Individuals responding to HOP’s 2010 National Needs Assessment on Farmworker Health Outreach reported that case management is one of the top five activities performed by outreach workers. They also listed case management as one of the top three activities that they want outreach workers to be doing in the next two years.
HOP is continually working to update our understanding of what is needed for successful case management in an outreach setting. To create a model for health outreach case management, HOP worked with a nationwide group of health professionals. Through this work, we identified the challenges in health outreach case management. We also created recommendations and ways to improve outreach workers’ ability to provide case management to patients.
What is Outreach?
Health Outreach Partners broadly defines outreach as a way to:
- Improve the quality of life for vulnerable and disadvantaged populations by aiding access to quality health care and social services.
- Provide health education.
- Bring linguistically and culturally responsive health care to these communities.
- Help individuals to become equal partners in their health care.
- Increase awareness of community health issues among the community.
Developing a Model of Outreach Case Management
Based on research and experience we used a few key points to create a model for outreach case management. Included in those key points are:
- Case management is an outcomes-focused coordination of services. These services include a client needs assessment, referrals to services, follow-up, and monitoring.
- Case management requires participation from everyone involved with service provision, connecting with formal and informal networks, and providing culturally responsive practices.
- The outreach case manager manages the relationship between the patient and health care community.
A successful case management process should:
- Create an initial assessment that identifies the patient’s strengths, resources, problem areas, services needed, and also screen for physical and mental health problems.
- In collaboration with the patient, develop a care plan that outlines desired outcomes and the steps needed to achieve them.
- Include a service provision, which may include of referrals and follow-up, helping the client get public assistance, meetings with specialists, family meetings, or other services.
- Monitor and follow-up with the patient.
Cultural responsiveness is very important for successful case management. Respect and understanding will encourage clear communication and help clarify needs and goals. Excellent listening skills are also important because these skills can help outreach workers understand a patient’s “complete message.” Finally, strong community partnerships and awareness of local resources will support the case management process and improve the impact of case management services.
The training, approach, and resources for case mangers at health centers differ across the country. Each program should decide on how much of a priority to place on case management. They should also create clear set of rules and a training plan for outreach staff members doing case management.
For more information on case management in health outreach, please contact Health Outreach Partners by visiting www.outreach-partners.org.