The ACMA case management process
Case management serves as a means for achieving client wellness and autonomy through advocacy, communication, education, identification of service resources and service facilitation . . .
Case management services are best offered in a climate that allows direct communication between the case manager, the client, and appropriate service personnel, in order to optimize the outcome for all concerned.
~Case Management Society of America (CMSA)
The ACMA case management process is the foundation for all ACMA programs and is based on the Case Management Society of America (CMSA) guidelines (although expanded and tailored to Australian conditions).
Part of the overall needs assessment and referral process, assessing a client’s needs is generally the first stage of your work together. Depending on the model, case managers may not do the initial needs assessment; instead, they may only meet with clients after it has been determined that the clients are eligible for case management. Generally, at that point, the case manager would likely conduct a more comprehensive assessment of client needs.
According to the National Case Management network, “Assessment is a dynamic and ongoing collaborative process that actively involves the client and others to secure information in a timely manner and to identify the client’s values, goals, functional and cognitive capacity, strengths, abilities, preferences, resources, supports, and needs. Assessment must be managed from the beginning with the end in mind and understanding eligibility, to being observant and taking a holistic approach. It is important to go beyond the obvious – to ask probing questions and use clarifying statements to ensure that the client’s needs are fully assessed (e.g., if a client mentions recovering from a car accident, an effective needs assessment would surface the employment-related barriers resulting from that accident, such as daily pain, loss of concentration, or panic attacks). Other components of a needs assessment and referral are (e.g., understanding mandate, building a working alliance, conceptualizing the case).
Case managers may use in-house or customized forms for conducting preliminary, as well as comprehensive, needs assessments; such forms are used to document the assessment process and, later, anchor the client’s goals and action plan. It is important, however, that case managers do not overly rely on these forms; instead, they should have the skills to know when to move beyond the form in order to ensure an adequate assessment of client needs has been completed.
In many funded programs, there can be some pressure to ensure the number of clients served is consistently reaching, or even exceeding, expectations. This can, in turn, result in programs accepting clients who are not employment-ready (where “ready for work” is mandatory for the intervention) or who fail, in some other way, to meet minimum requirements (e.g., language level, living within a specific geographical region). When case managers feel pressured to accept clients who don’t adequately fit program mandates, it would be a good time to consult with their supervisors or managers about how to navigate the disconnect.
There are formal and informal assessment tools/tests that might form part of the needs assessment process. The use of assessment tools is an area of speciality and not all case managers will have the competency or qualifications to administer some types of formal career/vocational assessment tools. However, the sector does have comprehensive training available in the use of assessment tools/tests.
Beyond career/vocational assessment tools, case managers may work with clients who need specialized assessments (e.g., educational, functional, medical, psychological). They should, therefore, be aware of who in the region is able to offer specialized assessment services. Referrals to these types of services should only be done when there is a clear need that can be supported by a strong rationale. Specialized assessments cannot be used as a “holding activity” to keep the client busy while waiting for a funding decision.
When case managers receive detailed assessment reports, they need to be able to integrate that information into their work with clients which may require additional training and/or consultation. The information cannot just be placed in the file without action. Of course, it is also important to understand that some assessment reports are not well-written; in these instances, the problem lies not with the case manager but with the assessment specialist. Case managers, and the agencies that employ them, therefore need to be good consumers of specialized services, understanding how to choose who to work with and evaluate his/her areas of expertise.
The case manager’s theoretical orientation, prior experiences, and personal biases will all influence his or her perception and understanding of the client’s unique situation. This perception/understanding is sometimes referred to as “case conceptualization.” Delving deeply into career development theories and personal biases is beyond the scope of this guide.
It is absolutely essential for case managers to be aware of the impact their theoretical perspectives, and personal biases may have on their work with clients. da Vinci once said, “He who loves practice without theory is like the sailor who boards ship without a rudder and compass and never knows where he may cast.” Theory is the foundation on which work with clients can begin; each theoretical orientation can help case managers view the client’s career story through a different lens allowing for an enhanced analysis of need.
For example, considering person-environment fit perspectives can help case managers identify the type of work and/or work environment the client is most suited for. Conversely, using a developmental perspective can help case managers identify what stage of development the client’s career may be in, as well as what stage the client believes he or she should be in. Utilizing a systems theory, case managers can help identify the various career influences (e.g., environmental, economic, social) impacting the client’s career.
Perhaps most importantly, case conceptualization, done well, will help case managers sense when to seek consultation with a colleague or supervisor and when to gently push back or question a client. For example, effective case conceptualization can help surface the possibility of mental health issues, supporting the case manager in identifying what work the client can reasonably succeed at now to allow time and space for mental and emotional healing.
After opportunities and options have been explored and discussed, case managers will guide clients through a decision-making process. It may be tempting to jump into this stage prematurely, perhaps due to a perceived pressure to develop an action plan. However, successful case managers provide efficient, cost-effective case management support while building in reasonable timelines for the client to gather sufficient information to make informed decisions. Bear in mind that, although the client may decide to pursue any number of options, to be eligible for government-funded services the decision will need to fit within very specific guidelines and be based on factual research, demonstrated likelihood of employment results, and the nebulous concept of “fairness.”
Some decision-making strategies include:
- Using “emergent” decisions (i.e., after research, a “right” choice seems to emerge)
- Normalizing ambiguity and doubt
- Leaving open the option to change
- Making a series of small decisions, rather than one big one
- Introducing formal problem-solving techniques
- Acknowledging that “every decision is a career decision
COLLABORATIVE ACTION PLANNING
Case managers are often tasked with helping clients set short-, mid-, and long-term goals and develop an action plan to facilitate reaching those goals. Perhaps most importantly, case managers need to remember that action planning can be an emergent process. In most instances, clients will be expected to develop an action plan during their first meeting with a case manager. However, this action plan may be revised multiple times as clients explore opportunities and connect with the community.
Through their community connections and thorough understanding of available supports, case managers can help link clients to resources they’ll need to achieve their goals and finalize their action plans. Case managers, along with their clients, can also identify various strategic client supports. These may include specific tasks that are anchored in the broad plan (e.g., informational interviewing, researching training institutions) as well as other activities that will help a client stay on task but may not be specifically outlined in the plan (e.g., scheduling regular walk breaks, getting sufficient rest).
Developing a solid action plan will likely involve stakeholders beyond the case manager and client (e.g., career counsellors/coaches, family members, job developers, funders, educational institutions, and employers). Case managers play a key role in coordinating stakeholder input into action planning that maximizing the client’s chance of success. This could include bringing interdisciplinary teams together to case conference or facilitating discussions across stakeholders in order to better serve and support clients. Case managers may also need to skillfully manage collaborative processes to prevent and/or manage and resolve conflicts.
Case managers will also need to document activities and communication, as well as supports and concerns raised by stakeholders. This documentation will help case managers negotiate a plan with the final decision maker (e.g., funder).
From a case management perspective, as a plan is being finalized, it needs to be organized into specific, measurable, achievable, time-lined steps. Some strategies include:
- Providing guidance and models for goal-setting and action planning
- Asking for clarification and further explanation if the steps seem vague or unrealistic
- Helping the client visualize how short-term action steps fit with long-term plans
- Working backwards – beginning with long term goals, then specifying what will happen “just before,” then backing up to immediate steps with specific timelines, back-up plans, and daily “to-do” lists
- Seriously considering financial implications of the plan (i.e., needs/resources)
The Canadian Standards of Practice for Case Management consider case management as a purposeful activity; interventions need to address the specific, and immediate, needs of clients. Sometimes, however, the most relevant interventions may not be offered by the agency a case manager works for; instead, the best option may be offered by another service provider. In a systems-driven model, where funding is often tied to services provided, it can seem counter-intuitive to refer to an external service provider as this can result in reduced fees for their own organization. However, ethical case management requires prioritizing the needs of the client above the needs of the organization. As such, case managers are encouraged to remain aware of the services offered not only by their own agencies but by other organizations throughout the region.
Further, every referral must be to services deemed necessary and appropriate. To be necessary, a service should be required (i.e., needed by the client); to be appropriate, a service must take into account the client’s specific circumstances.
Only after a strong working alliance has been established, needs have been assessed, and goals have been set, can case managers begin to work on exploring opportunities and options. It can be easy to jump into this stage too soon, especially given the time and resource constraints case managers may be working within. Once a working relationship and clear goals are in place, however, simple strategies for exploration include:
- Discussing appropriate funding or program alternatives that meet the client’s needs and eligibility
- Introducing the client to work options that may include short-term contracts, self-employment, multi-tracking (i.e., combining two or more part-time roles)
- Introducing the client to reference materials and community resources
- Introducing research techniques such as informational interviewing and job-shadowing; the Career Research Worksheet
- Providing forms or tip sheets to guide the client’s independent research
- Referring to another service provider for more comprehensive career decision-making support
MEASURING AND EVALUATING PROGRESS / MAKING ADJUSTMENTS
Case managers have a significant responsibility to monitor their clients’ progress, determine and report results, modify the action plan as required, and eventually close the client file. To do this effectively requires skills in conducting surveys and phone interviews, efficiently collecting data, and keeping comprehensive records. Case managers will also need to use their assessment and counselling skills at this stage to determine if the client requires further support and/or a renewed action plan. Many case managers struggle with this part of their mandate, wondering:
- How often to attempt to contact the client
- How to efficiently track client progress while maintaining confidentiality
- What to do when clients don’t respond to phone messages or can no longer be contacted
Although each of these concerns needs to be addressed and resolved at a local level, some experienced case managers have utilized strategies such as calling at irregular hours (evenings or weekends) or on rainy days, sending letters with prepaid reply cards inside, or supplying the client with dated postcards to return by mail at pre-arranged times. Technology can also assist at this stage, including connecting with clients through email, text messaging, and Facebook messaging. Care must always be taken, however, when using any type of social media. Case managers need to understand the various ethical issues (e.g., “friending” clients, confidentiality) that may be present and ensure adherence to organizational policies.
As follow-up occurs, case managers are expected to monitor and evaluate progress to ensure the action plan still meets the client’s needs. If the plan requires adjustment, case managers need to document an alternate plan and a rationale for recommending it. It is important to consider both individual characteristics (e.g., client motivation) and systemic factors (e.g., denied funding, family changes) that may be impacting success.
In performance-based models, measuring and evaluating client progress is a crucial component of effective case management as, within such models, funding may not be released to the agency until the client achieves certain outcomes (e.g., employment).
TRANSITION AND CLOSING THE CASE
At this stage, case managers, along with clients and key stakeholders, decide whether a client’s case file can be closed or if, for some reason, a transition to another case manager and/or service provider is required.
Case managers are encouraged to work within a process that supports eventual disengagement and facilitates client independence and autonomy (i.e., lifelong career management). It is reasonable and respectful to give clients sufficient reminders of when and why their access to services will end and their file will be closed. It is also important to inform clients about how their files can be re-opened if additional services are required. When case files are closed, notes should be up-to-date, clearly indicating the client’s outcome(s) and any recommended next steps.
The Case Management Society of America (2010) noted that cases should be terminated “based upon established case closure guidelines”. As these could be different for each setting, case managers need to be aware of guidelines for case closure as well as documentation and reporting requirements.
Some clients may need additional time to fully attach to employment; therefore, it is important not to close client files prematurely. However, cases can’t be kept open when clients no longer need services. Avoiding case closure can create client dependency and can be an ethical issue (i.e., what work isn’t being done or what clients aren’t being served when working with clients who no longer need support?). Case closure is often linked to key metrics with funders. Closing a case too soon or leaving it open too long may impact how funders measure the outcome and impact of services.
Note: ACMA's (unlimited length) programs are not CLOSED until after the participant completes a full 12 months of employment in their new job or promotion position, or a satisfactory conclusion is reached when providing Employee Assitance Program (EAP).
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