Mental Health Case Management Research Articles

The Belgian Integrated DEpression Care (IDECA) project: implementation and scientific evaluation protocol

Background: Depression creates a substantial personal burden for affected individuals and their families, and produces significant economic and social hardships that affect society as a whole. In Belgium, depression is a leading cause of disability, measured as disability-adjusted life years. The COVID-19 pandemic has greatly exacerbated the already substantial health and socioeconomic consequences of depression and has led to major changes in the need for and delivery of mental health services. Integrating mental health services into primary care is the most viable way to closing existing treatment gaps. The majority of people with mental disorders treated in primary care have good outcomes, particularly when linked to a network of services at secondary level and in the community. A balanced model of depression care calls for a system with community-based mental health care, delivered by primary care physicians and supported by other professionals in an eco-system of care.
 Aim: Implementation of an integrated depression care (IDECA) intervention in two regions in Flanders, Belgium with evaluation of the intervention’s working components, its acceptance by patients and care providers, and the contextual conditions which needs to be fulfilled to safeguard success of the model of care.
 Methods: A scientific steering committee including multiple academic expertise areas and patient representatives guided the development of the intervention and its scientific evaluation. Moreover, feedback was obtained from the Flemish Institute for Primary Care (VIVEL), the Family Doctors Medical Association (Domus Medica), and a mental health interest group(Psyche VZW). This resulted in an implementation design without control group and a targeted heterogeneous patient population with depression to obtain real-world evidence. IDECA consists of three intervention pillars: (i) the integration of two reference persons mental health (case management function) into general medical practice and who provide diagnostic support, coordination, follow up care, and patient education; (ii) the implementation of a validated shared care treatment protocol; and (iii) professional training on depression screening and management. The three pillars will be further operationalized in co-creation with the selected regions. The intervention will run for 15 months.
 Data will be collected from both participating care providers and patients. Evaluation will take place using a Realist Evaluation approach in combination with the NoMad questionnaire for care providers which measures the four implementation metrics of the Normalization Process Theory: i. coherence, ii. cognitive participation, iii. collective action, and iv. reflexive monitoring. NoMad process data will serve as a basis for semi-structured qualitative research on Context-Mechanism-Outcome constellations. Questionnaires will be used to measure depression and anxiety levels, health literacy, quality of life, patient satisfaction, therapy adherence and self-efficacy, and healthcare resource utilization in patients.
 Results: Patient enrollment will start at the beginning of 2023. Preliminary data on patient characteristics and first data on care providers’ acceptance and engagement with the IDECA project will be presented, next to the co-creative development process of the intervention.
 Conclusion: The IDECA-study aims at the implementation of integrated depression care and evaluation of its feasibility in two different regions in Belgium.

Risk factors of involuntary referral by police to ER psychiatric services for patients with a severe mental illness: A GEE analysis.

This study aimed to identify risk factors for involuntary referral by police to emergency room (ER) psychiatric services for community-based patients with a mental illness via a generalized estimating equation (GEE) analysis. The analysis was based on data from the Management Information System of Psychiatric Care (MISPC) system for patients with a severe mental illness in Taipei, Taiwan and registered referral records of the police. Data on 6378 patients aged ≥20years were used in this study, including 164 patients who were involuntarily referred to the ER by the police and 6214 patients who were not during the period of January 1, 2018 to December 31, 2020. GEEs were utilized to explore possible risk factors of repeated involuntary referral to ER psychiatric services for patients with a severe mental illness. The logistic regressions indicated that patients defined as "severe" according to the Mental Health Act of Taiwan (crude odds ratio (OR): 3.840, 95% confidence interval (CI): 2.407-6.126), with a disability (crude OR: 3.567, 95% CI: 1.339-9.501), with two or more family members with a psychiatric disorder (crude OR: 1.598, 95% CI: 1.002-2.548), with a history of a suicide attempt (crude OR: 25.582, 95% CI: 17.608-37.167), and with a history of domestic violence (crude OR: 16.141, 95% CI: 11.539-22.579) were positively associated with involuntary referral to ER psychiatric services. However, age (crude OR: 0.971, 95% CI: 0.960-0.983) and the MISPC score (crude OR: 0.834, 95% CI: 0.800-0.869) were inversely associated with involuntary referral to ER psychiatric services. After adjusting for demographics and potential confounders, we found that patients defined as "severe" (Exp (β): 3.236), with a disability (Exp (β): 3.715), with a history of a suicide attempt (Exp (β): 8.706), and with a history of domestic violence (Exp (β): 8.826), as well as age (Exp (β): 0.986) and the MISPC score (Exp (β): 0.902) remained significantly associated with repeated involuntary referral to ER psychiatric services. In conclusion, community-based mentally ill patients with a history of a suicide attempt, with a history of domestic violence, with a severe illness, and with a profound level of disability were highly associated with involuntary referral to ER psychiatric services. We suggest that community mental health case managers identify significant factors associated with involuntary referral to ER psychiatric services to accordingly arrange case management plans.

The therapy capability framework and mapping process: perspectives of mental health clinical case managers

ABSTRACT Objective: The aim of this study was to investigate the utility of a workforce leadership initiative, the Therapy Capability Framework (TCF), designed to enhance the provision of evidence-informed psychosocial therapies by publicly funded mental health case managers. To understand the experiences and perceptions of ‘first-time users' of the TCF was conceived as an important first step to help guide service-wide implementation. Method: In 2018, a qualitative descriptive research methodology using two in-depth focus groups with frontline mental health clinicians in case management roles was adopted to explore their perceptions and experiences of the TCF and TCF Process across Metro South Addiction and Mental Health Services in Brisbane, Australia. An inductive approach to thematic analysis guided the generation of themes and subthemes. Results: Participants understood the purpose of the TCF; however, they identified several factors influencing their experience, including specific features of the framework; how it was used; and organisational, workforce, and leadership factors that restricted its potential utility and impact. Discussion: Clinicians reported the TCF as having the potential to facilitate incremental change in the existing case management model. This paper represents a phase of evaluation and continuous improvement of the TCF, which can assist publicly funded mental health leaders to augment the provision of evidence-informed psychosocial therapies.

Effects of a web-based education for community mental health case managers on physical healthcare for clients with severe mental illness.

This study aimed to develop and verify the effects of a web-based physical healthcare education program for community mental health case managers during the time of COVID-19. Six modules of mental health case management physical health education program were developed and provided using the EdWith education platform, which enables real-time streaming, lecture participant management and whether participants have watched the video and watch time. A total of 51 community mental health case managers participated in the study. Collected data were analyzed using SPSS 26.0 software. Participants of the physical healthcare education program testified increased performance in, as well as enhanced attitudes toward physical healthcare. Their confidence in physical healthcare increased significantly from that of the individuals in the control group. The web-based educational program for mental health case managers in physical healthcare may be beneficial to improving the physical health of clients with chronic mental illness.

‘Say hi to the lady on the television’: A review of clinic presentations and comparison of telepsychiatry and in‐person mental health assessments for people with intellectual disability in rural New South Wales

AbstractPeople with intellectual disabilities (ID) experience high levels of psychiatric comorbidity and difficulties accessing services, particularly in rural areas. An Intellectual Disability Mental Health Outreach Clinic was established to provide specialised psychiatric care in rural Australia through telepsychiatry and in‐person assessment. The study aims were to (i) contrast the characteristics of clinic attendees assessed by telepsychiatry or in‐person; (ii) assess the feasibility of care delivery by synchronous videoconference (telepsychiatry) or in‐person; and (iii) assess acceptability to, and experiences of, participating carers (family members, non‐government organisation workers or Community Mental Health Case Managers). An audit of clinical records was conducted of clients reviewed by the Clinic between August 2018 and April 2021. A survey of carers, either employed or family members, evaluated Clinic acceptability and experiences with the Clinic assessment, and as well as perceptions of thoroughness, accessibility, and ease. Of 145 people with ID, 46% were reviewed by telepsychiatry. These 67 telepsychiatry clients were more likely to have milder ID (p < 0.01) and were seen more frequently (p < 0.05) than the 78 clients with in‐person reviews. Results from the carer survey (31.7% response rate, n = 46/145) indicated high overall service acceptability, with telepsychiatry perceived to offer more convenient appointment times (91% agreed vs. 75% of in‐person, p < 0.05). The high uptake of telepsychiatric review indicates that it is feasible and acceptable to carers of people with ID and comorbid mental health concerns. Telepsychiatry is a potential tool to address equity of access to mental health services for people with ID—particularly those from disadvantaged and rural populations.

Service Needs of Clients Before and After Short Term Community Mental Health Case Management.

This study evaluated level of service need before and after a short-term community mental health case management intervention from the perspective of both clients and case managers. Ontario Common Assessment of Need data were used to describe client needs. McNemar's test was applied to assess differences in pre- and post- need scores. Psychological distress, company, daytime activities, and physical health were most commonly rated by clients as unmet needs at enrolment. At discharge, there was a significant change in psychological distress from the perspective of clients, and in psychological distress and daytime activities from the perspective of case managers. Statistically significant changes were observed for Total Need, Total Unmet Need and Met Need scores from the perspective of case managers. While both clients and case managers reported changes in total service needs between admission and discharge from short-term case management, clients were less likely to report a difference in needs.

Patient expectations of and experiences with a suicide risk identification algorithm in clinical practice

BackgroundSuicide risk prediction models derived from electronic health records (EHR) and insurance claims are a novel innovation in suicide prevention but patient perspectives on their use have been understudied.MethodsIn this qualitative study, between March and November 2020, 62 patients were interviewed from three health systems: one anticipating implementation of an EHR-derived suicide risk prediction model and two others piloting different implementation approaches. Site-tailored interview guides focused on patients’ perceptions of this technology, concerns, and preferences for and experiences with suicide risk prediction model implementation in clinical practice. A constant comparative analytic approach was used to derive themes.ResultsInterview participants were generally supportive of suicide risk prediction models derived from EHR data. Concerns included apprehension about inducing anxiety and suicidal thoughts, or triggering coercive treatment, particularly among those who reported prior negative experiences seeking mental health care. Participants who were engaged in mental health care or case management expected to be asked about their suicide risk and largely appreciated suicide risk conversations, particularly by clinicians comfortable discussing suicidality.ConclusionMost patients approved of suicide risk models that use EHR data to identify patients at-risk for suicide. As health systems proceed to implement such models, patient-centered care would involve dialogue initiated by clinicians experienced with assessing suicide risk during virtual or in person care encounters. Health systems should proactively monitor for negative consequences that result from risk model implementation to protect patient trust.

Comparing treatment and substance use in case-managed and non-case managed clients receiving opiate replacement therapy with a co-existing mental illness: a cross-sectional study

ABSTRACT Objectives This study examines the differences in clinical presentation, treatment, and clinical outcomes for clients with co-existing psychiatric and substance use disorders (CED) undergoing opioid replacement therapy (ORT) through a physician-led metropolitan specialist addiction clinic (SAC), in comparison to clients who receive concurrent community mental health case management (CMH-CM). Method A cross-sectional study of data extracted from electronic medical records was conducted on all active clients identified with CED who were actively engaged with the SAC for ORT over a 2-month period. Results Of 310 clients on ORT, 21% (N = 64) had a CED. CMH-CM was concurrent in a minority of those with a CED (N = 18, 28%). CMH-CM clients were significantly more likely to have a single psychiatric diagnosis (X2 9.2627; P < .01), a diagnosis of psychotic disorder (X2 8.2197; P < .01), and be prescribed antipsychotics (X2 12.863; P < .01). Multiple psychiatric diagnoses (X2 9.2627; P < .01) and a diagnosis other than psychotic disorder (X2 6.7046; P < .01) were significantly more common in Non-CM clients. Conclusions In the absence of fully integrated addiction and CMH services, the provision of evidence-based treatment requires building clinical capacity to identify and manage CED across mental health and addiction services.

San Diego officials tout success of mobile crisis teams to treat mental health and drug abuse

San Diego County officials touted the successes of a new specialized team that responds to people experiencing mental health and substance abuse crises, situations that were often previously handled by law enforcement, the Times of San Diego reported Feb. 28. The Mobile Crisis Response Teams (MCRTs), which are composed of mental health clinicians, case managers and peer support specialists, began services in January 2021 and are now available countywide. Those suffering from nonviolent crises are given assessments and crisis intervention services and linked to treatment and other services, according to the county. MCRTs are partnered with the Chula Vista and National City police departments — which refer calls to MCRTs when appropriate — though county officials say work is underway to establish partnerships with nine other jurisdictions. MCRTs have responded to 672 referrals and linked more than 110 people to treatment services, according to the county. Officials say 47% of the referrals have led to people gaining access to treatment options in their communities. County officials said the recent focus on behavioral health services has been beneficial, with the implementation of MCRTs and crisis stabilization units, which provide individuals with services in a community‐based or hospital setting. “These response teams are saving lives, demonstrating that this new approach to mental health is showing signs of real progress,” Supervisor Terra Lawson‐Remer said.

An evaluation of the feasibility of implementing a novel tobacco dependence treatment program for high-risk individuals into clinical practice within a community mental health center

BackgroundIndividuals with serious mental illnesses experience deaths related to smoking at a higher prevalence than individuals without a psychotic-spectrum disorders. Traditional smoking cessation programs are often not effective among individuals with chronic mental disorders. Little is known about how to implement a tobacco cessation treatment program for this at-risk population within a community health center. The current study used qualitative methods to examine the factors that may enhance or impede the delivery of a novel tobacco cessation treatment for smokers with a psychotic-spectrum disorder diagnosis in an integrated care community health center.MethodsUsing a case study design, we conducted 22 semi-structured interviews with primary care providers, mental health providers, addiction counselors, case managers, intake specialists, schedulers, pharmacists, and administrative staff employed at the organization. Interviews were transcribed and themes were identified through a rich coding process.ResultsWe identified environmental factors, organizational factors, provider factors and patient factors which describe the potential factors that may enhance or impede the implementation of a smoking cessation program at the integrated care community health center. Most notably, we identified that community mental health centers looking to implement a smoking cessation program for individuals with chronic mental health disorders should ensure the incentives for providers to participate align with the program’s objectives. Additionally, organizations should invest in educating providers to address stigma related to smoking cessation and nicotine use.ConclusionsThe findings of our study provide valuable insight for administrators to consider when implementing a smoking cessation program in an integrated care community health center. Our findings provide public health practitioners with potential considerations that should be discussed when designing and implementing a smoking cessation program for individuals with chronic mental disorders.

Case management in community mental health centers: Staffing considerations that account for client and agency context

Tailored, responsive behavioral health services received in community mental health centers are associated with healthy outcomes for children and youth and their families. The coordination of care and services, often provided by case managers, is imperative to maximize these benefits for children and families. Thus, staffing considerations of case managers within community mental health centers are a relevant concern for multiple stakeholders. This research and policy note begins with an overview of the types of case management employed in community mental health centers. Then, we present a research-informed, context-rich approach to identifying the number of case managers needed to serve children and youth in diverse community mental health centers. The proposed approach draws from a literature review by King, Meadows, and Le Bas (2004) that described seven factors pertinent for identifying the appropriate caseload for mental health case managers. Utilizing those seven factors and other considerations identified from the extant research, a practical and modifiable formula for staffing is presented that considers the unique and individualized demands of the center.

Effectiveness of Mental Health Case Management Services during pandemic Covid 19

Effectiveness of Mental Health Case Management Services during pandemic Covid 19

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

Findings From a Process Evaluation of an Indigenous Holistic Housing Support and Mental Health Case Management Program in Downtown Toronto

&#x0D; &#x0D; &#x0D; While urban Indigenous populations in Canada are increasing and represent many diverse and culturally vibrant communities, disparities between Indigenous and non-Indigenous people’s experiences of the social determinants of health are significant. The Mino Kaanjigoowin (MK) program at Na-Me-Res (Native Men’s Residence) in Toronto, Ontario, Canada, supports Indigenous men who are experiencing homelessness or are precariously housed and who have complex health and social needs. Using a community-partnered approach that aligns with wise practices for conducting Indigenous health research, a mixed-methods process evaluation of the MK program was conducted in 2017‒2018 by the Well Living House in partnership with Na-Me-Res. Thematic analysis of qualitative data gathered through two focus groups with community members who access the MK program (n = 9) and key informant interviews with staff (n = 11) was carried out using a decolonizing lens. Results indicate that the MK program provides a unique healing model that is grounded in trust, honour, and respect. Strengths of the program include a harm reduction framework, meeting basic needs, and person-centred care. The program could be enhanced through increased human resource capacity and improved infrastructure, including a separate space for MK staff and activities. The evaluation findings demonstrate how the MK program provides specialized and culturally safe services as a best- practice model to meet the complex health and social needs of urban Indigenous people.&#x0D; &#x0D; &#x0D;

Cross-sectorial collaboration in return to work interventions: perspectives from patients, mental health care professionals and case managers in the social insurance sector

Purpose Common mental disorders (CMD) are major causes of sick leave and have huge negative impacts on psychosocial well-being and to overall society. The return to work (RTW) process involves various welfare sectors, but often lack collaboration across these sectors and may cause uneven RTW processes. This study reports from an intervention aimed to increase collaboration between the mental health care system (MHCS) and the social insurance sector (SIS). The intervention consisted of two phases: (a) a development phase building on a participatory approach and (b) an implementation phase. Interprofessional meetings, evaluation workshops and joint consultations with workers from SIS and MHCS, and patients, comprised the key components of the intervention. The study explores how the collaborative process is experienced during the implementation phase with a focus on how collaboration maintains and challenges professional identities. Methods A qualitative design was employed consisting of individual interviews (n20), focus group discussions (4), and observations of interactions between Patients with CMDs, case managers from SIS, and professionals working in MHCS. Results Patients with CMDs felt supported and did not feel pushed to RTW prematurely. SIS and MHCS professionals reported that they were not sufficiently prepared and it was not clear who was responsible for which tasks. MHCS professionals experienced that their professional identities were in conflict with the aim of the intervention whereas SIS professionals found that the intervention improved their poor reputation. Conclusions The results suggest that a higher level of participation in the intervention design and implementation process can improve a clear and transparent role distribution between professionals in MHCS and SIS. IMPLICATIONS FOR REHABILITATION Collaboration across sectors is key to successful Return-to-work after sickness-related absence. Professional identities are challenged in collaborative interventions as different agendas are at play. Collaboration is most likely to be successful when engaging involved professions to decide goals and methods which are compatible with local work procedures.

Preparing for Disasters at the Community Level: Prevention and Social Cohesion

Back to table of contents Previous article Next article Climate ChangeFull AccessPreparing for Disasters at the Community Level: Prevention and Social CohesionAndrew J. McLean, M.D., M.P.H.Andrew J. McLeanSearch for more papers by this author, M.D., M.P.H.Published Online:20 Mar 2020https://doi.org/10.1176/appi.pn.2020.3b21AbstractAs I write this commentary, I’ve just used my snow blower for the fourth time this weekend after a massive winter snow that followed a massively wet fall, and now I’m hearing predictions of a potentially massive spring flood. (My wife and I thought this winter might be rough, so we took a work vacation in warmer climes, at a mental health conference in Australia—while bush fires raged. You can’t make this stuff up.)As psychiatrists, we are impacted by disasters in multiple ways. We attempt to mitigate the impact of trauma on our patients (both those with a history of adverse experiences and those without) and prevent further victimization. We strive to buffer our families and communities from the effects of natural, human-caused, and other perils, and yet there are often too many variables that may affect the outcome.How do we help ourselves and others not to catastrophize catastrophes? How do we channel Osler’s “Aequanimitas” to benefit both individual and population health? (Osler defined this term as “coolness and presence of mind under all circumstances.”) Let’s review the common concepts in both prevention and disaster.Physicians are trained in prevention concepts as they pertain to health. Types of prevention include the following: primary, secondary, and tertiary. (I like the oft-noted “quaternary prevention” as well, which essentially is avoiding iatrogenic causes of harm.)Phases of disaster include mitigation, preparedness, response, and recovery:Mitigation ties in with primary prevention: foreseeing risk and limiting likelihood of occurrence.Preparedness is linked with the event at hand—evaluating imminent risk and dampening down impact, in a secondary prevention fashion.Response is the management of significant impact, that is, tertiary prevention.Recovery allows not only for review of impact, but of lessons learned; the opportunity to evaluate, grow, and build.Let’s apply these concepts as they relate to disaster mental health work:Mitigation/primary prevention can include assisting our patients and families in disaster planning. It can include managing current illnesses to the best of our abilities. It can also include reminders to reinforce social connections. We know that social isolation is a significant risk factor for many physical and mental health issues. Data from some recent disasters, including our experiences with flooding in the upper Midwest, demonstrate that increased social cohesion may be linked to fewer negative mental health outcomes.Preparedness/secondary prevention can include activities related to both psychological/individual and infrastructure, particularly if one has timely knowledge of potential or slow-moving disasters such as floods, droughts, heat waves, wildfires, rising sea levels, and other climate change consequences. For example: “This is what you might expect during this event; make sure you have refills of your medication and a ‘go kit.’ If our office is closed and you have an emergency, please do the following. ... ”During one flood, our city’s engineering department worked with social and mental health case managers to assist vulnerable populations with housing planning after assessment of infrastructure risk.Response/tertiary prevention can manifest in many ways, depending on severity and type of impact. Mental health professionals may be able to work not only with patients in providing care, but also with city and social communities in assisting populations by providing wellness recommendations via media, social media, and other communication channels.Given the hot topic of burnout, mental health professionals need to be aware of their own needs during the above situations. One of my colleagues, a Red Cross disaster mental health trainer, always taps a colleague to help her track any signs of her own stress and struggles.Let’s not forget that during times of such crises, we have a significant amount of training that can be applied in helping ourselves and others. We are physicians—we have competence. We have cognitive and behavioral tools to identify and reduce stress; we have expertise in problem solving. And after all is said and done and we have tried our best, we are trained scientists. We need to evaluate the process, learn, and grow. Regrettably, there will be increasing opportunities to use our skills as the adverse consequences of climate change accelerate and proliferate. ■Andrew J. McLean, M.D., M.P.H., is a clinical professor and chair of the Department of Psychiatry and Behavioral Science at the University of North Dakota School of Medicine and Health Sciences. 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.

Implementing strengths model for youth in community mental health: Impact on case managers' professional quality of life

Case management is a frequently offered service to children and families receiving community based mental health care. However, despite its frequent use, child and adolescent mental health case management lacks formal structure leading to service ambiguity and poor outcomes, for both families being served, and the professionals serving them. This paper explores the implementation of the Strengths Model for Youth, a recovery oriented case management model, at a community mental health center and its relationship with case managers' professional quality of life. Researchers administered the Professional Quality of Life survey to child and adolescent mental health case managers implementing the Strengths Model for Youth at baseline and at six months into implementation. Results indicate the Strengths Model for Youth has positive impacts on case managers' feelings of compassion satisfaction and compassion fatigue after six months of using the model.

Case Managers on the Front Lines of Opioid Epidemic Response: Advocacy, Education, and Empowerment for Users of Medical and Nonmedical Opioids.

The purpose of this article is to examine how case managers, taking a holistic, patient-centered approach that is grounded in advocacy, have a crucial role to play in the opioid crisis response. This includes providing education, support, and resources to prevent misuse of and addiction to opioids prescribed for pain management and intervening with more resources to help combat the nonmedical use of prescription opioids and heroin. In addition to case managers in acute care, workers' compensation, and palliative care, who have frequent contact with patients who are prescribed opioid medications for pain management, all case managers may interact with patients and support systems/families who are directly or indirectly impacted by opioid use, misuse, and addiction. The broad scope of the opioid epidemic necessitates individualized interventions to address the multiple needs of individuals. The case manager, particularly one who is board-certified, has the expertise and knowledge to assess individual needs, identify treatment and other resources, and provide education and support to the patient and family/support system. In addition, given the complexity and life-or-death consequences associated with the opioid crisis, a timely and comprehensive approach is essential, bringing together multiple disciplines in health care, public health, addiction, pain management, social work, mental health counseling, pharmacology, and case management.

Rewards and Challenges in Caring for Older Adults with Multiple Chronic Conditions: Perspectives of Seniors’ Mental Health Case Managers

Healthcare professionals play an important role in caring for older adults with multiple chronic conditions (MCC). Yet few studies have examined the experiences of working with this population, particularly among non-physicians. Twenty-two mental health professionals participated in focus groups to explore the experiences of caring for older adults with MCC. Challenges included a fragmented system, stigma, and knowledge gaps. Rewards included the challenges that complexity presented and human connections. Understanding health professionals’ experiences in working with this growing population demographic can assist in the development of appropriate interventions to support providers that best meet the needs of older adults.