Goals Of Case Management Research Articles

A hospital and community-based violence intervention program for Black & Latino youth and their caregivers.

Black and Latino youth are disproportionately affected by trauma from community violence, but to date, few data support the benefit of evidence-based treatments for these youth or of including peer support to engage these youth in mental health services. From 2018 until 2020, a hospital and community-based violence intervention program in Philadelphia pilot tested the integration of home and community-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with peer services and case management for youth impacted by community violence. This study describes the implementation of this intervention. Data was gathered by querying the program's database. The Child Post Traumatic Stress Symptom Severity Scale (CPSS-SR-5) and the Short Mood and Feelings Questionnaire (SMFQ) were utilized to evaluate the participants' pre- and post-intervention assessment of PTSD and depression. The sample (N = 50) consisted of Black and Latino youth, mean age 14. Twenty-nine (58%) completed TF-CBT, and 82% met peer and case management goals. Youth who completed therapy showed significant improvement in both PTSD and depression symptoms at post-test. To our knowledge, this is the first study describing the implementation of home and community-based TF-CBT with peer support and case management. The study's limitations and need for further research are discussed.

Protecting Against Adversity: The Role of Positive Childhood Experiences in Youth Recidivism

An abundance of research has established Adverse Childhood Experiences’ (ACEs’) contributions to deviant behavior. Recently, studies have demonstrated the importance of Positive Childhood Experiences (PCEs). Yet, the PCE establishment as a predictive scale is needed. In a multistate, robust sample (N = 254,874) of justice-involved youth, we examined PCE scale effects and ACE-PCE combinations on recidivism using mixed effects logistic regression while adjusting for the impact of state. Presence of PCEs was associated with lower reoffending likelihood, and ACEs were related to increased recidivism odds. Further, PCEs demonstrated a protective impact on ACEs. A ceiling effect on the ACE-PCE composite score was also identified, where an increase in scale items presented a curvilinear recidivism association. Findings provide an examination of PCE influence across multiple youth populations and their ability to counteract ACE effects. Policy implications discuss the utility of PCEs as case management goals and intermediate outcomes.

Periostin as a promising biological marker of early recurrence of polyposis rhinosinusitis after surgical treatment

Introduction. In spite of the numerous studies devoted to the issues of chronic rhinosinusitis with nasal polyps, the urgency of this problem remains due to the high incidence of the disease. The relapsing course of chronic rhinosinusitis with nasal polyps determines the uncontrolled course of bronchial asthma by patients with combined pathology. The main goal of case management of patients with chronic rhinosinusitis with nasal polyps is to achieve control over the polyposis process. It has been shown, that a promising direction is the study of biological markers. Goal. Study of the concentration of serum periostin in combination with serum eosinophilia and the number of eosinophils of the nasal secretion to predict early recurrence of chronic rhinosinusitis with nasal polyps after surgical treatment.Materials and methods. The study included 47 patients with a diagnosis of chronic rhinosinusitis with nasal polyps and chronic rhinosinusitis with nasal polyps in combination with bronchial asthma. All patients underwent bilateral endoscopic polysinusotomy followed by case follow-up for a year. The diagnosis of bronchial asthma was made based on the diagnostic criteria defined in the Global Strategy for the Treatment and Prevention of Bronchial Asthma and in the Federal Clinical Guidelines for the Diagnosis and Treatment of Bronchial Asthma. All patients were consulted by a pulmonologist. Control examinations of patients were carried out every 3 months. All patients underwent a study of the concentration of periostin in the blood serum. Blood probe samples were taken before the start of treatment and after 12 months.Results and discussion. In the course of the study, was proved the relationship between a high concentration of serum periostin in combination with increased eosinophils of blood and nasal secretion with an early relapse of polyposis rhinosinusitis.Conclusions. An increased concentration of serum periostin before surgical treatment is a prognostically unfavorable factor for early recurrence of chronic rhinosinusitis with nasal polyps.

Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats.

Case management programs often designate a nurse or social worker to take responsibility for guiding care when patients are expected to be expensive or risk a major decline. We hypothesized that though an intuitively appealing idea, careful program design and faithful implementation are essential if case management programs are to succeed. We employed two theory perspectives, principal-agent framework and street-level bureaucratic theory to describe the relationship between program designers (principals) and case managers (agents/street-level bureaucrats) to review 65 case management studies. Most programs were successful in limited program-specific process and outcome goals. But there was much less success in cost-saving or cost-effectiveness-the original and overarching goal of case management. Cost results might be improved if additional ideas of agency and street-level theory were adopted, specifically, incentives, as well as "green tape," clear rules, guidelines, and algorithms relating to resource allocation among patients.

How do case managers spend time on their functions and activities?

BackgroundCase management has been a widely accepted approach to practice in various care settings. This study aimed to explore how community aged care case managers allocated their time to case management functions, how frequently they performed specific case management activities, and what factors influenced the frequency of their activities.MethodsThe study involved 154 survey participants, or 17.1 % of the target case managers in the State of Victoria, Australia. Key information collected included participants’ socio-demographic characteristics, proportions of time allocated to six core case management functions, and frequency ratings of 41 specific activities within seven case management functions. Ordinal regression analyses were performed to determine significant factors associated with participants’ frequency ratings of their activities.ResultsParticipants allocated the largest proportion of time to care coordination (22.0 %), and the smallest proportion of time to outcome evaluation (8.0 %). Over 70 % of the participants assigned high frequency ratings to 31 of the 41 case management activities. The remaining ten activities, including all four outcome evaluation activities, three needs assessment activities, one care planning activity, one care coordination activity, and one general functions-related activity were less commonly performed very frequently. The regression analyses indicated that some case manager and client factors were significantly associated with frequency ratings of nine of the ten activities aforementioned. The two main findings of the regression analyses were: First, emphasising achieving more case management goals was significantly associated with higher frequency of three outcome evaluation activities; second, longer work experience was significantly associated with higher frequency of one care coordination activity and one outcome evaluation activity.ConclusionsThe frequent performance of most case management activities and relative absence of factors influencing their frequency suggest a uniformity of practice in community aged care case managers’ practice. What is not clear is whether the frequency of these activities (in particular less frequent performance of outcome evaluation activities) conforms to expectations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1333-6) contains supplementary material, which is available to authorized users.

Important Case Management Goals in Community Aged Care Practice and Key Influences.

To investigate important case management goals and key influences on the achievement of the goals in community aged care practice from the perspectives of case managers in Australia. We surveyed 154 case managers, representing 17.1% of the target population in the State of Victoria, Australia. The key information collected was case managers' characteristics and their selections of important case management goals. We also conducted 33 interviews with 47 case managers to explore their perceptions of important case-managed community aged care goals and the key influences on the achievement of these goals. Descriptive analysis, logistic regression, and qualitative thematic analysis were performed. The survey findings showed that important case management goals included improving client outcomes, improving care quality, enhancing care coordination and accessibility, and reducing nursing home admissions. The interview findings indicated that important case management goals were divided into client-centered goals (e.g., maintaining clients safely at home), case managers' personal goals (e.g., gaining professional development), and organizational goals/expectations/values (e.g., expecting case managers to manage budgets wisely). Finally, the mixed research methods determined constraints of organizational resources and policies, clients' risky decisions, and case managers' work experience and employment status as key influences or significant factors associated with the achievement of case management goals. Client-centered goals are of particular importance among those important case management goals. Case managers helping clients establish reasonable expectations and organizations developing favorable professional development policies and establishing reasonable job requirements and expectations will facilitate the achievement of case management goals.

Spiritual Strengths Assessment in Mental Health Practice

Proponents of recovery and strengths-based approaches recognise spirituality as an important factor in mental health recovery. Minimal guidance is available, however, for how to assess spirituality with people diagnosed with severe mental illnesses. To address this gap, six focus group interviews were conducted with a total of fortyeight community mental health service providers and users who have been involved in spiritual strengths assessment. An additional panel of ten international leaders in the strengths case management approach gave feedback on focus group insights in order to expand recommendations congruent with the strengths model. Findings revealed that, while spirituality can be a recovery-related resource for people with severe mental illnesses, some service providers and users experience challenges related to spiritual strengths assessment such as a sense of discomfort about the topic, and uncertainty related to defining spirituality and setting relevant case management goals. This article addresses these and other challenges by offering guidelines for spiritual assessment within the context of the strengths model.

The role of symptom distress and goal attainment in promoting aspects of psychological recovery for consumers with enduring mental illness

Background: Conceptualizations of recovery involve more than just symptom amelioration and include the development of hope, meaning and self-identity. Goal attainment increases wellbeing within non-clinical samples and mental health consumers report its facilitative value for psychological recovery. There is a lack of empirical data regarding the impact of goal progress/attainment on mental health outcome for consumers with enduring mental illness.Aims: (i) To examine whether baseline measures of symptoms, functioning and recovery are associated with greater goal progress, and (ii) to examine the impact of goal attainment on improvements in mental health outcome.Method: Seventy-one consumers with enduring mental illness who were receiving case-management support from mental health services in eastern Australia participated in the study. Level of attainment for case-management goals was examined against mental health outcome measures for the corresponding goal-setting period.Results: Path modelling indicated that goal attainment mediated the relationship between baseline (pre-goal setting) levels of symptom distress and progress on recovery constructs; hope, self-confidence, sense of purpose and positive identity.Conclusions: When symptoms are perceived as less distressing consumers are better able to progress toward their case-management goals, which in turn promotes aspects of psychological recovery.

A primer for nursing case management

Abstract Nursing case management evolved in the mid-1980s as a hospital-based acute care delivery system to respond to changes in healthcare reimbursement, shortened length of stay and limited hospital resources. Nursing case management is a nurse driven model of care to organize and structure the complex processes in the delivery of healthcare. The framework of case management correlates with the nursing process. The goals of case management correlate with professional responsibilities to manage quality and cost and to achieve positive patient and organizational outcomes. The case management care plan serves as a step-bystep map to organize and guide care across a continuum.

Case Management and Client Access to Health and Social Services in Outpatient Substance Abuse Treatment

A primary goal of case management is to coordinate services across treatment settings and to integrate substance abuse services with other types of services offered in the community, including housing, mental health, medical, and social services. However, case management is a global construct that consists of several key dimensions, which include extent of case management coverage, the degree of management of the referral process, and the location of case management activity (on-site, off-site, or both). This study examines the relationship between specific dimensions of case management and the utilization of health and ancillary social services in outpatient substance abuse treatment. In general, results suggest that more active case management during the referral process and providing case management both on-site and off-site are most consistent with our predictions of greater use of health and ancillary social services by substance abuse clients. However, these effects are specific to general health care and mental health services. Case management appears to have little effect on use of social services or aftercare plans.

Triage of the Autistic Spectrum Child Utilizing the Congruence of Case Management Concepts and Orem’s Nursing Theories

The purpose of this project was to design and implement a case management framework for the benefit of children diagnosed with an autistic spectrum disorder (ASD). The process consisted of selecting two children exhibiting symptoms of an ASD and managing them across a continuum of care. Methodological structure was derived from case management standards of practice and Orem's Nursing Theories. Although some objectives sustained a slight delay because of variances, findings revealed successful outcomes based on progression toward measurable case management goals. The children were directed to appropriate school placements and habilitative therapies in an efficient manner. Their parents received support and education related to special needs children. The process yielded assurance that Orem's Nursing Theories and case management concepts articulate seamlessly within nursing care boundaries.

Designing measurements to assess case management outcomes.

Evaluating outcomes begins with determining the goals of case management. As the emphasis on the delivery of cost-effective patient care increases, comparing outcomes across settings is desirable and essential. A key component to comparing how an organization rates with similar institutions is to identify commonly used measures. Conducting a literature search, benchmarking, participating in initiatives of accrediting bodies, and establishing ways to collect and manage reliable and valid data are vital in laying the groundwork for an organization's ability to join evaluation projects across settings.

Case Manager-Defined Roles in the Medicare Alzheimer’s Disease Demonstration: Relationship to Client and Caregiver Outcomes

This study explores the different approaches to case management within, the Medicare Alzheimer's Disease Demonstration. Eight sites from around the country were selected to participate in a survey of case managers (N = 57) that evaluated their professional background and experience and how certain tasks, functions, and goals of case management were prioritized at each site. Client and caregiver outcomes were collected on a site-by-site basis as part of the demonstration. The hypothesis was that the way in which case managers performed their work would vary by site. Furthermore it was hypothesized that these differences would be measurable and correlated with project outcomes. Case managers differed significantly by site in how they prioritized tasks, functions, and goals, viewing themselves along a continuum from a clinical approach to one that emphasizes service management. These differences in case management style are reflected in between-site differences in certain client and caregiver outcomes but not others. Specifically, variations in case management style are not related to client cognitive or functional status but to other outcomes including behavioral management, caregiver burden, and service use.

Systems Redesign in Rehabilitation

A performance improvement team overhauled its facility's rehabilitation systems. A rehabilitation care plan was revised and an integrated assessment reduced 29 pages of documentation to 17 pages. Case management goals and documentation are integrated into one care plan.

Trauma case management: an extension of the trauma coordinator role.

Case management is a process of linking services by assigning accountability to an identified individual(s) for coordinating a patient's care across a continuum of care. The goal of case management is to ensure cost-effective, nonfragmented quality care. Adoption of the case management role by the trauma coordinator can have a positive impact on both patient care and resources.

Physician Referrals in a Competitive Environment

To the Editor.— As a physician who has served as a medical director in several third-party payer organizations, the article in the March 18 issue of JAMA about physician referrals caught my eye. The referrals, as briefly outlined, do not allow one to identify them as appropriate or necessary, but at first blush one would suspect the goal of case management in the prepaid group was probably not being met, if the referral rates were equal. While not wishing to plant the seeds for future referral abuse, I also would like to point out a referral pattern that may be unethical and that seems to be growing in our competitive world, certainly adding to the cost of medical care. The situation usually involves a generalist who finds that his practice has a lot of outgoing referral work. The generalist then insists that the specialist see referred patients in space rented

The Ombudsman and the Case Manager

The Ombudsman and the Case Manager

Policy Foundations for Case Management:

The Federal Council on the Aging is now developing a national policy for providing home care for the frail elderly. Case management is specified as the primary delivery mechanism. This article recommends areas, not now included in the policy considerations, that must be examined before case management goals can be achieved.