Characteristics Of Case Management Research Articles

Factors that contribute to strong working alliances between case managers and clients

Summary Published literature has demonstrated that strong case manager–client working alliances foster improvement among clients. Reflecting a case-management context, this study explored how working alliances, as perceived by clients, are related to interpersonal capacities (or social support); intrapersonal dynamics; severity of problems facing client; and other client and case manager characteristics. The study included 101 clients and their 26 case managers at four nonprofit social-service agencies. Findings Working alliances, as perceived by clients, were observed to be associated positively with 3 variables: working alliance as viewed by case manager, length of time client worked with case manager, and client female gender. In turn, client mental-health or substance-use problem was linked to client unfavorable perception of working alliance. No link was observed between client perception of alliance and 6 variables: client social support, goal achievement, problem severity, client–case manager shared ethnicity, case manager work experience, and client age. Applications The findings suggest that working alliance is collaborative and interactive throughout the helping process. This impacts social work training protocols. Case managers who must establish working alliances with clients need the relevant collaboration skills, which may need to be introduced and practiced at in-service meetings or workshops.

Delphi Approach to explore ways to optimize case manager services in inpatient wards of Sanglah General Hospital

Background and purpose: Case manager services in inpatient rooms have gained popularity in many hospitals in Indonesia, however there are challenges in its implementation. This study aims to explore ways to optimize the characteristics of the case manager, case management practice and outcome of the case manager in cases in inpatient wards based on the Sanglah Hospital standards.Methods: The study utilized a two-stage Delphi study design, started with a qualitative data collection and followed by a quantitative survey. Data collection was done in May-June 2020 based on the concept of case manager characteristics, practice and outcomes. The qualitative data collection through in-depth interviews involved 9 key informants. It aimed to explore case manager services based on qualifications, competencies, ethical standards, workload, hierarchy and guidelines, implementation of case management and indicators of effectiveness of case management at Sanglah General Hospital. The results of the in-depth interviews with thematic analysis informed the Delphi survey instrument development. The Delphi survey aimed to generate agreement on the characteristic of the case manager, case management practice and outcome of the case manager among 21 expert panelists (case managers) in the inpatient wards of Sanglah Hospital. This Delphi survey was conducted in 3 rounds, the results were analyzed based on the median value and quartile deviation (QD).Results: The three rounds of the Delphi survey showed that there was an agreement regarding the qualifications of the case manager, competency development, mechanism for appointment and placement of case managers, case manager guidelines, organizational structure, job descriptions and authorities, information of the presence and role of case managers, screening indicators according to characteristics of inpatient cases, case management target measurement tools, case manager service evaluation indicators as well as the activity feedback loop.Conclusion: Optimization of the case manager service should focus on aspects of human resources, developing guidelines and work systems as well as evaluation indicators and feedback mechanism.

Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review.

Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care. For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1)population: adult frequent users with chronic disease, (2)intervention: CM in a primary care setting with a postintervention evaluation, and (3)primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods. Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes. Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes.

Multilevel Predictors of Case Managers' Assessment Administration Behavior in a Precursor to a Measurement Feedback System.

This study examines factors associated with administration of a treatment monitoring assessment measure (the Ohio Scales) in the context of a precursor to a measurement feedback system in a youth public mental health setting. 82% of all state case managers (N = 46) completed interviews and administered at least one Ohio Scale over a 12-month period. A multi-level model accounting for variance between both case managers and their administrative offices indicated that case manager characteristics (lower self-reported burnout, more experience) and monthly caseload characteristics (fewer active cases, younger average age of youth, and increased time since initial administration) predicted increased monthly administration proportions.

Clinical Survey and Predictors of Outcomes of Pediatric Out-of-Hospital Cardiac Arrest Admitted to the Emergency Department

Pediatric out-of-hospital cardiac arrest (OHCA) is a rare event with severe sequelae. Although the survival to hospital-discharge (STHD) rate has improved from 2–6% to 17.6–40.2%, only 1–4% of OHCA survivors have a good neurological outcome. This study investigated the characteristics of case management before and after admittance to the emergency department (ED) associated with outcomes of pediatric OHCA in an ED. This was a retrospective study of data collected from our ED resuscitation room logbooks dating from 2005 to 2016. All records of children under 18 years old with OHCA were reviewed. Outcomes of interest included sustained return of spontaneous circulation (SROSC), STHD, and neurological outcomes. From the 12-year study period, 152 patients were included. Pediatric OHCA commonly affects males (55.3%, n = 84) and infants younger than 1 year of age (47.4%, n = 72) at home (76.3%, n = 116). Most triggers of pediatric OHCA were respiratory in nature (53.2%, n = 81). Sudden infant death syndrome (SIDS) (29.6%, n = 45), unknown medical causes (25%, n = 38), and trauma (10.5%, n = 16) were the main causes of pediatric OHCA. Sixty-two initial cardiac rhythms at the scene were obtained, most of which were asystole and pulseless electrical activity (PEA) (93.5%, n/all: 58/62). Upon ED arrival, cardiopulmonary resuscitation (CPR) was continued for 32.66 ± 20.71 min in the ED and 34.9% (n = 53) gained SROSC. Among them, 13.8% (n = 21) achieved STHD and 4.6% (n = 7) had a favorable neurological outcome. In multivariate analyses, fewer ED epinephrine doses (p < 0.05), witness of OHCA (p = 0.001), and shorter ED CPR duration (p = 0.007) were factors that increased the rate of SROSC at the ED. A longer emergency medical service (EMS) scene interval (p = 0.047) and shorter ED CPR interval (p = 0.047) improved STHD.

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry

ObjectiveTo describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalisation. MethodFollow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. ResultsData from 835 patients with a mean age of 76.8years (SD: 12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD: 2.5) and high dependence (Barthel 37.5, SD: 31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR: 1.41; 95% CI: 1.22–1.63), more telephone interventions by case managers (OR: 1.12; 95% CI: 1.02–1.24) and imaging tests (OR: 1.37; 95% CI: 1.17–1.60), together with greater caregiver burden (OR: 1.31; 95% CI: 1.08–1.59), the presence of medical devices at home (OR: 1.69; 95% CI: 1.00–2.87) and received less “Case Management” intervention. ConclusionsThe patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Characteristics of the provision of case management services in the community setting in Andalusia based on the RANGECOM registry.

To describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization. Follow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers. Data from 835 patients with a mean age of 76.8years (SD:12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD:2.5) and high dependence (Barthel 37.5, SD:31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR:1.41; 95%CI: 1.22-1.63), more telephone interventions by case managers (OR:1.12; 95%CI: 1.02-1.24) and imaging tests (OR:1.37; 95%CI: 1.17-1.60), together with greater caregiver burden (OR:1.31; 95%CI: 1.08-1.59), the presence of medical devices at home (OR:1.69; 95%CI: 1.00-2.87) and received less "Case Management" intervention. The patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.

Case management for child protection services: A multi-level evaluation study

This article presents an evaluation study of a case management method for child protection services, the Delta Method for Family Supervision, in terms of supervision order duration and occurrence and duration of out-of-home placements. Additionally, case and case manager characteristics were examined. Data was collected about 224 cases, 58 case managers and 30 team managers of all 15 offices of the Child and Youth Protection Services in the Netherlands. In all cases the Delta Method was applied. Data were obtained by interviews, questionnaires and case files. Multi-level analysis was performed to study the influence of independent variables on supervision order duration, and the occurrence and duration of out-of-home placements. Case characteristics related to 87% of the differences in the duration of supervision order, case manager characteristics to 13% of the differences. Some case manager characteristics about applying the Delta Method were significantly related to shorter duration of the supervision order and the occurrence and duration of out-of-home placement. Case characteristics also showed strong relations. Together with the more general aspects of case management supported by this study, such as a one family and one worker approach, this contributes to a more effective practice of case management for child protection services.

Passing the torch: evaluating exportability of a violence intervention program

BackgroundA violence intervention program (VIP) developed at our trauma center resulted in a reduction of injury recidivism to 4% from a historical rate of 16%. Our aim was to investigate the feasibility of exporting our program to another trauma center by examining rates of and identifying potential barriers to recruitment, enrollment, and impact. We hypothesized that our VIP is feasible at another trauma center and successfully meets needs associated with risk reduction. MethodsIn January 2010, we introduced our VIP to another trauma center. To assess exportability of our program, we used a standard model of program evaluation for VIPs promoted by the Centers for Disease Control and Prevention. Specifically, the process and impact portions of the model evaluation were performed in this comparative analysis over a 1-year period. Recruitment, enrollment (process), and success at meeting risk reduction needs (impact) were our outcomes. This included patient and case manager characteristics in addition to rates at which eligible patients were approached and enrolled. These variables were compared using the Wilcoxon rank-sum and chi-square tests. ResultsDuring the study period, 155 patients were eligible for inclusion at the exported program compared with 119 at the original VIP. Rates at which eligible patients were approached at the exported program were significantly lower than the original program (44% vs 92%, P = .04). Rates at which approached patients were enrolled were also significantly lower (21% vs 55%, P = .002). The difference was associated with the time of injury and hospital length of stay because 40% of eligible patients were missed if injury occurred during a weekend and 70% were missed if the length of stay was less than or equal to 48 hours at the exported program. A cultural match between the client and case manager was assessed by race/ethnicity and language spoken; 2 of the 3 case managers at our site are Latino and bilingual and the other is black, whereas the 1 case manager at the exported program is black and monolingual. Cultural match was 91% versus 47%, respectively (P < .05). Impact: Both programs met more than 50% of identified client needs in several categories. ConclusionsProgram exportation is based on the replication of both the program model and the program infrastructure. The data in our study support success of the program model (case management process) at our export site, but the actual program infrastructure was not successfully exported to this hospital.

Palliative care case management in primary care settings: A nationwide survey

BackgroundIn case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the content of care and organisational characteristics of case management in palliative care is needed. ObjectivesTo investigate how many case management initiatives for palliative care there are in the Netherlands for patients living at home; to describe the characteristics of these initiatives with regard to content and organisation of care. SettingPrimary care. Design and participantsA nationwide survey of all 50 coordinators of networks in palliative care in the Netherlands was conducted. Additional respondents were found through snowball sampling. We looked at 33 possible initiatives using interviews (n=33) and questionnaires (n=30). ResultsWe identified 20 initiatives for case management. All stated that case management is supplemental to other care. In all initiatives the case managers are registered nurses and most possess higher vocational education and/or further training. All initiatives seek to identify the multidimensional care needs of the patients and the relatives and friends who care for them. Almost all provide information and support and refer patients who need care. Differences are found between the organisations offering the case management, their target groups, the names of the initiatives and whether direct patient care is provided by the case manager. ConclusionsIn the Netherlands, case management in palliative care is new. Several models of delivery were identified. Research is needed to gain insight into the best way to deliver case management. By describing characteristics of case management in palliative care, an important first step is made in identifying effective elements of case management.

Searching for the Social Work Practice from the Strengths Perspective in the ‘Integrated Case Management’ Services for Children in Poverty

Increasingly many social service settings are implementing ‘integrated case management.’ Especially child welfare is an leading arena where started providing case management services based on family centered and community-based approach in early 2000. The case management services are expanded in other arenas including people with disabilities, families in poverty, and the elderly. While there is yet to be a consensus on what is meant by ‘case management’ in Korea, characteristics of case management is unclear, although the system is known to be taking strengths-perspective and client-centered approach. These issues raise a question regarding what exactly this newly developing system is heading towards in terms of its underlying emphasis on child and family-centered, strengths perspective, and ‘integrated,’; and expects for social workers do both in the service system and in the process of providing mass-services for the children and their family. Thus, this study briefly reviewed theoretical foundation for the children in poverty: social environment where the children and family resides, changes in family functioning and relationships for children and necessary shift of perspectives for the social work practice; and reconceptualization of children as the service user. Then taking the two projects as example, this study outlined the characteristic of the case management services, contents of the services, and role of the case manager, I. e. social worker in the two representative projects, the ‘We Start’ and the ‘Dream Start.’ Then this study examined and discussed characteristics of their perspectives in the two projects, their views of the family and their functioning, the level of strengths perspective, roles of the case manager. Finally this study suggested complementary components for better case management practice for the children in poverty from the strengths perspective.

What is case management in palliative care? An expert panel study

BackgroundCase management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands.MethodsA modified version of the RAND®/University of California at Los Angeles (UCLA) appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round.ResultsNine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager.ConclusionsAlthough aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent.

Adherence to Scheduled Sessions in a Randomized Field Trial of Case Management: The Criminal Justice-Drug Abuse Treatment Studies Transitional Case Management Study.

The Transitional Case Management (TCM) study, one of the projects of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative, was a multi-site randomized test of whether a strengths-based case management intervention provided during an inmate’s transition from incarceration to the community increases participation in community substance abuse treatment, enhances access to needed social services, and improves drug use and crime outcomes. As in many intervention studies, TCM experienced a relatively large percentage of treatment-group participants who attended few or no scheduled sessions. The paper discusses issues with regard to participation in community case management sessions, examines patterns of session attendance among TCM participants, and analyzes client and case manager characteristics that are associated with number of sessions attended and with patterns of attendance. The average number of sessions (out of 12) attended was 5.7. Few client or case manager characteristics were found to be significantly related to session attendance. Clinical and research implications of the findings and of adherence in case management generally are discussed.

Client Satisfaction With Rural Substance Abuse Case Management Services

Although many substance abuse organizations offer case management services, little is known about clients' satisfaction as consumers of case management services. The purpose of this study was to evaluate consumer preferences regarding the delivery of case management services in a rural substance abuse treatment program. For this study, 120 clients (30 in each of four research conditions) were interviewed about their experiences in the Iowa Case Management Project (ICMP), a field-based clinical trial evaluating a strengths-based model of case management for rural clients in drug abuse treatment. A mixed-method approach evaluated clients' responses from a semistructured interview. Most clients preferred meeting with their case manager in their own home. Clients also stated that they preferred specific characteristics of case management services-namely, convenience, privacy, comfort, and accessibility. Finally, clients wanted more time with their case managers over time. Although clients in drug treatment are not often considered as consumers, we found that client satisfaction with case management services could be studied and that clients appreciated being asked about their experiences. By targeting perceived and actual barriers to meeting with case managers (e.g., availability of transportation), service utilization by clients may be increased along with overall satisfaction.

Case Management Services at Ten Federally Funded Sites Targeting Homeless Children and Their Families

Of the 128 federally funded projects providing health care to homeless people, only 10 specifically target homeless children. In this article we describe these 10 health care for the homeless projects, the case managers, and the children that they serve. Data collected from the case managers and from federal reports demonstrated differences among projects by case manager characteristics, number of children served, and federal funding levels. Case management is a legislatively mandated service for the federally funded homeless children's grantees, but its implementation is very diverse. These different sites illustrate the different ways that a federally funded program has evolved to meet the needs of its community.

Client satisfaction with case management: A study of 10 pilot services in Sweden

Client satisfaction has become important both as a measure of outcome of psychiatric care and as a measure of the process of care. However, relatively few studies have investigated client satisfaction with case management services. The general aim of the present study was to investigate client satisfaction in 10 new case management services established in Sweden in 1995. The specific research questions were; how satisfied are the clients of case management services? Are there differences in satisfaction with regard to clinical and social characteristics of the client, case manager characteristics, type of case manager interventions, and characteristics of the service? The study comprised 176 clients out of which 154, (88%) responded to an 11-item satisfaction questionnaire administered at an 18-month follow up. The results showed that client satisfaction with the case management services was high. Type of interventions and life area of the client concerned was mainly unrelated to satisfaction. However, it seems that advocacy and case manager time spent on this type of intervention is essential and associated with a better satisfaction with services.

A Study on the Plans for Case Management Practice in Mental Health

The purpose of this study is to present appropriate plans for case management practice in mental health. The main contents of this study are to examine characteristics of case management, review necessity of case management practice in mental health, and present appropriate plans for case management practice in mental health.br/ This study presents appropriate plans for case management practice in mental health through application of case management practice process. Case management practice includes six processes, and they are entry, assessment, planning, linking, monitoring, and evaluation. Case manager must find the mentally ill through outreach and referral, prescreen them, identify individual clients, and contract with them Case manager assess multiple needs, abilities, and social resources of the mentally ill by team approach. And case manager sets goals, priority of goals and care plans for the mentally ill, links social resources to the mentally ill, implements care plans, and coordinates services. Case manager monitors services provided to the mentally ill and implementation of care plans, reassesses at appropriation of care plans, and evaluates client's satisfaction, effectiveness, efficiency, cost-effectiveness and of services.br/ Advocacy is particularly important to case management practice in mental health because the mentally ill have not fair access to services, have been assumed to be unsuitable for services, and have dependence. Finally the study of case management practice in mental health have been facilitated for improvement of welfare to the mentally ill.br/

A Study of Case Managers’ Decision-Making Processes

Decision-making processes were explored in a study of 122 case managers from community-based aging network agencies. Of interest was how often case managers employed a consumer-driven model whereby elders' input is always considered during the assessment and decision-making processes. Approximately 80% always used clients as a source of information during assessment but less than a majority always used client recommendations in decision making. The case managers indicated that safety was more frequently a guiding principle used in decision making than the least restrictive alternative, disruption to lifestyle, and freedom. When clients disagreed with the case managers' decisions, attempting to convince the client was the strategy the greatest proportion of respondents employed. Case manager characteristics (gender and degree) were not found to be associated with consumer-oriented methods of assessment or decision making. The authors concluded that the respondents tended to use a consumer-oriented approach when assessing clients but moved away from the consumer-driven model when making decisions with regard to clients. Safety, rather than freedom, was the prevailing guiding principle.

Does Assertive Community Treatment Reduce Burnout? A Comparison with Traditional Case Management

We examined burnout and job satisfaction among 216 case managers serving clients with severe mental illness, comparing assertive community treatment (ACT) workers with traditional case managers (TCMs) in two Midwestern states. Compared to TCM, ACT workers reported significantly lower levels of burnout, higher levels of job satisfaction, and more favorable perceptions of their work environment. In the TCM sample, length of time in current job was associated with greater burnout, and severity of client problems was associated with greater burnout and job dissatisfaction. Neither of these sets of factors predicted burnout in the ACT sample, however. Instead, no case manager characteristics, caseload characteristics, or service delivery variables, except for age, predicted burnout in the ACT sample. The findings suggest that the ACT model may be especially suited to protect against burnout in case managers serving clients with the most severe disabilities and who are most prone to psychiatric readmissions. However, the small effect sizes and the lack of a prospective, experimental design suggest that further research is needed before drawing firm conclusions.

Computers and process description for community mental health care.

The focus of mental health care has seen a significant shift from institutional care to community based care and has been well described (Thornicroft &amp; Bebbington, 1989). This shift has necessitated the development of new and flexible models for ensuring that patients' needs are met. Mental health professionals have to operate across a wide range of community contexts dealing with a complex range of needs. Intensive Case Management (ICM) also known as Assertive Community Treatment is a model of service provision to the long term mentally ill in the community. The Programme of Assertive Community Treatment (ACT) developed by Stein &amp; Test (1980) in the United States has a number of Key elements (figure 1).ACT-based ICM is unusual in that it has been extensively researched (principally in the United States of America), and programmes are relatively well described. Such descriptions, especially of programmes outside America, often focus on underlying principals and philosophies and do little to measure practice. Teague et al. (1995), however, devised clear criteria for measuring practice components and McGrew et al. (1994) asked ACT “experts” to rate the “key” elements of PACT and related a number of these to levels of hospital use. In the United Kingdom, Thornicroft (1991) listed twelve axes for describing the central practice characteristics of case management (a broad concept including ICM). These UK ‘practice characteristics’ also focus more on macro-level programme description rather than on the practices of programme staff. There is a pressing need for research into exactly what teams do.