1. Case management is an intervention that aims to provide coordinated, comprehensive, and ongoing support to clients with complex needs. It originated in the early 20th century and has been applied to populations with substance abuse issues in the US and Canada since the 1970s.
2. The study aimed to conceptualize case management and the role of the case manager, and to provide recommendations for implementing case management in Belgium's criminal justice and treatment systems. It examined existing case management projects and gathered perspectives from key informants.
3. The study identified 17 case management projects in Belgian substance abuse treatment. Implementation of case management has been limited, and it has not yet been applied in the criminal justice system as envisioned in policy documents
The impact-of-therapeutic-intervention-on-increasing-capabilities-andefficien...abdelaziz thabet
The document summarizes a research study that evaluated the impact of therapeutic interventions on 170 patients referred to three community mental health centers in Gaza. Patients completed an assessment scale at their first, second, and third visits to measure capabilities and efficiency across eight domains. Statistical analysis found a significant increase in patients' personal and daily capacities after the second visit compared to the first. All scale items also showed significant improvements between the first and third visits, indicating that the therapeutic process helped increase clients' abilities. The study concludes the therapeutic services provided by the centers were effective in improving patients' functioning after multiple visits.
This document contains a portfolio submitted for a position in criminal justice. It includes an executive summary outlining the contents which are a CV, statement of criminal justice philosophy focused on restorative justice, exemplar essays from graduate coursework, a five-year professional goals plan, and a research proposal on cybercrime. The philosophy discusses applying restorative justice principles to heal victims and restore offenders to the community. The essays cover topics like restorative justice, the criminal justice system, and applying restorative justice principles to increase trust in law enforcement.
The Role of Collaborative Arrangements on Quality Perception in Ambulatory CareBruno Agnetti
Il pronto intervento italiano aveva posto un accento particolare sulla promozione di nuove modalità organizzative. Alcuni studi hanno analizzato il loro impatto sulla percezione della qualità. Con l'obiettivo di esaminare i clienti 'e medici' in cura ambulatoriale all'interno dei diversi modelli organizzativi, abbiamo studiato 96 pazienti (di età compresa tra i 18-80 anni) e 22 medici (M = 50,33 anni).
This document discusses the legal and historical context of social work with adults with mental health issues in England. It outlines key legislation like the 1959 and 1983 Mental Health Acts and how they have evolved to increase protections for individuals and allow for community-based treatment. The most recent Mental Health Act of 2007 and Care Act of 2014 take a recovery-oriented approach focused on person-centered care and least restrictive options. The document also examines theories and models used in social work practice, like systems theory and recovery models, as well as issues around diversity, collaboration between medical and social perspectives, and reducing conflicts between approaches.
Ethical implications of scarcity of patients for HTAHTAi Bilbao 2012
1. The document discusses the ethical implications of scarcity of patients for health technology assessment, using the case study of discontinuing reimbursement of Mexiletine for patients with Non-myotonic Muscular Dystrophy due to lack of evidence of clinical effectiveness.
2. It proposes systematically identifying and resolving ethical issues by specifying general moral principles or "norms" to provide more nuanced guidance for concrete cases where principles may conflict.
3. By qualifying three proposed norms to account for individual consent, proportional evidence requirements, and access to healthcare, the analysis concludes that discontinuing Mexiletine reimbursement for these patients is ethically unfounded.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence is regarding psychotropics. As a consequence, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence-based prescriptive practice. BARRY DUNCAN and DAVID ANTONUCCIO call for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced-based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, a patient bill of rights for psychotropic prescription is presented. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. This is a Psychotherapy in Australia reprint of an earlier article.
Click here for a video of the presentation http://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=97
Click here for a pdf of the slides: http://heartandsoulofchange.com/content/resources/viewer.php?resource=handout&id=127
Social workers currently do not have the authority to prescribe or administer medication, though they play an important role in medication management and adherence. Some other non-physician professions, like psychologists, have begun gaining limited prescribing privileges. This document discusses the expanding roles of social workers in medication management, reviews new laws allowing prescribing by psychologists in New Mexico and Louisiana, and raises questions about whether social work should also pursue prescribing privileges.
Tim Bingham coordinates the Irish Needle Exchange Forum and has 22 years of experience working in harm reduction. He discusses the history and principles of harm reduction, noting it aims to reduce harms associated with drug use rather than prevent drug use. He then outlines supervised injecting facilities, explaining they provide a safe and hygienic environment for drug consumption along with access to healthcare. Studies of existing facilities in Vancouver and Sydney found they reduced overdoses, disease transmission, and public drug use without increasing local drug use. While legally complex, evidence shows supervised injection can be considered a form of drug treatment that helps connect users to other health services.
The impact-of-therapeutic-intervention-on-increasing-capabilities-andefficien...abdelaziz thabet
The document summarizes a research study that evaluated the impact of therapeutic interventions on 170 patients referred to three community mental health centers in Gaza. Patients completed an assessment scale at their first, second, and third visits to measure capabilities and efficiency across eight domains. Statistical analysis found a significant increase in patients' personal and daily capacities after the second visit compared to the first. All scale items also showed significant improvements between the first and third visits, indicating that the therapeutic process helped increase clients' abilities. The study concludes the therapeutic services provided by the centers were effective in improving patients' functioning after multiple visits.
This document contains a portfolio submitted for a position in criminal justice. It includes an executive summary outlining the contents which are a CV, statement of criminal justice philosophy focused on restorative justice, exemplar essays from graduate coursework, a five-year professional goals plan, and a research proposal on cybercrime. The philosophy discusses applying restorative justice principles to heal victims and restore offenders to the community. The essays cover topics like restorative justice, the criminal justice system, and applying restorative justice principles to increase trust in law enforcement.
The Role of Collaborative Arrangements on Quality Perception in Ambulatory CareBruno Agnetti
Il pronto intervento italiano aveva posto un accento particolare sulla promozione di nuove modalità organizzative. Alcuni studi hanno analizzato il loro impatto sulla percezione della qualità. Con l'obiettivo di esaminare i clienti 'e medici' in cura ambulatoriale all'interno dei diversi modelli organizzativi, abbiamo studiato 96 pazienti (di età compresa tra i 18-80 anni) e 22 medici (M = 50,33 anni).
This document discusses the legal and historical context of social work with adults with mental health issues in England. It outlines key legislation like the 1959 and 1983 Mental Health Acts and how they have evolved to increase protections for individuals and allow for community-based treatment. The most recent Mental Health Act of 2007 and Care Act of 2014 take a recovery-oriented approach focused on person-centered care and least restrictive options. The document also examines theories and models used in social work practice, like systems theory and recovery models, as well as issues around diversity, collaboration between medical and social perspectives, and reducing conflicts between approaches.
Ethical implications of scarcity of patients for HTAHTAi Bilbao 2012
1. The document discusses the ethical implications of scarcity of patients for health technology assessment, using the case study of discontinuing reimbursement of Mexiletine for patients with Non-myotonic Muscular Dystrophy due to lack of evidence of clinical effectiveness.
2. It proposes systematically identifying and resolving ethical issues by specifying general moral principles or "norms" to provide more nuanced guidance for concrete cases where principles may conflict.
3. By qualifying three proposed norms to account for individual consent, proportional evidence requirements, and access to healthcare, the analysis concludes that discontinuing Mexiletine reimbursement for these patients is ethically unfounded.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence is regarding psychotropics. As a consequence, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence-based prescriptive practice. BARRY DUNCAN and DAVID ANTONUCCIO call for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced-based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, a patient bill of rights for psychotropic prescription is presented. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. This is a Psychotherapy in Australia reprint of an earlier article.
Click here for a video of the presentation http://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=97
Click here for a pdf of the slides: http://heartandsoulofchange.com/content/resources/viewer.php?resource=handout&id=127
Social workers currently do not have the authority to prescribe or administer medication, though they play an important role in medication management and adherence. Some other non-physician professions, like psychologists, have begun gaining limited prescribing privileges. This document discusses the expanding roles of social workers in medication management, reviews new laws allowing prescribing by psychologists in New Mexico and Louisiana, and raises questions about whether social work should also pursue prescribing privileges.
Tim Bingham coordinates the Irish Needle Exchange Forum and has 22 years of experience working in harm reduction. He discusses the history and principles of harm reduction, noting it aims to reduce harms associated with drug use rather than prevent drug use. He then outlines supervised injecting facilities, explaining they provide a safe and hygienic environment for drug consumption along with access to healthcare. Studies of existing facilities in Vancouver and Sydney found they reduced overdoses, disease transmission, and public drug use without increasing local drug use. While legally complex, evidence shows supervised injection can be considered a form of drug treatment that helps connect users to other health services.
1. Three Collective Management Organizations (CMOs) - MCSK, PRISC and KAMP - claim the right to collect public performance license fees for sound and audiovisual works played at Prime Chic Holdings restaurants.
2. Prime Chic Holdings seeks clarification on which body is mandated to collect fees, as the CMOs each demand separate payments for the same content.
3. The legal opinion analyzes the Copyright Act and determines that MCSK has been approved by the Copyright Board to collect fees for public performance of musical works in restaurants. PRISC and KAMP/PRISK together issue licenses for sound recordings and audiovisual works, but MCSK alone is entitled to collect
1. Vickie Lynn Marshall filed a claim in federal bankruptcy court against E. Pierce Marshall for tortiously interfering with the inheritance she expected from J. Howard Marshall. The bankruptcy court ruled in her favor but the Ninth Circuit reversed, citing the probate exception.
2. The Supreme Court held that the probate exception did not apply because Vickie's claim did not require validating or invalidating a will. It was a recognized tort claim for interfering with an expected inheritance.
3. The Court also found that Vickie had a valid expectation of inheritance from J. Howard Marshall based on his promises, and that Pierce's actions of depleting assets and restricting access tortiously interfered with that expectation.
Do you find yourself unable to agree contract terms because of their complexity?
Are you paralysed by indecision over which elements are important?
Do you find yourself avoiding the pain of paperwork by not signing or reviewing contracts?
Do you want a quick way of sorting out if your construction contract is good to go or may cause problems later in the project?
This checklist is designed for use during the tender stage to determine whether to continue.
The checklist was developed by Sarah Fox, author of the 500-Word Contract for construction projects. If you want to know how to use 4 key elements to evaluate contracts before they are signed then 500 Words Ltd runs a 90-minute introductory workshop to help you spot the disasters waiting to happen.
For information on how we can give you the confidence to use contracts for project success, email sarah@500words.co.uk or visit www.500words.co.uk
This memorandum discusses whether stamping political messages on U.S. currency to raise awareness of corporate personhood and money as free speech would be legal. It analyzes two relevant federal statutes, 18 USC 333 and 18 USC 475, and concludes that while 18 USC 333 prohibits damaging currency to remove it from circulation, stamping political messages would not meet this standard and convictions would be unlikely. It also concludes that 18 USC 475, which prohibits commercial advertising on currency, would not apply to political speech and a content-based restriction would not withstand the highest scrutiny.
The document discusses legal opinions, which are provided in financing transactions to confirm the legal validity of transaction documents for the lender. Legal opinions cover issues like a borrower's legal authority to enter the transaction, the enforceability of transaction documents, and compliance with relevant laws. However, legal opinions have limitations and do not guarantee a borrower's ability to repay a loan or predict future changes in law. The document outlines typical contents of a legal opinion and when they are provided, such as for cross-border transactions or to satisfy loan conditions. Legal opinions address the laws of relevant jurisdictions like a borrower's home country and the governing law jurisdiction. Opinions are usually provided by independent external lawyers, though sometimes by a borrower
This document provides an introduction to different types of technical drawings including orthographic projection views, sectional views, auxiliary views, and isometric drawings. It discusses topics such as dimensioning of radii, holes, countersinks, counterbores, and spot faces. Examples are provided for various types of projection views and isometric drawings. Exercises are included at the end to apply the concepts learned.
Randomized Controlled Trials in Evaluating Socially Complex Interventions: A ...Jean-Paul Grund
Randomized Controlled Trials in Evaluating Socially Complex Interventions: A Square Peg in a Round Hole?
This lecture will discuss a number of challenges and problems in Randomized Controlled Trials (RCTs), in particular in evaluating interventions aimed at (i) altering complex human behaviour, (ii) in marginalized and stigmatized populations; and, (iii) by socially complex interventions. Using examples from the literature and his own research, Dr. Grund will provide a transdisciplinary perspective on the utility of the RCT model in evaluating interventions aimed at, for example, people who use drugs or homeless people, two very complex “Real World” problems in the Czech Republic and elsewhere.
He argues that the arena of services for PUD, the homeless and other marginalised populations is rife with poorly understood contingencies. Consequently, the complexity of the research environment becomes a function of I, ii and iii above, but with enigmatic mathematical operators. Strategies for addressing this complexity through accompanying process evaluation and qualitative research will be discussed.
Published in ―Theory and Practice of Clinical Social Work (2.docxamrit47
Published in ―Theory and Practice of Clinical Social Work (2
nd
Edition), J. Brandell,
Ed., Columbia University Press, 2010.
2200
CLINICAL CASE MANAGEMENT
Joel Kanter
Over the past 30 years, case management has become a ubiquitous intervention
approach throughout the mental health and health care fields. Often poorly defined, case
management, perhaps a linguistic repackaging of ―social work‖ or ―social casework,‖
encompasses a wide range of environmental interventions with persons in need,
including persons suffering from severe mental illness, substance abuse, and chronic
medical conditions such as HIV, tuberculosis, and diabetes. In health care, the term case
management can refer to cost-conscious telephone interventions to monitor medical
services or to discharge planning from an inpatient facility. In mental health, case
management may refer to helping a client obtain disability benefits or apply for housing
assistance. Or it may refer to a friendly paraprofessional visitor who assists with
homemaking and transportation.
Addressing these disparate needs, an array of case management models have
been identified and articulated: brokerage, rehabilitation, strengths based, and clinical.
Other adjectives have been frequently used to characterize less specific case
management interventions: ―intensive,‖ ―assertive,‖ and ―standard.‖ Understanding the
case management literature often requires readers to carefully examine details of the
actual interventions and human resource issues to determine what the term case
management means in each situation.
Were the interventions short-term or long-term?
Were the relationships between case managers and clients personal or
administrative?
Was ―case management‖ the main activity of the worker or one of an array
of interventions?
What were the duration and frequency of case management contacts?
Were the scope of case management interventions focused on clients
holistically or were they narrowly focused on a single illness or life domain?
How large were case managers‘ caseloads?
Did case managers address the interplay between psychological and
environmental concerns?
What was the professional training and experience of the case managers?
In this chapter, the focus will be on a specific case management model—clinical
case management—that addresses the above questions with more clarity than other
approaches. In a clinical case management approach, relationships with clients are
valued, interventions are holistically focused, and case managers recognize the interplay
between psychological and environmental domains. Clinical case management can be
defined as a modality of social work practice that, acknowledging the importance of
biological and psychological factors, addresses the overall function and maintenance of
the person‘s physical and social environment toward the goals of facilitating physical
surv ...
Law enfercement & Alternative Sentence for drug offenders youthrise
The document discusses alternative sentencing approaches for drug offenders as an alternative to incarceration. It describes how drug courts and diversion programs identify nonviolent drug offenders and provide treatment and rehabilitation services instead of prison time. If treatment is successfully completed, criminal charges are dropped. The document also discusses decriminalization and depenalization policies in other countries and how diversion at arrest and sentencing can help reduce prison overcrowding while addressing substance abuse issues.
I. Drug courts that are ran effectively, can curb drug use and d.docxsheronlewthwaite
I. Drug courts that are ran effectively, can curb drug use and distribution with insight and
prevention.
i. “Using retrospective data, researchers in several studies found that drug courts reduced recidivism among program participants in contrast to comparable probationers” (nij.gov, n.d.). Repeat offenders have dropped significantly with the introduction of drug courts.
ii. Explains how percentages of reoffenders has dropped in percentages with statistical data.
II. Funding drug courts comes from grants and many other federal and local sources.
a. “The Drug Court Discretionary Grant Program provides financial and technical assistance to states, state courts, local courts, units of local government, and Indian tribal governments to develop and implement treatment drug courts that effectively integrate substance abuse treatment, mandatory drug testing, sanctions and incentives, and transitional services in a judicially supervised court setting with jurisdiction over nonviolent, substance-abusing offenders” (NCJRS, n.d.).
i. Funding is crucial to the development and sustainability of running effective drug court programs.
III. Monitoring and development to increase effectiveness has reduced reoffenders and costs associated with nonviolent drug cases.
a. “In times of serious budget cuts, the drug court model offers State and local governments a cost‐effective way to increase the percentage of addicted offenders who achieve sustained recovery, thereby improving public safety and reducing costs associated with re‐arrest and additional incarceration” (Drug courts, n.d.).
i. Monetary and manpower issues are reduced drastically once effective drug courts are put into play
Do Drug Courts Work? Findings From Drug Court Research. (n.d.). Retrieved from https://nij.gov/topics/courts/drug-courts/Pages/work.aspx#note1
In the Spotlight: Drug Courts - Grants and Funding | NCJRS. (n.d.). Retrieved from https://www.ncjrs.gov/spotlight/drug_courts/grants.html
Drug Courts. (n.d.). Retrieved from https://obamawhitehouse.archives.gov/ondcp/ondcp-fact-sheets/drug-courts-smart-approach-to-criminal-justice
1
DRUG COURTS
3
DRUG COURTS
Drug Court Effectiveness
Sean Markl
American International University
Drug Court Effectiveness
The main function of a drug court is to prevent and discourage use, selling of, or distributing illegal drugs by offenders. By utilizing drugs courts in ways such as deterrent, prevention, and treatment to curb nonviolent offenders can be a crucial step in rehabilitation for the majority. “Drug courts were designed to put treatment and rehabilitation ahead of punishment” (Emigh,2018). By putting treatment and rehabilitation ahead of prison or jailtime, many offenders are set on a path to recovery that reduces recidivism. Most states have set up these specific courts to deal with nonviolent offenders.” The Carroll County Drug Treatment Court operates in the Circuit Court for Carroll County and has been specifically desi ...
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Continuity of Offender Treatment for Substance Use Disorders from Institution to Community.
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Chapter 2—Case Management and Accountability
Coordinating systems to help the newly released offender can seem overwhelming, due in large part to the burgeoning caseloads carried by public sector agencies. Not only are the criminal justice and substance use disorder treatment systems fragmented and sprawling, but the offender will likely need ancillary services as well (discussed in Chapter 5), which calls for case management. As discussed in Chapter 1, case management can follow an outreach, reach-in, or third-party approach, or some combination of the three. No matter what the model, research shows cost benefits, through reduced recidivism, of cross-system integration for offender transitional services (Inciardi, 1996; Abt Associates, 1995; Swartz et al., 1996).
Case management is the function that links the offender with appropriate resources, tracks progress, reports information to supervisors, and monitors conditions imposed by the supervising agency. These activities take place within the context of an ongoing relationship with the client. The goal of case management is continuity of treatment, which, for the offender in transition, can be defined as the ongoing assessment and identification of needs and the provision of treatment without gaps in services or supervision. Accountability is an important element of a transition plan, and case management includes coordinating the use of sanctions among the criminal justice, substance use disorder treatment, and possibly other systems.
Go to:
Case Management in Transition Planning
Ideally, case management activities should begin in the institution before release and continue without interruption throughout the transition period and into the community. It is recommended that transition planning begin at least 90 days before release from jail or prison. Early initiation of transition planning is important because it establishes a long-term, consistent treatment process from institution to community that increases the likelihood of positive outcomes. The case manager's communication with other transition team members at an early stage supports all aspects of the offender's recovery and rehabilitation (e.g., education, health, vocational training).
Ideal Array of Services
Certain services are integral to a substance-using offender's successful transition to the community. Reassessments should be conducted at various stages throughout the incarceration and community release process. Similarly, offenders also need continued supervision after institution release. Continued supervision also includes on.
This document provides information on interventions that can help health systems achieve cost savings while delivering better quality care. It outlines eight high impact interventions that were identified from a literature review. For each intervention, it provides a summary case study, details of additional case studies, how the intervention impacts quality ambitions, and information on implementation. The eight interventions are: early diagnosis, reducing variability in primary care, self-management programs, telehealth/telecare, case management, rapid assessment of mental health, improving dementia care pathways, and palliative care.
The document describes the vision and key elements of a modern mental health and addiction service system. The system aims to provide prevention, early intervention, treatment, and recovery support services across multiple sectors like healthcare, employment, housing and education. It emphasizes integration with primary care, accountability, accessibility, and use of evidence-based practices. The system strives for improved health outcomes, quality of life, and overall well-being for those suffering from mental health and substance abuse issues.
Implementing comprehensive HIV/STI programmers with Sex Workersclac.cab
The document presents a tool for implementing comprehensive HIV/STI programs for sex workers. It was developed in response to requests for guidance on how to apply the WHO's 2012 recommendations. The tool provides practical examples from global programs on community empowerment, addressing violence, community-led services, condom programming, clinical services, and program management. Its goal is to support public health officials, NGOs, and health workers in planning, delivering, and monitoring effective HIV/STI interventions for sex workers.
This document summarizes a study evaluating the implementation of an integrated care policy called Partners in Recovery (PIR) for people with severe and complex mental illness in Western Sydney, Australia. PIR aims to improve coordination of clinical and other support services for these individuals. The study is prospectively evaluating PIR's impact on individual recovery outcomes, service delivery processes, and system integration over three years. Preliminary findings after the first year will describe any indications of improved system integration found so far and factors facilitating or impeding the integration process. The study setting presents challenges as the target population and their needs were previously unknown, requiring discovery during implementation. However, this practice-based enactment also allows for positive innovation and regional variation in services.
Running Head DISCUSION ON CRIMINAL MATTERS .docxhealdkathaleen
Running Head: DISCUSION ON CRIMINAL MATTERS 1
DISCUSSION ON CRIMINAL MATTERS 2
Use this assignment area to submit a rough draft of your final paper. You will receive feedback for this draft. This is required but ungraded.
· The student will develop a five-page research paper (excluding title page, reference page, and any applicable attachments) that addresses a single component of the corrections subsystem (e.g., jails and prisons, probation/parole/community corrections, OR juvenile corrections).
· From the focused perspective of a subsystem, develop a theme or hypothesis concerning the area (i.e., overcrowding in prisons, the effectiveness of reentry programs, or alternatives to juvenile incarceration, etc. – Note these are just examples – you can develop a topic and subtopic area in corrections that interests you) and form the research around this subtopic.
· The student is expected to use at least 10 scholarly sources for this paper.
· The paper should critically analyze the theoretical and applied nature of the issues and develop evidence-based conclusions on the accuracy and effectiveness or lack of effectiveness of those theories in modern society.
Student’s name:
Professor’s name:
Topic:
Institution:
Date:
Discussion on Criminal Matters
Discussion 1
My chosen topic for the final paper is police misconduct. Cases of police misconduct continue to raise eyebrows, and unfortunately, this has become a major social problem. Police misconduct comes in many forms. It can come in the form of unwarranted arrests, police brutality, racism especially towards a specific group, abuse of their authority, dishonesty, using unjust means to force confessions, and also promising suspects leniency by demanding sexual favors. This societal pattern has been witnessed for such a long time, prompting citizens to wonder whether the legal system truly cares about the actions of the police. Research studies show that police misconduct is a leading cause of wrongful convictions. To be more specific, statistics reveal that close to 50% of wrongful convictions are as a result of police misconduct, as stated by Harris (2014).
Police officers are charged with the responsibility of making the society safe and secure. More often than not, their zeal to see justice being served results to even greater injustice. Thanks to cell phone cameras, citizens have been able to capture and report incidents of police misconduct when observed, raising public awareness on the same. However, for most citizens, reporting an incident of police misconduct is quite challenging, majorly because of the due processes that ought to be followed when filing police misconduct complaints, and the fear of being victimized. Police misconduct has also resulted in serious financial implications for the government. Police agencies have been forced ...
This document summarizes a presentation on case management. It discusses that while there is no universal definition of case management, core components generally involve locating resources, coordinating services, and monitoring care to meet assessed needs. The key requisites of a case manager are experience, strong communication and problem-solving skills, and the ability to coordinate complex care packages. Effective case management provides an organized long-term care framework that aims to improve patient outcomes by streamlining services and reducing emergency admissions.
Management Concerns Of Corrections For Special Populations...Erin Torres
The document discusses the services provided by the Montford Unit, which treats both criminal offenders and general patients with medical or psychiatric issues. The Montford Unit has 550 psychiatric beds, a 48 bed general medical unit, gardens for a food bank, stables, and facilities on 120 acres of land. It provides services like art, music, occupational, and recreational therapy to patients. Reintegration with family and social support are important for individuals' recovery after being treated at a mental health facility like the Montford Unit.
This document provides a summary of effective techniques for engaging young people who offend based on three sources: 1) A review of research highlighting effective engagement techniques; 2) Reviews of effective interventions from other YJB documents; 3) Messages from practice literature. The document covers general findings on effective interventions and the importance of engagement, as well as specific techniques around assessment, addressing individual needs, communication, service delivery, transitions, training, management, and monitoring/evaluation.
Tackling the multiple and complex needs of short sentenced prisonersDominic_Williamson
Dominic Williamson from the Revolving Doors Agency gave a presentation about short sentenced prisoners and how to stop the revolving door of reoffending. He discussed that short sentenced prisoners, who serve less than 12 months, make up the majority of prisoners but receive little rehabilitation support. They have high rates of reoffending due to multiple complex needs including homelessness, substance abuse issues, and mental health problems. Effective interventions involve assertive outreach, building trust, coordinating wraparound services, and promoting self-efficacy, hope, and motivation in the individual. Providing long-term, community-based support that addresses an individual's specific needs and goals can help reduce reoffending rates.
This document summarizes research on the economic benefits of drug treatment. It finds that substance abuse treatment consistently results in positive economic outcomes through reduced health care and criminal justice costs. Specifically:
- Outpatient treatment is generally the most cost-effective approach, achieving reductions in substance use at a lower cost than residential programs. However, residential programs may be more effective for higher-risk populations.
- Enhanced outpatient programs that provide more services are often more cost-effective than standard outpatient programs.
- Prison-based treatment can be cost-effective, but only when combined with post-release aftercare services. Effectiveness is greater for high-risk inmates who receive this continuum of care.
1. Three Collective Management Organizations (CMOs) - MCSK, PRISC and KAMP - claim the right to collect public performance license fees for sound and audiovisual works played at Prime Chic Holdings restaurants.
2. Prime Chic Holdings seeks clarification on which body is mandated to collect fees, as the CMOs each demand separate payments for the same content.
3. The legal opinion analyzes the Copyright Act and determines that MCSK has been approved by the Copyright Board to collect fees for public performance of musical works in restaurants. PRISC and KAMP/PRISK together issue licenses for sound recordings and audiovisual works, but MCSK alone is entitled to collect
1. Vickie Lynn Marshall filed a claim in federal bankruptcy court against E. Pierce Marshall for tortiously interfering with the inheritance she expected from J. Howard Marshall. The bankruptcy court ruled in her favor but the Ninth Circuit reversed, citing the probate exception.
2. The Supreme Court held that the probate exception did not apply because Vickie's claim did not require validating or invalidating a will. It was a recognized tort claim for interfering with an expected inheritance.
3. The Court also found that Vickie had a valid expectation of inheritance from J. Howard Marshall based on his promises, and that Pierce's actions of depleting assets and restricting access tortiously interfered with that expectation.
Do you find yourself unable to agree contract terms because of their complexity?
Are you paralysed by indecision over which elements are important?
Do you find yourself avoiding the pain of paperwork by not signing or reviewing contracts?
Do you want a quick way of sorting out if your construction contract is good to go or may cause problems later in the project?
This checklist is designed for use during the tender stage to determine whether to continue.
The checklist was developed by Sarah Fox, author of the 500-Word Contract for construction projects. If you want to know how to use 4 key elements to evaluate contracts before they are signed then 500 Words Ltd runs a 90-minute introductory workshop to help you spot the disasters waiting to happen.
For information on how we can give you the confidence to use contracts for project success, email sarah@500words.co.uk or visit www.500words.co.uk
This memorandum discusses whether stamping political messages on U.S. currency to raise awareness of corporate personhood and money as free speech would be legal. It analyzes two relevant federal statutes, 18 USC 333 and 18 USC 475, and concludes that while 18 USC 333 prohibits damaging currency to remove it from circulation, stamping political messages would not meet this standard and convictions would be unlikely. It also concludes that 18 USC 475, which prohibits commercial advertising on currency, would not apply to political speech and a content-based restriction would not withstand the highest scrutiny.
The document discusses legal opinions, which are provided in financing transactions to confirm the legal validity of transaction documents for the lender. Legal opinions cover issues like a borrower's legal authority to enter the transaction, the enforceability of transaction documents, and compliance with relevant laws. However, legal opinions have limitations and do not guarantee a borrower's ability to repay a loan or predict future changes in law. The document outlines typical contents of a legal opinion and when they are provided, such as for cross-border transactions or to satisfy loan conditions. Legal opinions address the laws of relevant jurisdictions like a borrower's home country and the governing law jurisdiction. Opinions are usually provided by independent external lawyers, though sometimes by a borrower
This document provides an introduction to different types of technical drawings including orthographic projection views, sectional views, auxiliary views, and isometric drawings. It discusses topics such as dimensioning of radii, holes, countersinks, counterbores, and spot faces. Examples are provided for various types of projection views and isometric drawings. Exercises are included at the end to apply the concepts learned.
Randomized Controlled Trials in Evaluating Socially Complex Interventions: A ...Jean-Paul Grund
Randomized Controlled Trials in Evaluating Socially Complex Interventions: A Square Peg in a Round Hole?
This lecture will discuss a number of challenges and problems in Randomized Controlled Trials (RCTs), in particular in evaluating interventions aimed at (i) altering complex human behaviour, (ii) in marginalized and stigmatized populations; and, (iii) by socially complex interventions. Using examples from the literature and his own research, Dr. Grund will provide a transdisciplinary perspective on the utility of the RCT model in evaluating interventions aimed at, for example, people who use drugs or homeless people, two very complex “Real World” problems in the Czech Republic and elsewhere.
He argues that the arena of services for PUD, the homeless and other marginalised populations is rife with poorly understood contingencies. Consequently, the complexity of the research environment becomes a function of I, ii and iii above, but with enigmatic mathematical operators. Strategies for addressing this complexity through accompanying process evaluation and qualitative research will be discussed.
Published in ―Theory and Practice of Clinical Social Work (2.docxamrit47
Published in ―Theory and Practice of Clinical Social Work (2
nd
Edition), J. Brandell,
Ed., Columbia University Press, 2010.
2200
CLINICAL CASE MANAGEMENT
Joel Kanter
Over the past 30 years, case management has become a ubiquitous intervention
approach throughout the mental health and health care fields. Often poorly defined, case
management, perhaps a linguistic repackaging of ―social work‖ or ―social casework,‖
encompasses a wide range of environmental interventions with persons in need,
including persons suffering from severe mental illness, substance abuse, and chronic
medical conditions such as HIV, tuberculosis, and diabetes. In health care, the term case
management can refer to cost-conscious telephone interventions to monitor medical
services or to discharge planning from an inpatient facility. In mental health, case
management may refer to helping a client obtain disability benefits or apply for housing
assistance. Or it may refer to a friendly paraprofessional visitor who assists with
homemaking and transportation.
Addressing these disparate needs, an array of case management models have
been identified and articulated: brokerage, rehabilitation, strengths based, and clinical.
Other adjectives have been frequently used to characterize less specific case
management interventions: ―intensive,‖ ―assertive,‖ and ―standard.‖ Understanding the
case management literature often requires readers to carefully examine details of the
actual interventions and human resource issues to determine what the term case
management means in each situation.
Were the interventions short-term or long-term?
Were the relationships between case managers and clients personal or
administrative?
Was ―case management‖ the main activity of the worker or one of an array
of interventions?
What were the duration and frequency of case management contacts?
Were the scope of case management interventions focused on clients
holistically or were they narrowly focused on a single illness or life domain?
How large were case managers‘ caseloads?
Did case managers address the interplay between psychological and
environmental concerns?
What was the professional training and experience of the case managers?
In this chapter, the focus will be on a specific case management model—clinical
case management—that addresses the above questions with more clarity than other
approaches. In a clinical case management approach, relationships with clients are
valued, interventions are holistically focused, and case managers recognize the interplay
between psychological and environmental domains. Clinical case management can be
defined as a modality of social work practice that, acknowledging the importance of
biological and psychological factors, addresses the overall function and maintenance of
the person‘s physical and social environment toward the goals of facilitating physical
surv ...
Law enfercement & Alternative Sentence for drug offenders youthrise
The document discusses alternative sentencing approaches for drug offenders as an alternative to incarceration. It describes how drug courts and diversion programs identify nonviolent drug offenders and provide treatment and rehabilitation services instead of prison time. If treatment is successfully completed, criminal charges are dropped. The document also discusses decriminalization and depenalization policies in other countries and how diversion at arrest and sentencing can help reduce prison overcrowding while addressing substance abuse issues.
I. Drug courts that are ran effectively, can curb drug use and d.docxsheronlewthwaite
I. Drug courts that are ran effectively, can curb drug use and distribution with insight and
prevention.
i. “Using retrospective data, researchers in several studies found that drug courts reduced recidivism among program participants in contrast to comparable probationers” (nij.gov, n.d.). Repeat offenders have dropped significantly with the introduction of drug courts.
ii. Explains how percentages of reoffenders has dropped in percentages with statistical data.
II. Funding drug courts comes from grants and many other federal and local sources.
a. “The Drug Court Discretionary Grant Program provides financial and technical assistance to states, state courts, local courts, units of local government, and Indian tribal governments to develop and implement treatment drug courts that effectively integrate substance abuse treatment, mandatory drug testing, sanctions and incentives, and transitional services in a judicially supervised court setting with jurisdiction over nonviolent, substance-abusing offenders” (NCJRS, n.d.).
i. Funding is crucial to the development and sustainability of running effective drug court programs.
III. Monitoring and development to increase effectiveness has reduced reoffenders and costs associated with nonviolent drug cases.
a. “In times of serious budget cuts, the drug court model offers State and local governments a cost‐effective way to increase the percentage of addicted offenders who achieve sustained recovery, thereby improving public safety and reducing costs associated with re‐arrest and additional incarceration” (Drug courts, n.d.).
i. Monetary and manpower issues are reduced drastically once effective drug courts are put into play
Do Drug Courts Work? Findings From Drug Court Research. (n.d.). Retrieved from https://nij.gov/topics/courts/drug-courts/Pages/work.aspx#note1
In the Spotlight: Drug Courts - Grants and Funding | NCJRS. (n.d.). Retrieved from https://www.ncjrs.gov/spotlight/drug_courts/grants.html
Drug Courts. (n.d.). Retrieved from https://obamawhitehouse.archives.gov/ondcp/ondcp-fact-sheets/drug-courts-smart-approach-to-criminal-justice
1
DRUG COURTS
3
DRUG COURTS
Drug Court Effectiveness
Sean Markl
American International University
Drug Court Effectiveness
The main function of a drug court is to prevent and discourage use, selling of, or distributing illegal drugs by offenders. By utilizing drugs courts in ways such as deterrent, prevention, and treatment to curb nonviolent offenders can be a crucial step in rehabilitation for the majority. “Drug courts were designed to put treatment and rehabilitation ahead of punishment” (Emigh,2018). By putting treatment and rehabilitation ahead of prison or jailtime, many offenders are set on a path to recovery that reduces recidivism. Most states have set up these specific courts to deal with nonviolent offenders.” The Carroll County Drug Treatment Court operates in the Circuit Court for Carroll County and has been specifically desi ...
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Continuity of Offender Treatment for Substance Use Disorders from Institution to Community.
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Chapter 2—Case Management and Accountability
Coordinating systems to help the newly released offender can seem overwhelming, due in large part to the burgeoning caseloads carried by public sector agencies. Not only are the criminal justice and substance use disorder treatment systems fragmented and sprawling, but the offender will likely need ancillary services as well (discussed in Chapter 5), which calls for case management. As discussed in Chapter 1, case management can follow an outreach, reach-in, or third-party approach, or some combination of the three. No matter what the model, research shows cost benefits, through reduced recidivism, of cross-system integration for offender transitional services (Inciardi, 1996; Abt Associates, 1995; Swartz et al., 1996).
Case management is the function that links the offender with appropriate resources, tracks progress, reports information to supervisors, and monitors conditions imposed by the supervising agency. These activities take place within the context of an ongoing relationship with the client. The goal of case management is continuity of treatment, which, for the offender in transition, can be defined as the ongoing assessment and identification of needs and the provision of treatment without gaps in services or supervision. Accountability is an important element of a transition plan, and case management includes coordinating the use of sanctions among the criminal justice, substance use disorder treatment, and possibly other systems.
Go to:
Case Management in Transition Planning
Ideally, case management activities should begin in the institution before release and continue without interruption throughout the transition period and into the community. It is recommended that transition planning begin at least 90 days before release from jail or prison. Early initiation of transition planning is important because it establishes a long-term, consistent treatment process from institution to community that increases the likelihood of positive outcomes. The case manager's communication with other transition team members at an early stage supports all aspects of the offender's recovery and rehabilitation (e.g., education, health, vocational training).
Ideal Array of Services
Certain services are integral to a substance-using offender's successful transition to the community. Reassessments should be conducted at various stages throughout the incarceration and community release process. Similarly, offenders also need continued supervision after institution release. Continued supervision also includes on.
This document provides information on interventions that can help health systems achieve cost savings while delivering better quality care. It outlines eight high impact interventions that were identified from a literature review. For each intervention, it provides a summary case study, details of additional case studies, how the intervention impacts quality ambitions, and information on implementation. The eight interventions are: early diagnosis, reducing variability in primary care, self-management programs, telehealth/telecare, case management, rapid assessment of mental health, improving dementia care pathways, and palliative care.
The document describes the vision and key elements of a modern mental health and addiction service system. The system aims to provide prevention, early intervention, treatment, and recovery support services across multiple sectors like healthcare, employment, housing and education. It emphasizes integration with primary care, accountability, accessibility, and use of evidence-based practices. The system strives for improved health outcomes, quality of life, and overall well-being for those suffering from mental health and substance abuse issues.
Implementing comprehensive HIV/STI programmers with Sex Workersclac.cab
The document presents a tool for implementing comprehensive HIV/STI programs for sex workers. It was developed in response to requests for guidance on how to apply the WHO's 2012 recommendations. The tool provides practical examples from global programs on community empowerment, addressing violence, community-led services, condom programming, clinical services, and program management. Its goal is to support public health officials, NGOs, and health workers in planning, delivering, and monitoring effective HIV/STI interventions for sex workers.
This document summarizes a study evaluating the implementation of an integrated care policy called Partners in Recovery (PIR) for people with severe and complex mental illness in Western Sydney, Australia. PIR aims to improve coordination of clinical and other support services for these individuals. The study is prospectively evaluating PIR's impact on individual recovery outcomes, service delivery processes, and system integration over three years. Preliminary findings after the first year will describe any indications of improved system integration found so far and factors facilitating or impeding the integration process. The study setting presents challenges as the target population and their needs were previously unknown, requiring discovery during implementation. However, this practice-based enactment also allows for positive innovation and regional variation in services.
Running Head DISCUSION ON CRIMINAL MATTERS .docxhealdkathaleen
Running Head: DISCUSION ON CRIMINAL MATTERS 1
DISCUSSION ON CRIMINAL MATTERS 2
Use this assignment area to submit a rough draft of your final paper. You will receive feedback for this draft. This is required but ungraded.
· The student will develop a five-page research paper (excluding title page, reference page, and any applicable attachments) that addresses a single component of the corrections subsystem (e.g., jails and prisons, probation/parole/community corrections, OR juvenile corrections).
· From the focused perspective of a subsystem, develop a theme or hypothesis concerning the area (i.e., overcrowding in prisons, the effectiveness of reentry programs, or alternatives to juvenile incarceration, etc. – Note these are just examples – you can develop a topic and subtopic area in corrections that interests you) and form the research around this subtopic.
· The student is expected to use at least 10 scholarly sources for this paper.
· The paper should critically analyze the theoretical and applied nature of the issues and develop evidence-based conclusions on the accuracy and effectiveness or lack of effectiveness of those theories in modern society.
Student’s name:
Professor’s name:
Topic:
Institution:
Date:
Discussion on Criminal Matters
Discussion 1
My chosen topic for the final paper is police misconduct. Cases of police misconduct continue to raise eyebrows, and unfortunately, this has become a major social problem. Police misconduct comes in many forms. It can come in the form of unwarranted arrests, police brutality, racism especially towards a specific group, abuse of their authority, dishonesty, using unjust means to force confessions, and also promising suspects leniency by demanding sexual favors. This societal pattern has been witnessed for such a long time, prompting citizens to wonder whether the legal system truly cares about the actions of the police. Research studies show that police misconduct is a leading cause of wrongful convictions. To be more specific, statistics reveal that close to 50% of wrongful convictions are as a result of police misconduct, as stated by Harris (2014).
Police officers are charged with the responsibility of making the society safe and secure. More often than not, their zeal to see justice being served results to even greater injustice. Thanks to cell phone cameras, citizens have been able to capture and report incidents of police misconduct when observed, raising public awareness on the same. However, for most citizens, reporting an incident of police misconduct is quite challenging, majorly because of the due processes that ought to be followed when filing police misconduct complaints, and the fear of being victimized. Police misconduct has also resulted in serious financial implications for the government. Police agencies have been forced ...
This document summarizes a presentation on case management. It discusses that while there is no universal definition of case management, core components generally involve locating resources, coordinating services, and monitoring care to meet assessed needs. The key requisites of a case manager are experience, strong communication and problem-solving skills, and the ability to coordinate complex care packages. Effective case management provides an organized long-term care framework that aims to improve patient outcomes by streamlining services and reducing emergency admissions.
Management Concerns Of Corrections For Special Populations...Erin Torres
The document discusses the services provided by the Montford Unit, which treats both criminal offenders and general patients with medical or psychiatric issues. The Montford Unit has 550 psychiatric beds, a 48 bed general medical unit, gardens for a food bank, stables, and facilities on 120 acres of land. It provides services like art, music, occupational, and recreational therapy to patients. Reintegration with family and social support are important for individuals' recovery after being treated at a mental health facility like the Montford Unit.
This document provides a summary of effective techniques for engaging young people who offend based on three sources: 1) A review of research highlighting effective engagement techniques; 2) Reviews of effective interventions from other YJB documents; 3) Messages from practice literature. The document covers general findings on effective interventions and the importance of engagement, as well as specific techniques around assessment, addressing individual needs, communication, service delivery, transitions, training, management, and monitoring/evaluation.
Tackling the multiple and complex needs of short sentenced prisonersDominic_Williamson
Dominic Williamson from the Revolving Doors Agency gave a presentation about short sentenced prisoners and how to stop the revolving door of reoffending. He discussed that short sentenced prisoners, who serve less than 12 months, make up the majority of prisoners but receive little rehabilitation support. They have high rates of reoffending due to multiple complex needs including homelessness, substance abuse issues, and mental health problems. Effective interventions involve assertive outreach, building trust, coordinating wraparound services, and promoting self-efficacy, hope, and motivation in the individual. Providing long-term, community-based support that addresses an individual's specific needs and goals can help reduce reoffending rates.
This document summarizes research on the economic benefits of drug treatment. It finds that substance abuse treatment consistently results in positive economic outcomes through reduced health care and criminal justice costs. Specifically:
- Outpatient treatment is generally the most cost-effective approach, achieving reductions in substance use at a lower cost than residential programs. However, residential programs may be more effective for higher-risk populations.
- Enhanced outpatient programs that provide more services are often more cost-effective than standard outpatient programs.
- Prison-based treatment can be cost-effective, but only when combined with post-release aftercare services. Effectiveness is greater for high-risk inmates who receive this continuum of care.
Programs for public health practitioners in the field, due to the profession is so dispersed in its work—from employment in private managed care organizations and clinics. The main purpose of this study is to analysis the relationship between law and ethics with public healthcare performance. The present study used a quantitative research design, specifically the descriptive survey design. This is because such design accurately and objectively describes the characteristics of a situation or phenomenon being investigated in a given study. It provides a description of the variables in a particular situation and, sometimes, the relationship among these variables rather than focusing on the cause-and effect relationships. Thus, this study used a questionnaire which was developed from previous research in order to measure the relationships among the investigated variables. This study was carried out in different healthcare centers located in Erbil, the total of 81 participants participated in this study. The researcher developed research hypothesis as follow; there is a positive and significant relationship between law and healthcare performance in Erbil. The finding of this study showed that the value of beta for law and ethics factor is .749 with the P-value .000 this means that the law and ethics will have positive and significant influence on healthcare performance; accordingly the main research hypothesis is supported.
This study investigated factors influencing older adults' intention to use mobile medical apps in the Netherlands. Data was collected through questionnaires administered both digitally and on paper to over 1000 community-dwelling older adults aged 65 and over. Logistic regression analysis identified several significant factors: a positive attitude towards use, perceived usefulness, perceived ease of use, availability of support services, sense of control, self-perceived effectiveness, access to technology, personal innovativeness, social relationships, subjective norms, and lower anxiety levels increased intention to use apps, whereas cost did not. The study provides insight into important factors for developing policies to advance older adults' adoption of medical apps.
This document summarizes a research study that used the Intervention Mapping framework to develop a guiding framework for improving patient discharge from hospitals to primary care. The study conducted interviews and focus groups with patients, families, and providers to identify barriers to effective discharge. Key issues included lack of communication between hospital and primary care providers, incomplete discharge information, and lack of patient understanding. The study then defined desired outcomes, specific performance objectives, and change objectives needed to address the identified barriers. Finally, the study selected evidence-based methods and strategies to achieve the change objectives, such as discharge templates, medication reconciliation, and teach-back techniques. The resulting framework provides guidance for interventions to improve patient handovers between hospital and primary care.
This document discusses assessing and improving the quality of mental health services. It proposes an eight-dimensional model for evaluating mental health services quality, including dimensions like accessibility, acceptability, effectiveness, and safety. Each dimension contains indicators that are defined and have targets outlined. The purpose is to provide a standardized way to measure quality across mental health systems and identify areas for improvement.
This research article examines the ethical dilemmas faced by palliative care physicians through surveys and interviews with 30 palliative care specialists in Mexico.
The study identified 113 common dilemmas, most frequently regarding sedation, home administration of opioids, and institutional regulations. It was observed that truth-telling and bidirectional trust between patients and providers are core to palliative medicine ethics. The most prominent virtues among participants were justice and professional humility. Physicians in palliative care see themselves most importantly as educators and advisers who provide medical assistance.
The research aims to better understand the values that guide decision-making in palliative care in order to improve care for patients at the end of life. It finds rediscovering virtues in clinical practice can
1. Between Dream and Reality:
Implementation of case management among
drug abusers in the treatment and
criminal justice system
Summary
Kim Geenens
Wouter Vanderplasschen
Eric Broekaert
Brice De Ruyver
Sébastien Alexandre
Commissioned by:
Belgian Federal Science Policy Office
2. Summary
2
1. PROBLEM DEFINITION
Drug dependence is a complex phenomenon, closely related to various other problems, including
unemployment, criminal behavior, contacts with police authorities and the criminal justice system,
psychological and physical complaints, social exclusion, relational problems, homelessness, etc. [1].
Motivation for treatment and change is described as a long-term and cyclical process [2]. Drop-out
during and (re)lapse after treatment are nowadays considered as common among drug dependent
individuals [3,4]. Consequently, many drug abusers have long treatment careers. Some of them can
even be called “drug treatment tourists” [5,6].
1.1. Origins of case management
Case management is a promising approach that was developed to provide a comprehensive and
ongoing response to clients’ needs [7]. Building on the substantial history of this intervention with
other at-risk populations (e.g., severely mentally ill persons, disabled persons, elderly, and multi-
problem families), several programs for substance abusers in the United States began to integrate case
management services from the 1990s onwards, as an effective and cost-efficient method of delivering
coordinated care. The origins of case management go back to the 1920s, when Mary Richmond
applied the term “social casework” to activities that affected the adjustment between individuals and
their social environment [8]. Social casework was characterized by the coordination of human
services, conservation of public funds, care for poor and sick people, belief in the worth and dignity of
clients and the empowerment of vulnerable populations [9]. This social work intervention focused on
poor and disadvantaged people who were struggling with basic survival needs and its activities were
similar to the key functions of what we now call case management. Some authors [7,9] even situate
the roots of case management in the nineteenth century (1863), since the early history of human
services included settlement houses and charity organization societies, which were involved in case
coordination and can thus be regarded as an early conceptualization of case management.
The boom of case management was associated with the deinstitutionalization of psychiatric care,
which led to the expansion of community-based services [10]. The categorical nature of eligibility for
services and the fragmentation of service delivery hampered the effective utilization of such services
and necessitated the introduction of so-called “case managers”. Since the 1970s, a wealth of literature
has been published concerning the implementation, practice and evaluation of case management
among mentally ill persons [11]. A recent meta-analysis of evaluation studies have generally
demonstrated positive outcomes such as reduced hospitalization rates, increased use of outpatient and
community services, improved quality of life, and high client satisfaction [12].
1.2. Application of case management among drug abusers
Case management has a long tradition for the treatment of substance abusers in the United States and
Canada. As early as the beginning of the 1970s, case management has been introduced within the
framework of the TASC-program (Treatment Alternatives to Street Crime) as a strategy to link the
criminal justice and health care system and to co-ordinate care for substance abusers with judicial
problems [13]. Since the beginning of the 1990s, case management became a widespread intervention
as a reaction to the limitations of existing services and in order to help drug abusers with multiple and
chronic problems [14,15]. Cost-containment was another important incentive for implementing case
management [16].
From that point onwards, hundreds of projects have been implemented – both within the criminal
justice and substance abuse treatment system – , aiming at:
- enhancing treatment access, participation and retention [10];
- improving treatment results concerning alcohol- and drug use, employment, psychological
problems and criminality [17];
- promoting coordination and continuity of care[18].
3. Summary
3
Case management has only recently been implemented in Europe, namely in the Netherlands [19,20],
Germany [21,22] and Belgium [23,24]. Guiding drug abusers through the complex network of services
is the goal of this intervention [25]. Also other European countries have introduced case management,
but the implementation of this intervention in the criminal justice system is relatively scarce, except
for a limited number of projects in the Netherlands and the United Kingdom.
It can be considered as an alternative intervention for providing more individualized care to extremely
problematic drug users (“case management in substance abuse treatment”) and for improving co-
operation between the criminal justice and substance abuse treatment-system (“case management in
the criminal justice system”) [26].
2. AIMS OF THE STUDY
This study can be situated within the international tendency towards more individualized care,
networking and continuity of care in substance abuse treatment o. Some authors [27] argue that the
demand for case management will only increase, due to the growing complexity of problems and
systems of care. Research concerning case management for substance abusers is very limited,
especially in Europe. Yet, it is essential to adapt this originally American intervention to the needs of
Western European treatment and criminal justice systems. Moreover, the practice of case management
seems to vary from place to place and few information is available about the crucial features of
effective case management [8].
Case management is a type of outpatient, intensive and individualized care, provided by one caregiver
(or a team) during a well-defined period, intended to guarantee the continuity of care and coordination
of services for a limited number of persons [28,29]. The case manager is the coordinator of the
treatment process and the client’s advocate [30]. Case management cannot always be clearly
distinguished from other interventions in the field of substance abuse treatment [14]. Siegal and
colleagues state that traditional substance abuse services are usually directed at motivation, control,
rehabilitation and relapse prevention, while case management is intended to support and facilitate the
realization of these objectives [8].
It has been defined as “that part of substance abuse treatment that provides ongoing supportive care to
clients and facilitates linking of clients with appropriate helping resources in the community” [14].
However, no consensus exists about its definition [8]. While some agreement can be found about case
managers’ basic functions and the core principles of this intervention, many issues concerning the
implementation and evaluation of case management remain unanswered: What are the motives and
objectives of this intervention? Should it be directed at some specific target groups? How can case
management be integrated in existing services or in the network of agencies? How long should this
intervention be continued? Who should do this? What are the effects of this intervention on clients’
functioning and can it affect the system of services?
In this research report we seek for responses to these and other questions.
The objective of this study was to conceptualize the terms “case management” and “case manager”,
since ambiguity exists concerning these terms both in the literature and among practitioners [31]. For
this conceptualization, we looked at differences between case managers appointed by the criminal
justice and the treatment system, respectively.
On the other hand, we studied how case management can be best implemented both in the criminal
justice and substance abuse treatment system, taking into account regional differences (Flanders,
Brussels and the Walloon provinces in Belgium) and existing practices. We tried to identify the
premises for the implementation of this intervention in both systems, followed by some clear
guidelines for bringing case management into practice.
The research focused on case management for persons of age (>18 years), who are dependent on or
abuse illicit drugs (often in combination with the use of other licit drugs) and who are followed by a
case manager from the criminal justice or (substance abuse) treatment system.
4. Summary
4
3. METHODS
We distinguish four different parts in this research: the literature study, the inventory of foreign
examples of “good practice”, the empirical research concerning the feasibility of the implementation
of case management, and the analysis and report of the data.
3.1.Literature study
- Definition of case management and profile of the case manager
For the conceptualization of case management, the literature concerning the practice of this
intervention (definition, characteristics, basic functions, models, legal framework, …) will be
compared based on the theoretical frameworks of Moxley [29], Van Riet & Wouters [30] and Siegal
[8]. This resulted in an operational definition of case management and a profile of a case manager,
taking into account the differences between case managers operating within the criminal justice and
substance abuse treatment system.
- Legal issues concerning case management
National and international examples of "good practice" and the legal framework of foreign case
management projects will be studied. A practical model will be developed for the exchange of
information, including legal guarantees for all parties involved.
- Evaluation of case management
The literature concerning the evaluation of case management for substance abusers will be used to
study the effectiveness of this intervention. Available literature concerning the evaluation of case
management will be compared, looking for contextual factors, objectives and specific target-groups,
specific models of case management, various outcome-variables, etc..
- Implementation of case management
This part of the study aims at formulating recommendations for the implementation of case
management in the criminal justice and substance abuse treatment system, taking into account present-
day practices in both fields.
Based on the available literature and empirical findings, we want to answer following questions:
- What are the motives for implementing case management and which are the specific objectives
and target-group of this intervention?
- Which is the place of case management within the substance abuse treatment and criminal justice
system, respectively? How can this intervention be integrated in the existing network of services
in both fields?
- Which model of case management should be chosen? Which are prerequisites for implementing
this specific model?
- Which are requirements of a good case manager in the criminal justice and substance abuse
treatment system, respectively?
- How will the project be financed and how can the continuity of this intervention be guaranteed?
- How can case management best be evaluated, taking into account scientific standards and
expectations from practitioners, policy makers and researchers?
5. Summary
5
3.2.Inventory of examples of “good practice”
As only limited information is available in the literature concerning recently initiated or terminated
projects, existing case management projects will be studied through contacting key-informants in
various foreign countries.
- Development of a short survey concerning the conceptualization (and implementation) of case
management-projects abroad
We will look at, among others, systematic treatment planning, pro-active outreaching, client-
centeredness, a strengths-based approach, the role of coercion, …
- Mailing of this questionnaire to case management-projects in the United States (n=10), the
Netherlands (n=5) and Germany (n=5)
- The practice of at least 3 of these projects will be further elaborated during on-site study visits
3.3. Study concerning the feasibility of case management in the criminal justice and substance
abuse treatment system, based on a Delphi study
- Written inquiry of care coordinators and coordinators of so-called "houses of justice"
For the survey among care coordinators and coordinators of the "houses of justice" a short
questionnaire will be used, including a description of the administrative information, aims, target
populations and practice of already existing case management projects.
- Semi-structured interviews with key-informants of case management-projects
After this inventory, the researchers will take contact with the identified projects, in order to have a
semi-structured interview with a key-informant in each project. An interview scheme will be used,
including both the conceptualization and the implementation of this intervention. If possible, annual
reports and reports about the activities of these projects will be collected.
- Focus groups to test the feasibility and generalization of the findings resulting from the
literature review and structured interviews
Based on the preliminary results of the literature review and structured interviews, a number of theses
will be formulated concerning the implementation of case management within the treatment and
criminal justice system. These theses will be presented during two parallel focus groups in 3
metropolitan areas (Antwerp, Charleroi, and Ghent). The results of these focus groups will be used to
further adapt the presented theses, which will be further discussed, this time in mixed focus groups
with key-informants from both the treatment and criminal justice system and some policy-makers. In
this way, we want to test if our findings can be generalized to the rest of the district and if there are
any differences between the selected districts. In order to have a balanced representation from the
treatment and criminal justice system, key-informants invited to the focus groups will be selected at
random from the different judicial and treatment services in the district. During these focus groups, the
collaboration between case managers from the criminal justice and the treatment system will be
highlighted.
3.4. Data-analysis and report
For the content-analysis of the structured interviews and focus groups, the software package WinMAX
98 Pro [32] will be used. These results will be compared with the findings from earlier research in
6. Summary
6
East-Flanders (region around Gent) concerning the feasibility of the implementation of case
management [33,34].
The first part of the research report will focus on the conceptualization of case management,
developing a definition and describing the characteristics of this intervention and the profile of both
types of case managers. Moreover, the legal embedment of the intervention, including ways of dealing
with the professional secrecy and clients’ privacy and possibilities for co-operation and
communication between both types of case managers, are described. The second part will focus on the
implementation of this intervention, including the question how this intervention can best be
implemented in the present-day criminal justice and substance abuse treatment system. Finally, a
manual will be developed for the implementation and practice of case management.
4. MAIN FINDINGS
4.1. Implementation of case management in Belgium and related policy issues
Since 5 years case management has been implemented for substance abusers in the Dutch-speaking
area of Belgium, mainly to meet these persons’ multiple and complex problems and to counter the lack
of co-operation and coordination in the field of substance abuse treatment [24].
The importance of individualized and continuous care and of cooperation between the criminal justice
and treatment system has been stressed in two recent policy notes [26,35]. The establishment of an
integrated treatment system for substance abusers and the implementation of case management were
identified as two main action points for optimizing the substance abuse treatment system.
Consequently, the concepts of “case manager public health” and “case manager justice” were
introduced into the field of substance abuse treatment and the criminal justice system, respectively.
This illustrates the desirability and political willingness (“dream”) to implement this intervention at a
larger scale in Belgium.
The “case managers public health” were implemented at the end of 2002 within the pilot projects for
the establishment of crisis units for persons with substance-related disorders [36]. Substance abusers
often address emergency or psychiatric wards of general hospitals, but these centers do not often have
sufficient resources to deal with this population. These pilot projects intend to improve crisis
intervention within these psychiatric wards, to provide the means for adequate assistance and
treatment of substance abusers, and to implement the function of case manager [37].
The judicial case managers should – according to the policy note on “drugs” – bridge the gap between
the criminal justice and treatment system, inform the police and the prosecuting authorities about
treatment possibilities for drug offenders, and advise them about the desirability of coercion [26]. Up
to now, no judicial case managers have been appointed. Moreover, for many practitioners the
definition of “case manager justice” as defined in the policy note of 2001 is still unclear, in particular
their role towards clients. Also many questions rose concerning its compatibility with existing services
and structures. Given the specific features of “case management”, it can be questioned whether the
description of case management in this policy document meets the criteria of a case manager as
outlined in the literature.
The application of case management (“reality”) is limited to some projects in the substance abuse
treatment system and this intervention has not yet been implemented as such in the criminal justice
system.
7. Summary
7
4.2. Differences concerning the implementation of case management between the Dutch- and
French-speaking region in Belgium
During our study, we identified 17 case management projects in the field of substance abuse treatment.
Based on their implementation in the network of services, four clusters could be distinguished: pilot
projects for the establishment of crisis units for substance abusers (n=9); case management in
psychiatric hospitals (n=4); independent case management projects (n=2) and projects attached to
centers for medical and social assistance (n=2).
Since case managers in crisis units do not apply systematically tasks like coordination, advocacy and
outreaching, most of these practices resemble a brokerage or generalist model of case management. In
the other projects, practices are related to more specialized models of case management, i.c. intensive
case management and assertive community treatment.
The projects we studied, differed substantially from each other concerning organizational aspects and
the performance of the basic case management functions. We also identified great differences within
the pilot projects for the establishment of crisis units. Both observations illustrate the heterogeneity
and flexibility of this intervention. For, case management consists of a continuum of different models
and this intervention can be started at several points in the treatment process (e.g. at intake or after
dismissal from a detoxification or treatment center, following custody, …). If these different features
and organizational aspects are not clearly communicated, confusion may arise about what this
intervention entails.
Four of the identified projects (pilot projects for the establishment of crisis units for persons with
substance-related disorders) are situated in the French-speaking area of Belgium, but besides these
projects no other case management initiatives exist in this region. It is thus fair to say that the
implementation of case management is still in its infancy in the French-speaking region. The
feasibility study showed that care givers stick to their therapeutic freedom and are rather reluctant
towards case management, as this is regarded as an intrusive intervention.
Consequently, case management was implemented less smoothly in the French-speaking area of
Belgium. The case managers in the crisis units had to prove the additional value of this intervention by
adding something extra to the existing services. Other treatment services were very reluctant, which
was mainly due to a lack of knowledge about and experience with this intervention. Similar reactions
have been observed during the initial implementation of case management in East-Flanders [33,34].
Moreover, the difference between care-coordination and case management is not clear for all
practitioners.
Many French-speaking caregivers feel they have to obey and follow a political decision about the
implementation of an intervention, which does – according to at least some of them – not meet the
reality and needs of the Walloon substance abuse treatment system.
The feasibility study further showed a clear discrepancy between the insights and standpoints of
subjects with experience with case management and persons who were far less accustomed to this
method. Persons without experience with this intervention were usually much more positive about it,
as compared with their counterparts who had far less experience with it. This observation also explains
the great differences between the Dutch- and French speaking region.
Although case management is regarded as a desirable and feasible intervention in the Dutch-speaking
area of Belgium, French-speaking care givers state there is no need for this intervention. Still, its
additional value is recognized in the pilot projects in the crisis units in the latter region.
8. Summary
8
4.3. Effectiveness of case management for substance abusers
Any conclusion about the effectiveness of case management for substance abusers is at this moment
premature and even unwarranted, given the relative scarcity of randomized and controlled trials,
especially concerning some specific models of case management [38]. Still, most studies have
reported positive effects of this intervention, particularly concerning clients’ functioning, service
utilization, participation and retention in treatment, quality of life, satisfaction with services provided
and cost-effectiveness. The long-term outcomes of case management are still unclear, although
longitudinal studies have demonstrated significant effects.
Several studies of case management among drug abusers involved in the criminal justice system have
shown that coercion may help to enhance treatment participation and retention, which is associated
with positive effects on clients’ drug use and criminal involvement. Empirical evidence concerning the
effectiveness of judicial case management is still lacking, but available data do not show compelling
evidence of its effectiveness. Positive effects of this intervention are reduced drug use and relapse
rates, increased treatment participation and retention and less violation of judicial conditions.
However, uncertainty remains about the differential effect of coercion in case management.
Both in the field of substance abuse treatment and in the criminal justice system, the value of case
management for substance abusers has been proven, but due to a lack of sufficient number of
randomized and controlled studies this intervention can – at this moment – not be considered as an
evidence-based practice. On-site visits of some foreign examples of “good practice” have shown that
especially strengths-based case management and its combination with motivational interviewing are
promising approaches.
4.4. Training and supervision of case managers
Semi-structured interviews with case managers have clearly shown that only the case workers in
psychiatric hospitals and those who have got a formal training start from a clear vision and theoretical
framework. Lack of training contributes to confusion of ideas about case management and the
heterogeneity of this intervention. The case managers in the pilot projects for the establishment of
crisis units for substance abusers were asked to provide case management without any formal training
or supervision. Consequently, nine diverse projects can be observed, since all case managers looked
themselves for the most adequate application of this intervention in the hospital concerned.
The practice in other case management-projects (for example, Bubbels & Babbels, Middelenmisbruik
Oost-Vlaanderen, Gezondheidsbevordering Injecterende druggebruikers) reveals a step-wise
implementation of this intervention. If accompanied by specific training, education and supervision of
case managers, case managers’ role towards other services is much clearer and this further contributes
to a more homogeneous approach.
Case managers who did not get any formal training consider this as an important shortcoming. Some
of them try to meet this gap by reading books and scientific articles and by attending conferences. It
was remarked that a low threshold approach, requires more training. In addition, applying a flexible
and pragmatic approach like case management requires several skills. All case managers recognize the
absolute need for initial training and consecutive supervision of case managers.
Training and supervision of case managers is a prerequisite for any case management project. Step-
wise and gradual implementation of this intervention can help to let case managers adjust to their new
job and function.
9. Summary
9
4.5. Prerequisites for the implementation of case management
The survey among case managers and key-informants of case management projects showed some
structural barriers that may debilitate efficient implementation of this intervention.
1. Case managers working in crisis units of general hospitals state that the period patients can
stay at the ward (max. 5 days) is too short. During this short period, it is often unrealistic to
refer clients effectively and to guarantee continuous care, especially since clients are admitted
during a crisis situation and it usually takes at least a few days before they are sufficiently
stabilized. Moreover, if it is not possible to provide post-primary treatment, there should be a
possibility for patients to stay longer at the crisis unit.
2. The general practitioner should have a central role when establishing an informal helping
network for the client. However, it appears to be very difficult too involve general
practitioners, since they are not reimbursed for participation in client consultation or
coordination meetings.
3. Existing case management projects have a limited capacity. Consequently, clients who might
benefit from this intervention, may not receive this kind of help. This is regarded as
discriminating by most respondents, since not all clients have equal access to this intervention.
4. The success of case management largely depends on its integration in a comprehensive
network of services [18,19,39]. If not, this intervention risks being just one more of the
fragmented pieces of the system of services.
5. The majority of the case management projects in substance abuse treatment are subsidized by
the federal government. In most cases, the continuity of these projects is insecure, since most
projects are prolonged annually, which hinders long-term planning. At this moment, only case
management in psychiatric hospitals is subsidized structurally by the health care system.
6. For most case managers it remains unclear when, if ever, to stop case management. The
feasibility study showed that it is important to determine – together with the client – short and
long-term goals, to plan regular evaluation moments and to foresee the possibility – for both
case manager and client – to stop case management. Still, case managers ask for clear
guidelines in order to determine when to stop this intervention.
Several structural barriers need to be tackled in order to further implement case management. If not,
this intervention will fail to realize the postulated goals and will only contribute to the fragmentation
in the treatment system.
4.6. Judicial case management and the assistance of offenders by judicial assistants
In Belgium, case management is not (yet) part of the wide range of judicial conditions in case of drug-
related offences. According to the respondents, drug abusers are individually assisted and monitored
by judicial assistants. This assistance of offenders within the framework of different judicial
regulations is similar to what is called “case management” in the literature.
As compared with the tasks of case managers in the substance abuse treatment system, the tasks of the
judicial assistants vary significantly less. The latter are obliged to follow some legally imposed tasks,
which makes differentiation almost impossible. In case of differentiated tasks, this is usually due to
smaller caseloads. Consequently, judicial assistants have more time to work intensively with their
clients.
10. Summary
10
Given the fact that judicial assistants do not apply systematically some essential case management
functions like linking, coordination, advocacy and outreaching and that they focus on some specific
life domains (drugs, police and justice), the tasks of judicial assistants do not fully meet the criteria of
case management as outlined in the literature. The method applied by judicial assistants for assisting
and monitoring drug abusers seems to be satisfactory, but in some judicial districts the judicial
assistants have a (too) high caseload.
We also observed a clear discrepancy between the reactions of respondents with some experience with
case management and between those who were not accustomed to this intervention. The latter group is
generally rather reluctant about this intervention. Moreover, these respondents do not make a
distinction between “judicial” and “health care” case management [26].
Despite the political intentions expressed in the drug note of 2001, judicial case management is not yet
implemented and its implementation is not deemed necessary, since several of the basic functions of
case managers are already taken up by the judicial assistants when monitoring (drug) offenders.
4.7. Need for an advisory and referring agency at the level of the prosecuting authorities
The prosecuting and investigating authorities state that they need a body that can inform them about
the possibilities for referral of drug offenders. Besides the police, the prosecutor and investigating
judge are the first who have contact with drug offenders. They ask for a permanence system, staffed at
night and during the weekend, which they can contact for advice concerning referral and the
desirability of coercive measures.
The proposed function actually meets the description of the “case manager justice”, as conceptualized
in the federal policy note on drugs of 2001. However, this function is situated at a policy level, since it
concerns an advisory and supporting agency. It can be questioned if such an agency can be regarded as
“case management”.
Concerning the tasks of the judicial case managers, it was suggested to extend the tasks of the judicial
assistants, as foreseen in the federal policy note on drugs (2001). This extension should be
accompanied by additional means for operating and staffing these services.
It can be concluded that there is a need for a advisory and referring agency that can be situated at the
crossroads of the criminal justice and treatment system, in order to arrange a rapid and accurate
referral to the treatment system.
4.8. Intensive assistance of public inebriates and repeated offenders
For some drug offenders referral to drug treatment within the framework of coercive judicial measures
and standard assistance and follow-up by judicial assistants seems to be insufficient to prevent relapse
and recidivism. Studies concerning the effectiveness of judicial case management abroad have shown
that this intervention can help to reduce significantly recidivism and the number of violations of
judicial conditions among problem drug users. Moreover, this intervention allowed to enhance
treatment participation and retention. Examples of good practice include the GAVO-project
(Geïntegreerde Aanpak Verslavingsproblematiek en Overlast) in Utrecht, the Netherlands, and some
TASC-programs (Treatment Accountability for Safer Communities) in the United States, in which
relapsing drug offenders are followed by a case manager to guarantee coordination and continuity of
care and thus to reduce recidivism.
According to several judicial actors, it is not desirable to implement a separate and additional kind of
judicial case management for drug offenders. On the other hand, it should be considered if it is not
worthwhile to integrate case management into some of the existing judicial modalities. For example,
11. Summary
11
an experiment could be started in which judicial assistants have sufficient means and resources to
apply case management among public inebriates and repeated offenders. The assistance of offenders
by judicia l assistants is similar to the basic functions of case management, but can only be called case
management if all these functions (assessment, planning, linking, coordination, advocacy, monitoring)
are applied systematically and comprehensively. In practice, this could be operationalized as follows:
in each of the houses of justice some judicial assistants could be appointed as case manager and
provide intensive assistance and monitoring to a limited number of clients. As outlined before,
efficient implementation of this intervention will depend, among others, on good training and
supervision of the case managers, formal agreements with all parties involved, a limited caseload (10
to 15 clients) and a clear-cut target population.
As the assistance of offenders by judicial assistants is evaluated positively, it can be questioned if this
intervention cannot be optimized for some target populations that fall between the cracks of the
existing system by implementing intensive case management.
4.9. Cooperation and exchange of information between the treatment and judicial system
It can be questioned if the increasing cooperation and accompanying exchange of information between
treatment services and with the judicial sector meets the prerequisites of the professional secrecy.
Treatment providers often experience difficulties between adhering to the professional secrecy and the
establishment of a confidential relation with the client on the one hand, and the exchange of
information in the interest of the client and of the good cooperation with judicial authorities on the
other hand.
Given the fact that many case management clients are drug offenders, the case manager is an
important agent when communicating information between both systems. If case management will be
structurally implemented in the near future, case managers will become the central contact for all
parties involved, including the judicial authorities.
The communication of sensitive person-related information requires a formal description of the
procedure that should be followed (who communicates what kind of information, in which way, at
what time, ...), in accordance with the legislation concerning the professional secrecy, privacy
regulations and the law on patients’ rights.
Our study has shown that:
1. the legislation, jurisdiction and jurisprudence concerning the professional secrecy is extremely
complex and not unambiguous. Consequently, care givers do not see the wood for the trees. A
lack of regulation was observed for the exchange of information between the treatment and
judicial system. Only the legislation concerning the conditional release and the internment
provide clear regulations for the exchange and report of information;
2. there is also a lot of ambiguity concerning the so-called “shared professional secrecy”. This
notion is used to enable communication between care givers and treatment providers with
different professional backgrounds and from different agencies. Although this “shared
professional secrecy” is not formally accepted by all professionals, it is widely used among
practitioners;
3. judicial assistants do not have the same professional secrecy as external care givers and
treatment providers. Consequently, care givers and judicial assistants do not have a shared
professional secrecy. This has far-reaching consequences for the exchange of information
between the treatment and criminal justice system;
12. Summary
12
4. jurisdiction and jurisprudence illustrate that it has become increasingly accepted that clients or
patients can give permission to the keeper of the secret to reveal or communicate confidential
information (the so-called informed consent of the client).
To improve cooperation between the criminal justice and treatment system, more communication is
needed both at the client level and at a more structural level. On the one hand, we refer to the
exchange of information when an offender is referred by the criminal justice system to the treatment
system, and on the other hand to the lack of information both systems have about each others’ methods
and identity. They are thus asking for a clearly defined protocol and procedure for this exchange of
information, in accordance with the professional secrecy.
During the interviews, following suggestions were made for improving the cooperation between both
systems:
- the organization of meetings or regular consultations between judicial assistants and care givers,
during which information is provided about each others’ working methods;
- agreements concerning cooperation can be formalized in a protocol for cooperation. In this
context, it was often referred to the protocol for cooperation concerning the treatment of sexual
delinquents in which is outlined who should exchange what kind of information, at what time and
to whom;
- a three-cornered discussion, including the client, care giver, and the judicial authority involved,
can prevent some of the problems concerning the exchange of information.
Results of the focus groups show that judicial authorities rather believe in guidelines and regulations
imposed by the federal government (“top down” approach), while representatives of the treatment
system are rather in favor of formal agreements and protocols on a local level (“bottom up” approach),
which can eventually be extended to other regions.
The cooperation and communication between the criminal justice and treatment system is still
problematic and the present-day legislation needs to be further adapted in order to resolve some of the
existing obscurities and problems.
4.10. Coordination and continuity of care among drug offenders
The feasibility study concerning the implementation of case management has shown some important
bottlenecks that may hamper the coordination and continuity of care among drug offenders.
1. Drug offenders often experience difficulties in following the imposed conditions, due to the
fact that the judicial conditions are often not feasible for them. For example, drug offenders
are inflicted not to have contact with other drug users, although their social networks’ often
consist almost exclusively of drug users. Also coerced detoxification and abstinence is not an
evident objective, especially not for chronic addicts. Moreover, the duration of most of the
conditions imposed, is limited. Consequently, it is necessary to recognize addiction – as in
several recent scientific publications – as a chronic relapsing disorder characterized by periods
of controlled and excessive use, including the possibility of recovery [38,40].
2. Also various judicial measures need to be attuned and coordinated in order to improve
continuity of care among incarcerated drug offenders. Particularly, probation conditions need
to be attuned with the measures that were previously imposed within the status of a
conditional release, and vice versa. The conditions imposed within the framework of a
conditional release can than be regarded as a s kind of orientation for determining which
direction clients should go afterwards.
13. Summary
13
3. Incarcerated drug users are usually assisted by the psycho-social services of the prison. It was
reported several times that the offender was released without any communication with this
psycho-social service, nor with the care giver or case manager involved, which hampers the
continuity of the assistance and monitoring.
5. RECOMMENDATIONS
5.1. Implementation of case management
Given the fact that substantial differences between case management projects often lead to confusion
of ideas about case management among practitioners and given the reluctance concerning this
intervention in some services, deliberate conceptualization and implementation of case management is
an important prerequisite. Deliberate conceptualization and implementation have been identified in
various studies as crucial determinants of effective case management. This includes, among others,
that case management should be matched to the individual’s needs and that it should be adjusted to
and integrated in the network of services. Moreover, case managers should be provided with clear
guidelines and protocols in order to apply this intervention effectively and efficiently.
5.2. Evaluation of case management
In order to evaluate thoroughly the effectiveness of case management for drug abusers, more
randomized and controlled studies are needed especially among sufficiently large samples. To assess
the long term effects of this intervention, a longitudinal perspective is required. In addition, qualitative
studies are needed to understand the impact of several aspects of case management on the treatment
process and its outcomes.
As (quasi-) experimental research concerning the effects of case management is still lacking, there is a
need for randomized and controlled research in order to assess if the postulated goals are realized and
if this intervention has a positive effect on drug users’ functioning and service utilization. Such
evaluation studies should also focus on the intervention that is actually delivered, as this may vary
from place to place and from project to project.
5.3. Training and supervision of case managers
Since case management is a specific and relatively new intervention, its implementation should be
well prepared and realized in step-wise way. It is important that case managers are trained in advance
for this function, so that they can rely on clear guidelines. Also providing supervision may help them,
as this intervention is still in its infancy in Belgium and as case managers can often not rely on a team.
5.4. Prerequisites for the implementation of case management
The structural bottlenecks for efficient implementation of case management we mentioned before, can
be translated into some essential prerequisites:
- For an efficient implementation of case management in the crisis units of the general hospitals,
case managers need to have sufficient time for assessment, planning and linking. If patient cannot
continue immediately with post-primary treatment, alternatives should be available such as a
longer stay at the crisis unit in order to guarantee the continuity of care.
- In order to involve general practitioners as full-fledged partners in the network around the client,
arrangements should be made to reimburse them for their participation in client consultation
meetings.
14. Summary
14
- In view of the structural implementation of case management, it should be clearly defined which
target population is most adequately served by this intervention.
- In order to avoid that case management becomes one of the fragmented pieces of the system of
services, this intervention should be integrated in the regional treatment system for drug abusers.
- Developing projects should be given sufficient time (3 to 5 years) to realize their objectives, as it
has been shown that it may take up to two years before case management is generating the
intended outcomes [41]. Moreover, it is important that the decision whether to stop or to continue
projects should be based on a thorough evaluation of the realization of the intended goals. In the
end, case management projects should be structurally implemented in substance abuse treatment,
taking into account the specific characteristics of this intervention.
- Finally, a manual or concrete guidelines should be provided for case managers, so that it is clear
for them how this intervention should be elaborated and so that the intervention can be evaluated
properly.
5.5. Judicial case management and the assistance of offenders by judicial assistants
Our study has shown that there is – for the moment – few need for the implementation of judicial case
management for drug offenders. Most respondents find that the judicial assistants already fulfill this
task with in the framework of different judicial regulations in which a referral to the treatment system
and monitoring of the assistance is provided. In addition, they state that the method that is used for the
assistance of offenders is satisfactory. Additional efforts are needed in order to:
- run the existing programs and modalities optimally, by providing sufficient staff and means;
- avoid misuse of the treatment system by some drug offenders (so-called “revolving door clients”).
5.6. Need for an advisory and referring agency at the level of the prosecuting authorities
As proposed in the federal policy note on drugs of 2001, our study confirms the need for the creation
of an advisory and referring agency at the level of the prosecuting authorities that supports the
prosecutors and investigating judges concerning the possibilities for referral to treatment agencies and
the desirability of coercive measures for drug offenders. As this situation cannot be situated at a client
level, but rather at a policy level, it is not desirable to call this “case management”.
5.7. Intensive assistance of public inebriates and repeated offenders
In order to reduce recidivism among so-called repeated offenders it is worthwhile examining the
feasibility of the implementation of intensive (judicial) case management for repeated drug offenders.
This can be realized within the existing system by providing the judicial assistants the means and
resources to apply all basic case management functions intensively and systematically, taking into
account the crucial prerequisites for an efficient implementation of this intervention. This intervention
could be implemented as a pilot experiment in some judicial districts where this kind of intensive
support of drug abusers is deemed necessary.
15. Summary
15
5.8. Cooperation and exchange of information between the treatment and judicial system
- The shared professional secrecy is not formally or legally recognized and is thus regarded as an
unsteady and ramshackle construction. To avoid that care givers violate the conditions of the
professional secrecy, it is necessary that the tasks and responsibilities of all actors involved are
clearly defined, particularly when caregivers accept to provide treatment to judicial clients.
Moreover, it is recommended to elaborate a protocol and a deontological code when implementing
care-coordination or when establishing an integrated treatment system.
- It is further recommended to recognize – under strict conditions – the informed consent of the
client as a justification for the violation of the professional secrecy, by means of an alteration of
the law, a correction of the deontological codes or a refinement of the jurisdiction of the Court of
Cassation. Furthermore, it is recommended to apply systematically three-cornered discussions or
meetings, so that clients can attend any exchange of information between a caregiver and the
judicial authorities.
- Concerning the legislation of several judicial modalities that provide the possibility of a referral to
the treatment system, it is recommended to improve the exchange of information between the
treatment and judicial system, on the analogy of the legislation concerning the conditional release
from prison and the internship.
- Another alternative is to formalize the agreements concerning cooperation and exchange of
information in a protocol, as has been the case with the protocol of cooperation between the
Federal State and the Flemish Community concerning the treatment of sexual delinquents.
5.9. Coordination and continuity of care among drug offenders
Despite the fact that case management is a suitable intervention for improving coordination and
continuity of care, a lack of coordination and continuity of care at the level of the individual client has
been observed at the moment they switch from one judicial state to another, including the risk of
relapse and recidivism.
- It is recommended to formulate realistic and feasible judicial conditions for drug offenders.
Effective deliberation between judicial authorities, treatment providers and case managers in the
field of substance abuse treatment may help to better adapt the conditions imposed to the offenders
needs’ and thus to enhance the chance to comply with these conditions.
- It is further necessary to attune the various judicial measures to each other. The conditions within
the framework of the conditional release of the client are the main orientation for the further
treatment trajectory of the client.
- In order to guarantee the continuity of care and to prevent relapse and recidivism among drug
offenders who are released from prison, at least minimal communication is required between the
judicial authorities, case manager and treatment services involved.
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