CASE MANAGEMENT: THEN AND NOW. BDAP DEFINES CASE MANAGEMENT AS:.
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A collaborative process between the client and the case manager that facilitates the access to available resources and retention in treatment and support services, while simultaneously educating the client in the skills necessary to achieve and maintain self-sufficiency and recovery from substance abuse disorders.
1. To increase client retention in and completion of treatment in order to move clients toward recovery and self-sufficiency and,
2. To increase client access to core services such as primary health care, psychiatric care, stable and secure living environment, positive support networks, vocational training, and employment.
3. Intensive Case Management (ICM)
Screening is specifically defined as the determination of the need for a referral to emergent care services.
If the SCA or its sub-contractors choose to develop their own screening tool, the tool must include areas to gather the following information:
1) date of initial contact;
2) date of Level of Care Assessment;
3) if necessary, an explanation of why the time frame for an assessment was not met must be documented;
4) questions to determine the need for emergent care; and
5)When the SCA chooses the second option of screening, the screening tool must include trigger questions.
The SCA shall use the provider monitoring tool to ensure that all providers sub-contracted to perform screenings are using screening tools which include the information on the preceding slide.
1) Level of Care Assessment and Placement Determination;
2) Level of Case Management Determination;
3) Continued Stay Review; and,
4) Client Liability Determination
1) Date of Initial Contact & Date of Assessment
6) Physical Health
7) Drug and Alcohol
8) Abstinence and Recovery Periods
9) Perceptions of Use
10) Behavioral and Emotional
13) Living Arrangements
14) Physical/Sexual/Emotional Abuse
16) Self-Care and Role Functioning
17) Consumer Factors
18) Assessment Worksheet/Results
Information required for each of the above components, necessary to complete the LOC assessment and the LOCM Determination, can be found in the Case Management Manual on page twenty-three.
BDAP has provided a LOCM Determination Form in the Case Management Manual.
If the SCA or its sub-contractors choose not to use this form, documentation must include:
CONTINUED STAY PROCESS
Pre-approved detoxification treatment may occur for up to three (3) days. Treatment beyond the third day requires the completion of a continued stay PCPC Summary Sheet/ASAM that must be forwarded for approval. The summary sheets must also be maintained in the client file.
Pre-approved outpatient treatment may occur for up to six (6) months. Treatment beyond the six month period requires the treatment provider to document that the case was clinically staffed and that a continued stay PCPC Summary Sheet/ASAM was completed and maintained in the client file.CONTINUED STAY REVIEW
Pre-approved partial hospitalization or intensive outpatient treatment may occur for up to ten (10) weeks. Treatment beyond the ten week period requires the treatment provider to document that the case was clinically staffed and that a continued stay PCPC Summary Sheet/ASAM was completed and maintained in the client file.
Inpatient Residential; Short-term
Continued stay reviews are recommended every 14 days. A PCPC Summary Sheet/ASAM shall be completed and forwarded for approval. The summary sheets shall also be maintained in the client file.
Inpatient Residential; Long-term to include Halfway House
Continued stay reviews are recommended every 30 days. A PCPC Summary Sheet/ASAM shall be completed and forwarded for approval. The summary sheets shall also be maintained in the client file.CONTINUED STAY REVIEW continued
There shall be no client fee for initial services (assessment). Initial service refers to the services necessary to determine whether or not the individual is in need of diagnostic and treatment services, and to arrange for such services.
Referrals to ICM will be based on the needs of the client, either identified during the LOC assessment or during the course of treatment.
The SCA is required to have a written policy that describes the protocols for admission. The policy must state that the following items are to be completed with the client as part of the admission process:
1) An Agreement to Participate form;
2) Description of ICM services;
3) Discharge criteria;
4) Grievance and appeal procedure;
5) Follow-up requirements;
6) Appropriate consent forms;
7) Administration of ISS; and
8) Development of Service Plan.
The case manager must meet with the client as per the requirements listed below; however, more frequent contact may be necessary to address needs and to coordinate services.
For clients in residential care, at least one contact must be made every 15 days.
Completed ICM: Client has completed ICM e.g. support service needs have been adequately addressed and client is no longer in need of additional ICM services.
Institutionalized / Incarcerated: Client is currently committed to a long-term psychiatric facility or has been incarcerated, either sentenced or pending disposition of his/her criminal case, for more than thirty days.
Voluntary Discharge: Client indicated that he/she no longer wants the ICM services or support services that were being offered.
Administrative Discharge: The SCA is required to specifically define administrative discharge. For example, the SCA would define how many missedappointments and in what time interval would initiate an administrative discharge.
Transfer: Client has moved to another county within Pennsylvania and wishes to continue receiving ICM services.
Other: Any other reasons for discharge that do not fit the above categories.
A discharge form is to be completed for each client at the point of discharge from ICM. The primary areas included in the discharge form are:
1) Client’s name;
2) Date of admission to ICM, date of discharge, and date of last contact: In some cases the date of last contact may be the discharge meeting. However, in cases where this discharge does not occur as part of a face- to-face meeting, the date of last contact should be the last time the case manager has had any direct contact with the client, either face-to-face or via telephone;
3) Reason(s) for discharge;
4) Level of self-sufficiency: The case manager must record the level of self-sufficiency based on the ISS administered at the point of discharge. If the ISS is not administered at the point of discharge, a client’s progress or level of self-sufficiency should be determined by the scores of the last ISS; and,
5) The discharge form must be completed and signed by the case manager. The case management supervisor is only required to sign off on discharge forms if the client has not completed ICM.
This manual must include, at a minimum, policies and procedures that address the following:
1) Client orientation
3) Structure of the client files
4) Client grievance and appeal process
6) **LOC Assessment
7) Liability and Abatement
8) Continued Stay Review
9) **Evaluation of the need for support services
**Indicates a new requirement for the manual
10) ICM Referrals
11) Admission and readmissions to, and discharge/**transfer from ICM services.
12) **ICM waiting list
14) Client Satisfaction Survey
16) **Provider reporting, as applicable
**Indicates a new requirement for the manual
The manual must also include the following items:
1) **SCA’s definition of case management philosophy
2) Structure of case management system; **including client access
3) **Description of RC, if provided
4) Current community resource list
**Indicates new requirements for the manual
The files for case management clients may be combined into one chart. Case Management client files must, when applicable, include required items as follows:
1) Manner and frequency of supervision for both case management specialists as well as case management specialist trainees. In the case of a sub-contracted treatment provider, this would include any counselor or counselor assistant providing case management services on behalf of the SCA;
2) The manner and frequency for completing chart reviews for both active and discharged clients;
3) The manner in which supervision and chart reviews will be documented;
4) The process for allowing new staff to perform case management functions without having received required/related core trainings, which must include a combination of job shadowing and direct observation. Close supervision and supervisory sign-off on written documentation until the case manager has received all appropriate training.
Course selection and completion requirements depend upon which functions the case manager has been assigned to perform. The course requirements for each function are outlined below:
Assessment Function - 42 total training hours
Intensive Case Management Function - 27 total training hours
Screening and Assessment
Screening and Assessment
Practical Application of PCPC:
Practical Application of Confidentiality Laws and Regulations:
1) adherence to federal and state confidentiality regulations
2) client sign-off on the SCA’s grievance and appeal policy.