Dilemmas when working with substance abusers with multiple and complex problems: the case manager's perspective

Abstract

Since the 1990s, case management has been implemented in the USA and Canada – and recently also in various European countries – to support substance abusers with multiple and complex needs. Although this intervention is often presented as a set of standardised functions, its application is often a subjective task involving various dilemmas, which may influence case management outcomes significantly. Based on a comparison of case managers’ experiences in Denmark and Belgium, we focus on several core dilemmas in case management for substance abusers with complex problems. Case management practices vary from one project to the next and even within the same project. Such differences are apparently related to the way in which case managers approach dilemmas such as those existing between control versus self‐determination, or between systematic versus ad‐hoc planning. The conclusion is that it is vital to discuss these dilemmas during training courses and supervision meetings in order to ensure that the intended form of intervention is actually delivered on the ground.

Barriers in Case Managers’ Roles: A Qualitative Systematic Review

“…Ten studies met the inclusion criteria for this qualitative systematic review: Bamford et al (2014); Eack, Greeno, Christian-Michaels, Dennis, and Anderson, (2009); Gustafsson, Kristensson, Holst, Willman, and Bohman (2013); Iliffe et al (2011); Klockmo and Marnetoft (2016); Kolind, Vanderplasschen, and De Maeyer (2009); Moise and Mulhall (2016); O’Donnell (2007); Sandberg, Jakobsson, Midlöv, and Kristensson (2014); and You et al (2016). These studies were all published between 2007 and 2016.…”

“…Three each were conducted in the United States and Sweden, two in the United Kingdom, and one in Australia. One study was conducted both in Denmark and Belgium (Kolind et al, 2009). Only one study setting was based in a hospital; the rest were community based.…”

“…The data synthesis identified five themes, all barriers to CM implementation: unclear scope of practice, diverse and complex CM activities, insufficient training, poor collaboration with other health-care providers, and client relationship challenges (see Table 2). (Kolind et al, 2009;Sandberg et al, 2014) • • Difficult to negotiate best solutions on behalf of clients and to advocate for patients, thus need to balance (Gustafsson et al, 2013;Klockmo & Marnetoft, 2016;O'Donnell, 2007) Note. CM = case management; NCM = nurse case manager.…”

“…Summary of Thematic Analysis. Less positive experiences when working with nurses because nurses are focused on technical task rather than broad spectrum of patients(Iliffe et al, 2011;You et al, 2016) • • Communication issues with other health-care professionals and poor collaboration for client's care(Kolind et al, 2009;You et al, 2016) …”

A Meta-Analysis of the Efficacy of Case Management for Substance Use Disorders: A Recovery Perspective

“…The findings support an obvious premise: if individuals with SUDs do not link with and remain in treatment, especially in substance abuse services, they cannot benefit from these services (25). Consequently, case management should be regarded as a missing link in substance abuse treatment (24, 70).…”