ED 365 909

TITLEINSTITUTION

PUB DATENOTE

AVAILABLE FROM

PUB TYPE

EDRS PRICEDESCRIPTORS

IDENTIFIERS

ABSTRACT

DOCUMENT RESUME

CG 025 173

NASW Standards for Social Work Case Management.National Association of Social Workers, Washington,

D.C.

Jun 9228p.; For related pamphlets, see CG 025 174-178.Prepared by the Case Management Standards WorkGroup.NASW Distribution Center, P.O. Box 431, Annapolis

JCT, MD 20701 (single copy, free).Legal/Legislative/Regulatory Materials (090)

MF01/PCO2 Plus Postage.Caseworkers; *Professional Associations; *Social

Work; Social Workers; *Standards*Case Management; National Association of Social

Workers

This document presents the standards for social work

case management created by the National Association of Social Workers

(NASW). Social work case management is defined as "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." The goals of case management are discussed, including the

primary goal of optimizing the client's functioning by providing

quality services in the most efficient and effective manner to

individuals with multiple complex needs. Tasks and functions of the

case manager in both client-level and system-level interventions are

described. The 10 standards for case management are then presented

and interpreted. Standard 1 describes the necessary qualifications of

the social work case manager. Standards 2 through 5 pertain to client

issues: primacy of the client's interests, self-determination,

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 interprofessional relationships.

The document concludes with a summary of the major principles of the

NASW Code of Ethics. (NB)

***********************************************************************

Reproductions supplied by EDRS are the best that can be made

from the original document.***********************************************************************

.4 .

U S DEPARTMENT Of EDUCATIONOffice ot Educational Research and improvement

EDUCATIONAL RESOURCES INFORMATIONCENTER (ERIC)

%This document has been repraluced asreceived from the person or organizationoriginating IL

0 Minor changes have been made to improvereproduction quality

Points of view Or opinions stated in this docu-ment do not necessarily represent officialOERI position or policy

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

L.Or E.,ano1

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)"

.

.c

A.": --4

'

BEST COPY AVAILABLE'

r,-.W.Wwwwvew

NASW PROFESSIONAL STANDARDS

Bylaws of the National Association of Social Workers

Code of Ethics

Standards for the Classification of Social Work Practice

Standards for Continuing Professional Education

Standards for Social Work Personnel Practices

Standards and Guidelines for Social WorkCase Management for the Functionally Impaired

Standards for the Practice of Clinical Social Work

Standards for Social Work in Health Care Settings

Standards for Social Work Practice in Child Protection

Standards for Social Work Services inLong-Term Care Facilities

Standards for Social Work Services in Schools

NASW CLINICAL INDICATORS

Clinical Indicators for Social Work and PsychosocialServices in the Acute Psychiatric Hospital

Clinical Indicators for Social Work and PsychosocialServices in the Acute Care Medical Hospital

A single copy of the standards ;s available free of charge.Standards also may be ordered in bulk for a fee. Contact

NASW Distribution CenterP.O. Box 431Annapolis JCT, MD 207011-800-227-3590

NASWstandardsforsocial workcasemanagement

Prepared by the Case Management StandardsWork Group

Approved by the NASW Board of Directors,June 1992

*NASWNational Association of Social Workers

750 First Street, NE, Suite 700Washington, DC 20002-4241

(202) 408-8600

.,.ceo.

Contents

NASW Standards for Social Work Case Management 4

Standard 1. The social work case manager shall have abaccalaureate or graduate degree from a social workprogram accredited by the Council on Social WorkEducation and shall possess the knowledge. skills, andexperience necessary to competently perform casemanagement activities 8

Standard 2. The social work case manager shall usehis or her professional skills and competence to servethe client whose interests are of primary concern 9

Standard 3. The social work case manager shall ensure thatclients are involved in all phases of case managementpractice to the greatest extent possible. 10

Standard 4. The social work case manager shall ensure theclient's right to privacy and ensure appropriateconfidentiality when information about the client isreleased to others 11

Standard 5. The social work case manager shall interveneat the client level to provide and/or coordinate thedelivery of direct services to clients and their families. . . 12

Standard 6. The social work case manager shall interveneat the service system3 level to support existing casemanagement services and to expand the supply of andimprove access to needed services. 13

Standard 7. The social work case manager shall beknowledgeable about resource availability, servicecosts, and budgetary parameters and be fiscallyresponsible in carrying out all case managementfunctions and activities. 18

Standard 8. The social work case manager shall participatein evaluative and quality assurance activities designedto monitor the appropriateness and effectiveness of boththe service delivery system in which case managementoperates as well as the case manager's own casemanagement services, and to otherwise ensure fullprofessional accountability. 19

Standard 9. The social work case manager shall carry areasonable caseload that allows the case manager toeffectively plan, provide, and evaluate case managementtasks related to client and system interventions. 20

Standard 10. The social work case manager shall treatcolleagues with courtesy and respect and strive toenhance interprofessional, intraprofessional. andinteragency cooperation on behalf of the client 21

Code of Ethics: Summary of Major Principles 23

NASW Standards for Social WorkCase Management

The National Association of Social Workers (NASW)Standards for Social Work Case Management are ad.dressed toprofessional social workers who perform the case manage-ment function in the specifically designated role of "casemanager." These social work case managers serve as part ofsocial work service or as members of a case management teamin human services agencies or other servicc delivery settings,such as schools, health care facilities, hospitals, and employeeassistance programs, or in the context of private practice.These standards are formulated in full recognition that there isno universally accepted definition of case management, nor isthere one definitive model of case management as practicedwithin the social work profession. The purpose of thesestandards is to clarify the nature of social work case manage-ment as well as the role of the social work case manager.

Case management encompasses well-established socialwork concepts and techniques. As an approach to arrangingand coordinating care, it has its origins in the earliest historyof social work practice and the social work profession. Socialwork case management is clearly linked to social casework, afundamental concept of social work practice. Traditionalsocial caseworkers maintained a dual focus on the client andthe environment, working directly with and indirectly onbehalf of individual clients and families in need of socialservices. Case management remains an important profes-sional component of competent social work practice. It isbased on the recognition that a trusting and empowering directrelationship between the social worker and the client is essentialto expedite the client's use of services along a continuum of careand to restore or maintain the client' s independent functioningto the fullest extent possible. This approach to service deliveryhas become increasingly prominent across many disciplines andpractice settings, because it is believed to be an efficient andcost-effective method for managing the delivery of multiplelabor-intensive services to targeted populations.

All aspects of social work case management rest on a bodyof established social work knowledge, technical expertise,and humanistic values that allows for the provision of aspecialized and unique service to designated client groups.The social work case manager must have the capacity toprovide assistance in a sensitive and supportive manner toparticular client populations based on knowledge of humanbehavior and well-developed observational and communica-tion skills. With this foundation, a social work case managerestablishes helping relationships, assesses complex problents,

selects problem-solving interventions, and helps clients tofunction effectively and, thus, is a therapeutic process.

The conduct of the social work case manager follows thebasic social work ethical tenets of the NASW Code of Ethics,

including the primacy of the client's interests, the recognitionof the inherent worth and clpacity of the individual, and the

individual's right to self-determination and confidentiality.As a social worker, the case manager abides by all NASWprofessional standards and should be licensed or certified topractice by the state regulatory agency.

Definition

The practice of case management varies greatly acrosssocial work settings and is even more diverse as applied byother professionals. Despite this diversity, several elementsdistinguish social work case management from other forms ofcase management.

Social work case management is a method of providingservices whereby a professional social worker assesses theneeds of the client and the client's family, when appropri-ate, and arranges, coordinates, monitors, evaluates, andadvocates for a package of multiple services to meet thespecific client's complex needs. A professional social workeris the primary provider of social work case management.Distinct from other forms of case management. social workcase management addresses both the individual client' sbiopsychosocial status as well as the state of the social systemin which case management operates. Social work case man-agement is both micro and macro in nature: intervention

occurs at both the client and system levels. It requires thesocial worker to develop and maintain a therapeutic relation-ship with the client, which may include linking the client with

systems that provide him or her with needed services, re-sources, 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 mostefficient

and effective manner to individuals with multiple complex

needs. Like all methods of social work practice, case manage-ment rests on a foundation of professional training, values,knowledge, theory, and skills used in the service of attaining

goals that arc established in conjunction with the client and the

client's family, when appropriate. Such goals include

5

enhancing developmental, problem-solving, and copingcapacities of clientscreating and promoting the effective and humane opera-tion of systems that provide resources and services topeoplelinking people with systems that provide them withresources, services, and opportunitiesimproving the scope and capacity of the delivery systemcontributing to the development and improvement ofsocial policy.

Tasks and Functions

Although the roles and responsibilities of individual socialwork case managers can vary considerably depending onprogram or system objectives, social work case managersperform a range of common tasks related to client-levelintervention and system-level intervention.

Client-Level Intervention

Once the social work case manager has identified and en-gaged clients as a result of outreach or referral activities, he orshe conducts a face-to-face comprehensive assessment witheach client of that client' s strengths and limitations and of thesocial, financial, and institutional resources available to theclient. The social work case manager focuses particularly onhow these resources relate to the principal concerns identifiedduring the assessment. On the basis of this assessment, the socialworker develops an individualized service plan with the clientthat identifies priorities, desired outcomes, and the strategies andresources to be used in attaining the outcomes. The responsbili-ties of the social worker, the client, and others should be claritedthroughout development of the plan. The direct contact betwe ensocial worker and client is essential to effectively accomplish theassessment and service plan development.

Additional social work case management tasks related toclient intervention include implementing the service planaimed at mobilizing the formal and informal resources and theservices needed to maximize the client' s physical, social, andemotional well-being, and coordinating and monitoring ser-vice delivery. The social work case manager also advocates onbehalf of the plan for needed client resources and services;periodically reassesses client status, the effectiveness of inter-ventions, and the attainment of outcomes with revision of theservice plan as indicated; and terminates the case.

At all stages of client intervention, it is crucial that the socialwork case manager be granted sufficient authority to access,allocate, monitor, and evaluate service and fiscal resources.

Such authority is a prerequisite of effective case managementpractice. Optimal control over and management of scarceresources may be more readily achieved in delivery systemsstructured with a single point of entry and integrated funding.Case managers will be more effective in delivery systems thatare designed to reduce fragmentation.

System-Level Intervention

An organization's structure, policies, and budget as wellas the community network of services should adequatelyprovide for the implementation of client-centered case man-agement. The social work case manager is respons;ble forunderstanding how the agency and environmental systemscan both positively and negatively affect clients and to inter-vene at the system level to optimize these conditions. To thisend, the social work case manager engages in a range of tasksthat support and enhance the system in which case manage-ment exists. For example, the social work case manager

analyzes the strengths and limitations of environmentalsystemsdelineates desired outcomesselects- strategies to improve systemsassesses the effectiveness of strategiescontinues to revise, as indicated, desired outcomes andstrategies.

Specific activities include, but are not limited to, resourcedevelopment, financial accountability, social action, agencypolicy formation, data collection, information management,program evaluation, and quality assurance. Like client inter-vention. system intervention occurs along a continuum andcomprises an ongoing, uninterrupted cycle of tasks that areperformed by the social work case manager.

Standards for Client. System, and Case Manager

The following 10 standards are generally organized intothree areas: the client, t:-ic system, and the social work casemanager. Beginning with the necessary qualifications of thesocial work case manager (standard I ), standards 2 through 5pertain to client issues: primacy of the client's interests, self-determination, confidentiality, and client intervention. Stan-dards 6 through 8 pertain to systems issues: system interven-tion, fiscal accountability and quality assurance, and programevaluation. Standards 9 and 10 return to the initial focus of thesocial work case manager with a discussion of adequatestaffing and intraprofessional relationships.

9 7

Standard 1

The social work case manager shall have a baccalaure-ate or graduate degree from a social work program ac-credited by the Council on Social Work Education andshall possess the knowledge, skills, and experience neces-sary to competently perform case management activities.

Interpretation

The practice of social work case management is highlycomplex and calls for a variety of roles and skills, such asadvocate, broker, diagnostician, planner, community orga-nizer, evaluator, consultant, and therapist. The qualificationsof staff should be appropriately matcl-ed to the skills requiredto perform case management duties. Where required by statelaw, the social work case manager should be licensed orcertified to practice.

A differential use of staff may be implemented in carryingout case management responsibilities, particularly when spe-cialized 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 [MSW] degree)should conduct the assessment and handle difficult and com-plex situations. The less highly trained professional (i.e., asociai worker with a bacheior of social work [BSWI degree)should perform more routine tasks under supervision. Thesocial worker should accept responsibility or employmentonly on the basis of existing competence or should agree toparticipate in the training and supervision required by theemployer to acquire the necessary competence.

Professional social work supervision or consultation shouldbe available to all social work case managers, either in theagency or through a contractual arrangement. The beginningbaccalaureate social work case manager requires regularconsultation or supervision. For the first two years ofpostbaccalaureate professional experience, at least one hourof supervision should be provided for every 15 hours of directclient-level case management tasks. After the first two years,the ratio may be reduced to a minimum of one hour of caseconsultation or supervision for every 30 hours of client inter-vention activities. For the first two years of postgraduateprofessional experience, one hour of consultation or supervi-sion should be provided for every 30 hours of client interven-tion activities. The BSW case manager with five years or moreof experience or the MSW case manager with two years ormore of experience should use consultation or supervision onan as-needed, self-determined basis.

8 1 0

The social worker should strive to become and remainproficient in professional case management practice and in theperformance of professional case management functions bycritically examining and keeping current with emerging re-lated knowledge. The employing organization should rrovideregular in-service training as a means of enhancing the skillsof the case management staff.

Each social work case manager shall assume personalresponsibility for continuing professional education. He orshe should complete 90 hours of such education every threeyears in accordance with the NASW Standards for ContinuingProfessional Education.

In addition to academic credentials and educational en-deavors, it is most important that the social work case managerunderstand the characteristics of the client population andpractice setting in which this population is served; the socio-economic, cultural, gender, racial, and sexual orientationissues that may affect the differential use of services; the fiscalimpact and consequences of using particular services; and thesystem of agency-community resources and the interrelation-ships among system components.

Standard 2

The social work case manager shall use his or herprofessional skills and competence to serve the clientwhose interests are of primary concern.

Interpretation

As with all social workers, the social work case manager'sprimary responsibility is to his or her clients. While workingwithin the context of an agency' s goals and resources, the casemanager must ensure that each client receives appropriateassistance by providing accurate and complete informationabout the extent and nature of available services and byhelping the client decide which services will best meet his orher needs. Personal or professional gains should never be putbefore the primacy of the clients' interests and the social workcase manager must not exploit relationships with clients forsuch advantages. Furthermore, the case manager should

ask the advice of colleagues and supervisors wheneversuch consultation is in the best interests of the clientexercise professional judgment and prudence in select-ing and recommending servicesterminate a service when it is no longer needed by or nolonger helpful to the client

1 1

promptly notify the client if the case manager anticipatesthat a service will be interrupted or terminated by aservice providermake the necessary transfer or referral if the client stillneeds such a service to ensure continuity of care.

It may be difficult to adhere to a position of primacy of theclient's interests, particularly in a climate of resource scarcity.Agency cost containment goals may conflict with the bestinterests of the client. When primacy of the ciient's interestruns counter to agency goals, policies, or resources, andethical dilemmas are encountered, a mechanism, such as peerreview or administratively sponsored ethics committees, shouldbe available to the social work case manager to remedy suchconflicts. If no such mechanism exists within the internaloperations of the organization, the social work case managershall advocate for internal change and seek appropriate exter-nal consultation with, for example. the NASW Chapter Com-mittee on Inquiry.

Standard 3

The social work case manager shall ensure that clientsare involved in all phases of case management practice tothe greatest extent possible.

Interpretation

The social work case manager shall make every effort tofoster and respect maximum client self-determination. Thecase manager is responsible for helping clients make informeddecisions about selecting services. Many clients must beassisted in negotiating complex, sometimes intimidating, ser-vice delivery systems.

Although the lack of organizational or community re-sources may limit a client' s options, the case manager shouldinform the client of the full range of existing choices. Fulldisclosure includes information on the lack or limited avail-ability of relevant services and the financial implications ofservice selections and use.

The involvement of clients in needs identification and indecision making is a basic tenet of practice; only when the clientis severely mentally impaired should the client' s family orguardian make decisions for the client. When the case managermust 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 onbehalf of a client, the case manager should deal with that personby always considering the client's best interests.

10 12

Involvement of the client, family, and social Worker incase management tasks need not be mutually exclusive. Thecase manager and the client can share responsibility for certaincase management tasks and, thus, maximize client involve-ment in decision making and problem solving. Sharing casemanagement functions mobilizes the client and the client'sfamily, enables them to use their abilities, and empowers theclient by giving the client more control of the services he or sheis receiving. However, collaborative decision making shouldoccur to determine the appropriate allocation of tasks. More-over, the social work case manager must provide support tofamily members who serve as resources to the client to avoidoverburdening them and inadvertently facilitating caregiverburnout.

By the same token, family members who have the time, apersonal interest in the client, and an extensive knowledge ofand a trusting relationship with the client and with the casemanager can be in an advantageous position to schedule,supervise, monitor, adjust, and interpret services. Each client'ssituation should be weighed on its merits; therefore, the socialworker must be flexible in the case management role.

Standard 4

The social work case manager shall ensure the client'sright to privacy and ensure appropriate confidentialitywhen information abcut the client is released to others.

Interpretation

All information about a client and the client' s family that isobtained by the social worker in carrying out case manage-ment tasks shall be held in the strictest confidence. Informa-tion may be released to other professionals and agencies onlywith the written permission of the client or his or her guardian.This release sh;ll detail what information is to be disclosed, towhom, and in what time frame.

Certain limits of confidentiality are inherent in servicedelivery. The case manager should orally restate assurance ofconfidentiality to the client, including disclaimers and excep-tions, if any. State laws may exist that invalidate blanketconfidentiality under particular circumstances, such as threatsof suicide or harm to others. Court orders may require that anagency or independent pracdtioner release certain informa-tion about a client. These are but two exceptions wheresociety's need to know is pitted against the individual's rightto privacy, and may outweigh it. The social work case man-ager shall seek appropriate consultation before disclosing anyinformation not covered bv the client's written release.

31 1

Professional discretion should be exercised in releasing onlythe information that is relevant to the problem at hand and inmonitoring the duration of a time-limited consent for releaseof information.

The social work case manager should interview clientsprivately and offer them the opportunity to be interviewedalone. It is important to ask clients what information theywould and would not like shared with significant others. Outof respect for the client's privacy and need for preparation, thecase manager should schedule appointments in advance.

Human services agencies and service delivery settings thatprovide case management services should develop and dis-seminate clear policies and guides that cover at least thefollowintz:

what information is to be sought and from whomwhat information is to be recorded and in what formwho has access to information about cases and underwhat circumstancesmeans for ensuring the accuracy of records or for notingdifferencesplans for the retention and disposition of records.

Standard 5

The social work case manager shall intervere at theclient level to provide and/or coordinate the delivery ofdirect services to clients and their families.

Interpretation

Social work case management shall consist of the followin2eight components in the provision of direct services to clientsand their families: ( 1) outreach, referral, client identification.and engagement; (2) a biopsychosocial assessment of theclient; (3) the development of a service plan; (4) implementa-tion of the service plan; (5) coordination and monitoring ofservice delivery; (6) advocacy on behalf of the client includingcreating, obtaining, or brokering needed client resources; (7)reassessment of the client's status; and (8) termination of thecase when services are no longer warranted.

Outreach, referral, client identification, and engagement.Through outreach, the social worker identifies, accesses, andengages those individuals who would benefit from availableservices. Having received referrals or having identified peoplelikely to qualify for and need case management. social workcase managers screen clients' circumstances and resources todetermine eligibility and appropriateness for the case man-agement program.

1412

Biopsychosocial assessment. The social work case man-ager shall conduct a face-to-face biopsychosocial assessmentof the client to identify strengths as well as weaknessesthrough a systematic evaluation of the client's current level offunctioning. To understand the client as a whole person, thesocial worker must assess the interplay among physical,environmental, behavioral, psychological, economic, andsocial factors. Areas commonly evaluated by the social workcase manager include mental health status; preexisting healthor mental health problems; an appraisal of the client' s needsand the resources of the client' s informal support system,including family members, friends, and organizational mem-berships; social role functioning; environmental issues, in-cluding economic situation, employment status, and otherbasic needs; and relevant cultural and religious factors. Thesocial work case manager formulates an intervention planbased on the findings of this assessment.

The biopsychosocial assessment includes the input of rel-evant specialists, including the client' s self-assessment of hisor her strengths and weaknesses. The participation of otherheaith professionals is essential to the assessment of theclient' s physical status. Professionals from all the disciplineswho are involved in the client's care should contribute to theassessment. Where such joint action is impossible, the socialwork case manager should gather necessary information andinitiate, coordinate, conduct, and document the assessment.

A uniform method of collecting and reporting assessmentfindings should be developed for use by all case managers inthe agency or service system. Such methods are to be usedonly as tools in making a professional judgment.

Development of the service plan. On the basis of thebiopsychosocial assessment, the social work case manager, inconcert with the client and his or her family, when appropriate,selects and outlines an array of services and interventions inthe form of an individualized service plan. The case manageris responsible for coordinating and documenting the develop-ment of the service plan with the client's participation. Ideally,the case manager will have involved professionals fromrelevant disciplines in the assessment and the development ofthe service plan; ideally, these professionals will have agreedto assume specific functions and responsibilities.

Two important aspects of the plan are the client' s personaland capacity-building goals. Other important factors are thecase manager' s knowledge of the following: resources, infor-mal and formal linkages with agencies that provide services,the client's use of services. and applicable costs of use, as wellas the case manager's selection of alternate resources. Thesocial work case manager should recognize that care planning

15 13

is an important resource allocation function and be cognizantof the costs and financing of the particular service plan.

This service plan incorporates the client's expectations andchoices and the short- and long-term goals to which the clientclearly has agreed. Outcome criteria should be selected thatwill be used to evaluate whether objectives have been accom-plished and goals have been attained. A schedule for reassess-ing and modifying the initial goals and plans should be part ofthe initial plan. Whenever possible, the client and/or thefamily should sign the service plan to indicate agreement withand participation in the development of the plan as well as theexpected concomitant behaviors.

Implementation of the service plan. Implementation of theservice plan involves arranging for a continuum of services tobe prcvided to the client through formal and informal systemsand ensuring that these services both meet the client's needsand are cost effective. The social work case manager selectsagencies that clearly meet established standards and expecta-tions for the services they are to provide. The case managerexplains his or her role in arranging for the services, describesto the client the services to be provided, informs the clientwhen services are to begin, and promotes those activities thatfoster client self-sufficiency.

Coordination and monitoring of service delivery. The so-cial work case manager should coordinate service delivery toensure the continuity and complementarity of the interven-tions. The case manager should have frequent contact withproviders and clients to ensure that services are provided asindicated in the service plan and to ascertain whether suchservices continue to meet the client's needs. Monitoring the7.lient's receipt of services is an essential element of theongoing reassessment of client status and the interventionplan. Monitoring permits the case manager to promptly re-spond to changes in the client's needs and alter the delivery ofclient services appropriately. It can ensure that sufficientservices are being provided and that excessive services are notinhibiting the client and family's ability to meet their ownneeds. The responsiveness to changes in clients' needs resultsin the optimal, cost-effective use of service resources. Thefrequency of monitoring activities varies, depending on theextent of client need and the type of service delivered.

Advocacy for the client and client resources. The casemanager may need to advocate for individual clients and theirfamilies for them to receive entitlements or obtain neededservices, including those provided by the case manager's ownagency. The case manager also serves as an advocate to ensure

14 iS

1

that services actually are delivered, gaps in service are iden-tified and filled, the individual's needs are recognized, clientservices are not prematurely terminated, and client servicesare terminated when appropriate. Data collected during theimplementation and monitoring phases of the plan should beused in advocacy on behalf of the client.

Reassessment. The social work case manager will periodi-cally reassess the client's needs and progress in meeting theobjectives in accordance with established benchmarks toensure the effective and timely provision of services. Thetiming of reassessments shall be prescribed by the program,preestablished by the case manager based on his or herjudgment of an appropriate time frame, or performed on an as-needed basis due to situational changes. Reassessments mayconstitute readministering all or part of the original assess-ment or a partial reevaluation of the client's most significantproblems. Regardless of the timing, reassessments, like moni-toring, often provide the social work case manager with newinformation he or she will use to reformulate the interventionplan and alter the client's service package.

Termination of the case. Termination occurs for a numberof reasons, including the client's attainment of stated goals,rehabilitation, client or family noncompliance, the client orthe case manager's withdrawal, or the client's death. Termi-nation also may occur because of limited service availability.In such instances, the client should be transferred to anothersuitable case management program, whenever possible, toensure continuity of care. Although an agency will set certaincriteria for terminating a case, it is the responsibility of thecase manager, the client, and significant others to prepare forthe effects of termination. The case manager should makeappropriate arrangements with the service providers and con-clude the financial aspects of the case.

After termination, it may be necessary to follow up on theclient and the client's family to ensure that the current situa-tion is adequate and appropriate. Follow-up also may beperformed to collect program evaluation measures pertainingto client outcomes. Follow-up may include assessing theadequacy of the client's current living arrangements and thestability of the client's functioning.

Standard 6

The social work case manager shall intervene at theservice systems level to support existing case managementservices and to expand the supply of and improve access toneeded services.

1 7 15

Interpretation

The social work case manager is responsible for ensuringthat the agency and environmental systems in which casemanagement exists function appropriately on behalf of theclient. Case management operates in a complex environmentcomprising various policies, providers, and service and finan-cial resources. To maximize the effectiveness of this interven-tion, the social work case manager engages in tasks thatsupport and enhance the system in which case managementexists. For example, the case manager develops resources;engages in social action; participates in lobbying/legislativeactivity; reviews, recommends, and modifies agency policy;collects data; manages information; evaluates programs; andis involved in quality assurance.

Resource development and social action. Because a widerange of social and health care systems must be available toassist high-risk populations and their families, the social workcase manager must be able to recognize duplicative services,identify gaps in services, and facilitate the expansion orestablishment of services in the agency and in the largercommunity to meet these needs. Data collected in the assess-ment, implementation, and monitoring phases of case man-agement practice should provide a database for identifyingsuch resource issues.

Advocacy is often required to ensure that the agency meetsits commitment to provide access to and adequacy of services,the services are actually delivered, the needs of the client arerecognized, and the client is not prematurely discharged by theservice providers. It also is the case manager's responsibilityto present agency executives, community leaders. and gov-ernment and consumer representatives with documented in-formation about resource limitations and other major casemanagement problems, and recommend solutions. The casemanager has a responsibility to participate in communityneeds assessments, community organization, and resourcedevelopment to see that the needs of clients are identified andunderstood and that community actionpublic, private, orvoluntaryis initiated to meet particular needs.

Agency policy review and modification. Case managernzntservices must be supported by.the agency boards and admin-istration through the agency's planning, policy making, staff-ing, and budgeting processes. The agency's policies on casemanagement should be reviewed and modified periodically.This review should include the service delivery sequencesrequired for client assessment, case management planningand evaluation, referral and follow-up, and shared responsi-bilities with other agencies or individuals. Effective case

16 181

management often requires the establishment of linkages andcommunication channels with many different social and healthcare agencies. These must be defined and maintained throughjoint agreements on policy and reimbursement. Adequateresources and a sufficient number of qualified social workpersonnel must be allocated by the agency for case manage-ment to be successful.

Data collection and information management. Compre-hensive data on the case and the program are essential forevaluating the performance of staff and the agency, makingadministrative decisions, and ensuring the effectiveness ofinteragency agreements. Information also is needed to iden-tify the client's need for services and for . search, account-ability to payers or funding sources, and reimbursementpurposes. Agency policies should specify the agency's re-quirements for record keeping, including the length of timecase records are retained, the data collection on a program,confidentiality, and other ongoing documentation.

Case records should contain at least the following data toprovide a basis for reviewing a case, evaluating the program,and for related purposes:

written permission to release information, signed by theclientrelevant historical and demographic information on theclient, the client's family, and significant othersresults of the initial assessment and periodic reassess-ments of the client, including data on the client's psycho-social, behavioral, and physical statusthe social work plan and specified goals, interim objec-tives and time frames, and schedules and procedures formonitoring progress toward accomplishment of goalsand objectivesthe outcomes for a clientreferrals to other agencies or resources, including follow-up and feedback from or recommendations by outsideagencies or individualscost of the care planreason for termination of services.

The collection and documentation of program-related datashould allow for the aggregation of information on issues suchas services needed by clients and the availability and accessi-bility of needed resources, the types of referrals made and theresources used, the types of services actually delivered and theperiods during which they were provided, services needed butunavailable, reasons goals were not attained and reasons whyservices were terminated, types of funding mechanisms, the

1 917

total cost of services, the amount and services paid for byclients, and the amount and services paio for by other specifiedsources. Case documentation and the maintenance of updated,concise records also serve to protect the social work casemanager from potential legal problems, as well as provide abasis for service planning.

The degree to which these tasks affect the system is relatedto the degree of fornmi authority vested in the case managerrole. Although the scope of case manager authority variesacross settings, the case manager's influence on system func-tioning will be greatly enhanced given the discretion to use abroad range of resources. It is the control over the flow ofclients, information, services, and funding resources thatempowers the case manager and promotes his or her effective-ness in enhancing system functioning.

Standard 7

The social work case manager shall be knowledgeableabout resource availability, service costs, and budgetaryparameters and be fiscally responsible in carrying out allcase management mctions and activities.

Interpretation

Case manager as agent of agency. Social work case manag-ers practice with varying levels and types of authority forresource allocation. Expanded financial authority may be readilyidentified in delivery systems structured with a single point ofentry. In many of these settings, social work case managementfunctions as a system "gatekeeper," controlling access andallocating resources. The agency should establish criteria forcase managers to determine which clients are entitled to use thescarce resources and under what circumstances.

Client-centered social work case management practiceoccurs within the parameters imposed by the program andagency. As such, the social work case manager maintains theclient focus and simultaneously allocates service resourcesand provides critical feedback regarding program, agency,and delivery system performance. Thus, the case manager isresponsible both for delivering appropriate services to theclient and for carefully allocating and managing agencyservices and financial resources.

Social work case managers must fully disclose the follow-ing to clients: the resources that are available and that areunavailable, required copayments and cost sharing, time lim-its on service provision, timing and frequency of requiredreassessments, and appropriateness and fiscal effects of treat-ment choices.

18 20

As a gatekeeper and resource allocator, the social work casemanager collects information and provides feedback on thefiscal effects on the agency, necessary program modifica-tions, required delivery system changes, quality of providerperformance, and effectiveness of the agency's contractingsystem.

Accounting practices. Distinct from administrative tasks,the time the social work case manager spends with the clientand the client's family for assessment, planning, counseling,and monitoring is an integral part of direct service and servicecosts. Whether the case manager offers case managementservices privately or as part of the agency program, he or shemust carefully account for costs, establish and charge fees forservices rendered, and obtain reimbursement for professionalservices. The agency should establish criteria for case managersto use in determining the proportion of time he or she will spendon particular types of cases in relation to the total caseload. Likeother services provided directly to the client for his or her benefit,case management should be appropriately reimbursed throughdirect program support, third-party payments, fees for service,and other suitable financing mechanisms.

Whenever possible, the social work case manager shouldencourage the agency to contain a separate line item for casemanagement services to distinguish this direct service systemfrom what previously has been considered strictly an admin-istrative function. This is not to negate the case manager'scontribution to administration nor to attribute all the casemanager's time to nonadministrative functions. Rather, suchbudgetary practices will readily identify the costs associatedwith case management and facilitate appropriate reimburse-ment of these direct services.

Expanded fiscal accountability may create ethical dilem-mas for the social work case manager. Social work casemanagement practice requires the professional to put theclient' s needs first, as well as to justify how resources are spenton behalf of that client. Attainment of thesegoals requires thatthe social work case manager develop and maintain fiscalmanagement skills.

Standard 8

The social work case manager shall participate in evalu-ative and quality assurance activities designed to monitorthe appropriateness and effectiveness of both the servicedelivery system in which case management operates aswell as the case manager's own case management services,and to otherwise ensure full professional accountability.

19

Interpretation

The accountability of the staff and the agency should be

ensured through ongoing quality assurance efforts and peri-

odic evaluation of the appropriateness, adequacy, and effec-tiveness of both the case management system and of theservices provided through this system.

The case manager is involved in evaluating the quality,appropriateness, and effectiveness of the case managementservices on two levels. At the level of the individual client, thecase manager, through completion of data collection forms,record keeping, and participation in peer review, obtainsaccurate and timely information about each case and the casemanager's activities that provide a basis for monitoring,evaluation, and cost-accounting systems. At the deliverysystem level, achieving program improvements and ensuringthe equitable allocation of resources depends on reliableaggregate case data to demonstrate needs and service gaps andto document both the absence and presence of problems.Evaluation and quality assurance ensure that intended out-comes of services are attained and that the services areimplemented in a consistent manner according to standards.

The quality, effectiveness, and appropriateness of socialwork case management services shall be regularly reviewed,evaluated, and ensured using established criteria and stan-dards. Such criteria and standards shall relate to the indicatorsof need for services and to the effectiveness of requiredinterventions. Contracted providers shall be reviewed andevaluated in the same manner. Appropriate client feedbackshould be sought on the services they have received and thatfeedback should be incorporated in this process. The reviewand evaluation of social work case manaument servicesshallbe documented and shall include feedback and implementa-tion of corrective measures, when necessary.

Standard 9

The social work case manager shall carry a reasonablecaseload that allows the case manager to effectively plan,provide, and evaluate case management tasks related toclient and system interventions.

Interpretation

The size of the social work case management staff shall be

related to the scope and complexity of the case managementsystem and to the nature of the populations to be served.Staffing shall be sufficient to enable the provision of timelyquality services by the social work case manager. The compo-sition of the staff also shall be related to the ethnic andcultural

20 22

composition of the client populations to provide for culturallysensitive case management practice and to allow staff toeffectively respond to the unique needs of particular clientgroups. Appropriate and adequate supervision andmultidisciplinary consultation services should be available toand used by case management supervisors and staff.

The agency should establish policies and develop systemsgoverning reasonable workloads and caseloads for supervi-sors and staff. A number of variables affect caseload size.Caseload standards should be based on the scope of profes-sional responsibilities, the volume of clients to be served, theamount of time the case manager needs to spend with clients,the breadth and complexity of client problems or services, andthe length and duration of case mix in determining casemanagerclient involvement. The number of cases a socialwork case manager can realistically handle is limited to thedegree to which caseloads consist of acute, high-risk, multineedclients. Caseload size must realistically allow for meaningfulopportunities for face-to-face client contact. As caseload sizeincreases, the case manager has a decreasing capacity toperform ongoing case management activities such as follow-up, monitoring, and reassessment. It is the joint responsibilityof the agency and the social work case manager to address andremedy caseload issues and concerns. -

Standard 10

The social work case manager shall treat colleagueswith courtesy and respect and strive to enhanceinterprofessional, intraprofessional, and interagency co-operation on behalf of the client.

Interpretation

Case management requires well-coordinated and effectiveinterdisciplinary efforts if the client's needs are to be served.It is important that interpersonal relationships be character-ized by a spirit of respect and caring that is critical to the socialworkerclient relationship. Moreover, the respectful treat-ment of colleagues is a prerequisite for effective communica-tion and cooperation among professionals from differentdisciplines.

The social worker often performs case management func-tions in collaboration with other professionals and agencies.In such cases, it is advisable that the duties be delineated inwriting. Formal agency linkage agreements should be estab-lished when any two organizations work together to serve theinterests of a single client or particular client populations.Such agreements should detail the operational and financial

21

arrangements of the working relationship as well as confiden-tiality policies.

When more than one individual will be performing casemanagement tasks, the social work case manager will workwith his or her agency, staff, and other relevant professionalsto identify a primary case manager. Thus, the client shall havea single, identifiable case manager throughout the continuumof service delivery. Ideally, the client should be able to choosethe person who will perform the case management function,and hence, the authority of the social work case manager willbe vested by the client. An organization' s policies shouldprovide for continuity of responsibilities when the primarycase manager is unavailable to provide services to a client.

2 422

Code of Ethics

SUMMARY OF MAJOR PRINCIPLES

I. The Social Worker's Conduct and Comportment as aSocial Worker

A. Propriety. The social worker should maintain highstandards of personal conduct in the capacity or identityas social worker.

B. Competence and Professional Ekvelopment. Thesocial worker should strive to become and remain profi-cient in professional practice and the performance of pro-fessional functions.

C. Service. The social worker should regard as primarythe service obligation of the social work profession.

D. Integrity. The social worker should act in accordancewith the highest standards of professional integrity.

E. Scholarship and Research. The social worker engagedin study and research should be guided by the conven-tions of scholarly inquiry.

II. The Social Worker's Ethical Responsibility to Clients

F. Primacy of Clients' Interests. The social worker'sprimary responsibility is to clients.

G. Rights and Prerogatives of Clients. The socialworker should make every effort to foster maximum self-determination on the part of clients.

H. Confidentiality and Privacy. The social workershould respect the privacy of clients and hold in con-fidence all information obtained in the course of profes-sional service.

I. Fees. When setting fees, the social worker shouldensure that they are fair, reasonable, considerate, andcommensurate with the service performed and with dueregard for the clients' ability to pay.

HI. The Social Worker's Ethical Responsibility toColleagues

J. Respect, Fairness, and Courtesy. The social workershould treat colleagues with respect, courtesy, fairness, andgood faith.

K. Dealing with Colleagues' Clients. The social workerhas the responsibility to relate to the clients of colleagueswith full professional consideration.

5 23

IV. The Social Worker's Ethical Responsibility toEmployers and Employing Organizations

L. Commitments to Employing Organizations. Thesocial worker should adhere to commitments made to theemploying organizations.

V. The Social Worker's Ethical Responsibility to the SocialWork Profession

M. Maintaining the Integrity of the Profession. Thesocial worker should uphold and advance the values,ethics, knowledge, and mission of the profession.

N. Community Service. The social worker should assistthe profession in making social services available to thegeneral public.

O. Development of Knowledge. The social worker shouldtake responsibility for identifying, developing, and fullyutilizing knowledge for professional practice.

VI. The Social Worker's Ethical Responsibility to Society

P. Promoting the General Welfare. The social workershould promote the general welfare of society.

This summary is of the N,4SW Code of Ethics, effective July I, 1980,as adopted by the 1979 NASW Delegate Assembly and revised by the

1990 Delegate Assembly. The complete text, including the preamble andexpanded definitions of prmciples, is available on request.

2 6

24

Case Management Standards Work Group

James M. Karls, DSW, ACSW (Chair)Social Work Education DepartmentSan Francisco State UniversitySausalito, CA

Sandra A. Lopez, MSW. ACSWSandra A. Lopez and AssociatesHouston. TX

Carol D. Austin, PhDCollege of Social WorkOhio State UniversityColumbus. OH

Gary M. Gould, PhDCanadore College/Nipissing UniversityOntario, Canada

Betsy Vourlekis, PhD, ACSWDepartment of Social WorkUniversity of MarylandBethesda, MD

Howard Blonsky. MSW. LCSWSan Francisco Unified SchoolsBurlingame. CA

Lynda Eubank, MSW, ACSWArlington County Department of Human ServicesArlington, VA

Rebecca Mahler, MSW, ACSWSheltering Arms Rehabilitation HospitalRichmond. VA

Louise Doss Martin, MA, ACSAlcohol and Drug Abuse Serves AdministrationWashington, DC

Loreen McNair. MSWHealth Management StrategiesAlexandria, VA

Janice Edwards, DSW, ACSWMetropolitan Psychiatric Group/Psychiatric InstituteWashington, DC

NASW Staff: James P. Brennan. MSW, ACSWProject Consultant: Caren Kaplan, MSW

111

About NASW

The National Association of Social Workers (NASW)is the largest organization of professional socialworkers in the world. As of August 1992, over139,000 members participated in 55 chapters through-out the United States, Puerto Rico, the Virgin Islands,and the international community.

The association works to enhance the professionalgrowth and development of its members, to createand maintain professional standards, and to advancesound social policies. NASW provides a variety ofmembership benefits including credentials (Acad-emy of Certified Social Workers, Academy of Cer-tified Baccalaureate Social Workers, the QualifiedClinical Social Worker, and the School Social WorkSpecialist) and insurance (professional liability,health, and life). The NASW Press, which producesSocial Work and the NASW News as membershipbenefits as well as three otherjournals and numerousbooks each year, is a major service in professionaldevelopment. In January 1991, the association re-leased a major proposal for National Health Care, asingle-payer system.

For more information on NASW membership orprograms, write NASW, 750 First Street, NE, Suite

700, Washinaton, DC 20002-4241 (telephone: 1-800-638-8799 or 1-202-408-8600).

: 4V7-:;';1/47.7r..

.

yr,