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Using the information discovered by the assessment is the next step in the care management process. The tools of CMAG allow for planning and intervention. The care manager’s role is one of facilitator and coordinator of care. Above all, the care manager, regardless of the setting or his/her role, is an advocate for the individual with depression. Due to the nature of the disease, this may well be the most important role the case manager plays.

Trust is of the utmost importance. The assessment tools and interventions in CMAG will only be effective if the individual trusts the integrated care management professional. Therefore, the rapport must be built in a non- threatening manner and be specific to the individual. There are no “cookie cutter” approaches to this task.

For the following tools and instructions, access CMAG workbook on www.cmsa.org. While the following section is specific to an individual with depression, the tools of CMAG are standardized and cross all diagnoses.

REALM-R

The REALM-R is the first assessment tool in CMAG and is used to assess the health literacy of the individual. The 2003 National Assessment of Adult Literacy (NAAL) survey shows that two out of every five adult Americans have difficulty obtaining, processing, and understanding the basic health information and services needed to make appropriate health decisions.67 The REALM-R may be delivered over the phone by spelling the words to the individual and asking him/her to write them down and then read them back. It may be sent via email or mail, followed by a phone call to read the words. It may be presented onsite. Regardless of how it is presented to the individual with depression, be aware that due to the disease process energy is low, concentration is difficult, and the individual may be suspicious of the intentions of the care manager. Take this slow. The best approach may be to simply work the delivery of the REALM-R into the conversation so that it does not sound like a “test.” Finally, never refer to the REALM-R because the associated anxiety often is stifling in the depressed individual. Health literacy may change once energy returns and concentration with the treatment team can occur.

In the case of depression, it is imperative for the individual understand his/her disorder. This understanding will help the individual discuss topics of concern with the physician, psychiatrist, or psychologist. Delivery of information must be tailored to conform to the patient’s ability to use and apply the information.

Bearing this in mind, the case manager might begin work if the individual is ready and willing to discuss their concerns. This may not happen in one phone call or during one meeting.

Depression

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