Case management (mental health)

This article is about the mental health approach. For other uses, see Case management.

Case management is the coordination of community-based services by a professional or team to provide individually-customized mental health care for people experiencing frequent setbacks or persistent challenges to their recovery.[1][2] Case management seeks to reduce hospitalizations and support individuals' recovery through a holistic approach that considers each person's overall biopsychosocial needs. As a result, care coordination includes traditional mental health services but may also encompass primary healthcare, housing, transportation, employment, social relationships, and community participation.[2]

History

The case management model developed in the USA[3] in response to the closure of large psychiatric hospitals (known as deinstitutionalisation) and initially following a brokeage model, where professionals arranged for the provisions of services, without the need for direct patient care or contact. Clinical or therapeutic case management then developed as the need for the mental health professional to establish a therapeutic relationship and be actively involved in clinical care was recognised.[4][5] A more intensive form of case management (assertive community treatment or Intensive Case Management) was also developed for patients with more severe illness who needed a more assertive approach.[6] With the rise in popularity of value-based purchasing in healthcare, case management has begun to undergo a transition. In April 2014, The Maine Department of Health and Human Services introduced the Behavioral Health Home case management program which follows a value-based purchasing approach. The Behavioral Health Home provides a holistic and integrated approach to psychiatric case management with a goal to promote increased wellness amongst an agency's entire population.

Process

The underlying tasks of case management form a five-step cycle:

  1. Assessment of individual needs and strengths
  2. Care planning
  3. Plan implementation
  4. Progress monitoring
  5. Regular review and re-assessment (initiating a new case management cycle)[1]

Models

Several models of case management emerged to coordinate care for individuals with different needs. These models differ in their approach to care, frequency of contact, and the number of professionals and individuals involved.

Model Developed Focus[2] Case manager(s)[2] Client(s)[2]
Brokerage Model ? Connect client to services Individual Individual
Clinical Case Management ? Involve case manager in treatment Individual Individual
Assertive Community Treatment ? Reduce hospitalizations Multidisciplinary team,
10–12 members[7]		 Individual
Intensive Case Management ? Reduce hospital and emergency service use Individual Individual
Personal Empowerment Model /
Strengths Model		 1980s[7] Client abilities and interests Individual Individual
Rehabilitation Model ? Client goals, disability rehabilitation plan Individual Individual
Individual Case Management ? Varies Individual Individual
Team Case Management ? Varies Team Individual
Cluster Case Management ? Mutual support Individual with optional assistant Group

In addition to the outcome measures typically used to assess the effectiveness of treatment interventions, researchers have developed fidelity measures to assess the implementation of a particular case management model. As of 2012, there are documented fidelity measures for Assertive Community Treatment (the Dartmouth ACT Scale and the Tool for Measurement of ACT) and the Strengths Model (the Strengths Model Fidelity Scale).[7]

See also

References

  1. 1 2 Onyett, Steve (1998) [1992]. Case management in mental health (reprint ed.). Cheltenham, UK: Stanley Thornes. p. 3. ISBN 978-0-7487-3845-8.
  2. 1 2 3 4 5 Ivezić, Slađana Štrkalj; Mužinić, Lana; Filipac, Vanda (March 2010). "Case management: a pillar of community psychiatry" (PDF). Psychiatria Danubina 22 (1): 28–33. PMID 20305587.
  3. ↑ Intagliata, James (1982). "Improving the quality of community care for the chronically mentally disabled: the role of case management". Schizophrenia Bulletin 8 (4): 655–74. doi:10.1093/schbul/8.4.655. PMID 7178854.
  4. ↑ Holloway, F (March 1991). "Case management for the mentally ill: looking at the evidence". International Journal of Social Psychiatry 37 (1): 2–13. doi:10.1177/002076409103700102. PMID 2045238. (subscription required)
  5. ↑ Kanter, Joel (April 1989). "Clinical case management: definition, principles, components". Hospital and Community Psychiatry 40 (4): 361–8. doi:10.1176/ps.40.4.361. PMID 2714749. (subscription required)
  6. ↑ Stein, Leonard I.; Test, Mary Ann (April 1980). "Alternative to mental hospital treatment: I. Conceptual model, treatment program, and clinical evaluation". Archives of General Psychiatry 37 (4): 392–7. doi:10.1001/archpsyc.1980.01780170034003. PMID 7362425. (subscription required)
  7. 1 2 3 Teague, Gregory B.; Mueser, Kim T.; Rapp, Charles A. (August 2012). "Advances in fidelity measurement for mental health services research". Psychiatric Services 63 (8): 765–71. doi:10.1176/appi.ps.201100430. PMC 3954528. PMID 22854723.

Further reading

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