Community Case Management
Using a systems approach to serving
individuals with complex needs
Identifying Complex Needs
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Human Service Agencies
Social Services
911/211 Systems
Mental Health/Substance Abuse Systems
Schools
Hospital Systems
Courts & Correctional Systems
Community Support Agencies
Law Enforcement
Family & Friends
Community at Large
Etc, etc, etc
System of Care
• A valued-based approach/philosophy for
serving people with complex needs that is
client driven, community-based, and culturally
and linguistically competent.
Case Management
• Case management is a collaborative service
that provides assessment, planning,
facilitation and advocacy for options and
services to meet an individual’s holistic needs
through communication and available
resources to promote quality cost-effective
outcomes.
Historical Overview
Schools
Corrections
Mental Health
Child,
Adult
and/or
Family
Human Services
Court Services
Social Services
Alcohol & Drug
Historical Overview
Schools
Corrections
Mental Health
Child,
Adult
and/or
Family
Human Services
Court Services
Social Services
Alcohol & Drug
SOC Approach
Schools
Corrections
Mental Health
Court Services
Informal
Community
Supports
Child,
Adult
and/or
Family
Human Services
Social Services
Alcohol & Drug
Pennington County Health and Human Services
Changing Lives….. Changing Courses…..
A diversion program empowering people to make positive changes!
Community Resources Committed to Rebound Members
Goodwill
Industries
Sioux San
Hospital
Social
Security
Pennington
County
Housing
Cornerstone
Rescue
Mission
John T.
Vucurevich
FoundationCommunity
Food Bank of
the Black
Hills
Department
of Social
Services
Community
Transitions
City County
Alcohol and
Drug
Programs
Rapid City
Transit
States
Attorneys
Office
Church
Response
REBOUND
Family
Practice
Residency
Public
Defenders
Office
Community
Health Center
of the Black
Hills
7th Judicial
Circuit
Court
Western
Resources for
the Disabled
Court
Services
Career
Learning
Center
US
Probation
South
Dakota Dept
of Labor
Behavior
Management
Systems
Salvation
Army
Rapid City ReEntry
Program
Community
Action
Program
Parole
Services
Pennington County Health and Human Services
Rebound
Community Referrals to Rebound Program
12/01/2006 to 04/30/2012
Probation
11
Meth Program
11
Parole
36
Adams Street Facility
121
PC Jail, 235
Friend
2
Mission
2
Family
2
CCADP/Detox
119
Penn. Co. Housing
1
Sioux San
1
Self
56
Court Services
58
US Probation
11
•
Veterans Service Office
1
Dept. of Social Services
1
Public Defender
18
Community Alternatives of BH
4 Crimes Unit
RCPD Street
2
RC Regional West
3
Crisis Care Center
7
Behavior Management
Dept. of Labor
6
1
Intensive case management provides the tool in reducing the barriers clients often face when obtaining services.
• Since 2006, Rebound caseworkers have made 2,948 physical contacts with 709 members in the program.
Pennington County Health and Human Services
Rebound
Rebound Referrals to the Community
01/01/2011 to 04/30/2012
Career Learning Center,
Community Health
Center, Residency
Clinic, Church
Response, Community
Transistions,
Cornerstone Mission &
Lions Club, HUD,
Shelter Plus, RC
Schools, DMV, Hope
Center, New Start
64
Pennington Co. Housing
37
Social Security
24
Sioux San
19
Behavior Management
Systems
89
John T. Vucurevich
86
Pennington Co. Heath and
Human Services
116
Community Action Program
130
Food Bank
69
Dept. of Labor
39
•
CCADP (Detox)
14
Salvation Army & Goodwill
75
Dept. of Social Services
45
• Barriers that once complicated members success have been resolved.
Multiple agencies have come together to assist in the success of these individuals.
John T. Vucurevich
Foundation
2011Grant Report
Pennington County Health & Human Services
October 12, 2011
Pennington County Health and Human Services
John T. Vucurevich Foundation Grant
Referrals From Community Agencies
TOTAL: 310 Referrals
01/01/2011 to 12/31/2011
VA-Vash, 12
US Probation, 3
WAVI, 4
VOA, 2
Dept of Labor, 4
School System, 4
Hope Center, 2
LSS, 1
Utility Co, 1
VA, 2
Self, 70
Church Response, 4
Salvation Army, 22
Unknown, 1
Community
Health
Center, 2
211, 25
Rebound, 50
BMS, 4
CAP, 3
CCADP Detox, 4
Probation, 1
Political Office, 1
CCADP Treatment, 1
PCH, 4
Parole, 3
CCC, 20
Landlord, 3
HHS, 6
CSRM, 4
Goodwill, 1
Doctor, 3
Family, 24
Friend, 12
DSS, 5
Church, 2
Pennington County Health and Human Services
John T. Vucurevich Foundation Grant
Financial Assistance Provided on Behalf of Community Referrals Received
01/01/2011 to 12/31/2011
Dept of Labor, $305.31
Church Response, $356.76
Goodwill, $240.00
Hope Center,
$270.00
Parole, $117.93
PCH, $990.00
WAVI, $525.83
Friend, $1,766.88
Utility Co, $100.00
VA, $25.00
VA-Vash, $1,331.44
US Probation, $35.64
Probation, $157.36
$35,000.00 Total Expended
211, $2,570.45
BMS, $407.94
CAP, $626.50
CCADP-Detox, $445.00
CCADP-Treatment, $20.00
CCC, $1,619.03
Rebound, $5,093.07
Landlord, $464.00
School System,
$860.00
HHS, $462.59
CHCBH, $60.64
CSRM, $805.37
Self, $6,967.23
Doctor, $130.54
DSS, $462.77
VOA, $289.99
Unknown, $20.00
Political Office, $1,653.45
Salvation Army, $2,259.12
Family, $3,532.61
Pennington County Health and Human Services
John T. Vucurevich Foundation Grant
Financial Assistance by the Type of Service Provided
01/01/2011 to12/31/2011
Car Repair, $141.77
Work Tools, $420.03
Home Taxes, $1,653.45
Work Clothes, $357.58
Car Maintenance, $657.54
Meds, $78.25
Marriage Certif, $15.00
Program Fees,
$25.00
Student Buss, CCC Room,
$460.00
$300.00
$35,000.00 Total Expended
Bean Bag,$923.78 Bike Repairs, $59.94
Birth Certificate, $526.11
Client Storage, $64.00
Bus Ticket, $846.93
Bus Monthly, $400.00
Clothing, $250.87
Dr Copay, $45.00
ID/Liscense, $480.00
Education Exps, $107.99
Bus Daily, $30.00
Household Misc,
$1,226.34
Rent Application,
$105.00
Rent,
$2,435.36
Phones ,
$79.95
Utility Past Due, $3,566.52
Utility Fees, $506.65
Home Deposit, $15,809.00
Utility Deposit, $1,219.17
Household Appliance, $56.48
Additional Education, $190.00
Phone Minutes, $194.89
Mortgage, $360.70
Medication Copay, $1,362.21
Groceries, $10.00
Medical Supplies, $26.49 Laundry, $8.00
Pennington County Health and Human Services
John T. Vucurevich Foundation Grant
Cost Share with Client and Agency
Total: 248
01/01/2011 to 10/17/2011
Cost Share with Client; 31
Cost Share with Client
and Agency; 3
Cost Share with Agency;
17
No Cost Share; 197
Crisis Care Center
Transitional Case Management
Client Referrals
01/01/2011 to 04/30/2012
30
Total CCC Referrals
HHS/TCM New Clients
HHS/TCM Ongoing Previous Referrals
28
25
25
22
21
19
20
17
16
16 16
12
10
8
6
7
12
12
18
17
16
15
20
17
13
13
12
11
11 11 11
7
8
7
9
5
0
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan-12
Feb-12
Mar-12
12-Apr
• From January 1, 2011 through April 30, 2012, a total of 219 new individuals were referred to HHS/transitional case management
(TCM) for services.
• HHS/TCM now tracks ongoing previous referrals receiving case management services from HHS/TCM. In April 2012 HHS/TCM
worked with 9 ongoing CCC clients.
Crisis Care Center
Transitional Case Management
Referrals to Community Agencies
Total: 165
01/01/2011 to 04/30/2012
Job Corps
1
Goodwill
2
Food Bank
16
Dept. of Labor
4
Church Response
1
Dept. of Social Services
19
Lions Club
1
Southern Hills Alcohol/Drug
(SHAD)
1
Mission
20
Salvation Army
11
Community Health
13
Sioux San
7
CCADP/Detox
7
Rebound
9
Lutheran Social Services
4
Behavior Management
32
Social Security
4
Volunteers of America
3
Western Resources for
Disabled
1
Catholic Social Services
2
BH Workshop
2
Penn. Co. Housing
1
Hope Center
2
WAVI
2
As of April 30, 2012 transitional case management staff have coordinated services with 24 community
agencies. A total of 165 referrals have been made to these agencies.
Crisis Care Center
Transitional Case Management
Coordinated/Provided Services
Total: 230
01/01/2011 to 04/30/2012
Medical
3
Social Security
4
Transportation
30
Medicaid/Medicare
4
Clothing
9
Medications/Med Mgt.
30
Counseling
31
Housing
32
Case Mgmt
11
Household
3
Glasses
1
Emergency Housing
24
Education
1
Food (voucher, pantry,
SNAP)
36
Drivers License/ID
3
Rent
1
Employment
4
Phone Service
3
As of April 30, 2012 Health & Human Services Transitional Case Management staff, as well as varied
community agencies, have coordinated and provided a total of 230 services for Crisis Care Clients.
Crisis Care Center
Transitional Case Management
Caseworker Activity
01/01/2011 to 4/30/2012
Total: 1,049
Agency Transports
181
Physical Client Contacts
445
Phone Calls
423
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Physical client contacts refer to actual face-to-face contact with a CCC client.
Agency transport refers to transports given to a CCC client by Transitional Case Management with a
company vehicle for the purposes of getting to appointments, obtaining food, shelter, clothing, etc.
Phone calls made by Transitional Case Management to both the CCC client and community agencies on
the clients behalf.
Pennington County Health and Human Services
Rebound, JTV Grant and Crisis Care Transitional Case Management
Total Referrals IN FROM Community Agencies
01/2011 to 02/29/2012
Meth Program
11
Parole
37
PC Jail
230
Probation
11
Total: 879
Sioux San Public Defender
1
18
Penn. Co. Housing
2
Community Alternatives
of BH 4
Adams Street Facility
121
RC Regional West
3
Crisis Care Center
Behavior 20
Management
9
Dept. of Social Services
2
Mission
5
Self
54
Friend
7
Family
23
CCADP/Detox
123
Community
HHS Health
Landlord, Political Office,
2
Church
Goodwill, Church, CAP, Doctor, 6
Response
Unknown
2
8
Court Services, 58
211
24
CSRM
3
US Probation
School
14
System
3
Salvation Army
19
Rebound
45
VA-Vash
12
VOA
2
Pennington County Health and Human Services
Rebound, JTV Grant and Crisis Care Transitional Case Management
Total PCHHS Referrals OUT TO Community Agencies
Total: 1,137
01/01/2011 to 02/29/2012
Salvation Army & Goodwill
103
Dept. of Labor
40
BH Workshop
2
Sioux San
25
Food Bank
81
Rebound
50
Behavior Management Systems
114
John T. Vucurevich
83
Social Security
26
Pennington Co.
Housing
36
Community Action Program
128
CCADP (Detox)
26
211, Career Learning Center,
Community Health Center,
Residency Clinic, Church
Response, Community
Transistions, Cornerstone
Mission & Lions Club, HUD,
Shelter Plus, RC Schools, DMV,
Hope Center, New Start, Job
Corps, SHAD, WAVI
207
Dept. of Social Services
77
Pennington Co. Heath and
Human Services
Catholic Social Services
124
2
Volunteers of America
5
Lutheran Social Services
4
• Agencies Working Together
• Motivational Interviewing
• Effective Case Managers
Creates
• Changed Lives
• Empowered Clients
• Moving to the
Steps for Getting There
• An agreed upon definition and role of
community case management.
• A forum for training new case managers and
linking new and seasoned case managers
together.
• Develop processes that result in integrated
community case service plans.
• Develop web-based software to monitor
services to individuals with complex needs.