Sarah Himmelheber, LCSW

In today’s discussion...
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Defining case management
Reviewing models of case management
Process of rapport building
Developing case plans
Working the case
Successfully partnering with clients
Discharge process
Confidentiality issues
Supervision
Self-care strategies
Case examples

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Type of service to clients
 coordinating and therapeutic function for clients receiving services
Defining the case
Goals of the working relationship
Objectives and interventions
Timeline/ boundaries of the relationship

Models of Case Management
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The Broker
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The primary function is to link the client to needed, usually external, resources. This model limits the role of the case manager/ client relationship. The main task is to identify what the client needs and then to facilitate the referral so the client is connected to the service provider.
The Rehabilitationist
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The Rehabilitation model identifies strengths and deficits of the client and attempts to remedy a wide array of problems and barriers that may include medical, mental health, vocational and housing issues. The case manager’s role is to assist the client in overcoming barriers that prevent independent functioning in the community. When barriers have been addressed, the relationship between the case manager and the client is reduced or terminated.

Models of Case Management
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The Full Support
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By using an integrated team of providers including case managers, outreach workers, rehabilitation specialists, and medical professionals, this model relies less on outside referrals and provides the client with in-house service delivery. In this model the case manager not only coordinates care but also provides clinical support and life skills training.
“Full Support” models have been effective in reducing inpatient psychiatric hospitalizations and are generally used with clients who have long-term care needs. The relationship between client and the treatment team is open-ended and ongoing rather than limited to specific goals (Draine, 1997). Determining when to terminate services can be challenging when using this model.

Models of Case Management
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The Strengths Model
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As implied in the name, the Strengths model avoids assessing client needs in terms of pathology or deficits. The focus is exclusively on strengths. Self-determination of the client and assisting with client-specific goals are the task of the case manager. This model places strong emphasis on case managerclient relationships. The efficacy of this model relies on intensive outreach and follow up (Standard, 1999, Rapp, 1998).
Fliesher, P. and Henrickson, M. (2002). Towards a Typology of Case
Management.
Retrieved from: http://www.hawaii.edu/hivandaids/Towards%20a%20Typology%20o f%20Case%20Management.pdf

Building the Trust Relationship
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Living social work values
Using active listening skills
Task-centered trust development

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Service
Social justice
Dignity and worth of the person
Importance of human relationships
Integrity
Competence

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Reflecting
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Paraphrasing
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Clarifying
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Summarizing

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Partner up, with each person playing the client once
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Refer to active listening scenario handout
Comments?
Limitations to active listening
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Serves as a starting point

Task-Centered
Trust Development
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Method for building relationships with apprehensive clients
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Cleaning
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Food inventory/ meal planning/ grocery shopping
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Public transportation assistance
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Side-by-side linking
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Community-based or office-based

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Example cases?
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Realism
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In goal formulation
The role of you/ your agency
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Resources

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Intake process
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Review example form
Goal and objective formulation
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Keeping a time frame
Schedule towards the goal
Interventions: what you can do
Dealing with challenges

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Knowing your local resources
Coalitions
Staff time to attend meetings
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Organizational strategies
Post-meeting notes
Scheduled office time
Jointly monitoring and reviewing goals
Celebrating progress

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Idea of progressive client control
May be related to length of case plan
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Boundaries
What type are appropriate?
Strategies for handling challenges
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Avoiding us/them
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Modeling
Responsibility
Acceptance
Understanding
Expectations for the working relationship

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Strategies for improving the relationship
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Back to assessment
Highlighting changes
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The importance of documentation

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May vary by service provider
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Connected to goals
Start from the first session
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What ought to be included
Medicare defines discharge
planning this way: “A process used to decide what a patient needs for a smooth move from one level of care to another.”
Review example form

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Within agencies
Employees & volunteers
Review example volunteer form
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With other agencies
Review example Release of
Information form

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Formal versus informal
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What to cover

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Being mindful of stress
- Signs of stress?
Strategies for stress reduction ...
How to ask for a break...
"We learned that it was not the clients themselves who were causing the major portion of the stress, but the
work environment itself," said Tracy Whitaker, director of the Center. "The primary stress social workers face is that they don't have enough time to do their jobs, and related to that, have too heavy a workload. This was true across practice areas.” http://www.naswdc.org/pubs/news/2008/11/self-care.asp

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Contact information:
Sarah Himmelheber, LCSW sarah.himmelheber@gmail.com