NASW Standards for Social Work Case Management

 

Prepared by the Case Management Standards Work Group.

Approved by the NASW Board of Directors, June 1992.

 

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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