Section 1: An Introduction to Case Management

Many clients who access counselling have multiple services assisting them with their ongoing living, health, and social needs. In some cases, clients are supported by a case manager (or a case management service) who coordinates these services to make sure that clients’ needs and goals are met in an efficient and effective manner (Summers, 2016).

The History of Case Management

The concept of case management traditionally emerged from the mental health sector as a way to meet the complex needs of clients accessing mental health services, which often involves engaging with multiple services (Woodside & McClam, 2018). Since then, the field of case management has evolved, moving away from “managing” client cases to “supporting” and “coordinating” care and services, which better reflects the role of case managers today. Case management practices are now widely implemented in human services contexts as a promising way to support effective and quality service delivery.

The Case Management Society of Australia & New Zealand provides the following definitions for case management and manager:

What is a Case Manager?

This video describes what a case manager is, what a case manager does, and helpful skills to have, as well as how to apply these skills into your daily work routine.

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Collaborative case management has now become a common element within most community services organisations. The social and economic pressures of modern society resulted in increasing demands for services as well as competition for funding. To cope with this demand, many organisations and practitioners are opting to provide more specialised care and work in partnerships and/or referral networks to provide the multiple layers of support clients require – this is where case management becomes vitally important (Blundo & Simon, 2016). Consequently, some community services organisations will have staff and practitioners acquiring generic case management duties instead of having designated case managers.

With the increasing recognition of multicultural and diversity in modern societies, case management principles and practices also support service delivery to become more streamlined, culturally appropriate, and personalised to suit particular clients’ needs. The following extract provides a glimpse of the diversity and expertise involved in case management today:

Essentially, case management involves facilitating the coordination of, and communication between clients, service providers and other key stakeholders, as well as monitoring progress. In this module, we will discuss a generalist case management approach; however, note that a case manager’s role and the respective processes will vary by the contexts they work within, such as child protection, disability support, homelessness service, family violence services, and criminal justice settings. In general, case managers assume three essential functions:

As you can see, counselling skills are important for a case manager, and it is not uncommon for counsellors to take up coordinating and advocacy duties where necessary (and appropriate for their work role) to assist clients. In addition, some of the theoretical concepts and best practices underpinning counselling practice – such as person-centred, strength-based and working collaboratively with clients – are essential elements of effective case management practice.

Elle's Story (Case Manager)

This video takes a look at Elle, a case manager at Townsville Community Corrections, supervising offenders in the community to achieve positive outcomes from their sentences and working to prevent further offending.

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In comparison to a counselling process, the case management process is typically more solution-focused and structured with concrete steps. As it is heavily guided by the organisation’s service delivery framework and relevant legislation, case management can come across as more directive than a counselling process. Nevertheless, both counselling and case management processes operate from a client-centred perspective and aim to work collaboratively with clients to achieve positive life goals or outcomes.

There are three key components of case management: assessment, planning, and implementation. The following diagram depicts tasks relevant to these components (adapted from Woodside & McClam, 2013, p. 9):

Essentially, assessment is a process in which the client provides the case manager with information about their needs and desires and the case manager analyses this (along with other information) in order to fully understand the client’s needs and the goals for case management. This is similar in nature to the assessment and exploration of client needs in the counselling process; however, case managers tend to have a broader focus, hence the assessment may cover multiple layers of client needs (for example, emotional, mental, physical, occupational and relational).

Assessment often involves engaging not only the client, but also their family members, carers, and other significant people in the client’s life. It is important to remember that the process of assessment continues throughout the case management process so that the suitability of services can be continually monitored, and evaluated, and the case plan re-assessed if necessary (Woodside & McClam, 2013).

The planning stage involves the case manager consulting with the client and their family/significant people to determine which services would best suit the client’s needs. The case manager then uses this information to develop a written case management plan (or case plan) that facilitates the coordination of services at the implementation stage.

Implementation involves ensuring that the case management plan is put into action and that the client begins taking steps to achieve their goals within the plan. This involves the case manager liaising with the client, their family, and relevant services in order to encourage the client’s progress, monitor the case plan, and make adjustments if required (Summers, 2016).

These specific processes of case management will be explored in greater detail in the remaining sections of this part of the module. However, you should be able to see from this brief overview that the client is the central focus of the entire process. The case manager takes the time to develop rapport with the client, then uses effective communication skills in order to help the client identify their needs/goals, strengths, resources and supports, and develops an appropriate case management plan for the individual client.

Moreover, the case management process should not be regarded as a linear process; instead, you are likely to revisit previous stages or steps with clients whenever their needs or circumstances change.

Case Management Session

This video provides a scenario of a brief case management session between a correctional counsellor and an incarcerated offender. After watching the video, answer the questions that follow.

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As Summers (2016) outlines, case management is a multi-faceted approach that involves critical consideration of five key factors:

1. The relationship dynamics of clients and their families

Case management often involves engaging and supporting not only the client but also other people who are significant in the client’s life, such as family members, friends and carers (Guzys et al., 2021). Indeed, case plans will usually include one or more significant people in the client’s life. In such cases, it is important to consider the dynamics, particularly the power dynamics, of these relationships and how they might be impacting on a client’s life and their capacity for self-determination. The complexity of these dynamics is perhaps no more obvious than within the structure of the family unit.

The client’s involvement in (or separation from) their family, the family’s current situation, and their expected level of involvement are important considerations when assessing, planning and implementing a case management plan (Mullahy, 2014). As Mullahy (2014) argues, when developing a case plan where family is involved in the case management process, consideration must be given to:

• Family structure and functioning, for example, who has the closest bond with the client? Who assumes the caretaker role? Such consideration will help make sure the case plan developed takes into account how the client’s changing circumstances and needs have impacted and interacted with their family role and the needs of the other members (for example, financial and emotional). For instance, a parent becoming ill or unemployed can have a huge impact on the children’s well-being and the functioning of the family overall.
• Family communication styles, for example, is it confrontational or respectful? Do some family members talk over others? Though well-intentioned, some family members can become overprotective and may foster a mentality of dependence in the client, which can hinder the client’s engagement and commitment to the case plan. A common indicator is when communication with service providers is overtaken by family members and the client is “not allowed” to speak for themselves (even when they are capable of doing so).
• Family dynamics and decision-making processes, for example, is the client able to make their own decisions? Will these decisions be supported by the family? Will the family likely interfere with the client’s case plan? During the assessment phase, it is important that case managers understand how family members perceive their roles and the current situation. It can be problematic if family members’ perceptions are completely different to the client's. Where possible, the case manager should seek to empower the client, such as by directing important questions to the client, so as to support their autonomy and rights. However, it is important to do so respectfully and not demean the family members’ role and support to the client.

2. The relationship between the client’s social, psychological, physiological, and economic circumstances

All aspects of the client’s life are interconnected. Therefore, it is important to consider each client holistically when developing a case management plan. This is an important consideration because if both you as a case manager and the client understand these links, you can help them clarify their needs and then they can set more effective goals. If the client is engaged in goal setting, they are more inclined to participate in the case management process.

Ecological systems theory highlights the importance of a ‘person-in-environment perspective’, stressing how critical interactions occur between individuals and their environment. The importance of this ‘person-in-environment approach’ becomes apparent when a concern or challenge in one area of a client’s life has a strong impact on another area. For example, if a client becomes seriously ill, they may as a consequence lose their job, become depressed, and withdraw from their support network. While consideration must be given to all areas of the person’s life and while intervention may still target all areas, the illness can be seen as the primary issue, because treatment of the illness is likely to have a positive flow-on effect to other areas of the client’s life.

In this way, it is also important for the case manager to develop a holistic understanding of the client’s circumstances so that a realistic case plan can be developed. This understanding can help the case manager provide or coordinate interventions that not only address client needs but are fully accessible and realistic for the client based on their individual circumstances. For example, there is little point in referring a client to a high-cost service provider if the client has no means of paying for the service.

3. Organisational services, policies, procedures, and documentation requirements

It is vital for case managers (as well as counsellors and other helping professionals) to work within their organisation’s policies and procedures. This involves managing their role and responsibilities as well as maintaining adequate documentation. The requirements not only serve to make sure best practices are applied for each client, but also to protect both the case manager and their agency/organisation. Specific organisational requirements will be explored in more detail later in this module.

4. Relevant state and federal laws and regulations

Case managers must also be well-versed in all laws and regulations relevant to their location, type of work, and the types of clients they work with. In some cases, participation in the case management process is statutory (for example, legally required); hence, the nature and approach to case management will be influenced by respective requirements. Some areas of laws and regulations relevant to case managers (or counsellors working in a case management capacity) include:

• Mandatory reporting laws
  While different states and territories vary in their mandatory reporting guidelines, all case managers must follow their organisational guidelines for the mandatory reporting of suspected abuse – regardless of whether they work directly with children. This typically involves reporting the relevant information to a supervisor/manager and designated child safety authority where appropriate.
• Guardianship, trustee and administration acts
  Case managers often work with clients who are under guardianship or trustee orders. In these cases, the case manager must be aware of the extent of the guardian’s or trustee’s authority to make decisions on behalf of the client. Alternatively, if a case manager believes that a client is unable to manage their own affairs, it might be appropriate to contact their state’s administrative tribunal to arrange for a guardian or trustee to be appointed.
• Mental health legislation
  Case managers working with clients experiencing mental health issues must ensure that they consider all relevant mental health acts, such as admission into involuntary care and decision-making capacity. Such understanding is also essential for advocating for the rights of these clients.
• Child protection laws
  Each state and territory has its own set of laws that apply to the protection of children. Case managers working with children and families involved with child protection issues must be fully versed in this area of legislation. These laws inform the existing practice guidelines and policy frameworks that guide the nature and extent of services and interventions to be provided, and principles that service providers should base their work upon. For example, case managers should support families to consider and work towards the best interests of children; support children and young people to be engaged appropriately in decision-making; and promote early intervention where possible (Australian Institute of Family Studies, 2018).
• Home and community care standards
  These standards have been developed to ensure quality standards across the various government and non-government agencies that deliver community support services. Case managers (and counsellors) working in this field must ensure that they meet these standards.
• Clients with statutory limitations imposed upon them
  Case managers may be working with clients who must comply with bail or parole conditions, community service orders, good behaviour bonds, restrictive practices or even clients in prison. In these cases, the case manager must fully understand these restrictions and plan their case management approach accordingly. For instance, there may be additional reporting duties for case managers, and clients must be advised of possible consequences for not complying with the case management plan.

It is the case manager’s responsibility to ensure that they work within all statutory requirements and specific practice standards that relate to their area of work. On top of the previous list, there are more common legal considerations relating to information sharing (for example, privacy legislation), the client’s right to confidentiality, informed consent, and work health and safety legislation. Case managers must also comply with relevant practice standards and professional codes that regulate their profession and/or area of work. Examples include the National Standards of Practice for Case Management and the Australian Community Workers Code of Ethics.

5. Local community services and support resources

Finally, case managers must be familiar with the resources available in their local area – this includes both the services available within their own organisation as well as those offered by other service providers. This will allow the case manager to develop the most effective case management plan with their client. Directories such as infoXchange service seeker, Lifeline service finder, and local service directories can be used as a starting point in building a referral directory. In doing so, case managers should not only gather information about services provided but how to make a referral as well as eligibility and funding requirements.

With this information, case managers can prepare case plans (in collaboration with clients) with the inclusion of the most appropriate service providers for each individual client. Therefore, the ongoing development of strong and positive relationships with other service providers can be seen as a major part of being a case manager. Interagency network meetings are excellent opportunities to develop these relationships.

Case Study 1: Case Management with Voluntary Client

Anh is a 30-year-old single father, with two children under five. Anh lost his job recently and couldn’t afford to pay rent. He received a notice to vacate his rental place within four weeks. Presenting with depression and anxiety symptoms, he was referred by his GP to the local community centre, and assigned to a case manager, Sue. He was told that Sue would assess his needs and find out more about his circumstances in order to see how they could help him and his family. He was also made aware that Sue can link him up with other agencies that help families in need.

Through the assessment process, Sue works collaboratively with Anh and discusses multiple issues that are affecting his family, including needs for parenting support, financial aid, employment, mental health assessment, and liaison with the children’s school. Sue works with Anh to come up with goals to resolve his tenancy issues and help get his life back on track.

In this case study, Anh is considered a voluntary client, and the statutory requirements that Sue must cover would include:

• Organisation’s client confidentiality policy
• Mandatory reporting requirements
• Consent for information sharing with other agencies
• Organisation’s record keeping and documentation requirements
• Work health and safety requirements during service delivery.

^{(Adapted from Arnott et al., 2020, pp. 316-317)}

Case Study 2: Case Management with Involuntary Client

Lucy suffers from schizophrenia and has a long-term drug addiction to ice. She is currently under a treatment order under the Mental Health Act to ensure her condition is treated due to periods of imprisonment and hospitalisation in the past. As Lucy’s case manager, Shanti has been working hard to build a relationship with Lucy and engage her in the process of case management; however, it can be challenging when Lucy refuses to engage or disappears for periods of time.

Lucy’s engagement with case management is compulsory as part of her community treatment order made under the Mental Health Act. As the case manager, Shanti’s work with Lucy will involve:

• Encouraging and ensuring compliance with treatment orders
• Working holistically with Lucy on a range of psychosocial needs
• Complying with requirements set out in the relevant Mental Health Act
• Ensuring that Lucy is aware of her rights and responsibilities under the legislation
• Monitoring and providing reports to a mental health review tribunal about Lucy’s progress
• Supporting Lucy to participate as much as possible in key decisions and treatment plans
• Continually making efforts to engage Lucy during periods of no contact
• Work health and safety requirements during service delivery.

^{(Adapted from Arnott et al., 2020, pp. 316-317)}

A Note on Motivation and Stages of Change

If you are working as a case manager, you will need to learn how to work effectively with mandated clients or clients who may be reluctant or resistant to engage in case management. Facilitating the engagement of clients who are not ready to make a change will inevitably be more challenging than working with those who are motivated to change. Understanding the concepts of behaviour change models (for example, the Stages of Change model) and identifying a client’s readiness for change can help you to make the necessary adjustments to your approach in order to better engage these clients (Guzys et al., 2021).

The following extract outlines some critical considerations in case management planning for clients at different stages of change: (Adapted from Summers, 2016, pp. 240-242)

Importantly, the Stages of Change model should not be understood as a linear process, but instead as a spiral where individuals can relapse and return to earlier stages of the change process at any time.

Case Management - Bad Practice

Study the following video on bad practices, and then answer the questions that follow.

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Demonstration of Evoking Change Talk

Review the following video on good practices, and then answer the questions that follow.

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It is important to remember that a case plan must reflect the needs of the client – not only the immediate needs of the client, but also the client’s specific situation, including factors related to the client’s diversity factors, such as cultural background, sexual orientation, age, and other sociodemographic characteristics (for example, employment, education and household composition).

Case managers should sensitively consider these factors in order to develop an appropriate and viable case plan. For example, a female Muslim client may feel uncomfortable working with male practitioners; an elderly client may prefer to work with a practitioner of mature age. Where practicable, the case manager should respect this and incorporate these considerations accordingly.

However, case managers must not make assumptions about a client’s preference or needs based on their diversity factors. Case managers must take the time to observe and consult with the client in order to develop an understanding of the unique individual before them. It is then the case manager’s responsibility to integrate the specific cultural and diversity considerations of the client into the development of an individualised case plan. At times this may mean adapting existing protocols and case management processes (within your organisational limits) to better suit the client's needs.

Introduction to Cultural Sensitivity

This video provides a brief introduction to cultural competency.

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Let’s consider the following examples.

When working with clients from culturally and linguistically diverse (CALD) backgrounds, you may need to consider if clients have specific language needs and whether interpreters are required. You will also need to make sure that any referral organisations are able to cater for these needs (e.g., Do they support language and/or cultural interpreter services? Are they culturally competent in working with your client?). Additionally, you should seek to understand the client’s family dynamics and structure and how their value systems may impact their perception of issues and interventions.

For instance, mental health issues may be seen as negative and a sign of weakness by the client; hence, they may receive little community support or feel reluctant towards addressing mental health-relevant issues. Some clients may also put family or group interests before their own, in which case the case plan must reflect and enable the client to serve their priorities.

When working with Aboriginal and/or Torres Strait Islander clients, case managers should take care to ensure cultural safety in their own workplace as well as potential referral sites. Sometimes this may mean working with the client to determine if they would like to receive services from Aboriginal community-controlled organisations (ACCOs) that might have greater capacity to address the unique needs of Aboriginal and/or Torres Strait Islander clients. However, we must not assume that Aboriginal and/or Torres Strait Islander clients would always prefer to work with a practitioner from their own culture – instead, clients should be informed of the available options and be supported to make their own decisions.

Another important aspect of promoting cultural safety is to make sure all practitioners (and their organisations) working with the client have a good understanding of the impacts of historical trauma and oppression on clients, particularly their engagement and attitudes toward service providers. For instance, racism and discrimination experienced by past and current generations of Aboriginal and/or Torres Strait Islander communities can result in distrust of social services and lack of commitment. Higher exposure to potentially traumatising experiences can also impact the ability to make decisions, communicate, understand, and retain information.

Like counsellors, it is important that case managers make sure that the environments in which the client will engage are safe and respectful spaces. To do this, case managers should ensure that their own workplace has a welcoming and respectful atmosphere, both physically and emotionally, so that clients of different ages, sexual orientations and/or identities, abilities and varying socio-economic backgrounds feel comfortable in accessing services.

This includes being open and accepting of all client’s beliefs and lifestyles as well as making sure referrals to organisations are appropriately competent in working with the particular client (for example, referring a client from LGBTIQA+ community to a service that is friendly and inclusive). Where clients are living with certain disabilities, such as those with limited mobility, case managers must be vigilant about making sure that all work environments, including referral services, are safe and accessible. Additional communication methods may also be required for those with an intellectual, visual or auditory impairment – such as easy-to-read literature, braille, Makaton, sign language or augmented communication devices.

Age is also a relevant factor. When working with children and young people, case managers must make sure the case management processes and relevant documentation are developmentally appropriate. Moreover, a guardian or parent is often involved in providing consent and making decisions – however, it is important to make sure that the child or young person you are working with is engaged and consulted as much as possible.

On the other hand, an elderly client may have additional needs such as health, medical, transport and financial needs that need to be incorporated into service processes and case management plans. It may be useful to engage the client’s family or carer in the planning process and make sure that the client is supported to implement their case plan.

It is also important to consider clients’ circumstances and access to resources. For example, if a case manager is working with a client at risk of homelessness, they may not have access to stable accommodation or reliable transport. These needs must be taken into account when developing the case plan with the client, such as prioritising urgent needs and only referring clients to services that the client could easily access or incorporating transportation arrangements.

Tailoring Counselling Approaches

Tailoring counselling approaches to the special needs of each client population fosters a more inclusive and effective therapeutic environment. Study several examples of special needs that may apply to the following diverse client populations. This is by no means a comprehensive list but provides ideas as to how you might tailor your counselling in this context.

Learning about a Client's Cultural Identity and Establishing Trust

This role-play provides an example of how a counsellor establishes trust. Answer the questions that follow.

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Overall, case managers must be sensitive and respectful of the cultural beliefs and practices of their clients. Where possible (and desired by the client), effort should be made to link clients with support services that are appropriate for the client’s age, abilities, preferences, and cultural background. In addition, case managers must possess ample understanding of the needs of marginalised groups whose disadvantaged positions often drive them to human services. People living with disadvantages are often subject to a higher risk of abuse, discrimination, exclusion and traumatic experiences.

Such experiences can impact their capacity to communicate, ability to trust services or others, and engagement with services. They may also have higher physical, mental and emotional health needs due to lack of stability, access to care, education and employment. Case managers will need to work on facilitating client participation and commitment while protecting their dignity and rights.

Diversity in Counselling

This video presents a brief discussion on diversity in counselling.

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Check your understanding of the content so far!

Like counsellors, case managers have the responsibility to protect the rights of the client. Kohleis (2009) outlines the following client rights within the context of case management:

Clients’ rights to privacy and confidentiality are particularly important. Clients (or their parents/guardians/power of attorney) have the right to control their information (and understand exclusions to this right) and to know that their information is kept securely and appropriately within the organisation’s documentation system. It is important that clients are informed of how their information will be handled from the outset, and that their consent (preferably written) is always attained prior to sharing their information with a third party (for example, for referral purposes).

In addition, confidentiality and its limitations must be clearly discussed and continuously reminded throughout the case management processes. Clients can expect that their information and discussions with practitioners are kept confidential, except for specific situations such as:

• When information that suggests a child may have been or is experiencing abuse is disclosed, the case manager must inform clients about mandatory reporting duty and relevant organisational procedures
• When a client discloses that they may harm themselves (for example, suicide) or another person
• Where statutory requirements may demand a report or sharing of information (for example, in a child protection scenario, the case manager may be obligated to provide a progress report for the department’s consideration).

Typically, the decision to break confidentiality will be made in consultation with your supervisor/manager. However, it is the case manager’s responsibility to discuss and inform clients of these exceptional circumstances in which confidentiality is limited. This will also support case managers in managing any complex or high-risk situations that may require a breach of confidentiality, as you have already prepared each client for this possibility.

Similarly, clients must be informed of their rights to appeal or make a complaint if they are not satisfied with any area of service delivery (or if they believe one of their rights has been infringed upon). As such, the avenues for complaint and rights of appeal must be clearly outlined to each client from the beginning of the process.

Essentially, it is the case manager’s responsibility to ensure that these client rights are protected. Each agency/organisation has its own policies and procedures for ensuring client rights and it will be absolutely essential for you to be familiar with, and adhere to, the specific policies of the agency/organisation for which you work. One common method many organisations use to help introduce clients to the processes of case management and their rights as clients is to provide them with an information sheet outlining the case management process.

'Client Rights and Responsibilities' is an example of a typical information sheet outlining client rights and responsibilities in the helping relationship. A second example, 'What is a Case Plan?' provides information outlining the case management process.

Client Rights and Responsibilities

As a client, you have the right to:

• Receive services in a professional, courteous and caring manner that respects and appreciates individual differences
• Be provided with adequate and accurate information regarding the services provided in order to make informed choices about engaging in the case management process
• Receive case management that is evidence-based, flexible and responsive to your individual needs and circumstances
• Participate in, and contribute to, decision-making in your care and management where appropriate
• Expect that your personal privacy is respected and confidentiality protected to the greatest extent permitted by law
• Access any personal and other information held for the provision of services and correct any wrong information as permitted by law
• Make a complaint about a service or your case management experience, with the expectation that any complaint will be investigated appropriately and in confidence without fear of it affecting decisions related to your provision of professional services
• Proper attention of a case manager at all times throughout the case management process.

As a client, you have the responsibility to:

• Be respectful to case managers and other staff
• Respect the privacy and confidentiality of other people who may be receiving services within the organisation or referral sites
• Not use a service for a purpose for which it was not intended
• Provide accurate information necessary for the provision of a service.

What is a Case Plan?

An individual case plan is developed between you and your case manager. It is a document detailing your goals, the strategies for meeting these goals and other agencies and support people who will support you in the strategies. The plan is broken down into clear, easy-to-understand steps which are agreed upon by you and your family or carer.

The plan will be monitored and reviewed as changes are required to match your changing needs. This should not happen without your permission (consent). A family member, your carer or an advocate may also contribute their ideas to the plan with your permission. Other professionals who are included in your case management plan will offer their evaluations and opinions for changes as they are required. If you disagree with parts of the plan, let the case manager know so that an adjustment can be discussed and appropriate changes can be made.

The case management plan is regularly reviewed so further changes can be made at this time. The timing of this review will be determined by your case manager or every three months, whichever is the sooner. You are entitled to have a family member, carer or advocate present for these meetings. Advise your case manager so that any necessary arrangements can be made.

Your individual case management plan is flexible. As your needs and circumstances change, your plan will be reviewed with you for suitability and any necessary changes will be made with mutual agreement.

Implementing your Case Plan

You will have an interview with your appointed case manager to discuss:

1. Your current strengths, resources and problems
2. The goals you aim for, to improve the current situation
3. The strategies to achieve these goals
4. Your role and the case manager’s role in putting the strategies into action
5. A future review date to discuss your case plan

In most cases, our case managers contact other professionals and support services to involve them in case plans as a way to best match all of your needs. The case manager’s role is to coordinate all participants and support services included in your case plan.

What Happens at the Review of my Case Plan?

The review has three purposes:

• Check to see if the goals and strategies of the case plan are being implemented as planned
• Review the original goals and outcomes; agree to any necessary changes to the plan
• Review the progress towards meeting your goals; the next stage of case management will be discussed. This could be a plan change or, if the goals have been achieved, it could involve working towards concluding the case management process.

Our Procedures for Receiving a Complaint

We respect your right to a professional service. If you are unhappy with the service you receive, we have the following procedures in place to receive your complaint:

• Discuss the situation with your case manager so the matter can be dealt with promptly. If you want support in making a complaint, ask someone you trust to accompany you. This may be a family member, carer or advocate.
• If the situation is not settled at this level, you can put your complaint in writing and send it to the Director. We can provide you with some assistance with this if you need it.

Of course, when working with young people, people with low-level literacy, or people with intellectual disabilities, it is critical that this information is presented in a manner the client can understand. This might involve providing more simplified versions of these documents, discussing this information in detail in developmentally appropriate language, and reminding clients of relevant aspects at appropriate times.

Also, remember, just as it is crucial that all clients know and understand their rights and responsibilities within the helping relationship, clients also must be informed of the limitations of those rights, and situations in which a case manager must breach a client’s rights according to duty of care requirements.

Client Rights and Counselor Responsibilities

This video provides a definition of informed consent and a brief example of how to deliver the information needed to acquire informed consent. It also covers the SOAP note format and provides a brief example of how one might document a therapy session with a client.

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Just like counsellors, case managers (and other community service workers) are compelled by law to engage in professional behaviours that do no harm. “Duty of care means being in a position where someone else is relying on you to be careful, and where, if you are not careful, it is reasonably predictable that the client or another person might suffer harm” (Community Support Incorporated, 2015). You need to be clear about exactly what the nature of the care or support is that you are providing and how potential risks are managed.

Whilst duty of care is a broad and overarching concept, case managers must be particularly vigilant about risks and responsibilities associated with issues relating to child protection, domestic and family violence, suicide, and elder abuse, as well as when working with people living with disabilities. It is important to make sure you are always acting in accordance with relevant statutory and organisational requirements while promoting the rights and safety of clients and relevant others.

What is Duty of Care? Duty of Care vs Dignity of Risk

This video examines the vital differences between duty of care and dignity of risk.

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There are four key evidence-based best practice approaches that are helpful for case managers to be aware of: strengths-based, rights-based, person-centred, and needs-based. Case managers may use one approach or a combination of approaches to best meet the client’s needs.

Strengths-Based Approach

Working from a strengths-based perspective means that case managers focus and work to build on the client’s unique assets, culture, skills, interests, abilities and competencies to enhance protective factors, move clients toward goal achievement, and build resilience. A strengths-based approach offers case managers a mechanism for addressing and valuing the experience, skills, values, and development of clients. Within the strengths-based perspective, case management is seen as a collaborative process between the case manager, the client, and other key stakeholders.

The strengths-based approach is about assessing client strengths and building on those strengths to support clients in achieving their goals. It is about getting case managers to reinforce the good and positive characteristics of clients so that they can build from that. When case managers are engaging with clients, they should be looking at them through a lens of assets and strengths, not problems and weaknesses.

Rights-Based Approach

A rights-based approach to case management focuses on upholding and reinforcing the client’s human rights, both within the context of the helping relationship, as well as within the client’s personal environment. This approach offers case managers a framework that helps them better understand professional expectations by providing a common language - the language of human rights - through which policies and procedures of the organisation and service quality can be measured. Utilising a rights-based approach also ensures that services are respectful of the inherent dignity of every client.

Adopting a rights-based approach to case management can support organisations in improving the quality of service delivery. A rights-based approach to service delivery can bring a range of benefits including (adapted from Equality and Human Rights Impact Assessment, n.d.):

• Empowering people to know and claim their rights, and promoting greater participation of service users in shaping the policies and practices that affect them
• Increasing accountability of workers and organisations who are responsible for respecting, protecting, and fulfilling clients’ rights
• Reducing and preventing discrimination, particularly for clients from marginalised populations.

Implementing a rights-based approach to case management also supports community services organisations to maintain compliance with state and federal legislation. Some of the Commonwealth legislation to consider when reviewing the comprehensiveness of a rights-based approach include the following:

• Age Discrimination Act 2004
• Crimes Act 1914
• Disability Discrimination Act 1992
• Australian Human Rights Commission Act 1986
• Racial Discrimination Act 1975
• Sex Discrimination Act 1984
• Mental Health Act 2007.

A rights-based approach ensures that case managers and their organisations are upholding all the relevant legislation in their day-to-day practices. It is important to involve both staff and clients in the maintenance of human rights compliance, including reviewing all organisational policies and procedures and assessing how well both client and worker rights are upheld in all of the organisation’s operations. Organisations and case managers may find it helpful to adopt a human rights language within their policies, procedures and protocols to help support a shared language and understanding of the rights of clients.

Person-Centred Approach

Earlier in your studies, you learned about person-centred therapy and that its principles are now widely incorporated into various aspects of human services, including case management. The person-centred approach to case management is “an individualised approach intended to reflect the unique circumstances of the individual client both in assessing and in organising what should be done” (Mansell & Beadle-Brown, 2004, p. 1).

Like the strengths-based approach, the person-centred approach to case management aims to highlight the client’s aspirations and capacities rather than needs and deficiencies. This model of service delivery focuses on mobilising the client’s broader social network and expanding the range of services available to offer support and improve quality of life.

There are five key principles commonly cited in person-centred planning and case management literature (PDD Central Alberta Community Board, 2004):

1. The person is at the centre of the work.
2. Family members and friends are partners in planning.
3. The plan reflects what is important to the individual client now and for the future, reflecting their capacities and supports required.
4. The plan helps build the client’s sense of belonging and self-worth.
5. The plan results in on-going listening, learning, and further action based on reassessment. Putting the plan into action helps the person achieve what they want out of life.

When operating from a person-centred perspective, the role of the case manager is to engage in a “process of continual listening, and learning; focused on what is important to a client now, and for the future; and acting upon this in alliance with their family and friends in which having meetings, involving the client and making the plan is not the outcome. The outcome is to help the client to get a better life on his/her own terms” (Mansell & Beadle-Brown, 2004, p. 14).

A person-centred approach focuses on both what is important for the client and what is important to the client. Working to accomplish goals that are important for the client is about offering the help and support that the individual requires to maintain health, safety, and well-being. Of equal importance, what is important to the client constitutes what really matters from the client’s perspective.

The things that are important to the client are often the things that make them feel happy and fulfilled, and the things that they look forward to. Balancing what is important for the client and what is important to the client should be the focus of person-centred planning in case management.

The following questions can help you determine if you are operating from a person-centred approach in your work with clients:

• Do I fully understand what is important to the person and their communication?
• Am I the best person to support this decision-making?
• Is the information that I have and am giving the person relevant to the decision?
• Am I presenting it in a way that the person can understand?
• Am I giving the information in the right place and time?
• Have I given the person the best chance to make the decision themselves?

Needs-Based Approach

Taking a needs-based approach to case management involves a process of taking responsibility to ensure that the needs of clients are met and reviewed on a regular basis. The focus of needs-based approaches to case management is on identifying client needs and creating goals and objectives to ensure needs are met. “In a needs-based approach, basic needs – such as housing, food, and education – are addressed depending on the availability of resources and the judgments of service providers” (Poindexter, 2010, p. 65).

Unlike the other approaches to case management that focus on the strengths and capacities of clients, the needs-based approach tends to be more problem-focused, highlighting deficits and working to overcome them.

Key features of the needs-based approach include that it:

• Works toward outcome goals over process goals
• Recognises needs as valid claims
• Sees empowerment as not necessary to meet all needs
• Accepts charity as the driving motivation for meeting needs
• Focuses on manifestations of problems and immediate cases of problems.

The needs-based approach is based on the premise that individuals are entitled to the things they lack or are necessary to them. Based on the principle of ‘equality of outcome’, the needs-based approach advocates treating clients differently where it is warranted” (Bigilhole, 2009, p. 46). The primary concern of the needs-based approach is equality in larger society.

However, the needs-based approach to case management is becoming obsolete in most case management settings in favour of more strengths-based, rights-based and person-centred approaches.

A Note on Evidence-Based Practice

Another important approach that guides best practice and decision-making of helping professionals is evidence-based practice. Practicing in an evidence-based manner means that your practice is guided by the best available evidence relating to the practice. In layman's terms, this means that each time you say, “OK, I think this may be the best way to go forward in this situation”, you know that you are making a sound professional decision, incorporating the best available evidence derived from the latest research, relevant professional experience, and client’s preferences, values and circumstances.

Evidence-based practice (EBP) is not about rigidly trying to replicate interventions tested in research studies; rather, the integration of clinical expertise and a client’s preferences, values and circumstances are key components of EBP. External evidence can inform, but cannot replace, sound clinical reasoning and your client’s preferences and choice in their treatment. It is imperative to take an individualized approach in practice, consider cultural factors and thoughtfully integrate these aspects in every client–clinician encounter.

^{(Adapted from Orygen, 2018, p. 6)}

When developing a case management plan, for example, case managers must consider what is the most evidence-based intervention available for the client and which service is more likely to be a good match for this client. Case managers also monitor the interventions implemented by other practitioners/services within the case management team to make sure that they are working in line with evidence-based requirements and documenting all casework interventions accordingly.

Evidence-Based Practices

In this video, Drs. Beck and Evans discuss Evidence-Based Practices.

watch

This section of the module has introduced you to the practice of case management and some of the key considerations involved in effective case management work. In the remaining sections of the module, you will be provided with additional information on developing case management plans, conducting case management meetings, and monitoring case management processes.

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