Dismantle the system
I have worked in the social services arena in Portland for close to 24 years. I am disappointed that your paper did not take the time to see if the view expressed in “The Case Management Trap” (April 2016) is the view of case managers working for other agencies, because agencies vary greatly. Based on my experience, some of the concerns raised, such as “focus on raking in the money,” certainly exist in some agencies — but not all.
I currently work as a case manager with adults with mental illness, and I work for a very ethical and caring agency. It is clear to me that what lacked for the case manager featured in your article was appropriate training and experience. This article helps to explain why I have received so many referrals from individuals who claim to have had terrible service from other agencies. And to be clear, I do not taxi my clients or bribe them to meet with me. I listen to them, and I work hard to get them the services they need — and for this, they appreciate and respect me.
I have proudly discharged many clients after successfully assisting them in linking to needed service providers who are able to assist them in reaching their goals. Discharges, for me, are a joyous occasion.
It is the case manager’s job to assess the needs of clients and then connect them with the appropriate service providers to help them gain skills and get mental health and/or medical support, housing, food — whatever services they need to live as independent a life as possible. The overriding goal is to help alleviate their mental health symptoms. We do not teach skills (aside from, perhaps, how to reach out to other providers and advocate for themselves when possible). It is the job of the programs we connect our clients with to teach skills.
Finding providers and linking clients to these services is only step one. The most challenging part of the job is following up on these referrals, ensuring that the agencies are following through, advocating for clients when they are not being treated fairly, and then monitoring to ensure the services are actually helping the client move forward. Rarely does the puzzle come together neatly and easily. It more often takes a lot of monitoring, communicating and, most important, listening to the client and learning what is working and what is not working in order to make the necessary adjustments.
Your article paints a terrible picture of case management. I have worked for several social services agencies that have “lost their way” and push forward chasing the dollar and engaging in mission drift to follow grant dollars. There are many agencies in Portland that have dedicated, caring employees who engage in this work because they are improving people’s lives. Our agency offers “pro-bono” hours, paid time to case managers for clients who have lost their medical insurance, so clients do not go without services they desperately need.
If someone wants to rant about social services in Maine, there are plenty of areas that need change.
Our current system is broken. Social service provision in Maine is broken up into so many little pieces that it takes a lot of time and effort to bring the pieces together. Clients receive four hours of services from one individual, another four-to-six hours from another, another hour from yet another, and often these providers work for different agencies, and each of these agencies have spent time and resources to complete assessments, treatment plans, etc., and they rarely communicate with each other.
This whole process should be dismantled. Our policymakers should look at the big picture and rewrite the policies to be more flexible in allowing direct-care workers to provide a wider spectrum of services, thus allowing one worker to address all the client’s needs. The savings in administrative costs would be huge. This would also allow agencies to pay direct-care providers a better wage, reducing burnout and turnover.
I would suggest the author make a formal complaint to the state about the agency he or she worked for, but the Department of Health and Human Services is so underfunded and understaffed that they would have no one available to respond in a thoughtful or meaningful way. Whenever I support a client at DHHS, I tell them before we go in, “Remember, the people who work here are doing their best with what little resources they have.” DHHS has lost a lot of the institutional knowledge from the people who have quit due to being broken under the weight of the “do more for less” policies of the present administration.
Christine Olsen, LSW, MPPM