Psychosocial Concepts and Support Systems
This domain tests how psychological, social, cultural, and environmental factors shape health behavior, and how case managers assess and mobilize support systems without taking over the patient's decisions.
Core concepts
- Biopsychosocial assessment covers mental status, coping, health literacy, social support, finances, housing, transportation, safety, and cultural beliefs.
- The transtheoretical model describes stages of change: precontemplation, contemplation, preparation, action, maintenance. Motivational interviewing uses open questions, affirmations, reflections, and summaries to build readiness rather than confront.
- Family systems: assess caregiver burden, roles, and capacity; a genogram or ecomap can reveal who actually helps.
- Cultural competence requires qualified interpreters, attention to health beliefs and mistrust, and equity in resource referral.
- Crisis and safety: screen for depression and suicide risk, abuse, neglect, and food or housing insecurity; follow mandatory reporting and safety planning.
- Community supports include peer programs, support groups, faith communities, transportation vouchers, and behavioral health.
Worked example
A patient with diabetes and depression misses appointments and has an HbA1c of 10%. The case manager avoids labeling this 'noncompliance.' Assessment shows a PHQ-9 of 17, no transport, and isolation. The plan arranges a warm handoff to behavioral health, telehealth visits, a transportation voucher, and a peer supporter, with the patient's permission. Reasoning: depression and access barriers are treated as drivers of the outcome; the plan matches the patient's readiness and resources.
Traps
- Calling missed appointments noncompliance without assessing barriers.
- Using family interpreters for sensitive information.
- Rescuing rather than building self-efficacy.
- Missing suicide, abuse, or housing risk.
- Designing support without patient consent.