Competence 5: Continuing Care of Families Affected by FASD
Clinical and Environmental Stabilization for Clients with an FASD or Possible FASD
Studies show that addiction affects multiple facets of women’s lives. Best practices in addiction treatment have long reflected the need for a holistic, comprehensive approach to clinical and environmental stabilization. It is important to address the diverse needs of women, their children, and their families over an extended period of time.
Services are often fragmented and emanate from different funding streams with different requirements. Therefore, efforts are needed to address problems of access, efficiency, accountability, and continuity of care. The challenge is to coordinate and integrate services provided by multiple agencies or systems.
Case management is a process used to create an integrated plan to promote recovery. It enables women and their children to receive and appropriately use a variety of services for their improved functioning. Services should be provided for as long as a woman and her family need and can benefit from them.
Despite the challenges of service integration, collaborative efforts (e.g., service linkages) are essential ingredients in meeting the multifaceted needs of women with an FASD, children with an FASD, and families of clients with an FASD. The table describes the characteristics of effective case management models.
| Characteristic | Model A | Model B | Model C |
|---|---|---|---|
| Duration | Indefinite (defined by client needs) | Time-limited | Begins at intake, continues throughout treatment, and trails client through followup |
| Intensity | Frequent contact (daily) High staff ratio (1:10) |
Infrequent contact (quarterly) Low staff ratio (1:75) |
Frequent contact High staff ratio (1:10) |
| Focus of services | Broad, inclusive | Narrow, exclusive | Comprehensive, including identification and outreach, assessment, planning, linkage, monitoring, evaluation, direct service, crisis intervention, system advocacy, and resource development |
| Availability | 24 hours | Office hours | 24 hours |
| Site of service | In vivo | Office only | Wherever appropriate |
| Consumer direction | Consumer directed | Consumer directed | Consumer directed |
| Advocacy | Advocates for client to gain access to services | Gatekeeper for system (finds alternatives to requested services) | Advocates for the client to gain access to services, advocates for system changes |
| Case management training | Advanced professional degrees | On-the-job training | Advanced professional degrees |
| Case management authority | Broad authority, administrative control | No authority, persuasion only | Authorization of services and utilization review; decisionmaking authority |
| Team structure | Full team model: All case managers share all clients | Primary counselor with individual caseload | Primary case manager with individual caseload |
Source: Siegal, H.A. 1998. Comprehensive Case Management for Substance Abuse Treatment. Treatment Improvement Protocol Series 27. DHHS Publication No. (SMA) 98-3222. Rockville, MD: Substance Abuse and Mental Health Services Administration.
