00:00:01 Introduction and roadmap

Hello everyone. Thank you so much for joining today. I'm really excited to be here. Before we dive in, let's take a quick look at our roadmap for this session. First, we'll start with the foundations of Case Management, where we'll cover the basic definition, why it's important, and its scope. We'll also look at some common use cases across different sectors to give you a real-world feel for it.

Next, we'll walk through the Case Management process itself, from initial intake and assessment all the way to action and follow-up. Finally, we'll dedicate time to crucial aspects like upholding ethical standards. We'll talk about core principles like 'Do No Harm' and confidentiality, as well as the importance of professional conduct and solid documentation.

00:00:52 Foundations of case management

Let's begin with our first section: the foundations of Case Management. To do some research for this presentation, I got a little curious about the history of the term 'Case Management' itself. I started by using a tool called Google Ngram Viewer, which charts the frequency of any word or phrase found in Google's vast collection of digitized books over the centuries. As you can see from this chart, the term 'Case Management' isn't new. It really started appearing in texts back in the early 1900s, primarily used by public health nurses and social workers who were coordinating care for individuals in the community.

Then we see a bigger jump in usage post-World War II. This was largely driven by insurance companies who needed a system to coordinate the complex medical and rehabilitative care for returning soldiers, as well as their families. Finally, in the early 1970s, the term really entered the mainstream. This is when formalized Case Management was established, particularly with the advent of large-scale programs like Medicaid and Medicare in the United States, which required a structured way to manage patient care and costs. It's fascinating to see how the practice grew from niche beginnings to a formalized profession.

This history brings us to where we are today. So, what exactly is Case Management? Before we speak about the definition, I want you to imagine a scenario. Picture a refugee family that has recently arrived in a refugee camp. They might need multiple supports: housing assistance, specific health interventions, legal aid to process their documents, and enrollment in school for their children. Imagine that family having to navigate this complex system alone, knocking on the door of every single organization, retelling their story over and over again. It would be overwhelming, inefficient, and honestly retraumatizing.

This is the problem that Case Management is designed to solve. Therefore, Case Management is first and foremost a method of organizing and delivering work to meet individual and family needs. It's a repetitive, formal, and multi-stage process that is applied consistently for every case. Case Management is not a single service in and of itself, like providing food or shelter. It's the process that connects people to those services. It's not a specific program, but a professional practice, and it's definitely not an easy or fast solution. It's a dedicated and often long-term process. Ultimately, the goals are to empower individuals to achieve their own goals and improve their overall well-being by providing coordinated and effective supports.

00:04:02 Common pathways and sectors

Now that we have a working definition, let's look at where you'll find Case Management in action. It's applied in many different sectors which we can think of as common pathways. First, in the humanitarian response sector, Case Management is absolutely critical. It's used to provide support for refugees and internally displaced persons, survivors of human trafficking, or natural disasters, and especially for survivors of Gender-Based Violence (GBV) who require sensitive and confidential coordination of services.

Moving to social and health services, we see it everywhere. It is the cornerstone of Child Protection Services, ensuring a child's safety and well-being. It's used to support the elderly, helping them access the care they need to live with dignity. You'll also find it in disability services for individuals managing severe mental health conditions or chronic illnesses, helping them navigate complex healthcare systems. Finally, in the justice system, Case Management plays a key role in rehabilitation programs for former inmates, helping them reintegrate into society. It's also fundamental to probation and parole support, where case managers monitor progress and connect individuals with relevant resources.

00:05:21 The case management process

Now that we've covered the what and why, let's move on to the how by explaining the Case Management process. A couple of quick disclaimers: I'll be presenting these in a linear fashion, but in reality, the process is cyclical. As a case evolves, you'll often move back and forth between steps. Also, if you are a caseworker, please remember to always follow your organization's specific Standard Operating Procedures (SOPs) and guidelines, which will vary depending on their focus (protection, GBV, cash assistance, etc.).

It all begins with case identification, step number one, where we first become aware of the individual in need. This is followed by a thorough case assessment to understand their situation. From there, we develop a case plan, make necessary referrals, and conduct ongoing follow-up and review. Finally, when the goals have been met, we move to case closure.

00:06:33 Intake and assessment

Let's zoom in on that first phase: intake and assessment. It starts with case identification, which is the process of identifying or screening people who have been harmed or are at risk, and then formally registering them in the case management system. Cases can come from many sources: individuals might self-refer, or we get referrals from other organizations like civil society organizations, NGOs, and humanitarian partners. Referrals also come from formal institutions like health services, hospitals, schools, and judicial authorities.

A critical step right at the beginning is securing informed agreement. This involves two key concepts: consent and assent. Consent is the voluntary agreement given by an adult who has the capacity to make that decision. For consent to be valid, the person must have the capacity to understand the information and consequences, and they must give it voluntarily, free from pressure. Assent is used when working with minors or individuals who may not have full legal capacity. It is the child's affirmative agreement to participate. The child must have a basic understanding of what is being proposed and show willingness to participate. For children, you typically seek both assent from the child and consent from their parent or legal guardian.

Once the case is identified and biodata is collected, we move to the assessment phase. Assessment is the process of gathering and analyzing information to truly understand a person's or a household's needs, allowing us to make informed care decisions. A key part of this is identifying the risks and threats they face, not just as individuals but also within their family and community context. Assessment is not a one-time event; it is an ongoing process. A person's circumstances can change, so we must keep reassessing.

A good assessment is holistic. We look at basic needs like water and sanitation, health (chronic diseases, access to centers), economic status (income sources, livelihood opportunities), and food availability. We must also consider protection issues: legal documents, birth registration, and identification. In cases involving families, child protection is paramount, screening for abuse, child labor, or separation. For children, we look at education attendance and barriers. Gender-based violence is also a major issue, requiring knowledge of available support services. Finally, we consider the living environment, especially camp conditions and safety.

00:11:10 Categorizing risk levels

During the assessment, we categorize the level of risk to determine how quickly we need to act. First, for an emergency high-risk situation, there is imminent danger to personal safety. Examples include a GBV survivor threatened with a weapon or a child showing signs of severe physical abuse. Intervention is required immediately, and follow-up must happen within 48 hours.

Second, we have urgent or moderate risks. Here, there's a possible risk to safety requiring prompt intervention, such as a family facing aggressive verbal threats or a person with a chronic illness running out of medication. They need help quickly but are not in a life-or-death crisis. For these cases, we generally follow up within three to five days.

Finally, low-risk situations are cases where the likelihood of harm is low, but intervention is needed. An example is a family with stable housing needing guidance on school enrollment. For these important but non-urgent needs, a follow-up within 10 days is usually appropriate. Using clear categories helps us triage cases effectively.

00:13:17 Action planning and follow-up

Once the assessment is complete, we move to action and follow-up. This begins by creating a solid case plan. Case planning is a step-by-step process where the caseworker and the individual jointly identify and connect to needed services in a safe and supportive manner. This is a collaborative effort. The goal is to select interventions that address needs and openly discuss the pros and cons of each potential action.

The steps for case action planning are:

00:15:51 The referral process

A major part of plan implementation is making referrals. A referral is the process of linking an individual with the service they need, such as financial assistance, healthcare, or legal aid. The objectives are to coordinate service provision, enhance timely access, and ensure active beneficiary participation.

The referral process has key steps:

To make referrals, you need a strong network of partners. The caseworker must contact other organizations and build effective working relationships. When making a referral, it is essential to apply protection principles: safeguard safety and dignity, avoid causing harm, handle information confidentially, and show respect. Safety is the top priority. A caseworker should never pressure someone to report an incident. Every person under 18 should be accompanied by a trusted adult.

It is also important to know when not to make a referral:

00:19:50 Follow-up and review

Follow-up is the process of checking back with both the beneficiary and the service provider to confirm that the person received the service. This allows case managers to verify service receipt, confirm beneficiary satisfaction, identify new needs, and seek additional services if necessary.

If a referral doesn't work out, there are common pathways:

When conducting follow-up, always involve the beneficiary in decisions, check if the referral met its objectives, consider new risk factors, and collaborate with partners on complex cases.

00:23:13 Case closure

Case closure is the final step in the formal process, though it may not be the last contact. A case can be closed, transferred, or resumed. We must recognize when our direct involvement is complete—when goals are met, risks reduced, and protective factors strengthened.

Practical steps for closure include:

There are three main triggers for closure:

00:28:18 Upholding ethical standards

Running through every step is the absolute necessity of upholding ethical standards. The foundational principle is 'Do No Harm'. We must ensure our aid programs are at minimum harmless to an individual's safety and dignity. We must ask: can my good intentions cause more harm than help?

Examples of unintended harm include:

To prevent harm, we must understand local cultural norms, study community tensions, acknowledge and report harm if it occurs, and correct the situation. Sometimes, the most ethical decision is to not provide assistance if it creates greater risk.

00:33:37 Confidentiality and documentation

Confidentiality means protecting a beneficiary's personal information and not disclosing it to anyone else, including colleagues not involved, friends, or family. Personally Identifiable Information (PII) includes names, locations, financial info, medical history, and sensitive details like political views or sexual history. Breaching confidentiality can lead to loss of trust, discrimination, direct harm, or loss of employment.

Exceptions to confidentiality exist, such as if an individual states an intention to harm themselves or others. This should be handled carefully, typically by informing a supervisor. When making a referral, you share basic contact details only with the person's explicit consent.

Documentation is the backbone of professional conduct. It ensures accuracy and continuity of care. Remember the acronym FACTS:

Documentation exists as hard copies (locked cabinets) or soft copies (digital records). Effective digital systems, like ActivityInfo, require a well-structured database starting with a data model. A data model is a blueprint defining how information connects—linking a case to an assessment, action plan, and follow-up.

00:39:05 Key takeaways

To conclude, here are four key takeaways:

00:40:12 Questions and answers

Zeíla: Thank you, Firas. We have some questions coming in.

Question: How can Somalia solve the problem of marriage of young girls, some of whom are forced into marriages they do not consent to?

Firas: This is a deep-seated problem globally. Case management tries to solve this through a survivor-centered, multi-sector response. We need to protect children, provide care, and remember 'Do No Harm'. Often, we need to raise awareness and advocacy, ensuring the child can speak up without causing them harm. We establish confidential case management steps to help as much as possible.

Question: I want to know the similarity and difference between transfer and referral.

Firas: A transfer usually means handing the case over entirely. Sometimes this is within the same organization (e.g., transferring to a different department). A referral is linking the person to a service, often at another organization, while you may maintain the case management role. Both require follow-ups, reassessment, and satisfaction checks. Transfers within an organization might be easier regarding communication, but the core steps remain similar.

Question: Will this be compatible and usable through the app, collection link, especially offline?

Firas: Yes, ActivityInfo works offline via the app. However, for case management specifically, we do not recommend using public collection links for case managers due to protection standards. Case managers should be users within the system to ensure proper roles, permissions, and data security.

Question: In general, during the assessment and planning steps, we are forgetting to assess or take into consideration the capacity/strength of individuals.

Firas: You are absolutely right. Assessment should identify strengths, not just weaknesses. If a person can access a service themselves or has a family member with skills to assist, we should leverage that. This aligns with the goal of empowerment.

Question: Can closed files be transferred to a partner organization without consent if the child is deceased, reunified, or turned the age of maturity?

Firas: This depends on the organization's SOPs, but instinctively, the answer is no. We usually need consent from a guardian or parents. The data belongs to the individual, and we are protectors of that data. Unless there are extreme cases defined by law or protocol, we generally do not transfer without consent.

Question: You mentioned that Case Management is a process. How will my organization create a standard Case Management plan, and yet build flexibility to adjust where necessary?

Firas: It is a cycle of Accountability and Learning. You need standard guidelines—non-negotiables like ethics and core steps. However, the specific path depends on the case (e.g., GBV vs. Child Protection). Systems like ActivityInfo allow for flexible templates that can be adjusted to the particular case while maintaining the standard framework.

Question: You talk about cases where sometimes you do not give the assistance. Can you elaborate please?

Participant (Mamoudou): Sometimes the decision after investigation is not to give the assistance. I have examples where you should stop it if it is not good for them.

Firas: Exactly. It goes back to 'Do No Harm'. For example, installing a water pump that causes conflict, or referring a domestic violence survivor to a clinic where her abuser works. If providing assistance causes more harm or puts the individual at greater risk, the ethical decision is to not provide that specific assistance and look for alternatives.

Question: In a scenario with significant caseload, what do you recommend for preventing or managing empathy fatigue?

Firas: This is a critical issue. Case managers are often overworked. Organizations need to implement "Care for Caregivers," providing psychosocial support and relief for staff. You need to take care of yourself to take care of others. It is important to remember your role is a service provider, not a family member, to maintain professional boundaries while being empathetic.

Question: Are there any digital tools or low-tech solutions that work best for tracking referrals and follow-ups with implementing partners?

Firas: ActivityInfo handles this. You can create specific referral forms and share them with other organizations to standardize the work. We are also launching a specific Case Management database template soon that you can duplicate and use.