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human servicePoints to Consider in Human Services Delivery

The Irony of Human Services

Read these introductory materials carefully, as they form the basis of the assignments and discussions that follow.

Yeheskel Hasenfeld

Click the image to review Hasenfeld’s Reality: What A Concept! Ten Concepts from Human Services as Complex Organizations

In order to effectively develop components in the human service delivery system it is important to understand the characteristics of human service organizations. Yeheskel Hasenfeld in an article, “The Nature of Human Service Organizations,” discusses the types of work that are transacted in these organizations. Hasenfeld introduces us to familiar human service organizations as those that provide services to people in need. Institutions such as hospitals, schools, mental health centers and welfare departments are examples of such entities.

Hasenfeld notes an essential irony in these human services organizations. In outward form and manifestations, the human service agency embodies the values of caring and commitment to human welfare through effective and timely response to client needs. However, in practical terms, the human service organization is often a formidable bureaucracy, burdened by incomprehensible rules and regulations that impede the delivery of services. This course is designed to help you effectively respond to human needs within the constraints of bureaucratic requirements.

Halley: Learning the Language of Human Services

In the Halley text, the discussions move from the theoretical to the pragmatic and focus on the steps the practitioners go through in a learning process that focuses on the awareness of the skills and knowledge that are necessary to properly deliver services to clients in need.

The readings and exercises in the introductory portion prepare you to understand and implement practice elements that are needed to respond to the client’s service needs. Many of the interactions that human service workers and clients enter into require listening, reading, observation, and analytical skills. The focus of this section is to concentrate on learning the language and systems necessary to manage work and competent practice. The readings and exercises will heighten your awareness of your role as practitioner in complex and sometimes confusing systems.

Halley’s third lesson in Chapter One introduces systems approach as a way of thinking about delivering human services. (See the videos on this module’s Media Section for descriptions of systems thinking.) There are several ways Human Service systems can be analyzed when using systems thinking. Halley reviews human service systems from the perspective of single social institutions, as subsystems of programs, as areas of functioning, as networks of agencies and based upon approaches to service delivery. Institutions, agencies and consumers themselves are all systems, which can be analyzed using this method. We are all a part of several systems and systems thinking means recognizing the interrelatedness of these parts. Consumers are also connected to multiple systems and a systems thinking approach means the human services worker looks at a consumer holistically, as a person connected to multiple systems.

Changes in Case Management

Dr. Kenneth B. Clark, a New York psychologist and educator, is shown at a staff meeting of the North Side Center for Child Development he founded, in Harlem, NYC, 11/9/1965. Earlier this year Dr. Clarke resigned from the Harlem Youth Opportunities Unlimited program, stating it was becoming a political vehicle.The program provided guidelines for President Johnson’s War on Poverty initiative. (AP Photo)

Case Management is a central ingredient in the delivery of human services that provides the linkage between the client, and the agency or program that will meet the client’s needs. The case manager furnishes direction and leadership in an effort to deliver quality services. Norma Raiff (1993) in her discussion of case management, states that case management is a major activity that is critically important to the delivery of human services.

The majority of professionals involved in the delivery of services have recognized the importance of case management. Despite that recognition, they have not always used it effectively as a link to the client’s needs. Raiff begins the discussion of case management by defining it. In the “new case management paradigm,” Raiff introduces terminology, which relates to components and models of service delivery that have emerged in the past two decades. Landmark movements like the War on Poverty, and the Model Cities programs of the 1960’s brought the issue of fragmentation and inaccessibility of human services programs to national conscientiousness. In the 1970’s, service integration became the key ingredient of case management. At that time, “information and referral” became two of the key components of service for people in need. Large multi-service agencies grew out of this era, and have been a major part of the service delivery system ever since.

After these innovations were introduced, there was an effort to develop methods to focus on the “hard to reach” clients. These “treatment resistant” groups caused the professionals in the field to rethink old models. This effort caused the birth of new forms of case management such as Intensive Case Management. managed care and other alternative delivery systems that dominate the delivery system emerged from these intensive case management efforts. With the onset of these new forms of client triage and management, case management has taken on a new perspective. While case management is critically important, its content and application have had to be adapted to respond to the new and sometimes complex infrastructures have been developed to accommodate new reimbursement and funding methodology.

Core Tasks of Case Management

Core Tasks of Case Management

Norma Raiff and Barbara Shore (1993) in a textbook used for this course in the past, list six core tasks of case managers. Although this textbook is now fourteen years old, the core tasks of case management remain the same although the list has been modified by McKnight (2007) to reflect the recent emphasis on outcomes based assessment. It should be noted that although the term “client” generally refers to an individual, it may also refer to a couple, a family, a small group, an organization, a neighborhood or community, or a self-identified category such as alcoholics, parents of small children, etc.
A word cloud created from the text of this page. The larger the word, the more frequently it appears(and by implication the more important it is).

The six core tasks are:

1. Assessment: To ensure adequate understanding of the client’s strengths, weaknesses, values, goals, and interpersonal environment

• Collection of information on clients’ needs and resources including resources within the family and community

• Establishment of a baseline status by observation and contact with other service providers (observing appropriate rules of confidentiality)

• Conduct formal assessments

• Collect ancillary information as appropriate

• Integrate case management assessment with clinical and testing data

2. Service Planning To plan appropriate services with the active participation of the client

• Ensure client input and feedback

• Set long and short term goals compatible with the client’s values and strengths

• Consult with multidisciplinary team for input and review

• Establish who (staff, client, other) is responsible for specific functions

• Establish clear criteria for success

• Establish timeline for objectives and plan review

• Establish crisis plan in advance

• Develop a cycle of service planning review with the client.

3. Implementation To assure optimum outcomes based on client needs

• Maximize client autonomy in making contacts, keeping appointments, and following through with service plan

• Provide direct counseling and support to empower clients to participate in services

• Contact and broker individually tailored “wrap-around” services

• Provide crisis services, if needed

• Discuss progress regularly with client and make changes as needed.

4. Systems Coordination To monitor the various service systems involved in the service plan. To make corrections as needed

• Identify key systems involved in service plan including internal agency services, other formal human services organizations, community systems, family supports, and other formal or informal support systems available to the client.

• Develop/clarify purchase of service control and authority.

• Develop a joint process for client and case manager evaluation of each system as implementation unfolds.

• With client jointly monitor service provision for appropriateness, quantity, quality, intensity, and efficacy.

• Systematically document unmet needs in services/resources.

• Monitor outcomes in measurable terms such as client’s/case manager’s perceptions of client quality of life, crisis events, acute/long term care requirements, overall client satisfaction.

• Monitor cost of services.

• Monitor client utilization of services and reasons for non-compliance (i.e. missed appointments, failure to follow through on recommended treatment options, etc.).

• Work with client to identify and “unblock” barriers to compliance.

• Follow-up with service providers as well as with client to assure expectations of each are being met (being careful to maintain client confidentiality).

5. Advocacy Advocacy involves both enabling individual clients to obtain deserved services and whole categories of clients to receive needed services. Case managers have a responsibility in both areas.

Case Advocacy: To enable clients to receive needed services.

• Explain client’s perspective to others

• Appropriately intervene on client’s behalf

• Help client collect evidence of need and qualify for benefits

• Support client attendance at self-advocacy training

• Role play self-advocacy with the client.

Class Advocacy

• Define group or “class” in need of advocacy

• Document need using accepted social science research methods

• Provide accurate information for needs assessments

• Staff an advocacy committee or group

• Identify effective community leaders and resources

• Facilitate community groups

6. Termination typically takes two forms: transfer to another case manager or completion of services

Case Transfer

• Help client assess continuing need for services and their intensity

• Provide (and/or brainstorm) options for meaningful choice

• Schedule transition meetings with yourself, client, and new case manager

Termination

• Allow time for termination and processing experiences

• Help client assess options and maximize choices with emphasis on client-generated plans

• Allow ventilation of feelings (expect feelings of abandonment, fear, loneliness, relief, etc.)

• Mutually review progress and goal achievement

• Celebrate successes

• Follow-up as needed and appropriate

• Be careful of encouraging on-going dependency

Raiff and Shore (1993) edited by McKnight (2007)

M1 Media Resources

Systems Thinking Videos

This Systems Thinking video was produced by the University of South Australia.

Systems Thinking – Text

Systems thinking explores how separate parts work together as a whole. It’s a way of looking at the world, where everything works as a system of systems.

In this line of thinking, every system is made up of smaller systems. For example, a lake is composed of the chemical systems of the water, but also biological systems of plants and fish.

Conversely, every system is also part of a larger system. For example, our lake is also part of an ecological system weather patterns, mountains, plants, animals and watershed. This ecological system is also part of a larger social system of a resort community composed of vacationers and townspeople. Additionally, all of these local systems interact with and within larger political, economic and ecological systems.

This complex relationship of systems is called an environment. Environments are dynamic, which means they are constantly changing. A change in any one system can have a ripple effect on all the other systems that make up the environment. For example, waste water from the watershed can cause a change in the chemical composition of the lake that may kill off a number of plants, which may decrease the population of the fish, which may discourage vacationers from coming to the lake, which then may depress the economy of the town.

Systems thinking views the world as a system of systems. Each system is made up of a number of smaller systems; while at the same time is part of a number of larger systems. Consumers are always part of multiple systems.


Systems Thinking and Systems Coordination

Systems Thinking is an approach to problem solving that looks at all of the parts of system and examines the relationship of these parts. The goal is to see the larger picture rather than narrowly focusing on one element of the problem. When working with consumers, using a systems thinking approach means attempting to understand more than a single issue or problem. 

Systems Coordination is one of the tasks of case management that involves monitoring the various service systems that a consumer is involved with. A consumer may be referred to different agencies for help with different types of problems. Perhaps the consumer has a housing problem and mental health problem and a child care problem. The role of the human services worker is to not just make referrals to agencies to assist the consumer but to coordinate and monitor the consumer’s progress with all of these systems.

 

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