- Case management expectations
- Assessment should identify participant motivations, strengths, barriers and resources;
- Assessment and screening address the functioning of the whole family;
- All clients need to be offered learning needs, domestic violence, alcohol and drug, mental health and physical health needs screenings within two weeks of their intake for services;
- Family needs screenings help us to identify and address any potential child abuse risk factors and other factors that may reduce the likelihood the client is able to move towards self-sufficiency;
- Client assessment is ongoing, beginning with their first contact with the Department of Human Services (DHS) and continuing through changes in benefit programs and client circumstances;
- Involve experts in assessing further client needs if the screening indicates a need.
- Case plans are mutually developed between the client and the case manager;
- Case plans are individualized to identify services that support each client's self-sufficiency goals and are based on client strengths, needs and abilities;
- Clients are provided information about available programs, resources and program requirements to support them in making informed choices about plan activities;
- Case staffings with the client, branch team members and other partners can be used to ensure that the best thinking is available in case planning decisions;
- Case plans should be coordinated with other partners if those partners also have a case or service plan with the client. (For example: child welfare, vocational rehabilitation, community action
agencies, housing, etc.);
- All case plans are continually updated and evaluated based on client need and using information from ongoing screenings and assessments;
- Client contacts are frequent (at least monthly) and based on the needs of the client and case plan;
- All case plans reflect current client abilities and the services they need to meet short- and long-term goals;
- Case plan, progress, strategies and resources should be documented in TRACS;
- Support service payments are made in a timely manner to support the client's ability to complete their case plan.
Employment, self-sufficiency and wage enhancement focus
- All staff are responsible for helping families toward self-sufficiency;
- Previous work history, reasons for job loss and any criminal history concerns should be used to assess for appropriate employment related services;
- Factors that impact a client's ability to maintain employment are addressed at the initial contact with clients, during job readiness activities and after clients go to work;
- Support is offered for working clients to enable them to retain jobs and enhance income.
- Decisions are made within program policy and intent;
- Program benefits are intended to support individuals and families temporarily as they increase self-sufficiency;
- Benefits are issued in a timely and accurate manner.
- Our clients are capable of making strides toward self-sufficiency;
- Our clients lead the development of their plans to become self-sufficient;
- Plans are based upon client goals, strengths, barriers and resources;
- Our clients are accountable for their progress toward goals;
- Our services enable clients to become proactive so they learn to use resources to meet their own needs;
- The re-engagement process is used to reconnect the client with their case plan goals and steps needed to address self-sufficiency, to establish whether the client is able to complete their case plan and to address any barriers to participation;
- Disqualifications are used only when it has been established that the client is willfully noncompliant.
- Case management is provided using the brokering concept, which means that we identify client needs, assist clients in accessing services to address their needs and follow up on results of the referral and interactions with the service provider;
- Brokering includes collaboration with clients, other staff, partners and the community to provide services that ensure our client's success;
- Clients are taught how to become their own broker so they may access services independently when needs arise;
- Program benefits are one of the resources we access when we broker for services;
- Our clients should be treated with the respect and dignity that honors their differences.
Meeting basic needs
- All staff are responsible for providing eligibility determination
and benefit issuance in a timely and accurate manner;
- Ongoing eligibility processes are also opportunities for client assessment
and brokering for resources;
- The benefit determination and issuance process is integrated with
the case management process; both support each other.
Case management requirements
Case management includes assessing strengths and needs, developing a
case plan and monitoring and supporting client participation to promote
movement toward self-sufficiency.
Definitions; SNAP OFSET Components and Activities: 461-001-0020
Definitions of Terms, Components, and Activities; JOBS, Pre-TANF, Post-TANF, TANF: 461-001-0025
TA-DVS; Definitions: 461-135-1230
- Case management activities overview
Case management consists of the following primary activities:
- Screening & Assessment includes all the interactions we have with DHS clients,
from initial branch contact and screening, through intake and case management contacts. Initial screening for client strengths, needs and goals is based on information gained from reviewing the Application for Services (MSC 415F) and the My Self Assessment form (DHS 7823), as well as from the client interview. All branch staff and contractors with client contact can contribute to assessment of client needs based on their interactions with the client. In all of these interactions, the goal is to help the client identify which services are needed to support family self-sufficiency. Rapport and trust are built by helping clients identify and address their own issues;
- Brokering for resources, communication with partners, and case staffings, ensures that the most appropriate services are provided to the client. Case managers will work closely with community partners, DHS partners including, child welfare and vocational rehabilitation as appropriate. Brokering also involves continual evaluation of each service's usefulness and success. Brokered services include not only case plan activities and local resources, but DHS, Social Security, child support and other benefits as well. Client confidentiality is critical, so it is important to ask clients to sign appropriate information releases as soon as possible;
- Case plans are the road map for the client in their journey toward enhanced self-sufficiency. They are developed using the client's best thinking on how they can increase self-sufficiency. The results of client assessment are used to help the client choose self-sufficiency-enhancing services and the case manager acts as a broker to access these services. The plan states when, where, how and by whom these activities will be provided. Case plans should be individualized based on client need and can be added to and adjusted over time;
- Eligibility determination and benefit issuance are one of the
primary responsibilities of DHS. These services are integrated with case planning aimed at increasing self-sufficiency. The case plan is the primary agreement between the client and DHS, and the benefits are one of the temporary supports in that plan;
- Progress evaluation allows DHS to maintain successful
case plans and accurate benefit delivery for our clients. This is where
the relationship between the client and DHS staff is developed. Consistency
and timely follow up by DHS staff are very important here so that trust, support
and accountability are fostered on both sides;
- Narration and computer entry are the means by which our benefits
are provided and case activities recorded. They also enable us to collect and evaluate data to continually improve program services. Accuracy and timeliness of narration and computer entry are necessary to help us maintain federal and state funding. Case plans should be entered into TRACS no later than five working days from the date the plan was developed or sooner if required to meet client participation or partner needs. Narrations should be clear, comprehensive and void of personal opinion.
All these activities occur during case management, but the order may vary depending on the client situation and local procedures. In each case, we use case management skills such as asking open-ended questions, restating and summarizing, and helping clients develop their own plan of action and be accountable for their own progress. Each of these case management activities are discussed in detail in the following sections, and at the end of the Case Management chapter there are examples of how all these activities can be put into practice in specific kinds of cases.
- Retention case management
The case management services described above can be offered to families who are employed and receive ERDC, SNAP or OHP services from the branch. This includes families leaving TANF, those in the Post-TANF program and those who were not receiving TANF when they found employment or found employment during Pre-TANF. The focus of retention case management is to enable the client to maintain employment, increase wages and employee benefits and learn how to access community services themselves so that they become independent of DHS self-sufficiency and benefit programs. Retention case management plans should build on previous assessment information. Case management issues affecting job retention should be identified beginning with the client's first contact with DHS. Because of this, retention case management is a part of all other stages of case management, including initial assessment and ongoing case management.