No matter what type of client your Drug Court is serving, case management is one of the keystones to success. The learning objectives for this session are: * Learn best practices in the filed of case management * Learn how to best serve specific case management needs

1. Chief Mack Jenkins, M.S.
San Diego County Probation

2. Objectives
 Define Case Management
 Discuss the Core Functions of Case Management
 Review Evidenced Practices of Case Management
 Review Strategies of Case Management

3. Definition Of Case Management
• a collaborative process which assesses, plans,
implements, coordinates, monitors and evaluates the
options and services required to meet an individual’s
health needs, using communications and available
resources to promote quality, cost-effective outcomes.”
Case Management Society of America

4. More Definitions
 The provision of, or referral to a comprehensive set of
services designed to increase the probationer’s overall
success.
 A system of support, monitoring and advocacy to
assist the probationer through change.
 “helping people whose lives are unsatisfying or
unproductive due to the presence of many problems
which require assistance from several helpers at once”
(Ballew and Mink, 1996, p. 3)

5. Case Management In Drug Court
 More than one case manager
 Non-case managers providing some services
 Coordinated case management a must
 Sharing of information from all team members
 Everyone’s on the same page

6. Core Functions Of Case Management

7. Core Functions Of Case
Management
 Assessment
 Planning
 Linkage
 Monitoring
 Advocacy

8. It begins with Engagement
 Determine motivation to change behavior
 Identify degree of support from family and friends.
 Discuss realistic criminal justice system (or other)
consequences.
 Establish a positive, professional, therapeutic
relationship with the participant.
 Be consistent

9. Try to identify the problem…
 Is it addiction?
 Is it criminal thinking
 Is it co-occurring disorders (MH, DD, Physical)
 Is it all of that…and more?

10. Assessment
 Make sure it’s ongoing.
 Avoid duplication when possible.
 Consider and discuss varied responses.
 Consider formal and informal assessment.
 Coordinate!

11. Assess Your Assessments
 What assessments are being conducted?
 Who’s conducting them?
 Are they 3rd or 4th generation?
 What are the assessments assessing?
 How is the information being shared?

12. Case Planning
 Don’t overwhelm the participant—make it doable.
 Include the participant in developing the case plan.
 Make the tasks and objectives measurable.
 Prioritize the tasks.
 SMART: specific, measurable, attainable, rewarding,
timely
 Individualize! Individualize! Individualize

13. Case Planning Questions
 Is there more than one case plan?
 If there are, can they be combined?
 If they can’t, how can your team be sure they don’t
contradict each other?
 Do all team members know what’s on all case plans?
 Does the participant know what’s on all case plans?!

14. Linkage
 Know what services are available in your community.
 Know the services participants are eligible for .
 Know the participants.
 Help the participants make the initial contact.
 Follow up after a referral is made

15. Linkage Questions
 What services do your drug court participants need?
 What services does THIS participants need?
 What changes do you see in your target population? In
your community?
 What partnerships do you need to make to increase
services available to participants?

16. Monitoring
 Detect non-compliance including new AOD use.
 Catch the participants doing something right!
 Assess the recovery environment (i.e. home)
 Track attendance and participation
 Share information timely
 Look for small changes

17. Monitoring Questions
 Does your drug court team have a community
supervision component?
 How often are participants seen in their homes?
 Are searches allowed? Conducted?
 How often are participants drug tested?
 How is information shared and how timely is it
shared?

18. Monitoring
 Multifaceted:
 Quality assurance of service provision
 probationer performance: attendance, participation
 Coordination of assessments with providers
 Supervision
 Office visits
 Home visits
 Other field contacts
 Drug Testing

19. Field Visits
 Identify goals of visit
 Use visit to assess the recovery environment
 Communicate the good and the bad back to the
team—timely!
 Safety First!

20. Advocacy
 Know what participants can do and what they need
help with.
 Help the participant assert him/herself and learn to
advocate for him/herself.
 Identify program areas that need some advocacy for
the benefit of all participants.

21. Advocacy Questions
 What’s the difference between helping and enabling?
 What skill development is occurring to help
participants learn how to advocate for themselves?

23. Eight Evidence-Based Principles for
Effective Interventions
1. Assess Actuarial Risk/Needs.
2. Enhance Intrinsic Motivation.
3. Target Interventions.
4. Skill Train with Directed Practice
5. Increase Positive Reinforcement.
6. Engage Ongoing Support in Natural
Communities.
7. Measure Relevant Processes/Practices.
8. Provide Measurement Feedback
NIC, 2004

24. 1. Assess Actuarial Risk/Needs
 Know the assessments used
 Review assessments with offender
 Incorporate into case plan
 Re-assess and measure change

25. 2. Enhance Intrinsic Motivation
 Use verbal and non-verbal communication skills:
 Attending, reflections, summarizations, open-ended
questions, etc.
 Explore offender’s attitude toward change
 Avoid non-productive arguing and blaming
 Encourage praise, be optimistic

26. 3. Target Interventions
a. Risk Principle: Prioritize supervision and treatment
resources for higher risk offenders.
b. Need Principle: Target interventions to criminogenic
needs.
c. Responsivity Principle: Be responsive to
temperament, learning style, motivation, culture, and
gender when assigning programs.

27. 3. Target Interventions
d. Dosage: Structure 40-70% of high-risk
offenders’ time for 3-9 months.
e. Treatment: Integrate treatment into the full
sentence/sanction requirements.

28. 4. Skill Train with Directed Practice
 Use Cognitive Behavioral treatment methods
 Support treatment efforts in field work
 Understand anti-social thinking and appropriate
communication techniques
 Positively reinforce pro-social attitudes and behaviors
 Make appropriate referrals using evidence-based
information

29. 5. Increase Positive Reinforcement
 Identify short-term goals for participants
 Acknowledge achievement of short-term goals
 Convey optimism that the participants can change
 Encourage and praise any evidence of pro-social
behavior.
 Reinforce participant change talk and self-efficacy

30. 6. Engage Ongoing Support in Natural
Communities
 Assist participants in identifying who is supportive
and who is not
 Conduct frequent home visits
 Case Managers need to learn and apply relapse
prevention techniques.
 Identify and establish relationships with participant’s
positive support systems in the community.
 Recognize triggers for relapse and make timely
intervention

31. 7. Measure Relevant Processes/Practices
 Documentation! Documentation! Documentation!
 Identify strategies
 “You can’t manage what you don’t measure”

32. 8. Provide Measurement Feedback
 Feedback to the participants
 Feedback to your supervisor
 Feedback to service providers

34. Drug Court Populations
 Re-entry
 Juveniles and Young Adults
 Participants with a Mental Health Diagnosis

35. Re- Entry Population
“an estimated 80% of the state prison population report
histories of substance abuse, 90% fail to obtain those
services while incarcerated. It is estimated that only
10% of offenders receive appropriate community
linkage and follow-up services upon release.”
Scott Sylak
President, National TASC
House Subcommittee Hearing
Feb. 8, 2006

36. Strategies for Reentry
 Process starts at the time of the presentence report.
 Services accessed while in custody.
 Upon release, re-assessment and linkage to
community services.
 Coordination and information flow throughout the
process is key.

37. Juvenile and Young Adults:
Significant brain distinctions
 Memory deficits
 Increased impulsiveness
 Visual learning
 Disturbed sleep cycles
 “Hormone Hell”

38. Brain Chemistry
 For different reasons, brain chemistry is an issue for
juveniles, young adults and methamphetamine users.
 A longitudinal study on adolescent brain development
shows that brains are still developing until age 24 or
so.
 Methamphetamine causes physical changes in the
brain.

39. Juveniles
 Consider brain development issues
 Provide sequential direction
 Provide shorter time span between hearings
 Focus on short-term goals and outcomes
 Differentiate between willful non-compliance and
inability to comply
 Encourage “dream talk” to begin goal discussion

41. Young Adults
 Consider brain development issues
 Provide sequential direction
 18-24 year olds are still going through some of the
same changes as their younger counterparts

42. Methamphetamine Users
 Consider brain development issues-reduced
memory, lack of motivation, lack of feelings
 Provide sequential direction
 Attend to the physical maladies caused by use
 Attend to the life skills deficits left by use
 Constantly keep the message hopeful, simple, clear,
and consistent.

43. With many participants, but especially meth
users and youth
 Patience
 Redundancy
 Instilling hope
 Maximizing engagement strategies
 Accountability

44. Tools:
 Encourage & support
 Repeat everything
 Reaffirm
 Remind of next contact, reaffirm message of other
treatment team members
 Repeat consistent message of “show up”.
 Require repeat backs
 Write it down (them), reaffirm.

45. Clients with a Mental Health Diagnosis
 Participants with co-occurring disorders often
experience more severe and chronic medical,
social and emotional problems.
 They are more vulnerable to both AOD relapse
and a worsening of the psychiatric disorder.
 Participants with co-occurring disorders often
require longer treatment, have more crises, and
progress more gradually in treatment. They
often have reduced skill retention.

46. Clients with a Mental Health
Diagnosis
 Team must be familiar with psychotropic medications
and their side effects
 Do not dismiss participants as a resource
 Provide enhanced community supports
 Understand what role drug use has played in the
participants ’s life
 Expect setbacks, but don’t assume failure

47. Summary
 Defining Case Management
 As an individual case manager
 As part of a team
 Employ the key functions
 Assess and reassess
 Develop a case plan to target identified needs
 Actively work to link participants to services
 Closely monitor the participant’s progress, provide
feedback and support
 Support but don’t enable

48. Summary
 Know the Evidence Based Practices
 Develop Strategies that recognize the deficits of the
targeted population and use strengthen based
approaches to the address them.