Fundamentals of Case Management Practice Skills For The Human Services 5th Edition Ebook PDF

Fundamentals of Case Management
Practice: Skills for the Human Services

5th Edition, (Ebook PDF)
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Reality Check 123
How Clients Are Discouraged 124
A Further Understanding of Boundaries 127
Seeing Yourself and the Client as Completely Separate Individuals 127
Erecting Detrimental Boundaries 129
Transference and Countertransference 129
Summary 130
Exercises I: Demonstrating Warmth, Genuineness, and Empathy 131
Exercises II: Recognizing the Difference—Encouragement
or Discouragement 136
Exercises III: Blurred Boundaries 136
Chapter 6 Clarifying Who Owns the Problem 139

Introduction 139
Boundaries and Power 140
If the Client Owns the Problem 141
If You Own the Problem 143
If You Both Own the Problem 144
Summary 145
Exercises I: Who Owns the Problem? 145
Exercises II: Making the Strategic Decision 147
Section 3 Effective Communication
Chapter 7 Identifying Good Responses and Poor Responses 149

Introduction 149
Communication Is a Process 150
Twelve Roadblocks to Communication 151
Useful Responses 156
Summary 164
Exercises: Identifying Roadblocks 165
Chapter 8 Listening and Responding 169

Introduction 169
Defining Reflective Listening 170
Responding to Feelings 170
Responding to Content 174
Positive Reasons for Reflective Listening 176
Points to Remember 177
Summary 178
Exercises I: How Many Feelings Can You Name? 179
Exercises II: Finding the Right Feeling 179
Exercises III: Reflective Listening 180
Chapter 9 Asking Questions 187

Introduction 187
When Questions Are Important 187
Closed Questions 188
Open Questions 189
vi Contents
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Questions That Make the Other Person Feel
Uncomfortable 190
A Formula for Asking Open Questions 192
Summary 195
Exercises I: What Is Wrong with These Questions? 195
Exercises II: Which Question Is Better? 197
Exercises III: Opening Closed Questions 198
Exercises IV: Try Asking Questions 200
Chapter 10 Bringing Up Difficult Issues 203

Introduction 203
Confrontation 203
Exchanging Views 204
When to Initiate an Exchange of Views 204
Using I-Messages to Initiate an Exchange of Views 207
Asking Permission to Share Ideas 213
Advocacy: Confronting Collaterals 214
On Not Becoming Overbearing 215
Follow-up 217
Summary 217
Exercises I: What Is Wrong Here? 217
Exercise II: Constructing a Better Response 219
Exercises III: Expressing Your Concern 219
Exercises IV: Expressing a Stronger Message 222
Chapter 11 Addressing and Disarming Anger 225

Introduction 225
Common Reasons for Anger 225
Why Disarming Anger Is Important 226
Avoiding the Number-One Mistake 227
Erroneous Expectations for Perfect Communication:
Another Reality Check 228
The Four-Step Process 229
What You Do Not Want to Do 231
Look for Useful Information 233
Safety in the Workplace 233
The Importance of Staff Behavior 234
Summary 235
Exercises I: Initial Responses to Anger 235
Exercises II: Practicing Disarming 236
Chapter 12 Collaborating with People for Change 239

Introduction 239
What Is Change? 239
Stages of Change 240
Understanding Ambivalence and Resistance 244
Encouragement 247
Recovery Tools 250
Communication Skills That Facilitate Change 252
Contents
vii
Trapping the Client 258
From Adversarial to Collaborative 258
Summary 262
Exercises: Helping People Change 263
Chapter 13 Case Management Principles: Optional Review 265

Introduction 265
Combining Skills and Attitudes 265
Practice 267
Exercise I 267
Exercise II 268
Exercise III 271
Exercise IV 273
Exercise V 274
Section 4 Meeting Clients and Assessing

Their Strengths and Needs
Chapter 14 Documenting Initial Inquiries 277

Introduction 277
Walk-ins 278
Guidelines for Filling Out Forms 278
Steps for Filling Out the New Referral
or Inquiry Form 278
Evaluating the Client’s Motivation
and Mood 282
Steps for Preparing the Verification of Appointment Form 282
Summary 284
Exercises I: Intake of a Middle-Aged Adult 284
Exercises II: Intake of a Child 284
Exercises III: Intake of an Infirm, Older Person 285
Chapter 15 The First Interview 287

Introduction 287
Your Role 288
The Client’s Understanding 288
Preparing for the First Interview 288
Your Office 290
Meeting the Client 290
Summary 295
Chapter 16 Social Histories and Assessment Forms 297

Introduction 297
What Is a Social History? 298
Layout of the Social History 298
How to Ask What You Need to Know 299
Who Took the Social History 306
Social Histories in Other Settings 310
Writing Brief Social Histories 311
viii Contents
Using an Assessment Form 314
Taking Social Histories on a Computer 316
Taking Social Histories in the Home 316
The Next Step 317
Summary 317
Exercises I: Practice with Social Histories 318
Exercises II: Assessment of a Middle-Aged Adult 318
Exercises III: Assessment of a Child 319
Exercises IV: Assessment of an Infirm, Older Person 320
Exercises V: Creating a File 320
Chapter 17 Using the DSM 321

Introduction 321
Is DSM Only a Mental Health Tool? 322
Cautions 322
Who Makes the Diagnosis? 323
Background Information 323
The DSM-IV-TR 327
DSM 5, the Current Diagnostic Manual 328
Making the Code Using DSM 5 330
Multiple Diagnoses 331
Other Conditions That May Be a Focus
of Clinical Attention 332
When the Diagnosis Does Not Quite Fit 332
When There Is No Number 333
Summary 333
Exercises: Using the DSM 5 334
Chapter 18 The Mental Status Examination 337

Introduction 337
Observing the Client 338
Mental Status Examination Outline 339
Summary 356
Exercises: Using the MSE Vocabulary 356
Chapter 19 Receiving and Releasing Information 359

Introduction 359
Sending for Information 359
If You Release Information 359
Directions for Using Release Forms 360
Examples of the Release Forms 362
When the Client Wants You to Release Information 363
When the Material Is Received 363
Other Issues Related to Releasing Information 365
Summary 365
Exercises I: Send for Information Related to a
Middle-Aged Adult 366
Exercises II: Send for Information Related to a Child 366
Exercises III: Send for Information Related to a Frail,
Older Person 366
Exercises IV: Maintaining Your Charts 366
Contents
ix
Section 5 Developing a Plan with the Client
Chapter 20 Developing a Service Plan at the Case Management Unit 367

Introduction 367
Involving the Client and the Family 368
Using the Assessment 369
Creating the Treatment or Service Plan 372
How to Identify the Client’s Strengths 373
Individualized Planning 374
Understanding Barriers 375
Sample Goal Plan 375
Summary 376
Exercises: Broad General Goal Planning 377
Exercise I: Planning for a Middle-Aged Adult 377
Exercise II: Planning for a Child 377
Exercise III: Planning for an Infirm, Older Person 377
Exercise IV: Maintaining Your Charts 377
Exercise V: Checking Services 378
Chapter 21 Preparing for a Service Planning Conference or

Disposition Planning Meeting 379
Introduction 379
What You Will Need to Bring to the Meeting 380
Goals for the Meeting 380
Benefits of Conference Planning 381
Collaboration 382
Preparing to Present Your Case 383
Making the Presentation 383
Sample Presentation 384
Follow-Up to Meeting 385
Summary 385
Exercises: Planning 386
Exercise I: Developing a Service Directory 386
Exercise II: A Simulated Planning Meeting 386
Chapter 22 Making the Referral and Assembling the Record 387

Introduction 387
Determining Dates 388
Sample Referral Notification Form 389
The Face Sheet 390
Summary 392
Exercises: Assembling the Record 393
Chapter 23 Documentation and Recording 395

Introduction 395
The Importance of Documentation 396
Writing Contact Notes 396
Labeling the Contact 398
Documenting Service Monitoring 398
Documentation: Best Practice 399
Government Requirements 402
Do Not Be Judgmental 402
x Contents
Distinguish Between Facts and Impressions 403
Give a Balanced Picture of the Person 404
Provide Evidence of Agreement 404
Making Changes to the Plan 404
Summary 404
Exercises: Recording Your Meeting with the Client 405
Exercise I: Recording Client Contacts 405
Exercise II: Using Government Guidelines to Correct Errors 411
Exercise III: Spotting Recording Errors 411
Section 6 Monitoring Services and Following the Client
Chapter 24 Monitoring the Services or Treatment 413

Introduction 413
What Is Monitoring? 414
The Financial Purpose of Monitoring 414
Follow-Up 416
Collaboration with Other Agencies 416
Advocating 417
Leave the Office 418
Responding to a Crisis 419
Summary 420
Chapter 25 Developing Goals and Objectives at

the Provider Agency 421
Introduction 421
Client Participation/Collaboration 422
Make Objectives Manageable 423
Expect Positive Outcomes 423
Objectives 425
Combining Goals and Treatment Objectives 426
Finishing Touches 428
Review Dates 429
Vocabulary 430
Summary 432
Exercises: Developing Goals and Objectives 432
Exercise I 432
Exercise II 433
Exercise III 434
Exercise IV 436
Exercise V 437
Chapter 26 Terminating the Case 439

Introduction 439
A Successful Termination 440
The Discharge Summary 443
Examples 444
Summary 447
Exercises I: Termination of a Middle-Aged Adult 448
Exercises II: Termination of a Child 448
Exercises III: Termination of a Frail, Older Person 448
Exercises IV: Organizing the Record 448
Contents
xi
Appendix A Ten Fundamental Components of Recovery 449
Appendix B Vocabulary of Emotions 451
Appendix C Wildwood Case Management Unit Forms 454
Appendix D Prochaska and DiClemente’s Stages of Change Model 487
Appendix E Work Samples 490
Appendix F Grading the Final Files 496
Appendix G Information for Understanding DSM IV TR Diagnoses 499
Appendix H Case Manager’s Toolbox 506
References 515
Index 518
xii Contents
Preface
In a small nonprofit agency handling cases of domestic violence, a woman answers the
phone. She assesses the caller’s concerns, accurately notes the caller’s ambivalence on
the inquiry record, and readily connects the caller to the person most able to assist.
In a mental health case management unit a new worker listens with interest to
the other case managers, the psychologist, and the psychiatrist discuss the possible
diagnosis for a new client of the agency. The worker is able to understand the conver-
sation as the group talks about the DSM IV TR diagnosis and the new DSM 5 diagnosis.
Down the street a young man acting as a case manager in a substance abuse
detox center handles intake calls from physicians’ offices. He competently notes the
main concerns for incoming patients and asks the questions he knows will give him
information that doctors and therapists will need later as they work with these new
admissions. His notes are clear and useful.
How long did it take these people to acquire these skills? Did they acquire this
ability well after being hired in a social service agency, or did they arrive able to handle
case management tasks competently?
Purpose
For me and for students, the issue has been how we can teach the social services skills
that will promote their walking from the classroom into the social service setting with
confidence. How can we be assured that students, often steeped in sound theoretical
knowledge, will be able to fill out an inquiry form or make a referral effectively?
It is important to teach these practical skills. In addition, it is important to equip
students with the vocabulary and methods used by more advanced professionals in the
human service field so that upon entering the field students are prepared to engage in
meaningful discussions around client issues. Although entry-level individuals would
not usually give a DSM diagnosis, it is useful for individuals entering the field to be
knowledgeable about what such a diagnosis is and what is meant by an Axis I or Axis II
diagnosis or how diagnoses are given using DSM 5. In this way, conversations among
professionals will not be misunderstood.
Today individuals with a sparse education or with recent college degrees are find-
ing themselves thrust immediately into roles for which they have had little formal
training. It is crucial, therefore, to find a method for teaching the actual human service
experience at the entry level. Fundamentals of Case Management Practice: Skills for the
Human Services, fifth edition, seeks to provide that experience in a thorough, step-by-
step process that leads the reader from intake through monitoring to termination.
Preface
xiii
New in the Fifth Edition
New material has been added to this fifth edition to bring the textbook up to date.
Added to this edition:
• Current terms are used throughout
• Information on the DSM 5 and how entry level individuals can use this
• Recent changes to HIPAA
• Expanded Appendices to include material helpful in completing exercises in the
text, a safety planning tool and a case manager’s tool box with information to
assist in assessment and disposition.
• A clear look at case management as a process
• A discussion of how the size of a caseload affects service
• Ethical considerations for those working in the field of substance abuse
• A discussion of the differences among moral, ethical, and legal behavior and how
violations are addressed
• More information on the importance of mandated reporting
• Expanded treatment of the ecological model
• Broader section on empathy and more recent findings on empathy
• An extensive feelings list in the appendix for use in various exercises
• Differences between confrontation and an exchange of points of view
• Enhanced discussion of motivational interviewing and why this is useful
• More detail on the significance of the first interview
• There are fewer chapters as some material has been combined in single chapters
In addition, a considerable number of smaller items and changes specifically request-
ed by our reviewers were added to the textbook.
Fundamentals for Practice with High Risk Populations (Summers, 2002) has been
published as an adjunct to this text, giving students information and scenarios on
populations in which they are interested or with whom they intend to work. Chapters
cover topics such as case management with children and their families, survivors of
rape and violence, older people, issues with drug and alcohol dependence, and men-
tal illness and developmental disabilities. Each chapter features information about
specific populations and provides exercises and intake forms. This textbook also con-
tains a set of forms that can be copied (see Appendix C). These forms can be found
on CengageBrain. Taken from actual social service settings, they give the reader an
opportunity to practice accuracy and skill in handling social service forms and records
and in organizing information.
If you do not wish to cover all of the populations discussed in the text on high-risk
populations and instead want to focus on specific populations, you can order individual
chapters from Fundamentals for Practice with High Risk Populations (Summers, 2002). Please
visit http://www.textchoice2.com/ to view chapters online and to build your custom text.
You can pick chapters about specific populations and create individualized booklets that
you can bundle with this text. If you would like more information about custom options,
please contact your local customer service representative. You can locate your representa-
tive by using our rep finder at http://custom.cengage.com/.
xiv Preface
Format
For each chapter in the textbook, basic information is laid out, followed in most chap-
ters by many exercises that prompt the reader to handle real issues and practice real
skills. Each of the chapters on case management describes one of the case manage-
ment responsibilities followed by exercises to practice applying the information. As
readers progress through the text, they gradually assemble files on specific cases. Stu-
dents can create and monitor believable fictional clients using one of the high-risk
populations discussed in Fundamentals for Practice with High Risk Populations (Sum-
mers, 2002). Classroom discussions about these cases and the best disposition for each
of them are not unlike the discussions that occur every day in a variety of social ser-
vice settings.
Organization of the Textbook

The organization of the textbook follows a logical progression, beginning with the
most basic foundation for good practice, moving to discussions on attitudes, followed
by how the student will talk to others effectively. The second half of the book fol-
lows a similar process, beginning with the person’s first contact with the agency and
the assessment and planning process through all the case management procedures to
termination.
In Part One, “Foundations for Best Practice in Case Management,” readers are
introduced to important foundation pieces for this field. A definition of case manage-
ment and how it is central to social services, ethics and ethical issues, and the impor-
tance of the ecological model in assessment and planning give readers an introduction
to professional basics.
In Part Two, “Useful Clarifications and Attitudes,” readers are invited to exam-
ine what in their thinking will impede effective helping in the social service setting.
Beginning with issues of cultural diversity and moving to the role of personal attitudes
and boundaries, this part concludes with information and exercises related to deter-
mining who owns the problem. Each chapter in this part contains exercises encourag-
ing readers to examine realistically their own attitudes and judgments.
Part Three, “Effective Communication,” begins by introducing the reader to
good and poor responses, with exercises that help students see the c onsequences
of poor communication. Chapters on listening and responding, asking questions,
bringing up difficult issues, responding to emotions, confronting problematic

behavior, and disarming anger are included. Included is a chapter that gives an
expanded examination of some of the techniques and ideas related to motivational
interviewing. The section ends with a chapter on the effective application of what
students have just learned and exercises designed to have students practice all the
communication skills in order to smooth out the communication and allow it to b
ecome
natural and responsive.
In Part Four, “Meeting Clients and Assessing Their Strengths and Needs,”
readers begin to take inquiries for services. Forms are provided that ask for basic
Preface
xv
information, teaching the student what is important to find out in that first call. This
section also includes a chapter on preparing for the first interview, helping the reader
become sensitive to issues that clients might have at a first meeting. A chapter on
social histories and assessment forms teaches students how to use these to assemble
relevant information. Introductions to the DSM and to the mental status examination
allow the reader to become familiar with the vocabulary and the information most
important to other professionals in the human service field. Students are encouraged
to begin noting how a person seems to them at the time of contact. The chapters and
classroom discussions will help students pin down what is important to note. In this
section, readers also practice completing release of information forms for the clients
they have developed in the classroom setting, mastering which records are useful and
which are not.
Part Five, “Developing a Plan with the Client,” allows readers to further develop
a plan for those clients for whom they have created phone inquiries. Here, individually
or in planning teams, according to the instructor’s process, students develop realistic
plans for their clients. A chapter is included instructing students on how to prepare for
and participate in team planning. In the final chapters, students refer cases to provid-
ers of services and learn about documentation and recording.
Part Six, “Monitoring Services and Following the Client,” is the final section,
and the section begins with a chapter on monitoring services and treatment. Students
switch to the role of a worker in the agency of a provider of service and take the gen-
eral goals given them by case managers and develop specific goals and objectives to be
accomplished within stipulated time lines. Here students learn how to develop attain-
able goals for their clients. In this part, readers also learn the importance of monitoring
cases from a case management perspective and how to terminate the case. Numerous
documentation exercises provide opportunities for students to begin writing profes-
sional notes and keeping good records.
Supplements Accompanying This Text

Cengage Learning Testing, powered by Cognero Cognero is a flexible, online sys-
tem that allows you to author, edit, and manage test bank content as well as create
multiple test versions in an instant. You can deliver tests from your school’s learning
management system, your classroom, or wherever you want.
Online Instructor’s Manual The instructor’s manual contains a variety of resources
to aid instructors in preparing and presenting text material in a manner that meets
their personal preferences and course needs. It presents chapter-by-chapter sugges-
tions and resources to enhance and facilitate learning.
Online PowerPoint® These vibrant Microsoft PowerPoint® lecture slides for each
chapter assist you with your lecture by providing concept coverage using images, fig-
ures, and tables directly from the textbook.
xvi Preface
MindTap MindTap for Counseling engages and empowers students to produce
their best work—consistently. By seamlessly integrating course material with videos,
activities, apps, and much more, MindTap creates a unique learning path that fosters
increased comprehension and efficiency.
For students:
• MindTap delivers real-world relevance with activities and assignments that
help students build critical thinking and analytic skills that will transfer to other
courses and their professional lives.
• MindTap helps students stay organized and efficient with a single destination
that reflects what’s important to the instructor, along with the tools students
need to master the content.
• MindTap empowers and motivates students with information that shows where
they stand at all times—both individually and compared to the highest performers
in class.
Additionally, for instructors, MindTap allows you to:
• Control what content students see and when they see it with a learning path that
can be used as-is or matched to your syllabus exactly.
• Create a unique learning path of relevant readings and multimedia activities that
move students up the learning taxonomy from basic knowledge and comprehen-
sion to analysis, application, and critical thinking.
• Integrate your own content into the MindTap Reader using your own documents
or pulling from sources like RSS feeds, YouTube videos, websites, GoogleDocs,
and more.
• Use powerful analytics and reports that provide a snapshot of class progress, time
in course, engagement, and completion.
In addition to the benefits of the platform, MindTap for Counseling offers:
• Video clips tied to the learning outcomes and content of specific chapters.
• Activities to introduce and engage students with each chapter’s key concepts.
• Interactive exercises and in-platform discussion questions to provide direct,
hands-on experiences for students of various learning styles.
• Review and reflection activities to demonstrate growth and a mastering of skills
as students progress through the course.
Helping Professions Learning Center Designed to help you bridge the gap be-
tween coursework and practice, the Helping Professions Learning Center offers a
centralized online resource that allows you to build your skills and gain even more
confidence and familiarity with the principles that govern the life of the helping pro-
fessional. The interactive site consists of five learning components: video activities
organized by curriculum area and accompanied by critical thinking questions; ethics,
diversity, and theory-based case studies; flashcards and practice quizzes; a professional
development center; and a research and writing center.
Preface
xvii
To the Students
It is always a challenge to know what skills and information you will need on the first
day of your first job. Even when you are already working in the field and managing
many of the tasks well, you often do not know for certain why agencies choose to do
things one way as opposed to another. This textbook seeks to empower you to func-
tion competently and to know why you are proceeding or should be proceeding with
clients in a particular way.
In Fundamentals of Case Management Practice, you will follow a specific series of
steps, beginning with what you are thinking and how to incorporate ethics into your
thinking in client–worker relationships, continuing through your communication with
clients, and ending with your putting together hypothetical case files and managing
those hypothetical cases.
Throughout the course you will find yourself in discussions with others about
possible treatment or service plans or the dynamics of a person’s situation. Use these
discussions to learn more about collaboration and to increase your ability to participate
in the same sort of discussions in the agency where you will work.
Many students have taken this textbook to work with them and have found it
both useful and realistic. Students have contributed their experiences on the job to
make this textbook replicate as nearly as possible the issues and concerns you will
encounter in your work with other people.
Further, in developing your hypothetical clients, you may want to refer to Fun-
damentals for Practice with High Risk Populations (Summers, 2002). In that textbook, six
populations commonly served by social services, such as those associated with domestic
violence, substance abuse, or mental health issues, are detailed so that you will be very
familiar with their issues and likely problems. It is also possible to purchase individual
chapters from that textbook on the population or populations that interest you. Each
chapter will give you information on common problems, diagnoses, medications, treat-
ments, and other considerations such as legal issues or common medical problems each
specific population often experiences. See the instructions on how to order specific
chapters in the earlier section of this Preface titled “New in the Fifth Edition.”
To the Instructor: Suggestions for

Using This Text
This text can be used to take students step-by-step through the case management
process outside of the often harried and pressured atmosphere of a real social service
agency. When the student is ultimately confronted with the actual situation, the rou-
tine and expectations will not be new. Chapters are broken down into each step in the
case management process. Readers progress according to their skill levels, finally cre-
ating cases and caseloads with you acting as the supervisor, much as a supervisor would
act in an actual agency. Without the urgency, you will have time to let students look up
xviii Preface
information, discuss possible diagnoses, and develop sound interventions under your
guidance. For example, exercises on the DSM and on the mental status examination
have a number of possible answers. Your discussion with your students, similar to the
discussions that take place in agencies about these possibilities, is more important
than the actual answers that are chosen.
Most chapters include exercises to help students practice their skills. Often
several versions of the same exercise are provided. It is useful to students to begin
in small groups to address the issues posed in the exercises. Their discussions and
the ideas and concerns they bring back to the larger class are consistent with discus-
sions held in social service agencies. Later, versions of the exercises can be used as
tests, or you can go back to them at a later time to make sure students continue to
practice their skills.
It is extremely worthwhile for students to apply the skills described in this book
to specific populations. To do this, you can use this book in conjunction with my other
book, Fundamentals for Practice with High Risk Populations (Summers, 2002). After stu-
dents have read the chapters on the specific populations you have assigned or on those
that are most interesting to them, they can create a fictional “typical” client that they
can then walk through all the exercises from intake to termination. Case notes would
reflect the common problems encountered by the population, and intake would de-
scribe a common reason for seeking services among people in this population. This
gives students a good beginning look at how cases come in and unfold while clients
are receiving services.
Details on six high-risk populations are provided in Fundamentals for Practice
with High Risk Populations (Summers, 2002). A detailed chapter on children and their
families gives students information on how to include others involved in the child’s
life and how to coordinate all the various entities with whom the family interacts.
Another chapter focuses on domestic violence and rape, including how these issues
affect children.
A third chapter looks at substance abuse and includes the common social and
medical issues that arise for this population. This chapter also includes the com-
mon challenges this population presents to case managers and gives tips for how to
handle these. Mental health and intellectual disabilities each are featured in chap-
ters, giving common problems and issues, diagnoses, and treatments. Finally, there
is a chapter focusing on aging that includes both medical and social issues for this
population. All the chapters include an assessment form for that population taken
from actual agencies that work with that population, and all the chapters give the
most typical diagnoses and medications used with each population. Where a popula-
tion has special considerations the student should know, these are included as well.
For example, in the chapter dealing with issues most likely to affect women, there
is a discussion of how women’s programs and agencies differ in their approach to cli-
ents from other social service agencies. To order specific chapters related to specific
populations, see instructions in the earlier section of this Preface titled “New in the
Fifth Edition.”
Preface
xix
Benefits and Advantages
This material has been used in my own classroom for 30 years and has been updated
to meet current social service trends and changes. Students have commented that
using this text is like walking from the classroom into the social service setting with
very little lost time in learning the actual process. Instructors teaching the practicum
course have used the word empowered when describing what this text has done to give
students confidence and skill in their first encounter with a social service position.
Employers as well often contact me to say how well prepared students are who have
used this textbook.
Three positive features of this textbook make it especially useful in preparing
students to work in this field:
1. The text gives very basic information a person needs to handle each of the tasks
described. Theoretical information can be found in many other places, and thus
the concentration and focus are on what is important to note, think about, docu-
ment, and pass on in each step of the human service process.
2. Numerous exercises create very real situations for students to consider and han-
dle. These exercises are based on real experiences taken from my 23 years of
practice in human services and from the experiences of many others who gra-
ciously contributed to this book. Doing the exercises and participating in the
classroom discussions that follow will expose students to an extremely broad
range of possible circumstances and difficulties in the field.
3. The book contains forms that give students an opportunity to practice compil-
ing information at various times throughout the management of the case. These
forms can be copied and used to create files on clients developed by the stu-
dents. Using each form a number of times gives students practice in preparation
for real clients in real social service settings.
These features, when taken together, create a nearly realistic social service setting in
the classroom, giving the instructor many opportunities to strengthen student skills
and sensitivity.
In addition, Fundamentals for Practice with High Risk Populations (Summers, 2002)
supports students with applicable details and considerable information on various at-
risk populations. This textbook acts as a reference so that the hypothetical clients
students develop are real with entirely likely problems. Students can use the material
found in this supplemental textbook to develop realistic clients, create useful service
plans, and make appropriate referrals.
Acknowledgments
As with each edition of this textbook, I could not write such a realistic work without
the wonderful help of the staff at the Dauphin County Case Management Unit.
Always ready to give their time and support, they have answered important questions,
clarified new national policies, and brought enthusiasm to the writing of this book.
xx Preface
I particularly want to acknowledge the help of Mathew Kopechny, former Executive
Director who went out of his way to see that I had access to what I needed to make this
textbook current. I am grateful for the time and useful examples provided by Michelle
Beahm, who allowed me to shadow her for the preparation for this edition. In addition,
I want to express my gratitude to Kim Castle, clerical supervisor, who has worked with
me on each edition of this book to clarify issues and give me details I might otherwise
have missed. Just knowing she was there to help made writing this book much easier.
Thanks go as well to Joel Smith, intake case manager, who graciously allowed me to
observe an intake with a client during my time observing at the Dauphin County Case
Management Unit.
I am particularly indebted to Charles Curie, MA, ACSW who has always
given time to discuss issues related to the textbook. He headed the Pennsylvania
Office of Mental Health and Substance Abuse Services, making Pennsylvania a
leader in innovative services and procedures. Appointed by President Bush to
head the Substance Abuse and Mental Health Services Administration (SAMHSA)
he instituted state-of-the art prevention and treatment ideas nationally. His support of
this textbook has ensured the teaching of best practices.
At the Dauphin County Executive Commission on Drugs, Alcohol and
Tobacco, I want to thank John Sponeybarger for his help in formulating realistic
plans and services. I am grateful to the late Ruby Porr for her ideas based on her
work as a service provider and to Aimee Bollinger Smith, Karen Polite, Wendy
Bratina, and Carol R einertsen who use this textbook and had teaching suggestions
for additions to the text.
I deeply appreciate the support and information my husband, Martin Yespy, con-
tributed to this work. His unfailing assistance and encouragement of these textbooks
and the useful material and information he brought from the field of crisis intervention
have enhanced this work.
I especially want to thank my editor, Julie Martinez, who has given me support,
guidance, and a good dose of humor when needed. She has always been there when
I needed help and her advice greatly enhanced this work.
The two students, Danica Zirkle and Keyanna Watkins, who organized and then
participated in the videos deserve considerable gratitude for all the work they did to
keep everyone on track. The students who participated in the vignettes, w riting and
rehearsing their work also deserve my gratitude for all their hard work. They are
Catherine Wrighstone, Tom Moulfair, Sean Taney, Michele Anthony, and Alison Kilgore.
Many thanks to Michelle Beahm again for participating in the videos and giving her
ideas to make the vignettes more realistic. Brian Peterson and his crew from Motion
Masters provided considerable direction and made the filming smooth and effortless.
My thanks to all of them for the time they spent with us.
Preface
xxi
I would also like to thank the reviewers of this textbook for their very helpful
comments:
Susan M. Scully-Hill,
Assumption College
Barry Yvonne,
John Tyler Community College
Paula Gelber Dromi,
California State University, Los Angeles
Alyssa Forcehimes,
University of New Mexico
Monte Gray,
Bronx Community College
Karen Guerrieri,
Kent State University, Salem
Richard Jenks,
Tillamook Bay Community College
Lee Ann Rawlins,
University of Tennessee
Their ideas and suggestions greatly strengthened this work.
xxii Preface
C h a p t e r 1
Case Management: Definition
and Responsibilities
Introduction
Case management is one of the primary places in human service systems where the
whole person is taken into account. Unlike specific services, case management does
not focus on just one problem but rather on the many strengths, needs, and personal
concerns a person brings.
For example, an elderly person may be referred to Help Ministries for a voucher
for fuel oil because it has been unusually cold and the elderly person has been unable
to pay for the additional oil needed to warm his home adequately. In this case, Help
Ministries is concerned with his fuel oil need and the warmth he will need to stay in
his home during the winter. That is their only concern with regard to this man.
The case manager, on the other hand, is concerned with the person’s need for
fuel oil, with his desire to move into public housing for the elderly in the spring, with
what resources he has among his children, with his recent slurred speech indicating
a possible stroke, and with his need for meals-on-wheels. The case manager is aware
that there is a neighbor who can look in on him daily, that the man has ties to a church,
and that he receives Social Security but little other income. She knows he has a sense
of humor, goes to bingo once a month, and should be fitted for a cane.
Case management is a process for assessing the individual’s total situation and
addressing the needs and problems found in that assessment. As a part of this pro-
cess, the person’s strengths and interests are used to improve the overall situation
wherever possible. The primary purpose for case management is to improve the qual-
ity of life for your client. This might mean more comfortable or safer living arrange-
ments, or it might require psychiatric care or medication for diabetes. Another major
purpose of this activity is to prevent problems from growing worse and costing more to
Chapter 1 Case Management: Definition and Responsibilities 1
remedy in the future. In the situation of the elderly man just described, we find that
the meals-on-wheels program will deliver a certain standard of good nutrition, pre-
venting malnutrition and costly medical bills in the future. By getting the man a cane,
we may be preventing falls that would shorten his life and cost much more in medi-
cal bills to repair his injuries. If we enlist the neighbor to look in on our client every
day, we have provided a link between the man and his neighborhood. In addition, the
neighbor can alert us to small problems that require our attention. In this way we have
foreseen possible difficulties and taken steps to prevent them.
A History of Case Management

In the late 1800s, a formal attempt was made to organize the delivery of services to
people in need. Initially the Charity Organization Society took control of this approach,
making the collecting of information and the delivery of services more systematic. In
the course of its work, the society developed casework as a useful method for tracking
needs, progress, and changes in each case. As people had more needs and problems
beyond poverty, the need to coordinate these services became important to prevent
duplication. Casework also was employed as a means of tracking and using scarce
resources to the best advantage. In the 1960s, the process of deinstitutionalization
meant that individuals once housed in institutions were now placed in communities
where they needed considerable support to live more independent lives; as a result,
casework became ever more important for a larger number of people.
In the 1980s, the term caseworker evolved into the term case manager, and these
managers took on greater responsibility for managing resources, finding innovative
supports, and coordinating services. Agencies began to use case management as a pro-
cedure to assess needs, to find ways to meet those needs, and to follow people as they
used those services. In addition to keeping an eye on how scarce resources were spent,
case managers were charged with taking a more holistic approach to their clients,
looking at all their needs rather than addressing only those that brought the person
in for assistance. As part of this charge came the directive to develop individualized
plans, plans constructed specifically for that person and not a cookie-cutter approach
to supplying services.
Today case managers are seen as a significant service in almost all social service
settings and are viewed as the most important way to prevent relapse, track clients’
needs, and support progress toward good health.
Language in Social Services

Language in the social services is a funny thing. After a word is adopted to describe
people who use a service, that word becomes pejorative over time and a new word
meaning the same thing is sought. In social services, we have gone from labeling peo-
ple patient (which implied people seeking services were all sick in some way) to client
and finally to consumer.
2 Section 1 Foundations for Best Practice in Case Management
Client was meant to denote that the person was being served by a case manager
in a relationship much like a lawyer–client relationship. This originally conferred an
obligation on the part of the case manager to give good service to someone paying,
in some manner, for that service. However, as with all words describing people who
use social services, the word client developed a negative connotation and the word
consumer was increasingly used instead. Consumer also implied the person was paying
for good services from the case manager.
With the Recovery Model (Appendix A) developed by the Substance Abuse
and Mental Health Services Administration (SAMHSA) and the emphasis on partner-
ships between case managers and the people seeking services, those words are no
longer considered appropriate. The concern is that these words denote a difference
in status between case manager and those they serve. Thus, in recent years, the terms
client and consumer have given way to person or individual, and in many cases no term is
used but rather the person’s name is used instead.
In this textbook, we subscribe to the idea that case managers and the people
they serve are in a partnership to which each brings a certain degree of expertise. In
your work, we strongly encourage you to drop the use of the words consumer and client
and adopt what is seen as the more respectful terms of individual and person.
However, having said that, there are places in this textbook where using person
and individual alters the meaning of the sentence and the point that is being made.
For that reason, in this textbook, we need to use client to denote a person seeking
professional services from a professional case manager in order for the point to make
sense. This is in no way meant to diminish the person who does seek service, but
rather to make our points more coherent.
Why We Use Case Management

Case management serves two purposes. First, it is a method for determining an
individualized service plan for each person and monitoring that plan to be sure it is
effective. Second, it is a process used to ensure that the money being spent for the
person’s services is being spent wisely and in the most efficient manner.
The money you oversee in consumer care may be public money, such as the
money that comes from the state to a county to administer mental health services or
substance abuse treatment. It may be money that is provided by insurance compa-
nies for services to a policyholder. It may be money provided directly to an agency
from either of these sources for the care of a client. Sometimes organizations, such
as United Way, divide the money they have raised among various community agen-
cies. These organizations then employ case managers to make certain the most
effective use is made of that money. It is therefore the case manager who deter-
mines what is needed and how to prevent needs and problems from e scalating.
It is the case manager who, in collaboration with the consumer, determines what
services should be authorized with the existing money. It is the case manager who
then follows the consumer and the consumer’s services and treatment to keep the
plan on track.
Case management is more than looking out for another entity’s money. It is also
the most efficient way to make certain a person receives the most individualized plan
for service and treatment possible. To ensure that this will be done, case management
responsibilities have been broken into four basic categories of service: assessment,
planning, linking, and monitoring. These four activities constitute the case manage-
ment process. Let’s look at these categories in the order in which they are usually
accomplished when working with a person.
Case Management as a Process

Assessment
The first case management task is assessment. A good assessment is the foundation
for understanding the problem and informing and guiding the treatment and ser-
vices. Therefore, it must be done with care. This is an initial assessment, meant to
be comprehensive and thorough. For that reason, it covers many different aspects of
the person’s life in an attempt to develop an accurate profile of the individual and the
individual’s problem.
There are several kinds of assessments. In some cases you will be asked to do a
social history (see Chapter 16). Here you ask a series of questions, and as the person
answers, you construct a written narrative. Social histories usually have a number of
elements that you are to assess, and each is given a subheading within the narrative.
For example, current medical condition, living arrangements, relationships, and work
experience are all important. In another kind of assessment, you may be given an
intake assessment form that lists all the questions you are to ask and gives you a place
to note the answer. Each of these assessment procedures attempts to be comprehen-
sive. Each seeks to assemble a considerable amount of material about the person and
his or her problem.
The first thing the case manager does is assess the initial or presenting problem.
Why did this person come into the agency, and what is the person asking for? Here
case managers look at the extent to which problems have interfered with clients’ abil-
ities to function and care for themselves. Does this problem interfere with work or
with relationships? It is especially important to note the background of the problem,
how long it has gone on, and how it started. In addition, the reasons the person is
seeking help now are important.
Case managers include an opinion about what possible problems might arise for
this person in the future and what plan might be put into effect with the person to
prevent these problems. Your opinions about potential future problems are formed as
you listen to consumers describe their situations. Will the individual be likely to be
around people who encourage him to drink? Does she have a medical problem that
needs attention because it exacerbates her depression?
A discussion of the problem uncovers the person’s needs and how he or she
views those needs. Case managers look at the overall situation and consider what that
person needs to bring stability and resolution to his or her life and problem. Are there
needs that can be addressed that will relieve the problem, or at least alleviate it to
some extent?
In every assessment with an individual, you will begin to learn what strengths
the person has that you and he may draw upon to resolve the current problem. Does
your client have an advanced degree, a particularly supportive family, a number of
friends, a sympathetic boss, a particular skill? An assessment should never be just
about the person’s problems, but should also include the strengths the person brings
to the problems and the strengths you see in the person’s environment.
As you take the information from the consumer, you are, through your observa-
tions, also evaluating the person’s ability to think clearly and to understand options,
and the person’s general mood. You are seeking to understand the extent to which the
person understands the origin of their problems. Chapter 18 discusses in more detail
something called the mental status examination. This is not a series of questions but
rather your astute observations of the individual during the interview.
At the end of your assessment document, you will be asked to express your
assessment and recommendations. Here you will summarize briefly the problem and
the person’s ability to handle the problem, noting the person’s strengths and needs.
Then you will give your own recommendations for service or treatment. Recommen-
dations are generally worked out with the consumer as you learn what it is the person
is seeking and share with that person what you have to offer.
To summarize, in an assessment you are exploring and evaluating the following:
1. The initial problem and the background to that problem
2. The person’s current situation
3. The person’s background in areas such as education, relationships, work history,
legal history
4. What the person needs to make life more stable and to resolve the current
problem
5. The strengths, including those the person brings to the problem and those in the
person’s environment that would be useful in resolving the situation
6. Observations about how well the person functions cognitively and any seeming
mental problems you have noted
7. Recommendations for a service or treatment plan for the person
A good assessment is the foundation for the development of an individual plan
for service or treatment. It delineates what essential services should be provided
for individualized treatment. The assessment also establishes a baseline detailing
where the person was when he or she entered services and against which you can
measure progress.
Planning
After the assessment, you will be expected to develop an initial plan with the client
that is comprehensive and addresses all the issues raised in your assessment. This
plan should show incremental steps toward improvement and expected outcomes.
As a case manager, you cannot plan well with the person unless you are thoroughly
aware of the services, social activities, and resources in your community.
Formal Agencies Every community has social service agencies that serve specific
needs. The best case managers seem to know all the good places to send people for
the services those people need. Some communities and counties have more services
than others, but in most locations, agencies are serving children and their families,
older adults, individuals with substance abuse problems, individuals on probation,
women in abusive or rape situations, and individuals with mental illness or intellectual
disabilities. Generally, case managers need to learn about other services as well, and
the information and phone numbers for these services should be readily available to
you when you practice. You will want to gradually develop contacts in these places so
that your referrals are smooth and problems are quickly handled.
Begin by knowing what formal agencies are out there to help with a particular
issue. For instance, if your client has a mental health problem, you might refer him
to an agency that specializes in mental health treatment. The staff at that agency is
familiar with medications, diagnoses, and treatment alternatives for mental health
problems. Another individual may be elderly and in need of protective services
because you suspect she is being physically abused by her family. You would refer
her to a specific agency that offers protective services to older people. A third person
may have intermittent problems with substance abuse and need services from an
office where there is an intensive outpatient treatment program in the evenings.
Knowing the agencies in your community and the formal services they offer is a
good foundation.
Generic Resources Good planning is not limited to formal agencies, however.

Learn about resources that are available for common problems we all have. Not every
problem a person with an intellectual disability has will need to be treated by agen-
cies set up exclusively for individuals with intellectual disabilities. For example, a
woman with an intellectual disability, grieving the death of her mother, was welcomed
into a grief support group at the local church and given much support. In another
example, a child with academic problems in school was referred to the free tutoring at
a local church. An older person who needs more social contacts might be referred to a
senior center where many older people go for social and recreational opportunities. In
the previous examples, the older person suffering abuse may also need the services of
your local district attorney, and the person with a substance abuse issue might need
medical care from a general practitioner and a public defender for pending charges
of disorderly conduct. These are all services anyone can use. Knowing how to access
them for your clients is important.
Support Groups and Educational Seminars Other resources often overlooked

are support groups and educational seminars. For example, you may have referred the
family of a child you are working with to formal family therapy sessions. In addition,
you would look at support groups where parents dealing with similar problems can get
together to support each other. Further, you might find a workshop on parenting skills
that would greatly benefit this family, and you would tell them about the w orkshop
and strongly encourage them to attend. A man on probation might benefit from a
workshop for job readiness or a support group for ex-offenders attempting to make
significant life changes. A woman who is struggling with years of sexual and physical
abuse might benefit from a support group of other women facing similar issues.
These resources augment your own efforts and those of formal services and give
consumers additional support and information. Often they are free or at very little
cost. What your clients gain from their experiences in such groups reinforces the other
services you are arranging.
Peer Support A relatively recent trend is to use peer support wherein a former client
who is doing well is hired by an agency to support others on the road to recovery and
life changes. It might be individuals who were able to turn their lives around after a
period in juvenile detention and now are supporting others coming out of juvenile
detention to do the same thing. It might be someone who has had a mental illness
and is now helping others who are recovering from their own mental illness. And, of
course, in substance abuse, Alcoholics Anonymous (AA) has always used that model
of one person in AA helping another. The idea is based on the fact that not all profes-
sionals know what it is like to experience some problems firsthand. The peer support
person is able to say he has been there and can show another how to resolve the issues
with firsthand practical information.
Individuals whose functioning is impaired might benefit from a peer support
person who can help them function better educationally, socially, or vocationally and
may even become involved in helping them with issues of self-care. Much like case
management, the peer support person ascertains that the consumer will accept peer
support and then works with that person to set realistic and meaningful goals the two
can approach together. Good peer support helps people formulate the small action
steps needed to move toward the goals the two have identified together, and the peer
support person can be there with advice and ideas if the action step doesn’t work very
well. As a case manager, you will use peer support when a person needs more sus-
tained time than you can give, and the support will significantly help the person move
toward recovery.
Informal Resources and Social Support Systems You will also want to be
aware of social activities your clients might enjoy that would keep them involved in
their communities. Perhaps one person likes to work on models and could become a
member of the model railroaders club. Perhaps another genuinely likes people and
enjoys being with them. This person might do well as a member of the Jaycees.
People do better living in a community in which they have healthy social
support systems. A social support system refers to the kinds of supports most of us
have in our communities such as Lions Club, a church, or volunteering on specific
community projects. All of us need to feel we are a part of the place where we live,
but many people do not have the skills to interact with others and find useful activi-
ties on their own. As a case manager, it is your responsibility to integrate your con-
sumer into the community if this is a need. Find social clubs, churches, and groups
that pursue similar interests, and help your client make contact with those people.
The more contacts the person has and the more useful activities the person engages
in, the more support the community can give.
A particularly touching example of the use of informal social supports occurred
in a small town in which the firehouse was located just around the corner from a group
home for five older men with mental health problems. They had been institutional-
ized for most of their lives, spent years on medication, and had the common long-term
side effects that can develop. One of the men, Nick, wanted to be a fireman, so the
case manager connected this man to the fire company around the corner. The men
at the firehouse made Nick a part of their everyday routine. Nick helped roll hoses,
swept floors, and took his meals with the men. Nick was included in meetings and
made decisions about the dinner menu. He became such a part of the fire company
that when he died suddenly of cardiac complications the men were deeply saddened.
As a tribute to Nick on the day of his funeral, the procession from the funeral home
to the cemetery was led by a number of fire trucks, beginning with the trucks from
Nick’s home station and including some from neighboring communities. This was
an excellent example of using social supports to give a person a valued place in his
community and a sense of doing something worthwhile.
Case managers often fail to use these valuable informal resources for several
reasons. They may feel that their client cannot handle being with ordinary people in
ordinary settings. This is often based on the case manager’s attitude about the per-
son’s disability and is often quite erroneous. Having consumers in small numbers in
social activities or organizations that give them an opportunity to practice strengths
is an invaluable experience for everyone concerned. Another reason a case manager
might be reluctant to place a consumer in a community social group might stem from
the case manager’s perception that people in such groups do not want to be bothered
with people who have disabilities. In some cases, this assessment is correct, but in
others it is quite the opposite. Many organizations are set up to provide service and
perceive this as an opportunity to grow and serve the community.
Doing your homework pays off. You cannot rely on suppositions and specula-
tions. Know what is available in your community and have places in mind that would
serve your consumers as the need arises. Meet people and talk to them about what
you would like to have available for your clients. Gradually, you will develop a list
of people and places that welcome your clients and provide the specific experiences
and support you are seeking. Your task is to have many resources you can use at your
fingertips when developing plans for your clients and to continually be developing
new ones in your community.
Creating an Individualized Plan After you have worked with people to determine
where the problems are and what areas need attention, you will also know about the
supports and other resources people have in the community and among their family
members and friends. You will know what they do well and what interests them most.
Each person will be different.
As you go about designing the plan with the person, you will place in that plan
elements that take advantage of the client’s strengths and supports. In addition, you will
address those problems most outstanding or immediate for that client. Each person has
a different set of strengths, life circumstances, immediate problems, and personal goals.
No two people view their situations in exactly the same way, so no two plans will be
exactly alike. Each plan will be developed specifically for that individual client.
At one time, a small program for homeless women employed a part-time case
manager for the children. Homeless women were given 2 years’ residence in apart-
ments belonging to the program to work hard on getting an education or training,
and a stable source of income. Many of them were distracted from this by concerns
about their children. Still others had little time to think about what their children
needed as they went about restructuring their lives. The county social services
department gave the shelter a small stipend to hire a children’s case manager. The
shelter hired a young woman who had just graduated from college. This seemed
like an ideal choice. She was energetic, related well to the children, and was genu-
inely concerned about each of them. In the next year, the program monitor from
the county noticed two things. First, there seemed to be very little material on the
children in any records. No individual plans could be found, and no assessments
on each child a ppeared to have been done. Second, the children were all following
much the same plan. All the girls attended gymnastics; all the boys were enrolled
in Little League. On certain weekends, all the children, regardless of their age or
interests, went to the zoo or to the circus.
After receiving repeated requests for individualized plans for each child
and some guidance about how to create them, the case manager quit. She said, on
departing, that she did not have time to sit and write up records, that the children had
been “having fun,” and that the county was unreasonable. The county became more
involved in hiring the second case manager, and this person was well aware of the
importance of individualized planning.
In the first 6 months, two children began to get orthodontic work done, one
received a scholarship to a private school, four boys went to Little League, one took
violin lessons, and a third joined the swim team at the YMCA. Most of the younger
children went to the circus and to the zoo. Most of the older children went on a bus
trip to Washington, D.C., and half of them went to two symphony orchestra perfor-
mances that winter. No child’s plan was the same as that of another child. Each child’s
needs had been documented and addressed in some way, and each child’s strengths
and interests were brought into play as the plans were developed.
In developing these plans, the case manager called all her contacts in the
community. She asked two dentists to donate their time. She prevailed upon the
symphony to give her the tickets for two performances. She went to a private school
and talked to them about this particularly gifted child until a plan for financing the
child’s education was worked out. She found a violin teacher and asked for 15 free
lessons as a gift to the shelter. In churches, mosques, and synagogues, she got people
enthused about helping the children whose mothers were working so hard to put a
stable life together for their families. She looked at scout troops, church youth groups,
and organized sports for possible answers to the children’s needs. In any number of
cases, the plan simply involved the case manager helping an older child choose from
among school activities and arranging transportation.
This is what is meant by individualized planning. When it is done well and done
creatively, your clients can grow and thrive.
Continued Assessment and Continued Planning In continued assessment

and planning, as you follow the case, you will take into account changes the person
may face. An example will illustrate this kind of planning, which you may be called
upon to provide. Mary Beth has an intellectual disability and was assigned to you
when she left a state-run institution for individuals with intellectual disabilities.
When you did the intake assessment and planning, you determined that she would
do better initially in a sheltered living arrangement for about a year. Because the
goal is for her to move to an apartment of her own at the end of the year, your plan-
ning should start well in advance of this move. This planning makes the transition
easier for her and for you. There are no shocks and sudden surprises that might
necessitate her need for hospitalization or a regression back to greater dependence
on the agency.
You might begin by setting up services and activities with Mary Beth that
involve her in her community. Mary Beth told you when you first talked to her
of her interest in singing. The people at the institution said she loved music and
sang well, although she could not read music. At the time Mary Beth came out of
the institution, you could not find a good place for her to use her musical interests,
but you noted this as a strength and kept your eyes open for an appropriate link.
Now you have found a choir director at a small church who is willing to have Mary
Beth sing with her choir. The church has numerous activities, and there are mem-
bers who see to it that Mary Beth is included. In this way, you begin to prepare
her for a move to more independent living. You seek and find a place for her to
live not too far from the church, and you work with interested members to ensure
that Mary Beth will have their continued help with transportation and inclusion in
church activities.
You may think it best that Mary Beth has other social ties to her community as
well. There is the Aurora Club, created by professionals just for people with some
intellectual disabilities. This club is a place to go and meet others; and the club takes
trips, goes bowling, and goes out to dinner together. You could refer her there; how-
ever, you might decide that Mary Beth’s mild disability does not warrant her being
limited to social activities only for individuals with intellectual disabilities. Instead,
you might develop a relationship with a local women’s club, getting them to take
Mary Beth as a member.
As Mary Beth makes an adjustment to being outside the institution, you look
for a job placement. You make a referral to Goodwill, where she is able to develop her
social skills, and soon she is hired by a local Wal-Mart as a greeter. All the while Mary
Beth is away from the institution, you are meeting with her, assessing her progress
toward independence, and planning for her to take a little more personal responsibility.
By the time Mary Beth moves into an apartment of her own, she has gained new
confidence and many friends who connect her to the community. Her success is due
in large measure to both your wise initial plan and your modifications of the plan as
Mary Beth grew more independent.
Linking
Linking is the general term we use to mean connecting clients to people or agencies
where they will receive the help or service they need. Once the plan is drawn up, the
case manager links the person to the service, activity, organization or club, or people
who will carry out the plan. When we connect the person to a formal agency we make
a referral (see chapter 22) but, as noted before, we will link people to more than just
formal agencies. Linking a client to a specific service requires care and skill on your
part. You need to know the best service that will meet the individual issues and needs
of your client.
Linking your client to a social service agency that provides a specific service—
such as day treatment, drug rehabilitation, or groups for victims of violent crime—will
require a written referral. You will state why you are making the referral, indicating
the problem for which the referral is being made, and the goal that you expect as
a result of your client’s contact with the agency. The referral will also indicate the
amount of time you estimate it will take for the agency to reach this goal. The time
limit is very important. It keeps treatment from becoming endless and unstructured.
With a goal and a set amount of time in which to attain that goal, both the agency and
the client are more likely to make the most of their time together.
Sometimes people can take advantage of services on their own. You might tell a
client about the Aurora Club, for example, and the next week he may take a bus there
and begin going to the club regularly, participating in activities and social events. At
other times, you may have clients who are unable to take the first step and who will
need you to accompany them or to arrange transportation for them.
In a formal social service agency, personnel at that agency will be able to support
your clients in their programs and implement the goals and work on the issues you
and your clients have identified as important. Some agencies with very fine programs
or specialized services are small, which may require you to give more support to your
client. For example, at New Start, a staff of three focuses on second-stage groups for
victims of rape and domestic violence, and much of the work is done by volunteers.
The success rate is excellent, and clients report a high degree of satisfaction with the
agency. However, the small staff is not equipped to handle other problems that might
develop while your client is in their group. If you refer a client to a group at New Start
and your client has landlord problems between group sessions, the staff at New
Start may not be aware of it in time to prevent an eviction notice. Even if they become
aware of the notice, they will need to refer the client to you to resolve the matter be-
cause of the limited staff time available to clients. On the other hand, at Riverview,
a day-treatment program, nurses are aware of medication problems, social workers
monitor progress toward goals, and staff can work to prevent eviction of a client, if that
appears imminent.
On occasion you may find a service for your client at an agency that does not
seem interested in serving her. Perhaps they are reluctant because your client has
been ill recently or because the agency is not interested in her type of problem. The
agency may accept the client into service with them to fill all their slots and draw down
payment for services, but in reality they may give poor or no services. In such instances,
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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Fundamentals of Case Management

Practice: Skills for the Human Services

Chapter 6 Clarifying Who Owns the Problem 139

Section 3 Effective Communication

Chapter 7 Identifying Good Responses and Poor Responses 149

Chapter 8 Listening and Responding 169

Chapter 9 Asking Questions 187

Chapter 10 Bringing Up Difficult Issues 203

Chapter 11 Addressing and Disarming Anger 225

Chapter 12 Collaborating with People for Change 239

Chapter 13 Case Management Principles: Optional Review 265

Section 4 Meeting Clients and Assessing

Chapter 14 Documenting Initial Inquiries 277

Chapter 15 The First Interview 287

Chapter 16 Social Histories and Assessment Forms 297

Chapter 17 Using the DSM 321

Chapter 18 The Mental Status Examination 337

Chapter 19 Receiving and Releasing Information 359

Chapter 20 Developing a Service Plan at the Case Management Unit 367

Chapter 21 Preparing for a Service Planning Conference or

Chapter 22 Making the Referral and Assembling the Record 387

Chapter 23 Documentation and Recording 395

Section 6 Monitoring Services and Following the Client

Chapter 24 Monitoring the Services or Treatment 413

Chapter 25 Developing Goals and Objectives at

Chapter 26 Terminating the Case 439

Appendix B Vocabulary of Emotions 451

Appendix C Wildwood Case Management Unit Forms 454

Appendix D Prochaska and DiClemente’s Stages of Change Model 487

Appendix E Work Samples 490

Appendix F Grading the Final Files 496

Appendix G Information for Understanding DSM IV TR Diagnoses 499

Appendix H Case Manager’s Toolbox 506

Organization of the Textbook

Supplements Accompanying This Text

To the Instructor: Suggestions for

Chapter 1 Case Management: Definition and Responsibilities 1

A History of Case Management

Language in Social Services

2 Section 1 Foundations for Best Practice in Case Management

Why We Use Case Management

Chapter 1 Case Management: Definition and Responsibilities 3

Case Management as a Process

4 Section 1 Foundations for Best Practice in Case Management

Chapter 1 Case Management: Definition and Responsibilities 5

Generic Resources Good planning is not limited to formal agencies, however.

Support Groups and Educational Seminars Other resources often overlooked

6 Section 1 Foundations for Best Practice in Case Management

Chapter 1 Case Management: Definition and Responsibilities 7

8 Section 1 Foundations for Best Practice in Case Management

Chapter 1 Case Management: Definition and Responsibilities 9

Continued Assessment and Continued Planning In continued assessment

10 Section 1 Foundations for Best Practice in Case Management

Chapter 1 Case Management: Definition and Responsibilities 11

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

Section 4 Meeting Clients and Assessing

Chapter 21 Preparing for a Service Planning Conference or

Chapter 25 Developing Goals and Objectives at

Chapter 1 Case Management: Definition and Responsibilities 1

Chapter 1 Case Management: Definition and Responsibilities 3

Chapter 1 Case Management: Definition and Responsibilities 5

Chapter 1 Case Management: Definition and Responsibilities 7

Chapter 1 Case Management: Definition and Responsibilities 9

Chapter 1 Case Management: Definition and Responsibilities 11