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Skip Navigation Links > Competency 5: Continuing Care of Families Affected by FASD > 4. Clinical and Environmental Stabilization for Clients with an FASD or Possible FASD

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Competence 5: Continuing Care of Families Affected by FASD

Clinical and Environmental Stabilization for Clients with an FASD or Possible FASD

Studies show that addiction affects multiple facets of women’s lives. Best practices in addiction treatment have long reflected the need for a holistic, comprehensive approach to clinical and environmental stabilization. It is important to address the diverse needs of women, their children, and their families over an extended period of time.

Young man and woman hugging and smiling

Services are often fragmented and emanate from different funding streams with different requirements. Therefore, efforts are needed to address problems of access, efficiency, accountability, and continuity of care. The challenge is to coordinate and integrate services provided by multiple agencies or systems.

Case management is a process used to create an integrated plan to promote recovery. It enables women and their children to receive and appropriately use a variety of services for their improved functioning. Services should be provided for as long as a woman and her family need and can benefit from them.

Despite the challenges of service integration, collaborative efforts (e.g., service linkages) are essential ingredients in meeting the multifaceted needs of women with an FASD, children with an FASD, and families of clients with an FASD. The table describes the characteristics of effective case management models.

Characteristics of Case Management
Characteristic Model A Model B Model C
Duration Indefinite (defined by client needs) Time-limited Begins at intake, continues throughout treatment, and trails client through followup
Intensity Frequent contact (daily)
High staff ratio (1:10)
Infrequent contact (quarterly)
Low staff ratio (1:75)
Frequent contact
High staff ratio (1:10)
Focus of services Broad, inclusive Narrow, exclusive Comprehensive, including identification and outreach, assessment, planning, linkage, monitoring, evaluation, direct service, crisis intervention, system advocacy, and resource development
Availability 24 hours Office hours 24 hours
Site of service In vivo Office only Wherever appropriate
Consumer direction Consumer directed Consumer directed Consumer directed
Advocacy Advocates for client to gain access to services Gatekeeper for system (finds alternatives to requested services) Advocates for the client to gain access to services, advocates for system changes
Case management training Advanced professional degrees On-the-job training Advanced professional degrees
Case management authority Broad authority, administrative control No authority, persuasion only Authorization of services and utilization review; decisionmaking authority
Team structure Full team model: All case managers share all clients Primary counselor with individual caseload Primary case manager with individual caseload

Source:  Siegal, H.A. 1998. Comprehensive Case Management for Substance Abuse Treatment. Treatment Improvement Protocol Series 27. DHHS Publication No. (SMA) 98-3222. Rockville, MD: Substance Abuse and Mental Health Services Administration.

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