The Medi-Cal Program's enhanced care management (ECM) benefit was created to help individuals with complex needs navigate systems, programs and providers. Children and youth in foster care, formerly in foster care or in family maintenance are automatically eligible for ECM. ECM case managers aim to help program enrollees identify and close service gaps and improve coordination across a child’s and/or family’s medical, behavioral health, and social services delivery systems. ECM services should augment any existing case management efforts and promote effective, timely communication.
ECM has great potential to bolster capacity of child welfare case workers and public health nurses improving their job satisfaction and promoting their ability to support children and families along the entire service continuum.
To help social workers imagine how ECM can support the children and families they are working to reunify or create permanency plans for, Full Circle Health Network created a series of case studies. There are different case studies for different scenarios in child welfare.
Download the case studies here.
We hope you will use these scenarios as part of your education curriculum to increase the number of children in foster care being supported with ECM. Each case study has a hypothetical but real-world scenario, a summary of presenting needs and examples of the role the ECM lead care manager can play.
Scenario 1: Family Maintenance
Sonja, 7, was removed from her mother’s care and placed with her father, Carlos, and a family maintenance case was opened. Carlos had not seen her in several years. He was living in his mother’s subsidized apartment in violation of the apartment complex’ rules. He and Sonja could not stay there long-term. Sonja is enrolled in a Medi-Cal managed care plan. Sonja goes to half-day school due to emotional dysregulation and stays with grandma for other part of day. Grandma has diabetes and may not be able to take care of Sonja if it is not better managed. Grandma is enrolled in the same Medi-Cal managed care plan as Sonja.
Scenario 1: Family Reunification
Two sisters ages 9 and 7 were removed from their home due to sexual abuse by their mother’s boyfriend. The mother is an undocumented immigrant and Spanish is her primary language. The mother wants her children back ASAP, but had no family or supports. She needs a place where she and her children could live, but she has never rented an apartment before on her own.
Scenario 3: Permanent Placement Stability
Marcee, 17, was adopted by her grandparents out of foster care when she 2 years old. Her grandfather died unexpectedly when she was 3. Adoption assistance funds helped the family survive financially. Marcee was diagnosed with bipolar disorder, anxiety and ADHD. She had suicidal ideation in the past but currently was receiving services to help her manage. She was doing well in school. Her 18th birthday was approaching and the family worried that the adoption assistance financial support would end, which would be disastrous for the family. Marcee’s grandma needed a plan for after she turned 18. Additionally, Marcee had severe tooth pain but couldn’t find a dentist.
Scenario 4: Permanent Placement Stability & Complex Medical Support
Three brothers, ages 13 and 9 (twins), were removed from their adoptive grandmother for neglect and placed with their great aunt and uncle. Soon after the placement, the grandmother died unexpectedly. The older boy has short gut syndrome requiring a feeding tube and one of the younger boys (twins) has ADHD. The eldest sibling requires frequent medical care and hospital visits due to short gut syndrome. The aunt has learned to care for him. The boys are happy to be together but sad about grandma’s death.They did not get to visit or say goodbye. Great aunt and uncle are in their 60’s and are mentally and financially overwhelmed raising three young boys.
Scenario 5: Probation Youth Support
David was recently released back home from Juvenile Hall with terms and conditions placed upon him from the probation department. He must attend school, meet curfew, not associate with old acquaintances and follow his grandmother’s rules in the home. The apartment building doesn’t want David to return due to fear of bringing violence at the building, adding to his grandmother’s stress. David has a history smoking marijuana on a daily basis. He has asthma. David has not been to the dentist in 3+ years and is complaining of a toothache and is self-conscious about an underbite. Grandma feels stressed about being able to manage her own health issues (hypertension and diabetes) while supporting David.
Scenario 6: Non-minor dependent transitioning to adulthood
Jo is in extended foster care as a non-minor dependent.She lives in a transitional housing plus program and attends community college, traveling to and from school on the bus. She plans to transfer to a state university to complete a bachelor’s degree and wants to be a teacher.She is suffering from frequent panic attacks and reports a constant feeling of anxiety. She acknowledges struggling with healthy eating to cope with her anxiety. She has some contact with her birth family but says she has not fully addressed her prior trauma exposure. After contact with her family, her anxiety increases. Due to her trauma history, Jo also struggles with developing trusting relationships and has few friendships. She does not engage in many clubs or activities outside the classroom.
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