Case Management for Teenage Parents: Lessons from the Teenage Parent Demonstration. WHAT CAN PROGRAM MANAGERS DO TO HELP CASE MANAGERS?


Case management in the Teenage Parent Demonstration involved a variety of specific staff tasks and skills.  Program managers had to organize their staffs and define staff roles for a broad range of staff functions: counseling individual clients, leading group intake sessions, conducting program workshops, maintaining client case records, entering data to automated case management systems, collecting and recording attendance data concerning both on-site and off-site program activities, issuing sanction warning notices and communicating with income maintenance workers to impose or end sanctions, developing child care resources and arranging child care for individual clients, developing contacts with community service providers and encouraging special service features of value to teenage parents, and a variety of special tasks to support the research data collection aspects of the demonstration.

It is important, therefore, to think of case management as the job of a case management team rather than just a set of case managers, and to focus on the question of how to help case managers be most effective in their direct relationships with clients.  The demonstration experience showed the importance of support and specialization, service development, and supervision.

Specialized Staff Roles Can Increase Case Manager Time with Clients and Access to Special Expertise

The kinds of case management staff specialization described earlier have several potential advantages.  They can increase the time that direct service staff spend with clients, promote the use of special expertise, and develop special case management resources.

Assigning tasks to specialized staff is valuable because it relieves case-managers of quasi-clerical tasks and allows them to spend a greater portion of their time in client contact.  For example, clerical staff can be used to check attendance of clients enrolled in local high schools and other education and training programs, for all case managers.  Clerical staff can be used to schedule clients for group activities, and to maintain contact with income maintenance staff to monitor the implementation and termination of sanctions requested by case managers.

In other instances, defining specialized staff roles allows greater expertise to be brought to bear on specific services to program participants.  Specialized staff were used to lead and coordinate program workshops, to varying degrees in the demonstration sites.  In the New Jersey programs, specialists were brought in from other agencies to conduct initial workshops on nutrition, grooming, family planning and parenting, drug abuse and AIDS, and other topics.  In all of the programs, specialist staff from other agencies conducted workshops for ongoing clients, on topics such as employment readiness and home and life management skills.  Case managers generally felt that specialized staff could be more effective in this role, particularly in workshops concerning topics requiring up-to-date knowledge in health, nutrition, and physiology.

Specialized staff may also be particularly suitable for developing an aspect of the program by focusing attention and energy on it in a way that general case managers might find more difficult.  This was particularly evident in the role of the Camden child care counselor, who played a very active role in identifying suitable family day care providers in the community, maintaining ongoing contact with providers, and encouraging them to communicate with program staff about problems they observed in the lives of the teenage parents or their children.

Program Management Can Help by Taking the Lead in Developing Suitable Services

To be effective at getting teenage parents into appropriate education, training, and employment, case managers must be aware of and have access to suitable services.  Program managers can play an important role in creating these "service-access" conditions.  Managers in the demonstration did this in two ways that provide a model for managers of teenage parent units under the JOBS program.

Most importantly, program managers actively promoted contacts between their case management units and other public and community agencies that offered services of potential use to teenage parents.  In effect, they "marketed" the Teenage Parent Demonstration program to other programs that could serve demonstration participants.  Representatives of other agencies -- such as those offering housing assistance, drug abuse treatment, summer job placement, special services for Hispanics, psychological counseling, tutoring, etc.  -- were invited to the demonstration offices.  In this way, case managers became more familiar with the specific services available in the community, and could broaden the options they considered as they developed client self-sufficiency plans.  In addition, such meetings developed personal contacts between case managers and other service providers; such contacts helped staff overcome bureaucratic problems that could arise as they sought to gain entry to a particular service for individual clients.

Program managers also found it important to try to affect the characteristics of services available to program participants.  Some pre-existing community services were not ideally suited to the needs of teenage parents.  For example, program managers found that community GED programs serving the public at large were more geared to adults' needs and did not always offer the supportive environment needed by teenage parents.  They found shortages of child care for infants and a lack of job training for the Spanish-speaking.  Issues such as these had to be addressed by program managers rather than by individual case managers.

Program managers worked with other service providers to get them to tailor their services to teenagers' needs, modifying entrance requirements, altering class schedules, expanding certain classes, reserving slots, and even providing special services for teenage parents at the demonstration site.  For example, one program worked out an arrangement to reserve child care slots in local centers for the infant children of teenage parents.  In two programs, local community college or school district officials agreed to run ABE and GED classes at the program offices.  A local Hispanic community center in one site began to offer a life skills workshop in Spanish.  A job training provider in another site, on an experimental basis, lowered the reading-skill entrance requirements for its office skills course and offered extra basic skills instruction in an attempt to increase the number of teenage parents who could qualify for training.  To overcome a shortage of job training for Hispanic clients with limited English proficiency, one program worked with the local JTPA agency to identify and fund some on-the-job training positions with Spanish- speaking employers.

Case Managers Need Strong Supervision

Case managers in the Teenage Parent Demonstration were in effect called upon to function in some respects as social workers, although their employment backgrounds and formal training in many instances had not fully prepared them for such roles.  They were expected to be effective in individual counseling, to develop and oversee suitable service plans for clients, and to maintain thorough documentation of casework.  Strong supervisors can help case managers meet this challenge.

Above all, supervisors can help case managers develop and apply sound casework methods.  Demonstration staff pointed out several issues of particular concern.  For example, case managers sometimes needed help defining the limits of appropriate intervention for individual clients.  Some clients' needs were so extreme that they could consume large portions of a case managers' time and draw case managers into attempts to deal with problems that required much greater clinical expertise or specialized resources than they disposed of themselves.  Case managers' supervisors needed to help their staff recognize the limits of their roles and the need either to call on other available resources or acknowledge their inability to solve some problems.

A second concern cited by demonstration staff is avoiding over-reliance on routine approaches to planning for client activities.  In addition to regular individual supervision, program managers tried other supervisory techniques to deal with such concerns.  In Camden, for example, they used case conferences, at which groups of case managers presented individual "problem cases" to their supervisors and other case managers; discussion of individual cases was found useful in identifying creative solutions and in identifying when limits had to be placed on case management intervention.

Strong supervision was also important to promote rigorous and consistent maintenance of case files.  This was particularly true because the programs all used automated case management systems designed to maintain data on client activities.  Because the systems were to generate data for research as well as purely operational purposes, they imposed broad data requirements that in some cases were not fully understood by case managers.  In addition, these systems defined data requirements in very structured form rather than in more flexible formats such as case narrative.  Although demonstration research needs are somewhat unusual, the problems of defining and implementing methods for maintaining structured data on participant activities are already clear in the states' implementation of the JOBS programs.  The demonstration experience made it clear that these problems can be minimized if the case management unit supervisor is thoroughly versed in data definitions, committed to the goal of maintaining consistent data on program participants, and systematic about conducting ongoing reviews of case managers' files and refresher training.

Program Managers Need to Understand, Monitor, and Control Caseloads

The single most important factor affecting case managers' ability to work effectively with clients is the size of their caseloads, but care must be taken to define a caseload measure that reasonably reflects workload.  In the demonstration, for example, the overall number of teenage parents assigned to case managers rose to an average of 100-115 in the New Jersey programs and to about 140 in Chicago.  However, teenage parents entered the demonstration gradually over time, so case managers gradually built up their caseloads over time.  As a result, this "gross" caseload size included clients in a variety of stages of participation: developing self-sufficiency plans, participating in workshops, or engaged in a major program activity (education, training, or employment).  This gross measure also included individuals who were not participating because they had been sanctioned, had gone off AFDC, or had been temporarily deferred from program requirements.(8) 

Defining the acceptable limits of caseload size thus requires monitoring the number of cases that are no longer active, as well as judging how much case manager attention is required for clients in different stages of participation.

Demonstration managers monitored (with varying degrees of precision) the size of their staff's active caseloads rather than broader measures of total assigned caseload.  Managers may of course choose varying definitions of "active" to gauge the workload burden on case managers.  Program managers and staff, for example, voiced a range of views about whether sanctioned and deferred cases should be included in an "active caseload" measure.  On the one hand, many sanctioned and deferred clients have virtually no contact with case managers.  On the other hand, in some instances case managers must devote substantial time to such cases, trying to pressure and coax sanctioned clients back into participation or reevaluating deferrals.  One reasonable definition of "activity" for measuring case manager workload is to include clients who are developing self-sufficiency plans, participating in workshops, education, training or employment, sanctioned or pending sanction action, and to exclude only cases that are deferred or off AFDC.  By this measure, caseloads in the demonstration rose on average to roughly 60-65 in the New Jersey programs and 80-85 in Chicago.

The demonstration experience suggests that active caseloads around the maximum reached in Chicago stretch the capacities of case managers to perform the full range of functions described earlier.  Evaluation staff noted temporary staff morale problems and staff concerns about their inability to monitor their clients' status when caseloads rose to their peak in Chicago.  Many factors are likely to impinge on managers' ability to determine their staff's caseloads, of course.  However, the demonstration experience suggests the importance of monitoring not only gross caseload but a net active caseload measure, and using that information to make decisions about staff size and distribution of clients among case managers.

Program Managers Can Help to Maintain Staff Morale and Stability

Given the central role that case management staff are likely to play in a teenage parent program of the sort undertaken in the demonstration, it is important that program managers do what they can to maintain staff morale and stability as part of an overall strategy to promote staff effectiveness.  The stress of working with clients in crisis, with clients who at times resist help, in positions demanding great responsibility and initiative but with relatively little professional status, is a constant factor that program managers must recognize and counter.  They can do so by concerning themselves with staff recognition, professional development, and the nature of work assignments.

Case managers need to be recognized for their accomplishments and efforts, as do all of us.  Recognition can come in many forms.  Supervisors need to follow the most elementary rule of telling staff directly that they notice and appreciate a particular effort or a successful piece of progress with a particular client, or an approach to organizing case management work.  Formal occasions can be created in which case managers' efforts and accomplishments are recognized, such as staff awards and visits by top agency officials.  Occasions that highlight client successes, such as award lunches, can also contribute to staff recognition, for they give opportunities for individual staff to be publicly thanked and share in the success of their clients.  Given the research objectives of the demonstration, researchers periodically conducted conferences with case management staff to gather their perceptions and opinions about case management and program operations; similar consultations by program and policy officials, even in an ongoing program, can convey to line staff the importance of their professional experience.

The way that managers define case management staff's assignments can also affect morale.  Some demonstration staff found case manager participation in leading program workshops a desirable change of pace from constant casework, as long as it could be scheduled to be only a periodic burden on individual case managers.  Leading special events for clients -- outings to the theater, to museums, or even to go shopping outside familiar neighborhoods -- created some variety for case managers as well.  Some case managers were given -- or created for themselves -- areas of special responsibility or expertise which gave them special roles.  One case manager, for example, was particularly interested in the use of the automated case tracking system, and was treated as a local "consultant" by other case managers.  Some case managers became particularly aware of certain types of services, and could offer advice to others.  Site managers found it useful to encourage staff to develop special expertise and take pride in it.

Finally, it is important to find ways to develop the professional qualifications and skills of the case management staff.  Staff retreats were used in the Chicago program to provide calm settings for ongoing training, review of program policy and procedures, and respite from daily routine.  Training sessions demonstrate to staff the willingness of management to invest in them.  Case management supervisors need to follow up on training by giving staff feedback on their application of training -- to remind them of material and guidance they were given in training, and to help them identify situations in which they can sharpen their case management methods.