Case Manager Critical Time Intervention

Job Description

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JOB SUMMARY:

The Case Manager of Critical Time Intervention (CTI) is responsible for case management activities associated with the CTI model. The CTI model is a time-limited form of case management, lasting nine months, that focuses on helping people with severe mental illness (SMI) and a history of homelessness during a “critical time” transitional period in their lives. CTI service planning specifically around maintenance of housing begins at the institution with case workers and discharge planners and continues in the community. CTI is designed specifically to enhance the continuity of care during transition from hospital to community care. CTI addresses problems encountered during this difficult and stressful transition period by bridging the gaps between hospital-based and community-based treatment services. CTI is a time-limited intervention; CTI case managers have small caseloads to permit intensive work, and they develop comprehensive plans of care with an early focus on engagement and rapport-building, an implementation phase to refer and connect individuals with long-term mental health services and natural supports, a testing phase where the Case Manager CTI monitors the support plan as the individual builds relationships with new providers, and a fade out of services occurs in approximately nine months. CTI case management ensures transitions of care are planful, specific, and accountable while also ensuring that long-term services are established and effective.

ESSENTIAL FUNCTIONS:

• Support individuals who are transitioning from homelessness or institutional settings (e.g., hospitals, jails) to Permanent Supported Housing (PSH).
• Provide an enhance, continual, and ongoing continuity of care for individuals transitioning from hospitals to community settings.
• Gradually shift all services to the community, identifying people in agencies who would assume coordination of psychiatric aftercare services, including the provision and monitoring of medication.
• Help with other relevant aspects of functioning, such as money management and community integration to foster self-help and create linkages that will persist over time; linkage and coordination not only include the formal, such as mental health services, but also the informal, such as local stores, eateries, and pharmacies.
• Develop person-centered plan as well as conduct visits at no less than bi-weekly and as needed to assess stability and progress towards goals.
• CTI staff interaction will change as served individuals proceed through the three phases; CTI regards this process of establishing linkages and resolving crises as opportunities to teach self-reliance to the individual, while remaining accessible for needed support and reminders (stepping in and stepping back).
• Document all service delivery in the Electronic Health Record (EHR); comply with policies and procedures established by the Agency, Licensure, Medicaid, and other regulatory bodies; adhere to confidentiality standards accordingly.
• Actively participate in meetings such as supervision, clinical staffing, and committees as assigned; utilize these meetings for active problem solving and to enhance a team approach to decision making; keep mandatory trainings up-to-date and attend training to increase case management knowledge, skills, and abilities.

OTHER DUTIES:

• Attend regular group or individual supervision as required.
• Act as a broker, mediating between the individual and his or her respective networks of support.
• Assist the individual in developing skills toward advocating for himself/herself.
• Role-play (or practice test "in vivo") to help in the individual's deficient areas.
• Provide direct interventions to build socialization, behavior management skills, and daily/community living skills.
• Assist individuals to bridge crises and find good housing placements.
• Maintain effective relationships with served individuals.
• Facilitate a “warm hand-off” to community-based mental health service and housing providers.
• Perform such other duties as assigned by supervisor.

QUALIFICATIONS:

• Must be available on an as-needed basis for consultation and an on-call basis to assist in problem solving or addressing specific concerns.
• Knowledge of treatment modalities and interventions such as service coordination, behavior management, independent living skills training, supportive counseling, family education, discharge planning, and crisis interventions.
• Skill in interviewing, assessment, and service planning development and implementation.
• Strong ability to manage diverse duties and multiple priorities.
• Effective oral and written communication; knowledge of general principles of recordkeeping.
• Function and contribute as a member of a treatment team.

Job Requirements

EXPERIENCE/EDUCATION REQUIRED:

Bachelor’s degree in a Human Services, Business Management, or a related field is preferred, or equivalent education and/or experience may be acceptable

QMHP credential is preferred.

Valid Driver’s license with a safe driving record.