The role of case management for counselors in general, and rehabilitation counselors in particular, has grown and changed over the last 30 years. Federal and state legislation have continuously affected how we practice and serve people with disabilities. First, it is important to understand that counselors are not case managers. Case management is one of the many tasks we perform. Unfortunately, those outside the field, even some inside the field, refer to counselors, even more often for rehabilitation counselors, as case managers. This diminishes the understanding of our practice. Because the importance of case management has grown as a task we perform, it has become identified with who we are instead of something important we do. I certainly cringe every time someone calls me or a colleague or one of my students a “case manager.” I find myself invested in correcting the comment and pressing for them to understand I am a counselor, a rehabilitation counselor, a person clinically trained to serve people with disabilities as a rehabilitation counselor.

It’s a Task – Not an Identity

Case management is an essential task for rehabilitation counselors and programs serving people with disabilities. It is reflected at three levels: how we manage individual services for the people we serve, how we manage our entire caseload, and how the program we work for tracks performance. For a rehabilitation counselor to be effective, all three levels must be efficiently managed. The individual needs of our consumer must be managed and tracked. This means we keep an accurate record of what we have provided and what we plan to do moving forward with our consumer. My first supervisor repeatedly told me, “If it is not documented in the record, it didn’t happen. If it is not in the plan, it can’t happen.” As part of our service, we need to serve several consumers at the same time. In the public sector this can mean more than 100 participants on our caseload. In the private sector it may mean fewer consumers, but they require more intensive services at a faster pace. For the agency or program that we work for, the total record of the program’s service determines their resources and future opportunities. The record of performance is required in federal monitoring for state agencies and in potential contracts or third-party payment for private sector partners (both for-profit and not-for-profit organizations). Regardless of where we work, effective case management is critical to our participant’s success, our professional success, and our organizations success.

Historical Changes in Our Practice

We all remember the stories from our parents or grandparents about how they walked up hill in the snow both ways, to and from school. When I began as a counselor over 45 years ago, recording case notes to track what I had done was much easier. We had a three-ring binder that we hand wrote notes in and then regularly moved those notes to a paper chart. Frankly, minimal thought went into those notes. We just wanted to get them completed each day. It mattered that they were in the record, but it didn’t seem to matter how much was recorded. We just needed reviewers to know that we had done something. This has obviously changed. We continued to use paper files, but over time these records had greater meaning. We moved from handwritten notes to a partnership with a secretary. We had a Dictaphone and left our tapes with them at the end of each day. We dictated actions between sessions with our consumers. If we had a plan or a report, we had a dictated format we used. Usually within one or two days the notes and reports would show up in our in-box for signatures and then back to the outbox where the secretary would pick them up and file them. We were not required to type anything. We were not required to file anything. Someone in the agency, usually a manager, was required to track performance and complete reporting to whichever agency or partner required the information. As a counselor, we did not have to spend much time thinking about performance issues (yes, we were held accountable for applications, plans and closures, but someone else tracked it; if we were in the private sector someone tracked what we had done for payment). We were focused entirely on counseling our consumer and did not feel responsible for the other distractions of case management. We may or may not have had budgets to help make decisions. When we look back, we often speak about our ability to focus entirely on counseling and our consumers.

Although there was some movement toward electronic case management systems in the late 1980’s, it began in earnest in the 1990’s. This impacted the role of the counselor and the secretary in the process. Federal monitoring, accreditation requirements for programs, and licensure requirements for counselors all increased the expectations for more detailed tracking of what happened with the participants we served. Typing skills became an essential skill for counselors and secretary’s roles were changed to technicians or assistants in the process. Counselors began to spend more of their time in front of a computer and less time with their consumers. Over time counselors have reported spending 40-60 percent of their time in front of computers, more time in meetings with management about performance, more meetings with partners, all of which resulted in less time with the people they serve. If you speak with counselors today, regardless of setting (schools, mental health, substance abuse, private and public rehabilitation), they all agree they are spending too much time with computers and not enough time with consumers. The complaint is they want to be counselors, not data entry experts.

Where Do the Expectations Come From – Does it Matter?

So why does any of this matter? Case management is an essential function for successful rehabilitation counseling. Every five years or so, the Council on Rehabilitation Counselor Certification (CRCC) completes a role and function study. Case management tasks are always near the top of the list for successful expected counselor performance. What has changed to make this such a high priority? Congressional regulation and monitoring by the Rehabilitation Services Administration have driven increased performance accountability to assure effective use of federal resources. Accreditation bodies such as the Council on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission on Accreditation of Healthcare Organizations (JACHO), and the Council on Accreditation of Counseling and Related Educational Programs (CACREP) drive expectations for performance measures and required measurable case management activities. State licensure boards and certification boards such as CRCC, the National Council on Counselor Certification (NCCC), and the National Certification Commission for Addiction Counselors (NCC AC) set case management standards for practicing counselors. Each of the above groups have an expectation of reviewing records and counting performance to determine if quality services have been provided.

One of my graduate students recently asked me if VR should be entirely about data; shouldn’t it be about making a difference for people? My response was no, it’s not just about data, but without good data, it won’t matter to funding and regulatory agencies. If we can’t count what we do and report it accurately, we can’t exist. In the end we will not matter. Numbers represent service. Numbers represent the difference we make. Numbers represent jobs and independence. It has also been my experience that if we count things and require reporting, they actually happen. Another important part of this equation is the push for better, higher quality jobs, with higher levels of service since the passage of the Workforce Innovation and Opportunities Action (WIOA). The Rehabilitation Services Administration has really encouraged, frankly pushed aggressively, for high quality placements, increased credential attainment and educational gains, and assuring that every single consumer receives effective counseling and guidance. As part of my current work, I have reviewed every monitoring report since 2016. The above themes appear consistently in almost every report. My conclusion for my student was that we can overcome the pressures of data and case management activities by focusing on quality counseling and improved services and then telling that story. The story is what matters, and it is represented in the case management record. Federal leadership wants us focused on counseling and guidance, improved services and high-quality employment. Our ability to tell that story assures the future of our practice.

Case Manager or Counselor?

The challenge for each of us is how do we see our role? Are we a case manager who simply refers consumers to other providers and purchase services? If so, we really are more of an insurance adjuster writing checks for services. Or do we see ourselves as rehabilitation counselors? Do we create meaningful relationships and understand the person we serve? Do we assure informed consumer choice and an effective partnership to plan for independence and quality employment? Do we see ourselves as difference makers? Do we tell the consumer’s story in a way that matters? Another challenge that effects our image is the shortage of rehabilitation counselors. Many states have had to resort to hiring people with bachelor’s degrees or from other fields to fill positions. How are they trained, in the adjuster model or the counselor model? As qualified counselors who practice alongside these new practitioners who are new to the field, not trained at the master’s degree level, can we influence their perception of being a rehabilitation counselor? Can we reflect the need to be counselors who happen to do case management as part of their work?

How Can We Get More Counseling Time?

All of this is ultimately to get to the point, “How can we make case management more efficient and get back more time for counseling the people we serve?” The data matters. The numbers matter. What we record and how we plan matters. How we manage our caseloads so that everyone is served matters. The story we tell in the record matters. No matter how uncomfortable we are with using case management systems, being effective with case management means we have more time to be counselors.

I agree with many counselors; I hate computer time instead of consumer time and counseling. Having said this, what do I do to get more counseling time. First, I make sure that I value my role as a rehabilitation counselor, and I stress the difference I make when I get to do effective counseling. Second, I look at how I write notes, plans, and reports. I have supervised thousands of counselors over the last 45 years. By far the thing I see most often is that everything we write is way too long. We inlcude to much unnecessary information in almost everything we write. We must learn to be more precise and only include essential information; the information that gets counted; the information that makes the story clear. I have seen too many case notes that were two or three pages and should have been a paragraph or less. I have seen applications, intake notes, and reports that were 8-10 pages that should have been two pages or less. We must decide what is important and what is counted and only inlcude that information in what we write. The more precise we are, the more time we will get for counseling. Third, everything we write should tell an accurate story for the consumer and for the counselor’s action. If we decide to value the story and the importance of the numbers that come from the story, then we see the power of case management as a meaningful task in our work. Too often we procrastinate this type of work because we don’t like the computer time. If we see its value, we can get it quickly off our plate. Fourth, we become skilled with whatever electronic case management system we use. We need to understand how to quickly navigate the system and complete the essential fields that provide the needed information. The better we are with the system, the faster we complete tasks, the more time we have freed up to provide the counseling we want to do. Finally, if you are a leader or decision maker in the organization you have to choose effective electronic case management systems that fulfill compliance requirements for your organization and allow your counselors to spend as much time as possible with their consumers. Your system must count what needs to be counted. Numbers represent people. Numbers represent the difference your agency makes. It’s not just about the cheapest or easiest system. It is about finding the system that helps you tell your story best and creates efficiencies for your counselor.

A Clear Story Is Essential

Case management is an essential task counselors must perform. It tells our consumer’s story of success and change. It tells the story of the role of the counselor. It tells federal monitoring agencies and other regulatory organizations the story about our programs. It reflects why we matter in the end. It means more resources. It means more people become independent. It means more choice and quality employment. If we do it well, we get to be better counselors.