Case Management Commentary

Essential Standard(s):

Your agency provides case management for clients, which includes identifying needs and increasing access to services and resources to meet those needs in support of the client’s recovery and goals;
Your agency has an established process and intervals for monitoring and communicating client progress related to program objectives and client’s self-identified goals, with the client directly;
Your agency provides for basic physical, emotional, and social needs of all clients in the program (i.e. food, housing, emotionally supportive environment);
Your agency ensures the client’s well-being by providing information and access to medical/dental/mental health service providers.

This table specifies both required and recommended attributes that are evaluated during the accreditation process. Those attributes labeled as required must be present for accreditation. Attributes labeled as recommended could be reviewed, but are not necessarily required, during the accreditation process. Each requirement and recommendation is further explained in the sections below.

Required

Have a designated case manager or staff member for the case management of each client
Ensure that case management addresses the basic physical, emotional, and social needs of clients
Provide information, referrals, and access to medical, dental, and mental health service providers for all clients
Provide a client-specific, flexible approach to case management that tailors the process to each client’s unique needs
Provide culturally competent & appropriate case management by integrating client background into the assessment and provision of services
Utilize a standard process and procedure for monitoring and communicating client progress with each client

Introduction

NTSA recognizes that in order to help survivors recover from their exploitation, it is essential for their needs (physical, emotional, and social) to be addressed by the providers serving them. This includes creating a safe, stable, and supportive environment within a trauma-informed residential program, while ensuring that all clients’ needs are met and they are provided with adequate resources and support to meet their goals. Creating a comprehensive and survivor-centered case management system within your agency is critical to ensuring these needs are met.

Throughout this commentary, the position and responsibilities of a case manager are defined, please note that if your agency does not utilize case managers, this information applies to whichever staff member at your agency provides case management to your clients.

To provide guidance on what case management should include and how your agency can meet the specialized needs of survivors, this commentary defines what aspects are required vs. recommended for your agency to have in place.

The Importance of Comprehensive Case Management for Survivors

According to the National Association of Case Management, case management is defined as “a professional practice in which the service recipient is a partner, to the greatest extent possible, in assessing needs, defining desired outcomes, obtaining services, treatments, and supports, and in preventing and managing crisis.” The Office for Victims of Crime identifies case management as the central aspect in the provision of victim-centered services to survivors of human trafficking.

Centering the client within their own recovery, this collaborative process seeks to help survivors identify their individual needs and provide services and care that will result in desired outcomes, including the overall physical, mental, and social well-being of the client. For residential programs serving survivors of trafficking, case management must be included within their various services provided to their clients in-house, otherwise, clients will not have the opportunities and resources to pursue long-term recovery.

Within their recovery and journey to being independent and self-sufficient, comprehensive case management is regarded as critical for clients. Case management that addresses the multi-faceted needs of clients, through service systems and appropriate referrals, provides clients with the resources and opportunities to overcome the most significant barriers to their recovery, including the physical, emotional, and social issues commonly faced by survivors. Through case management, clients have increased access to social services support systems and improved quality of service, improved reintegration outcomes, increased empowerment, and increased client involvement in decision-making and service provision. By providing clients with assistance and support in addressing their needs, survivors are empowered with the ability and resources to focus on and progress in their recovery.

Essential Standard Requirement: The Necessary Components of Case Management

The essential aspects of case management include:

1. Assessing client strengths and needs

This should include both initial and ongoing assessments that are utilized to identify client strengths, accomplishments, and service priorities. A client’s initial needs assessment should be conducted during intake. This may include providing clients with a goal sheet, where they are able to identify their top three to five goals and their service needs that correspond with each goal.

To assist clients in realizing their own strengths, case managers can utilize the following questions:

How have you managed to overcome/survive the challenges that you have faced?
What have you learned about yourself during difficult times?
Who have you met in your life that was a positive influence?
Who are the people that you can rely on? Who makes you feel understood, supported or encouraged?
What do you feel proud of?
What positive things do other people say about you?
What are your ideas about how you will achieve your goals?
What do you think is necessary for things to change? What could you do to make that happen?
What are challenges in your life now, and how do you think you can overcome them?

Additionally, the needs assessment must be considered an ongoing process for survivors, where the case manager continuously assesses what new needs the client must have met. As OVC states “as one set of needs are met, another may be identified.” After basic survival needs are met, including shelter and food, the short-term and long-term needs of the client often shift to focusing on recovering from their trafficking experiences and working towards long-term stability and well-being.

A list of the common needs of survivors is identified below:

Short-Term Needs

Safety plan
Secure shelter
Food
Clothing
Personal necessities
Acute medical and dental assistance
Information
Advocacy

Intermediate Needs

Ongoing medical and dental assistance
Mental health services
Transitional housing
Education
Job training
Work permits

Long-Term Needs

Services for life/social skills and competencies (i.e. using public transportation, managing finances, building relationships, setting boundaries)
Life stabilization
Employment assistance
Resolution of immigranton status
Independent, permanent housing
Advanced and continued education
Continued safety planning

2. Developing a service plan to achieve desired outcomes, alongside the client

To center the survivor in their own recovery, case managers should work alongside clients to set goals and an individual service plan that is driven by the client and for the client. As recovery and case management is an ongoing process with the client, this service plan, as well as outcomes, may be adjusted over time to better suit the client.

It is important that the client sets their own goals and needs, with the case manager assisting them, rather than the case manager telling the client what they need. When clients have agency in creating their own goals, clients are more likely to have greater buy-in that can lead to higher chances of success in meeting their goals.

3. Identifying and locating the necessary services and supports for the client and making the direct connection or referral to such services

A central aspect of case management is connecting clients to the services they are in need of, in order to meet their outlined goals. Your agency should be intentional about referring and connecting clients to services that also provide trauma-informed, client-centered care.

Essential Standard Requirement: NTSA requires that your agency ensures that all clients have their basic physical, emotional, and social needs met. This includes providing an emotionally supportive environment where clients have adequate and stable housing, food, and clothing.
- Physical: Clients should feel that within your shelter they are secure and safe, where their health and overall wellness is provided for through food, clothing, housing, necessary hygiene services, and access to medical services. Physical well being is defined as “the lifestyle behavior choices you make to ensure health, avoid preventable diseases and conditions, and live in a balanced state of body, mind, and spirit.” To achieve and maintain physical well being, clients must be provided with the opportunities and resources to have regular physical activity, eat healthy meals, have adequate sleep, and maintain good personal hygiene. For clients to have good hygiene, they must have adequate access to facilities and supplies that support personal hygiene. These facilities and supplies include showers with warm water; restrooms with bathing, personal, and menstrual products; internal laundry facilities or a regular process for cleaning client clothes; and proper storage for clients to separtently store their personal belongings and individual hygiene items. Additionally, a critical requirement to ensure physical well being of clients must be providing them with access to resources and professionals to address their medical needs. NTSA requires that your agency ensures that all clients receive medical care through appropriate referrals, not only to prevent disease and medical conditions but to address the often unaddressed physical and mental needs of trafficking survivors.
- Emotional: It is important that your shelter fosters an environment that is conducive to clients coming to a place of emotional stability and self-management. This should include providing clients with the space to work on their emotional control and trauma reactions and to heal from their trauma overall. To do so, your agency and its staff should ensure that you are listening to and validating client emotions, while helping them to address their emotional needs through adequate support and necessary mental health services, whether in-house or provided externally through referrals. For survivors, it is essential to have an environment where they feel valued, respected, and cared for, which in turn can improve their self-esteem and overall well being.
- Social: Your residential program should additionally be an environment that aids clients in learning or re-learning how to have healthy, trusting relationships and develop social intimacy within a healthy setting. Clients should feel that they have social support through things such as friendships, social groups, community groups, churches and religious organizations. A sense of community and support is incredibly beneficial for survivors who are at increased risk for isolation and mental health issues, such as depression and anxiety. Helping clients foster a support system within your shelter will only help them on their journey to recovery and healing.
Essential Standard Requirement: Additionally, NTSA requires that your case management includes providing access to appropriate external resources through referrals to medical, dental, and mental health services. For all service needs that cannot be met in-house at your agency, it is critical for your agency to not only provide referrals to the necessary services but also provide clients with the resources and help to access such services, including by providing transportation and support at appointments, whenever necessary. Clients should also be educated and equipped to manage their own needs over time, so that when they graduate from the program, they are able to successfully manage and identify their own resources and needs.
- This process of identifying necessary services can additionally include the identification of service gaps at your agency that may be necessary to fill with an external community partner or service, in order to provide comprehensive services and case management.

4. Providing a client-specific and flexible approach to case management that centers the individual needs of each client

Each client will be in a different stage of their recovery with their own unique and individualized needs necessary to meet, in order to continue to move forward in their healing. Thus, case management should be intentional about meeting each client where they are in their healing process and working with them to address the specific needs they have. Case managers urge that it is important to be flexible and begin wherever the client themself is most comfortable, ensuring you are not making any assumptions about what is best for the client without the client’s input and voice in the process.

Based on their own needs and desires, the approach for case management for clients may vary, with some clients needing greater hands-on assistance and involvement from the case manager in service provision and other clients desiring more independence with the case manager being a support, when necessary. The timeline for self-sufficiency and independence for clients, where they depend less and less on their case manager, will vary and should be assessed on an ongoing basis for each client.

5. Providing culturally competent & appropriate case management by integrating client background into the assessment and provision of services

Recognizing that survivors are a diverse group of people, with various identities, it is important for case management to provide support and services that address clients’ specialized needs and interests. This may include ensuring that case managers have an understanding of client background, including the religious and cultural backgrounds of each of their clients, and the various ways this may impact their needs and desires for services.

There is not a “one-size-fits-all” standard for case management for survivors and thus, it is recommended that in order to create the best possible outcomes for each client, case managers utilize client background to inform the assessment of needs and the development of appropriate services.

6. Monitoring and adjusting services and supports over time, in order to ensure that they are achieving the desired outcomes

Recovery is not linear or straight-forward and often requires re-assessment over time to identify what services would be best, according to the client’s current state and needs. Case managers should continuously monitor how services are meeting clients needs at that moment and assess if alternative efforts would better help them to achieve their desired outcomes.

Essential Standard Requirement: NTSA requires that your agency has an established process for monitoring and communicating client progress related to program objectives and client’s self-identified goals. This entails that the client’s case manager should monitor and assess progress over time, document such progress in the client’s case file, and communicate their observations with the client, as well as listen to the client’s understanding of their own progress. This is considered an imperative step in providing the client with agency and voice in their own recovery and in ensuring that services are effectively meeting the needs of the client. While agencies’ process for communicating client progress may differ, one mechanism of doing so is through regularly scheduled case meetings with the client, where needs, services, and outcomes can be discussed by the client and their case manager.

7. Advocating for the well-being, needs, and interests of the client

Case management is a process of supporting and aiding clients in receiving necessary services so that they can move forward in their recovery. For an agency, case management encompasses a role of advocating and supporting clients in a variety of fields and experiences, in order to improve clients’ overall quality of life and well-being. At the center of the service, the individual and specialized needs and interests of each client is championed and worked towards by your agency.

Best Practices in Effective Case Management

The following are considered best practices in providing effective and adequate case management for survivors of human trafficking and are thus, recommended by NTSA:

Collaborating with Others
- Collaboration with other agencies and services to meet the needs of clients is beneficial in providing clients with comprehensive services. This may entail collaboration between case managers, including at other agencies serving survivors; between case managers and law enforcement or attorneys; and between case managers and other service providers. By collaborating and sharing policies, practices, information, and procedures, agencies are often able to enhance their case management system and network of services available to their clients.
Consistent, Central Case Manager
- It is considered best practice for each client to work with a single case manager at your agency. As survivors may find it difficult to build trusting relationships with various staff members at once, having a single individual that they can turn to for their needs and offer them the support they need in a safe and stable relationship is critical. Not only is this practice considered beneficial for the client’s sense of stability and trust within the agency, it also helps ensure that service delivery is more seamless and there is effective communication of the client’s needs across the agency.
Self-Care for Case Managers
- As case management requires staff to provide extensive support to clients, including emotional support, vicarious trauma and staff burnout is a concern for your agency to always consider. As recommended for all staff, case managers should be provided with opportunities and outlets to engage in self-care practices so they have the time and space to work through the stress, frustrations, and emotions that accompany their position. This may take the form of providing staff with mental health professionals and counseling to talk through their feelings, through designated time off to practice self-care as they see fit (See NTSA’s Vicarious Trauma Commentary for more information) or creating blocks of case managers’ schedules considered ‘admin’ time where they work on tasks that can act as a reprieve from the more emotionally intense work.
- Additionally, case managers can be encouraged to set boundaries with their clients. For example, for the wellbeing of both the client and case manager, the case manager may set boundaries regarding over-sharing, where the case manager directs the client to share with the appropriate provider, such as a mental health professional.

The Role of a Case Manager in Survivor Recovery

At the center of case management is the relationship between the client and their case manager or whatever direct staff member at your agency is working with clients on case management. A case manager is tasked with being an advocate, point person, and facilitator of communication, helping clients to locate and obtain services.

Establishing a relationship where the client feels valued and heard is essential to creating a process where clients feel in-control of their own recovery and understand the importance of the services they are receiving. For survivors who have often dealt with multiple systems and their representatives, including law enforcement, medical providers, housing providers, public benefit personnel, and prosecutors, it is considered beneficial to provide them with a single point of contact at the agency that helps clients assess and identify all their service and care needs. Additionally outside of identifying, obtaining, and managing services for their client, case managers can provide beneficial support, such as accompanying clients to appointments and teaching clients basic life skills they may need assistance with. Overall, the role of a case manager is one of a supporter who advocates, provides, and helps the client to receive all the critical care they need and deserve.

Characteristics of an Effective Case Manager

In order to be an effective advocate and support for clients, it is important that staff work to create a feeling and environment of safety and trust for survivors. To be an effective case manager, caseworkers should understand human trafficking and its multi-faceted impact on survivors, their families, and their communities; understand the life experiences and issues of survivors before, during, and after exploitation; and have cultural competence with survivors from various social, economic, religious, and ethnic backgorunds and trauma histories.

It is considered essential that a case manager also validates the emotional responses and decisions of their clients, demonstrating alliance and unity. Case managers should recognize that while they are not the ones providing mental health services, they are an important emotional support for their clients. Case managers provide a restorative relationship for survivors, where respect, interpersonal connection, safety, and hope is fostered. This relationship is important in the client’s self-determination, restoration, and recovery as they rely on their case manager to support them and connect them to essential services.

Challenges to Case Management

As case management requires an agency to identify and ensure all critical services for their clients, there are often challenges, particularly when there are resource limitations. Often case management is considered a 24/7 responsibility, as clients continuously have growing and new specialized needs that case managers must support them in meeting. Working with many clients at once, agencies have a significant case load and may have challenges with balancing the needs of clients, while maintaining staff capacity to respond to such needs. With a possibility of limited resources and funding, maintaining an adequate number of staff to support clients in their case management needs can be a significant issue for smaller or newer agencies serving survivors.

Additionally, as staff are often managing large caseloads, staff burnout and turnover is a major concern for agencies, which in turn can negatively impact clients who benefit from having a consistent and long-term relationship with those serving them. With constant turnover, clients are less likely to establish a trusting relationship with each new case manager, which is considered critical for providing effective care. Due to their relationships with clients, staff may also experience vicarious trauma from their work, which should be intentionally prevented and addressed by the agency. Due to these challenges, agencies should be intentional about not only ensuring that clients are receiving the best possible care but should additionally ensure that case managers feel supported in their role. While case management is considered a 24/7 responsibility, case managers should be encouraged to set professional boundaries and practice self-care, in order to promote staff retention and care. Overall, agencies should try to provide case managers with manageable caseloads that do not overwhelm them and threaten the effectiveness of their service, while also providing space and resources for case managers to practice self-care (See NTSA’s Vicarious Trauma Commentary for more information).