Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study

Area of Science:

• Public Health
• Health Services Research
• Social Work

Background:

• Case management is crucial for optimal service delivery to women and families.
• Structural factors significantly influence the effective implementation of case management programs.
• Healthy Start case managers identified both benefits and implementation challenges.

Purpose of the Study:

• To investigate structural challenges faced by case managers in implementing programs for participants.
• To identify potential strategies for enhancing case management within medical home settings.

Main Methods:

• Two focus groups were conducted with case managers from four program service sites.
• Discussions were facilitated using a semi-structured interview guide and audio-recorded.
• Transcripts were analyzed using thematic analysis, a deductive approach.

Main Results:

• Case managers face challenges including externalities (population shifts, poverty), contractual limits (caseloads), and insufficient support (training, incentives, high turnover).
• Logistic and organizational difficulties further complicate service delivery.
• Case managers prioritize linking clients to services over performance reporting, favoring measurable deliverables.

Conclusions:

• Case managers are aware of the challenging operational environment.
• Future interventions require clear performance measures and enhanced systems support.
• Iterative learning and shared decision-making among stakeholders are proposed solutions.