CASE MANAGEMENT in Business Guide12.pptx

Informative Presentation for Study guide

1. CASE MANAGEMENT Alice Molina, RSSW, MSSW

2. Social Case Management Social case management is: A skill in social work intervention An approach to service delivery It uses the helping process

3. Social work case management is a method of providing services whereby a professional social worker assesses the needs of the client and the client’s family, when appropriate, and arranges, coordinates, monitors, evaluates and advocates for a package of multiple services to meet the specific client’s complex needs. (NASW) Social Case Management

4. Social work case management is a method of providing services whereby a professional social worker assesses the needs of the client and the client’s family, when appropriate, and arranges, coordinates, monitors., evaluates, and advocates for a package of multiple services to meet the specific client’s complex needs. case management, social work case management addresses both the individual client’s biopsychosocial status as well as the state of the social system in which case management operates. Social work case management is both micro and macro in nature: intervention occurs at both the client and system levels.

5. Multidisciplinary Case Management Multidisciplinary teams are groups of professionals from diverse disciplines who come together to provide comprehensive assessment and consultation in a certain cases. The primary purpose is typically to help team members resolve difficult cases, teams may fulfil a variety of additional functions.

6. GOAL OF CM The primary goal of case management is to optimize client functioning by providing quality services in the most efficient and effective manner to individuals with multiple complex needs. The primary goal of case management is to optimize client functioning by providing quality services in the most efficient and effective manner to individuals with multiple complex needs.

7. Goal…… enhancing developmental, problem- solving, and coping capacities of clients creating and promoting the effective and humane operation of systems that provide resources and services to people linking people with systems that provide them with resources, services, and opportunities improving the scope and capacity of the delivery system contributing to the development and improvement of social policy.

8. Principles of Case Management Integration of Services Means developing and implementing a plan that brings together a variety of services to help the client . Designed to enhances and support the efforts and the guiding principles of case management. Continuity of Care Services are provided to the client from the first encounter through to the termination of the case. Refers to the comprehensive services from therapeutic intervention, support services within the environment, family system, and others

9. Equal Access to Services Means that everyone in need of assistance has the same opportunity to approach, apply for, and use case management Quality of Service Means effective and efficien t service delivery Commitments, respect and accountability Advocacy Within the case management process an act representing the interest of the client and teaching the client to advocate herself .

10. The whole Person Recognizes that they work with the whole person acknowledgement the many human dimensions to be considered in human service delivery, from psychological, medical, financial, educational and others Client Empowerment In the case management process means respecting client as individuals, building on their strengths and interest, placing them in partnership role and moving them toward self-sufficiency.

11. A process based on a trusting and enabling client-social worker relationship. Utilizes the social dual focus of understanding the person in the environment in working with populations at risk. Aims to ensure a continuum of care to clients with complex, multiple problems and disabilities. Attempts to intervene clinically to ameliorate the emotional problem accompanying illness or loss of function. Key Features of Social Work Case Management Practice

12. Utilizes the social work skills in brokering and advocacy to service delivery. Targets clients requiring a range of community-based or long-term care services, encompassing economic, health/medical, social/, and personal care. Aims to provide services in the least restrictive environment. Requires the use of assessment of the client’s functional capacity and support network in determining the level of care. Affirms the traditional social work values of self-determination and the worth and dignity of the individual and the concept of mutual responsibility. Key Features of Social Work Case Management Practice…

13. Continuity of services Planfulness (i.e., rational, informed decision making) in designing and executing a treatment package Coordination among all providers of services Effective involvement of clients Timeliness in moving clients through the process Maintenance of an informative and useful case record A good case management implies:

14. Case Management (As a Practice and as a Process)

15. A network of formal resources and services that could assist the client in problem-solving and decision making Client’s access to the goals and resources of the agency in which the case manager works Assessment of client’s strengths and needs, emphasis on strengths rather than problems Development of a case plan—use of basic steps in goal planning/ problem solving process Client-agency contract Designing an individualized service network and natural helping network Implementation of case plan and mobilization of client’s network Monitoring delivery of services under case plan; modification of case plan when necessary Evaluation (effectiveness of activities) Termination (inform client of the re-entry into the system and discussion of progress) Follow-up FUNCTIONS OF CASE MANAGEMENT

16. CASE MANAGEMENT PROCESS Access to agency Outreach Referral INTAKE ASSESSMENT Psychological Social Medical GOAL SETING Short-term Long-term Intervention Planning Resource identification & Indexing LINKING CLIENTS FORMAL— to agencies LINKING CLIENTS INFORMAL—to families, etc. MONITORING REASSESSMENT OUTCOME EVALUATION (discharge) Interagency coordination Interagency coordination counseling therapy advocacy

17. Channeling Clients Access to the agency— Through referrals Through outreach Walk in Case Management Functions/ Process

18. Intake Components of intake — From the worker’s standpoint: The earliest contact with the client; process of becoming acquainted Obtaining basic information about the client Composing a case history—to trace previous manifestations of the client’s difficulty and past services provided Clarification of the presenting problem Determination of eligibility and appropriateness to receive services offered by the agency From the client’s standpoint: Decision to accept and/ or receive help

19. Engagement/Initial Contact/Intake Establish communi-cation: process one individual conveys information – intention-ally or unintentionally – to another ; verbal & non-verbal Establish a professional client-worker relationship: Engagement/Initial Contact/Intake : building relationships at initial contact; gathering initial information on problem presented

20. Relationship Building at Intake Personal warmth – SW responds to clients in ways that help them to feel safe and accepted. Genuineness: & Caring -- SW is real & speaks from the heart Trust – client experiences the SW as truthful, dependable & competent Objectivity – being unbiased & able to appreciate differing points of view Unconditional positive regard : views client as having inherent worth & treats him/her with respect regardless of what the client may have done in the past or how he/she behaves

21. Communication Skills Non-verbal communi-cation: -Eye contact -Gestures of greeting -Personal space -Body positioning -Facial expressions -Touch -Arm & hand movement -Tone of voice -Dress & appearance Verbal communication skills: facilitate inter-personal helping &/or facilitate the exchange of information within an agency, between & among agencies & professionals

22. Preparing for the interview Planning for the interview read case notes; prepare a checklist of issues identify purpose/s of interview Creating a rapport and establishing a worker-client relationship Welcoming skills - informal opening conversations (social chat)

23. The initial/intake interview Beginning Phase Establishes a client – worker relationship Explore/get information on the problems that led to the client’s seeking for assistance. Establish a situation in which the client feels at ease and comfortable enough to express him/herself and to tell his/her story. Take steps to have privacy during the interview and assure the client of the confidential nature of any shared information with the agency.

24. Phases of the interview B. The Middle Phase Deepening of the relationship through Sharing/gathering of information about client’s problems, Assessing her strengths and resources, Clarifying available services both by agency & other agencies Initial actions to be undertaken such as provision of requested service or referral to another agency, if appropriate. Intake/information forms/referral forms maybe accomplished during this time with the client’s participation.

25. Phases of the interview C. The Closure Phase Focuses on a summary of what has taken place and agreement/s on what are the follow – up actions. The client may decide not to pursue her application for service. If both the client and the social worker agree to continue, then they identify the next steps they have to undertake such as a home visit, collateral information, another interview, etc.  

26. A few tips in interviewing Let the client tell his/her own story. Ask open questions. Ask close questions to gather basic information. Gather only data directly related to the identified problem. Taking notes during the interview. Listen to verbal messages and observe non-verbal behaviours . Deal with silence. Be alert to what is going on in the interview.

27. Problem identification Psycho-social/ case history Demographic information Determine prior treatment activities Determine medication use Initiate treatment planning Determine mental functioning Orientation to treatment program Determine agency appropriateness Determine financial capability Social security insurances Determine drug/ alcohol abuse level Determine physical/ sexual abuse experience Some Intake Activities of Case Managers

28. Name Living arrangements Referral source Age, sex, marital or civil status Ethnicity Religion Family members and their location Education Work history Medical history Financial information Presenting problem and precipitating event Previous service provision Emergencies contacts Behavior in the interview Compiling a Data Base:

29. Early Steps Determine whether client has come to the right place for help Establish eligibility; review agency’s criteria for service with client and clarify eligibility Construct a data base Case history write up Practice Guidelines for Intake

30. Developing Problem Statements : A common difficulty—the tendency to confuse underlying cause of the problem with the manifesting problem or symptom Example: Memory impairment (cause) Versus Forgets to pay bills (problem/ symptom) Another difficulty in developing problem statements---not describing the problem in enough specific detail Example: Forgets to pay bills versus “for the past 4 months, Mrs. P has consistently forgotten to pay her rent bill due to short-term memory impairment of approximately 4 to 6 months duration. This has resulted in an eviction notice dated Sept. 4, 2006”. Note that this problem statement may be too inclusive—a better way to state the problem may be: “Failure to pay rent due to memory impairment has resulted in an eviction notice dated Sept. 4 2006

31. PROBLEM IDENTIFICATION & DEFINITION Immediate Problem is about w/c the client is most concerned, that w/c is causing the current difficulty, & in terms of w/c he perceives his needs Underlying Problem refers to the over-all situation that created & tends to perpetuate the immediate problem Working Problem refers to those contributory factors that stand in the way of both remedy & prevention w/c must be dealt with if change is to take place. In identifying problem, care should be taken to focus on the target problem, that which the worker & the client agree to work on, considering the socio-economic situation of the client, & the resources available, both the client’s and the external ones.

32. Make it sufficiently detailed Write it out Avoid fuzzy or global statements Include the cause if it is known (remember to separate the problem, the immediate, symptomatic difficulty, from the underlying cause) Strategies for developing problem statements include:

33. Exercise: Identifying Immediate, Underlying, and Working Problems She is worried she could not provide for her child: need for child ’ s medical check-up, buy milk for her baby (immediate ); jobless (underlying ) and has no other source of support (underlying ); She does not have anybody to turn to for their daily subsistence ( underlying) ; her live-in partner abandoned her ( underlying ); partner ’ s family with whom she used to live refused to accept her back underlying ). She is thinking of giving up her baby for adoption; expressed she does not want to give up her baby but she feels she has no choice (working problem ).

34. Assessment is the investigation & determi-nation of variables affecting an identified problem/issue as viewed from the micro, mezzo & macro perspectives. Assessment : gathering more information about the problem; analyzing, evaluating the nature, causes, extent of the problem and the resources strengths of the client which are the bases on how to proceed with the solution of problem. : 3. Data Gathering and Assessment

35. Assessment Strengths –based Assessment : -identifies problems & recognizes strengths; -take into considera - tion human diversity e.g. marital status, family structure, etx . -consider mezzo & macro levels Traditional Assessment involves presenting problem, problem & personal & family history, economic & education, summary & treatment recommendations

36. PRACTICE FRAMEWORK

37. BIO-PSYCHOSOCIAL –SPIRITUAL Persons and populations are viewed holistically when the focus is on: The total person and the interdependent dimensions of body, spirit, mind, and feelings b) The person nested within and transacting with the environment

38. Social systems perspective: a philosophical viewpoint on the relationship of persons with their social environment. A social system is composed of persons or groups of persons who interact and mutually influence each other’s behavior. A social system is a bounded by a set of interrelated activities that together constitute a single entity. Social Systems Theory Conceptual model for SW practice

39. Micro level, where the focus is on the individual client’ s personality, motivation, feelings and other personal characteristics Meso level, where the focus is on the context immediately surrounding the client e.g. family, church/peer group Macro level, where the focus is on the larger society ’s characteristics & the way the client experiences these or the way these are brought to bear on the client’s situation e.g. political system, educational system, the economy, etc. Ecological Framework

40. Life Span Perspective Assumes that growth occurs: At every period of life (from conception to old age) That there is continuity & change That the whole person must be understood & the meaning of a given behavior pattern or change must be interpreted in the light of significant physical & social environment in which it occurs.

41. Personality Theories & Deviation in Human Behavior Freud’s psychosexual development Erickson’s psychosocial stages of development: 8 stages Maslow’s theory of motivation & hierarchy of needs Deviation on human behavior Personality disorders Psychiatric disorders

42. Strengths Perspective ( Saleeby 1997) Major principles: Every individual, family, community has strengths, assets and resources; trauma & abuse, illness & struggles may be devastating but they maybe opportunities for growth & source of challenge and opportunities; An approach that focuses on client’s strengths, abilities & positive qualities instead of problems, defects, etc.

43. Resilience & Empowerment Empowerment : people are capable of making their own choices & decisions to resolve their own difficult life situations & contribute to the well being of society. Resilience : capacity to withstand, to bounce back, recover or even grow from negative experiences.

44. Critical Thinking:Definition (Kersting, Robert,2008) Critical thinking & evidence-based practice Critical thinking – a process used by social workers to determine which if any sets of beliefs about a given issue warrant our using these beliefs in practice…when we do not find absolute answers.

45. To facilitate assessment, a variety of standardized instruments are readily available To gauge psychological and emotional deficits and provides uniform nomenclature, categories, and procedures across mental health professions (also referred to as clinical measures) Importance of Assessment Tools

46. Genogram The genogram is similar to a family tree but more detailed. It includes basic information the members of client’s family across generations (sex, civil status), the quality of relationships (close, hostile, cut off), and other circumstances (experience of abuse, gender identity, history of alcoholism and drug addiction). These information are represented by the lines and symbols used for each member in the family tree. Assessment Tools

47. Maternal grandmother Mother -33 years old Father – 39 years old Ian - 9 3 rd high school MARRIED 2000 *The mother a Day care worker, *died during Typhoon Yolanda The two lines represent the closeness Regina to her aunts and her father of supportive and close to her The broken line means that they live in the same house . Regina – 15 years old (3 rd yr. HS Maternal auntie Maternal auntie *died during Typhoon Yolanda *died during Typhoon Yolanda Paternal grandmother Paternal grandfather Maternal grandfather GENOGRAM OF REGINA ’ S FAMILY

48. Eco-Map The ecomap shows the client’s social context. The quality of the relationship of the client to people and institutions are represented by lines and its distance in relation to the client in the map.

49. Stepfather Mother Angeline 15 yrs .old Family Employer NGO Family Friend LSWDO Centre HEALTH CENTRE The broken line represents that the child had stopped schooling for many years The two arrow line means she is was able to back schooling The family is very supportive but due to poverty they might accept the settlement money being offered by the perpetrators family and withdraw from the case The case is filed already but the Angeline and her family is still afraid because the perpetrator remains at-large. They also have doubts that he could be brought to justice given his influence in the community The two arrow line means she was able to have a regular checkups in the centre, because she is a 4Ps beneficiary. The NGO is very supportive especially on the livelihood. project The family friend helped Angeline escape her abusive employer and also told her other about the sexual abuse. Angeline admitted to the center for protective custody LSWDO provides the biopsychosocial intervention to Angeline The perpetrator. The employer has close connection to their family because her mother had been working for them for 30 years before Angeline took her place. Angeline is afraid that he might harm her again because is a influential man in the community. School Legal Police And Prosecutor LSWDO ECOMAP OF ANGELINE Case category: sexual abuse in relation To R.A. 7610

50. Risk Level Description Time Frame High Risk   Child needs urgent medical attention, is likely to be seriously harmed or injured, Subjected to immediate and on-going sexual abuse, exploitation Trafficked or died Traumatized children Unaccompanied children Intervention should be done ideally before leaving the child to proper agencies like LSWDO, CSWDO or DSWDO Medium Risk Child is likely to suffer some degree of harm but no evidence that the child is at risk of imminent serious injury or death Intervention should be done within 72 hours Low Risk . The home is safe for children. But are concerns about the potential for a child to be at risk if services are not provided to prevent the child for protective intervention. Intervention to prevent the need for protective Risk Assessment

51. 4. Intervention / Case Planning The core of case management function—the worker addresses the client’s problems by formulating a structured plan for achieving both short-and long-term goals Encompasses both (psychologically-oriented) treatment planning and (situation-oriented) service planning Intervention plan—a design of action that incorporates strategic elements (how best to achieve goals) and procedural elements (how strategy will be enacted i.e. tasks to be carried out) Specificity of service plan—a useful therapeutic tool and planning tool for client involvement; this involvement is the beginning step for client empowerment In this stage case conferencing is necessary

52. Case Conferencing Multi-disciplinary Case Conference is a forum by which professionals directly involved with the case and may share their professional knowledge, information and concern on the case.      

53. The Case Conference may analyze risk and recommend the responsibility for action to be taken in relation to the welfare planning of the case ,his/her family, respecting the statutory obligation of individual members . The Conference may consider the following: The level of risk; Welfare planning to protect the person , such as, to return the person to live with family/parents/guardian to live at home of relatives removal from home and be placed at foster home, children’s home etc.     The objectives of the case conference are:

54. Clearly defined goals High potential for attainment Specific actions Realistic time frames Potential barriers Components of Intervention Plan Case Management Function: (6) Intervention Planning

55. Diagram of Intervention Planning and Resource Identification Intervention Planning Selecting a Strategy Selecting tactics And techniques Specifying Procedural Steps Case Management Function: (6) Intervention Planning Treatment Planning Service Planning Basic Approach to Goal Attainment Modeling Role Playing Information Input Preparing the Client Enlisting Relevant Others Obtaining Materials And facilities Initiating the Strategy Tracking progress Formal Supports Informal Supports Resource Identification G O A L

56. 5. Implementation of Intervention Plan It is the action phase; social worker, client & others concerned parties take the steps & complete the tasks that will implement the plan they have formulated which will bring about the desired outcome. Monitoring is keeping track of what is happening & continuously evaluate the progress of the service provision or intervention.

57. Implementation: Tools in Service Provision Task- centered counseling Total family approach Generalist social work practice Capacity building of families: Family Camp, Family Development Sessions and others Team approach in Case Management

58. Services/Interventions Education & health services Family development/enrichment sessions livelihood/income-generating projects Family counseling/therapy/conferencing Psychosocial interventions Legal assistance

59. HEALING “wellness” TEACHING “ Healing/ Teaching Interface Therapeutic Activity Services Psycho-educational Services Teaching Services Educational Caring Services Living Unit Services Support Services Administrative Services Healing/Caring/Teaching Interface Bio-psycho-social services Healing Services Psychiatric Services Psychological Services Social work Pastoral/Religious Child/Youth/ Family Caring /Teaching Interface Bio-educational services CARING HEALING AND TEACHING FRAMEWORK “CARING “ Security and Safety”

60. The purpose of monitoring---is to keep current on whether existing arrangements are satisfactory for the client Appraise the suitability of provisions made to sustain the client in the community Includes a reassessment component to determine whether changes are necessary Systematic contact wit agency providers and with informal support is at the heart of monitoring Strategies: telephoning the contacts, visitations, phoning clients, having the support individuals or clients phone the worker, Requires a definite and substantive allotment of time , flexibility in working hours 7. Monitoring Case Management Function

61. Recurrent appraisal of the situation is a necessity May be formal or informal, periodic or on-going, and at various intervals of frequency Clients should be direct and active participant in the process Some hindrances to effective reassessment: Ill-defined goals Client’s deliberate efforts to withhold information and cooperate Irregular and uncertain participation of client in the process Lack of support from linkages 8. Reassessment Case Management Function

62. Evaluation—carries the sense of termination or discharge Occurs when a client is ready to operate in a fully independent way without further service 10. Outcome Evaluation (for Termination)

63. This the integral part of continuing relationship. 11. Follow-up or after care

64. ROLES, TASKS, FUNCTIONS OF CASE MANAGEMENT… ROLES FUNCTIONS TASKS CASEWORKER Assessment Care planning Implementation Monitoring Reassessment Evaluation Arrange meetings Provide safe place Keep conduct reviews Write assessments Collaborate BROKER Outreach Link with resources Resource acquisition Make contacts Plan meetings Obtain directories

65. ROLES, TASKS, FUNCTIONS OF CASE MANAGEMENT… ROLES FUNCTIONS TASKS ADVOCATE Promote fairness Tell clients their rights Support ethics Testify in courts Write letters Change procedures EDUCATOR Increase client’s awareness Increase staff’s awareness Increase awareness in community Conduct enrichment classes Conduct in-service training Conduct community meetings COUNSELOR Provide crisis stabilization Provide brief therapy Assist in networking Call clients Empower clients Hold family sessions CONSULTANT Help client solve problems Help agency solve problems Help community agencies cooperate Assist clients in examining alternatives Assist staff in examining alternatives Meet with agency staff

66. ROLES, TASKS, FUNCTIONS OF CASE MANAGEMENT… ROLES FUNCTIONS TASKS COMMUNITY ORGANIZER Identify community resource Help mobilize community resources Help acquire community resources Hold community meetings Research community resources Write resource directory GATEKEEPER Assess client’s needs Determine who is eligible for service Refer clients out Track cases Conduct assessment interviews Review case files

67. References : Social Casework: the Journal of Contemporary Social Work , 1987 Family Services America Basic Training Interventions for Street Children Services Providers Generalist Case Management by Mariane Woodside Tricia McClam , Thomson Brook/Cole,2003 Manual on Gender Responsive Case Management, DSWD & UNFPA