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Substance Abuse Case Management, Cheat Sheet of Humanities

Wake Technical Community CollegeHumanities
Prof. Donald Little

Substance Abuse Case Management Notes

Typology: Cheat Sheet

2024/2025

Uploaded on 05/16/2025

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Summary of Chapter 8: Case Management (CAM)
Key Challenges in Substance Use Disorder (SUD) Treatment
Clients often face additional problems (employment, finances, family relationships, legal, health,
emotional).
Ignoring these issues can increase relapse risk.
Ancillary services (e.g., transportation, housing, family counseling) support primary care &
improve recovery outcomes.
What is CAM (Case Management)?
Aims to help client’s access resources to resolve life challenges & reduce stress.
Works alongside primary treatment to enhance recovery.
Can be provided individually or by a team, in various settings (hospitals, residential facilities).
CAM Models
1. Traditional Broker/Generalist Model: Connects clients to external services.
2. Strengths-Based Assertive Community Treatment (ACT): Provides proactive advocacy,
especially for clients with SUD & co-occurring mental health disorders.
3. Clinical/Rehabilitation Approaches: Incorporate therapeutic skills for more intensive care.
Benefits of CAM
Clients with CAM are more likely to:
oEnter & remain in treatment.
oShow improvement in substance use, employment, health, & family functioning.
CAM is most effective when:
oThere’s a strong client-CM relationship.
oServices are structured & accessible.
oCM prioritizes client advocacy & service coordination.
Barriers to Client Engagement
Perceived Importance: Clients may doubt the relevance or need for services.
Perceived Ability: Practical obstacles (e.g., childcare, transportation) or low self-confidence may
hinder engagement.
Motivational Strategies for CAM
Build client readiness through MI, empathy, & acknowledgment of client autonomy.
Break large goals into smaller, achievable tasks.
Address & plan for obstacles (e.g., lack of resources, time constraints).
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Summary of Chapter 8: Case Management (CAM) Key Challenges in Substance Use Disorder (SUD) Treatment  Clients often face additional problems (employment, finances, family relationships, legal, health, emotional).  Ignoring these issues can increase relapse risk.  Ancillary services (e.g., transportation, housing, family counseling) support primary care & improve recovery outcomes. What is CAM (Case Management)?  Aims to help client’s access resources to resolve life challenges & reduce stress.  Works alongside primary treatment to enhance recovery.  Can be provided individually or by a team, in various settings (hospitals, residential facilities). CAM Models

  1. Traditional Broker/Generalist Model : Connects clients to external services.
  2. Strengths-Based Assertive Community Treatment (ACT) : Provides proactive advocacy, especially for clients with SUD & co-occurring mental health disorders.
  3. Clinical/Rehabilitation Approaches : Incorporate therapeutic skills for more intensive care. Benefits of CAM  Clients with CAM are more likely to: o Enter & remain in treatment. o Show improvement in substance use, employment, health, & family functioning.  CAM is most effective when: o There’s a strong client-CM relationship. o Services are structured & accessible. o CM prioritizes client advocacy & service coordination. Barriers to Client EngagementPerceived Importance : Clients may doubt the relevance or need for services.  Perceived Ability : Practical obstacles (e.g., childcare, transportation) or low self-confidence may hinder engagement. Motivational Strategies for CAM  Build client readiness through MI, empathy, & acknowledgment of client autonomy.  Break large goals into smaller, achievable tasks.  Address & plan for obstacles (e.g., lack of resources, time constraints).

CAM Plan Development

  1. Establish Case Manager’s Consensus : Mutual agreement on client needs, priorities, & goals.
  2. Create a Change Plan : Specific steps to achieve goals, informed by consensus. CAM in Practice  Use tools like service request forms to assess client needs.  Provide written materials & follow up to track progress & encourage task completion.  Include supportive significant others when appropriate, but focus on client preferences.  Respond to setbacks with problem-solving & flexibility. Research & Limitations  CAM clients demonstrate better outcomes, but challenges include: o Limited evaluation of standalone CAM models. o Need for quality assurance to ensure consistent, high-quality service delivery. Integration with Interdisciplinary Teams  Case managers provide client insights, address barriers, & align care plans with client needs. Key Takeaways  CAM addresses psychosocial problems linked to addiction, enhancing treatment outcomes.  Strong relationships, structured services, & motivational strategies are crucial for CAM success.  CM’s role extends beyond resource referral, emphasizing ongoing support, advocacy, & engagement.

 Clinical/Rehabilitation Approaches ACT  More comprehensive than traditional broker model  Advocates proactively for developing new community resources as a response to the needs of clients in coping with the problems of everyday living  Most often serve clients with both SUDs & concomitant serious mental disorders o b/c this population can struggle if alone with these problems, they benefit the most from a wide variety of concrete resources & unlimited contacts to improve their functioning in the community Research on CAM Convincing Research  Ppl. Who are given CAM are: o more likely to enter & remain in addiction treatment o Less likely to be readmitted o Show greater improvement across a number of life areas (substance use, employment, physical & mental health, HIV risk behaviors, parenting skills, criminal justice/legal issues, housing, & family functioning) compared to those who aren’t given CAM. CAM appears to be MORE EFFECTIVE when:  there is a strong working relationship between the client & CM  needed services are more readily available & accessible  when the CM follows a more structured approach  more time is spent on care functions (goal setting, case monitoring, client advocacy, service coordination)  the quality in delivering CAM services (MI) through training, coaching, supervision, & strong administrative support Limitations:  Outcome Evaluations  Lack of information on the relative efficacy of stand-alone CAM models o Relative efficacy - refers to how effective one treatment, intervention, or method is compared to another under similar conditions. It measures the comparative success or outcomes between options to determine which works better.  Lack of monitoring & quality assurance to ensure the fidelity of CAM services (making sure that CAM is done properly, following all guidelines, so clients get the consistent & high-quality help they need.) o WHAT DOES “quality assurance to ensure fidelity of CAM mean?”

o Quality Assurance (QA) :  Quality Assurance - involves monitoring & improving the processes & outcomes of CAM services.  It ensures that services meet quality benchmarks & address client needs effectively. o Fidelity :  Fidelity - means providing CAM services as they were designed or intended, without deviation or gaps.  It ensures that clients receive the full range of support they need, like connecting them to appropriate resources or services. o CAM Services :  In this context, CAM refers to case management services, which may include coordination of care, resource referrals, & client advocacy. Client Readiness for Change An important consideration is a client’s readiness to seek services. How willing clients are to undertake various CAM tasks depends on 2 factors:

  1. Their perceived importance of OR need for the service
  2. Their perceived ability to use the service Clients are more likely to use a service if they perceive it to be relevant to their personal goals & possible for them to access. BARRIERS: What might stand in the way of the client’s perceived importance? o Need : Client may perceive that they do not really need the services. o Efficacy : They may not believe the services would be helpful or work for them. o Relevance: They may not perceive a relationship between the services & their problems. o Priority : They may see a need, believe it would be helpful, & see the relevance BUT may have higher priorities right now. What might stand in the way of the client’s perceived ability? o Practical Obstacles : Such as childcare, transportation, safety, cost, etc. that prevent them from seeking services. o Self-efficacy : They may perceive that they are personally unable to do what is needed (don’t have the skills, time, or education). o Feeling Overwhelmed : They may be to demoralized to do it (depression, medical problems, hardships, confusion, low self-esteem)

Why?

  1. Case Manager's Consensus (1st^ Step) : o The CM works with the client to identify & agree on the client’s needs, challenges, & goals. o This step involves active listening, building trust, & creating a shared understanding of what the client wants to achieve.
  2. Change Plan (2nd^ Step) : o Once the consensus is reached, the CM creates a detailed & actionable plan outlining the steps, resources, & strategies needed to achieve the agreed-upon goals. o The change plan is informed by the consensus & tailored to the client’s specific circumstances. Summary: The case manager starts with a consensus to ensure agreement on the client’s needs & goals. Then, they develop a change plan as the next step to outline the actions required to achieve those goals. Establish a consensus with the client concerning which life areas need to be addressed & in what order of priority. o Interesting way to assess discrepancies: both you & the client fill out separate services request forms & fill then talk about & compare your ratings o This identifies differences in perceptions of what is needed & how important each issue is to reaching a specific goal. Negotiate a change plan that the client will endorse, own, & commit to follow. o Clients become disengaged when counselors push their OWN agenda & don’t listen & understand the clients goals Client’s reluctance to follow up/referral may be: o Underlying concerns about the consequences of change rather than unawareness of their CAM needs. o Due to real doubts about their own abilities to succeed with certain goals & task that they require & interfere with the willingness to proceed. Failing to understand & address underlying motivational issues can increase chances of treatment dropout.

Motivational Strategies to Strengthen Adherence

Motivational Interviewing o Empathetic listening o Normalizing counselor/client differences in perception, explaining its common

o Recognize, acknowledge, & honor clients own perspectives & autonomy (their right & ability to make choices on their own)! o Developing Proximal Goals  Developing Proximal Goals o Accomplishing even minor goals helps build confidence, which is important to building motivation! o Break down goals into specific short-term component tasks. o Provide a safe space for the client to feel comfortable in expressing their ambivalence about changing  Problem-Solving Obstacles o Consider/Identify possible Obstacles & Ask how client would respond to it  Ex. Transportation, waiting lists, lack of child care, unexpected illness o Normalize such setbacks so that there is no shame if the client doesn’t carry out the task o Respond to nonadherence/setbacks with problem-solving o What went wrong? What can you & the client do to make it work next time? o Emphasize personal choice o If one referral source doesn’t work out, explore more  Use of Written Materials o Give clients written materials such as brochures, downloads from possible referral agencies that explain location, services, contact persons, fees, insurance coverage, waiting period, etc. o Review materials with client to clarify misunderstanding, alleviate concerns, & support intentions  The Importance of Follow-up o Proactive, assertive follow-up of your clients progress  HOW?  After sessions or progress reports over the phone or email between sessions  WHY?  It communicates that you care, are available, willing to help, & support them  It allows you to intercede if there are obstacles  Objective to follow-up: o Provide support o Monitor progress towards CAM goals o If needed, modify goals/plans or develop new goals  AT FOLLOW-UP: o Ask client “What has happen since your last contact in terms of completing tasks towards CAM goals  For some clients, it may be beneficial to get them to create a log of tasks completed (ex. Went to job interview on 1/2/23) o Affirm clients efforts at completing tasks o Follow up as each successive task is complete, agree on next step, & stay engaged o Remain supportive & nonjudgmental if they didn’t complete task