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No matter what type of client your Drug Court is serving, case management is one of the keystones to success. The learning objectives for this session are: * Learn best practices in the filed of case management * Learn how to best serve specific case management needs
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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.