PS450 Unit 2 Case Management Models Paper Example

Why a List of Agencies Would Not Have Worked: A PS450 Unit 2 Case Management Models Paper

[Student Name]

Purdue University Global

PS450: Case Management in Clinical Settings

Unit 2 Case Management Models Paper

[Instructor Name]

[Date]

The client, her family and the program are composite; the theory, models and review cited are real.

The Client and Her Systems

Brandi is a 34-year-old mother of two in Huntington, West Virginia. She used opioids for several years after a back injury at work and later methamphetamine. Last winter, child protective services removed her children, Tyler, 15, and Kaylee, 6, after Kaylee was found alone in the apartment, and placed them with Brandi's mother. Brandi was offered the county's family treatment court, which combines substance use treatment with her child welfare case and gives her a path to reunification. She entered our outpatient recovery program in March, and I became her case manager.

Bronfenbrenner (1979) described human development as taking place within nested systems. Closest in is the microsystem, the everyday places such as home and work where the person is physically present. The mesosystem consists of the connections between those settings. The exosystem holds places where decisions about her are made in her absence, such as an agency's office rules or a court's docket. The macrosystem consists of broader cultural values, laws and economic conditions.

Brandi's systems are crowded. Her microsystem includes her mother's household, where her children now live, our program, her sobriety group and a job she lost when she was arrested. Her mesosystem is strained: her mother and the child welfare caseworker disagree about visitation, and her treatment schedule conflicts with the court's hearing times. Her exosystem includes the housing authority's waiting list and the state's child welfare timelines, which require progress toward reunification within months. Her macrosystem includes stigma toward mothers who use drugs, a regional economy hit hard by the opioid epidemic and a Medicaid system that covers her treatment but not her transportation.

Systems theory turns Brandi's chaos into a map: most of her problems sit not in her but in the connections between the systems around her.

Three Models of Case Management

The brokerage model is the most limited. The case manager assesses needs, refers the client to services and has relatively little ongoing contact. It assumes that clients can follow through on referrals once they know where to go.

Intensive and clinical models add sustained contact. The case manager carries a small caseload, meets the client often, often in the community, and provides some direct support, such as skills coaching and crisis help, alongside linking and monitoring. Assertive community treatment is the most intensive version, delivering services through a team.

The strengths model, developed by Rapp and colleagues, builds the plan around the client's abilities, interests and resources rather than deficits (Rapp & Goscha, 2012). It treats the community as a source of resources, emphasizes the relationship between case manager and client, and gives the client direction over the plan.

What the Research Shows

Vanderplasschen et al. (2007) compared how well different styles of case management served people with drug and alcohol problems. They found that case management in general improved linkage to services and retention in treatment, with less consistent effects on substance use itself. The models differed. Brokerage approaches showed the weakest results, while more intensive models and the strengths-based model showed more favorable outcomes on retention and service use. Assertive community treatment was most useful for people with severe co-occurring mental illness.

Why Brokerage Would Fail Brandi

Applied to Brandi, the brokerage model would mean a thorough assessment followed by a list: the treatment program, the housing authority, the health department, a parenting class, a job program and a dentist. Each referral would be reasonable. Together they would require Brandi, without a car and with a prepaid phone, to make and keep appointments at six agencies while attending group three times a week and appearing in court every two weeks. The mesosystem conflicts would remain unresolved, since no one would be responsible for the connections between systems. The review's finding that brokerage performs worst fits this picture.

Why a Strengths-Based, Intensive Approach Fits

A strengths-based model starts with what Brandi brings. Before her arrest she was a shift lead at a discount store, responsible for scheduling and cash counts, which shows organizational skill. She has a close bond with her children and a mother who, despite their conflicts, took them in. She attends a church where the pastor has offered rides. She wants her children back more than anything, which is a powerful motivation.

Those strengths become resources in her plan. Her organizational skill becomes a weekly calendar she manages, with my help in the first months. Her pastor's offer becomes a transportation plan. Her motivation becomes the anchor for each goal, linked to the court's reunification steps.

Intensive contact addresses the mesosystem. Meeting Brandi weekly, attending her court hearings and joining her child welfare meetings let me resolve conflicts between systems rather than leaving her to manage them. When the court's hearing time conflicted with group, I asked the judge's coordinator to move her hearings to the afternoon. When her mother and the caseworker disagreed about visits, I arranged a meeting with all three.

A Week Under Each Model

The difference becomes concrete in a single week. Under brokerage, Brandi's week in April would have held a court hearing, three groups, a drug screen, a housing interview across town, a liver clinic appointment and a supervised visit with her children, all arranged by her from a list. Under the approach we used, the same week held the same obligations, but I had moved the hearing to fit her group schedule, the pastor drove her to the housing interview, the liver clinic visit was booked for the same afternoon as her screen in the same building, and I attended the supervised visit to answer the caseworker's questions about her progress. The requirements did not shrink. What changed was who carried the work of fitting them together.

Limits

This approach has costs. Intensive case management requires small caseloads, which programs struggle to fund. A strong relationship with the case manager can become dependence if the plan does not build toward independence. And the strengths model's emphasis on client direction can conflict with the court's requirements, which Brandi did not choose. Those tensions will come up again in later units.

Conclusion

Bronfenbrenner's systems theory shows that Brandi's difficulties lie largely in the connections between the systems around her. A brokerage model would leave those connections to her and, as research suggests, would probably fail. A strengths-based model with intensive contact builds on her skills and motivation while giving someone responsibility for making the systems work together.

References

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Harvard University Press.

Rapp, C. A., & Goscha, R. J. (2012). The strengths model: A recovery-oriented approach to mental health services (3rd ed.). Oxford University Press.

Vanderplasschen, W., Wolf, J., Rapp, R. C., & Broekaert, E. (2007). Effectiveness of different models of case management for substance-abusing populations. Journal of Psychoactive Drugs, 39(1), 81-95. https://doi.org/10.1080/02791072.2007.10399867