Perspectives Of Case Managers Research Articles

Challenges Associated with Screening Community-dwelling Older Adults for Malnutrition Risk: A Case Management Perspective

Challenges Associated with Screening Community-dwelling Older Adults for Malnutrition Risk: A Case Management Perspective

The Meaning of Social Support for Mental Health Service-Users: The Case Managers' Perspective.

This study sought to understand the unique types of social support salient to mental health service-users from the perspective of case managers. The sample consisted of case managers working in county mental health agencies in the southwest and west coast. Data was gathered from three focus groups and analyzed using NVivo 10 and Consensual Qualitative Research. Six themes were described including relational support, consistency support, validation and affirmation support, social connection support, day-to-day living support and vocational support. While the social support domains described in this study share conceptual underpinnings with traditional conceptualizations of support, our findings reveal unique types of support from the perspective of case managers. Findings from this study offer an important perspective-case managers-to the extant body of research investigating the meaning of social support for people with lived mental health experiences. Of particular interest is the finding that relational support, affirmative and validation support, and consistency support are salient case manager functions.

A Qualitative Study of the Delivery of Tele-Mental Health Services to People with Severe and Persistent Mental Illness with a History of Homelessness

Covid-19 has presented challenges to community mental health organizations that have historically almost exclusively delivered in-person services. This study uses qualitative methods to examine the launch of tele-mental health case management delivery in response to the Covid-19 pandemic in a community mental health organization, from the perspectives of case managers and clients. Tele-mental health challenges included access to and use of technology, and limitations of technology. Our findings suggest that tele-mental health case management delivered via the phone and videoconferencing is viewed, for the most part, positively by both clients and case managers, although it cannot fully replicate in-person services.

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.

How family crises may limit engagement of youth with disabilities in services to support successful transitions to postsecondary education and employment

Abstract Youth with disabilities receiving Supplemental Security Income (SSI) experience multiple barriers to successful transitions to postsecondary education and employment. To improve outcomes for this group, the PROMISE Initiative funded six demonstration programs across the US to test a set of evidence-based services linked to improved employment and educational outcomes, such as case management, benefits counseling, and financial literacy training. Unfortunately, study youth and families did not fully engage in program services, perhaps diminishing effectiveness of the intervention and opportunities for better outcomes. The aim of this descriptive qualitative study was to document family crises experienced by PROMISE participants and explore how these crises contributed to their lack of engagement from the perspectives of case managers who worked with young SSI beneficiaries and their families. Focus groups with nine case managers representing six states from one PROMISE program identified five types of family crises: financial, transportation, behavioral, legal/corrections, and family conflict. Findings suggest that case managers may need additional resources to effectively address the crises encountered. Strategies and future interventions to address crisis situations are suggested.

The Role of Voice Suppression in Case Managers’ Job Satisfaction and Retention

With the goal of improving child well-being, child welfare agencies have begun to focus on the child welfare workforce and to advance strategies that address job satisfaction and retention. A qualitative approach was employed to gather the perspectives of case managers regarding these important issues. Ten foster care case managers participated through three focus groups. Responses were solicited using a semi-structured set of questions primarily focused on critical factors that affect job satisfaction and turnover. Through inductive coding, a prominent theme emerged regarding the suppression of case managers’ voices. Case managers described the suppression of their voices during decision-making in foster care cases by five types of actors, i.e., supervisors, judges, guardians ad litem, attorneys, and funding agency representatives. Further, they described the negative effects this experience had on both themselves and the children and families they serve. These results demonstrate the importance of inter-professional interactions in the foster care field. Further research is needed to identify the extent of this problem and the ways in which interactions can be improved and all voices can be considered.

Improving Care Transitions to Drive Patient Outcomes: The Triple Aim Meets the Four Pillars.

The purpose of this article is to examine how case managers can support positive outcomes during care transitions by focusing on the goals of the Triple Aim () and Coleman's Four Pillars (). Case managers can play a pivotal role to ensure high-quality transitions by assessing patients and identifying those who are at high risk; coordinating care and services among providers and settings; reconciling medications; and facilitating education of patients and their support systems to improve self-management. These activities are congruent with an underlying value of case management as defined by the Code of Professional Conduct for Case Managers: "improving client [i.e., patient] health, wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation" (). Case managers across health or human services must assess for, identify, and understand the vulnerability of patients during care transitions and must adopt best practices to support successful care transitions. This includes case managers in acute care, primary care, rehabilitation, home health, community-based, and other settings. Two frameworks that support care transitions are the Triple Aim of improving the individual's experience of care, advancing the health of populations, and reducing the costs of care (), and Coleman's "Four Pillars" of care transition activities of medication management, patient-centered health records, follow-up visits with providers and specialists, and patient knowledge about red flags that indicate worsening conditions or drug reactions (). From a case management perspective, these approaches and their goals are interrelated. As an advocate for the individual and at the hub of the care team, the professional case manager engages in important activities such as facilitating communication across multiple providers and care settings, arranging "warm handoffs," undertaking medication reconciliation, and engaging in follow-up, particularly with high-risk patients. To support successful transitions of care, case managers must adopt best practices and advocate within their organizations for systematic approaches to care transitions to improve outcomes.

The missing voice of engagement: an exploratory study from the perspectives of case-managers at an early intervention service for first-episode psychosis

BackgroundA key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated. The aim of this study was to understand how case-managers at an early intervention service experience the process of engagement and working with varying levels of attendance and participation.MethodsQualitative interviews were conducted with the case-managers of nine young people treated at an early intervention service for first-episode psychosis within 6 months of treatment entry. Interviews discussed the process of working with the young person and factors that influenced service engagement. Interviews were analyzed using thematic analysis.ResultsCase-managers described a range of influences on engagement which were grouped under the themes: young person and caregiver influences on engagement, case-manager influences on engagement, and influences of the early intervention service system on engagement. The experience of engagement was described as relational, however it occurred in the context of broader influences, some of which were unable to be changed or challenged by the case-manager (e.g., resource allocation, models of treatment, young person demographics).ConclusionThis study illustrates the challenges that case-managers face when working with young people with first-episode psychosis, and the direct influence this has on engagement with treatment. Understanding these challenges and addressing them in policy and service design may lead to improvements in young peoples’ recovery from first-episode psychosis and increase case-manager job satisfaction.

Case management in early psychosis intervention programme: perspectives of case managers

ABSTRACTAim: This qualitative study elicited the perspectives of case managers (CM) on case management, with the aim to understand salient aspects of case management from their own perspective.Methods: This study was conducted as part of a larger study that explored the perspectives of clients, caregivers and case managers on case management. All CMs except the CM researchers were recruited. Two CM focus group discussions (FGD) were conducted and facilitated by an experienced independent researcher from the research department. The FGDs were audio recorded and transcribed verbatim with all participants’ identifiers omitted to protect confidentiality. Qualitative thematic analysis was conducted using NVivo V.10. (QSR International. NVivo V.10 (Computer software). 2012. http://www.qsrinternational.com)Results: Eleven themes emerged from the CM FGDs which are based on the CMs’ work with both clients and caregivers: therapeutic alliance, holistic monitoring, collaborative role with other care providers, counselling and guidance, crisis management, bridging role, client-centred care, client empowerment and strength building, psychoeducation, support and advocacy.Conclusions: The voices of CMs are important in planning service delivery models and improving the quality of care to clients and caregivers.

Explaining Lead Poisoning among Refugee Children: The Role of the Resettlement Process

United States children living in poorly maintained housing built before 1978 are at particular risk of lead poisoning, which harms their physical and cognitive development. Studies have shown that although refugee children may have been exposed to lead in their homelands, some experienced increased blood lead (BPb) levels after their resettlement in the United States. This study provides an insider's account of the resettlement process from the perspectives of case managers to explain why refugee children are at higher risk of being placed in substandard housing and of consequently being exposed to lead. We examine the productivity demands, financial pressures, and time constraints that case managers face and how the demands of their supervisors and resettlement agency funders may redirect their priorities away from protecting refugees' health. We conclude with recommendations to reduce the pressures on case managers and lessen the burden of lead poisoning among refugee children.

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.

Through their lens: Case managers’ experiences of the child welfare system

Case managers play a significant role in the child welfare system. Although previous studies have highlighted the multiple demands and requirements for case managers, few studies have utilized the perspective of case managers to highlight practices and areas of need within the child welfare system. The purpose of this qualitative study was to expand the understanding of issues related to child welfare by exploring the perspectives of current and former child welfare case managers. Thirty-one case managers provided their perspectives on their experiences within the child welfare system, perspectives and views of the system, relationships with other parts and persons within the system, and how they developed their knowledge of the intricate child welfare system. Themes related to the roles and responsibilities of case managers, support and collaboration, and learning and growing within the system emerged. Practice, research, and policy implications are discussed.

Case managers for older persons with multi-morbidity and their everyday work - a focused ethnography.

BackgroundModern-day health systems are complex, making it difficult to assure continuity of care for older persons with multi-morbidity. One way of intervening in a health system that is leading to fragmented care is by utilising Case Management (CM). CM aims to improve co-ordination of healthcare and social services. To better understand and advance the development of CM, there is a need for additional research that provides rich descriptions of CM in practice. This knowledge is important as there could be unknown mechanisms, contextual or interpersonal, that contribute to the success or failure of a CM intervention. Furthermore, the CM intervention in this study is conducted in the context of the Swedish health system, which prior to this intervention was unfamiliar with this kind of coordinative service. The aim of this study was to explore the everyday work undertaken by case managers within a CM intervention, with a focus on their experiences.MethodsThe study design was qualitative and inductive, utilising a focused ethnographic approach. Data collection consisted of participant observations with field notes as well as a group interview and individual interviews with nine case managers, conducted in 2012/2013. The interviews were recorded, transcribed verbatim and subjected to thematic analysis.ResultsAn overarching theme emerged from the data: Challenging current professional identity, with three sub-themes. The sub-themes were 1) Adjusting to familiar work in an unfamiliar role; 2) Striving to improve the health system through a new role; 3) Trust is vital to advocacy.ConclusionsFindings from this study shed some light on the complexity of CM for older persons with multi-morbidity, as seen from the perspective of case managers. The findings illustrate how their everyday work as case managers represents a challenge to their current professional identity. These findings could help to understand and promote the development of CM models aimed at a population of older persons with complex health needs.

Spirit Lifting: Hope and Recovery in Case Management Practice

Case managers play an important role in the recovery process for consumers with severe mental illness. This study sought to capture the perspectives of case managers in two Midwestern states regarding the consumers they serve and their beliefs about the concept, process, and possibility of recovery from mental illness. Interviews from 50 mental health case managers were reviewed and rated on the basis of their perceived hopefulness about the prospects of recovery from mental illness. The study revealed that case managers hold divergent views on the definition and likelihood of recovery. The results suggest that practitioners may benefit from additional training and support to further develop their perspectives on recovery, which may also increase their hopefulness toward consumer outcomes.

Involving clients and their relatives and friends in psychiatric care: Case managers' experiences of training in resource group assertive community treatment

The purpose of this project was to do a qualitative study of an integrated and flexible ACT model, the Resource Group Assertive Community Treatment (RACT), as seen from the perspective of case managers in training. The resource group normally consists of the client, the case manager and other available personnel in the medical and support areas, as well as family members. Nineteen theses were randomly chosen from a set of 80 theses written by a group of Swedish trainee case managers. The exams were conducted as case studies and concerned 19 clients with psychotic problems, 11 men and 8 women. “The Empirical Phenomenological Psychological Method” was used in the analysis, which generated five overarching themes: (a) the RACT program; (b) the resource group; (c) the empowerment of the client; (d) progress in treatment; and (e) the case manager. These together constituted a “therapeutic circle,” in which methods and tools used within the RACT made it possible for the resource group to empower the clients who, as a result, experienced progress with treatment, during which the case manager was the unifying and connecting link.

Case Managers' and Independent Living Counselors' Perspectives on Health Promotion Activities for Individuals with Physical and Developmental Disabilities

A fundamental component of maximizing the quality of life for individuals with disabilities is quality health care. We describe the perspectives of case managers and independent living counselors on the role of health promotion as a component of targeted case management services. Respondents held health promotion as an essential element of maximizing the quality of life for individuals with disabilities, although they spent more time on social services as compared to medical services. Their confidence in assisting the individuals they serve with respect to health promotion and disease management activities was demonstrably weaker than their reported knowledge levels for most items. Barriers to accessing those services might create this apparent disconnect between knowledge and confidence.

Case Management with Hurricane Katrina Survivors: Perspectives of Case Managers and Supervisors

ABSTRACT Disaster case management is an important but under-researched aspect of disaster recovery. This study explored the perspectives of case managers and supervisors about the needs of Hurricane Katrina survivors. Telephone interviews with 168 case managers and supervisors in 32 states identified client motivation and availability of resources as key factors in successful cases. Conversely, lack of client motivation perceived or resources were key factors in challenging cases. Housing, employment, and transportation were identified as survivors' greatest needs. Further research is needed to develop best practices in enhancing client motivation, addressing cultural differences, and improving post-disaster resource development.

Understanding Service Disengagement From the Perspective of Case Managers

Disengagement from services by persons experiencing homelessness and co-occurring disorders challenges the mental health system and the frontline providers who build clinical relationships that end prematurely. This qualitative study explored how case managers understand and respond to disengagement. This study was conducted at four programs serving persons with co-occurring disorders experiencing homelessness. The qualitative design used a case study approach based on in-depth interviews with 18 case managers about 29 cases of disengagement. The study compared their accounts with predisengagement interviews when available and the postdeparture residential status of consumers. Themes were derived by independent coding and consensus. Case managers attributed disengagement primarily to substance relapse and a preference for alternative living arrangements. The following themes emerged: seeing disengagement as part of their work, believing disengagement to be poor decision making on the part of the consumer, and coping with the revolving-door syndrome. The majority of consumers experienced homelessness after disengagement. The study illustrated the challenge of building hope-instilling relationships with consumers when faced with the reality of frequent disengagement. In an era of recovery-oriented services and consumer choice, case managers need support when faced with consumer decisions to leave treatment settings. Greater program flexibility may also help to reduce disengagement.

Understanding Service Disengagement From the Perspective of Case Managers

Disengagement from services by persons experiencing homelessness and co-occurring disorders challenges the mental health system and the frontline providers who build clinical relationships that end prematurely. This qualitative study explored how case managers understand and respond to disengagement. This study was conducted at four programs serving persons with co-occurring disorders experiencing homelessness. The qualitative design used a case study approach based on in-depth interviews with 18 case managers about 29 cases of disengagement. The study compared their accounts with predisengagement interviews when available and the postdeparture residential status of consumers. Themes were derived by independent coding and consensus. Case managers attributed disengagement primarily to substance relapse and a preference for alternative living arrangements. The following themes emerged: seeing disengagement as part of their work, believing disengagement to be poor decision making on the part of the consumer, and coping with the revolving-door syndrome. The majority of consumers experienced homelessness after disengagement. The study illustrated the challenge of building hope-instilling relationships with consumers when faced with the reality of frequent disengagement. In an era of recovery-oriented services and consumer choice, case managers need support when faced with consumer decisions to leave treatment settings. Greater program flexibility may also help to reduce disengagement.

The Value of Case Management in the Publicly Funded Substance Abuse Treatment System: The Perspective of Program Directors, Case Managers and Clients

The many purposes of this article is to understand the role and value of case management from the perspective of program directors, case managers and clients. A survey of program directors from publicly funded substance abuse treatment programs in Boston was administered, and in-depth interviews with a sample of program directors, case managers, and clients were conducted. Case management allowed programs to serve more complex clients and increased time available for counselors to focus on the clinical needs of clients. From the perspective of case managers and clients, much of the value of case management came from educating clients about steps they could take to meet their needs and then supporting them in their efforts as they took these steps. Successful steps taken to deal with these needs helped lay the foundation necessary to confront the challenges of treatment. Program directors, case managers, and clients considered case management a valuable enhancement to substance abuse treatment.