Comparing Case Management Models: Clinical vs Brokerage Approach

This essay provides a comprehensive comparison of two case management models: the clinical case model and the brokerage model. The clinical case model, where the case manager is a clinical caregiver offering direct counseling, is contrasted with the brokerage model, which serves as a brief link between clients and supportive services. The essay analyzes the underpinning ideologies and theoretical perspectives of each model, examining their operationalization in the human services context, including their suitability in disability services and mental health. It also considers the impact of legislative and regulatory changes. The essay highlights the strengths and weaknesses of both models, noting the clinical case model's potential for deeper engagement but higher cost, and the brokerage model's efficiency but reliance on client initiative. Ultimately, the essay concludes that both models have their effectiveness depending on the context of application, and addresses the existing disparity in variance.

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Case Management
Name
Institution

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Compare and contrast any two models of case management.
Case management has three healthcare professions that are mostly involved in it.
These are: nursing, social work and physicians. They all enter into case management
service bringing into it their profession’s values while being respectful of the values of
the rest of the other professions. Case management, therefore, is defines as a
collaborative process that assesses, plans, implements, coordinates, monitors and
evaluates the options and services required to meet a client’s health and human service
needs. It employs advocacy, communication and resource management. It also promotes
quality cost-effective interventions and outcomes (Oyiesam and Naeku, 2017). Therefore,
the work of a case manager would be to help families and individuals meet their
comprehensive health needs by advocating for them and coordinating the required care.
Any agency desiring to have a case managed approach with its dealings with its
clients has to employ effective case management techniques. That is, the different
approaches to case management are determined by the differences in context. For
example, physically disabled adults could be best served by certain approaches to case
management which, if used on children with mental health problems, could be harmful or
irrelevant to them. Therefore, effective case management practices have to be carefully
adapted to the needs, constraints and resources available in a given context. Generally,
there has been some evidence of effectiveness of some case management models (Marty,
Rapp, Carlson, 2011). They are, however, small and modest – the longitudinal outcomes
are quite unclear and several aspects of effectiveness still require to be studied further.

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Underpinning ideologies and Theoretical Perspectives
The clinical case model
In this model, the case manager is a clinical care giver. Quite often the case
manager is either a counselor or a therapist. The case manager provides direct counseling
for a client’s personal concerns and it helps the case manager have unique insight into the
clients needs. These needs may include mental health service and recovery from
addiction support. This model integrates the clinical acumen, individual participation, and
environmental interventions required to address the holistic maintenance of a patient’s
physical and social environments. Vanderplasschen, Wolf, Rapp, & Broekaert, (2017)
connotes that It is relationship based, and thus offers conversation and direct counseling
regarding clients concerns. This entails a list of activities such as consultation with
families, patient engagement, linkage with resources, and crisis intervention. These
responses are often intense and the clinical manager must be equipped to know how to
recognize and contain them. As a result, the case manager is requires to have a high level
of clinical social work expertise (Hopkins & Ramsundar, 2016). This model is often
employed in substance abuse treatment programs and is particularly useful to patients that
require support for an extended period of time.
Brokerage case management
While the clinical case model offers support to clients over an extended period,
the brokerage model is quite brief and acts as a link between clients and supportive
services. Here, the case workers help clients identify their needs and broker supportive
services (resources) from contacts available. On going monitoring is usually relatively

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brief or not provide at all. Whereas clinical case model reaches out even to clients who
are less likely to engage in voluntarily with services, the brokerage model relies on the
willingness of a client to voluntarily access service recommended (Clark, Guenther &
Mitchell, 2016). This model therefore, offers very little contact between care givers and
clients and as a result there is a limited nature of relationships. Only that, this also allows
the care givers room handle more clients compared to the clinical case model. This model
assumes that the needed services are available and that the client will make use of them
voluntarily. This model can be said to be effective to clients who are not economically
deprived, with significant intent and sufficient resources (Snowden, Masland, Wallace &
Fawley, 2019). It can be deduced that the major similarity between these two is that they
both serve to link clients to resources and, they can be used in the context of substance
abuse.
Analysis of the Operation in the Human Service Context
In the 1960’s case management arose to curb the issue of deinstitutionalizing of a
big number of people with severe mental health conditions and required referral to out
patient health services. The subsequent decades experienced an increasing cost of health
care and decentralization of health services. This brought about a shift in the role of case
managers. The case management tasks are now being carried out by people from various
disciplines. This has brought about variability in the description of case management
(Shelesky, Weatherford & Silbert, 2016). This is due to the interdependent and
interacting parameters of case management. Case managers perform a set of sequential
and overlapping functions in the field of mental health, rehabilitation, healthcare and
aging. These may include; screening and case finding, comprehensive assessment, of

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client needs and resources, need based care planning, service coordination, monitoring,
reassessment and discharge. These functions vary immensely on how they are
implemented by care givers to differing client needs based on context. For example,
reassessment intervals may vary as do the method that determines a reassessment for
different groups of patients with mental problems.
Despite the use of case management; having had different names, variations and
context, it continues to support the overall growth of the healthcare (Rapp, Van Den
Noortgate, Broekaert, & Vanderplasschen, 2014). But it’s not without drawbacks. Over
the span of its existence, since the 1960’s, studies show that (over time) the description
and terminological variance remains. These terminological variances bring about role
confusion and ambiguity. Thus, there is an urgent need for a globally agreed taxonomy
for coordination, navigation and management of care.
The clinical case model and the brokerage model can be applied to most contexts
having people with mental problems, people with learning disabilities and people with
rehabilitation needs. Quite often, these people will require some financial and/ or
employment related benefits owing to their conditions. The challenge, however, is the
making of policies to address disability given that disability is quite difficult to assess.
Medical assessment by insurance doctors is employed in these cases (Bender, Schau,
Begun, Haffeje, Adhikari & Hathaway, 2015). However, medical assessment is getting
more complex such that there has to be involvement from more specialists such as
psychologists and psychiatrists. These involvements have increased the costs and length
of the assessment procedures. At this point, clinical case model becomes more taxing and
expensive compared to the brokerage model. In some countries, clients own treating

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doctors have the responsibility of assessment. In such a clinical model, at times, it can be
perceived that the doctors are too close to ensure neutrality in assessment. As a result,
other countries, like Germany, have published guidelines with which doctors have to
comply as regards to treatment and rehabilitation of people living with disabilities. In
cases where a doctor is attaches to a social security agency they refer individuals
elsewhere for service. And thus, eligibility for certain benefits such as the disability
pension is determined from other contacts (Newcomer, Arnsberger & Zhang, 2013). This
can be seen as a brokerage model move. It can be deduced that the brokerage model
offers a lower chance of biasness when it comes to the acquisition of benefits by groups
that require special health care. But generally, both models reduce attrition and improve
psychosocial, drugs and alcohol outcomes. When it comes to having far reaching, lasting
and effective outcomes on the people, it is the clinical case model that is more influential.
Conclusion
We can conclude that both models have their effectiveness depending on the
context of application. However, the existing disparity in variance is something that
needs to be addressed in order for case management to have far reaching benefits to the
general public. Appropriate training for health workers and the general public
information and participation will help provide quality healthcare and create
opportunities for employment to people living with physical or mental disabilities.

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References
Bender, K., Schau, N., Begun, S., Haffejee, B., Barman-Adhikari, A., & Hathaway, J.
(2015). Electronic case management with homeless youth. Evaluation & Program
Planning, 50, 36–42. https://doi.org/10.1016/j.evalprogplan.2015.02.002

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Clark, C., Guenther, C. C., & Mitchell, J. N. (2016). Case Management Models in
Permanent Supported Housing Programs for People With Complex Behavioral
Issues Who Are Homeless. Journal of Dual Diagnosis, 12(2), 185–192.
https://doi.org/10.1080/15504263.2016.1176852
Hopkins, M., & Ramsundar, N. (2016). Which factors predict case management services
and how do these services relate to client outcomes? Psychiatric Rehabilitation
Journal, 29(3), 219–222. https://doi.org/10.2975/29.2006.219.222
Marty, D., Rapp, C. A., & Carlson, L. (2011). The experts speak: The critical ingredients
of strengths model case management. Psychiatric Rehabilitation Journal, 24(3),
214–221. https://doi.org/10.1037/h0095090
Newcomer, R., Arnsberger, P., & Zhang, X. (2013). Case management, client risk
factors, and service use. Health Care Financing Review, 19(1), 105. Retrieved
from http://search.ebscohost.com/login.aspx?
direct=true&db=buh&AN=654819&site=ehost-live
Oyiesam P. and Naeku . S (2017). Developing a New Approach to Case Management in
Youth Mental Health: Strengths Model for Youth Case Management. Child &
Adolescent Social Work Journal, 34(4), 369–379. https://doi.org/10.1007/s10560-
016-0467-z
Rapp, R. C., Van Den Noortgate, W., Broekaert, E., & Vanderplasschen, W. (2014). The
efficacy of case management with persons who have substance abuse problems: A
three-level meta-analysis of outcomes. Journal of Consulting and Clinical
Psychology, 82(4), 605–618. https://doi.org/10.1037/a0036750

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Shelesky, K., Weatherford, R. D., & Silbert, J. (2016). Responding to the Increased
Needs of College Students: A Case Study of Case Management. Journal of
College Student Psychotherapy, 30(4), 284–299.
https://doi.org/10.1080/87568225.2016.1219613
Snowden, L. R., Masland, M. C., Wallace, N., & Fawley, K. (2019). Associating
supplemental case management activities with ethnic minority children’s reduced
use of psychiatric emergency services. Psychological Services, 6(2), 117–125.
https://doi.org/10.1037/a0015346
Vanderplasschen, W., Wolf, J., Rapp, R. C., & Broekaert, E. (2007). Effectiveness of
different models of case management for substance-abusing populations. Journal
of Psychoactive Drugs, 39(1), 81–95.
https://doi.org/10.1080/02791072.2007.10399867