2.3 Differentiating PCM from Other Forms of Case Management

Case management is widely acknowledged to be an important psychosocial strategy with potential for addressing a wide range of social ills (Rothman 1992). The fundamental principles underlying case management services are that case managers (1) facilitate linking clients to the complex delivery system and (2) help to enable clients, through psychosocial interventions, to benefit from appropriate services. For persons living with HIV and AIDS, case management has emerged as the prominent strategy for coordinating the wide range of needed health care, psychiatric, psychosocial, and practical support services (Mor, Piette, and Fleishman 1989). Although researchers and clinicians have been unable to agree on one widely accepted definition of case management (Baldwin and Woods 1994; Graham and Birchmore-Timney 1990; and Piette, Fleishman, Mor, and Dill 1990), most might agree with the following broad definition of case management:

". . . the provision for some greater continuity of care through periodic contact between case manager(s) and the client that provides greater (or longer) coordination and brokerage of services than the client could be expected to obtain without case management" (Orwin et al. 1994, p. 154).

Although PCM also provides greater continuity of care, it is specifically focused on HIV-related behavior change. PCM involves the identification of HIV risk behaviors and medical and psychosocial needs that influence HIV risk taking followed by the development of a client-centered Prevention Plan with specific behavioral objectives for HIV risk reduction. Through both direct and facilitative service provision, PCM provides primary and secondary HIV prevention services and facilitates the provision of other medical and psychosocial services affecting risk behavior, including STD evaluation and treatment and substance abuse treatment. HIV primary prevention aims to reduce the transmission and acquisition of HIV infection, whereas HIV secondary prevention aims to prevent a person living with HIV from becoming ill or dying as a result of HIV-related illness and opportunistic infections (Last and Wallace 1992).

The foundation of PCM involves multiple-session risk-reduction counseling in which a variety of strategies are applied by the prevention case manager to influence HIV risk behavior change. Like case management, prevention case managers broker needed medical and psychosocial services, specifically those that influence HIV risk-taking such as STD and substance abuse treatment, thereby providing more efficient coordination of services. For example, an injecting drug user may have difficulty benefiting from HIV risk-reduction counseling without receiving substance abuse treatment.

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