A Service Map Is Not Yet a Support Network

From a providers' directory to a providers' network with actual capacity, clear roles and working relationships.

A colourful service map can be comforting until a worker cancels, a referral gets stuck or a family member becomes exhausted. Availability, fit or coordination does not follow from names on a page.

Case managers frequently are given lists of people who have been referred, but not if the service has started, what they can actually provide and how the people involved relate to one another. The difference is most critical after hours, during transitions or when risks increase.

Why this matters for case managers

The added value is very often realised between formal decisions, at a handover, at a provider change or when a day-to-day issue brings to light that the agreed arrangement is not yet working. The best answer will be in combination with concise records, named responsibilities and realistic review point that include the participant's direction. That helps to minimise the need for coordination noise, without compromising professional and provider accountability.

What better coordination looks like

A support network is tested in three ways: capacity, relationships and contingency. It has established contacts, comprehended responsibilities, communicated permissions and has at least one realistic alternative for critical supports.

Verify, do not assume

Verify the status of the service, when it will begin, how often it will occur, the areas covered, who is responsible for cancelling the service, and who will be involved with the service on a day-to-day basis.

Verify, do not assume

Demonstrate who shares information with whom and what consents will allow and where there are overlaps or gaps that may lead to confusion.

Test the weak points

What would happen if the regular worker, transport or informal carer is not available for one day and one week?

Make the change last

A helpful change is specific enough to practise and small enough to review. Decide who will be the first to take the action, where it will be documented and when the person will be asked if it helped. If it requires multiple services, make sure to verify each service's readiness individually, not during the meeting. Keep what works, change what doesn't, and eliminate the things that need to be eliminated for the temporary purpose they were put in place for.

Questions for the next review

How does “do not assume” look from the person's perspective?

What part of the arrangement is being assumed and what part is yet to be confirmed?

What will the person and team be able to see that will indicate whether this method is working?

Keep the boundary clear

A case manager coordinates, they are not responsible for ensuring that another organisation is capable of doing so and do not provide direction to independent workers in non-agreed cases. Make note of what is confirmed, the provisional and what the participant has decided.

A practical example

One participant's map contained 6 organisations, but only 2 with services. A brief validation period revealed an unfilled weekend gap. The case manager assisted the participant to consider other options before the next family carer break, to prevent a late race.