Case Management: Getting Clients To Zero

AHP Case Management Team

If the phrase “case manager” conjures a mental image of a desk-facing worker managing an endless caseload of destitute people, then you are entertaining a myth. AHP case managers build relationships with clients, are actively working out in the community, connecting with people and saving lives.

Case managers reach out and serve clients, on the streets, in clients’ homes, and sitting with them at AHP’s Services Center. Their goal is simple: assess a client’s needs, find the resources to meet those needs, and ensure they gain access to those resources. If San Francisco’s pioneering Getting to Zero campaign is going to work, it’s partly due to case managers on the frontlines getting clients into care and helping them be successful by using a client-centered, peer-based model of care that was pioneered during the early days of the AIDS epidemic. Getting to Zero is a two-pronged initiative, working with both people with HIV and people at risk for contracting it. By helping people living with HIV stay in care and on treatment, Getting to Zero case managers help these clients protect their health and protect their partners: treating HIV reduces symptoms and increases well-being and it reduces the likelihood that an HIV-positive person might transmit HIV to their partners.

Chris Saito, AHP’s Behavioral Health Psychiatric Supervisor, puts it succinctly: “Our goal is to make case managers obsolete because everyone is in care.”

In San Francisco, 73 percent of people living with HIV are in treatment and most are successful in keeping their HIV infection suppressed. That is, by staying in care and adhering to treatment, they are able to live healthy fulfilling lives. But there is a small percentage of the population, faced with barriers such as drug use, homelessness, stigma, mental illness, and poverty, who “fall out of care.” Studies prove, however, that with a little help—case management!—these resilient clients, too, can live healthy lives. The case manager is, in fact, a life-saving bridge between the client’s own resilience and the services that can carry that client beyond the obstacles that impede them.

Case management is a tried-and-true public health intervention; case management has been central to AHP’s mission since the early 1990s when we teamed up with ZSFG to conduct the first hospital-based HIV case management program in San Francisco. And we continue to provide case management as an HIV prevention tool and a way to help clients get into substance use treatment, housing, medical care, mental health care and psychiatry. By building non-judgmental, trusting, consistent relationships with clients, AHP case managers construct a container in which clients get to make choices—to be the arbiters of their own care—supported in that process by an informed and caring staff.

In the Getting to Zero efforts, according to Saito, half of the job is finding people who do not have a permanent address, access to a phone or email. After locating clients who need help, Saito says, “It can take several visits to gain enough trust for them to open the door or engage in a conversation. A series of steps follows that includes building rapport, escorting clients to the clinic, continuing to support them at appointments, and offering additional resource referrals, for example, mental health treatment, substance use support, housing, and legal services.

It’s fitting that AHP’s supplementary support group for these clients is called Home Base, a place where clients begin to end their isolation, where they engage with peers about their substance use and other concerns. Home Base is just another way that AHP’s case managers ensure that the chain of support does not break until the clients achieve their goals. As Saito put it, the majority of our clients “graduate” out of AHP case management, “because their lives have been transformed.”