| Although case management is an important intervention, case management is "indistinct and amorphous," and many disagree about the practice of it (Rothman, 1992, p. 1). Researchers and clinicians have been unable to agree on one widely accepted definition of case management (Baldwin & Woods, 1994; Graham & Birchmore Timney, 1990; Piette, Fleishman, Mor, & Dill, 1990). This lack of clarity may be attributed to the two potentially divergent social goals of case management: (1) coordinating and maximizing resources for clients, and (2) containing costs of extended care (Brennan & Kaplan, 1993). Managed health care is a form of case management that focuses primarily on cost control. In contrast, many of the AIDS case management programs that have developed in CBOs across the country focus on maximizing access to resources for their clients, relegating cost control to a secondary goal (Cruise & Liou, 1993). Therefore, an inherent tension seems to exist between the gatekeeper function - ensuring that scarce resources go to the neediest - and the service advocate function - maximizing services for a client, regardless of overall systems needs (Piette, Fleishman, Mor, & Thompson, 1992). These potentially competing goals affect both program implementation and the evaluation of outcomes.
In the absence of a clear definition and protocol, agencies have tended to develop case management programs or models that address a particular set of local issues or problems (Rothman, 1992). These models are likely to be influenced by organizational culture (Piette et al., 1990). For example, reportedly, if an agency's goal is continuity of care and responsiveness to clients rather than cost containment, greater variability is observed in how case management is implemented (Graham & Birchmore Timney, 1990). Although the flexible definition of case management makes it an attractive intervention for addressing a variety of social ills, this means that no universally accepted case management models are available. Constructing case management guidelines and evaluating case management interventions are more difficult because of this definitional ambiguity (Graham & Birchmore Timney, 1990).
Go to section 2.1.2 Models |
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