Definition, Principles, skills required, benefits for case managers and clients, useful proformas, limitations, case management practice approach, social theories relevant to case management
This page has three sections:
Background Material that provides the context for the topic
A suggested Practice Approach
A list of Supporting Material / References
Feedback welcome!
Background Material
An introductory comment
The term ‘case management’ suggests that power and expertise reside with the mental health practitioner in the relationship, diminishing the consumer as a person with expertise in her or his own right and intentions of collaborative working. Alternative terms are becoming more common: key worker, service coordinator, and care coordinator. Other terms have also been suggested—recovery guide or coach—as more reflective of the role that mental health professionals might undertake in recovery-oriented alternatives to case management practice (Fossey, 2012). While ‘case management’ is used throughout this discussion, it is important to ensure that the process is client-driven and client-focused.
Definition
Case management is ongoing in nature (Ross et al., 2011). In case management, an individual or a small team is responsible for navigating the client through a complex process in the most efficient, effective, and acceptable way. The focus of the case management model is on a more comprehensive coordination of services across the continuum of care, as viewed from a client perspective. Care coordination is determined not only by the client’s medical needs but also by the financial, psychological, and social circumstances of the client (Uittenbroek et al., 2018). Kuyini (2014) elaborates. Case management is:
Client driven and client-focused
Requires client commitment
Depends on the client's wishes
Collaborative—with the client and other services providers
Aimed at empowering clients
Either undertaken by one worker or a team approach.
Principles of Good Practice Case Management
The ten principles that follow are drawn from Mission Australia’s (2020) case management approach. Some are mentioned by other authors as indicated.
Client Centred Clients actively participate in and are at the centre of decision making and support planning (Uittenbroek et al., 2018).
Holistic and Strengths-based A holistic assessment and planning approach considers all life domains experienced by an individual, in terms of their strengths, needs, goals and supports needed to achieve these.
Goal Oriented Clients are encouraged to create realistic and achievable SMART goals and empowered to develop the self-sufficiency and independence to achieve these goals (Uittenbroek et al., 2018).
Dynamic and Flexible The case management approach should be dynamic and flexible. The case plan should be a living document, regularly reviewed with clients and their support network, and changed as necessary (Hudon et al., 2017; Uittenbroek et al., 2018).
Collaborative Current support networks, together with agencies and professionals that can be accessed for support, are identified and included in the case plan (Hudon, et al., 2017; Uittenbroek et al., 2018).
Culturally and Socially Safe Exploring how culture impacts on engagement and access to community resources is an important aspect of attending to cultural and social safety.
Evidence Informed Practitioner and client expertise, as well as the best available research, form the basis of the case management relationship.
The Right to Privacy and Consent Adherence to privacy and consent legislation is necessary.
Child and Youth Safe A child safe culture and environment is promoted and maintained.
Evaluation and Continuous Improvement Evaluation of systems, processes and outcomes is a continuous process leading to improvement in effectiveness and efficiency of programs.
Skills Required by Case Managers
Uittenbroek et al. (2018) suggest case managers need:
Knowledge and experience in providing care and support to clients
Client-based communication and collaboration skills
Skill in motivating clients to adopt self-management and independence
Observational skills around the person and environment
Knowledge of the skills available in the health community to support the client
Ability to communicate with and coordinate different professionals to achieve the best outcomes for the patient
Ross et al. (2011) suggest case managers require skills in four key areas:
1. The ability and willingness to oversee and be accountable for the whole process.
2. The skill to clarify roles, responsibilities and boundaries for all involved.
3. The ability to build effective relationships with
a. Patients—building an empowering relationship to promote independence
b. General practitioners—building a good, collaborative working relationships
c. Specialists and hospital staff.
4. Miscellaneous skills to enable the case manager to:
a. Develop good relationships and communicate with a range of people
b. Solve problems by drawing on various service providers and networks
c. Advocate for clients
d. Ensure timely access to medication
e. Access training, support and mentoring
Benefits for the Case Manager
Kuyini (2014) suggests case management:
Increases consistency of service quality and outcomes
Allows for sharing of client burden and resources
Facilitates the establishment of uniform processes for clients with similar needs
Promotes shared responsibility for client outcomes: it takes some of the responsibility from the worker and gives it to the client
Reduces worker burnout
Gives workers opportunity to share ideas and receive feedback and peer support about direction of work to meet client needs
Increases the social worker’s network interactions and resources, which help to meet diverse needs
Benefits for the Client
Ross et al. (2011), Kuyini (2014) and Uittenbroek et al. (2018) the benefits of case management for the client include:
Increased access to different services
Increased network of workers and interactions
Increased involvement in decision making and service provision
Improved quality of service
Reductions in hospital utilisation, length of stay and admissions to long-term care
Positive impact on health outcomes such as quality of life, independence, functionality and general wellbeing
Case management theories and practice approaches
Johnson & Deegan (2012) list a number of theories and practice approaches that are relevant when supporting clients as a case manager.
Attachment theory Attachment theory argues that the quality of attachment in childhood and adolescent relationships will have a profound impact on adult relationships and emotional wellbeing. Poor attachment in childhood can lead to more insecure and less trusting adults. Positive attachment experiences can result in greater confidence and social skills.
Developmental theory A developmental approach involves adjusting supports to match the developmental stage of the client. It generally applies to children and adolescents but also, in some circumstances, to adults. Developmental theory considers five main areas of development: cognitive, social and emotional, speech and language, fine motor skill and gross motor skill development.
Social inclusion This involves building a fairer Australia by targeting the problems that keep people in disadvantage and prevent them from participating fully in Australian life.
Strengths-based practice This approach focuses on the strengths that a client has rather than focusing on the deficits or things that they are lacking. The client is seen as the expert on themselves. A case manager applies strengths-based practice by:
establishing and keeping a client focus – listening to the client’s preferred outcomes
identifying, acknowledging and building on the client’s existing strengths, achievements and resources
establishing and maintaining a partnership approach with the client and other services involved
ensuring solutions are decided by the client and caseworker working together collaboratively
Solution-focused therapy Solution focused therapy is a strengths-based intervention. It assumes clients have the knowledge and solutions to solve their own problems and these can be uncovered by using certain questions. For example, looking at when life is ‘slightly better’ and what is different then, identifying ‘exceptions’ to the current situation, asking the ‘miracle question’, and using ‘scaling questions’.
A resilience approach The resilience approach tries to identify risk factors and build protective factors so that clients are better able to face and respond to adversity within their own resources. Protective factors are generally seen as internal strengths/skills and external community networks of support.
Trauma-informed care and practice Trauma-informed care is based on the idea that a client’s past exposure to trauma can have an (unconscious at times) impact on their behavioural and psychological responses and may impair their cognitive or emotional functioning. Many clients have experienced a range of traumas. Caseworkers can help clients identify links to past trauma and seek appropriate care for the client.
Evidence-based practice This is an approach to decision making which is transparent and accountable. It is based on current evidence about the effects of particular interventions on the welfare of individuals, groups and communities. Evidence-based practice forms the basis for decision making about appropriate care of clients.
Limitations of Case Management
Its cost-effectiveness is sometimes disputed (Uittenbroek et al., 2018).
Case managers in rural areas must negotiate workforce shortages, lack of services, poor infrastructure, inadequate funding, and lack of transport, as well as high levels of distrust and fear of stigma. Successful rural case management practice needs to be closely aligned with the unique strengths, needs, and culture of the relevant rural communities (Dellemain & Warburton, 2013).
Case management is associated with a move from supply-side funding to demand-side funding, where resources are tied to individuals rather than to services. This creates a tension between agency-centred and user-centred objectives (O’Connor et al., 2008).
The way that staff carry out case management practice is largely moulded and constrained by contemporary social policies, such as those informed by neoliberalism and new public management. This results in a welfare sector dominated by: a quasi- market framework that emphasises funding competition; a focus on effectiveness, cost efficiency, and client outcomes; and positioning the responsibility for risk in the hands of individuals and families. Consequently, case managers are asked to “do more with less”, which can affect case management practice in terms of increased caseloads and reduced interagency collaboration as services compete over who may claim the client for government outcome requirements. Brokerage approaches, top-down models, and funder-driven requirements have started to dominate service delivery. This has resulted in an under-emphasis on the time-intensive nature of building a relationship that is critical to effective case management (Davidson et al., 2018).
Proformas that may be useful
Johnson and Deegan (2012) provide a number of form that case managers can adapt as necessary. These are located in the appendices in their case management resource kit at https://www.housing.nsw.gov.au/__data/assets/pdf_file/0020/325226/SHSCMRK.pdf
1. Rights and responsibilities for clients
2. Sample supervision record
3. Sample supervision contract
4. Sample code of conduct
5. SHS client risk assessment tool
6. SHS client risk assessment guidelines
7. Client consent form
8. Case assessment report
9. Case planning tools
10. SMART goals
11. Sample case plan
12. Strengths-based sample questions for caseworkers to use with clients
13. Client self-reflection
14. Sample client feedback form
15. Caseworker’s guide for reflective practice
16. Example case plan
17. Sample memorandum of understanding (MOU)
Practice Approach
Central themes of case management
The following themes are contained in the material above and are central to a successful case management approach.
Client commitment is required
The process is client driven and focused—consider medical, financial, psychological and social circumstances
Empowerment of clients is central; a strength-based approach aiming at self-sufficiency and independence underpins case management
Coordination of services across a continuum of care is central
Case management should be a collaborative process between client and other service providers; case management requires skills in promoting collaboration.
A flexible case plan, devised by the client and participating professionals, is central to success.
Ability to build relationships with key people across organisations is essential
The case manager should be knowledgeable in a variety of practice approaches and management theories.
A possible practice approach
The following is a summary of the Mission Australia (2020) case management approach. Information from other sources is acknowledged.
1. Referral In
A person who self-refers or who is referred to a service or worker is screened against acceptance criteria. It they meet the criteria they are included in entry and eligibility assessment. If they cannot be accommodated, clear explanations are offered, and all possible efforts are made to refer them on to an alternative service. This should all occur in a timely manner.
After acceptance each client becomes part of a case manager’s load with caseloads regularly reviewed to ensure work allocation is manageable.
2. Intake and Engagement
Intake processes include identifying client needs, gaining client consent to collect, use, share and store personal information, assessing risk, explaining rights and responsibilities of a client including involvement in case planning and service delivery. Limitations to the service should be explained as well as the case manager’s role.
3. Strengths and Needs Assessment
Assessment involves an ongoing collaborative process of observation, information gathering, reflection and engagement with the client, and analysis of information collected. Case managers work collaboratively with the client to build a relationship and gather information to holistically assess strengths, needs and biopsychosocial issues. All assessments are client-centred, strengths-based and guided by the client’s views and choices.
Most people requiring case management have complex health and social care needs, so it is important that assessment is comprehensive and also includes the health and wellbeing of any carers involved. Issues that may be covered include:
clinical background and current health status
current level of mobility
current ability and needs in terms of activities of daily living
current level of cognitive functioning
current formal care arrangements
current informal care arrangements
social history
physical care needs
medication review
social care needs
wider needs, including housing, welfare, employment and education (Ross et al., 2011).
4. Case Planning
Case planning refers to the process of developing, in collaboration with the client, the strategies to be used to address the client’s presenting issues and needs and achieve their short- and long-term goals. Collaborative planning with the client helps them to build self-reliance and encourages them to undertake an active role in achieving their goals. Case planning includes:
Identify and prioritise short- and long-term goals with the client
Determine strategies and actions tailored to the client to achieve these goals
Build in opportunities for, and indicators of, success
Clarify roles of case manager, client and any other stakeholders and timeframes
Identify other organisations and supports for referrals out
Coordinate resources and services as needed
Each client receives a copy of their case plan and all subsequent reviews in a format and language that is meaningful for them. Each document is signed by the case manager and client, where possible.
5. Implementation
Case Plan implementation involves conscious, deliberate and purposeful activity with the client, which is outcomes focused and aimed at achieving the case plan goals. It requires the case manager engaging and working with the client and all stakeholders ensuring the client’s views, choices and right to self-determination are respected.
Care co-ordination is the essence of case management. It can include medication management, providing support to enable self-care (e.g. general health advice), advocacy and negotiation for access to services and equipment, psychosocial support, and monitoring and review of the case plan (Ross et al., 2011).
It is important to work within the timeframes of the case plan and length of service delivery, and to be proactive and flexible if an activity isn’t working. Where required, the case manager discusses any difficulties with the client and gains their input on possible changes or solutions. Where necessary, external support options and resources are sourced to support the client to achieve their goals.
Always work from a strengths-based, client-led perspective.
6. Referrals Out
A strengths and needs assessment and case plan may reveal life domains where the client seeks support that is outside the service’s scope. The case plan should identify organisations (such as agencies and services) and individuals (such as practitioners and professionals) and community resources (such as social groups) that may be accessed for support. To facilitate successful referrals out the case manager should:
Develop collaborative relationships with relevant organisations and individuals in the community
Provide referrals to other organisations or individuals as needed to support the client to reach their goals
Advocate on behalf of the client
Support the client to access those organisations or individuals
7. Monitoring and Review
Case Plans, risk assessments and support strategies are regularly reviewed with the client, and as relevant, third parties, including other service providers. Case plan reviews evaluate the effectiveness of supports, resources and services so far mobilised towards meeting the client’s goals. Review processes focus on:
Celebrating client achievements and milestones
Reviewing support strategies to meet changing needs, goals and changes in wellbeing
Reviewing assessments of client and staff risk when required due to changes in circumstances
Identifying emerging or ongoing personal and social barriers to achievement
Identifying alternate or new services and supports to benefit the individual
A case plan review is also a chance to begin to work towards exit planning once the client has made significant progress.
8. Transition or Exit
Exit planning is the process of helping a client prepare to maintain their progress without the case manager’s support. Service exit is discussed at the assessment and review stages and at each stage there is discussion around the aim of independence from the service when the client’s goals have been achieved and/or the available support timeframe has ended. Exit planning includes:
Provide recognition of client’s achievements
Identify any supports needed through the exit process
Evaluate progress and outcomes
Gather feedback from the client
Identify opportunities for continuous improvement
After exiting, it is regarded as best practice to contact the client to ask how they are going and if they would like assistance to connect with support in the community. It may also include following up on referrals made for the client prior to exit to identify any issues with engagement. Where ‘follow up’ is offered, it should be tailored according to each client’s ongoing needs and choices.
Supporting Material / References
(Available on request)
Community Access, Department of Human Services, NSW. (2010). Case management practice guide: 7 phases of case management. Retrieved from http://www.abistafftraining.info/pdf/case_management_practice_guide_7_phases_march2010.pdf
Davidson, D., Marston, G., Mays, J., & Johnson-Abdelmalik, J. (2018). Role of relational case management in transitioning from poverty. Australian Social Work, 71(1). https://doi.org/10.1080/0312407X.2017.1376102
Dellemain, J., & Warburton, J. (2013). Case management in rural Australia: Arguments for improved practice understandings. Australian Social Work, 66(2), 297-310. https://doi.org/10.1080/0312407X.2012.675345
Dorsett, P., & Fronek, P. (2009). Case manager standards and skills development. In E. Moore (ed.), Case management for community practice. South Melbourne, Victoria: Oxford University Press, pp. 248-272.
Fossey, E. (2012). Case management: Introduction. In G. Meadows, J. Farhall., E. Fossey, M. Grigg F. McDermott, & B. Singh (Eds.), Mental health in Australia: Collaborative community practice (3rd ed., pp. 429-430). Oxford University Press.
Green, D. M., & Ellis, S. (2017). Proactive case management: Social work active engagement revisited. Journal of Sociology and Social Work, 5(1), 10-16. https://doi.org/10.15640/jssw.v5n1a2
Hudon C., Chouinard M-C., Lambert M., Diadiou, F., Bouliane, D., & Beaudin, J. (2017). Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review. BMJ Open,7(e017762). doi:10.1136/ bmjopen-2017-017762
Johnson, P., & Deegan, D. (2012). Specialist homelessness services case management resource kit. Retrieved from https://www.housing.nsw.gov.au/__data/assets/pdf_file/0020/325226/SHSCMRK.pdf
Kuyini, B. (2014). Issues in case management. Lecture given at University of New England, Armidale, on 11th August 2014.
Mission Australia. (2020). National case management approach. Retrieved from https://www.missionaustralia.com.au/documents/1303-national-case-management-approach
NSW Health. (2020). Case Management. Retrieved from https://www.health.nsw.gov.au/adahps/Pages/case-management.aspx
O’Connor, I., Wilson, J., Setterlund, D., & Hughes, M. (2008). Social work and human service practice (5th ed.). Frenchs Forest, Australia: Pearson Longman.
Ross, S., Curry, N., & Goodwin, N. (2011). Case management: What it is and how it can best be implemented. The King’s Fund. Retrieved from https://www.kingsfund.org.uk/publications/case-management
Uittenbroek, R.J., van der Mei, S.F., Slotman, K., Reijneveld, S.A., & Wynia, K. (2018) Experiences of case managers in providing person-centered and integrated care based on the Chronic Care Model: A qualitative study on Embrace. PLoS ONE 13(11): e0207109. https://doi.org/10.1371/journal. pone.0207109