Case Management for Teenage Parents: Lessons from the Teenage Parent Demonstration. WHAT DOES IT TAKE TO BE A GOOD CASE MANAGER?

12/01/1991

Case management is a very demanding job.  It requires energy and patience, imagination and discipline, warmth and realism, a capacity for insight about human emotions and motivation, and well-organized work habits.  As described above, the demonstration sites took different paths to recruiting and training case managers, but program managers shared common perceptions of the important qualities of a good case manager and of some factors to be considered in building a case management staff.

Case Management Requires a Balance of Caring and Toughness

In any case management staff, there is likely to be a variety of personal backgrounds, styles of interaction with clients, and strengths and weaknesses.  Case managers' own personalities will determine the relative emphasis to which they rely on supportiveness, warmth, trust, and encouragement to motivate and guide clients, and the degree to which they push clients forward with strict demands, deadlines, and tough application of sanction policies.  Case managers and supervisors clearly recognized the need to balance these two qualities to be effective, and supervisors and managers can promote this balance.  They can recognize individual case managers' personal styles, guide those who lean towards a supportive, lenient approach to recognize the circumstances in which a stern, insistent stance can be productive, and likewise help the natural disciplinarian to see the value of warmth and empathy in communications with clients.

Case Managers Need to Be Able to Talk Comfortably and Constructively About Sensitive Topics

Case managers' ability to help clients into education and training and to overcome personal barriers depends on their ability to identify and address personal issues that are often very difficult for clients to acknowledge and discuss, and that are widely avoided in general in our society.  Demonstration clients, as teenagers, struggled with the typical confusion and uncertainty over sexuality and relationships to men and their own families.  As very young parents, they had to deal, relatively unprepared, with the difficult demands of caring for an infant.  Beyond these typical concerns, numerous clients had suffered sexual, physical, and emotional abuse.  Case managers had to uncover and discuss these issues as they affected their clients' lives, in a down-to-earth, nonjudgmental manner, and to try to guide them towards recognizing the choices they had available to them.  Although case managers were certainly not trained as clinical therapists, they could apply their own personal skills to make it easier for clients to talk about these issues and to give constructive support.  When necessary, they had the option of making referrals to other mental health agencies for more specialized counseling.

Good Case Managers Actively Initiate Client Contact

One demonstration program manager reported that a useful criterion for judging the performance of case managers is their level of client contact.  All case managers are likely to have clients contacting them, so the major variable affecting levels of client contact is likely to be what the case manager does to encourage or explicitly initiate contacts.  On the one hand, case managers initiate contacts with clients in the process of identifying and addressing problems in client attendance.  Case managers who follow a more "formal" approach, relying mostly on written sanction warnings, are likely to have less client contact than case managers who insistently reach out to try to discuss problems with clients.  Levels of client contact are also likely to vary with the degree to which case managers initiate periodic "check-up" calls with their clients who are successfully pursuing program education or training courses or are working.  Making the time for such calls underscores the fact that program staff care about how the clients are doing as people, and not just about whether they comply with program requirements; this kind of communication can increase chances that clients will turn quickly to the case manager if a problem arises.

Ideally, case managers will attempt periodic contacts with clients who are sanctioned, although time constraints inevitably affect their ability to do so.  As explained earlier, such contacts can increase the chances of either convincing a noncompliant client to participate or creating enough continued informal communication so the client comes back to the program staff when circumstances change.  JOBS rules require that program staff send a notice three months after the start of a sanction, reminding clients that they can return to a full benefit level by participating, but this requirement is likely to be satisfied by a formal printed notice.(7)  More personal contact by case managers will likely have a stronger effect on clients' perceptions of the program.

Case Management Requires Teamwork

The pressures of case management, the use of specialized staff, and the importance of successful personal interaction as an ingredient in case management make it important that staff be able to work as a team and avoid jealousies or turf issues.  Case managers reported that clients often seek help with very urgent problems, and if these crises arise when the client's assigned case manager is out of the office, other staff must be ready to respond.  A spirit of helpfulness and an ability to avoid being possessive about one's caseload are important to make this kind of teamwork successful.  Staff specialists form relationships with clients, and the specialists and case managers must work in partnership rather than in competition for the attention or recognition of clients.  These issues are particularly important because, according to demonstration staff, there are times when a client may gravitate towards a staff member other than the assigned case manager; it is important that staff be able to take advantage of these affinities and promote the formation of any positive relationships rather than react jealously to them.  At the same time, of course, staff must take care to avoid conveying conflicting guidance or expectations.

A Mix of Personal Styles and Backgrounds Can Strengthen a Case Management Unit

Program managers and case managers pointed out the value of having a variety of personal styles and backgrounds represented in the case management unit.  To some extent, the staff mix may be affected by the recruiting methods used and the effect these methods have on educational qualifications and relevant job experience.  Educational qualifications of at least some staff can enhance the understanding of other unit members of adolescent development and behavior and ways of working with teenage parents.

Program managers pointed out the comparable importance of having at least some staff with strong "street savvy" -- familiarity with the neighborhoods where clients live, some personal experience with the life problems they face, and awareness of the strategies that people growing up in poverty can develop to overcome the terrible problems they face or to avoid dealing productively with them.  Case managers with such backgrounds are sometimes best equipped to see through evasive justifications that some clients may offer for not participating in the program, to detect the underlying circumstances that contribute to such behavior and that must be overcome, and to have a realistic sense of what clients can do to help themselves.  Within the limits of personal safety, it is valuable to have case managers willing and able to circulate in the community where their clients live, making home visits when necessary and as time allows.

Case Managers Need to be Organized in their Work Habits

Case managers have to be both systematic -- keeping track of their own agenda of planned work -- and also responsive -- able to deal with interruptions and crises that are thrust upon them by the inevitably unexpected needs and demands of teenage clients.  Individuals who need the structure of a rigid schedule of appointments to maintain their composure and their forward progress on scheduled work are likely to fare poorly as case managers.

Organized work habits are particularly important because case managers must engage in extensive client contact and also keep case records up to date.  They must find time to write case notes and prepare or enter structured data into whatever automated client data system is used.  Effective time management is likely to maximize both time spent with clients and the completeness and accuracy of client records.

Efforts to Find Creative, Personally Tailored Solutions Are Particularly Valued

Case managers deal with individuals, and the activities toward which they guide clients will ideally reflect the attention they pay to individual clients' specific needs, the constraints in their lives, and their strengths and interests.  However, if service options are relatively narrow, case managers may rely on "cookbook" solutions such as courses to prepare for General Educational Development (GED) examinations, Adult Basic Education (ABE) classes for low-skilled high school dropouts, referral to the JTPA agency for high school graduates, or job club for those who resist school and training and say they want a job.  Relying routinely on certain activities in plan development is a particularly easy habit to fall into, because case managers are likely to develop relationships with certain service providers whom they trust and respect.

Finding creative approaches to individual clients' circumstances requires thinking specifically about each client's goals and what specific steps will help her toward that goal.  For example, a Camden case manager realized that for one client having a driver's license was going to be essential to attaining her goals, and incorporated driving lessons and taking the motor vehicle test into her self-sufficiency plan.  For a client interested in becoming a nurse, a case manager might help arrange visits to a local hospital to talk to nurses about their jobs.  A creative case manager might assemble small groups of clients in similar circumstances -- for example, clients who are deferred from full-time program activity requirements after child-birth, clients in active job search, or those on "hold" awaiting a training start -- for informal conversation, to maintain communications and motivation.

Being creative does not necessarily imply using unusual service providers or activities, but it does mean being very conscious of and attentive to the advantages and disadvantages of each activity for each individual client.  One program manager pointed out that it is important, for example, that case managers have a very tangible sense of what a training site looks like, the setting of a GED class, or the atmosphere created by the staff at a youth corps site.  Program managers can help develop contacts for the case management unit with local service providers, but creative case managers will make the time to become personally familiar with available program options by visiting program sites themselves.  Program managers can help in this respect, of course, by organizing visits to major service sites for groups of case managers.