Section 63.12. Case management.

 

(1)   Single point of contact for a client. Each CSP client shall have a designated case manager who shall be responsible for maintaining a clinical treatment relationship with the client on a continuing basis whether the client is in the hospital, in the community, or involved with other agencies. Case managers shall meet the qualifications for clinical coordinators under s. DHS 63.06 (2) (c) or staff under s. DHS 63.06 (4) (a) 1. to 8.

(2)   Coordination of treatment.

(a) The case manager shall work with other CSP professional and paraprofessional staff and other agencies to:

1. Coordinate the assessment under s. DHS 63.10 (1) and ensure that a diagnosis is made;

2. Develop and implement the treatment plan under s. DHS 63.10 (2) ; and

3. Directly provide or coordinate treatment and services.

(b) The case manager shall work with other CSP staff and community agency staff to ensure that treatment plans are updated in accordance with s. DHS 63.10 (2) (a) .

(c) The case manager shall organize and conduct case-specific staffings with other agencies, as needed.

(3)   Coordination of referrals.

(a) A CSP shall have policies and procedures that facilitate coordination of referrals and ensure follow-up of clients referred to other community service providers.

(b) The case manager shall work with other community agency or community service staff to:

1. Coordinate linkages and referrals;

2. Coordinate contracting for specialized assessment and diagnosis or treatment, rehabilitation and support services; and

3. Integrate other agency or service activities into the CSP treatment plan.

(4)   Monitoring symptom status.

(a) The case manager shall assess, on a consistent basis, the client's symptom status. Changes in status shall be documented in the client's treatment record to measure progress or decompensation.

(b) The case manager shall keep the CSP program director and clinical coordinator informed of all changes in symptom status by signed notation in the client's treatment record.

(c) The case manager shall coordinate the provision of emergency services when a client is in crisis and shall provide documentation in the client's treatment record of emergency services provided.

(5)   Supportive psychotherapy and education. The case manager shall coordinate the provision of or provide supportive psychotherapy and education in symptom and illness management to the client.

(6)   Advocacy.

(a) The case manager shall advocate for and help his or her clients obtain needed benefits and services, including general relief, supplemental security income, housing subsidies, food stamps, medical assistance and legal services.

(b) The case manager shall work with existing community agencies to develop needed CSP resources, including housing, employment options and income assistance.

(7)   Education, support and consultation to clients' families and other major supports.

(a) The case manager shall determine what support, consultation and education the client's family may need from the CSP to manage the symptoms and illness of the client family member.

(b) The case manager shall coordinate support and consult with the client's family at time intervals as specified in the client's treatment plan.

(c) The case manager shall provide the client's other support systems with education and information about chronic mental illness and community support program treatment.

History: Cr. Register, April, 1989, No. 400 , eff. 5-1-89.