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Utilization Management Programs - Essay Example

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In the mid-1950s, the development of phenothiazines, along with a new collective social conscience and concern for patient's civil rights and treatment costs, led to the release of large numbers of people with serious mental illnesses from state institutions into the community and to the expansion of community treatment programs.
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Utilization Management Programs
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Download file to see previous pages Services did become better coordinated at the CMHC level, but the responsibility for negotiating the service system and compliance of the treatment remained with the client.
Specific case management service guidelines vary somewhat as the individual states' interpretation and implementation of federal mandates differs. The needs and resources of a large inner-city population vary considerably from those of a rural community.
A clear and consistent service definition has not been reached, and there is no consensus on what does and what does not constitute case management. Some people describe case management as purely a brokering or linkage function while others include comprehensive skill teaching and support in addition to service linkage.
Controversy also exists regarding who can best provide the service: nonprofessionals, specified mental health professionals, or a combination of both in a team approach. Consumer case management, in which clients or consumer sin the mental health system act as case manager aides for those with less functional ability, is also being undertaken
The initial case management evaluation period is typically 30 days, during which it is desirable to gain as complete a picture as possible of the client's past and current functioning. The case manager must evaluate the client's status, needs, and goals in each of the following areas: mental health, physical health, financial status, housing, living skills, leisure, vocational and educational activities, and availability of a support system.
Because case management is designed to address the broad range of a client's needs for maintaining satisfactory and stable community living, the initial evaluation phase is critical in identifying existing resources, skills, and strengths, as well as service and support needs and skill deficits. The overall goal of case management is help maintain the client's quality of life in the least restrictive community environment possible: therefore, evaluation data should assist the case manager in identifying factors that may have resulted in either the client's successes or failures in the past.
Service Plan Development
The service plan is the case management equivalent of the treatment plan as used in traditional inpatient or outpatient setting. It identifies the client's goals and objectives for a specified time period, typically a six-month time period, and it must be updated at least that often, or as necessary, as goals are achieved or are deemed inappropriate or unrealistic at any point during that period.
The format of the service plan varies, but generally it identifies the client's goals and the client's case management objectives and service activities for achieving each one. Because services are individualized, the number of goals appearing on the plan at any one time will vary.
It is important to be realistic and set no more goals than can be accomplished within a given time period. It is preferable to state the client's goals in his or her own words. Objectives must be measurable, have projected time frames, and be consistent with evaluation results and client goals. They should be realistic and broken down as necessary into tasks deemed achievable for the particular client.
Placement Services
Case management placement assistance may be defines as any support provided to the client ...Download file to see next pagesRead More
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