Teaming Up for Case Management

— Lyn Stoesen, News Staff


Case management is an integral part of the jobs of many social workers in many areas of practice. While social workers have always looked beyond isolated problems toward a more holistic approach, case management provides a specific approach to providing services.

Recently, NASW has been working on a number of projects related to case management, and several new products will be released in coming months to enhance case managers' effectiveness.

NASW has worked closely with the Case Management Society of America (CMSA) to develop several products and publications, including a matrix that examines elements that affect caseloads and a revision of CMSA's standards of practice for case managers. NASW and CMSA have also been working together on projects through the National Transitions of Care Coalition (NTOCC).

Social work and case management

CMSA materials note that "case management is not a profession in itself, but an area of practice within one's profession." While not all case managers are social workers, many are, and the social work profession is well-suited for addressing and navigating the often complex aspects of clients' lives.

Case management is a function of many social work jobs, including those in the field of health, behavioral health, mental health, aging and clinical work. While some have the title "case manager," others perform case management functions under other titles.

A case management approach to providing services grew during the shift in the United States from institutionalized services to community-based care, as social workers needed to address clients in their own environment rather than in traditional institutional settings.

Today, case managers may help clients with needs such as housing, health and mental health concerns, job resources and social services. The functions of case management are considered outreach and engagement; assessment; service or treatment planning; resource linkages and referrals; and monitoring delivered services.

"Social workers are ideally suited for case management work," said NASW Senior Policy Associate Karyn Walsh. "The social work approach takes into account many elements that can impact a person's life or health, without isolating one issue and ignoring others."

Sen. Barbara Mikulski (D-Md.), a social worker, recently spoke about the importance of case management on the Senate floor when introducing an amendment to halt a new rule that would cut funding for Medicaid case management for children in foster care. "Targeted case management services help individuals get and coordinate necessary medical, social and educational services," she told her colleagues. She offered two examples of how case managers helped people and said the amendment was about "how we make sure the American people get the services they need to be able to lead independent lives."

Geriatric case management provides a good example of the ways case management encompasses many complex dimensions.

Kathy Black is a Hartford Geriatric Social Work Faculty Scholar and assistant professor in the School of Social Work at the University of South Florida at Sarasota/Manatee. She has 25 years of direct-practice experience in working with older adults and their families.

While the exact case management services provided depend on whether a social worker is agency based, acute-care based or community based, Black said, they all include a holistic perspective.

Black emphasized that working with families is a crucial part of case management. "There are many issues at the family level, such as the availability of family members. We live in a geographically dispersed society — older adults don't always live next door to their oldest daughter."

Sometimes the comprehensive nature of case management presents challenges. Black has published research exploring aspects of geriatric case management. In one qualitative study, she identified themes that address some of the barriers that case managers face, including the extent of family presence and involvement, degrees of client receptivity to planning, and limited communication with providers.

Despite challenges in the work, Black said she foresees an increasing focus on case management in the years ahead. Managed care organizations and medical providers "have identified the need to increase cost savings and better manage clients as one way to reduce emergency-room visits and limit utilization days," she said.

She added that "there's a very big future in geriatric case management because of the demographics of the population. Private case management is a for-pay model, but there is a great need among older people who do not have money and who rely on public forms of assistance. . . . [But] the trend is for an increase in funding for community-based services such as case management because they can delay nursing home placements."

Work with CMSA

NASW's work with CMSA will help social workers better perform the kind of functions Black described. As social workers address the layered needs of clients and juggle responsibilities within their work settings, having resources specific to case management will help them do so successfully.

CMSA was founded in 1990. Its mission is to support and advance case management through educational forums, networking opportunities, legislative advocacy and establishing standards. It has more than 70 chapters, including international chapters, and 20,000 members.

CMSA Executive Director Cheri Lattimer said her organization's work with NASW has been very productive. "Our voices together expand our reach. We face many of the same problems as we've talked with each other, [such as] how do we bring younger members in, what are we going to do to address [case manager] shortages."

CMSA and NASW have teamed up to develop a caseload matrix targeted toward health, behavioral health and long-term care settings that will be released later this year. The organizations are also preparing a white paper on case management, which will also be completed this year and will explain the need for caseload guidance and factors that influence the case management process.

"Both NASW and CMSA have found that there is tremendous interest in tools and information to help determine optimum caseloads for case managers," said NASW Senior Practice Associate Chris Herman. Herman and Walsh have been working with CMSA on the projects. "We have received inquiries from organizations, individuals and government agencies."

The matrix delineates many factors that affect the case management process. One section includes systemic elements that have an effect on caseloads, such as regulatory and legislative requirements, insurance, practice settings and technology support. Another section addresses clinical factors as well as psychosocial factors related to the client, the client's family and the environment. The matrix also includes a section on interventions as well as immediate and long-term outcomes.

"Determining appropriate caseload size is challenging, in part, due to different perceptions of what influences a case manager's work," Herman explained. "It can be difficult to explain, or understand, why seemingly small caseloads take so much work or why caseloads of the same size may require vastly different amounts of time and energy. We hope this matrix will help frame that discussion among practitioners, managers, employers and other groups involved in case management."

NASW is also working with CMSA on revisions to CMSA's Standards of Practice for Case Management. NASW is part of a multidisciplinary work group involved in revising the standards. Public comments, solicited by CMSA, will be evaluated for incorporation into the new version. Walsh is also leading an effort by NASW to provide an in-depth review of the standards.

The standards include information about the concept and philosophy of case management and a description of the roles of case managers, as well as standards of care and performance indicators for case management. The standards were first developed in 1995, and the revised version should be available by the end of this year.

Transitions of care

CMSA also chairs and coordinates the National Transitions of Care Coalition (NTOCC), in which NASW serves on the Advisory Task Force. The coalition was developed in 2006 to bring together experts to improve transitions of care through education, resource development, policy advocacy and performance measurement. It is sponsored by sanofi-aventis U.S. LLC.

Transitions of care take place when clients move from one health or behavioral health setting to another. Members of NTOCC work to address problems associated with these transitions, such as fragmented responsibility and communication failures.

One of NTOCC's products is the "Elements of Excellence in Transitions of Care Checklist," which is expected to be released for use in the next several months. NASW and CMSA developed the checklist jointly, and both organizations' members provided public comment on it.

The checklist is designed to enhance communication about patient assessments, care plans and other clinical information among health care providers, between care settings and between clinicians and clients/caregivers. It includes some basic concepts for communication, such as engagement and strengths-based assessments, and common elements for assessment and intervention, including physiological and psychosocial functioning. It also includes a glossary and a checklist example.

NASW, CMSA and other NTOCC members are working on a transitions-of-care checklist for consumers, to help them improve their understanding of and activity in their own health care. It is designed for consumers to bring to appointments or when seeing health care professionals in any setting.

Additionally, NASW has worked with NTOCC to provide input on the development of resources related to medication reconciliation, as well as a consumer tool to help people track their medications.

"Case management will continue to grow as an important aspect of social work practice," Herman said. "Developing these resources now will help guide us as these roles increase.

"It's been very rewarding to work closely with CMSA and NTOCC on these projects," she said. "We have a good collaborative relationship that has helped us create tools that can improve case management. This benefits our organizations, our members and, ultimately, the clients we serve through case management."

CMSA's Lattimer agreed. "Case management will continue to grow and expand, and that brings our two professional organizations together to work to make sure our members are well-prepared to take on the tasks and functions as they evolve."