Case Management for Rural Substance Abuse

1
Case Management for Rural Substance Abuse

• Center for Addiction Research,
• University of Iowa
• Mid-Eastern Council on Chemical Addiction (MECCA)
• Ali Manwar, CSAT Project Officer

2
The Team

• James A. Hall, Ph.D., LISW, Principal
  Investigator
• Diane Huber, Ph.D., RN, Project Director
• Case Managers
• Becky Clayton
• Carol Hengemuhle
• Bruce Tarwater
• Amy Weber

3
Overall Goals of the Project

• Improve our knowledge about case management and
  substance abuse treatment
• Improve quality of life for rural substance abuse
  clients
• Compare the impact of two models of case
  management

4
Background for Iowa Case Management Models

• Previous Work
• Iowa Case Management Project for Rural Drug Abuse
  (NIDA)
• Case Management for Rural Substance Abuse (CSAT)

5
Definition (CMSA, 1995)

• Case management is a collaborative process which
  assesses, plans, implements, coordinates,
  monitors and evaluates options and services to
  meet an individuals health needs through
  communication and available resources to promote
  quality cost-effective outcomes.

6
Definition (NAWS, 1992)

• The primary goal of case management is to
• optimize client functioning by providing quality
  services in the most efficient and effective
  manner to individuals with multiple complex needs.

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Two Models of Case Management for Substance Abuse
Treatment

• Iowa Comprehensive Case Management (CCM)
• Iowa Brokerage Case Management (BCM)

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Comprehensive Case Management Conceptual
Foundation

• Techniques of Behavioral Problem Solving Therapy
• Language from Solution-focused Therapy
• Social Work Strengths Perspective

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CCM The Basic Functions

• Assessment and monitoring
• Contracting and negotiating
• Brief solution-based counseling
• Planning for referral, and
• Evaluation of process and outcomes

10
CCM Key Activities

• Strengths and Resources Assessment
• Personal Evaluation Scale rating system
• Contracting for Improvements

11
Brokerage Case Management Conceptual Foundation

• Based on targeted Case Management System
• No theoretical foundation practice based
• Developed and maintained in practice settings
  usually government sponsored?

12
BCM The Basic Functions

• Assessment and monitoring
• Contracting and negotiating
• Planning and referral, and
• Evaluation of process and outcomes

13
BCM Key Activities

• Few direct services to minimize costs
• Operate primarily from the office
• Mainly assessment, case planning, coordination,
  and referral
• Contract with community agencies for all services
• Helps the client in receiving, paying for, and
  monitoring the services

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Dosage Characteristics for Both Models

• Duration eligible for up to 1 year
• Frequency more for CCM, less for BCM
• Breadth see functions and activities
• Intensity first 3 months is most important,
  depends on problems

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Comparison of Models

• Brokerage (BCM)
• Match resources to clients needs broker
  services
• Problem focused
• Fewer sessions
• Client mainly comes to case manager
• Comprehensive (CCM)
• Greater intensity of referrals and direct
  services
• Strengths focused
• More therapeutic services including direct
  counseling
• Case manager meets client in community or office

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Impact of Both Models

• Increased use of services more in CCM
• Increased physician visits in CCM
• Improved employment in CCM
• At 12 months, differences were not significant
  need longer time to capture full effect

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Targeted Utilization of Services to Improve
Effectiveness