Case management, a coordinating process designed to align service provision more closely to the identified needs of people requiring assistance in the context of complex care systems, is an example of those policies and practices that cross the borders of different national welfare systems, ostensibly to resolve the same or similar problems in the adopting country. Developed in the USA, case management was re-named 'care management' upon adoption in the UK as part of the community care reforms of the early 1990s, reforms which have framed my professional life in English local authority adult social care services ever since.
In 2007, a temporary research fellowship (TH Marshall Fellowship, London School of Economics) enabled me to spend four months in Berlin studying a citywide case management service for older people in the context of German long-term care policy and legislation. This experience sits at the core of this thesis which addresses the extent to which the study of a specific case management service for older people in Berlin can illuminate how case management translates across differing national welfare contexts, taking into account the particular methodological challenges of cross-national research.
Drawing on both cross-national social policy and translation studies literatures and adopting a multi-method case study approach, the central problems of determining similarity and difference, equivalence and translation form the core of the thesis. Informed by a realist understanding of the social world, the study took a naturalistic turn in situ that fore-grounded the more ethnographic elements in the mix of documentary research, semi-participant observation and meetings with key informants that formed my data sources and were recorded in extensive field notes. The data were analysed to trace how case management was constructed locally in relation to both state and federal level policy and legislation, and then comparatively re-examined in the context of the key methodological problems identified above in relation to understandings of care management in England as reported in the literature, in order to further explore the question of comparability of case management across different welfare contexts.
The research clearly demonstrates how institutional context both shaped and constrained the adoption of case management in Berlin, and highlights a need in comparative research for close contextual examination of the apparently similar, with a focus on functionally equivalent mechanisms, to determine the extent to which case management can be said to be similar or different in different contexts, particularly where English words and expressions are directly absorbed into the local language. Relating the case study to findings from earlier studies of care management in England highlights the extent to which care management in England is itself a locally shaped and contextualised variant of case management as developed in the USA that matches poorly to the variant in Berlin. Indeed problems discovered in the research site constructing definitional boundaries for case management in practice mirror issues in the wider literature and raise questions about the specificity of the original concept itself. Nonetheless, the study shows that, despite the multiple asymmetries of equivalence and difficulties of translation, there are sufficient points of similarity for cautious potential lessons to be drawn from Berlin, particularly with regards to policy changes on the horizon in England, but also in the other direction with regards to how case management in Berlin may also be re-shaped following recent reforms to German long-term care legislation
