Section 4: Monitoring and Reviewing Case Work Activities and Processes

As we have discussed throughout this module, case management is not a fixed or linear process. To ensure effective service provision, it must be regularly monitored and reviewed and, where necessary, adapted to suit changing needs and circumstances of the client and services. Monitoring aims to determine the effectiveness of the case management process by considering the following factors:

• Is the client meeting the agreed goals as outlined within the case plan?
• Are the services/programs involved doing what was intended?
• Are the client and relevant stakeholders satisfied with the process?
• Are there any problems or barriers to effective service provision?

Some commonly used methods of case monitoring include:

• Regular case management meetings with all stakeholders, also referred to as a case conference. This is a more formal channel for stakeholders to review and reflect, as well as to celebrate milestones and successes.
• One-on-one meetings between the case manager and the client, often referred to as case review meetings.
• Maintaining regular contact with stakeholders for formal and informal briefings on client progress. This also helps to ensure that communication channels are open for addressing challenges or proposing necessary changes.
• Preparing and distributing feedback forms for all key stakeholders.

Throughout the monitoring process, it is important for case managers to effectively liaise with all stakeholders so they can form an accurate assessment of the progress being made in the case plan. Case managers should observe their clients directly and seek feedback from the client as well as other stakeholders in order to determine whether the planned strategies are meeting the client’s goals (Woodside & McClam, 2013). Facilitating these reviews in a respectful and collaborative manner assists in obtaining realistic evaluations of progress.

Of course, case managers are also encouraged to reflect and review their own practice through participation in supervision. Like counsellors, case managers can access supervision with experienced case managers to review challenges they face and learn strategies to work effectively with clients who have complex needs. Consider the following case study:

Case Study

Zoe

When Zoe and her two children first arrived at the service, she had low self-esteem and little confidence in her ability to manage her day-to-day affairs. Zoe experienced difficulties in managing daily tasks with her children and at home. She also had difficulty making appointments and negotiating with other services, including communicating with her children’s teachers.

Zoe is like a lot of other clients who have been in an abusive relationship. She is used to being told what, when and how to do everything, which means her ability to trust her own judgement is at an all-time low.

To assist her, Zoe’s caseworker, Sally, worked with her to formulate a case plan. However, as Zoe was unable to manage many basic tasks, Sally advocated for her and helped her with everything; such as organising the children for school, helping her cook meals and making all the phone appointments for her.

Sally’s supervisor became concerned about the amount of hands-on tasks that Sally was doing for Zoe. She decided to ask Sally some questions about Zoe’s case in supervision. Sally described how she was making great progress on the case plan and that Zoe was meeting all of her goals so far.

When Sally’s supervisor asked her about the skills that Zoe was developing and what she was doing to help Zoe transition out of the service, she realised that she had been going about things the wrong way. Instead of Zoe gaining confidence in her own abilities and developing the skills to manage her own life, she continued to struggle and relied on her caseworker for these tasks. Zoe was not gaining the skills and self-esteem needed to get her out of homelessness.

Sally’s supervisor helped her to develop some strategies to engage Zoe in doing the tasks in the case plan rather than doing them for her. Sally would now try getting Zoe to do these tasks and in the process help her to learn these skills and gain confidence to do them for herself.

Practice tips:

• Effective casework support does not equal doing everything for the client.
• Supervision is a key aspect of reflective practice and improving practice.
• The goal of the client/caseworker relationship is to transition the client out of homelessness. Everything you do with a client should work towards this goal.
• Casework support provides many opportunities to educate and empower the client.

^{(NSW Department of Family and Community Services, 2012, pp. 84-85)}

The information gathered through the case review process must be used to assess if any changes are required. Common situations that may result in changes to a case plan include:

• The review indicates the client is not making the expected progress or that they are unable to achieve specified goals.
• The client’s circumstances or priorities change (e.g., changes in the client’s health, the client moves to another area).
• Changes in service delivery, such as when a service is discontinued or restructured; or additional or more suitable services become available.
• The client or other stakeholders request a change to the case plan.

It is important to keep the client central to the review process by seeking their feedback on how the case plan is working or not working. Their feedback is incredibly important because there may be a significant clash between the client’s understanding of their progress and the case manager’s perspective.

For example, if the case manager perceives some positive change but the client does not, it may be appropriate for the case manager to draw attention to the changes that they have observed. While this can be powerful for some, it is important that case managers are careful not to disregard the client’s feeling that they haven’t achieved what they set out to achieve. On the other hand, while the case manager may perceive little progress, the client might see and feel big changes.

Allowing the client opportunity to share these changes can lead to discussion about what they view as their achievements, how they perceive the plan to have helped them, how they can make further improvements, and what they see as their next steps. It can also help identify barriers that may be preventing progress. Involving the client in monitoring helps case managers to avoid making assumption about clients – we can’t assume that we “know” how the plan is progressing. It is important that we not only use our own judgement, but also check this out with the client and/or other service providers.

Where the client is not making progress toward their goals, it is important that the case manager and the client work together to understand the barriers that may be preventing the client from moving forward and develop alternative strategies to overcome these barriers (Mullahy, 2010). This may involve small changes to the case plan such as lengthening the timeframes for existing action steps, referring the client to additional services, and/or engaging alternative supports.

The actual steps you would take to amend a plan may vary depending on the nature of the change. For example, a minor change to timeframe of service that is unlikely to affect other parts of the plan may only need to be discussed and agreed with the client and relevant service provider, and documented appropriately. However, a change to the client’s goals or involvement of new services may call for a discussion between the stakeholders.

Following are some reminders of what a case manager should do when making changes to a case plan:

Occasionally, urgent updates and changes may be required following a crisis (e.g., client is hospitalised, disengaged, imprisoned, or become homeless). Case managers may need to coordinate and negotiate for changes to the case plan on short notice. Negotiation and communication skills are particularly important during these times.

Evidence-Based Treatment Planning

This video provides a role-play where the counsellor shows how to negotiate change using a detailed, practical evidence-based treatment plan. Answer the questions that follow.

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Any significant changes to a case plan must be negotiated and agreed with all relevant stakeholders. For example, if the client and case manager decide upon the need to engage additional services from a certain provider, then the case manager will need to negotiate this change in service provision with that agency/organisation.

This process highlights the importance of the case manager having a thorough understanding of the requirements of other service providers. For example, if a particular service provider only provided time-limited services it would not be possible to extend the provision of this service and the case manager would need to find a suitable alternative.

Where practicable, changes are best discussed in a case conference so that a consensus is reached about what changes will be made to the plan and the altered roles and responsibilities of all stakeholders. Agreement must be sought for all changes and these changes must then be documented and an amended case plan distributed to all stakeholders.

Nevertheless, case meetings may not always be a viable option due to urgency of issues and availability of stakeholders, in which case the case manager should seek alternative ways to discuss and confirm the changes (e.g., through phone, email) and make sure the discussion and outcomes are appropriately documented.

As with most things in life, case management don’t always go to plan. Clients can sometimes experience an unsettling event or an escalation of their current circumstances which lead to a crisis. In a crisis, case plans may need to be changed or completely put aside so that case managers and clients can collaboratively and effectively respond to the crisis.

Obviously, none of us can see the future and certain events cannot be predicted (e.g., loss of job), but wherever possible, case managers should work with their client to plan for any foreseeable crises (Summers 2016). For example, if working with a client who has a mother diagnosed with terminal cancer, it would be important that the case manager work with the client to plan for her mother’s care (e.g., arranging additional support).

Summers (2016) provides four suggestions to support case managers to respond in the event of a crisis:

1. Respond immediately: A quick and timely response can sometimes prevent further escalation of the situation.
2. Construct the best course of action under the present circumstances: The best course of action may not be immediately obvious to the case manager and/or the client, so it may require consultation with your supervisor or other service providers as/when required.
3. Listen to the person: Giving your client the opportunity to be heard, understood and make sense of the crisis can go a long way to de-escalate a situation. The use of counselling and communication skills (e.g., open question, paraphrasing, empathy, etc.) are incredibly important here.
4. Help the person to begin to look ahead: At an appropriate time, encourage your client to look beyond the crisis and consider how they would like to move forward as well as barriers that may be preventing them from doing so. In the midst of a crisis, this may be a challenging process to facilitate, but in doing so you are supporting your client to take back control of their life.

Where a crisis has occurred and has been adequately responded to, case managers will then need to return to the case plan with their client and make any changes required as a consequence of the crisis.

The ultimate goal of any case management process is to support clients to exit the service system wherever possible (Summers, 2016), ideally after achieving their goals. This should always be kept at the forefront of your mind throughout the entire case management process. When working with clients, every effort should be made to ensure that the client is supported to develop their own independence.

However, certain clients may require ongoing case management due to complexity of their situations. For example, a client living with a severe developmental disability may require ongoing support. Nevertheless, even in cases such as this, the goal is to continue to support that person to live as independently as possible (Summers, 2016).

It is important to be aware that case closure and the termination of a case management relationship can be a significant and sometimes difficult process for clients. Clients may question their capacity to live their lives without the support of a case manager, or they may just really like their case manager and want to continue seeing them.

Whilst the end of service use may represent a positive milestone for a client, it may stir up feelings of anxiety and hesitation. For this reason, adequate exit planning is incredibly important and must be dealt with sensitively to help prepare clients to maintain their progress without the support of a case manager (Mullahy, 2014). Where relevant, celebrating and validating client success (even if they have not fully met their goals) is important to help client recognise the positive changes they have achieved towards the end of the case management relationship.

Preparing clients for the potential end of case management relationship ahead of time can be extremely useful (Summers, 2016). Case manager should inform client of the possible reasons for case closure from the very beginning of the case management process so that there will be no surprises – particularly if they work for an organisation that only sets out to provide time-limited service.

Other common reasons for ending a case management relationship include: the client moves beyond geographical area of service catchment (in which case they may be referred to another suitable case management service provider); the client has met their goals and decided not to return; the client no longer meet the service criteria of your organisation; service or funding changes in your organsiation; and the client has disengaged (i.e., unable to be contacted or located). Some organisations may take a gradual approach to case closure, such as gradually reducing contact and transitioning them to more remote monitoring or more informal support options before the definitive case closure.

The following extract provides some useful information on the practical concerns of exit planning:

Your responsibilities as a case manager do not terminate immediately after case closure. It is important to make sure you document the reasons of case closure and that all client files and records are properly maintained as per organisational requirements. This is not only important for meeting legal documentation requirements, but also supports potential future work with the clients should they choose to re-engage with your service.

The exact procedures for case closure differ between organisations, however, the following are common elements across most settings:

• Identify and document the reason for the case closure (e.g., goals have been achieved or client is not complying with plan so further case management is not attainable).
• Wherever possible, document evidence that the end of case management relationship has been agreed to by all relevant stakeholders, including the client.
• Document evidence that reasonable notice of case closure has been provided specific to the circumstances of the case
• Provide notice of closure to all relevant stakeholders.
• If the client is transferring to another service, document their written permission to transfer their case information to that provider.

You may have noticed that documentation is a constant component in case management work, and can take up a significant amount of your work time as a case manager. Keeping accurate records of client work is critical for keeping service providers accountable, as well as for complying with legal obligations, such as privacy and confidentiality requirements.

Throughout a case management process, you may need to manage a range of documents, including: an intake form, case notes, assessment tools or reports, case management plans, case management meeting agenda and minutes, reports or referrals to/from stakeholders, and case closure documentation.

Any documentation must be completed accurately in a professional manner (e.g., free of jargon and derogatory language), given that information is often shared between stakeholders. Summers (2016) outlines the following ‘best practice’ tips for effectively writing case notes and other documentation:

• Avoid hostility: Make sure that your notes do not reflect any negative feelings you might have toward any person.
• Document significant aspects of the meeting: You do not need to detail every single detail of what occurred in the meeting but on the other hand you will need to document those aspects that are significant (e.g., client’s participation in the meeting).
• Be clear and precise: Avoid using vague terms, general descriptions or indefinite statements.
• Use quotations: Where the exact words of a client are important to be included in a record, you should document their exact words in quotation marks.
• Avoid contradictions: Any updated documentation should not contradict previous notes without an explanation. For example, if a case plan has changed, give an explanation as to why.
• Use language the people you serve understand: Avoid jargon not only to ensure that everyone can understand what is written but as a way to reduce any power differences between the client and other stakeholders.
• Do not be judgemental: While you might “judge” some aspects of your client’s life and/or behaviour, this is not helpful and can be extremely harmful when this is obvious in your case notes. These notes can leave a legacy that follow your client.
• Distinguish between facts and impressions: A fact is something observed whereas an impression is simply a clue.
• Give a balanced view of the person: Your documentation should not just be a collection of problems. Remember, we all have strengths and we all have things that we struggle with.
• Making changes to the plan: Where the case management meeting has resulted in a change to the case plan, clearly document the reasons for a change and note the revisions to the plan.

Using Collaborative Documentation for Counseling Treatment Plans

In this video, Dr. Maelisa McCaffrey of QA Prep reviews how to introduce this topic with clients and ways to guarantee it's truly a collaborative and client-centered process, while still meeting legislative and documentation requirements.

WATCH

This final section of Part A of this module has provided you with an overview of the processes of case monitoring and review. You have learned about the importance of obtaining feedback from all stakeholders in order to monitor client progress and satisfaction. You also learned about how case managers can review plans and develop alternative strategies in cases where the case plan is failing to meet client needs. Finally, you learned about the steps involved in ending a case management relationship.

Overall, Part A of the module has introduced you to the key considerations and practices involved in case management practice. Many counsellors who work in community services organisation have case management duties or work regularly with case managers. In Part B of this module we will ‘flip our perspective’ and explore the processes involved in working as a counsellor to implement part of a client’s case management plan.

Mullahy, C. M. (2014). The case manager’s handbook. Jones & Barlett Learning.

Queensland Council of Social Service. (2014). Planned support guide: An approach to case management. Brisbane, QLD: QCOSS.

Summers, N. (2016). Fundamentals of Case Management Practice: Skills for the Human Services. (5th ed.). Boston, MA: Cengage Learning.

Woodside, M. & McClam, T. (2013). Generalist Case Management: A method of human service delivery (4th ed.). Belmont, CA: Brooks/Cole, Cengage Learning.