23 -Case Management | Addiction Counselor Exam Review
Addiction Counselor Exam Review

 
 
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Addiction Counselor
Exam Review
Case Management and
Service Coordination
Instructor: Dr. Dawn-Elise Snipes
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery & The Addiction Counselor Exam Review

Objectives
~ Define referral and service coordination within the context of case management
~ Explore why CM is necessary
~ Identify the different approaches to case management
~ Identify the CM role in service coordination
~ Define service planning
~ Identify challenges and solutions to collaboration
Service Coordination: Case Management
~ A client-level collaborative process designed to:
~ Help individuals access needed services
~ Select the most appropriate services
~ Facilitate linkage with those services
~ Promote continued retention in services by monitoring participation
~ Coordination of multiple services when necessary
~ Advocate for continued participation
Service Coordination: Case Management
~ Objectives of case management
~ Continuity of care
~ Accessibility:
~ Establish relationships with “gatekeepers”
~ Develop contracts or MOUs which specify
~ Available “slots”
~ Consequences for failure to implement specified activities/procedures
~ Accountability
~ Following up on the referral with client and referral resource
~ Measuring outcomes with
~ Client satisfaction
~ Client outcomes
~ Service system outcomes (i.e. reduction in cost to treat)
~ Efficiency “Know the system and make it work”

Service Coordination: Case Management
~ Necessary because of poor service coordination, lack of service continuity and difficulty of clients negotiating the gap between services
~ Structure
~ Case manager who acts as the human link between the client and service providers
~ Core agency
~ Develops contracts with providers for identified services
~ Controls case management funds
~ Acts as a single point of entry for clients
~ Develops missing service elements
Service Coordination: Case Management
~ Approaches
~ Intensive/Assertive Community Treatment
~ Comprehensive, multidisciplinary, community based
~ Growth
~ Paternalism
~ Clinical
~ Case manager provides many services including counseling
~ Stabilization
~ Strengths based
~ Focus on strengths and empowerment
~ Growth
~ Empowerment
Service Coordination: Case Management
~ Approaches
~ Brokerage
~ Coordinates services and provides few, if any services
~ Stabilization
~ Empowerment
~ Integrated
~ Family-focused, strength-based program that uses an independent facilitator to coordinate all relevant people, including providers, family and natural supports.
~ This team then works in partnership with the family to create a safety-based comprehensive plan addressing the needs of all family members.
~ Growth
Service Coordination: Case Management Principles
~ Offers a single point of contact for clients
~ Client-driven and strengths based
~ Involves advocacy
~ Between services with seemingly contradictory requirements to serve the best interests of the client
~ With agencies, families, legal systems and legislative bodies
~ May involve the recommendation of sanctions to encourage client compliance and motivation
~ Community based
~ Pragmatic “Where the client is”
~ Anticipatory based on the natural course of the client’s presenting issues
~ Flexible to individual needs
~ Culturally sensitive
Service Coordination: Case Manager’s Role
~ To coordinate, manage, link, advocate and support clients in their quest to maximize their quality of life and achieve as much independence as possible
~ Basic Prerequisites and Competencies
~ Ability to establish rapport
~ Awareness of how to maintain boundaries
~ Willingness to be nonjudgmental
~ Recognize the importance of family, social networks and community in the process
~ Understand the variety of insurance and payment options available
~ Understand culture and respond in a culturally sensitive manner
~ Understand the value of an interdisciplinary approach to treatment
~ Serve as both facilitator of referrals and advocate

Service Coordination: Case Manager’s Role
~ Facilitator Duties
~ Composing the team
~ Notifying participants of meetings
~ Chairing the meeting
~ Maintaining team focus on the client
~ Ensuring clients’ desires and needs are adequately represented and considered

Service Coordination: Referral
~ Referral is the process of facilitating the client’s use of available services and support systems to meet the needs identified in assessment or treatment planning
~ Involves identifying needs of the clients which cannot be met by the agency (regardless of whether client is receiving case management services)
~ Inappropriate referrals may lead to dropout if clients hopes get up then they are denied access to services
~ Inadequate follow up also often leads to premature drop-out
Service Coordination: Referral
~ Counselors must know resources in their community
~ Processes
~ Limitations
~ Requirements
~ Confidentiality
~ Counselors should visit the referral agencies
~ Initially
~ Semi-annually
~ Potential problems in referrals
~ Differences in agency functioning
~ Differences in eligibility
~ Inadequate data sharing
~ Conflicting treatment plans
~ Moving between agencies may interrupt continuity of care
Service Coordination: Referral
~ Potential referral resources
~ Marriage and family & mental health counselors
~ Abuse and trauma counseling resources
~ Health:
~ Primary care
~ Women’s health
~ Nutrition
~ Holistic practitioners
~ Pain management
~ Legal
~ Financial counseling
~ Housing
~ Career counseling/educational planning
~ Religious/spiritual/faith support
Service Coordination: Referral
~ Potential referral resources
~ Career counseling/educational planning
~ Religious/spiritual/faith support
~ LGBTQ Support
~ 12-step meetings—variety and locations
~ Veterans Administration
~ Childcare
~ Transportation

Service Coordination: Referral
~ Potential reasons
~ Counselor’s agency does not provide that service
~ Counselor may not be the best person to provide the service (i.e. sexual identity issues)
~ Counselor believes there might be a conflict of interest
~ Counselor recognizes the need for a different level of care
Service Coordination: Referrals
~ Counselor should
~ Explain the rationale for any referrals to facilitate participation
~ Familiarize the client with the agency to quell anxieties
~ Contact the referral source in the client’s presence
~ Have client schedule the actual appointment
~ Give the client
~ Contact name and number
~ Agency address
~ Document the referral and follow (with client AND provider) up in the client record
Service Coordination: Referral
~ Dual-diagnosis or co-occurring disorders indicates the presence of both mental health and addiction issues.
~ People with co-occurring issues often experience more severe emotional, social and physical problems than someone with only one issue
~ Medical, Mental health and Addictive disorders all influence each other
~ Use and withdrawal can both cause mood, social and physical conditions
~ Continuum: Disorders vary in terms of…
~ Severity
~ Chronicity
~ Disability/degree of impairment in functioning

Service Coordination: Service Planning
~ Treatment plans are designed with the provider to identify treatment objectives necessary to achieve goals
~ Service plans is an umbrella document which ties together all of the
~ Treatment plans from the various providers
~ Short term goals and objectives
~ Structure of the Comprehensive Service Plan
~ Long Term Goals
~ Current status narrative
~ Required services, supports and resources

Service Coordination: Linking, Monitoring, Advocacy
~ Linkages
~ goes beyond providing a list of resources
~ Involves developing a network of known resources and contacts
~ Foundation for successful implementation is based upon interdisciplinary team planning effort (including the client)
~ Decides goal priorities
~ Assigns responsibilities for each goal
~ Reaches consensus in overall approaches
Service Coordination
~ Encompasses administrative, clinical and evaluative activities that bring the client , treatment services, community agencies and other resources together to focus on needs identified in the recovery plan
~ Service coordination includes:
~ Case management
~ Collaboration with client and SOs
~ Coordination of treatment and referral services to address issues contributing to and caused by addictive behaviors
~ Liaison activities with community resources
~ Ongoing evaluation of treatment progress and client needs
~ Client Advocacy

Service Coordination
~ Tasks
~ Initiating and collaborating with referral source “warm referral”
~ Obtain, review and interpret all relevant screening, assessment and treatment planning information
~ Confirm client eligibility for admission and continued readiness for change
~ Completing necessary administrative procedures for admission
~ Coordinating all treatment activities with services provided to the client by other resources

Service Coordination
~ Tasks
~ Establishing realistic recovery expectations including
~ Nature of services (IOP, Residential etc.)
~ Program goals
~ Program procedures (schedule, services offered)
~ Rules regarding client conduct
~ Client rights and responsibilities
~ Schedule of treatment activities
~ Costs of treatment
~ Facts impacting duration of treatment

Service Coordination
~ Types of services
~ Mental health
~ Physical health (liver (including hepatitis), brain, HIV, tuberculosis, STDs etc)
~ Job skills
~ Employment opportunities
~ Interpersonal skills
~ Training/education
~ Legal services
~ Housing services
~ Food
~ Childcare
~ Transportation

Service Coordination: Collaboration
~ Service coordination is essential to
~ Prevent clients from falling through the cracks
~ Foster a more holistic view of the client…not just a person with an addiction
~ Client no-show because cant find sitter. Noncompliance or responsible parent?
Service Coordination: Collaboration
~ Challenges
~ Use of different assessment tools at each agency to gather same information
~ Produces a fragmented picture of the client (unless integrated)
~ Creates frustration for the client. (Didn’t I just do this?)
~ Agreeing which agency or clinician is “lead” or primary contact for the client and other agencies
~ Lead agency uses holistic assessment that meets the needs of all associated agencies
~ Funding/eligibility barriers (i.e. services for persons with a felony)
~ Difficult to treat clients
~ Differing staff credentials

Service Coordination
~ Challenges to collaboration/service coordination
~ Can occur at 3 levels
~ Personal: Attitudes and attributes
~ Professional: Differing theoretical beliefs/approaches to treatment of addiction, and “jargon”
~ Organizational
~ Not recognizing the need for partnership
~ Lack of a shared mission
~ Lack of ownership by senior management
~ Lack of trust between agencies
~ Unclear guidelines for collaboration
~ Lack of a process for monitoring and managing collaboration process
The End
~ This concludes our series for the Addiction Counselor Exam Review
~ In-depth podcasts and videos of all of the topics we reviewed can be found on our YouTube channel, allceus.com/YouTube or as episodes in the Counselor Toolbox Podcast.
~ If there are areas you would like additional information, please send a support ticket to support@allceus.com and I will create future podcasts for this series based on viewer questions.
Summary
~ Case management is necessary because of poor service coordination, lack of service continuity and difficulty of clients negotiating the gap between services
~ There are many CM models ranging from brokerage to clinical
~ Case managers are charged with developing the comprehensive service plan to ensure client needs are met
~ Collaboration challenges can often be addressed through effective communication, creativity and negotiation

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