HIV case managers have worked with fewer resources in recent years. This suggests they could best help their patients if they collaborate with other service providers.

The results of a new study suggest case managers and other providers need greater awareness of each other’s expertise and understanding of the communities they serve. This allows them to collaborate with other agencies in making referrals and developing programs.1

“Organizations need to reassure case managers that while doing interprofessional collaboration they’re not losing clients,” says Rahbel Rahman, PhD, LMSW, assistant professor in the Graduate School of Social Work at Fordham University in New York City. “We need to reconceptualize how we define outcomes and how we define provider success. It could be that sometimes in budget constraints you may feel a little fearful about making referrals.”

For example, a client might visit one agency and case manager for HIV clinical services. A second agency offers clinical services and mental health services. “I might feel like I don’t have mental health services in my agency, so I make a referral to the second agency,” Rahman says. “I would be afraid about making the right referral and wondering if they would take away my client because they have both services.”

Is it better not to send the client to two different agencies? “These are questions that are important in how we define success,” Rahman says. “How are we accountable to our funders when we talk about collective ownership and interprofessional collaboration?”

The case manager’s role is to ensure clients receive comprehensive services. They also have to think about organizational culture and how their collaborations and referrals might affect their own organization’s fiscal health. “The work of a case manager cannot be done in a silo,” Rahman says.

IPC Best Practices

Researchers studied best practices for interprofessional collaboration (IPC). They surveyed 112 case managers, 80 peer educators, and 75 counselors in New York City. They asked for demographic information, and assessed their knowledge, skills, and self-efficacy, as well as their understanding of the community.1

All the professionals interviewed worked in 36 agencies in New York that offered HIV prevention services or clinical services. “These case managers are offering services to those who are at risk for HIV or need any assistance regarding linkages to HIV and social services,” Rahman says.

Researchers assessed whether case managers, counselors, and peer educators were confident in their ability to make referrals. “We asked about their opinions and experiences with intercollaboration in HIV care,” Rahman says.

They looked at five domains of IPC. These included interdependence, professional activities, flexibility, collective ownership of goals, and reflection on process. The researchers found most case managers were Black and women. Also, a large portion of them had held the position for less than one year.

“Most of the counselors were social workers or mental health counselors and had professional licensure,” Rahman says. “Most of our providers, overall, said they had received formal HIV prevention training.”

The mean age of the providers was 40 years. About half the case managers had a bachelor’s degree. Thirty-five percent of counselors held a master’s degree, and 35% of peer educators earned a high school diploma or GED. Researchers found significant predictors of IPC included knowledge, skills, competence, and understanding of the community.

“Our study warns about the need for greater training and supervision to ensure providers are able to go beyond stipulated ability and resolve conflicts,” Rahman says. “These jobs warrant interprofessional collaboration to integrate services. Providers need confidence, and that can only be given in terms of assuring them of what they can and cannot do. This happens through training.”

Although this study was conducted before the COVID-19 pandemic, its findings were extremely important to the major disruption of preventive clinical and social services during the pandemic, she says.

“Imagine what is happening in the pandemic when providers may not be exclusively having in-person visits right now,” Rahman notes. “Think about how referrals were affected when so many providers were laid off because of budget shortfalls and constraints in different agencies. That’s what we are seeing.”

Providers were working virtually, under extremely tight budgets. “When we conducted the study, we saw that the Centers for Disease Control and Prevention started to de-emphasize the implementation of behavioral interventions, creating budget constraints,” Rahman explains. “Providers would say ‘I don’t want to give my referral to another agency,’ not realizing they’re offering a continuum of care.”

Providers should make a concerted effort in this environment to reinforce and demonstrate greater leadership. Providers and case managers need to collaborate interprofessionally and make effective referrals.

“It’s not to think in terms of losing clients, because the agency’s effectiveness is influenced by the clients they serve,” Rahman says. “We need to think about how to redefine ownership when talking about collective ownership and how to redefine measurements of our collective success.”

REFERENCE

  1. Rahman R, Meireles Pinto R, Troost JP. Examining interprofessional collaboration across case managers, peer educators, and counselors in New York City. Soc Work Pub Health 2021;36:448-459.