Collaborative Development of a Recovery-Oriented System of Case Management

Background and purpose: Community mental health agencies are under significant pressure to improve case management and other community-based models of care for people with severe and persistent mental illness as mental health systems move to embrace the recovery orientation and the overall portfolio of publicly supported services now includes much less inpatient care. In this context, we developed a shared program of work to examine and improve case management. This initiative resulted from opportunities and needs that became apparent after the collaboration was established. We have completed three studies, and a fourth is underway. This paper describes the development of recovery-oriented case management and its adoption by the county as a model of care for other service providers. Methods: The agency partner, Family Services of Western Pa., was selected by a county regulator as a site to study case management and make recommendations for systems-wide improvement, in part because of the presence of the research collaboration. The county regulator contracted with a national case management expert to act as a consultant to the agency and to make recommendations. She was in residence at the agency half time for five months. She attended three or more consumer visits with all case managers, debriefed each visit, attended all meetings related to case management, and provided a series of trainings. University team-members developed a system to study the design process, and to recognize and enhance the lessons learned in order to create a program that could be implemented at FSWP and disseminated to other agencies in that county. All debriefings were audio-taped, transcribed and coded, case manager rating forms were developed and collected, and all personnel involved in the project were interviewed. Fourteen case managers, three supervisors and two administrators participated in the study. In addition 50 clients were surveyed regarding their experiences, and 39 of these clients participated in a follow-up survey. Results: The multiple sources of data were used to develop a four-point plan to improve case management, including: 1) the introduction of a “back-to-basics” curriculum for new case managers, 2) the introduction of formal “mentoring” of new case managers by more senior case managers, and formal recognition of that activity for senior case managers, 3) changes to supervision including smaller, team-based supervision and supervision in the field, and 4) organizational changes including team-based practice, separation of adult and child case management, and the equalization of case loads. Conclusions and implications: The collaboration provided a unique setting to quickly advance a clinical agenda of importance to the agency and also to county and state policy makers. This work has led to a successful follow-on project, funded by the state of Pennsylvania, to examine outcomes for people recently discharged from a state psychiatric hospital, and has also led to a broadly-based group of community stakeholders that has collaboratively developed an approach to test the effectiveness of the program described here as the county moves to implement it across agencies.