Some Thoughts on Case Management

1. A basic dilemma of case management is how to help and empower at the same time. On the one hand, the caseworker wants to use his/her skills and resources to help the client. On the other hand, the client needs to solve his/her own problems to develop a sense of mastery, self-esteem, and confidence.  The worker must balance these two goals.
2. Often, workers must deal with a large caseload that leaves little time to think about how to best serve their clients or to make detailed inquiries to find useful resources.  Every case-worker must set up a work routine that insures that all cases get a fair share of the worker’s attention and that none “fall between the cracks” of an overburdened system.
3. Case-workers need to be active listeners, paying close attention to what clients say about their problems and possible solutions.  Having an attentive listener does not solve problems, but it does provide some relief from internal pressure.  However, a caseworker is not a counselor or a therapist and sometimes it is wise to make a referral.
4. Sometimes a caseworker may experience a conflict between the needs of a client and the goals and mission of the agency that employs him/her.  This is a difficult issue that does not have a simple answer.  Workers usually want to help their clients, but at the same time they should be loyal to and abide by the procedures of their agency.  A worker may need the help of a more experienced individual to sort through this issue.
5. Paperwork is a constant burden and it must be done, not only for the internal records of the agency, but also to meet legal requirements.  Workers should have a regular routine for doing this part of their job.
6. Case-workers need to maintain strong networks of contacts so that they can get information as well as provide referrals.  Modern society is very bureaucratic and help may be literally just around the corner, but if the client is unaware of it, it is useless.
7. Clients may have difficulty asking for something they need.  A caseworker can act as a strong advocate for his/her client and help the client to get what is needed.  At the same time, the worker must be wary of infantilizing the client (see #1 above).
8. Most people have several problems or issues at the same time.  The caseworker can assist the client to develop a network of support to address various issues.
9. Any help is useful, but staying with a client over time provides a better chance of solving long-range problems.
10. Beware of caseworker burnout. Take care of yourself

Case Management Exercise

            The purpose of this exercise is to simulate as closely as possible a case management situation.  In this simulation, you are to take the role of a caseworker and describe all the steps you would take to provide what the families in this situation need.  There are three basic stages.  The first is what you would do before you meet your clients, the second is the process through which you interact with the clients, and the third is focused on referrals and resources that you are able to access to help the client(s).  A possible fourth stage might be a follow up interview after the intervention has taken place.

Phase I: Preliminary

A.    Fact gathering

What do you already know about the case from the written records you have received?  What do you need to know to make an effective intervention in this case?  This might lead you to think of some questions you will ask the client at the preliminary interview.  Perhaps you will make some preliminary inquiries to see what resources might be available to address an issue of this type.

1. Preparatory Empathy

How would you feel if you were in the client’s shoes?  It is of course impossible to predict the emotions of others, but you might consider the range of possibilities.  If an individual is facing a particular problem or dilemma, how might s/he feel?

Phase II: Interaction

1. You are now in a face-to-face interview with your client. How will you help the client to sort out the issues facing him/her?

1. People who are working with a caseworker usually have a serious problem. It may be a long-term issue or an immediate crisis.  Often, they require reassurance or emotional support.  How will you provide some form of reassurance or support?

1. The caseworker cannot relate to all the issues a client may be dealing with. It is helpful to anticipate those issues a client may define as critical.  Perhaps the client is so overwhelmed that s/he has not set priorities.  In that case, helping the client to figure out what requires their immediate attention may be extremely helpful.  If a client does not mention an issue that you think might be important, you can be prepared to bring it up in an open and nonjudgmental way.

1. Your client needs to be engaged in a process of defining the issues, setting goals, and developing a plan of action. The action must be manageable and realistic.  The client needs to feel comfortable with the plan and feel that s/he can do what the plan calls for.  The plan should include clearly stated goals and a time frame including target dates for specific actions.  The plan should help the client to feel more in control of his/her life, rather than being an additional burdensome requirement.

Phase III: Referrals and Recommendations

A.  What type of human service agency could help your client?  You may make a number of referrals to specific agencies that can supply useful services.  The referral process should be thoughtful and creative.  Does your client need health care, childcare, training, employment, counseling, education, and recreation?  What agencies can supply these needs?  Are there steps a client can take without your assistance, e.g. sign up for a course in a local high school?  The most useful referrals are specific and complete.

Phase IV: Follow up

1. You will probably want to meet with your client after some time has elapsed. Has the client implemented the plan?  Did it help the client progress toward his/her goals?  Does the plan need to be modified or extended?  Were the referrals helpful?  Is the client feeling more hopeful?  Are there new problems or issues?  What new long-range goals has the client formulated

Case Management Scenarios

Scenario # 1

Background:  Mr. and Mrs. Smith is a married couple in their late forties.  Mr. Smith worked as an electronics technician and Mrs. Smith was a housewife.  Occasionally, she did some part-time work in the neighborhood.  They are both high school graduates and Mr. Smith had an additional eighteen months of training after high school to qualify for his position.  They have two children, a son and a daughter.  Both of the children are married and both live within a fifty-mile radius of the Smiths.  The Smiths own their home, but there are still mortgage payments, taxes, and upkeep.  The Smiths were never rich, but they lived in modest comfort on Mr. Smith’s salary.

Issue:  Mr. Smith has cancer.  His illness can no longer be controlled by surgery or medical treatment.  His doctors estimate that he has about one year to live.  He is now living at home and his wife is caring for him.  However, the problem of pain management and comfort are an increasing concern.  Mr. Smith is depressed about his illness and angry about his fate.  He worries about his wife’s future and whether or not she will be able to take care of herself and pay the bills.  He worries that she will lose the house.  Mrs. Smith cannot even imagine life without her husband.  They have been together since their late teens.  She fears the loneliness she sees in the future and the loss of a loved partner.  How can you help them address both the emotional and practical issues that Mr. Smith’s illness raise?

Scenario #2

Background:  Ms. Brown is a woman in her late thirties who is the mother of a fourteen-year-old son.  She and her husband separated about two years ago and her husband plays a diminishing role in her son Christopher’s life.  At the time of her husband’s departure, Ms. Brown was particularly worried about how she would support herself and her son.  However, she brushed up on her secretarial skills and considers herself fortunate to have gotten a good job with benefits and good pay as a legal secretary.  She appreciates her salary and the medical coverage she gets for herself and her son, but she is frequently called on to work overtime and often does not arrive home until the late evening.

Issue:  Christopher is becoming increasingly difficult and rebellious.  His grades in school have gone down and he is often in trouble at school.  Ms. Brown fears that he has been cutting class and hanging out with other students who are engaged in questionable activities.  He has also been increasingly defiant at home and often becomes angry and storms out of the house.  Ms. Brown tries to keep track of his homework, but this is difficult because she frequently comes home late in the evening.  Ms. Brown is wondering whether or not she can exercise enough control over her son to keep him from getting into serious trouble.  She is grateful for her well-paid job, but it does demand long hours of work.  How can Ms. Brown and Christopher work through their feelings about the departure of Mr. Brown, function as a family in spite of the husband and father’s absence, and help Christopher to find ways to enjoy a healthy and productive adolescence?

Scenario # 3

Background:  Janet Jones is twenty-seven years old.  She lives in Boston in a small apartment with her husband of two years. After years of working for others, she is in the process of starting her new business a wedding photographer.  While her business is in the upstart phase, she knows that money will be tight.  With husband’s income, she is still able to make rent and pay her bills. During the last six months, her relationship with her husband has become increasingly controlling.

Issue:  Although he has never become physically violent, Mr. Jones has exhibited increasingly controlling behavior. Prior to their marriage, Mr. Jones assumed responsibility for Ms. Jones’ cell phone bill and has recently started to scrutinize her calls and data use.  Additionally, with the blending of their incomes, Mr. Jones has been monitoring her general spending and putting restrictions on expenses that were otherwise routine.  In the last two weeks, Mr. Jones has started to refuse to participate in his wife’s family events and activities, of whom he has become increasingly critical. This is putting stress on Janet, and in order to avoid conflict, she is withdrawing from her family. She is curious about how other people in her position deal with these issue.  She is afraid that this situation could escalate, and is worried that she will not be able to make it on her own.