3 N/A 4 Case Management Steps

o Assessment

o Planning

o Implementation and Coordination

(Networking) o Monitoring o Evaluation o Advocacy 4 4 4 4 4 4 45

CURRENT LOCAL PRACTICE

Tamara Blickem from the Office of the Public Defender, Ninth Judicial Circuit surveyed local community agencies using the Case Management Checklist. At the time this report

went to press, only four agencies had responded: the Salvation Army, Miracle of Love, Lakeside Alternatives and the Center for Drug Free Living. The Case Management Checklistwas completed based on this sample of four community provider agencies.

To bring additional research to bear on the issue, the Center for Community Partnerships (CCP) consulted a previous study conducted on case management services in central Florida during the spring of 2003. The results of this previous survey are currently being used by the CCP in the design of a continuing education case management certificate program. The research included: (a) a brief telephone survey to provide an asset map of case management services, (b) research on the subject of best practices in case management, and (3) the conduct of focus groups with case management supervisors in a number of service areas. The results are presented below.

Asset Mapping Survey of Case Management Services & Activities

The following are questions that were asked of local case managers concerning their activities and services as well as the structure of their organizations. The answers provided are a compilation of the responses and provide an overview of the information that was received.

What type of case management services or activities is provided by your organization?

This was very organization specific. However, there did not seem to be any overall

coordination of case management of clients. If a client was referred to another organization they were then managed by that organization. There appeared to be little inter-agency coordination of case management by that organization. Also, numerous organizations said they would not accept clients that had substance abuse problems.

What are the hours of operation?

Most organizations operated between 8 a.m. – 5 p.m., Monday – Friday. Depending on the type of service offered, some were open 24/7. Most provided on-call services. .

How many case managers does your agency have on site?

What are the basic educational and work experience requirements for case managers?

Almost all the organizations required at least a bachelor’s degree, however, a few mentioned they had staff that had been grandfathered in and a few said they would accept experience as equivalent. Some required a bachelor’s degree plus some experience. A small percentage had staff with a master’s degree.

How many clients does your agency see on average per month?

The range of responses for this question was substantial. It really depended on the type of service being provided by the organization. For example a homeless shelter serviced 800 clients per day, but for another organization it was as few as 10 clients per week. There were organizations that had a large volume like 300-400 per month per case manager. The mode was between 30-40 cases that had to be seen per month per case manager. A lot of the organizations were required by Florida law to have specified case loads, depending on the service area.

How are referrals made? (To your agency)?

A significant number of organizations said they got referrals via word-of mouth, walk-ins, or a friend or neighbor told them about the organization. Organizations refer to each other, as did a lot of state agencies. One organization mentioned that clients in Seminole County are given a list of providers and the client gets to pick the organization. No one in Orange County mentioned this approach.

How do you know whom to refer to?

The vast majority said they know the case management community and they “just know.” It was also mentioned that the Community Services Network (Yellow) book was used as a reference but it was criticized as being at least a year old at any given time.

Summary of Focus Group Findings Conducted on June 26, 2003

Two focus groups were held with local agencies that provide case management services across a variety of service areas. The summary of findings is presented below.

Basic ideas for excellent in case management certificate program: 1) Real life experience with 2-1-1

2) Understand NIRS taxonomy systematically approaching client need. 3) Understand basic human needs

a. Basic needs first of food and housing

4) Agencies need to know more about each other 5) Strong understanding of community resources

6) Understanding the funding streams and the impact on service referral 7) Clear understanding of eligibility requirements

8) Understand what motivates your funder and why you need to do outcome reporting a. Include outcome based training

9) Know how to read complex materials for bureaucratic requirements 10)Teach systematic approach

11)Legal requirements a. Confidentiality

b. Ethics & shared motives

c. Help to professionalize the profession

12)Documentation especially for non-social work majors

13)The eligibility forms are very difficult to understand and need a manual that is easy to understand

14)Awareness of cultural competence 15)Supervisory component

16)Technology – software systems

17)Core competency: people skills, interviewing skills, ability to gain trust (see Table):

Strengths Challenges

Support in the community Fragmentation (Jacksonville model for

integration across 211

University willing to participate Strength is the eligibility component

Confidentiality issues Confidentiality issues

Technology integration among certain groups

Silo perspective

Paperwork; funding streams

Revolving case managers because of salary variation

18)Salaries among organizations for entry level case managers (see Box):

Salaries of Entry Level Case Managers

Organization Entry – Level Salary

Range Work Force $26,000 - $28,000 Mental Health >$20,000 Homeless Organizations $18,000 - $20,000 Substance Abuse $21,000 - $25,000 Orange County $25,000 Howard Philips $29,000

19) Perfect case managers program would include: a. On-line component

b. Interaction and case approach

c. Provide classes on evenings and weekends (perhaps 1 weekend per month) d. Screening of students to determine proper fit with profession of case

management

e. Use an introductory course to help identify those individuals that need to be redirected to another profession

19)How to utilize 2-1-1 in case management program for students: a. Have a 2-1-1 staff training

b. Dove-tail with 2-1-1 certification

c. Research & Referral scavenger hunt for services d. Quality assurance component

e. Customer satisfaction f. Customer service 20)Excellence in listening skills

21)Scholarship sources

a. Funding sources may be interested in just covering a couple of courses b. Look at the market; what can potential students afford

c. Look for funding partner

Summary of Focus Group Findings Conducted on June 27, 2003

1) Components of a good training program

a. Budgeting – how do you manage your own resources

b. Skill set – assessment skills: planning, monitoring, communication c. Creating case plans: measurable and individualized

d. Critical pathways analysis: How to interpret ISD (Intensity of service, severity of disease)

e. Structural: basic skills 2) Resource development

a. Knowledge of resources

b. University of Kansas: Developmental acquisition.

c. Seek resources when missing. Case managers help identify system gaps. d. Community forum to coordinate policy

3) Ethics/ Moral components a. Confidentiality: HIPPA

4) Assessment: Case Plans: Activate: Measurement (create links through these phases) 5) Documentation skills

6) Management skills for career advancement 7) Understanding of organizational outcomes

a. Why do we need to collect data b. Productivity measurements c. Tracking activities

8) Technology: software

9) Emergency Department Case Management has different components than typical case management

10)Need to know how to work with resistant, non-compliant clients. Know the difference between disagreement and cultural resistance

11)Need cultural competency

a. Languages of the community b. Language bank started under CAP 12)Creating professionalism for yourself

a. Resources are: journals, certifying organizations, networking groups 13)Develop practicum and mentoring

15)Discharge timing for management of case loads 16)Salaries of case managers (see Table):

Salaries of Case Managers Organization Salary Orange County $25,000 RN Case Managers $40,000 - $50,000 RN Nurses $30,000 SW Nurses $37,400 Health SW $20,000 HIV/AIDS $22,000 RN ED $43,600 Work Force $26,000 - $30,000 CCE $24,000 17) Strengths Challenges Technology to assist tracking,

measuring, communication

Fragmentation, need coordination

211: Central point of entry Perception of profession not

as respected Use the lessons learned in our

own community

Salaries are low: service profession, not $ generating Link to research to quantify

benefits of case management

Hard to measure successes in area of prevention

18)Open entry

19)Have case management modules so you can pick what you want. This is much needed do to a growing population of uninsured and underinsured.

20)Cohort aspect, on-line component