Case Management

1. Case Management Sarah Himmelheber, LCSW

2. In today’s 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

3. 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

4. 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 manager’s 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.

5. 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.

6. 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/Towards%20a%20Typology%20of%20Case%20Management.pdf

7. Building the Trust Relationship • Living social work values • Using active listening skills • Task-centered trust development

8. Social Work Values • Service • Social justice • Dignity and worth of the person • Importance of human relationships • Integrity • Competence

9. Active Listening Skills • Reflecting • Paraphrasing • Clarifying • Summarizing

10. 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

11. 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

12. Moving towards...Developing a Case Plan • Example cases? • Realism • In goal formulation • The role of you/ your agency • Resources

13. 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

14. 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

15. 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

16. Dealing with Challenges • Strategies for improving the relationship • Back to assessment • Highlighting changes • The importance of documentation

17. 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

18. Confidentiality Issues • Within agencies • Employees & volunteers • Review example volunteer form • With other agencies • Review example Release of Information form

19. Supervision • Formal versus informal • What to cover

20. 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

21. Wrapping Up… • Case Examples? • Questions & Ideas?

22. Thank you! Contact information: Sarah Himmelheber, LCSW sarah.himmelheber@gmail.com