BY JENNY QUIGLEY-STICKNEY, RN, MSN, MHA, MA, CCM, ACM-RN, CPHM, CMAC
When asked, “What does it take to create a professional pediatric case manager?” Shahzina Karim, senior director in care management from Boston Children’s Hospital, answered, “It takes patience and commitment.” To better understand this concept and what is required to develop the specialized skills to work at the world-renowned Boston’s Children’s Hospital, CMSA Today invited three case managers from this prestigious center designed to treat pediatric patients from birth to adulthood, with acute to chronic pediatric care conditions.
Shahzina Karim, MSW, LICSW, CCM, joined us, along with two of her team members, veteran case manager Karrie Mohammed, BSN, RN, CCM, and novice pediatric case manager Barbara Annie Montgomery, BSN, RN, to help professional case managers understand the unique skills and talents needed to work with this specialized population.
When asked what she looks for as a leader in hiring and developing pediatric case managers, Shahzina began by explaining her own background. Shahzina has a background in care coordination, behavioral management in clinically integrated programs for complex case management. She began her work with the adult population, inpatient and ambulatory, and later transitioned to pediatric care coordination and planning. She looks for case management individuals who have a strong acute care nursing background and who also have a passion and specific focus on pediatric care. She explains, “Building a strong RN case management team requires being flexible and looking for not just acute clinical expertise, but also the right character, cognitive flexibility and a nurse who has the desire to learn new things. Case management requires understanding the patient’s trajectory, collaborating with all team members, multitasking, thinking outside the box, setting boundaries of what we can and cannot accomplish and maintaining a work-life balance.” The nurse case managers work on acute care, medically complex chronic care, surgical care, complex care and ambulatory pediatric plans. She has learned that case managers who work with pediatric patients understand that “it takes a village.” The village refers to the team encompassing the MD, primary nurse, RN case manager, social worker, physical therapist, occupational therapist, speech therapist, pharmacist, specialty physicians, PCP, community vendors/pediatric agencies (“I cannot emphasize enough how important it is to have a collaborative working relationship with all of our vendors, the only way to make each discharge a success”), as well as the patient/family who are at the center of any plan. Each case may have a different composite of the team, but successful pediatric case managers know that regardless of the team, each member is essential to achieving a positive outcome for the patient /family to transition safely from the hospital to home.
Karrie Mohammed, BSN, RN, CCM, veteran pediatric case manager, came to this specialization from the field of oncology nursing. She then transitioned to pediatric neuro oncology/BMT care planning. Karrie has spent the last year developing her skills through education in the field of case management to add to her specialized knowledge in the pediatric field and to prepare herself for testing and achieving the rank of Certified Case Manager through the Commission for Case Manager Certification. Karrie finds that pediatric case management allows her to utilize her skills to research options and develop solutions for her specialized population, challenging her to creatively find the best resolution for her patients’ and families’ needs.
Barbara Annie Montgomery, BSN, RN, is a novice in the pediatric case management department with a background in medical surgery, trauma and NICU. Barbara Annie may be a novice in case management, but her background in nursing brings a wealth of knowledge to develop complex care plans for pediatric care. Barbara Annie loves the fact that while it takes time to develop case management skills, she has a rich environment of mentors in her group — from the director to veteran case managers — to discuss cases and learn about new resources for care management planning. Barbara Annie, although not certified, is planning and establishing goals for professional development, certification and transitions of care planning in her first year in the field.
The pediatric care manager works very closely with the family, and that could include: a single parent, paired couple, aunt, uncle, grandparent, guardian or agency-based decision-maker, and accommodate the care plan to adapt to the specific needs of the patient and family. Culture plays an important role in a pediatric hospital system. The pediatric population is highly dependent on managing social determinants of health to create a comprehensive care plan. These include transportation, finance, medications, culture, access to healthcare, insurance and availability of caregivers to assist with managing the healthcare plan. Psychosocial determinants of health include engagement, cooperation, custody of patients, alcohol abuse and drug addiction’s impact on the care plan and unexpected medical complications that create higher than average utilization of resources for care planning.
When asked about a day in the life of a pediatric care manager, all three case managers agreed that a major benefit of this work is that no day is the same: Flexibility is key. Each day brings new challenges, but those challenges make the work exciting and creative. Varying acuity levels of patients and facilitating between managing acute versus chronic conditions add to the variation in the pediatric work and care plan. Trends in the pediatric population are consistent with work pre-COVID. Pediatric case managers work onsite and with telehealth models to encompass all team members, patients and families, maintaining effective and consistent communication to keep care plans focused and on target. When asked, “What is the best advice you can give a family member?” Karrie, veteran case manager, said, “I ask the parent to trust me to do what I do best — get the resources and care team organized — while you sit back and relax until it’s time for us to start teaching and helping you transition to home, where you will take over.” My job is to help them feel in control of their child’s medical care plan. Barbara Annie, novice RN, works on a surgical care floor and states she is most amazed by the resiliency of the kids, which does not exist as often in the adult population. When a patient or parent thanks you for the care you have given and is grateful that you empowered them to manage their child’s healthcare, the work is especially rewarding.
When asked if the pediatric care provided had changed due to the pandemic, the answer was an emphatic no. We must be flexible, and we continue to treat acute and complex patients from around the world, utilizing onsite and telehealth options to coordinate communication among all members of the team. Because of the specific nature of this population, resources for pediatric patients have always been scarce, leaving this team uniquely set up to manage within a pandemic environment. They continue to provide the same unique, creative solutions for their pediatric population. One thing that did change with the pandemic was a stronger emphasis on maintaining a work-life balance. Senior Director Shahzina Karim has created a culture of self-care and peer support to ensure that her RN team stays healthy so that they can continue to provide that essential passion to create world-renowned pediatric care plans while also maintaining flexibility, navigating constant change and executing successful patient/family transitions of care.
Case managers interviewed:
Shahzina Karim, MSW, LICSW, CCM, senior director, care management
Karrie Mohammed, BSN, RN, CCM, case manager
Barbara Annie Montgomery, BSN, RN, case manager