Exploring the perspectives of people who use drugs living with hepatitis C on interactions with case managers: A qualitative study in Taiwan.

PurposeSchool social workers (SSWs) deliver case management (CM) services to connect students to an array of supports that meet their academic and non-academic needs. However, gaps exist in understanding the profiles of students receiving CM services delivered by SSWs, and the relationships between dosage and receipt of CM services and student outcomes.MethodResearchers utilized secondary data from three large middle schools to explore the demographics of students (N = 3,012) receiving CM services and students not receiving CM services. Among students receiving CM services (n = 238), binary and multinomial regression analyses explored relationships among students’ demographic characteristics, dosage of CM services, and non-academic and academic outcomes. Student outcomes were also compared among a demographically matched subsample of 181 students receiving CM services and 181 students not receiving CM services.ResultsStudents receiving CM services were more likely to be at-risk, Hispanic/Latino, and limited English proficiency status than students not receiving CM services. Regression analyses indicated a higher dosage of CM services was associated with higher odds of receiving two or more behavioral referrals and failing 60% or more courses. Moreover, among a demographically matched subsample, students receiving CM services were significantly more likely to have two or more behavioral referrals and fail 60% or more courses than students not receiving CM services.DiscussionOur findings suggest SSWs provide CM services to students with significant academic and behavioral risks. We discuss the implications of our results concerning SSW practice, education, research, and policy.

Since the early 1980s, policymakers and analysts have urged hospitals to be more active in managing the care of their patients beyond the hospital walls. In particular, hospitals have been criticized for failing to address the postdischarge needs of elderly patients with chronic health problems. An influential essay in The New England Journal of Medicine observed that “most of these institutions have no comprehensive geriatric program geared to the long-term medical, rehabilitative, and social needs that are linked to acute illness. To provide quality care, hospitals must make a commitment to long-term care for the chronically ill elderly patient. It is becoming apparent that no one else can.” As part of a strategy for addressing this perceived shortcoming, the authors argued, “Unlike other providers, hospitals could offer comprehensive case management of patients, from home care to acute care, thus ensuring continuity of services.” Under this approach, hospital-based case managers would identify clients, assess their needs, develop care plans, coordinate service delivery, and monitor results. Since many of these activities would take place after the patient left the hospital, hospital-based case management would be a considerable extension of hospitals’ typical discharge planning activities. In part, it was expected that the costs of hospital-based case management programs would be covered through user fees. If the hospital also offered long-term care services, hospital-based case management could generate additional revenues through increased use of these services. If it facilitated the earlier discharge of Medicare patients and reduced Medi-

Associations of Housing Status With Substance Abuse Treatment and Service Use Outcomes Among Veterans

Statistical Benchmarks for Process Measures of Quality of Care for Mental and Substance Use Disorders

The benefits of having a support system, such as social relationships with close friends and family, have been well documented for patients with serious health issues. As scientific evidence has shown, individuals who have the lowest level of involvement in social relationships face a greater mortality risk. Support systems, however, are not infallible. Relationship stress can have a negative impact on people-patient and caregiver alike-behaviorally, psychosocially, and physiologically. The purpose of this article is to encourage case managers who take a patient-centered approach to also consider the existence and extent of the support system, as well as any stresses or tensions that are observable within the support system. Although the case manager is ethically obliged to advocate for the individual receiving case management services, that advocacy can be extended to the support system for the good of all. This discussion applies to numerous case management practices and work settings including (but not limited to) hospital-based case management, home health, geriatrics, catastrophic case management, mental health, palliative care, and end of life/hospice. As part of the assessment phase of the case management process, case managers determine the extent of the patient's support system or social support network such as family and close friends. Although their advocacy is primarily for the patient receiving case management services, case managers also become aware of the needs of the support system members as they face their loved one's serious illness, severe injury, geriatric care demands, or end of life. Case managers can use their communication skills, especially motivational interviewing, with patients and their support systems to identify stresses and issues that can impact the pursuit of health goals. In addition, case managers ensure that individuals and their support systems are kept informed such as about the health condition, stage of disease, plan of care, treatment options, and care transition plan. Professional case managers expand their role as advocates, serving primarily the patients ("clients") who receive case management services and also members of the support system. By becoming more aware and sensitive to the needs of the support system, case managers help reduce stress on the support system, which can contribute to positive outcomes for patients ("clients").

Assessing Outcomes for Consumers in New York's Assisted Outpatient Treatment Program

This study compared the quality of treatment relationships and engagement in peer-based and regular case management. It also assessed the value of positive relationship qualities in predicting motivation for and use of community-based services for persons with severe mental illness. One hundred thirty-seven adults with severe mental illness participated in a 2x2 prospective longitudinal randomized clinical trial with two levels of case management intervention (peer and regular) and two interviews (six and 12 months). Self-report questionnaires assessed treatment relationships, motivation, and service use, and providers rated participants' initial engagement and monthly attendance in treatment. Participants perceived higher positive regard, understanding, and acceptance from peer providers rather than from regular providers at six months only, with initially unengaged clients showing more contacts with case managers in the peer condition and decreasing contacts in the regular condition. Six-month positive regard and understanding positively predicted 12-month treatment motivation for psychiatric, alcohol, and drug use problems and attendance at Alcoholics and Narcotics Anonymous meetings. Early in treatment, peer providers may possess distinctive skills in communicating positive regard, understanding, and acceptance to clients and a facility for increasing treatment participation among the most disengaged, leading to greater motivation for further treatment and use of peer-based community services. Findings strongly suggest that peer providers serve a valued role in quickly forging therapeutic connections with persons typically considered to be among the most alienated from the health care service system.

This study examined interventions for substance use disorders within the Department of Veterans Affairs (VA) psychiatric and primary care settings. National random samples of 83 VA psychiatry program directors and 102 primary care practitioners were surveyed by telephone. The survey assessed screening practices to detect substance use disorders, protocols for treating patients with substance use disorders, and available treatments for substance use disorders. Respondents reported extensive contact with patients with substance use problems. However, a majority reported being ill equipped to treat substance use disorders themselves; they usually referred such patients to specialty substance use disorder treatment programs. Offering fewer specialty substance use disorder services within the VA may be problematic: providers can refer patients to specialty programs only if such programs exist. Caring for veterans with substance use disorders may require increasing the capacity of and establishing new specialty programs or expanding the ability of psychiatric programs and primary care practitioners to provide such care.

The purpose of this cross-sectional study was to determine the effects of case management of Korea Medical Aid on recipients' satisfaction, ability to handle health problems, health behaviour, quality of life (QoL), hospital visiting days and medical expenditure. Data from structured interviews and claim data from medical institutions to the Korea National Health Insurance Corporation were used. Survey data were collected by questionnaire during September 2008. There were 647 responses out of 1069 (response rate 60.5%), but 260 were excluded from the analyses in this paper because they had received case management for <18 months. This left 269 individuals who had received case management services for 18 months continuously and 118 who had received no case management services in the same time period. Among the former group, 86.9% were satisfied or strongly satisfied with the initiative. Results indicate that the satisfaction for the case management was very high. Although there was no difference in terms of health behaviour and QoL between the two groups, the overall ability to handle health problems was higher in the case management group (P < 0.001). As for healthcare use, the programme produced a significant reduction in hospital visiting days (P = 0.034), and while the mean increase in cost from 2007 to 2008 was 29.1% lower for individuals in the programme, the difference between the groups was not significant (P = 0.851). Case management in Korea is in its early stages, and efforts should be made to extend this approach.

In their study, Glass et al. 1 examined whether Screening, Brief Intervention and Referral to Treatment (SBIRT) is efficacious for linking medical-setting patients with alcohol misuse, but not seeking alcohol-related care, to specialty addiction treatment. The results of their meta-analysis indicate that the referral to treatment component of SBIRT is not effective for promoting this care linkage. We commend the authors for highlighting the need to specify and evaluate interventions that can bridge this care gap. This commentary briefly summarizes some of the challenges to bridging the gap between medical settings and specialty addiction treatment and promising approaches to promoting this care linkage. The authors bring to our attention that substantial barriers exist to linking patients in medical settings with alcohol misuse to specialty addiction treatment. Barriers to linking patients to addiction treatment are well documented and can be categorized as those pertaining to the patient, provider and care system 2. Patient-level barriers include not perceiving oneself as in need of services, difficulties accessing treatment, stigma associated with receiving treatment and limited financial resources 3, 4. Provider-level barriers include lack of knowledge about available treatment options and beliefs that addiction treatment is a 'revolving door' and/or not effective, while system-level barriers include large distances and/or low collaboration between care sites and little or no availability of addiction treatment services 5. Understanding the specific barriers that interfere with this care process is a critical step in helping clinics and providers to identify strategies that may improve the linkage between medical settings and addiction treatment. Glass et al.'s 1 findings show that SBIRT's referral to treatment components alone, including brief discussions of addiction treatment options, encouraging appointment-making, formal prescriptions for making an appointment to receive addiction treatment and a single booster session, are unlikely to be sufficient in helping patients' link to addiction treatment. More intensive yet feasible interventions will probably need to be adopted to connect patients effectively with more severe alcohol misuse to this next level of care. The authors present telephone monitoring and brief case management as examples of higher intensity alternatives to SBIRT, both of which have promise for overcoming potential barriers that may interfere with linking patients successfully to an addiction treatment setting, and may be feasible for medical settings with limited time, staff and resources. Telephone monitoring consists typically of one face-to-face meeting orienting the patient to the protocol, followed by regular telephone contact, with the option of adding supplementary case management elements if indicated clinically 6. Ongoing, supportive contact over time may be needed for patients to recognize and agree that their drinking is problematic and requires behavior change that may be more likely to occur with treatment. Telephone monitoring approaches have been shown to be feasible for use in substance-abusing populations and are effective in improving attendance to continuing care for a substance use disorder 6. Indeed, telephone monitoring may be ideal for medical settings with limited resources and staff time as various providers, including physicians, nurses and administrative support staff, could be involved in its delivery. In addition, brief case management, consisting of assessment, planning, monitoring and advocacy, along with teaching patients how to leverage existing skills and strengths to promote treatment linkage, can also improve linkage to addiction treatment effectively among substance-abusing individuals compared to a single session of motivational interviewing or standard care 7. Although probably requiring more resources to implement, brief case management may help medical settings to overcome patient- and system-level barriers to care, such as difficulties accessing addiction treatment and limited availability of treatment options. However, despite their promise, to our knowledge neither telephone monitoring nor brief case management has been tested formally in a medical setting such as primary care, thus indicating the need for such studies. In summary, we agree with Glass et al. 1 that there is a need for continued research on identifying optimal ways to improve the linkage between medical settings and addiction treatment, as well as the treatment of addictions in integrated primary care settings. Their research recommendation is also timely, as the passing of the Affordable Care Act in the United States comes with the promise of improving the affordability and availability of addiction treatment for more than 27 million uninsured people who historically have high rates of alcohol use disorders 8. However, to be optimally informative, this line of research will need to be cognizant of both the many potential barriers to care linkage and the variable levels of resources within various types of medical settings that provide care to patients with more severe alcohol misuse. None. This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development (CRE 12-009 to M.A.C.; RCS 00-001 to C.T.). The views expressed in this paper are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Nursing leadership: new initiatives in case management

Multiple-Family Group Treatment for English- and Vietnamese-Speaking Families Living With Schizophrenia

Pharmacotherapy of Alcohol Use Disorders in the Veterans Health Administration

Case management services have been implemented in suicide prevention programs. To investigate whether case management is an effective strategy for reducing the risks of repeated suicide attempts and completed suicides in a city with high suicide rates in northern Taiwan. The Suicide Prevention Center of Keelung City (KSPC) was established in April 2005. Subjects included a consecutive sample of individuals (N = 2,496) registered in KSPC databases between January 1, 2006, and December 31, 2011, with at least one episode of nonfatal self-harm. Subjects were tracked for the duration of the study. Of all the subjects, 1,013 (40.6%) received case management services; 416 (16.7%) had at least one other deliberate self-harm episode and 52 (2.1%) eventually died by suicide. No significant differences were found in the risks of repeated self-harm and completed suicides between suicide survivors who received case management and those who refused the services. However, a significant reduction in suicide rates was found after KSPC was established. Findings suggest that case management services might not reduce the risks of suicide repetition among suicide survivors during long-term follow-up. Future investigation is warranted to determine factors impacting the downward trend of suicide rates.

Background Case management is a structured, client centered approach that incorporates various strategies such as employing lay counsellors to provide psychosocial and adherence support to strengthen antiretroviral (ART) adherence, improve retention in care and viral load (VL) suppression. This study aimed to evaluate the effects of case management on VL in clients enrolled due to non-suppression (&gt; = 50 copies/ml) in Capricorn District, Limpopo Province. Methods We conducted a case control study using two datasets (1) cases were selected from case management data collected from June 2021 to November 2022 at 35 facilities and captured on the REDCap system. (2) controls were identified from TIER.Net data from facilities where case management is not available and with at least two VLs on record since June 2021. Our study was restricted to clients with an unsuppressed (&gt; = 50 copies) VL at enrollment, over the age of 18 years and excluded clients with a missing VL at enrollment. Using similar age, gender, and VL characteristics, an equal number of clients not receiving case management was randomly sampled from the TIER.Net data. Descriptive and multivariate logistic regression analysis were used to determine the factors associated with viral suppression. Results Our final study sample consisted of 3 256 clients, half of which received case management (N = 1 628), 1084 (33%) with a first VL in study of 50–399 copies/ml, 404 (12%) 400–999 copies/ml and 1768 (54%) &gt;1000 copies/ml. Post case management intervention results showed that 49% had a VL below 50 copies/ml amongst those receiving case management and 44% among those who did not receive case management. In the adjusted model we found that case management (Odds ratio [OR] 1.25; 95% Confidence Interval [CI] 1.08–1.44) versus no case management, 35–54 years old (1.43; 1.07–1.91) and 55+ year old (1.88; 1.35–2.61) versus 18–24-year-old increased odds of VL suppression whilst being male (0.72; 0.61–0.84) versus being female has decreased odd of VL suppression. Conclusion Close to half of the clients had a VL below 50 copies/ml after case management. Factors that increased the odds of VL suppression were case management and older age, whilst being male was associated with reduced odds of VL suppression. Differentiated services for virally unsuppressed clients would be helpful for men. Case management was associated with viral suppression in those with a starting VL &gt; 1000 copies/ml and not for those starting with low level viremia (50–999 copies/ml).