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Review Appendix 1A-1G and define the case management protocols for high-risk clients. What levels of services are indicated for those determined as high risk?

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APPENDIX
1A
Integrated Case Management Team Formation and
Training
O
consultation, collaboration
implementation
Nurse Manager, RN, CCM
Medical Director, MD
-conÅŸult
, advise, direct
ਰ
Medical Nurse
Psychiatric
Nurse
Social Worker/Medical
Nurse
Social Worker/
Psychiatric Nurse
Medical
Nurse
Pediatric/Child
Psychiatric Nurse
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Skills
– Manager (RN, CCM)-preferably with background in general medical and mental health nursing, otherwise cross-
training (CCM: certificate-integrated CM. motivational interviewing)
– Medical Director, MD—this is either a physician having comfort with assessment and treatment of physical and
mental health problems or a collaborative team including a primary care physician and psychiatrist.
– Staff (CCM or working toward CCM: certificate-integrated CM with basic cross-training in the discipline from
which they do not come); team size can vary by 1 or 2 either way
Cross-Training-basics started in integrated CM manual and onsite training (extra training
required for child/youth integrated CM)
– Three weeks didactics in cross-discipline
– Three weeks direct mentoring in cross-discipline
• Case management vignettes
– Special integrated case management issues-legal, documentation standards, care coordination emergency
procedures (medical, psychiatric, and pediatric)
Shift Work
. During the first 4 months, there will always be staff from both disciplines available for consultation
• Team composition ratios adjusted based on clinical needs of the population served
Case Responsibility
– Full indirect, nonclinical assistance for patient needs (physical and mental condition care coordination
authorization, etc.) with advice from cross-trained teammates when needed
– Initial assignment should take into account the CM’s case load composite IM-CAG or PIM-CAG-based health
complexity level
. Few handoffs
O
Continuing Educational Enhancement
– Integrated CM grand rounds, complicated case reviews, news and views handouts on common problems, member
outcomes, obstacles, successes; consultation with medical director (special arrangements for childlyouth CM)
Expert Backup
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• Special integrated case management issues-legal, documentation standards, care coordination emergency
procedures (medical, psychiatric, and pediatric)
Shift Work
. During the first 4 months, there will always be staff from both disciplines available for consultation
• Team composition ratios adjusted based on clinical needs of the population served
Case Responsibility
• Full indirect, nonclinical assistance for patient needs (physical and mental condition care coordination
authorization, etc.) with advice from cross-trained teammates when needed
– Initial assignment should take into account the CM’s case load composite IM-CAG or PIM-CAG-based health
complexity
level
. Few handoffs
O
Continuing Educational Enhancement
– Integrated CM grand rounds, complicated case reviews, news and views handouts on common problems, member
outcomes, obstacles, successes; consultation with medical director (special arrangements for childlyouth CM)
Expert Backup
Team member collaboration
– Medical directors-general medical, psychiatric, pediatric
– Expert consultant specialists
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APPENDIX
1B
Cross-Disciplinary Integrated Case Manager
Training
Case Manager Training
O
All Trainees (use integrated care vignettes, e.g., diabetic crises, suicidal, medically
compromised eating disorder)
Case Management Standards (see CMSA Standards of Practice, Chapter 1 and www.cmsa.org), eg.
assessment, planning, facilitation, advocacy
– Standards of care, eg, identification of patient’s need for CM services problem identification:
planning, monitoring; evaluating; outcomes measurement case closure
– Interpersonal skills, coping stills training
– Interviewing techniques, eg, developing a relationship. use of open-ended questions, when and how to
share personal information, motivational interviewing techniques
• Assessment of physical and mental condition insurance coverage limitations and exclusions
. Documentation processes, e.g. check sheet for opening and closing cases, use of scripts, use of
computer, here and now entry
. Follow-up.eg, how often should the patient be seen, how to work through prioritized actions
– Legal concerns, e.g.- HIPAA privacy, physical, mental health, and child youth consents; approach to
confidentiality: objective documentation techniques
• Closing cases, e.g. proper graduation processes with the patient/client handling of medical records
received, etc.
– Use of internet, e… educational sites and social service and community
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Use of internet, e.g. Oucational sites and social service and community
resource links
From Psychiatric Background
• General medical disorders/problems update. eg. diabetes, hypertension, back pain asthma, enuresis,
congestive heart failure, emphysema, ischemic heart disease, dementia, head injury
Community resources available for medically ill
– Basics on medical emergencies, medical admissions, placement durable medical equipment
procurment and use in the medical setting
From Medical Background
. General psychiatric disorders/problems update, e.g., affective disorders, anxiety, eating disorders,
schizophrenia autism, delirium, somatoform disorders, chemical dependence
– Community resources available for psychiatrically ill
. Basics on psychiatric emergencies, admissions, placement payment issues in the psychiatric setting,
levels of care (residential, partial hospitalization, intensive outpatient, etc.)
O
Pediatric Case Management
• Pediatric Management Practices, e.g., working with parents/caregivers and childrenlyouth
Cross-disciplinary updates, e.g, child psychiatry for those with medical backgrounds and
medical for those with psychiatric backgrounds
– Pediatric Resources and Procedures, e.g. foster homes, abuse reporting, guardianship
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