Case Management: Initial Steps and Core Attitudes

Core Attitudes and Skills in Case Management

• A person-centered ecological approach is the primary aim, focusing on the individual within their environment to promote well-being and positive change.

• Attitude towards the client significantly impacts the helping relationship; understanding personal biases and perspectives is crucial for effective interaction.

Key Attitudes:

• Acceptance: Validating clients by meeting them where they are in their change process is essential. This involves more than simple acknowledgment; it means:

  • Acknowledging the client's current stage of change, whether pre-contemplation, contemplation, preparation, action, or maintenance, adapting interventions accordingly.

  • Validating their feelings and experiences, creating a safe space for them to express themselves without fear of judgment.

  • Providing consistent support and encouragement, reinforcing their efforts and progress, no matter how small.

• Self-determination: Respecting and honoring client choices to uphold social work values and client autonomy. This entails:

  • Helping clients set realistic goals and identify services based on their needs, ensuring that the case manager's preferences do not overshadow the client's.

  • Supporting client autonomy by empowering them to make informed decisions and take control of their lives.

  • Prioritizing the client's needs and preferences, even when they differ from what others might consider best.

• Non-judgmental Attitude: Striving for non-judgment, especially when client choices diverge from personal beliefs. This requires:

  • Accepting the client's decisions and lifestyle choices, understanding that these are often influenced by their unique circumstances and experiences.

  • Focusing on the client's goals and priorities, helping them achieve what they deem important, not what the case manager believes they should value.

  • Avoiding imposing personal values or beliefs, maintaining a clear boundary between the client's needs and the case manager's opinions.

• Motivation and Encouragement: Instilling hope and optimism while highlighting client strengths to support their journey. Strategies include:

  • Instilling hope by focusing on past successes and potential future achievements.

  • Highlighting the strengths of the client, reinforcing their resilience and capabilities.

  • Being optimistic and supportive, providing reassurance and positive reinforcement during challenging times.

• Collaboration: Partnering with the client enhances their situation and helps them to achieve their goals through:

  • Fostering self-efficacy and trust by involving the client in decision-making and planning.

  • Modeling and encouraging self-efficacy for future independence, preparing them to manage their lives effectively.

  • Working as a team with the client, ensuring that the client is an active participant in the process.

• Individualization: Recognizing each client's uniqueness prevents imposing generalizations. This includes:

  • Recognizing unique strengths and support systems, tailoring interventions to fit their specific circumstances.

  • Tailoring treatment planning and service planning to the individual, ensuring that services are relevant and effective.

  • Skillfully utilizing supports within their own life and community, leveraging available resources to enhance their outcomes.

• Seeing the Client as Separate: Maintaining clear boundaries prevents emotional over-involvement by:

  • Recognizing that you are separate from your client's problems, reducing the risk of burnout and maintaining professional objectivity.

Key Skills for Successful Relationships and Outcomes:

• Reflective Listening: Demonstrates acceptance, fosters self-acceptance, encourages progress, and showcases understanding by:

  • Reflecting content and emotion to build empathy and rapport, ensuring the client feels heard and understood.

• Open-ended Questions: Encourage detailed responses from the client in their own words, providing deeper insights.

• "I" Messages: Disarm anger and facilitate skillful communication, helping to express feelings and needs assertively.

• Informed Consent: Ensures client understanding and agreement to the process, which involves:

  • Making sure people are consenting to our help, clarifying procedures, risks, and benefits.

Handling and Documenting Initial Inquiries

• Initial information must be collected, reviewed, and organized before beginning case management services to ensure readiness.

• This pre-work prepares for assessment and service planning and may be part of a gatekeeping process to allocate resources effectively.

• The purpose is to gather essential information about the person seeking services, potentially scheduling a full intake appointment to proceed.

• Tone: Being friendly and a clear communicator demonstrates care during this initial contact, setting a positive tone.

How initial inquiries may occur:

• Phone (self-referral, family member, professional referral), providing immediate access to services.

• Email, offering a convenient method for sharing detailed information.

• Walk-in, providing a direct and personal approach.

Guidelines When Receiving Information:

• Receiving information from someone else does not violate HIPAA; HIPAA concerns disclosure of protected health information.

• If the referral source is someone else, the intake must be consented to by and completed with the client (unless a parent with decision-making power or power of attorney).

• If someone else briefly gather: information about the problem, the client's demographic information, and contact information to facilitate follow-up.

• If it's the client briefly gather: some demographics, some basic information about the problem; the client could also assess and address if they are in distress right now, ensuring immediate support.

• Obtain necessary demographic information and document the chief complaint/presenting problem, forming a clear initial record.

Completing a New Inquiry Form

• Thorough and accurate documentation is essential for continuity of care and assessment so that subsequent actions are appropriate.

Basic Form Elements:

• Stylistic: Formal, black ink, no pencil/correction liquid, signed and dated, and using "N/A" instead of leaving blank ensures professionalism.

• Handwriting: Must be legible, avoiding misunderstandings and errors.

• Information to Collect:

  • Name, for proper identification.

  • Sex, for demographic purposes.

  • Date of birth, for age verification.

  • Address, for location and contact.

  • Home/work/cell phone numbers, for communication.

  • Parent/spouse information (if applicable), for familial context.

  • Employer/school (if applicable), for occupational and educational context.

  • Referral source, to understand how the client accessed services.

  • Primary doctor/specialists/therapist, for integrated care.

  • Chief complaint/presenting problem: The reason they are contacting you, providing focus for the consultation.

  • Previous relevant treatment: Dates, providers, hospitals, giving historical insight.

  • Note disposition of client with brief behavioral language, not assumptions, ensuring objectivity.

  • If in crisis, refer to the appropriate level of care immediately.

  • Confirm and verify appointment for intake, establishing the next step.

  • Sign and date the intake, validating its authenticity.

Chief Complaint/Presenting Problem

• Summarize quickly on the intake; be specific, be brief, and avoid generalities to direct attention.

• Start with "Client called today because…", clearly stating the immediate reason.

• Note any distress or motivation expressed, providing context for the interaction.

• Examples:

  • "Jane Wilson called today after a serious fight with her husband involving physical abuse. Jane states her husband has been verbally abusive in the past but not physically. Client is hospitalized and looking for alternatives and safe living arrangements upon discharge. Client sounds depressed but cooperative."

  • "John Hollik called today because his employer requested he seek help for a drug problem. For crack, in the last two weeks, he has missed or been late to work every day, sleeping on the job, and cited for safety violations. Client sounded distressed and anxious to begin treatment."

• Present the client's unconditional positive regard and authentic presence to maintain rapport.

The Initial Interview Process

• The goal is to build a holistic understanding of the client's situation and needs (subjective understanding) to formulate an informed professional opinion.

• This is the first real chance to build a positive relationship/alliance, ensuring future engagement.

Information to Gather

• Presenting problem/chief complaint and related needs (top priority) and relevant history, forming the immediate focus.

• History about their overall health and wellness, giving a comprehensive view.

• Array of client-identified needs and priorities, ensuring client-centered direction.

• Foundational understanding of their support system, possibly using: - Genogram (family relationships).

  • Ecomap (visual representation of systems in their life).

• Current service providers and services, integrating existing support structure.

• Client's strengths, accentuating positive capabilities.

• Areas of risk and safety, addressing potential threats.

• Sense of the client's identity, values, beliefs, and self-concept, appreciating individuality.

• Readiness to change, assessing motivation for improvement.

• Affect, disposition, and social skills, evaluating functional behavior.

Preparing for the Interview

• Set the stage for success through mindful preparation.

• Review intake materials and consult the intake report, looking for gaps in the information.

• If you have access to them check: - Past agency records or acquired records.

  • Medical history, medications, past services, resources utilized, enabling a richer understanding.

• Approach records critically, noting potential inaccuracies, biases, or misinterpretations to mitigate misinformation.

• Prepare Questions:

  • Overall health and wellbeing, covering general status.

  • Presenting problem/chief complaint and related context, exploring immediate concern.

  • Inconsistencies in the records (verifying not presenting as truth), confirming factual accuracy.

  • Client's interests, strengths, and past successes, identifying beneficial coping mechanisms.

  • Standard questions about risk and safety (home safety, thoughts of harm to self/others), ensuring client protection.

• By asking questions in a manner that shows you've done your homework, the client may feel more confident in you.

Questions about Safety

• Examples:

  • Do you feel safe where you live and with the people who you live with?, assessing immediate environment.

  • Is there anyone that you have to be around regularly who you don't feel safe with?, identifying potential recurring threats.

  • Over the past two weeks, have you had any thoughts of harm to self or other?, ensuring proper crisis detection.

Meeting and Greeting the Client

• Make a good professional first impression and foster rapport, setting the stage appropriately.

• It is true that you never get a second chance to make that first impression.

• Consider your physical presentation, affect, language, and tone to ensure effective communication.

• Recognize potential client nervousness or baggage from past interactions to respond with empathy.

• Show respect and have a level of formality to balance the working relationship with a proper dynamic.

Practical Steps:

• Greet the client warmly, either in person or virtually, creating a welcoming atmosphere.

• Make your initial greeting formal (Mr./Mrs. so-and-so), respecting professional conventions.

• Formally introduce yourself, your role, and your agency, providing clarity and context.

• Note initial observations about the client's affect, presentation, and social skills, gathering immediate data.

• Engage in casual conversation but keep it professional (avoid religion/politics/vulgarity) and avoid too many personal details, maintaining boundaries.

• Authentic presence sends a potent message that you value their time; redirect any personal inquiries to maintain focus on the client's needs.

Setting the Stage for Accurate Information

• Collect enough data and that it's information that's accurate to establish a reliable understanding.

• Vital to collect enough info and accurate info to the point that's a holistic view, allowing for comprehensive insight.

• Clients will not share that much if they feel: uncomfortable, judged, misunderstood, or anxious. But those feelings will be avoided if you stay focused on that person-centered framework and embody those things that have been talked about.

• Those things that should continue to be embodied are:

  • Authentic presences, creating immediate trust.

  • Supportive attitude from minute one, ensuring sustained comfort.

  • Avoid barriers to communication, enabling seamless interaction.

  • Non-judgmental curiosities, encouraging open expression.

  • Embracing non-judgmental curiosity, fostering complete honesty.

• Open-ended questions should primarily be used with the clients to elicit detailed responses.

• Closed-ended questions are ok for verification of information and or clarification, but open-ended are the way to go, when aiming for depth.

• Reflect the content of the client's feelings (active listening/reflective listening) and it verifies to make sure what their saying is factual.

Specific Interview Parts

• Start with the presemting problem because that is why the client is there and made the appointment to align focus.

Exploration

• Explore the issue and learn about it within its context to develop a thorough understanding.

  • Can ask "Why now?" to investigate triggering events.

  • You will want to explore how the issue is impacting the client's wellbeing, identifying areas of concern.

  • Clarify the issue with the client. Then, if you can, telescope out to other issues related to the client, uncovering contributing factors.

  • Then discuss the clients support system. Talk about their strengths and their protective factors to capitalize on available assets.

  • Always remember their strengths and support system, ensuring consistent positivity.

Changes

• Explore the readiness to change as it pertains to the presenting problem to align goals.

Questions and information

• Questions must feel like they are a part of a conversation and not an interrogation to maintain rapport.

  • Use open questions that encourage elaboration. Use close questions sparingly because they may come off as too harsh or intruding, choosing questions deliberately.

• Be respectful of clients. The goal is to understand enough, not to exhaust.

Client aspect. Discuss and ensure requirements are understood.

• Discuss the expectations of both the cllient and the case manager, aligning expectations.

  • Always be honest about your case load/schedule, managing availabilty.

  • Discuss policies for no-shows, canceling and or missing appointments, outlining responsibilities.

Ensure the Client can:

• Provide paperwork,

• Sing consent as necessary, adhering to regulations.

• Provide documents and records, supplementing information.

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