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