The Case of Lonnie and Dorothy Individuals or families who need case management services do so because they have a number of problems. Like Lonnie and Dorothy, they may get by? for a perio
The Case of Lonnie and Dorothy
Individuals or families who need case management services do so because they have a number of problems. Like Lonnie and Dorothy, they may “get by” for a period of time. At some point, their problems escalate, multiply, or both, making it difficult to cope. It is at the end of this case, when Lonnie is beginning to experience some serious medical problems, that you enter their lives as a case manager.
Lonnie and Dorothy live in the southern part of town in a low-income area. At one time, the neighborhood was nice. This was long before Lonnie and Dorothy arrived. They have two grown sons, John and Leroy, who occasionally come by to visit, and a grown daughter they never talk to. Lonnie, 62, works at a nursing home as a janitor. Dorothy, 60, does not work due to health problems, though she has worked as a personal nurse at some time in the past. They have been married for thirty-nine years but do not get along very well. They bicker constantly, and Dorothy has talked of times when Lonnie would lock her in the house due to jealousy while he was at work. Now, they basically coexist together without much substantial interaction.
Lonnie’s job is rough on him—he works seven-day shifts and then has three days off. He drives forty-five minutes to work in his 1985 pickup, on which he is still making payments. He spends all day on his feet and is exhausted when he gets home. For years, Lonnie was the head janitor at a truck stop and enjoyed the job. Unfortunately, he was laid off due to cutbacks and has been trying to find a job with better pay. He has found that his age has kept him from getting better work. He has been working at the nursing home since. He has talked of finding better work, but because he and Dorothy live from paycheck to paycheck, they cannot afford for him to take any kind of pay cut, even temporarily. Lonnie spends most of his spare time in front of the television.
This is hard on Dorothy. Due to heart problems, she is on disability and rarely gets away from the house, often spending days alone in the house. This causes her to be lonely and to have a limited view of the world—the “other side of town” is like another world to her. If she does get away, it is only to go to the grocery store or the pharmacy. She also has a tendency to be paranoid. For instance, if her disability check does not come on the exact day it did the previous month, she spends the afternoon on the phone talking to the disability office and the post office, positive someone has “made a mistake” or has “taken her check.” In some ways this is understandable, since Lonnie and Dorothy need the check to pay their bills. Dorothy’s check pays the rent and what little spending money she gets, while Lonnie’s covers the car payment, food, utilities, and medical bills. They spend every penny each month, leaving nothing for savings. Last month, Lonnie started to have medical problems himself and has had to go the doctor more frequently than usual.
- List the needs that Lonnie and Dorothy have. Then prioritize them.
- Identify the necessary case management roles and purposes for each of the three most important needs Lonnie and Dorothy have.
- The three methods of delivering case management you read about in Chapter 3 provide a structure for the case manager’s roles, responsibilities, and length of involvement with a client. Review the methods.
Which one would be most effective with Lonnie and Dorothy’s situation? Why?
Book: for chapter 3 question (#3)
Generalist Case Management A Method of Human Service Delivery 5th Edition
Marianne R. Woodside Tricia McClam
Photo used with permission by Marianne R. Woodside Copyright © 2018 Cengage Learning. All Rights Reserved.
CHAPTER 3
Methods of Delivering Case Management Services
Introduction
Historically, case managers have focused on clients and their needs.
Two ways to understand case management include exploring case management service delivery and examining the goals, roles, strengths, and weaknesses of case management approaches.
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Methods of Delivering Case Management Services
There are two ways to view case management service delivery: consider how services are delivered and consider who functions as a case manager.
Seeing case management as flexible helps meet client’s needs.
Different approaches to case management focus on different goals; case manager responsibilities roles and length of involvement with the client also differ by approach.
Each method of service delivery has particular strengths and weaknesses.
Knowing about multiple approaches helps in understanding the service delivery system.
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How Case Management Services Are Delivered, Slide 1
The form of service delivery depends on the agency organizing case management services. Services can be delivered through one-stop comprehensive centers, by interdisciplinary teams, at psychosocial rehabilitation centers, or as a crisis response.
Case management services delivered at one-stop comprehensive centers are characterized by the following:
Goal: the case manager attempts to meet all the needs of the client though a single point of access. Responsibilities: broad set including service coordination, intake interviewing, assessment, planning, monitoring, and case termination, in addition to leading a team of service providers.
Primary roles: may include advocate, broker, coordinator, planner, problem-solver and record-keeper.
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How Case Management Services Are Delivered, Slide 2
Length of involvement: varies according to the complexity of the client’s needs.
Strengths: one location for services, multifaceted client assessment, holistic yet individualized plan that is easy to monitor, and team based service provision driven by common goals, featuring regular communication, and shared report templates.
Weaknesses: variations in resource availability and level of service integration, lower family engagement due to presence of a strong team of staff, and client’s possible overreliance on the center.
One –Stop Comprehensive Services: The Wisconsin Works (W-2) program provides services to parents with children. (read more on following slide)
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Comprehensive Case Management: Wisconsin’s Model Approach for W-2 Participants
This program represents a fundamental change in the way services are designed and delivered. It is a comprehensive case management method.
Successful treatment programs that focus on recover to work should not only offer a continuum of services but also integrate these services within the larger community.
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Comprehensive Case Management: Interdisciplinary Team
Case management services delivered by interdisciplinary teams are characterized by the following:
Teams can provide services for multiple-problem clients and may include professionals from case management, mental health, social work, and occupational therapy disciplines.
The team has to determine which of the client’s problems are most urgent and prioritize care according to urgency of the problems.
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Comprehensive Case Management: Psychosocial Rehabilitation
Case management services delivered at psychosocial rehabilitation centers are characterized by the following:
Client’s ability to function is lower as compared to functioning prior to an accident or traumatic event.
Goal: rehabilitation
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Comprehensive Case Management: Crisis Response
Case management services delivered as a crisis response are characterized by the following:
Provision of immediate short-term help to persons experiencing a physical, emotional, and/or behavioral crisis.
Case managers may initially focus on the source of the crisis and then provide services focused on long-term care.
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Who Assumes the Responsibility of Case Management? Slide 1
The needs of the client and the goals of case management determines who assumes case management responsibilities.
Other considerations include, severity of client’s problems, duration of need for services, existence and strength of client’s support system, skills of those involved with the case, and resources available.
In general, persons assuming primary case management functions may be helpers, family members, peers, or the client.
Primary roles may include brokering, coordinating and planning services, problem-solving, and record-keeping.
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Who Assumes the Responsibility of Case Management? Slide 2
Goal – The goals of the case manager may include short- and long-term involvement with the case, coordination of services, helping volunteers, and empowering clients.
Responsibilities – Responsibilities of the case manager may include finding and coordinating assessment services and obtaining access to specialists, identifying problems, and developing and implementing the case plan.
Primary Roles – The case manager is a broker, coordinator, planner, problem solver, and record-keeper
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Who Assumes the Responsibility of Case Management? Slide 3
Length of Involvement – Can be short or long-term. Strengths include flexibility in who assumes the case management responsibilities.
Weaknesses – Weaknesses include use of non-professionals as case managers; such persons may lack needed knowledge and skills, may not be able to monitor services, or may not be able to coordinate or access services. Non-professionals may not have the client’s best interest at heart.
Family as Case Manager – Due to rising costs and deinstitutionalization, more family members are being asked to act as case managers. Family members may need the help of professionals when a crisis occurs.
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Who Assumes the Responsibility of Case Management? Slide 4
Peers Performing the Case Management Function- Rising costs are also increasing the use of volunteers as case managers. Volunteers receive initial and ongoing training and supervision.
The Client as Case Manager – Strengths-based case management emphasizes developing a client’s maximum potential (Rapp & Goscha, 2006). Having a client serve as his or her own case manager recognizes the role of self-determination, builds skills and resources , and helps the client learn to provide long-term care for him or herself.
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Roles in Case Management, Slide 1
Roles constitute the actual work that case managers do as they provide services to clients.
Advocate: speaks on behalf of clients when they are unable to do so, or when they speak but no one listens. The case manager represents the interests of the client, helping to gain access to services or improve their quality.
At the organizational level, the case manager serves as a community organizer who influences the policies that control eligibility and access to services.
At the legislative level, case managers can work to influence government policies and programs that serve the needs of their clients, which include addressing issues of inequality and discrimination.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Roles in Case Management, Slide 2
Broker: role in which the case manager links client with needed services.
The broker helps the client choose the most appropriate service and negotiates the terms of service delivery.
Coordinator: role in which the case manager works with other professionals and agency staff to ensure that services are integrated and to expedite service.
The case manager can help the client with problems such as ineligibility, seemingly closed doors, poor service quality, and irrelevant services.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Roles in Case Management, Slide 3
Consultant: an outside professional with the expertise to identify a problem, study it, and make recommendations.
An organization many need assistance with such matters as cost analysis, quality control, and organizational structure.
Cost Containment: agency representative who follows guidelines for allocating resources and advocates for the client’s needs.
Counselor: or therapist; maintains a primary relationship with the client and his/her family regarding mental health concerns. Planner: prepares for the service or treatment that the client is to receive.
The planner evaluates to determine the client’s functioning and to assess service provision.
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Roles in Case Management, Slide 4
Problem-solver: goal of this role is to help make clients self-sufficient by helping them determine their strengths, find alternatives to their current situations, and learn to solve their own problems.
The case manager is continually involved in problem solving; many problems arise unexpectedly, and time must be allotted each day for them.
Record-keeper: maintains detailed information relating to all contracts and services.
Good documentation constitutes the linking element in the case management process.
Wanted: Case Managers: Vignettes are presented in the text to highlight the increasing number of agencies who use case managers to provide services to their clients.
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Topics in Case Management Today, Slide 1
Performance of Multiple Roles: Case managers perform multiple roles such as advocate, broker, coordinator, planner and/or problem-solver. Case managers need to be a Jack or Jill of all trades. Organizational Abilities: Case managers need organizational abilities: the ability to manage and organize multiple items and responsibilities. Disorganization adversely affects clients. The Concept of Time: The concept of time influences case management through organizing, budgeting, scheduling, responding, balancing, and slowing down. Case managers also have to complete documentation.
Difficulty with time management arises from unpredictably in the workday, external deadlines, and ever-changing bureaucracy. Organizing is critical survival skill.
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Topics in Case Management Today, Slide 2
Paperwork and Documentation – Completing paperwork or documentation is another organizational skill that case managers practice daily. Documentation may include initial assessments, family histories, psychosocial assessments, contact notes, goals, service plans, and evaluations.
Organizing time, paperwork, caseloads, daily schedules, and emergencies is a critical survival skill.
Communication Skills: Case managers need communication skills such as listening, questioning, and persuading. These skills help establish relationships, identify problems, and move through the case management process.
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Topics in Case Management Today, Slide 3
Setting-Specific Knowledge: Case managers need setting-specific knowledge such as typing and computer knowledge, understanding of human behavior, knowledge of systems that impact clients, and “street smarts.” Ethical Decision Making: Case managers must engage in ethical decision-making: the process of identifying ethical issues and asking questions, and making appropriate professional responses.
Ethical issues may include self-determination, confidentiality, and role conflict.
Boundaries: Case managers need boundaries, or rules and limits between themselves and their clients.
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Topics in Case Management Today, Slide 4
Critical Thinking: Case managers must think critically and clearly, asking the right questions, not taking things at face value, continually evaluating, and assessing communication as it is happening. Personal Qualities: Helpful personal qualities for case managers include flexibility, patience, self-confidence, and a sense of adventure. Multicultural Perspective: Case managers need a multicultural perspective and must attend to the ethnic and cultural dimensions of each client.
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References
Sue, D. W., & Sue, D. (2007). Counseling the culturally diverse (4th ed.). Boston: John Wiley. Rapp & Goscha (2006).
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