Identifying a holistic case management approach in fetal alcohol spectrum disorder

Care coordination is a person-centred approach that aims to support clients’ achievement of goals within their environment.  Its use in practice needs to be explored given the paucity of evidence of interventions for adults with fetal alcohol syndrome disorder (FASD).  This qualitative study sought to identify the components of a holistic care coordination approach used by service providers. Five case studies were summarized; each case comprised interactions with service recipients and their families, key stakeholders, and the care coordinator.  Details of each case were summarized and subsequently analyzed for themes, using a qualitative content analysis approach

Results conveyed six central elements of person-centred care based on a holistic case management approach: advocacy (e.g., building capacity to support the service user), strengthening the service user/case coordinator relationship (e.g., taking time to build rapport between the service user and a care coordinator), inter-agency collaboration (e.g., nurturing linkages between agencies and groups that are involved in the lives of service users), honoring cultural safety (e.g., tailoring service delivery to honor cultural values of service users), and implementation of a harm-reduction approach (e.g., employing a set of practices that honor and respect service users’ wishes), a trauma-informed approach (e.g., working with service users to build plans of actions that consider influences of historical trauma), and a holistic approach (e.g., wrapping support around the multiple needs of a service user). In highlighting key elements of a holistic care coordination approach, ecological practice comprised micro, mezzo and macro-elements of practice in addressing the needs of the individual and community, and building system capacity.

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