Case Management Guidebook

Comprehensive guidance and support to professionals working in homeless and drug services

Key Goals

  1. Explain service options and choices and assist the service user in developing a plan, which suits their situation and goals.
  2. Undertake appropriate referrals and prepare the service user for next steps.
  3. Monitor progress and ensure appro-priate supports are provided at each stage and in preparation for each stage i.e. counselling, relapse prevention supports and aftercare.


While the journey through drug treatment services will differ for every individual, an overarching pathway that people can take can be described as a continuum of care. Figure 7. on page 80 illustrates this continuum of care across services. The case manager’s role in the various stages of the continuum is summarised in the list below. In all cases this work should be part of a holistic support plan, which clarifies realistic short-term and longer-term goals:

  1. Harm reduction – ensuring that drug use is as safe and informed as possible.
  2. Methadone maintenance – ensuring access to drug treatment.
  3. Stabilisation – supporting the individual to be compliant with drug treatment i.e. reduce illegal drug use.
  4. Detoxification – ensuring access to detox services and that relapse prevention supports and aftercare are in place.
  5. Rehabilitation – ensuring access to rehabilitation supports and that an aftercare plan is in place.
  6. Aftercare – ensuring that a holistic aftercare plan is in place.

Different services and combinations of services will suit different people. A number of factors will determine an individual’s ideal continuum of care, including:

  • type of drug/s being used
  • individual goals
  • level of personal motivation
  • ability to attend residential services
  • physical and mental health
  • educational and training aspirations
  • supports within their family/community

It should be noted that this continuum is not neces-sarily linear and that steps can, in some cases, be omitted. For instance, an individual could go straight into methadone treatment or a methadone detox without having accessed harm reduction services (as illustrated in Figure 7.).