The “professional” helper as moral guide:

 The history and origin of case management is deeply connected to a number of developments in the trajectory of organized human life that began to take shape during the industrial revolution and coincided with the large-scale urbanization of human society. As more and more people began to crowd into urban centres created by factories and related industries that supported urbanisation and an industrialised society, poverty, social ills and the diversity of human form and function were on display in these urban centres, which then heightened the overall changes in the environment in which human beings lived. 1920 is considered a pivotal year in American history, as more people were living in cities than on farms. With industrialisation came the urbanisation of America, the erosion of the extended family, and an exponential rise in what could be considered poverty. These changes also exacerbate various conditions in the human experience that make life in urban America challenging—into this environment stepped people like Jane Adams, Clara Barton, and Ida Maude Cannon, and countless nameless others who acted as intermediaries between the rising groups of people who, for a variety of reasons, were unable to meet their needs in these new urbanized semi-rural environments. The early forms of case managers or social workers were simply community members who acted as intermediaries between those experiencing various needs and the organizations that began to develop in an effort to meet those needs. These early charitable organizations and social work efforts must be expressly noted as operating from a religious perspective, and the philosophical view that drove the growing charitable and helping systems was focused primarily on moral guidance and the belief that people’s circumstances reflected their moral failings. The overwhelming view and character of the assistance provided was paternalistic in nature, where the helping “professional” knew what was best and made all the decisions for those in need. The charitable organizations and their community intermediaries were in place, addressing human needs and striving to achieve human flourishing, predating any form of government role in the delivery of human services. There were the days of settlement houses where intermediaries guided families to private and public support networks.

Meanwhile…

Parallel developments were taking shape in the lives of people who experience IDD. As mindsets on the care treatment and understanding of intellectual and developmental disabilities were evolving and the state Schools for the developmentally disabled were being closed in the wake of exposure of the widespread abusive inhuman practices that characterized the so-called care and treatment received in these state-run institutions and asylums, there arose a similar need for care coordination in the community settings.

 Language in the President's Panel on mental retardation illuminated a concern about how effective people with IDD and their families would be in finding and securing the needed services. The proposed “Program for National Action to Combat Mental Retardation” evolved into what we now know as case management. Though this model is still largely paternalistic, high-minded, and looks at people with IDD through the lens of the medical model, in that IDD was a problem that needed to be fixed. This is even in the language of the program itself, National Action to Combat Mental retardation. Within this document, the nature and function of how support and services would be coordinated, how government agencies would establish support systems, and how local and regional services would be organized were prescribed. Aside from this structural discussion, the term' case management' is used only once in the entire document. However, the document is considered a fundamental contributor to the implementation of case management in the development of the local, national, and federal service systems for people with IDD.

 Nevertheless, from the foundation of this national program,  45 pilot demonstration projects took shape across the country, and case management became the intervention utilized to establish linkages between services and service recipients. Simultaneously, the NIH proposed a comprehensive network of services, which they called a coordinated community support network, with case management as the key element in their promised system. From there, the Home and Community-based Waiver program took flight, and case management became the central component of the HCBS program nationwide.

The Evolution of Support Coordination

Though case management and support coordination are terms that are used interchangeably, a careful examination of the trajectory of the paradigms that have contextualized the IDD service and support systems and structures demonstrates clearly that support coordination is a distinct service model, and primarily only used within service systems that support people with IDD. What distinguishes support coordination from case management is the process and function. As time moved forward, the service systems, in general, and specifically those concerning people with IDD, shifted their focus and emphasis to strength-based and person-centered approaches. Between the 1980s and the 1990s, the focus on service models for people with IDD shifted to emphasize individual choice, so-called community integration, a strengths-based approach, and developing a personal vision for a good life, for what the state of PA rightfully calls an everyday life. There is a philosophical difference between case management and support coordination. Case management, first and foremost, is designed to identify a problem, develop solutions to that problem, and help create a level of independence in the person to manage the situation and others that may evolve, and then discharge the person either to another system or towards a life of independent ability to solve a problem or meet a need. A set of standardized assessment tools, actions, and solutions typically characterizes case management. Case management, in most cases, tends to rely on formalized supports and is service-centered, as opposed to person-centered. Most importantly, case management is time-restricted and, in many ways, serves as a bridge towards greater independence or an increased capacity to achieve human flourishing and quality of life independently. Case management is generally a service delivered over a specified period, from intake and assessment through discharge. The literature and case management texts across multiple service sectors share a similar trajectory. All starting with the evaluation of the problem and all ending with discharge.

 Support coordination, by contrast, is first predicated upon the relationship between the SC and the individual and their family.  The traditional stance of the worker-client relationship in the human services has always been characterized by “professional distance”, an arm’s length approach. Effective support coordination is built upon the establishment and maintenance of a collaborative relationship with the individual and their circle of supportive others. Why the relationship is so critical is directly tied to the second distinct characteristic of support coordination: it is a lifetime service. While the person of the SC may not be the same from year to year (high turnover is endemic in the ranks of support coordination, as with most roles in human services), support coordination as a service stretches across the lifespan. Support coordinators do not discharge clients once a goal is achieved. The life plans or PCSPs’ ISP, etc., are designed to help each individual prepare for successful transitions and the challenges that come with each new developmental task and life stage. This is not how case management is supposed to function. Though many jurisdictions use the two terms interchangeably, and some may make the argument that their case manager perform tasks through the person-centered approach and are strength-based, I would reply to that argument if case managers are in fact doing these things and serving across the life span of their clients, they are not case managers, they are support coordinators.