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PSYCHOSOCIAL INTERVENTIONS: CASE MANAGEMENT 

FUNCTIONS OF A CASE MANAGER

Case management initiatives with first episode clients tend to move away from liaison with those community agencies which more appropriately serve the needs of people with chronic psychiatric illness. The liaison in first episode work is mostly with generic community agencies. The goal is to normalize the young person's environment as soon as possible. The majority of instrumental case management work is in the areas of education and vocational reintegration. This means returning young adults to school or work as quickly as possible. This is often accomplished in coordination with an occupational therapist and/or clinical psychologist. The case manager is proactive in making timely and meaningful contacts with guidance counsellors, occupational workplace departments, employers, etc. The case manager can sometimes intervene to get a client reinstated if they have been dismissed due to symptoms, or negotiate a reduced schedule on return to work when sick leave is finished. At the same time, the case manager can educate the workplace personnel about the difficulties the client has been experiencing without stigmatizing the client in the process. The language used to mediate such negotiations needs to be devoid of medical/psychiatric lexicon. Using descriptions of cognitive difficulties such as poor concentration and memory, confusion, etc., are more meaningful than telling an employer that the person has psychosis or schizophrenia. Likewise, the case manager often needs to go out to secondary and post secondary educational institutions with the client to negotiate a feasible curriculum of study and facilitate a working relationship between the guidance counsellor, client and case manager. At times, the case manager will help the client arrange independent studies through correspondence or upgrade through specific educational facilities. The case manager uses the information made available through their client's completion of the (PEPP) cognitive testing battery to give added support to the planned psychosocial interventions. The timing of the cognitive tests is coordinated with the psychologist. 

HOUSING AND FINANCE

In terms of housing, the majority of clients presenting with first episode psychosis have stable housing with their families, usually parents. Some clients live in independent housing or post-secondary (college/university) residences. There is a concerted effort to avoid housing which is more suitable for clients with chronic illness as young clients may prematurely take on a sick role identity or become unduly concerned about managing future episodes of illness. Transitional housing may be necessary in some instances and therefore contact with more traditional mental health agencies may be required in such circumstances. Financially, young clients are often dependent on parents. Some clients hold educational loans. They are often ineligible for social assistance such as welfare except on a temporary basis. PEPP discourages premature applications for disability benefits. The case manager can help clients negotiate finances and housing through interim arrangements with parents and/or the welfare office.

LIAISON WITH OTHER PROFESSIONALS AND INTERVENTIONS WITHIN THE PROGRAM  

Ongoing informal discussion with the psychiatrist, psychologist and occupational therapist about any new initiative is extremely valuable. The case manager is expected to link his/her client with other resources within PEPP. Most clients will require intensive assessment and treatment in the Recovery, Activity and Participation (RAP) Group which is available to new clients whether inpatient or outpatient for up to three months. It is expected that each client in PEPP participate in the Youth Education and Support Group (YES). Clients who require assistance in resuming their educational and vocational roles will benefit from the Cognitive Skills Training Group (COST). See Group Interventions for full descriptions of these interventions.