Too Many Cooks in the #CareManagement Kitchen?

Earlier this week I participated in a health care tweet chat. The topic of the tweet chat was the potential need for DIY healthcare.  As the pace of health care increases, the need for clients to do things are their own is increasing. This can be a tall order for someone with comorbid medical and psychiatric problems.  Especially if you have multiple providers involved. This can be confusing for persons utilizing services, their family’s and their providers; but there is often room for a lot of success.

In my role as a mental health case manager, I often have to juggle the “identified client” with multiple perspectives. What it most important is that I first listen to my client and his parents’ narrative. How did they get to me and what can I do help? As one might imagine the youth’s experience of recieving services might vary from their parents’. This is tricky enough to negotiate.

Now you throw in a school, child protective services, pediatrician, and lets say an endocrinologist for diabetes management. Helping the youth and his family understand the youths’ treatment needs becomes even more complicated. There become a lot of “Cooks in The Kitchen”. Not only does the parent/youth differ from their definition of “the problem” and how to “fix it”; other providers and disciplines do to. Here are somethings that I have learned to attempt to avoid there being “too many cooks in the kitchen.”  We have to work together to cook the best meal we can for the client and family.

With the family, Co-Create a check list of providers.  Find out who exactly is on “the team”. More importantly does the family/person want us to communicate with each other. Discuss their fears about the team sharing information and also review the benefits of increasing communication. Also think to yourself, as the provider, why it would be important to coordinate with others. As a social worker, why should I communicate with an endocrinologist?

Gather Assessments and reports from other team members. See if these reports can guide you in treatment. In the case of an endocrinologist, this report might yield poor diabetes management. This will certinaly provide some insight into my treatment plan as a social worker. Conversely the endocrinologist would also benefit from hearing about this youth’s mental health progress. This begins an understanding of the ingredients of treatment.

Educate the Family/Client about connections. Going with cooking analogy, we need to see what ingredients are. Once we know who is involved, attempt to synthesize this info. Sometimes it is a fairly obvious connection (i.e diabetes / mental health) or it can be more subtle. Also attempt to educate the client, family, and other providers about a connection you see. For instance, I often use testing from a school psychologist to identify strengths and weaknesses. These can be helpful to guide mental health treatment. Sharing these connections with family can be critical in their success of managing the youth’s symptoms.

Attempt to Develop a Shared Understanding of “The Problem.” Begin to discuss what ingredients might work together.  This has to start with the client/family and works it’s way outward. By now the family will have some understanding of what each provider thinks may be helpful.  This is where the water starts to get muddy. The cooks might start to disagree about the ingredients. A teacher will differ from a social worker in what they think “the problem”. A social worker will probably feel different about what the focus of treatment should be compared to an endocrinologist.

Getting Everyone at “The Same Table.”  All the cooks need to listen to what the family wants served.  After being informed about assessment and initial treatment options, these differences need to be shared in an open dialogue. If the person receiving services is making poor progress, a face to face meeting with all care providers is the ideal situation.  With psychiatry and medical professions, this is not always possible. Sometimes you have to do it with a lot of phone tag or email exchange.

Present “The Meal.”  Now the cooks (providers) have to go back to the kitchen and cook the meal. Try to work together and develop a plan that will benefit the family and their needs. There may be some disagreement on how care is presented, but the bottom line is that it should be about what our expertise brings and how it can benefit the client.

One might need to repeat different parts of this process. This is essence of working together as a team with the family to create something that meets the family’s needs. At the same time attempting to be clear with each other as providers. As the cooks of the treatment plan we don’t want cook a meal that gives the client/family a bad feeling in their stomach. We need to work together to do our best to cook a plan that can benefit everyone.

Sean 🙂


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