Case Management Within A Circle of Care

Case management services are a key part of the continuum of mental health services and supports for individuals with mental health concerns. A case management approach to assisting students with a variety of needs through the coordination of appropriate on and off campus services and the provision ongoing support to promote independence and quality of life for these students.

Centennial College developed a Mental Health Case Management Framework document. The framework document outlines the holistic mental health and wellbeing approach employed at Centennial; defines the roles and responsibilities of various campus partners in supporting student health and wellbeing; and provides an overview of the supportive case management model implemented for students with mental health and substance use concerns.

In the Centennial model, each service area involved in the direct provision of mental health support has a defined role:

• The Case Management Working Group coordinates high risk student situations
• The Case Manager Lead intervenes in high risk student situations with a mental health or substance use component
• Counsellors, Disability Counsellors and Learning Strategists address low-to moderate risk student situations
• The Counselling Coordinator, CSD Coordinator and Case Manager Lead are standing members of the Case Management Working Group and provide consultation on cases with a mental health or disability-related component
• Counsellors intervene in crisis situations

Accessed from: Campus Mental Health Partnerships Final Report

CICMH: What led up to the genesis of the case management model at Centennial College?

Michelle DeIrish: In 2014, we received some funding via the Mental Health Innovation Fund for a joint project with Georgian College and researcher from OISE to design, implement and evaluate a service delivery model based on a case management approach.

We put together a model at both of our institutions, and had the researcher evaluate how much partnership and collaboration was happening – to see if the implementation of the project was successful from that point of view.

Comparing Georgian and Centennial, there was a fair amount of overlap in our approach. We evaluated what services there were existing on the ground, then went on to design a model that would work on each of our campuses.

The approach taken to designing and implementing the role was similar, but our starting points were different. Georgian did not have an existing Student of Concern Committee, whereas Centennial had a Case Management Working Group. Georgian had a client record management system, whereas Centennial does not. Georgian’s case management framework/approach (Stepped Care) is distinct from Centennial’s but there is significant overlap in the case manager role, where the case manager is housed (Counselling), and referral criteria. A lot of the documentation that we created for the program and the data that we collected was kept as similar as possible to make replication and comparison easier.

We then applied for the next round of funding and in 2015 received another 2 years of funding to extend this approach to addictions, students transitioning from high school and some peer mentoring opportunities.

In the second round of the project, the focus of Centennial was to build collaborative relationships with community-based services to improve access to off-campus services. We also looked at building capacity through professional development for our staff to support students with mental health and/or addiction concerns. Examples of professional development are: Applied Suicide Intervention Skills Training, Identifying & Responding to Students in Distress, Collaborative Lunch & Learn series (webinars, in-service presentations, presentations by community providers on services), harm reduction, and threat/risk assessment training.

CICMH: And how has that been going?

Michelle DeIrish: Well, we’re located in Scarborough (and East York) so sometimes it can be a bit of a challenge to access what’s out there – but looking at the work that we’ve done so far, there are some good relationships that are starting to be built.

For example, the Scarborough-East York Service Collaborative were doing a project on transitional age youth, and we participated in that and helped provide input about their walk-in service for youth. We also signed a letter of intent with them stating that we’d provide in-kind resources to that project.

Another initiative that we collaborated with was the Scarborough Addiction Services Partnership. That’s been a great one. The steering committee meets monthly, and a lot of the organizations that are part of that service table receive some funding to enhance addiction services in Scarborough. I delivered a workshop to the project leads at these agencies on program evaluation and outcome measurement. That’s just one of the ways in which we help to build capacity in the community.

CICMH: Are there challenges in working with such a diverse stakeholder group both within and outside the college?

Michelle DeIrish: We’ve been doing this for a few years now, and I think it’s been smooth for the most part. With the training provided and resources created, staff have a good understanding of where to refer students of concern. However, because we don’t have a centralized database, we’re usually relying on people to feed information whenever they become aware of it. For example, when instructors in a class notice a student with concerns, they might report it to a counsellor for follow-up – but we don’t have a way to flag all the concerns in a systematic way yet. We are currently in the process of implementing an Early Alert system.

CICMH: How does a case manager work together with a counsellor to support a student?

Michelle DeIrish: I get referrals from different places; many come via the Case Management Working Group and Security. I tend to see students who are hospitalized, students who experienced a mental health emergency on campus or are at risk of (in)voluntary withdrawal. If a student has already been seeing a counsellor, a lot of the time it’s about coordinating with that counsellor to make sure that supports are put in place to facilitate the student’s return to campus. The counsellor is often the first point of contact for the student – intervening in crisis situations (Security manages after-hours support). For students requiring case management follow up, the counsellor will notify me and I will follow up with the student while they’re in hospital or shortly after discharge, make sure instructors are notified, and generally ensure all the supports are in place for the student’s return.

CICMH: Looking at the impact assessment report from Centennial College and Georgian College, it is evident that the case management model has been very beneficial. What would you say to other institutions interested in taking up this model?

Michelle DeIrish: I would say that it’s a great approach. It’s about finding creative ways to support students. It’s not a model that require a huge amount of money to do – it really only requires a person, with a mindset to work collaboratively. It’s also something that could be tailored to every institution, as the role of a case manager can be made to fit the different needs of an institution.

You could have a case manager with a clinical background who can provide counselling in tandem with case coordination. You could have a residence case manager, to support students living in residence. You could also have an academic case manager who is responsible for early alert systems.

Initially, there may be some challenges getting buy-in from campus stakeholders and navigating the change management process. Therefore, schools looking to adopt this model would best be served by talking to other schools that have already implemented similar roles; assess their own existing structures, services, processes and service gaps, and see if case management would be a suitable fit.

At CICMH, we’d like to thank Michelle DeIrish for her time.

For our readers – to learn more about case management, head over to Georgian and Centennial’s case management toolkit.

Note: In our June newsletter announcing the Spotlight, there was a spelling error in Michelle DeIrish’s name.