Week 2 - Frankel and Gelman - Chap 3 - The Roles of a Case Manager PDF

CHAPTER 3 The Roles of a Case Manager During the process of case management with your clients, from the very inception of intake to the last follow-​up contact, you will be taking on a number of helping roles. They will be played out in the three major domains of assessment and intervention of the h...

CHAPTER 3 The Roles of a Case Manager During the process of case management with your clients, from the very inception of intake to the last follow-​up contact, you will be taking on a number of helping roles. They will be played out in the three major domains of assessment and intervention of the helping process—​direct intervention with clients, organizational/​community interventions, and in the broader political/​cultural/​ societal context. Each role requires you to focus on different problem-​solving strategies, different skills, and different conceptual bases. Which roles you integrate into your own case management practice will depend on a number of factors, including time, your level of practice and conceptual experience, the nature of your clientele, and the agency where you work. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. Direct Personal Support No matter what other roles you play in the life of your clients, one of the foundations to helping is having a good supportive relationship with clients and offering them a sense of hope. The reasons for developing good rapport with clients in case management are somewhat different from those in other helping relationships. Many casework theories discuss a good worker–​client relationship as a necessary part of the curative process. This is generally true in traditional casework; if such a relationship does not develop over time, the client should probably be transferred to another worker. But this is not necessarily true in case management. In many situations, it is not possible to develop the kinds of relationships that would allow you to offer direct support or allow it to be received. Some people who enter case management systems have been “burned” by social services or governmental agencies before coming to you. Their anger will not allow them to believe that their experience with you will be any different from the frustrating ones they have already had. Other clients are not able to connect 28 Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. The Roles of a Case Manager   29 because of mental or physical impairments. It may be difficult for you to engage meaningfully with autistic children, schizophrenics, or Alzheimer’s patients. Or you may have a good relationship with a family member who has little power to resolve a problem, such as a young abused child or a frail old person. Finally, many clients who are forced to see you come figuratively kicking and screaming; they are uncommunicative at best and hostile at worst. In all of these situations where good case management client–​ worker relationships are not possible, you can still be helpful. The bad news is that you will have to struggle to get good assessment information and work harder to motivate clients to accept support. The good news is that by the very nature of the case management process, you are not alone in trying to connect with these people or in finding ways to help them. Your job is to activate a community resource network that will meet your clients’ needs. Thus, there are many agencies, professionals, community organizations, and individuals who will care about your clients and, hopefully, connect with them when you cannot. Of course, having a good, trusting relationship with clients is desirable if it can be achieved. When someone comes to a case manager for help, the process is more pleasant if he or she likes the worker. This is as true for the helper as for the “helpee.” You will enjoy your work much more when you have good relationships with your clients. Good relationships have other positive side effects as well. People under stress need reassurance and a sense of hope. They do not normally allow case managers to give them this kind of support unless they feel some degree of trust and caring. Also, assessment is greatly enriched if clients and the important people around them actively participate in the process. People tend to share more with those they trust and respect. One way to develop good relationships with resistant clients is to improve your connecting skills: showing empathy, active listening, focusing, reframing, summarizing, goal setting, negotiating, contracting, partializing, offering “warm fuzzies,” and being able to accept anger and corrective feedback. All of these skills, and more, are part of case management training. Crisis Intervention As the name implies, crisis intervention is a limited and very focused strategy. Case managers do not normally offer casework or groupwork services to their clients, instead referring them to other agencies. But when case managers become aware of a crisis in their clients’ lives, time can be a critical factor. If a crisis threatens to devastate a client before an appropriate referral can be found, it is the case manager’s job to step in quickly to ameliorate the situation. Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. 30   Case Management A crisis is defined by either the client, people around the client, a professional, or someone in the community. In general, when a crisis is perceived, the first responsibility of the case manager is to assess the severity of the situation. Crises might include a clear suicide gesture, the loss of welfare benefits, hospitalization for a serious illness or injury, a drug overdose, or a sudden death in the family. In many situations, however, it is not clear how serious the crisis is or whether it even is a crisis. One of the best examples of ambiguity is in the area of suicide or suicidal ideation (when a client talks or thinks about committing suicide). Experience and research have suggested that some suicide ideations are more serious than others. You may be facing a crisis when a client has a history of suicide attempts; has a clear plan of how she or he will carry out the suicide; is planning on a violent means of death; has put his or her affairs in order; or seems to be saying goodbye to you and others. Criteria like these appear on checklists developed by agencies specializing in crisis intervention, such as suicide hotlines. It is not only the seriousness of a potential crisis that you have to assess but also the time available to deal with it. In some cases, you have no time at all; in others, you may be able to explore support options. It often depends on how clients and their families seem to be coping. For example, when a low-​income employee loses his or her job, it is definitely a crisis, but if he or she is coping with the loss reasonably well and has support from savings, severance pay, or another working family member, you probably have time to explore options. But if the economic picture is grim, and your client is on the verge of a nervous breakdown or about to revert to an addiction, you need to intervene immediately. Obviously, good assessment skills are essential in determining how a worker should proceed in a potential crisis situation. From a case management perspective, crisis intervention can be as minimal as ensuring that a referral source knows about the crisis and is dealing with it appropriately, to a full-​fledged intervention, with the case manager acting as the central worker. In all cases, it is the case manager’s responsibility to ensure that the client gets the support needed to bring the situation under control. When a case manager does act as the central person in crisis resolution, a number of skills are needed. First, as we have already said, the case manager must be able to quickly assess both the severity of a potential crisis and the time available for resolving it. This assessment, developed with the worker’s empathy and support, should lead to an immediate set of goals with clear behavioral steps designed to reach them. These should incorporate tasks for both the client (if possible) and the case manager. The case manager also needs to enlist cooperative people in the client’s natural and professional environment to help resolve the crisis. A case manager then needs to maintain frequent contact with the client and those enlisted until the immediate crisis has passed. Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. The Roles of a Case Manager   31 A case manager involved in crisis resolution needs to develop a clear plan so that the client can receive appropriate professional and family support over the longer term (the case management process being normally limited in time). This is not to say that the case manager needs to disappear. It does mean that the responsibility for long-​term support should be transferred to other professionals and agencies. In such a case, the worker should stay in touch with the client to make sure that long-​term support is forthcoming; if it is not, the manager needs to locate other resources. Crisis intervention is a fairly common role in case management, so regardless of the agency in which you practice, it is a good idea to learn more about managing crises. These will arise particularly in cases of drug and alcohol abuse, mental illness, domestic violence, death and bereavement, homelessness, and entitlement issues. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. Short-​Term Treatment Interventions There will be many times when your assessment indicates that the problems presented to you as a case manager could be resolved in the short term. Short-​ term treatment is usually defined as methodologies that help people deal with a problem in 1 to 12 sessions. This approach has become popular in the current era of managed care, when mental health costs are being scrutinized as never before. Short-​term intervention can be successful in a number of areas—​among them, mental health, family problems, prevention education that focuses on health or mental health, budgeting, educational tutoring, and employment. Short-​term treatment requires that case managers be trained in relevant theoretical and practical foundations. Numerous theories lend themselves to brief intervention strategies—​task-​centered and solution-​focused treatment, the behavioral approach, ego psychology, and cognitive interventions. All of these theoretical orientations have several things in common. First, a worker helps clients frame problems in ways that are manageable, dividing big problems into potentially solvable smaller ones. For example, a mother who is extremely distressed by her unmanageable adolescent son needs to focus on the specific behaviors that are troubling her. A couple with marital problems need to understand the particular issues that are causing conflict. A depressed man needs to focus on what is happening now in his life that is causing his unhappiness. The second common factor in all brief interventions is the necessity of helping clients clarify what they can do in the short term and what they should expect to be doing after treatment is completed. In other words, they need to translate their desires into clear, achievable goals and behavioral objectives. For example, a mother with a seemingly uncontrollable adolescent may set as a goal Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. 32   Case Management that he be “good” by the end of treatment. In this case, specific goals could require that at the end of 12 weeks, the teenager will be coming in at night by curfew five out of five school nights and doing one household chore a day. An estranged couple will probably want to “get along better.” What they specify at the end of brief treatment could be working out a monthly budget, negotiating a division of labor for child rearing, and going out on a “date” at least once a week. When a client says he wants to be less depressed at the end of treatment, goals could be framed as follows: within eight weeks he will be getting out of the house at least five days a week—​including attending day treatment three days a week and seeking a job two days a week—​and taking his antidepressant medication every day. The third factor that characterizes all brief therapies is that interventions are very specific from session to session. There are usually explicit “homework” assignments for clients. They are encouraged to be active participants in developing weekly interventions, although the worker often has to take an active and directive lead. In addition, there is a focus on weekly accountability and on making quick changes if something is not working. Many of the problems and goals treated in the short term may seem superficial as compared with those fully achieved by long-​term interventions, but time is a luxury rarely available in case management. If you judge that long-​term treatment is indicated, you should refer clients to professionals and agencies that specialize in it. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. Broker/​Facilitator After the assessment process, one of the most common case management tasks is to facilitate the helping process through linkages to social service agencies, governmental or voluntary community organizations, and other concerned people. This is most often done by making referrals. On the surface, this might seem to be a simple, almost rote process. Nothing could be further from the truth. Making a good referral assumes that case managers know the referral source and that there is a good fit between client needs and what is available. A case manager makes a referral not just to some place that is supposed to take care of a problem but to a place where it is highly probable that client needs will be met. Referring clients to sources that do not meet their needs increases people’s frustration and lack of faith in their community support system. Poor and inappropriate referrals do nothing for your reputation as a case manager either. The only way case managers can really know whether a referral can help their clients is to know how an organization functions, its program components, the kinds of clients it serves, its track record, its staff, and how user-​friendly it is. Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. The Roles of a Case Manager   33 One of the best ways to investigate a referral is to visit the site, talking with the professionals there, reading the organization’s brochures and other published information, observing client flow, and asking about outcomes. Because you need to conduct your assessment in an open and professional way, you should make appointments and identify yourself, your employer, and your purpose. You need to educate yourself about the agency’s work, the types of clients it serves, and how it would deal with referrals from your agency. Find out, specifically, how referrals should be made, what client eligibility requirements are, with whom you need to communicate, and the referral’s contact person in your own case management system. Other important issues center on finance: Are clients financed through public funds, such as Medicaid or other welfare benefits? Is there a sliding scale for fees? What is a client’s personal responsibility for payments? Having an open line of communication between the case manager and key referral staff is essential for the continued effectiveness of a referral source. It is helpful to have good professional relationships, and it never hurts to have friends in agencies as well. What you want to avoid if at all possible is strained relations between case management staff and agency referral sources. If such strains occur and persist, it is only your clients who will be hurt. So, when such situations happen—​and they are bound to every once in a while—​it is incumbent on case management staff to assess the problems and work to resolve them satisfactorily. Another way to evaluate the effectiveness of referral sites is to ask clients about their experiences there. Tracking “client careers” through what is often an organizational conundrum is an excellent way to assess referral sources over time. This tracking is usually not a problem while clients are still part of your case management program. But after they terminate case management and are still using referrals, periodic follow-​ups are needed to determine how agencies, organizations, and other community supports are performing. This process might involve periodic client or consumer satisfaction surveys. Referral sources, like people, change over time. Staff members come and go, funding sources dry up and new ones are found, and directors change policies. These changes can have profound effects on service delivery and will affect a referral agency’s ability to meet the needs of its clients. Nothing is more annoying than to find out, sometimes months later, that one of your favorite referral sources has not been providing the services you expected. Keeping in touch with referral contacts will allow a case manager to track how changes within agencies affect clients. Keeping track of political winds and governmental policies is very important in preparing clients for referrals to governmental agencies, such as social security. Having good contacts in these agencies, along with following the political process on TV and the Internet and in the newspapers, will help you know what changes are being considered even before they show up in regulations. Advanced Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. 34   Case Management knowledge can help you begin exploring referral alternatives, especially when entitlements are being curtailed or cut. Clearly, the case manager’s role of facilitator in referring clients for services is much more complicated than it might seem on the surface. It requires competency in organizational assessment, professional communication, tracking, and program evaluation. These are skills that can be learned and enhanced through training and experience. Along with referral, facilitation in case management may involve enhancing the support opportunities in a client’s family or friendship systems or connecting clients with new people-​to-​people helping networks in the community. The activation and empowering of families, friends, religious or ethnic affiliations, and neighborhood centers around a client may turn out to be the most important factor in the long-​term success of case management activities. While it may not always be possible to link and involve informal supports, their potential should always be explored. Often when you work with vulnerable populations—​children, the aged, and those who are impaired mentally, emotionally, developmentally, or physically—​you will need to consider their family members as clients, along with the “identified patient.” They are the center of a natural community support system, and their stability, motivation, and ability to help each other need to be assessed and made part of the helping process to the extent possible. You may find that much of your time as a case manager is spent working to motivate and empower this naturally occurring support system. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. Enabler/​Teacher/​Mediator The goal of case management in many instances is to have clients take increasing levels of responsibility for achieving identified and agreed-​upon goals. The role is described as enabling. Your ability to increase a client’s self-​confidence is a critical part of this incremental process. As a case manager, you must be aware of each client’s capacity to engage in the process and be able to encourage increasing levels of responsibility. Moving from doing for, to doing with, to having clients do for themselves increases client self-​confidence, self-​sufficiency, and independ­ ence. Gauging when clients are ready and able to do for themselves requires an accurate and continuing sense of where the client is in the helping process. Enabling a client to take acceptable and increasing levels of risk is one criterion that can be used in assessing effectiveness in case management. At times you will be called upon to act as a teacher, providing learning opportunities for clients. Activities commonly presented in case management programs include information about community resources, mental illness, health, sexually transmitted diseases (STDs), and alcohol and drugs. You may Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. The Roles of a Case Manager   35 find opportunities to use group discussion and role play to help clients practice behaviors that will help them manipulate service bureaucracies. The case manager will at times have to assume the role of mediator in disputes between clients, between clients and community services, or between personnel in agencies who are involved with your clients. There is a significant difference between a mediator role and an advocate role. The advocate is clearly taking one side; the mediator is trying to remain neutral and not favor one side or the other. Obviously, this can be tricky. In mediation, the case manager tries to bring the parties involved to a common ground or understanding of the conflict, recognizing the legitimate interests of each party. The goal in these cases is, of course, for the case manager to mediate a reasonable resolution of the conflict. Even when this goal cannot be reached, a good mediator still attempts to be perceived as neutral, so as to be available to mediate another day. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. Advocate Client advocacy is one of the most important case management roles. In fact, one could make a case for regarding other roles as subsidiary to that of advocate. Advocacy means that a case manager acts on behalf of clients who are unable or unwilling to act on their own behalf. Actually, advocacy may occur when clients are able to act on their own, but when it is judged that a case manager could intervene more effectively. This is apt to happen with clients who lack capacity for one reason or another—​such as with children, citizens with intellectual disabilities, the elderly, or those who are emotionally or physically impaired. Addicted or suicidal patients may fall into this category as well. Some clients—​often those who are mandated for treatment or those who live in inpatient settings—​are simply unwilling to act on their own behalf. Client advocacy can also be helpful when it is clear that case managers have more power or professional connections than their clients. There are times when it is essential to “grease the wheels” to find services, especially when prior experience has shown that clients have little power to influence a social service or health system. For instance, if a client is turned away from an agency or governmental entitlement and you believe that eligibility requirements have been met, it is time to use your professional muscle to do what the client couldn’t. Sometimes you may have a formal or informal connection with an agency that can be used on your client’s behalf. Advocacy is a good way to show clients that you care and are on their side. In such cases, case managers may resort to advocacy intervention even if the clients could have acted on their own. Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. 36   Case Management Case managers advocate for their clients in many ways, of which making referrals or appointments is one of the most obvious. Advocacy also includes seeking out and assessing the effectiveness of community resources, making it possible for clients to gather information and facilitate program access, communicating directly with relevant professionals and/​or family members about client welfare and needs, and acting as a mediator to resolve conflicts between a client and agency. Other kinds of case manager support could also qualify as advocacy such as, for example, shopping or cooking for a client or babysitting a client’s children when no one else is available. It is often unclear how much and to what degree case managers should be involved in client advocacy. Whenever case managers act on behalf of their clients, even just to make a referral, they are acting as client substitutes. Every time this happens, and often it must, clients are losing the opportunity to practice advocating for themselves. By definition, practicing any new behavior, including assertive skills, community assessment, and self-​advocacy, is a learning process that includes making mistakes (Wehmeyer & Metzler, 1995). At times the wisdom of Solomon may be required to decide when to back off and support clients in their attempts to act for themselves, when to advocate for them, and when to find some kind of middle ground. We must constantly remember that the more clients learn to act for themselves and their families, the more independent and self-​sufficient they will become. An additional value of self-​ advocacy is that people become more involved in their community and with people who share their life problems. Thus, case managers should not take on the advocacy role as a habit without careful consideration. Client advocacy can also be viewed at an organizational and community level (Gelman, 1989).When case managers work in their organizations to make services more effective and efficient, they are certainly advocating for all clients. Similarly, when workers get involved in community activities that highlight serious community problems or service deficits, when they initiate service development, or when they organize people for political and social change—​all of these actions are ultimately acts of client advocacy. Sometimes organizational and community advocacy is the most significant kind of intervention a case manager can be involved in, especially when resources are inadequate, inefficient, or nonexistent. Client advocacy is an essential part of case management practice, and the more effectively case managers master the prerequisite skills, the better they can serve their clients. However, an interesting philosophical dilemma arises here. Assume for the moment that there are only a finite number of available resources in a community—​say, 100 slots for outpatient drug treatment and 1,000 clients in various case management programs in desperate need of treatment. The addicted clients with more effective professional advocates will have a better Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. The Roles of a Case Manager   37 chance of getting one of the 100 available slots than the others. Perhaps those case managers had better contacts in the drug program or they may just be more persuasive. In any case, what this dynamic sets up is a subtle competition among case managers to garner for their clients as much as possible of the inadequate resources available. By definition, successful client advocacy in the face of inadequate resources comes at a cost to less-​fortunate clients. On one level, this success is just the result of good case management. On a larger scale, however, it raises the question: What are our professional responsibilities in a community when resources are inadequate and every client placement means that many others cannot get needed services? There are no simple answers to this important question. Professionals involved in case management need to take a broad community view of client populations and the services needed to support the disenfranchised, the poor, those who face discrimination, and others in need. Client advocacy at the organizational, community, and political level may be the most cogent response to resolving this dilemma. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. Service Coordinator Case managers often find themselves in a service coordination role. It can develop in several ways, either formally or informally, depending on how complicated the solutions for a client’s case become. Many case management programs are designed to be the service coordinators for a fixed amount of time. For example, there are intensive case management programs, called ICMs, in which case managers work with their clients very closely for four to eight weeks. ICMs are common in forensic aftercare, in working with the chronically mentally ill, when dealing with families to prevent children from being placed in foster care, and in addictions work. The assumption behind ICM starts with the idea that if clients can be immediately connected to a variety of community agencies—​ housing, welfare, treatment, medication, and so on—​the initial presenting problems will be ameliorated. It is further assumed that once the ICM worker establishes and coordinates this community support system, clients will be maintained indefinitely at a stable level. Case managers in ICM systems have their work cut out for them. They not only need a comprehensive grasp of available resources but also be able to quickly coordinate these services by acting as the hub in a social service wheel. In addition, since ICM case managers have a limited time to act as service coordinators, they must quickly establish communication among clients, agencies, and professionals, one of whom will (hopefully) take over their role. As you can imagine, this is no easy task. When clients terminate from ICM systems, there may Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. 38   Case Management not be another central community coordinator to pick up the slack over the long haul. Thus, the central problem facing ICM case managers is not only the need to support initial client stabilization but also to build a community resource coalition with the client in as proactive a role as possible. The service-​coordinating role may develop informally as a set of services develops around a client. Professionals and agencies may begin looking to you as the central resource person for clients simply because you have spent so much time trying to coordinate services on their behalf. You may find that other professionals are calling you to report problems even though you are no longer officially on the case. Social service coordinating functions in your community may be lacking, and you are seen as the only show in town. If you cannot continue in this role indefinitely, you will need to address this problem with staff in your agency and those in other community organizations. Clearly, there are clients who need long-​term case management support. If it is not forthcoming, they may become recidivists, which is just a technical term for clients who end up needing the same types of services over and over again. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. The Tracking/​Follow-​Up Role One of the most neglected roles in case management is the follow-​up role. Follow-​up requires not only the time to track clients after case management termination but also the organizational will to expend the effort. To find clients 6 or 12 months after they have left your agency can be a daunting task, particularly in programs that deal with transient populations. Even people who are not so transient change jobs, residences, or phone numbers as part of normal life. However difficult, tracking former clients is valuable. First, for people with whom you made a personal connection, it is good to know how they are doing. But beyond satisfying personal needs, learning the long-​term status of clients is an indication of how well your case management program is doing and how well other professional and community support systems are performing. Imagine for a moment that you are part of an incredibly effective case management program, connecting clients to services and community resources that quickly resolve their presenting problems. What if you found out that after six months, most of your clients were reporting the same problems that brought them to you in the first place? What would this say about the true effectiveness of the case management program? What would this say about the community’s ability to provide long-​term support to individuals and families? It is only through long-​term follow-​up, which is another form of evaluation (an outcome measure), that case managers find out whether their solutions to client problems are helpful over time. When other agencies are supposed to pick Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. The Roles of a Case Manager   39 Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. up the slack for client maintenance but do not, it will have profound implications for a case management program. At the very least, clients may have to be better empowered to independently support themselves before termination. Long-​ term follow-​up also allows you to assess the quality of referral sources; if treatment plans arranged with other agencies are not being continued over time, there is a problem. You and your agency do not necessarily have to take responsibility for the failure of other community and governmental support systems. Some of these failures are systemic, occurring when welfare laws change or the American economy deteriorates. Obviously, government policies, especially fiscal cutbacks, affect the ability of the mentally ill, the homeless, and the elderly—​ to name just a few—​to maintain themselves with dignity. Case management programs cannot be held accountable for these assaults on the social service, economic, and healthcare safety net. However, without knowing specifically what has happened to former clients, it is very difficult to know how to focus your case management program, your community action plans, and your efforts to design better long-​term community support systems for people in need. Follow-​up in case management takes time, energy, and money. This role for case managers is becoming more prevalent as professionals and funders understand its importance. Yet it is easy to see why administrators often have to make hard decisions concerning case manager time allocations in the face of ballooning caseloads and decreasing budgets. This does not make the issue any less important; it just means that case managers may have to be more creative and insistent in tracking former clients. Oversight and Purchase-​of-​Service Contracts Since the 1960s, public social service agencies with mandated responsibilities for overseeing, creating, and delivering services to vulnerable and involuntary clients have used purchase-​of-​service contracts to meet their responsibilities (Gibelman, 1995; Gibelman & Demone, 1998). While the purchase of services from voluntary nonprofit or for-​profit provider relieves the public funding entity of the provision of day-​to-​day direct services to eligible clients, it does not relieve those entities of case management oversight and service monitoring. While the wisdom, practicality, and outcomes of this type of funding and shift in service can be debated, the fact is that this is the way that the majority of social services are provided today and will be provided for in the foreseeable future. Therefore, the potential role of case management in oversight and quality management cannot be underestimated. Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. 40   Case Management A case in point: An eight-​year-​old child is removed from his home by a public welfare agency because of parental abuse and neglect. He is placed with a voluntary agency’s foster care program under an existing purchase-​of-​service contract. While the foster care agency provides direct care to the child, the public child welfare agency retains case management oversight. Both the child care agency and the funding agency have written policies that require regular visits and documentation of the child’s adjustment and progress. Because of problems (unspecified in the record), the child is removed from the foster home and placed with another foster family, a change that requires approval by the public agency. The second foster home encounters difficulty in dealing with the child’s behavior at home as well as at school. Multiple requests are made by the foster parents to the child care agency asking that the child be removed. While the foster family is specific as to the nature of the problem (fire setting), there is no indication of this in the record, which appears to coincide with chronological gaps in the file. Another fire is set, and several lives are lost. If appropriate case management practices had been followed by other parties to the purchase-​of-​service contract, could or would this tragedy have been avoided? Evaluations of many purchase-​of-​service contracts tend to focus on process rather than on the quality or outcome of the arrangement. This is, in part, because of difficulty in specifying specific performance expectations and the perfunctory renewal of service contracts. Quality case management is essential to good practice and accountable service delivery. Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. For the Teacher or Trainer: Optional Exercises for Chapter 3 CO M F O RT W I T H C A S E M A N AG E R R O L E S Ask students to list the seven case manager roles discussed in this chapter. For each role, ask them to indicate on a three-​point scale their present comfort levels, where 3 is “great comfort,” 1 is “some discomfort,” and 2 is “in the middle.” Collect these sheets, put the seven roles on the board, and list the students’ scores for each role. Using these collected scores, discuss the overall results as well as why people might have reported less or more comfort with specific roles. S P ECI A L I S SU E S R E L AT E D TO C A S E M A N AG E R R O L E S In a class discussion, present an ethical, cultural, racial, or religious issue that interacts with a case manager role. For instance: Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40. The Roles of a Case Manager   41 Copyright © 2019. Oxford University Press, Incorporated. All rights reserved. What ethical issues arise in tracking a client over time after termination? What are the issues involved in teaching about STDs or pregnancy prevention? What are the issues involved in intervening in a crisis when someone does not want your help (e.g., suicide prevention, drug treatment)? What are the implications of a short-​term treatment mandated by an insurance company when the problem can only be solved in a long-​term treatment? What are the ethical and practical issues involved in advocating for a client when doing so might put the case manager’s job at risk, for example, when a client has a real problem with the agency administration or when the case manager suspects his or her supervisor of inappropriate behavior toward a client? What are the issues that arise when advocating for a pregnant teen whose parents don’t want her to have an abortion? Frankel, Arthur J., et al. Case Management : An Introduction to Concepts and Skills, Oxford University Press, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/humber/detail.action?docID=5602452. Created from humber on 2024-01-04 19:46:40.