Paper
Service user experience of case managed interventions
- issue: Issue 1 / 2010
- authors: Susan Tregeagle
- keywords: technology, purpose, qualitative research, service users
- views: 3819
- downloaded: 0
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abstract
Introduction
This paper presents the findings of qualitative research on service users' experience of two case management systems: Looking After Children (LAC) and Supporting Children and Responding to Families (SCARF)[1]. The research aimed to assess service users' experience of the purpose and processes of interventions and the resulting partnership with workers. The paper will provide a brief overview of LAC and SCARF in Australia as a context for the research. It will then report on the experiences of thirty-two children, young people and their parents from eight welfare programs in New south Wales and the Australian Capital Territory.
Purpose
This research aimed to contribute findings on service users' experience of long-term case managed welfare interventions. Previous studies have been limited because they were conducted during early implementation, or in situations where workers and family members had not used the systems for long. In addition, many exiting studies had only examined experience of part of LAC.
Key findings
The findings showed that the majority of service users highly valued the practical, social and emotional support offered in case managed interventions. Most young people and parents felt comfortable with the values expressed in LAC and did not feel controlled in the intervention. However, some parents using SCARF were less accepting of attempts to assess parental capacity and felt the systems underestimated the impact of poverty and family obligations. Overall there seemed to be a difference in emphasis on the purpose of intervention as expressed in case management systems and the views of service users.
With respect to the processes used in the intervention, service users were generally not conscious of key planning principles embedded in LAC and SCARF. Examples included a lack of appreciation of time-limited decision-making and inter-agency collaboration. Instead, service users valued their relationship with their worker and relied heavily on individual workers. Service users were sometimes critical of the depth of assessment imposed by LAC and some young people reported being ambivalent about the level of detail and questioning required.
Service users frequently identified the documentation used in case management to be primarily organisational and often associated the 'forms' with bureaucratic requirements. Many preferred spontaneous face-to-face communication and felt intimidated by the use of paper-based systems. Many service users felt the case management systems could be user-friendlier. Few valued the offer of copies of documents and some service users noted that distribution presented problems for intra-family communication. Many had difficult to keep track of documents and some individuals felt that the forms reminded them of experiences that they would rather forget and had destroyed them.
The findings show that service users had mixed experience of participation in case managed intervention. By the end of the intervention, the majority of participants felt listened to, supported to express their views, and involved in decision-making. However many service users took considerable time to negotiate over the purpose of the relationship. Many felt constrained by external considerations and spoke of limiting the flow and accuracy of information that they gave workers. Some service users could not negotiate a satisfactory resolution over the purpose of the intervention and largely withdrew from engaging with their workers. Ironically, in situations where service users trusted their workers, they sometimes withdrew from decision-making and allowed workers to exercise considerable control of the intervention. Where there was no specific consultation process, young people were frequently not included in participatory strategies.
Recommendations
Case management systems may better engage service users by acknowledging the period of negotiation taken to develop a relationship and address tensions between helpful assistance and control of behaviour. Barriers to service users' communication such as fear of external authority or misconceptions about consequences could be better addressed. Greater opportunity to negotiate the reasons for using the systems may assist in avoiding situations in which service users substantially withdrew from the intervention.
The difference between the participatory experiences of young people using LAC and SCARF indicates that text based provisions for including young people in SCARF would be useful.
Further research is needed on the experiences of younger children currently excluded from participatory strategies such as under ten-year-olds. Research is needed on the potential to use information and communication technology to increase social support and efficiency of communication. This research could be supplemented with reference to individuals who are no longer are contactable by welfare agencies.
Contact details
Susan Tregeagle, Senior Manager Barnardo's Australia, PhD candidate University of Western Sydney.
Barnardo's Australia, 60 Bay St Ultimo 2007. Australia.
Email: suetreg@barnardos.org.au
[1]An Australian adaptation of the United Kingdom's Framework for Assessment of Children in Need and their Families case management systems