Case Management and Relapse Prevention
This domain tests coordination of services and relapse-prevention models. Expect questions on linkage, advocacy, continuing care, lapse versus relapse, and the case manager's role in keeping clients connected.
Case management
- Functions: assessment, service planning, linkage, monitoring, advocacy, and discharge/continuing care.
- Coordinate with courts, probation, medical, housing, and mutual-help groups; use valid releases.
- Document referrals, contacts, and outcomes.
Relapse prevention
- Marlatt model: high-risk situations, coping skills, and self-efficacy; a lapse is a single slip, relapse is a return to the pattern; watch the abstinence violation effect.
- Apparently irrelevant decisions build toward risk.
- Gorski model: warning signs, post-acute withdrawal, and relapse as a process.
- Continued care: step-down, recovery supports, mutual aid, medication adherence, and urine drug screening as a clinical tool.
Worked example
A client at 60 days avoids meetings, visits using friends, and says one drink is fine. Reasoning: these are apparently irrelevant decisions and a high-risk situation. Complete a relapse-prevention plan: identify triggers, rehearse refusal, re-engage supports, address the abstinence violation effect, and coordinate with his probation officer only with a valid release. A lapse would trigger reassessment, not automatic discharge.
Traps
- Treating a lapse as failure and discharging.
- Acting on a positive UDS without assessment or confirmation.
- Ignoring environmental triggers.
- Sharing legal information without consent.
- Closing the case without a continuing-care plan.