Elements and Performance Criteria
- Elements define the essential outcomes.
- Initiate complex case management process
- Confirm eligibility of client for case management and match their profile against service eligibility criteria
- Inform the client of all rights and responsibilities and obtain client’s consent to involvement in case management
- Collect information about the client, maintain confidentiality and privacy and minimise any duplication
- Work with the client to confirm and prioritise needs and to pursue relevant, achievable and time-framed goals
- 1.5 Recognise and respect the client's right to self-determination within legal parameters
- 1.6 Identify social, economic, housing, personal and family factors that may influence the client's health, well being and level of independence
- Discuss the case management process with the client, the complaint and appeal processes and the service criteria for exit
- Ascertain specific cultural needs of the client to provide appropriate services and support for their development
- 1.9 Estimate the level of case management support required to implement the client's plan and discuss with all relevant parties
- 1.10 Support and develop the client's ability to independently access alternative resources to meet needs in an appropriate manner
- Identify and consider possible solutions to complex issues
- Identify complex legal and ethical issues and questions about aspects of case management and resolve in line with organisation guidelines and regulatory requirements or seek appropriate resources
- Identify complex issues relating to funding of service provision and administer resources within relevant regulatory framework
- Ensure ethical standards are addressed to protect the autonomy, dignity, privacy and rights of the client
- Advocate for client-centred solutions to complex identified needs at service delivery and policy-making levels
- 2.5 Collaborate with colleagues, professionals and between services as needed to meet client's needs, achieve goals and to optimise outcomes
- Maintain up-to-date knowledge of, and links with, available resources and services within the community
- Develop plan of action to address identified priorities
- Use client identified goals and needs assessment to develop and agree on a plan of action
- 3.2 Support and develop the client's ability to independently access alternative resources to address needs
- Conduct research to establish an informed plan of action
- 3.4 Evaluate any barriers that may restrict the client's ability to meet identified goals and determine strategies to minimise their impact
- 3.5 Plan actions that are within client's financial resources
- Convene and/or participate in case conferences with services providers and/or family, carers, natural supports and relevant others
- 3.7 Seek and obtain the client's consent to undertake any referrals to other services and/or organisations
- Provide the client with timely information about available service options and support them to make informed decisions and exercise choice in all stages of the case management process
- 3.9 Document the client's goals and determine how effectiveness of interventions will be measured and evaluated
- Monitor service provision and coordination
- Communicate with service providers to discuss the case management plan, identify problems and adjust as necessary
- Advocate for service system improvements and identify and communicate gaps and/or inadequate services to program managers
- 4.3 Make adjustments to services, supports and resources according to client's needs and financial parameters
- Document and report to relevant organisation or funding body the implications from any variations to expected plan
- Evaluate client outcomes
- Undertake periodic reassessment and evaluation of outcomes against expected outcome
- Obtain information from clients, service providers, funding bodies and case managers to determine progress and evaluate against identified goals in the plan
- 5.3 Evaluate the effectiveness of plan adjustments to address client's ongoing situation and changing needs
- Evaluate the effectiveness of case management processes and service delivery, including client satisfaction and costs against benefits
- Work with the client to evaluate ongoing support needs to meet their goals, including review of parameters for disengagement
- Evaluate financial outcomes of adjustments to plan
- Identify opportunities for the client to maintain or develop independence from any aspect of the plan
- Document and report client outcomes and satisfaction in accordance with organisation requirements