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Introduction
This section is designed to assist counselors in providing effective
case management services when treating substance use disorders.
This training will present information about how a counselor functions
in case management; comprehensive case management assessments;
the use of strength-based perspective; how to establish referral
networks and how to evaluate and document the use of services.
Participants will be guided through discussions and exercises to apply
concepts to practical examples in their programs.
Session Agenda
Topics covered in this session include:
Defining case management
Role of the counselor (case manager)
Assessment
Planning
Linkage
Monitoring
Advocacy
Consultation
Collaboration
Provide the client with a single point of contact for a full array of
services.
1.
2.
3.
4.
5.
Each agency selected for the referral network should be listed with
similar, standard information:
1. Name, address, office hours, phone numbers.
2. List of services.
3. Experience with clients with substance use disorders.
4. Experience with special populations.
5. Av a i l a b i l i t y.
6. C o s t s .
7. S t a ffi n g .
Upon follow-up, evaluate the agencys ability to help the client.
Answer the following questions:
Explain in clear and specific language the necessity for and process
of referral to increase the likelihood of client understanding and
follow-through.
Activity
Break into small groups. Identify one person to take notes on the
discussion and to report back to the larger group.
List a variety of services needed to meet the needs of those in
treatment for addictions in a comprehensive way. Catalog these
resources by general area (health, social services, support services,
self-help groups, church, school, criminal justice, service clubs,
housing, food, childcare, transportation).
Elaborate on the information by reviewing the Directories provided.
Have your list contain as much of the key contact and other
information as possible (examples: service hours, location, contact
numbers, service criteria). Small groups are welcome to use the Case
Manager/Counselor Referral Services grid in the Appendix (found in
tab 9 at back of the participant handbook) or create your own
schedule/chart.
The following is comprehensive list of suggested services for effective
case management. This list will help you consider if there are other
services you would like to add to your grid, chart or schedule.
Suggested
Services
Management
for
Comprehensive
Case
Methadone/Buprenorphine to abstinence
programs Inpatient services
Recovery homes
Half-way houses
Health maintenance/prevention
Treatment
Nutritional services
Health maintenance/prevention
Treatment
Health maintenance/prevention
Treatment
Dental services
Health maintenance/prevention
Treatment
Childcare services
Day care
Nursery school
Babysitting
Neighborhood parks
Parenting classes/groups
Crisis intervention
Peer support
Support groups
Individual/couple/family counseling
Psychotherapy
Psychiatric care
Residential Services
Independent
Homemaker services
Home support for daily living
Home skilled nursing care
Hospice care
Supervised living
Day treatment services
Homeless shelters
Halfway houses
Group homes
Government-provided service
Leisure activities
Service Clubs
Educational/Vocational Services
School classes
Vocational training
Employment programs
Direct placement
Referrals
5-9
Helps clients take control and find their strengths and encourages
use of informal helping networks.
7
8
Activity
Are there any examples of clients you have worked with who felt
competent or saw their own strengths? Please share any stories of
people who felt unworthy and unskilled due to neglectful parenting
and/or years of being sidetracked from life skills by drug/alcohol use,
but actually had skills they didnt see in themselves.
The simplest of assets may be invisible to the client but, if identified,
can be a source of self-esteem.
Case Management Assessment
The primary difference between treatment and case management
assessments lies in case managements focus on the clients need for
community resources. The findings from the assessment, including
specific skill strengths and deficits, basic support needs, level of
functioning and risk status, define the scope and focus of the service
plan.
For clients who enter primary treatment, the case management
assessment focuses on problems that can be resolved through
therapy: substance use, psychological problems and family
dysfunction. A bio-psycho-social-spiritual assessment should examine
the clients situation in the life domains of housing, finances, physical
health, mental health, vocational/educational, social supports, family
relationships, recreation, transportation and spiritual needs. Detailed
information should be gathered on drug/alcohol use, drug/alcohol
use history, health history, current medical issues, mental health
status and family drug and alcohol use.
As the individual responsible for coordinating diverse services, the
counselor/case manager must take a broad view of client needs, look
beyond primary therapy to the impact of the clients addiction on
broader domains and assess the impact of these domains on the
clients recovery. The greater the number of problems the
counselor/case manager can help the client identify and manage
during primary treatment, the fewer problems the client must address
during aftercare and ongoing recovery, and the greater the chances
for treatment success. A case management assessment should
include a review of the following functional areas.9
Service procurement skills
While the focus of case management is to assist clients in accessing
health and social services as well as other recovery support services,
the goal is for clients to learn how to obtain those services,
themselves. The client should therefore be assessed for:
Timeliness, punctuality
The case management plan should reflect the level and intensity of
the service along with the clients specific objectives. As a client
progresses through the treatment continuum, the counselor/case
manager can turn more and more of the responsibility for action over
to the client.
Virtually all clients have multiple needs; consequently, the service
plan should be structured to enable clients to focus on addressing their
problems while they participate in treatment. For example, the idea that
one can put lack of housing, employment issues or a childs illness aside
to concentrate exclusively on addiction treatment and recovery is
unrealistic and sets up both the treatment provider and the client for
failure. At the same time, it is often necessary for the client and
counselor/case manager to prioritize needs.
During primary treatment, the counselor/case manager must:
Promote independence.
separation, set in motion once the client has developed a sense of selfefficacy and is able to function independently. Counselors should
review and summarize client progress and encourage their future
ability to access resources on their own.
10
11
5-18
Consultants.
Staff consensus.
Once benchmarks have been established, then the program needs to
measure its practice. This process involves developing and implementing a
method for measuring referral to and use of case management services.
This measurement is meant to answer the question Are case management
referrals seamless and are the services useful from the point of view of the
client?
One approach is to maintain a staff log that measures counselors
activities by contact. Staff logs typically record the names of clients, the
location and duration of the contact and activity and whether other
individuals participated, including staff from other agencies or family
members.
Another approach is to have the counselor/case manager complete a
Counselor/Case Manger Orientation Checklist of the services they provide
and how they rate their own skill and knowledge level of the services they
are providing. The clinical supervisor is able to review the written
evaluation of the counselor/case manager and rate their observation as
well. In the Appendix you will find this example form Counselor/Case
Manager Orientation Checklist for your review.
Additional information may be included (to compare the usefulness and
sensitivity of services, for example). Surveys of stakeholders can also
provide useful information (questioning various people such as agency
staff; staff from other substance use disorder and human service agencies,
homeless shelters and hospital emergency rooms; clients and their family
members; criminal justice and law enforcement personnel about their use
and experiences with various services). Knowing how clients themselves
perceive the services they receive can assist staff in evaluating activities
as well (Did the client feel that the case management services actually led
to needed resources? Did the counselor understand their needs and have
the skills and experience necessary to help them accomplish their
goals?). An example of a Client Feedback Survey is located in the
Appendix (in tab 9 and the back of this handbook) which may be a helpful
model for gathering client-based service feedback.
If the assessment goal is preventing clients from falling through the
cracks between levels of care (assessment to outpatient care), a systemlevel outcome might be measured by continuity of care. Access to a
computerized management information system (MIS) is helpful for
managers so they can view patterns of usage and costs quickly and easily.
Please consult the Appendix (found at the back of this handbook in tab 9)
for an example of an MIS form. This form can help measure system
outcomes and assist managers in determining the patterns of service use in
an agency.
While most would agree that evaluation is generally worthwhile, there is
considerably less agreement about the measurement and documentation
of specific outcomes for individual clients. Programs should carefully
consider what treatment objectives need to be tracked when measuring
client outcomes. There are many factors that can be tracked, including drug
use, vocational skill development, behavioral issues, and programs may
not be able to separate the effects of treatment activities from the
effects of case management activities. There is an example Client
Progress Survey in the Appendix (located in tab 9 and the back of this
handbook) for your use.
Activity: Evaluating Case Management Services
Break into small groups. Identify one person to take notes on the discussion
and to report back to the larger group.
Each small group will develop a form that can be used by their program to:
1. Evaluate the quality of various outside services.
2. Provide reference information about the different services (types of
service available in the program).
Summary
In the training today we defined case management and the role of the
counselor/case manager. We identified the skills needed to be an effective
case manager. We reviewed referral networks and began the development
of one for this class. We reviewed the planning, implementation and