Case management refers to a collaborative and planned approach to ensuring that a person who experiences homelessness gets the services and supports they need to move forward with their lives. Originating from the mental health and addictions sector, case management can be used more broadly to support anyone experiencing homelessness. It is a comprehensive and strategic form of service provision whereby a case worker assesses the needs of the client (and potentially their family) and, where appropriate, arranges, coordinates and advocates for delivery and access to a range of programs and services designed to meet the individual’s needs. The National Case Management Network of Canada (NCMN) defines case management as a:
“collaborative, client-driven process for the provision of quality health and support services through the effective and efficient use of resources. Case management supports the client’s achievement of safe, realistic, and reasonable goals within a complex health, social, and fiscal environment.” (National Case Management Network of Canada, 2009: 7)
A client-centered case management approach ensures that the person who has experienced homelessness has a major say in identifying goals and service needs, and that there is shared accountability. The goal of case management is to empower people, draw on their strengths and capabilities, and promote an improved quality of life by facilitating timely access to the necessary supports, thus reducing the risk of homelessness and/or enhancing housing stability.
Case management, well established in social work and health care, has many different approaches and practices. Case management can be short term (as in Critical Time Intervention) or long term and ongoing, dependent upon an identified need for crisis intervention related to problematic transitions, or for supports around chronic conditions. Critical Time Intervention (CTI) models are key to early intervention practice in that they are designed to prevent recurrent homelessness and help people transition to independence. This is achieved through:
“strengthening the individual’s long-term ties to services, family, and friends; and by providing emotional and practical support during the critical time of transition. An important aspect of CTI is that post-discharge services are delivered by workers who have established relationships with patients during their institutional stay.” (Critical Time Intervention Website)
Individuals with more complex, severe and persistent health, mental health and addictions challenges may require more intensive case management through Assertive Community Treatment (ACT) teams. In the ACT model, a multidisciplinary team from the community where the individual lives (rather than in an office-based practice or institutional setting) provides case management. The team involves psychiatrists, family physicians, social workers, nurses, occupational therapists, vocational specialists, peer support workers, etc., and is available to the patient/client 24 hour a day, 7 days a week.
A case management approach, then, necessarily works best within a system of care, where links are made to necessary services and supports, based on identified client need. That is, once a person becomes homeless, or is identified as being at risk, they are not simply unleashed into the emergency services sector. An intake process is followed, risks are identified, goals are established and plans are put in place. Individuals in need, therefore become ‘clients’ not of specific agencies, per se, but rather, of the sector. They are supported from the moment they are identified as (potentially) homeless, right through to the solution stage, and then after they have secured housing.
Case management, of course, requires a willingness on the part of the individual to participate, and development of a potentially therapeutic relationship may take time. When people become homeless and have very weak links or engagement with homelessness services, schools or other supports, and are only accessed through outreach and/or day programs, a period of relationship and trust building may be required before case management can be usefully implemented.
In reviewing case management as a key component to ending homelessness, Milaney identified it as a strengths-based team approach with six key dimensions:
- Collaboration and cooperation – a true team approach, involving several people with different backgrounds, skills and areas of expertise;
- Right matching of services – person-centered and based on the complexity of need;
- Contextual case management – Interventions must appropriately take account of age, ability, culture, gender and sexual orientation. In addition, an understanding of broader structural factors and personal history (of violence, sexual abuse or assault, for instance) must underline strategies and mode of engagement;
- The right kind of engagement – Building a strong relationship based on respectful encounters, openness, listening skills, non-judgmental attitudes and advocacy;
- Coordinated and well-managed system – Integrating the intervention into the broader system of care; and
- Evaluation for success – The ongoing and consistent assessment of case managed supports.
There are a number of useful resources to help service providers deliver case management in the homelessness sector. The Calgary Homeless Foundation has developed a report called “Dimensions of Promising Practice for Case Managed Supports in Ending Homelessness”. In Australia, the government has a dedicated website with a large number of resources for doing case management with people who have experienced homelessness. Finally, the National Alliance to End Homelessness also has a number of resources dedicated to this topic.