A Treatment Improvement Protocol on case management, which can be described as a coordinated approach to the delivery of health, substance abuse, mental health, & social services, linking clients with appropriate services to address specific needs & achieve stated goals. Case management lends itself to the treatment of substance abuse, particularly for clients with other disorders & conditions who require multiple services over extended periods of time & who face difficulty in gaining access to those services. This report details the factors that programs should consider as they decide to implement case management or modify their current case management activities.

Case management has been variously classified as a skill group, a core function, service coordination, or a network of "friendly neighbors." Although it defies precise definition, case management generally can be described as a coordinated approach to the delivery of health, substance abuse, mental health, and social services, linking clients with appropriate services to address specific needs and achieve stated goals. The Consensus Panel that developed this TIP believes that case management lends itself to the treatment of substance abuse, particularly for clients with other disorders and conditions who require multiple services over extended periods of time and who face difficulty in gaining access to those services. This document details the factors that programs should consider as they decide to implement case management or modify their current case management activities. This summary is excerpted from the main text, in which references to the research appear.

"Comprehensive Case Management for Substance Abuse Treatment". To provide optimal services for clients, a treatment professional should possess particular knowledge, skills, and attitudes including: - Understanding various models and theories of addiction and other problems related to substance abuse - Ability to describe the philosophies, practices, policies, and outcomes of the most generally accepted and scientifically supported models of treatment, recovery, relapse prevention, and continuing care for addiction and other substance-related problems - Ability to recognize the importance of family, social networks, community systems, and self-help groups in the treatment and recovery process - Understanding the variety of insurance and health maintenance options available and the importance of helping clients access those benefits - Understanding diverse cultures and incorporating the relevant needs of culturally diverse groups, as well as people with disabilities, into clinical practice - Understanding the value of an interdisciplinary approach to addiction treatment In addition to the above competencies, treatment professionals must have skills relating to interagency functioning, negotiating, and advocacy. CSAT's Addiction Technology Transfer Centers classify referral and service coordination-basic case management functions-as core competencies for substance abuse treatment providers.

Motivation is key to substance use behavior change. Counselors can support clients' movement toward positive changes in their substance use by identifying and enhancing motivation that already exists. Motivational approaches are based on the principles of person-centered counseling. Counselors' use of empathy, not authority and power, is key to enhancing clients' motivation to change. Clients are experts in their own recovery from SUDs. Counselors should engage them in collaborative partnerships. Ambivalence about change is normal. Resistance to change is an expression of ambivalence about change, not a client trait or characteristic. Confrontational approaches increase client resistance and discord in the counseling relationship. Motivational approaches explore ambivalence in a nonjudgmental and compassionate way.

American Indians and Alaska Natives have consistently experienced disparities in access to healthcare services, funding, and resources; quality and quantity of services; treatment outcomes; and health education and prevention services. Availability, accessibility, and acceptability of behavioral health services are major barriers to recovery for American Indians and Alaska Natives. Common factors that infuence engagement and participation in services include availability of transportation and child care, treatment infrastructure, level of social support, perceived provider effectiveness, cultural responsiveness of services, treatment settings, geographic locations, and tribal affliations.