Clinical_Mental_Health_Counseling_Practicing_in_In..._----_(Section_II_Working_with_Clients_).pdf

SECTION II WORKING WITH CLIENTS Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved....

SECTION II WORKING WITH CLIENTS Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00. Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  CHAPTER 3 ALLIED AND CLINICAL MENTAL HEALTH SYSTEMS-OF-CARE AND STRENGTH-BASED APPROACHES ELIAS MPOFU | MAIDEI MACHINA | BOYA WANG | REBEKAH KNIGHT Allied and clinical mental health case management is a systems-of-care and strength-based model of care that transcends professional affiliations. Allied health professionals and mental health clinicians (hereafter allied and clinical mental health professionals) implementing systems-of-care and strength-based case management approaches work collaboratively within multidisciplinary teams (MDTs) to provide patient- or client-oriented care services to maintain, augment, and restore health and function. This case management provided by allied and clinical mental health professionals includes the design system-of-care-wide therapeutic interventions for supporting patients/clients in their healthcare management, inclusive of mental health. Systems-of-care and strength-based approaches are framed by addressing the full scope of the health needs of the patient or client across areas of activity and participation and capitalizing on the patient's or Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. client’s resources for health recovery while maintaining the efficient use of treatment care resources. The successful implementation of a systems-of- care and strength-based model of care by allied and clinical mental health case managers depends on the use of appropriate training and skills, as well as a case referral system that minimizes service discontinuities. Misalignment of systems-of-care to patient’s or client’s needs and marginalization of the patient or client assets for health recovery, including mental health functioning, would result in suboptimal patient or client health outcomes and would rely on using stand-alone rather than integrated healthcare services. This chapter presents a systems-of-care and a strength-based approach to allied health case management likely to result in superior mental health function and well-being for patients or clients, their families or significant others, and care providers. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  44 Section II Working With Clients The following Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards are addressed in this chapter: CACREP 2016: 2F1.b, 2F1.c, 2F5.b, 5C3.d, 5C3.b, 5C3.e CACREP 2009: 2G1.b, 2G5.a LEARNING OBJECTIVES After reviewing this chapter, the reader should be able to: 1. Define allied and clinical mental health case management from a systems-of-care and strength-based approaches perspective. 2. Outline the evolution of allied and clinical mental health case management, high- lighting the significance of the systems-of-care and strength-based oriented practices. 3. Discuss systems-of-care and strength-based role and functions of allied and mental health clinicians in the delivery of case management services in acute and commun- ity care settings. 4. Identify and discuss ethical issues in the use of systems-of-care and strength-based approaches to allied and clinical mental health case management. 5. Apply systems-of-care and strength-based case management approaches to case illustrations of patients or clients with complex (mental) healthcare needs. 6. Discuss the potential of and constraints to systems-of-care and strength-based approaches to allied and clinical mental health case management to address mental health function needs in patients or clients. Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. INTRODUCTION Allied and clinical mental health case managers seek to optimize healthcare coordin- ation for the patient or client, ensuring comprehensive care provision, while reducing healthcare use and costs (Case Management Society of America [CMSA], 2010; Hudon, Chouinard, Lambert, Dufour, & Krieg, 2016; Robinson, 2010). Major players of allied health and clinical mental health include occupational therapists, physiotherapists, nurses, social workers, and clinical mental health counselors. Each of these professionals has unique care roles in providing a system-of-care that spans disciplines and comple- ments expertise, and that focuses on augmenting patient or client health and functional strengths. For instance, occupational therapists typically focus on conducting compre- hensive assessments and designing treatment plans that address the physical, cognitive, affective, social, financial, environmental, and spiritual components that influence a client’s health and well-being (Willard et al., 2014). Physiotherapists focus on optimiz- ing clients’ active mobility, while social workers conduct comprehensive psychosocial López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  Chapter 3 Allied and Clinical Mental Health Systems-of-Care and Strength-Based Approaches 45 assessments that explore the physical, psychological, and social aspects of the clients and their respective situations (Society for Social Work Leadership in Health, 2015). Clinical mental health counselors provide interventions designed to improve a client’s mental health functioning. Clinical mental health counselors and nursing staff are critical to safe discharge planning and sustainable community living with chronic illness or disease. In addition to their discipline-specific responsibilities, all allied health professionals assist with generic case management tasks that include, but are not limited to, monitoring symtoms, providing supportive counseling, organizing family conferences, referring cli- ents to in-hospital and external services, and assisting with discharge planning (Lloyd, King, & Ryan, 2007; Smith, 2011). Allied and clinical mental healthcare professionals work with federal agencies, healthcare policy makers, and healthcare providers, working collaboratively to provide high quality and efficient client-centered healthcare services while ensuring health sys- tem sustainability. Sustainable health services are likely only when mental healthcare needs are addressed together with any presenting physical healthcare needs. Chronic illness and disease often are accompanied by mental health challenges that need to be addressed in order to achieve sustained recovery (see Chapter 6). The Association of Schools of Allied Health Professionals (2018) defines allied health case management as “the segment of the healthcare field that delivers services involving the identi- fication, evaluation, and prevention of diseases and disorders; dietary and nutrition services; and rehabilitation and health systems management” (p. 1). This involves the mental health- care that is primary or secondary to other health conditions. Similarly, the CMSA (2010) defines case management as “a collaborative process of assessment planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individuals’ and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes” (p. 6). These service qualities are optimal when mental health needs are addressed as a part of comprehensive healthcare provision. Current health policies emphasize the need for systems-of-care and strength-based Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. services to provide integrated and coordinated care for patients with chronic diseases, such as asthma, diabetes, heart disease, stroke and vascular disease, osteoarthritis, rheu- matoid arthritis, osteoporosis, and cancer. Case management services are pertinent for people with chronic conditions who often require long-term care that crosses conven- tional care service boundaries, but such clients or patients typically have experienced, fragmented, and poorly coordinated care management. There is a growing body of evidence that suggests that a positive correlation exists between the implementation of a systems-of-care and strength-based case management approach to the delivery of healthcare services and improved health outcomes for clients with chronic diseases (Burke et al., 2016; Gabbay et al., 2013; Huntley, Johnson, King, Morris, & Purdy, 2016; Morrish et al., 2009; Scherz et al., 2017). For example, with case management utilization by specialty MDTs, repeat asthma admissions fell by 33% in 2 years. Length of hospital stays also fell by 52% in difficult asthma patients who had prior frequent admissions (Burke et al., 2016). Disconnected services come with mental health stress from patients or clients seeking to negotiate the care service niches separately. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  46 Section II Working With Clients Systems-of-care provided by MDTs comprised of allied health professionals and clinical mental health clinicians providing coordinated or integrated services can utilize their discipline-specific skills sets, knowledge, and training to address mental health needs of persons with complex and chronic conditions (Krupa & Clark, 1995). This chapter provides an overview of systems-of-care and strength-based qualities that allow effective allied and clinical mental healthcare management to deliver optimal care with sustainability. We provide a brief overview of the evolution of allied and clinical mental healthcare management services in the United States. Next, we discuss the scope and func- tioning of allied and clinical mental health case management services and related ethical issues. Then we provide a comprehensive digest on types of allied and clinical mental health case management settings and related practices with illustrative case studies. Finally, we consider research and practice issues in allied and clinical mental health case management. HISTORY OF ALLIED AND CLINICAL HEALTH IN CASE MANAGEMENT The historical evolution of case management in the United States can be traced as far back as the 19th century when almshouses were established during the Colonial period in order to provide a place for the dependent aging and poor populations to receive care for their ill- nesses (Linz, McAnally, & Wieck, 1989). Churches or municipalities were the primary pro- viders during this period. Subsequently, state governments provided homes for the aged and infirm. Families carried the burden of care for their vulnerable members from any cause. Social workers were among the first healthcare professionals to recognize the need for a case management approach to the delivery of healthcare services in order to improve the quality of care and health outcomes of impoverished and vulnerable populations (Aus- tralian Association of Social Workers, 2015; Society of Social Work Leadership in Health, 2015). A timeline for the development of case management is shown in Figure 3.1. In 1935, Franklin D. Roosevelt signed the Social Security Act, which was designed to provide old-age pensions and old-age assistance payments to the elderly, the unem- Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. ployed, and the disadvantaged. This Act gave individuals the ability to receive pensions and cash assistance to procure quality care in emerging private institutions. These non- governmental care institutions were some of the first to receive federal funds for provid- ing care as long as they adhered to the guidelines set forth by the Act (Doty, 1996). In 1965, the U.S. Congress passed the Medicare (Title 18) and Medicaid (Title 19) sec- tions of the Social Security Act, which provided funding appropriations for medical and social services. Following this, there was a proliferation of case management providers in both the public and private sectors; however, patients and families were still faced with ongoing challenges in regard to how to navigate their continuum and management of care. Additional legislation continued to be passed in the 1970s, and there arose a need to coordinate the various services and programs offered through diverse agencies and delivery systems. There was a spike in the demand for case managers across a variety of settings including long-term care, inpatient and outpatient hospitalizations, community service settings, home care, and others. Currently, healthcare provisioning is a multibil- lion dollar business in the United States, and organizations are turning to case managers López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  Chapter 3 Allied and Clinical Mental Health Systems-of-Care and Strength-Based Approaches 47 19th ­Century Private singular charity organizations started to provide case management services to people in need. 1935 Social Security Act attempted to bring together categorical programs (i.e., public ­ ssistance and social insurance programs) into logical relationships. a 1960s Great wave of federal legislation for social services occurs. The need for case­ management emerges in response to the deinstitutionalization of large numbers of people with severe mental health conditions who required referrals to outpatient and community health services. 1970s The rapid increase in the number of human service programs results in negative c­ onsequences (i.e., fragmented and uncoordinated care systems). 1971 The Secretary of Health, Education, and Welfare declared service integration as a ­policy objective. Forty-five federally funded projects called Service Integration Targets of ­Opportunity started to build local interagency linkages. 1980s The increasing cost of healthcare and decentralization of health services influence the role of case management. Growing bodies of evidence demonstrate that case manage­ ment can potentially reduce the cost of services for individuals with chronic disabilities. Late 1980s Case management processes are adapted for implementation in all healthcare areas and until now practice settings (i.e., acute, subacute, rehabilitation, and community settings). Case management roles are undertaken by individuals from various disciplines to cater to people with different health conditions in diverse contexts and settings. FIGURE 3.1 The historical evolution of allied health and mental health case management. SOURCE: Linz, M., McAnally, P., & Wieck, C. (1989). Case management: Historical, current and future perspectives. Cambridge, MA: Brookline Books. to help patients receive the highest quality of care possible while also promoting the most efficient use of resources and services. In recent years, the realization that case management is a model of care that transcends professional affiliations has created the unique opportunity for members of various allied health and mental health professions to assume certain aspects of the case management role. As early as 1991, the American Occupational Therapy Association published the Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. document Statement: The Occupational Therapist as Case Manager and asserted that occupational therapists can serve successfully as case managers (American Occupa- tional Therapy Association, 2017). Baldwin and Fisher (2005) found that the educational premises and standards of occupational therapy programs paralleled the fundamental concepts of case management as defined by the CMSA, including the holistic (i.e., med- ical, spiritual, and psychosocial) management of chronic and complex conditions. The Australian Physiotherapy Association’s position statement supports a physical therapist’s role in case management in addition to clinical-based interventions, particularly in the areas of occupational rehabilitation and chronic diseases. Occupational therapists and physiotherapists are well trained to work collaboratively within MDTs, performing com- prehensive functional and environmental assessments, designing therapeutic interven- tions, and developing management plans using a holistic approach to practice (Krupa & Clark, 1995; Robinson, Fisher, & Broussard, 2016; Willard, Spackmen, Schelle, Gillen, & Scaffa, 2014). In these roles, they typically collaborate with medical doctors, social work- ers, mental health clinicians, families, and community health support agencies. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  48 Section II Working With Clients The determination of which specific allied health professional or mental health clinician is best suited to provide short-term and long-term case management services is dependent upon the specific care needs of the client, the care setting, and the professional background of the clinician providing the service (Gursansky, Kennedy, & Camilleri, 2012; Powell & Tahan, 2010). For example, a client whose chronic obstructive pulmonary disease (COPD) interferes with the performance of activities of daily living and increases the risk of falls would benefit from having an occupational therapist as a case manager. By successfully matching the needs of the client to a case manager with the most relevant professional background, training, skills, and knowledge, clients experience better access to appropri- ate care, receive improved care coordination, and experience enhanced clinical outcomes while de-escalating healthcare costs. Furthermore, effective case management also may serve to empower clients by providing them with relevant clinical information, support, resources, and resource management strategies that enable them to increase their partici- pation in the decision-making processes and planning for their current and future needs. Allied health and clinical mental health case managers applying systems-of-care and strength-based practices typically work alongside with, or in lieu of, the family physician and are able to offer additional explanation and coordination of healthcare for the indi- vidual client (Dugdale, Epstein, & Pantilat, 1999). When one assesses the total amount of healthcare paperwork, instructions, prescriptions, and appointments that the average client must navigate, it becomes very clear that professional help is needed to navigate these challenges. ALLIED HEALTH AND CLINICAL MENTAL HEALTH CASE MANAGEMENT: CONTEXT AND SCOPE OF PRACTICE Case management is aimed to improve the coordination of care for clients with chronic and complex conditions across various healthcare settings (CMSA, 2010). The main goals of systems-of-care and strength-based case management are to focus on providing Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. seamlessly networked services for improving quality of care by providing therapeutic and beneficial care that is responsive to emerging health needs from disease progression, including those that are related to a primary mental health disorder diagnosis. Context of Allied Health and Clinical Mental Health Case Management For decades, nurses and social workers have taken the central role in allied healthcare coor­ dination, and they are recognized as experts in care management. However, as the U.S. fed- eral government seeks new ways of controlling escalating healthcare costs while maintaining quality of care (Robinson et al., 2016), case management strategies delivered by MDTs, in collaboration with clinical mental health professionals, have become more prevalent. For this reason, allied health and clinical mental health case managers provide coordinated, client-centered services for improving the quality of care and health outcomes, across the spectrum of health conditions and service systems (Baldwin & Fisher, 2005; Chapleau, Seroczynski, Meyers, Lamb, & Haynes, 2011; Smith, Yeowell, & Fatoye, 2017). The following is a representative list of allied and clinical mental health case management practice settings: López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  Chapter 3 Allied and Clinical Mental Health Systems-of-Care and Strength-Based Approaches 49 Hospitals and integrated care delivery systems, including acute care, ­sub-acute care, long-term acute care facilities, nursing facilities, and rehabilitation f­ acilities; Ambulatory care clinics and community-based organizations; Public health insurance programs (i.e., Medicare, Medicaid, and state-funded programs); Private health insurance programs (i.e., workers’ compensation, occupational health, disability, accident and health, long-term care insurance, and group health insurance); Independent and private case management companies; Government-sponsored programs (i.e., correctional facilities and military healthcare/Veterans Affairs); Provider agencies and community facilities (i.e., mental health facilities, home health services, ambulatory, and day-care facilities); Geriatric services, including residential and assisted living facilities; Long-term care services, including home and community-based services; Hospice, palliative, and respite care programs; Physician and medical group practices; Life care planning programs; and, Disease management companies (CMSA, 2010). Allied health and clinical mental health case management currently is provided at all levels of care from the acute hospital setting to rehabilitation centers and community programs. Moreover, systems-of-care and strength-based case management practices are expanding to emphasize client education and self-advocacy, enabling clients to seek services for emerging health needs, including those that arise from mental health func- Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. tion compromise. Allied health and clinical health professionals bring distinct value and unique expertise to the role of case management not only from their medical, psycho- social, and practical clinical experience, but also from their knowledge of related health services to supplement or complement those that are discipline specific but likely to enhance the overall health and function of the patient or client. Moreover, poor organi- zational relationships, which include lack of clarity in directions and expectations from supervisors/management, compromise the quality of care for patients or clients by allied and clinical mental health case managers (Salloum, Kondrat, Johnco, & Olson, 2015). The Role and Scope of Practice of Allied and Clinical Mental Health Case Management The roles and responsibilities of allied health and clinical mental health case managers vary depending on the care setting (i.e., hospital, community, hospice, and insurer), model of practice used (i.e., brokerage, rehabilitation, clinical, and strength based), target population being served, area of specialty (i.e., mental health, elder care, long-term care, López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  50 Section II Working With Clients and child welfare), and the profession of the person providing the service (i.e., medical, nursing, allied health professionals, and mental health clinicians). For this reason, some care settings may prioritize mental healthcare needs more than others. A system-of-care is when a specific service deliberately addresses patient and client needs with an appro- priate and timely referral. Furthermore, the roles and scope of practice of case managers can be influenced significantly by funding priorities and programs or organizational mandates. This being the case, some service care settings may overlook the mental health function needs of clients that are important for overall quality of treatment care. A yawning healthcare practice gap occurs when allied health management systems-of- care fail to address the mental health needs of patients or clients that are important for health-related quality-of-life and treatment adherence for comorbid health conditions. For instance, in the context of rehabilitation care, case management often begins in the emergency department, immediately after a patient diagnosis has been confirmed and the patient has been stabilized (Wissel, Olver, & Sunnerhagen, 2013). Emergency reha- bilitation will include a coordinated multidisciplinary approach, which often will involve pharmacotherapy, surgical intervention, and physical or occupational therapy. Emergency rehabilitation service case managers fulfill the responsibilities of their discipline while working toward a common goal for a treatment plan for the health function recovery of the patient. Emergency rehabilitation case managers determine the discharge destination of the patient as the level of functional recovery (Jesus & Hoenig, 2015), often without a men- tal healthcare qualified person on the case management roster. Needless to say, the mental healthcare needs of patients in emergency medical care settings likely are short-changed or ignored from a lack of systems-of-care approach to patient or client management. Allied and clinical mental health case manager roles are defined operationally by the behaviors and expected outcomes associated with a person’s position in a social structure (CMSA, 2010). For instance, the roles of allied health and clinical mental health case man- agers can be divided into two areas: patient/client and family-system roles, or service-system roles, otherwise known as clinical or administrative roles, respectively (You, Dunt, & Doyle, Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. 2015). Each of these two broad roles carries both potentialities and constraints for address- ing existing or emerging mental health function needs of patients or clients. Clinical Roles An allied and clinical mental health case manager’s clinical roles, such as caregiver, edu- cator, problem solver, and supporter, focus on providing quality care through apply- ing systems-of-care and strength-based interventions. Case managers implementing ­systems-of-care and strength-based interventions within this capacity are expected to fulfill some of the following responsibilities: Conduct comprehensive assessments of the health and psychosocial needs of the client while taking into consideration the needs and expectations of the family or caregivers; Identify the current and potential needs of the client in order to develop a case management or clinical pathway plan in collaboration with the client, family, care- givers, and all appropriate healthcare, social, and community service providers; López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  Chapter 3 Allied and Clinical Mental Health Systems-of-Care and Strength-Based Approaches 51 Inform and educate the client, family, or caregivers regarding the management of acute or chronic conditions, available treatment options, available health, social, and community resources, insurance benefits, and so forth; Assist the client in safe transitioning of care among healthcare settings, service providers, and levels of care to ensure the seamless continuity of care; and, Empower the client to engage in self-advocacy and self-determination by ex- ploring options of care when available and alternative plans when necessary to achieve desired outcomes (CMSA, 2010). Allied and clinical mental health practices subscribe to the dictum “do no harm,” which is widely acknowledged alongside several ethical principles of medical and health- care practice, and which also includes beneficence, respect for autonomy, and justice (Hain & Saad, 2016). However, the extent to which allied and clinical mental health prac- titioners are trained in interdisciplinary practice ethics in healthcare to guide acceptable professional conduct is questionable. This is primarily because few preservice healthcare professional programs provide direct instruction concerning interdisciplinary systems- of-care oriented practices, with the seeming expectation that practitioners somehow will learn the ethical practices from work experience. Consequently, apparent mental healthcare needs of patients or clients are likely to be overlooked by practitioners overly invested in their discipline-specific roles and functions. Administrative Roles Administrative roles, such as gatekeeper, care coordinator, negotiator, and advocate, focus on the coordination of services and the management of resources. Allied health and clinical mental health case managers implementing systems-of-care and strength- based interventions in this capacity are expected to: Generate referrals to appropriate health, social, and community services; Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. Facilitate efficient and timely communication and coordination of services among providers to minimize fragmentation; Manage financial resources, analyze fiscal benefits, maintain cost-effectiveness, and ensure effective resource utilization; Advocate for the attainment of resources and the achievement of desired out- comes for the client and the healthcare providers; and, Remain up-to-date with policy, funding, and research developments (CMSA, 2010). In this regard, allied health and clinical mental health case managers apply systems- of-care and strength-based approaches to assist patients or clients to navigate complex health, social, and community service systems. Matters related to the scope of practice in allied health case management continue to evolve with the increasing impetus toward interdisciplinary practices. Regrettably, role ambiguities and conflicts are often the rule rather than the exception (Beard & Barter, 2016; Dasgupta, 2013), hazarding the overall López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  52 Section II Working With Clients quality of care, with risk for escalating mental healthcare needs from suboptimal care. For instance, when working in a healthcare role, ethical conflicts can arise from system- atic constraints on the extent to which a care provider can go beyond the call of duty to care without infringing on client autonomy (Beard & Barter, 2016). Other administrative practice-related ethical issues arise from the need to maintain continuity of care while facing barriers, such as under-resourcing, high staff turnover, and understaffing (Brady, 2003). This is particularly the case when allied and clinical mental health professionals seek to serve dispersed client populations, such as those in rural or remote locations, and residents of historically disadvantaged neighborhoods (Davis & Bartlett, 2008; Morgan, Innes, & Kosteniuk, 2011), though there is increasing use of tele-health technology to mitigate some of these barriers to systems-of-care ori- ented services (Inglis, Clark, Dierchx, Prieto-Merino, & Cleland, 2015; Morgan et al., 2011; Reinius et al., 2013). For instance, the community virtual ward (CVW) model has been developed in order to assist healthcare professionals to support and provide treat- ment to older healthcare clients within their own home environment in order to reduce emergency department presentations and unplanned hospital admissions. The CVW model provides a framework of care that assists healthcare professionals with prioritizing client care coordination and ensuring the timely mobilization of services. This innova- tive approach to the provision of healthcare services allows allied health professionals and clinical mental health counselors to circumvent some of the continuity-of-care eth- ical concerns that were noted previously. However, research evidence is needed on the incremental value of the use of CVW in allied health professions and clinical mental health case management. Ethical practice issues also arrive from allied and clinical mental health practitioners in both service system (administration) roles and client system (clinical) case manager roles, which may require knowledge and skills that can be vastly different from those required by some allied health professionals when fulfilling their traditional profes- sional roles (Krupa & Clark, 1995; Lloyd et al., 2007). Some service-system roles involve Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. managing client budgets, monitoring the use of resources, and being gatekeepers to accessing services, while client-system roles may involve being a crisis manager, coun- selor, monitor, and educator (CMSA, 2010; You et al., 2015). In this regard, allied and clinical mental health professionals may experience significant challenges to assume systems-of-care and strength-based role and functions new to their scope of practice and training. From the legal realm come regulatory standards and policies, such as the Health Information Privacy and Accountability Act (HIPAA) of 1996, issued by the U.S. Depart- ment of Health and Human Services and aimed at protecting the use and disclosure of the private health information of individuals. While this rule has been deemed success- ful in protecting the individual’s health information from commodification or abuse, it also may limit allied and clinical mental health professionals in collaborations that are intended to address the mental healthcare needs of the patient or client at the planning stage of the case management process. In other words, at least in some ways, this Act may make it more cumbersome for allied and clinical mental health counseling (CMHC) López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  Chapter 3 Allied and Clinical Mental Health Systems-of-Care and Strength-Based Approaches 53 professionals to collaborate on services that are needed by the client or patient. However, what may seem to be a somewhat restrictive function of the act actually affords protec- tion to clients and patients. While professional collaboration generally is encouraged, HIPAA regulations require a signed release of information from the client as a necessary step in protecting clients’ and patients’ rights. The Case Management Process In applying systems-of-care and strength-based approaches, allied and clinical mental health case managers help clients to progress through each phase of the case manage- ment process, taking into consideration the health status, needs, values, and wishes of the clients, their families, and caregivers within the service-provider policy framework. Healthcare case management also is “carried out within the ethical and legal realm of a case manager’s scope of practice, using critical thinking and evidence-based knowledge” (CMSA, 2010, p. 14). The typical steps in the case management process are included in the following list: Screening/Intake or On-Boarding  is involves the gathering and reviewing of relevant information related to a Th client’s past and present health conditions, functional abilities, social supports, home environment, current and prior services, and financial and insurance assets. The allied health case manager’s objective is to identify client needs for targeted case management services. Assessment This entails the gathering of in-depth information about a client’s circumstanc­ es similar to that gathered during the screening phase. The case manager’s objective is to identify the client’s needs and assets in order to facilitate the de- velopment of a comprehensive case management or clinical pathway plan. The assessment of a client’s needs occurs repeatedly throughout the case manage- Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. ment process as the client’s needs and the situation change. Planning This entails establishing, modifying, and prioritizing the client’s long-term and short-term goals for intervention in addition to determining the resources and the health, social, and community services required to meet the established goals and achieve the client’s desired quality of life. Implementation This is about the execution of the case management plan. The allied health or clinical mental health case manager’s objectives are to engage in active care coordination. Monitoring and Review This spans the activities aimed at monitoring the effectiveness of the case man- agement plan. It also provides the opportunity to revise any irrelevant plans and/or address any unforeseen problems. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  54 Section II Working With Clients Monitoring Screening Assessment Planning Implementation Evaluation Transfer or and Closure Review FIGURE 3.2 Systems-of-care and strength-based case management process. Evaluation This involves the formal and informal assessment of the effectiveness of the case management plan, applying a systems-of-care and strength-based ap- proach. The allied health or clinical mental health case manager’s objective is to determine the effect of the case management plan on improving the client’s health condition(s) and quality of life. Transfer or Closure This is about the transfer or termination of case management services when all of the client’s goals have been met, or the needs of the client have changed, and his or her recovery-oriented assets have been enhanced. A systems-of-care and strength-based case management process is not a linear one. It is recursive and involves the constant reassessment, planning, monitoring, reviewing, and evaluation of the case management plan to ensure that the clients’ desired outcomes are met as illustrated in Figure 3.2. Regardless of the specific health condition for which a patient or client is receiving care, systems-of-care, and strength-based case management functions must address mental health function needs, as these are critically important for overall health-related quality of life. Depending on the coping resource supports to the patient or client, their mental healthcare needs would fluctuate across the case management process phases, Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. requiring interdisciplinary collaboration to address the needs adequately. Coping refers to the actions and thoughts individuals engage to enable them to deal with stressors. Strength-based case management interventions seek to support patients or clients to adopt and utilize active coping strategies or psychological or behavioral responses that foster a positive mental health attitude toward living with a debilitating health condition. TYPES AND LEVELS OF ALLIED HEALTH AND CLINICAL MENTAL HEALTH CASE MANAGEMENT APPROACHES Case management services can be initiated in any treatment setting and can be provided during a single episode of care and/or throughout the care continuum. This ensures that clients receive the right care at the right time and from the right provider for the best price. Systems-of-care and strength-based case management services generally are implemented based on two models of care: internal case management and external case management (Rutter et al., 2004). López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  Chapter 3 Allied and Clinical Mental Health Systems-of-Care and Strength-Based Approaches 55 Internal Case Management Internal or “within the walls” case management services are provided mainly within the hospital acute, subacute, and inpatient rehabilitation setting. These services typically are implemented to coordinate internal and transitional hospital services during a single episode of care (Rutter et al., 2004). Efficient and effective internal case management service provision often is provided by nursing staff and, to a lesser extent, by allied health professionals. The Clinical Setting Within a clinical setting, the case management process and coordination of clinical care begin at the moment of triage. As previously noted, this process involves facilitat- ing efficient patient flow through the healthcare system, thus ensuring needed assess- ments along with treatment planning and implementation with the clients, their families, and other health providers for timely referral. This, in turn, can enhance client clinical outcomes, reducing the length of hospitalization, readmission rates, and costs of care delivery (Gursansky et al., 2012; Rutter et al., 2004). To achieve these goals in a systems- of-care manner, case managers working within this capacity are required to: Understand and facilitate efficient patient flow; Be knowledgeable about various insurance plans; Understand the roles of all members of the MDT; Be knowledgeable of available community and in-facility resources; Be able to interpret the meaning of laboratory test results; Be able to develop and implement complex clinical pathway plans; and, Have extensive knowledge of all major medical diagnoses, procedures, and medications (Powell & Tahan, 2010; Scherz et al., 2017; Smith, 2011). Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. While the lead internal allied and clinical health case manager may be nursing staff, clinical mental health counselors play a key role in ensuring the safe and timely discharge of clients from the clinical setting, as typically is the case with clinical mental health counselors working in psychiatric hospitals (Lloyd et al., 2007; Smith, 2011). Allied health professionals making a transition from providing discipline-specific interventions to engaging in nondiscipline-specific tasks can expect to experience sub- stantial role confusion and role conflict. Role confusion is characterized by feelings of uncertainty on the part of the case managers as to what their role is within a practice setting, in addition to the existence of uncertainty regarding what is expected of them by colleagues (Smith, 2011). Case manager role confusion and role conflict are occupa- tional hazards that persist due to insufficient training for the case management role and variations in role definition, depending on the practice setting. Within the context of a multidisciplinary case management team, some professionals may become conflicted and disempowered due to role overlap. Case Illustration 3.1 is a hypothetical case study in relation to allied health case management in a clinical setting. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:17:00.  56 Section II Working With Clients CASE ILLUSTRATION 3.1 HOSPITAL-BASED ALLIED HEALTH AND CLINICAL MENTAL HEALTH ­COUNSELING CASE MANAGEMENT: THE CASE OF SCOTT Scott is an 80-year-old man who was brought into the hospital by ambulance with increased urinary frequency and urgency and potential delirium on a background of chronic renal failure. Scott was found by police at the scene of a motor vehicle accident after he crashed his car into a tree while attempting to pull over to the side of the road to urinate. Upon admis- sion, Scott was put under the care of an MDT consisting of a geriatric consultant, registrar, junior medical officer, clinical care coordinator, occupational therapist, physiotherapist, and clinical mental health counselor. During his admission, the occupational therapist and clinical mental health counselor made several attempts to collect information regarding Scott’s social situation, home en- vironment, and preadmission functional status. However, they were unsuccessful, as Scott was in a state of hyperactive delirium. The occupational therapists observed that Scott was disorientated to person, place, and time; looked unkempt; and was unable to manage his personal activities of daily living in the ward (i.e., Scott was refusing to shower and was observed to urinate on the floor, despite being given a urinary bottle and being orientated to the location of the toilets in the ward). The physiotherapist was unable to assess Scott’s active mobility, due to his restlessness and agitation. The urology team also came to review Scott and, upon their investigation, determined that he needed to have surgery prior to discharge from the hospital, once his delirium had resolved. The occupational therapist, physiotherapist, clinical mental health counselor, and nurs- ing staff reported their findings, or lack thereof, and expressed their concerns to the treating