Case Management

Since the 1980s, the case management approach has gained acceptance throughout the United States as a strategy for assisting homeless people. Service providers and researchers alike have recommended the development of such approaches, and the U.S. Congress has encouraged states to do so through legislative initiatives and appropriations. Today, case management is a key ingredient in local, state, and federal efforts to provide homeless people with needed services and resources.

Why is the case management strategy so widely advocated? In part, it reflects a trend within the entire field of health and human services during the late twentieth century—a trend that encourages a comprehensive view of each client, or case. In this model, a designated case manager first assesses a client's needs, then works to coordinate and optimize the client's services over time. But as Morse (1999, p. 7–2) has noted, there are also “several interrelated, key assumptions about the problems, causes, and solutions of homelessness” that make the case management approach especially suitable in this arena. These premises are based on several observations. First, homeless people often have serious and multiple unmet service needs. Second, the existing service system is typically fragmented, composed of various disconnected organizations. Third, clients often encounter barriers to needed services and resources. And fourth, case managers are needed to ensure access to these services in a coordinated and efficient manner.

Together, these observations point to problems in the way existing service systems are organized and operate. Indeed, some researchers and policymakers believe that case management can also serve to improve the service systems themselves. That remains debatable, but case managers certainly do, as Hopper and colleagues (1989) put it, perform [Page 47]service-system “microsurgery” on behalf of specific clients. A case manager may, for example, successfully intervene with public housing officials to keep a Section 8 voucher open for a client who has been temporarily hospitalized for psychiatric problems, and therefore unable to meet a deadline for moving into a new apartment.