Case Management and the Loss of a ‘Personal Touch’

by Alison Lozano I am an “old world” social worker and possibly that is why I have some real concerns about how the practice of social work has lost ground over the past few years, in particular as it relates to individuals with developmental disabilities and their families. The changes have come about slowly as the social service system has shifted away from social workers being on the front lines of direct services for families and towards case management and managed care. Unfortunately, this shift has created a huge void for individuals with developmental disabilities and their families. Traditionally, social workers are not only a social service and community resource for people but they have the skills to assess family dynamics and treat dysfunctional behavior. As a new social worker in the 1970s, I traveled many miles from the state school where I worked as a community caseworker. I visited with families who had applied to the state school for placement, but my intervention very often stopped the institutional placement. Often, all the families needed were someone to offer them alternatives and choices to crisis situations that, not surprisingly, we are still seeing today. These situations include: parents growing old or sick, thus rendering them unable to take care of their loved one with developmental disabilities; a family crisis that needs a short or long term intervention; behavior problems brought on by change or stress; and, problems of social and economic isolation. As a trained social worker I had the skills to evaluate the situation and offer immediate assistance or counseling to ameliorate the problems. I also had the community resource skills to manage the complicated social service system on their behalf. I often intervened on the individual or family’s behalf with their natural supports, using the community rather than the social service system. The focus of the intervention was seeing the person in their natural setting and problem solving within that system. Over the past few years when accountability and cost saving became the mantra for social service systems, the focus of service to families is to do it as cheaply as possible. Thus social workers have been replaced by case managers and often they are nothing but a voice at the end of a telephone. Usually, case managers are minimally trained because their primary function is making sure the paperwork is in order and the rules of the agency are followed. A home visit is a thing of the past and individual assessments take place in an office or over the phone rather than in the person’s home. As we move towards a new paradigm for social service provision, it is imperative we do not take the ‘personal touch’ out of our contacts with individuals with developmental disabilities and their families. The families are not just numbers on a list, they are a combination of problems, concerns, abilities to cope and impossible situations. Each family needs that individualized attention from someone who has been trained to deal with psychosocial dynamics and intervention strategies. We cannot allow families in distress to have their only contact be a letter once a year informing them of their number on a waiting list, and an informal voice at the end of a telephone. It is short sighted to think we are saving money by not investing in social work services. Social workers are often the very people who can prevent situations from becoming an expensive crisis because they have the skills to intervene. For the sake of the individuals and their families our social service system must reverse the trend of depersonalizing interactions with constituents in the name of cost saving. We must individualize the way people are served so their lives are enriched and fully supported. In order to do this I would suggest we seek out social workers in training and offer them incentives to choose developmental disabilities as their specialty. Have these trained individuals develop professional relationships with individuals with developmental disabilities and their families and fully support them with whatever means works for that particular family. Without a doubt this type of investment will result in individuals and families who are less frustrated with the social service system, happier with their lives in general and may result in fewer people needing extensive and expensive social services. In addition to enriching people’s lives, that would probably qualify as a cost cutting measure! – Alison Lozano, Ph.D., M.P.A NJCDD Executive Director