KACL Case Management Policy Analysis Paper

 

November 12 2003

KACL Case Management Policy Analysis Paper 1

Purpose. 1

Background. 1

Definition of Case Manager 1

Goals of Case Manager 1

Practice Functions of Case Managers. 2

Assessment 2

Major area of goals/needs. 3

Development of the Client Service and Support Plan (Memorandum of Understanding) 3

Considerations in Advanced Case Management 4

Direct Service Roles of Case Managers. 4

Monitoring of service plan implementation and tracking of client status, service delivery and involvement of social network members. 4

Appendices. 4

 

Purpose

The purpose of this paper is to review the role of Case Manager within KACL.

Background

 

At least since the early 1980s KACL has had “case managers” whether such were called “case manager”, “key counsellor”, personal planners etc. In the early 2000s the Provincial government commenced to fund a number of ‘case mangers” which KACL and its clients have had to contend[1].  The use of the term has caused some confusion and 

Definition of Case Manager

For the purposes of this paper, Case Management is defined as a designated person (or team who organizes, coordinates, and sustains a network of formal and informal supports and activities designed to optimize the functioning and well-being of people served by KACL.[2][3]

Goals of Case Manager

Through activities the case manager seeks to accomplish the following goals

  1. To promote when possible the skills of the client[4] in accessing and utilizing these supports and services
  2. To develop the capacities of secondary clients and social network and relevant human service providers in promoting the functioning and well being of the client.
  3. To promote service effectiveness while attempting to have services and supports delivered in the most efficient manner possible.[5]

Practice Functions of Case Managers

  1. Assessment of
    1. Primary client[6] of dreams, desires and aspirations
    2. Primary client service needs to achieve them
    3. Secondary client’s dreams, desires and aspirations as they effect primary client
    4. Social network capacities
    5. involvement of social networks
    6. capacities of human service providers
  2. Development of service plan [JR1] based on professional, secondary client, social network and substantial client involvement
  3. Intervention directly with client as a means of enhancing skills and capacities for self-care and/or indirectly with systems impinging on client.
  4. Monitoring of service plan implementation and tracking of client status, service delivery and involvement of social network members
  5. Evaluation of service plan effectiveness and its impact on client functioning, on social network’s capacity to support client, and on capacity of human service professional to work with client (and similar clients).[7]

Assessment

For systems assessment is the process by which the case manager and the client cooperate in the collection, analysis, prioritization, and synthesis of information concerning the identified needs of the client (Hepworth & Larsen 1982)[8][9].  In community living assessment is the process by which the assists a client, secondary clients and possibly social network to collect, analyze, prioritize and synthesize information concerning a client’s dreams desires and aspirations and environment in order to assist the consumer succeed in achieving them.

 

The assessment process attempts to achieve the following:

 

  1. The identification of primary client’s  dreams, desires and aspirations

 

Systems need needs and deficiencies to justify their existence.  Community living is about pursuing dreams, desires and aspirations.  KACL’s planning commences with a thorough grounding in the consumer’s dreams, desires and aspirations. .  Since strengths often follow desires, identification of strengths often suggest leads in determining dreams, desires and aspirations. However it is dreams, desires and aspirations that must remain in focus.

 

  1. The identification of the extent and the nature of client knowledge, skills and attitudes[10] in order to assist client to achieve his dreams, desires and aspirations.

 

The gap between the dreams, the resources necessary to achieve them and the existing situation and resources provide the context for the programs of the Association.  The client’s knowledge, skills and attitudes are the resources that the consumer can use to assist him or herself to achieve his or her dreams desires and aspirations

 

  1. The identification of the secondary client’s dreams, desires and aspirations as they effect the primary client

 

Parents, Siblings, other relatives and close friends of the primary client are people too who have their own dreams, desires and aspirations both for themselves as well as for the primary client.  Sometimes such dreams, desires and aspirations are in conflict with those of the primary consumer and provide further obstacles to the primary client.  However such dreams desires and aspirations of secondary clients provide the vision that can propel the client to growth and development.

 

  1. The identification of the capacity of the client to increase his knowledge, skills and attitudes in order to assist consumer to achieve his dreams, desires and aspirations.

 

So often assessments concentrate on needs and deficiencies that new KACL staff must be reminded to focus on wants and resources.  “You musty be realistic” often means “You must accept by limited perspective of what is possible.  A proper assessment of capacity determines what gap in resources might be decreased by training, growth and development.  If capacities are lacking than alternative ways must be found to assist the consumer achieve his dreams

 

  1. The identification of the capacity of the client’s social network’s knowledge, skills and attitudes in order to assist consumer to achieve his dreams, desires and aspirations

 

Again the capacity of the client’s support network provides the assessment as to what might be accomplished by working with such group to assist the consumer achieve his dreams, desires and aspirations.  If capacity is severely limited it may be that extensive effort must be spent to develop it. Marsha Forrest’s comment: The lack of relationships is the only disability.

 

  1. The identification of the capacity of human services to assist client to achieve his dreams, desires, and aspirations.

 

The human service system may have some assets that can be employed to assist the consumer.  Such assets may become liabilities if they are used to create dependencies.  There mere existence of such assets may create problems.  Staff must always be aware of such dangers to ensure that in total the Association produces and maximize the consumer’s opportunities.

Major area of goals/needs

 

Autonomous source of Income

Housing/shelter

Employment/Vocational

Health Care

Social and Interpersonal

Recreation and Leisure

Activities of daily living

1.      preparing nutritious meals

2.      bathing

3.      dressing

4.      maintain household

Transportation

Legal

Education

Development of the Client Service and Support Plan (Memorandum of Understanding)

Five Characteristic:

  1. Work Plan and Division of labour
  2. Participatory nature: By involving client, social network members and professionals case manager can build commitment to plan.
  3. Accountability: Because plan identifies roles, activities and timelines of actors, the case manager can assure the follow through of key individuals.
  4. Guidance System: The completed plan can be used by case manager to monitor the completion of tasks, activities, responsibilities and the achievement of goals activities
  5. Evaluability of plan  Goals, objectives and activities of plan can be evaluated

Considerations in Advanced Case Management

    1. Service Planning discussions should be paced so consumers and secondary clients feel comfortable in disclosing information
    2. Higher level planning is accomplished when a more comprehensive and intimate knowledge of the community’s resources is brought top the planning process.
    3. Plans should demonstrate a relationship to the dreams desires and aspirations , strengths and limitations demonstrated in the assessment

Direct Service Roles of Case Managers

 

Intervention directly with client as a means of enhancing skills and capacities for self-care

 

Six Direct Service Roles

 

  1. Case manager as Implementer
  2. Case manager as teacher/instructor
  3. Case manager as Guide/collaborator
  4. Case manager as processor
  5. Case Manager as Information Specialist
  6. Case manager as Supporter

 

Six Indirect Service functions (indirectly with systems impinging on client)

 

  1. Brokering Services to meet client needs
  2. Linking Clients to services and resources
  3. Advocacy
  4. Co-ordinating Client service delivery
  5. Social network intervention
  6. Technical assistance and consultation

Monitoring of service plan implementation and tracking of client status, service delivery and involvement of social network members

 

Evaluation of service plan effectiveness and its impact on client functioning, on social network’s capacity to support client, and on capacity of human service professional to work with client (and similar clients

Appendices

 

Appendix A KACL Mission Statement

 

The goal of KACL is to ensure that all persons with special needs have the opportunity to live a meaningful and satisfying lifestyle and interact as an equal in their community by providing continuing opportunities for personal growth through education, training, support, advocacy and an informed public.

 

Appendix B Issues

 

Case Managers Load

 

Appendix C Reference

 

Moxley, David P (1989) the Practice of Case Management, Newbury Park, California: Sage Publications, Inc

 

Raiff, Norma Radol and Barbara K. Shore (1993) Advanced Case Management, Newbury Park, California: Sage Publications, Inc

 



[1] In general KACL’s experience with such case managers have been negative.  Such external case managers have served to add an additional layer of bureaucracy with adding any substantial benefit to KACL’s clients.  Case management as imposed by government has generally been regarded as an approach to societal resource management that in the local Kenora context might be better described as a societal resource mismanagement

[2] Moxley 1989, Page 17

[3] A broker model of case manager is about knowing everything – doing nothing.

[4] Client in this case involves both primary client and those who care about his goals and needs being achieved

[5] Moxley 1989, Page 17

[6] The primary client is generally regarded as the individual with the disability or concern served by KACL.  The secondary client is the person or person who immediately surrounds the consumer and who plays a significant role in the client’s life and supports.  This generally includes parent and siblings but may also include foster parents, life sharers and significant others.  Social network in different contexts may include secondary clients and others in the client’s environment such as friends, acquaintances and others who play a less direct role in the client’s life

[7] Moxley 1989

[8] Moxley 1989, Page 26

[9] John McKnight: Only systems need needs – KACL is about community living

[10] Elsewhere knowledge may be referred to as cognitive domain, skills may be referred to as psychomotor domain and attitudes as affective domain.


 [JR1]What do we currently call our plans Goals and Roles?