Case Management

1. CaseManagement Overview, History and the Models Presented by Marilyn Gibson Drug Court Administrator October 8, 2014

2. Resources Case Management forms the framework around which the drug court process can credibly and effectively operate. Whether carried out by a formally designated case manager or split among multiple team members, Case Management is the force holding the varied and many drug court elements together, ensuring that: • Clients are linked to relevant and effective services; • All service efforts are monitored, connected, and in synchrony; and • Pertinent information gathered during assessment and monitoring is provided to the entire drug court team in real time.

3. Case Management: Overview, History and the Models Case Management is the driving force that holds the varied and many Drug Court elements together by: • Linking clients to relevant and effective services • Monitoring, connecting and synchronizing all service efforts • Gathering and relaying pertinent information to the entire Drug Court Team in real time

4. Case Management:Overview, History and the Models Case Management is essential to carrying out the mandate of the Drug Court 10 Key Components.

5. Case Management:Overview, History and the Models • Key #1: Drug Courts integrate alcohol and other drug (AOD) treatment services with justice system processing. • It is the Case Manager who coordinates the flow of drug court information across and within the treatment and justice systems.

6. Case Management: Overview, History and the Models • Key #2: Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants’ due process rights- • The Case Manager assists in keeping these traditionally adversarial parties focused on the primary purpose of the program. • Advocating for the participants recovery, the case manager supports due process, ethical and strengths-based treatment, and confidentiality while promoting individual accountability and community safety.

7. Case Management: Overview, History and the Models • Key #3: Eligible participants are identified early and promptly placed in the drug court program- • The Case Manager helps to ensure the coordination of this process by “tracking” and facilitating the prompt sharing among the team of all relevant information arising from the initial referral, eligibility screening and assessment process.

8. Case Management: Overview, History and the Models • Key #4: Drug courts provide access to a continuum of alcohol, drug, and other related treatment and rehabilitation services- • The Case Manger works closely with the clinical treatment providers and community supervision officers to provide ongoing assessment. • The Case Manager identifies and monitors each participant’s unique needs for support and rehabilitation- • Coordinates participant access to these services • Ensures linkage and coordination among the drug court service provider

9. Case Management: Overview, History and the Models • Key #5: Abstinence is monitored by frequent alcohol and other drug testing- • The Case Manager ensures that drug test results, regardless of who administers the test, are promptly and accurately recorded and disseminated to the Drug Court Team.

10. Case Management: Overview, History and the Models • Key #6: A coordinated strategy governs drug court responses to participants’ compliance- • The Case Manager tracks and monitors the courts’ allocation of sanctions and incentives to each participant to help ensure that subsequent sanctions, incentives, interventions are graduated, treatment-relevant, strengths-based, and otherwise consistent with the programs philosophy.

11. Case Management: Overview, History and the Models • Key #7: Ongoing judicial interaction with each participant is essential- • The Case Manager is the primary link between treatment and the justice system • Relays critical insight and input to the Drug Court Judge

12. Case Management: Overview, History and the Models • Key #8: Monitoring and evaluating measures of the achievement of program goals and gauge effectiveness- • The Case Manager ensures that all relevant information is accurately, promptly and systemically documented so that ongoing monitoring of the participants and evaluation of the program can occur.

13. Case Management: Overview, History and the Models • Key #9: Continuing interdisciplinary education promotes effective drug court planning and implementation, and operations- • The Case Manager is best situated to facilitate interdisciplinary education within the drug court team • They can enlist ancillary services providers to address the team and, if applicable, participate in the staffing process.

14. Case Management: Overview, History and the Models • Key #10: Forging partnerships among drug court, public agencies, and community-based organizations increases the availability of treatment services, enhances drug court effectiveness, and generates local support- • The Case Manager sustains ongoing contact with the key line staff of the partnering agencies and organizations. • They are in a position to learn the policies, procedures, capacities, strengths, and limitations of existing support service organizations. • They can identify gaps in service, community needs, and other strategies to facilitate collaboration between the court and the community.

15. Case Management: Overview, History and the Models History

16. Case Management: Overview, History and the Models • Case management, as a tool for improving service delivery, has a long history beginning with social casework in the early 20th century. • Case management emerged as a separate and professional service in the 1970s, where it was seen as a way to connect clients with multiple needs to an increasingly complex social service delivery system (Turner & TenHoor, 1978).

17. Case Management: Overview, History and the Models • Throughout its history, case management has focused on the holistic needs of clients, • Addressing basic needs such as safety, food, and shelter, as well as emotional, medical, and other needs including employment, education, and connection with others in the community (Rapp, 1998).

18. Case Management: Overview, History and the Models • Though there is little literature on case management specific to drug courts, the founding principles and concepts that guide case management in other milieus can be generalized to the drug court setting.

19. Case Management: Overview, History and the Models • Early research focused on case management as a way of helping people with mental illnesses stay out of psychiatric hospitals. • Assertive case management teams provided care to individuals with serious mental illnesses in the community, and showed that it was possible to significantly decrease hospitalization rates and increase community stability through the use of the case management model (Bond, McGrew, & Fekete, 1995; Stein & Test, 1980).

20. Case Management: Overview, History and the Models • Later, this research expanded to include other populations, including people with alcohol and other drug treatment needs (US DHHS, 1998). • An early study conducted in Ontario, Canada showed that substance abusers receiving case management had better community outcomes than a control group, with the intervention being particularly effective with clients who lacked social support and had a history of treatment failure (Lightfoot et al., 1982).

21. Case Management: Overview, History and the Models • More recent research has demonstrated increased retention in substance abuse treatment for clients provided with case management as an adjunct to treatment. • This was seen both with clients leaving an inpatient setting (Siegal, et al., 1995) and those enrolled in outpatient treatment (Siegal, et al., 1997).

22. Case Management: Overview, History and the Models • The effectiveness of case management has been studied within a variety of AOD populations. • One study showed that case management helped pregnant substance abusing women stay in treatment longer and have better clinical outcomes (Laken & Ager, 1996). • In a study of rural AOD clients, individuals who received case management colocated with their treatment facility accepted significantly more substance abuse and medical services (Vaughan-Sarrazin, Hall, & Rick, 2000). • A study of homeless alcoholic men showed that those receiving case management services more successfully engaged in treatment and moved through the continuum of services from a sobering-up shelter through a vocational program (Bonham, et al., 1990).

23. Case Management: Overview, History and the Models • Of most relevance to drug courts, case management has been shown to be effective with substance abusing people involved in the criminal justice system.

24. Case Management: Overview, History and the Models CASE MANAGEMENT MODELS

25. Case Management: Overview, History and the Models • Most case management programs follow one of four major case management models (Walsh, 2000): • Broker/Generalist • Strengths-Based Perspective • Assertive Community Treatment • Clinical/Rehabilitation

26. Case Management: Overview, History and the Models • These models are neither clear-cut nor distinct, but rather overlap and complement each other in many areas. • Each case management program must decide which model (or modification of a model) best meets the needs of its client population and matches the resources available in the program and community.

27. Case Management: Overview, History and the Models Broker/Generalist - Narrower in Scope of Action • Focuses on rapid linkage and referral • Provides limited direct services • Conducts the initial assessment to determine: • Service Needs • Service Referral • Occasional monitoring of service provision • Helpful where resources are limited and the caseload-to-case manager ratio is high. • Allows for the provision of a limited number of services to the greatest number of participants. (see Bokos, et al., 1993 for an example of utilization of the broker model for intravenous drug abusers).

28. Case Management: Overview, History and the Models In drug court, this model may be appropriate in the intake setting only. It is during the intake process that the case manager conducts initial screening and assessments. However, to ensure that the participant’s needs are more fully met, comprehensive case management must follow.

29. Case Management: Overview, History and the Models Strengths-Based Perspective • Involves assisting clients to examine and identify their own strengths and assets as the vehicle for resource acquisition and goal attainment. • The case manager supports the client in defining goals, and helps identify ways the client’s strengths can be used to reach these goals. • The case manager supports the client so that he/she may assert direct control over his/her search for resources, such as housing and employment (Rapp, 1998).

30. Case Management: Overview, History and the Models In drug court, the strengths-based perspective calls upon the utilization of the participant’s existing strengths and resources to shape a recovery plan that will transcend his or her drug court tenure and provide ongoing community-based support after completion of the program.

31. Case Management: Overview, History and the Models Assertive Community Treatment • Intensive case management model with low caseloads and frequent, community-based contact with clients. • Grounded in a multidisciplinary team approach where all team members share the caseload and work together to provide proactive services, assertive outreach, and strong advocacy to clients. • The case management team provides many services to the client directly, and, if referring to an outside agency, carefully monitors the relationship between the client and the service provider(s) • (Bond, McGrew, & Fekete, 1995; Stein & Test, 1980).

32. Case Management: Overview, History and the Models In drug court, the model incorporates the multidisciplinary team approach while highlighting the importance of manageable caseload sizes that allow for the intensity of service delivery required in drug court. Consistent with Key Component #1, the combined efforts of a multidisciplinary team assist the participant in maintaining a clean and sober lifestyle.

33. Case Management: Overview, History and the Models Clinical/Rehabilitation • Those providing case management services deliver the clinical treatment as well, providing both in an integrated manner. • The case manager in this model has the primary responsibility for providing therapeutic intervention, including therapy, counseling, skills teaching, and other rehabilitative interventions along with case management services • (Anthony, Cohen, & Farkas, 1990).

34. Case Management: Overview, History and the Models • The clinical/rehabilitation model provides one option for identifying who will perform the case management functions. In drug courts, this model may be particularly useful where participants are heavily involved in treatment or where treatment providers are skilled in case management and able to take on that additional responsibility.

35. Case StudyAdult Drug Court 20 years old, School dropout, Homeless, Pot smoker since 12, Mother in and out of prison, Raised by grandmother, Father never around or 25 years old, College graduate, Unemployed, Pot smoker since high school, Injured playing soccer, Addicted to opiates, now using heroin

36. Case StudyDWI/DUI Court Male 41 yoa Divorced No contact with children 4 DUI’s including 1 injury accident (BAC .18) Been in treatment 1x Blacks out frequently Began drinking at age 12 Abused by babysitter

37. Questions & Comments Marilyn Gibson Drug Court Administrator Greene County, Missouri 417-829-6240 Marilyn.Gibson@courts.mo.gov