Preparation of Rehabilitation Counselors for Case Management Practice in Health Care Settings

Article excerpt

The American health care system and the insurance industry are currently undergoing significant reforms in order to rein in the high cost of delivering health care services in this country. Managed care is considered the cornerstone of the new health reform age (Choppa, Shafer, Reid, & Siefker, 1996; Strickland, 1995). The case management industry with its focus on cost containment, managed competition, and quality care is playing an increasingly important role in the managed care environment (Mullahy, 1995; Owens, 1996). According to Mullahy (1995), the number of case managers has risen from an estimated five to ten thousand in 1985 to a total of fifty to one hundred thousand today. These individuals come from diverse training backgrounds and practice settings that include nursing, rehabilitation counseling, and social work. Presently, there are 19,000 Certified Case Managers (CCMs) (E. Holt, personal communication, October 22, 1996).

The role of case managers is to facilitate the delivery of cost-efficient individualized and coordinated care to patients afflicted with chronic illnesses and disabilities in today's technologically advanced medical environment. Case management is a disciplined application of skills, tools, and techniques that facilitate positive movement toward a desired outcome. Specifically, case management can be defined as a "collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs through communications and available resources to promote quality, cost-effective outcomes." (Mullahy, 1995, p. 9).

Recently, Leahy (1994) surveyed 14,078 CCMS to empirically validate the common knowledge dimensions required for case management practice. He developed a 132-item knowledge importance instrument based on a comprehensive review of the literature, an inspection of 500 job descriptions of case managers, and the recommendations of 30 content experts. Because case management is practiced in a variety of settings by many different professionals, only items which attained a mean importance rating of 3 or higher (0=not important, 1=little importance, 2=moderate importance,(3=highly important, 4=essential) were included in a principal component analysis to determine the underlying knowledge dimensions for case managers in all settings. He found five knowledge domains to be important to case management practice: coordination and service delivery, physical and psychosocial aspects, benefit systems/cost benefit analysis, case management concepts, and community re-entry. The internal consistency reliability coefficients of these five factors were found to range from .86 to .93. Although case management is practiced in a variety of settings and by many different professionals, his research suggested that CCMs do share common core of knowledge areas required for effective case management practice.

Increasingly, registered nurses and rehabilitation counselors are being hired to fill the function of case managers in the disability/health care marketplace. Although Leahy (1994) identified several universal knowledge domains that are essential for case management practice across settings, those familiar with case managers frequently note that there appears to be some differences in function and emphasis among case managers drawn from different disciplines (Choppa et. al., 1996). It then becomes important to determine whether there are knowledge domains specific to the professional specialization of the case managers, such as case managers with a rehabilitation counseling background. The purpose of this study is to determine the universal and specific knowledge domains perceived by rehabilitation counselors as important to case management practice in today's disability/health care settings. Most importantly, we are interested in determining the degree of reported preparedness of rehabilitation counselors to perform the case management functions identified in this study. …