Comprehensive Case Management for Substance Abuse Treatment

ACCSA Module 19: Comprehensive Case Management for Substance Abuse Treatment

Contents Overview

• TIP: Treatment Improvement Protocols; best-practice guidelines for substance use disorders treatment.
• Foreword: Mission to improve prevention and treatment of substance use and mental disorders.
• Executive Summary: Case management as a coordinated approach to deliver health, substance abuse, mental health, and social services.
• Case Management & Substance Abuse Treatment: Enhancing addiction treatment scope and recovery continuum.
• Interagency Case Management: Expanding client service network.
• Evaluation & Quality Assurance: Outcome data reliance and effectiveness indicators.
• Special Needs Clients: Case management for minority clients, HIV/AIDS, mental illness, homeless, women, adolescents, physical disabilities, and LGBTQ+.
• Funding Under Managed Care: Adapting to managed care environment.
• Introduction: Case management for substance abusers accessing social services.
• Why Case Management: Addressing fragmented and inadequate services.
• Brief History: Social work evolution; legislative embodiments.
• Definitions and Functions: Core group of functions including assessment, planning, linkage, monitoring and advocacy.
• Models: Broker/generalist, strengths-based, assertive community treatment, and clinical/rehabilitation.
• Applying Case Management: Principles, practice, knowledge, skills, and attitudes.
• Treatment Continuum: Case finding, pretreatment, primary treatment, and aftercare.
• Community Context: Interagency perspective; characteristics of the three models.
• Evaluation and Quality Assurance: Overview of the research literature.
• Clients With Special Needs: Case management for minority clients, HIV infection and AIDS, mental illness homeless challenges, women with substance abuse problems, adolescent substance abusers, clients with physical disabilities, gay, lesbian, transgendered, and bisexual clients. Case Management in Rural Areas.
• Bibliography

Resources and TIPs

• ACCSA compiles courses from international organizations like CSAT, SAMHSA, NIDA, and NAADAC.
• Course information is sourced from TIPs (Treatment Improvement Protocols) and TAPs (Technical Assistance Protocols).
• TIPs are developed by CSAT, part of SAMHSA within HHS.
• TIPs serve as best-practice guidelines for treating substance use disorders, drawing from clinical, research, and administrative expertise.
• TIPs strive to include evidence-based practices but recognize that research often lags behind innovations.
• TIPs aim to convey front-line information quickly and responsibly.
• The Treatment Improvement Protocol (TIP) series supports SAMHSA’s mission; resilience and facilitating recovery people with or at risk for mental or substance use disorders by providing best- practices guidance to clinicians, program administrators, and payers to improve the quality and effectiveness of service delivery and thereby promote recovery.
• Each TIP involves a consensus panel of experts and field reviewers.

Foreword

• TIP series fulfills SAMHSA’s mission to improve prevention and treatment of substance use and mental disorders.
• It provides best practices guidance to clinicians, program administrators, and payers.
• TIPs result from careful consideration of clinical and health services research findings, demonstration experience, and implementation requirements.
• The panel's work is reviewed and critiqued by field reviewers.

Executive Summary

• Case management is a coordinated approach to delivering health, substance abuse, mental health, and social services.
• It links clients with appropriate services to address specific needs and achieve stated goals.
• Effective for clients with other disorders who need multiple services over time and face access barriers.
• Retention in treatment is associated with better outcomes; case management aims to keep clients engaged in treatment.
• Treatment is more likely to succeed when a client’s other problems are addressed concurrently.
• Case management focuses on the individual and stresses comprehensive assessment, service planning, and coordination.
• Functions: assessment, planning, linkage, monitoring, and advocacy.

Case Management and Substance Abuse Treatment

• Enhances the scope of addictions treatment and the recovery continuum.
• Provides a single contact point for multiple health and social service systems.
• Advocates for the client and is flexible, community-based, and client-oriented.
• Assists the client with needs outside traditional substance abuse treatment.
• Treatment professionals should:
  • Understand addiction models and theories.
  • Describe accepted treatment models, recovery, relapse prevention, and continuing care.
  • Recognize the importance of family, networks, community, and self-help groups.
  • Understand insurance and health maintenance options.
  • Incorporate diverse cultures and needs into clinical practice.
  • Understand the value of an interdisciplinary approach.
• Skills in interagency functioning, negotiating, and advocacy are essential.
• Referral and service coordination are core competencies.

Substance Abuse Treatment Continuum and Functions of Case Management

• Continuum ranges from case finding and pretreatment to primary treatment to aftercare.
• Client needs rarely fit into one area at a time; case management serves to span needs and program structure.
• Treatment helps abusers recognize problems and develop tools for abstinence; case management helps acquire resources.
• Case management supports a client as he moves through the RECOVERY CONTINUUM and reinforces treatment goals.

Interagency Case Management

• Goal: to expand the network of services available to clients.
• All organizations have boundaries; case managers or “boundary spanners” transcend them to facilitate interactions among agencies.
• Three identified interagency models: single agency, informal partnership, and formal consortium.
• Essential to have defined roles among all three models to ensure that services are coordinated.
• Formalized connections include memoranda of understanding and interagency agreements and contracts.

Environmental Assessment

Exploring the environment in whichan agency operates is crucial to determining the feasibility of aninteragency effort. Analysis of the community environment will enhance understanding of the changes that occur among clients, within the program, and in the community. Case management takes place within a dynamic social service environment in which agencies are in constant flux:

Potential Conflicts

• Potential for conflict exists whenever agencies or service providers work together.
• Tension may be present from the onset; an example of this would be a new project is viewed as competition for scarce resources.
• Informal communication can clarify issues.

Evaluation and Quality Assurance of Case Management Services

• Substance abuse treatment programs are increasingly operating in a managed care environment.
• Policy and clinical decision-making rely on outcome data describing the impact of case management and substance abuse treatment interventions.
• An additional demand for data comes from public and private payers who want services linked to specific outcomes.
• Indicators of “success” must be defined.
• Establish benchmarks to measure the case management process.

Evaluation and Quality Assurance

• Documenting case manager's activities.
  • Maintenance of simple staff log. Simple staff log procedure that measures case managers’ activities by contact.
    • Reviews of case manager client records to evaluate how service planning and referrals adhere to benchmarks.
    • Interviews or surveys of case managers or clients and their family members to collect information on activities that case managers engage in
    • Analysis of data from the agency’s management information system.

Measuring System Outcomes

• System outcomes are important in the managed care environment.
• System outcomes can measure cost savings and quality of care.
  • For example, continuity of care is an appropriate measure for a client at risk for relapse after detoxification and before entry into outpatient treatment.
• A computerized management information system (MIS) is essential.

Measuring Client Outcomes

• Specific outcomes for individual clients that are measured might included sobriety, family functioning, and fewer encounters with the criminal justice system.

Anticipating Quality Assurance Data Needs

*Structured feedback loops should be established to ensure that the gathered data are returned to various stakeholders in some meaningful way so that they have an impact on shaping future program development (and future data needs). One of the benefits of the case management approach is that it can be adapted to meet the sometimes contradictory needs of the various stakeholders.
*A management information system contains all of the case management services information and allows stakeholders to access it.In evaluating a MIS, local programs should:*