Case Management Paper
Kimberly Owens
University of Oregon, FHS 494
November 20, 2011
Agency and
Population
Rain Rock, a Monte Nido Affiliate Treatment Center, is a comprehensive
eating disorder treatment center located in Eugene, Oregon. “Eating and exercise disorders are
progressive and debilitating illnesses requiring medical, nutritional and
psychological intervention.” (Costin, 2011).
Their mission focuses on the different aspects of intervention to help
each client reach her potential and holistically heal. The center provides a structured environment
that not only teaches the client how to recover but also how to sustain it once
client recedes back into her daily routine.
Adult females are the targeted population for this paper, due to the
fact that the treatment center accepts mostly adults, with 16 and 17 year olds
on a case-to-case basis.
Case Management
Process
Assessment
Initial assessment is done over the phone in a 30-40 minute
interview. Due to the high demand of the
facility, there is always a wait-list at Rain Rock. Assessment at Rain Rock is client directed as
she must be the one to seek out the treatment center. If interested in attending, one must call the
intake office to arrange a phone interview.
During this interview, questions about the individual, her problems, and
her goals will be discussed. This will
also be the time for the individual to have her questions answered and to learn
whether or not Rain Rock would be a suitable match. The interviewer will create a written
narrative based off of responses from individual’s social history (Summers,
2009). The initial assessment, although
over the phone, provides the intake office with substantial information to
either further the process or for the client to look elsewhere for
treatment. The intake office strives to
be as comprehensive as possible to gather material about the client and her
problems (Summers, 2009). Rain Rock
individualizes each treatment plan for their clients, thus resulting in an
individualized assessment plan.
Planning
The intake office will develop a plan for the possible future
client. During this time, the client is
sent an information packet with forms to complete and send back. The planning time depends upon the length of
the wait list and the urgency of the client’s problems (Costin, 2011). The client is encouraged to seek other
community resources during the waiting period, which are provided on their
website. Support groups and educational
seminars are often overlooked and may be extremely beneficial to the client
during that time (Summers, 2009). While
the client is on the waiting list, the intake office is in communication with
client in hopes to plan accordingly.
Rain Rock provides articulate and individualized planning and thus upon
entrance into the treatment center, planning is extensive and thorough. Summers states that clients do better living
in communities that they feel supported by their peers in a healthy manner
(2009). Eating disorders not only affect
the individual but also the systems in which the individual carries herself. Planning for the individual’s family and
peers are also apart of whether or not she will succeed after graduating and
re-entering her community (Costin, 2011).
Linking
Once the client passes the waiting list, the time to enter the treatment
center is sensitive and needs to be thought out carefully and attention to
detail is crucial. Sometimes the client
can be eager to receive services at a residential center, however, at other
times, the client may be apprehensive and may need more guidance and
arrangements planned to make it more efficient on her (Summers, 2009). The
transition into a residential program can be intimidating and it is important
for her case manager to make it as easy on her as possible. Since Rain Rock has such high demand in
communities, their acceptance of the client foreshadows that it will be a good
fit and they will provide the best services for the client in an individualized
manner (Summers, 2009).
Monitoring
At Rain Rock, the client is highly monitored. There is a team of individuals who are
assigned to the client in order to help her succeed through the program. The case manager will be involved in the
client’s treatment weekly to be sure that the client receives treatments the
case manager authorized (Summers, 2009).
Rain Rock is a formal residential treatment center and therefore the
client’s team of professionals will be on site for each weekly meeting.
Individual Profile
The individual who is seeking treatment at Rain Rock, Karen, is an adult
mother battling bulimia and exercise addiction. Karen lives a comfortable upper-middle class
lifestyle in a suburban neighborhood.
Her marriage is stable, but she does not feel like she is living her
life, but moving through the motions. She is fifty-two years old and is the
mother of three children. Karen has been
battling the disorder now for five years and is down to 94 pounds. Her family has encouraged her to seek out a
residential treatment center to disrupt her daily routine and unhealthy
habits. She has refused to seek help in
the past as she has denied having a problem, but as her health deteriorates,
she is now working with her case manager to be accepted into Rain Rock. Karen’s
husband earns a high enough income for Karen to be a stay-at-home mother and
thus leaves Karen with more time on her hands than activities. Her children are all in school and she feels
lonely because her husband is a workaholic and her children are all
over-scheduled in activities. She finds
pleasure in over-eating and vomiting as well as spending much of her time at
the gym exercising. Karen however, has
now come to terms with her disorder and is seeking treatment. Her feelings of isolation from her family
cause her to binge eat and vomit as she finds comfort in food. Exercising fills her empty schedule and she
finds security at her gym. Karen often
has low energy and mood imbalances due to her diet. Her lack of knowledge towards treatment
centers and eating disorders is what caused her to prolong seeking treatment.
However, Karen is highly motivated and wants to be a healthy role model to her
children and a better wife to her husband.
She is worried that when the time arrives for her children to move out,
her life will diminish, as she will be emotionally and physically lost. She is motivated and wants to be healthy and
live a “regular” life as Karen describes as “being the easy-going, carefree,
happy soccer mom who makes full course meals and eats with her family.” Self-determination is a positive attribute
that will help Karen through her treatment.
Population Specific
Considerations
The population Rain Rock works with is
a sensitive group of individuals. Eating disorders have many different causes
and each person is struggling with the disorder for a specific reason. Karen’s case is unusual compared to typical
cases that Rain Rock manages due to Karen’s age. Adolescents and young women account for 90
percent of all eating disorders in our culture (Gray, 2011). Gray also states than females make up 90
percent of the eating disorder population, with males accounting for the other
10 percent. Eating disorders are
commonly accompanied with other disorders such as substance abuse and anxiety
and mood disorders. Assessing
individuals with eating disorders is difficult for multiple reasons and thus
diagnosing accurately is also difficult.
People with eating disorders often face stages of denial in regards to
the severity of their problems and thus present challenges to case managers
(Gray, 2011). In times of residential
treatment, family members need to be informed about the urgency of improving
their loved ones nutrition habits and inpatient care (Robinson, 2009). Before graduation from residential treatment,
family should be highly educated about how to handle certain situations with
their loved one recovering in order to sustain success from the disorder.
Client Perspective
The client is the focus
of the case management. Her determination, focus, will, and goals determine the
success of the residential treatment.
The support of her family is crucial to whether or not she will stay
motivated and positive throughout her time at Rain Rock. Her family is also a huge contribution to
once Karen graduates from Rain Rock to how well she will transition back into
her life and whether she will relapse or sustain her recovery. At Rain Rock, it
is believed that the efforts, love, and support of the client’s loved ones may
speed recovery and may be the guiding force to recovery at all. Those who have recovered from eating
disorders have said that it was the unconditional support, belief, and love
that contributed to their recovery and sustaining their success (Costin, 2011). Family and friends are allowed to visit
during visiting hours that are allotted through the client’s free time. Rain Rock has specified times in which they
believe visiting hours are best, but it is ultimately the client’s choice as to
how she spends her free time (Costin, 2011).
Karen’s family is extremely busy and so finding hobbies that interest
her and make her feel good about herself will be a large part of her success
and recovery once she returns home from treatment. Rain Rock is sensitive to each individual’s
food concerns, and they work individually with clients to ensure the client is
comfortable with the eating plan the nutritionists design. They strive to be empathetic and patient with
food issues and will take Karen’s preferences into consideration. However, sometimes food allergies and preferences
are actually apart of the disorder itself and so nutritionists and therapists
work closely to determine healthy eating behaviors.
Systemic Considerations
The ecological model of case management is extremely important in
regards to how successful the client will be throughout treatment and
afterwards. For example, if the client
is well supported while in residential care, she is more likely to be motivated
to ease into transitioning back home to be with her family. There are three levels that Summers describes
and those are the micro level, meso level, and the macro level (2009). At the micro level, the client’s personality,
motivation, and other personal characteristics are noted. Meso is the direct contact with one’s
community such as church group and close friends. In Karen’s case, the meso level will be the
most targeted level to work between.
Karen needs to find hobbies and interests outside of family life that
will benefit her and add to her happiness.
By targeting the meso level, her treatment and recovery will have a
higher sustainability affect. Then at
the macro level, the larger society’s characteristics are considered. In this specific case, the macro level does
not need to draw attention as the meso level does (Summers, 2009). At Rain
Rock, the center focuses on the client’s wellbeing and happiness. The clients have free time and opportunities
to participate in activities other than eating and exercising are abundant (Costin,
2011).
Evaluation
The case management at
Rain Rock is extensive, individualized, and comprehensive. The treatment center struggles due to the
high demand for services and the small, intimate settings that lack space to
host clients (Costin, 2011). However,
their planning procedure and treatments for clients meet individual needs and
preferences. The process could be
improved if there were more treatment centers located throughout the
country. Also, Rain Rock costs
approximately $1400 per day for residential treatment and so it is not
financially feasible for many possible clients who would benefit from receiving
Rain Rock’s services (Costin, 2011). Overall, Rain Rock provides substantial
services to women battling eating disorders and exercise addictions. Their individualized outlook on recovery
seems to optimize each client’s success rate and ability to recovery from a
disorder and/or addiction (Costin, 2011).
References
Costin, Carolyn. (2011). Eating
Disorder Education. Retrieved from http://www.rainrock.org/
Gray, S. (2011). Competency-Based Assessments in Mental Health Practice: Cases and
Practical Applications. Hoboken: John Wiley & Sons, Inc.
Summers, N.
(2009). Case management practice: Skills
for the human services, 3rd ed.. Belmont, CA.: Brooks/Cole
Robinson, P. (2009). Severe
and Enduring Eating Disorder (SEED): Management of Complex Presentations of
Anorexia and Bulimia Nervosa. Chichester: John Wiley & Sons.
Case Note
Client’s Name: Karen
Date November 15, 2011
Type of Contact: Home Visit
Focus of the interview: To make a concrete and
feasible plan about seeking treatment and prepare Karen for Rain Rock interview
by discussing her goals and motives for seeking care. We will discuss the
treatment center and research the facility.
Assessment:
Client has battled bulimia and an exercise addiction going on five years. Client is ready and willing to seek treatment
at a residential treatment center.
Health is deteriorating and client is feeling depressed and unhappy
overall.
Resolution:
Client will phone the intake office at Rain Rock. Client will write down personal goals,
problems, and hopes for the program to prepare for interview. Have client agree to only working out for one
hour four days a week until admission is determined at treatment center.
Reason
for next contact or follow-up: Check in with client to see the status of
acceptance at Rain Rock. Intake office
allows potential client to call office for updates on admission status.
SAMPLE INDIVIDUAL PLANNING FORM
Client: Karen Case
Manager: Kim Date:
11.15.11
Summary of Strengths and Interests: Motivated and driven to
recover and heal from bulimia and her exercise addiction. Family is supportive.
She can financially afford a premier residential treatment facility. Karen
seeks to live a more fulfilling life and be a better wife and mother.
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Goals and
Objectives
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Person Responsible
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Target Date
|
|
Goal One: Get
involved in the community
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||
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Objective 1.1 Talk to friends to gather ideas about
different groups offered
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Karen
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12.1.12
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Objective 1.2 Research groups online, knitting classes,
writing classes, etc.
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Karen
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12.15.12
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Objective 1.3 Start
a daily self-check-in journal
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Karen
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12.1.12
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Objective 1.4 Sign up for women’s support group
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Karen
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12.15.12
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Goal Two: Eat more
throughout the day in smaller quantities
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||
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Objective 1.1 Eat breakfast and dinner with family
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Karen
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Daily
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Objective 1.2 Eat three substantial, healthy snacks
throughout the day
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Karen
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Daily
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Objective 1.3 Meet with a nutritionist
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Nutritionist
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1x week
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Objective 1.4 Record daily food in food journal/check in
with case manager
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Karen & Case Manager
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Daily check-ins
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Goal Three: Exercise
less
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||
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Objective 1.1 Join group exercise classes
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Karen
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12.15.11
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Objective 1.2 Go to the gym four days a week instead of
every day
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Karen
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Start by 12.1.12
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Objective 1.3 Sign up with a personal trainer and get a
personal fitness assessment
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Karen & personal trainer
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12.15.11
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Objective 1.4 Dedicate “you time” the three other days
|
Karen
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Daily
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Case Manager
Signature Kim Owens Client Signature____________________
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