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47СОЦИОЛОГИЧЕСКИЕ НАУКИ
CASE MANAGEMENT IN SOCIAL WORK Zhakupbayev M.M.
Zhakupbayev Madi Medelkhanuly — BA in Anthropology and Sociology, Social and Cultural Anthropology Subject
Leader,
DEPARTMENT OF HUMANITIES, NAZARBAYEVINTELLECTUAL SCHOOL, ASTANA, REPUBLIC OF KAZAKHSTAN
Abstract: in recent years of the world social work practice, there has been a trend towards the integration of different practices. One of them is the method of case management which became significant primarily in the West. The area have been filled with different studies regarding its application and the outcomes in areas ranging from mental health to addressing the family and child welfare. However, the case management has been a rather novelty for the CIS countries. In Kazakhstan, case management has gained certain importance as a result of national modernization program which also extended to include the social side. This study was designed to explore the state of social work in Kazakhstan, and the technology of case management practice. The main tools employed in the present study were an analysis of the existing literature and the case study based on evaluating teenagers and children welfare system in the Center of Adaptation for Youth involving interviews and observation methods. The research study has shown that case management technology in social work in Kazakhstan is rather underdeveloped what also comes along the current period of transformation of the social service delivery in Kazakhstan. The study also draws recommendations on system level to set the ground for further integration of modernization techniques including case management. Keywords: social work, case management, case study, case management models.
Case management approach in social work represents rather interesting and distinct area of study due to its relative recency and lack of clear strategy. Social Work Case Management is essentially a service, while a professional social worker serves to cooperatively assess the client's and his family's needs and demands. To satisfy the client's specific and complex needs a social worker scrutinizes, coordinates and promotes a bundle of various services. Case Management methods range across a broad spectrum of Social Work settings and can vary even more depending on the professional field in which it is applied. Yet, Social Work Case Management has a number of features which sets it apart from other case management types. One of these features is the approach of SWCM towards the clients: it addresses both the individual client's biopsychosocial state and the surrounding social system. In this sense the practice operates both on micro and macro levels, involving patient and his family and the system. A social worker specialist is the chief provider of social work case management services and SWCM requires him to evolve and support a therapeutic relationship with each client. This might involve connecting the client with various systems which supply particular services, means and possibilities.
Services which are specifically provided by the SWCM practice can be concentrated in a single agency or might be distributed across number of organizations and agencies [1, p.1]. The principle objective of social work case management is "to optimize client functioning and well-being by providing and coordinating high-quality services, in the most effective and efficient manner possible, to individuals with multiple complex needs" [2, p.15].
While case management has gained its prominence in the Western practice of social work, its application in other parts of the world can provide a perspective on its shortcomings and strengths. The scope of the present paper applies to the context of the Republic of Kazakhstan. While the sphere of social work is rather wide in its spectrum, the focus will be made on particular group of teenagers and children at risk in order to assess the current state of case management practice in Kazakhstan. This work will provide valuable insights not only on detailed aspects of case management in social work but also can give insights on its procedural aspects.
The Republic of Kazakhstan is a post-Soviet country which gained its independence in 1991. Since then due to the presence of immense oil and gas reserves Kazakhstan has managed to become one of the fastest growing economies in the region. Also, an ambitious plan has been set by the President called the strategy "Kazakhstan-2050", which seeks reforms in political and socioeconomic areas to set the base for becoming one of the most competitive economies in the world. Significant reforms have been in the process of the implementation since then. Some of the areas targeted include education and health care. The prevailing rhetoric behind those reforms is reformation which will allow integration
and development of the institutions and values recognized by the Western schools of thought. In the message "Strategy Kazakhstan-2050. New policy course held state» President of the country defined new principles social policy, designating one of the important development priorities countries for the coming years, the protection of childhood, and outlined the main priorities in the activities of government agencies for its implementation. State social policy is designed to ensure a full physical, intellectual, spiritual, moral and social development child in accordance with the norms of the Constitution of the Republic of Kazakhstan and international obligations [3].
The transition period brought about radical changes in economic and social spheres of life which exerted a massive influence on the citizens. Various social problems, including unemployment and poverty increased dramatically resulting in significant stress for people who had a comfort of stable employment during the Soviet period. Therefore, in reaction to the rise of social issues and changes, all institutions, both governmental and non-governmental delivered their services to vulnerable parts of the population [4, p.819].
General socioeconomic and political setting and further paradigm shift in welfare certainly affected the development of social work in post-Soviet Kazakhstan. An identifies 2 phases in the development of policy environment between 1991 and 2012. The breakup of the planned economy, swift rearrangement and restructuring of economy, shrinking of the Soviet welfare system, and worsening of the living standards of the population led to severe economic depression in the first ten years of independence, between 1991 and 2000,. The second decade between 2011 and 2012 led to slow economic upturn, numerous changes and restructuring of welfare system, and gradual improvements in human development indicators. In addition to progressive aspect, the analysis reveals four layers in the policy environment which affected both directly and secondarily the evolution of social work.
Firstly, the economic downturn of the 1990s led to drastic depreciation of living standards for the main part of the population, increasing the need for social work.
"The economic restructuring in Kazakhstan was followed by the explosion of social and health problems, such as poverty, family disruption, unhealthy behaviors, crime, drug and alcohol abuse, decreased life expectancy, dislocation, and suicide, similar to the developments affecting all of the post-Soviet and postsocialist region and referred to as 'a human crisis of monumental proportions' [5, pp.898-899].
Secondly, the post-Soviet reorganization of the welfare system itself drove in the development of social work. As Ann summarizes, 1990s was marked by welfare cutback as a reaction to economic situation, while in 2000s there was a slow revival in both. Understandably, in the first phase the government significantly decreased the spending on public welfare programs which helped it to balance the general budget.
Furthermore, the safety net which was available to families further shrank due to "cuts in income transfers to families along with the decimation and/or privatization of public services further eroded the safety net available to families". In addition to that, the need for voluntary work as a vocation arose due to sudden retraction of traditional programs which were supplied by the Soviet system (such as care for disabled and children deprived of parental care). The former filled the void created by the later providing emergency relief.
The expenditure on welfare programs and social policies progressively increased throughout the 2000s as they become strategically critical spheres to ensure public content and social stability. Thus, the government made it its priority and provided various social services through NGOs and through governmental services, which were created or reformed. Thirdly, association of social work with new democratic reforms and post-Soviet political setting facilitated social mobilization and enabled association creation and participation. As a result, non-state actors were able to enter welfare provision activities.
According to Ann "Adopted in 1991, the Law on Public Associations provided a legal framework for forming non-state voluntary associations, including political parties, unions, mass movements, and NGOs. Over the 1990s, the number of new non-state organizations grew exponentially, and by the mid-1990s thousands of NGOs were registered". The main areas of concentration for the NGOs which appeared in the early years were human rights and general political issues, which then expanded to include number of fields like "awareness raising, education, community mobilization, building alliances, fund raising, humanitarian assistance, and social welfare provision" [5, pp.898-899]
Finally, the evolution of social work in Kazakhstan has been affected by international and regional policy actors which entered the policy space of the newly independent country.2 The leadership opted for the multi-vector foreign policy which entailed sustaining strategic relations with multiple states and balancing own and their interests. This resulted in various international organizations' active
involvement in new reforms in the country. Bigger international organizations provided support to newly established, yet underdeveloped NGOs by giving technical and financial help. To sum up, the emergence and evolution of social work and the growth of social services in welfare system were induced by number of structural and overlapping factors in the policy environment. The first is the positive and gradual change of economic context from 1990s to 2000s ; second is the shift in welfare landscape - from shrinking in 1990s to revival of welfare 2000s; the third is the new political environment and development of NGOs and finally "transnationalization of social policy and the engagement of transnational actors in the national policy reforms".
Research questions: To what extent the case management approach is integrated in the social service provision in Kazakhstan? How are the social services applied in Kazakhstan? Effectiveness and Treatment? What are the main approaches in addressing social work with teenagers and children in Kazakhstan? What are the main challenges for the modernization of social work reforms in Kazakhstan?
Social work in Kazakhstan; First stage (2010 - 2013): "normative legal acts were developed, according to which the transfer from provision of general rehabilitation services to provision of special social services was carried out" [6]. Second stage (2014 - 2017):"demonopolization of the social service system is ensured. Citizens are given the right to choose social service organizations and implemented the principle of co-financing of costs by the recipients of services"[6] . Third stage (2018-2021):"in order to increase the availability of social services, it was planned to conduct deinstitutionalization of the existing large boarding schools, to expand the network of small-scale organizations, to introduce monetization of some of the services provided, and to ensure information support for the system" [6].
Main Achievements. Demarcation and systematization of the number of social services created and supplied on free basis by the state can be considered as an achievement. These special social services include general socio-psychological, socio-legal, social and socio-economic, socio-medical, and socio-educational services. As a result of structuralizing efforts, "standards for the provision of special social services had been developed that determine the scope, quality and timing of the provided services and the necessary labor and financial resources to provide them" (In 2009, the Standard for the provision of special social services for children with disabilities with psychoneurological diseases was introduced; in 2010 - the Standard for people with these types of diseases older than 18 years; in 2011 - the Standards for children with musculoskeletal disorders and elderly Age, in 2012 - for persons with no fixed abode; in 2016 - for human trafficking victims; since 2017 - for domestic abuse victims) [6]. Meanwhile, with the support provided by the Kazakh Academy of Nutrition and based on their recommendations, additional nutrition was added along with improving pharmaceutical and logistical backing. (In 2009, the Standard for the provision of special social services for children with disabilities with psychoneurological diseases was introduced; in 2010 - the Standard for people with these types of diseases older than 18 years; in 2011 - the Standards for children with musculoskeletal disorders and elderly Age, in 2012 - for persons with no fixed abode; in 2016 - for human trafficking victims; since 2017 - for domestic abuse victims). [6]. As a result of execution of institutional reforms, new forms of social services were created in addition to increasing the general availability of services. According to report, "back in 2008, about 2.5 thousand children were in residential homes for children with psychoneurological diseases, and 2 thousand children were waiting to enroll into such homes. Currently more than 50 day-patient hospitals have opened on the basis of 110 functioning in-patient residential care facilities that cover more than 5 thousand children and persons over 18 years old with their services. The number of social home health care units has increased by more than 1.5 times. Today they serve about 43.7 thousand elderly and disabled people, and more than 13 thousand children with disabilities; about 3 thousand children with disabilities receive services in a semi-permanent and home environment in non-governmental organizations that received a social services commissioning ". The realization and provision of social services touched upon largely the private sector leading to development of the volunteer movements. It is highlighted, "As a result, those in need of social services have the opportunity to choose social service organizations depending on services provision terms." The reform and development of social services led to empowerment of family tradition, for example, more than 600 children deprived of parental care and who were allocated previously in care homes, were reunited with their parents or families creating a potential for total restoration of important functions.1 They also still receive support of day care units. Moreover, the reform also helped to solve the problem of parents' unemployment. In addition to it, the financing system has been altered, "Until 2009, specialized agencies were not funded on the basis of standard costs, but according to the cost estimate". The amount of financial support and funds vary in accordance with the regional
differences and each location's budget capacity. One of the examples provided is "for example, the cost of services provided in residential care homes for people with psychoneurological diseases ranged from KZT 1,164 in Mangistau region to KZT 3,781 in the city ofAstana".
The stark regional differences were eliminated by balancing the funding - the budget is managed by providing special social services based on the number of receivers, type and scope of services. This enabled expansion of rights for special institutions by improving their planning and making the distribution of state-provided resources more target-specific.
Another development was the introduction of co-financing of the social services by clients themselves. This change takes into account the income differences of social service beneficiaries and provides options. For instance, "starting on January 1, 2016, 70% of pensions and benefits of persons fully supported by the state in residential care homes are channeled to cover the costs of their rehabilitation. However, it was established that the amount of pensions remaining with clients should not be less than the minimum pension, and not lower than the cost of living for people with disabilities" [6].
Furthermore, the quality of social services were increased by changing and enlarging the number of social institutions' workers. Previously, social work sphere was mostly populated by teachers and junior medical workers, whereas gradually the staff grew to include special social work consultants and social workers who can evaluate and assess the level of services provided.
Challenges
The application principle dominates in the social services delivery field, which means that most of the time the citizens who proactively applied to receive social assistance could get it, while others who do not. Considerable number of citizens might be in need of social help, but if they do not apply for it, it is not available to them.
Moreover, this application principle presumes that a person is already in a challenging situation to turn for social assistance, which increases the amount of efforts needed to tackle the situation and provide solutions. This highlights absence of a prevention element as if the situation is addressed in its early stage of progression, it can significantly lessen the negative trends which might develop due to deficiency of timely actions. As a result, according to report, "In a number of cases, this generates the dependency of individual consumers of social services and results in preservation of social problems and difficult situations in a family".
Significant difficulties with accessing services and their low quality are still persistent issues, especially in remotely located areas and villages. The distribution of social service organizations and workers is not even across the country, as major cities and regional centers account for 71% of all the social assistance centers available. It is also noted that disproportionate number of social care receivers, or 48.7% live in such remote rural areas, where they mainly receive help through home-based social service structures. Further issue with such setting is that these social facilities ensure only first time adjustment of disabled people to their context while further social integration and development are not ensured. It is proposed "to take measures aimed at further expanding the institutional base of the system, categorizing service recipients depending on their individual capabilities and reinforcing targeted orientation of the provided services".
Another significant challenge that can be pointed out is the issues in tariffication system. The tariffication system of special social services vary based on a type of organization that provides them and the conditions set. For example, as a result of such inconsistencies, services provided by inpatient medico-social organizations are more expensive than identical services offered by other organization which can provide only partly permanent or home setting care. Additionally, tariffs is not the most precise tool for assessing the costs incurred by organizations as it does not necessarily indicate actual costs. The possible reasons are : "On the one hand, this is due to the fact that the mechanisms for the revision of tariffs are not provided for in the regulatory structure, and on the other hand, to the lack of an automated system for monitoring and accounting for the costs incurred by an organization in providing certain types of special social services". Consequently, this order of settings discourage participation of private, semi-permanent or home-based services.
Conclusion and Recommendations
The results of the research based on the methods of interviews and observations of the Center of Adaptation have demonstrated that the general work of the Center doesn't employ the technology of case management as their approach. Rather the center is a temporary location for children and teenagers at risk due to the problems of their families. Despite the wide range of activities which seek to improve the psychological state of teenagers and children observations showed that children are attached to their families regardless of their situation. This demonstrates that addressing the families
based on their individual needs and based on the peculiarity of their situation should be viewed as a potential solution. This is what is central to the case management approach.
Another important point which should be underlined in the context of the present paper is that overall quality assurance criteria which together with case management includes gate-keeping, supervision and referral components are in the integration process as well in Kazakhstan. And it can be easily claimed that all criteria face same challenges in the context of Kazakhstan. Therefore, this study can also shed light on the potential challenges which can correlate with other criterion.
As has been mentioned earlier in the paper there is lack of legal framework for the case management to develop in Kazakhstan. Apart from the lack of the research on this particular topic, the area of social work in Kazakhstan in general is in the process of reformation and transition. It is stated that "embedded in the contradictory and shifting policy environment, social work evolves in a fragmentary and heterogenous entity, impeded by the inter-agency and inter- sectoral divisions" [5, p. 904]. The performance and functioning of the social work is also linked to other social institutions including "family, justice, health, education, labor". In this light, all these mentioned social institutions currently are undergoing the process of the reformation and modernization in the context of the Kazakhstan 2050 Strategy policy.
Many of the ambitious reforms in the social institutions in Kazakhstan are in a process of stagnation because of the wider systemic challenges in political and socio-economic structures. Therefore, it should be kept in mind that case management technology requires synchronized and systematic interaction with other social institutions. Whether the case management technology is implemented in different areas of social work in Kazakhstan it is questionable whether it will bring the expected results. The cases of the successful solution of the cases presented in the literature review section were achieved due to the availability of the resources, time, and experts. And it might be couple of cases in a wide range of others. The successful practice of case management technology is by all means can bring positive contribution but it requires organization and system what seems rather unattainable currently in Kazakhstan. Another important thing to remember is that case management technology was created in the socio political realities of the Western countries. When applying it in the countries in transition like Kazakhstan, many factors which affect the decision making and social interaction locally should be paid attention.
An example of the SOS villages in Kazakhstan show at glance how some internal issues put a significant constraint on the proper functioning of the social organization.
Taking into account the limitations described in the methodological section, the results of the present study cannot be generalized to the whole Kazakhstan. Besides, the results cannot be applied to the whole social work performance in Kazakhstan. The social work is not bounded only by the centers taken as a case study which work with teenagers and children. Also because of the lack of the literature on the social services provision in different areas, it is challenging to draw concrete conclusions and based on that propose certain recommendations.
A positive view, maybe a hopeful one, of the improvement of case administration could be a move from a care framework which is benefit commanded in a progression of vertical pecking orders to one that is customer centered. Be that as it may, this will require perceiving the scope of levels at which change is required, exact detail of the issues which must be beaten, the speculation of significant administrative exertion and duty into a territory prominent by its need in examination with administrations for kids, arrangement of the assets required for staff, arranging and preparing and an ability to reconsider completely some long standing propensities, practices and methods of association. On the off chance that hierarchical latency, and agreeable redefinition of old practices into new dialect consolidate with lacking assets, at that point case administration may in five years time be viewed so far another of those arrangements which were not able convey the particularly critical changes in group mind which we as a whole perceive are required.
Another recommendations would include
- Getting close with that key material, which institutions posses about the family, gathering of extra information about administrations of intrigue marvels, structures and highlights of the course of procedures.
- Development of proper hypo-postulations (suppositions) about interior instruments also, the reasons for the atypical advancement process based on the synthesis of all information about family.
- Guaranteeing the conditions vital for confirmation of theories made (during the time spent shaping relational associations with the customer for trust and blunt discussion about socially negative parts of life).
- Making a comprehensive socio-mental model, in which the outcomes got from the speculation testing of individual features and components of patho-development of the family.
- Look for chances to utilize theoretical models by and by, that is, during the time spent cooperation with relatives, activity on them.
- "optimization of the social services methodology with the application of new approaches to the administration of social services and alternative forms of social services;
- formation of professional staff on the basis of continuous professional training and an independent qualification assessment system» [7].
The following are the strategies to employ based on the case management technology when considering children at the risk of separation according to the USAID recommendations [8].There are both system and individual oriented ones. The following are strategies to improve the very foundation (entry points).
References
1. "Social Work Best Practice Healthcare Case Management Standards". [Electronic resource]. URL: http://www.sswlhc.org/docs/swbest-practices.pdf. / (date of access: 15.06.2018).
2. "NASW Standards for Social Work Case Management". (2013). National Association of Social Workers. p. 15 Accessed from https://www.socialworkers.org/LinkClick.aspx?fileticket=acrzqmEfhlo%3D&portalid=0
3. Доклад о положении детей в Республике Казахстан (2013) Министерство образования и науки Республики Казахстан Комитет по охране прав детей.
4. Grebneva, I. (2006). Social work development in Kazakhstan. A ladder to a healthier nation. International Social Work, 49(6), 819-823.
5. Sofiya An (2017) 'Social work of boundaries': emerging multiple socialwork fields in post-Soviet Eurasia, European Journal of Social Work, 20:6, 894-906, DOI: 10.1080/13691457.2017.1320532
6. Concept of further modernization of social services system (2017). Ministry of Labor and Social Protection of the Republic of Kazakhstan. [Electronic resource]. URL: http://www.kswf.kz/programm/en/koncept.pdf/ (date of access: 15.06.2018).
7. Lebedeva, N. (2016). Case study: a method of learning in the system of additional professional training of social workers. Ученые записки СпбГИПСР, 1 (25).
8. Case management toolkit: a user's guide for strengthening case management services in child welfare (2014). USAID. [Electronic resource]. URL: http://www.iss-usa.org/uploads/File/Case%20Management%20Toolkit.pdf/ (date of access: 15.06.2018).
