Ann E. P. Dill, Managing to Care: Case Management and Service System Reform.

Hawthorne, NY: Aldine de Gruyter, 2001. $40.95 hardcover, $20.95 papercover.

This book is a product of fifteen years of Ann Dill's various encounters--scholarly and personal--with case management. She carefully describes, analyzes, theorizes, synthesizes, and provides historical, institutional, and organizational contexts to case management. Dill, a sociology professor at Brown University, has been greatly influenced by sociologists Elinson, Colombotos, and Mechanic, each of whom have made significant contributions to our understanding of social services. This book provides a sociological and historical context for case management that is seldom considered or understood in case management practice books.

Dill demonstrates how case management began as a reform movement to improve coordination of care and better access to services. Over time, as a conservative ideology became more prominent, case management has become a tool to regulate costs, maximize efficiencies, rationalize service delivery, and ration service resources.

Dill is highly critical of case management practice, particularly as it has "come to absorb and reflect the organizational flaws of the very service systems it was intended to reform" (p. x). In chapter one she presents the many definitions of case management, reviews its organizational and institutional history, and identifies three theoretically grounded views of case management; as a boundary spanning position; as an institutionalized practice; and as a concept within a system of symbolic relations. In subsequent chapters she examines case management: 1) in longterm care for the elderly, 2) for people with chronic mental illness, and 3) in "social welfare" with an emphasis on income transfer programs. In each of these chapters Professor Dill presents a case management historical and sociological context of which every "helping profession" practitioner and student should be familiar. She demonstrates how case management in all its many forms and for many different reasons, continues to be popular despite a lack of evidence that it is effective. In Chapter 5, she answers some questions and asks others. She argues that case management's past, present, and future are linked to its role as a bureaucratic tool and its link to the social structure of our society.

According to Dill, case management has been successful for three significant reasons. First, case management programs have been part of much broader policy movements, secondly, in each service sector there has been a constituency promoting case management and at least one funding it, and, finally, its arrival coincided with high turbulence in the environments surrounding human service organizations. She documents the complexity of case management and it relationship to its many environments. To fully understand case management is to understand issues of design, culture, organizations, efficacy, and efficiency. Case management is implemented with multiple purposes that cut across program and Sector boundaries. Over time it has continued to be the product of conflicting objectives. Dill identifies the following additional trends: 1) designed as a mechanism to bypass the categorical limitations of service bureaucracies, case management has itself become bureaucratized, 2) in the movement from goals for clients to goals for service systems it has increasingly lowered worker educational qualifications, 3) the authority of case managers has narrowed, 4) the ultimate irony for case management itself is to reinforce social class inequities through its differential use as a result of privatization and its increasing use in private practice.

Dill concludes that it may not be possible to keep case management programs from reflecting the broader class system. However, she argues that case management has an under realized potential for advocacy to "empower clients and class advocacy to regress problems and deficiencies in service programs and systems."

This book reads well, has an exceptional logical integrity, is full of delightful insights, and is grounded in a theoretical and historical framework. Dill is a master at weaving together history, culture, organizational theory (particularly bureaucratization), the role of professions, and the analysis of multiple objectives and paradoxes, with a value system that is committed to "a fabric of care that could sustain us all" (vii).

Charles D. Cowger
University of Missouri, Columbia