Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program

Knox, Margae; Esteban, Emily E; Hernandez, Elizabeth A; Fleming, Mark D.; Safaeinilli, Nadia; Brewster, Amanda L.

doi:10.1136/bmjoq-2021-001807

Cited by 9 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Trusting relationships between patient and case manager have been found to help patients feel more secure and empowered to make decisions and take actions to support their health [ 16 , 24 ]. Patient trust may also be an important indicator of success in case management programs [ 24 ]. Additionally, we found that a positive relationship with a case manager may help to mitigate the impacts of mental health challenges.…”

Section: Discussionmentioning

confidence: 99%

Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study

Fleming

Safaeinili

Knox

et al. 2022

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

Background Social needs case management programs are a strategy to coordinate social and medical care for high-risk patients. Despite widespread interest in social needs case management, not all interventions have shown effectiveness. A lack of evidence about the mechanisms through which these complex interventions benefit patients inhibits effective translation to new settings. The CommunityConnect social needs case management program in Contra Costa County, California recently demonstrated an ability to reduce inpatient hospital admissions by 11% in a randomized study. We sought to characterize the mechanisms through which the Community Connect social needs case management program was effective in helping patients access needed medical and social services and avoid hospitalization. An in-depth understanding of how this intervention worked can support effective replication elsewhere. Methods Using a case study design, we conducted semi-structured, qualitative interviews with case managers (n = 30) and patients enrolled in social needs case management (n = 31), along with field observations of patient visits (n = 31). Two researchers coded all interview transcripts and observation fieldnotes. Analysis focused on program elements identified by patients and staff as important to effectiveness. Results Our analyses uncovered three primary mechanisms through which case management impacted patient access to needed medical and social services: [1] Psychosocial work, defined as interpersonal and emotional support provided through the case manager-patient relationship, [2] System mediation work to navigate systems, coordinate resources, and communicate information and [3] Addressing social needs, or working to directly mitigate the impact of social conditions on patient health. Conclusions These findings highlight that the system mediation tasks which are the focus of many social needs assistance interventions offered by health care systems may be necessary but insufficient. Psychosocial support and direct assistance with social needs, enabled by a relationship-focused program, may also be necessary for effectiveness.

show abstract

Section: Discussionmentioning

confidence: 99%

Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study

Fleming

Safaeinili

Knox

et al. 2022

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…Considerable research validates this fact. Current literature by Knox et al (2022) firmly acknowledges case management's interdisciplinary expertise, especially in addressing health-related social needs and other social determinants of health. However, incorporation of interprofessional perspectives within existing case management models continues to yield challenges.…”

Section: Interprofessional Expertisementioning

confidence: 99%

Diversity, Equity, and Inclusion Start From Within

Fink-Samnick

2024

Professional Case Management

View full text Add to dashboard Cite

The values associated with diversity, equity, and inclusion (DEI) initiatives are well known to case managers. All values align with the ethical tenets of case management and its established resources of guidance, Yet, how effective is case management at applying these values within the workforce. Opportunities exist for implementation of an inclusive case management model that heeds with quality mandates and ethical expectations for practice.

show abstract

“…16 Therapeutic alliance itself appears to affect treatment and outcomes, for example, stronger therapeutic alliance is related to higher levels of clinician optimism about patient recovery, a greater sense of personal growth, 17 clinician flexibility, and opportunities to observe and respond to changes in patients' mindsets. 18 Other studies explored the clinician's experience of treatment, for example their preferences or how it affects them personally. One study found that a recovery oriented or strengths-based approach had positive effects on professional and personal satisfaction for providers in community based rehabilitation settings.…”

Section: Clinician Experience Of the Process Of Rehabilitationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

Faith,

Wiesepape,

Kukla

et al. 2023

NDT

View full text Add to dashboard Cite

Introduction Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients’ experience of recovery oriented approaches, there are less studies examining clinicians’ perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis. Methods Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services. Results Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work. Discussion As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.

show abstract

Defining case management success: a qualitative study of case manager perspectives from a large-scale health and social needs support program

Cited by 9 publications

References 31 publications

Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study

Conceptualizing the effective mechanisms of a social needs case management program shown to reduce hospital use: a qualitative study

Diversity, Equity, and Inclusion Start From Within

Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation

Contact Info

Product

Resources

About