Case Management in the Health Sector: An Australian Review

 

Questions:			S	NS
1.      In your own words explain what case management is (write one to two paragraphs). Giardino and De Jesus (2021) defined case management as a process in health care in which the professional assists a client or patient to develop a plan that will be used to coordinate and integrate the support services needed by the client or patient for optimizing overall healthcare and possible psychosocial outcomes and goals. What case management process does is that it helps the patent and their family to go through a complicated set of services and support that are made available to them within a benefit plan, an institution or organization, and their community (Hudon et al., 2019).   In any case, one must state that since case management feature wide range of activities, it is challenging providing a uniform definition of case management as a discrete intervention. On the same note, the definitional variability of case management as well as the clinical settings in which case management occur are not always simple, therefore, depending on the service setting and service sector, case management is known to occur across a continuum of involvement that range from relatively brief episodic form of interaction between the health care professional and the patients, to more of a holistic, longitudinal interaction that might occur within the context of a patient that severe mental health issue who has been served over many years by an organization that is based in the community (Lukersmith et al., 2016).			☐	☐
2.      What are five principles of good case management practice?   Principle 1: Client-Cantered One of the principles of a good case management practice is a client-centred case management approach; it ensures that the client is the centre of the planning process and decision making, encouraging the client to actively participate in the process. A client-centred approach requires that the health care professional collaboratively work with the client in order to identify their needs, strengths and goals, how the clients perceive them services and work towards assisting the clients, and also to understand and respondent to their different choices and views (Mission Australia, 2021).   Principle 2: Holistic and Strength-based In a holistic and planning approach to case management, considerations are made for the life domains experienced by an individual, in relation to their needs, strengths, goals and support necessary to achieve set goals. To determine this, different wellbeing index measures are sued such as: standard of living, personal health, achievements in life, personal relationships, community connections, personal safety, and future security. In a strength-based approach, the values, skills, resources and support, and the knowledge of the client are considered, and not just the client’s issues and needs. This approach is focused on the positive aspects of the client, promoting self-esteem and providing the healthcare professional with the opportunity to conduct an all-round assessment of the client’s well-being (Mission Australia, 2021).   Principle 3: Goal Oriented A good practice in case management is to assess, plan and encourage the clients towards creating an achievable and realistic goals, one that is capable of empowering them to develop the skills and knowledge necessary to enhancing independence and self-sufficiency. Such plan should be SMART: specific, measurable, attainable, relevant and time-bound. At the right interval, a review of progress made towards the set goal is conducted, creating room to identify and address the challenges and obstacles, eventually leading to the attainment of set goal (Mission Australia, 2021).   Principle 4: Dynamic and Flexible A good case management practice should be one where the case manager makes sure that the process of engagement is flexible and dynamic enough to address and/or respond to changes that might occur in the life of the patient or in the broader context. This would require that the case manager regularly review and monitor the case plan, which is a “living document”, in line with the relevant support network, patient, and developing alternative strategies that can be used to meet the changes in needs. This could also include providing support in outreach locations in order to meet the needs of the clients, where the service has the capacity to do so. In the event that a case management is transitioned to another worker, it is imperative that the original professional caregiver hands over key information to the new staff in order to make sure that the progress continues and the transmission is smooth for the client (Mission Australia, 2021).   Principle 5: Culturally and Socially Safe A good case management acknowledges, and responsive and sensitive to, the needs and strengths of each client. Therefore, it makes sure that the process is culturally and socially safe, which involves being aware of the cultural and social safety of different people, including those that identify as Aboriginal or Torres Strait Islander or CALD or from a particular faith group (Mission Australia, 2021).			☐	☐
3.      Describe each of the following case management approaches:			☐	☐
	Strength-based approach	As the name suggests, this model is based on the strength of the client. In this approach, the case manager has the responsibility and skill to highlight and analyse the strength of the client. This analysis is then used to provide the groundwork for a service plan that is tailored for the patient. Strength-based case management approach has a promising success rate and this is because it is based on the goals and personal needs of the client, ensuring that valuable information are carefully incorporated in every steps taken in the rehabilitation process. It is a personalized care that dispels the idea of “one-size-fits-all”, instead, creating a care plan that is tailored perfectly towards the individual needs of clients.
	Rights-based approach	This approach places emphasis on the importance of human right and utilizes the strategies that provide support for people to attain their rights. Thus, it is focused on addressing structural issues and barriers, and advocacy. In order for the professional healthcare to effectively work using this approach, the person will need a sound understanding of legislations that support the rights of diverse people and human right in general, including legislations on anti-discriminations, avenues for complaints, appealing decisions, and addressing cases of injustice
	Person-centred approach	This approach acknowledges and respects the contribution that a person can make towards their own need. Therefore, it resects the specific needs and goals of the individual. It relies on the positive relationship and alliance between the manger and the person, as well as working flexibly and collaboratively with one another. In this approach, engagement, motivation and timely response to person’s outcomes are improved.
	Needs-based approach	This approach resects the specific goals and needs of the patient or client, relying on the root cause of the issues under consideration to develop the right plant for effective healing process.

 

4.      In the table below choose three behaviour change models (for example, transtheoretical model, social cognitive theory etc.) Provide a short description of each and provide an example of how each may be used when providing case management for a client.			☐	☐
Behaviour change model	Description	Example of use
Theory of planned behaviour / reasoned action	Developed by Fishbein and Ajzen in the 1970s, the theory posits that behaviour is the outcome of intention, and intention is influenced by the perceived social norms and attitude of the individual (Madden, Ellen, & Ajzen, 1992).   The implication is that the more positive an individual’s attitude is towards changing behaviour, the more likely the person will do the desired behaviour or support the behaviour change.	If someone wants to stop smoking, if the person clearly understand that such change will amount to better health and is willing to access better health, the more likely the person will stop smoking
Social cognitive theory	Proposed by Bandura in 1986, it is an expansion of the scholar’s early theory of social learning, in which it is stated that many of the behaviours are learned by observing other people do the same act in the social environment (Bandura, 1999).   Therefore, in order to adopt a behaviour, one needs to pay attention to the behaviour being modelled, be able to remember it, and reproduce it when the time comes. Rewards might be able to reinforce such behaviour, while punishment will decrease the chances of doing it again.	For instance, if the person sees others quitting smoking and getting better life outcomes, the person will likely quit smoking. The reward in this case, which reinforces the behaviour to quit smoking, is the better life they can access afterwards.
Transtheoretical model	This is also known as the stages of change, and it suggest six stages of change as: pre-contemplation, contemplation, preparation, action, maintenance, and termination (Prochaska, 1979; Prochaska & DiClemente, 1982).	In the case of smoking, the individual starts to think whether or not to quit, then contemplating on the benefits of quitting. With time, the individual starts to prepare to quit, followed by action (stop smoking), maintenance (continue to encourage his or herself to sustain the new behaviour), and finally termination (no longer smokes no matter to circumstances of temptation).
5.      Describe three confidentiality issues when implementing a case management plan.   Issue 1: Disclosure issue At the beginning, the case manager needs to inform the client that any information gathered through their relationship may be disclosed to a third party, for the client to reach the decision of whether or not to continue the process.   Issue 2: Record Maintenance Issue The records of the clients, no matter its form (written, computerized, taped, or stored through other medium) must be maintained by the case manager in a way that will ensure preservation of confidentiality.   Issue 3: Clients’ identify The case manager must at all cost, including when sharing the information obtained through the case management with another party, protect the confidentiality of the client’s identity.			☐	☐
6a. Access the ACWA Community Work Practice Standards at http://www.acwa.org.au/migration-assessment/practic_%20standards_template%20.pdf. How does this document assist case management workers in their professional practice?   The document sets the ethical and practice benchmark for community workers in line with public expectations and industry standards. Therefore, it guides the professional workers on how to work based on set of clear guidelines and strong ethical framework that would ensure delivery of quality services that meet the needs and goals of clients, while also protecting them from all forms of disclosure capable of undermining their human person. ACWA members can be held accountable in cases where they breach any of the Code.			☐		☐

 

6b. What are three other documents available in a community services workplace that set out the legislation and guidelines for case management practice?   Document 1: Australian Community Workers’ Code of Ethics   Document 2: Australian Community Work Practice Guidelines.   Document 3: ACWA-Ethics-and-good-practice-guide		☐		☐
7.      Consider the following scenarios and identify the potential risks to the client and responsibilities for the case manager.
a.       You are aware that the child of a client is not attending school and is living in filthy conditions.		☐	☐
Risks:	Risk of crime and health relates issues, becoming a havoc or menace in the society.
Responsibilities of case manager:	Understand the reasons for not attending school and living in such environment, create the room and plan for necessary change to avert the potential risks identified.
b.      Your client is escaping a family violence situation. She has no access to housing or money tonight.		☐	☐
Risks:	Risk of being homeless, rape, or even death.
Responsibilities of case manager:	Start by sourcing for shelter and proper care, then make moves to get client work where she can earn a living for herself.
c.       Your client discloses that they are planning to suicide with an overdose of sleeping pills that they have hoarded		☐	☐
Risks:	Death
Responsibilities of case manager.	Discover where the overdose was hidden and remove, initiate a rehabilitation process to remove such thought from the client’s mind.

 

d.      Your elderly client tells you that her daughter has control of her finances. She is now planning to sell her house against her wishes.		☐	☐
Risks:	Risk of losing her house and other financial losses.
Responsibilities of case manager:	Get access to law enforcement agencies and protect the client’s finances against potential damages from the daughter.
e.       Your client has a disability and needs a wheelchair to go out of her house. She recently applied for a job in the local library. She was told that she could not be considered for the job as she had a disability and it would be too dangerous for other workers and members of the public for her to be wheeling around between the book stands.		☐	☐
Risk:	Risk of emotional and psychological trauma due to the issues being faced.
Responsibilities of case manager:	Source for wheelchair through donors for the client, rehabilitate the client and try to secure a better job for the client.
f.       Your client has a life experience and values that are very different to your own, and that of other stakeholders in the case management process.		☐	☐
Risk:	Risk of ineffective case management plan as the life experience of the client is different from that of the professional service provider and other stakeholders.
Responsibilities of case manager:	Gain a clear understanding of the client’s life and adopt strength-based and person-centred approach to plan a case management that is tailored for the exact needs and experience of the client.

 

8.      In the table below, list any aspects you need to consider including historical perceptions, life experiences, and special needs/services that are relevant to clients from the following groups.
Group	Aspects to consider
People with a disability	1.      Special needs 2.      Personal experience 3.      History of disability 4.      Rehabilitation or medication used before	☐	☐
LGBTI community	1.      Personal experience 2.      History	☐	☐
Culturally and Linguistically diverse (CALD)	1.      Special needs 2.      Personal experience 3.      History	☐	☐
Older people	1.      Special needs 2.      Personal experience 3.      History 4.      Rehabilitation or medication used before	☐	☐
Children and young people	1.      Personal experience 2.      History	☐	☐
Aboriginal and Torres Strait Islander people	1.      Personal experience 2.      History 3.      Cultural values and norms 4.      Personal needs and goals	☐	☐
People at risk of homelessness	1.      Personal experience 2.      History 3.      Rehabilitation or medication used before	☐	☐

 

9.      Why is it important to consider a client’s family structure and dynamics during case management? This is because a clear understanding of the family dynamics and structure will assist the case manager in providing intervention and resources as needed. This can be based on referencing the family support groups or counselling, encouraging the family members and clients to maintain as much of their usual routines as possible.	☐	☐

 

References

Bandura, A. (1999). Social cognitive theory: An agentic perspective. Asian Journal of Social Psychology, 2(1), 21–41.

Giardino, A. P., & De Jesus, O. (2021). Case Management. Treasure Island (FL), StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562214/

Hudon, C., Chouinard, M. C., Pluye, P., El Sherif, R., Bush, P. L., Rihoux, B., Poitras, M. E., Lambert, M., Zomahoun, H. T. V., & Légaré, F. (2019). Characteristics of Case Management in Primary Care Associated With Positive Outcomes for Frequent Users of Health Care: A Systematic Review. Ann Fam Med, 17(5), 448-458.

Lukersmith, S., Millington, M., & Salvador-Carulla, L. (2016). What Is Case Management? A Scoping and Mapping Review. International Journal of Integrated Care, 16(4), 2.

Madden, T. J., Ellen, P. S., & Ajzen, I. (1992). A comparison of the theory of planned behavior and the theory of reasoned action. Personality and Social Psychology Bulletin, 18(1), 3–9.

Mission Australia (2021). National Case Management Approach. Mission Australia https://www.missionaustralia.com.au/documents/resource-sharing/1303-national-case-management-approach

Prochaska, J. O. (1979). Systems of psychotherapy: A transtheoretical analysis. Dorsey Press.

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, research & practice, 19(3), 276-288.