The interview with a case manager took place in Kevin on October 25, 2013 at 11:00am and it was done approximately at 12:15pm. What we will be evaluating in this interview using the questionnaire as a guide to better understand case management. The questionnaire or survey used for this interview has twenty-four question related to case management, which we will explore one question at a time. The first part of the survey address different function of case management. Kevin was ask based on his own experience in the department of Mental Health, would he eliminate any functions from the list given that included: Client identification and outreach, Intake, Psychosocial assessment, Goal setting, Resource identification and indexing, Getting general agreement by community agencies, Direct treatment (Therapy), Service planning, Counseling, Linking clients to needed services and supports, Monitoring service delivery, Reassessment, Advocacy, and Client evaluation? Kevin said, “He said that this is a sum of what they do but they go even further by engagement with the community, partnering with different non-profit and faith base organizations and integrating different resources to create a more comprehensive services for their clients.”
According to Kevin the engagement with the community, different non-profit and faith base organization is what needed to be added to the function list for assisting clients with his or her needs. Also Kevin stated, “I would not change the chronological order because this is just a format” but he clarified by saying, “The way the chronological order is makes a guide but each client has unique needs, which can cause a change of the chronological order given to meet the most pressing needs at a time. The second question Kevin was asked, “Do You preform this function as part of your case management role?” Kevin response to the question, “Yes, let me explain to you how we do our process.’ ‘I have twenty-seven staff working for me and each staff has his or her own expertise.’ ‘The different staff, which includes ten case managers, psychologist, house specialist, therapist, psychoactive nurses, all has goals in assisting individual clients; making it a team effort.’ ‘So the functions for each client is done through shared responsibility.” He also explained that the staff have regular meeting to determine if goals of clients is being properly carried out and if not what can be done to achieve his or her clients plan.
Kevin also said the only one thing that hinders his team from performing his or her function is lack of resources and policies can restrict how he can serve his clients. In addition, Kevin told me that in order to be refer to his department there has to be some kind of psychological problem but with the psychological problem there can be other condition present such as: drugs use, homelessness and criminal activities; making serving these individual more complex. The time spent of each function during a typical week depends on the individual and different people and as stated before these function are achieve with many different professional with his or her own expertise working together to serve his or her client. The next question asked Kevin was, “Where he would like to devote more time to a given function and why?” He stated, “As a agency he feels they are always on a consistent bases putting out fires and he would like to spend more time in engagement and working with individual with long term goals.” Kevin also said that different crisis, which needed immediate attention is what keeps his organization from devoting more time to engagement and working with individual with long term goals. Kevin told me he works full time and that his case manager spends about eighty percent of his or her time doing case management. When ask if the work done at the agency was his own or a team or group basis he restated what he said earlier about team effort but also added it was also one his own because each team member has a part in the process where he or she focuses on; so to answer the question he said both individual and team effort. The next question for Kevin was, “What does he think is required for effective case management to occur?” Kevin says that empathy is important when working effectively as a case manager, resources and communication. He also said the way they determine family involvement in a clients is by first assessing the clinical risk, is this relationship with family a healthy one that will assist his clients to achieve his or her personal goals.
The question that followed the last question asked was, “What has been the most successful part of your experience as a case manager?” He shared a story how when he first started working for the agency that he would see patients who had psychotic episodes during his or her intake and it was rewarding when he saw these patients at the end of his or her treatment functioning relatively normal, which demonstrated progression. He went on to explain to me that the ultimate goal of a case manager is to help improve lives and that this type of field is investing in the betterment of others. Moreover, Kevin said the attribute to his success is a collaboration of clients, agency team effort, families and the community. The next question in the interview was, “Is there something distinctive about Stanislaus County that gives case management a unique form here?” Kevin response was base on what he stated earlier about how his organization engagement makes his agency unique. He stress by working with different non-profit and faith base organization the agency was working outside the box. He also told me that his agency has also works with other city such as: San Francisco, San Jose, Bakersfield and as far as Redding to provide service for his clients collaborating with different organization throughout Northern California. Kevin told me my working with different organization has broadened the agency resources causing them not to be limited to a geographical area making their approach different and unique.
The next question in the interview was, “What are some of the main problems you face in doing case management?” Kevin stated resources is the main problem as a practitioner; not enough resources to assist all of his clients. Also Kevin said motivation of his clients is an issue to even recognize he or she has a problem, which needs to be address. Kevin also told me that with some clients basic needs are not being met and his clients cannot focus on assistance because of this problem. He went on to state the lack of understanding of both family and community is a problem, which his agency is trying to address through educating both family and community. He told me these have specific programs for family member to help educate them and they are actively involved with many events in the community. Also according to Mr. Panyanovong service gaps he encounters can be either lack of resources or policy issue where an individual cannot meet requirement to qualify for a certain program.
He also told me that lack of insurance and state funding can be a problem in service gaps or lack of space where the program and facility is overcrowded. The next question I asked Kevin was, “When there is a service gap, are there any things as an organization they can do?” He said that as an organization they work hard to remove barriers, discover new resources, change policies and try to determine how to get from point “A” to point “B”. He said with his team they work together talking about how can we expedite the process and continue to say his organization does not see it as just them but working with other resources. Then Kevin was asked, “What problems do you have with service providers, particularly agencies in the community that are essential to your clients?” He said he was not sure if he had a problem with a particular provider but with the physical he stated there could be disconnect because many of clients have Medicare and Medicaid, which has limitations. According to Kevin many of his clients have health issue, which can be a major problem in the care of his clients.
The interviewer went on to ask, “What administrative problems do you encounter in your daily work?” He said that Medicaid has been a problem and there are many regulations that the organization needs to follow, which can make it difficult in servicing his clients. However, as a program Kevin explain to me they do what they can to serve their client despite Medicaid regulations and many times it has resulted in loss in revenue. The next question in the interview was, “What are some crisis situations you typically face with clients?” Kevin responded by saying, “Medication emergencies, client becomes suicidal, homicidal”, he goes on to say we do crisis assessments, evaluation and place clients in the hospital all the time, which answered the next question, “What are some things you typically do when these crises arise?” The question in the interview that followed that last question is a close end question where the interviewer asked Kevin, “Can you generally handle these situations in an adequate way?” Kevin answered the question by saying, “Yes”. As the interview continues the interviewer ask Kevin, “How could you be enabled to deal with crisis situations more adequately?” Kevin answered was again resources and working with different organizations. The next question is base on a scenario and it is, “A board-and-care home calls you to state a client of yours in this category is having hallucinations that are causing behaviors threatening to other clients. What do you consider your most therapeutic intervention, given no limitation on resources?” The first thing Kevin said, “Is that he needs to assess is this an immediate crisis, which it sounds like it is?” He asses if this particular person is a risk to self or the community and if so he has the authority to put this client on a seventy two hours hold, placing them in a hospital for the individual safety and the safety of the community.
The other thing Kevin mention is by assessing he can determine if this is an ongoing issue and nothing ever happens; than he may set up a meeting with this client. Kevin said because it is their client it is important to look into the history, which can shed light to what is causing him or her to act this way. The second part of the question for this scenario, “If the patient were living at home with family would you do anything differently?” Kevin said yes they would involve the family members more, which is ideal because now the client has support that he feel could be a benefit to the client. Also the family member could help with administration of medication and to determine if something is not right in their family member who needs special assistance. He went on to say the majority of his clients do not have that family support. The question the interviewer asked Kevin next was, “What can case managers do to optimize maintaining hard to handle patients in board-and-care facilities or with their families?” Meeting with client and working with him or her to remain medication compliant, forming good partnership with board-and-care facilities or family members. Kevin went on to say it would be better to treat the individual early before it becomes a crisis. The following question Kevin is asked is, “What recommendations would you make to strengthen the case management process and program in the Department?”
Kevin states resources and also changing policies of organizations, which creates barriers in his clients being place in their respect program. Kevin continue on and said, that practitioners need to set healthy boundaries but at the same time have empathy for their clients and being able to connect with a client at a human level. He also stated that strengthen the commitment of clients to the goals that has been set and for the clients to acknowledge that there is an issue. When it comes to families and informal support networks, Kevin said, communication is key when working with them and education to assist them in helping the needs of the individual client. The interviewer than asked, “Since you started working in this program, have you initiated any major changes in the way you do things or in the procedures?” Kevin says, “Yes” and that he has been in this program for over seventeen years and that the biggest shift according to Kevin is community oriented, which is forming different partnership that the organization did not use in the past. This forming of partnership is done to increase the natural support system for clients in working with outside agencies. He went on to explain to me that when he first started the mentality was in the organization that they were the only agency.
Also as a case manager they as an organization has heighten the awareness that the problem with mental health is a community issue; that everyone needs to be involve in supporting these type of individuals. Kevin continue by saying that they invited community partnerships, they invited faith base, invited community leaders to come to the table and have a conversation of how they could work together to make the problem of mental health better in their city. Kevin said this is accomplished through a town hall meeting to address all these concerns. Also Kevin said this change is adopted by his organization because it is a team effort and they have to work together for the benefit of their clients. The next question interviewer presented to Kevin was, “If you could design a case management program from scratch, based on your experience here, what changes would you make?” Kevin said many of the things they are currently doing is a direction that is offering more assistance for their clients by adding resources through many different organizations.
The last question the interviewer asked, Kevin was, “What advice would you give to a new case manager coming into this agency?” Kevin said he would tell them to know their resources and that they are in the business of helping people, which requires them to have empathy towards their clients and to work as a team with colleague to give the best situation for his or her clients needs. The interview came to a conclusion and the interviewer thank Kevin for taking the time out of schedule to meet with him. The interviewer also ask if in the future if he has similar projects would it be alright for him to contact him again, which he said if his schedule permits he does not mind and he told me he tries to make time for these type of interviews because he feels it is part of educating the community and that he has not only met with college student but high school students to do similar interviews. Than, the interviewer said his final thank you and told Kevin to have a good weekend.