Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

Sullivan, Patrick; McCabe, Heather

doi:10.1080/1533256x.2015.1027447

Cited by 3 publications

(2 citation statements)

References 46 publications

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“…While integrated care aspires for all services and resources to be available and easily accessible to consumers, our findings present an alternative perspective, recognising conflicting goals and agendas that exist within a complex care system through the introduction of the service labyrinth metaphor. While passing references to service labyrinths appear in the interdisciplinary literature on social services (Cooper, 2015; Sullivan and McCabe, 2015), this is the first study to develop this concept in depth. This metaphor facilitates the recognition of key elements that actively contribute to creating the labyrinth through the interactions and inherent tensions that occur between them.…”

Section: Discussionmentioning

confidence: 97%

A paradoxical dynamic in a service labyrinth: insights from HIV care

Cruz

Snuggs

Tsarenko

2018

EJM

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Purpose While theories of complex service systems have advanced important insights about integrated care, less attention has been paid to social dynamics in systems with finite resources. This paper aims to uncover a paradoxical social dynamic undermining the objective of integrated care within an HIV care service system. Design/methodology/approach Grounded in a hermeneutic analysis of depth interviews with 26 people living with HIV/AIDS (PLWHA) and drawing on Bourdieu’s (1984) theory of capital consumption to unpack dynamics of power, struggle and contestation, the authors introduce the concept of the service labyrinth. Findings To competently navigate the service labyrinth of HIV care, consumers adopt capital consumption practices. Paradoxically, these practices enhance empowerment at the individual level but contribute to the fragmentation of the HIV care labyrinth at the system level, ultimately undermining integrated care. Research limitations/implications This study enhances understanding of integrated care in three ways. First, the metaphor of the service labyrinth can be used to better understand complex care-related service systems. Second, as consumers of care enact capital consumption practices, the authors demonstrate how they do not merely experience but actively shape the care system. Third, fragmentation is expectedly part of the human dynamics in complex service systems. Thus, the authors discuss its implications. Further research should investigate whether a similar paradox undermines integrated care in better resourced systems, acute care systems and systems embedded in other cultural contexts. Originality/value Contrasted to provider-centric views of service systems, this study explicates a customer-centric view from the perspective of heterosexual PLWHA.

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Section: Discussionmentioning

confidence: 97%

A paradoxical dynamic in a service labyrinth: insights from HIV care

Cruz

Snuggs

Tsarenko

2018

EJM

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“…In a previous study of individuals who had comorbid opiate dependence and medical problems, case management was found to be associated with a reduction in unnecessary emergency department visits (Chen, Huang, Yeh, & Chien, 2015). Thus, case management has recently been recommended for its ability to improve care for substance-abusing individuals in the contemporary system of integrated health care (Sullivan & McCabe, 2015). If funding allows, treatment providers should provide case management as part of their services to ensure that low-income clients are properly linked to applicable resources.…”

Section: Interdisciplinary Teamsmentioning

confidence: 99%

There's No Time like the Present: Improving the Current System of Care for Low-Income Substance Abusers with Comorbid Health Conditions

Wahler

Sullivan

2017

Families in Society

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Due to social determinants of health, people living in poverty are at high risk for having comorbid substance use and medical disorders, yet are also the least able to afford and access the care needed to adequately address their health. There has been a recent call for providing integrated care for behavioral and physical health problems, yet there are challenges to fully integrating the two systems. In this article, several suggestions for improving the current system of care for low-income individuals are presented. Suggestions are derived from components of the chronic care model, the model underlying most conceptions of integrated care, and include increasing the use of technology and interdisciplinary teams to supplement assessment and intervention.

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The Affordable Care Act, Substance Use Disorders, and Low-Income Clients: Implications for Social Work

McCabe

Wahler

2016

Social Work

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Social workers are leaders in the substance abuse services field and may often work in substance use disorder (SUD) education, prevention, assessment, treatment, or resource coordination and case management roles. As the Patient Protection and Affordable Care Act (ACA) (2010) drives changes in the fields of health and behavioral health, social workers have an opportunity to lead structural changes at the micro and macro levels that will have a positive impact on low-income clients with SUDs. In this article, authors examine the current state of SUDs and health care access, the impact of the ACA on the field, and implications for social work practice and education. Social workers should seek specialized education and credentialing in SUD services, know how to help clients apply for health care coverage, and advocate for integrated substance abuse treatment and health care programs and an expansion of Medicaid in their local communities. Social workers are well positioned to be a voice for clients to ensure that the current structural changes result in a better, integrated system of care that is able to respond to the needs of low-income clients with SUDs.

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Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

Cited by 3 publications

References 46 publications

A paradoxical dynamic in a service labyrinth: insights from HIV care

A paradoxical dynamic in a service labyrinth: insights from HIV care

There's No Time like the Present: Improving the Current System of Care for Low-Income Substance Abusers with Comorbid Health Conditions

The Affordable Care Act, Substance Use Disorders, and Low-Income Clients: Implications for Social Work

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