Case Management: Definition and Responsibilities 1

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Fundamentals of Case Management Practice Skills for the Human Services

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N a N c y S u m m e r S Harrisburg Area Community College
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Fundamentals of Case Management Practice: Skills for the Human Services, Fifth edition Nancy Summers
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To my parents, whose humor and wisdom about people and relationships formed the foundation for my work with others
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iv Contents
Preface xiii
Section 1 Foundations for Best Practice in Case Management
Chapter 1 Case Management: Definition and Responsibilities 1
Introduction 1 A History of Case Management 2 Language in Social Services 2 Why We Use Case Management 3 Case Management as a Process 4 Advocacy 13 Service Coordination 13 Levels of Case Management 16 Separating Case Management from Therapy 19 Case Management in Provider Agencies 19 Managed Care and Case Management 21 Caseloads 25 Generic Case Management 26 Summary 26 Exercises I: Case Management 27 Exercises II: Decide on the Best Course of Action 30
Chapter 2 Ethics and Other Professional Responsibilities for Human Service Workers 33
Introduction 33 The Broader Ethical Concept 34 Dual Relationships 35 Boundaries 40 Value Conflicts 40 The Rights of Individuals Receiving Services 44 Confidentiality 47 Privacy 51 Health Insurance Portability and Accountability Act 52 Social Networking 55 Privileged Communication 56 When You Can Give Information 56 Diagnostic Labeling 59
Contents
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Contents v
Involuntary Commitment 60 Ethical Responsibilities 61 Protecting a Person’s Self-Esteem 62 Stealing from Clients 64 Competence 65 Responsibility to Your Colleagues and the Profession 65 Professional Responsibility 67 Summary 68 Exercises I: Ethics 69 Exercises II: Ethically, What Went Wrong? 71 Exercises III: Decide on the Best Course of Action 76 Exercises IV: What is Wrong Here? 76
Chapter 3 Applying the Ecological Model: A Theoretical Foundation for Human Services 77
Introduction 77 The Three Levels of the Ecological Model 79 The Micro Level: Looking at What the Person Brings 80 Looking at What the Context Brings 80 Why Context Is Important 81 Seeking a Balanced View of the Client 82 Developmental Transitions 86 Developing the Interventions 87 Working with the Generalist Approach 88 Macro Level Interventions Are Advocacy 88 Summary 90 Exercises I: Looking at Florence’s Problem on Three Levels 90 Exercises II: Designing Three Levels of Intervention 91
Section 2 Useful Clarifications and Attitudes
Chapter 4 Cultural Competence 95
Introduction 95 Culture and Communication 95 Your Ethical Responsibility 96 Where Are the Differences? 96 Strangers 98 Anxiety and Uncertainty 99 Thoughtless versus Thoughtful Communication 100 Dimensions of Culture 104 Obstacles to Understanding 109 Competence 111 Summary 112 Exercises I: Testing Your Cultural Competence 113
Chapter 5 Attitudes and Boundaries 117
Introduction 117 Understanding Attitudes 117 Basic Helping Attitudes 118
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vi Contents
Reality Check 123 How Clients Are Discouraged 124 A Further Understanding of Boundaries 127 Seeing Yourself and the Client as Completely Separate Individuals 127 Erecting Detrimental Boundaries 129 Transference and Countertransference 129 Summary 130 Exercises I: Demonstrating Warmth, Genuineness, and Empathy 131 Exercises II: Recognizing the Difference—Encouragement
or Discouragement 136 Exercises III: Blurred Boundaries 136
Chapter 6 Clarifying Who Owns the Problem 139
Introduction 139 Boundaries and Power 140 If the Client Owns the Problem 141 If You Own the Problem 143 If You Both Own the Problem 144 Summary 145 Exercises I: Who Owns the Problem? 145 Exercises II: Making the Strategic Decision 147
Section 3 Effective Communication
Chapter 7 Identifying Good Responses and Poor Responses 149
Introduction 149 Communication Is a Process 150 Twelve Roadblocks to Communication 151 Useful Responses 156 Summary 164 Exercises: Identifying Roadblocks 165
Chapter 8 Listening and Responding 169
Introduction 169 Defining Reflective Listening 170 Responding to Feelings 170 Responding to Content 174 Positive Reasons for Reflective Listening 176 Points to Remember 177 Summary 178 Exercises I: How Many Feelings Can You Name? 179 Exercises II: Finding the Right Feeling 179 Exercises III: Reflective Listening 180
Chapter 9 Asking Questions 187
Introduction 187 When Questions Are Important 187 Closed Questions 188 Open Questions 189
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Contents vii
Questions That Make the Other Person Feel Uncomfortable 190
A Formula for Asking Open Questions 192 Summary 195 Exercises I: What Is Wrong with These Questions? 195 Exercises II: Which Question Is Better? 197 Exercises III: Opening Closed Questions 198 Exercises IV: Try Asking Questions 200
Chapter 10 Bringing Up Difficult Issues 203
Introduction 203 Confrontation 203 Exchanging Views 204 When to Initiate an Exchange of Views 204 Using I-Messages to Initiate an Exchange of Views 207 Asking Permission to Share Ideas 213 Advocacy: Confronting Collaterals 214 On Not Becoming Overbearing 215 Follow-up 217 Summary 217 Exercises I: What Is Wrong Here? 217 Exercise II: Constructing a Better Response 219 Exercises III: Expressing Your Concern 219 Exercises IV: Expressing a Stronger Message 222
Chapter 11 Addressing and Disarming Anger 225
Introduction 225 Common Reasons for Anger 225 Why Disarming Anger Is Important 226 Avoiding the Number-One Mistake 227 Erroneous Expectations for Perfect Communication:
Another Reality Check 228 The Four-Step Process 229 What You Do Not Want to Do 231 Look for Useful Information 233 Safety in the Workplace 233 The Importance of Staff Behavior 234 Summary 235 Exercises I: Initial Responses to Anger 235 Exercises II: Practicing Disarming 236
Chapter 12 Collaborating with People for Change 239
Introduction 239 What Is Change? 239 Stages of Change 240 Understanding Ambivalence and Resistance 244 Encouragement 247 Recovery Tools 250 Communication Skills That Facilitate Change 252
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viii Contents
Trapping the Client 258 From Adversarial to Collaborative 258 Summary 262 Exercises: Helping People Change 263
Chapter 13 Case Management Principles: Optional Review 265
Introduction 265 Combining Skills and Attitudes 265 Practice 267 Exercise I 267 Exercise II 268 Exercise III 271 Exercise IV 273 Exercise V 274
Section 4 Meeting Clients and Assessing Their Strengths and Needs
Chapter 14 Documenting Initial Inquiries 277
Introduction 277 Walk-ins 278 Guidelines for Filling Out Forms 278 Steps for Filling Out the New Referral
or Inquiry Form 278 Evaluating the Client’s Motivation
and Mood 282 Steps for Preparing the Verification of Appointment Form 282 Summary 284 Exercises I: Intake of a Middle-Aged Adult 284 Exercises II: Intake of a Child 284 Exercises III: Intake of an Infirm, Older Person 285
Chapter 15 The First Interview 287
Introduction 287 Your Role 288 The Client’s Understanding 288 Preparing for the First Interview 288 Your Office 290 Meeting the Client 290 Summary 295
Chapter 16 Social Histories and Assessment Forms 297
Introduction 297 What Is a Social History? 298 Layout of the Social History 298 How to Ask What You Need to Know 299 Who Took the Social History 306 Social Histories in Other Settings 310 Writing Brief Social Histories 311
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Contents ix
Using an Assessment Form 314 Taking Social Histories on a Computer 316 Taking Social Histories in the Home 316 The Next Step 317 Summary 317 Exercises I: Practice with Social Histories 318 Exercises II: Assessment of a Middle-Aged Adult 318 Exercises III: Assessment of a Child 319 Exercises IV: Assessment of an Infirm, Older Person 320 Exercises V: Creating a File 320
Chapter 17 Using the DSM 321
Introduction 321 Is DSM Only a Mental Health Tool? 322 Cautions 322 Who Makes the Diagnosis? 323 Background Information 323 The DSM-IV-TR 327 DSM 5, the Current Diagnostic Manual 328 Making the Code Using DSM 5 330 Multiple Diagnoses 331 Other Conditions That May Be a Focus
of Clinical Attention 332 When the Diagnosis Does Not Quite Fit 332 When There Is No Number 333 Summary 333 Exercises: Using the DSM 5 334
Chapter 18 The Mental Status Examination 337
Introduction 337 Observing the Client 338 Mental Status Examination Outline 339 Summary 356 Exercises: Using the MSE Vocabulary 356
Chapter 19 Receiving and Releasing Information 359
Introduction 359 Sending for Information 359 If You Release Information 359 Directions for Using Release Forms 360 Examples of the Release Forms 362 When the Client Wants You to Release Information 363 When the Material Is Received 363 Other Issues Related to Releasing Information 365 Summary 365 Exercises I: Send for Information Related to a
Middle-Aged Adult 366 Exercises II: Send for Information Related to a Child 366 Exercises III: Send for Information Related to a Frail,
Older Person 366 Exercises IV: Maintaining Your Charts 366
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x Contents
Section 5 Developing a Plan with the Client
Chapter 20 Developing a Service Plan at the Case Management Unit 367
Introduction 367 Involving the Client and the Family 368 Using the Assessment 369 Creating the Treatment or Service Plan 372 How to Identify the Client’s Strengths 373 Individualized Planning 374 Understanding Barriers 375 Sample Goal Plan 375 Summary 376 Exercises: Broad General Goal Planning 377 Exercise I: Planning for a Middle-Aged Adult 377 Exercise II: Planning for a Child 377 Exercise III: Planning for an Infirm, Older Person 377 Exercise IV: Maintaining Your Charts 377 Exercise V: Checking Services 378
Chapter 21 Preparing for a Service Planning Conference or Disposition Planning Meeting 379
Introduction 379 What You Will Need to Bring to the Meeting 380 Goals for the Meeting 380 Benefits of Conference Planning 381 Collaboration 382 Preparing to Present Your Case 383 Making the Presentation 383 Sample Presentation 384 Follow-Up to Meeting 385 Summary 385 Exercises: Planning 386 Exercise I: Developing a Service Directory 386 Exercise II: A Simulated Planning Meeting 386
Chapter 22 Making the Referral and Assembling the Record 387
Introduction 387 Determining Dates 388 Sample Referral Notification Form 389 The Face Sheet 390 Summary 392 Exercises: Assembling the Record 393
Chapter 23 Documentation and Recording 395
Introduction 395 The Importance of Documentation 396 Writing Contact Notes 396 Labeling the Contact 398 Documenting Service Monitoring 398 Documentation: Best Practice 399 Government Requirements 402 Do Not Be Judgmental 402
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Contents xi
Distinguish Between Facts and Impressions 403 Give a Balanced Picture of the Person 404 Provide Evidence of Agreement 404 Making Changes to the Plan 404 Summary 404 Exercises: Recording Your Meeting with the Client 405 Exercise I: Recording Client Contacts 405 Exercise II: Using Government Guidelines to Correct Errors 411 Exercise III: Spotting Recording Errors 411
Section 6 Monitoring Services and Following the Client
Chapter 24 Monitoring the Services or Treatment 413
Introduction 413 What Is Monitoring? 414 The Financial Purpose of Monitoring 414 Follow-Up 416 Collaboration with Other Agencies 416 Advocating 417 Leave the Office 418 Responding to a Crisis 419 Summary 420
Chapter 25 Developing Goals and Objectives at the Provider Agency 421
Introduction 421 Client Participation/Collaboration 422 Make Objectives Manageable 423 Expect Positive Outcomes 423 Objectives 425 Combining Goals and Treatment Objectives 426 Finishing Touches 428 Review Dates 429 Vocabulary 430 Summary 432 Exercises: Developing Goals and Objectives 432 Exercise I 432 Exercise II 433 Exercise III 434 Exercise IV 436 Exercise V 437
Chapter 26 Terminating the Case 439
Introduction 439 A Successful Termination 440 The Discharge Summary 443 Examples 444 Summary 447 Exercises I: Termination of a Middle-Aged Adult 448 Exercises II: Termination of a Child 448 Exercises III: Termination of a Frail, Older Person 448 Exercises IV: Organizing the Record 448
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xii Contents
Appendix A Ten Fundamental Components of Recovery 449
Appendix B Vocabulary of Emotions 451
Appendix C Wildwood Case Management Unit Forms 454
Appendix D Prochaska and DiClemente’s Stages of Change Model 487
Appendix E Work Samples 490
Appendix F Grading the Final Files 496
Appendix G Information for Understanding DSM IV TR Diagnoses 499
Appendix H Case Manager’s Toolbox 506
References 515
Index 518
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