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Substance Abuse Case Management Notes
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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
CAM Plan Development
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:
Why?
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