Case Management & Continuing Care Flashcards

A client with opioid use disorder completes 90 days of residential treatment and is stepping down to intensive outpatient care. The client has stable housing but no transportation, and the IOP site is 40 minutes away by a bus route that stops running before evening sessions end. According to best practice in continuing care planning, what should the case manager do FIRST?

Answer: Collaboratively problem-solve the access barrier (e.g., transportation vouchers, telehealth hybrid sessions, adjusted schedule) while keeping the level of care matched to the ASAM assessment

Level of care placement should be driven by clinical need (ASAM dimensions), not by logistical barriers. The case manager should address Dimension 6 (recovery environment) barriers through creative solutions while preserving the clinically appropriate level of care. Downgrading for convenience compromises outcomes, extending residential care is not the least restrictive appropriate option, and labeling the barrier as noncompliance is a systems failure rather than client-centered practice.

A case manager receives a request from a client's employer, who is funding part of the treatment through an EAP, asking for a progress update that includes attendance, drug screen results, and diagnosis. The client signed a general release for 'EAP communication' at intake. Under 42 CFR Part 2, what is the most appropriate action?

Answer: Verify that the consent form specifies the exact information to be disclosed and its purpose, and limit disclosure to what is named in the consent

42 CFR Part 2 requires a valid consent to name the specific information to be disclosed, the recipient, and the purpose, and disclosure must be limited to the minimum necessary. A vague 'EAP communication' release does not authorize disclosure of diagnosis or drug screen results. Disclosure to employers is permitted when properly consented, so an absolute refusal is incorrect.

Six months after discharge, a client in a continuing care program misses two consecutive recovery check-in calls. The client's last contact noted job loss and strained family relationships. Which response best reflects an evidence-based approach to continuing care and recovery management?

Answer: Initiate assertive outreach using multiple modes of contact, including approved collateral contacts, and offer a rapid re-engagement option without requiring a full re-intake

Recovery management check-ups and assertive continuing care models emphasize proactive, persistent outreach and low-barrier re-engagement, especially when risk factors such as job loss and family strain are present. Closing the case, sending one letter, or requiring full re-intake adds barriers during a high-risk period.

A client with co-occurring bipolar disorder and alcohol use disorder is receiving substance use services from your agency and psychiatric medication management from an outside clinic. The client reports the prescriber recently changed lithium dosing, and the client now shows tremor, confusion, and vomiting. What is the case manager's most appropriate immediate action within scope of practice?

Answer: Treat this as a potential medical emergency, arrange immediate medical evaluation, and notify the prescriber once the client is safe, using appropriate consent

Tremor, confusion, and vomiting after a lithium change may indicate lithium toxicity, a medical emergency. Case managers do not adjust medication but must ensure rapid access to emergency medical care and coordinate with the prescriber, observing consent requirements (emergency exceptions under Part 2 may apply). Advising dose changes exceeds scope, and waiting or home monitoring endangers the client.

When developing a continuing care plan, a case manager notices that a client's stated goals (return to work, regain custody of children) conflict with the treatment team's goal of extended residential care. Which approach BEST aligns with person-centered case management?

Answer: Use motivational interviewing to explore how the recommended care connects with the client's own goals, and document areas of agreement and disagreement in the plan

Person-centered planning integrates client-identified goals with clinical recommendations through collaborative exploration, such as motivational interviewing, and transparently documents divergence. Overriding the client, abandoning clinical recommendations, or obtaining signatures without genuine engagement all undermine shared decision-making.

A case manager is coordinating care for a client who has been referred through drug court. The court requests monthly reports. The client signed a Part 2-compliant consent allowing disclosure to the court, then later verbally says they want to revoke it. What should the case manager do?

Answer: Honor the revocation as to future disclosures, document it, and inform the client and the court of the consequences, since the revocation does not affect disclosures already made in reliance on the consent

Under 42 CFR Part 2, a patient may revoke consent at any time (it need not be written), and the revocation applies prospectively, not to disclosures already made in good-faith reliance. The case manager should document the revocation, stop further disclosure, and explain the consequences of non-participation, which may include sanctions in the drug court context. Revocation is not overridden by court participation, although criminal justice consents may be structured to remain irrevocable until a defined event such as case disposition, which must be explicit in the original consent.