Unit of competency details

Descriptor 

This unit describes the knowledge and skills required to undertake complex case management

Application 

This unit may apply to work in a range of community sector contexts

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement.

ELEMENT 

PERFORMANCE CRITERIA 

1. Initiate complex case management process 

1.1 Confirm eligibility of persons for case management by matching client profile against service criteria

1.2 Obtain person's consent to their involvement in case management, ensuring the client understands their rights and responsibilities

1.3 Collect information about person, ensuring confidentiality and privacy and minimising any duplication

1.4 Work with person to identify and prioritise their needs to inform more comprehensive assessment and to identify relevant goals that are achievable within an identified timeframe

1.5 Recognise and respect person's right to self-determination within legal parameters

1.6 Identify social, economic, housing, personal and family factors that may influence person's health, well being and level of dependence/independence

1.7 Explain case management process to person, ensuring their understanding of relevant complaint/appeal processes and service criteria for disengagement

1.8 Ascertain specific cultural needs of person as a basis for providing appropriate services and support for their development

2. Identify and document complex client needs 

2.1 In conjunction with person, identify their needs as a basis for planning an intervention and identifying appropriate resources

2.2 Document and confirm identified needs with person, using language that is understood by them

2.3 Work with person to identify and analyse risk factors and determine needs that may have greater impact on their well being

2.4 Estimate the level of case management support required to implement person's care plan and discuss this with those involved in aspects of case management

3. Identify and consider possible solutions to complex issues

3.1 Identify complex legal and ethical issues and questions pertaining to aspects of case management and resolve in line with organisation guidelines and regulatory requirements or seek appropriate resources to assist with their resolution as required

3.2 Identify complex issues relating to funding of service provision and administer resources within relevant regulatory framework

3.3 Ensure ethical standards are addressed to protect the autonomy, dignity, privacy and rights of individuals

3.4 Advocate for client-oriented solutions to complex identified needs at service delivery and policy-making levels

3.5 Draw on established collaborative relationships as required to provide care and optimise outcomes for clients with complex needs

3.6 Use collaboration to generate innovative responses to meet person's needs where available solutions are not sufficient or effective

3.7 Maintain strong up-to-date knowledge of available resources and services within the community and area of expertise

4. Develop plan of action to address identified priorities

4.1 Use client-identified goals and needs assessment as basis for developing and agreeing plan of action

4.2 Support person to make informed decisions, providing necessary information in a timely manner, reflecting understanding of their current situation, probable future situation and ensuing care needs

4.3 Support and develop person's ability to independently access alternative resources to address identified needs

4.4 Conduct research as required to establish an informed factual basis for formulating plan of action

4.5 Evaluate any barriers that may restrict person's ability to meet identified goals  and determine strategies to minimise their impact

4.6 Ensure plan of action is within person's financial resources

4.7 Network with appropriate professionals and organisations to maximise potential for achieving person's goals and addressing identified needs

4.8 Convene and/or participate in case conferences with services providers and/or family carers and relevant others as required

4.9 Seek and obtain person's consent before undertaking any referrals to other services and/or organisations

4.10 Provide person with clear understanding of available services and choices, so they are an informed participant in all stages of case management process

4.11 Document person's goals, including measurable criteria, as a basis for determining effectiveness of interventions provided

5. Monitor implementation of client care plan

5.1 Regularly monitor planned services, support and resources against client-identified goals to ensure effective implementation of their care plan

5.2 Ensure appropriate level of rapport and communication with client is maintained as required to support disclosure of information regarding delivery of services and resources in line with care plan

5.3 Foster and support collaborative relationships between clients, carers, service providers and funding bodies to support people with complex needs

5.4 Maintain professional rapport with service providers to enable objective discussion of case management plan, identification of problems and adjustment as necessary

5.5 Advocate for service system improvements by identifying and communicating gaps and/or inadequate services to program managers

5.6 Make adjustments to services, supports and resources as required to best meet person's needs

5.7 Document and report to relevant organisation or funding body, likely implications from any variations to expected care plan

6. Evaluate client outcomes

6.1 Undertake periodic reassessment and evaluation of outcomes against expected outcomes with reference to available evidence

6.2 Obtain information from clients, service providers, funding bodies and case managers to determine progress and evaluate against identified goals in care plan

6.3 Take into account adjustments made to services and resources to better address person's ongoing situation and changing needs

6.4 Ensure evaluation includes determination of client satisfaction, comparison of costs against benefits received and assessment of quality and effectiveness of service delivery and case management components

6.5 Work with person to evaluate ongoing support needs to meet their goals, including review of parameters for disengagement, where applicable

6.6 Demonstrate accountability for adjustments to the care plan and associated financial outcomes

6.7 Identify opportunities for person to maintain or develop independence within any aspects of their overall care

6.8 Document and report quantifiable impacts experienced by person as a result of implementation of care plan and indicate how client-centred outcomes have been achieved

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

These include knowledge of:

• Case management models and practices literature
• Case Management Society of Australia's National Standards for Practice of Case Management
• Wide range of services and resources available to clients
• Components of service delivery system
• Funding processes and bodies related to provision of relevant services and resources
• Characteristics and needs of identified client population
• Nature and significance of service setting
• Organisation policies and practices relating to case management and client complaint and appeal processes
• Professional standards/code of ethics and relevant legislative requirements
• Government legislation, regulations, policies and standards
• Documentation requirements and practices
• Current research literature in area of practice

Essential skills :

It is critical that the candidate demonstrate the ability to:

• Work within relevant case management standards, professional standards and applicable legislation, regulations and government policies
• Examine clients and aggregate data to reflect case manager performance
• Review and apply outcomes data for clients and programs as a means to continually improve practice
• Practise in an ethical manner noted by professional discipline or defined ethical standards
• Work within guidelines for currently identified best practices
• Minimise client dependency by developing their self-advocacy skills
• Examine issues related to sustainability of care to address client's level of need
• Demonstrate actions to support improvement/maintenance of quality of life for clients
• Navigate the service delivery system to meet client needs and support encouragement of client independence where possible
• Apply communication and leadership skills with providers to services and resources meet client needs
• Maintain client confidentiality when engaging stakeholders
• Identify and consider duty of care issues

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

These include the ability to:

• Demonstrate application of skills in:

• interviewing
• convening and participating in meetings
• consultation, liaison and networking
• analysis of social, economic, housing, health, personal, family and other factors
• report and case note writing
• literature review
• facilitation
• advocacy

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this unit of competency :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• This unit of competence will be most appropriately assessed in the workplace or in a simulated workplace and under the normal range of workplace conditions
• Assessment may be conducted over one or more occasions and should include both the development and promotion of best practice

Access and equity considerations :

• All workers in community services should be aware of access, equity and human rights issues in relation to their own area of work
• All workers should develop their ability to work in a culturally diverse environment
• In recognition of particular issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on Aboriginal and Torres Strait Islander people
• Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on Aboriginal and/or Torres Strait Islander clients and communities

Context of and specific resources for assessment :

• This unit can be assessed independently, however holistic assessment practice with other community services units of competency is encouraged
• Resources required for assessment include access to:

• an appropriate workplace where assessment can take place
• simulation of realistic workplace setting e.g. role plays, writing case notes based on case studies

Method of assessment :

• Assessment may include observation, questioning and evidence gathered from the workplace setting

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Complex case management process may refer to :

• Complexity of client circumstances or needs
• Complex range of issues involved in addressing client needs
• Involvement of multiple service providers
• Longevity of case management process
• Family relationship problems
• One or more of social, economic, housing and health problems

Complex client needs may refer to :

• Client needs requiring multiple service types with heightened needs for collaboration between service providers
• Clients with a range of needs that may not be met by available services and resources
• Clients who have family and carer needs that require additional service inputs
• Clients having unstable health conditions.
• Clients have housing and/or financial problems
• Substance abuse

Barriers that may restrict person's ability to meet identified goals may include :

• Physical, mental or emotional issues or events
• Legal or regulatory constraints
• Incidents or accidents
• Cultural issues
• Service provider issues
• Eligibility criteria
• Unstable housing
• Financial problems
• Substance abuse
• Unstable health