Case management may be defined and practiced in a variety of ways. In the Teenage Parent Demonstration, staff units consisting of case managers and specialists in employment, training, education, and child care worked with participants as long as they were on AFDC, providing personal support, planning and monitoring, and referral into available education, training, and jobs. The experience of the Teenage Parent Demonstration suggests conclusions about case management for teenage parents that are likely to be relevant in ongoing programs. Conclusions about "effective" case management are drawn from the insights shared by program staff about their experiences, the obstacles they had to overcome as they worked with participants, and the approaches they tried to motivate and guide them. They are not based on rigorous estimates of the impact of various practices on measurable outcomes such as school retention, training participation, or employment. Information was drawn from case conferences with case managers and interviews with program managers, a series of site visits during the course of the demonstration, and regular discussion with site managers as part of demonstration monitoring. The main conclusions of this study are as follows:
- Case management encompasses a wide range of staff functions. A case management unit is likely to be involved in providing initial and ongoing assessment and service planning, personal counseling and support, advocacy on behalf of clients, delivery of child care subsidies, enforcement of participation requirements, and thorough maintenance of case records.
- Case managers' persistent enforcement of program participation requirements can be a constructive intervention in clients' lives. Insisting on participation is a way of establishing a set of clear expectations, often an essential ingredient in motivating and guiding adolescents, and one which many participants have not had. The process of enforcement itself involves ongoing communication -- even when possible during periods of sanction -- that can provide time for initially resistant teenage parents to become acquainted with program staff and interested in participating, and serve as a clear reminder of where these young mothers can turn for help when they need it. In many cases, teenage parents may resist pressures to participate and seem immune even to the financial incentives created by sanctions, but changes in their lives -- getting older, losing income or the support of a boyfriend -- can lead them into productive participation if they are kept aware of the program, the requirement to participate, the services the program can offer, and the potential it offers for improving their future lives.
- The process of case management is likely to be helped by an informal environment where supportive conversation and the development of trusting relationships can occur. Program staff can make the case management unit a place of refuge and interest for teenage parents by promoting a cooperative staff spirit, providing attractive and comfortable facilities, and encouraging clients to visit whenever they need support or advice.
- Personal skills are important ingredients of successful case management. Good case managers are both tough and supportive with their clients -- setting consistent expectations for client effort, but providing the warmth and encouragement the teenage parents need to overcome often daunting obstacles in their personal lives in order to pursue self-sufficiency goals. Good case managers are open-minded, comfortable dealing with teenagers and their sexuality, and benefit from having in their backgrounds something in common with the clients they are helping. They also need to be well- organized in their work habits to deal with the pressures of high caseloads and often very unpredictable demands on their time.
- Program managers can help case managers be effective by creating specialized positions in their units, thus maximizing the time case managers can spend with clients. Clerical staff can be used for scheduling clients for group sessions, monitoring client attendance, maintaining liaison with income maintenance staff concerning sanction actions, processing child care vouchers, and performing data entry. Special expert staff can be used to conduct program workshops, and child care counselors can be used to great advantage to develop appropriate providers for teenage parents and link up clients with providers who can help them best.
- Program managers can help their staff by taking the lead in developing and shaping the array of services available to teenage parent clients. Program managers can arrange briefings for case managers by community service providers, "market" their program to other agencies, and in some instances use their funding to encourage other agencies to tailor their services to the special needs of teenage clients.
- Program managers need to monitor and control case managers' caseloads, and use a measure of caseload size that reflects the different stages of client participation. Although the total number of clients assigned to a case manager over time will continue to grow, some clients will leave AFDC each month. Moreover, the total assigned caseload will at any given time include individuals who have been sanctioned or deferred, and some who are well established in ongoing training or education -- because caseloads build up over time and include clients at very different stages of program involvement. Attention must be paid to the portion of assigned caseloads that actually represent ongoing demands on case managers' time. Although total assigned caseloads in the demonstration grew as high as about 140 in one site, the demonstration experience suggests that the number of active cases per case manager -- excluding cases that are deferred, have gone off AFDC, or are under sanction -- probably ought not to exceed about 80 cases. Larger active caseloads threaten case managers' ability to provide personal attention when it is needed.
- Program managers can help to maintain the morale of case managers and promote staff stability. Managers should focus on ways to promote recognition of staff effort and accomplishments, vary their work assignments and allow room for creativity. Ongoing training can strengthen staff understanding of their daily challenges, provide some occasional break in routine, and demonstrate management recognition of the complexity of the problems they are working on.