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[|case management (case coordination) analysis]
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Case Management general definition:
Currently in Texas, case management is delivered by numerous health and human services programs and through a range of program structures and modalities. It is also referred to differently, e.g., care coordination, community support, service coordination, care management and through other terms. These multiple references to the concept of case management are not unique to Texas; we know of and could find no reference to a state that has developed a single definition of case management or a single term to refer to those services.

Case management activities (under various names) generally have two key features: providing a connection between individuals and the system of publicly‐ funded services and supports, and assuring that these services meet reasonable standards of quality and lead to improved outcomes for individuals. Individuals who are at the highest levels of risk, with the greatest needs for social support and chronic problems, are the most likely to benefit from case management.

One such group with great needs is the transition age group. That is, those person's leaving high school and entering the adult world needing various support services. At the public school level, these are persons who have been served through special education services. There are various systems in place to accomplish what is commonly called "transition" in public schools.

This project is an attempt to critically review two electronic documents previously utilized by the State of Texas in accessing the state of Case Management.

__Texas Case Management Optimization__ In 2005 Texas legislators passed bill 1188. This bill was put in place to instruct the HHSC (Health and Human Service Commision) to optimize services **The key** objectives of this bill include:

Making case management more efficient and cost effective

Ensuring quality consumer services

Optimizing Federaland State funding sources

Enhancing or replacing programs that aren't meeting cost or quality targets

Assessing the feasability of a medicaid waiver that combines case management with related services

__Analysis of Current Case Management System__

Some of the current issues that have been identified by case managers and consumers are as follows.One of the biggest problems that case managers identified is that their caseloads are too large to manage effectively. They do not have the time to effectively build rapport with consumers. This reduces the case management role to an administrative position instead of an advocate for the consumer.

Another issue that has been identified is a lack of communication between agencies. This is detremental on more that one front. The first is that of the wrong door scenario. This occurs when a consumer goes to a particular agency for services and they are denied because they do not qualify for that agency's services. If agencies are communicating effectively a referral can be made instead of a denial of services. This will cut down on consumer frustration. Another issue with the lack of inter-agency communication is that consumers often end up with multiple case managers and services become redundant. One client could end up doing multiple intakes and assessments all to service a single need.

One of the other issues that was mentioned were geographical issues. Most of these issues were reported by case managers and consumers in rural areas.Case managers say that there are certain services that they do not reccomen because of geographical constraints. There are also cases where case managers cannot make proper client client contact because of proximity and geography.

Variations of Case Management
Medicaid is a big provider for public services. There is also a big push for reimbursement or waivers for home and community based services.

There is a broad range of qualifications for case managers. Some organizations only require a high school diploma. There are agencies that require a graduate level degree and years of experience. One of the trends that is also prevalent is the use of case managers that have a license in a certain field such as an RN, or a licensed social worker.
 * Qualifications of persons delivering the service**

Potential Solutions:
States are developing : Single entry point systems These programs enable consumers to access long‐term and supportive services through one agency or organization.

No wrong door programs These programs, which also provide a single entry port, are emerging to integrate the delivery of social services across target populations. Under these models, case management is coordinated for those individuals and families in need of more than one service.

**This Texas State Action Team project will focus on**
Reviewing the study and attempting to gather data about local Collin County Case Management

Utilizing community mapping, attempt to identify agencies that utilize case management

Attempt to obtain data to support the effectiveness of Case management beyond surveys and questionnaires.

Define how case coordination could improve the outcome data for young adults leaving high school

Develop a model for implementing such a system within Collin County Texas

Secure funding to implement/sustain care coordination for students transitioning from the three high schools in McKinney Texas.

In an effort to make this project a reality, it appears that focusing on the need for care coordination for High School Transition aged students is practical.

Transition aged students represent an under-served group of consumers with disabilities. There is money allocated by the educational system for services under the "transition" umbrella, but like the general case management report, there is very little outcome data to determine the effectiveness of these services.