Surviving as a Case Manager 303 of police, and an indeterminant number of people involved in facilitating and obstructing the case

management process. Many individuals were helpful, some were passive or indiferent. Several individuals did not trust the clients, the parents of the child. Some professionals believed that the child was the client, not the parents. The activity in this case reflects many of the themes described earlier in this chapter, such as the performance of multiple roles, the ability to communicate. knowledge of ethical decision making, and the ability to be flexible and patient. The case also suggests how difficult performing the role of case manager can be. It emphasizes the stressful and emotional nature of the work that can sometime leads to burnout. Ms. Fuentes, the case manager, saw her work come to a positive end. It is one of her best successes. Often she works hundreds of hours with little reward for her efforts. The skills of time management and assertiveness can provide the case manager with stability and support to counter many of the challenges of this difficult work. These are survival skills. The following section discusses the nature of burnout and describes how time management and assertiveness can prevent or alleviate it. The Prevention of Burnout Burnout was first defined by Christine Maslach (1978) as a phenomenon experienced by those who work in the human service area. Current research on burnout underscores Maslachs findings (Woodside & McClam, 2002). Those most vulnerable to burnout are people whose work in one way or another involves direct contact with different kinds of recipientswelfare clients, patients, children, prisoners. . . (Maslach. 1978, p. 56). According to Maslach. burnout is the emotional exhaustion resulting from the stress of interpersonal contact (p. 56). Professionals with case management responsibilities are particularly susceptible to burnout because many of the factors that contribute to burnout are integral to their work. Among those factors are the nature of the clients, the stresses of dealing with bureaucracy and a personal tendency to react negatively in stressed situations.
Delores Fuentes, who worked so hard to reclaim Juan for his parents, experienced many of the work characteristics that can lead to burnout. In this case, she did not react negativly On the contrary she was able to pursue her advocacy for Me and Mrs. Ruiz beyond the bounds of her agency responsibilities and across state lines.

Much of the work of case management involves clients who have very complex and longterm difficulties: children who are at risk, adults who have disabilities or are elderly, and people with medical problems, such as AIDS or cancer. In fact, modern-day case management emerged as a methodology designed to handle the overwhelming stress of serving clients with multiple problems. Case managers daily come face to face with clients who hare little hope and who often confront long-term illnessand severe social difficulties. Other case managers work with clients who demand intense services over long periods. Often, no one asks if he case manager has the time or the resources to provide the services needed.
Delores Fuentes certainly expenenced a situation that required her immediate and undivided ttention. Her

other work teas left undone. in addition, she was working in unharted waters, with a variety of professionals from other states and other international governmental agencies.

Case managers also struggle with the bureaucracy in which they work. One l)enasive difficulty is the size of caseloads. Case managers often lack sufficient time so give each client quality treatment; they must settle for services that arc adequate as best. The programs offered and she resources available often do not match clients needs. Case managers find themselves in the middleunderstanding clicnts needs all too well, yet knowing the limitations of the system. As Dciorcs Fuctitcs strue,glcd to provide a fair hearing for the parents, site found that the bureaucracy was UI equipped to handle a sit uation that involicd ,ion-U.S. citizens across state lines. Ms. Fucntcs had to forge new allianccs with agencies such as the Mexican Consulate. Certain observable symptoms related to work habits, psychological and physical tvellbeing. and relationships with clients can indicate that case managers are reacting negatively to stress. Absenteeism, tardiness, and high job turnover rates are several indicators of widespread burnout. A case manager might also have symptoms such as gastrointestinal problems. substance abuse. exhaustion, sleep disturbance, poor sell-concept, inability so concentrate, and difficulties in personal relationships. Their attitudes and working patterns may change: They become disorganized. have difficulty working with colleagues, blame clients for their own problems, and depersonalize clients by referring to them with disparaging names (Anderson, 2000; Maslach, 1978; Rohland, 2000: \Voodside & MeClam, 2002). These changes soon affect job pcrformane, and case managers can feel increasingly frustrated and worn down by their responsibilities. Burnout is a devastating problem for an agenq the case managers affected, and the clients served. Acquiring time-management and assertiveness skills can help case managers avoid burnout. Both skills allow them to be more effective case managers. Managing Time Time manageir ent is particularly important for case managers, but the nature of their work makes it especially difficult. Many types of activities are required of them: interviewing clients: writing reports: meetings with clients, team members,
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