What is Case Management, Anyway? (Much more than Problems and Paperwork)

1. What is Case Management, Anyway? (Much more than Problems and Paperwork) Molly Brooms, MA Retired (formerly Director, Office of Mental Illness Community Programs, Division of Mental Illness, ADMH)

2. My Perspective Mental health services Administrator Program Evaluator Regulator Interagency Collaborator

3. Overview History Definitions Context Importance Trends What it is not Coalition Work

4. A Bit of History DMH had a case management demonstration program in the mid-80’s. Started Medicaid coverage of Optional Targeted Case Management in late 80’s. Have been involved in development of instruments for assessment of need for adults and children Have seen firsthand in my previously mentioned roles the importance of case management

5. So What the Heck is it? Someone once said that case management is the mother you always wish you had had.

6. DMH Definition – Certification Standards Systematic needs assessment (requires standardized assessment) Plan development with goals and actions Crisis assistance Transportation Linkage between consumers and other resources Advocacy for and developing access to needed services when consumer is unable to do so alone Monitoring Systematic re-evaluation

7. Medicaid Definition Medicaid Provider Manual General Definition: assist recipients in gaining access to needed medical, social, education, and other services.

8. Core ElementsMedicaid Provider Manual Needs Assessment – written and comprehensive Case Planning – systematic, collaborative effort with consumer, family, and support system Service Arrangement – linkage and advocacy with other agencies Social Support – through linkage and advocacy, assists to establish or expand social support network Re-assessment and Follow-up – Monitoring - what services have been delivered and to what effect

9. Draft Wellness Case Management Manual Elements of Case Management: Assessment – sufficiently detailed information to determine need and eligibility for services Wellness Plan – establishes client goals and means of achieving Education – chronic disease management, navigation of the health care system, healthy lifestyle, insurance, use of emergency room, importance of medical home Tracking and Follow-up - review of goals, progress, and use of services

10. Common Elements Assessment Case Plan Linking, Coordinating Re-assessment On-going monitoring

11. Maslow’s Hierarchy of Needs Abraham Maslow (1954) was a psychologist who theorized human motivation based on meeting needs conceptualized as a pyramid from the most basic needs at the base to higher level needs at the top.

12. Hierarchy – cont’d The five levels of need are as follows: 1. Biological and Physiological needs - air, food, drink, shelter, warmth, sex, sleep, etc. 2. Safety needs - protection from elements, security, order, law, limits, stability, etc. 3. Belongingness and Love needs - work group, family, affection, relationships, etc. 4. Esteem needs - self-esteem, achievement, mastery, independence, status, dominance, prestige, managerial responsibility, etc. 5. Self-Actualization needs - realizing personal potential, self-fulfillment, seeking personal growth and peak experiences.

13. Context Puts case management work in perspective At a minimum, helps recipients meet basic survival and safety needs At best, helps consumers create and maintain social supports, develop skills, and achieve improved sense of self-worth and competence

14. Importance of Case Management Vulnerable population either psychiatrically or medically or both High co-morbidity of psychiatric and medical disorders 25 year early mortality for persons with severe mental illness due in large part to un- and/or under-treated medical conditions (NASMPD) Target population generally poorly resourced in every aspect of life – financial, medical, social, and educational Inadequately equipped to make sense of complex service systems

15. It’s Not Just Me! SAMHSA in 2011 published a paper entitled “Description of a Good and Modern Addictions and Mental Health Service System” which includes care management as one essential element of a service system. Care management “….integrates primary and specialty health services through approaches that coordinate an individual’s medical care and provide assistance in navigating other healthcare providers and systems, including behavioral health.

16. Cont’d Not a one-size fits all model – need to use elements of different models “Regardless of the approach, individuals performing care management must be well trained and appropriately paid and reimbursement systems/strategies must recognize the importance of collateral contacts”.

17. More of My Opinions Case management has been a linchpin in the efforts to decrease use of state hospitals for adults and children with serious mental illness and severe emotional disturbance. When prioritizing services, I would rank case management in the same category as psychiatrists, nurses, and medications.

18. Important Related Trends Decreasing public budgets Reliance on demonstrated effectiveness Healthcare reform

19. What Case Management is Not Owning a client’s problems Doing for, instead of working with Dictating what is important to a client Assuming that you know best Assuming that a client is incompetent/incapable of change A means to eternal health and happiness

20. Kudos to the Wellness Coalition Represents multiple local agencies Designed to eliminate inter-agency duplication Includes psychiatric as well as medical services Focuses on improving access to consistent care as a means of managing chronic diseases