Community Case Management

1. Community Case Management Using a systems approach to serving individuals with complex needs

2. Identifying Complex Needs • Human Service Agencies • Social Services • 911/211 Systems • Mental Health/Substance Abuse Systems • Schools • Hospital Systems • Courts & Correctional Systems • Community Support Agencies • Law Enforcement • Family & Friends • Community at Large • Etc, etc, etc

3. System of Care • A valued-based approach/philosophy for serving people with complex needs that is client driven, community-based, and culturally and linguistically competent.

4. Case Management • Case management is a collaborative service that provides assessment, planning, facilitation and advocacy for options and services to meet an individual’s holistic needs through communication and available resources to promote quality cost-effective outcomes.

5. Historical Overview Schools Corrections Mental Health Child, Adult and/or Family Human Services Court Services Social Services Alcohol & Drug

6. Historical Overview Schools Corrections Mental Health Child, Adult and/or Family Human Services Court Services Social Services Alcohol & Drug

7. SOC Approach Schools Corrections Mental Health Child, Adult and/or Family Human Services Court Services Informal Community Supports Social Services Alcohol & Drug

8. SYSTEMS of CARE COMMUNITY ASSISTANCE RESOURCES EMPOWERMENT Community Case Management

9. Pennington County Health and Human Services Changing Lives….. Changing Courses….. A diversion program empowering people to make positive changes!

10. Community Resources Committed to Rebound Members

11. Pennington County Health and Human Services Rebound Community Referrals to Rebound Program 12/01/2006 to 04/30/2012 • Intensive case management provides the tool in reducing the barriers clients often face when obtaining services. • Since 2006, Rebound caseworkers have made 2,948 physical contacts with 709 members in the program.

12. Pennington County Health and Human Services Rebound Rebound Referrals to the Community 01/01/2011 to 04/30/2012 • Barriers that once complicated members success have been resolved. • Multiple agencies have come together to assist in the success of these individuals.

14. Pennington County Health and Human Services John T. Vucurevich Foundation Grant Referrals From Community Agencies 01/01/2011 to 12/31/2011 TOTAL: 310 Referrals

15. Pennington County Health and Human Services John T. Vucurevich Foundation Grant Financial Assistance Provided on Behalf of Community Referrals Received 01/01/2011 to 12/31/2011 $35,000.00 Total Expended

16. Pennington County Health and Human Services John T. Vucurevich Foundation Grant Financial Assistance by the Type of Service Provided 01/01/2011 to12/31/2011 $35,000.00 Total Expended

17. Pennington County Health and Human Services John T. Vucurevich Foundation Grant Cost Share with Client and Agency 01/01/2011 to 10/17/2011 Total: 248

19. Crisis Care Center Transitional Case Management Client Referrals 01/01/2011 to 04/30/2012 • From January 1, 2011 through April 30, 2012, a total of 219 new individuals were referred to HHS/transitional case management (TCM) for services. • HHS/TCM now tracks ongoing previous referrals receiving case management services from HHS/TCM. In April 2012 HHS/TCM worked with 9ongoing CCC clients.

20. Crisis Care Center Transitional Case Management Referrals to Community Agencies 01/01/2011 to 04/30/2012 Total: 165 As of April 30, 2012 transitional case management staff have coordinated services with 24 community agencies. A total of 165 referrals have been made to these agencies.

21. Crisis Care Center Transitional Case Management Coordinated/Provided Services 01/01/2011 to 04/30/2012 Total: 230 As of April 30, 2012 Health & Human Services Transitional Case Management staff, as well as varied community agencies, have coordinated and provided a total of 230 services for Crisis Care Clients.

22. Crisis Care Center Transitional Case Management Caseworker Activity 01/01/2011 to 4/30/2012 Total: 1,049 • Physical client contacts refer to actual face-to-face contact with a CCC client. • Agency transport refers to transports given to a CCC client by Transitional Case Management with a company vehicle for the purposes of getting to appointments, obtaining food, shelter, clothing, etc. • Phone calls made by Transitional Case Management to both the CCC client and community agencies on the clients behalf.

23. Pennington County Health and Human Services Rebound, JTV Grant and Crisis Care Transitional Case Management Total Referrals IN FROM Community Agencies 01/2011 to 02/29/2012 Total: 879

24. Pennington County Health and Human Services Rebound, JTV Grant and Crisis Care Transitional Case Management Total PCHHS Referrals OUT TO Community Agencies 01/01/2011 to 02/29/2012 Total: 1,137

25. Agencies Working Together • Motivational Interviewing • Effective Case Managers Creates • Changed Lives • Empowered Clients • Moving to the

26. Steps for Getting There • An agreed upon definition and role of community case management. • A forum for training new case managers and linking new and seasoned case managers together. • Develop processes that result in integrated community case service plans. • Develop web-based software to monitor services to individuals with complex needs.