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Case Management Essay

Case Management

Case management is a broad term that is used in many different specialized areas throughout social services and health care. Depending on the specialization, case managers can provider a wide variety of services. In general, case managers offer supportive services and coordination of services to individuals that require that assistance in order to follow-thru with their individual treatment plan. The clients referred to case managements services are often those with multiple problems and sever disabilities. However, case management can also be used for individual with less complex problems, on a short-term basis as a preventative measure.

As the term implies, a case manager is a person that manages the care of another. This is a professional person assigned to be in charge of the overall care of the client. Depending on the seriousness of the problem, the case manager may work with a person for a few months or for many years. The goal of case management programs is to help the individuals learn the skills necessary to manage their own care. Depending on he individual client, this can mean teaching the person how and when to take medication, how to schedule a doctor’s appointments, how to arrange transportation and

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how to recognize a potential problem. While much of the case managers’ job is related to improving overall health, a medical degree or training is not necessary. The case mangers helps and teaches the client how to follow the advice of the other professionals involved with their care.

Case managers usually have a bachelor’s degree, though this is not always a requirement for the job. It is most important that the case manager has a very good knowledge of community resources in their area and that they have the skills necessary to work one on one with people the case manager is the person responsible for working through the system and getting through the barriers to service. A case manager may be called to help a client secure social security benefits, drive a client to a food bank or help a client secure the necessary furniture for a new apartment. The case manager may help a client apply for benefits to pay for the cost of medication and may also help a client link with AA or NA services. The case manager might help a young adult get a driver’s license or apply to a community college. While the primary role of the case manger is to support health and medical services, the approach is meant to be holistic. The case management model speaks to the idea that if person’s self-esteem is improved by links to social, recreational and educational survives; their compliance and follow-through with medical care will improve as well.

Case managers assist other professionals and work as part of a larger team. The case manager helps social workers, mental health professionals, and health care workers, to provide services to people. They assure that all aspects of a clients care are coordinated. The case manager usually works under the supervision of someone with a professional degree in the field such as psychology, nursing, rehabilitative or social work. One can assume that if a case manger is involved, there are likely a number of aspects of a client’s case to be considered. Fro example, the client who is seen by a doctor once a month and has no financial, social, vocational or transportation needs will not likely need the services of a case manager. This person would be able to manage his or her own case with the assistance of the doctor.

Case managers provide services to clients that are aimed at improving quality of life by assuring that the individual receives and follows through with all the needed services. Upon first meeting a client, the case manager will assess he client on all life domains including social, health, vocational, legal, financial and spiritual. The case manager will review all of the medical concerns, as well as mental health and substance abuse issues. A plan to address all of the areas in need will be developed with the clients. The case managers role will be to keep all of professional “in the loop” and to consult wit them to assure that all aspects of treatment are addressed. The case manager can make referral and linkage to social services agencies that provider benefits such as financial assistance, food stamps, Medicaid and housing. The case manger can also help the person complete the necessary paperwork and may even provide or arrange transportation.  If helpful, the case manger can simply sit and provide support to the person as they complete the application process for services and act as another set of ears, just to be sure that the client has heard and understood the instructions and the process. Much of what a good case manager provides is emotional support. This support and encouragement can help a client to follow through and stick with the treatment plan.

Case managers are not just involved with individuals. Thy can also assist families by providing education and support that help the family, help the client. For example, a case manager may be able to visit a family at home and explain he treatment plan to all family members. This can help the family members to understand the importance keeping appointments, taking medications and follow through with recommended activities and therapies. The case manager can help engage family members to share the responsibility of supporting the individual client. This process helps the client to build stronger natural support systems that may ultimately make professional case management services unnecessary. The case manager can actually help the client and family identify natural support systems in the client’s family, friends, church and social network. The case manager generally has the information from all of the treatment providers and so can pull everything together in a holistic plan. They case manager is often the information conduit, the person who keeps everyone in the loop and up to date on the clients progress, compliance, problems and barriers to service.  The case manager can identify potential problems before they become crisis situations.

For other social service, health and human service organization, the case managers is like the spoke in the wheel. The case manager can provide insight to the other professionals regarding the client’s day-to-day life in the community and their progress or problems with the overall treatment plan. With waiting lists for many health care professionals including mental health and substance abuse professionals, the case manger can spend time working with the client that the other professional may not have. For example, a psychiatrist in a busy clinic may have a large caseload and long waiting list that allows very limited time for an assessment or medication check with a client. The psychiatrist may not have the time to make sure that the client can get to a pharmacy and afford medications. The psychiatrist relies on the case manager to make the order become a reality. Similarly, the doctor or therapist may advise the client to became involved with a nutritionist, exercise more or to loose weight. These professionals rely on the community case manager to link the client to appropriate and affordable services and perhaps to bring the client to the gym, nutritionist or recreational program for the first time to ensure that the client is linked and comfortable with the program.

People are attracted to the work as a case manager for a number of reasons. While it is not an actual degree program, it is frequently where entry-level social service and human services staff begin their careers. Individuals take these jobs because they are committed to the helping profession and view the opportunity to case mange, as a chance to get to understand all aspects of the social service world. Case management is not a particularly high paying job and yet it can be extremely emotionally demanding. It can also require working weekends and evenings with a difficult and often demanding clientele. When the other professionals involved with a clients treatment are not working, on weekends and in he evenings, case mangers are typically still available to respond and visit with clients. The goal is to teach clients the skills needed to become self-sufficient and follow trough with services on their own, if possible. Fore some people, case management service may be needed for a lifetime.

 Individuals able to follow thru with services on their own, do not require case management so those that are referred for this service are among the most needy and multi problem individuals. Many people enter the field as a first job, a stepping-stone towards higher paying positions. This work is emotionally draining and can lead to burn out and may lead some staff to leave the field and change career paths. These problems can result in case manager which are young, inexperienced and new to the field. The job demands them to coordinate services across a wide variety of professionals and explain he plan to clients and families. Without experience or expertise themselves, the case managers can find it difficult to be effective.

To combat this problem, agencies generally organize teams of case manager who can provide support and information for each other. An experienced case management supervisor can make all the difference in a successful case management program. Case managers working in the community may be required to visit clients in their homes, shelters, clinics, day programs or hospital settings. Because the clientele in need of case management services are often difficult, the work environment can present risks and many programs require travel in teams at least under certain circumstances. Recent research has actually shown that in the mental health field, case managers are staying longer which results in more experienced staff. This research also shows that while the role of the case manager has stayed fairly constant, the caseloads have increased.

It is important for case managers to have good communication skills and have a sense of responsibility to the helping professions. The clients case mangers work with are often victims of abuse, or suffer from mental illness, substance abuse or physical and developmental disabilities. Because of the vulnerable population, case managers may be required o complete background checks. .

There is a growing demand for social service case managers and the field is expected to grow by 35% over the next ten years. Though the job can be relatively low paying, many of the jobs are with government entities that can offer good benefits to supplement the pay. For those who enjoy flexibility, the ability to work with a broad client and professional population and limited time sitting at a desk, case management can be an ideal position.

Much of the increased future demand is expected to address the growing elderly population. In addition, the fact that many individuals with serious mental illness and developmental disabilities that were once institutionalized, now live in the community with supportive services including case management. The combination of these factors has led to a growing number of people in the community with co existing medical, psychiatric, developmental or substance abuse problems. As these people grow older, the problems are more problematic and require more community support and case management services.

Managed care has had an effect on case management which has resulted in the increased need and demand for this service. Managed care focuses on cutting costs and preventing the need for costly specialized s services. Casemanagers have an important role in this preventative focus. A diligent case manger can work to ensure that clients get to all appointments, follow through with recommended medical care and social programs. Case managers also often provide health education and promote wellness activities including exercises and nutrition. This function makes the case manger a very important component of the managed care system. Particularly in states that have adopted the managed care system for Medicaid, the role of case managers is critical and in fact reimbursable under the federal Medicaid program. Case management services have been used for both child and adult Medicaid models. The case management model in these states has been to focus on smaller caseloads with more intensive services and wraparound service capability. The philosophy of this model is that clients can avoid hospital and institutional placements and remain in community settings. For children this can mean the ability to remain home as opposed to placemen in residential settings. While this option is obviously preferred and is less costly, it also helps state governments to comply with orders. For some states, lawsuits regarding an over reliance on institutional care for both children and adults has results din the need to seek alternative ways of dealing with difficult cases. Case management is often the glue that holds the community system together and this services ahs been expanded in many states.

The increase in the number o complicated AID and HIV cases has added to the need for case management services. Case managers working in this field have been highly successful in assuring that clients receive the needed medical and emotional support services. Case managers have the ability to check on people in the community and make sure they get to doctor’s appointments and have access to the latest treatment and services.

The benefits of case management as a cost cutter have been shown in a number of research studies.  Specifically for clients with serious mental illness, case management has been proven to have a very significant impact on hospital costs by preventing hospitalizations. Clients with case management services take medications, comply with treatment program and follow through with needed services which reduce the risk of hospitalization. Communities and more often state agencies may see an increase in the cost of residential programs for these populations with the success of case management. Community residences cost significantly les than hospitalization. Studies show that with ongoing intensive case management services for as long as 5 years, the effects of case management were long lasting and highly effective in keeping people out of the hospital.

Helping to keep people in the least restrictive and most appropriate setting is often a primary role of the case manager. The case manager is always focused on helping people remain in their own homes and communities when at all possible. Case mangers bring the services to the client in the community rather than requiring a client to go to a hospital or institution for treatment. With the focus on assuring the rights of disables citizens as well as finding ways to reduce costs, case managers play a very important and critical role.

References

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition, Social and Human Service Assistants, on the Internet at http://www.bls.gov/oco/ocos059.htm (visited May 03, 2008).

Council for Standards in Human Services Education, PMB 703, 1050 Larrabee Avenue, Suite 104, Bellingham, WA 98225-7367. Internet: http://www.cshse.org

National Organization for Human Services, 90 Madison Street, Suite 206, Denver, CO 80206. Internet: http://www.nationalhumanservices.org

Prospective Evaluation of the Effect of Managed Care on Medical Care Utilization among Severely Disabled Independently Living Adults

Allan R. Meyers, Adrienne Cupples, Ruth I. Lederman, Laurence G. Branch, Marie Feltin, Robert J. Master, Doreen Nicastro, Mary Glover and Denise Kress

Medical Care, Vol. 25, No. 11 (Nov., 1987), pp. 1057-1068   (article consists of 12 pages) Published by: Lippincott Williams & Wilkins

Joseph G. Hromco1 , Michael W. Moore2 and Robert E. Nikkel2, Tualatin Valley Centers, 14600 NW Cornell Rd., Portland, OR 97229, USA  Oregon Mental Health & Addiction Services Division, USA

Community-Based Treatment for Severe Mental Illness from Medscape Psychiatry & Mental Health eJournal[TM]The Costs of Assertive Community Treatment Medscape Psychiatry & Mental Health eJournal 2(5), 1997. © 1997 Medscape

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