Virtual Case Management - Catholic Charities Fort Worth

The Issue

Poverty knows no geographical boundaries. The overall rate of poverty is higher in nonmetro counties than in metro counties. That difference is largest in the South: from 2015 to 2019, the South had a nonmetro poverty rate of 19.7 percent, nearly 6 percentage points higher than in the region’s metro areas. And counties where poverty is persistent — defined as having 20 percent or more of their population in poverty based on the 1980, 1990, and 2000 decennial censuses and 2007-11 ACS 5-year estimates — are majority nonmetro.

Despite this, resources for families in poverty are often concentrated in metropolitan areas. Large agencies based in metropolitan areas try to serve individuals from surrounding rural areas, but that provides a strain on their already limited resources. When overworked and underresourced organizations can make it to more rural areas, they can often only provide one service, while research suggests that holistic case management is effective in bringing people out of poverty.

Poverty has many dimensions. Families in poverty juggle numerous complex, co-occuring issues. Case management programs aim to reconcile short-term needs — such as help filling out an application for rental assistance — and long-term solutions to poverty — such as reducing the debt-to-income ratio. But case management asks a lot of those involved. The case managers have to juggle multiple cases, sometimes meeting their clients across town, and the clients themselves have to take time out of their workday to navigate the complex world of public support.

In an increasingly virtual world, many case management programs have looked toward moving their services online or making them hybrid. However, questions remain about the efficacy of virtual programs.

Studies suggest that virtual education in a college-length course has negative effects on learning outcomes relative to in-person instruction (Alpert et al., 2016; Bettinger et al., 2017; Figlio et al., 2023; Kofoed, 2021). These effects are stronger for Hispanic students, male students, and lower-achieving students. Some findings suggest that remote peer mentoring has positive impacts on studying behavior and student motivation (Hardt et al., 2020), while others suggest that online class worsens student concentration and their relationships with their instructors (Kofoed, 2021). At the same time, several telehealth interventions have been shown to be feasible, effective, and noninferior, including virtual education for adolescents with asthma and virtual obesity pharmacotherapy in adults (Faraji et al., 2020; Griebeler 2022; Robb et al., 2019).

Most rigorous research on the efficacy of virtual interventions were limited to a specific age group and not focused on one-on-one mentor-mentee relationships. There has been little to no rigorous research evaluating virtual versus in-person case management.

Virtual case management would expand the reach of anti-poverty agencies and increase flexibility for case managers. Clients would have increased access to services and enhanced convenience when accessing those services. And for individuals in poverty who live in rural areas, the difference between no case management and virtual case management could mean the difference between staying in poverty and financial mobility. But, if case management does not work virtually and fails to deliver the same outcomes for individuals in poverty, then agencies need to know to focus their efforts on in-person case management. More evidence is needed to ensure that support is provided equally — regardless of where you live.

 

The Intervention

As part of their mission to relentlessly fight poverty with holistic solutions, Catholic Charities Fort Worth (CCFW) operates Working Family Services (WFS) as a way of helping people achieve personal and economic stability. The program pairs clients with highly-skilled Navigators, who provide tailored economic and personal support. WFS began in 2016 and has helped to end poverty for more than 500 clients in the Dallas-Fort Worth area.

Developed by Catholic Charities Fort Worth and rigorously evaluated by their internal Research & Analytics Department, WFS is informed by the proven Padua model to increase earnings, employment and overall wellbeing. Specifically, 50 percent of WFS clients increased their discretionary income, and 48 percent increased their total savings by an average of $463. 50 percent reduced their debt-to-income ratio by an average of nearly 20 percent. Finally, 71 percent of WFS clients improved their financial management behavior by an average score of 15 percent.

But, CCFW serves a vast geographical area that spans 28 North Texas counties. Serving clients in the more rural parts of this service area is more difficult. But, CCFW knows that there are individuals dealing with the complex issue of poverty across this area, and they want to help by providing case management services virtually.

 

Research Question

What is the impact of virtual case management, in comparison to in-person case management, on service engagement, goal attainment, and trust between client and navigator?

 

Intended Outcomes

• Individuals who receive virtual case management will be as engaged in the program and attain the same number of goals as those who receive in-person services.
• They will also demonstrate similar trust in their Navigators, ability to plan for the future, and ability to cope with current challenges.
• In addition to improved labor market outcomes, individuals participating in virtual and in-person case management will have better financial stability and financial literacy.

 

Research Study Design

LEO’s evaluation of the virtual and in-person modes of WFS is a randomized control trial. Right now, there are not enough WFS Navigators across all geographic areas served by CCFW to provide in-person case management to all program participants. Some people will receive virtual case management. To fairly allocate spots, in-person and virtual program spots will be filled by random lottery.

A total of 1352 participants will be randomly placed in either the virtual or in-person group. To be eligible, participants must be 18 years of age or older, speak English or Spanish, be ready and able to work, and live or work within the 28 county area that CCFW serves.

To test the effectiveness of virtual case management across a diverse geographical area, CCFW will recruit clients from additional counties. Prospective clients learn about WFS and apply through various streams, including direct referrals, parish referrals, other community partners, and word of mouth.

Individuals randomized into the in-person group will receive 100 percent in-person services, and individuals randomized into the virtual group will receive 100 percent virtual services. LEO researchers will track the client’s self report as collected by CCFW surveys and link administrative data on earnings, credit reports, consumer reference data, and other records.

 

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