Study of HHS Programs Serving Human Trafficking Victims: : Table 15

12/15/2009

: Table 15

Case Management Definition of Case Management Case management is a professional practice in which the service recipient is a partner, to the greatest extent possible, in assessing needs, defining desired outcomes, obtaining services, treatments, and supports, and in preventing and managing crisis. National Association of Case Management (2008) Having a central case manager was viewed by service providers and law enforcement alike as a critical service not only for victims but for other service providers and agencies involved in a trafficking case. In fact, the case manager was considered to have a critical role throughout the lifespan of a trafficking case, including at initial contact by law enforcement or others, during depositions, appearances in court, application renewals for benefits and services, and family reunification. According to respondents, the case manager is responsible for assessing clients needs for service and support; identifying, obtaining, and coordinating those services for clients; coordinating and managing communications across systems involved in a case; and serving as a liaison for the client with other agencies. For some clients, the case manager also serves as translator or obtains translation services for the clients. Other common responsibilities include accompanying clients to appointments, assisting/teaching clients to access public transportation, and teaching clients basic life skills. The importance of this role is evident in the fact that most of the programs in the study reported providing some form of case management as part of their menu of services for trafficking victims. However, like with other services, providing case management to victims is not without challenges. Ingredients for Effective Case Management Establishing a hopeful relationship with the client; Assessing client strengths and needs; Developing, in partnership with the client, a service plan to achieve desired outcomes; Locating, linking, and following up with needed services and support; Monitoring, coordinating, and adjusting services and supports to achieve desired outcomes; Providing crisis prevention and intervention services and support; and Advocating for the client. Extracted from the NACM Web site, http://www.yournacm.com/definition.html Challenges to case management One of the greatest challenges respondents reported to providing effective case management was limited resources. Case management for trafficking victims can be a 24/7 responsibility. In fact, providing case management to a single client can be a full-time job; although not true for all clients. This generally limits the amount of time that a case manager is available to other clients and thus necessitates a limited case load for each case manager. In contrast, resources to support full-time case managers are scarce. In particular, smaller agencies without the kind of back-office functions and infrastructure as larger organizations, struggle with funding streams like the per capita program. It is difficult for them to keep up with the reimbursement process and difficult to support case managers during periods when they are not serving any trafficking victims. Large agencies on the other hand are able to support case managers under other funding streams and often have case managers working with different (victim) populations, such as domestic violence victims or refugees. While those in the field, including smaller agencies, recognize that the current per capita funding is intended to be a more efficient use of limited resources than previous funding streams in that it allows for the provision of services to victims anytime, anywhere throughout the country, and only reimburses providers for services actually provided to victims, not all agencies, including those specific to human trafficking, have been able to diversify their funding beyond the per capita program. As a result, some agencies have had to move to part-time case managers which has limited their ability to be available on a 24/7 basis. When it comes to providing case management services to domestic victims of trafficking, domestic victims have to currently rely on case management services that may be offered through existing systems and programs, such as the child welfare system and domestic violence and youth shelter programs, which are often already overburdened and hence struggle with providing effective case management to their existing caseload. This significant gap in services for domestic trafficking victims is beginning to be addressed. For example, OVC recently released an announcement to fund two demonstration programs to provide comprehensive services, including case management, to domestic child victims of human trafficking, and an evaluation of the demonstrations is being funded by the National Institute of Justice. Another significant challenge or barrier to effective case management is the length of service eligibility (e.g., 9 months for pre-certification services and 4 months for certification services under the per capita program; 15-, 30-, and 60-day stays in shelters for runaway and homeless youth). Service providers reported that it can take significant time to build trust with clients and get them to begin opening up to their case managers. Until this happens, getting clients to accept and engage in services can be difficult and often times inappropriate. The eligibility time restrictions can limit the ability of case managers to move some clients from crisis to thriving and toward the accomplishment of their service goals. When working with a domestic victim, I just need more time. I cant stabilize a client with extensive trauma histories within 90 days or transition them to permanent housing within 18-months. Many of my clients struggle to get an education (or GED), learn life skills, obtain employable skills, and get employed. This is especially true if they have not begun to work on trauma recovery and this can take years. Service provider Working with other service providers and law enforcement is acknowledged as a key factor underlying a case managers success in working with victims. Limited access to information regarding details of a clients case can hinder the role of the case manager. For example, several providers reported incidents where case managers were put in difficult situations with their clients because they did not have information that the clients thought they should have about their legal cases, and in some situations, the results of medical tests. When case managers are unable to provide clients with (timely) answers to their questions, respondents reported that this creates feelings of distrust and can cause set-backs in the victims recovery. While effective case managers were described by respondents as highly committed and dedicated to their work, these same strengths can create another challenge to case management; a high turnover rate. Service providers and law enforcement reported that case managers working with victims of human trafficking are overworked and underpaid, contributing to staff burnout. Additionally, respondents pointed to vicarious or secondary trauma and the lack of resources to address this for staff as another contributing factor to the burnout and high turnover. As one service provider put it, There are few resources devoted to helping the helpers.Definition of Case Management Case management is a professional practice in which the service recipient is a partner, to the greatest extent possible, in assessing needs, defining desired outcomes, obtaining services, treatments, and supports, and in preventing and managing crisis. National Association of Case Management (2008)Ingredients for Effective Case Management Establishing a hopeful relationship with the client; Assessing client strengths and needs; Developing, in partnership with the client, a service plan to achieve desired outcomes; Locating, linking, and following up with needed services and support; Monitoring, coordinating, and adjusting services and supports to achieve desired outcomes; Providing crisis prevention and intervention services and support; and Advocating for the client. Extracted from the NACM Web site, http://www.yournacm.com/definition.htmlWhen working with a domestic victim, I just need more time. I cant stabilize a client with extensive trauma histories within 90 days or transition them to permanent housing within 18-months. Many of my clients struggle to get an education (or GED), learn life skills, obtain employable skills, and get employed. This is especially true if they have not begun to work on trauma recovery and this can take years. Service provider