Clinical case management is a core
aspect of Marillac Clinic's Integrated Care model. It is provided by a
full-time case manager, all of our counselors, and (to a lesser degree)
by our medical and nursing providers. These services were recently described in the national periodical for case managers and in a description of Marillac Clinic's integrated care services that was presented to the Advancing Colorado's Mental Health Care initiative.
The following is a description of an actual day in the life of our full-time case manager, Sarah.
Sarah starts her Tuesday at 8:00 am at the weekly mental health
providers' meeting. Her participation in the meeting is disrupted when
the front desks calls her to help with a patient. Martha, a 58 year old
homeless woman, has come to the Clinic, asking for an early medication
By 10 am, Sarah has handled phone calls from two parents calling on
behalf of adult children waiting for medications through the Medication
Assistance Program (MAP). She's assisted two patients with the
disability application process. The local mental health center has
faxed a discharge plan for a patient who will be coming to Marillac for
service, and she decides she needs to follow up for additional
Over the next hour and a half, Sarah gets two requests from women
needing early medication refills because of travel plans. Lisa makes
her request in person. Sarah is familiar with Lisa's case and provides a
brief counseling intervention since her mental health provider is not
available. The other early refill request is made over the phone.
Sarah is familiar with Karen, who has "no-showed" for several medical
appointments. The patient has been told repeatedly she needs to see a
medical provider before her prescriptions will be refilled. Sarah tells
both women she will need to check with the "medical team" and get back
The Clinical Case Manager also answers disability related questions
from another patient, reassures an asthmatic patient who calls concerned
that her Advair will not arrive in time, and handles a phone call from a
pharmacy provider confused about the pharmacy's new contract with
Marillac Clinic. She briefs two of her colleagues, a physician
assistant and a mental health provider, about a patient with auditory
hallucinations. Sarah's scheduled the two providers for a joint
appointment with this patient.
When a medical provider asks Sarah to "meet and greet" a patient just
discharged from an inpatient substance abuse program, Sarah goes into
the exam room, talks with him, and reinforces his relapse prevention
plan. After 25 minutes, the two of them decide he currently has enough
structure and support in an aftercare program. Sarah tells him to call
her if he needs help.
At 11:40 am, Sarah finds the Medical Officer of the Day (MOD) and
discusses the two early refill requests. The MOD approves Lisa's
request. However, the MOD does not approve Karen's request. Instead,
the MOD writes a prescription with instructions on how to taper down the
patient's anti-anxiety medication. When Karen returns from her trip
and keeps an appointment with a medical provider, her health status and
medication needs can be reassessed.
Before she leaves for lunch, Sarah discusses financial assistance
programs with a 29 year old patient who needs shoulder and eye surgery.
After lunch, she fields another call from the pharmacy and faxes a
voucher so the cost of medication for a homeless man will be billed to
Marillac. She listens to voice mail message from a case manager at the
local domestic violence shelter who's checking on the status of the
agency's request for a psychiatric evaluation of an undocumented person.
There's also a message from a man who needs a psychiatric
consultation about potential interactions between his psychiatric and
other medications. Sarah has been working for three months to arrange a
consultation with an out of town psychiatrist, due to the local
shortage of psychiatrists. She makes several phone calls to arrange an
appointment on a day the patient will have transportation.
Mid-afternoon finds the Clinical Case Manager getting patient updates
from several colleagues, a volunteer counselor and a staff mental
health provider. She reviews the records on Larry, who has two
prostheses. Larry can't afford the approximately $1,000/year cost of
replacement parts. She calls the prosthetics provider about arranging a
At 3:15 pm, a medical provider asks Sarah to meet with a woman who's
grieving her mother's recent death. Sarah spends nearly an hour
encouraging the woman to find some balance between meeting her father's
needs and her own self care.
As the day draws near to an end, Sarah talks to a medical provider
about potential resources for Leonor, a woman who has a very large
kidney stone. Leonor's not a citizen so she isn't eligible for most
She responds to another call from the pharmacy and another patient
who's seeking sample medications while waiting for MAP. After receiving
a second phone call from a father about his daughter's medication,
Sarah checks the Medication Outlet and finds the medication has
arrived. She calls the father back with the good news.
Sarah ends her day noting that it has been kind of slow!