Introduction
Clinical case management has come a long way to its current definition, interpretation, and scope of activities. The concept of case management and the procedures associated with it are century-old, as they were mentioned by Mary Richmond in 1922 as “social casework” (Kanter, 2010). The key issue in the history of case management has been the simultaneous association with both environmental and psychological interventions. By the 1970s, the issue worsened as social workers engaged in casework pursued the careers of either psychotherapists or community organizers, making the idea of casework obsolete. The introduction of the case management concept in 1976 revived the idea of a profession that effectively combines psychological and environmental interventions (Kanter, 2010). The root of the problem is the difference between the idealized view of case management and the actual challenges that managers face. In the best-case scenario, the case manager should only assess the patient’s needs and coordinate their satisfaction together with other more specialized professionals. However, in the reality, the case manager has to manage the psychotherapeutic aspect of the process as well. This discrepancy within the profession resulted in the development of clinical case management to emphasize the equal importance of environmental and psychological approaches.
Case Management Knowledge Base
Due to the practical nature of the occupation and its broad role, case management professionals are supposed to accumulate knowledge from different fields, such as psychoanalysis, biological psychiatry, medicine, and others. According to Kanter (2010), two key components of the case management knowledge base are “information specific to the client population and the community served” and “specific knowledge of environmental resources.” Various combinations of diseases and disorders, including mental ones, can produce unexpected results and complicate the treatment. Thus, case managers need to be able to understand the situation fully and take the most appropriate actions. Regarding environmental resources, the case manager is expected to be able to assist the patient with any information and procedures needed for the patient in their specific circumstances (von Wangenheim & Nunes, 2019). For instance, in case the patient is to return to work, the case manager should be able to consult the patient about the relevant employment programs and social benefits. This is especially important because the external resources and the patient’s freedom to choose may be limited, and the case manager will have to resolve the situation on their own.
Case Management Practical Issue
As mentioned, one of the key practical issues in clinical case management is the need for the case manager to connect the client with appropriate resources with sufficient psychological support during the process. Separating the roles of the therapist and facilitator is virtually impossible in real-world scenarios (Suzuki et al., 2019). Moreover, it may be necessary for case managers to provide adequate psychological support to patients because, without it, some environmental interventions may not be effective. How a patient is approached can significantly affect the outcome of any intervention – this requires knowledge, skill, and understanding on the part of the case manager.
The role of the facilitator is equally vital within case management because, in many cases, the manager is the only person who can gather all the necessary information and use it appropriately. In addition, when it comes to group engagement in case management, the facilitator plans and leads the planning event and manages it, ensuring several things. Among these are, first and foremost, the effective achievement of the case goals, a clear understanding of what is going on by each participant, good involvement of everyone in the discussion, and getting the most out of everyone. The problem with facilitation in case management is that this procedure can take a lot of mental effort (Parker, 2018). During the facilitation process, it can be challenging for a person to think about the content of the meeting, much less contribute to it. Neutrality on the part of such a person is also essential. Thus, planners should consider bringing in an outside facilitator if they have an interest in the outcome of the meeting.
Another challenge in case management is assessing the client’s situation and needs. For each client, the case manager makes an individual card. It contains information about the date of admission to the case management project, individual data, and contact information. In addition, it indicates whether the client is registered with the AIDS center, whether he or she has been tested for CD4 levels, whether he or she is receiving substitution maintenance therapy, and whether he or she has been on tuberculosis prophylaxis treatment (Jeong et al., 2019). Based on these data, the case manager determines the stage the client is at and makes an individualized follow-up plan. It can be problematic that the client may not know or remember important information for the card or may deliberately withhold some information. Because of this, the data may be incomplete or inaccurate, making it difficult to make an individualized plan.
Case Study by Kanter
Clinical case management is a complex and multi-component process that runs individually for each client. Case studies provide a comprehensive introduction to it. There are many valuable lessons for clinical case managers in the study presented by Kanter. The most important lesson for me was to be persistent and patient, even if the patient refuses to make contact. For example, Kanter (2010) followed his patient down the street for several hours and then bedded a meeting with him in the theater to make contact. At first glance, it would seem much more effective to keep a patient named Craig off the street and try to talk to him at home. However, Kanter acted in a much more thoughtful manner, showing an insistence on dialogue and at the same time giving the patient a free hand.
Conclusion
From this comes the next lesson, which is that the patient must not be restricted because it must be shown that the case manager is here to help, not to inconvenience. This is important to show patients in crisis or patients with mental disorders because they, like Craig, will probably at first see the attempt to help as hostile. The job of the clinical case manager, on the other hand, is to make the patient feel comfortable with him or her and with what will be offered as treatment. In general, the case study provided by Kanter (2010) shows a variant of interaction with a crisis and distrustful client. It is a good lesson about patience when working with patients for future clinical case managers. Crisis patients need to be unobtrusively and kindly cooperated with enough persistence to achieve the best possible outcome.
References
Jeong, W., Keighley, C., Wolfe, R., Lee, W.L., Slavin, M.A., Chen, S.C., & Kong, D.C. (2019). Contemporary management and clinical outcomes of mucormycosis: A systematic review and meta-analysis of case reports. International Journal of Antimicrobial Agents, 53(5), 589-597.
Kanter, J. S. (1988). Clinical issues in the case management relationship. New Directions for Mental Health Services, 1988(40), 15-27.
Kanter, J. (2010). Clinical case management. In J. Brandell (Ed.), Theory and practice of clinical social work (2nd ed.). Columbia University Press.
Parker, D. (2018). Case management. In Dementia care (pp. 35-45). Routledge.
Suzuki, K., Yamaguchi, S., Kawasoe, Y., Nayuki, K., Aoki, T., Hasegawa, N., & Fujii, C. (2019). Core services of intensive case management for people with mental illness: A network analysis. International Journal of Social Psychiatry, 65(7-8), 621-630.
von Wangenheim, A., & Nunes, D.H. (2019). Creating a web infrastructure for the support of clinical protocols and clinical management: An example in teledermatology. Telemedicine and e-Health, 25(9), 781-790.