Case Management Practice: Intake, Referral, and Client Engagement

Introduction: Personal Motivation and Professional Identity

"Never mind if you fall far short of the thing you want to do — encourage your effort. If no one else will say it to you, say it to yourself: 'Not so bad.' It will make the next effort easier and better." (Robinson, 1926, 1996)

Stop! my mind screamed, as several gunshots rang out. In the distance I saw a young woman running for safety. And then, from the corner of my eye, I saw Ben (name changed), one of my few friends, also running. The difference between where Ben and the young woman were running, however, changed my life — forever.

What the young woman ran away from, Ben ran straight toward. Without regard for what would happen to him, Ben flung his body over the baby buggy the woman had left in the path of the flying bullets. Ben did not die that day, but his legs were hit several times. After surgery, his wounds healed, leaving him with only scars. The memory of how Ben saved the life of a baby he did not know, with no thought for himself, helped me begin to come out of my shell and stirred in me the desire to try to help others.

Stop! marks another time my mind screamed — this time in pain. Because I was too little to defend myself, because certain men wanted to hurt and humiliate me, because they could not stop themselves — whatever the reason, I may never fully understand. I do know, however, that being raped before I was 11 years old left the kind of scar that, even though the human eye cannot see it, never completely fades.

This incident also profoundly impacted my life — initially, not for good. For more than 20 years after being raped, I isolated myself from what I considered to be a cruel world. I kept what happened locked inside me. After I met my wife, however, and she encouraged me to share my life with her, I began to receive counseling. In the process of healing, I decided to follow through with what I had resolved to do with my life after Ben saved the baby: I wanted to help others.

Stop! also defines the message I try to impress upon the clients I currently work with as Case Manager/Retention Specialist. As I help clients stop and look at their lives where they are now, I also encourage them to go — to begin heading toward something better, to set goals, and to set out to reach those goals.

As Case Manager/Retention Specialist, I do not always see positive results from trying to help people. Many times, however, I do. One recent success story brings a smile to mind. Marcia (name changed), a young female client who had just been accepted into our program, was struggling to stay off methadone. Marcia had a son, she told me, but he had been taken into State custody because, at the time, she could not quit using methamphetamines — commonly known as "meth."

To help Marcia get clean, I arranged for her to enter a drug treatment program. After getting off methamphetamines, Marcia began to attend counseling sessions. Through my work, I helped her secure a full-time job. Within a year and a half, Marcia regained custody of her son from DCFS. One day, while I was working at my desk, Marcia came to my door wearing the biggest smile I had seen in a long time. "You helped me," she said. "You helped me get my son back."

Knowing that I can help make a change in someone's life encourages me. At one time in my life, I did not care about people. Not having love from my father, who was an alcoholic, also scarred me inside. Gradually, however, this scar — like the one from the rape — began to fade.

Work History and Learning in Case Management

From 2001 to 2002, my duties as Assistant Project Coordinator/Team Leader included assisting the project coordinator in the administration of case management services. I communicated regularly with program funding sources and reviewed all program referrals. Part of my duties was to maintain an accurate Master Referral Log and to ensure that cases were opened and closed in accordance with operational procedures.

Another major portion of my work involved assisting with the monitoring, collecting, and reporting of clear and accurate data. While working face-to-face with clients, I communicated assessment results to them and provided vocational and supportive counseling. I provided daily supervision for case managers to ensure that program policies and protocols were followed. I also assisted in the daily supervision of team leaders to ensure that Jobs First Employment Services program operations and protocols were maintained.

In addition, I provided the Project Coordinator with weekly case counts and other required reports. I coordinated and facilitated effective relationships with the Regional Board, the Department of Social Services, and the Department of Labor. I maintained a solid understanding of JFBS contract requirements and federal and state TANF regulations, and I administered training schedules for new hires. I assisted in the recruitment and interviewing of applicants and assumed a lead role in ensuring that the program continued to operate as expected in the absence of supervisors.

During my employment from 1997 to 2000 at Capital Region Workforce Development Board, I was progressively promoted from Intake Specialist to Supervisor. I provided guidance and resources for staff development while ensuring compliance with all applicable federal, state, and local regulatory and professional standards, including JTPA, WTW, and WIA regulations, as well as CRWDB policies and procedures.

I ensured that internal programs were consistent with and complied with federal, state, and local organizations, service providers, CT Works, staff, and affiliated organizations. I assisted in the planning, implementation, and development of recruitment strategies, including brochures, advertisements, press releases, and presentations. I also provided input for program planning and ensured that contractual obligations with service providers and vendors were fulfilled in an efficient and effective manner.

My learning in the Dynamics of Case Management occurred across each of these three periods of employment.

My first learning experience related to Dynamics of Case Management occurred while I worked at Capital Region Workforce Development Board in Hartford, Connecticut. During this time I began to explore the question posited by Gursansky, Harvey, and Kennedy (2003, p. 140): "Who are case managers?" "The short and simple answer to this question," these researchers state, "is that case managers are drawn from the health, human and social service employees of the past." I may not completely agree with this answer.

On the other hand, I am not certain that the definition of Case Manager can be so easily or neatly explained — just as the term client embodies a range of meanings. I do agree, however, that "databases are critical" and that "the compilation and maintenance of a dynamic directory of complementary and alternative services can save untold time and frustration" (Gursansky et al., 2003, p. 65). Although in some lines of work forms and records may be considered a tedious chore, I learned that clear, understandable statements of eligibility criteria, user-friendly intake forms, and an accessible database can help transform case management — as well as an organization's ability to market and utilize its services efficiently and with the best results.

Rather than learning to dread the assessment process, I came to agree that assessment qualifies as "the bedrock of the helping process" (Gursansky et al., 2003). During assessment, vital information is gathered. At this stage, the case manager ensures he or she obtains an adequate data foundation to use when making decisions about how best to work with and assist a client.

During my second period of employment from 2001 to 2002, Ken Fracaro — a freelance writer who also has front-line supervisory experience in major industrial firms — articulates several points I learned to practice, related to the Dynamics of Case Management:

I began a new position in 2003 but continued to work full-time, steadily gaining more knowledge of the Dynamics of Case Management. During this time, I studied and practiced more about interviewing in order to strengthen and enhance my intake and assessment skills.

Interviewing Techniques and Client Data Collection

Although McDonough (2005) discusses interviewing techniques geared for use in the law enforcement realm, some — though not all — of those techniques also apply to work in case management.

Kinesics and the Nine-Step Approach, developed by John E. Reid & Associates, emerged as two widely accepted interviewing techniques. McDonough (2005) utilizes both and notes that while the two share some common components, each proposes varying views regarding behavior and which method triggers particular behaviors. Kinesics interviewing identifies and "interprets a range of verbal and nonverbal, conscious and unconscious behavior" (McDonough, 2005) that individuals typically exhibit when questioned. The more definite the pattern of an individual's observed behaviors, the more likely that person is being "evasive or untruthful." No single behavior, however, stands alone or can serve as absolute proof regarding the validity of a statement. Instead, a combination of behaviors must be assessed, and the interviewer must look at the cumulative message of behaviors.

Relevant behavior includes not only how words are spoken, but also components that accompany speech — for instance: stalling, hesitating, being excessively polite, responding to a question with another question, or trying to attach validity to a response by invoking God or religion (e.g., "I swear to God") (McDonough, 2005). Gaining and maintaining a client's attention during interviews is a key technique for securing relevant data. Although I do not perceive my clients as criminals, studying and utilizing interviewing techniques from law enforcement has strengthened my ability to obtain more relevant data during the interview process.

Conclusion

To begin to establish a contractual relationship with an agency, the first step is to schedule a meeting to discuss options and determine if the contractual relationship would be feasible and mutually beneficial for both agencies as well as their clients.

"Let no one say that taking action is hard. Action is aided by courage, by the moment, by impulse, and the hardest thing in the world is making a decision." (Grillparzer, 1872)

References

Grillparzer, Franz. (1872; 1996). Columbia World of Quotations. New York: Columbia University Press, 1996. Retrieved November 2, 2006, from

Gursansky, D., Harvey, J., & Kennedy, R. (2003). Case Management: Policy, Practice and Professional Business. Crows Nest, N.S.W.: Allen & Unwin.

McDonough, Edward. (2005). Asking the hard questions: Interviewing and interrogation require often overlapping, but sometimes markedly different, approaches.

Robinson, Josephine Demott. (1926; 1996). The Columbia World of Quotations. New York: Columbia University Press. Retrieved November 3, 2006, from

Watson, S. (2002, October). A lesson in training: Learn how to develop training programs that work. Security Management, 46, 75+.