Morning Future Fishing Net
Guiding Trend 30 October Oct 2019 0730 30 October 2019

Who is the Case Manager, or rather, the manager of complexity

Who is the case manager? Increasingly complex welfare needs require a holistic vision, tailored action and the ability to coordinate several sources of aid. This is how the profession of social worker is being transformed.

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“La persona al centro” (centred round the person): in recent years, this phrase has become the keystone of social initiatives. Individual and social welfare needs have changed deeply and in relation to this complexity, which requires the deployment of many different types of sources of aid and both formal and informal services. Responses from the social protection system have become oriented towards building assistance models with multidisciplinary and interdisciplinary approaches, able to read each situation of fragility in a holistic way and to intervene with a personalised assistance plan.

Created in the USA in the 1970s, this method of case management in social service is based on five elements:

  • initial evaluation (assessment);
  • the creation of an individualised assistance plan (care planning);
  • implementation of the project (making available a “package of services”, which is different for each client);
  • monitoring;
  • final evaluation.

The key figure in this method is the case manager. Who is the case manager? The case manager is the professional who becomes the “reference person” of the case. His or here tasks include the effective assessment of the client’s needs with a holistic vision, planning the necessary support, resources and actions, coordinating the processes, and guaranteeing continuity of service. The Italian translation of “case manager” is “gestore del caso”, which is not a very empathetic expression in either language. The action of this figure is guided by the effectiveness of each action and by the financial optimisation of resources. In other words, case managers take on the management of the needs of the assisted person, called the “client”. Case managers prevent aid from being fragmented, ineffective and expensive, factors that in the past brought many clients to feel like ping-pong balls bouncing from one service to the next.

“Case management is the methodology that defines new professional competences which are no longer used to simply distribute individual services, but instead to facilitate, activate and coordinate the network of services. In this context, social workers handle cases by using typical managerial capacities, which involve activating and connecting territorial resources into a network,” as stated in the presentation of Malcolm Payne’s book Social Work and Community Care, (published in Italy with the following title: Case management e servizio sociale. La costruzione dei piani assistenziali individualizzati nelle cure di comunità), which for the first time in 1998 brought the case management methodology to Italy.

The case manager is the operator who manages all of the client’s needs and prevents aid from being fragmented, ineffective and expensive.

Typical complex situations in which case management is a useful methodology are mental illness, people with disabilities, the homeless, minors who require protective interventions, refugees the unemployed, and many more categories of people. There are so many facets to this profession that a recent toolkit from the European Social Network, Tools for inclusive activation. Improving the social inclusion of people furthest from the labour market, has underscored how case management guarantees three advantages in this area: the personalisation of processes and the definition of “tailor made” assistance plans; the increase in take-up, due to the fact that clients learn about all of the services and resources to which they have a right and that they be accompanied as they “navigate” among the different services which offer different responses; and monitoring the implementation of personalised plans.

“Wishing to overcome the idea of social inclusion solely driven by employment, we propose an inclusive activation approach grounded on a practice that responds to the multiple causes of social exclusion in a holistic manner and promotes services, personalisation and the autonomy of people using services,” reads the preface writted by Alfonso Lara Montero, Chief Executive of the European Social Network.

The underlying idea - common for all fields of intervention - is that activation based only on employment is insufficient to offer real chances of social inclusion to people going through very complex life situations and who, on the contrary, require a more holistic approach, in which social, healthcare, housing and employment services are considered equally relevant for the purpose of the social inclusion of more vulnerable people.

Case management guarantees three advantages: the personalisation of processes, the increase in take-up, and the implementation and monitoring of personalised plans.

Different professional figures can fulfil the function of case manager: educators, nurses, psychologists, and social workers are only a few. According to the ISTUD Business School, it is important that the case manager not be a hierarchical figure added to the team (which would involve forming a hierarchy with bureaucratic steps that would slow down the work of the professionals). Instead, this function should be assigned to professionals who already work inside a multi-professional team, and who have had additional, specialised training: universities and some large training companies offer master’s programs and specifically designed courses to become care managers. For its mandate, training and focus, the profession of social worker is particularly suited to this function.

Reality is complex, but the complexity is seen if one looks at it with a trained eye: if one simplifies reality, then its complexity is not apparent.

The social worker, a profession in which 93% of workers are women, has a professional statute that causes them to look at situations comprehensively, in all of their complexity. This is a “priority” competence also for managers of all types, if it is true that the Learning Trend Survey of the Osservatorio Permanente in Italia of learning in ISTUD Foundation organisations showed that 50% of managers indicate their “overall vision” as a capacity to be developed: “This is what we’ve always done, regardless of where we work and the role that we have. We look at situations of fragility from several different angles and factors, because the true causes of distress and marginality are not single problems, but rather the comprehensive situation. Reality is complex, but the complexity can be seen only with a trained eye: if one looks at reality through a filter of simplification, then the complexity cannot be seen,” explained Nunzia Bartolomei, vice-president of Consiglio Nazionale dell’Ordine degli Assistenti Sociali (CNOAS) (the National Council of the Order of Social Workers). “Not all people who have a problem with housing or work, for example, need to go to a social worker: the difference lies in the possibility for that person to tap into personal, environmental and social resources. Our work has always been oriented towards much more that just seeing all these factors. Since we actually do put the different dimensions together - the person, the family, the general context - we are used to working in a network with other institutions and the entire territory, in the private social sector in particular, I believe. Fragile people belong to the territory, not the institutions.

“People centred” is not a slogan for us: "When I set up a project, I certainly start with a professional assessment, but I cannot force my objectives on anyone. What emerges from a session between a social worker and a client is a negotiation about “where we will go together”. For Bartolomei, there is a strong drive in the professional community - in operative models and research at the same level - to undertake this three-fold approach (we see this in particular from the studies of Luigi Gui, from the University of Trieste), which hinges on the relationship between the person, the environment and the organisation of services, but there is still much work to do. “We need recognised institutional integration, which would allow us to truly work together because each operator would work inside a structure of the mandate conferred by his or her own institution. Achieving this comprehensive and integrated vision of the person requires improvement in service organisation, so that work can be done with coordination and coherence: without this passage, people risk being “fragmented” all over again.

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