Social Work is a helping profession. The people who enter into this field often do so because they are motivated to assist others who are in some form of need. As it pertains to homelessness, Social Work plays a vital role in helping people establish connections within the community, such as to housing, food, employment, and health and wellness supports. Case management is a particular skill set of Social Workers that uses established protocols to identify clients in need of assistance and work with them over a period of time to help them access the services they need to obtain stability and security.

Before we take a more in-depth look at the role of case management within Social Work, we encourage you to pause and consider how you think it might be useful as a method for supporting people experiencing homelessness. You may use the space below to write your response.

Recently a team of health care providers, researchers, community members, and people with lived experience of homelessness worked together to develop a document entitled, “Clinical guideline for homeless and vulnerably housed people, and people with lived homelessness experience” (Pottie et al., 2020). You will have the opportunity to read this document and learn more about it in the chapter on Primary Care & Nursing. However, we introduce it here because it also has relevance to the field of Social Work. The authors of these clinical guidelines write that having case management interventions, with access to psychiatric support, is recommended as an initial step to support the primary health care of people experiencing homelessness or housing vulnerability, particularly as a means to address mental illness and/or addictions issues that might complicate one’s medical care (Pottie et al., 2020).

Case management is a critical piece in helping people experiencing homelessness to connect with supports, such as health care, within their community. This raises the questions of what exactly case management is and how we can understand it as being situated within Social Work. The Canadian Observatory on Homelessness has prepared a brief overview that discusses the definition, goals, and conditions of case management in relation to homelessness. We invite you now to flip through this document below.

The Global Social Service Workforce Alliance (2018) further expands upon the definition of case management. They write that case management is a process practiced by Social Workers, that guides the delivery of social service support to vulnerable individuals in need. It begins when a person or family is identified as being in a difficult situation requiring support or assistance. They further indicate that case management involves a Social Worker who collaboratively assesses the needs of a client (and when appropriate the client unit) and arranges, coordinates, monitors, evaluates and advocates for a package of services to meet the client’s specific needs.  (Global Social Service Workforce Alliance, 2018).

The Global Social Service Workforce Alliance (2018) document identifies 9 key principles that underpin the case management process. These include: [1] increasing resiliency and improving quality of life, [2] collaboration and partnership, [3] doing no harm, [4] respect and promotion of client strengths, [5] respect for diversity, culture, and tradition, [6] respect for, and reflection of, a human rights-based approach, [7] consent to participate in case management, [8] confidentiality, and [9] assurance of quality in case management, such as through clear job descriptions, supervision, and monitoring and evaluation.

These principles are important because they establish the criteria for “good case management,” which is an idea that re-emerged throughout the researcher interviews conducted for this book. For instance, we spoke to Dr. Jeannette Waegemakers Schiff, who is the author of “Working with homeless and vulnerable people: Basic skills and practice,” a text that prepares frontline workers through offering knowledge and understanding of homelessness and vulnerability from a lived perspective, as well as from professional practice considerations (Waegemakers Schiff, 2015). Dr. Waegemakers Schiff explained the history of case management and why it is important that it be done properly.

Dr. Jeannette Waegemakers Schiff: What is the role of case management in social work?

In this video, Dr. Jeannette Waegemakers Schiff likens good case management to a form of preventative medicine, that supports people from falling through the cracks of long-term and intractable problems in their lives. She traces the two roots of case management, including in hospitals through discharge nursing, and in Social Work where there is a comprehensive consideration of people’s psychosocial, physical, and behavioural needs. Dr. Waegemakers Schiff argues that good Social Work is not about providing clients with a checklist of what they need to do, but rather walking alongside them and continually returning to check in on them over time. This video is 3:44 in length and has closed captions available in English.

Professional helping relationships are a distinct part of interventions designed to support people who are highly disadvantaged, such as those experiencing homelessness (Sandu, Anyan, & Stergiopoulos, 2021). It is important to understand that there are different types of interventions, and that case managers play a role in helping their clients navigate through them. For instance, considering different profiles of people’s need when they are experiencing homelessness, researchers have found that increased assertive or intensive case management may be particularly beneficial for those who have multiple and complex health problems and high frequency of service use (Fleury, Grenier, Cao, & Meng, 2020). Family systems therapy has been found to be an effective intervention for addressing youth homelessness, because it is an approach that includes the whole family in an effort to help them reconnect and see problems as resulting from the relational system rather than individual deficiencies (Cully, Wu, & Slesnick, 2018). Even after a client is housed, case managers play an important role in continuing to provide support for a period of time, to help reduce the risk of homelessness reoccurring (Kaltsidis, Grenier, Cao, & Fleury, 2020).

How the case manager operates – such as which organizations or individuals they reach out to and connect with – will be determined by the individual needs of their client, as identified by the client themselves. A systemic review of the literature on youth homelessness, for instance, has found that the effectiveness of interventions varies according to the issue that needs to be addressed (Wang et al., 2019). Most notably, cognitive behavioural therapy was shown to be promising for addressing depression, family-based therapy was successful for improving substance use outcomes, and housing programs were effective for achieving greater housing stability (Wang et al., 2019). While the case manager themselves would not be providing the interventions, such as cognitive behavioural therapy, their role would be to help the person identify what kind of support they need and then connect to the right program or service. It is essential that Social Workers come to their roles with an open and inclusive mindset that respects the unique histories, experiences, and needs of their clients so that they can offer the right kinds of support. Consider this as you watch a brief video entitled, “Indigenous Social Work” created by the Alberta College of Social Workers.

Dr. David Firang: What is the role of case management in social work?

In this video, Dr. David Firang identifies the three foundational elements of case management. The first element is engagement, which means establishing rapport, a therapeutical alliance relationship, warmth, and general care to create the conditions where the client feels comfortable and supported in sharing personal information. The second element of case management is assessment, in which the client and case manager discuss the presenting issues and come to an understanding, much like a medical doctor making a diagnosis. The final element of case management Dr. Firang identifies is jointly creating an intervention plan with the client by empowering them to access supports but also advocating for and organizing referrals to services in the community. These elements are the essence of case management in Social Work. This video is 6:08 in length and has closed captions available in English.

Dr. Jeff Karabanow: What is the role of case management in social work?

In this video, Dr. Jeff Karabanow discusses how the formal and bureaucratic nature of our social systems can make them difficult and overwhelming for people to navigate. He argues that good casement management is about connecting with clients to help them broker, negotiate, and navigate complex systems in society, by using a practice that is deeply grounded in the principles of social justice, a critical engagement with anti-oppressive dynamics, and an accompaniment style. This video is 2:24 in length and has closed captions available in English.

As Dr. Karabanow points out, Social Workers who undertake case management need to have a keen sense of how to provide support in a way that is respectful of a person’s unique needs and personal history. People who experience homelessness are often deeply impacted by trauma, both through their homelessness experience and as a precipitating factor. The three principles Dr. Karabanow identifies – of working with a social justice, anti-oppressive, and accompaniment style – are all situated within a trauma-informed framework of care. Engaging in trauma-informed care work means treating clients with respect, honouring individual differences, providing an emotionally safe caregiving environment, using an empowerment framework to support self-efficacy, facilitating access to trauma-specific services, and considering individuals within their larger social environments (Hopper, Olivet, & Bassuk, 2018).

Professional Social Workers play an important role, but increasingly interventions designed to support people experiencing homelessness are also integrating peer support. While peers are generally not formally credentialed, such as having an undergraduate or graduate degree, they do work alongside case managers to provide individualized supports to clients in need. It has only been in recent years that researchers have begun to study the role of peer support in-depth. For instance, Parkes et al., (2019) note that peer-delivered approaches seem to have particular promise, but there is limited evidence regarding peer interventions that are both acceptable to, and effective for, people who are experiencing homelessness and using drugs and/or alcohol. Likewise, Kidd et al., (2019) have pointed out there has been limited research conducted on peer support work for young people, but the research that does exist suggests peer support has the potential for positive outcomes, provided the peer support is a robust part of the programming in a way that benefits clients and peer workers alike.

The importance of peer support is evident across many types of interventions for people experiencing homelessness, including tobacco reduction programs (Charron et al., 2018), decreasing traumatic brain injury rates among cisgender and transgender women involved in sex trade work (Baumann et al., 2019), and normalizing drug use in shelters as part of harm reduction interventions (Bardwell, Boyd, Kerr, & McNeil, 2018). In this last study, researchers examined the perspectives of people who use drugs residing in two emergency shelters and found peer support was related to relationship-building and trust, that people felt increased safety using drugs in front of peer support workers, and that the dynamics between worker and client felt more equitable and balanced (Bardwell et al., 2018).

Community-based research that looked at why peer support workers engage in these positions found three key motivators, including obtaining a sense of purpose from helping others, being an inspiration for others, and feeling a sense of belonging (Pauly et al., 2021). These sources of motivation were important in giving meaning to the work and helped to provide a buffer against the stressors that go along with these roles (Pauly et al., 2021). Having a buffering effect is important, as peer work has also been found to have common challenges related to inadequate financial compensation, lack of respect and recognition at work, having their own housing challenges, an inability to access or refer clients to other resources, and constant exposure to death and trauma related to the work (Mamdani et al., 2021).

When researchers study peer support work they often describe it in complicated ways, identifying the positive benefits for clients but also the toll it takes on peer support workers themselves. For instance, Kenney et al., (2019) have noted that peer workers, such as at overdose prevention sites, provide expertise that can enable communication, foster harm reduction practices, and promote health benefits, yet these positions are often not well compensated and can result in grief, trauma, and burnout over time. Likewise, Greer, Buxton, Pauly, and Bungay (2021) note that peer harm reduction work is complex and demanding because they are at the forefront of support and that, while these roles can be rewarding, they also tend to lack definition and clarity within organizational structures.

Moving beyond peer support work can also be a challenge. In the video below, from the Ontario Harm Reduction Network, Stephanie explains the stigma that surrounds the word “peer” on a resume. While she discusses this in relation to harm reduction, the same stigmas would likely apply to peers working in fields related to mental illness and/or sex trade work. As you watch this video, we encourage you to consider what could be done to reduce this stigma.

What do you think?

In the preceding video, Stephanie explained that peer work is not always highly regarded in the labour force. Consider for a moment that you are on a hiring committee at work. Someone who is highly qualified applies and has harm reduction and sex trade peer support work on their resume. Your fellow hiring committee member argues they should not be considered for an interview because of their history with drug use and sex trade work. What could you say to persuade them to give the person a chance? How could you convince them that peer support work is valuable?

In this section we examined the role of case management in Social Work, beginning with a brief definition from the Canadian Observatory on Homelessness and a longer featured reading from the Global Social Service Workforce Alliance (2018). We traced the early roots of case management and considered the qualities that make someone a good case manager. We posed this section’s guiding question, “What is the role of case management in Social Work?” to three researchers, all professors in the field of Social Work, and they each independently distinguished case management from “good” case management.

Ultimately, good case management is about recognizing it cannot be done alone. As Dr. Firang said, no Social Worker is expected to be Hercules or Superman. Rather they must reach out to other agencies, case managers, and peer support workers in the community to best support their clients.

Podcast: What is the role of case management? (13:05)

Click the link below to listen to all of the researchers answer the question “What is the role of case management?” in audio format on our podcast!

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Listen to “What is the role of case management?” on Spreaker