Increasing Case Management Effectiveness

Dr. Dawn-Elise Snipes PhD, LPC-MHSP

Executive Director, AllCEUs Counseling Continuing Education

Host: Counselor Toolbox and Case Management Toolbox Podcasts

Objectives

– Identify the benefits of case management

– Explore the impact of ineffective “standard” treatment

– Identify goals of the case manager

– Review the research identifying the most helpful factors in case management

– Review assessment areas

– Explore common needs of CM clients

– Describe characteristics of effective care plans

Intro

– CM can be defined as a “coordinated integrated approach to service delivery, ongoing supportive care and help to access resources for living and functioning in the community”

Why Case Management

– Frequent users of healthcare services are a small group of patients with multiple chronic conditions and psychosocial and mental health comorbidities accounting for a high number of healthcare visits

– Frequent use of services is often considered a symptom of gaps in accessibility and coordination of care.

– These patients are more at risk for incapacity, poorer quality of life and mortality.

– Case management (CM) is the most frequently implemented intervention to improve care for frequent users of healthcare services and to reduce healthcare usage and cost

– CM interventions resulted in decreases in ED use and cost, a better use of appropriate existing resources, and a reduction in social problems such as homelessness and drug and alcohol abuse

Impact of Ineffective Treatment

– Treatment dropout

– Continued illness

– Work impairment

– Financial problems

– Relationship impairment

– Impaired parenting

– Stress related health problems

– Development of (additional) mood issues

Case Example

– John has a substance use disorder, major depressive disorder and hepatitis C. He doesn’t know how to afford his medication for hepatitis or his depression, has a history of suicidal ideation and has a history of relapse. Currently he is living in a local motel. He recently lost his job and got a DUI.

– Counselors review your provider administration manual. Most insurers offer care/case management programs.

– http://www.aetna.com/healthcare-professionals/documents-forms/bh-provider-manual.pdf

Goals

– Increase/maintain client engagement/motivation by:

– Improving health literacy

– Identifying and addressing obstacles (payors, transportation, language/literacy, childcare)

– Identifying and enhancing strengths

– Serving as a healthcare guide

– Providing support and encouragement

– Reducing symptoms

– Reducing the burden on caregivers thereby improving the psychosocial environment (emotional support, social support, domestic help, insurance, transitional services)

– Increasing confidence in caregivers and clients for self-management

Helpful Factors in Case Management

– Helpful Factors

– Access to medical, social and community resources

– Calm and trusted case manager

– Case manager with strong relationships to referral sources

– Effective communication between CM and treating clinician(s) via a unified treatment strategy

– Multidisciplinary care plan

– Life skills coaching

– Frequent contacts with care provider

– Regular review of the care plan with the client

– Assistance with healthcare navigation

– Patient education/Health literacy enhancement

– Coordination and prioritization of care

Assessment Areas: Client and Caregiver

– Emotional needs

– Cognitive functioning

– Physical complaints

– Sleep

– Current physicians, medications, diagnoses and treatment plans

– Motivation

– Knowledge about the condition

– Health literacy

– Access to safe housing

– Access to healthy meals

– Ability to p