Implementation

This is really about making sure that everything gets done. Sometimes it might feel like you are chief cat-herder, but that's part of dealing with so many people.

• Make practical arrangements to support clients and stakeholders. For example, it might be your job to make appointments and make sure people can attend them.
• Define which parts of the intervention are negotiable and which aren't, and stick to it. If you have to deal with so many people with their own agendas, you will have to know when to discuss changes and when you must simply disagree.
• If necessary, develop contracts with external service providers and get agreement on them. (They should accurately reflect your timing and resource constraints.)

Regular monitoring and oversight

You now get to do whatever is in the plan to look after your client. As mentioned above, it means working with other services to make sure that the client (and any other stakeholders, such as carers) gets all the help he/she needs. Keep track of the progress of specialist services against the performance indicators that were defined.

Continually monitor the effectiveness of your case management against the goals that everybody had agreed on. Consider also the services that you work with, and the need to keep your client and stakeholders satisfied with the standards of service they get. Consider also the satisfaction of orhter organizations or departments you work with.

If you are a small service, and especially if you are residential, your monitoring won't need a special system. But as soon as you get a little bigger, you will need a system to make sure you don't overlook people. Just to make things a little more complex, some clients will need to be reviewed more often than others, and this will vary according to the stage of their case.

Assess the need for changes in case plans, your overall strategies, and any ongoing intervention, and plan alternatives if necessary. If you need to make any changes, negotiate them with the relevant parties and get agreement. Case review meetings will sometimes result in proposed changes so you need to get people to agree to them.

As you go, make sure that key stakeholders share information. Most simply need to know who they need to inform about what, but a few might be quite secretive.

During the case management process, you'll also be training the client to become increasingly independent of your help, and take responsibility for their own actions. Of course, this depends on the client; for example, while it is critical for success if working with the unemployed, some elderly infirm clients will probably never gain independence.

Even then, keep the client informed so that they feel they understand what is happening. Discuss how it's going with the client and other stakeholders, such as their significant others. Feedback goes both ways; you need the feedback of the client and other stakeholders, and you should also be able to give your feedback to them.

Monitor progress regularly, and contribute to updates of the the case plan. Some things might be too complex to handle in this way and you might save them to discuss at case review meetings.

Reporting

Your organization will probably have procedures for you to report to your supervisor. They could be:

• regular informal oral reports
• items in a regular staff meeting
• access to case notes
• reporting anything unusual, high-risk, or outside budget whenever it arises.
• regular written reports

You should also monitor the effectiveness of your case management system. Your organization should have a quality system for considering improvements, even if it is as simple as bringing it up in a staff meeting.

Unfortunately, you will probably have to deal with any problems and glitches along the way. If a crisis happens and nobody is already handling it, it's your job to figure out what to do and get it done. The most common kinds of crisis intervention for case managers are counseling, respite care, debriefing

Even if you do everything right, the client probably won't always get it right. If you need to, work with your supervisor to decide on a strategy of what to do if the client doesn’t do as hoped.

Should you change the plan? Assess the need for changes in the case plan, including the need for an ongoing intervention. If this is the way to go, develop a suitable strategy and negotiate with the relevant parties about any proposed changes arising from case reviews

You don't have to be brilliant at everything; one of your ethical responsibilities is to know when to get specialist help. If you might be getting out of your depth, consider the following:

• the severity of their needs
• the goals and planned outcomes
• the available resources
• how much community and family support the client gets
• whether you can do it (Do you have the skills, time and resources?)

If you refer the client to a specialist service, make sure that somebody will monitor the clients’ progress.

Respond appropriately to their difficulties and crises, whether real or potential. (See separate e-books on crisis response.)