Community-based Case Managers Research Articles

Demystifying Case Management in Aotearoa New Zealand: A Scoping and Mapping Review

Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.

APA Achievement Award Winners Meet Contemporary Challenges With Innovation

Back to table of contents Previous article Next article APA & MeetingsFull AccessAPA Achievement Award Winners Meet Contemporary Challenges With InnovationMark MoranMark MoranSearch for more papers by this authorPublished Online:13 Apr 2020https://doi.org/10.1176/appi.pn.2020.4b22AbstractThis year’s winners use collaboration and community engagement to extend psychiatric expertise to distressed populations and rural hospitals facing a shortage of mental health manpower.APA’s 2020 Achievement Award winners include innovative community and academic-based services focusing on veterans’ health and mental health, support for victims of sex trafficking, and psychiatric support of primary care practices given the shortage of mental health professionals.Since 1949, the Psychiatric Services Achievement Awards have recognized creative models of service delivery and innovative programs for people with mental illness or disabilities. Each year, APA bestows a Gold, a Silver, and a Bronze Award. Following are this year’s winners:Lt. Col. (Ret.) Army Medical Service Corps Michael Richardson, vice president for mental health and brain health programs of the Wounded Warrior Project’s Warrior Care NetworkMollie Gordon, M.D., medical director of the Baylor College of Medicine Anti-Human Trafficking ProgramZsuzsa Szombathyne Meszaros, M.D., Ph.D., director of the residency training program in the Department of Psychiatry and Behavioral Science at SUNY Upstate Medical CenterGold Award: Warrior Care Network. The Warrior Care Network, based in Jacksonville, Fla., is a collaboration of the Wounded Warrior Project and four academic medical centers throughout the United States: Emory Healthcare, Massachusetts General Hospital, Rush University Medical Center, and UCLA Health. The program operates in cooperation with the Department of Veterans Affairs to enhance access to clinical and family-centered treatment for veterans experiencing posttraumatic stress disorder, traumatic brain injury, and related conditions. Care is offered through standard outpatient treatment and an innovative intensive outpatient program.Silver Award: Baylor College of Medicine Anti-Human Trafficking Program. In this collaboration with the Houston Mayor’s Office and the Office of the Governor of Texas, Baylor Department of Psychiatry faculty members supervise two psychology postdoctoral fellows and a clinical social worker/case manager to address the problems related to human trafficking through a medical and public health lens. Through the program, health care professionals and community providers are trained in the identification and treatment of victims of human trafficking. By maintaining a working relationship with community-based case managers, the program enables victims to be referred for mental health treatment. An interdisciplinary approach enables the appropriate response to patients’ individual needs and provides a better chance for recovery and healing from this trauma.Bronze Award: SUNY Upstate Medical University. SUNY Upstate Medical University is located in a rural area where there is a serious shortage of psychiatrists. To help mitigate this problem, the school’s residency program has partnered with rural hospitals to support additional residency positions that will provide community care. The hospitals contract with the school with the understanding that the residents assigned to them, besides receiving standard residency training, will spend two months of the first two years of residency and one day a week during the second two years at a rural hospital site. The residents are committed to spending the five years after residency at the rural site. The first graduate has now started full-time work, and 12 residents are providing care to rural communities where people in need would otherwise have great difficulty accessing psychiatric care. ■ ISSUES NewArchived

Integrating Evidence-Supported Psychotherapy Principles in Mental Health Case Management: A Capacity-Building Pilot.

Mental health case managers comprise a large workforce who help patients who struggle with complex mental illnesses and unmet needs with respect to the social determinants of health. This mixed-methods capacity-building pilot examined the feasibility, experiences, and outcomes of training community-based mental health case managers to integrate evidence-based psychotherapy principles into their case conceptualization and management practices. Case-based, once-weekly, group consultations and training in applied therapeutic principles from mentalizing, interpersonal psychotherapy, motivational interviewing, and other evidence-based psychotherapies were provided to case managers over 8 months. A trauma-informed and culturally sensitive approach was emphasized to improve therapeutic alliances and to foster adaptive expertise and an appreciation of individual patient differences. Qualitative analyses of focus groups and individualized interviews identified a shift toward being more reflective rather than reactive, with improved empathy, patient engagement, morale, and confidence resulting from the training (N = 16). Self-reported pre-post counseling self-efficacy changes revealed significant improvements overall, driven by improved microskills and an ability to deal with challenging client behaviors (N = 10; P < 0.05). This pilot demonstrated that case-based consultations and training of mental health case managers within a community-of-practice in trauma-informed, culturally sensitive application of evidence-supported psychotherapy principles were feasible and acceptable with scalable potential to improve case managers' counseling self-efficacy, reflective capacity, empathy, and morale. Further research in this area is needed with a larger sample, and patient and health systems outcomes.

Strategies for expanding health insurance coverage in vulnerable populations.

BackgroundHealth insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations.ObjectivesTo assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations.Search methodsWe searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI‐Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD‐CNKI) (searched 2 November 2012).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies.Selection criteriaRandomised controlled trials (RCTs), non‐randomised controlled trials (NRCTs), controlled before‐after (CBA) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions.Data collection and analysisAt least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis.Main resultsWe included two studies, both from the United States. People offered health insurance information and application support by community‐based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence).In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence).Authors' conclusionsCommunity‐based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are needed in different settings, with careful attention given to study design.

Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. The model is intended to improve the quality of patient care and maintain the patients' health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased). Fraser Health's case manager-general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients.

Professional and Personal Factors Associated with Gerontological Practice: Implications for Training and Education

Professional practice with older adults is performed in a variety of settings and across a broad range of areas. Planning for care throughout the end of life represents an increasingly important aspect of work with older adults as a result of the nation's aging demographic and concomitant health care needs. Community-based geriatric case managers represent a growing cadre of professionals encountering frail older adults with future care needs that can be anticipated in advance; however, little is known regarding specific professional and personal factors associated with greater practice in this area. This article presents the findings from a study of 148 community-based case managers' advance care planning practices, conducted in the Southeastern United States. Correlational analyses revealed specific gerontological skills, educational activities, and personal experiences in advance care planning that was highly correlated with practice. Implications for training are discussed.

Case Managers and the Useof Medicare, Part D

The purpose of this study was to examine the experiences and opinions of community-based mental health case managers with the Medicare prescription drug benefit. A qualitative approach, consisting of analysis of data from 3 case manager focus groups, was used to achieve an understanding of the role that case managers played in beneficiaries' access to and use of prescription medicines. Two urban nonprofit community-based mental health agencies. Adults who are disabled by mental illness depend on case managers for information about their prescription drug insurance, help with formulary and plan switching information, and assistance with tasks related to medication adherence in the community. Common themes in the case managers' discussion were managing beneficiary problems, stress for beneficiaries, information and paperwork issues, and cynicism regarding health care reform. The critical role of case managers in the use of Medicare Part D is not well understood or appreciated. Case managers need to be informed about Medicare Part D and ready to advocate for their clients in the community. In addition, it is important for case managers to understand how Medicare Part D affects not only older adults, but also adults living with serious and persistent mental illness.

Reflective Practice

The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

Factors associated with community-based case managers' advance care planning practices

Community-based geriatric case managers work with an increasingly frail older population in need of advance care planning (ACP) throughout the end of life; however little is known regarding factors that...

Correlates of Case Managers' Advance Care Planning Practices

Advance care planning is an increasingly important aspect of professional practice with older adults. Community-based geriatric case managers handle growing caseloads of frail older adults with future care needs that can be anticipated in advance. However, practice in this area is not well understood. A model of factors contributing to health professionals' practice behavior is used as a conceptual framework to study whether advance care planning practices are influenced by professional attributes and experiences, and perceptions of role, knowledge, skills, and barriers in this area. This study surveyed community-based case managers (n = 148) in the state of Florida to examine factors associated with their advance care planning practices. Factors that predicted advanced care planning practice included years of experience, the amount of advance care planning training experiences, perceived skill in geriatric practice competencies, perceived barriers to practice, and experience in advance care planning of a personal nature. Implications for enhancing practice in this area are discussed.

Professional Relationships and Power Dynamics Between Urban Community-Based Nurses and Social Work Case Managers

The purpose of this study was to explore how community-based case managers interface with their clients' healthcare providers and other community organizations as a function within their advocacy efforts. Case managers previously defined advocacy as occurring at individual, organizational, and community levels. The relationships they attempt to develop and maintain are consistent with case management ideology, yet this is a complex process to ensure care for vulnerable populations with many medical and socioeconomic needs. Community-based case management settings. In-depth qualitative interviews with a total of 20 nurse and social work case managers working in public housing, university-affiliated community nursing centers, local parishes, and community ministry. The case managers in this study reflected on how they interface with their clients, other healthcare providers, and community organizations on behalf of their clients. They reflect on the importance of trust and communication to facilitate this process. The advocacy work of case managers is influenced by the setting, others' perceptions of their knowledge and expertise, and power dynamics. Their ability to effectively advocate is greatly influenced by the strength of the relationships they forge. Advocacy for vulnerable clients is influenced by the existing relationship between case managers and their clients' healthcare providers. Case managers need to be persistent in their interactions with other providers to ensure that their clients have access to valuable community resources. Clear lines of communication should be established between case managers so that there is clarity around roles and expectations in service provision. Case managers should also participate in the mentoring of future health professions students so they may learn the application of advocacy work in community settings.

Measuring Case Managers’ Advance Care Planning Practice: Translating Focus Group Findings to Survey Development

Sequential mixed methods is a useful research design to inform second-stage methodology when investigating an area of practice in which relatively little is known. This article describes how focus group findings were used to measure advance care planning practice among community-based case managers. The initial qualitative study utilized focus groups to explore aspects of practice in this area. Data revealed themes that embodied ambiguous views of advance care planning, divergent roles in practice, a continuum of practice activities, and multiple facilitators and barriers to practice. In order to further examine case managers' advance care planning practices, qualitative findings were used to develop the Case Managers Advance Care Planning Practices Instrument. Implications for qualitative to quantitative measurement are discussed.

Exploring Case Managers' Advance Care Planning Practices

Community-based geriatric case managers handle increasing caseloads of frail older adults with future care needs that can be anticipated; however, little is known regarding their advance care planning practices with their clients. This qualitative study conducted 4 focus groups throughout the state of Florida in 2005 to explore case managers' (N =27) perceptions of their advance care planning practices. Findings suggest that case managers hold ambiguous views regarding advance care planning, perceive divergent roles in this area, and engage in a range of primarily informational advance care planning practices. Implications include the need to clarify the role and importance of advance care planning for older adults and better understand factors associated with practitioners' divergent advance care planning practices in order to enhance professional practice in this area.

Exploring Influences on Community-Based Case Managers' Advance Care Planning Practices: Facilitators or Barriers?

ABSTRACT Community-based geriatric case managers work with an increasingly frail older population in need of advance care planning throughout the end of life. However, little is known regarding factors that influence their professional practices in this area. This qualitative study used four focus groups to explore case managers' (N = 27) perceptions of facilitators and barriers to advance care planning practices. Themes from the study suggest that case managers view five key influences that appear to either assist or impede practices, depending on case manager's perceptions and experiences. Themes include: (1) Paradox of case management and programmatic realities; (2) extent of family presence and involvement; (3) level of proficiency in advance care planning; (4) degree of client receptivity to planning; and (5) limited communication with providers. The findings suggest that case managers vary in their advance care planning practices by differing perceptions regarding clients, families, professional expertise, program effects, and communication within the network of providers. More research is needed to clarify the factors associated with case managers' divergent advance care planning practices in order to enhance professional practice in this area.

Reliability of Medicaid Claims Versus??Medical Record Data

Palivizumab is one of the most costly paediatric medications for Medicaid and other health plans. It is uncertain whether the costs of palivizumab administration are justified in specific risk groups. Ongoing investigations of palivizumab require identification of reliable data sources. To estimate the reliability between Medicaid paid claims data and medical records documentation in a cost analysis of palivizumab. A cross-sectional study of data reliability was performed within a cost analysis study of palivizumab in a cohort of at-risk patients during the US 2002/3 respiratory syncytial virus season. Exposure classification (to palivizumab prophylaxis) was compared using Medicaid claims and medical records data. The study was performed in 28 widely dispersed paediatric medical practices serving North Carolina, USA Medicaid patients within the AccessCare/Community Care of North Carolina (CCNC) Program, an enhanced primary care case management programme. Patients were eligible if they were born between 1 March 2002 and 28 February 2003 at 32-35 weeks estimated gestational age, were enrolled in the North Carolina primary care case management Medicaid programme during the study period and were patients of the participating practices. Medicaid healthcare claims were obtained in December 2003 for services provided between October 2002 and May 2003. Medical records were abstracted by community-based case managers. Primary variables included frequency, dates and dose of palivizumab injections. The main outcomes measures were agreement in the number of palivizumab injections, dates of administration and doses of palivizumab between Medicaid paid claims and medical record data. Injection frequencies matched between medical record and Medicaid claims data for only 46.2% of study participants. Congruence in injection service dates occurred between data sources for only 1% of injections. Doses were similar between data sources for 81.9% of injections. In Medicaid recipients receiving palivizumab injection, Medicaid claims data were inconsistent with medical records data. Use of multiple data sources and validation are recommended to identify temporal relationships between drug administration and endpoints of interest.

A Randomized, Controlled Trial of the Effectiveness of Community-Based Case Management in Insuring Uninsured Latino Children

Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted. To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children. Randomized, controlled trial conducted from May 2002 to August 2004. A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received traditional Medicaid and State Children's Health Insurance Program (SCHIP) outreach and enrollment. Case managers provided information on program eligibility, helped families complete insurance applications, acted as a family liaison with Medicaid/SCHIP, and assisted in maintaining coverage. Obtaining health insurance, coverage continuity, the time to obtain coverage, and parental satisfaction with the process of obtaining insurance for children were assessed. Subjects were contacted monthly for 1 year to monitor outcomes by a researcher blinded with respect to group assignment. One hundred thirty-nine subjects were assigned randomly to the intervention group and 136 to the control group. Intervention group children were significantly more likely to obtain health insurance (96% vs 57%) and had approximately 8 times the adjusted odds (odds ratio: 7.78; 95% confidence interval: 5.20-11.64) of obtaining insurance. Seventy-eight percent of intervention group children were insured continuously, compared with 30% of control group children. Intervention group children obtained insurance significantly faster (mean: 87.5 vs 134.8 days), and their parents were significantly more satisfied with the process of obtaining insurance. Community-based case managers are more effective than traditional Medicaid/SCHIP outreach and enrollment in insuring uninsured Latino children. Case management may be a useful mechanism to reduce the number of uninsured children, especially among high-risk populations.

Teaching persons with severe mental disabilities to be their own case managers.

Teaching persons with severe mental disabilities to be their own case managers.

Intensity of case managers' participation in organizational decision making§

Prior research has indicated that registered nurse (RN) participation in decision making (PDM) is related to better outcomes in nursing homes and hospitals. Little is known, however, about the roles of community-based case managers (CMs), most of whom are RNs. Data from 68 prenatal case management programs were used to test hypotheses about the intensity of CM PDM and to describe their patterns of involvement in decision activities and mechanisms. CMs were most involved in the activity of "raising the issue" and least involved in "choosing the alternative." However, "choosing the alternative" was the strongest predictor of perceived CM influence over the final choice. When CMs were involved in informal meetings and chance encounters with administrators, they were more likely to be perceived as having influence over the final choices made. Intensity of CM PDM varied by decision level and content, supporting two of the three hypotheses. The findings are discussed in light of prior research and complexity theory.

A Community-Based Approach to HIV Case Management: Systematizing the Unmanageable

This article presents an analysis and typology of community-based care for a young Hispanic mother with acquired immune deficiency syndrome (AIDS). It develops a conceptual framework that examines retrospectively the needs generated by AIDS over time, the appropriateness of the services, and an assessment of the interventions. Community-based case management can effectively address some of the diverse and changing needs of AIDS patients and their families, such as bridging service gaps and fortifying patient and system strengths while minimizing their weaknesses. Community-based case managers may also be better equipped than hospital case managers to work with difficult patients and coordinate community- and hospital-based care. Conclusions are presented regarding the definition and implementation of community-based, culturally sensitive, family-centered human immunodeficiency virus case management, as well as the importance and difficulty of developing relationships among the family, health care providers, and institutions within the community.

Project connect: An interagency partnership to confront new challenges facing at-risk women and children in New York City

Project CONNECT is a New York State--New York City collaborative venture to facilitate access to, coordinate and expand the delivery of health and human services, during the perinatal period to women and children in the three areas of New York City with the highest rates of morbidity and mortality. Based on the concept of comprehensive case management, CONNECT coordinates diverse providers around existing resources. Services implemented by community-based case managers for families in need include: medical care, substance/alcohol abuse treatment, foster care preventive services, parent education, developmental assessment, screening and child care. The initial points of entry to CONNECT are specific hospitals within the three targeted neighborhoods. Additional points of entry, including other hospitals and prenatal care sites, are being added on an incremental basis. Enrollment in CONNECT is also enrollment in Medicaid and participants are eligible for Medicaid services. It is expected that the CONNECT program will result in improved birth and health outcomes for women and their children, reduction in chemical dependency and improved family preservation. The state and city agencies that created CONNECT hope that by working together, through a very specific interagency agreement monitored by the offices of the Governor and the Mayor, they will be able to reach those families who have many needs, but traditionally have been difficult to engage and keep involved in the service delivery system. The ultimate benefit will go to the family as a whole, particularly the children, both the newborns and their siblings.(ABSTRACT TRUNCATED AT 250 WORDS)