Case management

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No matter what type of client your Drug Court is serving, case management is one of the keystones to success. The learning objectives for this session are:
* Learn best practices in the filed of case management
* Learn how to best serve specific case management needs

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Case management

  1. 1. Chief Mack Jenkins, M.S.San Diego County Probation
  2. 2. Objectives Define Case Management Discuss the Core Functions of Case Management Review Evidenced Practices of Case Management Review Strategies of Case Management
  3. 3. Definition Of Case Management • a collaborative process which assesses, plans, implements, coordinates, monitors and evaluates the options and services required to meet an individual’s health needs, using communications and available resources to promote quality, cost-effective outcomes.” Case Management Society of America
  4. 4. More Definitions The provision of, or referral to a comprehensive set of services designed to increase the probationer’s overall success. A system of support, monitoring and advocacy to assist the probationer through change. “helping people whose lives are unsatisfying or unproductive due to the presence of many problems which require assistance from several helpers at once” (Ballew and Mink, 1996, p. 3)
  5. 5. Case Management In Drug Court More than one case manager Non-case managers providing some services Coordinated case management a must Sharing of information from all team members Everyone’s on the same page
  6. 6. Core Functions Of Case Management
  7. 7. Core Functions Of CaseManagement Assessment Planning Linkage Monitoring Advocacy
  8. 8. It begins with Engagement Determine motivation to change behavior Identify degree of support from family and friends. Discuss realistic criminal justice system (or other) consequences. Establish a positive, professional, therapeutic relationship with the participant. Be consistent
  9. 9. Try to identify the problem… Is it addiction? Is it criminal thinking Is it co-occurring disorders (MH, DD, Physical) Is it all of that…and more?
  10. 10. Assessment Make sure it’s ongoing. Avoid duplication when possible. Consider and discuss varied responses. Consider formal and informal assessment. Coordinate!
  11. 11. Assess Your Assessments What assessments are being conducted? Who’s conducting them? Are they 3rd or 4th generation? What are the assessments assessing? How is the information being shared?
  12. 12. Case Planning Don’t overwhelm the participant—make it doable. Include the participant in developing the case plan. Make the tasks and objectives measurable. Prioritize the tasks. SMART: specific, measurable, attainable, rewarding, timely Individualize! Individualize! Individualize
  13. 13. Case Planning Questions Is there more than one case plan? If there are, can they be combined? If they can’t, how can your team be sure they don’t contradict each other? Do all team members know what’s on all case plans? Does the participant know what’s on all case plans?!
  14. 14. Linkage Know what services are available in your community. Know the services participants are eligible for . Know the participants. Help the participants make the initial contact. Follow up after a referral is made
  15. 15. Linkage Questions What services do your drug court participants need? What services does THIS participants need? What changes do you see in your target population? In your community? What partnerships do you need to make to increase services available to participants?
  16. 16. Monitoring Detect non-compliance including new AOD use. Catch the participants doing something right! Assess the recovery environment (i.e. home) Track attendance and participation Share information timely Look for small changes
  17. 17. Monitoring Questions Does your drug court team have a community supervision component? How often are participants seen in their homes? Are searches allowed? Conducted? How often are participants drug tested? How is information shared and how timely is it shared?
  18. 18. Monitoring Multifaceted:  Quality assurance of service provision  probationer performance: attendance, participation  Coordination of assessments with providers Supervision  Office visits  Home visits  Other field contacts Drug Testing
  19. 19. Field Visits Identify goals of visit Use visit to assess the recovery environment Communicate the good and the bad back to the team—timely! Safety First!
  20. 20. Advocacy Know what participants can do and what they need help with. Help the participant assert him/herself and learn to advocate for him/herself. Identify program areas that need some advocacy for the benefit of all participants.
  21. 21. Advocacy Questions What’s the difference between helping and enabling? What skill development is occurring to help participants learn how to advocate for themselves?
  22. 22. Eight Evidence-Based Principles forEffective Interventions 1. Assess Actuarial Risk/Needs. 2. Enhance Intrinsic Motivation. 3. Target Interventions. 4. Skill Train with Directed Practice 5. Increase Positive Reinforcement. 6. Engage Ongoing Support in Natural Communities. 7. Measure Relevant Processes/Practices. 8. Provide Measurement Feedback NIC, 2004
  23. 23. 1. Assess Actuarial Risk/Needs  Know the assessments used  Review assessments with offender  Incorporate into case plan  Re-assess and measure change
  24. 24. 2. Enhance Intrinsic Motivation  Use verbal and non-verbal communication skills:  Attending, reflections, summarizations, open-ended questions, etc.  Explore offender’s attitude toward change  Avoid non-productive arguing and blaming  Encourage praise, be optimistic
  25. 25. 3. Target Interventions a. Risk Principle: Prioritize supervision and treatment resources for higher risk offenders. b. Need Principle: Target interventions to criminogenic needs. c. Responsivity Principle: Be responsive to temperament, learning style, motivation, culture, and gender when assigning programs.
  26. 26. 3. Target Interventions d. Dosage: Structure 40-70% of high-risk offenders’ time for 3-9 months. e. Treatment: Integrate treatment into the full sentence/sanction requirements.
  27. 27. 4. Skill Train with Directed Practice Use Cognitive Behavioral treatment methods Support treatment efforts in field work Understand anti-social thinking and appropriate communication techniques Positively reinforce pro-social attitudes and behaviors Make appropriate referrals using evidence-based information
  28. 28. 5. Increase Positive Reinforcement Identify short-term goals for participants Acknowledge achievement of short-term goals Convey optimism that the participants can change Encourage and praise any evidence of pro-social behavior. Reinforce participant change talk and self-efficacy
  29. 29. 6. Engage Ongoing Support in NaturalCommunities Assist participants in identifying who is supportive and who is not Conduct frequent home visits Case Managers need to learn and apply relapse prevention techniques. Identify and establish relationships with participant’s positive support systems in the community. Recognize triggers for relapse and make timely intervention
  30. 30. 7. Measure Relevant Processes/Practices Documentation! Documentation! Documentation! Identify strategies “You can’t manage what you don’t measure”
  31. 31. 8. Provide Measurement Feedback Feedback to the participants Feedback to your supervisor Feedback to service providers
  32. 32. Drug Court Populations Re-entry Juveniles and Young Adults Participants with a Mental Health Diagnosis
  33. 33. Re- Entry Population“an estimated 80% of the state prison population report histories of substance abuse, 90% fail to obtain those services while incarcerated. It is estimated that only 10% of offenders receive appropriate community linkage and follow-up services upon release.” Scott Sylak President, National TASC House Subcommittee Hearing Feb. 8, 2006
  34. 34. Strategies for Reentry Process starts at the time of the presentence report. Services accessed while in custody. Upon release, re-assessment and linkage to community services. Coordination and information flow throughout the process is key.
  35. 35. Juvenile and Young Adults: Significant brain distinctions Memory deficits Increased impulsiveness Visual learning Disturbed sleep cycles “Hormone Hell”
  36. 36. Brain Chemistry For different reasons, brain chemistry is an issue for juveniles, young adults and methamphetamine users. A longitudinal study on adolescent brain development shows that brains are still developing until age 24 or so. Methamphetamine causes physical changes in the brain.
  37. 37. Juveniles Consider brain development issues Provide sequential direction Provide shorter time span between hearings Focus on short-term goals and outcomes Differentiate between willful non-compliance and inability to comply Encourage “dream talk” to begin goal discussion
  38. 38. Young Adults Consider brain development issues Provide sequential direction 18-24 year olds are still going through some of the same changes as their younger counterparts
  39. 39. Methamphetamine Users Consider brain development issues-reduced memory, lack of motivation, lack of feelings Provide sequential direction Attend to the physical maladies caused by use Attend to the life skills deficits left by use Constantly keep the message hopeful, simple, clear, and consistent.
  40. 40. With many participants, but especially methusers and youth Patience Redundancy Instilling hope Maximizing engagement strategies Accountability
  41. 41. Tools: Encourage & support Repeat everything Reaffirm Remind of next contact, reaffirm message of other treatment team members Repeat consistent message of “show up”. Require repeat backs Write it down (them), reaffirm.
  42. 42. Clients with a Mental Health Diagnosis Participants with co-occurring disorders often experience more severe and chronic medical, social and emotional problems. They are more vulnerable to both AOD relapse and a worsening of the psychiatric disorder. Participants with co-occurring disorders often require longer treatment, have more crises, and progress more gradually in treatment. They often have reduced skill retention.
  43. 43. Clients with a Mental HealthDiagnosis Team must be familiar with psychotropic medications and their side effects Do not dismiss participants as a resource Provide enhanced community supports Understand what role drug use has played in the participants ’s life Expect setbacks, but don’t assume failure
  44. 44. Summary Defining Case Management  As an individual case manager  As part of a team Employ the key functions  Assess and reassess  Develop a case plan to target identified needs  Actively work to link participants to services  Closely monitor the participant’s progress, provide feedback and support  Support but don’t enable
  45. 45. Summary Know the Evidence Based Practices Develop Strategies that recognize the deficits of the targeted population and use strengthen based approaches to the address them.

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