Case Management Guidelines
Continuity of Care
Successor to "Bridge to Understandingtm
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The guideline here is one that we all need to work on – including us.  Ultimately we would like to see systems in place where services for special needs children and adults begin with a comprehensive assessment of the individual and the family, then proceed to with careful case management leads to seamless delivery of services through residential placement (if residential placement occurs at all) and continues through the transition process back home or to college or independent living.  

We probably should have entitled this page "Continuity of Care." In an update, we have added that as a subtitle. 

Increasingly, the parts of this are becoming available.  This means departing from the historic educational consultant model of a number of years ago in which students going to “behavioral change” schools were guided by highly educators who often had limited clinical knowledge and might not be receptive to clinical input, would do a “school search” with the idea of a long term residential school placement, either flowing into college or a boarding school, presuming that the young person should never return home.  Too often parents simply searching for school or program on the Internet, or with guidance of “head-hunting” consultants (not to be confused with educational consultants such as IECA member consultants who work only for families) are still looking at merely finding a school without adequately considering the family context of the young people.  Too seldom are providers of services in the private sector thinking of themselves simply as part of a continuum of services.

Historic Private Sector Programming based upon the model of the "school search" (from educational consultants) and stand alone programming, has been both foreign (if not overtly hostile) to the concept of Continuity of Care until very recently.  It is still not well embraced among private sector programming and educational consulting.  Our lead consultant, Tom Croke, says he does not recall any other educational consultant or private sector program utter the words "continuity of care" at any time -- other than within FamilyLight sm.  One exception is that the sequence of transition from wilderness to an emotional growth school is well established in the culture of the private placements, but otherwise the myth has been that parents send their sons or daughters to special schools and they go from there to have normal lives (but usually by going on to boarding school or college and never living home again).

We firmly believe that thinking in terms of continuity of care and utilization of excellent case management services can dramatically improve outcomes while lowering costs and family disruption.  We believe that an intensive, relatively short program, if combined with intensive family work while the young person is in the short term program and is followed by a quality wrap around service when the young person returns home can lead to improved outcomes over what we now see for longer term programs for over half of the young people now going to longer term programs, then abruptly returning home or going on to a radically lessened structure, such as the typical college campuses.  Excellent case management can help make this a reality.  We also need good outcome research. 

We remain concerned that too often schools and programs are selected in the belief that residential school or program can "fix" a kid without regard to what happens before, during (back home with the family), and after.  Parents frequently look to residential treatment to change their son or daughter in a vacuum; schools and programs play on that erroneous belief in order to sell their services;  referring professionals too often further encouraging that by using the totally inappropriate "school search" model rather than advising on the larger context of what needs to happen if a residential treatment or a special school is to be a good investment. 

Most important to include when excellent case management is applied to develop the best continuity of care, we will see much better developed family services before during and after any residential stay. We will also see vastly increased use of transitional services

We are encouraged by the increasing clinical knowledge of referring professionals, including but not limited to educational consultants, but we have a distance to go.  We await further developments. 

        We call upon parents, providers of service, and referring professionals to act upon the reality that residential programs do not "fix" kids by themselves, although they frequently have a healing effect surrounded by a larger system of change.  We reject both the "school search" model of referral and the "We'll fix you" model of school / program salesmanship. This needs to be replaced by a Continuity of Care / Case Management model.  See also Guidelines for Referral Sources.

        We call upon all providers of services including schools, programs, educational consultants, and other referral sources make every realistic attempt to serve their clients through utilization of the best principles of continuity of care.

         We call on all providers to maximize use of family intervention and high quality transition and aftercare services, cutting down on need for long term highly structured resources.

         For students likely to transition to college and/or conventional boarding school after structured treatment or therapeutic schools, advocate for proper and adequate transition and support services in those venues. 

Feedback is invited. We will publish selected feedback.  Email:

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. RReaders are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last updated March 26, 2009; minor edit April 25, 2009

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