical care use among HIV injection drug
  users (Knowlton et al, 2001)

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Case Management Models

• Broker/Generalist
• Strengths-based
• Clinical/rehabilitation
• Assertive Community Treatment (ACT)

• Broker Resource access sequenced goal setting
  planning skills development.
• Generalist Limited ? assessment and referral.
  In CJ settings, monitoring progress and
  compliance with judicial / correctional
  requirements.

• Helps clients identify their own strengths,
  assets, abilities.
• Obtains access to resources advocates for
  client encourages and supports clients in
  obtaining resources through their own efforts.

• Combined clinical services and resource
  acquisition activities.
• Requires proficiency in client-focused services
  such as psychotherapy, CBT, family therapy, as
  well as usual case management skills.

• Intensive ? for most severe, least intact
  clients. Frequent, assertive contact focus on
  tmt adherence, practical life problems team
  approach small caseloads long-term commitment.

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Transitional Case Managementt

• Time limited, quick intervention brokering to
  place clients with agencies, matching need to
  service. (loads of mediating variables give
  appearance of success)
• Lidz, Bux, Platt and Iguchi () Transitional Case
  Management A Service Model for AIDS Outreach
  Projects.

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Treatment Adherence, Health Outcomes and Cost
Study

• Clinical - therapeutic mental health and
  substance abuse interventions delivered by health
  and social services providers with advanced
  degrees and licenses/certifications.
•  
• Care Management  supportive services to help
  clients access, receive, and adhere to basic,
  medical, mental health, and alcohol and drug
  abuse treatment/services.
• Case Management - traditional case management
  services (e.g., assistance around shelter, food,
  clothing, finances).
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• Internal Coordination - case-specific
  collaboration among intervention providers.
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• External Coordination - case-specific
  collaboration with providers outside of the
  intervention.
•  
• Outreach/Engagement activities undertaken to
  find clients and promote intervention service
  use.
•  
• Referral - intervention provider-recommended use
  of services inside and outside of the
  intervention.

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Jim Inciardi

• ACT in Prison Settings---broke down over
  confidentiality and volunteer requirements
• Inciardi et al Assertive Community Treatment with
  a Parolee Population An Extension of Case
  Management in NIDAS MONO 127 (1992)
• Inciardi (ed) Drug Treatment and Criminal Justice
  Sage Pub, 1993

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Strengths Perspective

• The Dominant Model and Our Focus Today
• (Social work influence)

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Case Management From A Strengths Perspective

• Generalist CM Practice
• Assessment
• Planning
• Linking
• Coordinating
• Advocacy

• SP Principles
• Focus on strengths
• Client driven
• Primary relationship
• Aggressive outreach
• Use of informal resources

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Intended Impact of SBCM

• Case Management
• Planning approach to securing resources
• Accessing needed resources
• Meet needs beyond staying sober

• Strengths Perspective
• Increases client responsibility
• Learn how to set goals
• Learn how to advocate for self
• Decreases denial

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James HALL IOWA CM for Rural Drug Abuse

• Subsequent to DA residential treatment
• RCT-4 conditions, 3 CM (location of the manager
  and use of telecommunication) and TAU
• Clients assigned to cmgrs located in tx facility
  used more aftercare medical and SAT than TAU
  not true when cmgrs not located in facility, MH
  service use -no effect
• Vaughan-Sarrazin, Hall and Rick (2000) J Drug
  Issues, vol 30,2, 435-464.

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The Featured PresentationsTaking Strength-Based
to the Beyond

• Strengthening Communities
• SB Group treatment using MET/CBT
• Case management using SB procedures
• Strengths-Oriented Family Therapy

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Strengthening Communities

• Brad Richardson
• Demonstrates possibility of taking impact of SBCM
  to concentric system levels
• Begins to illustrate how to measures impact on
  community level
• Looking forward to research that takes this
  approach even further into the world of mapping
  and social network research

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SB Individual and GROUP TX Using MET/CBT

• Michael Mason
• Adaptation of strength-based, client-centered
  approach to MET/CBT
• Measurements on effect of social network and
  client building strengths
• Question of long-term, marinating strengths

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Strengths-Based Case Management For Adolescent
Drug Abuse

• Williams,Noel and Hall
• They report the efficacy of working with SBCM
  with the Adolescent Population (IOWA The
  gurus of SBCM and adolescents)
• Question of long-term effects is there a
  difference between groups?
• Question of difference on mediating variables?

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Strengths-Oriented Family Therapy

• Doug Smith
• SOFT appears to offer significant shift in family
  therapy approach
• Question of need for intact family, severity of
  problem.

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CITAR and Strengths-based Interventions
Enhanced Treatment Project/Case Management
Enhancements Project 1,100 primarily crack
cocaine substance abusers. Test effectiveness of
SBCM in facilitating move from primary
(residential) treatment to aftercare (community)
treatment. Supported by National Institute on
Drug Abuse, DA06944
Substance Abuse Treatment Continuum for Offenders
Project Incarcerated substance abusers in a
medium security prison. SBCM was part of a
re-entry continuum of care that included
cognitive behavioral therapy to help substance
abusers successfully reenter the community and
aftercare treatment. Supported by National
Institute on Justice and Ohio Department of
Rehabilitation and Correction
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CITAR and Strengths-based Interventions
ARTAS Case Management Project Diverse group of
newly diagnosed, HIV positive individuals. A
demonstration project in four major United States
cities that will test a brief model (six
contacts) of strengths-based case management for
encouraging individuals to follow through with
health care. ARTAS 2 expanded to 11
sites. Sponsored by Centers for Disease Control
and Prevention
Other (Inter)National Projects Development of
N.I.D.A. monograph and C.S.A.T. Treatment
Improvement Protocol on case management
Assisting in National Drug Court Institute
development of best practices standards Assisted
the government of East Flanders, Belgium develop
case management and integrated care system
widely published and provided technical
assistance in strengths-based and case
management interventions.
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Resources Case Management

• Treatment Improvement Protocol 27 Comprehensive
  Case Management for Substance Abuse Treatment
  (CSAT, 1998).
• Ballew, J.R., Mink, G. (1996) Case management
  in social work Developing the professional
  skills needed for work with multiproblem clients.
  Springfield, IL Charles C. Thomas.
• Ashery, R.S. (ed.) (1992). Progress and Issues
  in Case Management. NIDA Research Monograph 127.

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NIJ/NIDA Research Report 1997

• Case management Reduces Drug Use and Criminality
  Among Drug-Involved Arrestees An Experimental
  Study of an HIV Prevention Intervention
• Social support and removal of barriers, cm an
  enhanced intervention
• 3 CM sites/ models minimal success.

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NIDA 1992 MONOGRAPH 127

• Participants discussed research and service
  delivery issues
• Barriers to accessing services
• Gaps in services
• Community linkages development
• Model development
• Case manager/client ratio
• Cost-effectiveness and cost-containment
• Instruments and measurements
• Background and education of case managers