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May 21, 2015

Case Management: Changes over the last 10 years



This post addresses some of the changes in Intellectual Disabilities (ID) Case Management in the last 10-12 years. 

The job of a case manager has changed significantly in the last 10 plus years. Everything from the terminology to the amount of paperwork required has changed dramatically over the years. Some of the changes have been necessary but many of the changes have resulted in frustration. The source of much of the frustration has been largely due to the steady increase in responsibilities of case managers and service coordinators. Many case managers feel that the changes in requirements do not take into account the large amount of work that case managers already have on their plates. In my state of Virginia, the changes have been constant over the last 2-3 years. A lawsuit from the Department of Justice has lead to the downsizing of most long-term training centers for the disabled. 



Who’s responsible for finding all of these residents placement in the community? Of course the answer is the case manger. In addition handling caseloads that can reach up to 50 in some cases, case managers are also responsible for coordinating community placements for residents who have spent most of their adult lives in state operated facilities. Many of these residents are medically fragile in addition to having mental health and developmental disabilities. This makes it even more difficult to find providers that are suitable to meet their complex needs. The move to downsize the state facilities is to provide support in the community under the least restrictive environment. This is a move I fully support.

Jargon
Who are the people we serve? We seem to be confused on what we want to call them. I remember back in the day they referred to as “customers”. In my opinion, the term customer implies a retail environment which is really not accurate. We provide a service but the term customer implies that we are providing some product that is being purchased. Our relationship is much more personal. Then that term was later replaced with “consumers” which basically means the same thing. The newest term is to simply refer to them as an “individual”. I’m still trying to adjust to this one. I’m sure by the time I get used to saying this it will no longer be the correct buzz word. What’s politically correct today may be offensive next year. I’m sure there is someone out there right now that doesn’t want to be referred to as an “individual”. I sometimes use the term “client”.  I have yet to be admonished.

Some diagnostic terminology has also changed over the years. The term “Mental Retardation” has been replaced with Intellectual disability. The term had run its course and needed to be changed. People began to use the term in a derogatory fashion to describe things that weren’t acting or functioning the way they should.  The change in terminology involves more than a simple change in what we say verbally. It involves a complete overhaul of an agency’s documentation. The names of agencies/departments were also changed to adjust to the name change. This can be a costly change depending on the size of the department or agency.

The case manager’s title has also changed depending on where you live. Case managers are sometimes referred to as service coordinators. In recent years, the title of support coordinator has replaced case manager. I guess the theory behind this is that we shouldn’t consider people as a “case” that needs to be managed but rather a person that needs support.  

The Plan
The plan has also evolved over the years.  Again, the terminology has been the primary change. The true purpose of the service plan is to serve as a guide to how to provide support. The client has always been the focus of the plan. However, more and more emphasis has been placed on the client guiding his/her services. We have gone from the Consumer Service Plan (CSP), to the Individualized Service Plan (ISP) to now the Person Centered Plan (PCP). Goals and objectives have been replaced with “Desired Outcomes”. Although the words have changed, the mission remains the same. Case managers strive to ensure that people with disabilities receive the support they need and pursue opportunities to be included in their community either through employment, social activities, or both.  

Electronic Records
The introduction of electronic records is another change that has made a major impact on case management and the medical field in general. Electronic records have reduced the amount of paper used in the physical chart, as the client information is stored electronically. Although some have argued that they now use more paper than they did before electronic records. Electronic records have also caused an increase in accountability largely due to the time/date stamps. There is nowhere to hide when it comes to turning in late reports. The downside to electronic records is the tendency to crash or have technical difficulties. Technical problems can slow down productivity but are an overall positive change.


One thing I have learned over the last 10- 12 years is that change is a part of life as a case manager. I think the majority of the changes have been an attempt to improve the overall level of service and to make service providers more accountable. I hope some of the next wave of changes actually more toward more funding for people who need services. There are still people who are under served due to lack of funding. Wait lists continues to grow daily and the funding is not keeping pace.

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