Case management is the process of helping patients with lives that are not productive or satisfactory as a result of a number of problems among them drug and substance abuse.
Case management in social work is whereby a social worker professionally assesses the needs of the client and their respective families (Ballew & Mink 1997). The social worker then coordinates, monitors, evaluates, arranges and advocates an effective service package to meet the client's or patient's needs. Case management differs from managed care whereby the former is designed to obtain the most appropriate and perhaps best treatment for patients while the latter is designed to avoid hospitalization or initiate shorter hospital stays thereby reducing costs incurred.
Case managers' professional credentials will comprise broadly of the following:
A masters graduate accredited by the council on social work education
Have a current state or national social work certificate or license
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At least two years work experience at the masters level relating to bio-psych - social needs
Practicing in line with federal and state regulations and laws
An adherent to the social work code of ethics (National Association of Social Workers - NASW)
Case management constitutes psychological and clinical components. As a pre- requisite therefore, a case manager should be able to address a variety of matters some of which may include:
Crisis intervention: where the patient's state or situation signifies a crisis needing urgent attention
Resource brokerage: This involves marshalling of the necessary resources to commence treatment.
Teamwork collaboration: The bringing together of all the stakeholders involved in the treatment plan
Client / family education: Provision of all the necessary information and education related to the condition and treatment procedure.
Client / family advocacy: Advocate for patient or client where society or family puts forth a set of demands (Halley, Kopp & Austin 1997)
Psychological assessment and diagnostic procedures
Results and evaluation: Interpretation of patient assessment results.
Client / family counseling: Initiate patient / family counseling sessions.
Most importantly the case manager initiates a team oriented approach to case management. Generally case management procedures offered by organizations are effected based on a screening procedure outcome. This screening criteria will pinpoint all collaborative services through coordination of high quality care services. The coordination is meant to reduce any service fragmentation. The ultimate goal of this process would be to identify patients:
With costly illness or injury
With terminal condition
With chronic illness or illness in an acute stage
The coordination of the case services during screening is aimed at enhancing the quality of life and appropriate usage of health care resources. Client screening should cover the following aspects:
Cultural / spiritual
Client psychological screening is achieved through an assessment process which may include among other components:
Patient's personal data
Patient's health status and age
Patient's emotional and financial status
Patient's vocational and functional status including spirituality
Cognitive functioning focusing on the client
The case management process exploits a number of intervention options. The case manager assists clients / patients and family members to establish a suitable treatment plan. The plan pinpoints the patient's strengths and supportive systems. These are employed during the implementation.
Alternatively the case manager may monitor a patient from community to an inpatient facility and back to the community setting. The manager then adapts a treatment plan suited to the patient's needs in each of the set ups. Collaboration as an option can also be used where the case manager collaboratively and collectively involves the patient's family and others concerning the implementation of the treatment plan. The parties are continuously updated about the progress, goals, obstacles and any variations to the initial treatment plan. The Patrician movement most likely adopts this kind of approach or practice based on the fact that this movement considers the family as a basic societal unit that can be directly involved in the treatment and prevention of substance and drug abuse (The Patrician Movement 2010).
An important aspect concerning any process is the documentation process. In the case management process the manager develops suitable case management plans which are documented in the patient's record. These documentation should be accessible by all relevant and authorized team involved in the treatment plan of the patient in question. The documentation contains vital information based on the current or proposed treatment plan. Accordingly all medical documentation should be kept confidential and treated as so. The case management process must have an established measurement of outcomes. The plan's outcome indicators should include observed and measured goals for every problem, the progress being periodically measured by the case manager along with the supportive team. The measurement indicators will include:
Always on Time
Marked to Standard
Resolution of the problem: This will include the patient care plans connoting the percentages met, partially met or not yet met. The patient's level of dedication to treatment estimated by measuring the attendance frequencies for the assigned treatment sessions. A decrease in procedures and treatments that was unplanned for.
Service costs, reconciled service levels and utilization of resources
The patient's or client's satisfaction which can be derived by the use of tools such as questionnaires the likes of DUKE, Darmouth Co-op or SF- 36. Levels of patient satisfaction can also be demonstrated through contract renewal by the client usually an indicator of insurance company satisfaction.
The patrician movement was founded at St Patrick Parish on the Eastern side of San Antonio in Texas in the late 1950's as a church based drug and substance abuse prevention and treatment facility. Initially founded as a haven from multi racial violence within the neighborhood, patrician movement founders realized the need to address the substance abuse that was clearly evident among the various gang members who came to seek shelter at the parish. The movement has largely evolved into a fully fledged facility today offering prevention and treatment services from a holistic point of view (The Patrician Movement 2010). The treatment program is largely inclined on a self assessment journey making every case unique in its own sense. The core concept embraced by the patrician movement points to the fact that each individual is unique and has a right to develop maximum potential. The family is emphasized as the basic unit of society and education as paramount for human development and treatment. The prevention and treatment services at the patrician movement are somewhat unique. This is due to the fact that prevention and treatment process are family oriented and managed. Case managers are basically from within the community and a conservative approach to rehabilitation process is followed. Among the case managers are those with special skills, others are former clients of the patrician movement whereas some are family members (Ballew & Mink 1997)
The patrician movement is concerned with the whole person and serves the San Antonio population basically. However the entire Texas state also benefits from the services of this movement. This movement having started at community level and as a community initiative is thus strongly San Antonio based. While involving the family in case management; patrician movement is helping to build stronger rehabilitation programs with effective accountability and follow up. The age bracket covered by the services offered at Patrician movement ranging from 18 to 65 years ensures a wider population is catered for. Patrician movement runs a brief strategic family therapy (BSFT) to cater for youngsters exhibiting early substance abuse and delinquency. By focusing on the family as a base of contact and rehabilitation Patrician movement ensures full community involvement in the programs thereby making them quite effective. Established in a mixed race society, Patrician movement cross racial approach to treatment and prevention continues to elicit community support from people of mixed race. Posted statistics are indicative of the fact that as at 2003 over 2500 families had been served with over 2200 adults as well. Proportionally this implies almost one adult per family. This means drug and substance abuse rate in San Antonio is high. A perusal of the testimonials from the Patrician movement website indicates a community full of gratitude to the services offered at the movement. The GED diploma program is among the unique service offered at Patrician movement meant to empower the population intellectually.
By focusing on the whole person the Patrician movement boasts a higher level of success in rehabilitation unlike the common approaches that will mainly focus on the resolution of the problem. In developing and involving the family and therefore the community as a fundamental part of the rehabilitation process, Patrician movement is ensuring lower chances of relapse due to the fact that all other underlying factors are looked at and addressed.
Due to the fact that the San Antonio population is mixed race, the Patrician movement believes in intellectually empowering the community as part of its prevention and treatment strategy. The administration of GED program ensures that those without the basic intellectual skills are equipped and in so doing the general public is able to receive and act on general public information without misinterpretation or misunderstanding.
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