Assessment item 1
Reflective statement and essay
Length: 2,000 words
Discuss case management using the topics studied so far specifically:
Part A – Reflective statement
– reflect on an experience you have had of being a client, preferably in a case management episode (Centrelink, Job Network, Immigration, medical). Briefly specify the situation and comment on the effect it had on you , positive , negative, neutral. What did or didn’t get done, what would have enhanced the experience and usefulness for you. (Write the reflective statement on a separate page from your essay or provide headings to show clearly where Part A ends and Part B begins).)
Part B – Essay
– Discuss and critique the theories that have contributed to the evolution of Case Management
– Discuss the difference between person centred and provider driven models of practice
– Critically discuss the tensions and conflicts that can arise in practice
Use specific examples to illustrate your conceptual points and demonstrate that you understand their application in practice.
• You will demonstrate an understanding of the theoretical bases on which case management rests and some of the tensions between theory and practice application.
• You will find completing Module 1 and the textbook essential in undertaking the task.
All assignments must have an introduction, sub headings to structure the body of the paper, a conclusion, and a reference list. Write in sentences structured into paragraphs. Lists and dot points are not recommended. APA in-text referencing must be observed
Students should check online resources for styles and formatting including:
Submit as a word document and NOT as a PDF.
This assessment task is aligned to the following objectives:
* Defining case management and outlining the difference between client-centred and provider-driven models of practice.
* Outlining and discussing the theoretical underpinnings of case management practice and how these fit with the generic model of case management in your subject materials.
* Identifying and critiquing some of the tensions and conflicts that can arise in the case management role both with clients and in the broader context in which case management is delivered.
• Please refer to the presentation requirements outlined under assessment information details in the subject outline. These provide very specific details on how to present your work, as well as technical aspects relating to referencing.
o You must include a clear introduction, body and conclusion to your paper. This involves the use of headings to signpost your work.
o To analyse the key words for this assessment task e.g. comment, define, outline, etc, you are advised to access the link below and refer to page 5 specifically for more details.
o It is recommended you visit the guidelines on critical thinking and assessment writing checklist under assessment information in your subject outline.
• Prescribed text(s)
Moore, E. (Ed.) (2009). Case management for community practice. Melbourne, Australia: Oxford University Press.
Gursansky, D., Kennedy, R., and Peter Camilleri (2012), The Practice of Case Management: Effective strategies for positive outcomes. Allen &
Unwin, Sydney. ISBN: 9781742370446
Please note that when using the APA referencing system you will cite the author of the chapter (not the editor). You can refer to the APA summary for guidance/examples on how to do this
Textbook and additional readings are available on the LIbrary eReserve.
Session Week Week commencing Topic/Module Readings & Other information
1 29 February Subject overview
Topic 1: Origins and influences Subject outline; Modules; Readings; Plan study schedule. Understand assignment requirements.
Readings in support of Subject Overview; Readings include Text Chapters 1 & 18.
2 8 March Topic 2: Diverse definitions and systems; Topic 3: Ethos – values, principles and ethics Readings include Text Chapter 2; Readings include Text Chapter 3.
3 15 March Topic 3: Supporting theories Browse Part 3 of text; Search relevant e-links; Readings include Text Chapter 4.
4 22 March Topic 4: Supporting theories Readings include Text Chapter 5 & part Chapter 6.
CENSUS DATE: 23 MARCH
5 29 March Topic 5: Overarching practice functions Readings include Text Chapter 6.
6 4 April Topic 6: Integrating community and informal supports
Readings include Text chapters 7 & 8.
The emergence in capitalist societies of social policy and health and welfare provisions of the welfare state that aimed to assist vulnerable people originates from:
• 18th century industrialisation and colonisation
• 19th century nation building and philanthropy
• 20th century positivism, the growth of the social sciences and the emergence of the professions
• 20th century ideals of social citizenship rights and the responsibility of the state for providing for vulnerable citizens.
The professions – nursing and social work
The welfare state provided the context in which the work of philanthropic women shifted from charitable assistance to professional nursing and social work. The social sciences generated the knowledge about how people and society function that informed professional practice about how to intervene effectively to shape individuals and society toward the ideal society. The professions in turn generated expertise in particular interventions that were found to be more or less effective in practice with individuals and their social systems, families, communities and society as a whole.
In Australia the popularity of the term ‘case management’ in social policy, social service administration and individual practice with vulnerable population groups has increased over the last three decades. It marks shifts in policy and administration that are grounded in developments in social science and professional knowledge, technological and demographic changes in society and economic change that is closely linked with political ideological change.
De-institutionalisation of care
Commencing in the 1970s with the growth of social science knowledge and civil rights movements, social policy and the human service professions embraced the notion that institutional care was not only an ineffective response to personal vulnerability but also a violation of individual human rights. Care in the community required different and dispersed organisational arrangements for the provision of care to vulnerable people. The practice of late 19th and early 20th century philanthropists, who assisted people to establish their living and working arrangements in the face of social upheavals of migration and war was instructive. Like the work of the early philanthropists, the emphasis was on community located practice in community nursing and community development in social work.
At the social policy level governments sometimes saw this as an opportunity for cost savings in providing care for vulnerable citizens, and the mix of services needed to support people in a community setting was not reliably provided. The provision of care in the community to people previously institutionalised provided the basis for the emergence of the dual roles of social control and social care. Persons deemed to present a risk of harm to themselves or others could well be subjected to interventions marked by social isolation and surveillance. For those with limited capacity to satisfy their own personal care and social participation needs, their level of dependence could still result in the imposition of care practices within the community that took socially isolating and overly restrictive forms.
Societal, technological and demographic change
In the 21st century, in relation to people who are vulnerable:
• populations of economically developed nations are marked by diversity and social acceptance of diversity, thus increasing expectations of and opportunities for social participation and making diversity more visible in our society
• advancements in medical technology have increased the survival rates of people who have disabilies and the expected lifespan of people who are ageing, so that they make up a larger proportion of our population.
Economic change, influenced by the impact of economic globalisation, has fuelled ideological change in social policy and the extent to, and way in which, vulnerable people are offered assistance. In capitalist countries with welfare state provisions those provisions are at best being transformed and at worst being unwound. Economic liberalism has underpinned the notion that in a free market economy every person can and should provide for themselves. It is in this climate of increased numbers of people in need of social services that the economic and political ideology argues for self sufficiency. In this context the social policy discourse has sometimes co-opted case management as a tool that leans more toward social control than social care.
Defining case management
Case management systems serve several interests, not all of which are wholly compatible. Policy makers, programme administrators, practitioners, primary carers and the people who are vulnerable have their own expectations, resources and constraints. All of these come into play in decisions about systems design and practice approaches. Thus there can probably be no one definition that is applicable to all fields of practice, policies and programs. Even so, there are some identifiable common and distinctive features of a case management approach that can be identified.
Case management is generally distinguished from individual case work approaches to service by its focus on persons experiencing all of:
• limitations in personal functioning
• limitations in social functioning
• high level of dependency, temporarily or through the lifespan
• multiple needs requiring assistance from informal supports and formal services
• the need to access a complex system of formal resources and services.
Generic definitions tend to focus on the concepts of multiple needs that require access to multiple services and the case manager role as facilitating access to the complex mix of supports, resources and services that can assist. The definitional focus on multiple supports and service effectiveness and efficiency is important for the service provider and the service user. This is because of the complexity of contemporary service systems being such that scarce resources can be wasted and potential users might not know about or be able to access the services that can assist them. Definitions variously also specify the functions of the case management system and the role of the practitioner as a collaborator with the vulnerable person who brings to that relationship expertise in the service system and the ability to advocate for their access when systemic barriers to service arise.
In this subject we separate out case management from ‘managed care’. While many would not agree with this distinction, managed care in heavily privatised health care systems and legally contested accident and injury rehabilitation tend toward a different emphasis in their discourse. In these contexts case management systems can be defined and designed in terms that satisfy the cost holding or economic saving goals of the service providers. While the language of case management practice can be similar to generic definitions, the practitioner can find that their client is the service provider and that their partnership is more aligned with the health provider or lawyer rather than the service user. While managed care has emerged from the heavily privatised US health system, the escalating health care costs confronting Australian governments is leading to its adoption here. In the area of health care of people with chronic conditions, such as diabetes, research findings and practice developments are leading to the adoption of a range of strategies to ‘case manage’ people in ways that reduce reliance on medical and hospital assistance. For example self managed care that incorporates electronic and telephone communications for self-assessment and in home intervention.
Case management systems and approaches that focus on support of people experiencing multiple personal and social vulnerabilities are diverse in their client target groups, purpose, reach and functions. It is not hard to appreciate that case management within corrections will be defined differently to case management with people with a degenerative physical disability. Their purposes, ethos, risks, intensity, duration, accountability and functions differ.
Differentiating case management systems
Your reading does not settle on a ‘one size fits all’ definition. It might be that a system specific definition will be the most useful. Intagliata’s (1992) structure for differentiating specific case management systems addresses their:
The case management literature espouses the centrality to effective practice of the relationship between the case management practitioner and the vulnerable persons with whom they work. The quality of the relationship is ideally one of compassion, collaboration, facilitating agency/empowerment, person centred, strengths focused, open, honest and trusting. These ideals can be problematic in practice. In some contexts it is argued that they are operationalised through the design and implementation of instruments that guide practitioners in their adherence to agency policies and procedures. This chapter is less equivocal, demonstrating the centrality of ethics to practice. Ethics operate at the personal, professional and organisational levels, and can thus present practitioners with dilemmas in balancing competing interests and accountabilities in the pursuit of good case management practice. The dimension of ‘good’ here goes beyond outcome measures, and focuses on how a case manager goes about resolving competing interests to choose the ‘good’ course of action.
Ethical competence involves the acquisition of ethical skills, knowledge and virtues such as honesty, moral courage and integrity. This competence is what leads to professionalisation of practice as practitioners develop an orientation to practice that is informed by the goals and ideology of the case management program. A commitment to ethical competence can see practitioners achieving autonomy by adhering to the practice requirements of their organisation and for the professions, their professional body. It equips them to constructively challenge system limitations or contradictions that prevent good practice in the ethical sense.
Case management is not a profession. It is an approach to service delivery derived from nursing and social work that is applied widely in the human services. Case management does not have:
• a standard and accredited pre-qualifying educational framework
• requirements for gaining and retaining accreditation to practice
• a code of conduct about which there is a consensus amongst practitioners, and
• a body with oversight of the system of accreditation, regulation and professional discourse.
s of grief and loss as essential.
In Chapter 4 of your text Osburn provides a skillful demonstration of the way in which theories of effective helping can be integrated into practice. She demonstrates the integration of seven groups of theory, a huge task which makes the treatment of each theory necessarily brief. This chapter should help you understand how to approach the application of theory in your assignment. This subject’s necessarily brief treatment of theories of effective helping is simply meant to demonstrate their importance in framing our understanding and interventions. You are expected to understand the application of some generic theory, knowledge and skill that is fundamental to becoming an effective case manager in any setting.
Case management systems and practice have been informed by an eclectic theoretical system, drawing from ecological systems theory, task centred theory and humanist or constructionist theories of personality. Here and in your reading, you will be introduced to the essential elements of these theories. They should inform the way in which particular functions of case management are practiced. The three theoretical strands you are expected to incorporate in Three types of systems that can influence people are:
•informal or natural systems, (e.g. family, friends, shopkeepers, fellow practitioners);
•formal systems (e.g. community groups, trade unions);
•societal systems (e.g. hospitals, schools).
People may have difficulty in using these systems because:
•systems may not exist in their lives (they may not have the resources to access the systems or the systems may not be appropriate in their lives);
•people may not know or wish to use the systems;
•the system’s policies may create new problems for users;
•the systems may conflict with each other.
Systems and people interact with each other. Each changes and influences the other. Problems occur when the systems act in a negative way towards a person. In this regard the person may be influenced negatively while the system may acquire more control and power. The interaction between systems and the individual need to be restored to equilibrium. Within this framework it is assumed that there is a problem for clients in their interaction with informal, formal and societal systems. When clients are unable to negotiate systems they are in need someone to assist them to renegotiate and reintegrate with the systems. The appearance of case management in numerous service sectors attests to the universality of systems deficits, fragmentation and irrationality. There would be less ne·ed for case management if there were good inclusive services and adequate resources.
Within the ecological systems framework the case manager needs to identify and understand the person’s capacity to deal with environmental challenges at any one time. Equally, the case manager needs to assess the environment to ensure that appropriate resources and supports are available. The selected readings should help you appreciate the relevance to case management practice.
Task centred theory and problem solving
Again, this theory and its link with problem solving are borrowed from social work literature. This theory focuses on how clients can rationally control their emotional response to, and experience of, external events that cause distress or discomfort. In short, this perspective contributes to case management practice in two ways:
•inability to obtain needs/wants
•concept of self in society influences beliefs about problems, options and actions
•practitioner facilitates and teaches problem solving
•cyclical practice – plan, act, review, plan, act, review, plan……
The contribution of task centred theory comes from the work of Reid (1978) who argued that humans are self determining, having independent minds and motivations are influenced by internal and external conditions. Problems arise when a person wants something he/she does not have. Our problem’s are psychosocial, with our plans and actions usually will involve others – the individuals, groups and organisations that make up our social system.
It is important to concentrate on the factors that are currently causing a problem that can be changed. Self-determination is at the core of this theory so the needs that the practitioner must deal with are those that the client identifies, not those that the practitioner infers. Identified needs can be clearly defined and resolved at a practical level. This framework does not attempt to identify or address underlying psychological causes of problems in personal or social functioning. It assumes that a person’s emotions derive from the interaction between beliefs and wants. When a want is lost or threatened, anxiety and fear arise. Action is the best method of alleviating the fear or anxiety. Action needs to be carried out with intent rather than lashing out. When taking action a person needs to know what he or she intends to achieve. It is best to plan how to take action. Plans are the means of assessing alternative options. The best way to plan is in sequence.
Clients may not have skills to perform actions in particular circumstances. Skills can be learnt through a series of small steps that might be built into a plan of action. Each step will bring a response that may be negative or positive. Each action therefore becomes an interaction sequence where actions affect one another in circles or spirals. As many wants or needs can only be met by interacting with social or service provider systems, the plan needs to accommodate the interaction between the client and the system. In working with clients the aim is to help them to resolve problems of concern to them and give them a good experience of problem solving. This should improve their capacity to deal with difficulties and accept assistance.
Reid drew on social learning theory that paid attention to modes of action, identifying targets and task rehearsal. Also, he used communication theory which is concerned with sequences and interactions of behaviour. Within this framework the aim is not to study the client’s emotional responses, but to identify action steps, obstacles to action and unchangeable constraints.
Problem solving model – from problems to strengths and solutions
Compton et al. (2005) illustrate how task centred theory has been incorporated into social work theory and social casework practice. Don’t confuse the phases of the problem-solving with the functions of case management. Case management incorporates more functions than described here, as it also explains how the practitioner targets the social service system. Payne (1997) provides a detailed account of the processes involved in the task centred model. The problem solving model, while enduring, has been augmented by contemporary theorists who have emphasised the importance of a strengths focus. Thus, to adhere to this model would leave us open to a deficits driven approach to practice. Still, it is useful for illustrative purposes. In bold we have incorporated ideas for integration of a strengths focus.
•identify potential problems by helping clients describe difficulties and strengths in their own way;
•reach tentative agreements on the main problems and strengths;
•challenge unresolvable or undesirable problem definitions;
•raise additional problems and resources;
•seek others involvement if necessary;
•jointly assess the reason for referral;
•get precise details of where and when problems and solutions arise;
•specify the problem and strengths, usually in writing;
•decide on desired changes.
•agree to work on and specify one or more client defined problems;
•rank the problems in priority order;
•identify the strengths in the person and their social environment on which they can build
•define the desired outcome of intervention;
•design the first set of tasks;
•agree to the amount of contact and time limits.
Tasks are explicitly planned, practicable actions that the client does outside sessions. These tasks may be undertaken by the client, the practitioner or the client and the practitioner:
•identify alternative tasks through generating task possibilities;
•summarise the tasks;
•plan the implementation.
•set up a recording system ;
•establish the client’s understanding of the value of the task and how it may meet the goal;
•practice relevant skills using simulation (acting out a situation) or guided practice;
•analyse obstacles and deal with them, i.e. motivation, beliefs anxieties.
The practitioner may work with people who will be assisting the client achieve his or her objectives. Also the practitioner can share tasks with the client where he may have insufficient skills or resources to deal with them alone.
•describe the target problem as it was and as it is now;
•conduct assessments by practitioners and others involved in the changes;
•plan for the future;
•determine additional contracts;
•determine follow up checks;
•include another agency or professional
Client based case management draws from the task centred theory where the client’s issues are related to problems with formal organisations, inadequate resources, and decision making. As case management is informed by an ecological/systems perspective the client is seen as having problems located in the system of social and formal structures in society. Task centred theory provides a particular focus on how to deal with these problems by using a problem solving approach. (Payne 1997, pp. 106-12).
This label captures a substantial body of theory that has emerged from psychological and social work. These theories inform counselling practice by identifying the elements of effective helping relationships and discerning communication techniques and their impact on the change effort.
•Theories that inform the development of effective helping relationships
•person-centred (Carl Rogers) – listening with congruence, empathy, unconditional positive regard and without judgment
•gestalt (Fritz Perls) – hear and now and client responsibility
•cognitive behavioural (Albert Ellis) – thoughts shape behaviour
•brief therapies (De Jong, de Shazer, White) – strengths focused
•Effective communication – micro skills for rapport and change
•joining, listening and leading
•reflecting content and feeling
•challenging self-destructive beliefs
(Adapted from Geldard & Geldard 2005)
Humanist and constructionist theories tend to stress the relationship between the practitioner and the person. The term person centred is based on the theory that human beings try to make sense of the world that they experience. All humans have the capacity to improve their lives. This improvement occurs when the individual is able to take up personal power. This is accomplished through self actualisation. The contributions of humanist constructionist theories to person-centred strengths-based case management are two fold. Firstly, they provide guidance about the attitude and approach needed by case managers to establish effective helping relationships. Secondly, their frameworks lead to some communication strategies that assist case managers to facilitate clients’ in taking control over their situation and their lives.
The text from which the Geldard & Geldard (2005) readings are taken provides a valuable introduction to basic counselling for practitioners in the human services whose role involves some counselling, but who are not psychotherapists. It covers the counselling relationship and four theories that sit well with person-centred strengths based case management.
Establishing effective helping relationships
Practitioner/helper orientation toward client/helpee
Geldard & Geldard (2005) discuss the contribution of Carl Rogers’ person-centred theory to our understanding of the qualities of an effective helper. While the key qualities are variously labelled, there is wide acceptance that qualities such as genuineness, congruence, empathy, unconditional positive regard, respect, warmth and a non-judgmental attitude are essential in helping relationships that aim for self-determination.
Communication and micro skills
The central importance of the relationship to effective helping makes it important that practitioners also foster self-awareness in their practice communication. The advent of person-centred counselling increased the focus on the things that counsellors could do to enhance the relationship. At the macro-level, effective communication requires that practitioners plan such things as the most conducive location, physical setting, participants, agenda and means of recording. At the micro-level practitioners must select ways of communication most likely to encourage open dialogue that allows the exchange of information, feelings and ideas.
There are many books that can assist students who want to extend their micro skills. Geldard & Geldard (2005) is recommended here because it devotes a chapter to discussion of at least ten distinguishable micro skills and illustrates their application. These skills include: listening, leading, reflecting, summarising, construcitive confrontation, interpreting, clarifying and informing.
Practitioners should pursue self-awareness in order that they can:
•use all basic skills when appropriate;
•use the skills in a spontaneous way;
•be aware of the role of personal needs and motivation;
•increasingly attend to the quality of one’s responses;
•develop a perspective on the course of the helping relationship;
•use skills in a planned way.
Theories for strengths based practice
Person-centred counselling has provided the theoretical basis to guide the attitude and approach to communication in helping relationships. Other humanist theories have helped workers to encourage people to be self-determining and optimistic about their potential for change.Geldard & Geldard (2005) describe gestalt, cognitive behavioural and two of what we call the ‘brief therapies’, narrative and solution-focused therapy. We have included more detailed readings of the latter two because of their increasing popularity with practitioners and administrators.
A distinguishing feature of case management systems is the functions that are included within them. While case management systems are said to incorporate as many as fifteen functions, your text focuses on nine. It introduces you to three functions that are represented as overarching in the sense that they inform all other functions of practice.
Distinguishing casework and case management
Case management functions have parallels with clinical casework processes and practice is informed by the problem solving model of social casework. In other regards, case management systems and approaches to practice differ. The distinctiveness of case management is described by Rothman and Sager (1998) and cited in your text.
Three overarching functions
Community outreach recognises the contribution that social isolation and dislocation can make to disadvantage. Its incorporation into systems and practice opens the practitioner’s perspective on the wider possible sites for change. This is consistent with a person in society, or social-ecological view of practice. Engagement with community and informal community welfare systems is fully addressed in Topic 7. Keeping track of resources is essential to case management. Resource indexing manges information on formal services in their geographic community. Appendix 1 of this study guide is a resource index form suggested by Rothman and Sager (1998).
Diversity and cultural competency
Contemporary society is marked by increased diversity, but this is not always matched by cultural tolerance, or inclusion. Even those of us who regard ourselves as egalitarian in regard to differences in race, sexual preference, ability, gender, age, culture etc. can be biased by the perspective of dominant social groups. Anti-discriminatory practice and cultural competence are essential to practice with people whose vulnerability leaves them open to exploitation.
Since the early 19th century philanthropic activity, advocacy has been regarded as a central function of case management. It is fundamental to a systemic perspective that locates the contributing factors to social exclusion and dependency outside of the individual. A key role of intervention is to open up opportunities for social participation and inclusion. The focus might be the family, community, formal human service system or the wider social institutions. The advocacy effort might be to promote the interests of an individual or a number of individuals.
Topic 5 and the first part of Chapter 5 of your text book introduced you to the overarching functions of case management. The Chapter distinguished practice that aimed to maintain people in their family and community context, and emancipatory practice that aimed to enable them to overcome systemic and structural barriers to social participation and inclusion. An emancipatory approach to case management practice thus must engage with the social systems which contribute to social exclusion.
This approach involves identifying the strengths within communities, and the limitations and harmful factors within those communities. Essential to this approach to practice are community knowledge, advocacy and cross cultural competence. The importance of these concepts to practice is such that, just as advocacy was addressed in a dedicated Chapter of your text, so are community engagement and informal community welfare systems.
Many case management systems are shaped around a social control or maintenance approach to practice. Few explicitly address these functions that are critical to the ethos that they espouse. You are encouraged to ensure that your assignments embrace these functions and demonstrate an understanding of how they can be a vehicle for a truly empowering practice.
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