Melanie Cole, MS (Host): Welcome to Hope Beyond Addiction, a podcast by Our Hope Association. I'm Melanie Cole. And today, we're talking about case management at Our Hope Association, and joining me is Mackenzie Hamann. She's a case manager at Our Hope Association. Mackenzie, thank you so much for joining us today. For someone who's never heard of case management before, how would you describe the role of a case manager at Our Hope in the recovery process?

Mackenzie Hamann, B.S.: Hi there. Thank you for having me. A case manager at Our Hope, essentially, I describe a case manager as someone who is there to help you build a life that you want, but also supports your recovery. When it comes to individuals or women entering treatment, their rest of their life, it doesn't just stop when they come in here. It is still ongoing. She still may have housing concerns, medical needs, court dates, financial responsibilities. And it's my role as a case manager to walk alongside her to help identify what she needs, connect her with resources, and all while working on her recovery as well. So, a big part of my job is helping clients build confidence and independence. I want them to leave with connections in place and a better understanding of how to actually advocate for themselves and their needs.

Melanie Cole, MS: What an important job you have, Mackenzie, to help someone navigate recovery. And that certainly is not easy. And for them, it's a very dizzying, confusing time. So, your job is just so vital to that process. Walk us through what happens from the moment a new client is admitted to Our Hope. At what point does case management step in, begin, and what are the first priorities?

Mackenzie Hamann, B.S.: Absolutely. So, the minute that somebody comes into our facility, they will meet with one of our beautiful intake specialists, and they will go through the intake process. And then, from there, normally the next day, they will meet with one of our amazing clinicians that we have there, and they will complete what is called an ASAM assessment, and that is just assessing what level of care they are at.

And after that assessment is completed, that is when case management steps in. So essentially, I have seven days to complete what is called a needs assessment. I really try to get to them as soon as possible once that ASAM assessment is completed. And in that needs assessment is where I go over with the clients.

Essentially, I tell them, "This assessment tells me what you need from me and tells you what I can do for you while you are here." And we are going to go through those needs and really break them down into more comprehensive steps so it doesn't seem so overwhelming. So, I am really with them within their first week.

And in terms of what we address first, in terms of priorities, that is different for each client. So really, it depends on what they identified as their biggest need is what I'm going to work on first. Obviously, medical concerns, court concerns, children concerns are always my number one priority. Definitely making sure that when somebody comes into treatment, we are not keeping them from their children. We do not keep mamas from their babies whatsoever, making sure we are getting those children visits set up immediately so they aren't losing that contact. But making sure that we're connecting them with those vital resources they need.

Melanie Cole, MS: Well, thank you for telling us about that. It really lays it out very clearly. And how do case managers at Our Hope help clients navigate complex issues? You just mentioned a few of them, like insurance coverage, housing, employment, childcare, legal concerns, while they're focusing on recovery. That must be so difficult.

Mackenzie Hamann, B.S.: Kind of like I was talking about before, we break everything into smaller realistic steps. Because when we're looking at a need from a step back, a lot of times it's extremely overwhelming to know what that first step needs to be. And that's where I come in, is I often help break it down into steps that are realistic.

So, oftentimes it is making a phone call coming up with a script for those phone calls so we can practice them before the phone call is made, and then being there present with a client making those phone calls, making sure that they feel confident enough to make them on their own before they leave treatment.

So obviously, at first, I'm never going to expect a client to know what to do, and that is where I come into play. So, really breaking those down. And in terms of insurance, our Hope has very much so recognized that breaking the role of a case manager down into two separate roles here is necessary.

So, we have something called a program coordinator, and they are the individual who actually helps our clients obtain the insurance and food stamps and everything, so then I can work with them to help understand their coverage and what it actually looks like, so I can actually focus on that understanding and not just obtaining the coverage.

Melanie Cole, MS: MacKenzie, what does a typical week look like for a case manager at Our Hope? Describe for us the main types of meetings that you have, the assessments, the follow-up, all the tasks that you handle.

Mackenzie Hamann, B.S.: Every week looks different here, essentially. It depends on where my clients are within the program. If I'm having a big influx of newcomers, that means that I'm going to be running a lot of needs assessments. But if I'm having more clients who are closer to graduating, I'm going to be really focusing on connecting them with community resources so their care doesn't abruptly stop once they leave our home.

So, that care and that support, someone walking alongside them continues outside of treatment. So, it really depends on where my clients are at. But every week, I am running groups, I am meeting with clients, follow-ups, contacting sober livings, contacting PCP offices, dentists, the whole nine yards. Just really whatever my clients need in that moment, that is what my week is going to look like.

Melanie Cole, MS: Mackenzie, and you're such a busy lady, this is just such important information. What tools or evidence-based frameworks guide your case management practice at Our Hope? For example, ASAM criteria, trauma-informed care, motivational interviewing, certainly harm reduction. Tell us a little bit about those evidence-based frameworks that help you do your job.

Mackenzie Hamann, B.S.: Absolutely. So, starting with the ASAM assessment, that is the first thing the client will do once after intake is done. So, that really tells us which level of care they need and where they are struggling the most in that. I am not the one who completes those assessments. It is a clinician. So, that really is our baseline. And then, from there, I use a lot of person-centered care. So, this really starts with the clients identifying their goals, their preferences, their priorities to make sure that they feel involved with this process. I want to ensure that all of my clients, their voices are not only heard, but they feel confident expressing their voice and advocating for themselves once they leave our facility. So, they feel like they can continue caring for not only themselves but their sobriety and be on this journey for the rest of their lives and make it actually attainable.

Melanie Cole, MS: Mackenzie, you mentioned earlier that you don't just let clients be done after their recovery at Our Hope. So, explain a little bit about how case management supports continuity of care after a client leaves. What kind of follow-up referrals, relapse prevention planning do you build into that discharge?

Mackenzie Hamann, B.S.: So, our discharge planning starts within that needs assessment that I conduct within that first week. We are talking about where do you see yourself living after here? Do you need transportation support? Do you need help getting a job? Is there court requirements? And from there, once I do that needs assessment, I am immediately connecting them with outside resources. So, they establish that connection while they're in our care, and they feel comfortable utilizing those resources once they leave us. Because the big thing is like, yes, I could connect somebody with an IOP services, intensive outpatient to continue therapy and a lot of times with IOP services that comes with case management. I can connect them to that, but if they don't feel comfortable going to the appointment or they don't have transportation to the appointment, Doing all that work is moot in a sense. So, making sure we are covering all of our bases, making sure we're getting them bus passes if they need. We can offer clients a bike for transportation, making sure they feel safe within the outside community resources that they are utilizing, and making sure that they are fulfilling the needs that they have expressed. And they're not just kind of surface level, so they can continue utilizing those once they leave our services.

Melanie Cole, MS: This has all been such great information. Mackenzie, can you share examples of how case management has made a decisive difference in a client's recovery journey, especially in complex cases involving homelessness, legal issues, or severe mental illness along with addiction?

Mackenzie Hamann, B.S.: As a case manager, I have a unique ability to be able to help individuals with especially legal concerns, helping them navigate that process and helping the courts understand that they are truly trying and on their sobriety journey. For example, if there was a bench warrant out for not being able to pay child support while they're in care, we can reach out to those court services to get that warrant discharged for the time they are in treatment and explain to them that they are working on themselves while they are here in treatment.

And while they are in treatment, we do not allow clients to work while they're in treatment, but we work with them working on resumes and working with Michigan Works. So once they leave our facility, they are all set up to start employment. So, that can really make a huge difference in a client's willingness to stay also in the program. Because a lot of times with legal concerns or mental health concerns, it's very daunting on top of recovery as well. So if we can help negate one of those barriers, that makes all the difference in recovery. It makes recovery actually possible, because they're not sitting there focusing on either legal proceedings or mental health concerns. They can actually focus on their recovery and why they are here in treatment.

Melanie Cole, MS: Yeah, it can get really complex when there's mental health disorders and addiction, when there's this combination of all of these disparities going on, you know, and the social determinants that go into recovery and addiction. So, thank you for telling us about all these things. And Mackenzie, as we wrap up, what would you like listeners to know about case management at Our Hope and the important work that you do helping people to navigate their recovery?

Mackenzie Hamann, B.S.: Mostly I want individuals to know that case managers, we are here to truly support you and walk alongside you. Yes, it still requires some work on the client's end, but they are never alone. That is the big thing is, yes, phone calls are still going to have to be made, but we are going to work together to find that confidence and find the voice to advocate for ourselves, and really mostly that they are never alone. That is what I am here for, is to walk alongside them and make sure that they are never alone in this process and in this sobriety journey.

Melanie Cole, MS: Thank you so much, Mackenzie, for joining us today, sharing your incredible expertise, your role, your job with us. And also, I could hear your compassion and the passion in your voice for what you do. So, thank you again for all the great work that you're doing. And for more information, please visit our website at ourhopeassociation.org to get connected to one of our providers. I'm Melanie Cole. And that concludes today's episode of Hope Beyond Addiction, a podcast by Our Hope Association. Thank you so much for joining us today.