Case Management 101: The Basics

 

Case management is one of the most vital services in the healthcare field. Case managers are responsible for coordinating a variety of services for clients and patients. They are involved in just about every aspect of patient care from the intake process to discharge and subsequent outpatient services.

 

Assessment

Case managers are often responsible for the initial intake and assessment process. They complete a variety of assessments to determine eligibility for services. The assessment process also allows both the client and the case manager to establish what services are most appropriate for the situation. Some of these assessments include:

• Personal Profile/Social History Assessments: These assessments gather background information that can help with establishing treatment goals. The information gathered typically includes education, past treatment, family living situation, school history, behavioral/criminal history, and general preferences.
• Functional Assessments: Functional assessments help the case manager determine specific areas of need. These assessments measure abilities in areas such as healthcare, communication, mobility, task learning skills, behavior, and community living skills. These assessments help determine what services need to be put in place and what areas need the most support.
• Health Assessments: Health assessments collect information on any health issues that may impact services. These assessments gather information on current health issues and family history of any health conditions. Health assessments also collect information on all current healthcare providers such as primary care physicians, dentists, psychiatrists, neurologists, therapists, etc. 

Treatment Plans

·        After the case manager has completed all of the necessary assessments, a treatment plan is developed to help the client achieve their goals. Treatment plans are sometimes referred to as Individual Service Plans (ISP), Consumer Service Plans (CSP), and Person-Centered Plans (PCP). Treatment plans are usually updated annually or as needs change. Case managers are responsible for assisting their clients with achieving the goals established on the treatment plan. Case managers assist people with achieving their goals through three basic functions: Linking, Monitoring, and Coordinating Services.

 

Linking/Referral

Case managers are responsible for linking clients to resources in the community. There is no limit to the referral services that case managers can provide. They provide assistance with obtaining housing, vocational placement, counseling services, physical/occupational therapy, and medication management. Case managers also provide referral services at discharge. This could include transferring services to another city or another state.

Monitoring

Case managers are responsible for monitoring all aspects of client services. Case managers ensure that their clients have proper housing, medical care, and any other services they may need. Case managers serve as the first line in the oversight and regulation of services. Case managers make frequent home visits as well as visits to day support and work programs to ensure that services are delivered appropriately. Case managers also address any problems or concerns that clients may have with services and resolve them before they escalate to greater problems.

 

Case managers, like most human services professionals, are “mandated reporters.” This means that if they see evidence or suspect any abuse or neglect, they have to report it to Adult or Child Protective Services. This is one of the reasons why the monitoring aspect of the case manager’s job is so important. Case managers are responsible for the overall care of our most vulnerable population. A case manager’s clientele can consist of the very young, elderly, or individuals who cannot communicate when something is wrong. It’s important that case managers be good observers and recognize when there is a health and safety concern.

 

Coordinating Services

Case managers coordinate services that need to be put in place. Service coordination is basically all of the activities and techniques case managers use to put services in place. This involves scheduling various meetings, therapy appointments, etc. It also involves making contact with various providers in order to get the appropriate services in place. Service coordination is also an important function of a case manager. It sometimes requires constant follow-up to ensure that appointments with doctors, therapists, social services, social security, etc. Coordination is especially important if clients are on probation and need to meet with probation officers on a monthly basis. Coordination may consist of providing transportation or arranging transportation to ensure that appointments are kept.

 

Education/Experience

Case managers usually have at least a four-year degree. Some have graduate degrees but this is not a necessity. The degree should be closely related to the type of case management. For example, mental health case management would be best suited for someone with a degree in psychology and a case manager in a hospital would be someone with a nursing degree or social work degree. Case managers usually have at least a year of experience in case management or in a related position. In addition to education and experience, case managers must also have the following skills to be successful:

 

·        Communication Skills: Case managers communicate with all kinds of people every day. Case managers have to have the ability to communicate with people from various backgrounds. They also have to be able to communicate with other health providers to coordinate services. Written communication skills are needed for documentation and completing various reports. Oral communication skills are needed to conduct meetings, presentations, and for general interaction with clients and other health professionals.

·        Organization Skills: Case managers have to be organized to manage high caseloads. Time management and the ability to prioritize activities are critical. 

·        Customer Service Skills: Case managers need to have excellent customer service skills. This is particularly important when working with clientele that may be in distress or have some mental health challenges.

 Interviewing Skills: Interviewing skills are important when completing assessments. Asking the right questions will allow the case manager to complete a more thorough assessment of client needs.

 Conflict Resolution Skills: Case managers spend a great deal of time resolving problems between clients and service providers. Conflict resolution skills are critical in resolving minor issues before they spiral into a major crisis situation.

 

Types of Case Management

·        Mental Health

·        Intellectual Disabilities

·        Early Intervention

·        School-Based

·        Substance Abuse

·        Foster Care (Children and Adult)

·        Medical/Hospital/Hospice

 

The role of the case manager will continue to expand as more people are in need of services. Institutions are being downsized in many states, and more people will need to be served in the community. This also means that more people will need help navigating an increasingly complicated disability system. Case managers will continue to be at the forefront when it comes to ensuring people get the help they need.