Although case management has become a widely used term, its actual form and content vary widely depending on the target population it is meant to serve, the professions and training levels of the staff who provide the service, legislative or regulatory definitions, and administrative and financial constraints. It is therefore important to clarify what case management was designed to be in the Teenage Parent Demonstration.
Case Management Was Viewed as a Key Service in the Demonstration
The demonstration design as set forth by DHHS, and as implemented by the two States, made case management an important service in itself. Some models for case management -- such as the medical "managed care" model -- focus primarily on managing services provided by others. The demonstration case management staff were expected to help participants gain access to appropriate education, training, employment, and child care services. An equally important element of their jobs, however, was their direct interaction with participants -- motivating and encouraging them, helping them deal with crises in their personal lives, monitoring their attendance in program activities, and enforcing the rules that required their active participation.
Case Management Was Planned as a Distinct Service Apart from AFDC Income Maintenance Functions
The demonstration design envisioned delivery of services in a setting apart and distinct from the administration of income maintenance eligibility functions. Demonstration staff, although expected to maintain necessary communications with income maintenance staff, were to provide services and not be involved financial or categorical eligibility determination. The programs were therefore physically and organizationally distinct from the AFDC income maintenance staff. In Camden, the County Board of Social Services created a demonstration office near the main welfare office, in a building that also housed the Food Stamp Employment and Training unit. In Newark, the State Division of Economic Assistance ran the program directly, in rented space in a building occupied as well by a variety of outpatient medical services and a health-related job training program. An alternative originally suggested by the local Board of Social Services -- using income maintenance workers as case managers - - was rejected as not providing suitably focused, concentrated attention to participants' needs for services and personal attention. In Chicago, the Illinois Department of Public Aid leased offices in a building centrally located in the catchment area of the four local public assistance offices from which the demonstration population was drawn.
Case Management Practices Were Defined for the Context of a Mandatory, Publicly Funded Program
Demonstration guidelines, state regulations, and practical realities established the framework and constraints for case management practices. First, demonstration guidelines required 30 hours per week of active participation, and thus created clear demands not only on participants but on case managers as they developed plans with participants for the activities they would pursue. The guidelines specified that sanctions -- the removal of the needs of the teenage mother in the AFDC grant calculation -- should be imposed on teenage parents who failed to participate as required in program activities. Both states adopted specific regulations defining the steps that case managers would take in response to non- compliance with program requirements -- warning notices, conferences with participants, imposition of grant-reduction sanctions through the income maintenance units -- and the conditions under which sanctions would be lifted.
Anticipated and actual resource constraints also affected case management in the demonstration. In keeping with DHHS intentions to simulate the services that might realistically be provided in conjunction with the AFDC program, the two States planned for caseload levels higher than those often found in small, voluntary agency programs. Based on their projections of program staffing, intake rate, and rate of teenage parents' departure from AFDC, the States anticipated that on average case managers would serve 60-70 active participants. Actual caseloads (not counting teenage parents who had left AFDC) reached levels of 80-85 in one site. Caseload sizes naturally affected the range and intensity of case managers' roles.