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Cover | Preface | Contents | Overview | Care Manager Role | Clinician Communications


As the Supervising Psychiatrist What Can You Expect From the Care Manager
Care managers have varying clinical and discipline backgrounds. It may be helpful for you to discuss the care managerís background with the intermediary clinician director, to gain an appreciation of the care managerís level of expertise in this type of care. Each care manager will have had training and coaching in the RESPECT Three Component Model. Currently, however, there are few if any care managers prepared specifically (prior to our training) to provide this type of clinical care management for depressed patients. It is expected, therefore, that through the supervision and consultation provided on the supervision call, the care managerís expertise in this work will significantly increase.

The care manager will prepare for the call using the care manager agenda form. This organizes the report in a sequence that has been found by psychiatrists to be helpful and efficient.

You should receive a copy of the Agenda Report each week prior to the call, either by e-mail or fax.

The care manager will report the facts of the case as listed on the form. In addition the care manager will report on self management goals, and progress, and barriers that may be affecting the patientís adherence to the plan. Patients with significant problems are reported on separately.

The care manager will try and discuss cases with the psychiatrist before sending a care manager report. When this is not possible, then based on the discussion and your advice, the care manager may append or send a new care manager report to the primary care clinician.

Based on the nature of the consultative advice, the care manager and psychiatrist will decide on who will contact the primary care clinician with the consultative advice.

The care manager will call the patient per the protocol at weeks 1, 4, 8, and every four weeks until remission is achieved. The PHQ-9 will be done every 4 weeks.

At your request, the request of the primary care provider or at the discretion of the care manager, additional calls may be made, based on the patientís situation.

The care manager will provide patient education about depression, medications, counseling, as well as self- management goal setting, and will report on these at least early on in the consultative process. This provides an avenue for the consultative psychiatrist to assess the care managerís capacity to manage the calls, and for the care manager to seek consultation specific to patient issues.

The care manager will foster the patientís adherence to the treatment plan, including working with the patient to accept counseling if this has been recommended, and declined.

The care manager will identify barriers to reaching the treatment plan and help the patient identify potential solutions and action plans to remove the barrier.

The care manager will make at least three calls to contact the patient for the initial call, and subsequent calls. The care manager will discuss ďcanít contact ďpatients as part of the supervision call. Plans for follow-up are made, taking into account the severity of the patientís condition. Unless otherwise indicated, if after a ďgood faithĒ attempt to maintain contact with your patient, the care manager cannot locate the patient by phone, a letter will be sent to the primary care clinician and to the patient indicating that if the patient want s continued care management services the patient should contact the care manager or the primary care clinician. The care manager will notify the primary care clinician of any patients to whom services have been terminated based on patient choice.

What Should You NOT Expect From the Care Manager
The care manager will not have extensive historical, medical or psychosocial information about the patient. The care manager does not routinely access the patientís medical record, and limits the interview to current issues. Such information as family constellation, current family and other psychosocial issues, lose and grieving, prior mental health diagnosis, medications and treatments etc, will only be known to the care manager incidental to the conversations about treatment adherence and barriers.

The care manager will not provide psychological counseling or therapy. If the PCC recommendations or suggests that the patient would benefit from psychological counseling, and the patient has chosen not to accept this recommendation, the care manager will reinforce this recommendation, but will NOT get involved in in-depth discussions of family difficulties, loss and grief or other intense psychosocial issue. Rather, the care manager will point out the fact that since the patient is currently experiencing difficulty this is indicative that the patient may benefit from counseling.

The care manager will not schedule appointments for therapy, or other appointments needed in the care of this depressive episode.

The care manager will not make home visits; rather if this is identified as a need, the care manager will discuss this need with the PCC.

The care manager will not provide financial counseling. Rather, the care manager will assist the patient contact the appropriate resource(s).

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