Case Management

Overview

Case management systems coordinate the lifecycle of individual or entity focused work that requires assessment, decisioning, service delivery, and monitoring. In government settings this covers intake, eligibility and needs assessment, service planning and coordination, decisioning and enforcement, monitoring, and closure. Effective case management increases speed and consistency of service delivery, supports transparency and auditability, and improves outcomes while protecting privacy and equity.

This guidance focuses on common workflows, a minimal core data model, recommended features, and implementation considerations for designing and operating case management systems in government programs.

Where this use case is used

Common domains and program types (non‑exhaustive):

• Human and social services (child welfare, adult protective services, income support, case‑managed programs)
• Health and behavioral health care coordination and longitudinal care programs
• Public safety and justice workflows (investigations, probation, victim services)
• Licensing, permitting, and regulatory enforcement cases
• Workforce development, unemployment services, and veterans’ programs
• Immigration, asylum, legal aid, and court‑adjacent casework
• Any program requiring multi‑party coordination, evidence collection, lifecycle tracking, and auditability

High level processes

Typical high‑level steps in a government case lifecycle and the primary personas involved:

1. Intake & registration — Personas: citizen/portal, intake clerk
   • Capture identity, contact info, initial documents; create the case record and run basic validations/eligibility checks.
2. Triage & prioritization — Personas: triage officer, supervisor
   • Classify urgency/risk, set SLAs, assign to a worker/team.
3. Assessment & planning — Personas: caseworker, client, supervisor
   • Conduct needs assessment, create a service plan with tasks, milestones and responsible parties.
4. Service coordination & delivery — Personas: caseworker, service provider, external partner
   • Make referrals, schedule services, exchange documents, and record service events and outcomes.
5. Monitoring & follow‑up — Personas: caseworker, supervisor
   • Update case timeline, track progress vs plan, adjust as needed.
6. Escalation & investigation — Personas: investigator, legal, supervisor
   • Manage incidents, investigations, legal holds and inter‑agency escalations.
7. Decisioning & notification — Personas: authorized decision maker, caseworker
   • Record determinations (benefits, enforcement, disposition), notify affected parties, record appeals.
8. Closure & aftercare — Personas: caseworker, client
   • Capture final outcomes, close the case, and document follow‑up or referrals.
9. Reporting, audit & appeals — Personas: manager, analyst, auditor, legal
   • Provide dashboards, compliance reports, audit trails, and support appeals or reviews.

Core data model elements to support the lifecycle: Case, Person/Party, Program/Eligibility, Task, Event/Interaction, Document, Referral, Decision/Determination, Relationship, Location, Outcome, and Audit/History.

Common needs and challenges

• Interoperability with legacy systems and partner agencies (use open APIs and domain standards where applicable).
• Accurate identity resolution and deduplication across systems.
• Strong privacy and security controls (RBAC, encryption, retention policies, audit logs; HIPAA/CJIS awareness where relevant).
• Configurable workflows and business rules to accommodate program changes without heavy code changes.
• Robust document and evidence management (unstructured content, OCR, redaction, secure sharing).
• Usability for high caseloads and mobile/field workers (offline support, simplified UIs).
• Scalable reporting and analytics for performance, compliance, and outcomes.
• Procurement, budget and change‑management constraints in government contexts.

Success measures

Operational and program metrics to monitor:

• Average time to intake and average time to case resolution.
• Percentage of cases meeting SLA targets and first‑contact resolution rate.
• Average caseload per caseworker and worker throughput.
• Client satisfaction and service quality indicators.
• Data completeness, reduction in duplicate records, and data quality score.
• Compliance and audit pass rates (timely documentation, retention).
• Reduction in rework and referral loopbacks.
• Program‑specific outcome measures (e.g., employment placement, reduced recidivism, improved health outcomes).