Academic journal article Care Management Journals

HIV/AIDS Case Management: Views from the Frontline

Academic journal article Care Management Journals

HIV/AIDS Case Management: Views from the Frontline

Article excerpt

Case management has been a critical component of services to vulnerable populations for the past 20 years, and the knowledge base has been constantly evolving. This article offers an additional dimension to the study of case management practice by providing an opportunity for perceptions of case managers, heretofore relatively neglected, to be included in the literature. It reports the results of two study efforts (chart review and focus groups) that examined the case management system of care for people with HIV/AIDS in the New York tri-county region. While the literature and chart review findings stress the primacy of linkage activities, the case managers emphasize the importance of providing the support necessary to ensure that clients are able to maintain a reasonable quality of life. Findings are discussed in the context of the "strengths perspective" as well as service system and organizational contingencies. Potential methodological implications for the use of the study techniques are suggested.

While case management has been a critical component of services to vulnerable populations for the past 20 years, the knowledge base has been constantly evolving as a result of ongoing efforts to define and describe it. There is, however, general agreement regarding the purpose of case management. It is an approach to service delivery that attempts to ensure that clients with complex, multiple problems and disabilities receive all the services they need in a timely and appropriate fashion (Rubin, 1992). There also is agreement that case management involves a series of core functions or activities, but there is considerably less consensus regarding the number of functions, what these functions are, and how these functions are defined and implemented. In addition, efforts to establish the effectiveness of case management, the focus of extensive empirical study this past decade, have proven inconclusive. Without specific standards or protocols for case management practice, with diverse settings and targeted populations, multiple models, and differences in case manager credentials and training, it is not surprising that case management remains somewhat elusive and ambiguous.

This article builds on efforts to define the practice of case management by sharing results of research that examined the case management system of care for people with HIV/AIDS in the New York State tri-county region (Westchester, Rockland, and Putnam Counties). Specifically, it reports the results of two study efforts-a review of a sample of 60 charts, and two focus group sessions held with case managers who expressed their views and vision of case management. These findings offer an additional dimension to the study of case management practice by providing an opportunity for the perceptions of frontline service providers, heretofore relatively neglected, to be included in the literature. In addition, these findings contribute to the knowledge base of HIV/AIDS case management, which, as a relative newcomer in comparison to case management in mental health and long-term care, has been the subject of little empirical research.

Case Management With Persons With HIV/AIDS

Case management is well established as a modality for vulnerable populations in the mental health (Intagliata & Baker, 1983; Johnson & Rubin, 1983) and long-termcare (Austin, 1983) fields. By the mid-1980s, it was adopted for use with an additionally vulnerable population, people with HIV/AIDS. Community and hospitalbased case management programs were established around the country and quickly became a popular strategy for response to the wide range of service needs presented by persons with AIDS, AIDS-related complex, and HIV (Sonsel, Paradise, & Stroup, 1988). A significant step in the development of a case management service delivery system was taken in 1986 when the Robert Wood Johnson Foundation established nine demonstration projects, AIDS Health Services Programs, with case management as an integral component. …

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