Case Management Staff Research Articles

How SWAT Changed the Conversation: Implementation of a Discharge SWAT Team Improves Morale and Facilitates Communication During the COVID-19 Pandemic.

Hospital overcrowding and delays in discharge are serious issues in the modern health care landscape and can lead to poor patient outcomes and health care personnel (HCP) burnout. The goal of this project was to develop a collaborative forum where HCP representing the entire spectrum of the inpatient care team, including case management team members, could connect to discuss challenges and barriers to patient discharge. The following describes the development, implementation, and outcomes of the discharge SWAT (Solutions, Wins, Actions, and Tactics) team, which is a 30-min virtual daily meeting where discussion is primarily centered around challenges in discharging individual patients and addressing case manager needs. The primary aim of SWAT meetings is fostering a positive atmosphere to address barriers to discharge while prioritizing patient care and outcomes. This study was conducted in a 40-hospital academic health system in the United States. SWAT meetings were first implemented at a representative flagship facility in a health system. HCP at this first facility were surveyed to assess satisfaction with SWAT meetings. SWAT meetings then were implemented at the majority of facilities in a 40-hospital academic health system. During SWAT implementation, average inpatient length of stay (LOS) and patient care transitions were monitored for participating and nonparticipating service lines. Among surveyed HCP, the majority view SWAT meetings favorably and reported that it was a valuable use of their time and positively impacted their work in the patient discharge space. Nonprovider and case management staff in particular valued the SWAT meetings and found them beneficial. LOS remained stable for patients under the care of participating providers, despite the upheaval of the ongoing COVID-19 pandemic, and the research team also observed a positive impact of SWAT meetings on appropriate inpatient care transitions.

Examining Traumatic Experiences: Violence, Loss, Isolation, Cultural Struggle, and Their Influence on the Mental Health of Unaccompanied Rohingya Youth Resettled in the U.S.

The Rohingya, a stateless Muslim minority from Myanmar, are a relatively small, yet extremely vulnerable group of refugees in the United States. Most research on Rohingya focuses on trauma in Myanmar rather than adjustment to the U.S., and almost none looks specifically at adolescents. Therefore, in this paper the data are from qualitative focus groups (n = 10) with 23 service providers to help answer the research question: In what ways did service providers discuss the trauma histories and mental health adjustment of Rohingya unaccompanied refugee minors? Results indicate that both pre-migration trauma and aspects of adjustment post-arrival are factors influencing the rocky start to life in U.S. communities. Specifically, a history of normalized violence was noted to lead to acting out behaviors and seeking of harm; and their vast experiences of loss (family, friends, and culture) were discussed in terms of survivors’ guilt and prolonged mental health challenges. Themes in terms of post migration isolation in a new environment, and cultural struggles in understanding U.S. culture and the norms of foster care were also discussed. Implications include the need to destigmatize mental health services and seek alternatives, help youth overcome the survivor’s guilt, and ensure both foster parents and case management staff have adequate training and tools to work with youth who have experienced extreme institutional discrimination, personal violence, and ethnic cleansing.

A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study.

Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066.

Same-Day Total Joint Discharges: A Collaborative Effort for Patient Safety

<h3>Background Information</h3> Previously, both knee and hip replacement patients had been admitted to the hospital for several days on average. Our orthopedic surgeons began booking them as same day discharges. In navigating this new plan of care, we identified a lack of knowledge of the PACU RN regarding discharge instructions for these patients. The required home discharge information included: antibiotics, anticoagulation therapy, home visits with nursing, and physical therapy. Coordinating these therapies, same day, was identified as a new process for the PACU RN. <h3>Objective of Project</h3> The objective and goal of this project was to ensure our patients have a safe discharge on post-op day zero with adequate preparation for medication management and the necessary services at home. <h3>Process of Implementation</h3> Our team identified the key stakeholders to accomplish our objective. These stakeholders included: Orthopedic surgery, Orthopedic Nurse Practitioner, Case Management, Physical Therapy, PACU management, and PACU staff members. Multiple meetings occurred between these multidisciplinary team members to discuss each member's expectations for a safe discharge, potential roadblocks, and solutions. Issues identified were Case Management coverage for PACU, proper lovenox teaching, and physical therapy evaluation equipment needed in the PACU. These issues were addressed and resolved. To assure that the complex criteria for discharge was met, the PACU RN's created a tool to assist with this process. This tool listed all the activities to be completed prior to discharge. <h3>Statement of Successful Practice</h3> The identification of proper discharge requirements and the creation of the "Orthopedic Same-Day Surgery Tip Sheet" streamlined the discharge process. This tip sheet provided guidance to RN's to ensure each patient was being sent home with the correct teaching and tools for a safe same-day discharge. During the post-operative phone call the patients confirmed that the discharge instructions were complete and the home visits were scheduled. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The identification of a knowledge deficit led to a multidisciplinary group collaborating on best practices. The creation of a PACU "Tip Sheet" gave the RN's the necessary tool and knowledge to care for the same day discharged total joint patient. Our patients are going home with proper education and resources needed for a successful and safe recovery at home.

65 &amp; Thrive: Improving Patient Length of Stay, Readmission, and Quality of Care by Becoming an Age-Friendly Hospital

Data indicates that older persons will increase in numbers along with having an increase of life expectancy in the United States. Kaiser Permanente Los Angeles Medical Center’s Utilization Department developed “65 & Thrive”—an age-specialized initiative to provide holistic care that preserves independence, quality of life, prevents functional and cognitive decline, and promotes both patients and their families to continue thriving. The initiative’s focus is guided by the 5 M’s model on mobility, medication, mentation, multi-morbidity, and what matters. Case management staff were given age-sensitivity trainings, improved workflows and made assessments that identified, addressed, and secured resources for patients throughout their hospitalization. Silver Angel volunteers were specially trained to prevent physical and mental decline and focused on activities to prevent delirium, depression and falls. The volunteers visited with patients daily for these interactions. The initiative was piloted in April 2020 on a stroke telemetry unit and since then the hospital has seen a significant decrease in the overall annual readmission rates by 3.1% when compared to 2019. The average length of stay for older adult patients; however, increased from 4.05 to 4.83 days unfortunately due to COVID-19. This initiative demonstrates the necessity to expand “65 & Thrive” throughout the hospital and ultimately to other Kaiser Permanente medical centers to best provide holistic care to older adults.

65 &amp; Thrive: Improving Patient Length of Stay, Readmission, and Quality of Care by Becoming an Age-Friendly Hospital

Despite its importance for health and wellbeing, oral health quality of life (OHQoL) has received little attention in lower-income countries, such as Colombia. This study describes the prevalence of older adults’ OHQoL and variability by socioeconomic status. We use data from the 2015 SABE-Colombia (N=18,700), a nationally representative survey of community-dwelling Colombians ages 60 and older. We used the Simple Count Geriatric Oral Health Assessment Index (SC-GOHAI), a self-reported measure of frequent oral health problems such as chewing, swallowing, and speaking designed to assess OHQoL. The scale ranges from 0-12; higher scores indicate worse OHQoL. About 69% of older Colombians reported at least one OHQoL problem. The most common issues were difficulty chewing hard food and speaking. High education and income were associated with better OHQoL and smoking were associated with worse OHQoL. Oral health may therefore reflect another dimension of social and health inequality for older Colombians.

Barriers and Facilitators to Housing With Services: Lessons From The Right Care, Right Place, Right Time Program

The Right Care, Right Place, Right Time initiative (R3) was developed to enable seniors to remain at home as long as possible, while reducing health care costs. It was implemented in four senior housing communities in the Greater Boston area, and consists of two on-site wellness teams (wellness nurse, wellness coordinator), each responsible for about 200 participants across two housing sites. This study aimed to understand barriers and facilitators to implementing R3. Data derived from 31 semi-structured interviews with R3 staff, housing personnel, and community partners (e.g., first responders), as well as 150 key program documents. Facilitating factors in implementing R3 included: top-level management support; formal and informal mechanisms of communication between wellness team members and building staff; substantial discretion, flexibility, and creativity provided to wellness team members; and daily ambulance reports from first responders. Barriers to implementing R3 included: impediments to resident recruitment/engagement; initial role confusion between wellness team members and existing building staff; limited wellness team time at individual intervention sites; challenges establishing systematic relationships with case management staff from the hospitals, AAAs, and insurance companies; and the decentralized approach to data tracking and information exchange. This study suggests several lessons for implementing housing with services initiatives such as R3. Top-level support and buy-in at the organizational level is essential to program development and implementation. Despite early challenges, key program elements can improve over time (communication, data processes, role clarity). Establishing trust with both R3 participants and housing staff is key to building relationships that promote program success.

Women parolees' mental health in the context of reintegration.

Contributing to the literature on reintegration and community supervision, we consider the mental health experiences of women parolees and the implications for case management. We consider the different ways mental health considerations are responded to by parole officers and case management staff, identifying areas of tension (e.g., when psychological services are fused with supervision) but also areas of opportunity (e.g., when case management staff forge therapeutic relationships with parolees). Using a grounded approach we explore women's parole experiences and case management practices through a qualitative analysis of parole and casework documents. Our iterative process of document analysis included content and thematic analysis. Mental health is responded to both as a therapeutic need and criminogenic risk. Therapeutic responses entail both formal and informal supportive interventions that often appear welcomed by and beneficial to parolees. Risk-based responses fuse mental health considerations into supervisory frameworks, evidenced by the prominence of mental health-related parole conditions and the role of psychologists as assessors of risk. The tension between treatment and supervision can undermine conditions favourable to responsive case management and the working alliance.

338 Pet Friendly: The Role of Animal Care in Patient's Decisions Regarding Atypical Discharge

Animal care is frequently listed as a reason patients choose to sign out of the emergency department or hospital against medical advice. However, the frequency of this issue as a decision point in atypical discharges is unclear. We reviewed all atypical discharges for a 12-month period (January 1, 2019-December 31, 2019) from the ED at Veterans Health Administration medical center to determine the degree to which concerns regarding animal care were involved in an atypical discharge. The setting is a 28,000-visit high acuity tertiary Veterans Health Administration medical center ED. All patients with a disposition of atypical discharge (Left without being seen, LWBS: eloped, E; against medical advice, AMA) are contacted within 24 hours of discharge by a nurse case manager. Among the data points collected include reason for leaving. All charts of patients with atypical discharge were reviewed for a primary or secondary category of “pet/animal care’ under reason for leaving to determine the frequency with which this issue occurs as a factor in patient’s decision to opt for an atypical discharge. The lead author conducted all reviews of data obtained by the case management staff. A total of 1,397 charts were identified as atypical discharges. Of these, the majority (908, 65%) were LWBS, with 297 (21%) leaving AMA and 192 elopements. 1253/1397 (89%) were able to be contacted verbally within 48 hours of their atypical discharge. The most common reason for atypical discharge overall was wait time, which was the primary reason given in 998 (79%) of the cases. However, having an animal that needed care accounted for the primary reason for atypical discharge in 71 (24%) of the patients leaving AMA, and was the primary reason for atypical discharge in 49 (5%) of the elopements and 93 (10%) of the LWBS patients. Additionally, need to provide animal care was listed as a secondary reason for atypical discharge in 313 (25%) of the atypical discharges. 44 of the patients who left AMA went to the ED and were readmitted within 24 hours of leaving AMA after securing animal care The need to provide animal care was a frequent reason for atypical discharge at our facility, particularly for patients who signed out AMA. A significant number of patients who left AMA returned when they had secured animal care. Lack of animal care is a driver of decisions to leave the emergency department for a significant number of patients in our study.

Serious Illness Conversations: A Case Management Quality Improvement Project.

The purpose of this project was to develop, implement, and evaluate an educational program and a serious illness (SI) protocol for a case management team of nurses and social workers to achieve the following: (1) utilize an SI protocol to identify patients with SI; (2) utilize a Serious Illness Structured Communication Guide to elicit these patients' goals and preferences for SI care; and (3) document in the electronic medical record the patients' elicited values and goals using a structured SI documentation template. Seventeen nurse and 3 social work case managers in an Accountable Care Organization (ACO) in a large health system in a western suburb of Chicago participated in this project. The practice setting was the primary care clinics associated with the health system. Patients eligible for the project met the SI criteria and were part of the organization's ACO or Bundle Payment for Care Improvement program. Twenty members of the case management staff participated in a 4-hr face-to-face educational program, based in part on review of best practices related to SI care and communication. Participants completed a pre- and posttest survey of knowledge; self-rated their confidence in conducting SI conversations; and evaluated the educational program. Participants then engaged in the established protocol inclusive of the following: (1) identify patients appropriate for an SI conversation; (2) initiate the SI conversation; and (3) document components of the SI in the electronic medical record. Educational Program: Ninety-five percent of the RN and SW case managers reported that that the educational module objectives were met to a moderate or great extent. One hundred percent of the participants reported that the format to deliver the program was effective, the content of the program was directly relevant to their clinical practice, and they would change their practice because of learning/understanding the content in the program. Educational program pretest scores ranged from 46.2% to 84.6%, with posttest scores ranging from 69.2% to 100%. A paired-samples t test demonstrated a statistically significant increase in posttest scores. Baseline confidence scores ranged from 1 to 4, with postproject confidence scores ranging from 2 to 4. A paired-samples t test demonstrated a statistically significant increase in confidence.Serious Illness Protocol: The case managers correctly identified 92% of patients who met the established SI identification criteria for this project. In 91.8% of cases, the case managers conducted an SI conversation in adherence to the protocol. In 76% of the cases, documentation about the SI conversation was completed in accordance with the protocol. .

ATTITUDES OF STAFF TOWARDS A NEW CARE DELIVERY MODEL

The aim of a nursing home provider is, that staff from 4 nursing homes provides additionally home care and other services in an area that is in walking distance of the NH. This is unique Germany. Our subproject focuses on the perspective of staff toward this innovative care delivery model. This presentation will describe qualitative findings from 32 focus-group interviews at three different time points over the course of 2,5years. Participants were nurses, head of the nursing homes, case management, care assistants and housekeeping staff. Preliminary findings suggest, that the chosen way to implement the new care service model influences the attitude, acceptance and adoption. For example, if nurses experience an imbalance between requirements of the residents vs. home care recipients they tend to neglect the new routine. For example, if they experience high flexibility how to change their routine they tend to accept the new care delivery model.

Communicator or Shill?

Communicator or Shill?

Social support and housing transitions among homeless adults with serious mental illness and substance use disorders.

Research suggests that social supports are associated with housing retention among adults who have experienced homelessness. Yet, we know very little about the social support context in consumers find and retain housing. We examined the ways and identified the junctures in which consumers' skills and deficits in accessing and mobilizing social supports influenced their longitudinal housing status. We performed semi-structured qualitative interviews with VA Greater Los Angeles consumers (n = 19) with serious mental illness, substance use disorders, and a history of homelessness; interviews explored associations between longitudinal housing status (categorized as: stable, independent housing; sheltered housing, continually engaged in structured housing programs; and unstable housing) and social supports. We compared data from consumers in these 3 mutually exclusive categories. All participants described social support as important for finding and maintaining housing. However, participants used formal (provider/case managers) and informal (family/friends) supports in different ways. Participants in stable housing relied on formal and informal supports to obtain/maintain housing. Participants in sheltered housing primarily used formal supports, for example, case management staff. Unstably housed participants used formal and informal supports, but some of these relationships were superficial or of negative valence. Interpersonal problems were prevalent across longitudinal housing status categories. Social context, including patterns of formal and informal support, was associated with participants' longitudinal housing status. Within interventions to end homelessness, these findings suggest the value of future research to identify, tailor, and implement practices that can help consumers improve their social resources. (PsycINFO Database Record

Stakeholder perspectives on integrated services for people who experience chronic homelessness

ABSTRACTThis article concerns a SAMHSA-funded service intervention, Pathways to Independence, that combined the use of SAMHSA’s SSI/SSDI Outreach, Access, and Recovery approach to facilitating disability entitlement claims with financial management classes, mental health assessment and referral, and access to employment and housing for people experiencing chronic homelessness. The purpose of this study was to explore perceptions of this form of service delivery and the benefits and challenges of the program model from the perspective of those who experienced it. Focus groups were conducted with a total of 17 program stakeholders, including program participants, program staff, collaborating case management staff of the parent agency, and a landlord and an employer, with questions to each regarding the program and its impact. Focus groups were analyzed through independent coding followed by discussion to reach consensus on key themes. Five themes were identified across the groups: (a) the importance of relationships, (b) staff specialization and provision of individualized services, (c) an orientation to outcomes, (d) comprehensiveness of services and facilitation of connections to community resources, and (e) systems challenges. The Pathways to Independence program provides a working model for integrated employment, entitlement assessment and application, housing, and behavioral health treatment for persons experiencing chronic homelessness.

Case Management: Transforming Health Care Environment.

Case Management: Transforming Health Care Environment.

Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial

BackgroundImproving the extent to which evidence-based practices (EBPs)—treatments that have been empirically shown to be efficacious or effective—are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness–implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment.MethodsUsing a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration–preparation–implementation–sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome).DiscussionAlthough not without limitations, the ISF experiment has several strengths: a highly rigorous design (randomized, hypothesis-driven), high-need setting (ASOs), large sample size (39 ASOs), large geographic representation (23 states and the District of Columbia), and testing along multiple phases of the EPIS continuum (preparation, implementation, and sustainment). Thus, study findings will significantly improve generalizable knowledge regarding the best preparation, implementation, and sustainment strategies for advancing EBPs along the EPIS continuum. Moreover, increasing ASO’s capacity to address substance use may improve the HIV Care Continuum.Trial registration ClinicalTrials.gov: NCT03120598.

Testing the effectiveness of a motivational interviewing-based brief intervention for substance use as an adjunct to usual care in community-based AIDS service organizations: study protocol for a multisite randomized controlled trial

BackgroundIn 2010, the first comprehensive National HIV/AIDS Strategy for the United States was released and included three goals: (1) reducing the number of people who become infected with HIV, (2) increasing access to care and improving health outcomes for people living with HIV, and (3) reducing HIV-related health disparities and health inequities. In 2013, as part of its effort to help address the National HIV/AIDS Strategy, the National Institute on Drug Abuse (NIDA) funded a type 2 effectiveness-implementation hybrid trial titled the Substance Abuse Treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS Service Organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the MIBI Experiment.MethodsAs part of a multisite randomized controlled trial, individuals with comorbid HIV/AIDS and problematic substance use are randomized to receive either the ASOs’ usual care (control condition) or usual care plus a MIBI for substance use (experimental condition) delivered by trained ASO case-management staff. Primary outcome measures are reductions in days of primary substance use, number of substance-related problems, times engaging in risky behaviors, days of non-adherence to HIV medications, and increases in substance use treatment. As part of this paper, we describe the trial protocol in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines.DiscussionIf successfully able to implement MIBI as an effective adjunct to usual care, the current trial may have a significant impact on increasing the capacity of ASOs to address problematic substance use among individuals living with HIV/AIDS. Reducing the prevalence of problematic substance use among individuals living with HIV/AIDS within the United States may lead to significant improvements on key performance measures (i.e., the HIV Care Continuum and the 90-90-90 target).Trial registration ClinicalTrials.gov: NCT02495402

Reducing Hospitalization for Long Stay Patients

This case study described the structure and preliminary impact of a hospital program to improve efficiency by reducing long stays for adult medicine inpatients. The program focused resources on these patients, including an experienced case management staff, effective relationships with long term care providers, and Subacute and Complex Care services. The program caused the total number of adult medicine patient days associated with these patients to decline by 1593, or 4780 on an annual basis.

A 30-Year Retrospective: Degrees of Difficulty in Decreasing LOS.

In an attempt to avoid future revisionist history, the author offers a 30-year retrospective (1986-2016) on the evolution of strategies to reduce length of stay (LOS). She and her colleagues have been involved from the onset by developing tools such as critical paths, roles such as clinical case management, and operational systems for managing measureable outcome-driven care from the bedside to the boardroom. Acute care hospitals. The LOS for all inpatients has changed dramatically from 1970 (average LOS = 7.8 days) through solidly between 2005 and 2012 (average LOS = 4.5 days in 2012) despite a significant increase in the average age of hospital inpatients (; ). For patients 65 years and older, who comprised 38% of all inpatients, the decrease has been more drastic: from 12.6 days in 1970 to 5.5 days in 2005-2010 ().With the exception of hospitalists and case management staff, acute care hospitals have essentially doubled productivity without adding additional direct care full-time equivalents! Described in terms of "low-hanging" to "high-hanging" fruit, this article outlines the classic methods used to reduce LOS and concludes with some implications of LOS for health care reform. The U.S. health system could not have accomplished this feat without case managers and social workers. Acute care services should be very proud of their achievements and use their reputation to empower their work for the next frontier, which will be reducing cost per case, especially in risk contracts. Everything old seems new again.

Help for heroes? Evaluating a case management programme for ex-service personnel in the United Kingdom.

There is increasing recognition of the health and social needs of ex-service personnel, but the UK evidence base on interventions is small. This article presents the findings from an evaluation of a vocational case management programme co-funded by the National Health Service (NHS) to prevent ill health among ex-service personnel. Qualitative, semi-structured interviews with 15 ex-service personnel were conducted. Five interviews with case management staff were also undertaken. Data were transcribed, thematically coded and analysed using NVivo. Ex-service personnel valued the service and consistently highlighted 'being listened to', 'being made to feel valued by programme staff', 'having their problems taken seriously' and 'being treated as an individual' as the most valuable aspects of the programme. Respondents particularly valued the personal support that case managers provided and the environment in which the service was delivered. Case management is a viable way in which the military, health professionals and support services can provide ongoing support for ex-service personnel in transitioning successfully to civilian life.