Case ManagementCase Management

Sarah Himmelheber, LCSWSarah Himmelheber, LCSW

In today’s discussion...In today’s discussion... Defining case managementDefining case management Reviewing models of case managementReviewing models of case management Process of rapport buildingProcess of rapport building Developing case plansDeveloping case plans Working the caseWorking the case Successfully partnering with clientsSuccessfully partnering with clients Discharge processDischarge process Confidentiality issuesConfidentiality issues SupervisionSupervision Self-care strategiesSelf-care strategies Case examplesCase examples

What is Case What is Case Management?Management? Type of service to clientsType of service to clients

coordinating and therapeutic coordinating and therapeutic function for clients receiving function for clients receiving services services

Defining the caseDefining the case Goals of the working Goals of the working

relationshiprelationship Objectives and interventionsObjectives and interventions Timeline/ boundaries of the Timeline/ boundaries of the

relationshiprelationship

Models of Case ManagementModels of Case Management

The BrokerThe Broker The primary function is to link the client to The primary function is to link the client to

needed, usually external, resources. This model needed, usually external, resources. This model limits the role of the case manager/ client limits the role of the case manager/ client relationship. The main task is to identify what relationship. The main task is to identify what the client needs and then to facilitate the the client needs and then to facilitate the referral so the client is connected to the service referral so the client is connected to the service provider. provider.

The RehabilitationistThe Rehabilitationist The Rehabilitation model identifies strengths The Rehabilitation model identifies strengths

and deficits of the client and attempts to remedy and deficits of the client and attempts to remedy a wide array of problems and barriers that may a wide array of problems and barriers that may include medical, mental health, vocational and include medical, mental health, vocational and housing issues. The case manager’s role is to housing issues. The case manager’s role is to assist the client in overcoming barriers that assist the client in overcoming barriers that prevent independent functioning in the prevent independent functioning in the community. When barriers have been community. When barriers have been addressed, the relationship between the case addressed, the relationship between the case manager and the client is reduced or manager and the client is reduced or terminated. terminated.

Models of Case ManagementModels of Case Management The Full SupportThe Full Support

By using an integrated team of providers including By using an integrated team of providers including case managers, outreach workers, rehabilitation case managers, outreach workers, rehabilitation specialists, and medical professionals, this model specialists, and medical professionals, this model relies less on outside referrals and provides the client relies less on outside referrals and provides the client with in-house service delivery. In this model the case with in-house service delivery. In this model the case manager not only coordinates care but also provides manager not only coordinates care but also provides clinical support and life skills training. clinical support and life skills training.

““Full Support” models have been effective in Full Support” models have been effective in reducing inpatient psychiatric hospitalizations and reducing inpatient psychiatric hospitalizations and are generally used with clients who have long-term are generally used with clients who have long-term care needs. The relationship between client and the care needs. The relationship between client and the treatment team is open-ended and ongoing rather treatment team is open-ended and ongoing rather than limited to specific goals (Draine, 1997). than limited to specific goals (Draine, 1997). Determining when to terminate services can be Determining when to terminate services can be challenging when using this model. challenging when using this model.

Models of Case ManagementModels of Case Management

The Strengths ModelThe Strengths Model As implied in the name, the Strengths As implied in the name, the Strengths

model avoids assessing client needs in model avoids assessing client needs in terms of pathology or deficits. The focus is terms of pathology or deficits. The focus is exclusively on strengths. Self-determination exclusively on strengths. Self-determination of the client and assisting with client-of the client and assisting with client-specific goals are the task of the case specific goals are the task of the case manager. This model places strong manager. This model places strong emphasis on case manager-client emphasis on case manager-client relationships. The efficacy of this model relationships. The efficacy of this model relies on intensive outreach and follow up relies on intensive outreach and follow up (Standard, 1999, Rapp, 1998).(Standard, 1999, Rapp, 1998).

Fliesher, P. and Henrickson, M. (2002). Fliesher, P. and Henrickson, M. (2002). Towards a Typology of Case Management.

Retrieved from: http://www.hawaii.edu/hivandaids/Towards%20aRetrieved from: http://www.hawaii.edu/hivandaids/Towards%20a%20Typology%20of%20Case%20Management.pdf%20Typology%20of%20Case%20Management.pdf

Building the Trust Building the Trust RelationshipRelationship

• Living social work valuesLiving social work values

• Using active listening skillsUsing active listening skills

• Task-centered trust Task-centered trust

developmentdevelopment

Social Work ValuesSocial Work Values

Service Service Social justice Social justice Dignity and worth of the Dignity and worth of the

person person Importance of human Importance of human

relationships relationships Integrity Integrity CompetenceCompetence

Active Listening SkillsActive Listening Skills

Reflecting Reflecting

ParaphrasingParaphrasing

Clarifying Clarifying

SummarizingSummarizing

Active Listening ExerciseActive Listening Exercise

Partner up, with each person Partner up, with each person playing the client once playing the client once Refer to active listening Refer to active listening

scenario handoutscenario handout Comments? Comments? Limitations to active listeningLimitations to active listening

Serves as a starting pointServes as a starting point

Task-Centered Task-Centered Trust DevelopmentTrust Development

Method for building relationships Method for building relationships with apprehensive clientswith apprehensive clients

CleaningCleaning

Food inventory/ meal planning/ Food inventory/ meal planning/ grocery shoppinggrocery shopping

Public transportation assistancePublic transportation assistance

Side-by-side linking Side-by-side linking Community-based or office-basedCommunity-based or office-based

Moving towards...Moving towards...Developing a Case PlanDeveloping a Case Plan Example cases? Example cases?

Realism Realism In goal formulation In goal formulation The role of you/ your agencyThe role of you/ your agency ResourcesResources

Developing the Case PlanDeveloping the Case Plan

Intake processIntake process Review example formReview example form

Goal and objective Goal and objective formulationformulation Keeping a time frameKeeping a time frame Schedule towards the goalSchedule towards the goal

Interventions: what you Interventions: what you can docan do

Dealing with challengesDealing with challenges

Working the Plan….Working the Plan….

Knowing your local resourcesKnowing your local resources CoalitionsCoalitions Staff time to attend meetingsStaff time to attend meetings

Organizational strategiesOrganizational strategies Post-meeting notesPost-meeting notes Scheduled office timeScheduled office time

Jointly monitoring and Jointly monitoring and reviewing goalsreviewing goals

Celebrating progressCelebrating progress

Whose Case Is This?Whose Case Is This?

Idea of progressive client control Idea of progressive client control May be related to length of case planMay be related to length of case plan

BoundariesBoundaries What type are appropriate? What type are appropriate? Strategies for handling challengesStrategies for handling challenges Avoiding us/themAvoiding us/them

Modeling Modeling ResponsibilityResponsibility AcceptanceAcceptance UnderstandingUnderstanding Expectations for the working relationshipExpectations for the working relationship

Dealing with ChallengesDealing with Challenges

Strategies for improving Strategies for improving the relationshipthe relationship Back to assessmentBack to assessment Highlighting changesHighlighting changes

The importance of The importance of documentationdocumentation

The Discharge ProcessThe 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

Confidentiality IssuesConfidentiality Issues

Within agenciesWithin agencies Employees & volunteersEmployees & volunteers Review example volunteer Review example volunteer

formform

With other agenciesWith other agencies Review example Release of Review example Release of

Information formInformation form

Supervision Supervision

Formal versus informalFormal versus informal

What to coverWhat to cover

Stress and Self-CareStress and Self-Care

• Being mindful of stressBeing mindful of stress- Signs of stress? - Signs of stress?

• Strategies for stress reduction ...Strategies for stress reduction ...• How to ask for a break...How to ask for a break...

"We learned that it was not the clients themselves "We learned that it was not the clients themselves who were causing the major portion of the stress, who were causing the major portion of the stress, but the work environment itself," but the work environment itself," said Tracy said Tracy Whitaker, director of the Center.Whitaker, director of the Center. "The primary "The primary stress social workers face is that they don't have stress social workers face is that they don't have enough time to do their jobs, and related to that, enough time to do their jobs, and related to that, have too heavy a workload. This was true across have too heavy a workload. This was true across practice areas.”practice areas.”

http://www.naswdc.org/pubs/news/2008/11/self-care.asphttp://www.naswdc.org/pubs/news/2008/11/self-care.asp

Wrapping Up…Wrapping Up…

Case Examples? Case Examples?

Questions & Ideas?Questions & Ideas?

Thank you!Thank you!Contact information:Contact information:

Sarah Himmelheber, LCSWSarah Himmelheber, LCSWsarah.himmelheber@gmail.comsarah.himmelheber@gmail.com