Literature review
Some authors report that brief counseling therapies (six sessions or less) have been reported as successful techniques in helping clients with drug and alcohol addiction, depression and for the college aged population (McLendon, 2000; Murray, 1999; Sklare, 2000; Archer & Cooper, 1998; and Pinkerton 1996). Specifically interventions focused on empowering clients to recognize their own resources through a step by step model leads to positive outcomes. McLendon (2000) reports on Virginia Satir's system, which includes six strategies, resourcefulness, empowerment, congruence, inner system, patterns and externalization. Case management, as I will further describe is based on this brief therapy model; however less so. For example, when students come in for case management they are not obligated to commit to being seen regularly. With this in mind case managers must work quickly within half-hour sessions to determine the student's strengths and weaknesses in academics. If the student returns this will dictate future sessions and overall goals.
Context
I have been working as a case manager at the University of Massachusetts, Amherst since the fall semester of 1999 for the program that serves university students who have a psychological and/or medical disability. This program is funded through the provosts office and falls under the jurisdiction of Undergraduate Advising and Academic Support Center (UAASC). We provide a free service to the campus community of students who have a documented diagnosis. During the past year and a half I have not felt that there exists a clear definition of what contributes to successful case management, in particular some concrete ways to perform well. But instead I have a myriad of ways that previous case managers have supported students and am given free reign for how I spend time in each case management session. Hence, I have chosen to research the components of successful case management, from the student's and case manager's point of view. In conducting this research I aim to make one's role of case manager as clear as possible. For example, is there an area(s) that case managers should emphasize when they work with students? Or, are there certain issues that students need more help with than others? I predict that it will be difficult to pinpoint exactly what makes case management successful or not because of the wide range of needs students have who are in the program.
As a case manager, my primary role as it has been described is to help students who have either a psychological and/or medical documented diagnosis to be successful students. Our goal is to "even out the playing field" between students who have a documented disability with those who don't have a disability. We do not seek out students, but rather rely on them to voluntarily come in and disclose of their disability. Prior to having case management appointments students disclose their academic and clinical history in a question and answer session. Also, at this time student and case manager discuss what would be helpful to work towards in future appointments, with this information the case manager can follow the student's progress throughout the semester. Some students choose to come in only once at the beginning of the semester while others choose to come in weekly. So, in a counseling capacity, one to one we develop a rapport with students and help them figure out their strengths and weaknesses. We then serve as an advocate for students, and work as a liaison between them and the university. For example, if a student's weakness is approaching others I will call individual professors directly to ask for classroom accommodations, if a student has difficulty with certain subject matter I may refer a student for tutoring, consult with academic advisors, and make requests for a single dorm room. With students we strive to help him or her feel comfortable enough to make these contacts on their own. Academic accommodations are different for each individual student, but may include having extra time to take exams or have an assigned seat in the front row of the classroom. Each student who is in our program is eligible for weekly 1/2-hour appointments and can make standing appointments for the duration of the semester. Students are seen in offices that are shared by two case managers.
Intent and Methods
When given this Action Research assignment I initially started asking myself, what makes my role as a case manager effective with some students and not for others? What are my biases that influence the way in which I interact and listen to my clients? And, what do students think of case management? Questions such as these would certainly lead to answers that could inform my practice; however, it occurred to me that the definition of successful case management was necessary first. Hence, for this action research project I have asked the following question, what contributes to successful case management? To answer this question I have collected data from students and case managers. I first began to collect data through interviewing students, but found that I could not conduct interviews on a consistent basis during the course of case management because time did not allow. Thus, I created a survey to be filled out anonymously by all students who come in for case management (Appendix A). In this survey I wanted to know the following, how often students use our service and what brings them back to see their case manager. I then asked six questions about the different components of case management and asked if they agree or not whether these contribute to successful case management. Lastly they had an opportunity to make any other comments. Of the students who filled out the survey, some are seen regularly, either weekly or BI-weekly, and others come in as needed. I did not survey all students who are currently active in the program, which totals 190, but instead only those who came in for case management during the weeks of October 16 until the week of December 1, 2000. In the week previous to October 16 there were 60 students who were scheduled to come in, so I made 60 surveys to start; however, only 29 students filled out a survey.
In addition to collecting data from students in the program I collected some from the team of case managers. The case management team, of which I am part, is comprised of four graduate students. Together we work a total of 45 hours per week with students and receive 2 hours weekly of supervision with Dr. Deborah Berkman, a licensed psychologist. I asked the team to keep track of how time is spent in case a management appointment by completing tally sheets (Appendix B). Specifically, I asked them to keep track of the topics discussed, for example, study skills or personal issues. My intent with this information was to determine whether there is congruence between what students feel contributes to successful case management and what case managers are actually discussing!
The survey given to students asked them to voluntarily respond to eight questions total. Five questions, #1-5 asked for specific responses based on a five point likert scale, 1- strongly agree, 2- agree, 3- somewhat agree, 4- disagree, 5- strongly disagree. Three questions, #A, 6 and 7 asked students to mark the best response, and finally there were two opportunities for students to add their own comments, Question B and in a section called other comments, which was at the end of the survey. Calculations of the responses to the above mentioned questions are found in Appendices C-F.
Findings
I think that those who came in for case management during my surveying period feel that it is already successful and because of this agree with the overall spirit of the survey. As a result I think the results of this survey are skewed somewhat. If I could change something about this project it would be to survey those who did not come in for case management during this time. I wonder if, for example, after surveying these students what further information would be revealed by their not coming in. Or perhaps I would learn that their not coming has nothing to do with case management. However, I will not know until I ask!
I will discuss the findings that follow from the 29 surveys that were completed. Appendix C reveals that the majority of respondents either strongly agree (1) or agree (2) to questions #1-5 as to being some of the qualities that contribute to successful case management. To question 1, (Successful case management is a two way process--student to case manager and case manager to student?) the majority of respondents marked strongly agree (1). For question 2, (Successful case management does not involve regular visits?) the majority of respondents marked agree (2). For question 3, (Successful case management does not involve goal setting, either short-term or long-term (e.g. student will participate in weekly study group)?) the majority of respondents were tied between strongly agree (1) and agree (2). Question 4, (Successful case management involves student reporting back to case manager (e.g. reporting study habits, test performance)?) revealed that the majority of respondents agree (2). And lastly, for question 5 (A comfortable rapport between student and case manager does not contribute to successful case management?) the majority of respondents strongly agree (1). Although students were not asked to rank which qualities of case management contribute to successful case management, I did. According to the responses given here is the rank order. First it is a two way process; second it is comprised of a comfortable rapport; third it involves students reporting back to case manager; fourth that it involves goal setting and fifth is that it includes regularly scheduled appointments.
The tally sheet (Appendix D), which the case managers completed, reveals the number of times that a particular topic was discussed. The topic most discussed was time management and is followed closely by discussions of personal issues, study skills and resources on campus, respectively. Students responded in survey question 6 (Appendix E) that each of these does contribute to successful case management; however, the topic of resources on campus was marked the most. Respondents equally marked time management and study skills and less so were the topic of personal issues. So, even though case managers say that they discuss issues of time management more, students feel that the topic of resources on campus contributes more to successful case management.
Appendix F graphs the data collected in response to question 7, which asked what impedes successful case management? Of the total respondents that felt case management has not been successful for them, the majority marked that being a first time user was the main impediment to receiving successful case management. Next was the issue of too little appointment time available. The next leading issue was that there are not enough services provided to help and lastly, there was an equal number of responses between no knowledge of the program and no contact was made by case manager. Of the seven total respondents who answered question 7, the majority conceded that having not come in for case management before, impeded it from being successful.
Appendix G tracks the responses given to the fill in the blank questions on the survey, specifically question B and the other comments section at the end. Question B asks students what brought them back for case management? Out of 33 answers that were given the most frequent answer written in was to "receive help" with the following sub-categories: "help working through problems", "helps to stay on top of work", and "help build confidence". The next frequent reason that brought students back to see their case manager with 4 responses total was to "work towards goals". Next, to "make sure nothing falls apart" and a discussion of "time management". Also, some students reported that they came back for case management to "check in" and "get communication tips". The remainder of reasons that students wrote in, which brought them back to see their case manager and was given only once include,
| Receives good tips and ideas |
| Taking care of immediate issues |
| Provides pressure to do work -someone I am accountable to |
| prioritizing |
| To get settled in |
| Emotional support -to deal with issues in life |
| guidance |
| Service is free |
| Time for reflection |
The following responses were included at the end where students had the opportunity to add any additional comments. Overwhelmingly there are numerous ways that students conceptualize case management, which I feel contributes to its success.
| Comfortable with case manager |
| Helps to keep academics and personal issues separate where needed |
| Sharing of feelings |
| Case management takes away isolation as a result of disability |
| Case manager cares |
Implications
The implications that follow my research are two fold--on a general level, which is relevant to case management and also about what the future holds. From the responses given on the survey the overall tone was positive about how case management is received. Also, that there are numerous reasons that these students return for case management, which makes it difficult to determine a set way to work with students. I felt validated from the numerous favorable comments that students included on their surveys. I can not pinpoint what contributes to successful case management, I did get confirmation; however, that what is being done in case management is having a successful impact. So, I will encourage the case managers to continue with their good work.
As far as my action research skill development and future research projects, I learned a lot about the benefits of narrowing down my scope. Further I feel that the question of what contributes to successful case management was too broad. However, I do not deny that this data and experience was useful, and will consider conducting more research. In these future projects I would like to focus more on one aspect of case management, for example, rapport between case manager and client, strategies that students utilized as a result of suggestions from case managers, or the specific strategies or framework that case managers use during their sessions.
References
Archer, J., & Cooper, S. (1998). Counseling and Mental Health Services on Campus. San Francisco: Jossey-Bass Publishers.
McLendon, J. A. (2000). The Satir system: Brief therapy strategies. In J. Carlson and L. Sperry (Ed.), Brief therapy with individuals & couples (pp.331-364). Phoenix: Zeig, Tucker and Theisen, Inc.
Murray, B. (1999), 'Two-plus-one' therapy works for mild depression, study suggests. In American Psychological Association Monitor Online (http://www.apa.org/monitor/may99/therapy.html).
Pinkerton, R. S. (1996). The interaction between brief and very brief psychotherapy: Allowing for flexible time limits on individual counseling services. Professional Psychology, 27, 315.
Sklare, G. (2000). Solution-focused brief counseling strategies. In J. Carlson and L. Sperry (Ed.), Brief therapy with individuals & couples (pp.437-468). Phoenix: Zeig, Tucker and Theisen, Inc.
Appendix A
A. Please indicate how many times you have been in to see your case manager this semester, Fall 2000?
1-3 3-5 5-7 7-more
B. If you have been here more than two times, please tell us what brought you back to see your case manager?
Please use the following scale to indicate how much you agree that the following qualities contribute to successful case management.
1- strongly agree
2- agree
3- somewhat agree
4- disagree
5- strongly disagree
1. Successful case management is a two way process--student to case manager and case manager to student?
1 2 3 4 5
2. Successful case management involves regular visits?
1 2 3 4 5
3. Successful case management involves goal setting, either short-term or long-term (e.g. student will participate in weekly study group)?
1 2 3 4 5
4. Successful case management involves student reporting back to case manager (e.g. reporting study habits, test performance)?
1 2 3 4 5
5. A comfortable rapport between student and case manager contributes to successful case management?
1 2 3 4 5
6. What of the following contributes to successful case management? (choose all that apply)
Discussion of
____ time management
____ study skills
____ personal issues
____ resources on campus (e.g. academic advising, mental health, support groups)
7. If you feel that case management has not been successful for you, what of the following has impeded this from occurring? (choose all that apply)
____ minimal appointment time for meeting
____ not enough services to help me
____ never knew case management existed
____ case manager did not contact me
____ I did not use case management until this semester
If you have any other comments please feel free to use this space and/or the back. Thank you!
Appendix B
Tally sheet
Total of students seen who are regularly schedules
Total number of students who came in on an as needed basis
What of the following was discusses:
Personal issues
Resources on campus
Study skills
Time management skills