Case management Case management By By Prof. Ki Ki- -Yan MAK - PowerPoint PPT Presentation

Case management Case management By By Prof. Ki Ki- -Yan MAK Yan MAK Prof.

Introduction Introduction   Need to coordinate different psychiatric Need to coordinate different psychiatric services led to development of case services led to development of case management model management model   Yet there is absence of a common Yet there is absence of a common definition for all users. A general one is definition for all users. A general one is “A strategy for distributing and A strategy for distributing and “ coordinating services on behalf of coordinating services on behalf of patients” ” ( patients (Modrcin Modrcin et al, 1985 Case management with et al, 1985 Case management with psychiatrically disabled individuals. Lawrence, Kansas: Universi psychiatrically disabled individuals. Lawrence, Kansas: University of ty of Kansas) Kansas)

Historical development Historical development   In the US, a rapid expansion of human service In the US, a rapid expansion of human service programs – – specialized services for narrowly target specialized services for narrowly target programs groups, which result in many uncoordinated, groups, which result in many uncoordinated, fragmented, duplication services. Integration programs fragmented, duplication services. Integration programs are needed, and case management is one. are needed, and case management is one.   Deinstitutionalisation demand reasonable continuity of Deinstitutionalisation demand reasonable continuity of service in the community, but they developed service in the community, but they developed complicated adaptation problems in society. Case complicated adaptation problems in society. Case managers are opportune providers to fill the various managers are opportune providers to fill the various needs needs   Ref: Ref: Intagliata Intagliata, J (1982) , J (1982) Schiz Schiz Bull, 8, 655 Bull, 8, 655- -673 673

Historical development of Historical development of ACT ACT   1965- -70 Arnold Ludwig, Arnold Marx & Mary Ann Test 70 Arnold Ludwig, Arnold Marx & Mary Ann Test 1965 implemented innovative inpatient psychosocial implemented innovative inpatient psychosocial programs to combat institutionalization at Mendota programs to combat institutionalization at Mendota State Hospital, Wisconsin, resulting in better hospital State Hospital, Wisconsin, resulting in better hospital adjustment & more ready for discharge. But no adjustment & more ready for discharge. But no improvement in community adjustment. Joined by improvement in community adjustment. Joined by Leonard Stein, intensive postdischarge postdischarge community community Leonard Stein, intensive aftercare program was provided, effective even for aftercare program was provided, effective even for disturbed symptomatic patients disturbed symptomatic patients   1970- - Total In Total In- -Community Treatment & Training in Community Treatment & Training in 1970 Community Living, Assertive Community Treatment Community Living, Assertive Community Treatment Team, etc. were developed with positive results Team, etc. were developed with positive results   Ref: Thompson et al (1990) Hosp & Ref: Thompson et al (1990) Hosp & Comm Comm Psychiat Psychiat, 41, 625 , 41, 625- -634 634

Definition Definition   A modality of health practice that, in A modality of health practice that, in coordination with the traditional focus on coordination with the traditional focus on biological & psychological functioning, biological & psychological functioning, addresses the overall maintenance of the addresses the overall maintenance of the patient’ ’s physical and social environment with s physical and social environment with patient the goals of facilitating survival, personal the goals of facilitating survival, personal growth, community participation, and recovery growth, community participation, and recovery from or adaptation to the illness from or adaptation to the illness   Kanter, J (1989) Hosp & , J (1989) Hosp & Commun Commun Psychiat Psychiat, 40 361 , 40 361- -376 376 Kanter

Hong Kong definition Hong Kong definition   A systematic process of assessment, A systematic process of assessment, service co- -ordination, monitoring and ordination, monitoring and service co evaluation through which the unique evaluation through which the unique needs of clients are met needs of clients are met   Hospital Authority, 1995 Hospital Authority, 1995

Community psychiatric Community psychiatric nurses as case managers nurses as case managers   Direct client nursing care at home (& injections prn prn) ) Direct client nursing care at home (& injections   Continuity of care from hospital to community Continuity of care from hospital to community   Often have administrative training & should be able to Often have administrative training & should be able to assess level of functioning & other needs including assess level of functioning & other needs including physical & psychological aspects physical & psychological aspects   Used to 24 hours shift work, with ease to call on Used to 24 hours shift work, with ease to call on medical/psychological support during crisis medical/psychological support during crisis   Introduced to community nursing services (general) in Introduced to community nursing services (general) in 1996 (Mackenzie, et al, 1997 Evaluation of a pilot project to introdu 1996 (Mackenzie, et al, 1997 Evaluation of a pilot project to introduce ce case management into community nursing services in Hong Kong. Th case management into community nursing services in Hong Kong. The e Chinese University of Hong Kong) Chinese University of Hong Kong)

Case managers Case managers   In principle, every health care team member ca In principle, every health care team member ca be a case manager, but matching the most be a case manager, but matching the most suitable person is essential for the success suitable person is essential for the success   Initially case managers are to refer to, Initially case managers are to refer to, coordinate and integrate various psychiatric coordinate and integrate various psychiatric services into a cohesive program best suited to services into a cohesive program best suited to the individual needs of the patients the individual needs of the patients   Special features: individualised individualised continuity of continuity of Special features: care, comprehensiveness (a variety of care, comprehensiveness (a variety of services), longitudinality longitudinality (over time), supportive (over time), supportive services), relationship with caregiver relationship with caregiver

Case management Case management functions & activities functions & activities   Assessment: information collection & integration Assessment: information collection & integration   Linking: aware of resources & barriers for devising Linking: aware of resources & barriers for devising treatment plan, support patient own responsibility treatment plan, support patient own responsibility   Monitoring: notice changes though regular contact Monitoring: notice changes though regular contact   Assistance in daily living: encourage realistic Assistance in daily living: encourage realistic independence, with direct/indirect assistance independence, with direct/indirect assistance   Crisis intervention: identify early warning signs, timely Crisis intervention: identify early warning signs, timely support support   Advocacy: identify gaps & needs Advocacy: identify gaps & needs   NB collaboration between professionals & family NB collaboration between professionals & family members members   Ref: Intagliata Intagliata et al (1986) et al (1986) Schiz Schiz Bull, 12, 700 Bull, 12, 700- -708 708 Ref:

Principles of clinical case Principles of clinical case management management   Continuity of care that address the patients need for an Continuity of care that address the patients need for an extended period extended period   Use of case management personalised personalised relationship (a relationship (a Use of case management companion or guide rather than an agent) companion or guide rather than an agent)   Titrating environmental support and structure (at Titrating environmental support and structure (at optimal level) to patient’ ’s changing needs s changing needs optimal level) to patient   Flexibility tailor the intervention strategies to Flexibility tailor the intervention strategies to accommodate the diverse needs accommodate the diverse needs   Facilitating patient personal resourcefulness in self- - Facilitating patient personal resourcefulness in self management management   Kanter, J (1989) Hosp & , J (1989) Hosp & Commun Commun Psychiat Psychiat, 40 361 , 40 361- -368 368 Kanter