When all eight of us went through a fast-food drive-up, I wanted to be efficient and have everyone get the same thing. But little Blossom didn't like mustard, Mandrake didn't like pickles, Godiva wanted a fish sandwich, and so on. With all these custom orders, the food wasn’t very fast. I learned, however, you can’t force someone to like mustard or pickles.
This mundane example demonstrates a universal truth: each person is unique and deserves to be treated as an individual apart from any category she may belong to or any convenient grouping which may cover her, such as Hispanic or Caucasian, middle- or low-income, or even my children.
Government generally has to treat all citizens the same way, or at least in very large categories, i.e. “top-down.” It’s only natural and efficient. You can hardly tailor Social Security or income tax to the Bakers in Wisconsin or the Smiths in California. One size must fit all. But for the most part, we do better when we treat people as individuals, i.e. “bottom-up.” When government programs are able to focus on individuals rather than groups, outcomes can improve drastically.
Although not a real person, Ray is a composite of some chronically homeless. A 49-year-old male who dropped out of high school, Ray has low literacy skills, smokes and is bipolar. He served in the Army for four years with distinction, having been deployed to war zones twice. He has no money or assets. Ray wants to come in from the streets.
Once Ray is identified, he will be assigned a “coach” or “navigator.” This is the secret sauce, and it makes all the difference. Homeless workers call this approach “case management.” It says they are working with Ray the person rather than just another homeless guy. This approach has worked miracles in reducing chronic homelessness in Utah by three-fourths in the past decade. Utah has received nationwide attention for this achievement.
Skilled intake personnel will assess Ray’s condition. He will be identified by name. His case manager will use homeless network services to evaluate Ray’s physical and mental health, substance abuse problems, education, work history, family, abilities and disabilities. The case manager will identify the benefits and resources Ray qualifies for, such as VA health services, SSI, employment counseling and training, trade school tuition under the GI bill, food stamps, social services, substance abuse counseling, etc. But first, Ray will be placed in housing suitable to his situation. Once Ray is settled in, his case manager will work with him to attend to his other needs.
Where Ray once wandered in a fog of mental illness and addiction, now there is hope. Ray is back among us. If he sticks with it, the many friends and resources available to him will lift him and support him to get a job, a home and even a family. I have seen these miracles, and there is hardly anything more beautiful than seeing a human being redeemed.
Case management is being implemented more and more into corrections, mental illness, substance abuse and even public and higher education. At one of our state universities (and maybe others), when a student drops out, a university employee immediately contacts that person to inquire why she left and to offer financial and other resources to try to bring her back to finish her degree.
Focusing on individuals by name and on each one’s unique situation and needs takes a lot of time and dedicated personnel. It’s more expensive and difficult. But in the end, it’s the only really effective way.
Greg Bell is the former lieutenant governor of Utah and the current president and CEO of the Utah Hospital Association.