[Implementing case management at German Pension Insurance - Findings of the process evaluation of the pilot project "KiT"].

Abstract

Purpose: In the pilot project 'Coordination of individual participation: needs assessment and service provision from a single source', a case management (CM) concept was implemented and evaluated in vocational rehabilitation counseling (RC) at nine German Pension Insurances (DRV).

Methods: A sequential approach was designed as an iterative mixed-methods design in which the individual survey phases are linked instrumentally. Interviews were conducted with managers of the DRV (n=17) and counselors (n=11), who carried out CM after completing additional training, and online surveys were conducted with the latter (t1: n=47, t2: n=50). The surveys focused on the evaluation of CM and its organisation-specific implementation, changes since the introduction of CM, and prerequisites for its continuation. In addition, questionnaire surveys were conducted with participating insured persons at the beginning and end of the CM (t1: n=586; t2: n=329) and the standardised needs assessment of the case documentation was evaluated (n=820). This provided information on their characteristics and participation needs as well as their assessments of CM.

Results: CM was viewed mostly positively by managers and counselors, i. a., as an important pillar for the professionalisation of RC. Counselors considered the increased time available per case and the changed work and counseling routines to be particularly significant. Managers perceived a higher quality of counseling. Sufficient resources and stringent intra-organisational embedment were identified as prerequisites for the continuation of CM. CM was successful in reaching insured persons with multiple chronic conditions and greater needs for support. Insured persons rated the counseling as mainly positive.

Conclusion: The results indicate that CM is a promising approach for reaching and supporting insured persons with complex support needs for whom conventional services for participation in working life are insufficient. CM also strengthens needs orientation and person-centredness in vocational rehabilitation. However, there are significant differences between providers in the extent of CM implementation and the motivation to continue it. With the inclusion of CM in the German social law, questions about implementation, intra-organisational embedment and inter-organisational quality assurance have taken on new relevance.