Summary of "Case Management for High Risk/High Needs Individuals"

Summary: case management for High Risk/High Needs Individuals

This session focused on effective case management strategies for individuals identified as high risk and high need, particularly those with behavioral health challenges such as serious mental illness and substance abuse. The discussion emphasized integrating risk, need, and responsivity frameworks into case management practice to improve client outcomes and reduce recidivism.

Key Wellness and case management Strategies

Defining High Risk and High Need:
- High need is determined not just by diagnosis (e.g., schizophrenia) but by the impact of mental illness on functional ability (e.g., ability to work, maintain appointments, manage medication).
- Needs include psychosocial domains such as homelessness, income support, health insurance, and engagement in meaningful activities.
Models of case management:
- Assertive Community Treatment (ACT):
  - Evidence-based, multidisciplinary mobile teams that provide integrated mental health and substance abuse treatment.
  - Teams include psychiatrists, nurses, social workers (vocational, family, substance abuse specialists), and peer specialists.
  - Designed for high utilizers of hospitals and jails/prisons (forensic ACT).
- Basic case management:
  - May be a single case manager or small team.
  - Role includes boundary spanning between criminal justice and community systems.
  - Focus on advocacy, linking to services, and addressing both mental health and substance abuse needs.
- Integrated Dual Disorder Teams:
  - Specialized teams addressing co-occurring mental health and substance abuse disorders.
Addressing substance abuse Needs:
- Recognize distinctions between substance use, abuse, and dependence.
- Ensure access to integrated or coordinated treatment for co-occurring disorders.
- Link clients to appropriate treatment based on severity and needs.
case management Functions:
- Span systems (jail/prison to community).
- Serve as client advocates and system navigators.
- Provide direct support (transportation, reminders, crisis intervention).
- Facilitate communication and coordination between mental health and substance abuse providers.
- Use "warm handoffs" rather than just telephone referrals to ensure engagement.
- Address psychosocial needs beyond treatment (housing, transportation, family stress, education).
Utilizing Community Resources:
- Tap into peer-run organizations and informal support networks to provide social and recovery support.
- Encourage participation in pro-social activities such as volunteer work to improve functioning and community integration.
- Recognize the importance of intimate personal relationships and social supports for long-term recovery.
Incorporating criminogenic risk and Responsivity:
- Use validated risk assessments to identify dynamic risk factors related to recidivism (e.g., antisocial peers, criminal thinking).
- Integrate criminogenic risk factors into case plans and interventions.
- Coordinate with probation and criminal justice entities to align supervision and treatment efforts.
- Establish clear protocols for sharing relevant information with clients’ consent, balancing confidentiality and public safety.
- Address relapse proactively with treatment and supervision responses to reduce reoffending.
Case Load and Staffing Considerations:
- Lower case manager-to-client ratios (e.g., 1:14 to 1:25) recommended for high risk/high need populations.
- Licensed clinicians may be required for certain clinical interventions, but bachelor-level case managers and peer specialists can perform many supportive functions.
- Efficient use of resources by differentiating roles based on scope of practice and funding.
Sustainability and Transitions:
- Plan for discharge and step-down to less intensive services after court or program completion.
- Provide follow-up support for up to 90 days post-discharge to ensure continuity.
- Maintain communication and collaboration with new providers during transitions.
Communication and Client Engagement:
- Obtain releases of information upfront to facilitate coordination.
- Clearly explain to clients what information will be shared and when.
- Timing and trust are critical in communication, especially around sensitive topics like relapse or trauma.
- Use every interaction (e.g., rides, waiting times) as an opportunity for meaningful engagement and intervention.

Practical Tips and Methodologies

Use validated risk and needs assessments to guide individualized case plans.
Prioritize clients with the highest needs for more intensive services.
Leverage partnerships with mental health, substance abuse, probation, and community organizations.
Employ warm handoffs and physically accompany clients to appointments when possible.
Incorporate peer support and community resources to enhance recovery and social integration.
Develop clear protocols for information sharing balancing therapeutic trust and public safety.
Use case management creatively to address criminogenic risks even with limited resources.
Monitor and respond promptly to relapse or crisis situations.
Maintain ongoing communication with clients and treatment providers during and after program participation.

Presenters / Sources

Primary speaker (unnamed) – Program administrator and case management expert.
Additional contributors included program staff and participants sharing experiences and questions.
References made to research