School Counselors in Israel as Case Managers in Critical Events: a Qualitative Study

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https://doi.org/10.1007/s10447-021-09440-2 ORIGINAL ARTICLE

School Counselors in Israel as Case Managers in Critical Events: a Qualitative Study

Hilit Maizel¹

Accepted: 11 May 2021

Abstract

When school counselors manage an intervention in critical events, they must act both quickly and wisely to manage it effectively, with an eye toward rehabilitation.

Such events are traumatic for the children and families in need and may involve, for example, sexual assault, suicide attempts, or domestic abuse. Although it is an irregu- lar occurrence in an individual’s life, critical events are part of the daily routine in schools, thereby constituting an ongoing challenge for school counselors. This qualitative research was guided by a postmodern-constructivist approach that focused on the perspectives and experiences of the interviewees, who were licensed and experienced school counselors in Israel. The analysis of the data was thematic and included identifying main themes and conceptualizing them. It is suggested that the uniqueness of case management by school counselors lies in two factors: the large number of clients in each crisis event, in addition to the student and family at the center of the event, and the complex relationship with a large number of professionals whom it is essential to recruit into teams and manage. The findings challenge the existing theory on case management, which does not reflect the complexity of case management by school counselors. The overall goal of this study was to optimize child and youth rehabilitation services and refine the training of school counselors.

Keywords School counseling · Children and youth in need · Critical events · Qualitative research · Case management

Introduction

Children’s development is substantially affected by crisis events and trauma in their lives, especially if these are not handled properly (Zimmerman, 2010). Schools can become a supporting framework for children and families in their recovery, if they

* Hilit Maizel hilitmyzel@gmail.com

1 School of Education, Western Galilee College, Akko, Israel / Published online: 15 June 2021

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are able to provide individualized emotional, behavioral, social, and academic treatment (Mor & Loria, 2010). School counselors in Israel and worldwide are expected to become case managers in these crisis events, so that the child receives the best conditions to heal.

First, a review of the various models of case management in critical events will be presented, as reflected in the literature of the caregiving professions.

Then, I will focus on the job definition of school counselors as "case managers" in Israel and worldwide. The professional literature on the school counseling profession in many countries formally states that case management of critical events is the responsibility of the school counselor. The research literature includes studies of case management in special education school systems but not in mainstream schools. In addition, the existing studies do not focus on the school counselor’s role and sometimes fail to even mention this profession entirely. Previous studies on school counseling have concen- trated on the counselor’s therapeutic work with the student and their family but neglected to highlight their actions as the managers of these events as a whole.

Case Management

Case management only entered widespread use in the 1970s, when mental health patients, children, and youths were discharged from institutions and returned to the community. A case was defined as an individual or family, and the intervention was directed at helping the individual or family achieve maximum independ- ence within the community (Frankel et al., 2019). The school counseling profession adopted the case management practice, but the original models of case management do not necessarily reflect the unique characteristics of the practice as described by the participants of the present research.

All case management theories and models share certain principles derived from the field of social work (Thornicroft, 1991) and support its main purpose: promoting the clients’ integration into the community and improving their ability to function inde- pendently. The philosophy behind case management is that of system theory (Frankel et al., 2019), which is quite simple: People’s behavior is influenced by everyone and everything around them, including family, friends, economic situation, job, past educational experiences, and so forth. When individuals face a problem, their response derives not only from their personality but from a combination of the forces that have led them to react in a specific way. Consequently, understanding a person’s problems depends on understanding these forces. This is an underlying theory for school counselors as well, who also follow Bronfenbrenner’s ecological theory (Crowell et al., 2012; Erhard, 2014). The system theory approach and the ecological theory approach are social (as opposed to personal-medical), focusing on the individual and their support network. The main goal of case management is, therefore, to improve a person’s functioning within the community rather than to change their personality or eliminate disability. Thus, both intra- and inter-organizational interventions are needed, in addition to psychotherapeutic interventions (Gursansky et al., 2003).

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The general definition of case management describes a practice that helps people by defining the areas in which they need assistance and connecting them to the relevant resources (Rubin, 1992). According to the National Association of Social Workers, case management is a mechanism of linking components of service to meet an individual’s need for care. Similarly, in crisis counseling in schools, students may need treatments that schools cannot provide, requiring the counselor to create linkages with needed collaborative services (Sandoval et al., 2009; Ziguras &

Stuart, 2000). The rationale of case management is, therefore, identical in the school counseling profession and in other caregiving professions such as social work, mental health counseling, psychology, and family counseling.

Models of Case Management

Over the years, dozens of case management models have been developed, under varying names: mediating, expert, comprehensive, supportive, intensive, expanded, family, rehabilitating, clinical, assertive, community-life preparatory, and personal- strength based. Most of the models developed from research in the field of social work (Bedell et al., 2000; Burns et al., 2007; King et al., 2004). Today, these models lie on a spectrum from intensive case management at one end to non-intensive case management (an umbrella term for most types of case management) at the other end.

The location of a model on the spectrum between intensive and non-intensive case management (also called clinical case management in the literature) will reflect how the case manager’s work is characterized. At one end, case managers refer and medi- ate but do not directly provide services to the individual/family. They may not have face-to-face interactions with them, but instead supply information and recommen- dations via the internet or phone. At the other end, case managers provide for most needs by themselves, while also designing a full service plan (Bedell et al., 2000;

Burns et al., 2007; King et al., 2004).

The number of cases has direct impact on the essence of the case manager’s work.

This number may range from 300 in non-intensive models to twenty in intensive ones, with various clients at various stages of intervention (some at the more initial, intensive stages and others at the stages of follow-up and support). Because of its impact on the case manager’s work, the literature recommends limiting the number of cases to 25–40. The larger the number, the less frequent and more reactive the interactions with the clients become. In addition, response time drops, less advocacy takes place, fewer house calls are conducted, and documentation becomes compromised (King et al., 2004).

The actions of the case manager in all models were translated in the literature to a series of tasks and skills. In a comprehensive study (Mas-Exposito et al., 2014) that examined 25 years of professional literature on case management, the researchers found 69 components to describe what case managers do. This stands in contrast to other scholars, whose analysis has found only three roles or skills included in case management. The gap illustrates some confusion between the skills, activities, goals, components, and standards and thus reflects the complexity of case management, where events are distinct from one another and thus require different modes

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of assistance; it also reflects the tendency of researchers to specify or generalize.

Bar-On (2011) proposed mapping eight activities as lengthwise work stages. The eight activities are comprehensive and basic: identifying and determining initial entitlement; identifying needs; developing a service plan (involving the family and all formal and informal bodies) and setting goals that take into consideration the availability of all bodies involved; finding resources; plan implementation; monitoring; evaluation, and summary.

In all models, the case manager is responsible for one client (child/ family) in each case. The magnitude of the case manager’s involvement is described by the models as lying on a horizontal axis of service provision. That is, the more services the caregiver is providing, the further they proceed on the axis. This horizontal axis of involvement is not necessarily adequate to describe the complexity of case management by school counselors within mainstream schools due to the unique characteristics of the school counselor as case manager, which are presented below.

The School Counselor as a Case Manager in Critical Events as Presented in the Professional Literature

How do the education authorities view the role of the school counselor when a critical event occurs? How are school counselors expected to manage critical cases?

To evaluate this, the different official documents of education ministries and school counseling departments were examined in Israel and in several countries in the world. The professional literature on crisis counseling is either vague or focuses on protocols and formal regulations, even though it is known that critical events usually do not conform to a set of regulations (Dupre et al., 2014). In addition, the psychologists (rather than school counselors) working within schools are sometimes per- ceived, in the literature, as the first to handle the critical situation (Sandoval et al., 2009). However, this is not necessarily the case in reality, as this research has found.

The School Counselor Professional Standards & Competencies circular published by the American School Counselor Association (ASCA, 2019a) defined the basic principles of the counselor’s work and the mindset that underlies it. The expected response of counselors to critical events according to this document is to “make referrals to appropriate school and community resources” (p. 2) and “articulate why diagnoses and long-term therapy are outside the scope of school counseling” (p. 5).

This general definition does not, however, specify what types of critical events are referred to and what actions the counselor is expected to perform in order to manage them. Even the definition in the Safe Schools and Crisis Response (ASCA, 2019b, p. 60) that refers to the counselor’s role, stated that "school counselors are leaders in safe school initiatives and actively engage themselves in fostering safety and in responding to critical response situations in schools. School counselors are a vital resource in preventing, intervening, and responding to crisis situations." According to the same document, school counselors are also in charge of "providing interventions for students at risk of dropping out or harming self or others" (p. 59). This definition is also obscure, because it does not relate to the nature of the crisis events nor to the intervention expected.

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In Israel, where the present study is carried out, the broad definition of a critical event in the official ministry of education documents is that of severe violence, suicidality, abuse, use of drugs/alcohol, or any other action involving harm to self and/or others (Dashevsky, 2009). The official documents of SHEFI (the Ministry of Education’s psychological and school counseling services) stated a rather accurate and detailed definition in terms of rationale, action, and procedures expected from the counselors when managing a critical case. Case management is listed as one of eleven skills expected of a school counselor (SHEFI, 2009), who is described as someone who understands that providing optimal care for one child in a critical event "takes an entire village", and that certain situations are more complex, thus requiring more than one expert and more than one arena in which to act, as well as multiple professional perspectives. Other publications (Bar-On, 2011; Ritvo &

Goldstein, 2006), too, stress the interdisciplinary approach to case management and the responsibility of the school counselor. These publications state that “depositing”

the child in need in the hands of therapists without the cooperation of the school in the rehabilitation program may detract from the potential of the treatment (Mor &

Loria, 2010). Definitions, therefore, vary from general ones to detailed ones in terms of rationale, skills, and procedures in the different official documents of school counseling departments.

Notably, the role of the school counselor as a case manager occupies a respect- able amount of space in the literature regarding the role of counselors in Israel, but nonetheless, this role is not supported by any official, authoritative status. Meaning, the responsibility to manage critical cases is not mentioned in state laws. The result is that the plan of action drafted by the school counselor in a critical case is not man- datory, and abiding by it is optional.

On the other hand, Israeli law does refer to the legal duty of social workers to manage critical cases of children and youths and their families. The potential for confusion between the roles of counselors, psychologists, principals, and social workers is therefore clear. The potential for cooperation among the various treatment professionals is vast, but each type of professional is guided by a separate professional literature that describes their responsibility during a crisis event. The absence of an overall conception that defines the interfaces and the division of roles among the various professionals may be one reason for the lack of recognition of, and cooperation with, school counselors by external school professionals, as will be demonstrated shortly.

The School Counselor as a Case Manager in Critical Events according to the Research Literature

An examination of the published research literature on school counselors as case managers in critical events clearly reveals that such literature is rather scarce. One research found that ongoing supervision is essential even for licensed, experienced school counselors when they practice crisis counseling (Dupre et al., 2014). How- ever, regarding the skills, considerations, and characteristics, studies exist only on case management for special needs students within special education systems; there

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are no such studies on mainstream public schools. The studies on special education frameworks shed light on case management in schools for language-, speech-, and hearing-impaired students (Smith & Prelock, 2002), for students with disabilities (Franklin, 2010), for students with multiple needs (Welles & Gifford, 2013), for at-risk runaway youth (Arnold et al., 2007), for truant students with court intervention (Strand & Lovrich, 2014), or for at-risk youth within closed institutions (Arnold et al., 2007; Strand & Lovrich, 2014; Welles & Gifford, 2013). Some of these studies focused on the efficiency of case management by the health and human services, but did not examine the functioning of the school personnel, including that of the school counselor. A school-based model for case management was developed in the United States for at-risk students (ASCA, 2019a; Smith, 1995). This study too, while demonstrating the model’s efficiency in preventing dropout, did not describe the school counselor’s role as case manager. Other studies that do discuss the function of school counselors in critical events emphasize their role in providing therapy-oriented, individualized services to the child and their family (Ritvo &

Goldstein, 2006), while disregarding the management aspects.

A research on the skills, procedures, and difficulties encountered by school counselors when managing a critical case in mainstream public schools is therefore necessary due to the central place of case management in school counselors’ work, in order to refine the formal definition of school counseling, but primarily to optimize child and youth rehabilitation services and improve school counselors’ training.

Consequently, this research posed the following question:

What are the unique aspects of case management in critical events as performed by experienced school counselors in mainstream schools?

Research Method Research Design

The current research emerged out of my professional interest and initiatives on the topic, as a school counselor and also a supervisor of novice school counselors. As a school counselor with 30 years of experience, managing critical events has always been a substantial issue. I have come across hundreds of critical cases, no case identical to the others. In each case, management has a unique context according to the relevant considerations. As a supervisor, a prominent share of our personal and group meetings is dedicated to critical cases, which pose a great challenge for novice school counselors regarding how to analyze, interpret, and conceptualize these cases. Case management by school counselors is both complex and intense.

The expectations from school counselors are high, and the need to perform quickly is demanding.

The qualitative approach is the most appropriate one for this research, which aimed to construct the meaning of phenomena and processes out of the lives of individuals in specific times and places (Lieblich, 2015; Shakedi, 2014). In other words, the desire to delve deep into the experiences of school counselors, from their point of view and in their natural context, is the approach that guided the gathering

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and analysis of data. Due to my personal background, it was easy for me to be an involved researcher, characterized by reflectivity (Hunt, 2011; Lincoln, 2002). I understood the participants very well, my level of awareness was high, and I was able to ask questions that exposed their deliberations, concerns, and dilemmas. My approach in this research was postmodern-constructivist (Ben Yehoshua-Sabar, 2016). In other words, in addition to the great significance afforded to the personal and local voice, the research was directed at the community of school counselors, which it set out to serve, and the findings were implemented for the benefit of this community. The data were gathered in a climate of partnership: intimacy and empathy were most important, even at the expense of objective distance.

Semi-structured interviews were conducted and analyzed thematically, with the aim of obtaining rich and substantial data and understanding the complex nature of the reality of school counselors when they manage critical events.

Trustworthiness

The issue of trustworthiness was highly important in this qualitative research, which was a pioneering study in this specific field. Steps were taken throughout the various phases of the research (Lieblich et al., 2010). Designing and writing the questions was based on consultations I held with two nation-wide school counseling supervisors (see the ’Data Collection’ section below). Furthermore, while analyzing the findings, I consulted with several experts in the field of educational counseling and in qualitative research. These experts were separately presented with the raw data, and consultations were held with them regarding the major themes emerging from the data. This way, interrater reliability was obtained. At the analysis stage, the themes and supporting data were presented in two seminars for consulting and sharing research among peers in the educational field in order to refine the themes (see the ’Data Analysis’ chapter below).

Data Collection

The participants in the present research knew from the outset that I belonged to their professional world. However, while considering transparency to be highly important, I also did not want our shared profession to influence their responses. I sought to ensure they would not feel insecure, compare themselves to others, or fear criti- cism. Consequently, the approach to the interviews was with maximum empathy and understanding, putting aside my professional experience and aiming to uncover reality (Lieblich, 2015). At the initial phone call, the aims of the research were explained and privacy and confidentiality were guaranteed. Upon meeting the counselors face- to-face, they signed informed consent forms and were reassured that the interview transcript would be emailed to them for their validation prior to its analysis and pro- cessing. The counselors were also told they could stop the interview at any point.

The interviews took place in winter-spring 2019 at the participant’s schools or at their homes, according to their preference, and lasted for 1.5–2 h. Only the interviewee and myself were present at the interview. The interviews were

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audio-recorded, after receiving written consent. The data were collected through semi-structured in-depth interviews (Lieblich, 2015) and focused on the counselor’s response to critical events. These critical events played a major role in the interview. Numerous questions about a single event were asked, allowing the counselors to verbalize their thoughts, feelings, and dilemmas. They talked about critical events they had managed shortly before the interview, sometimes presenting related text messages and documents. The interviews continued mostly with follow-up questions in the form of "What did you do then?" and "Why did you do so?" Con- centrating on the examples brought up by the interviewees is a realization of the participant-focused approach that guided the entire research. The discourse about the world of the participants (rather than a theoretical discussion) and the richness of the data gathered and presented in this article are meant to enable the readers to enter the inner world of the interviewees and understand their context and perspective. The questions regarding each event were based on two main pillars: The first was the same theoretical background that established the research question itself, as explained above. The second was a consultation I held with the nation-wide direc- tor of novice educational counselors. In this consultation, we discussed her opinion regarding the main questions that must be included in such an interview. I held a similar consultation with one of the supervisors of educational counselors at the dis- trict level. This was a way to validate the research questions from an additional point of view, that of the field (in addition to the theoretical point of view). Since the par- ticipating counselors were also experienced, I gained their point of view about the questions themselves during the interviews, and consequently expanded them and made them more precise.

Analysis of the various events using guiding questions facilitated the ability to generalize from one case to another. In other words, even though the critical events presented here differed from each other, the thoughts and actions of the school counselors could be analyzed in a general way. This led to trustworthiness, dependability and transfer- ability, despite the subjectivity inherent in this type of postmodern-constructivist qualitative research.

Raising the topic of critical events brought up suppressed emotions and touched nerves. The interviews brought some of the counselors to tears, as they shared their feelings of being emotionally overwhelmed and overloaded with work, being treated with disrespect both by other professionals and by parents; and, most of all—being burdened with the constant, tremendous responsibility that leads to constant anxiety about loss of control and a possible downward spiral.

Research Participants

Fifteen school counselors were interviewed for this study, but one interview was omitted prior to the final analysis (see below). Each of the counselors had 7–20 years of experience. They all hold a master’s degree in school counseling and all of them hold a school counseling license (One counselor was a few months after retirement).

Seniority was extremely important due to the research’s overall aim. They all work in the state-secular public school system in Israel, in four out of six districts in the

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country. As it was important to understand how counselors manage critical cases in different educational frameworks in terms of student age and organizational structure, 6 counselors were from elementary schools, 3 from middle schools, 2 counselors were from middle schools which are also boarding schools, 2 were from high schools, and 2 were from a high school which is also a boarding school. Four- teen counselors were female and one was male. There was no prior acquaintance with any of the participants. The participants had been recommended by a mutual acquaintance and then sampled using the "snow ball" method, meaning each participant recommended another participant that met the criteria.

Data Analysis

Data analysis was guided by a combined approach: on the one hand observation of reality from an internal point of view, i.e., the perspective of the interviewees, which emphasized my involvement, empathy, and proximity to the issue and the interviewees, and on the other hand, a theoretical point of view that emphasized my reflective ability as a researcher. The methodological approach selected for the data analysis was participant-focused (rather than criteria-focused). This approach, which is also called “the narrative approach” (Bruner, 1996), is characterized by greater significance being granted to the internal aspects of the researched phenomenon. This means that the themes were not derived directly from the theoretical framework of the research; instead, they were determined during the research and after it, according to the material that emerged from the discourse with the interviewees.

The thematic analysis of the data was conducted in three main phases (Lieblich et al., 2010; Shakedi, 2014): The first phase was identifying the main themes in an inductive manner (Corbin & Strauss, 2014). To obtain trustworthiness, the raw data was also presented to three researchers in various colleges who are experts in qualitative research and data analysis. Each expert was introduced separately to the cor- pus to ensure that they identified the main themes emerging from the data, as they individually abstracted the preliminary themes. One of the experts accompanied the year-long process of defining and refining the main themes in this research.

Each transcript was thoroughly examined several times. The first interview was analyzed by identifying main themes. Attached to each theme were the quotation of the first participant, which demonstrated the theme. Then, the second interview was analyzed. Additional quotations were added to the themes identified in the first analysis. If identified, new themes were defined. All the interviews were analyzed in the same manner. The final outcome of this stage was many themes supported by quotations from all participants. This is the type of process that is required in the narrative approach, in which the themes are not determined a priori but rather during the analysis.

In the second phase, each theme was divided into many semi-themes that were identified. The third and final phase was focusing: limiting observations to specific themes with very rich findings and that were presented by most of the participants.

In this phase, the data were consolidated into a coherent explanation that describes each theme in depth. I also engaged, at this time, with theoretical concepts in order

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to define the themes both descriptively and theoretically. In order to refine the themes, the supporting data and the final structure, the findings were presented to two teams of experts from the field of education, in the context of seminars for consulting and sharing research among peers. The discussions were fertile and raised second thoughts and reservations and helped refine the themes and sub-themes in light of the data. Some of the peers in these teams were experts in educational counseling and all were experienced researchers. Those consultations increased the trustworthiness of the research.

Protecting Participant Rights

The participants were concerned about exposure, both of themselves and of the events. While no names of children and families were given, some of the events described had been dramatic enough to be reported in the media, and the participants feared that an internet search might expose the name of the school, causing the counselors both to break the law and their professional ethics code. School counselors are used to thinking about the students and families’ privacy, but the counselors’ own rights were also important in this study. I sought to reassure them that any information they might provide would in no way harm them. After sending the transcripts, four of the interviewees slightly changed their wording for the final transcripts, while ten of them left it untouched. One counselor altered her answers in such a way as to prevent her workplace and the events from being identified. As I understood her concerns, and due to the importance of protecting her privacy, and since this compromised the data, I omitted that interview. All the names in this article are pseudonyms.

Findings

This section presents the main themes as revealed by the interviewees. First, I will present the centrality of case management within the overall work of school counselors. This will be followed by three themes demonstrating the unique characteristics of case management by school counselors in mainstream schools: temporal limits, head of the octopus, referring to the complex relationship with the many profession- als involved in each critical event, and multiple clients, which refers to the responsibility for others, besides the child/family at the center of the critical event. These three themes are unique aspects of case management by school counselors, which the existing models of case management do not consider.

The Central Place of Critical Events Management in the Counselor’s Work

All interviewees described critical case management as a routine part of their work, an intensive activity demanding immediate attention and lengthy "counselor time".

The frequency of critical events is so high that it becomes a daily routine. Although they are experienced school counselors, the sheer number of critical events can

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overwhelm them. The intensity is affected not only by the growing quantity of events, but also by the complexity of handling each one. Ron, a middle-school counselor with 15 years of experience, said:

Most of the day I manage these critical cases. I try passing it over to the homeroom teachers, but they don’t know how to navigate it. The number of kids in schools today with critical emotional problems and behavioral problems is only getting higher. As a result: critical cases. We have 37 kids in a classroom, 7 classes in one grade level. So a big portion of my day demands case management. Every day there are new big events. Every day a new case opens. This adds to the follow-up on the previous cases. Most of the time, I have critical events back-to-back; there was a moment that I simply collapsed.

Edna, an elementary-school counselor for nine years, gives a concrete example of the centrality of case management in the counselors’ work:

I have two new cases only from the beginning of this week: In the first case, a girl was sexually abused in the youth organization she participates in (scouts) by her peers, and in the second case, we were informed that a student of ours was found wandering around the streets of the city late at night. Both are very serious cases and I am investing many hours in that.

The large number of cases, which the counselors are solely obligated to manage, are certainly greater than the number of cases recommended in the existing models of case management, both in the intensive models and non-intensive ones (Burns et al., 2007; King et al., 2004). Nonetheless, the amount of cases poses a great dif- ficulty because each case is very complex to manage, demanding a unique approach, as will be demonstrated below.

First Theme: Temporal Limits—"Holding it Together After the Storm"

A counselor will continue to be involved in managing the intervention for the child and the family as long as the child remains a student at the school, although the nature of the intervention may change. This indicates one of the unique characteristics of case management in the educational system. The school counselor never

“closes a case.” Although the last stage of all case management models is “summary” (Levi & Kriel, 2007), for the school counselor the case never ends. Claudia, an elementary-school counselor, with 12 years of experience, explains:

Every critical case that I have finished handling, immediately becomes part of my active “follow-up” cases. When the student graduates from my school, I give the information to the school counselor in the following educational framework, the middle school, under all privacy regulations.

The responsibility of the school counselor for the children remains theirs also in reporting about the critical event to the next educational framework (middle school/

high school). All the participants in the present research described their responsibility toward the student and family as having no time limitation.

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Gigi, a middle-school counselor in a boarding school, with approximately 20 years of experience in different educational frameworks in different cities, repeat- edly used the phrase "holding it" when describing how she actively follows up on a critical case:

I have a girl in middle school with a brother in high school whose mother passed away. Last year things deteriorated a lot. Not good, not good at all. The homeroom teacher reported to me some disturbing things the girl had said about her wish to end her life. I had to respond quickly and in a wide scale.

What I did was to bring together the whole high school team. We talked about everything. Since then, the boy, the girl, and their father are well taken care of. However, that doesn’t hold for long on its own…. And I have to hold it together [emphasis added], after the storm, all the time, long after it’s appar- ently over. Because it is not over. It is never over. What is important to me is to know that the different caregivers at the different services communicate with each other. I constantly have to tie up the loose ends since that is the optimal care. Because otherwise things might collapse, processes might fall, and the kids will go downhill again [emphasis added]. And I will feel a great sense of loss if that happens.

Gigi conducted periodic staff meetings with all the different caregivers who are involved in the case. She has done so constantly for three years in a proactive manner. Different counselors reported a variety of creative methods to "hold it together"

(or: follow-up): A counselor reported two phone calls a week with a mother. Another counselor reported weekly meetings with the child in need, and in a different case, monthly written reports from the counselor to the welfare service, signed by the parents. The different methods for monitoring or following up reflected the proactive, creative, long-term process, which lasts as long as the child and family are registered in the school—sometimes up to 6 years. These quotes and others emphasize the unique characteristic of case management by school counselors: no temporal limits.

This is not mentioned in the general literature on case management (Bar-On, 2011;

Mas-Exposito et al., 2014) nor in the school counseling professional literature.

Second theme: Recruiting Intra‑ and Inter‑Organizational Professionals: "The Octopus Head"

A central element in all definitions of case management is that of the integration of a range of services toward a shared goal (Ziguras & Stuart, 2000). Recruiting additional support sources—sometimes up to eight or nine different support professionals from different frameworks that handle the same critical event—is the most prominent action taken and was noted in all interviews. The interviewees described this with a variety of images such as “patchwork quilt”, “traffic police”, “centipede”,

“puzzle”, “octopus”, etc. However, the nature of the recruitment of professionals within the school and outside the school is different and reflects the different interactions counselors have with their colleagues.

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Recruiting Support Sources within the School: Intra‑Organizational—"Never Alone"

The participants in the present study described the internal school staff as natural partners when a critical event occurs. All the interviewed counselors emphasized practicing consultation with the internal staff: the principal, the grade-level coordinator, an internal therapist, the homeroom teacher, the special education teacher—

all were mentioned as immediate partners. Joy, a middle-school counselor a few months after retirement described the partnership:

The grade level is run by the grade-level coordinator and the school counselor.

This means that you are never alone, never alone. In critical cases, the counselor always plans and sets the meetings with parents, school psychologist, interdisciplinary team, and the special education professionals. I always manage those meetings and lay out the overall plan, after the approval of the principal.

This means that there was always a team in the room, a team that I formed specifically for the case. The counselor is never alone there. (…) One day, a student’s mom died from cancer. A single-parent family. The grade-level coordinator and I consulted with the headteacher and laid out an intervention plan.

We immediately formed a team within the school and had a meeting to carry out the support plan. It all happened that same day, while immediately recruiting the whole team.

Joy repeats that she is "never alone" when in school. She draws a picture of very tight collaboration. Joy does not describe equality among all the teachers but, rather, the existence of a team that leads the process in critical events and accepts the mandate to do so from the entire school staff. The emphasis Joy gives to the team within the school may imply the lack of it outside the school. The tight collaboration within the educational frameworks was a theme present in all interviews.

Recruiting Support Sources outside the School: Inter‑Organizational—"I Feel Alone"

Whereas counselors manage critical cases with full partnership within the school, they do not always feel that they have the mandate to do so with professionals outside the school framework. It appears that external professionals are not always aware of the need to cooperate proactively with the school counselor, and the relationship with these professionals is, therefore, more complex. All the counselors interviewed in the present research reported a large range of possible professional partners, dependent upon the specific case, the characteristics of the local munici- pality, the type of school, and the characteristics of the family. The counselors’ proactive approach to cooperation is prominent, but it appears that the external professionals do not initiate communication with them: they do not update the counselors or consult with them. This proactive communication stands out in Gigi’s description:

I’m the school counselor, so it’s obvious that I have all the information and coordinate everything. It is my responsibility. When I know something, of course it is my obligation to take the lead. For example, we have a girl

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with a borderline personality disorder. After a critical event we devised a plan and formed a team, and I started an online forum about the girl where we post updates about her, such as whether she came to therapy or not and what is her emotional condition and daily difficulties. The team was from within the school and from outside the school: her homeroom teacher, the social worker at the dormitories, all three emotional support therapists at the school, the other teachers, the special education teachers, her boarding school’s social worker, and our school grade coordinator. Certainly, I repeat- edly "nag" them to update me, and that is so tiring. Inside the school, teachers and therapists keep me posted all the time. But outside the school, I’m never updated if I’m not "nagging". It’s the only way, and it’s tiring. Now, let’s say that I felt her condition was getting worse—this whole caregiving team met and discussed it (…) How do we synchronize our approaches? We raised the level of care. The person who runs all this is me. And that is so tiring.

Maya, a middle-school counselor with seven years of experience at the same school, describes the problematics of a multi-factor system:

I think the counselor’s job… is to know who to recruit, when and how. Yet I really think that the more autonomous I am managing the cases, the better. Because this octopus, with all those arms, distributes responsibility, but at the end of the day the child stays with us. The child comes to school six days a week. If we let everybody run this—there will not be an appropriate response. And then the child will remain without a response, the family will remain without a response, and so will the teachers. Everybody will be frustrated.

When Maya says "who, when and how", she explains that based on her analysis of the situation, she determines what the best overall plan would be and accord- ingly refers to the relevant resources while advocating for the needs of the student and family. By “autonomous,” Maya contends that the recognition of her function as the manager of the case is best for the child and family. She explains that the larger the team of professionals (the "arms of the octopus"), the less responsibility each of the members feel toward the case, reminiscent of the bystander apathy phenomenon described by Latane and Darley (1969), while also implying that recognition as the “head of the octopus” may not always be given to her.

As Maya implied, another high school counselor, Alana, stated how not all of the “octopus’s arms” acknowledge her as a case manager or acknowledge her at all:

We touch a nerve. I can’t deny that we are often disappointed because we have to say, “The emperor has no clothes” and to “shake up” the professionals outside the school. They often demand that we report to them on critical cases, but we feel that someone on the other side is doing us a favor if they update us, and I don’t always feel in partnership; many times I feel that I have to get the process going and be the “engine”. I often get in touch

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with the professionals who see the child after school and check with them:

Do they see him/her? Do they meet him/her? Do they know what they are going through? Meaning, those external professionals, who, as far as I’m concerned, are a big part of the puzzle—do not update me on anything. For example, if a student doesn’t show up at school in the morning, he often gets up much later in the day and starts wandering the streets. So the “youth team” or “location team” or the police or the welfare services in my local authority probably know him. In other words, even if I don’t see him at school, someone else must have seen him, and it’s my job to find that someone. We have to work together. I don’t think that the external professionals involved see it as their responsibility to contact the school as part of their job. I think they just do not understand the full picture, they don’t see what I see. I think they don’t believe that it is worthwhile to contact the school and see what isn’t working properly with the teenager. I am usually the one who initiates the communication.

By "emperor", Alana, with 18 years of experience, is referring to social workers, psychologists, nonformal educational job holders, and other professionals from different frameworks working for the local authorities or in the private sector. They are frequently mentioned in the interviews as natural, inter-organizational partners.

Alana describes her frustration with the lack of cooperation, calling them "the other side". It is not only that the partners do not recognize her as the case manager (as managing all the arms of the octopus), but also do not even perceive her (represent- ing the school) as an “arm of the octopus”. There is a large discrepancy between the way counselors view their role and the manner in which what should be their natural partners perceive the role of the counselor, and this creates frustration and distrust and also a heavier workload, ultimately resulting in a deficient service for the child and family.

Maya demonstrates the lack of cooperation through a critical case with which she is currently involved:

Look how complicated this is. There was an interdisciplinary team committee of professionals about a student of ours, who was pregnant, an at-risk 12-year- old girl. There is no place for her in the emergency center for teenage girls.

The emergency center is full for now. What do we do? Legally, that is the welfare department’s responsibility to be in charge of this. I, the school, was sup- posed only to report to them. But what happened in reality is that the counselor, me, managed everything. I had to generate a plan and according to the way things have been going, it will also be me who does the follow-up on the case.

In all existing models of case management, a central element is that of the integration of a range of services toward a shared goal (Rubin, 1992; Ziguras &

Stuart, 2000). However, for school counselors, as revealed in the present study, this management skill poses complex relationships with external professionals who are theoretically "colleagues" of the school counselor. For most of the participants in this research, the lack of cooperation is prominent and considered a major obstacle. Nonetheless, one participant described a beneficial cooperation

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with the welfare department in their city, stating that "We work [together] tightly and I practically need a desk and a chair there." Complex professional relationships, including hierarchy issues, are not mentioned in the literature on case management nor in the existing theory of school counseling. It is therefore an inter- esting finding to examine and relate.

Third Theme: Multiple Clients

Managing a critical event, which is traumatic and dangerous, requires developing a sensitive, well-planned, and well-managed intervention for the student and family. However, for the experienced school counselor, the clients are not only the child at the center of the critical event and their family. For example, when a teenager is sexually attacked by their peers, the school counselors are responsible for the attackers as well as for the attacked and for the wider circles, which include the close peers, the grade-level students, the pedagogical staff, and the school as a whole. All of these are considered clients of the school counselors.

They are required to address and provide overall care for them as well. The con- sequence of this responsibility for multiple clients is that when a critical event occurs, there might be up to ten different clients requiring a considered response from the school counselor. This diverges from other case management models, including the intensive models, in which only the individual and his/her family are the clients of the case manager (Bar-On, 2011; Frankel et al., 2019; Mas- Exposito et al., 2014).

The Peers in the Affected Circles

Without appropriate emotional support, the peers themselves could experience breakdown. In addition to the child at the center of the critical event, they too need to reveal their feelings and fears and gain access to recovery (Algarisi et al., 2013).

This is a unique characteristic of managing critical cases in mainstream schools by the educational counselor, whereas in other caregiving professions, the responsibility is only for the child at the center of the case and his/her family.

Liz, a high school counselor in a boarding school who will soon be retired, explains that while the child at the center of the event and his family will receive individualized care (sometimes from a therapist/psychiatrist), other clients are under her sole responsibility. She maps out the affected circles, identifies peers who were close to the at-risk adolescent, conducts individualized therapy with the peers, and forms a therapy group:

After that suicide attempt, I formed three therapy groups of friends (of the student) from the grade level. These groups had a therapeutic nature and lasted from November until the end of the school year in June. This is a lot of work. I also conducted private weekly meetings with specific students who were close to the student or knew about the case.

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While intervention in critical events is a reactive response, counselors continue, as part of their intervention, to act for the benefit of the entire student population under their care.

The Pedagogic Staff

Obviously, the immediate goal is to respond effectively to the individual case, but when counselors also guide homeroom teachers, they enable them to increase their professionalism and acquire therapy-based tools. Perceiving the pedagogic staff also as clients is based on the ecological approach (Erhard, 2008), according to which providing optimal care for one child in a critical event "takes an entire village". The school counselor is, therefore, responsible for expanding the range of skills of every person who interacts with the child and affects her or him. This unique characteristic of school counselors’ responsibility was described by Shully, a very experienced elementary-school counselor, who demonstrated managing a critical event in which she defined many clients, focusing on the homeroom teacher and guiding her closely.

Here, a fifth-grade student presented unusual, unstable behavior, which deteriorated:

…I guided her [the homeroom teacher] over a long period. First, on how to work with the child with empathy, because this was the key to creating trust.

To her credit, she did it well throughout. Then, after a few months, the homeroom teacher and the child were close enough, and he told her he wanted to die. He is 11 years old!!!! The homeroom teacher was emotionally devastated.

I accompanied her this whole year closely, both emotionally and profession- ally, in her actions toward that kid and toward the whole class. I have been guiding the homeroom teacher in private meetings, and I also entered the class with her to see her teach and interact with this child, and then we talked about it. I guided the teacher and she practiced the whole process with my fulltime guidance.

Aside from the demanding work with the student, his recently divorced parents, the psychiatrist, school psychologist, and family’s social worker, Shully demonstrates in this quotation how the homeroom teacher is considered a significant client of hers. In addition to the homeroom teacher, Shully and the school psychologist also conducted a four-meeting workshop for the whole pedagogic staff on children in stress and suicidal expressions.

The Organizational Culture as a ‘Client’: Improving the School as a System after a Critical Case

The interviews revealed that at the later stages of intervention, school counselors consider how existing procedures at the school, which are part of its organizational culture, could be improved in order to provide an effective response to future critical events. The counselors gave varied interpretations of that aspect, presenting distinct proactive actions that reflect a range of responses of varying scope and depth.

Ori, an elementary-school counselor with six years of experience at the same school, initiated and conducted a workshop for a new staff team of teaching

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assistants in her school after a critical case had occurred. Personal teaching assistants are nowadays common in mainstream schools, following the worldwide implementation of inclusion policies (Dashevsky, 2009; UNESCO, 2005).

This new pedagogic team became routine:

Following a critical event of a girl who was a victim of violence at her home, I understood that the lack of knowledge and lack of communication had led us to oversee the symptoms. I formed a new team of all (seven) personal assistants in our school that are called “integrative teachers” to raise central issues in their work in general. We formed this team, eight sessions, once in three weeks. It was excellent. Now it’s a new regulation in my school. I think it had a double contribution: both to their professional work as a team and to their sense that they are part of the school.

Suddenly we formed an extended connection. It made them all feel better and improved their everyday work and also their functioning in critical events.

Like Ori, other counselors worked toward anchoring new work procedures that had proven to be effective when managing a specific critical event and turned them into part of the school culture and its routine. One example of this is, as reported by one of the counselors, to establish permanent weekly team meetings of therapists and homeroom teachers. Such meetings were reported to have taken place after a critical case and proved to be very effective, also in preventing future similar events. Other counselors reported other initiatives, such as workshops to help the pedagogic staff deal with counselor-related topics in order to enrich their toolbox. These topics include learning disabilities, attention disorders, eating disorders, and dealing with stress, all of which are topics that were needed for specific critical cases and that the counselors thought could be useful for the whole staff. Another example is an initiative of a new ceremony that created a significant change in the whole school’s approach toward evaluation and assessment following critical cases of stress. The school counselor was the initiator of that change.

School counselors see the organization itself as a client after a critical case occurs and ask themselves: "How can the school function better the next time?"

In this approach, the counselor does not only guide specific staff on how to best handle a critical event that has occurred, but also equips the whole school with processes that strengthen its ability to function well in the future.

Case management models in the existing literature (Frankel et al., 2019) not only refer to a single client but also do not consider the organizational aspects at all. School counselors implement a broader array of skills when managing a critical event than those indicated in the existing models of case management including identifying all the clients, designing, planning, and executing intervention plans for all the clients, and also facilitating discussions, individual therapy and family guidance, guiding therapy groups, and conducting yearlong pedagogic workshops. School counselors apply individual and organizational thinking while managing a critical event and do so simultaneously.

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Discussion and Conclusions

The school counselors’ organic position within the school staff, in addition to their professional training and expansive knowledge, places them in a key position to manage critical events that may traumatize the students, families, and pedagogic staff, who lack the skills and knowledge to handle such events (ASCA, 2019a; SHEFI, 2009). Research shows that even licensed and experienced school counselors expressed their need for supervision in order to best function in these fateful, complex situations (Dupre et al., 2014). Most of the literature examines the individualistic therapeutic aspects of school counseling, while the management aspects of the profession are not sufficiently studied. Some researches have examined the effectiveness of case management in special education frameworks (Arnold et al., 2007; Franklin, 2010; Smith & Prelock, 2002; Strand & Lovrich, 2014; Welles & Gifford, 2013) but not in mainstream ones. However, even these studies do not shed light on the role of the school counselor in critical cases, instead focusing on the role of other caregiving professions, such as social workers and psychologists (Frankel et al., 2019; Ritvo & Goldstein, 2006; Smith, 1995). The present research leads to a better understanding of the complexity of managing critical cases involving children and youth, with the aim of character- izing the uniqueness of the school counselor’s role as distinct from the role of other caregiving professions. Eventually, the goal is to improve the overall treatment given to the students, their families, and the students and staff of the entire school.

Two findings stood out in this research: The first is the school counselor’s responsibility for multiple clients in every critical case, rather than only for the one child/family at the center of the event; the second is the complex relationship counselors need to maintain while recruiting, forming, and managing teams of professionals ("octopus head").

While the child and family at the center of the event are the only clients for social workers, psychologists, psychiatrist, and CBT therapists, the school counselor is responsible for multiple clients in each event. Multiple clients is a distinct feature of case management by school counselors in mainstream schools.

The peers of the child in affected circles, the parents of the friends, the teachers, and sometimes even people in the community demand the school counselor’s intervention and care, each with different needs. Every client is, in fact, a critical case by itself. For example, when an adolescent attempts suicide, not only the suicidal teenager and their family are the clients of the school counselor—their classmates, friends, friend’s parents, and teachers are considered clients of the school counselor as well. School counselors are required, therefore, to implement skills that are beyond the formal definitions of case management models (Frankel et al., 2019; Sandoval et al., 2009), including identifying the clients, and designing, planning, and executing intervention plans for all clients. The experienced counselors reported varying scopes and depths of responses to the clients’

needs such as facilitating classrooms discussions with students, giving individual therapy and family guidance, guiding therapy groups, and conducting yearlong

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pedagogic workshops following the critical event. Unlike school counselors in their early stages, who focus only on students at the center of the event, experienced school counselors in this research are practicing unilateral, comprehensive thinking when identifying and responding to all the clients’ needs.

Another aspect of the first distinct finding (multiple clients) which stood out in this research is that school counselors contribute to the shaping of their school’s organizational culture after a critical case has occurred, as they consider the school’s organizational culture an additional client. They change work procedures and norms, form new teams, and promote communication habits. Experienced school counselors want to lead their schools forward toward strength and stability, so that they are capable of handling any crisis effectively and sensitively. The training and supervision of school counselors should encourage them to become leaders (House &

Sears, 2002) who orient their actions toward optimizing the welfare of all students, teachers, and the management of the institute.

The second significant finding is the recruitment of many different professionals (from different frameworks) and coordinating with them according to a coherent plan that the counselor devises after consultation. The formation of the teams for each critical case had no distinguishable pattern of personnel, with each case requiring a different set of professionals, which makes it almost impossible for a researcher to follow. Yet in this context, a paradox stood out: School counselors are obligated to form multi-professional teams, while they are required to manage those who do not always want to be managed or perhaps do not always realize that the school counselor is managing the case. Furthermore, professionals outside the school often do not perceive school counselors as part of the overall configuration and do not proactively contact, inform, or consult with them on any part of the processes. The result is complex relationships that counselors need to maintain. All things considered, it is necessary for work norms to be changed so that the collaboration is equally desired by all professionals.

The comprehensive involvement of school counselors in critical events is not ade- quately reflected by any of the existing models of case management. These models do not comprise the unilateral thinking and multifunctional skills counselors perform within the educational field. Counselors implement skills fitting both the intensive case management models (sometimes referred to as clinical models), while also fitting the other end of the spectrum, namely the non-intensive case management models (Bedell et al., 2000; Burns et al., 2007; King et al., 2004; Mas-Exposito et al., 2014). Nevertheless, they also perform skills that are not mentioned at all in these models, such as leadership and organizational orientation. As presented in the literature, while most caregivers place themselves within either one of the models, school counselors are almost solely responsible for a large number of cases (sometimes up to 30 for one grade level of 180 students) and extremely complex processes. It is not surprising, therefore, that counselors report emotional breakdown and burnout. This comparison could be another area of further research.

When experienced school counselors look retrospectively at their professional experience, they believe they have taught themselves over the years the art of managing critical events in all the aspects presented in this research. Several hidden aspects of the school counseling profession were first revealed and understood in the

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present research. These understandings contribute not only to the school counseling profession but could also influence the preparation, training, and supervision of novice counselors (Hayes & Paisley, 2002; Perusse et al., 2001). Another contribution of this research is the call to all caregiving professionals to pave the way for new collaborative procedures and work norms so that the rehabilitation of the child and family in need will be gradual, effective, and stable.

Declarations

Conflict of Interest The author declares that they have no conflict of interest.

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