why/when people need case management: complex problems complex medical problems, addiction, mental health disorders, homelessness, overdose, DV, legal problems, unemployment, "the system has so many holes"
CM duties: coordination of care, communication, identification of resources, "constantly problem-solving and communicating with clients," "help people in a very concrete way," "helping people live their best lives," "designed around each client," "assessment, planning, facilitation, care coordination," outreach, assessment, "like a bridge between a person and their wants," screen for barriers, "reaching out to other support systems the patients may have"
what they like about CM: it's "challenging," "always new," "never boring," "being creative," "helping and making a difference in clients' lives"
their work schedule: 8-5, 9-5, 8-4:30, "you have to be flexible," "depending on what walks in the door in comes in your email or voicemail," "checks with her team, her email, and her agenda," "appointments may not be scheduled"
CM skills: organization, flexibility, decision-making, problem-solving, good communication, conflict resolution, understanding, kindness, autonomy, time management, listening, de-escalation, empathy, give and receive feedback, documentation, computer use, motivational interviewing, knowledge of resources
what supervision looks like: "brainstorming difficult clients and resource needs," "collaborating how to meet each client's needs," "explore ways to overcome client obstacles,"
follow-up CM: proactive monitoring "checking in with clients," "checking up on clients," "seeing how they're doing," "at least weekly checks," "follow up appointments," "if a client is not improving go back to find something you might have missed," check back with other service providers, "most importantly keeps in touch with her patients"
their paperwork/documentation: "stick to the facts, observe, and describe," "all employees have access (with permission)," care plans, intake, assessment, service notes, "high volume of paperwork," "lots of paperwork," medical charts
teamwork: "she consults with her teammates," OT, MD, CNA, activities director, DSHS, state workers, doctor, therapist, housing, "weekly team meeting, round table," "collaborating together with other organizations,"
electronic health records: "more efficient," "share information with teammates"
caseload size: 44, 13, 50
duration of case manager-client relationships: varies, based on client need, up to 3 months, on-going
the challenges: "things don't always work,"
the nature of client-CM relationships: "having a relationship" is important, "work with clients as a team," "getting input from clients and families," individualized, person-centered, client-centered, "holistic," "make sure clients feel respected and comfortable," "comprehensive personal needs," "be patient," "guide people until they can do things on their own," "building rapport, gaining their trust," "looking at the person as a whole"
the values which underlie case management: you don't have all the answers, "all people deserve care," "their goals"