Case Management Services Research Articles

The Use of Motivational Interviewing with Chronically Unhoused Veterans

Abstract The Housing First model is embedded in a supportive housing federal program aimed at reducing homelessness by offering housing vouchers and case management services to chronically unhoused veterans with co-occurring disorders. Despite the successes Housing First programs have achieved with the chronic unhoused population, including veterans, the cycle of homelessness continues to exist in this subgroup. These veterans have significant vulnerabilities, such as severe mental health and addiction histories, that contribute to their housing instability. The case narrative in this paper illustrates the story of a chronically unhoused veteran who cycled through episodes of homelessness due to ongoing substance use and evictions. On the veteran's third entry into a Housing First program, the social worker utilized the transtheoretical model (TTM) to evaluate the veteran's readiness to change and applied motivational interviewing (MI) principles to find a representative payee who would support housing stability, even if the veteran experienced a relapse. This approach can be considered harm reduction in supportive housing. Through the application of MI, the veteran exercised self-efficacy, opted for implementing a protective factor, and experienced long-term stable housing.

Navigating the services maze: Assessing service needs, referrals, receipts, and child protective services re-report and foster care entry outcomes

BackgroundResearch shows that families involved with Child Protective Services (CPS) have diverse needs not fully met by service referrals and provision. Furthermore, it is still unknown whether the service provision gaps are linked to child safety and permanency outcomes. ObjectiveThis study aims to address this research gap by evaluating the rereport and foster care entry outcomes of child welfare services based on the needs, referrals, and receipt of services for families involved with CPS. Participant and settingThe National Survey on Child and Adolescent Well-being II (NSCAW II) was used for this study, excluding children with prior reports and those in foster care to focus on re-report and foster care entry outcomes, reducing the sample from 5872 to 2580 children. MethodsLogistic Regression analyses were performed to investigate the relationship between services needed, referred, and receipts and child welfare outcomes. The analyses were structured into three sets of models to explore different aspects of service engagement and its impact on child welfare outcomes. ResultsOur study shows that specific CPS services, particularly caregivers' needs for mental health and substance misuse services, significantly impact the likelihood of re-reporting and foster care placements. ConclusionMost families contacting the child welfare system receive only case management services if their report moves beyond investigation. Such an approach requires that services are available, acceptable, and of sufficient quality to meet needs. This paper highlights crucial disparities in service needs, referrals, and receipts among families engaged with CPS.

Community Health Workers Bridging the Gap: Connecting Medicaid Members with Providers, Managed Care, and Community-Based Organizations.

Community Health Workers (CHWs) are key to extending health care services, especially to marginalized communities to reduce challenges related to health care access. The study objective was to qualitatively explore the comprehensive role of CHWs in bridging the gap for Medicaid managed care organization (MCO) members' access to health care providers, managed care, and community-based organizations to address health-related social needs (HRSN). We conducted a retrospective thematic analysis of narratives developed by CHWs on their role and Medicaid member lives. Three CHWs were embedded in four predominantly Black neighborhoods of Pittsburgh, Pennsylvania, by an MCO for six-months (January-June 2017) to connect its members with the managed care, health care system, and HRSN. In total, 46 MCO members remained throughout the program. The CHWs developed narratives on 13% (n = 6) of MCO members as part of a quality improvement project. These documented narratives became raw data for this study. The age of MCO members ranged from 25 to 58 years and were Black (n = 6). The narrative had 50% of males and females. Three overarching themes in the narratives about CHWs' role were improving members' access to health care system (providers and medication), helping members with HRSN, and connecting members to managed care case management and member services. CHWs as MCO staff embedded in communities could help improve its members' health care continuity, care coordination, and HRSN access. Our study demonstrates that CHWs are instrumental in bridging the gap between different systems for Medicaid MCO members. They play a crucial role in connecting the members to primary care providers, specialists, prescription drugs, MCO benefits, case management, and addressing their HRSN such as food, childcare, and housing. Future research should focus on program effectiveness by measuring member experience, health care utilization, health outcomes, and costs in Medicaid managed care settings.

What Do Medicaid Members Want From Their Health Plan?: Insights From a Qualitative Study to Improve Engagement in Case Management.

Managed care organizations (MCOs) provide case management services to address unmet health and social needs among their members. Few studies have examined factors influencing members' decision to participate in these programs. The purpose of the present study was to describe the life circumstances of Medicaid members offered case management, what they wanted from their MCO, and their perceptions of case management and barriers to participation. Results will inform practice to raise the awareness, engagement, and impact of case management programs. Case management offered through a Midwestern Medicaid MCO. Adult members who had been offered case management services in the 6 months preceding the study were eligible for the study. Fifteen people from each strata were recruited: members who engaged with case management, declined it, or declined it initially but later engaged ( N = 45). Participants completed a qualitative interview by phone and a brief health survey online. Across strata, only 22 participants recalled engagement with case management. Members described a variety of life challenges (e.g., chronic health conditions, caregiver responsibilities, and limited finances) and services they desired from their MCO (e.g., stipends for over-the-counter health expenses, improved transportation services, and caregiver assistance). Participants identified direct communication, emotional support, and referrals for resources as benefits of case management.

Understanding services provided to children in DFV shelters: Exposing the ‘invisible’ work

Abstract This study examines practice responses for children who reside in the context of domestic and family violence (DFV) shelters in Australia. DFV is a recognized form of child abuse and identified as such in child protection legislations, policies, and practice guidelines. The prevalence of children who experience DFV is unknown and underestimated. DFV shelters that provide crisis accommodation and case management services were traditionally established to respond to the needs of women and are therefore adult centred. Increasingly, practitioners employed in DFV shelters are also responding to the needs of children and young people; however, they are not resourced to do so. This qualitative study conducted in South Australia explores practice responses provided for children and young people while they are residing in a DFV shelter with their mothers. Data were extracted and analysed from the DFV shelter case files of seventeen women and their children using a co-designed data collection instrument. The findings provide insight into children’s experiences due to DFV. Practitioners in DFV shelters were found to be providing an array of services to children exposing this ‘invisible’ work. Understanding the complex needs and service provided to children have practice implications for the DFV sector.

The sustainability of a community-based learning collaborative to improve the use of trauma-informed evidence-based practices

PurposeMost youth who experience trauma do not receive evidence-based trauma intervention. Efforts to increase use oftrauma-informed evidence-based practices (EBPs) have identified the learning collaborative (LC) as an effective training and implementation model, yet few studies have evaluated sustainability outcomes. This study examined the sustainability of a community-based LC (CBLC) by describing provider, agency, and community-level use of trauma-informed EBPs, an average of 5.3 years after the training. Methods106 participants from 20 agencies completed a follow-up survey after a CBLC training. Participants were trained in Trauma-Focused Cognitive-Behavior Therapy (TF-CBT; clinical track), in Evidence-Based Treatment Planning (EBTP; broker/case manager track), or in strategies to support TF-CBT and EBTP implementation (senior leader track). Clinical and broker track participants reported on their current employment and EBP use within the past three months. Senior leaders for all 20 agencies provided information about the use of trauma-informed EBPs at their agencies. ResultsAt the provider-level, only 36.5 % of the clinical track continued to use TF-CBT and 28.1 % of the broker track continued to use EBTP. Provider promotion to supervisory and leadership positions supported EBP sustainability. Agency-level outcomes indicated that 89 % of clinical agencies and 60% of broker agencies continued to use TF-CBT and EBTP. Although retention of providers within agencies was low, LC trained clinicians and brokers spread to twenty-four new agencies in the community providing psychotherapy and/or case management services to youth. ConclusionsFindings suggest the CBLC model resulted in some sustained community-level changes as agencies continued to use the trauma-informed EBPs and trained providers spread to other agencies within the local community. Provider promotions also increased representation of CBLC trainees in leadership positions. Results suggest that measuring sustainability as a multi-level implementation outcome can lead to a better understanding of implementation success.

Massed treatment of posttraumatic stress disorder, traumatic brain injury, and co-occurring conditions: the Home Base intensive outpatient program for military veterans and service members.

The two-week Home Base Intensive Clinical Program (ICP) provides treatment to veterans and active duty service members suffering from primary diagnoses of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), anxiety, or depression. First launched in 2015, this paper provides a programmatic update, including new treatment components implemented since inception, and examines outcomes for all participants who entered the program from September 2015 to July 2024 (n = 2561). The Home Base ICP provides a massed care approach through daily individual Prolonged Exposure, Cognitive Processing Therapy, Unified Protocol, or cognitive rehabilitation, along with groups targeting coping skills. Participants entering the program are provided with core group programming, as well as individualized therapy sessions tailored to their unique needs and symptom presentation. Supplemental dual recovery support is also available for all participants with co-occurring substance use or behavioral addiction concerns. Participants' support people receive education, support, and case management services. Participants have a multidisciplinary team comprising therapists, psychopharmacology providers, case managers, nurses, and wellness providers. Results demonstrate that program participants exhibited statistically significant reductions in PTSD symptoms (Cohen's d = 0.80), depression (d = 0.68), post-concussion symptoms (d = 0.71), and increased satisfaction in social roles (d = -0.65). Completion rate was 94.60% (n = 2422), suggesting that the Home Base ICP is a well-received and effective model of care for veterans and service members.

A public health/hospital partnership to improve Emergency Department transitions of care for vulnerable older adults.

Community-dwelling older adults are at high risk for unmet social service needs. We describe a novel partnership embedding county services case managers in the Emergency Department (ED) to connect older adults to community services alongside their medical care. Setting: A medium-sized urban ED with 55,000 patient visits a year. Case managers from the Franklin County, Ohio Office on Aging (OA) were embedded within the ED. The OA team worked with the ED social work team to identify community-dwelling older patients, perform an in-person intake assessment, and initiate needed community services (including home-delivered meals, emergency response systems, house repairs, and transportation). Program logic model and development are reported in detail. From June to December 2023, there were 7284 ED visits for adults ≥60 years old. Referrals to the OA case manager ranged from 1 to 13 per day. The OA case managers performed 252 full intake assessments on unique patients. The population was 51% men. Only 11% (n = 28) were currently connected to OA services, and of those already connected 29% (n = 8) needed increased services. Of the remaining unconnected patients (n = 224), 8% (n = 20) were not county residents and the OA team connected them with other county OAs. Half 53% (n = 120) were accepting of services and had services from the OA or other community health programs initiated during the ED visit. The OA team made three new Adult Protective Services referrals and one referral to the long-term care ombudsman. The program did not increase ED length of stay or hospital admission rates. Embedding county service enrollment within a community ED is a cost neutral intervention that reached a population without previous services. Future plans include expansion of the program and evaluation of the program's ability to detect elder mistreatment and self-neglect.

Intensity of Social Needs Case Management Services and Changes in Hospital and Emergency Department Use Among Adult Medicaid Beneficiaries.

We identify the association between high- and low-intensity case management services on hospital and emergency department (ED) use among CommunityConnect patients. Social needs case management services vary in intensity, including the modality, workforce specialization, and maximum caseload. CommunityConnect is a social needs case management program implemented by Contra Costa Health, a county safety-net health system in California's San Francisco Bay Area. Due to the endogeneity of high-intensity services assigned to high-risk patients, we instrument for service intensity using the number of specialist case managers hired each month of enrollment. Zero-inflated negative binomial models with 2-stage residual inclusion estimated total and avoidable hospital admissions and ED visits 12 months post-enrollment for adult Medicaid beneficiaries enrolled between August 2017 and December 2018 (n = 19,782). Compared with low-intensity case management, high-intensity services were associated with a reduction in the incidence rates of inpatient admissions [incidence rate ratio (IRR) = 0.341, 95% CI: 0.106-1.102; P = 0.072], ED visits (IRR = 0.608, 95% CI: 0.188-1.965; P = 0.058), and avoidable ED visits (IRR = 0.579, 95% CI: 0.179-1.872; P = 0.091). No significant association was found between service intensity and the likelihood of an event being an excess zero. High-intensity social needs case management may be more effective than low-intensity service at reducing health care use for individuals with non-zero use, suggesting that intensive case management may be especially helpful in supporting discharge and transitions of care.

State-Level Childhood Lead Poisoning Prevention Policies and Practices in the United States: 2022-2023.

The purpose of this analysis is to better understand laws and practices guiding prevention activities in childhood lead poisoning prevention programs funded by the Centers for Disease Control and Prevention (CDC). In 2022, CDC surveyed 62 funded programs using the Awardee Lead Profile Assessment. Information was collected about childhood lead poisoning-related laws and guidance, surveillance and prevention strategies, and program services including at what blood lead levels (BLLs) various activities are performed. Separately, CDC reviewed state health department websites to obtain information on which states implemented CDC's updated blood lead reference value. Awardee Lead Profile Assessment results are only reported for 47 states, the District of Columbia, and Puerto Rico. Almost all programs (96%) have laws requiring reporting of BLLs, and 51% require BLLs be reported electronically to jurisdictional health departments. Most programs (80%) prioritize areas and populations that are high risk for lead poisoning prevention activities. Approximately half of the programs (51%) have a lead elimination plan or goal. Thirty-nine percent of the programs have already implemented policies, laws, or regulations to achieve lead elimination, and 74% are in the Northeast and Midwest regions of the country. As of March 2023, 71% of the programs have implemented CDC's updated blood lead reference value, and most (65%) did so via guidance for health care providers and laboratories for what BLL should initiate case management and other services for lead-exposed children. Almost all programs have mandatory BLL reporting laws, and about two-thirds of the programs updated their BLLs that trigger public health action.

“Working within broken systems”: Social workers bridge the fractures of U.S. healthcare: A qualitative inquiry on moral injury

Healthcare social workers (HSWs) in the United States are integral to interdisciplinary teams and health services. HSWs have a unique role in healthcare, as they care for their patients' psychosocial needs, through case management and clinical services. There is a gap in understanding how HSWs are impacted by their healthcare work. This study aims to understand the experience of moral injury, a marker of well-being, amongst HSWs in one state in the United States. Moral injury is the moral transgression (or boundary breaking) by oneself or someone in a position of power in high stakes situations and the negative outcomes of those experiences. Using a qualitative approach, semi-structured interviews were conducted with 24 HSWs in August of 2022. Thematic analysis was used to understand the lived experience of moral injury for HSWs. Three themes emerged: 1) HSWs’ definition and examples of moral injury; 2) HSWs situated in the “in-between” of policy and practice; and 3) upholding social work values within the medical model. These findings impact healthcare practice and policy, in delineating what falls within the bounds of social work, changing the workflow of health services, and creating further opportunities for interdisciplinary training, well-being initiatives, and systems-level changes. The findings from this work highlight the importance of understanding the moral impact of healthcare work on social workers, which should be further examined in depth not only amongst HSWs but also across the healthcare workforce.

Short-Term Effects of an eHealth Care Experiential Learning Program Among Patients With Type 2 Diabetes: Randomized Controlled Trial.

Type 2 diabetes is a chronic disease with a significant medical burden. eHealth care integrates medicine and technology to enhance the outcomes of such patients; however, adequate eHealth literacy (eHL) is necessary for that to happen. Fostering eHL is crucial for patients with diabetes to engage with eHealth care and receive quality care and timely support. Experiential learning theory can enhance patients' eHL and skills to use eHealth care technology in their daily care. This study explored the effectiveness of an eHealth care experiential learning program in improving eHL, patient health engagement, and eHealth care use status among patients with type 2 diabetes in 3 months. In this randomized controlled trial, patients under case management services from various clinics in Taiwan were randomly assigned to either the intervention group receiving the 6-session eHealth care experiential learning program or the control group receiving the usual care. Data were collected using structured questionnaires at 3 time points: pretest, postintervention, and 3 months after the intervention. Descriptive data were presented using frequency distribution, percentage, mean, and SD. The outcomes were analyzed using a generalized estimating equation method by intention-to-treat analysis. A total of 92 participants (46 in each group) were recruited in this study. Of these, 86 completed the course and follow-up evaluations with a mean age of 62.38 (SD 12.91) years. After completing the intervention, the intervention group had significantly higher posttest scores in eHL (β=19.94, SE 3.52; P<.001), patient health engagement (β=.28, SE 0.13; P=.04), and eHealth use (β=3.96, SE 0.42; P<.001) than the control group. Furthermore, the intervention group maintained these significant improvements in eHL (β=18.19, SE 3.82; P<.001) and eHealth use (β=3.87, SE 0.49; P<.001) after 3 months. Participating in the eHealth care experiential learning program resulted in significant improvements in eHL, patient health engagement, and eHealth use among patients with type 2 diabetes. Our interventional program can inform future clinical practice and policies to strengthen self-management skills and facilitate the use of health technology in caring for patients with chronic diseases. ClinicalTrials.gov NCT05180604; https://clinicaltrials.gov/ct2/show/NCT05180604.

Randomized Controlled Trial of 60 minutes for Health With Rapid Antiretroviral Therapy to Reengage Persons With HIV Who Are Out of Care.

Many persons with HIV remain out of care (PWH-OOC). We evaluated InstaCare, a complex intervention integrating the brief behavioral intervention 60 minutes for Health with the rapid restart of antiretroviral therapy (rapid ART). Prospective open-label randomized controlled trial among PWH-OOC in San Diego, USA. PWH-OOC were randomized 1:1 to InstaCare or a time-and-attention control integrating a diet-and-nutrition behavioral intervention also with rapid ART initiation (restart ≤7 days from enrollment). All participants had access to support services (free transport, HIV peer navigation, adherence counseling, and linkage to care) and primary care services (mental health, case management, social work, medication-assisted treatment, and specialist pharmacy). The primary outcomes were viral suppression (<50 copies/mL) and re-engagement with care (≥2 HIV care visits >90 days apart) by 24 weeks. Outcomes were reported on an intention-to-treat basis. Between November 2020 and August 2022, 52 PWH-OOC were enrolled. Baseline substance use in the preceding month (49%), unstable housing (51%), moderate/severe depression (49%), and moderate/severe anxiety (41.7%) were prevalent. Rapid ART was provided for all participants. At week 24, the proportion with HIV viral load <50 copies/mL was 37.3% (19/51) (InstaCare 28.0%, control 46.2%, P = 0.25). Fourteen (27.5%) were engaged with care (InstaCare 7/25 [28.0%], control 7/26 [26.9%], P = 1.00). Most participants (94%) reported low or very low emotional distress associated with rapid ART. Study lost to follow-up by week 24 was high (23/51, 45%). The InstaCare complex intervention did not improve viral suppression or reengagement with care among PWH-OOC. Investigation of high-intensity, individually adapted interventions is needed among PWH-OOC.

CaseAIM: child welfare workers’ experiences using information and communication technology for case management services

ABSTRACT The use of information and communication technologies (ICT) to enhance child welfare services provides innovative tools and support for child welfare workers to manage caseloads effectively. This study used the Technology Acceptance Model (TAM) to understand case managers’ experiences with the CaseAIM mobile app, a tool that supports workload efficiency through documentation, case access, support, and transportation. Thematic analysis of interviews (n=11) revealed four domains of experiences with CaseAIM: time management, increased engagement with children and families, improved case management support, and challenges. Findings yield implications for agencies introducing new technologies into their workforce.

10-year outcome trajectories of people with mental illness and their families who receive services from multidisciplinary case management and outreach teams: protocol of a multisite longitudinal study

IntroductionIndividuals with mental illness and their families often undergo their recovery process in their communities. This study explored the long-term outcome trajectories of individuals and families who received case management...

Student Support and Retention

Traditional student support services offered by universities are broad and varied; however, many of these fall under either student or academic affairs and are located centrally on campus. Offering a decentralized, college-specific model of student support and retention that partners with both academic and student affairs allows for a holistic, integrated approach to student resources that is easily accessed within a student’s own academic area. UA Little Rock has implemented this innovative model by housing a licensed social worker in each main campus college. These social workers provide case management services ranging from triage of at-risk students to coordination of on-campus and community resources. Each social worker is also able to provide a limited number of small micro-grants as emergency funds. Primary goals of this initiative include increased student use of the case management services, increased faculty referrals, improved student retention, evaluation of interventions, and student satisfaction. Pilot evaluation data indicates that a diverse population of students across multiple disciplines are utilizing these services and that retention rates for students receiving case management services differs based on their presenting issue(s). To support ongoing evaluation of services, there is a need to more clearly standardize data collection without disruption to practice.

Making the Case: Exploring the Role of Case Management in Relocation and Return Decisions in Choice Neighborhoods Initiative

Leveraging novel case management data, we present the first comprehensive investigation into the role of case management services in housing relocation and return decisions within the framework of the Choice Neighborhoods Initiative (CNI), the current place-based public housing revitalization program. Our study employs multinomial logistic (MNL) regression models to demonstrate that a higher level of involvement in case management services is correlated with an increased probability of moving to a higher-income neighborhood during the redevelopment process, as well as a greater likelihood of returning to the revitalized neighborhood afterward. By achieving these outcomes, case management services play a crucial role in enhancing the chances for original CNI residents to reap the benefits of neighborhood redevelopment—a matter of enduring concern among social scientists. These findings are contextualized with both sociodemographic and neighborhood characteristics associated with relocation and return decisions.

Elevating Black fathers' experiences in the National Fatherhood Initiative: Strengths and areas for improvement of 24/7 Dad® curriculum and case management services.

The Healthy Marriage and Responsible Fatherhood grant program is one of the most robust mechanisms supporting fatherhood programming in the United States, with the gold standard of care including fatherhood curriculum (e.g., 24/7 Dad®) and case management services. Despite the fact that fatherhood in the United States is not a monolith and Black fathers make up over 40% of those served through Responsible Fatherhood (RF) program, little research explicitly centers the lived experiences of low-income Black fathers. The current study used focus groups with fathers (n = 23) and staff (n = 8) enrolled in a RF grantee program. Thematic analysis was used to determine programmatic mechanisms supporting these fathers' success and areas for improvement. Our findings highlight that the creation of a "safe space" by facilitators and the power of the group dynamic were essential elements for fathers' success overall. We also identified numerous programmatic mechanisms supporting Black fathers' success specific to fathering, healthy relationships, and economic stability. Finally, we highlighted important limitations that may impede the success of low-income, Black fathers related to the 24/7 Dad® curriculum, engagement efforts, and economic stability, and discuss related practice, policy, and research recommendations.

Certified Community Behavioral Health Clinic Services for Clients With Co-occurring Disorders: A Latent Class Approach.

Certified community behavioral health clinics (CCBHCs) are designed to provide comprehensive care for individuals with co-occurring mental and substance use disorders. The authors classified outpatient mental health treatment facilities on the basis of provision of services for clients with co-occurring disorders and assessed whether CCBHCs differed from other outpatient mental health facilities in services provided. The authors used latent class analysis to identify distinct services for clients with co-occurring disorders in 5,692 outpatient mental health facilities in the 2021 National Substance Use and Mental Health Services Survey. Nine indicators were included: treatment for clients with substance or alcohol use disorder co-occurring with serious mental illness or serious emotional disturbance, specialized programs or groups for such clients, medication-assisted treatment (MAT) for alcohol use disorder, MAT for opioid use disorder, detoxification, individual counseling, group counseling, case management, and 12-step groups. A multinomial logistic regression was used to estimate whether CCBHCs were associated with any identified classes after analyses controlled for facility characteristics. A four-class solution provided a model with the best fit, comprising comprehensive services (23.4%), case management services (17.7%), counseling and self-help services (58.6%), and professional services (4.3%). Regressing class membership on facility type and covariates, the authors found that compared with community mental health clinics (CMHCs), CCBHCs were more likely to belong to the comprehensive services class than to the case management services, counseling and self-help services, and professional services classes. CCBHCs were more likely than other outpatient programs to offer comprehensive care, and CCBHC status of a CMHC facilitated enhanced service provisions.

Self-Reported Mental Health and Addiction Outcomes of a Novel Community-Based Case Management Program for Frequent Emergency Department Users

Frequent emergency department users with mental illness or addiction often struggle to find the services they need. A pre-test/post-test design assessed outcomes for these individuals after participating in a novel community-based stepped-care program delivering individualized intensive case management services. Results indicated improvement in overall functioning and severity of anxious and depressive symptoms.