Case Planning and Case Management

1
Case Planning and Case Management
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tingsgt

• IACCAC 2012

2
Training Format and Goals

• Format -
• Distribution of Materials
• Presentation, Discussion and Practice of Concepts
• Questions
• Goals -
• To provide participants with information and
  tools to assist them implement (or continue to
  implement) effective case planning and case
  management strategies.
• To provide participants with resources to further
  develop the case planning and case management
  process in their workplace.

3
The Eight Principles of Evidence-Based Practice

• Assess Actuarial Risk/Need.
• Enhance Intrinsic Motivation.
• Target Interventions.
• Skill Train With Directed Practice.
• Increase Positive Reinforcement.
• Engage Ongoing Support in Natural Communities.
• Measure Relevant Processes/Practices.
• Provide Measurement Feedback.

4
The Principles Tell Us

• Assessment is necessary to conduct effective case
  planning and case management.
• The assessment tells us not only who to target
  for services (risk principle), but also what to
  target (need principle).
• Assessment drives case planning.

5
Why Use Case Planning and Case Management?

• Provides a bridge between client assessment and
  client risk reduction.
• Provides structure (staff and clients).
• Documents interventions and progress.
• Clarifies expectations of clients.
• Gauges client motivation/readiness to change.
• Engages clients in the process of change.
• Guides decision-making.
• Ensures the focus of participation remains on
  reduction of criminogenic need.
• EPICS Rhode Island Department of Correction 2010

6
Staff Characteristics

• Case Manager Relationship Skills
• Open, warm and engages in respectful
  communication with clients (and others in the
  workplace).
• Non-blaming and genuine.
• Flexible, using appropriate humor.
• Enthusiastic and expresses optimism.
• Avoids argumentation and supports self-efficacy.

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Case Plans

• At Minimum, Case Plans Should
• Identify client risk level and criminogenic need
  based on empirically-based, validated risk and
  need assessments.
• Outline client responsibilities.
• Lay out appropriate interventions to address the
  highest areas of criminogenic need.
• Clearly/concisely articulating client goals
  related to his/her criminogenic need.
• Each goal should include strategies for
  achievement that are specific, time-bound and
  measurable.
• Include assessments of clients readiness for
  change.
• Be updated to reflect client progress.
• TPC Case management Handbook An Integrated Case
  Management Approach 2010

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Stages of Change

• Understanding the Stages of Change is an
  important element in case planning and case
  management.
• Pre-Contemplation Client believes nothing needs
  to change.
• Contemplation Client begins to consider change.
• Preparation Client figuring out how to change.
• Action Client is working on reaching goals.
• Maintenance Client now working on keeping up
  changes.
• Relapse Client Feeling Ive fallen back . . .
  All is lost.
• Adapted from Motivating Offenders to Change A
  Guide for Probation and Parole, by S.T. Walters,
  M.D. Clark, B.A.Gingerich, and M.A. Meltzer
  (Washington, DC U.S. Department of Justice,
  National Institute of Corrections, 2007), p. 15.

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Assess Readiness for Change

• Offender Self-Assessment Survey (O-Self)
• Maryland Division of Probation and Parole O-Self
  Tool.
• Change Questionnaire
• By William R. Miller, Theresa B, Moyers, and
  Paul Amrhein (2005) Department of Psychology,
  University of New Mexico.

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Addressing the Stages of Change

• Pre-Contemplation Raise doubt. Increase
  clients perception of risks related to behavior.
• Contemplation Evoke reasons for change. Promote
  clients self-efficacy related to making the
  change.
• Preparation Assist client develop a plan.
• Action Implement plan.
• Maintenance Assist client develop strategies to
  avoid relapse.
• Relapse Assist the client recycle through the
  preceding stages, without becoming stuck or
  demoralized by the relapse.
• Prochaska and DiClemente (1986).

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Effective Communication Techniques

• An integral part of case planning and case
  management is reliance on effective communication
  techniques.
• Motivational Interviewing, for example,
  facilitates the work of case planning and
  management -
• Expresses Empathy.
• Amplifies Ambivilance.
• Reminds staff that resistance is expected and
  encourages us to roll with it.
• Supports Self-Efficacy.

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Supervision by risk

• Risk Management (low risk)
• - Involves providing the least restrictive, most
  appropriate sanctions and supervision
• Risk Reduction (moderate-high risk)
• - Involves determining criminogenic needs and
  reducing risk factors through effective
  intervention and appropriate supervision
• Risk Control (extreme high risk)
• - Involves techniques that control risk of
  reoffending while under correctional authority
• The Carey Group

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Applying the assessment

• Low risk GET OUT OF THE WAY
• - intensive treatment for lower-risk offenders
  an actually increase recidivism
• Moderate-high risk ZERO IN
• - Target these offenders
• Extreme high risk LIVE IN THEIR BACK POCKET
  provide the most intensive treatment to
  higher-risk offenders
• Carey group

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Case Planning by Risk and Need.

• The Risk Principle
• More service should be delivered to higher risk
  clients.
• The Practice
• See client more frequently.
• Use more focused interventions.
• Use community and family resources.
• EPICS

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Case Planning by Risk and Need

• The Need Principle
• Focus interventions on criminogenic needs.
• The Practice
• Translate risk and need assessment into need
  priorities.
• Facilitate change in thoughts, attitudes, values
  and beliefs.
• EPICS

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Case Planning by Risk and Need

• The Responsivity Principle
• Enhance behavioral change efforts by delivering
  services that are responsive to the client.
• The Practices
• Structure the case management sessions.
• Establish rapport with the client.
• Teach clients concepts and skills in a clear and
  concise manner.
• EPICS

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Gender Responsivity

• Programs should be gender-specific whenever
  possible
• Distractions
• Trauma/History issues
• Group dynamic
• Men and women have different ways of learning and
  relating to others

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Provide Most Intensive Interventions to Higher
Risk Offenders

• Higher risk offenders will require much higher
  dosage of treatment
• Rule of thumb 100 hours for moderate risk
• 200 hours for higher risk
• 100 hours for high risk will have little if any
  effect
• Does not include work/school and other activities
  that are not directly addressing criminogenic
  risk factors (Latessa, 2010)

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Case Plans for high risk offenders

• Use the risk assessment to develop the case plan
• When developing, ask the offender what areas they
  need to work on but include risk factors if they
  offender does not recognize
• Identify immediate targets and prioritize

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Referrals

• The assessment should determine program/community
  referrals
• Make sure the offender meets program criteria for
  referral
• Ensure the offender is appropriate for the
  program
• Assess the defendants motivation to change

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Referrals cont

• If referred to substance abuse/mental health
  agency, COMMUNICATE with the referring agency
• - referral form and release of information
• - Give the agency as much information as
  possible (PSI, drug screens, prior use history,
  current family/social situation)
• - the treatment agency should make
  recommendation for type of treatment

22
Case Management Targets

• Target First
• Attitudes, values/beliefs
• Peer Associations
• Personality factors (impulsivity, low
  self-control, etc.)

23
Case Management Targets

• Then These
• Education/Employment
• Family
• Substance Abuse
• Leisure/Recreation
• Substance Abuse can be identified as an acute
  issue and dealt with at the same
• time we address the first three areas.

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The Four Principles of Cognitive Intervention

• Thinking affects behavior.
• Antisocial, distorted, unproductive irrational
  thinking can lead to antisocial and unproductive
  behavior.
• Thinking can be influenced.
• We can change how we feel and behave by changing
  what we think.

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Cognitive-Behavioral Approach

• Cognitive-behavioral models involve the following
  -
• Scientific approach.
• Active.
• Focus on the present.
• Based on theories of learning.
• Individualized.
• Progression oriented.
• Can be accomplished in brief periods of time.
• Information Taken from EPICS.

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Session Structure

• Check-In
• Goals Develop relationship
• (How are you and what is going on?)
• Enhance working relationship.
• Assess for crisis.
• Assess for compliance.

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Session Structure

• Review
• Goals - Build trust and respect
• Enhance collaboration through mutually
  agreed upon goals.
• Enhance learning through repetition and
  feedback.
• Community agency
• follow-up.

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Session Structure

• Intervention
• Goals - Focus on pro-criminal thinking.
• Demonstrate cog-behavioral link.
• Use strategic CB Techniques.
• Teach new prosocial attitudes and
  skills.

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Session Structure

• Homework
• Goals - Practice, generalize, connect
• Rehearse new learning.
• Generalize new learning.
• Connect to community resources.
• EPICS

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Effective Strategies

• Effective Use of Authority
• Effective Use of Reinforcement
• Effective Use of Disapproval
• Effective Use of Problem-Solving
• Tapes and Counters
• Thinking Reports
• EPICS

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Effective Use of Authority

1. Focus the message on behavior and not the client.
2. Be direct and specific concerning requirements.
3. Use your normal voice, avoiding yelling.
4. Specify choice and the potential consequences
   (rather than using doomsday ultimatums).
5. Give encouraging messages.
6. Support words with action. Be sure to follow
   through.
7. Provide respectful guidance towards compliance.
8. Look for the positive.
9. Reward/praise compliance.

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Effective use of Authority

• Group Activity

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Increase Positive Reinforcement

• Reinforcement always involves frequency of
  behavior.
• The reinforcing consequence is known as a
  reinforcer.
• Research shows that behavioral change occurs at a
  ratio of four reinforcers to one punisher.

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Reinforcements/Incentives

• Reinforcers should be Specific and valued by the
  client.
• Client behavior must be Monitored, recognized,
  reinforced/rewarded, punished/sanctioned and
  corrected.
• Must be used with staffs use of prosocial
  modeling
• (Fulton, B.A., S.B. Stone, P. Gendreau, 1994.)

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Effective Use of Reinforcement

1. Immediately inform the client that you like what
   he/she did or said.
2. Tell the client why you like what he/she did or
   said. Be very specific.
3. The emphasis given should be different from the
   support he/she normally receives.
4. Explore with the client the short and long-term
   consequences of continuing to engage in that
   behavior.
5. Use a variety of social reinforcers.
6. Pair your verbal reinforcement with other
   reinforcers.

36
Contingency Contracts

• Contingency Contracts are also known as
  behavioral contracts. This tool can be used as a
  means to reinforce a desired behavior.
• Elements of a Contingency Contract include
• Clarification of roles for both the client and
  staff.
• Detailed description of expected behavior.
• Detailed description of the expected
  reinforcement/reward.
• Specific criteria to determine if the desired
  behavior occurred.
• Defined process for revising the contract
• (Patricia VanVoorhis, Michael Braswell, and David
  Lester)

37
Effective Disapproval

1. Immediately tell the client that you did not like
   the type of behavior or speech just exhibited by
   him/her.
2. Explain to the client why you did not like what
   he/she said or did. Be specific.
3. Explore with the client the short and long-term
   consequences of continuing to engage in that
   behavior.
4. Discuss and identify prosocial alternatives that
   could be used in place of the unacceptable
   behavior.

38
Effective Disapproval

• Group Activity

39
Effective Use of Problem-Solving

• Stop, think, and identify the problem.
• Assist the client in recognizing cues that might
  alert him/her there is a problem.
• Clarify goals.
• Assist client identify positive outcomes.
• Generate alternative solutions.
• Brainstorm possible solutions with client. Make a
  list of actions.
• Evaluate.
• Review the list of solutions and discuss the
  possible short and long-term consequences of each
  alternative.
• Implement the plan.
• Have the client develop a concrete action plan.
• Role-play the plan.
• Have client practice the plan between sessions.
• Evaluate the plan.
• Determine if the plan is working.

40
Problem-Solving

• Group Activity

41
Tapes and Counters

• These are thoughts, attitudes, values and beliefs
  that perpetuate criminal behavior.
• Generally, we see two categories of tapes
  Neutralizations and Macho Man Violence.

42
Tapes and Counters

• Neutralizations (Sykes and Matza, 1957) include
  various types of denial (i.e. responsibility,
  injury, victim), system bashing and appealing to
  higher loyalties.
• Macho Man Violence representing more aggressive
  ways to approach people and situations (i.e.,
  Fighting is just part of life).

43
Changing Tapes

• To promote risk reduction, we can engage in
  activities designed to target pro-criminal
  attitudes and beliefs.
• Strategy
• Teach clients to
• Catch it.
• Counter it.
• Cookie self.

44
Changing Tapes

• Catching it
• The first step is learning to recognize the tape.
• Countering it
• Generate more prosocial behaviors.
• Begin with working on developing a new prosocial
  alternate attitude.
• Then identify a new behavior.
• Follow the RULE (Realistic, Useful, logical, and
  evidence) tool.
• Cookie self
• Identify and apply an internal reward for doing
  the above.
• EPICS

45
Tapes and Counters

• Group Activity

46
Thinking Reports

• Thinking Reports -
• A brief description of the situation.
• A detailed account of the clients thoughts.
• A brief report of the clients feelings.

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Major Risk and/or Need Factors and Promising
Intermediate Targets for Reduced Recidivism

• Factor Risk Dynamic Need
• Family and/or marital Two key elements
  are Reduce conflict, build
• nurturance and/or caring positive
  relationships, better monitoring
  and/or communication, enhance
• supervision monitoring supervision
• School and/or work Low levels of
  performance Enhance performance,
• satisfaction rewards, satisfaction
• Leisure and/or recreation Low levels of
  involvement Enhancement involvement
• satisfaction in anti- satisfaction in
  prosocial
• criminal leisure activities activities
• Substance Abuse Abuse of alcohol and/or Reduce
  SA, reduce the
• drugs personal interpersonal
• supports for SA behavior,
• enhance alternatives to SA

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Major Risk and/or Need Factors and Promising
Intermediate Targets for Reduced Recidivism

• Factor Risk Dynamic Need
• History of Antisocial Early continued Build
  noncriminal
• Behavior involvement in a number alternative
  behaviors
• antisocial acts in risky situations
• Antisocial personality Adventurous,
  pleasure Build problem-solving, self-
• seeking, weak self management, anger mgt
• control, restlessly aggressive coping
  skills
• Antisocial cognition Attitudes, values,
  beliefs Reduce antisocial cognition,
• rationalizations recognize risky thinking
  
• supportive of crime, feelings, build up
  alternative
• cognitive emotional states less risky
  thinking feelings
• of anger, resentment, Adopt a reform
  and/or
• defiance ant criminal identity
• Antisocial associates Close association
  with Reduce association w/
• criminals relative isolation criminals,
  enhance

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Where to Get More Information

• University of Cincinnatis Corrections Institute
  - corrections.institute_at_uc.edu
• National Institute of Corrections nicic.gov
• Indiana Department of Correction