The Vail Place MHI Team Case Management Program offers guidance and support for people with SPMI who are at the greatest risk and needing the most assistance. These individuals are facing hospitalization or re-commitment to a state hospital and this vital program area addresses their many special needs in ensuring continuity of care, coordination and monitoring of services, discharge planning, housing support, and intensive goal planning.
The team includes social workers, a nurse, vocational staff and a clinical supervisor, and is a collaboration among Vail Place and Hennepin County Adult Behavioral Health Case Management.
The process begins with the case manager and the client completing a functional assessment which is used, along with the diagnostic assessment, to develop an Individualized Community Support Plan (ICSP), outlining client strengths, needs, and goals. Case managers also provide referrals to needed mental, physical, and chemical health providers. Team staff monitor, coordinate, and evaluate existing services and assess how the client is managing their illness, their living situation, and other areas of their life.
Case management services include:
- Referral to needed services
- Accessing services
- Benefits assistance
- Coordination of services
- Service plan development
- Monitoring and evaluating services
- Crisis assessment and assistance
If case management services are needed, contact Hennepin County Front Door Access at 612.348.4111.