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
* 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
NASW Standards for Social Work Case Management
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-establi shed 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.
Definition
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.
Goals
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.
Tasks and Functions
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&emdash;public, private, or voluntary&emdash;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