CMs meet mental health clients face to face
CMs meet mental health clients face to face
Case managers work to establish rapport, trust
By meeting their clients face-to-face and building relationships, case managers at the Mental Health Association of Westchester County, NY, are able to help adults and children working through mental illness or emotional distress access the kind of help they need to stabilize their conditions, says Amy Kohn, PhD, chief executive officer of the private not-for-profit mental health multi-service organization in Tarrytown, NY.
Case managers have either a master's degree in social work or the equivalent or a bachelor's in social work with several years of experience in working with the population to which they are assigned. The case managers do not provide therapy; instead, they address social issues such as food, shelter, and transportation and help remove barriers to the patient's goal.
"A lot of what the case managers are doing is identifying community resources and helping the individual access them, whether it's a doctor's appointment, a job, housing, social programs, or going to a school meeting to get a child back in school if he's been suspended," Kohn says.
The organization offers a variety of programs that vary in intensity depending on the needs of the patients. About 90% of the financing for the programs is provided by public funding. "Regardless of the type of individual, the case managers begin by completing a detailed assessment and developing a care plan that helps the individual identify their hopes and dreams for the future and a way to fulfill them. The common denominator is that the case managers work with their clients face to face and develop a relationship that builds trust and credibility," Kohn says.
Successful case management is based on creating a good relationship, and it's difficult to do that over the telephone, particularly with individuals who are facing multiple challenges, Kohn adds.
"These are individuals and families for whom traditional services haven't worked, not necessarily through any fault of their own," she says. "They are coping with stress and are not able to connect with the kinds of systems that are available to them. They are distrustful of institutions and may reject the notion of help for numerous reasons. Face-to-face meetings are a must."
Case managers meet their clients in their homes, at libraries, parks, fast-food restaurants, or wherever else the clients are most comfortable. Seeing patients outside the clinic setting is more effective than seeing them in the clinic, Kohn points out. "The no-show rate in clinics is huge, whether they're mental health clinics or primary care clinics. Clients may not have transportation and no money to pay for it, they may lack childcare, or have to take a two-hour trip and change buses to get to a clinic. A lot of things get in the way, and that's why we see our clients in person," she says.
Case managers in the Care Coordination program provide intense case management for individuals who are not connected to any service provider and who frequently are admitted to the hospital, have multiple emergency department visits, and/or are confined to jails and other institutions. Many are homeless. Most have physical problems and social issues as well as behavioral health issues. "These patients have intense needs and have been referred to us because they are recognized as individuals who are disenfranchised," Kohn says.
Case managers in the Care Coordination program have a caseload of just 12 clients at a time and spend an average of one to two years working with the client. At first they may see them in person every day. As the client stabilizes, the visits may taper off. By the time patients are ready to be discharged from the program, the case managers may be calling them weekly and seeing them in person once a month.
When they get a new client, the case managers' first challenge is to find the person. "Sometimes we're lucky enough so the client is referred while they're still in a shelter, the hospital, or jail. Often the last known address isn't correct so the case manager has to literally go out looking for them, enlisting the help of relatives or other people who know them," Kohn says.
When the case managers locate the person, they set up a meeting and introduce the services. The case managers help the clients set goals and priorities and address all life issues one at a time. For instance, if the goal is to see a primary care provider, the case manager will set up an appointment and often accompany the client.
They help patients connect to a primary care clinic to receive medical care instead of waiting until their condition necessitates an emergency department visit or hospital stay. They connect them to mental health providers and assistance with medication. They help them find housing and help with the paperwork and bureaucracy involved in signing up for disability and social services.
Case managers also provide intensive case management for children who have been diagnosed with emotional disturbances and their families. "This is a very stressful situation for the family, and case managers almost always are called in at the moment of crisis," she says. For instance, the child may have been expelled from school and working parents don't have childcare so there's no one to supervise the child while they are at work. In many cases, the child has been discharged after an inpatient psychiatric stay.
When families are newly referred to the program, the case manager may visit the home several times a week to develop a care plan and stabilize the situation, then help link the family to programs and services in the community. "A lot of the case managers' work is assessing community resources and developing natural support systems," Kohn says. "For instance, a neighbor could be signed up to get paid a small amount and take care of the child while the parents work."
The case manager connects the family to a clinic where the child can receive treatment and the family will get emotional support. They act as an advocate for the child with the school system to ensure that the child can continue to get an education.
The organization also provides supportive case management for individuals who have a stable living situation and are less fragile psychiatrically but who need maintenance to make sure they are staying on track. These case managers use a combination of personal visits and telephone calls to help their clients manage problems as they occur. For instance, if the individual is working, the case manager may provide job coaching to help them work through problems with the boss or co-workers.
They may accompany clients to their first visit at a primary care clinic or go with them to sign up for social services or disability, helping them fill out the forms. "We operate in a very person-centered, motivational, and non-threatening way. We don't tell them we're going to get them a particular service," she says. "We provide support, rather than doing things for the individuals. We want to help them learn how to access services for themselves."
By meeting their clients face-to-face and building relationships, case managers at the Mental Health Association of Westchester County, NY, are able to help adults and children working through mental illness or emotional distress access the kind of help they need to stabilize their conditions, says Amy Kohn, PhD, chief executive officer of the private not-for-profit mental health multi-service organization in Tarrytown, NY.Subscribe Now for Access
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