Recommended practice: case conferences

When we were small, we didn't have so many residents or staff. Staff meetings were the obvious place for case conferences; we were together in a meeting and it was simply something else we needed to discuss.

Later on, we became too big to do case conferences in staff meetings. The problems were:

• Fewer staff ever got to lead case conferences.
• With so many people, lots of staff didn't get a chance to say anything.
• Staff meetings took too long. And they'd have to either get even longer or inadequately cover our residents.
• Some information was too sensitive for such a large meeting, so we made the real decisions in a much smaller informal meeting. That is, we circumvented the case conference system altogether.
• Staff were highly dependent on the Director, and
• It was less useful as a training approach than it had been.

So we changed the way we did it. Here's our new procedure:

1. The staff meeting assigns residents to case managers with compatible personalities.
2. A senior worker assigns staff to different case conference teams and sets up conference schedules.
3. The case manager sets up the meeting (i.e. checks everyone can come) and leads it.
4. Those present are:
1. The case manager
2. One senior worker
3. One or two other case managers
4. One or two upcoming leaders in training
5. The director, but only if he/she wanted to be there. The group should be able to ask the director in if they get stuck with. a difficult or sensitive case that was outside their experience. But in general, they should be able to run case conferences without the Director.
6. The resident (client) also has a right to attend, unless it would be too stressful or too technical, or doesn't want to.
5. This produces a minimum of four people and a maximum of eight.
6. Some of those in attendance have other duties:
1. The case manager passes on relevant input from other services involved (e.g. medical practitioner, DCP, courts).
2. One of the senior workers monitors the effectiveness of the conference for training and assessing staff.
3. Someone will be responsible for taking notes.

We also needed some guidelines so that we could get the best possible benefit for our time:

1. Have a clear statement of why we were having case conferences (a.k.a. meetings).
2. Have a way of deciding who can call them (e.g. case manager).
3. Hold case conferences only when we needed them.
4. Have a way of not being interrupted.
5. Start with a list of questions that we needed answers for.
6. Make meetings are only as long as necessary and don't let them turn into chatter.
7. Make sure the way of documenting them is SUB (simple, useful, brief.)  This turned out to be a form.