Case Management Meetings Research Articles

Case Management Strategies to Promote Employment for Transition-Age Youth With Disabilities

Transitioning students with disabilities are at a disadvantage for post-school employment. This article explores ASPIRE case managers’ roles in promoting employment among transition-age youth with disabilities receiving SSI. Qualitative and quantitative studies examined programmatic factors related to employment. Results showed that higher rates of face-to-face case management meetings and early employment experiences were associated with improved employment outcomes. Effective case managers’ interactions with families were characterized by persistence, flexibility, and a holistic focus. Case management during the transition to adulthood, which crosses independent living, education, and employment domains, is important. A cross-domain case management model can be effective in mitigating multiple barriers to self-sufficiency experienced by families living with disability and poverty. Limitations and implications for research and practice are included.

A study protocol to assess the feasibility of conducting an evaluation trial of the ADVANCE integrated intervention to address both substance use and intimate partner abuse perpetration to men in substance use treatment

BackgroundStrong evidence exists that substance use is a contributory risk factor for intimate partner abuse (IPA) perpetration. Men in substance use treatment are more likely to perpetrate IPA than men from the general population. Despite this, referral pathways are lacking for this group. This trial will assess the feasibility of conducting an evaluation trial of a tailored integrated intervention to address substance use and IPA perpetration to men in substance use treatment.Methods/designADVANCE is a multicentre, parallel-group individually randomised controlled feasibility trial, with a nested formative evaluation, comparing an integrated intervention to reduce IPA + substance use treatment as usual (TAU) to TAU only. One hundred and eight men who have perpetrated IPA in the past 12 months from community substance use treatment in London, the West Midlands, and the South West will be recruited. ADVANCE is a manualised intervention comprising 2–4 individual sessions (2 compulsory) with a keyworker to set goals, develop a personal safety plan and increase motivation and readiness, followed by a 12-session weekly group intervention delivered in substance use services. Men will be randomly allocated (ratio 1:1) to receive the ADVANCE intervention + TAU or TAU only. Men’s female (ex) partners will be invited to provide outcome data and offered support from integrated safety services (ISS). Regular case management meetings between substance use and ISS will manage risk. Outcome measures will be obtained at the end of the intervention (approximately 4 months post-randomisation) for all male and female participants. The main objective of this feasibility trial is to estimate parameters required for planning a definitive trial including rates of consent, recruitment, and follow-up by site and group allocation. Nested formative evaluation including focus groups and in-depth interviews will explore the intervention’s acceptability to participants, group facilitators, keyworkers and ISS workers. Secondary outcomes include substance use, IPA, mental health, self-management, health and social care service use, criminal justice contacts, and quality of life.DiscussionFindings from this feasibility trial will inform the design of a multicentre randomised controlled trial evaluating the efficacy and cost-effectiveness of the ADVANCE intervention for reducing IPA and improving the well-being of female (ex)partners.Trial registrationISRCTN79435190.

A Prenatal Clinic Collaborates With Drug Treatment Programs to Improve Mother–Child Outcomes

As a result of the current opioid crisis, hospitals and clinics are experiencing increased numbers of prenatal women enrolled in methadone or buprenorphine programs or using illicit drugs. Many hospitals are changing their practice in caring for these women and their families by encouraging rooming-in, breastfeeding, shorter lengths of stay, and less medication for newborn withdrawal. As those changes were made at Yale New Haven Hospital, it was acknowledged that partnerships between the Women’s Center clinic and local drug treatment programs would be an important component of the new plan of care for the families, as they have frequent contact with these women. Before this program, there was very little interaction between the clinic and the program. The care coordinator in the Women’s Center began to reach out to the local clinics when a patient presented for prenatal care. She verified doses and compliance with the program. Over time, a relationship developed and a team from the hospital went to the drug treatment programs to provide in-services about changes in the care of the families. Three clinics decided to collaborate with the prenatal clinic and began biweekly case management meetings. Patients agreed to be discussed and were aware of the collaboration. Each current patient was discussed, and concerns were addressed immediately. Patients signed release-of-information documentation at both sites and named the program “the pregnancy team.” The drug treatment programs are identifying pregnancy earlier and facilitating entry to prenatal care. Seventy-five percent of the patients at these three sites have entered care in the first trimester. If patients miss prenatal appointments, the team works to re-engage in care by contacting the program. Patients are seeking out education in the clinic, and the no-show rate for prenatal care has decreased by 58%. Patients are receiving consistent messages across the continuum and have expressed positive comments. Patient satisfaction is not measured in this clinic. The model can easily be replicated at other prenatal practices. Inpatient nurses are very pleased that patients are well prepared for their hospitalization and understand the expectations. When patients enter care earlier, it allows for more preparation and education time.

Integration of community health workers into health systems in developing countries: Opportunities and challenges

Background Developing countries have the potential to reach vulnerable and underserved populations marginalized by the country’s health care systems by way of community health workers (CHWs). It is imperative that health care systems focus on improving access to quality continuous primary care through the use of CHWs while paying attention to the factors that impact on CHWs and their effectiveness. Objective To explore the possible opportunities and challenges of integrating CHWs into the health care systems of developing countries. Methods Six databases were examined for quantitative, qualitative, and mixed-methods studies that included the integration of CHWs, their motivation and supervision, and CHW policy making and implementation in developing countries. Thirty-three studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programs. Thematic coding was conducted and evidence on the main categories of contextual factors influencing integration of CHWs into the health system was synthesized. Results CHWs are an effective and appropriate element of a health care team and can assist in addressing health disparities and social determinants of health. Important facilitators of integration of CHWs into health care teams are support from other health workers and inclusion of CHWs in case management meetings. Sustainable integration of CHWs into the health care system requires the formulation and implementation of polices that support their work, as well as financial and nonfinancial incentives, motivation, collaborative and supportive supervision, and a manageable workload. Conclusions For sustainable integration of CHWs into health care systems, high-performing health systems with sound governance, adequate financing, well-organized service delivery, and adequate supplies and equipment are essential. Similarly, competent communities could contribute to better CHW performance through sound governance of community resources, promotion of inclusiveness and cohesion, engagement in participatory decision making, and mobilization of local resources for community welfare.

Competition as a savings incentive: A field experiment at a homeless shelter

This paper describes a randomized field experiment testing the impact of a savings competition on the behavior of homeless individuals staying at a transitional shelter. When monetary prizes were offered for achieving the highest saving rates within a particular month, average savings increased by $80 (a 30% increase in savings rate) while income and attendance at case management meetings remained unchanged. However, repeating the competition in the following month had no effect because responsive savers selected out of the shelter after the first month. In summary, while a savings competition can increase savings in the short run, its effect may be limited to the intensive margin and may diminish with repetition.

Requiring Case Management Meetings to Be Conducted Outside the Clinic

In this Open Forum a psychiatric health care consumer recounts his experience with his state's requirement to hold case management meetings outside of the clinic. Over time, the author found that meeting elsewhere amounted to being put on public display, and he felt embarrassed and powerless to change the situation. Requiring people with psychiatric disorders to meet outside a clinical setting may violate the Health Insurance Portability and Accountability Act and human rights. This New Hampshire state policy needs to be changed because it undermines treatment and reinforces the stigma that many consumers already feel because of their disability.

Requiring Case Management Meetings to Be Conducted Outside the Clinic

Requiring Case Management Meetings to Be Conducted Outside the Clinic

Having a permanent resident in intensive care: The rewards and challenges

Intensive care units are generally structured and staffed to care for short-term critically ill patients. This is in contrast to the increasing incidence of patients who require long-term (i.e. greater than 6 months) intensive care in the contemporary health care context. The aim of this paper is to share our experience of caring for a long-term ventilated patient in intensive care, including providing a summary of strategies and considerations that proved effective in our setting. Dealing with the initial reactions of the staff, patient and family was the first focus of care, with strategies developed to manage the psychological as well as practical challenges. Core to subsequent strategies was the early formation of a multi-disciplinary case management team. Ongoing challenges included integrating rehabilitation care into the intensive care, developing effective multi-dimensional communication strategies, facilitating appropriate involvement of the patient and her family, operationalising trips outside the intensive care environment and adapting the model of nursing care to suit the context. Elements essential for the effective care of a long-term patient within the intensive care setting included the development and maintenance of an open and honest relationship with the patient and family, regular multi-disciplinary case management meetings and effective communication strategies throughout the health care team. Importantly, clinical leaders should remain open to considering new ideas and strategies that facilitate effective care for a patient whose primary focus is different to the majority of intensive care patients.

Managing HIV in pregnancy in Glasgow

Methods Data were collected on all pregnancies occurring between 1 July 2005 and June 2008. Women already attending the Brownlee Centre for their HIV care who became pregnant and pregnant women found to be HIVpositive following antenatal screening were included in the study. Antenatal care was centralised mainly at Princess Royal Maternity, Glasgow, and HIV care provided at the Brownlee Centre, Glasgow. Monthly case management meetings were held between centres. All cases were reviewed at annual audit meetings.

Canada: Changing Priorities

Is it possible to describe a typical civil case in Canada? While there is probably no such thing, one can describe, at least in broad terms, certain common features of Canadian civil litigation. A civil action in Canada would be commenced in the general jurisdiction trial court of a province or territory. These courts are the result of the superimposition of an essen tially unitary court structure on a federal system of government. The courts and their nonjudicial staff are the constitutional responsibility of the provincial governments, while the judges that preside in the courts are appointed and paid by the federal govern ment. They have original jurisdiction in virtually all matters regardless of whether the subject matter of the suit is within the legislative competence of the federal or provin cial government. The division of legislative and appointment authority complicates effective management of the courts. Once a case is initiated, there is a significant chance that it will not be opposed. One recent study found that 65 percent of initiated actions are not defended. If the action is defended there is an even greater likelihood that the case will not reach trial. For exam ple, in at least one jurisdiction, only about 4 percent of the initiated actions are tried: The litigant may encounter a variety of court-sponsored mechanisms to promote set tlement. These will probably include pretrial conferences, case management meetings, and referral to alternative dispute resolution, particularly mediation. Given the very high rate of settlement even absent these sorts of interventions, it is not surprising that the available statistics show that their main contribution is facilitating earlier rather than more settlements. If the case proceeds to trial, it will almost certainly be a trial by judge alone. Although civil jury trials are generally available, they are optional, and the option is selected in a fairly small minority of cases. Our hypothetical litigant likely will be represented by a lawyer, and there is a good possibility that the lawyer will, at least to a degree, specialize in litigation. Although all Canadian lawyers are entitled to appear in court, most civil litigation of any sophistica tion is carried on by lawyers who specialize in this area. The client's fee arrangement with the lawyer will most likely be based on an hourly rate for services rendered, although the lawyer's final bill to the client (subject, of

Content Analysis in Design and Development

This article presents a method of content analysis for use in the early stages of a social work developmental research undertaking. The method enables researchers to carry out a systematic but expeditious review of data from preliminary trials of an innovative practice model, to identify strengths and problems in the model, and to devise ways of improving it. The method was used in the development of an innovative case management approach to problems of school failure. Tape recordings of 17 case management meetings drawn from early trials of the approach were analyzed. In addition to demonstrating the utility of the method, the application illustrated its specific techniques, such as study of a priori and informative events as a means of identifying promising and problematic aspects of the innovation as well as the use of thought experiments to modify it.