Academic journal article Care Management Journals

Case Management and Social Role Theory as Partners in Service Delivery

Academic journal article Care Management Journals

Case Management and Social Role Theory as Partners in Service Delivery

Article excerpt

This article proposes a reorganized model of case management for persons with a serious psychiatric illness, including a substance abuse disorder. The model was designed as a response to the changing demands of federal law, public funding sources, and social work licensure requirements in some states. It partners case management with social role theory and uses the person-in-situation paradigm and social functioning as organizing concepts.

This model may be helpful for those adult mental health agencies serving this population who are faced with making adjustments to changing demands of federal law, public funding sources, and the requirements of social work licensure in some states, all of which place restrictions on service delivery. An important feature of the model is partnering case management with social role theory in a way that enhances the delivery of case management services. It is being implemented at Touchstone innovaré, a mental health agency serving adults who have a serious psychiatric condition or a co-occurring disorder.

Keywords: case management; partnering; social role theory

Touchstone innovare' is located in Kent County, Michigan. Its program has been described in detail in Care Management Journals (Blakely & Dziadosz, 2003). It also has a co-occurring disorders program (Blakely & Dziadosz, 2007b), an electronic record system (Blakely, Smith, & Swenson, 2004 ), and a valid and reliable outcome measure (Blakely & Dziadosz, 2007a).

LITERATURE REVIEW

Studies by Taylor and Dear (1980) and Brockington, Hall, and Levings (1993) about respondents' stigmatizing attitudes toward persons with a mental illness centered on the factors of authoritarianism, benevolence, and fear and exclusion. These attitudes were that these persons cannot make their own decisions, that they need to be cared for like children, and that they should be feared and therefore segregated. Institutionalization was perceived as the most appropriate response.

Deinstitutionalization, beginning in the 1950s and continuing for the next two decades, changed the focus of treatment from the institution to the community (Talbott, 1987), with mixed results for many (Grainick, 1985; Hornbeck, 1997; Torrey, 1997). Associated with this change was the development of a new service function, case management, and a new mental health professional, a case manager (Mueser, Bond, Drake, & Resnick, 1998). However, the negative attitudes previously described established case management as a maintenance service. These attitudes continue to affect the delivery of mental health services, especially as they have influenced public decision makers about the definition of case management.

Case management has a long history in social work practice. Weil and Karls (1985) in their book about case management wrote that "the roots of case management in the United States can be traced as far back as 1863" (p. 4). They also expressed the view that case coordination as observed in the Charity Organization Society movement and the settlement house movement was "an early conceptualization of case management" (p. 133). From this it would appear that case management in some form has a long history in human services. However, this history is associated with a widely viewed goal of social work as helping people to help themselves by connecting them to community resources and service systems. Social work knowledge has advanced considerably beyond connecting clients with services, and this professional knowledge base should be applied more broadly.

Anthony, Cohen, Farkas, and Cohen (2000) have observed that services to persons with a mental illness have been described as "fragmented and uncoordinated" but that "case management is a needed function" (p. 97). Defined by the Case Management Society of America (2007), "Case management is a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality costeffective outcomes. …

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