UB Case Management Covenant House Georgia Discussion

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UB Case Management Covenant House Georgia Discussion

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I’m working on a psychology writing question and need an explanation and answer to help me learn.


Chapter 2 brings up issues of diversity and describes the contributions of Mary Richmond. Research a program in your town or city (Atlanta, ga) and identify the population it serves. Imagine implementing this program in another area with a different population (for example, make a program that services inner-city youth work for rural youth or vice versa). Identify changes you would need to make in order to adequately serve the new population.


Generalist Case Management A Method of Human Service Delivery 5th Edition Marianne R. Woodside Tricia McClam Photo used with permission by Marianne R. Woodside Copyright © 2018 Cengage Learning. All Rights Reserved. CHAPTER 2 Historical Perspectives on Case Management Introduction • Modern-day case management reflects many changes such as: changing needs of individuals served, financial constraints on the human service delivery system, increasing number of people needing services, and the growing emphasis on client empowerment, evaluation of quality, and service coordination. • Much of the foundation of case management developed when it was used to serve people with mental illness who were deinstitutionalized in the 1970s. Copyright © 2018 Cengage Learning. All Rights Reserved. Perspectives on Case Management • Four perspectives have shaped case management since the 1970s: • Case management as a process • Client involvement • The role of the case manager • Utilization review and cost-benefit analysis Copyright © 2018 Cengage Learning. All Rights Reserved. Case Management as a Process, Slide 1 • • The 1970s brought deinstitutionalization to the mental health community and changes to case management practice. • Deinstitutionalization: the movement of large numbers of people from self-contained institutions to community-based settings such as halfway houses, family homes, group homes, and single-residence dwellings. • During deinstitutionalization, case managers had to help determine which residents could live outside of an institution, and then they had to help such clients transition into new settings. Sam’s case (2.1 & 2.2) illustrates the issues that could arise during these two tasks. An early definition of case management came from the American Psychiatric Association’s Ad Hoc Committee on the Chronic Mental Patient. In summary, case managers helped persons with disabilities access and use resources; case managers played a key role in service integration. Copyright © 2018 Cengage Learning. All Rights Reserved. Case Management as a Process, Slide 2 • The three key elements for success in the case management process include: • Responsibility for assessing the client’s problem and developing a responsive plan. • Continuity in planning care and implementing the case plan through aftercare time periods. • Accountability for tracking and updating the case plan, helping the client gain independence, and incorporating the client’s voice during plan-of-care decision-making. • These elements ensure that a client’s problem is assessed, appropriate plans are put in place for the duration of treatment, and the client’s ability to function independently and to assume selfresponsibility are increased. • Case management provides a focus and oversees the delivery of services in an orderly fashion. Copyright © 2018 Cengage Learning. All Rights Reserved. Client Involvement • During the 1980s, client involvement came to be emphasized more strongly. • A new model of case management was proposed, giving clients a more active role in their development. Copyright © 2018 Cengage Learning. All Rights Reserved. The Role of the Case Manager, Slide 1 • Traditionally, terms such as caseworker and case manager described the efforts of helpers. • Today, job titles include service coordinator, liaison worker, counselor, case coordinator, health-care case manager, and care coordinator. • This range of titles reflects the diversity of service delivery today and the broader range of responsibilities and perception of roles. The emphasis shifted from the skills of managing someone to terminology reflecting a more equitable relationship Copyright © 2018 Cengage Learning. All Rights Reserved. The Role of the Case Manager, Slide 2 • Changes placed an emphasis on working with other professionals, coordinating care and other services, and empowering individuals to use the system to help themselves. • For the client, the focus became the ability to develop skills needed to work within the human services network. • For the case manager, the focus shifted from management to coordination. Copyright © 2018 Cengage Learning. All Rights Reserved. Utilization Review and Cost-Benefit Analysis • One result of the spiraling cost of medical and mental health services is the growth of the managed-care industry. • The purpose of managed care is to authorize the type of service and the length of time care is provided. An emphasis is placed on the efficient use of resources. • Case managers, working in managed care, are involved in utilization review and have the responsibility to authorize and deny services. • Case managers are also responsible for cost-benefit analysis, which focuses on the financial matters of the case, specifically the cost and efficiency of services. Copyright © 2018 Cengage Learning. All Rights Reserved. The History of Case Management • First used in institutional settings, case management included the responsibilities of intake, assessment of needs, and assignment of living space. A Pioneering Institution • An early example of such an institution was the Massachusetts School for Idiotic and Feebleminded Youth, established in 1848. • The school provided services in case management such as tracking student progress, providing follow-up services, and managing information. • Other practices at this school (aftercare, evaluation of services, and advances in recordkeeping) contributed to case management as we know it today. Copyright © 2018 Cengage Learning. All Rights Reserved. Early Pioneers, Slide 1 • Early case management took either of two forms: a multiservice center approach or a coordinated effort of service delivery. • Jane Addams, Lillian Wald, and Mary Richmond were three early pioneers who contributed to the development of the emerging case management process. Hull House • Jane Addams founded Hull House in Chicago (1889), committed to sharing a love of learning. • As services expanded, the need for effective administration and recordkeeping increased resulting in the collection of information about demographics, participation, and attendance. • Advocacy was also integrated into the work of Hull House. Copyright © 2018 Cengage Learning. All Rights Reserved. Early Pioneers, Slide 2 Henry Street Settlement House and Contributions to Case Management • Lillian Wald and Mary Brewster established the Henry Street Settlement House in New York (1895), and created a system for nursing the sick in their own homes, promoting the dignity and independence of the patient. • The work at Henry Street led to two significant innovations: the designation of the visiting nurse and the development of the Red Cross. Mary Richmond and Contributions to Case Management • Mary Richmond was a social reformer who promoted the idea that each person was a unique individual whose personality, family, and environment should be respected. • She believed that professionals should work with clients rather than “doing things” to them. Copyright © 2018 Cengage Learning. All Rights Reserved. Early Pioneers, Slide 3 Mary Richmond (continued) • Social diagnosis: developed by Richmond, is a systematic way for helping professionals to gather information and study client problems. • Richmond established a series of methods for gathering information about individuals, assessing their needs, and determining treatment. • She recognized that gathering data is a complex process and urged the use of different methods for different individuals. • She also believed in multiple sources of information and warned that data gathering was an often incomplete process. Copyright © 2018 Cengage Learning. All Rights Reserved. Impact of World Wars I and II/The Red Cross • During the First World War, the American Red Cross—in response to an increased interest in Mary Richmond’s style of casework—used casework to address individuals’ problems and their psychological needs. • The Home Service Corps helped address the needs of the families of military personnel (those experiencing problems such as illness and marital difficulties). • The Home Service Corps made two important contributions: 1) Extended help was offered to individuals and their families. 2) Volunteers became brokers of services, coordinating communications and requests between families and agencies. Copyright © 2018 Cengage Learning. All Rights Reserved. The Impact of Federal Legislation, Slide 1 Contributions to Case Management: The Older Americans Act of 1965 • Focused on providing services for older individuals in order to improve their quality of life. • Contributed to case management by emphasizing the multiplicity of human needs and recognizing the need to coordinate care. Contributions to Case Management: Rehabilitation Act of 1973 • This act and its subsequent amendments emphasized client involvement and satisfaction, consumer choice, and control in setting goals and objectives. Copyright © 2018 Cengage Learning. All Rights Reserved. The Impact of Federal Legislation, Slide 2 Contributions to Case Management: Children with Disabilities, Education for All Handicapped Children Act of 1975 • Included an explicit case management process to treat the client as a customer. • The client was to be involved in identifying the problem, given complete information about the results of the assessment of needs, and empowered to help determine the type of services delivered. Contributions to Case Management: The Family Support Act of 1988/The Personal Responsibility and Work Opportunity Act • Mandated that case management be applied to the process of serving those who were deemed eligible for welfare. • Case managers became a key component in welfare-to-work programs by developing the case plan and coordinating services. Copyright © 2018 Cengage Learning. All Rights Reserved. The Impact of Managed Care, Slide 1 History of Managed Care • The emergence of managed care has increased the demand for case management services and provided new models and definitions of service delivery. • Fee-for-service: an early provision of medical care; each patient was assessed a fee for each health or mental health service provided by a professional. • In the 1930s, physicians implemented prepaid group plans or managed plans for medical services. • The basic concept of a prepaid plan was to guarantee a defined set of services for a negotiated fee. • The prevalence of managed care is now commonly regarded as being connected to the rising cost and decreasing quality of health care and mental health care. Copyright © 2018 Cengage Learning. All Rights Reserved. The Impact of Managed Care, Slide 2 Defining Managed Care • Managed care: an organized structure that uses prepayment rather than fee-for-service payment. • It can designate the array of different payment plans, such as prepayment and negotiated discounts. • Policies restrict clients’ access to providers such as physicians and other health professionals. Copyright © 2018 Cengage Learning. All Rights Reserved. Models of Managed Care, Slide 1 • Pharmacy benefits management (PBM) : focuses on controlling prescription costs through negotiations, use of generic treatments, and mail delivery of prescriptions. Managers review drug benefits and determine payments. • HMO (health maintenance organization): a generic term covering a wide range of organizational structures; combines delivery and financing into one system. • HMOs provide health care or assure health care delivery in a geographic area, have an agreed-upon set of health maintenance and treatment services, and involve groups of voluntary enrollees. Copyright © 2018 Cengage Learning. All Rights Reserved. Models of Managed Care, Slide 2 • PPO (preferred provider organization): plan that falls between the traditional HMO and the standard indemnity health insurance plan. • • PPOs have established contracts with designated (preferred) medical providers. Clients receive better benefits when care is received from a preferred provider. POS (point-of-service): allows for more flexibility than HMO or PPO plans provide. • Coverage is reduced for out-of-plan providers and clients pay higher premiums, deductibles, and pay a higher percentage of medical fees. Copyright © 2018 Cengage Learning. All Rights Reserved. Models of Managed Care, Slide 3 • Health Savings Account : high-deductible but lower-premium health care plans that were developed in 2003. • Employers and employees make tax-free contributions, up to $2,500, to a savings plan that can be used for qualified medical expenses • Employees decide what qualified services they want to purchase • Unspent funds in the plan roll over to the next year • Health Reimbursement Arrangements: similar to health savings account, without the cap on employer contributions. • Plans Offered Under the Health Care Exchanges: these plans are mandated by the Affordable Care Act and provide a set of minimum services while covering varying percentages of medical costs, at either 60, 70, 80 or 90%. Copyright © 2018 Cengage Learning. All Rights Reserved. Managed Care: Summary • Managed care has emerged as a response to the fact that employers, governments, payers, clients, and providers are all seeking ways of containing health care costs. • All managed-care plans emphasize management of medical cases, review and control of utilization, and incentives for restrictions on providers and clients to reduce costs and maintain quality. • Clear advantages and disadvantages of these plans have emerged. • Case managers play a critical role in management of care. Organizations have developed to establish standards for case management in these settings, such as the Case Management Society of America. • In response to professional and client frustrations, several advocacy efforts have evolved. Copyright © 2018 Cengage Learning. All Rights Reserved. Professionalization of Case Management and Expanding Responsibilities • • The professionalization of case management within human service delivery includes a national certification offered by several professional organizations and states. • The Human Services Board-Certified Practitioner requires demonstrated competence in case management, professional practice, and ethics and requires several practitioner competencies that are related to case management. • The National Association of Social Workers (NASW) offers a credential for case managers with a bachelor’s of social work degree. As the care environment continues to shift, the case managers’ responsibilities and accountability through certification will increase. Copyright © 2018 Cengage Learning. All Rights Reserved. References Ozarin, L. (1978). The pros and cons of case management. In J. Talbott (Ed.), The chronic mental patient (pp. 165–170). Washington, DC: American Psychiatric Association. Copyright © 2018 Cengage Learning. All Rights Reserved.