Case Management Model for Substance Use Disorders

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines case management as:

“a coordinated, individualized approach that links patients with appropriate services to address their specific needs and help them achieve their stated goals.”

Case management uses a client-centered, collaborative approach to provide comprehensive care to patients. Principles of case management include:

Linking clients with community resources
Assisting with the navigation of the healthcare system
Providing a client with a single point of contact when navigating the health and social service system
Facilitating care

Substance use disorder (SUD) treatment ideally involves accessing a variety of health and social services. The case management model supports individuals as they move through the continuum of care, including recovery.

For opioid use disorder, the nurse care manager model streamlines office-based opioid treatment under the supervision of a nurse care manager. In this model, nurse care managers perform the initial screening, connect patients to providers for medication prescription, and conduct follow-up appointments with patients to monitor maintenance and recovery. The provider confirms whether treatment with medication for opioid use disorder (MOUD) is appropriate.

Boston Medical Center's Office Based Addiction Treatment (OBAT) Program, also known as the Massachusetts Model, relies on nurse care managers to support physicians in treating opioid use disorder (OUD). In this model, nurse care managers are responsible for conducting the initial screening and providing continued support for patients throughout treatment. This collaborative approach ensures effective, coordinated, and team-based care is provided to patients with OUD.

Community health workers (CHWs) are trusted public health workers with a close understanding of the communities they serve. CHWs can take on many roles and responsibilities within a community, including case management. CHWs can support case management for SUD programs by acting as a bridge between patients and treatment providers. CHWs in SUD programs can help patients improve access to care, retention in treatment, and overall well-being.

Examples of Rural Case Management Programs

Center for Community Resources in Butler, Pennsylvania offers drug and alcohol case management services to individuals referred by treatment providers, mental health providers, social services agencies, and self-referrals. Case managers connect individuals to treatment services, assist with applications for Medicaid and Social Security benefits, and advocate for individuals in various settings.
Chenango Health Network's Community Health Worker program in Norwich, NY offers case management support using a client-centered, non-judgmental, trauma-informed, and harm-reduction approach for individuals with SUD. The Community Health Worker program is also a part of the Rural Health Services Consortium.

Considerations for Implementation

In rural communities where access to social services may be limited, case managers serve as an important source of information about available community services and resources for people with SUD, particularly those with complex care needs. Case managers may be nurses, social workers, CHWs, or professionals in other health disciplines.

Rural SUD programs may consider designing SUD-specific training for case managers to enhance their understanding of program topics. For example, the Center for Health Impact in Worcester, Massachusetts offers a SUD training for CHWs with collaborative discussions, lectures, and lessons that build skills in supporting individuals with opioid use disorder and alcohol use disorder.

Use of a nurse care manager model for office-based opioid treatment can improve patient access to and retention in MOUD treatment while supporting the efficient use of physicians. This model relieves some of the burden from physicians prescribing medication. This model is highly dependent on the availability of a nurse care manager who can coordinate and manage a patient's care in an office-based setting. In rural areas with a shortage of healthcare providers, this can be a challenge.

Program Clearinghouse Examples

Resources to Learn More

Comprehensive Case Management for Substance Use Disorder Treatment
Document
Provides an overview of case management and discusses the principles of case management. Covers variations in the case manager role.
Organization(s): Substance Abuse and Mental Health Services Administration
Date: 1/2021