TIP 27: Comprehensive Case Management for Substance Abuse ...

Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment

Comprehensive Case Management for Substance Abuse Treatment

Treatment Improvement Protocol (TIP) Series

27

Comprehensive Case Management for Substance Abuse Treatment

Treatment Improvement Protocol (TIP) Series

27

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment 1 Choke Cherry Road Rockville, MD 20857

Acknowledgments This publication was produced under contract number 270-95-0013 for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Sandra Clunies, M.S., ICADC, served as the Government Project Officer.

Disclaimer The opinions expressed herein are the views of the consensus panel members and do not necessarily reflect the official position of SAMHSA or HHS. No official support of or endorsement by SAMHSA or HHS for these opinions or for the instruments or resources described are intended or should be inferred. The guidelines presented should not be considered substitutes for individualized client care and treatment decisions.

Public Domain Notice All materials appearing in this volume except those taken directly from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Printed Copies This publication may be ordered from or downloaded from SAMHSA's Publications Ordering Web page at . Or, please call SAMHSA at 1-877-SAMHSA-7 (1 877-726-4727) (English and Espa?ol).

Recommended Citation Center for Substance Abuse Treatment. Comprehensive Case Management for Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 27. HHS Publication No. (SMA) 15-4215. Rockville, MD: Center for Substance Abuse Treatment, 2000.

Originating Office Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857.

HHS Publication No. (SMA) 15-4215 Printed 2000 Revised 2002, 2003, 2006, 2008, 2010, 2012, and 2015

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Contents

What Is a TIP?............................................................................................................................................................ v

Editorial Advisory Board....................................................................................................................................... vii

Consensus Panel ...................................................................................................................................................... ix

Foreword.................................................................................................................................................................... xi

Executive Summary............................................................................................................................................... xiii Case Management and Substance Abuse Treatment ................................................................................... xiii Interagency Case Management ....................................................................................................................... xiv Evaluation and Quality Assurance of Case Management Services ............................................................ xv Case Management for Clients With Special Needs ..................................................................................... xvii Funding Under Managed Care .....................................................................................................................xviii

Chapter 1--Substance Abuse and Case Management: An Introduction.........................................................1 Why Case Management .......................................................................................................................................2 Case Management--A Brief History ..................................................................................................................4 Definitions and Functions....................................................................................................................................5 Models of Case Management with Substance Abusers ...................................................................................6

Chapter 2--Applying Case Management to Substance Abuse Treatment ...................................................13 Case Management Principles ............................................................................................................................13 Case Management Practice--Knowledge, Skills, and Attitudes ..................................................................15 The Substance Abuse Treatment Continuum and Functions of Case Management .................................17

Chapter 3--Case Management in the Community Context: An Interagency Perspective .........................29 Characteristics of the Three Models .................................................................................................................30 Forging the Linkages ..........................................................................................................................................33 Identifying Potential Partners ...........................................................................................................................35 The Agency Environment ..................................................................................................................................36 Potential Conflicts ...............................................................................................................................................39

Chapter 4--Evaluation and Quality Assurance of Case Management Services ..........................................41 A Brief Overview of the Research Literature ..................................................................................................41 iii

Contents

Evaluating Case Management Programs.........................................................................................................43 Future Research...................................................................................................................................................49 Chapter 5--Case Management for Clients With Special Needs .....................................................................51 Minority Clients ..................................................................................................................................................51 Clients With HIV Infection and AIDS..............................................................................................................52 Clients With Mental Illness................................................................................................................................53 Homeless Clients.................................................................................................................................................54 Women With Substance Abuse Problems .......................................................................................................55 Adolescent Substance Abusers .........................................................................................................................57 Clients in Criminal Justice Settings ..................................................................................................................57 Clients With Physical Disabilities .....................................................................................................................62 Gay, Lesbian, Transgendered, and Bisexual Clients ......................................................................................63 Case Management in Rural Areas ....................................................................................................................64 Chapter 6--Funding Case Management in a Managed Care Environment..................................................65 Funding Case Management in a Managed Care World ................................................................................65 Preparing a Program for Managed Care..........................................................................................................68 Future Directions ................................................................................................................................................71 Appendix A--Bibliography...................................................................................................................................73

Appendix B--Practice Dimensions ......................................................................................................................87 Referral .................................................................................................................................................................87 Service Coordination ..........................................................................................................................................90

Appendix C--Managed Healthcare Organizational Readiness Guide and Checklist: Special Report...99 Introduction .........................................................................................................................................................99 Goals and Objectives ........................................................................................................................................100 Background........................................................................................................................................................100 Ways To Use the Guide and Checklist...........................................................................................................100 Managed Healthcare Organizational Readiness Checklist .........................................................................104 Summary of Answers .......................................................................................................................................111 Common Questions and Answers..................................................................................................................112 How Can We Design an Action Program for Change? ...............................................................................113 Summary and Conclusion ...............................................................................................................................113 References ..........................................................................................................................................................114

Appendix D--Resource Panel .............................................................................................................................115

Appendix E--Field Reviewers ............................................................................................................................117

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What Is a TIP?

T reatment Improvement Protocols (TIPs) are developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (HHS). Each TIP involves the development of topic-specific best-practice guidelines for the prevention and treatment of substance use and mental disorders. TIPs draw on the experience and knowledge of clinical, research, and administrative experts of various forms of treatment and prevention. TIPs are distributed to facilities and individuals across the country. Published TIPs can be accessed via the Internet at .

Although each consensus-based TIP strives to include an evidence base for the practices it recommends, SAMHSA recognizes that behavioral health is continually evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front-line" information quickly but responsibly. If research supports a particular approach, citations are provided. When no citation is provided, the information is based on the collective clinical knowledge and experience of the consensus panel.

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Editorial Advisory Board

Note: The information given indicates each participant's affiliation during the time the board was convened and may no longer reflect the individual's current affiliation.

Karen Allen, Ph.D., R.N., C.A.R.N. President National Nurses Society on Addictions Associate Professor Department of Psychiatry, Community Health, and Adult Primary Care University of Maryland, Baltimore Baltimore, Maryland

Richard L. Brown, M.D., M.P.H. Associate Professor Department of Family Medicine University of Wisconsin School of Medicine Madison, Wisconsin

Dorynne Czechowicz, M.D. Associate Director Medical/Professional Affairs Treatment Research Branch Division of Clinical and Services Research National Institute on Drug Abuse Rockville, Maryland

Linda S. Foley, M.A. Former Director Project for Addiction Counselor Training National Association of State Alcohol and Drug Counselors Director Treatment Improvement Exchange Health Systems Research, Inc. Washington, D.C.

Wayde A. Glover, MIS, NCAC II Director Commonwealth Addictions Consultants and Trainers Richmond, Virginia

Pedro J. Greer, M.D. Assistant Dean for Homeless Education University of Miami School of Medicine Miami, Florida

Thomas W. Hester, M.D. Former State Director Substance Abuse Services Division of Mental Health, Mental Retardation and Substance Abuse Georgia Department of Human Resources Atlanta, Georgia

Gil Hill

Director Office of Substance Abuse American Psychological Association Washington, D.C.

Douglas B. Kamerow, M.D., M.P.H. Director Center for Practice and Technology Assessment Agency for Health Care Policy and Research Rockville, Maryland

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Editorial Advisory Board

Stephen W. Long Director Office of Policy Analysis National Institute on Alcohol Abuse and Alcoholism Rockville, Maryland

Richard A. Rawson, Ph.D. Executive Director Matrix Center Los Angeles, California

Ellen A. Renz, Ph.D. Former Vice President of Clinical Systems MEDCO Behavioral Care Corporation Kamuela, Hawaii

Richard K. Ries, M.D. Director and Associate Professor Outpatient Mental Health Services and Dual Disorder Programs Harborview Medical Center Seattle, Washington

Sidney H. Schnoll, M.D., Ph.D. Chairman Division of Substance Abuse Medicine Medical College of Virginia Richmond, Virginia

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