Psychosocial factors significantly impact health outcomes. Case managers must address mental health, social determinants, and community resources as integral components of the care plan.
Core Psychosocial Concepts
Biopsychosocial Model
Engel's model recognizes biological, psychological, AND social factors all influence health. CM must address all three dimensions for effective care coordination.
Social Determinants of Health (SDOH)
Non-medical factors affecting health outcomes — housing, food security, transportation, economic stability, education, social support, neighborhood safety.
Behavioral Health Integration
Mental health and substance use disorders frequently co-occur with medical conditions; integrated care improves outcomes; CM facilitates behavioral health referrals.
Crisis Intervention Principles
Immediate, short-term response to acute psychological distress; goal is stabilization and connection to appropriate services; safety assessment is priority.
Maslow's Hierarchy of Needs
Physiological
Food, water, shelter, sleep, warmth — must be met first; SDOH screening addresses these basics.
Safety
Personal security, employment, health, property — patients feel unsafe when diagnosis threatens stability.
Love / Belonging
Family, friendship, social connection — isolation worsens health outcomes; CM assesses support systems.
Esteem
Self-esteem, achievement, recognition — chronic illness threatens sense of competence and dignity.
Self-Actualization
Full potential, creativity, meaning — highest level; CM supports client toward maximum independence.
Motivational Interviewing (MI)
| MI Principle | Description | CM Application |
|---|---|---|
| Partnership | Collaborative, not confrontational | Explore client's own reasons for change |
| Acceptance | Non-judgmental respect for autonomy | Validate client experience |
| Compassion | Prioritize client's wellbeing | Focus on client goals, not CM goals |
| Evocation | Draw out client's own motivation | "What would motivating change look like to you?" |
| OARS | Open questions, Affirmations, Reflections, Summaries | Core MI communication skills |
| Change Talk | Statements favoring behavior change | Reinforce with reflections |
| Ambivalence | Normal; explore with reflective listening | Avoid argumentation |
Stages of Change (Prochaska / DiClemente)
| Stage | Client State | CM Strategy |
|---|---|---|
| Precontemplation | No intention to change | Raise awareness, plant seeds |
| Contemplation | Considering change | Explore pros/cons, ambivalence |
| Preparation | Planning to change soon | Help develop action plan |
| Action | Actively making changes | Support, reinforce, troubleshoot |
| Maintenance | Sustaining change | Prevent relapse, celebrate success |
| Relapse | Returns to old behavior | Non-judgmental, restart process |
Additional Psychosocial Factors
Grief and Loss
Kübler-Ross stages (DABDA): Denial, Anger, Bargaining, Depression, Acceptance — nonlinear; CM provides empathic support and appropriate referrals.
Coping Mechanisms
Adaptive (exercise, social support, problem-solving) vs. Maladaptive (substance use, denial, avoidance); CM assesses and reinforces adaptive coping.
Caregiver Burden
Stress, exhaustion, health decline in informal caregivers; CM assesses caregiver needs, arranges respite care, provides education and support.
Mental Health Conditions
| Condition | Key Features | CM Considerations |
|---|---|---|
| Depression | Persistent low mood, anhedonia, fatigue | Medication adherence, therapy referral, PHQ-9 screening |
| Anxiety Disorders | Excessive worry, panic, avoidance | CBT referral, relaxation techniques, GAD-7 screening |
| PTSD | Trauma response, hypervigilance, flashbacks | Trauma-informed care, avoid re-traumatization |
| Schizophrenia | Psychosis, hallucinations, disorganized thinking | ACT teams, medication management, supported housing |
| Bipolar Disorder | Alternating mania and depression | Mood stabilizers, crisis planning, recognize warning signs |
| Substance Use Disorder (SUD) | Dependence, tolerance, compulsive use despite harm | SBIRT, MAT (medications for addiction treatment), peer support |
Behavioral Health Interventions
SBIRT
Screening, Brief Intervention, and Referral to Treatment — standardized approach for identifying and addressing substance use in healthcare settings.
MAT (Medication-Assisted Treatment)
Medications (methadone, buprenorphine, naltrexone) + counseling for opioid/alcohol use disorders; CM supports adherence.
Trauma-Informed Care
Recognizes widespread trauma impact; emphasizes safety, trustworthiness, peer support, collaboration, empowerment; CM avoids re-traumatization.
ACT (Assertive Community Treatment)
Intensive, multidisciplinary team-based service for severe mental illness; brings services TO the client in the community.
Crisis Intervention Models
Roberts 7-Stage: Plan/conduct safety assessment, Rapport, Problem identification, Feelings/emotions, Alternatives, Action plan, Follow-up.
Crisis & Safety Assessment
Suicide Risk Assessment
Use Columbia Protocol (C-SSRS); assess ideation (passive vs. active), plan, means, intent, history; access to lethal means — CM arranges immediate resources.
Safety Planning
Collaborative identification of warning signs, coping strategies, support contacts, professional resources, means restriction — not just a contract.
Mental Health Resources
Community mental health centers, crisis hotlines (988 Suicide & Crisis Lifeline), mobile crisis teams, psychiatric ERs, peer support specialists.
SDOH Domains & Community Resources
| SDOH Domain | Common Challenges | Community Resources |
|---|---|---|
| Housing | Homelessness, unsafe conditions | HUD programs, Section 8, local shelters, transitional housing |
| Food Security | Food insecurity, poor nutrition | Food banks, SNAP (food stamps), Meals on Wheels, WIC |
| Transportation | Medical appointment access | Medicaid NEMT, volunteer driver programs, ride shares, bus passes |
| Economic Stability | Poverty, unemployment | Social Security, SSI/SSDI, unemployment benefits, job training |
| Healthcare Access | Uninsured, underinsured | FQHC (community health centers), free clinics, Ryan White Program |
| Social Support | Isolation, caregiver absence | Senior centers, Area Agency on Aging, adult day programs |
| Education | Low health literacy | Adult education, community education programs |
Key Community Resource Agencies
Area Agency on Aging (AAA)
Local agency providing services for adults 60+; connects to Meals on Wheels, transportation, caregiver support, adult day programs, legal services.
FQHC (Federally Qualified Health Center)
Community health centers providing comprehensive care regardless of ability to pay; sliding scale fees; serve underserved populations.
Social Security Programs
SSI (Supplemental Security Income) for aged/blind/disabled with limited income; SSDI (Social Security Disability Insurance) for those with work history.
Home and Community-Based Services (HCBS)
Medicaid waiver programs enabling services in home vs. institutional settings; personal care, homemaker, adult day, respite care.
Case Management Resources
211 helpline (social services directory), CMS resources, SAMHSA (behavioral health), National Alliance on Mental Illness (NAMI).
Health Literacy & Cultural Competency
Health Literacy Assessment Tools
REALM (Rapid Estimate of Adult Literacy in Medicine), NVS (Newest Vital Sign), S-TOFHLA — screen before patient education.
Teach-Back Method
Ask client to explain information in their own words; gold standard for confirming understanding; "What will you tell your family about your medications?"
Cultural Humility
Ongoing self-reflection and learning about cultural differences; awareness of own biases; different from cultural "competence" (implying mastery).
Health Disparities
Differences in health outcomes by race, ethnicity, socioeconomic status, gender, geography; CM addresses through equitable resource allocation.
Practice Quiz — 10 Questions
Quiz Complete!
Memory Hooks
Maslow's Hierarchy
Physiological → Safety → Love/Belonging → Esteem → Self-Actualization — 5 levels bottom to top
MI OARS
Open questions → Affirmations → Reflections → Summaries — core MI communication skills
Stages of Change
Pre-contemplation → Contemplation → Action → Maintenance → Relapse (→ restart)
Kübler-Ross DABDA
Denial → Anger → Bargaining → Depression → Acceptance — grief is nonlinear
SDOH Domains
Food security, Residence (housing), Economic stability, Social support, Healthcare access — five core SDOH domains
SBIRT
Screening for substance use → Brief Intervention (motivational feedback) → Referral to Treatment if needed
Flashcards
Click any card to flip it.
What are the 5 levels of Maslow's Hierarchy?
Physiological → Safety → Love/Belonging → Esteem → Self-Actualization. Mnemonic: "Please Stay Long Enough Superstar"
What is Motivational Interviewing (MI)?
Collaborative, person-centered approach to eliciting behavior change by exploring and resolving ambivalence. Core skills: OARS (Open questions, Affirmations, Reflections, Summaries)
Stages of Change in order
Precontemplation → Contemplation → Preparation → Action → Maintenance (→ Relapse possible). Not always linear.
What is SBIRT?
Screening, Brief Intervention, and Referral to Treatment — standardized approach to identify and address substance use in healthcare settings.
What is trauma-informed care?
Care approach recognizing widespread trauma impact; emphasizes safety, trustworthiness, peer support, collaboration, empowerment, cultural/gender sensitivity.
Area Agency on Aging (AAA) role
Local agency for adults 60+; provides Meals on Wheels, transportation, caregiver support, adult day programs, legal services, respite care.
Teach-back method
Ask client to explain instructions in their own words to confirm understanding. Example: "Can you show me how you'll take your medications at home?"
Kübler-Ross 5 stages of grief (DABDA)
Denial → Anger → Bargaining → Depression → Acceptance. Nonlinear process; not everyone experiences all stages.