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Fundamentals of Case Management Practice chapter 1, 6-11

Terms in this set (79)

The four basic categories of service that Case manager provide are
- Assessment
- Planning
- Linking
- Monitoring
Assessment (in Case management)
- Exploring and evaluating the following
1. the initial problem and the background
2. the current situation
3. the person's background (education, relationship, work history, legal history)
4. what is needed to make the person's life more stable and to resolve the current problem
5. the strengths,( including those the person brings to the problem and those in the person's environment that would be useful in resolving the situation)
6. observations (about how well the person functions cognitively and any possible mental problems that you have noted)
7. Recommendations for service or treatment plan for the person
Planning (in Case management)
- The process of anticipating future events and determining strategies to achieve organizational objectives in the future
(formal agencies, generic agencies, support groups and educational seminars, peer support, informal resources and social support systems, and creating individual plans).
Linking (in Case management)
- Is the general term that is used to mean connecting clients to people or agencies where they will receive the help or services they need
Advocate
- One who acts in support or defense of a person or cause
Generic services
- Requires no formal referral,
Monitoring (in Case management)
- The act of observing something (and sometimes keeping a record of it)
Advocacy (in Case management)
- Public support for or recommendation of a particular cause or policy.
Service Coordination (in Case management)
- The administrative, clinical, and evaluative activities that bring the client, treatment services, community agencies, and other resources together to focus on issues and needs identified in the treatment plan.
The overall purpose of case management is to:
- Improve the quality of life for the client
Broad view of case management (2 purposes)
- Create an individual services plan and to monitor progress on that plan.
- Ensure that money spent for client services is spent wisely.
Which of the following is not typically part of the assessment process
- Give the client advise about how to make productive changes for themselves
Assessment involves:
○ Gather info in order to determine appropriate services needed.
- Presenting problem
- Person's current situation (living/problems)
- Education
- Relationships,
- Work history,
- Legal history
- Needs
- Strengths that the person demonstrates
- Observation (cognitive functioning/ mental)
- Services
- Treatment plan
Linking
- Connecting the clients to people or agencies where they will receive the help or service they need.
Monitoring
- Ensuring that the client is receiving needed services
In order to plan well, a case manager must be aware of:
- Services, social activities, and resources in the community
The process of referring a client to others who will carry out aspects of the plan is often called:
- Linking
Monitoring is done for which of the following reasons?
- To be certain the treatment /services authorized is being delivered.
You are driving with your friend, Hilda, and Loretta, in your car. Hilda states that the seats in your car are very uncomfortable. Who owns the problem in this situation?
- Hilda
With respect to owning a problem which is the most important thing to remember?
-The person who owns the problem is the person whose needs are not being met.
Which of the following is not a reason to identify who owns a particular problem?
- You will be able to take on a larger case load
The best approach to helping a client with a problem such that the client has an opportunity for growth is to:
- Be involved just to the point of the client need and nothing more
If you have a problem with someone else's behaviors:
- Don't assume the other person knows that a problem exist
-Ask the person to help resolve the problem if necessary
- Accept the fact that the other person may not want to help you.
who owns the problem?
- It is the person whose needs are not being met.
If it turns out to be the client's problem what do you do?
- Your job is always to listen
- Engage the client in thinking- be a resource
○ Ask the client about what ideas they have
- Client must make the final decision
- Different clients have different needs
If you have a problem....
• Don't expect the other person to just know- state your problem
• You can ask for help in resolving BUT the other person can refuse
If you both have a problem...
• Provide the opportunity to negotiate/ collaborate ( both take responsibilities)
• How can you both reach an acceptable outcome?
Twelve Roadblocks Communication
1. Ordering, directing, commanding
2. Warning, admonishing, threatening
3. Exhorting, moralizing, preaching
4. Advising, giving solutions/ suggestions
5. Lecturing, teaching, giving logical arguments, dictating
6. Judging, criticizing, blaming
7. Praising, agreeing, placating
8. Naming calling, ridiculing, shaming
9. Interpreting, analyzing, diagnosing
10. Reassuring, consoling, supporting
11. Questioning, interrogating
12. Withdrawing, Humoring, diverting
6 Basic emotions are
□ Anger
□ Fear/ Scared
□ Disgust
□ Surprise
□ Happy
□ Sad
Reflecting emotions Communication
- Identify the client's feeling and then restate it back to them
- Strive for a single sentence
-Less is often more- one feeling at a time
Closed Questions Communication
- Limited number of responses

- there are times when you need facts or specific information
Open Questions Communication
- Allow for more extensive input

-when we are listening to clients give background about their concerns and problems our questions need to be more open to solicit the information the individual believes is significant.
I messages Communication
- There are times when you could be concerned about something the client has done or said.

- A way to state a concern in a non-accusatory manner
- I feel...
- I am concerned that...
- I'm not clear that...
- I'm not clear about...
- I am uncomfortable that...
- I guess that what worries me is that...
Useful ways to begin Firmer I messages Communication
- There are times when you need to act on behalf of the client.
- A request that needs to be more authoritative, but not offensive.

- I need you to...
- It would be very helpful...
- Would you please...
-I need your help to...
Showing appreciation Communication
- The clients bring something to your attention that is of concern to them, it is a good idea to let them know that you appreciate what they have to say. To disclosure and criticisms.

- Thanks for bringing this up...
- Thanks for telling me about this...
Disarming Anger Communication
○ Arguing typically does no good
○ It is very easy to become defensive
○ There is often some truth in the client's anger
○ Showing genuine interest in what is said
○ Too many questions feel like interrogation
○ Gain information (why are they upset)
- How did I offend you
- How often this happen
- Can you tell me more about what happened
- What might I do to clear this up
○ Agree when appropriate
- I'm sure we could do better at times
- We probably could do things a bit differently
○ Sometimes nothings can change
- I understand, but we need to continue this way for now
○ Sometimes, it can
- Here are some ways we can resolve this issues
Ordering, directing, commanding is the 1st Roadblocks means:
- Give the client/ person an order or command
Warning, admonishing, threatening 2nd Roadblocks mean:
- Warning of consequences if a person does something
Exhorting, moralizing, preaching 3rd Roadblocks means:
- Telling a client what they should or ought to do
Advising, giving solutions/ suggestions 4th Roadblocks means:
- How to solve their problems
Lecturing, teaching, giving logical arguments, dictating 5th Roadblocks means:
- Trying to influence with facts, arguments, and logic
Judging, criticizing, blaming 6th Roadblocks means:
- Negative judgement or evaluation of the clients
Praising, agreeing, placating 7th Roadblocks means:
- Offering a positive judgment or evaluation, or agreeing
Naming calling, ridiculing, shaming 8th Roadblocks means:
- Making the client feel foolish
Interpreting, analyzing, diagnosing 9th Roadblocks means:
- Telling the client what their motives are, or analyzing their actions
Reassuring, consoling, supporting 10th Roadblocks means:
- Making people feel better or trying to talk them out of their feelings
Questioning, interrogating 11th Roadblocks means:
- Trying to find motive reason or cause
Withdrawing, Humoring, diverting 12th Roadblocks means:
- Focus on something other than the problem
Ways to respond to feelings
- When people are talking to you about something that involves an emotion or feeling, it helps them to fell comfortable and understood.

- 1st if you identify their feelings and say them back to them(this shows empathy).

-It is best to use a single sentence and nothing more.
Ways to start collaboration
- Nothing really useful can happen for clients if there isn't collaboration
-It can let clients know they can trust your intention to be supportive without taking over and forcing a solution.
- It prevents you giving the impression that you are superior and that you see clients as being helpless and inadequate.
Collaboration
○ Creating a team approach
○ Acknowledging your desire to provide support
○ Treating client as equals
○ Involving clients who do not participate
○ Finish with question/comments
○ Positive feedback
What could two minor problems a therapist encounter during communication with clients?
- You assess the clients feeling incorrectly
- your mind wanders
What could four major problems a therapist encounter during communication with clients?
- You can't wait to pass judgment
- You ignore the client's feelings and focus on content
- You can't wait to offer a solution/ to give advice.
- You feel an overwhelming need to get to the bottom of the problem and solve it.
Reflective listening
- Is a term used to describe therapeutic listening and responding- a way of listening that is most helpful to people.
Reflective listening (3 methods)
- Lets people know that you have heard their concerns and feeling accurately
- Listening creates an opportunity for you to correct any misperceptions
- Listening illustrates your acceptance of where the person is at that moment.
Repsonding to feeling involves the following three steps
- Listening carefully to the client
- Identifying the most prominent feeling you are hearing
- Constructing a single statement that includes that feeling (empathic response)
Responding to Content (Listening)
- is a good way to help people who have just been through a traumatic event.
- Check for accuracy
- Clarify and understand
- Useful for those who have experienced trauma
Positive results of Reflective listening (Self-acceptance)
- Paradoxical theory of change (Fritz Perls')
(That people change only when they are able to accept themselves exactly where they are right now)
- Judging clients causes them to defend themselves- (they stay stuck)
Positive results of Reflective listening (Draining off feelings)
- Experiencing emotions leads to healing
Positive results of Reflective listening
- Do not cut short this important piece of the client's healing process because you feel pressed for time. be sure you go over the situation thoroughly once and, if you can, review it serval times
- reflective listening promotes healing
Paradoxical theory of change
- The more you try to change, the more you stay the same. Instead, become aware of and accept who you are because you can't be someone you're not.
When are the Three times it is important to ask questions?
1. Opening a case- many details must be provided
2. Compiling info for assessment and referral-facts are needed to accomplished this.
3. Encouraging the client to talk freely about the situation.
Closed Questions
• Requires simple answers
• Bad for trying to understand the client's situation
• Follow up with an open question if appropriate
Open questions
• Clients can talk about what is important to them
• You get more information
○ Emotions
○ Plans
○ Causes
○ A lot more information this way
○ Give examples
Thing to avoid when asking questions
- Don't ask why questions (190)
- Also, how, what, when, where
- One question at a time.
- Don't change the subject (191)
- Implying only one answer
- Don't ask did questions
- Did you...
- Don't inflict your values
- Don't make assumptions
- Don't ask things only because you are curious
What are the four parts of the formula for an open question?
- Opener
- Directive
- Softener
- Object
Directive question
- Share
- Describe
- Explain
- Summarize
- Outline
- Spell it out
- Talk
- Give me
- Tell me
- Help me
- Understand
- Clarify
Examples of Opener question:
- Can you
- Could you
Softener question
- A little bit more about
- Something about
- The problem with
Object question
- Your child, husband, medication...
Confrontation
• Bring something out in the open that needs to be addressed in a harsh, aggressive manner
○ Not angry or accusatory
○ Present your point of view for consideration
• Must be used strategically
• Used when discrepancies become apparent:
○ Client's words and behaviors are inconsistent
○ You perceive differently from the client
○ Client's words & body language are inconsistent
○ Clients behavior violates their stated values
• Other time for confrontation
○ Client has realistic expectations of you
○ Client has unrealistic expectations of themselves
○ Client asks for help then shows no interest
○ Clients behavior may be destructive
○Client is looking for a solutions to a problem
Rules for Confrontation
1. Exhibit empathy (208)
2. Pick the right time (212)
3. Be matter of fact (212)
4. Be tentative (212)
5. Focus on tangible
6. Take responsibility for your observation
7. Don't accuse
8. Don't confront when you're angry
9. Don't judge
10. Don't solve the problem
11. Collaborate
Reason for client Anger
- Something the agency ( programs, or the practices of the program) has done
• Something you have said/done
• The client is fearful
• The client is exhausted
• The client feels overwhelmed
• The client is confused
• The client feel a need for attention
Disarming Anger is important
• It is an obstacle to understanding
• It shows you respect client's message
• It enables you to understand the problem
• It allows you to practice empathy
• It focuses work on solving problems
Avoid the number 1 mistake when someone is projecting their Anger
- Taking the client's anger personally
○ It really doesn't have anything to do with you

- A particular issue for those who have:
○ Been made to feel powerless
○ Been taken advantages of
Avoid the number 2 mistake when someone is projecting their Anger
• Clients will give you no trouble
• Anger is the primary way clients misbehave
• Be empathic
○ "I was not myself then"
○ "that is not who they are it is just who they are now"
The four step process to disarming anger
1. Be appreciative
a. Thank you for bringing this to my attention
2. Ask for more information
a. Client who are upset may be skimming the surface of the issues. To understand the issue better, ask for particulars.
3. Find something with which you agree
a. Don't make up something to be agreeable
4. Begin to focus on a solution
a. Focusing on a solution should involve collaboration
b. Remember: the client owns the problem
c. The client is supposed to solve/ own their own problems
What not to do when disarming anger
• What not to do:
○ Become defensive
Do not fall into the trap of defending yourself
○ Sound sarcastic
○ Acting superior
○ Avoid to grilling of the client
Out-of-control anger
• Anger is usually rational

• Sometimes, anger becomes rage
○ Out of control anger is rage

• Try to stay calm
○ Any other reaction is just going to feed the rage
○ Even tone of voice
○ Be matter of fact
○ Reflective listening
○ Relaxed movements

• Anything else will likely make things worse
• If you feel in danger, call security/ police
• Counselors play an important role in defusing explosive situations
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