1. Health Disparities and Case Management
KATE FLANAGAN,
KARLA LINDQUIST,
AND
DAVID WU

2. Health Disparities

3. What is Health?
The WHO (World Health Organization) defines health as, “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Knowing a persons ideas on the definition of health is important to understanding where health disparities come from.

4. Biomedical and Bio-Psycho-Social Models
The way a patient receives heath care can greatly change health disparities.
The Biomedical Model is an older model where the focuses of treatment were on the body and determining the existence of signs of disease.
The newer Bio-Psycho-Social Model continues to look at the body for disease and infirmity but also takes into account varying social, cultural and spiritual factors that could effect treatment or the onset of varying illnesses.

5. Health Literacy
Health Literacy is the ability to accesses understand and correctly use the health-related tools and services available.
Involves the entire set of social and cultural practices
Depends on an individual's position in society
Factors impacting health literacy include: social status, age, gender, ethnicity, sexuality, family structure, etc.

6. Needs Assessment and Asset Mapping
Needs Assessment is a way of identifying problems, finding appropriate programs and interventions, and developing an action plan.
There are 4 steps to a Needs Assessment
Analyze the person’s or population’s existing situation;
Identify the varying importance of the factors in that situation and set priorities among them;
Identify causes of performance problems and/or opportunities;
Identify possible solutions and growth opportunities.
Asset Mapping focuses primarily on the available resources, assets, or strengths available in a community, so they can be used by the residents and the health center, together, to address concerns.

7. Health Disparities
A Health Disparity is a difference in the presence of disease, health outcomes, or access to health care between two or more populations
There are three theories on how disparities come about;
1. Health requires high levels of social, economic, human, political, and cultural capital.
2. Health requires access to care through health insurance or the ability to obtain services free or through sliding-scale payment plans.
3. Health requires personal health decisions.

8. Healthy People 2010
A comprehensive, nationwide initiative involving health promotion and disease prevention sponsored by the Department of Health and Human Services (DHHS)
Healthy People 2010 has two main goals.
To increase quality and years of healthy life;
To eliminate health disparities..
There have been advances of the diagnosis and treatment of some diseases and conditions. Some chronic conditions still present serious obstacles to public health.

9. Eliminating Health Disparities
There are 8 strategies for eliminating Health Disparities
Reduces the incidence/prevalence of disease and morbidity/mortality in targeted clinical areas.
Increase health care utilization for underserved populations.
Focus on target populations.
Diversify health care workforce.
Increase the cultural competence of the health care workforce.
Enhance and establish new partnerships.
Translate knowledge into clinical practice.
Enhance data collection.

10. Case Management

11. Case Management Overview
Case Management is the “process of assessing each client’s biological, psychological and social needs and addressing those needs by linking him or her to existing community services and resources.”
What does a case manager do?
What role does HealthCorps have in health care Case Management?

12. Elements of Case Management:
Patient Identification.
Patient Assessment.
Goal Setting.
Development and Implementation of an Action Plan.
Patient Referrals.
Follow-up and Reassessment.

13. Case Management Process
Patient Assessment.
Establish the situation?
What is the patients needs, status, and strengths?
Goal Setting.
Identifying check points relative to the materials you have.
Development and Implementation of an Action Plan.
Written out methodology as to what the patient should do to meet goals, with and without support.
Patient Referrals.
If the patient needs services that you can provide, then you refer them to a specialist.
Follow-up and Reassessment.
Once the patient has been to the specialist, you need to follow up to make sure that the plan is being followed.
This is important because it allows for you to assess the progress of your patient.

14. Traditional Assessments vs. Strength-based Assessments
Traditionally, assessments have focused solely on a client’s problems or needs; this is known as a deficit-oriented approach.
Strength-based approach focuses on the skills, attributes, and resources of each client which can be applied in reaching the family’s goals.

15. The New York State Department of Health has outlined the following principles of strength-based assessment:

16. First Principle
1. “Assessment is an ongoing process. Each family’s goals, needs, and resources will change over time, and the family will share more with you as trust develops.”

17. Second Principle
2. Focus on the family’s strengths, current situation, and future goals. When you help families evaluate past experiences and influences, focus on how these affect the family’s current situation.”

18. Third Principle
3. “Effective assessment is family-driven, not agency-centered. The primary goal of assessment is to help families become healthier and more self-reliant. While agencies do need to collect information about their own effectiveness, this must not become more important than helping families assess their own needs.”

19. Fourth Principle
4. “Assessment with families is much more effective than assessment of families or for families. Write down information with families in plain language and make sure they get a copy.”

20. Fifth Principle
5. “Collect only the information you really need and treat it with great care.”

21. Sixth Principle
6. “Assessment should be respectful and culturally appropriate to the family you are working with.”

22. Seventh Principle
7. “There are sometimes good reasons to use standardized assessments; collaborative agreements between agencies about assessment can make it easier for families to get services from these other agencies.”

23. Sources
Prescription for Success: Community HealthCorps Member Training