The Managerial Nature of Case Management

The prominence of case management as a service delivery method and as an area of study for social workers has increased in the past decade. Although case management has its roots in the earliest helping efforts of the social work profession (Ashley, 1988), only recently has this method received a considerable research and practice commitment. (For example, Social Work Research & Abstracts added case management as a separate section in its service methods section in 1989.) This article emphasizes the managerial nature of case management. The case manager is compared with managers in general, the properties of case managers are delineated, the complexities of managerial work are outlined, and the importance of improved case management is discussed. However, one caveat must be noted at the outset. The theoretical model presented in this article was developed through observations of chief executives of business and human services organizations. As a result the model represents a mosaic for prototypical managers that does not always equate with the realities experienced by practicing case managers. Moreover, pertinent issues such as client self-determination and autonomy, which distinguish the power relationships between employers and employees from case managers and consumers, militate against the wholesale translation of the model from one type of manager to another. Circumstances unique to case management, such as large caseloads, varied expectations on the substance of case management, and organizational barriers, are discussed. Nevertheless, the fundamental objective of this article is to provide case managers with a different way of looking at the nature of their work. The significant attention case management currently enjoys is the result of a number of factors. First, the philosophical and theoretical bases of case management enable it to be used with a wide range of clients. Within the past five years, journal articles have focused on case management with pregnant teenagers, (Kerson, 1990), people with acquired immune deficiency syndrome (AIDS) (Magee & Senizaiz, 1987; Sonsel, Paradise, & Stroup, 1988), chronically mentally ill people (Kanter, 1990), elderly people (Wimberly & Blazyk, 1989), and developmentally challenged people (Feine & Taylor, 1991). It can be confidently predicted that eventually no target population will be left unserved by case management activities. Second, the intervention techniques of case management are similar irrespective of the target population. Although different target populations may require different emphases, the process of case management proposed by Modrcin, Rapp, and Chamberlain (1985) is representative: Their process of assessment, development of a plan, procurement of a service, monitoring and advocacy, tracking, and evaluation is regarded as a most useful model. Third, the intervention techniques of case management are readily transferable to other professionals. Unlike some therapeutic interventions that rely on vague principles or faith, the skills necessary to perform competent case management services are specific, understandable, and logical. Fourth, the success of case management interventions is observable and measurable, because the models are generally based on observable and measurable objectives. In a period of increased accountability, the opportunity to effectively demonstrate movement on the part of clients has clinical as well as political benefits. Last, case management focuses on the person-in-environment perspective (Germain, 1990). This ecological approach has become fundamental for all social work practice but is best exemplified in the practice of case management. Moreover, this focus exalts the interaction of the person-environment relationship rather than places blame or excuses individual behavior because of the environment. The environment is viewed as an opportunity to enhance service options, not as an obstacle to overcome (Sullivan, 1991). …