CLINICAL HANDBOOK OF SCHIZOPHRENIA

316 V. SYSTEMS OF CARE4. Conducting comprehensive psychosocial assessments (e.g., mental status, psychosocial,substance abuse, and material/social supports).5. Offering psychoeducational services to individuals and families regarding mentalillness, substance abuse, and the importance of medication compliance.6. Designing and implementing monitoring and evaluation strategies.7. Using standardized measures.8. Employing standard problem-solving skills.9. Using role play, rehearsal, and corrective feedback to improve specific behavioraldeficits.10. Providing skills training, graduated exposure, and practice in the community toimprove overall psychosocial functioning and generalize behavioral competencies.The challenge of clarifying and improving clinical case management must include developmentof a curriculum of skills that can be incorporated into the role of case manager.Feasibility depends on commitment to a number of structural service issues, includingtraining, supervision, ongoing monitoring and evaluation, and the use of fidelitymeasures to maintain treatment quality. These steps also make clinical case managementprograms more amenable to much-needed controlled outcome research.The scope of therapeutic services provided by clinical case managers is likely to varyconsiderably across treatment systems. The actual clinical functions performed by clinicalcase managers may be a controversial issue given that many of the psychotherapeutic interventionsdescribed in this chapter may be seen as the domain of master’s- or doctorallevelclinicians. However, not all treatment teams have graduate-level trained specialistsat their disposal, and the services provided by these clinicians may be limited, leaving theongoing direct care largely to assigned case managers.Practically speaking, it is likely that much of the therapeutic work with seriouslymentally ill clients falls to the staff member who has the most frequent contact with clients,the case manager. However, there are considerable obstacles to effective incorporationof clinical skills into routine case management activities. Case management is stressfuland generally low-paying work, often resulting in high staff burnout and rapidemployee turnover. These problems put strain on the treatment delivery system and aredetrimental to client care, which depends on stable, responsive, ongoing services providedby compassionate caregivers. Understandably, clients often become discouraged whentheir assigned workers repeatedly terminate employment. The client is, yet again, facedwith establishing another relationship of unknown duration. This scenario tends to beless problematic on ACT teams that share caseloads, which encourages clients to interactwith multiple staff members; however, less intensive case management programs may assignonly one worker as the single contact point for a larger caseload of clients. These interruptionsin the continuity of care are likely to increase client relapses and treatmentcosts.Recruiting, training, and retaining highly skilled case managers require considerableeffort from administrative and supervisory staff. Optimally, clinical case managers shouldbe given ongoing training, support, and regular clinical supervision to foster effectivetherapeutic skills, to monitor client progress, to deal with challenging clients, and toguard against professional burnout. The role of clinical case manager often becomes adelicate balancing act that involves providing services for clients, meeting productivitydemands, advocating for various purposes, documenting services, and conducting otheradministrative tasks. Therefore, teaching effective time management strategies should beconsidered in the training and supervision of case managers. Nevertheless, despite these