Case Management is often overlooked and underestimated among the components of addiction treatment. Case managers ensure that clients don’t “fall through the cracks” by making sure that the continuum of care is followed and that clients transition smoothly from one phase of treatment to the next.
Case management can be generally described as an integrated approach to the impartment of health, substance abuse, mental health, and social services. Clients are linked with the appropriate services to address their specific needs or stated goals.
It is particularly useful in the treatment of substance abuse when the client has other disorders and conditions and requires multiple services over an extended period of time, and who have problems getting access to those programs.
Substance use treatment and case management functions are different. Treatment involves activities that help the client recognize their problems, acquire motivational abilities, and tools to stay abstinent. Case management supports the client as he goes through the recovery process.
The continuum of substance use disorder (SUD) treatment ranges from case finding and pretreatment to primary treatment to aftercare. Although there are goals and treatment actions at all points on the continuum, clients’ needs usually don’t fit into any one area at a given time. Case management will bridge the client’s needs and the structure of the program.
Case management focuses on the whole individual and emphasizes thorough assessment, service planning, and coordination to address all facets of a client’s life
Research points to two reasons why case management is effective as a complement to substance abuse treatment.
Because addiction has an effect on so many parts of a person’s life, an all-inclusive continuity of services promotes recovery and encourages the substance abuse client to integrate into society as a healthy, substance-free person. The continuum of care needs to provide engagement and motivation, treatment services at the appropriate level, and support services that will allow the individual to maintain long-term abstinence while leading a healthy life in the community.
In most jurisdictions, services are splintered and insufficient to meet the needs of the population of substance abusers. Treatment needs to be regulated to ensure smooth transitions to the next level of care, avoid gaps in service, and react quickly to the threat of relapse. Case management can help achieve all of that.
Most substance-dependent people can benefit from case management services, but some groups benefit the most from the more integrated manner of treatment and support services. The Journal of Global Drug Policy and Practice includes these groups:
When executed fully, case management will reinforce the range of addiction treatment and sustaining the recovery. A treatment professional using case management will:
Case management replaces a disorganized process of referrals with a single, well-structured service. This gives the client a sense of continuity. By being the single point of contact, case managers are obligated to the members in the systems they contact, as well as their clients. CMs must be familiar with protocols and operating procedures used by these other professionals, be able to negotiate and barter among service providers, and pursue informal networks.
The primary goal when dealing with SUD clients and an array of services with often contradictory requirements is the necessity to promote the client’s best interests. The case manager may need to advocate with many service systems including agencies, families, and legal systems. Sometimes the CM must negotiate an agency’s rules to gain access or continued participation on behalf of the client.
The CM uses her expertise to pinpoint alternatives for the client while the client’s right to self-determination is highlighted. Once the client chooses from the alternatives, the case manager’s knowledge and expertise help the client access the chosen services.
All case management methods can be considered community-based because they help the client negotiate with community agencies. But the amount of direct community involvement by the CM varies with the agency. Some agencies launch community outreach programs. In this situation, case managers may accompany clients as they wait in lines or take buses to register for the entitlement.
Personal involvement like this validates clients’ experiences in a way that other methods can’t. This level of familiarity with their clients helps the professional appreciate the realities of the client’s life and helps in setting more appropriate treatment goals. For institutionalized clients, case management involves preparing the client for living within the community. Case management can also coordinate release dates to make sure that there are no gaps in service.
Case managers working with substance users must be able to adapt to variations prompted by a range of factors, including co-occurring problems such as AIDS, mental health issues, agency structure, availability of resources, the power given to the CM and others.
Case managers need the ability to understand the normal course of addiction and recovery, to anticipate a problem, understand the options, and take appropriate action. That may be intervening directly or alerting another member of the care team.
Case management begins with the client’s needs at the time. By responding to tangible needs such as food, shelter, clothing, transportation, or child care, the case manager may subsequently make treatment a priority for the client. Teaching clients the daily skills necessary to live successfully and substance-free is an essential part of case management.
One of the main results from the drive to reduce the costs of treating addiction and mental illness has been the curtailment of hospital and residential care and the increased use of outpatient programs. This is especially true of patients supported by Medicaid and other public funds.
A similar effort aimed at cost containment has been the decreasing of social support services, aka “wraparound” services, deemed “not medically necessary” such as housing referral, employment counseling, and legal assistance that had traditionally been provided in addiction programs.
There have been efforts to address the problems correlated with the shift to the outpatient treatment setting and reductions in the availability of the wraparound services. In response to this, was the emergence of the intensive outpatient program (IOP). IOP is designed to provide more frequent and intensive treatment sessions without the expense of residential or hospital stays. Sessions are usually 2-4 hours, 3-4 times weekly
A recent study compared the quality of services provided within an intensive outpatient program with those from a traditional outpatient program (typically 1-2 hour sessions twice weekly). The intensive programs provided about twice the frequency of drug and alcohol-based counseling sessions each week, but not more employment, medical, psychiatric, housing, or family services than the traditional outpatient programs.
A six-month follow-up showed that patients treated in the intensive programs had improvements in their addiction problems but little change in their health and social problems. They did not have substantially better results than those treated in the traditional programs.
Due to the chronic and relapsing nature of substance use disorders, a broad and continuous method such as case management is required. During aftercare, also called continuing care, the patient no longer needs services at the intense level provided during primary treatment. Counseling is more of a monitoring function as clients get accustomed to a pro-social, sober lifestyle.
Whether they completed treatment in a residential or outpatient program, they have some of the skills to maintain sobriety and begin working on repairing various areas of their lives. Areas that relate to environmental issues such as vocational rehabilitation, finding employment, and safe housing are within the scope of case management.
The period after discharge from a treatment program typically has a high risk of relapse. There is also a substantial risk of overdose death following a long period of abstinence due to the patient’s lower tolerance.
The case manager’s in-depth knowledge of the client’s real-world needs helps the client who is no longer using. People in aftercare have a variety of needs, including housing, a source of income, marketable skills, and a support system. Many will seek medical or dental care for the first time in years.
These patients have multiple psychological, emotional, and social problems that are often not addressed in outpatient programs. Providing help in legal advice, basic needs, and family services may improve patients’ psychosocial performance. Treatment continuity is related to higher abstinence rates and fewer readmissions to hospitals.
We know that everybody’s situation is different. Footprints to Recovery has medical professionals and counselors who will work with you to develop your treatment plan. Your case manager will help you transition from phase to phase and on to recovery and reintegrating into your community. You will never be completely on your own without support.
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