“Because Somebody Cared about Me. That's How It Changed Things”: Homeless, Chronically Ill Patients’ Perspectives on Case Management

Abstract

BackgroundCase management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants’ perspectives on case management interventions.MethodsThis qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program.ResultsFour recurrent themes emerged: (1) Participants described profound social isolation prior to case management program enrollment; (2) Participants perceived that caring personal relationships with case managers were key to the program; (3) Participants valued assistance with navigating medical and social systems; and (4) Participants perceived that their health improved through both the interpersonal and the practical aspects of case management.ConclusionsChronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.

Voices of Homeless Alcoholics Who Frequent Bellevue Hospital: A Qualitative Study

“…Many of the existing qualitative analyses were designed to evaluate and inform aspects of interventions, such as low-barrier housing. 21,26,27,42,43 Participants in these studies may differ from ours because all agreed to participate in interventions, were receiving specialized services or housing, and were identified primarily through community rather than hospital referral. Yet these and other studies provide important insight into how structured, supportive environments and various means of approaching these individuals and caring for them helps to empower them by addressing factors that have contributed to their loss of self-identity and selfdetermination.…”

“…Yet these and other studies provide important insight into how structured, supportive environments and various means of approaching these individuals and caring for them helps to empower them by addressing factors that have contributed to their loss of self-identity and selfdetermination. 21,[23][24][25][26][27]44 Other researchers have explored the perspectives of medical professionals and others who encounter this population rather than directly studying the individuals of interest. 45,46 Incorporating a wide range of different perspectives through purposive sampling and exploring negative cases that may contradict prevailing theories strengthened our study.…”

“…[7][8][9][10][11]19,20 However, there are few data from the perspective of the individual describing the evolution, environment, and psychosocial context of the disease, and many of these qualitative studies have aimed to evaluate and inform components of interventions. [21][22][23][24][25][26][27][28][29] The purpose of this phenomenological study was to explore the evolution, environment, and psychosocial context of alcoholism from the perspective of chronically homeless, alcoholdependent persons who frequent Bellevue Hospital Center in Editor's Capsule Summary…”

Proactive Case Management: Social Work Active Engagement Revisited

“…An additional qualitative shelter-based intensive case management research study done by Davis, Tamayo & Fernandez (2012) demonstrated the benefits of the strong interpersonal relationship these patients had with their case manager. This relationship was the overwhelming self-reported key to recovery for homeless persons with mental health and substance abuse issues (Davis et al, 2012).…”

“…This relationship was the overwhelming self-reported key to recovery for homeless persons with mental health and substance abuse issues (Davis et al, 2012). Research done on the Transitional Care model of case management is reported to reduce re-admissions but -intuitively so, does little to improve long-term outcomes (Volland, Schraeder, Sheldon & Hess, 2013).…”