Concept, process, and technique of CASE MANAGEMENT

Nantaporn Ieumwananonthachai

Thammasat UniversityAugust 17, 2011

History Case management emerged as a separate and

professional service in the 1970s, where it was seen as a way to connect clients with multiple needs to an increasingly complex social service delivery system (Turner & TenHoor, 1978).

Throughout its history, case management has focused on the holistic needs of clients, addressing basic needs such as safety, food, and shelter, as well as emotional, medical, and other needs including employment, education, and connection with others in the community (Rapp, 1998)

Case Management Case management is a collaborative process of assessment,

planning, facilitation and advocacy for options and services to meet an individual’s holistic needs through communication and available resources to promote quality cost-effective outcomes. (Case Management Society of Australia 2009)

Although there are numerous definitions, the common theme is seen as a process for ensuring that clients are provided with whatever service/s they require in a coordinated, effective and efficient manner. (from ADAHPT Case Management Model)

Limitation on quality and access of services “Holistic

Interdisciplinary” concept

Limitation of resources and

services

Complex social situation and

problemsOrganization mandate is

not consistent with responses required

CM

Advancement of Sciences,

Technologies, and Medicine

“IndividualizedHuman Right”

conceptGlobalization and Gap

in Economic DevelopmentCross border

issuesRequire intensive coordination

Human Trafficking

The United Nations definition of Human Trafficking is “The recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation”

Limitation on quality and access of services “Holistic

Interdisciplinary” concept

Limitation of resources and

services

Complex social situation and

problemsOrganization mandate is

not consistent with responses required

CM

Advancement of Sciences,

Technologies, and Medicine

“IndividualizedHuman Right”

conceptGlobalization and Gap

in Economic DevelopmentCross border

issuesRequire intensive coordination

CRISIS INTERVENTIONCRISIS INTERVENTION

Medical treatmentMedical treatment physical examination and treatment psycho and emotional support

Legal assistance - law enforcementLegal assistance - law enforcement Legal advice Legal support Investigation and proceedings

Social servicesSocial services Crisis measures - inc. temporary care Complete assessment (incl. risk) Planning

Rehabilitation: Prevention of Rehabilitation: Prevention of further harmfurther harm Restriction/protection orders

Permanency planning and monitoring

Family support services (economic, mediation, social skills, housing, employment, social services…)

psychological and emotional support

support during and after legal proceedings

advocacy and referral to existing services

CM

Health Personnel Social Worker

Therapist

Psychologist

Community workers

Police

Other ProfessionalsFamilies

Coordination/ Linkages

Case Management definition in work with victims of trafficking "a collaborative means of helping people

who are disadvantaged or devalued in society, to discover their strengths and personal power, pursue their own objectives, and begin to confront the systems that oppress them, in order to redistribute power and thereby improve their life chances and quality of life" (Spindel, 2008, p.15).

The Case Management approach assumes that clients with complex and multiple needs will access services from a range of service providers and the goal is to achieve seamless service delivery. This assumption highlights that the concept of Case Management is based in service provision arrangements that require different responses from within organisations and across organisational boundaries. Case management is described as a boundary spanning strategy to ensure service provision is client rather than organisationally driven. (Case Management Society of Australia 2009)

Components of Case Management Process

Identification/ Selection

Assessment

PlanningImplementation/

Coordination

Termination

Evaluation

Standards of Practice for Case Management, revised 2010 (USA)

Client

1. Client Identification and Selection

Focus on identifying clients who would benefit from case management services.


2. Assessment and problem/opportunity identification: Begin after the completion of the case

selection and intake into case management and occurs intermittently, as needed, throughout the case.


3. Development of the Case Management Plan Establish goals of the intervention and

prioritizes the client’s needs, as well as determines the type of services and resources that are available in order to address the established goals or desired outcomes.


4. Implementation and coordinationof care activities Put the case management plan into action

through the coordination with service providers, and client and family.

If the client has to be referred, communicate with new provider (CM) and client, and ensure smooth transition.


Coordination

Divide into 3 phases1. Beginning 2. Network maintenance 3. Termination (Onopas, 2011)

Referral1. Identify objective of the referral, and jointly work with

client to select appropriate agency for referral2. Communicate with destination agency and new CM, to

ensure smooth transition3. Prepare necessary document for referral4. Prepare client for the transition5. If the client has to be transferred to another geographical

area, ensure that there is someone to accompany the client if s/he is not capable of travelling by him/herself.

6. Follow up on the transition, and evaluate client’s satisfaction.

5. Evaluation of the case management plan and follow-up Involve the evaluation of the client’s status

and goals and the associated outcomes.


6. Termination of the case management process Bring closure to the care and/or episode of

illness. The process focuses on discontinuing case management when the client transitions to the highest level of function, the best possible outcome has been attained, or the needs/desires of the client change.


Case Manager

Roles of Case Manager Facilitator (within service system) Advocator (rights holder) Educator Negotiator Coordinator Manager (monitor and follow up

on outcomes/ and transition)

Case Manager is working with Client/ Services User (Micro/Direct) Environment (Macro/Indirect)

Client/service user Individual, family and relative, group,

community: with problems that are complex, chronic, severe, repeated, etc.

Target group: elderly/ child and youth/ female (with all forms of violence), substance abuser, HIV/AIDS or chronic patients , disable (physical/ mental/ intellectual) , perpetrator after being released, those at risk of facing repeated problems, etc.

Environment

services system economic and politic culture and belief

Case Management is one of the services delivery approach with following goals

enhancing developmental, problem-solving, and coping capacities of clients

linking people with systems that provide them with resources, services, and opportunities

creating and promoting the effective and humane operation of systems that provide resources and services to people

improving the scope and capacity of the delivery system

contributing to the development and improvement of social policy (NASW, 1992)

Micro

Meso

Macro

Principles of Case Management The service delivery is individualized based on comprehensive

assessment that is used to develop a case or service plan The plan is developed in collaboration with the client and

reflects their choices and preferences for the service arrangements being developed

The goal is to empower the client and ensure that they are involved in all aspects of the planning and service arrangement in a dynamic way. (Case Management Society of Australia 2009)

Multiple services are provided to individual in a holistic approach with case manager as main coordination mechanism through multidisciplinary team and case conference

A team or group consisting of representatives from several different professional backgrounds who all have different areas of expertise. (http://society.guardian.co.uk/glossary/p)

A group of professionals from diverse disciplines who come together to provide comprehensive assessment and consultation in abuse cases (http://wiki.answers.com/Q/What_is_the_meaning_of_the_term_multidisciplinary_team#ixzz1UzV0oQFy)

Why a multidisciplinary approach? Deal with complicated problems Provide diverse and overall aspect on particular

issue Provide opportunity to see from different angles/

professional perspectives Allocate work among agencies Reduce duplication of work

Multidisciplinary team meetingA meeting consist of many professionals

vs.Case Conference

A meeting for a particular case

Multi Disciplinary Case Conference (MDCC)

For Child Protection (Abuse) case, MDCC is a forum by which professionals having a major role in

the handling and investigation of a suspected child protection case can share their professional knowledge, information and concern on the child health, development, functioning and his/her parents’/carers’ ability to ensure safety of the child.

Focus on protection and welfare of the child and not prosecution of the abuser.

Analyzes risks and recommends actions to be taken in relation to the welfare planning of the child and his/her family, respecting the statutory obligations of individual members for the case. (from: www.swd.gov.hk/doc/fcw/proc_guidelines/childabuse/Chapter11.pdf)

Objectives of case conference Discussion of the clients history Identification of the clients multi-disciplinary needs Identification of outcomes to be achieved by

members of the team providing services to client Identification of tasks to be undertaken to achieve

outcomes and allocation of tasks to team members Assessment of success or otherwise of previously

identified outcomes (adapted from http://www.gpageelong.

com.au/Our-Services/Medicare/case-conferencing.html)

Tools for CM Bio Psycho Social Assessment Strength Based Assessment Life Plan Contract Plan (Task Plan) Case Conference/ Multidisciplinary Team

meeting Resources mapping for coordination and

referral

Samples of roles of CM for Trafficking victim (US) In addition to serving as a single point of contact, a central case manager can

assess a client's need for services and support; identify, obtain, and coordinate those services for the client; coordinate and manage communications across systems; and serve as a liaison for the client. Other functions of the case manager include: translating for the victim or obtaining translation services; accompanying clients to appointments; assisting/teaching clients to access public transportation; and in some cases, teaching clients basic life skills. Sometimes this includes teaching clients how to use kitchen appliances or how to make a phone call.

Offering reassurance and comfort to clients often occupies much of a case manager's time, but it is essential in building trust and rapport with the client. In fact, many providers and law enforcement representatives note that the case mangers are often the first and sometimes the only person a victim trusts.

From: Case Management and the Victim of Human Trafficking: A Critical Service for Client Success By: Heather J. Clawson and Nicole Dutch , June 2008

Ingredients for Effective CM in Human Trafficking Establishing a hopeful relationship with the client; Assessing client strengths and needs; Developing, in partnership with the client, a service plan to

achieve desired outcomes; Locating, linking, and following up with needed services and

support; Monitoring, coordinating, and adjusting services and supports to

achieve desired outcomes; Providing crisis prevention and intervention services and

support; and Advocating for the client.

Extracted from the NACM Web site, http://www.yournacm.com/definition.html

Benefits of case management in human trafficking cases Victim: helping the victim move toward self-sufficiency, through

educating victims of their rights, helping them understand and navigate through criminal justice, immigration, and human service systems, identifying and making appropriate referrals, assisting victims in accessing services, advocating on behalf of the victim to other providers and agencies, and providing moral and emotional support.

Law Enforcement: helping stabilize the victim to assist in the investigation by providing services and support that are beyond the means and expertise of law enforcement.

Prosecutor: Case Manager as source of stability for the victim, helping translates victim into a more consistent and credible witness.


Challenges and Limitations of CM in Human Trafficking cases Resources limitation – staff : client ratio vs demanding

tasks Availability of services - accessing certain services can

be a challenge in many communities Length of services eligibility – inconsistent with client’s

needs and time require to go through process Access to information - issues of confidentiality are often

identified as barriers to keeping clients informed about their legal case, or medical diagnoses or results

Staff burnout and turnover – demanding work vs low pay


Samples of roles of CM for Trafficking victim (Thailand) Human Trafficking Act: assign competent official who

partially function as case manager for victim of human trafficking (crisis intervention, safety, legal aspect), while coordinate with MSDHS for other social services.

In Thailand, social workers usually act as Case Manager, who look after client and family holistically through need assessment, and services provision (management, coordination, monitor, evaluation, and advocacy) in order to ensure best interest of client.

The effectiveness of any case management program depends upon the availability of high-quality treatment and support services in a given community, the structure and coordination of the service system, and on the ability of an individual or family to pay for care either through private insurance or (more often) through public benefit and entitlement programs.


Concept, process, and technique of CASE MANAGEMENT

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