1. 2010 Job Corps National Health and Wellness Conference November 19, 2010 Orlando, Florida Case Management and Chronic Illness Case Studies 1

2. Facilitators and Panelists Facilitators  Shannon Bentley, RNc, Nurse Specialist  Melissa Cusey, RN, BSN, CCM, Nurse Specialist Panelists  Drew Alexander, MD, Medical Specialist  Pamela Alston, DDS, MPP, Lead Oral Health Specialist  Christy Hicks, MSW, TEAP Specialist  Suzanne Martin, PsyD, Mental Health Specialist 2

3. Learning Objectives Participants will be able to: Identify three goals of using a team approach to care Verbalize two benefits of utilizing community resources Identify three goals of case management Work through case scenarios Verbalize three ways case management is used to enhance quality of care 3

4. What is Case Management? Student Case Manager Team Case management is a collaborative process where the student is the focus. 4

5. Case Management Society of America, Standards of Practice for Case Management- Revised 2010, page 6 5

6. The FRAMES Approach Feedback: regarding risk is given to student. Responsibility: for change is placed with student. Advice: about change is provided in a non- judgmental manner. Menu of self-directed change and treatment options Empathetic Counseling: showing warmth, respect, and understanding. (uses reflective listening). Self-Efficacy: empowerment to encourage change. Source: SAMHSA TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment 6

7. Why Case Management? 145,000,000 people have a chronic illness and 60,000,000 have multiple illnesses. People with Bipolar are at an increase risk of heart disease or other physical conditions; people with mental health illnesses receive suboptimal care. Incidence of type 2 diabetes accounts for one third of all the new cases of diabetes diagnosed in adolescents. Sources: Copyright 1996-2010 The MacColl Institute. The Improving Chronic Illness Care program is supported by The Robert Wood Johnson Foundation, with direction and technical assistance provided by Group Health's MacColl Institute for Healthcare Innovation. Kilbourne, A.M, Post, E.P, Nossek, A., Drill, L., Cooley, S. & Bauer, M.S (2008) Improving Medical and Psychiatric Outcomes Among Individuals With Bipolar Disorder: A Randomized Controlled Trial PSYCHIATRIC SERVICES ' ps.psychiatryonline.org ' July 2008 Vol. 59 (7) 760-767 Morales Pozzo, A. (2010). Diabeses Mellitus, Type 2. Retrieved online from: http://emedicine.medscape.com/article/925700-overview 7

8. When & How Do We Start? When first become aware of problem or diagnosis Assess for the immediate needs Meet as a team to implement the plan Coordinate referrals Follow up/Monitor Evaluate 8

9. Case Management Functions 1. Assessment 2. Planning 3. Linking 4. Monitoring 5. Advocacy 6. Coordinating 7. Ongoing Engagement 9

10. During Assessment Phase Get to know the student Build trust – be a good listener Ask about past experiences and previous barriers Educate about importance of adherence to the recommended treatment plan Inform students of the risks of nonadherence Source: Center for Disease Control and Prevention. Self Study Modules on Tuberculosis. 10

11. Self Management Emphasize the patient's central role. Use effective self-management support strategies that include assessment, goal-setting, action planning, problem-solving, and follow-up. Organize resources to provide support. The MacColl Institute for Healthcare Innovation, ©1996 - 2010 with support from The Robert Wood Johnson Foundation. 11

12. Benefits of a Team Approach? Teams bring individuals and ideas together Define roles Distribute tasks Focus on goals 12

13. Benefits of a Team Approach Meet regularly as a team and document the team meeting “I do not have enough time to do this”  Individually there is not enough time, however as a team the work is dispersed. 13

14. Benefits of the Community Reduce cost Form partnerships Good referral sources Continuity of care Provide resources the student may use once they leave Job Corps 14

15. What are the Goals? Promote health Coordinate care Reduce cost Improve quality Monitor outcomes 15

16. Benefits of Case Management Correctly identifies student needs (which leads to satisfaction and retention in the program) Center performance goals are met (if students stay, they will complete program) Holistic approach Team approach 16

17. How Do I Assess Quality Management? Was the care appropriate? Were available resources used?  Use needymeds.org or PPARx.org  Clinics  Community Health Departments Was the student able to adhere to the plan? Was improvement measureable? 17

18. Where Can I Find Chronic Care Plans? 18 Medical  JC Community Website  Health and Wellness Health Topics (Chronic Illness) Asthma Diabetes Sickle Cell Hypertension Seizure Disorder Obesity

19. Where Can I Find Chronic Care Plans? Mental health  JC Community Website  Health and Wellness Health Topics (Mental Health) ADHD, Asperger's Syndrome, Bipolar Mood Disorder, Borderline Personality, Depressive Disorder, Gender Identity, OCD, PTSD, Schizophrenia, Tourette’s Disorder 19

20. 20 Questions before we work on the scenarios?

21. Scenario 1 Alicia Questions Would you place Alicia on MSWR? Which of the 3 reasons for MSWR would you use?  Preexisting condition that significantly interferes or precludes further training at Job Corps  Health problem is too complicated to manage  Necessary treatment will be unusually costly 21

22. Scenario 1 Alicia If you decide to work with Alicia on center  What would you do first?  Who from the wellness staff would you have on the team?  Who from the center staff would you have on the team?  What outside resources would you use?  How would you implement the plan?  How often would you meet as a team?  How would you evaluate and measure progress?  What are the benefits of Case Management? 22

23. Scenario 2 Dora Scenario 2 Questions What questions would you ask Dora during the interview? Would you recommend denial – state your reasons using one or of the 3 reasons for denial  Applicant poses a direct threat to self or others  Applicants training needs can not be best met through the Job Corps Program.  Applicant can not be reasonably expected to successfully participate in a group setting and is likely to engage in behavior that would prevent other students from receiving the benefit of Job Corps. 23

24. Scenario 2 Dora If you decide to accept Dora  When would you start the care plan?  Who from wellness would be on the team?  Who from the center would you recommend be on the team?  What outside resources would you use?  How would you implement the plan?  How often would you meet as a team?  How would you evaluate and measure progress?  What are the benefits of Case Management? 24

25. Future Considerations With Health Care Reform, case management is going to change –in more settings and with more individuals – the focus will change from just students who have health problems and expands across the whole continuum of care starting with prevention and wellness all the way through disease episodes and chronic care. Case management will require more specific and specialized knowledge and skills and to rely on advances in the industry like technology. Technology will likely shape and change the way case management is carried out. Source: Scott, R (2010). The Future of Case Management: New Roles, Leadership Positions and Opportunities. http://www.dorlandhealth.com/Trends/the-future-of-case-management-new-roles-leadership-positions-opportunity.html http://www.dorlandhealth.com/Trends/the-future-of-case-management-new-roles-leadership-positions-opportunity.html 25