Case Management18th Annual NADCP Training Conference

Nashville, TNJune 1 2012

Chief Mack Jenkins, M.S.San Diego County Probation

ObjectivesDefine Case Management

Discuss the Core Functions of Case Management

Review Evidenced Practices of Case Management

Review Strategies of Case Management

Definition Of Case Management• a collaborative process which assesses, plans,

implements, coordinates, monitors and evaluates the options and services required to meet an individual’s health needs, using communications and available resources to promote quality, cost-effective outcomes.”

Case Management Society of America

More DefinitionsThe provision of, or referral to a

comprehensive set of services designed to increase the probationer’s overall success.

A system of support, monitoring and advocacy to assist the probationer through change.

“helping people whose lives are unsatisfying or unproductive due to the presence of many problems which require assistance from several helpers at once” (Ballew and Mink, 1996, p. 3)

Case Management In Drug CourtMore than one case managerNon-case managers providing some servicesCoordinated case management a mustSharing of information from all team

membersEveryone’s on the same page

Core Functions Of Case Management

Core Functions Of Case Management

AssessmentPlanningLinkageMonitoringAdvocacy

It begins with EngagementDetermine motivation to change behavior Identify degree of support from family and

friends. Discuss realistic criminal justice system (or

other) consequences. Establish a positive, professional, therapeutic

relationship with the participant. Be consistent

Try to identify the problem…Is it addiction?Is it criminal thinkingIs it co-occurring disorders (MH, DD,

Physical)Is it all of that…and more?

AssessmentMake sure it’s ongoing.Avoid duplication when possible.Consider and discuss varied responses.Consider formal and informal assessment.Coordinate!

Assess Your AssessmentsWhat assessments are being conducted?Who’s conducting them?Are they 3rd or 4th generation?What are the assessments assessing?How is the information being shared?

Case PlanningDon’t overwhelm the participant—make it

doable.Include the participant in developing the case

plan.Make the tasks and objectives measurable.Prioritize the tasks.SMART: specific, measurable, attainable,

rewarding, timelyIndividualize! Individualize! Individualize

Case Planning QuestionsIs there more than one case plan?If there are, can they be combined?If they can’t, how can your team be sure they

don’t contradict each other?Do all team members know what’s on all case

plans?Does the participant know what’s on all case

plans?!

LinkageKnow what services are available in your

community.Know the services participants are eligible

for .Know the participants.Help the participants make the initial

contact.Follow up after a referral is made

Linkage QuestionsWhat services do your drug court

participants need?What services does THIS participants need?What changes do you see in your target

population? In your community?What partnerships do you need to make to

increase services available to participants?

MonitoringDetect non-compliance including new AOD

use.Catch the participants doing something right!Assess the recovery environment (i.e. home)Track attendance and participationShare information timelyLook for small changes

Monitoring QuestionsDoes your drug court team have a community

supervision component?How often are participants seen in their

homes?Are searches allowed? Conducted?How often are participants drug tested?How is information shared and how timely is

it shared?

MonitoringMultifaceted:

Quality assurance of service provisionprobationer performance: attendance,

participationCoordination of assessments with providers

SupervisionOffice visitsHome visitsOther field contacts

Drug Testing

Field VisitsIdentify goals of visitUse visit to assess the recovery environmentCommunicate the good and the bad back to

the team—timely!Safety First!

AdvocacyKnow what participants can do and what

they need help with.Help the participant assert him/herself and

learn to advocate for him/herself.Identify program areas that need some

advocacy for the benefit of all participants.

Advocacy QuestionsWhat’s the difference between helping and

enabling?What skill development is occurring to help

participants learn how to advocate for themselves?

Eight Evidence-Based Principles for Effective Interventions

Eight Evidence-Based Principles for Effective Interventions

1. Assess Actuarial Risk/Needs.2. Enhance Intrinsic Motivation.3. Target Interventions.4. Skill Train with Directed Practice 5. Increase Positive Reinforcement.6. Engage Ongoing Support in Natural

Communities.7. Measure Relevant Processes/Practices.8. Provide Measurement Feedback

NIC, 2004

1. Assess Actuarial Risk/Needs

Know the assessments usedReview assessments with offenderIncorporate into case planRe-assess and measure change

2. Enhance Intrinsic MotivationUse verbal and non-verbal communication

skills: Attending, reflections, summarizations, open-ended

questions, etc.Explore offender’s attitude toward changeAvoid non-productive arguing and blaming Encourage praise, be optimistic

3. Target Interventionsa. Risk Principle: Prioritize supervision and treatment resources for higher risk offenders.b. Need Principle: Target interventions to criminogenic needs.c. Responsivity Principle: Be responsive to temperament, learning style, motivation, culture, and gender when assigning programs.

3. Target Interventionsd. Dosage: Structure 40-70% of high-risk offenders’ time for 3-9 months.

e. Treatment: Integrate treatment into the full sentence/sanction requirements.

4. Skill Train with Directed PracticeUse Cognitive Behavioral treatment methods

Support treatment efforts in field workUnderstand anti-social thinking and

appropriate communication techniquesPositively reinforce pro-social attitudes and

behaviorsMake appropriate referrals using evidence-

based information

5. Increase Positive Reinforcement

Identify short-term goals for participants

Acknowledge achievement of short-term goals

Convey optimism that the participants can change

Encourage and praise any evidence of pro-social behavior.

Reinforce participant change talk and self-efficacy

6. Engage Ongoing Support in Natural CommunitiesAssist participants in identifying who is

supportive and who is not

Conduct frequent home visitsCase Managers need to learn and apply

relapse prevention techniques. Identify and establish relationships with

participant’s positive support systems in the community.

Recognize triggers for relapse and make timely intervention

7. Measure Relevant Processes/Practices

Documentation! Documentation! Documentation!

Identify strategies

“You can’t manage what you don’t measure”

8. Provide Measurement FeedbackFeedback to the participants

Feedback to your supervisor

Feedback to service providers

Case Management Strategies

Drug Court Populations

Re-entry

Juveniles and Young Adults

Participants with a Mental Health Diagnosis

Re- Entry Population“an estimated 80% of the state prison

population report histories of substance abuse, 90% fail to obtain those services while incarcerated. It is estimated that only 10% of offenders receive appropriate community linkage and follow-up services upon release.”

Scott SylakPresident, National TASCHouse Subcommittee HearingFeb. 8, 2006

Strategies for Reentry Process starts at the time of the presentence

report.Services accessed while in custody.Upon release, re-assessment and linkage to

community services.Coordination and information flow

throughout the process is key.

Juvenile and Young Adults:Significant brain distinctions

Memory deficitsIncreased impulsivenessVisual learningDisturbed sleep cycles“Hormone Hell”

Brain ChemistryFor different reasons, brain chemistry is an

issue for juveniles, young adults and methamphetamine users.

A longitudinal study on adolescent brain development shows that brains are still developing until age 24 or so.

Methamphetamine causes physical changes in the brain.

JuvenilesConsider brain development issuesProvide sequential directionProvide shorter time span between hearingsFocus on short-term goals and outcomesDifferentiate between willful non-compliance

and inability to complyEncourage “dream talk” to begin goal

discussion

Young AdultsConsider brain development issuesProvide sequential direction18-24 year olds are still going through some

of the same changes as their younger counterparts

Methamphetamine UsersConsider brain development issues-reduced

memory, lack of motivation, lack of feelingsProvide sequential directionAttend to the physical maladies caused by

useAttend to the life skills deficits left by useConstantly keep the message hopeful,

simple, clear, and consistent.

With many participants, but especially meth users and youthPatience

Redundancy

Instilling hope

Maximizing engagement strategies

Accountability

Tools:Encourage & supportRepeat everythingReaffirmRemind of next contact, reaffirm message of

other treatment team membersRepeat consistent message of “show up”.Require repeat backsWrite it down (them), reaffirm.

Clients with a Mental Health DiagnosisParticipants with co-occurring disorders

often experience more severe and chronic medical, social and emotional problems.

They are more vulnerable to both AOD relapse and a worsening of the psychiatric disorder.

Participants with co-occurring disorders often require longer treatment, have more crises, and progress more gradually in treatment. They often have reduced skill retention.

Clients with a Mental Health Diagnosis

Team must be familiar with psychotropic medications and their side effects

Do not dismiss participants as a resourceProvide enhanced community supportsUnderstand what role drug use has played in

the participants ’s lifeExpect setbacks, but don’t assume failure

SummaryDefining Case Management

As an individual case managerAs part of a team

Employ the key functionsAssess and reassessDevelop a case plan to target identified needsActively work to link participants to servicesClosely monitor the participant’s progress,

provide feedback and supportSupport but don’t enable

SummaryKnow the Evidence Based Practices

Develop Strategies that recognize the deficits of the targeted population and use strengthen based approaches to the address them.