Case Management

Policy, practice and professional business

Di Gursansky, Judy Harvey, Rosemary Kennedy

• Publisher: Routledge
• Year: 2020
• Topic: Social Sciences
• eBook ISBN:
  9781000247145
• Subtopic: Management
• Index: Social Sciences

A 'tour de force' that integrates all of the major theoretical arguments and issues and empirical realities that pertain to case management and its diversity into one text that enables a reader to grasp the major aspects of case management practice.It is an important addition to the case management literature and it has international significance.

Professor David P. Moxley, School of Social Work, Wayne State University

This is by far the best introduction to case management that is currently available in the literature.

Associate Professor Peter Camilleri, School of Social Work, Australian Catholic University

The sophisticated understanding of the complexity of case management and the recognition of the contested and dynamic value orientations that underlie case management practice in various settings is indeed refreshing.

Professor Judith M. Parker AM, School of Postgraduate Nursing, University of Melbourne

Case management has become synonymous with service delivery in health and the human services internationally. It is used across diverse organisational settings and with different professional and client groups. Yet despite its predominance, case management remains elusive and chameleon-like in character.

This book goes beyond the prevailing case management rhetoric to challenge preconceptions, offer strategies for practice and explore issues of professional identity and development.

PART I CASE MANAGEMENT AS POLICY

CHAPTER 1 THE DEVELOPMENT OF CASE MANAGEMENT

In a recent text on case management in the human services, Austin and McClelland (1996, p. 1) argue that the case management approach has become all-pervasive in service delivery. They echo the Cole Porter refrain, ‘everybody’s doing it’, to highlight the breadth of its application. Many other writers endorse the view that case management has become a preferred service delivery approach in the human services and health sectors, attesting to its dominance and adaptability across diverse settings (e.g. Rose 1992b; Moxley 1997; Woodside and McClam 1998; Holt 2000; Huber 2000). Indeed, case management was the ‘buzz word’ of the 1990s (Netting 1992, p. 160) and its currency is being maintained at the start of the new millennium.

Despite the continuing popularity of case management as a vehicle for service delivery, the debates about what it is, who needs it and under what conditions it is best provided are recurring themes in the literature and on the international conference circuits. The term ‘case management’ evokes a sense of understanding that is more elusive than is generally acknowledged. There is a perception of shared wisdom about case management that permeates the discourses and distracts us from the level of critical analysis that is sorely needed to develop knowledge and practice. Without deconstructing or teasing apart the ideas about case management, we do not establish precise knowledge about the various manifestations of the approach in diverse practice settings. What is, or is not, identified as case management is often determined by the commentator’s own position in the field. For example, the community care practitioner may see little common ground with the practice of case management in a prison environment, in managed care or case flow management in court administrations. However, from each of these settings, commentators would claim authority to speak about case management and its practice.

This first part of the book examines the conceptual basis and the context for case management as an international phenomenon in service delivery. It is asserted that case management now pervades policy statements, program development and practice in the human services and health sectors. We support the view that it is through the context of service delivery that the nuances and diversity of the approach are best understood (Burns et al. 2000; Austin 2001). It is the broad application of case management that has created conditions that are redefining the nature of professional practice, service provision and consumer expectations.

Any claim to produce a single history of case management defies the reality of its diversity and multiple applications. Depending on the commentator’s discipline base, orientation to the approach and experience, the perspectives on history vary. To echo a theme from Popper (cited in Tripp 1976), ‘there is no history . . . there are only many histories of all kinds of aspects of human life’. The exercise of searching for a single and continuous development of case management inevitably leads to simplistic analysis and detracts from our understanding of the complex and parallel processes that have contributed to a shift in service delivery approaches in the human services and health sectors.

With a critical eye, it is possible to discern a number of trends and issues that have contributed to the emergence of case management since the 1970s. In this chapter we will overview early historical accounts of case management documented in the nursing and social work professions. We will canvass the problems that arise from a quest for definition or typology of the approach. An analysis of contemporary developments of case management will demonstrate the diverse agendas that are served through its application. We would argue that, for various stakeholders, the rhetoric of case management has served different purposes and that the shifts in the culture of service delivery have yet to be fully explored. It is beyond the scope of this book to pursue this path. However, in the final section of this chapter, we will discuss the characteristics and principles underpinning case management, an approach to service delivery that is reconstructing practices and service provision.

ACKNOWLEDGING DIFFERENT TERMINOLOGY

In the Introduction, matters of terminology were raised. Here it is relevant to comment on some of the variations in nomenclature that apply to case management itself. In this book we generally adopt the term ‘case management’ as it is the one used most frequently at an international level. However, different terminology does prevail in particular countries and/or program contexts. For example, in UK community care policy and programs, the preferred term is ‘care management’ (Sheppard 1995; Burns and Perkins 2000). The adoption of the term ‘care management’ addresses the frequently voiced criticism that the emphasis on ‘case’ management detracts from the personal nature of services being offered. The consistent use of the term ‘care management’ is peculiar to the United Kingdom, but this term and other variations can be found in programs around the world.

Within programs, alternative terms such as ‘case’ or ‘care coordination’ and ‘service coordination’ are applied most often where service provision is focused on brokerage or service management. Here the coordination task is paramount, and the activities of the case manager are directed towards ensuring that the services deemed necessary in the assessment process remain responsive, effective and cost efficient for the client. When specific terms like clinical case management, team coordination, strengths or empowerment approaches are referred to, we are likely to find the case manager involved in more intensive activities, with clinical specialisation being incorporated into the case manager’s responsibilities. Examples of these clinical or specialised case management roles are frequently found in mental health, diagnostically based services in health, community based services and institutional settings. Terms such as critical or clinical pathways, risk or disease management, life care planning and managed care are synonymous with service provision in acute health and insurance based medical and injury management (Newell 1996; Weed 1999; Huber 2000) emphasises that many of these procedures are ‘algorithmic’ and are driven by systemic and clinical needs for demonstrable outcomes, quality improvement and cost containment. In acute health situations, for example, the case managers are focused on responding to variance from the clinical pathway to capitalise on gains from improved practice or to rectify individual or recurring incidents that require responses beyond the predicted pathway. In these circumstances the case manager is expected to maintain a monitoring role in terms of efficiency, risk management and cost containment (Cohen and Cesta 1997, pp. 158–9).

The agenda here is not to list all of the possible variations of the terms that might be found under the rubric of case management. It is fair to say that the term remains both ubiquitous and ambiguous (Rothman 1991, p. 520; Solomon 2000, p. 421). The goal is to alert readers to the fact that the terms are applied interchangeably, that variations do exist and different agendas in relation to outcomes are often accommodated within the notion of case management.

CONFRONTING PROBLEMS OF DEFINITION

Definitions of case management abound. To be consistent with our own analytical stance, we endorse efforts to provide descriptions of particular applications in definitional terms. It is through specificity that understanding of the different perspectives on the approach can be acquired. However, to leave the issue of definition aside would abrogate responsibility to scope developments and understanding of case management. We do not intend to present a ‘model’ per se, as this path is reductive analysis and does not facilitate the exploration of variations in application and context.

It is possible to discern at least two broad emphases in definitions found in the literature. First, there are those definitions that can be described as generic. They focus on the process, tasks and functions involved in practice without locating the particulars of the approach in terms of target population or setting. In this style of definition, key words and phrases include individually tailored services, coordination, linkage, service network and efficiency, and cost effectiveness. Several examples are presented here:

Case management is a set of logical steps and a process of interaction within a service network which assume that a client receives needed services in a supportive, effective, efficient and cost effective manner. (Weil et al. 1985, p. 2)

A process of tailoring services to individual needs. (Ovretveit 1993, p. 15)

Case management is widely viewed as a mechanism for linking and coordinating segments of the service delivery system . . . to ensure the most comprehensive program for meeting an individual client’s need for care. (Austin 1993, p. 16)

Second, there are definitions that designate case management as clinical or advanced practice. Definitions of this type are likely to detail coordination responsibilities and clinical tasks for the case manager. In these circumstances, it is likely that the target population will have complex and ongoing needs and that personnel will have professional backgrounds relevant to treatment strategies. The following definition is illustrative of the clinical or advanced practice:

Forming a relationship between the case manager and the patient; the use of the case manager as a model of healthy behaviour and as a potential object for identification; and active intervention in the patient’s daily life to structure a mutually tolerant environment. (Harris and Bergman 1988, cited in Raiff and Shore 1993, p. 86)

Kanter (1989), and more recently Burns and Perkins (2000) and Marshall and Creed (2000), elaborate the breadth of responsibilities of a clinical case manager in mental health settings. Kanter’s definition is detailed here as his practice orientation was widely endorsed with the initial shift to community-based service delivery in that sector:

A modality of mental health practice, that in coordination with the traditional psychiatric focus on biological and psychological functioning, addresses the overall maintenance of the mentally ill person’s physical and social environment, with the goals of facilitating his or her physical survival, personal growth, community participation and recovery from or adaptation to mental illness. (Kanter 1989, p. 361)

Although there is no intention to pursue the idea of one or more ‘models of case management’, it is acknowledged that this is often the language of practice. Examining ‘the models’ presented in the literature is illustrative of the diverse applications of the approach but does not produce clarity about it. Making sense of the many descriptions led to efforts to create some classification of the applications of the approach. For example, Austin (1992, p. 402) argues that the range of case management ‘models’ can be classified as a continuum. Kanter (1989), using a similar approach in the specific context of mental health, suggests that the extremes of such a continuum are analogous to the role of travel agent and travel companion. The travel agent coordinates, attends to detail, monitors and is a resource to be drawn on to assist with changed itinerary needs. The travel companion stays with the person for the whole journey, engages in the journey and shares the client’s experiences. In case management terms, the continuum extremes are aligned with program arrangements that are systems oriented, where the case manager is a more distant resource, though by no means inactive in setting up and maintaining the set of resources needed to support the client. At the other end of the continuum, we see the case manager as travel companion, engaged more intensely to support complex needs and higher risk populations.

As with all efforts to create conceptualisations across diverse contexts, where different professional and human service personnel practise, the inevitable blurring of boundaries poses many analytical challenges. We would also want to put one caveat on the preceding commentary in relation to the recent developments in managed care. In the literature, the terms ‘case management’ and ‘managed care’ can be used interchangeably, confusing the fact that the first is an approach and process in service delivery and the latter is policy and business strategy to control health care use (Cohen and Cesta 1997; Rossi 1999). The developments in managed care refocus service delivery in health care in very specific ways and we will explore this aspect of health care policy further in Chapter 2.

In spite of the necessary discussion of definition, agreement on it should be of less concern than the task of understanding the nature of practice generated by this service delivery approach. Key characteristics are the critical issue, and the task in each context is to seek precision about each application of case management. We shall return to this task later in the chapter and in more detail in the practice section, but before addressing the breadth of application, both the beginnings and contemporary trends of the approach are summarised.

THE BEGINNINGS OF CASE MANAGEMENT

Case management is seen to have its origins in the early practices of the social work and the nursing professions, primarily in the United States (Bower 1991; Murer and Brick 1997; O’Connor et al. 1998). This does not mean that the practices associated with the beginnings of case management in these professions might not be paralleled in other areas such as the United Kingdom, Europe and Australia. As a consequence of the US leadership of case management in the 1970s, the literature has been dominated by North American commentary, with an understandable focus on wide-ranging contemporary issues.

In the social work literature, the first efforts to coordinate public human services are identified with activities of the Massachusetts Board of Charity in 1863 (Weil et al. 1985, p. 4). Subsequently, case coordination ‘to promote cooperation in charitable work’ (Kennedy 1985) became a critical component of the practices developed through the internationally linked Charity Organisation Societies and the Settlement Houses in the late 1880s. The beginnings of case management are identified with the use of meth...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Tables and figures
• Acknowledgments
• Introduction
• PART I CASE MANAGEMENT AS POLICY
• PART II CASE MANAGEMENT AS PRACTICE
• PART III CASE MANAGEMENT AS PROFESSIONAL BUSINESS
• PART IV REFLECTIONS
• References
• Index