IV. SERVICE COORDINATION

The administrative, clinical, and evaluative activities that bring the client, treatment services, community agencies, and other resources together to focus on issues and needs identified in the treatment plan.

 
Service coordination, which includes case management and client advocacy, establishes a framework of action for the client to achieve specified goals. It involves collaboration with the client and significant others, coordination of treatment and referral services, liaison activities with community resources and managed care systems, client advocacy, and ongoing evaluation of treatment progress and client needs.

 
A. IMPLEMENTING THE TREATMENT PLAN

 

1. Initiate collaboration with referral source.  

Knowledge

1. How to access and transmit information necessary for referral.
2. Missions, functions, and resources of community service network.
3. Managed care and other systems affecting the client.
4. Eligibility criteria for referral to community service providers.
5. Appropriate confidentiality regulations.
6. Terminologies appropriate to the referral source.

Skills

1. Using appropriate technology to access, collect, summarize, and transmit referral data on client.
2. Communicating respect and empathy for cultural and lifestyle differences.
3. Demonstrating appropriate written and verbal communication.
4. Establishing trust and rapport with colleagues in the community.
5. Assessing level and intensity of client care needed.

Attitudes

1. Respect for contributions and needs of multiple disciplines to treatment process.
2. Confidence in using diverse systems and treatment approaches.
3. Open-mindedness to a variety of treatment approaches.
4. Willingness to modify or adapt plans.

 

2. Obtain, review, and interpret all relevant screening, assessment, and initial treatment-planning information.   

Knowledge

1. Methods for obtaining relevant screening, assessment, and initial treatment-planning information.
2. How to interpret information for the purpose of service coordination.
3. Theory, concepts, and philosophies of screening and assessment tools.
4. How to define long- and short-term goals of treatment.
5. Biopsychosocial assessment methods.

Skills

1. Using accurate, clear, and concise written and verbal communication.
2. Interpreting, prioritizing, and using client information.
3. Soliciting comprehensive and accurate information from numerous sources including the client.
4. Using appropriate technology to document appropriate information.

Attitudes

1. Appreciation for all sources and types of data and their possible treatment implications.
2. Awareness of personal biases that may impact work with client.
3. Respect for client self-assessment and reporting.

 

3. Confirm the clientís eligibility for admission and continued readiness for treatment and change.   

Knowledge

1. Philosophies, policies, procedures, and admission protocols for community agencies.
2. Eligibility criteria for referral to community service providers.
3. Principles for tailoring treatment to client needs.
4. Methods of assessing and documenting client change over time.
5. Federal and State confidentiality regulations.

Skills

1. Working with client to select the most appropriate treatment.
2. Accessing available funding resources.
3. Using effective communication styles.
4. Recognizing, documenting, and communicating client change.
5. Involving family and significant others in treatment planning.

Attitudes

1. Recognition of the importance of continued support, encouragement, and optimism.
2. Willingness to accept the limitations of treatment for some clients.
3. Appreciation for the goal of self-determination.
4. Recognition of the importance of family and significant others to treatment planning.
5. Appreciation of the need for continuing assessment and modifications to the treatment plan.

 

4. Complete necessary administrative procedures for admission to treatment.   

Knowledge

1. Admission criteria and protocols.
2. Documentation requirements and confidentiality regulations.
3. Appropriate Federal, State, and local regulations related to admission.
4. Funding mechanisms, reimbursement protocols, and required documentation.
5. Protocols required by managed care organizations.

Skills

1. Demonstrating accurate, clear, and concise written and verbal communication.
2. Using language the client will easily understand.
3. Negotiating with diverse treatment systems.
4. Advocating for client services.

Attitudes

1. Acceptance of the necessity to deal with bureaucratic systems.
2. Recognition of the importance of cooperation.
3. Patience and perseverance.

 

5. Establish accurate treatment and recovery expectations with the client and involved significant others including, but not limited to: 

- nature of services,
- program goals,
- program procedures,
- rules regarding client conduct,
- schedule of treatment activities,
- costs of treatment,
- factors affecting duration of care,
- client rights and responsibilities.  

Knowledge

1. Functions and resources provided by treatment services and managed care systems.
2. Available community services.
3. Effective communication styles.
4. Client rights and responsibilities.
5. Treatment schedule, time frames, discharge criteria, and costs.
6. Rules and regulations of the treatment program.
7. Role and limitations of significant others in treatment.
8. How to apply confidentiality regulations.

Skills

1. Demonstrating clear and concise written and verbal communication.
2. Establishing appropriate boundaries with client and significant others.

Attitudes

1. Respect for the contribution of clients and significant others.

 

6. Coordinate all treatment activities with services provided to the client by other resources.   

Knowledge

1. Methods for determining the clientís treatment status.
2. Documenting and reporting methods used by community agencies.
3. Service reimbursement issues and their impact on the treatment plan.
4. Case presentation techniques and protocols.
5. Applicable confidentiality regulations.
6. Terminology and methods used by community agencies.

Skills

1. Delivering case presentations.
2. Using appropriate technology to collect and interpret client treatment information from diverse sources.
3. Demonstrating accurate, clear, and concise verbal and written communication.
4. Participating in interdisciplinary team building.
5. Participating in negotiation, advocacy, conflict-resolution, problem solving, and mediation.

Attitudes

1. Willingness to collaborate.

 

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Email: no@nattc.org | Revised March 1998