Presented by Jen Chapman at AIDS2012

1. Case management versus M&E
in the context of OVC programs:
What have we learned?
Jenifer Chapman, PhD
Futures Group/MEASURE Evaluation

2. Overview
 Case management tools 101
 Update on the Child Status Index
 Key questions

3. What is a case mgmt tool?
 Paper-based instrument
 Completed by direct service providers (generally
low-literate volunteers)
 Assesses child’s well-being along priority
dimensions (e.g. health, social relations, etc.)
 Care plan documentation

4. Purpose of a case mgmt tool
Purpose: To improve quality of care
 Highest priority = Case workers’ needs
o Untested hypothesis: case workers will make
better decisions if they use a tool
 May also support M&E / reporting needs

5. What is included?
Information collected
 Client contact information / demographics
 Wellbeing information that is changeable over time
 Care plan: services & referrals provided
Information flow
 Most important use is at local/SDP level
 Some information may flow up regional level

6. A plethora of tools...
 Child Status Index (MEASURE Evaluation)
 Child Support Index (Pact)
 OVC Wellbeing Tool (CRS)
 Child Status Matrix (FHI)
 Parenting Map (TSA)
 Etc.

7. We need to be cautious
 Some CM tools are being applied for purposes
beyond case management
 Targeting (identifying beneficiaries)
 Program monitoring (recording services provided)
 Evaluation (aggregating wellbeing scores)
 Exercise caution in using a CM tool for other
purposes

8. Child Status Index
Assessment & Update

9. About the CSI
 5 years ago, CSI was designed for low-literate
home visitors to capture children’s status across the
6 domains of PEPFAR OVC programming
 Early hopes that CSI could meet a range of
information needs
 CSI has been implemented for different purposes:
case management to program evaluation
 CSI is used in at least 16 countries
O'Donnell K, Nyangara F, Murphy R, Nyberg B. Child Status Index. A Tool for Assessing the Well-
Being of Orphans and Vulnerable Children—MANUAL. Chapel Hill, NC: MEASURE Evaluation; 2009.

10. CSI Assessment: Phase I
 Rationale: to systematically assess how programs
are implementing & using the CSI and understand
OVC program field needs for additional tools to
meet care, support, and M&E demands
 Study questions
 For what purposes are OVC programs using CSI?
 What are the advantages and limitations of CSI?
 What are the unmet M&E needs of OVC programs?
Cannon & Snyder. 2012. The CSI Usage Assessment. Chapel Hill, NC: MEASURE Evaluation.

11. Summary of Findings: Phase 1
 25 interviews with senior program staff in 13
countries
 Program staff find the CSI useful
 CSI implemented mainly by volunteers
 Information collected via CSI is rarely used by
volunteers except for targeting (not
recommended)
 Care plans and referral protocols are inadequate

12. Summary of Findings: Phase 1
 Variation in CSI implementation, data use due to:
 Unclear purpose & guidance on CSI use with
desire to assess impact
 Variability in training approaches
 Insufficient support/funding for technical
assistance, follow-up, and training (data
management, analysis)
 CSI is important, but one tool in the toolkit

13. So now what?
 Study Phase II
 Problem: Lack of information on the utility of the CSI at the
community-level as a job aid & input from CCWs
 Purpose: To understand how CCWs and care teams make
decisions about children (including role of job aid / data)
 Methods: Interviews with CCWs and team leads in five
countries, among organizations using/not using the CSI
 Revision of CSI Guidance

14. 6 Core CSI functions (we think)
1. Builds rapport between service provider and
beneficiaries
2. Orients service provider to the holistic needs of
the child and encourages referrals
3. Strengthens informed care decisions by
systematically considering and documenting
child’s needs

15. 6 Core CSI functions (we think)
4. If applied regularly with the same child, may show
a child’s progress over time in particular
domains
5. May be helpful in community-level planning and
resource allocation decision making
6. May reveal emergency situations (a score of 1
in any outcome area)

16. Probably inappropriate CSI uses
 Targeting
 Unnecessarily complex
 May lead to expectations of action/enrolment
 1st contact with child may not be reliable
 Evaluating regional or national program impact
 Children’s needs/status are assessed relative to their
local community, and not to national standards

17. Probably inappropriate CSI uses
 Producing a single combined score for the child
 CSI assessment should be presented as 12
independent measures
 Risk varies across domains
 CSI scale values are not equal-interval, but ordinal
 Evaluating implementing organizations

18. Back to Case Management tools
generally…

19. Some key questions
 Are case management tools effective at improving
care decision making?
 For all types of case workers? Formal? Informal?
 How does training in both case management and
tool use factor?
 What specifically about a case management tool
improves care decision making? For whom?
 Does the benefit outweigh the burden?

20. Some key questions II
 Are CM tools useful in managing case workers?
 Are some CM tools useful also for targeting
beneficiaries, monitoring outputs (services
delivered, and evaluating impact?
 What are the risks?

21. The research presented here has been supported by the
President’s Emergency Plan for AIDS Relief (PEPFAR)
through the United States Agency for International
Development (USAID) under the terms of MEASURE
Evaluation cooperative agreement GHA-A-00-08-00003-
00. Views expressed are not necessarily those of
PEPFAR, USAID or the United States government.
MEASURE Evaluation is implemented by the Carolina
Population Center at the University of North Carolina at
Chapel Hill in partnership with Futures Group, ICF
International, John Snow, Inc., Management Sciences for
Health, and Tulane University.