Using Clinical Management for Substance Abusing Behaviors Essay

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Clinical Case Management

Case management emerged during the late 19th and early 20th centuries in an effort by professional social workers to address the broad-based social problems that followed the Industrial Revolution, including most especially poverty (Aufderhaar, Giddens, Holder, et al., 2013). Since that time, case management has influenced by a wide range of evidence-based practices and social workers in virtually every field use these techniques to help their clients overcome the problems that are adversely affecting their lives. To gain a better understanding of the process, this paper reviews the relevant literature to provide a definition of case management, the rationale in support of its use, and a discussion concerning how case management can be useful as part of an overall treatment plan. In addition, based on a representative vignette involving a young couple and their minor daughter, this paper also examines how case management can help these clients, including an explanation concerning how the clients would benefit from referrals in the local community and the rationale in support of these referrals. Finally, an analysis concerning how the clients can be expected to improve if they comply with the case management plans is followed by a summary of the research and important findings about social work case management in the conclusion.

What is case management?

According to the definition provided by Aufderhaar et al. (2013), case management "is a process to plan, seek, advocate for, and monitor services from different social services or health care organizations and staff on behalf of a client" (p. 13). In sum, the case management process facilities the coordination of efforts by social workers to provide clients with individualized assistance that draw on a wide array of community-based resources (Aufderhaar et al., 2013). There are two distinct aspects of case management in social work practice that set it apart from other disciplines as follows:

1. Social work has a dual focus on the person and the environment and social work's biopsychosocial focus means that social workers are concerned with the interaction between the body, the mind, and the social system;

2. Social workers carry out case management by using a strengths-based approach, which focuses on strengths rather than deficits and views the community as an "oasis of resources" (Darnell, 2013, p. 124).

Having defined case management, the question then arises concerning the rationale in support of its use by social workers and other helping professions, and these issues are discussed further below.

Why do we use case management?

Case management is needed in order to provide clients with the multidisciplinary team-based interventions they need to address the problems that are adversely affecting the quality of their lives. Properly formulated, implemented and administered, case management provides a useful framework in which social workers can better coordinate care and ensure the continuity of that care (Aufderhaar et al., 2013). In this regard, Aufderhaar et al. (2013) report that, "Case management limits problems arising from fragmentation of services, staff turnover, and inadequate coordination among providers" (p. 13). Likewise, this point is also made by Vaughn-Sarrazin and Hall (2009) who emphasize, "Case management offers continuity of services, linkage to necessary collateral services, and coordination of services that cannot be met by a single agency" (p. 436). Moreover, because social work resources are by definition scarce, case management is also used because it is a highly cost-effective strategy for developing optimal interventions for clients who present with multiple issues (Darnell, 2013). Although every individual's needs vary, there are some common positive outcomes that can be achieved by using case management as part of the overall treatment plan as discussed below.

How can case management be useful as part of your overall treatment plan?

Because case management regards the local community as an "oasis of resources," it is possible for social workers to draw on a much wider range of resources by using case management methods as part of their overall treatment plan than would otherwise be possible. Indeed, Miller (2011) maintains that, "Good case management the cornerstone of high quality care" (p. 8). An important point made by Vaughan-Serrazin and Hall (2009), though, it that even the most carefully designed and implemented case management strategy will not replace but is rather intended to complement conventional treatment modalities. In this regard, Vaughan-Serrazin and Hall (2009) point out that, "Most experts agree that case management should be complementary to traditional treatment services" (p. 436). Notwithstanding this caveat, though, it is clear that case management can help coordinate the multidisciplinary resources that are needed by social work clients and these issues are discussed further below as they relate to Susan and Randy's hypothetical but typical vignette.

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Given the information found in the vignette, how would you use case management to help your clients?

Unfortunately, the circumstances described in the vignette concerning Susan and Randy are not uncommon, and many young adults find themselves the victims of their substance-abusing behaviors. Although Susan has managed to overcome her reliance on alcohol and marijuana and has secured gainful employment (the case study is silent concerning her educational status noting only that she attended at least one year of college), Randy's alcoholism and substance abuse have led him on a downward spiral that resulted in his involvement with the law enforcement community which may have serious repercussions, particularly if he fails to actively pursue rehabilitation.

Therefore, case management should be used to coordinate the various types of services that this family needs to address their main but multifaceted problems which include the following:

The father is unemployed and suffers from alcoholism and marijuana abuse;

The father faces criminal charges for driving while intoxicated and endangering a minor child; and,

This married couple faces divorce unless the father seeks help.

Fortunately, this couple can be referred to a number of community-based resources in the couple's hometown of Indio, California. A list of these community-based resources is provided at Appendix A. The case management referrals would include couples therapy at the Riverside County Mental Health Service and a referral for Randy to the Coachella Valley Rescue Mission for inpatient detoxification and dual-diagnosis counseling. Providing Randy with the opportunity to detoxify in a secure setting would likely enhance the effectiveness of the other case management elements. Although the case study is silent concerning the impact these events have had on the couple's minor child, consideration should also be given to including the couple's 9-year-old daughter, Mattie, in family therapy sessions provided at the Riverside County Mental Health Service. In addition, both Randy would be referred to a local Narcotics Anonymous and/or the Riverside County Substance Abuse Program for participation in their 12-step program.

In addition, there are some other private resources in the Indio, California area that could be used for referrals, but the case study is silent concerning the couple's health insurance status and this would undoubtedly have an effect on the decision to utilize these expensive facilities versus the free or low-cost alternatives described above and at Appendix A. Finally, Randy should be referred to a legal services center such as the Riverside Legal Aid Clinic which provides pro bono legal services to Indio residents to ensure the court is aware of Randy's participation in rehabilitation and counseling programs which may help mitigate the severity of his sentencing.

Explain how the clients would benefit from each orchestrated referral.

The referral to the Riverside County Mental Health Service for couples therapy can be reasonably expected to help Susan and Randy focus on their marital problems in general and help Randy in particular come to grips with his responsibilities as an individual, husband and father (Perosa & Perosa, 2010). The case study is also silent concerning Randy's current educational and training status, but it is reasonable to conclude that this individual is in need of academic and vocational counseling and training opportunities which could be provided by Indio-based Arbor Education and Training which partners with the College of the Desert (Center for Employment and Development), Center for Employment and Training, National University Academy, Patricia M. Drown and the Student Assistance Program, the Esperanza Youth and Family Center, Incight and the Indio Performing Arts Center.

Although the effectiveness of 12-step programs such as those offered by Alcoholics and Narcotics Anonymous groups varies, a growing body of evidence confirms that motivated clients can achieve and maintain sobriety with the support of these groups (Smock & Trepper, 2008). Likewise, Randy's referral to a legal services center such as Riverside Legal Aid may help mitigate the severity of the punishment that is meted out by the court for Randy's recent driving under the influence and endangering a minor charges. Reducing any jail time or a suspended sentence could help Randy continue his participation in couples/family therapy and the rehabilitation programs he needs to address his substance abusing behaviors.

Conclusion

Regrettably, some practitioners might be tempted to view Randy's predicament as hopeless and counsel Susan to seek a divorce at her earliest opportunity to protect her and the couple's minor child from….....

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