Summary for the Evaluation of Case Management Services

Summary for the Evaluation of Case Management Services

Audit and Evaluation Division – Veterans Affairs Canada
March 2019

Evaluation Results

1. Are VAC’s Case Management Services being provided to Veterans who require this level of support?

There is an opportunity for VAC to increase screening and case management reach for subsets of CAF Veterans and former RCMP Members with complex needs.

VAC should undertake further efforts for Veterans that do not have complex needs and are currently receiving the support of a Case Manager.

2. Are the tools available for case management effective and efficient in achieving their intended results?

Significant opportunities exist to improve the effectiveness and efficiency of Case Management tools.

Enhancements should be aimed at reaching Veterans with complex needs, reducing the administrative burden on Case Managers, and improving the achievement and associated monitoring/reporting of outcomes.

3. Can VAC’s Case Management Services be enhanced by adopting practices and professional standards utilized in other Federal Government departments?

Potential best practices/opportunities regarding tools to be considered from other Federal Government Departments.

4. Do VAC’s Case Management Services support Veterans with complex needs, including women, men and gender-diverse individuals with many identity factors (GBA+) in addressing their needs?

VAC’s Case Management Services are supporting Veterans to reduce their level of complex needs, especially for Veterans most in need (those that have a considerable need for improvement).

5. Are VAC Case Management service standards/ commitments being achieved/ appropriate?

Despite significant recruitment and staffing efforts for Case Managers, the increasing number of case managed clients has prevented VAC from achieving the 25:1 case plan ratio commitment.

The evaluation found that standards for case management should be developed to align with a client’s level of needs and complexity.

Recommendations Management Response and Action Plan
Recommendation #1: Reach

It is recommended that the Director General, Service Delivery and Program Management, work in collaboration with the Director General, Field Operations to:

A) Increase screening and case management reach for CAF Veterans and former RCMP members with complex needs.

And

B) Reduce barriers and provide additional support to further enable Case Managers to transition Veterans that do not have complex needs into a more appropriate level of support.		 A1) The Director General Service Delivery and Program Management will work in collaboration with the Director General Field Operations to:
  1. Develop new service delivery monitoring and follow-up reporting processes to support the early identification/screening of Veterans that may have complex needs based on the Veteran accessing other VAC programing/services (December 2019).
  2. Provide enhanced mental health training to Veteran Service Agents to support early identification and triaging of Veterans experiencing mental health concerns (March 2020).
A2) The Director General Service Delivery and Program Management will work in collaboration with the Director General Field Operations to increase screening and case management consideration of former RCMP members by completing the following:
  1. Increasing awareness of services available to RCMP by establishing an outreach program for RCMP / VAC (March 2020).
  2. Developing a RCMP Veteran & Family Resource page, and providing enhanced training for VAC staff to help inform of the services and benefits available (March 2020).
  3. Exploring ways for enhanced transition services to be offered to the RCMP (March 2020).
  4. Implementing new monitoring reports to ensure RCMP are being screened/reached more proportionally (March 2020).
  5. Reviewing VAC's resource requirements needed to support RCMP transition and case management services, and if required, exploring options for increased resource allocation (March 2020).
B) The Director General Service Delivery and Program Management and the Director General Field Operations will work in collaboration to reduce barriers and provide additional support to further enable Case Managers transition Veterans that do not have complex needs into a more appropriate level of support.
  1. Conducting a review of case management and rehabilitation processes, including the processes around the decision related to Diminished Earning Capacity, with aim to identify and implement changes that will streamline the process and reduce burden on case managers (March 2020).
  2. Developing a new monitoring, reporting and follow-up process to ensure Veterans are receiving a level of support that aligns with their needs (March 2020).
  3. Establishing and implementing a strategy to support the transition of low risk/low needs Case Managed Veterans to guided support services and/or targeted assistance (March 2020).
  4. Implementing a new team approach to Case Management that will result in Veterans with specific types of needs receiving service delivery support from VAC roles best suited to meet their needs, such as health professionals and/or Veteran Service Agents. If required, changes to delegated decision making authorities will be pursued to support this approach (March 2020).
  5. Conducting a qualitative research study to follow-up on the VAC National Survey results from 2017 in order to better understand the client experience of case management and inform the development of tools and processes (June 2019).
Recommendation 2: Tools

It is recommended that the Director General, Service Delivery and Program Management, work in collaboration with the Director General, Field Operations, to improve the effectiveness and efficiency of case management tools by:

A) Updating processes to have Case Managers complete a CNCI at entry/closure from Case Management and when their professional judgment deems there is a change in need/complexity level, thus eliminating the requirement to complete it every 90 days;

B) Increasing efforts to monitor the effectiveness of the new screening tool by developing/implementing performance metrics and quality management processes to assess/measure that clients are being triaged to the appropriate level of service;

C) Implementing system/tool/process improvements (over the medium-long term, next 1-3 years)		 The Director General, Service Delivery and Program Management, work in collaboration with the Director General, Field Operations, to improve the effectiveness and efficiency of case management tools by:

A) Implementing system and process changes to eliminate the need for a CM to complete a CNCI every 90 days (June 2019).

B) Developing a quality management framework for the new screening tool to ensure that Veterans are being triaged to the appropriate level of services, and implementing ongoing performance metrics to monitor the effectiveness of the new screening tool (April 2020).

C1) Leveraging the development of the client plan as part of Pension for Life to update and finalize new case plan/client plan requirements that will:
  • Align client assessments to goals/outcomes within the plan;
  • Establish domains/categories that case plan desired outcomes, actions steps, and resources can be assigned to;
  • Improve usability, including streamlining, and providing standardized options where appropriate;
  • Integrate the ongoing assessment of complexity and need directly within the Case Plan, thus eliminating the CNCI tool;
  • Provide options for information to be updated/shared through My VAC Account (where appropriate). (April 2020)
C2) Establishing an implementation strategy for the new case plan/client plan requirements, and if required, identifying/pursuing additional resource requirements (April 2020).

C3) Fully implementing a new case plan/client plan (April 2021).
Recommendation #3: Service Standards and Outcomes Measurement

It is recommended that the Director General, Service Delivery and Program Management work in collaboration with the Director General, Field Operations to:

A) Develop and implement case management standards based on the client’s levels of need and complexity;

And

B) Formalize the intended outcomes for VAC’s Case Management Services, including targets and associated monitoring.		 The Director General, Service Delivery and Program Management, work in collaboration with the Director General, Field Operations, to develop and implement case management standards based on the client's level of needs by:

A1) Conducting research and environmental scans of other federal and provincial case management service standards and models (September 2019).

A2) Developing approaches to defining client's needs and complexity (March 2020).

A3) Developing service standards, as part of the program management framework, that will meet the needs of clients and demonstrate outcomes based on the domains of well-being (March 2021).

The Director General, Service Delivery and Program Management, work in collaboration with the Director General, Field Operations, to formalize the intended outcomes for VAC's Case Management Services, including targets and associated monitoring by:

B1) Formally identifying the intended outcomes that are to be achieved by VAC's Case Management Services (supporting domains of well-being for Veterans) (March 2020).

B2) Implementing the ongoing monitoring/reporting of VAC's Case Management outcomes, including targeted performance levels (June 2020).

B3) Developing a program management (performance) framework (June 2020).

Program Description

  • VAC Case Management Services enable recipients to achieve mutually agreed upon goals through a collaborative, organized and dynamic process, coordinated by a VAC Case Manager.
  • Goals and improvements to well-being are targeted for individuals with complex needs in areas such as physical health, mental health, employment, financial, housing, social integration, life skills, etc.
  • As of March 2018, VAC was providing Case Management Services to 13,437 individuals.

About the Evaluation

Scope and Methodology:

  • Conducted in accordance with the directive and standards specified in Treasury Board of Canada’s 2016 Policy on Results.
  • Covers the time frame from April 2014 to March 2018.
  • Conducted between January 2018 and October 2018.
  • Multiple lines of evidence were used.

Constraints and Limitations:

  • Case Management is not a program, thus there is no requirement for a Program Information Profile
  • The evaluation team did not speak directly with program applicants.
  • VAC completed a National Survey of clients in 2017, however, the last survey conducted by the department was in 2010.
  • Departmental pilots and renewal projects that relate to VAC’s Case Management Services were occurring during the period of this evaluation.

Evaluation Report

Evaluation of Case Management Services (Final - March 2019)

 
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