Termination of Case Management
May 25, 2015
Case management offers the potential for customized services, coordination, and a coherent, comprehensive approach to the problems of clients. It is not a magic bullet. The reality is that an effective case management effort is tough and time-consuming to implement. Whatever form it takes (and it takes many forms), case management is more likely to pave the way for valuable, but incremental, improvements in services rather than wholesale change. Case managers serve as surrogate parents, role models, counselors, social entrepreneurs, and political advocates. They nag, cajole, prod, and encourage clients. They pressure ...view middle of the document...
When the case manager discusses termination of services, the client may experience a sense of abandonment, rejection, betrayal, or loss. When the client fears termination of services, the case manager may observe a decline in the client’s progress toward established objectives or may observe some avoidance behaviors on the part of the client. Other clients may have no observable response because they have insulated themselves from such emotions due to hurtful separations of the past.
The case manager will need to assess each client to determine his or her reaction to the termination of services and make an effort to deal with the negative emotions or reactions of the client. The ideal condition for discharge occurs when the client has met his or her desired outcomes and the case manager and client mutually agree that there is no longer a need for case management services. In this instance, discharge may be viewed as the client’s “graduation” to a more independent way of life (Rothman, 1998). At other times, circumstances that result in termination of case management services may be less than ideal. For example, the client may lose eligibility for the service before reaching desired outcomes or the case manager may be unable to continue the relationship due to client non-compliance, lack of progress towards established goals, or health and safety concerns.
Other strategy may begin a relationship with a client knowing that some degree of intervention will be required on a long-term, open-ended basis. Intervention may be needed due to the physical, mental, or emotional condition of the client or may be related to the client’s circumstances such as poverty, abusive relationships, or capacity. An example would be case management services offered to a person who is diagnosed with AIDS. The client may function quite independently except at various crisis points during which the case manager may need to provide fairly intensive services.
The case manager needs to periodically review the purpose of continuing the case management relationship with the client. The decision to discharge a client from care needs to be carefully considered depending on the client’s level of dependence on the case manager. The case manager may need to gradually decrease the level of contact with the client functioning more and more independently. The gradual decrease in contact may not be necessary if the client’s stability is not be grounded in the relationship with case manager. The case manager must use their professional judgment to determine the appropriate...