Case Management
If you are a health sciences student and want to learn how to provide personalized services to increase an individual's ability to improve their health and prevent disease, then you might be interested in learning case management. In NCNS, case management involves helping clients improve their lifestyles by improving their diet and increasing physical activity.
You team with one of the lay health educators, known in Spanish as promotoras. Promotoras are residents of the Nogales community from Mariposa Community Health Center who follow women who are pregnant or have children under 2 to connect them to the services that they need to have a healthy baby. These services include medical care and assurance that they have the ability to obtain care, assurance that they have a healthy diet, and that their baby is receiving appropriate well-baby check-ups and is being immunized. Because many residents of Nogales speak Spanish, the promotoras are bilingual and can help with translation or interpretation if needed. They also can help you learn about the local culture, which often is neither American nor Mexican but a blend of both.
Case management in NCNS is community-based, so you make home visits with the promotora that you are collaborating with. To learn about conducting a home visit, you make a shadow visit with one of the promotoras to observe how she greets the client, conducts the visit, makes an appointment for the next visit and terminates the visit.
Once a week, everyone involved in case management, including students, faculty, promotoras, and clinical staff from Mariposa clinic, meet for a team conference. You will present the work that you and the promotora are doing with each client. (Students usually follow one to four clients depending on how long they are in the community.) You might mention that one of your clients does not appear to get much physical activity and another member of the team could suggest that you see if the client would be interested in using a pedometer. The pedometer allows the client to see for herself how many steps she actually takes in a day.
Or you might do a 24-hour food recall and you and the client discover that she rarely eats fruits and vegetables. Other team members might suggest that you determine if the client is eligible for obtaining food at the food bank and that you provide some recipes in Spanish for fruits and vegetables. Additionally, you might observe that the client seems depressed and one of the interdisciplinary team members might suggest that you refer the client to the social worker at the clinic. Because this is an interdisciplinary team, you have access to expertise in a number of different disciplines and you can consult with members of other disciplines or have them make a home visit with you.
All the work that you do with the client is documented using a system known as the Omaha. This is a holistic system that allows you to document and plan interventions that best meet the client's needs whether the needs are related to environmental issues (e.g., is the client's neighborhood safe to walk in?), physiological issues (e.g., does the client have gestational diabetes?), psychosocial issues (e.g., does the client feel depressed?) and health-related behaviors (e.g., is the client getting adequate exercise?). The documentation allows students who follow you to identify what has been done with each client so that they do not duplicate efforts and can identify those interventions that will most benefit the client.