1. CASE MANAGEMENT TRAINING PACKAGE
Module 4.
The Case Management process ...
following a concrete case somewhere in the
world, and some general situations

2. The Case Management practical process
Once a Case Manager is involved in providing help to a family in a social
need situation, taking the case in charge follows a characteristic process,
which is very similar, in structure, in almost all the cases.
At the beginning, the Case Manager can only count on a small number of
people already involved in the case.
They can be informal or formal members of the “coping” network.
The first task of the Case Manager is to reach a shared and articulated
definition of the problem, starting from which he will be able to widen the
coping network with other informal members.
At this point only, the Case Manager guides the coping network to widen
itself with other formal members.
It is very important not to change the
correct sequence: if a Case Manager tries
to involve new formal members before the
informal ones, the latter may not be
available to be involved any further
Case Management – module 4 – slide 2

3. The Case Management practical process:
contents of this module
Firstly, the general flow chart of Case Management methodology will
be described, step by step. You can see that the passage from one
step to another is guided by specific questions that the Case
Manager asks to the coping network members.
Secondly, a practical application of this process will be described,
through the analysis of a real situation, the case of Judith and her
family. It is a traditional case for a social protection service, not too
difficult, chosen for didactical reasons, because it has shown itself
useful for explaining the process to students at the beginning of
their training in Case Management.
Finally, two specialized processes, related to two very difficult
situations, will be shown. Generally, Case Management methodology
works with more efficacy than any others, both for the cases which
are becoming chronic (whatever the level of difficulty), and for
those cases requiring a high social protection level.
Case Management – module 4 – slide 3

4. Case Management methodological process for improving and guiding
the coping network
First (self) report of a social Is there already a little group of No
need people aware of the problem?
Yes Is it possible to involve some
Do we want to involve these subjects?
How, practically, do we gather them
people belonging to the informal
for improving the situation? network?
What operative solution is better for us? Who could we involve? How can we
Are we doing what is agreed among us? improve the whole situation?
What operative solution is better for us?
Are we doing what is agreed among us?
Next Yes No
Next
Is it necessary/appropriate to Is it necessary/appropriate to
involve other informal subjects? No
involve other formal subjects?
Yes No Exit (1)
Who could we involve? How can we
improve the whole situation?
What operative solution is better for
Yes What must we face together?
us?
How can we improve the situation?
Are we doing what is agreed among us?
What operative solution is better for
us?
Are we doing what is agreed among us?
No
Yes
Next Yes
Are we on the way to reaching
(have we already reached) what Is it necessary/possible that Can we share the role of guide?
we hoped for? someone else takes the role of How can we realize that?
case manager? What organizational way is better for
us?
Exit (2) Are we doing what is agreed among us?
Yes
Case Management – module 4 – slide 4

5. A practical application of Case Management:
the Judith case
Judith’s parents go to the social protection service (SPS) to meet the social worker
who will be their case manager (CM).
Their case has been reported to the CM by Dr. Marcus, working as Child Psychiatrist
in the local health service: in fact the girl, who is eleven, has been referred to this
service for problematic behaviour, lack of attention, hyperactivity, lack of impulse
control, aggressive conduct.
Her parents have been worried for a long time, but particularly at the moment, about
school attendance (the teachers are complaining more and more) and homework, which
the girl refuses to do with her mother, the only person who has the time to spend
looking after Judith during the day.
Judith has had a complex and hard life: she was adopted by her parents when she was
six; her biological family was a multi-problematic one, the mother having chronic
mental health problems, and the father was unknown. She was separated from her
mother when she was three for seriously inadequate parental care, put in a residential
care institute, and then adopted after a long and complex legal process.
For the problems during her early childhood, the girl was diagnosed with “early
attachment reactive syndrome”. After adoption her condition slowly improved, but
when she was nine a new child, her little sister, was unexpectedly born in a natural
way, and Judith’s psychological condition got worse again.
The parents, particularly the mother, are now very stressed and exhausted.
Case Management – module 4 – slide 5

6. The Case Manager arranges and guides the
first coping network (1)
At the beginning, the CM could describe Judith’s situation in this way: there are some
people – her parents and Dr. Marcus – who cannot deal with the task (that has become
a problem precisely because they cannot address it) of ensuring that Judith has
adequate educational support. They are aware that it is a problem (even if in
different degrees and ways) and for that reason they have called the SPS and have
held a meeting with the CM. After receiving the report of the problem, the CM also
becomes part of the network, because he/she must do something (according to
his/her role), and, like the other network members, he/she does not yet know what
he/she has to do, and how to improve the situation.
In Judith's case it should not be very difficult to reach a (first) shared definition of
the problem and make all the network members aware of it: despite the parents
asking firstly for help with Judith's homework, the wise CM will be able to recognize
that their real need is to ensure support for their parental role, and provide for
themselves and for their daughters a family climate less conditioned by the problem
of Judith's homework and school behaviour. So, the CM could try to revise the tasks
to be addressed, more or less in these terms: "we must (together) try to improve the
family relational climate; I think I have understood that the most important thing for
this is to provide support for Judith's homework".
Note: The CM places the first problem brought by the parents (Judith’s homework) in
a wider framework (the family relational climate).
Case Management – module 4 – slide 6

7. The Case Manager arranges and guides the
first coping network (2)
At this stage the coping network is not able to manage the problem yet: it is poor and weak. Although
the Case Manager works from this base to improve the network and its capacity of action.
Note: the Case Manager is both a member of the network (he is also not able to help Judith’s family
yet), and the guide of the network. This dual role will be maintained for the whole helping process.
Case
Manager
Judith’s Judith’s
mother father Taking care of
Judith
Coordinated
Dr Marcus
actions
Guiding
Case
Manager
Case Management – module 4 – slide 7

8. The case manager guides the coping network to
widen itself with new informal members (1)
Let's imagine that Judith's parents have named the parish priest, some of
Judith's past teachers, and the headmaster of the school, because they are
keen and willing. Involved in the network through the mediation of the CM, these
people begin to formulate some proposals. The priest advises asking Monica for
help. She lives a bit far from the town, but she knows many boys and girls who
are very busy in social activities like volunteering. Further, she is studying
psychology and this experience could be important, beyond the usual altruistic
reasons. The headmaster proposes contacting a young but very good teacher
who works part-time, and could be interested in adding some activities to her
spare time.
The young teacher says that it will be difficult for him to guarantee a continuing
effort, because of his uncertain work situation; while Monica is more available.
Judith’s parents prefer the teacher to Monica, because he has a bit of
experience; and Monica is doubtful because she has never dealt with children
with this kind of problems.
Later, Judith’s parents report to the CM the outcomes of their contacts and
the CM decides to meet them for a more in-depth discussion.
Case Management – module 4 – slide 8

9. The Case Manager guides the coping network to
widen itself with new informal members (2)
During this network meeting, a first division of tasks is drafted: Monica will take care
of Judith for three afternoons a week, maybe four when the girl has a school test,
but she needs more information about the behaviour of the girl and how she can deal
with it: Dr Marcus is available to provide this information and to supervise. And on
the other days? The CM feels that Judith’s mother is stressed and a bit
disappointed; in fact, she is worried, particularly about Saturdays, when she has to
look after the other daughter as well. The CM takes note that the proposed help is
not yet sufficient, but Monica cannot give more: it is too much work for only one
person. Maybe Judith’s aunt, so far forgotten, could get involved - following an idea
expressed by Judith’s parents? (everyone had previously thought she was not
available).
So, Judith’s father proposes to contact her himself. Unexpectedly, she seems very
happy to receive the call and she is available to help Judith with her homework on
Saturdays. But that is not all: she says that Judith likes swimming very much, so they
can go to the swimming pool, or shopping on Saturday after doing the homework: it is
important to involve Judith in something enjoyable after the trouble of her
homework! More, because Judith’s aunt always goes to the parish recreation centre
every Wednesday, she can take her niece there as well, to play with other children in
a friendly setting.
Now, Judith’s mother seems more relieved: for the other two days, she and her
husband can take care of Judith by themselves.
Case Management – module 4 – slide 9

10. The Case Manager guides the coping network to
widen itself with new informal members (3)
More people (informal members) are involved in the coping network,
and the task of the network (taking care of Judith) is better
specified in three sub-tasks
Case
Manager
Helping Judith Helping Judith to
Judith’s Judith’s to meet new
mother father do her homework
friends
Judith’s
Monica aunt Taking care of
Judith
Coordinated
Dr Marcus actions
Taking Judith to
the swimming pool
Guiding
Case
Manager
Case Management – module 4 – slide 10

11. The Case Manager guides the coping network to
widen itself with new formal members
The CM has to ask himself: “are we sure that we have explored all the problems of
this family? Have we ignored some important questions that can suddenly spring up,
and undermine all our work?”
It is clear, for example, that the problems with Judith rose partly from her difficult
childhood, and partly from the unexpected birth of her sister. Both Judith and her
parents will have to be aided, now and then, to face these psychological problems. It
seems necessary that a psychologist takes a more active role for this purpose. If this
specialized intervention had been made before, at the beginning of the taking in
charge, that would have compromised the whole process, because it would have made
both Judith and her parents feel guilty: in the case management perspective, the
first step is always action-oriented.
Since the problem was firstly described as an educational one, and the solution has
been built for dealing with it, it seems necessary to provide specific supervision in the
educational area: a tutor. The coping network has not faced the school problem yet.
Do you remember? The teachers are very upset about Judith’s school behaviour.
Maybe it could be useful to provide for Judith a special teacher for some hours a
week, at least for a year: the coping network is already sure that when Judith
benefits from personalized relationships, she becomes calmer and more open to
learning.
Case Management – module 4 – slide 11

12. The Case Manager tries to share the guiding
role, involving a member of the coping network
Some months have now elapsed, Judith is attending the school with some difficulty,
but much better than before the project began; her parents, her aunt, Monica and
the tutor help her with her homework; the socialization activities are becoming more
and more important, the psychological interventions (both for Judith and for her
parents) are producing some results, and the family relational climate has
significantly improved.
It seems very important that Judith’s mother feels a lesser sense of guilt and can
stay close to Judith without anxiety and fear of the behaviour of her adoptive
daughter.
The CM has met the network at regular intervals, verifying that the coping network is
steady, all its members are satisfied with their work for dealing with Judith’s
problems, and even when some tension occurs among some of them (Judith is still a
problematic child), the network seems to have learnt to regulate itself and solve the
tensions without the need for an external intervention. At this point, the CM could
say to the network; “Things seem to work quite well and all of you are satisfied about
what you are doing for Judith. It is important you meet together from time to time,
and whenever it is necessary. I can’t promise to be present all times, so it would be a
good idea if someone else takes responsibility for organizing these meetings, or
calling the others to listen to the news and to judge if everything is working in a
positive way. Of course, I’ll always be available for involvement in your meetings, or to
give some advice to my substitute. Is all that possible, in your opinion? How?”.
Case Management – module 4 – slide 12

13. The Case Manager guides the coping network to widen itself
with new formal members, and shares the guiding role
More practitioners (formal members) are involved in the network. The role of
network guide is shared by the Case Manager with another member of the network.
Case
Manager
Judith’s Judith’s
mother father
Monica Judith’s
aunt
Special
teacher psychologist
Taking care of
Teacher Dr Marcus Judith
Coordinated
actions
Double
guiding
Judith’s
aunt
Case
Manager
Case Management – module 4 – slide 13

14. The great importance that a Local Social Plan
can have for coping with social cases like Judith’s
It is possible to imagine the role which the Local Social Plan, if it exists, can play in
this simple situation. In fact, let’s consider the work of the Case Manager
described above in the following alternative scenarios:
The Social Protection Service where the Case Manager is working has never
formalised an agreement of mutual collaboration with the school; besides, it has a
conflictive relationship with the Child Neuropsychiatric Service, and the priest
and other NGOs in the territory are known by nobody belonging to the Social
Protection Service.
The Social Protection Service has an agreement with the school for enhancing mutual
collaboration, the Case Manager knows almost all the teachers working there, and
very often he meets the headmaster and the most relevant teachers for
discussing pupils and students who are showing some school and social problem, or
for proposing some actions for preventing social risks for young people; the Case
Manager and child psychiatrist have worked together on several cases, on the
basis of an understanding between the two services; and this understanding
belongs firmly within the Local Social Plan. Many agreements between the Social
Protection Service and the main NGOs operating in the territory in the social
field or having a social relevance for the population have been in place for a long
time....
What is the best scenario in which the Case Manager can work?
Case Management – module 4 – slide 14

15. Different models of (co)operative action
coordination
What I think about the others’ action/work
I abide by the
I prefer to
+ We can negotiate an
What I think about my action/work
others’ authority agreement
depend on the
others We can try to compromise
Only a competition among us
- I IV
+
II III
Let me work alone!
I work against the others
I’d like to stay alone... I try to exploit the others
with my depression
- I only deal with my “garden”
Case Management – module 4 – slide 15

16. Case Management in very severe social needs
situations
The concrete case discussed analytically above is not very hard, but it
represents a classical one, because most of the cases treated by a Social
Protection Service are similar to it, and these cases taken as a whole, on the
one hand require the allocation of much work and resources, and on the
other have a high risk of becoming chronic and multi-generational. Not only
are their human and economic costs very high, but also they block many
social resources for generations.
Now, two specialized processes will be explained, related to two very
difficult situations: a case of child abuse, requiring a high protection
project to be provided very quickly; and a case of an institutionalized child
which is a difficult situation to face, but not having the feature of
emergency like the previous one.
These cases are not explained so analytically as the Judith case, and
reference is not made to concrete cases, but only to a general situation.
Case Management – module 4 – slide 16

17. Acute protection cases (violence and abuse): the flow chart
Report of the case (victim, family,
institute, public, hospital) to the
Police or other public offices –
First emergency care (hospital,
separation from the family) if required.
Investigation of the Police and reports
Identification of a CASE from the hospital
MANAGER (TOSS)
No
Can the case manager follow
directly and immediately the case?
Yes
Outsourcing: the case manager Registration, collection of information,
Can delegate to somebody else the involvement of professionals, relatives and
case, under his/her responsibility others that can contribute to define a care
What is the motivation of
plan. Data are collected in the CASE FILE
these persons to help?
How can we ensure their commitment?
Other persons are identified among
Is the network of persons identified No
professionals and resources of the
sufficient to help the child and the family community
to improve their situation?
Yes
A CASE CONFERENCE is organised, with the involvement «States Parties shall take all
of the family. The case is presented by the Case manager. appropriate legislative,
Decisions are taken by all the participants and documented administrative, social and educational
in the Case File measures to protect the child from
all forms of physical or mental
violence, injury or abuse, neglect
The child and the family are referred to the
or negligent treatment,
appropriate services available to provide them
maltreatment or exploitation,
with protection and support. The case manager is
including sexual abuse, while in the
Can the persons involved identify responsible for the monitoring of the case
care of parent(s), legal guardian(s) or
other services/resources that can help?
any other person who has the care of
No Are the objectives achieved? the child.»
Is the child protected according to CRC, Article 19
her/his best interest?
Other case conferences and bilateral
meetings are organised, till when the Yes
network can autonomously provide The case is closed
care and protection to the child

18. Acute protection cases (violence and abuse):
some comments
These types of cases are characterized by emergency and great urgency.
Unlike the Judith case, in these urgent situations the CM cannot begin the
networking process at once, because it is firstly necessary to put the child
into a safe setting, or make safe its usual place of life.
Because of this initial intervention, the CM could be tempted to be directive
even when the emergency is over. Instead, in this case the case management
methodology is strategic, in order to avoid further problems for the child,
and to build a future for it.
For the cases of abuse or violence against children, the rehabilitation and
therapeutic processes are very important and usually have to begin as soon
as possible, usually before the building of a coping network, rich with
informal members. This is also a relevant difference compared to the
Judith case, where the involvement of new formal members in the coping
network happens only after the involvement of new informal members.
For these reasons, the case manager must pay great attention to ensuring
that the early involvement of professional people does not compromise the
enlargement of the network to new informal members.
Case Management – module 4 – slide 18

19. Children in residential
care (including
In collaboration with the
children’s home manager, a CASE
FILE is prepared and the situation
detention!): of the family is analyzed
After identification of the special needs of
the child (psychological support, resolution of
the flow chart Clarification with the home
manager of the responsibilities of
the case in court, health check, education
support) the additional professional support
the CASE MANAGER (TOSS) required is identified
Is the placement in residential Yes
institution Actions are agreed with the home
the best solution for the child? manager and the family on the
additional support provided to the
child
No
A CASE CONFERENCE is organised
with the family and other
professionals to verify which other
solutions are possible for the care of
the child
Is the family in the condition Yes The child is reunified with the family.
to take care Other resources are identified at
of the child at home, community level that can support the
ensuring the access to health, family
education and social services?
Are there available families in the No
community « 1. In all actions concerning children, whether undertaken
That can foster or adopt the child? by public or private social welfare institutions,
In cases of abandonment, neglect, abuse, and when it is
clear that the family will not be able to take care of the courts of law, administrative authorities or legislative
child, alternative care solutions are identified (Foster bodies,
families, Adoption) the best interests of the child shall be a primary
consideration.
Yes 2. States Parties undertake to ensure the child such
An order is requested to the Guardianship and protection and care as is necessary for his or her well-
No Trusteeship Commission to declare the being,
abandonment of the child, and authorize another taking into account the rights and duties of his or her
care solution parents, legal guardians, or other individuals legally
Initiatives are developed in the responsible for him or her, and, to this end, shall take all
community to raise the awareness appropriate legislative and administrative measures.»
about the right of the child to live in No
Is the new solution responding to CRC, Article 3
a family and identify possible foster the best interest of the child?
families «A child temporarily or permanently deprived of his or
her family environment, or in whose
Yes own best interests cannot be allowed to remain in that
environment, shall be entitled to
The case continues to be special protection and assistance provided by the State.»
monitored until it is closed CRC, Article 20

20. Children in residential care (including detention!):
some comments
Unlike the cases involving abuse and violence against children, the cases of
de-institutionalization do not present any emergency feature.
The institutional condition is not desirable at all, and grievously prejudices
the natural rights of people; and, there being no immediate need to
intervene, there is a risk of a certain inertia in the appropriate Social
Protection Service, which must organize some internal process of
assessment for taking into account these cases.
Fortunately, these cases permit the CM to organize his work without the
urgency of the case applying pressure, and can study very deeply the
situation and involve an efficient coping network before the project begins.
In any case, for these situations a very articulated Local Social Plan is
required, because it is usually necessary to have at the CM’s disposal some
specific formal (day care centre, specialized pedagogue, and so on) and
informal (foster family, volunteers) services and subjects.
Case Management – module 4 – slide 20

21. Case Management & referral process –
an example (1)
Steps in procedure Responsibility Timeframe
0. Report of the case – first aid From family, police, hospital, community, Day 0
provided school, social services…
1. Referral of the case to the Social Any service receiving information of the case. Day 1
Services (front desk or officer in Availability on call of the case manager also out of
working time
charge)
2. Registration The officer of the SS on duty – the Day 1
information is registered in the registration
book
3. Emergency response - referral SS or Police in consultation with officer in Day 1-3
to: charge in social services.
Police (if required) Police or court will proceed with the
Safe place (if required) – NGO? investigation and preparation of documents
Foster family? required by their services
Magistrate for temporary placement In case of non compliance, the case can be
(if required) referred to the supervisor
4. Appointment of the case manager The name of the case manager is registered Day 1-3
– opening of a CASE FILE in the Case File Time limit: 7th
day

22. Case Management & referral process –
an example (2)
Steps in procedure Responsibility Timeframe
5. Assessment of the child and Case Manager – this task can be partially Day 4-6
family situation – involvement of the delegated to persons whose names are
persons who can be part of the included in the Case File, but the overall
coping network of the child (including responsibility is with the case manager. In
health, education services, and case of non compliance the CM can be
relatives/neighbours) referred to his/her supervisor
6. Organisation of the first CASE Case Manager – this task cannot be Day 7-14 –
CONFERENCE - identification of the delegated. Time limit:
actions to be implemented as part of The family/guardian of the child have to 15th day
the care plan participate
(Case manager) The decisions taken by common consensus are
reported in the Case File
7. Recommendations to the Case Manager – this task cannot be Day 15
Magistrate based on the decisions delegated. Recommendations are reported in
taken at the case conference (if the social inquiry form
required)
8. Court order (if required) – Magistrate, based on the required reports Day 15 and
CHANGE OF LEGAL CUSTODY from case manager, Police following

23. Case Management & referral process –
an example (3)
Steps in procedure Responsibility Timeframe
9. FOLLOW UP – monitoring of the Case Manager - this task can be partially Day 15 -
situation of the child, on the actions delegated to persons whose names are ongoing
implemented, and referral to other included in the Case File, but the overall
services if recommended at the case responsibility is with the case manager
conference
10. Organisation of the second CASE Case Manager – this task cannot be Day 15-45 –
CONFERENCE – monitoring the delegated. The family/guardian of the depending on
capacity of the coping network to child have to participate the case
protect and care for the child The decisions are reported in the Case File
11. Progress report (social inquiry) Case Manager – this task cannot be Depending on
presented to the magistrate (if delegated. the case
required)
12. Statistics on caseload and Data input from the Case File to the To be defined
recurrent protection issues are shared database (at regional level) – logistics to –every 2
with the regional departments of social be defined - figures are discussed at the months?
services social services office meetings
13. Following case conferences - if Case Manager – the case can be closed Depending on
required - and closure of the case only when the coping network is strong the case
enough to protect the child