Saturday, November 20, 2010

The Challenge of Breadth of Case Management

Working with clients on a host of issues is exciting and daunting. Exciting to be working on tasks covering different areas, from legal to health to housing. True, much of it is more basic counseling -- I haven't suddenly turned into a doctor (even if a number of clients have little hesitation in sharing full details about their ailments) or another specialist. I do, however, have some background on a number of issues through training or experience. I'm familiar with the law to be able to counsel my client on basic courses of action to take when she has a maintenance concern that her landlord won't fix. As much of the job involves advocacy and referrals it helps to have some knowledge in my client's concern.

As part of this job I also become a resource genie. I know where to find medical resources for people who have no insurance, I know where clothes pantries are, or where you can find vouchers for certain furniture items. I know because I keep an eye out. I'm walking around and notice flyers advertising an upcoming workshop. Hmmm would clients or staff find it useful?... Let me grab that.  And I'll likely go to the workshop if I don't know much about the topic. I love training opportunities and enjoy learning for my clients and because I like to learn. 

Yet realizing the breadth of what our work as case managers at Empoder is at times daunting. I don't only work on finding a client housing or advising on a legal matter like other providers. I could potentially work with one client on several concerns. Add to that low income, perhaps mental illness or a child in the mix, and the fact that my caseload includes 35 other lower maintenance clients and awaaaaaaaaaaaaay we go. Over the past few years I've had a number of clients with multiple issues who became -- or still are -- intensive and demanding. 

I materialize my aspirations to become an octopus and get all the different tasks done. Unable to make multiple Anotolias I try and do that in my mind -- re-prioritizing my to do list throughout the day, plan, get a coworker on my team to help when he can, and plan to be surprised. 

Sure, having some set boundaries help and we do know what's expected of us and know what we typically help clients with. But it's not unusual to need to revisit these boundaries and to assess on an ongoing basis -- typically with more demanding clients -- what we're able to help with in the long term. Not to mention the duties as assigned clause. Some situations call on the case manager to take action when it seems no one else will take care of a problem a client is unable to deal with.*

In theory we're the middle person and no more. We help clients stay housed by providing emergency assistance, advocacy, and referrals. Yet due to the way our department is structured is that we often offer long term support -- the client is welcome to continue and receive case management services while she continues to live in one of the buildings we support. And if this client is willing to build a relationship with us and has ongoing challenge it's easier to see how we may become more deeply involved in a client's life.

* Possible reasons it's difficult to have a client's problem dealt with by a person who's not you -- lack of community (no family or friends), lack of other agencies in client's life, lack of funds by client.


Btrflygl said...

Great post. I have often been told that I am ultimately responsible for "everything" in my clients lives. It's just constantly coming up with creative ways to manage this........

I totally hear you on the boundaries thing as well as prioritizing through a to-do list.

Anatolia said...

Ultimately responsible for "everything" in a client's life -- what a tall order. Few professions are called to provide everything for a client.

What creative ways have you come up with in dealing with this challenge?

Something I didn't include in my post is that when working with a client with a multitude of concerns, if there are a few issues I can't help him with, I'll refer him to another provider and follow up he's getting the support he needs.