The provision for some greater continuity of care through periodic contact between case manager(s) and the client that provides greater (or longer) coordination and brokerage of services than the client could be expected to obtain without case management. (Orwin et al., 1994, p. 154)

Most commentators view case management as a "boundary spanning" activity (Rubin, 1987, p. 210) because it involves work with individuals and communities, from micro- to macrosystems (Rothman, 1991). In addition, case management clients are usually defined as those who have severe and chronic disabilities and who require long-term rather than acute treatment, and treatment is focused broadly on the client's multiple needs. In other words, case management is cross-sectional (providing a broad array of services at one point in time) and longitudinal (striving to ensure that services extend over time to meet the client's changing needs) (Rothman, 1992).

Generally, case management involves locating and pooling resources, sequencing and coordinating services and resources to respond to assessed needs, and monitoring the service delivery and service needs for a defined group of people (Baldwin & Woods, 1994; Loomis, 1988). No established procedure exists for providing the activities that may be part of case management (Graham & Birchmore Timney, 1990). Although these activities have been grouped in many ways, the following six core case management tasks seem most relevant for PCM (Brennan & Kaplan, 1993; Intagliata, 1982; Piette et al., 1990; Rothman, 1991, 1992):

• Client identification, outreach, and engagement
• Medical and psychosocial assessment of need
• Development of a service plan or care plan
• Implementation of the care plan by linking with service delivery systems
• Monitoring of service delivery and reassessment of needs
• Advocacy on behalf of the client (including creating, obtaining, or brokering needed client resources)

Note that counseling usually is not considered a core case management task, although this controversy will be discussed further in the Section 2.1.5, "Key Questions." Rothman (1991; Rothman & Sager, 1998) developed an empirically based model of case management that incorporates these six core functions. Figure 1 is a graphic representation of his model. Case management is represented by a flow diagram, whereas functions that take place intermittently during case management, such as interagency coordination, counseling, therapy, and advocacy, are outside the main flow of the model.

In conjunction with his model, Rothman (1992) developed an extensive set of generalizations and action guidelines for the practice of case management that were based on an extensive review of the research. Figure 1 reflects the first generalization that emerged from the research: case management is, "a phased process with sequential functions that often overlap" (Rothman, 1992, p. 15). Although Rothman's generalizations were developed from research and experience with clients who had severe mental illness, they have relevance for PCM as well.

Figure 1. Schematic model of intervention (Rothman, 1991; Rothman & Sager, 1998; Reprinted with permission of Allyn & Bacon).

Go to section 2.1.4 Broad Services Provided by Case Managers