So, what exactly do you do as case manager?

Finally, today, April 24 and nearly 10 months since I took up the job of case manager, a client asked me, “So, what exactly do you do? ... what do you mean you work with me?” The question sounds so personal when a client asks it this way.

     This question goes to the heart of who I am, why I am here, and why I do what I do, the way I do it. I have probably said it many times already in different ways. This is different because clients do not generally ask these kinds of questions. I was caught unawares by the client and I had to give my honest and sincere answers through a conversation.

“I am your friend and advocate; the person who listens to you, to hear what you have to say ...as to why you are here in the shelter; where you want to go from here, what you want to do ...now and in more generally in life, and to find ways by which I can be helpful to you.” I explained.

“Do I make sense?”

He nodded his head and went on to ask, “So, what more can you tell me about your work?”

This sounded to me like an educated question asked by someone who knows something about this work. I gently sat back in my chair to search the vocabulary of case management studies that I did over four months earlier to come up with appropriate details of what this work involves and what I do.

“The client is the most important person in this work. You are the client and I am your case manager. I might have some good ideas for your life, but I cannot tell you what to do. Most of the time I will ask you questions to clarify your own direction in life. The main thing is that it is all about you; you are speaking to me and I am listening. Together, we are doing.” I explained.

“Are you a counselor?” He said.

“Not exactly a counselor. I am a steward. In this kind of stewardship perhaps 10 percent of what I do is counseling. The major part of my work is advocacy. An advocate is like a lawyer. I am not a lawyer. In a major way I function as your advocate, knocking on some doors for you, pointing you to social service organizations and human service resources available in organizations locally and beyond.” I explained.

He nodded and said, “Okay, now I understand.” He nodded his head some more.

I continued to explain, “You can look at me as your friend while you stay in the shelter. If you encounter challenges during your day out while looking for a job, give me a call so that we can talk about it. If you anticipate problems, for instance you are delayed by some unforeseen circumstances you can call me so that we talk about it. I will listen to you.”

"Your success is my success. Your success today is a milestone for tomorrow. Your milestone today is determined by the goals you set for today. Equally true, your success in future is determined by the goals you set for yourself."

     Many case managers are social workers and nurses; however, a case manager is not a social worker; neither is case management nursing. It is a relatively new system in terms of how to define it. Although case management has been practiced by many people in some ways, only recently has this occupation been given meat and bones to bring it to full life. 

     Even then, many times people refer to case management when they are talking about one of a nurse's tasks of nursing care. Case management is a collaborative process involving many human service organizations. At the center of this system is a client; the case manager's role is helping the client access the services available to him or her.

     A good case manager has a deep understanding of human needs and human services available to clients, is aware that some of the needs of clients cannot be fully met; is compassionate and prepared to show it by doing what he or she can for the client without dis-empowering the client.

     Nursing care, counseling, funding, sympathizing, advising, and psychotherapy are some of the traps a case manager faces. Case management is not one of these; it is at most a small fraction of some of these activities. Many clients have the wrong impression that a case manager is there to solve the client's problems; others think the case manager is a counselor and adviser to tell the client what to do, or perhaps that the case manager is a sympathizer who feels pity for the client. This is why it is important to draw boundaries and define expectations in the first meeting with the client.

     In my experience, the case manager is misunderstood by clients as well as by other professionals who do not take the time to ask, "What exactly do you do?" I have encountered some problems relating with some colleagues who are surprised when I seem to side with the client as if I am making a stand against my own organization. Such colleagues either forget or are ignorant of my role as advocate for the client. I am expected to stand for my clients and to fight for their rights without compromising my organization's integrity. 

     Of such I am one. My background is in medical laboratory sciences. I worked in the blood bank and general routine medical laboratory, taught hematology and blood banking in colleges of laboratory sciences for 20 years, and I worked as a manager for community health and development systems in rural Africa for more than five years. I have deep Christian convictions and faith in Jesus. As a soldier of the Salvation Army, case management is one more example of how I can exercise my faith in Jesus. My uniform has two S's; one on my right another on my left. The one says Saved, the other: to Serve. SS: saved to serve.

     A good case manager has a deep respect for the organization he or she represents, understands the ethos and positions of the organization vis-a-vis human needs and human services available to clients, is aware that no one organization can meet all the needs of every client; remains sensitive to organization needs and is prepared to show it by doing what he or she can for the client without discrediting the organizations involved.