The case management process consists of five parts: assessment, treatment planning, linking, advocacy, and monitoring. It is not a linear process and does not follow the order it is written up. There may be some back and forth and returning to certain points. Screening Contact between an addictions counsellor and a client is usually initiated by the client referring him/her self, an outside agency refers them, family physician or the addictions counsellor initiates contact through outreach or other agencies.
Assessment can be seen as the beginning of treatment and it becomes an opportunity to encourage the client to begin to move towards change. The initial assessment involves a mutual investigation and exploration between the client and the assessor, which allows the assessor to determine with the client, any specific needs, their goals, characteristics and problems. While the ongoing assessment allows the client to see the changes and determine, with the assessor, what treatment plan needs to be altered.
It is important for the counsellors to set the tone and use the appropriate setting for the screening interview with varying approaches dependent on the client. Explain to the client that the screening process may take one or more sessions and that you may go over the same topics more than once because it is not a straightforward process. Maintain a client-centered focus and never make assumptions or take anything for granted about a client or their life, as their experiences are different from yours.
Use open-ended questions as often as possible and use closed questions where applicable to address specific areas. When the initial assessment process begins, it is generally informal, and begins with the assessor explaining the process to the client. The assessor will explain the functions and procedures of the assessment. That this assessment will provide the client with helpful information for planning treatment, including information about the treatment system, how long the assessment usually takes, and that the client may choose not to continue at anytime.
In addition, the limits to the confidentiality will be explained, examples of where confidentiality may be broken such as court subpoenas, medical emergencies and child abuse. The client and the assessor will discuss information about consent forms. The assessor also needs to explain to the client what kind of information will be collected. It is also important to gather information about how the client is functioning in life skills. Do they have accommodations? What the marital and family relations and social relations are like? The clients education and employment history.
There is also a need to determine their emotional/physical health and their finances. The client’s previous treatment history, as well as any mental health treatment. The extent of the initial assessment varies with each client. The counsellor should be aware of the many different cultural interpretations related to addictions and immigration. Although some clients will choose to continue the assessment, others may need time to explore their fears and expectations about their substance abuse. Some clients may require referrals to other agencies to stabilize their lives before they are ready to begin treatment assessment.
Family members may also be included in the assessment process to assist the client and to receive information on how best to their family member. If the family member(s) is troubled, it may be appropriate for them to become clients as well and in these instances, the family member would be assessed separately. There are many benefits of the assessment process, including allowing the client and counsellor to clarify any areas of anxiety and reduce fears. A key function of the assessors is to continually assess the client’s readiness for change and offer encouragement for the client to set appropriate goals.
For many clients, the assessment allows them to have their first opportunity to gain an objective feedback and insight about the issues in their lives. Although the main goal of the assessment is to refer clients to treatment, many clients refuse treatment. However, they are willing to accept referrals to non-addiction agencies to resolve problems that have either been caused by addiction or that led to the problems. This assessment may be an intervention that the client needs. You will want to use the appropriate research-based screening tools that may be applicable to the client’s individual circumstances.
Treatment Planning The treatment planning process helps the client select the level and intensity of treatment that works best for them. When planning treatment the counsellor can consider preferences and the services available. The treatment plan may change over time but it provides a focus for ongoing support. The treatment plan comprises of two main functions, it allows for a negotiation between the client and assessor for specific interventions to address the identified problems as well as allows them to develop a manageable plan.
It is important when negotiating with the client that the counsellor listens to what the client wants and is capable of undertaking with agreement to implement. Each client is unique and every treatment plan should also be tailored to meet his or her needs. The client must agree to all aspects of the plan. The treatment involves four stages, prioritizing problem areas and exploring options with the client, matching services available to the client’s needs, identifying potential barriers in using particular services, as well as preparing the client for treatment. Linking
Linking is the process of referring or transferring clients to services to other care giving systems. The steps involved in linking clients will vary dependant on their needs for support and their capabilities and resources. A client with a strong support system and skills to access resources may only require the names and numbers of agencies and be able to contact the agency on their own. A client with no support system and lacking in skills may require you to contact the agencies for them. The linking process is also affected by characteristics of the referral agencies.
The assessor will need to know which steps are required by these agencies for contact. It is important to be able to communicate effectively with the referral agency, which means be familiar with the requirements for each agency, as well as providing important client information. This is especially important regarding sensitivities. This allows for a good match between the client and the services. The next step is to ensure that there is a case manager and if one has not already been identified, this person will provide advocacy for the client. The case manager also monitors the clients’ progress.
Advocacy Advocacy involves interceding on behalf of a person to help get access to needed resources and support. The assessor or the case manager may advocate on behalf of the client with treatment agencies and non-treatment persons, which includes family and employers. Coordinating is a function that is closely associated with advocacy, when bringing together support and services to enhance the client’s treatment plan. Monitoring Monitoring is an important ongoing process of evaluating the treatment plan, adjusting goals/ referrals and then taking action as requested or required.
It provides continuity of care that is important to treatment. Monitoring helps keep the client focused and on track with the treatment plan. The case manager must focus on systematic plans for change, not the general aspects of the client’s life. With a treatment plan as the central core of discussion the client can remain focused and there is less risk of discouragement. Feedback about the client’s progress can be given to other service providers with the client’s permission. There are two type of monitoring, formal, and informal monitoring.
Informal monitoring is done with every contact with the client, this is when the counsellor or case manager observes the client’s condition. The case manager makes notes on whether the client appears health and general condition. Contact with the client should include general monitoring questions as well as questions that are more specific. Being able to introduce and maintain that with a client is the importance of knowing that there will be end to their counselling is important to help the client grow in their own confidence to deal with closure when the time comes. Self Identification of Learning Needs
At this point in my professional life, I feel confident in my abilities to carry out the core functions of case management. I have been working as a registered nurse for twenty years. During that time, I also worked as a community nurse in the inner city and did addictions counselling as part of my job requirements. I have always felt that self-determination and the freedom to choose is important to clients. The case management process is frequently used in nursing and is my preferred model of care. That is not to say that there is not more to learn on an ongoing basis, as the learning process never stops!