Steps in Case Management Process

This document discusses the steps involved in the case management process, including screening, assessing, stratifying risk, planning, implementing, following up, transitioning, communication post-transition, and evaluation. It also explores the importance of monitoring the case management plan and the requirements of evidence-based practice. Additionally, it summarizes different approaches to service delivery and contemporary behavior change models. The document highlights the importance of family systems and dynamics, individual communication and decision-making styles, and considerations for diverse clients. It also discusses the rights, roles, and responsibilities of people within the decision-making process and the protocols, policies, procedures, standards, legislation, and statutory mandates that apply to case management.

UNIT – 11 ASSESSMENT
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TABLE OF CONTENTS
TASK 2.............................................................................................................................................3
1. Steps involved in the case management process.....................................................................3
2. Formal case management meeting process..............................................................................4
3. Monitor case management plan...............................................................................................5
4. Evidence based practice requirements of case management...................................................5
5. Summarise different approaches to service delivery...............................................................6
6. Contemporary behaviour change models................................................................................7
7. Importance of following things in case management..............................................................8
8. Considerations, protocols, history and special needs of diverse clients..................................8
9. Rights, roles and responsibilities of people within decision making process..........................9
10. Protocols, policies, procedures, standards, legislation and statutory mandates that apply to
case management.........................................................................................................................9
11. Risks and responsibilities relating to duty of care for following...........................................9
12. Range of services available to clients..................................................................................10
13. Value systems of workers, clients and key stakeholders impact the outcomes of the case
management process..................................................................................................................11
14. Experience, skills values and development of participants in the case management process
...................................................................................................................................................11
REFERENCES...................................................................................................................................12
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TASK 2
1. Steps involved in the case management process
Case Management process can be defined as the context in which case managers provide
health and human services to the clients and their support systems (Fortenberry Jr &
McGoldrick, 2016). The steps involved in the process are as follows:
Aspects Description
Screening At the initial stage, care worker has to
determine if the patient would benefit from
case management services. Current health
status and history about the patient is being
identified in this stage.
Assessing Proper diagnosing of the patient’s condition is
essential (Setiawan, Dignam, Waters &
Dawson, 2016).
Stratifying risk This phase determines the appropriate level of
intervention by classifying the patient’s
conditions as being low or high risk.
Associated risk factors are analysed in this
phase.
Planning Proper planning is done and objectives are
framed according to requirements of clients.
Plan is always action- oriented.
Implementing (care coordination) Specific activities are implemented according
to the required interventions so that to get
success in case management plan
(McAlearney, Hefner, Robbins, & Garman,
2016).
Following – up During this phase, information is collected by
the care manager from patient, caregiver and
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relevant sources.
Transitioning Proper guidelines are given by the care
manager in respect of reducing the issues
related to patient transition to different
hospitals.
Communication post transition Care manager has to properly communicate
with the patients and their family members.
During this stage, issues are properly
addressed and additional resolutions are
developed for the same (Zur, Linton, & Mead,
2016).
Evaluation Lastly, the effectiveness of care management
plan is being analysed by considering the
condition of clients.
2. Formal case management meeting process
While organizing a formal case management meeting process, it is essential for the
support worker to discuss everything with the client so that actual health aspects can be
identified. Proper communication is must so that patient and care worker both can discuss the
prevailing issues. For instance – a 14 year old girl prefers to smoke and drink all the time and
never communicates with the family regarding any aspect (Bishop and et.al., 2016). This
generates differences among the family members and as a result, the family environment is
getting affected. Hence, in this case scenario, support worker has to conduct separate meeting
with the girl and family members so that the actual cause of this problem can be resolved.
Support worker can also ask several questions from the girl regarding her habit of
smoking and drinking (Schmidt and et.al., 2016). Further, support worker should also
communicate with the girl as how she came in contact with smoking and alcohol. Appropriate
reasons are required to be ascertained. Decision related to the intervention should be taken at this
stage so that support worker can manage the condition of patient accordingly. Along with that, in
this process, history of the patients should be discussed. This will assist in adopting the best
practices to overcome the issue.
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3. Monitor case management plan
Case management plan needs to be prominently developed and monitored so that specific
activities can be included to treat the patient (Escaron and et.al., 2016). Several action plan and
intervention needs to be developed for treating the patient in best possible manner. Similarly, it is
also crucial to monitor the entire plan so that the areas of modifications and improvements can be
ascertained. On the other hand, appropriate monitoring also assists the support worker to analyze
the service dimensions that needs to be included in the care plan. For instance- a school going
girl who smokes consistently and having various problems with the family members needs to
have proper counselling so that everything about her condition can be discussed prominently.
In order to monitor the entire plan, it is crucial for the support worker to analyze the
effective of case management process and how useful it is in improving the health conditions of
respective patient (Mesterton and et.al., 2016). After giving specific treatment to the patient, it is
crucial for the support worker to ascertain the value of service as that can only aid in improving
the condition of the patient. Monitoring is also essential for showcasing the importance of
adopted intervention.
4. Evidence based practice requirements of case management
Evidence- based practice supports professionalism, patient safety and quality care. All
these aspects are important for the purpose of enhancing the value of case management process.
Support worker needs to be maintain professionalism while playing their duties so that suitable
care can be delivered to the patients (Pepin, Hoyt, Seifert & Bartels, 2016). This is crucial for the
purpose of adopting suitable intervention and strategies for patient recovery. However, most of
the case manages bear heavy workloads and limited time is also given to them to undertake a
clinical decision. Hence, in most of the cases, inappropriate intervention is followed by the
support workers regarding any clinical decision.
Therefore, looking towards this, systematic reviews are developed and published by a
variety of professional groups so that several new ways can be ascertained to manage the
requirements of the patients (Shidhaye and et.al., 2016). Evidence based practices are essential in
case management process because actual and prominent services are ought to be delivered to the
patients. Such amenities needs existence because case management process specifically deals
with psychological aspects of the patients. For instance – the girl (who drinks and smokes a lot)
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needs to be provided appropriate services so that she could come out of her health problem and
that is possible merely with evidence- based practice.
5. Summarise different approaches to service delivery
 Rights-based: This approach means integrating human rights norms, principles of design,
implementation and monitoring in health related policies and programs (Fortenberry Jr &
McGoldrick, 2016). It includes humanity, dignity for people, protection of rights of
vulnerable groups and an emphasis on ensuring that health systems can be properly
accessed by people. The approach includes the principle of equality and freedom which
underpins the capability of service delivery procedure. With the help of this approach,
support care workers needs to involve the patients in decision making process. However,
at the same time, support workers also need to incorporate accountability and
transparency mechanism for suitable service delivery procedure.
 Strength-based: The approach believes in providing support and resources to individuals
so that they can build their skills to implement suitable changes in the health care
dimensions (Setiawan, Dignam, Waters & Dawson, 2016).
 Needs- based: This approach states that support workers need to consider the needs of the
patients so that suitable services could be delivered. The subsequent approach can be
used at the time of selecting intervention for the patients.
 Person-centred: Person centred care is a philosophical approach to service development
and service delivery dimension which ensure that health care amenities are provided to
the patients in the best possible manner (McAlearney, Hefner, Robbins & Garman, 2016).
People need to be valued; hence at the time of providing services, proper attention and
treatment should be given to the patients. At the same time, provisions like valuing
people, autonomy and dignity should be maintained for enhancing the value of service
delivery process.
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6. Contemporary behaviour change models
 Social cognitive theory: The theory is highly useful in the field of psychology which
states that when people observe a model performing a behaviour along with the
consequences, they always remember the sequence of the event and use that information
as a guide in subsequent behaviour (Zur, Linton & Mead, 2016). This aids in adopting
different things while perceiving people.
 Theory of reasoned action: The theory explains the relationship among attitude and
behaviours within human action. It is useful in predicting how individual will behave
according to their pre-existing attitudes and behavioural intentions. Here, in the theory an
individual decision in involved in engaging a particular behaviour that is based on the
outcomes which are expected to come. Hence, the theory is useful for the purpose of
predicting the situation along with best outcomes (Askew and et.al., 2016).
 Planned behaviour theory: The subsequent theory is linked with beliefs and behaviour as
it explains human behaviour. It is crucial for the purpose of analysing behavioural
changes in the persons according to different situations. The theory also states that
subjective norms and individual behaviour intention changes the way of behaving in
diverse situations.
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Person-
centred
Strength-
based
Needs-
based
Rights-
based

7. Importance of following things in case management
 Family systems and dynamics: It is crucial to comprehend family systems and dynamics
in case management because the entire history and family background is essential in
treating the patient in effective manner (Gini and et.al., 2016). For instance- a girl who
smokes in her early years maintains distance from her family and as a result it affects all
the family members. In this case, involvement of family members is essential so that they
can help the support workers to give appropriate care to the patients. In case
management, psychological treatment is also included; hence family involvement is
essential.
 Individual communication and decision-making styles: It is crucial for the case manager
to communicate effectively with the individual so that proper intervention can be
followed up for treating the patient in best effective manner (Bishop and et.al., 2016).
Discussion and counselling session is required to be held among the case manager and
patient so that actual reasons behind the problem can be ascertained. Moreover, this can
also assist in undertaking appropriate decision for patient along with effective
participation.
8. Considerations, protocols, history and special needs of diverse clients
 At the time of dealing with culturally and linguistically diverse people, case manager has
to ensure that proper language is being used to communicate with patient. At the same
time, legal considerations should be adhered wherein respect and dignity should be given
to the clients (Schmidt and et.al., 2016). The legal act of equality and diversity should be
followed upon similarly.
 While dealing with a disable person, it is crucial for care manager to consider all the
specific needs so that suitable care services can be delivered accordingly.
 There should not be any sort of unusual behaviour for lesbian, gay, transgender and
bisexual people and while delivering health care services to them, suitable concern is
required to be given.
 People experiencing risk of homelessness should be provided more motivated and
encouraged services so that they can derive a sense of homely feeling.
 Further, older people are less expressive in their specific needs; hence there should be
proper response towards their health needs (Escaron and et.al., 2016).
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 For children and young people, it is crucial for case managers to follow all the legislation
so that suitable care services can be delivered.
9. Rights, roles and responsibilities of people within decision making process
 People involved in the decision making process needs to get information about all the
decision aspects so that their views and opinions can be included.
 Further, respect should be given to each and every partner’s opinion and views. Moreover
this can help in developing collaboration among the associated partners (Ferlie and et.al.,
2016).
 While undertaking decision, partners have to ensure that appropriate decisions according
to the situations are being taken with the consent of all the partners.
 People involved in decision making process should ensure that they are delegating roles
and responsibilities in suitable way.
10. Protocols, policies, procedures, standards, legislation and statutory mandates that apply to
case management
Working in a case management requires several standards, protocols and legislation to be
followed. This states that client groups should have proper accessibility to the community service
industry so that they can be provided suitable services (Mesterton and et.al., 2016). Accurate and
reliable services should be delivered to the clients for optimum protection of their health status.
Prominent action plan is required to be developed so that suitable care amenities can be given.
The provision of confidentiality should be maintained and information about the patients should
not be disclosed prior any information. In this context, assertive community treatment, clinical
case management modes and intensive case management model can be applied at the time of
dealing with the patients (having psychological problems).
11. Risks and responsibilities relating to duty of care for following
Aspects Risks Responsibilities
Child protection Children are not able to
collaborate with the
support workers due to
lack of understanding
(Shidhaye and et.al.,
Appropriate provision should be
followed to protect the children
in effective manner.
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2016).
Domestic violence Risks exist related to
internal activities.
Proper assessment of the
scenario is required.
Suicide Patients may commit
suicidal attempts anytime
in the absence of health
care workers (Pepin,
Hoyt, Seifert & Bartels,
2016).
Proper monitoring is essential.
Elder abuse Activities of parents may
give emotional trauma to
patients
Specific care is required to be
given
Disabilities Inappropriate treatment
from other people
Adoption of proper intervention.
12. Range of services available to clients
There are generally two different type of care that is provided to clients. In this context,
below given are as follows: Permanent residential aged care: This is a type of care that is provided who cannot be
supported by the community (Weske, 2012). Clients are evaluated that and the issues are
identified and as per the services are listed down and proper care is provided. More
specifically, there are two type of care that is provided and it includes high care and low.
High care are for those clients who are not capable to perform any activity own their
own. On the other hand, low care covers clients who are able to perform basic activities
in relation to make sure that they can handle themselves.
 Residential respite care: As per this type of care, the client is looked after for short term.
This is generally done on the basis of emergency or planned basis for older people
(Swayne, Duncan and Ginter, 2012). There is systematic plan that is developed by care
providers so that within the planned time they are provided with proper care and the
issues that they are facing can be solved.
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13. Value systems of workers, clients and key stakeholders impact the outcomes of the case
management process
In cross management process, there are different set of areas covered and it is important
that all the areas covered are effective enough to make sure that proper services are provided to
client. Below given are the value system that is provided to workers:
It is important for the health care organization to have proper support from workers so
that they will be able to perform their set of roles and responsibilities effectively and efficiently
(Rosemann and vom Brocke, 2015). Value system workers when there is proper coordination
among staff members and they also understand the type of services that they have to perform.
Value system for client is also important as the opinion is very essential. They are the one
who will take up the services and so proper information should be taken. They need to convey all
the relevant information so that there is no issued faced in order to deliver proper care.
All the stakeholders should be valued so that the roles and responsibilities that has to be
played is effectively done. In case any of the stakeholder do not perform their roles effectively,
then it will negatively affect the client.
14. Experience, skills values and development of participants in the case management process
All the people who are involved in case management process need to have proper
experience so that they will be able to handle any type of case that is provided to them. Further,
it is essential to have certain set of skills which will enable to have effective case management
process. In this context, among all the different type of skills one of the most important skill
includes communication (Armitage, Berkes and Doubleday, 2010). There should have proper
interaction so that they will be able to understand that issues or problems that are faced by client.
Further, there are various strategies that are developed in order to make sure that it is being
conveyed properly to client. When there is proper coordination, then it given raise to
coordination. So, as to develop proper plan, it requires effective development of plan that has to
be made so that they will be able to overcome the barriers that arise in order to provide proper
care to the patient.
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REFERENCES
Armitage, D., Berkes, F., & Doubleday, N. (Eds.). (2010). Adaptive co-management:
collaboration, learning, and multi-level governance. UBC Press.
Askew, D. A. and et.al., (2016). Investigating the feasibility, acceptability and appropriateness of
outreach case management in an urban Aboriginal and Torres Strait Islander primary
health care service: a mixed methods exploratory study. BMC health services
research. 16(1). pp.1.
Bishop, T. F. and et.al., (2016). Care management processes used less often for depression than
for other chronic conditions in US primary care practices. Health Affairs. 35(3). 394-400.
Escaron, A. L. and et.al., (2016). Testing an Adapted Modified Delphi Method Synthesizing
Multiple Stakeholder Ratings of Health Care Service Effectiveness. Health promotion
practice. 17(2). pp.217-225.
Ferlie, E. and et.al., (2016). Strategic management in the healthcare sector: the debate about the
resource-based view flourishes in response to recent commentaries. International journal
of health policy and management. 5(2). pp.145.
Fortenberry Jr, J. L., & McGoldrick, P. J. (2016). Internal marketing: A pathway for healthcare
facilities to improve the patient experience. International Journal of Healthcare
Management. 9(1). 28-33.
Gini, R. and et.al., (2016). Data Extraction and Management in Networks of Observational
Health Care Databases for Scientific Research: A Comparison of EU-ADR, OMOP,
Mini-Sentinel and MATRICE Strategies. eGEMs. 4(1).
McAlearney, A. S., Hefner, J., Robbins, J., & Garman, A. N. (2016). Toward a high-performance
management system in health care, part 4: Using high-performance work practices to
prevent central line-associated blood stream infections—a comparative case
study. Health care management review. 41(3). pp.233-243.
Mesterton, J. and et.al., (2016). Case mix adjustment of health outcomes, resource use and
process indicators in childbirth care: a register-based study. BMC pregnancy and
childbirth. 16(1). pp.1.
Pepin, R., Hoyt, J., Seifert, B., & Bartels, S. J. (2016). A Multi-Stakeholder Process to Transform
a Community-based Screening and Referral Program to Implement Evidence-Based
Depression Care. Journal of evidence-informed social work. pp.1-11.
12

Rosemann, M., & vom Brocke, J. (2015). The six core elements of business process
management. In Handbook on Business Process Management 1(pp. 105-122). Springer
Berlin Heidelberg.
Schmidt, K. and et.al., (2016). Effect of a Primary Care Management Intervention on Mental
Health–Related Quality of Life Among Survivors of Sepsis: A Randomized Clinical
Trial. Jama, 315(24). 2703-2711.
Setiawan, A., Dignam, D., Waters, C., & Dawson, A. (2016). Improving access to child health
care in Indonesia through community case management. Maternal and child health
journal. 20(11). 2254-2260.
Shidhaye, R. and et.al., (2016). Development and piloting of a plan for integrating mental health
in primary care in Sehore district, Madhya Pradesh, India. The British Journal of
Psychiatry. 208(s56). pp.13-s20.
Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2012). Strategic management of health care
organizations. John Wiley & Sons.
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Weske, M. (2012). Business process management architectures. In Business Process
Management (pp. 333-371). Springer Berlin Heidelberg.
Zur, J., Linton, S., & Mead, H. (2016). Medical Respite and Linkages to Outpatient Health Care
Providers among Individuals Experiencing Homelessness. Journal of community health
nursing. 33(2). pp.81-89.
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