The evaluation finds that VAC’s standards in relation to Case Management Services should be reviewed in order to align with a client’s level of need and complexity.
This section of the evaluation report assesses whether VAC’s case management related services standards/commitments are being achieved and whether they are appropriate.
VAC uses two primary standards relating to Case Management Services, these two standards are:
- A published service standard which states “The ratio of case managed clients to Case Managers will not exceed 25:1.”
- An internal standard which states “A Case Manager will contact the Veteran at least every 90 days to discuss progress towards achieving their goals”
7.1 Ratio of Case Management Clients to Case Managers will not Exceed 25:1
This section of the report identifies the results of key activities the evaluation team completed in support of assessing the results associated with the 25:1 service standard and to determine if this is an appropriate standard.
7.1.1 Data Analysis
In analysing the volume of case managed clients (open case plans) assigned to each of VAC’s Case Managers, the evaluation team found that as of March 2018:
- 86% of VAC’s Case Managers had a caseload size of greater than 25.
- 56% of VAC’s Case Managers had a caseload size of 35 or greater.
To further assess VAC’s performance against this standard and accurately report against the average caseload size, the evaluation team completed an in-depth data analysis. The data analysis compared the overall volume of clients receiving Case Management Services, to; a) the volume of case management resources based on VAC’s Financial Management System Data; and b) the volume of Case Manager positions based on VAC’s Human Resource system data. In both instances, the analysis shows similar results, which are reflected below.
7.1.1.1 Case Plan Ratio Based on VAC’s Financial Management System Data
Analysis of VAC’s Financial Management system data shows that the number of Case Manager position full-time equivalents (FTEs) utilized has increased substantially over the past 4 years. Between fiscal years 2014-15 and 2017-18, Case Manager FTEs increased from 197.9 to 361.3, an increase of 82.6%.
During the same time period, the volume of case managed clients also increased substantially. Between March 2015 to March 2018 case managed clients increased from 7,448 to 13,437, an increase of 80.4%. The surge in Veterans requiring Case Management services can be explained by two factors: Government of Canada approved changes to the Earnings Loss Benefit in October 2016 which increased Veteran earnings from 75% to 90% of pre-release salary, coupled with increases in medical releases from the Canadian Armed Forces.
Table 16 shows the year-over-year analysis of FTEs in the Case Manager position and the average volume of case managed clients.
| Fiscal Year | Average Case Managed Clients per Case Manager |
|---|---|
| 2014-15 | 36.5 |
| 2015-16 | 34.6 |
| 2016-17 | 33.3 |
| 2017-18 | 35.0 |
As shown in Table 16, despite significant recruitment and staffing efforts for Case Managers, the increasing number of case managed clients has prevented VAC from achieving the 25:1 case plan ratio commitment.
A further breakdown of resources and case managed clients by location and year, can be found in Appendix B.
7.1.1.2 Case Plan Ratio Based on VAC’s Human Resource System Data
As of April 2018, VAC had:
- 407.4 indeterminate Case Managers, of these:
- 350.2 were “Active” in their position as a Case Manager
- 7 were “on assignment/acting” outside of their position as a Case Manager
- 50.2 were on a period of leave with/without pay
In addition to the 350.2 “Active” indeterminate Case Managers, there were 8 employees on assignment/acting in Case Manager positions and 14.3 individuals were casual/term-position Case Managers. This resulted in an overall total of 372.5 active Case Managers.
As of March 31, 2018, there were 13,437 case managed clients, resulting in overall average of 36.1 clients per Case Manager, above the 25:1 service standard target.
7.1.2 Site Visit Interviews
Case Managers interviewed identified that they are currently assigned a much higher caseload than 25:1. However, when Case Managers were asked what they felt an appropriate caseload size would be, most estimated a range of around 30:1 and felt that 25:1 may be too low. In addition, interviews also identified that caseload standards should be based on the level of need/complexity of Veterans, as each Veterans’ needs are unique the level of support required could vary significantly.
7.1.3 Case Manager Survey
Through the July 2018 Case Manager Survey, when asked about their current caseload:
- 76% of Case Managers reported that they are overburdened/ over-capacity.
- 21% of Case Managers reported that they are at optimal capacity.
- 3% of Case Managers reported that they are under-capacity.
The Case Managers who identified that they are “overburdened/over-capacity” or “under capacity” were asked “what caseload size do you feel you would be closest to optimal capacity?” Responses showed:
- 2% reported they would be closest to optimal capacity with a caseload size > 40.
- 15% reported they would be closest to optimal capacity with a caseload size of 35-40.
- 32% reported they would be closest to optimal capacity with a caseload size of 30-34.
- 43% reported they would be closest to optimal capacity with a caseload size of 25-29.
- 8% reported they would be closest to optimal capacity with a caseload size under 25.
Similar to the feedback received through interviews, findings from the survey highlighted that a large portion of Case Managers felt an optimal caseload size would be higher than 25:1.
In addition, when Case Managers were asked what the most appropriate method would be for measuring their caseload, 74% of Case Managers reported that the most accurate method of representing their caseload would be based on “A combination of the volume, intensity and complexity of the Veterans they are case managing.” This finding highlights that caseload related standards for Case Managers should be broader than a volume of cases per Case Manager ratio.
7.1.4 Observation
During the evaluation team’s site-visit to an office of Correctional Services Canada (CSC), the team was informed that caseload allocation at CSC is based on the level of needs for each individual. The level of need determines the frequency of contacts that a Parole Officer should have with that individual. The primary method of allocating caseload for Parole Officers is by reviewing the volume of contacts (based on the needs of the individual) each officer is responsible for, rather than the specific volume of cases.
7.1.5 Conclusion/Summary
As identified in this section, VAC has significantly increased the volume of Case Managers over the past 4 years. Despite these staffing efforts, the surge in case managed clients combined with VAC’s need to increase efforts to transition Veterans out of case management when it is no longer the appropriate level of support (as highlighted in section 3.1(b) has prevented the department from achieving the 25:1 case ratio standard, instead resulting in averages of 35-36:1. In reviewing the appropriateness of the case ratio standard, it was determined that a large portion of Case Managers feel that a higher target ratio than 25:1 would be optimal (in the 30:1 range). However, through interviews, the Case Manager survey, and observations at another government department, the evaluation team found that caseload allocation should also be based on other factors, such as the level of the Veterans needs/complexity. These findings are used to contribute to Recommendation #3.
7.2 A Case Manager will contact the Veteran at least every 90 days to discuss progress towards achieving their goals
This section of the report identifies the results of key activities the evaluation team completed in support of assessing the results associated with the case managed client contact every 90 days, and whether this is an appropriate standard.
7.2.1 Data Analysis
Analysis found that VAC Case Managers are achieving the internal standard of Veteran contact every 90 days. During the period of April 2014-March 2018, case managed clients had direct contact with their Case Manager 360,840 times. In 88.5% of these instances, the contact was less than 90 days since the previous contact. In a large portion of cases (77.1%) contact occurred less than 60 days since previous contact, and in over half (59.6%) of the contacts were less than 30 days since previous contact. Overall, during the 4 year period, on average case managed clients were contacted every 40 days. Breakdowns of the yearly results are included in Table 18 below.
| Fiscal Year 2014-15 | Fiscal Year 2015-16 | Fiscal Year 2016-17 | Fiscal Year 2018-19 | Totals | |
|---|---|---|---|---|---|
| Total contacts with Case Managed clients | 64,890 | 73,210 | 101,486 | 121,245 | 360,840 |
| % of contacts within 30 days | 57.7% | 58.1% | 61.8% | 59.7% | 59.6% |
| % of contacts within 60 days | 75.5% | 75.3% | 78.8% | 77.5% | 77.1% |
| % of contacts within 90 days | 88.3% | 87.3% | 89.3% | 88.8% | 88.5% |
| Average days between contact | 39.0 | 41.2 | 38.2 | 40.3 | 39.6 |
7.2.2 Site Visit Interviews
During interviews with Case Managers, they highlighted it is valuable/appropriate to have a client contact related standard, however the standard should be based more on the clients’ level of needs/complexity rather than a blanket standard for all clients. It was identified that in instances when clients have considerable needs, a more frequent standard (shorter than 90 days) would be more appropriate.
7.2.3 Observation
During the evaluation team’s site-visit to an office of Correctional Services Canada, the team was informed that the level of need an individual has determines the frequency of contacts that a Parole Officer should have with that individual. This approach results in individuals with high levels of need being contacted on a more frequent basis.
7.2.4 2017 VAC National Survey
Results from the 2017 VAC National Survey found that 76% of case managed clients interviewed agreed/strongly agreed that “I am satisfied with my Case Manager’s availability.”
In addition, as part of the 2017 VAC National Survey, VAC asked clients “what could VAC do to better the service experience for you?” The evaluation team reviewed the textual responses to this question for the 124 case managed clients that responded. In total, 30 (24%) made reference to wanting additional direct contact with their Case Manager (via more frequent contacts, wanting regular meetings, a direct line, by hiring more Case Managers, etc.). These results highlight that while a large portion of case managed clients are satisfied with their Case Managers availability, there is an opportunity to increase contacts with clients based on their level of need.
Overall the findings of this section, combined with the findings of section 7.1 regarding the case plan ratio standard, contributed to the following recommendation.
Recommendation #3 (Medium-Long Term):
It is recommended that the Director General, Service Delivery and Program Management work in collaboration with the Director General, Field Operations to:
- develop and implement case management standards based on the client’s levels of need and complexity;
- formalize the intended outcomes for VAC’s Case Management Services, establish targets and implement monitoring.
[Consideration on the timing of management actions for this recommendation will need to be based upon previous recommendations being implemented to ensure case management is appropriately reaching Veterans with complex needs (Recommendation #1), and to improve the effectiveness and efficiency of tools used to support case management (Recommendation #2)]
Management Response:
Management agrees with this recommendation.
| Corrective Actions to be taken | Office of Primary Interest (OPI) | Target Completion Date |
|---|---|---|
| The Director General, Service Delivery and Program Management, work in collaboration with the Director General, Field Operations, to develop and implement case management standards based on the client's level of needs by: | ||
| i) Conducting research and environmental scans of other federal and provincial case management service standards and models. | Director General, Service Delivery and Program Management Division and Director General, Field Operations Division | September 2019 |
| ii) Developing approaches to defining client's needs and complexity. | March 2020 | |
| iii) Developing service standards, as part of the program management framework, that will meet the needs of clients and demonstrate outcomes based on the domains of well-being. | March 2021 | |
| The Director General, Service Delivery and Program Management, work in collaboration with the Director General, Field Operations, to formalize the intended outcomes for VAC's Case Management Services, including targets and associated monitoring by: | ||
| i) Formally identifying the intended outcomes that are to be achieved by VAC's Case Management Services (supporting domains of well-being for Veterans). | Director General, Service Delivery and Program Management Division and Director General, Field Operations Division | March 2020 |
| ii) Implementing the ongoing monitoring/reporting of VAC's Case Management outcomes, including targeted performance levels. | June 2020 | |
| iii) Developing a program management (performance) framework. | ||