Luna Gale Nails It: The Problem with Case Management


It is a pity that so few people will see Rebecca Gilman's amazing new play, Luna Gale, now showing at the Goodman Theater in Chicago. Mary Beth Fisher is spellbinding in the role of Caroline, a competent, yet ethically challenged veteran foster care worker battling her supervisor, her own demons, burnout and an ill-structured service system to help a young couple addicted to methamphetamine. In a perfect world, the play would be shown around the world, and Mary Beth Fisher would play the character Caroline on a HBO series for the next five years. And we could all have a conversation about our social service systems.

There is a point in the first act when the young couple reports back to Caroline on the services that she has arranged for them. They can't get into the substance abuse treatment they need. The support group for addicted Moms is showing movies. The therapist cancelled. And a young couple trying to stay off drugs is reduced to using 5 Hour Energy Drink as a detox substitute.

When the world discovers troubled families, it often calls on case managers to fix things up. The child welfare, juvenile justice, mental health, homeless services and health care systems all rely to some extent on case managers to hook up clients to the services they need so that their lives can be adequately supported or repaired so that they are no longer be a danger to society or themselves. The case plan on this young couple looks good on paper. But it won't help anyone get better, let alone a desperate young family in acute crisis in need of top-rate help.

Somehow, playwright Gilman has discovered the dirty secret of the social service world. The services that are counted on to turn around a troubled family simply are often simply not up to the task. Last year a young man in trouble described the therapy groups he was asked to attend as "content free." It reminded me of a young person in one of my research studies who was asked to talk about his psychotherapy. "I can't explain to you why this person is not able to help me. But if you met her, "he said, "it would be immediately obvious."  I never met her, but I knew just what he meant.

Our social service clients know when services can't help. Oddly enough, the people who don't know are the people who pay for them and the heads of the agencies that operate them. Our social service systems too often operate without data. Programs and therapy can be "content free" without anyone knowing but the direct service provider and her client. They get away with it because the people who need to know are data free. This is a simplification, of course. Social service programs suffer from a lack of a quality for a variety of reasons, including underfunding. But without the data to show that quality is lacking, we are reduced to hearing that news from some fabulous actors and a socially attuned playwright in one theater in Chicago.

Read a review of the play, Luna Gale, here.

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