CLINICAL HANDBOOK OF SCHIZOPHRENIA

31. Clinical Case Management 313As a first step, case managers are expected to undertake comprehensive assessmentand treatment planning across all client domains, often working in tandem with psychiatrists,nurses, clinicians, and vocational specialists.In the assessment phase, it is important to collate data from multiple sources, includingother mental health professionals, primary physicians, counselors, community members,law enforcement, and family members. Discharge summaries documenting prior episodesof care in other treatment settings should be reviewed thoroughly. Clinical casemanagers should be concerned with the following areas for ongoing assessment andpsychosocial interventions:• Mental status (e.g., psychiatric symptoms, including hallucinations, delusions, disorganizedthinking, depression, anxiety, social withdrawal and motor retardation,and blunted affect, among others).• Highly stressful or traumatic events (e.g., rape and other assaults, sudden losses)that may require modification in service delivery or referral for specializedposttraumatic stress disorder (PTSD) treatment.• Use of medications and other substances (e.g., type and number of medications,compliance with prescribed regimen, use of medications without prescription,quantity, frequency of alcohol and other drug use, and consequences associatedwith their use).• Social functioning in interpersonal relationships (e.g., family, friends) and extendedrelationships (e.g., number and types of social supports, quality ofconnectedness with others in the community, or signs of isolation and withdrawal).• Ability to negotiate daily living activities (e.g., shopping, laundry, hygiene).• Access to and use of environmental resources (e.g., housing, transportation, housingand safety concerns).• Money management and gainful vocational activity (e.g., job/education).• Monitoring of general health status (and facilitating primary care and dental care,including specialists for identified medical conditions).• Leisure activities.• Spiritual and/or religious beliefs.• Legal concerns (civil and criminal).A detailed functional analysis that includes an examination of the day-to-day experiencesof the client during a “typical week” may reveal circumstances under which the clientis likely to do particularly well or to experience stressors that may be associated withcrises or deterioration in well-being. Potential problems may include conflict with familymembers, acquaintances, workmates, or others in the community; depression or anxietyassociated with trauma-related symptoms (e.g., flashbacks, reexperiencing); abuse of alcoholor other drugs; or exacerbation of symptoms due to medication noncompliance.These difficulties can easily escalate into serious crises that may require emergency intervention,police involvement, or hospitalization.Whether created by an individual case manager or as part of a treatment team, a client’streatment plan should reflect the goals of the client, not merely the treatment goalsestablished by the team. This should be done in a collaborative fashion, ensuring that thetreatment plan and clinical reviews accurately reflect the client’s wishes in treatment, includinga plan to be followed if he or she is in crisis.There should be considerable flexibility and tailoring of services and interventionstrategies to suit the particular client’s needs and goals. Psychotherapeutic work per-