Report on Case Management for Teenage Parents, Executive Summary
CASE MANAGEMENT FOR TEENAGE PARENTS:
Lessons from the Teenage Parent Demonstration
Alan M. Hershey
From 1986 through 1990, the States of New Jersey and Illinois conducted the Demonstration of Innovative Approaches to Reduce Long Term AFDC Dependency Among Teenage Parents -- also known as the Teenage Parent Demonstration (TPD). The demonstration was conducted with the support of grants from the Office of Family Assistance of the U.S. Department of Health and Human Services. In Camden and Newark, New Jersey, and the south side of Chicago, Illinois, all teenage parents of one child who began receiving Aid to Families With Dependent Children (AFDC) were required to attend a demonstration intake session, where they were assigned to program or control status for evaluation purposes. The program group was required to participate in education, training, or employment as long as they received AFDC, or risk a sanction in the form of a grant reduction. They also participated in program workshops, could get subsidies for child care and transportation expenses, and were assigned to a case manager. The control group could not receive any special services through the demonstration, and were not required to pursue education, training, or employment. An extensive evaluation is being conducted to determine, through comparisons of these two sample groups, whether the demonstration program affected key outcomes such as employment, AFDC dependency, continued education, and repeat pregnancies. In addition, qualitative studies of the demonstration offer operational lessons for states as they develop aspects of their Job Opportunities and Basic Skills (JOBS) programs for teenage parents. This report presents lessons from the Teenage Parent Demonstration about case management.
HOW WAS CASE MANAGEMENT DEFINED AND WHAT DID IT INCLUDE?
Case managers were a key element of demonstration services. Case management units were created apart from the AFDC income maintenance offices. Case managers performed assessments and helped to plan participants' activities. They provided ongoing personal support and motivation, helped participants gain access to services, helped to find child care and arrange payment, and enforced participation requirements, issuing warning notices and imposing sanctions when necessary. The three sites developed a variety of specialized staff positions to help case managers -- education and employment/training specialists who developed particular familiarity with community resources, child care counselors to maintain liaison with providers and make referrals, and clerical staff to handle intake call-in, attendance monitoring, sanction monitoring, data entry, and supportive service voucher processing.
HOW CAN CASE MANAGERS PROMOTE CLIENT PARTICIPATION?
Although some participants came to the demonstration strongly motivated and quickly took advantage of available services, many lacked motivation or sense of direction, and had serious personal problems that threatened to block their participation in demonstration activities. An important part of the case managers' role was to help participants overcome these obstacles and promote participation.
Case managers had to use a combination of supportiveness and helpfulness on the one hand, and pressure and clear expectations on the other, to promote participation. Persistence was important. Teenage parents were sometimes very reluctant to participate at first. Continued insistence by case managers that they participate sometimes succeeded in exposing them to the program and its staff enough to overcome their fears and suspicions. Persistence was also important because clients' circumstances change. The breakup of a relationship, the loss of a source of non-AFDC income, or simply maturing with age turned some teenage parents from long-standing refusal to participate to active involvement. Continued communication with teenage parents and repeated reminders of their obligation to participate can be instrumental, when these changes occur, in leading them into the program.
Case management units should provide a setting for open, informal communications. Small case management units, with attractively decorated facilities apart from income maintenance offices, can foster a "clubhouse" atmosphere that helps clients feel comfortable dropping in to visit staff or their peers. Group activities early in the program sequence can help clients form peer relationships that provide additional reason to view the program positively. Case managers and other staff should function as a cooperative team, because some teenage parents form strong, productive relationships not only with their assigned case manager but other staff as well.
WHAT DOES IT TAKE TO BE A GOOD CASE MANAGER?
Case managers are most effective when they balance caring and toughness, providing warmth and encouragement, but also being clear and strict about activity schedules and attendance. They need to be able to talk comfortably about sensitive topics such as sexuality, family relationships, and drugs in a down-to-earth, nonjudgmental manner that still provides guidance. They should take the initiative to keep in touch with their clients -- even when there are no apparent problems -- as a way of building trust and encouraging the client to view the program as a source of help when crises arise.
Effective case managers may have a variety of formal qualifications, and a staff unit may include a mix of personal styles and backgrounds. It is important that the staff include individuals who are "street savvy" -- familiar with the neighborhoods and life problems of their clients, and thus in some cases best equipped to see through clients' excuses for not participating, detect root problems, and have a realistic sense of what clients can do to help themselves.
WHAT CAN PROGRAM MANAGERS DO TO HELP CASE MANAGERS?
Case management units need to be led by strong supervisors and managers. By defining appropriate specialist roles, managers can free case managers of distracting paper work and create needed expertise that general case managers may not be able to develop. Managers should take the lead in establishing relationships with community agencies that provide needed services, and can lobby those agencies to tailor services to the particular needs of teenage parents.
Program managers should monitor caseload sizes. Although levels of attention for individual teenage parents will vary over time, the demonstration experience suggests that caseloads of active participants exceeding 80 will undermine case managers' ability to provide services as they were defined in the demonstration.
Case managers need training and encouragement. Particularly if case managers are recruited with limited professional qualification, sensitive training on a wide range of topics concerning adolescents will be important. Supervisors also need to find ways to encourage the development of special expertise within their staff, to provide opportunities for breaks from the daily routine and caseload pressures, and to make time for reviews of case management practices.