MHM Demonstration Case Management Services

1. Coordinating the Performance of Assessments of Functional Skills and Needs

• Comprehensive Evaluation: Conducting thorough assessments to identify the individual’s strengths, challenges, functional abilities, and areas of need.
• Functional Skills Assessment: Evaluating the individual’s skills in various domains, such as daily living activities, communication, social interaction, vocational abilities, and more.
• Needs Assessment: Identifying the specific support, resources, and interventions required to address the individual’s unique needs and promote optimal functioning.

2. Developing, Reviewing, and Revising Individual Service Plans

• Individualized Planning: Creating tailored service plans that align with the individual’s goals, preferences, and identified needs.
• Goal Setting: Collaboratively establishing short-term and long-term goals that are realistic, measurable, and relevant to the individual’s recovery and well-being.
• Plan Review and Revision: Periodically reviewing and updating the service plan to reflect progress, address new challenges, and adapt to changing circumstances.

3. Informing Individuals and Their Legal Representatives of Service Options and Providers

• Resource Navigation: Providing information about available services, programs, and community resources that align with the individual’s needs and preferences.
• Provider Collaboration: Facilitating communication and collaboration with various service providers to ensure coordinated and integrated care.
• Participants Rights: Assisting individuals and their legal representatives in understanding rights, responsibilities, consent processes, and other relevant legal considerations related to service provision.

4. Helping the Person Access Services

• Service Coordination: Assisting individuals in navigating the healthcare system, accessing necessary services, and overcoming barriers to care.
• Linkage to Resources: Connecting individuals with community-based resources, support groups, advocacy services, and other relevant supports to enhance their well-being and quality of life.
• Supportive Guidance: Offering guidance, encouragement, and practical assistance to empower individuals in taking proactive steps towards accessing and utilizing available services.

5. Coordinating Service Delivery

• Service Integration: Ensuring seamless coordination and integration of services across various providers, settings, and levels of care.
• Monitoring Progress: Regularly monitoring the implementation of the service plan, tracking progress towards goals, and addressing any gaps or concerns that arise.

Communication and Collaboration: Facilitating open communication, collaboration, and teamwork among all involved parties to promote continuity of care, effective problem-solving, and shared decision-making.