Although demonstration plans and guidelines anticipated a central role for case management, the details of the case managers' work and the structure and organization of case management staff were defined by the States and evolved with experience. The programs also developed their own staff structures, which allocated certain roles to case managers and some specialized or support roles to other staff in the demonstration units. The case management function performed by this overall unit included six broad roles:
- Initial and Ongoing Assessment and Planning. When teenage parents had completed their intake session, they were assigned to a case manager, who conducted a comprehensive assessment and worked with the participant to develop a self-sufficiency plan for full-time program activity. Assessments drew on information collected in several ways. Case managers conducted an in-depth interview using a specially prepared interview guide that covered educational progress and aspirations, work experience and occupational interests, child care needs and resources, transportation problems, housing situation, history of substance abuse, health problems, legal problems, family planning practices and attitudes, and general self-esteem. The Test of Adult Basic Education (TABE), administered at intake, provided grade-equivalent measures of math, reading, and language skills. TABE scores were used in conjunction with information on school progress and staff's observations of new participants, rather than as a decisive factor alone. Participants sometimes did not take the TABE seriously at intake because they were not aware that it could affect the choice of their program activities; case managers therefore had to be careful to consider other indicators of participants' skills, and in some instances read ministered the TABE when clients had entered the program. Demonstration staff also had available an occupational interest questionnaire, which was useful primarily with older participants who had a clearer awareness of occupations. Depending on available time, home visits were sometimes made as part of assessment.
Assessment was an ongoing process. The initial assessment interview and intake TABE scores provided the basis for an initial plan, but further events provided more information and circumstances changed. Case management staff observed new participants in initial program workshops, and in the process uncovered new information about their strengths and weaknesses which could suggest that plans for post-workshop activity should be changed. Reassessments of activity plans were repeated as changes occurred in participants' personal or family lives, as they progressed through program activities or had difficulties in them, and as changes occurred in the types of available services.
- Personal Support and Motivation. A large part of the challenge the staff faced in working with many clients was to overcome the personal, family, and community pressures that could discourage teenage parents from participating and seriously divert their attention from the effort the program demanded of them. Case management staff had to strengthen participants' faith in the possibility of building a better life for themselves and their children, and help them build confidence and self-esteem that in many cases had withered over years of difficulties in school, chaotic family ties, and sometimes abusive relationships with men. Case managers provided encouragement and sympathy, but also the kind of clear and consistent expectations that they perceived had been missing in many participants' lives and that many adolescents need for motivation and guidance.
- Service Coordination and Advocacy. An important concern of the case managers was to ensure that participants gained access to the services they needed. Case managers had to keep track of the availability of desirable education and training courses and program workshops, and fit together plans which made optimal use of available resources and participants' time. Often they had to intercede on behalf of clients. For example, they might talk to income maintenance workers to help get benefit errors corrected or with local school officials to obtain permission for a client still of mandatory school-age to enroll in GED classes. Case managers might persuade a nursing school to waive a registration fee or defer a payment deadline, convince a welfare department housing unit to provide a near-homeless client with an apartment deposit, or enlist the help of relatives or the cooperation of landlords to stabilize a client's housing situation.
- Providing Child Care and Transportation Assistance. Demonstration staff helped participants locate child care arrangements, and when necessary inspected them. In many cases they repeated this effort when arrangements with a particular provider broke down or when clients' participation in the program was interrupted and then resumed. The counseling role played by demonstration staff was particularly important, because many teenage parents had strong reservations about using non-relative child care. They often had to be helped to appreciate both the overriding importance of their own continued education or training and the potential benefits to their children of choosing a stimulating child care environment.
To varying extents, the demonstration programs offered limited on-site child care, mostly for periods when participants were attending workshops, classes, or appointments at the program offices. Unit staff also processed vouchers from child care providers and authorized issuance of payments to them, and authorized issuance of weekly checks to participants for bus fare and lunch expenses. In Camden, the program operated a van to take some participants to training or to take groups of participants on cultural or educational outings.
- Enforcing Participation Requirements. The case management unit enforced the requirement that eligible teenage parents attend the initial intake session. Once new participants had completed intake, their assigned case managers, with support from clerical staff, monitored their attendance at scheduled assessment interviews, workshop sessions, on-site classes, public school, and other off-site education and training courses. When participants failed to attend scheduled activities as required, case managers sent warning notices to them, tried to set appointments to discuss problems that might be interfering with their program attendance, and in many cases eventually requested grant- reduction sanctions if the participant failed to comply. Sanctions were treated as a last resort; case managers tried first to persuade and pressure clients to participate, and often developed alternative plans for activities that seemed more likely to motivate them.
- Maintaining Case Records. The program staff at the demonstration sites used a combination of computerized and manual systems to maintain records concerning assessment and self-sufficiency plans, participants' program activity and attendance, case notes, and payment issuance for child care and transportation. Both states developed microcomputer-based tracking systems in which staff entered extensive baseline data, and recorded completion of program workshops, entry to and exit from education, training, and employment activities, and sanction actions. These systems were designed to use information on participant status as a basis for issuing notices of scheduled workshops, warnings of sanction action for failure to attend program activities, other notices, and management reports. Case managers also maintained written case narratives; in some sites these narratives were conveniently maintained with word processing tools available to the case managers through the same terminals as the formal case tracking system.
Some aspects of the case management role evolved over time based on experience. For example, early in the demonstration home visits were used fairly frequently -- to promote attendance at intake sessions, to complement the in-office assessment process, and in some instances to clarify a home situation or confer with a participant's parent. As the pressures of increasing caseloads grew, the practice of making home visits was scaled back to relatively infrequent use. Experience also led program managers to recognize the need to help case managers avoid excessive involvement with individual participants whose problems could consume large fractions of their attention and might, in some cases, need the attention of more specialized, clinically trained professionals.
The Programs Developed a Staff Structure and Specialized Roles
To deliver the range of services described above, each site created a structure of supervisory relationships, specialist roles, and support roles. Most staff at the demonstration offices were directly employed by the unit of the public assistance agency sponsoring the demonstration, but staff on loan from other agencies or units in the public assistance agency were also located on site, full-time or part- time.
The basic staff structure at all three sites consisted of a site manager, assistant managers or supervisors, and a team of case managers. The Camden and Newark sites each had five case managers, overseen by an assistant site manager or case management supervisor in addition to the site manager. At the larger Chicago site, the staff of ten case managers was divided into two units, each with a supervisor reporting to the site manager.
The sites also developed roles for specialists who worked directly with participants in aspects of the broad case management functions described earlier. All three programs used specialists to focus on helping participants make a transition into employment or job training, or back to school. In Chicago, an employment specialist ran job clubs, sought out promising job openings, working with the State employment service and employers. An education specialist conducted intensive "study skills" sessions with participants preparing to go back to school to help them schedule their time and develop effective study habits, drawing in part on a computer-equipped learning center developed at the demonstration site. The Camden program had the services of a training counselor on loan from the county Job Training Partnership Act employment program and a part-time job placement counselor, and the Newark program had an employment training counselor who conducted job clubs and found job placements. The Camden and Newark programs also had child care counselors who helped educate participants about the use of child care, find suitable child care openings, inspect providers' homes or facilities if necessary, and serve as a liaison to providers.(3) These specialists were integral parts of the case management staff. They worked closely with the case managers and, in some instances, played important counseling roles with individual participants.
Clerical staff performed important support roles in the demonstration units to help case managers monitor their caseloads and take required actions. They performed -- to different degrees in the three sites -- five kinds of tasks:
- Client Call-in and Scheduling. Clerical staff scheduled newly identified teenage parents for program intake, and used program computer systems to generate call-in notices. This function corresponds approximately to the step in many states of calling in AFDC recipients subject to JOBS requirements for an initial evaluation. In ongoing JOBS programs, this function may be handled by general AFDC eligibility systems which flag teenage parents.
- Attendance Monitoring. Demonstration participants attended a variety of off-site activities (e.g., high school, GED classes, job training). Collecting regular, frequent information on their attendance at these activities was an essential part of monitoring compliance with participation requirements and identifying problems so case managers could intervene rapidly. Clerical staff were used to maintain contacts with service providers, record attendance, and inform case managers of attendance problems.
- Liaison with Income Maintenance Unit on Sanction Status. When a client persistently failed to respond to repeated call-ins or failed to attend later program activities, case management staff initiated requests to income maintenance staff to impose sanctions. Clerical staff were used to monitor sanction status, checking to be sure that sanctions were implemented as requested and that they were removed when requested by case managers upon clients' compliance with program requirements.
- Data Entry. All three demonstration programs trained case managers to use an automated case management system directly, but they also used clerical staff for entry of certain types of information. For example, attendance at initial group intake sessions was entered by clerical staff, and clerical staff then used the system to generate repeat call-in notices. Data entry staff were also used to enter baseline information collected in intake interviews. In all programs, it was possible for either case managers or data entry staff to input information on participants' ongoing activities, although each site followed a general practice of relying primarily on one or the other.
- Voucher Processing. The case management units had to approve payments for child care and transportation -- functions also required in the JOBS program. The demonstration programs used clerical staff to review child care providers' invoices, check to be sure that the period of child care corresponded to actual client attendance at program activities, and authorize payment. Clerical staff prepared authorizations of payments to clients for transportation, which also involved reviewing their activity schedules and attendance records.
Other special functions that might be viewed as beyond the definition of case management were performed at the sites -- by demonstration staff or staff from other agencies. The programs used various combinations of case managers and outside specialists to run initial workshops for new participants and other ongoing workshops for selected active participants.(4) In Chicago, a representative of the child support enforcement unit of the Illinois Department of Public Aid was stationed part-time at the demonstration office to conduct interviews with participants and promote their cooperation with and understanding of the child support process.
Case Managers Were Recruited Through Different Channels, and Received Special Training
Circumstances gave rise to quite different approaches to recruiting case managers in each of the three demonstration sites and, as a result, to case management staffs with quite different backgrounds. In Chicago, civil service rules required that case managers be recruited from the ranks of income maintenance workers; as a result, most case managers' highest credential was a high school diploma, the educational requirement for income maintenance positions. In Newark, case managers were recruited largely from the ranks of the State's Division of Youth and Family Services and its Bureau of Employment Programs; this process yielded case managers with at least bachelor's degrees and in several cases with master's degrees, and considerable experience in social work and counseling. In Camden, the County Board of Social Services was able to recruit at large; in this process, personal skills were given substantial weight, and the staff hired had a variety of educational levels and professional experience.
In all programs, case managers were given initial and ongoing training, but the extent of training and the emphasis on approaches to working with adolescents and their problems were clearly greater in Chicago. In New Jersey, a total of four days of case manager training was conducted in the first several months of the demonstration, focusing heavily on procedures for intake and client data collection. This training was held before most of the Newark case managers had been hired. Over the next year, several days of additional training focusing on techniques for working with teenage parents were provided. In the third program year, about nine additional days of training on case management techniques were provided by an outside consultant.
Training was more extensive in Chicago. Two weeks of initial training sessions were conducted, mostly by outside experts invited to speak about issues such as adolescent health risks, pregnancy prevention programs, employment problems facing teenage parents, the child support enforcement process, adolescent development, teenage sexuality, parenting and child discipline, in addition to demonstration procedures and data collection. An additional 20-30 days of ongoing training sessions were held during the course of the demonstration, covering topics such as adolescent health, reproduction and family planning, parent-child relations, child care and child safety, child sexuality, group dynamics, sexual assault and abuse, domestic violence, child abuse and neglect, managing stress and conflict, AIDS, promoting self-esteem, and methods for motivating youth. The substantially greater level of training provided in Chicago probably reflected the availability of a well-developed State training capacity and procedures for using training, as well as the relatively lower level of formal education and relevant experience among the Chicago case managers.