Family Ties Project staff continues to struggle to effectively involve the many agencies funded to case manage District HIV clients. The maintenance of the project organizational structure, the purpose of which is to build upon, not replace, existing case management, requires on-going contact with those agencies, especially with new case managers, case manager training and support groups, monthly brown bag informational and training sessions, paying for off-site training and participation in professional development activities, a biweekly fax newsletter, a listserv and a Web site that makes forms and other documents readily accessible. The on-site enrollment training provided to 5 case management agencies this year was described above under the section on the role of the life planning specialist.
In the past clinical consultations were also utilized frequently by case managers. Based on data for year 4, the Family Ties Project coordinator, a licensed clinical social worker, was consulted on approximately 40% of the families, and multi-disciplinary consultation was provided on 24%. Since the resignation of the coordinator in March 2001, this is no longer one of the major services provided by the project.
A major feature of the collaborative organizational structure is the institutionalization of the 6-month case conferences, an important mechanism for ensuring continuity of care.
Multi-disciplinary case conferences are held every 6 months of a family's active enrollment. These meetings allow agencies serving the same clients to discuss the life planning issues being addressed with the client family, establish new service goals, reduce duplication of effort and ensure family centered care. Frequent coordinated conferencing helps to address the needs of the individual clients and the family as a unit. The face-to-face conference is followed by a written summary of the meeting, prepared by the project director. Figure 9 shows the number of 6-month conferences convened and the number held as due.
Overall, 85% of the cases were reviewed on the expected 6-month cycle. The 24- and the 36-month meetings were convened most infrequently; 50% and 70% respectively were held on schedule.
A total of 114 6-month case conferences were convened during the period October 2000 through September 2001. 12% (14) were the first 6- month meeting for the case. Figure 9, which shows the time range for the conferences, portrays the very long periods of service to these families. 9% (10) of the 114 conferences pertained to clients who were in the fourth year of receiving services and 3 of the meetings were 54th month conferences. The latter cases have spanned the life of the project. Conferences not held in the 6-month period indicate a period during which the case is inactive or non-progressing.
Anecdotal evidence, as well as the case studies completed parallel to this report, suggests clients involved in inactive/non-progressing cases often re-contact the project, or the staff is contacted on their behalf, when a medical crisis occurs, or when the patient is terminal.
An analysis was conducted of the 114 multi-disciplinary case conferences convened during this 12-month reporting period; 79% of the meetings took place at Family Ties office and 21% at the office of a case management agencyeither Children's National Medical Center or Family and Medical Counseling Services. As part of the memorandum of agreement with collaborating case management agencies, the agency case manager is expected to participate in the client case conference. Ideally, this would be the enrolling case manager, but over the years Family Ties Project staff has found that high turnover among case managers makes it difficult to obtain their participation. However, as seen below, other staff case managers do participate at varying rates.
Participation in 6-month Case Conferences |
|
who |
percent of conferences |
| Enrolling case manager present | 24% |
| Case manager from enrolling agency present | 45% |
| Involvement of attorney and present | 88% 3 |
| Involvement of kinship case manager and present | 100% 4 |
| Involvement of art therapist and present | 100% 5 |
TOTAL |
114 conferences |
The participation of the enrolling agency in only 45% of the conferences during year 5 represents a considerable decline from the 87% participation from January 1997 through March 2000. Participation rates are considerably higher among the Family Ties subcontractors (88 to 100%) than the other collaborating agencies.
Preparation and distribution of the case conference summaries is important is keeping all providers informed and engaged in the case. Timely distribution may also encourage participation in conferences. Reportedly, the case management agencies, where staff turnover is high, also file and use the summaries as a source of information on the current status of their cases. The project director has set a standard of distribution of 100% of summaries within 2 weeks of the conference as a quality improvement measure for the project. This year 71% of the conference summaries met that standard.
In addition to case conferences, case manager support groups are another mechanism for enhancing working relationships with case management providers. The project coordinator and later in the year the life planning specialist convened a monthly case managers support group, which is intended to support these workers in addressing work-related, but not case specific, issues. The support group, which was established during the first year of the project, is a unique forum in the District for bringing together professional and paraprofessional case managers from many public and private agencies. During the reporting period, 12 support group sessions were convened.6
At 1 of the 12 sessions, Family Ties Project staff used a fixed response form to obtain feedback on the sessions. 11 participants responded.7 82% of the attending case managers had been employed in their current job for less than 12 months. 45% of them had been attending support groups since their employment. Asked to indicate on a 4-point scale the extent to which the support group session helps in the case management of their clients, they assigned a mean of 3.27. Only 1 case manager responded that she was uncomfortable in discussing work related issues in the group. All agreed that the support group met their expectations and that they would recommend it to a colleague doing similar work. On a 4-point scale of satisfaction with the support from the Family Ties Project, their mean satisfaction score was 3.36.
Case managers from the collaborating agencies also receive continuing education and training through orientation to Family Ties Project services and enrollment procedures, brown bag lunch sessions and skills building training. This year 5 brown bag sessions were held for a total of 36 participants. (See Figure 10 for a list of topics.) Attendance ranged from 2 (Legal Options for Life Planning) to 11 (Reporting Child Maltreatment in DC). Topics for the 3 other sessions were Evaluating Mental Health Services, Working with Sexual Minority Youth and How to Secure SSI/SSDI Benefits for Your Clients.
Sessions are assessed through participant responses to a 1-page feedback form administered at the conclusion of each session. A very high97%response rate was obtained. The results are displayed in Figure 11. Mean ratings of 4 items on a 4-point scale ranged from 3.6 (I feel more comfortable addressing this issue with my clients) to 3.8 (Goals of the training were met). Figure 12 shows the type of brown bag participant by job category.
The project director is responsible for collecting and compiling participant feedback data. He compiles the responses from each session and forwards a report to the presenter/trainer. The feedback process is also used to solicit ideas and requests for future training sessions. According to the project director, few suggestions have been received.
