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Why I Hate Case Management or Hug Your “Support Staff”

Posted on April 24, 2015

I’m excited to be in Minneapolis this week and Flint, Michigan next week, launching our revised HIV Medical Case Management Certificate. In the process of updating and expanding our online courses and creating the in-person training, I’ve been thinking a lot lately about “Case Management.” I have come to strongly dislike the term Case Management and feel that, along with other titles like Outreach Worker, Front Desk Person, etc, fail to state the importance of their impact on clients’ lives and the health of our communities.

Very early on as a therapist, I learned that the “magic” of the healing process happened long before the client stepped into my office. In almost every case, the client had established a trusting and safe relationship with an outreach worker, case management, nurse, or front desk person. Through this relationship, the brilliant staff helped the client to see the need and get over the stigma that many associate with mental health and substance abuse services.

By the time the client sat on my “couch,” they were already several stages into their Stages of Change, and I could help them start addressing their traumatic pasts and current mental health or substance abuse issues. My clients’ clinical outcomes improved dramatically when they also had a great case manager or other “support” staff in their lives. Some of my greatest moments as a therapist were being just one part of a multidisciplinary team, creatively advocating and helping clients achieve difficult life changes.

Nurse, physician, therapist, psychologist, social worker are all titles with a history, leaders, and strong connections to our sense of healers in our society. I’ve done a lot of research on case management over the years, and I’ve realized that there is little attention paid to the history of case management, and it lacks figures like Freud, Hippocrates, Florence Nightingale, or Jane Addams. The Case Management Society of America’s definition is: “Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.” This definition speaks little to the healing work of case managers and their direct role in the change process. These folks are doing very complex work coordinating referrals but also working with the client to become ready to receive and succeed within these services.

I’ve been advocating in recent years for people from all professional backgrounds to think of themselves as healers. While healer can put a little more emphasis on our role, we know healing is a collaborative process with the client, and I think there is a historical, spiritual, and power associated with being a healer. Too often, if the client had never met and built trust with the case manager, patient navigator, or outreach workers, they never would have set foot in our medical or mental health services in the first place.

Without these staff, we might never reach or engage many of our folks, and if we lost our “support” staff, I believe many of our folks would soon disengage from our services as well. To say these professionals just “manage cases” is an insult to the great, creative, and difficult work being done every day in our organizations and communities. It is no wonder that systems with case managers consistently show improved outcomes and decreases, in cost in addition to the following outcomes (Rizzo & Abrams, 2008; Claiborne & Vandenburgh, 2001):

  • Facilitate healthy weight loss
  • Better heart rates
  • Decreased morbidity & mortality rates
  • Decreased depression
  • Decrease in chronic pain
  • Decreased stress
  • Increased client satisfaction
  • Lower health care costs
  • Increased quality of life

One last, but critical, note on these “support” staff. I believe because they often don’t have graduate degrees (though I know this isn’t always the case), or have a bunch of initials behind their name, we do not value their work enough in our communities. Often, these professionals are some of the lowest paid people who ironically do the toughest work. As a therapist, I sat in my nice office while outreach workers combed “dangerous” areas of town looking for our clients who dropped out of care, and gave hope to those not getting services. Case managers challenge long-established relational templates that all people are dangerous and out to hurt you, all while helping clients find motivation and hope for a better future. Front desk staff manages the complexity of the waiting room, while answering the phone, and often running the organization behind the scenes!

For those of us with those initials behind our names, we often have nicer offices, business cards, and higher pay. We must make sure we are at least showing our appreciation to these staff that make our work possible (engaging clients) and dramatically increase the likelihood for the desired clinical outcomes. I would also call on all of us to advocate to our communities and systems of care to make sure these folks receive a livable wage and fair compensation that aligns with the difficultly of the work they do. Too many of these people have to get second jobs just to make ends meet and that should be unacceptable to us all!

Homework: Think about those people that often get little attention or credit for their great work and tell them why you value them and their work.

6 responses to “Why I Hate Case Management or Hug Your “Support Staff””

  1. Right on Matt! Hardest working folks, doing the hardest work. I will be dishing out the hugs today!

  2. Right on Matt! Hardest working folks, doing the hardest work. I will be dishing out the hugs today!

  3. Completely agree Matt! My favorite line here: “To say these professionals just “manage cases” is an insult to the great, creative, and difficult work being done every day in our organizations and communities.”

    The upshot is that there is widespread–and growing–agreement among policymakers and more research showing that CM professionals are vital partners of integrated care teams. The struggle now is how we get consistent Medicaid payments for these services built into fee structures. If we can stabilize funding for these services much like the medical care that’s now available (thanks to expansion, though not everywhere), we’d be able to grow these services much faster–and get greater recognition for the folks that do this difficult, time-consuming work.

    Thanks for your blog post–keep writing this great stuff!
    See you at the HCH national conference on May 6!
    Barbara

  4. Completely agree Matt! My favorite line here: “To say these professionals just “manage cases” is an insult to the great, creative, and difficult work being done every day in our organizations and communities.”

    The upshot is that there is widespread–and growing–agreement among policymakers and more research showing that CM professionals are vital partners of integrated care teams. The struggle now is how we get consistent Medicaid payments for these services built into fee structures. If we can stabilize funding for these services much like the medical care that’s now available (thanks to expansion, though not everywhere), we’d be able to grow these services much faster–and get greater recognition for the folks that do this difficult, time-consuming work.

    Thanks for your blog post–keep writing this great stuff!
    See you at the HCH national conference on May 6!
    Barbara

  5. Here, here! We need to challenge ourselves to come up with a way to make case management more sustainable in all communities. Turn over is very high for direct support positions and the work is very demanding. I appreciate that you are drawing attention to case management as a profession and how it lacks the same well-known scholars as other similar professions.

  6. Here, here! We need to challenge ourselves to come up with a way to make case management more sustainable in all communities. Turn over is very high for direct support positions and the work is very demanding. I appreciate that you are drawing attention to case management as a profession and how it lacks the same well-known scholars as other similar professions.

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