Q&A With Intervention Expert Earl Hightower

Intervention expert Earl Hightower has conducted over 1,000 interventions since he started in this field in the early 1980s.

Read our Q&A with Hightower:

Question: What is case management in the intervention process and why do some families benefit from full case management?

Earl: Case management is a pretty broad term that covers a lot of purposes of intervention, there are two types of case management. One type is done post-intervention, post-treatment. We’ll sometimes be called upon to help by the family because they’re comfortable with us, they trust our judgment, and they know we’re not going to tell them we do things that we don’t. They see us as the first line of defense for the family in the ongoing process. They take our counsel when we did the intervention. Once the treatment center was identified, they needed to focus on their counselor — that’s your number one person now; we want you to focus on that person because they’re the ones who have your family member in their care. They’re the ones with the day to day information, most up to date information, engaging your family member in moving through this phase of the treatment process.

However, during that treatment, a lot of times family members come to us and say, listen, you found us the right treatment center, you found the right counselor, things are going well, we’d like to keep you involved in this process, so we’d like to contract with you to determine along with the treatment team what services will be utilized post treatment — are they going to go onto extended care, are they going to go onto day treatment or outpatient, if so where, from there will they go into sober living. What is this continuum of care starting to map out and look like; what facilities, individuals, and allied professionals will we be engaging in this process. They want the person they trust to oversee this. They retain us to facilitate that for them. That’s one type of case management.

Another way we get engaged as case managers is, a family will call us up and say, there’s a lot going on — some horrific scenario, such as our son has been trafficking in cocaine; he’s been arrested, he’s in jail; we’re facing multiple felony counts. He’s also got Hepatitis C and it looks as if there’s another mental health issue that’s starting to rear up and present itself. We have no idea how to deal with all this. We want to retain you to help case manage from the get go.

In a case like that we would be team leader. We would coordinate with the attorney for the legal issues; we would put the medical team together to address the hepatitis; we would enlist the aid of a psychiatrist and the mental health community to address the presenting depression; we would bring in an addictionologist to address the cocaine issue. And all of this would have to be coordinated because there are conflicting priorities. When seeking the counsel of the attorney, the attorney is looking at the case from the perspective of do as little time as possible, beat the case, because that’s his job he’s going to look at this that way. The liver doc is going to feel that what takes the lead is the need to address liver function; that’s his job, his focus, even though what he might be suggesting as the doctor is in direct conflict with what the attorney wants to do, which might be in conflict with what the addictionologist is saying, which might be in direct conflict with what the psychiatrist who is addressing the depression is suggesting. So somebody has to coordinate all of this — someone who is able to step back far enough to look at all elements of the case, effectively prioritize; it’s kind of like creating a tree of services — what’s number 1, what falls in places as number 2a or 2b, however it breaks down. As case manager I take the time to coordinate all this, and the family that’s paying for everything can control it financially: how you get paid is you listen to him. Everybody falls into line under the case manager.

Question: What are some of the other benefits of having a case manager?

Earl: A good example would be a case where we need independent clinical supervision or the case requires some other expertise. If we don’t have enough clinical expertise to make a certain decision, we’ve got our own provider network; we’ve got all the professionals a person would ever need that we’ve worked with for years — people that we trust, that we have long-term working relationship with that we can call upon to make a decision that is not in any way conflicted — they’re going to make a decision based on the information on hand. We can get, whether it be psychiatric supervision, general medicine supervision, legal consultation, whatever it may be, we can get that and bring it to bear on the case. Those are actually exciting cases because it’s like being a football coach, and if you all the elements working together right you can have a profound impact on somebody’s life. You can take a disaster like the one I described and come out the other end with an individual who’s in really good shape, who has a good foundation underneath them, and has a great deal of hope in their life to create something positive for themselves.

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