...Case managers have a hard job. They are working with clients, dealing with a great amount of paper work, working with community agencies, and following rules and regulations. When managed care is a part of the equation it is much harder for the case manager due to what is and is not allowed. In this paper I will discuss managed care and how it affects the case manager’s job. What is Managed Care? Managed care consists of a variety of structures, processes and strategies designed to monitor, review, and guide processes of care (Mechanic, 1997). There are several types of managed care, the most popular being HMOs and PPOs. Managed care usually provides a network of providers that the client is allowed to see in order for the client to be covered. Managed care usually allows for the client to only obtain health care and services from those within their network. Here in lies the problem for case managers. Depending on the managed care that the client is under, he or she may not be able to utilize the resources that the case manager has provided for the client. It also may be more difficult for the case manager to find resources that are part of the allowed network within a client’s managed care plan. Managed Care in Case Management Managed care has an exceptional part in how mental illness is treated in our country. It can be very difficult for a case manager to find resources for a client with mental illness because the care they need may not be covered. To reduce costs...
Words: 552 - Pages: 3
...------------------------------------------------- ------------------------------------------------- ------------------------------------------------- Mental Health in the Work place ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- Ellen Blewett ------------------------------------------------- ------------------------------------------------- Human Resource Management ------------------------------------------------- ------------------------------------------------- University of Portsmouth ------------------------------------------------- ------------------------------------------------- 2011 ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- ...
Words: 11481 - Pages: 46
...Northwestern Human Services Philadelphia, PA Recovery Guide • Introduce and advance the principles of mental health recovery, peer support and community integration as the catalyst for transforming individual lives and also local, state, and national mental health systems. • Seek to establish personal empowerment, attitudinal change, skill building, self-determination, self-help, peer support, and community integration as the foundations of mental health treatment that emphasizes hope, affirmation, participation, and productivity for consumers of mental health services in a culturally competent manner. 2007-July 2010 Northwestern Human Services Philadelphia, PA Children Case Manager Coordination of interagency meeting and necessary psychological or psychiatric evaluations for all clients. Coordinate access to medical and/or other treatment services as needed by family members. Responsible for client/family outreach in all matters surrounding the coordination of services. Responsible to assure ongoing communication and integration of services among all service providers and support systems involved with the child and family. Responsible to implement clinical strategies as developed with team 2006-2007 Northwestern Human Services Philadelphia, PA Resource Coordinator Team Leader Assisting with training of new case managers on policy procedure, service documentation and chart compliance as well as how to write personal goal...
Words: 306 - Pages: 2
...Behavioral Health Case Manager. This professionals are usually social workers that work in coordination with the clinical team to come up with and implement treatment plans for patients with conditions such as eating disorders, substance addiction and mental problems. Behavioral case managers are usually required to have at least a bachelor’s degree, but most facilities actually require a master’s degree in field such as social work or psychology. Some institutions require that these professionals also have clinical related degrees such as a nursing degree. Some of the responsibilities of the Behavioral Case Manger are: - Identify patients who will benefit from the case management - Meet on a regular basis with patients - Monitor the patients well-being - Connect patients with resources in the community - Monitor providers treatments to ensure quality and effectiveness - Provide education consultation and information to patients, family members and other coworkers - Coordinate with patient’s insurances to ensure that services are covered. The website Global post states that the reported average annual salary was about $43,340 for mental health and substance abuse social workers as of May 2012. The top 10 percent earned more than $66,880 annually. Social workers earned average salaries of $54,870 in 2012, according to the BLS, while top earners exceed $80,320. While the U.S. Bureau of Labor Statistics (BLS) doesn't forecast jobs specifically for mental health...
Words: 1177 - Pages: 5
...Part One: Questions and Answers 1. In your own words describe the role of Carers in Australia. Carer is a friend, neighbour, relative who will look after other person (someone who has disability, frail and aged care people). Mother is a carer for her children, children are carers for their parents, support worker is a carer for someone with disability etc. Carer is also a qualified paid worker with an expertise in health care needs of people with illness, disability and frail aged (the correct name for these people is support worker and they are employed by organisations that provides services). People become carers for different reasons. No two caring situations are the same. Carers are from diversity and circumstances. There is no rules about who can become a carer nor about what a carer is expected to do. There is no rule for an appropriate age of the carer. Carers don't chose to become carers it just happens and they have to get on with it. The role of carer range from helping with domestic duties, shopping assistance, paying bills at Australia Post to more complex duties such as helping with personal care for client who is hoisted or assisting client with daily bowel care program. The variety of the job and associated responsibilities are wide, everyday is different. In summary, carers play a vital role in our community, and we- people should get to know more about them as well as show appreciation if possible as they really deserve it. 2. Identify available...
Words: 2916 - Pages: 12
...Concurrent Disorders: The Role of Case Management Introduction to Concurrent Disorders The combination of a substance use or gambling disorder paired with a mental health disorder is known as a Concurrent Disorder, and is sometimes referred to as “dual diagnosis”. There is no specific reason why people develop Concurrent Disorders. Substance use might cause negative changes to occur in one’s life, thus leading to a mental health disorder. Also, some people with mental health disorders use substances to self medication to cope with the symptoms of their mental disorder. Other reasons might include a traumatic event in one’s life or biological reasons. The prevalence of Concurrent Disorders has been on the rise over the past two decades, and the need to coordinate services for treatment of these disorders is of high priority. It is said that around half the people with an Addiction or Mental Illness will also have the other. In the past, the treatment approach was to address each disorder on an individual basis, which led to an absence of coordinated care. Integrated services have proven to be more successful in treating this population. People who plan and manage substance abuse and mental health programs in Ontario have been working to improve how they provide services to persons with Concurrent Disorders since the release of the “Canadian Best Practices” document. Substance use can worsen or even induce psychiatric symptoms, making this disorder very complex and...
Words: 1220 - Pages: 5
...political trends. Mental health as a general public concern – and its role in the workplace – has garnered increasing attention over the past several years. One in five Canadians will experience a mental disorder in their lifetime. Whatever the reason for this new awareness, mental illness and poor mental health is now being recognized as a major business concern. 3 In order for workplace health promotion to be adopted, it must make a difference to the financial bottom line and be presented as a strategic priority to organizations. Taking a proactive approach to protecting employees’ mental health is the right move for organizations looking to keep a healthy staff team and a healthy budget. There this company, XYZ want to help improve the mental health of employees as it is beneficial in helping both the individual and the whole organization to achieve long-term excellence. As a result, a detailed project plan is described in the report that tells how the overall project will be carried out. 3 1 The Definition of Project 3 1.1 Project Objectives: 4 2. Business Projects: 4 Key Personnel Involved is: 5 2.1Assessment of costs relating to stress and psychosocial risks 5 2.2 Methodology for Carrying out the Project: 6 Creating a Healthy Workplace Committee 6 2.3 Conducting a Situational Assessment – Getting to the Root of the Problem 7 2.4 Developing a Healthy Workplace Plan 8 2.4.1 Types of planning 8 2.5 Role and responsibilities of a Project manager 8 2.6 A Detailed...
Words: 4745 - Pages: 19
...47% of all humanitarian entrants (Department of Immigration and Multicultural and Indigenous Affairs, 2003). Humanitarian immigrants present higher levels of stress and socialisation problems when compared to other migrant entrants (MacLennan, 1997). A significant portion of humanitarian entrants have ran from circumstances involving great violence and exhibit trauma, economic turmoil, loss of family and social networks, and significant breaks from education or work (Kline &Mone, 2003). Refugees tend to have experienced war and famine (Adams et al, 2004) and these experiences have led them to experience substantially trauma, involving physical and mental torture, sexual abuse, and other distressing conditions (Neuner et al, 2004). According to Farwell (2004), experiencing trauma during war and economic troubles leads to their mental turmoil. Experiencing and witnessing violence is connected to an array of various deliberating psychological effects such as anxiety, depression, substance abuse and post-traumatic stress disorder (Silove, 2001). Psychological distress related to psychosomatic disorders, grief and questioning the meaning of life areexhibited to a lesser extend as a result of such experiences (Silove, 1999., Steel, 1991). Refugees who had their life threatened tend to experience post traumatic stress disorder (Momartin et al, 2004) and refuges who had experienced four or more traumatic circumstances had a significantly higher rate of anxiety, depression,...
Words: 4608 - Pages: 19
...Case: Ledina Lushko The case of Ledina Lushko, a patient enrolled in a Blue Cross and Blue Shield of Illinois individual plan, highlights many of the issues that have plagued the United States healthcare system for some time. As an insurance plan provider, BCBS of Illinois takes pride in the health outcomes of our members and has a responsibility to contribute positively to their care. The fractured, ineffective care Mrs. Lushko received is disappointing, however, this case provides strong support for a shift in focus towards managed care and specifically, the Accountable Care Organization structure. The following details several aspects of Mrs. Lushko’s experience and how her care could have been improved by enrollment in BCBS of Illinois’ private ACO plan. 1. Issue: Repeat & Poorly Documented Testing One concerning aspect of Mrs. Lushko’s experience was the lack of proper organization of test results and test history. Beginning very early within her first contact, a repeat abdominal CT was performed after this test was already carried out just a few weeks earlier by a health system in Albania. Although there is not an obvious connection or relationship with an overseas health system of this sort, Mrs. Lushko had no knowledge that repeat tests could have been avoided prior to the appointment if she had obtained her files ahead of time. Additionally, there were several occasions throughout her care where providers did not have readily available access to recent...
Words: 1420 - Pages: 6
...more than 100 beds, allocated so that families are housed together in single units. The agency employs four case managers and one case management supervisor. Case management focuses on assuring that residents have access to community medical care, including general medicine, psychiatric services, dental, and vision services. In addition, case managers coordinate access to community services, such as transportation to vocational training and workplace sites, places of worship, and 12-step meetings (for those in recovery). Finally, case managers assure that children’s educational needs are met through access to school and after-school programs. These services, of course, are provided by organizations and agencies external to CASA. CASA employs three mental health workers and one clinical supervisor. Mental health services provide individual, family, and group counseling to address residents’ problems in living and general mental wellness concerns. In addition, the agency employs an office manager, who coordinates food services (provided by an outside vendor), housecleaning and grounds maintenance (also provided by vendors), safety and security, and general day-to-day operations. Coordination with other area homeless shelters is a vital part of office management, as there are times when there are more people seeking assistance than CASA can serve. The office manager has a staff of two part-time office administrators who assist with CASA’s operations after-hours. Finally...
Words: 289 - Pages: 2
...more than 100 beds, allocated so that families are housed together in single units. The agency employs four case managers and one case management supervisor. Case management focuses on assuring that residents have access to community medical care, including general medicine, psychiatric services, dental, and vision services. In addition, case managers coordinate access to community services, such as transportation to vocational training and workplace sites, places of worship, and 12-step meetings (for those in recovery). Finally, case managers assure that children’s educational needs are met through access to school and after-school programs. These services, of course, are provided by organizations and agencies external to CASA. CASA employs three mental health workers and one clinical supervisor. Mental health services provide individual, family, and group counseling to address residents’ problems in living and general mental wellness concerns. In addition, the agency employs an office manager, who coordinates food services (provided by an outside vendor), housecleaning and grounds maintenance (also provided by vendors), safety and security, and general day-to-day operations. Coordination with other area homeless shelters is a vital part of office management, as there are times when there are more people seeking assistance than CASA can serve. The office manager has a staff of two part-time office administrators who assist with CASA’s operations after-hours. Finally...
Words: 290 - Pages: 2
...University PO Box 256 DICKSON ACT 2602 icps@signadou.acu.edu.au Phone: 02 6209 1225 Fax: 02 6209 1216 http://www.acu.edu.au/icps/ Institute of Child Protection Studies, p2 October 1, 2011 [HEALTHY HOME: HEALTHY ME] Foreword by Northside Community Service ‘Healthy Home Healthy Me’ was an 18 week pilot program that supported nine clients to reduce severe domestic squalor and chronic hoarding within Canberra’s Inner North. During 2009/10, the Aged and Disability Home and Community Care (HACC) program at Northside Community Service (NCS) had received a high number of referrals for people presenting with issues related to hoarding and/or squalor. Prior to the pilot program, all nine of the program participants initially received HACC case management as well as a range of other HACC services, such as domestic assistance, social support or transport, in an effort to address the presenting issues. An initial one off episodic major clean was organized with some of these clients through another HACC-funded organization. However, it became quickly evident that mainstream HACC support was not sufficient to...
Words: 15200 - Pages: 61
...a gun’. Peter has been very subdued and withdrawn for the last week. You call an ambulance after speaking to Peter’s doctor. The doctor has recommended urgent admission and has notified the hospital. Peter refuses to go to hospital; he claims he cannot be forced to consent to this. The economic burden of mental health treatment in Australia is enormous. The Australian Institute of Health and Welfare reported that the national expenditure on mental health services in 2006-07 was estimated to be $4.7b (AIHW, 2009). Chronic mental illness can impact all aspects of a person’s life. Mental illness can be a debilitating barrier to goal establishment, realisation of self expectations and ultimately the perception of a meaningful life. Economic hardships and social problems such as stigma, isolation, loneliness and victimisation all negatively affect the quality of life of sufferers of mental health disorders. Furthermore, patients with chronic mental illness are at greater risk of co-occurring physical illnesses (such as hypertension or diabetes), reduced life expectancy, depression, suicide and substance abuse (Herzog & Shoemaker, 2010, p. 681). Mental illness is mainly attributable to non adherence to antipsychotic medication, which has consistently been...
Words: 3145 - Pages: 13
...continuous effort and case management to keep our youth off the street (Paulson, 2013). Over the last thirty eight years, juvenile crime is at its lowest level, yet there is still a significant need to find and retain resources and commitment. Even with this change in delinquent deviancy we would still like to see an effort on the deterrence towards juvenile deviancy with still bigger commitments for those of professional case management on juvenile delinquency. Those working in Juvenile Case Management must still posse a level of knowledge required to become a skilled social worker who contains knowledge of not only family and their environmental settings but also in juvenile justice, family law and practice, youth education and awareness, with an array of so many other personal attributes to keep these youth off the street. According to the National Institute of Juvenile Justice Research in Action Newsletter (1999), traditional case management consists of a social or mental health worker who secures and coordinates continued social, mental health, medical, and other services for a client (Healey). With the deinstitutionalize of inmates in 1970 the mental health workers found new ways and initiative to coordinate efforts in an attempt to connect social services while monitoring recent released inmates where different agencies were able to derive distinct programs and agencies for within the criminal justice system. Alongside these programs the case managers begin to differentiate...
Words: 1118 - Pages: 5
...five variables. According to Parker and Smith (2010), the Neuman System Model is described as, “wellness orientation, client perception and motivation, and a dynamic systems perspective of energy and variable interaction with the environment to mitigate possible harm from internal and external stressors” (p. 183). The patient/ family are the client system and interrelate with the five variables namely; the physiological, psychological, sociocultural, developmental, and spiritual beliefs. The Neuman System Model has been used in diverse settings such as, in critical nursing, psychiatric nursing, gerontological nursing, and for teaching purposes. In the United States, “the model is used to guide practice with clients with acute and chronic health problems” (Parker &ump; Smith, 2010, p. 192). As further explained by Parker and Smith (2010), the client system is the core: a person, individual, or community and the core interact with the flexible lines of defense, the normal lines of defense, and the lines of resistance. The client system is constantly affected by internal and external stressors. The goal of nurses in applying the Neuman System Model is, “to maximizing the quality of life lived, maintaining the highest level of independence possible, and preventing exacerbations of the on-going illness” (Ebersole, Hess, Touhy, Jett, and Luggen, 2008, p. 258). Mrs. J is a 79-year-old African-American female client, who lives with her husband in a wheelchair accessible home. She...
Words: 1557 - Pages: 7
