|
|
NASW
Standards for Social Work Case Management
Prepared
by the Case Management Standards Work Group
Approved by the NASW Board of Directors, June 1992
Contents
- NASW
Standards for Social Work Case Management
- Definition
- Goals
- Tasks
and Functions
- Standards
for Client, System, and Case Manager
- Standard
1. The social work case manager shall have a baccalaureate
or graduate degree from a social work program accredited
by the Council on Social Work Education and shall possess
the knowledge, skills, and experience necessary to competently
perform case management activities
- Standard
2. The social work case manager shall use his or
her professional skills and competence to serve the client
whose interests are of primary concern
- Standard
3. The social work case manager shall ensure that
clients are involved in all phases of case management
practice to the greatest extent possible
- Standard
4. The social work case manager shall ensure the
client’s right to privacy and ensure appropriate confidentiality
when information about the client is released to others.
. . .
- Standard
5. The social work case manager shall intervene at
the client level to provide and/or coordinate the delivery
of direct services to clients and their families
- Standard
6. The social work case manager shall intervene at
the service systems level to support existing case management
services and to expand the supply of and improve access
to needed services
- Standard
7. The social work case manager shall be knowledgeable
about resource availability, service costs, and budgetary
parameters and be fiscally responsible in carrying out
all case management functions and activities
- Standard
8. The social work case manager shall participate
in evaluative and quality assurance activities designed
to monitor the appropriateness and effectiveness of both
the service delivery system in which case management
operates as well as the case manager’s own case management
services, and to otherwise ensure full professional accountability
- Standard
9. The social work case manager shall carry a reasonable
caseload that allows the case manager to effectively
plan, provide, and evaluate case management tasks related
to client and system interventions
- Standard
10. The social work case manager shall treat colleagues
with courtesy and respect and strive to enhance interprofessional,
intraprofessional, and interagency cooperation on behalf
of the client
The National Association
of Social Workers (NASW) Standards for Social Work Case Management
are addressed to professional social workers who perform the case
management function in the specifically designated role of "case
manager." These social work case managers serve as part of social
work service or as members of a case management team in human services
agencies or other service delivery settings, such as schools, health
care facilities, hospitals, and employee assistance programs, or
in the context of private practice. These standards are formulated
in full recognition that there is no universally accepted definition
of case management, nor is there one definitive model of case management
as practiced within the social work profession. The purpose of
these standards is to clarify the nature of social work case management
as well as the role of the social work case manager.
Case management
encompasses well-established social work concepts and techniques.
As an approach to arranging and coordinating care, it has its origins
in the earliest history of social work practice and the social
work profession. Social work case management is clearly linked
to social casework, a fundamental concept of social work practice.
Traditional social caseworkers maintained a dual focus on the client
and the environment, working directly with and indirectly on behalf
of individual clients and families in need of social services.
Case management remains an important professional component of
competent social work practice. It is based on the recognition
that a trusting and empowering direct relationship between the
social worker and the client is essential to expedite the client’s
use of services along a continuum of care and to restore or maintain
the client’s independent functioning to the fullest extent possible.
This approach to service delivery has become increasingly prominent
across many disciplines and practice settings, because it is believed
to be an efficient and cost-effective method for managing the delivery
of multiple labor-intensive services to targeted populations.
All aspects of
social work case management rest on a body of established social
work knowledge, technical expertise, and humanistic values that
allows for the provision of a specialized and unique service to
designated client groups. The social work case manager must have
the capacity to provide assistance in a sensitive and supportive
manner to particular client populations based on knowledge of human
behavior and well-developed observational and communication skills.
With this foundation, a social work case manager establishes helping
relationships, assesses complex problems, selects problem-solving
interventions, and helps clients to function effectively and, thus,
is a therapeutic process.
The conduct of
the social work case manager follows the basic social work ethical
tenets of the NASW Code of Ethics, including the primacy of the
client’s interests, the recognition of the inherent worth and capacity
of the individual, and the individual’s right to self-determination
and confidentiality. As a social worker, the case manager abides
by all NASW professional standards and should be licensed or certified
to practice by the state regulatory agency.
The practice of
case management varies greatly across social work settings and
is even more diverse as applied by other professionals. Despite
this diversity, several elements distinguish social work case management
from other forms of case management.
Social work case
management is a method of providing services whereby a professional
social worker assesses the needs of the client and the client’s
family, when appropriate, and arranges, coordinates, monitors.,
evaluates, and advocates for a package of multiple services to
meet the specific client’s complex needs. A professional social
worker is the primary provider of social work case management.
Distinct from other forms of case management, social work case
management addresses both the individual client’s biopsychosocial
status as well as the state of the social system in which case
management operates. Social work case management is both micro
and macro in nature: intervention occurs at both the client and
system levels. It requires the social worker to develop and maintain
a therapeutic relationship with the client, which may include linking
the client with systems that provide him or her with needed services,
resources, and opportunities. Services provided under the rubric
of social work case management practice may be located in a single
agency or may be spread across numerous agencies or organizations.
The primary goal
of case management is to optimize client functioning by providing
quality services in the most efficient and effective manner to
individuals with multiple complex needs. Like all methods of social
work practice, case management rests on a foundation of professional
training, values, knowledge, theory, and skills used in the service
of attaining goals that are established in conjunction with the
client and the client’s family, when appropriate. Such goals include
- enhancing developmental,
problem- solving, and coping capacities of clients
- creating and
promoting the effective and humane operation of systems that
provide resources and services to people
- linking people
with systems that provide them with resources, services, and
opportunities
- improving the
scope and capacity of the delivery system
- contributing
to the development and improvement of social policy.
Although the roles
and responsibilities of individual social work case managers can
vary considerably depending on program or system objectives, social
work case managers perform a range of common tasks related to client-
level intervention and system-level intervention.
Client-Level Intervention
Once the social
work case manager has identified and engaged clients as a result
of outreach or referral activities, he or she conducts a face-to-face
comprehensive assessment with each client of that client’s strengths
and limitations and of the social, financial, and institutional
resources available to the client. The social work case manager
focuses particularly on how these resources relate to the principal
concerns identified during the assessment. On the basis of this
assessment, the social worker develops an individualized service
plan with the client that identifies priorities, desired outcomes,
and the strategies and resources to be used in attaining the outcomes.
The responsibilities of the social worker, the client, and others
should be clarified throughout development of the plan. The direct
contact between social worker and client is essential to effectively
accomplish the assessment and service plan development.
Additional social
work case management tasks related to client intervention include
implementing the service plan aimed at mobilizing the formal and
informal resources and the services needed to maximize the client’s
physical, social, and emotional well-being, and coordinating and
monitoring service delivery. The social work case manager also
advocates on behalf of the plan for needed client resources and
services; periodically reassesses client status, the effectiveness
of interventions, and the attainment of outcomes with revision
of the service plan as indicated; and terminates the case.
At all stages of
client intervention, it is crucial that the social work case manager
be granted sufficient authority to access, allocate, monitor, and
evaluate service and fiscal resources. Such authority is a prerequisite
of effective case management practice. Optimal control over and
management of scarce resources may be more readily achieved in
delivery systems structured with a single point of entry and integrated
funding. Case managers will be more effective in delivery systems
that are designed to reduce fragmentation.
System-Level Intervention
An organization’s
structure, policies, and budget as well as the community network
of services should adequately provide for the implementation of
client-centered case management. The social work case manager is
responsible for understanding how the agency and environmental
systems can both positively and negatively affect clients and to
intervene at the system level to optimize these conditions. To
this end, the social work case manager engages in a range of tasks
that support and enhance the system in which case management exists.
For example, the social work case manager
- analyzes the
strengths and limitations of environmental systems
- delineates desired
outcomes
- selects strategies
to improve systems
- assesses the
effectiveness of strategies
- continues to
revise, as indicated, desired outcomes and strategies.
Specific activities
include, but are not limited to, resource development, financial
accountability, social action, agency policy formation, data collection,
information management, program evaluation, and quality assurance.
Like client intervention, system intervention occurs along a continuum
and comprises an ongoing, uninterrupted cycle of tasks that are
performed by the social work case manager.
Standards
for Client, System, and Case Manager
The following 10
standards are generally organized into three areas: the client,
the system, and the social work case manager. Beginning with the
necessary qualifications of the social work case manager (standard
1), standards 2 through 5 pertain to client issues: primacy of
the client’s interests, selfdetermination, confidentiality, and
client intervention. Standards 6 through 8 pertain to systems issues:
system intervention, fiscal accountability and quality assurance,
and program evaluation. Standards 9 and 10 return to the initial
focus of the social work case manager with a discussion of adequate
staffing and intraprofessional relationships.
Standard
1. The social work case manager shall have a baccalaureate
or graduate degree from a social work program accredited by the
Council on Social Work Education and shall possess the knowledge,
skills, and experience necessary to competently perform case
management activities.
Interpretation
The practice of
social work case management is highly complex and calls for a variety
of roles and skills, such as advocate, broker, diagnostician, planner,
community organizer, evaluator, consultant, and therapist. The
qualifications of staff should be appropriately matched to the
skills required to perform case management duties. Where required
by state law, the social work case manager should be licensed or
certified to practice.
A differential
use of staff may be implemented in carrying out case management
responsibilities, particularly when specialized expertise is indicated.
The more highly educated, more skilled, and experienced social
work case manager (i.e., a social worker with a master of social
work [MSWI degree) should conduct the assessment and handle difficult
and complex situations. The less highly trained professional (i.e.,
a social worker with a bachelor of social work [BSW] degree) should
perform more routine tasks under supervision. The social worker
should accept responsibility or employment only on the basis of
existing competence or should agree to participate in the training
and supervision required by the employer to acquire the necessary
competence.
Professional social
work supervision or consultation should be available to all social
work case managers, either in the agency or through a contractual
arrangement. The beginning baccalaureate social work case manager
requires regular consultation or supervision. For the first two
years of postbaccalaureate professional experience, at least one
hour of supervision should be provided for every 15 hours of direct
client-level case management tasks. After the first two years,
the ratio may be reduced to a minimum of one hour of case consultation
or supervision for every 30 hours of client intervention activities.
For the first two years of postgraduate professional experience,
one hour of consultation or supervision should be provided for
every 30 hours of client intervention activities. The BSW case
manager with five years or more of experience or the MSW case manager
with two years or more of experience should use consultation or
supervision on an as-needed, self-determined basis.
The social worker
should strive to become and remain proficient in professional case
management practice and in the performance of professional case
management functions by critically examining and keeping current
with emerging related knowledge. The employing organization should
provide regular in-service training as a means of enhancing the
skills of the case management staff.
Each social work
case manager shall assume personal responsibility for continuing
professional education. He or she should complete 90 hours of such
education every three years in accordance with the NASW Standards
for Continuing Professional Education.
In addition to
academic credentials and educational endeavors, it is most important
that the social work case manager understand the characteristics
of the client population and practice setting in which this population
is served; the socioeconomic, cultural, gender, racial, and sexual
orientation issues that may affect the differential use of services;
the fiscal impact and consequences of using particular services;
and the system of agency -community resources and the interrelationships
among system components.
Standard
2. The social work case manager shall use his or her professional
skills and competence to serve the client whose interests are
of primary concern.
Interpretation
As with all social
workers, the social work case manager’s primary responsibility
is to his or her clients. While working within the context of an
agency’s goals and resources, the case manager must ensure that
each client receives appropriate assistance by providing accurate
and complete information about the extent and nature of available
services and by helping the client decide which services will best
meet his or her needs. Personal or professional gains should never
be put before the primacy of the clients’ interests and the social
work case manager must not exploit relationships with clients for
such advantages. Furthermore, the case manager should
- ask the advice
of colleagues and supervisors whenever such consultation is in
the best interests of the client
- exercise professional
judgment and prudence in selecting and recommending services
- terminate a
service when it is no longer needed by or no longer helpful to
the client
- promptly notify
the client if the case manager anticipates that a service will
be interrupted or terminated by a service provider
- make the necessary
transfer or referral if the client still needs such a service
to ensure continuity of care.
It may be difficult
to adhere to a position of primacy of the client’s interests, particularly
in a climate of resource scarcity. Agency cost containment goals
may conflict with the best interests of the client. When primacy
of the client’s interest runs counter to agency goals, policies,
or resources, and ethical dilemmas are encountered, a mechanism,
such as peer review or administratively sponsored ethics committees,
should be available to the social work case manager to remedy such
conflicts. If no such mechanism exists within the internal operations
of the organization, the social work case manager shall advocate
for internal change and seek appropriate external consultation
with, for example, the NASW Chapter Committee on Inquiry.
Standard
3. The social work case manager shall ensure that clients
are involved in all phases of case management practice to the
greatest extent possible.
Interpretation
The social work
case manager shall make every effort to foster and respect maximum
client self-determination. The case manager is responsible for
helping clients make informed decisions about selecting services.
Many clients must be assisted in negotiating complex, sometimes
intimidating, service delivery systems.
Although the lack
of organizational or community resources may limit a client’s options,
the case manager should inform the client of the full range of
existing choices. Full disclosure includes information on the lack
or limited availability of relevant services and the financial
implications of service selections and use.
The involvement
of clients in needs identification and in decision making is a
basic tenet of practice; only when the client is severely mentally
impaired should the client’s farm" ly or guardian make decisions
for the client. When the case manager must act on behalf of a client
who has been judged incompetent, he or she should safeguard the
interests and rights of the client. When another person has been
legally authorized to act on behalf of a client, the case manager
should deal with that person by always considering the client’s
best interests.
Involvement of
the client, family, and social worker in case management tasks
need not be mutually exclusive. The case manager and the client
can share responsibility for certain case management tasks and,
thus, maximize client involvement in decision making and problem
solving. Sharing case management functions mobilizes the client
and the client’s family, enables them to use their abilities, and
empowers the client by giving the client more control of the services
he or she is receiving. However, collaborative decision making
should occur to determine the appropriate allocation of tasks.
Moreover, the social work case manager must provide support to
family members who serve as resources to the client to avoid overburdening
them and inadvertently facilitating caregiver burnout.
By the same token,
family members who have the time, a personal interest in the client,
and an extensive knowledge of and a trusting relationship with
the client and with the case manager can be in an advantageous
position to schedule, supervise, monitor, adjust, and interpret
services. Each client’s situation should be weighed on its merits;
therefore, the social worker must be flexible in the case management
role.
Standard
4. The social work case manager shall ensure the client’s
right to privacy and ensure appropriate confidentiality when
information about the client is released to others.
Interpretation
All information
about a client and the client’s family that is obtained by the
social worker in carrying out case management tasks shall be held
in the strictest confidence. Information may be released to other
professionals and agencies only with the written permission of
the client or his or her guardian. This release shall detail what
information is to be disclosed, to whom, and in what time frame.
Certain limits
of confidentiality are inherent in service delivery. The case manager
should orally restate assurance of confidentiality to the client,
including disclaimers and exceptions, if any. State laws may exist
that invalidate blanket confidentiality under particular circumstances,
such as threats of suicide or harm to others. Court orders may
require that an agency or independent practitioner release certain
information about a client. These are but two exceptions where
society’s need to know is pitted against the individual’s right
to privacy, and may outweigh it. The social work case manager shall
seek appropriate consultation before disclosing any information
not covered by the client’s written release. Professional discretion
should be exercised in releasing only the information that is relevant
to the problem at hand and in monitoring the duration of a time-limited
consent for release of information.
The social work
case manager should interview clients privately and offer them
the opportunity to be interviewed alone. It is important to ask
clients what information they would and would not like shared with
significant others. Out of respect for the client’s privacy and
need for preparation, the case manager should schedule appointments
in advance.
Human services
agencies and service delivery settings that provide case management
services should develop and disseminate clear policies and guides
that cover at least the following:
- what information
is to be sought and from whom
- what information
is to be recorded and in what form
- who has access
to information about cases and under what circumstances
- means for ensuring
the accuracy of records or for noting differences
- plans for the
retention and disposition of records.
Standard
5. The social work case manager shall intervene at the client
level to provide and/or coordinate the delivery of direct services
to clients and their families.
Interpretation
Social work case
management shall consist of the following eight components in the
provision of direct services to clients and their families: (1)
outreach, referral, client identification, and engagement; (2)
a biopsychosocial assessment of the client; (3) the development
of a service plan; (4) implementation of the service plan; (5)
coordination and monitoring of service delivery; (6) advocacy on
behalf of the client including creating, obtaining, or brokering
needed client resources; (7) reassessment of the client’s status;
and (8) termination of the case when services are no longer warranted.
Outreach, referral,
client identification, and engagement. Through outreach, the social
worker identifies, accesses, and engages those individuals who
would benefit from available services. Having received referrals
or having identified people likely to qualify for and need case
management, social work case managers screen clients’ circumstances
and resources to determine eligibility and appropriateness for
the case management program.
Biopsychosocial
assessment. The social work case manager shall conduct a face-to-face
biopsychosocial assessment of the client to identify strengths
as well as weaknesses through a systematic evaluation of the client’s
current level of functioning. To understand the client as a whole
person, the social worker must assess the interplay among physical,
environmental, behavioral, psychological, economic, and social
factors. Areas commonly evaluated by the social work case manager
include mental health status; preexisting health or mental health
problems; an appraisal of the client’s needs and the resources
of the client’s informal support system, including family members,
friends, and organizational memberships; social role functioning;
environmental issues, including economic situation, employment
status, and other basic needs; and relevant cultural and religious
factors. The social work case manager formulates an intervention
plan based on the findings of this assessment.
The biopsychosocial
assessment includes the input of relevant specialists, including
the client’s self-assessment of his or her strengths and weaknesses.
The participation of other health professionals is essential to
the assessment of the client’s physical status. Professionals from
all the disciplines who are involved in the client’s care should
contribute to the assessment. Where such joint action is impossible,
the social work case manager should gather necessary information
and initiate, coordinate, conduct, and document the assessment.
A uniform method
of collecting and reporting assessment findings should be, developed
for use by all case managers in the agency or service system. Such
methods are to be used only as tools in making a professional judgment.
Development of
the service plan. On the basis of the biopsychosocial assessment,
the social work case manager, in concert with the client and his
or her family, when appropriate, selects and outlines an array
of services and interventions in the form of an individualized
service plan. The case manager is responsible for coordinating
and documenting the development of the service plan with the client’s
participation. Ideally, the case manager will have involved professionals
from relevant disciplines in the assessment and the development
of the service plan; ideally, these professionals will have agreed
to assume specific functions and responsibilities.
Two important aspects
of the plan are the client’s personal and capacity-building goals.
Other important factors are the case manager’s knowledge of the
following: resources, informal and formal linkages with agencies
that provide services, the client’s use of services, and applicable
costs of use, as well as the case manager’s selection of alternate
resources. The social work case manager should recognize that care
planning is an important resource allocation function and be cognizant
of the costs and financing of the particular service plan.
This service plan
incorporates the client’s expectations and choices and the short-
and long-term goals to which the client clearly has agreed. Outcome
criteria should be selected that will be used to evaluate whether
objectives have been accomplished and goals have been attained.
A schedule for reassessing and modifying the initial goals and
plans should be part of the initial plan. Whenever possible, the
client and/or the family should sign the service plan to indicate
agreement with and participation in the development of the plan
as well as the expected concomitant behaviors.
Implementation
of the service plan. Implementation of the service plan involves
arranging for a continuum of services to be provided to the client
through formal and informal systems and ensuring that these services
both meet the client’s needs and are cost effective. The social
work case manager selects agencies that clearly meet established
standards and expectations for the services they are to provide.
The case manager explains his or her role in arranging for the
services, describes to the client the services to be provided,
informs the client when services are to begin, and promotes those
activities that foster client self-sufficiency.
Coordination and
monitoring of service delivery. The social work case manager should
coordinate service delivery to ensure the continuity and complementarity
of the interventions. The case manager should have frequent contact
with providers and clients to ensure that services are provided
as indicated in the service plan and to ascertain whether such
services continue to meet the client’s needs. Monitoring the client’s
receipt of services is an essential element of the ongoing reassessment
of client status and the intervention plan. Monitoring permits
the case manager to promptly respond to changes in the client’s
needs and alter the delivery of client services appropriately.
It can ensure that sufficient services are being provided and that
excessive services are not inhibiting the client and family’s ability
to meet their own needs. The responsiveness to changes in clients’ needs
results in the optimal, cost-effective use of service resources.
The frequency of monitoring activities varies, depending on the
extent of client need and the type of service delivered.
Advocacy for the
client and client resources. The case manager may need to advocate
for individual clients and their families for them to receive entitlements
or obtain needed services, including those provided by the case
manager’s own agency. The case manager also serves as an advocate
to ensure that services actually are delivered, gaps in service
are identified and filled, the individual’s needs are recognized,
client services are not prematurely terminated, and client services
are terminated when appropriate. Data collected during the implementation
and monitoring phases of the plan should be used in advocacy on
behalf of the client.
Reassessment. The
social work case manager will periodically reassess the client’s
needs and progress in meeting the objectives in accordance with
established benchmarks to ensure the effective and timely provision
of services. The timing of reassessments shall be prescribed by
the program, preestablished by the case manager based on his or
her judgment of an appropriate time frame, or performed on an asneeded
basis due to situational changes. Reassessments may constitute
readministering all or part of the original assessment or a partial
reevaluation of the client’s most significant problems. Regardless
of the timing, reassessments, like monitoring, often provide the
social work case manager with new information he or she will use
to reformulate the intervention plan and alter the client’s service
package.
Termination of
the case. Termination occurs for a number of reasons, including
the client’s attainment of stated goals, rehabilitation, client
or family noncompliance, the client or the case manager’s withdrawal,
or the client’s death. Termination also may occur because of limited
service availability. In such instances, the client should be transferred
to another suitable case management program, whenever possible,
to ensure continuity of care. Although an agency will set certain
criteria for terminating a case, it is the responsibility of the
case manager, the client, and significant others to prepare for
the effects of termination. The case manager should make appropriate
arrangements with the service providers and conclude the financial
aspects of the case.
After termination,
it may be necessary to follow up on the client and the client’s
family to ensure that the current situation is adequate and appropriate.
Follow-up also may be performed to collect program evaluation measures
pertaining to client outcomes. Follow-up may include assessing
the adequacy of the client’s current living arrangements and the
stability of the client’s functioning.
Standard
6. The social work case manager shall intervene at the service
systems level to support existing case management services and
to expand the supply of and improve access to needed services.
Interpretation
The social work
case manager is responsible for ensuring that the agency and environmental
systems in which case management exists function appropriately
on behalf of the client. Case management operates in a complex
environment ,comprising various policies, providers, and service
and financial resources. To maximize the effectiveness of this
intervention, the social work case manager engages in tasks that
support and enhance the system in which case management exists.
For example, the case manager develops resources; engages in social
action; participates in lobby ing/legi slative activity; reviews,
recommends, and modifies agency policy; collects data; manages
information; evaluates programs; and is involved in quality assurance.
Resource development
and social action. Because a wide range of social and health care
systems must be available to assist high-risk populations and their
families, the social work case manager must be able to recognize
duplicative services, identify gaps in services, and facilitate
the expansion or establishment of services in the agency and in
the larger community to meet these needs. Data collected in the
assessment, implementation, and monitoring phases of case management
practice should provide a database for identifying such resource
issues.
Advocacy is often
required to ensure that the agency meets its commitment to provide
access to and adequacy of services, the services are actually delivered,
the needs of the client are recognized, and the client is not prematurely
discharged by the service providers. It also is the case manager’s
responsibility to present agency executives, community leaders,
and government and consumer representatives with documented information
about resource limitations and other major case management problems,
and recommend solutions. The case manager has a responsibility
to participate in community needs assessments, community organization,
and resource development to see that the needs of clients are identified
and understood and that community action—public, private, or voluntary—is
initiated to meet particular needs.
Agency policy review
and modification. Case management services must be supported by
the agency boards and administration through the agency’s planning,
policy making, staffing, and budgeting processes. The agency’s
policies on case management should be reviewed and modified periodically.
This review should include the service delivery sequences required
for client assessment, case management planning and evaluation,
referral and follow-up, and shared responsibilities with other
agencies or individuals. Effective case management often requires
the establishment of linkages and communication channels with many
different social and health .care agencies. These must be defined
and maintained through joint agreements on policy and reimbursement.
Adequate resources and a sufficient number of qualified social
work personnel must be allocated by the agency for case management
to be successful.
Data collection
and information management. Comprehensive data on the case and
the program are essential for evaluating the performance of staff
and the agency, making administrative decisions, and ensuring the
effectiveness of interagency agreements. Information also is needed
to identify the client’s need for services and for research, accountability
to payers or funding sources, and reimbursement purposes. Agency
policies should specify the agency’s requirements for record keeping,
including the length of time case records are retained, the data
collection on a program, confidentiality, and other ongoing documentation.
Case records should
contain at least the following data to provide a basis for reviewing
a case, evaluating the program, and for related purposes:
- written permission
to release information, signed by the client
- relevant historical
and demographic information on the client, the client’s family,
and significant others
- results of the
initial assessment and periodic reassessments of the client,
including data on the client’s psychosocial, behavioral, and
physical status
- the social work
plan and specified goals, interim objectives and time frames,
and schedules and procedures for monitoring progress toward accomplishment
of goals and objectives
- the outcomes
for a client
- referrals to
other agencies or resources, including follow up and feedback
from or recommendations by outside agencies or individuals
- cost of the
care plan
- reason for termination
of services.
The collection
and documentation of program-related data should allow for the
aggregation of information on issues such as services needed by
clients and the availability and accessibility of needed resources,
the types of referrals made and the resources used, the types of
services actually delivered and the periods during which they were
provided, services needed but unavailable, reasons goals were not
attained and reasons why services were terminated, types of funding
mechanisms, the total cost of services, the amount and services
paid for by clients, and the amount and services paid for by other
specified sources. Case documentation and the maintenance of updated,
concise records also serve to protect the social work case manager
from potential legal problems, as well as provide a basis for service
planning.
The degree to which
these tasks affect the system is related to the degree of formal
authority vested in the case manager role. Although the scope of
case manager authority varies across settings, the case manager’s
influence on system functioning will be greatly enhanced given
the discretion to use a broad range of resources. It is the control
over the flow of clients, information, services, and funding resources
that empowers the case manager and promotes his or her effectiveness
in enhancing system functioning.
Standard
7. The social work case manager shall be knowledgeable about
resource availability, service costs, and budgetary parameters
and be fiscally responsible in carrying out all case management
functions and activities.
Interpretation
Case manager as
agent of agency. Social work case managers practice with varying
levels and types of authority for resource allocation. Expanded
financial authority may be readily identified in delivery systems
structured with a single point of entry. In many of these settings,
social work case management functions as a system "gatekeeper," controlling
access and allocating resources. The agency should establish criteria
for case managers to determine which clients are entitled to use
the scarce resources and under what circumstances.
Client-centered
social work case management practice occurs within the parameters
imposed by the program and agency. As such, the social work case
manager maintains the client focus and simultaneously allocates
service resources and provides critical feedback regarding program,
agency, and delivery system performance. Thus, the case manager
is responsible both for delivering appropriate services to the
client and for carefully allocating and managing agency services
and financial resources.
Social work case
managers must fully disclose the following to clients: the resources
that are available and that are unavailable, required copayments
and cost sharing, time limits on service provision, timing and
frequency of required reassessments, and appropriateness and fiscal
effects of treatment choices.
As a gatekeeper
and resource allocator, the social work case manager collects information
and provides feedback on the fiscal effects on the agency, necessary
program modifications, required delivery system changes, quality
of provider performance, and effectiveness of the agency’s contracting
system.
Accounting practices.
Distinct from administrative tasks, the time the social work case
manager spends with the client and the client’s family for assessment,
planning, counseling, and monitoring is an integral part of direct
service and service costs. Whether the case manager offers case
management services privately or as part of the agency program,
he or she must carefully account for costs, establish and charge
fees for services rendered, and obtain reimbursement for professional
services. The agency should establish criteria for case managers
to use in determining the proportion of time he or she will spend
on particular types of cases in relation to the total caseload.
Like other services provided directly to the client for his or
her benefit, case management should be appropriately reimbursed
through direct program support, third- party payments, fees for
service, and other suitable financing mechanisms.
Whenever possible,
the social work case manager should encourage the agency to contain
a separate line item for case management services to distinguish
this direct service system from what previously has been considered
strictly an administrative function. This is not to negate the
case manager’s contribution to administration nor to attribute
all the case manager’s time to nonadministrative functions. Rather,
such budgetary practices will readily identify the costs associated
with case management and facilitate appropriate reimbursement of
these direct services.
Expanded fiscal
accountability may create ethical dilemmas for the social work
case manager. Social work case management practice requires the
professional to put the client’s needs first, as well as to justify
how resources are spent on behalf of that client. Attainment of
these goals requires that the social work case manager develop
and maintain fiscal management skills.
Standard
8. The social work case manager shall participate in evaluative
and quality assurance activities designed to monitor the appropriateness
and effectiveness of both the service delivery system in which
case management operates as well as the case manager’s own case
management services, and to otherwise ensure full professional
accountability.
Interpretation
The accountability
of the staff and the agency should be ensured through ongoing quality
assurance efforts and periodic evaluation of the appropriateness,
adequacy, and effectiveness of both the case management system
and of the services provided through this system.
The case manager
is involved in evaluating the quality, appropriateness, and effectiveness
of the case management services on two levels. At the level of
the individual client, the case manager, through completion of
data collection forms, record keeping, and participation in peer
review, obtains accurate and timely information about each case
and the case manager’s activities that provide a basis for monitoring,
evaluation, and cost-accounting systems. At the delivery system
level, achieving program improvements and ensuring the equitable
allocation of resources depends on reliable aggregate case data
to demonstrate needs and service gaps and to document both the
absence and presence of problems. Evaluation and quality assurance
ensure that intended outcomes of services are attained and that
the services are implemented in a consistent manner according to
standards.
The quality, effectiveness,
and appropriateness of social work case management services shall
be regularly reviewed, evaluated, and ensured using established
criteria and standards. Such criteria and standards shall relate
to the indicators of need for services and to the effectiveness
of required interventions. Contracted providers shall be reviewed
and evaluated in the same manner. Appropriate client feedback should
be sought on the services they have received and that feedback
should be incorporated in this process. The review and evaluation
of social work case management services shall be documented and
shall include feedback and implementation of corrective measures,
when necessary.
Standard
9. The social work case manager shall carry a reasonable
caseload that allows the case manager to effectively plan, provide,
and evaluate case management tasks related to client and system
interventions.
Interpretation
The size of the
social work case management staff shall be related to the scope
and complexity of the case management system and to the nature
of the populations to be served. Staffing shall be sufficient to
enable the provision of timely quality services by the social work
case manager. The composition of the staff also shall be related
to the ethnic and cultural composition of the client populations
to provide for culturally sensitive case management practice and
to allow staff to effectively respond to the unique needs of particular
client groups. Appropriate and adequate supervision and multidisciplinary
consultation services should be available to and used by case management
supervisors and staff.
The agency should
establish policies and develop systems governing reasonable workloads
and caseloads for supervisors and staff. A number of variables
affect caseload size. Caseload standards should be based on the
scope of professional responsibilities, the volume of clients to
be served, the amount of time the case manager needs to spend with
clients, the breadth and complexity of client problems or services,
and the length and duration of case mix in determining case manager-client
involvement. The number of cases a social work case manager can
realistically handle is limited to the degree to which caseloads
consist of acute, high-risk, multineed clients. Caseload size must
realistically allow for meaningful opportunities for face-to-face
client contact. As caseload size increases, the case manager has
a decreasing capacity to perform ongoing case management activities
such as followup, monitoring, and reassessment. It is the joint
responsibility of the agency and the social work case manager to
address and remedy caseload issues and concerns.
Standard
10. The social work case manager shall treat colleagues with
courtesy and respect and strive to enhance interprofessional,
intraprofessional, and interagency cooperation on behalf of the
client.
Interpretation
Case management
requires well-coordinated and effective interdisciplinary efforts
if the client’s needs are to be served. It is important that interpersonal
relationships be characterized by a spirit of respect and caring
that is critical to the social worker-client relationship. Moreover,
the respectful treatment of colleagues is a prerequisite for effective
communication and cooperation among professionals from different
disciplines.
The social worker
often performs case management functions in collaboration with
other professionals and agencies. In such cases, it is advisable
that the duties be delin eated in writing. Formal agency linkage
agreements should be established when any two organizations work
together to serve the interests of a single client or particular
client populations. Such agreements should detail the operational
and financial arrangements of the working relationship as well
as confidentiality policies.
When more than
one individual will be performing case management tasks, the social
work case manager will work with his or her agency, staff, and
other relevant professionals to identify a primary case manager.
Thus, the client shall have a single, identifiable case manager
throughout the continuum of service delivery. Ideally, the client
should be able to choose the person who will perform the case management
function, and hence, the authority of the social work case manager
will be vested by the client. An organization’s policies should
provide for continuity of responsibilities when the primary case
manager is unavailable to provide services to a client.
Case
Management Standards Work Group
- James M. Karls,
DSW, ACSW (Chair), Social Work Education Department, San Francisco
State University, Sausalito, CA
- Sandra A. Lopez,
MSW, ACSW, Sandra A. Lopez and Associates, Houston, TX
- Carol D. Austin,
PhD, College of Social Work, Ohio State University, Columbus,
OH
- Gary M. Gould,
PhD, Canadore College/Nipissing University, Ontario, Canada
- Betsy Vourlekis,
PhD, ACSW, Department of Social Work, University of Maryland,
Bethesda, MD
- Howard Blonsky,
MSW, LCSW, San Francisco Unified Schools, Burlingame, CA
- Lynda Eubank,
MSW, ACSW, Arlington County Department of Human Services, Arlington,
VA
- Rebecca Mahler,
MSW, ACSW, Sheltering Arms Rehabilitation Hospital, Richmond,
VA
- Louise Doss
Martin, MA, ACSW, Alcohol and Drug Abuse Services Administration,
Washington, DC
- Loreen McNair,
MSW, Health Management Strategies, Alexandria, VA
- Janice Edwards,
DSW, ACSW, Metropolitan Psychiatric Group/Psychiatric Institute,
Washington, DC
- NASW Staff:
James P. Brennan, MSW, ACSW
- Project Consultant:
Caren Kaplan, MSW
|
About
NASW