Unit 2.1 db: elements for success

By the end of each section of the chapter, you should be able to accomplish the performance objectives listed.

Perspectives on Case Management

· Identify four perspectives on case management.

· Trace the evolution of case management.

· Describe the impact of managed care organizations on case management and service delivery.

The History of Case Management

· Assess the contributions of the pioneers in the areas of advocacy, data gathering, recordkeeping, and cooperation.

· Using the Red Cross as an example, describe casework during World War I and World War II.

· Name the key pieces of federal legislation that spurred the development of case management.

The Impact of Managed Care

· List the goals of managed care.

· Summarize the impact of managed care on human service delivery.

· Differentiate between the various types of managed care organizations: Pharmacy Benefits Management, HMOs, PPOs, POSs, Health Savings Accounts, Health Reimbursement Arrangements, and plans offered under the health insurance exchanges.

Expanding the Responsibilities of Case Management

· Trace the shift in emphasis in case management.

· Explain the strengths and weaknesses of managed care.

2-1Introduction

Case management has long been used to assist human service clients. Today, professionals are discovering new and more effective ways to deliver services, and there is no longer a standard definition. Modern case management does resemble the practice of the past, but many dramatic changes have occurred. Among them are the changing needs of individuals served, financial constraints on the human service delivery system, the increasing number of people needing services, and the growing emphasis on client empowerment, evaluation of quality, and service coordination.

Families we work with, they have lots of needs and many of the families get really lost in the system. Some never had services before. Our job is to provide casework … this means helping them pay for services such as utilities … we also work with them in their homes. Going there lets them know we will extend ourselves for them. It is respectful … and we help our clients help themselves by advocating for them. Things at the local, state, and federal levels change so rapidly and we help our clients respond to those changes and how they influence the services they receive or can receive.

—Case manager, family services, New York, NY

We absolutely refuse to work against other agencies … we build a cooperative environment … we believe there are enough clients for everyone … our case managers work with intake and establishing eligibility. That means they are gatekeepers … we have a certain district that we serve … a good number of our clients come from the hospital. This is continuing to increase with the change in healthcare delivery.

—Director and case manager, counseling center, Tucson, AZ

Our services began with the apartments in the northeast part of the city. We needed housing for clients coming out of psychiatric hospitals. The clients had a difficult time finding a stable place to live other than the traditional SROs … The goal was to provide a more supportive and stable environment. This is a really difficult goal for us and for them.

—Director and care coordinator, housing services center, New York, NY

The caseworker from a family services agency describes the work of her agency as providing financial assistance and advocacy for families for whom there is no other support. The counseling center, however, gives patients just discharged from the hospital only the aftercare services they need. This often includes support to meet psychological, social, medical, financial, and daily living needs. The housing services center began by providing temporary housing with accompanying support services.

One way to think about the case management process is to examine the key elements for success: responsibility, continuity, and accountability (Ozarin, 1978). Responsibility means that one person or team assesses the client’s problem and then plans accordingly. Linkages “must be established to form a network of service agencies which can provide specific resources when called upon without assuming total responsibility for the client, unless responsibility for carrying out the total plan is also transferred and accepted” (Ozarin, 1978, p. 167). In other words, there must be a clear line of responsibility for the case and the client.

Continuity is another significant element of good case management. Planning is the key that ensures continuity. It is important not only during the intensive treatment phase but also in aftercare. To foster accountability, methods “must be in place to assure the patient is not lost …. The case management process must help the client increase the ability to function independently and to assume self-responsibility. The client should be involved in all aspects of decision making” (Ozarin, 1978, p. 168). Guided by these goals, organizations and professionals at every level work hard to develop systems that participants understand by working together to serve and involve the clients.

Case management can be seen as a “set of logical steps and a process of interaction within a service network which assure that a client receives needed services in a supportive, effective, efficient, and cost-effective manner” (Weil & Karls, 1985a, p. 2). In a more recent definition, a social work best practice white paper (n.d.) described case management as “a method of providing services whereby a professional Social Worker collaboratively 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” (Social Work Best Practice: Health Care Management, n.d.).

Case management is an important and necessary component of the human service delivery system because it provides a focus and oversees the delivery of services in an orderly fashion. As you read about Sam’s case, you will see case management evolve into a more logical and complex process that focuses on client participation, integration of services, and cost effectiveness.

Class Discussion

Relate Sam’s Experience to the Case Management Process

After reading about case management as a process as a class, in small groups, or as an individual, describe the characteristics of the process. Use the information you learned about Sam to illustrate the characteristics that you presented. Also, you can use the text material and the quotes from the three case managers presented at the beginning of the chapter to illustrate what you learned about case management as a process.

Share this information with your classmates.

Client Involvement

Sam’s Story 2.3

Sam remained institutionalized for the next 4 months because there was a shift in the case management process. The institution decided to contract with a local mental health agency for case management services. Case management was a new role and responsibility for this agency; it assigned two individuals 50 cases each, with few guidelines for performing this new function. Sam’s new case manager, his second, spent some time assessing Sam’s needs, getting to know him, and talking with the mental health professionals within the institution. In concert, they determined that Sam needed a very structured environment in the community if his deinstitutionalization was to succeed. He also needed to learn sign language and to begin to communicate with others using this medium. Because he was hearing impaired but did not have mental illness, he needed to be in contact with the deaf community, where he could find support and role models for independent living. At the age of 27, he had little ability to care for himself.

Sam’s Story 2.4

Unfortunately, his case manager left her position before she had the opportunity to implement the plan. A third case manager assumed responsibility for Sam’s case, with much determination. Her own brother had been hearing impaired since birth, and she recognized Sam’s potential. She could communicate with him using ASL. She was also committed to planning, documenting her work, involving Sam in the case management process, and following through on referrals and the involvement of other professionals.

Sam’s Story 2.5

The goals of the plan included having Sam learn ASL, teaching him socialization skills and independent living skills, and introducing him to members of the deaf community. His case manager was able to find a day care program where Sam could learn independent living skills. Three times per week, he went to the local school for the deaf for ASL lessons. Once per week, Sam and his case manager joined other hearing impaired adults for a special community program and social hour. Sam still lived at the institution. By the end of the second year, the case manager was able to include Sam in the process of setting priorities and planning for his treatment.

Sam’s Story 2.6

After 2 years, Sam had made considerable progress. He was able to use ASL to communicate his needs, and he had developed several friendships with people he met at the school for the deaf and at the community programs. On his thirtieth birthday, he celebrated with his friends from the school. Tantrums continued to occur, but less frequently.

After a rocky beginning, Sam benefited from the service delivery process as it evolved. His third case manager assumed responsibility for his case, provided the continuity needed for him to make progress, and was accountable for his care. She used a process of logical steps to establish goals and set priorities. She also established a partnership with Sam by involving him in problem identification, plan development, and service provision. By learning daily living skills, Sam reinforced his ability to care for himself, and his increasing mastery of ASL gave him a new medium for self-expression and communication.

Sharon Bello, Entry 2.1

Marianne asked me if I would read through this chapter about the history of case management and pay attention to Sam and his story. She wanted me to write about my reactions to the history and to Sam. I wanted to talk about Sam first because my heart went out to him. He seems to move from place to place and go from help to help. I think that my life was something like his because I really didn’t know where to go for help. But I did have a good neighborhood and friends that could really help me. The death of my sons shook my life and me. But I had Lucia and Maria depending upon me, so I felt I had to hold on. I am not much on history, but when I talked with Marianne, I told her that it seemed to me that before I was born case management was just beginning. But when I go to meet with my case manager, there is no hesitation about what he or she can do to help me. Even though I have changed case managers, because they moved on for one reason or another, I feel the way services were delivered didn’t change. I think that Sam’s experience was different than mine. I am glad that I am receiving case management now, when the agency is sure of the services they want to deliver.

The Role of the Case Manager

Utilization Review and Cost-Benefit Analysis

One result of the spiraling cost of medical and mental health services and the push for healthcare reform has been the growth of the managed care industry. The purpose of managed care is to authorize the type of service and the length of time care is provided and to monitor the quality of care. In the managed care environment, case managers function very differently from those described previously.

What makes case management in managed care distinctive is the emphasis on the efficient use of resources. Case managers are involved in utilization review and have the responsibility of authorizing or denying services. Also, they must know how to interact with insurance providers and how to process claims through the insurance system.

The case manager is also responsible for cost-benefit analysis. Today, this is a critical responsibility. Such an analysis does not include the traditional reporting that is found in a case history in the form of notes or recommendations and follow-up. It is focused on the financial matters of the case, specifically the cost and efficiency of services.

My Story

Sharon’s Case Manager, Tom Chapman, Entry 2.2

I was amazed to read about the history of case management, especially the part about cost-benefit analysis. I guess we are most involved with that type of analysis at the beginning of the case. Remember the early forms that we fill out about the client. We want to know about the client, employment, other income or support, and support from family or friends. We also need to know, for Sharon’s case, about the cost of school and how the cost of school matches her goals. We also need to make a judgment if the client, when eligible, can meet the goals and outcomes we established. When Sharon’s goals changed and she decided to major in interpreting, we had to cost out how the financial expenditures would differ from her first plan. And for each amount of money and service we provided, I had to verify this on the record. Costs also included the time that I spent and the amount of time we contracted with other professionals, such as mental health and other medical professionals. I want to believe that we always do the best we can for our clients, but there is always the concern for and verification of expenditures.

Sam’s Story 2.8

As we leave Sam at the age of 42, he is 2 months away from assuming responsibility for all the vending machines in a nearby neighborhood. It has taken two successive 6-month training sessions to teach Sam the necessary job skills and repair techniques. Sam is living with a new friend in a small apartment near his vending area. This friend is also a client at the rehab center and is helping Sam train for his new job. Sam’s rehabilitation counselor and his care coordinator from the mental health center have met and developed a coordinated plan, with input from Sam. Because of his recent success in rehabilitation, mental health services are no longer authorized for Sam.

Class Discussion

Describe Sam’s Involvement in the Case Management Process

After reading about client involvement in case management, the role of the case manager, and utilization review as a class, in small groups, or as an individual, describe how each of these concepts played a role in Sam’s case.

Share this information with your classmates.

2-1bThe History of Case Management

As important as various current perspectives on case management are, the historical roots are equally informative. The pages that follow trace the history of case management from its origins in institutional settings through the work of early pioneers, the impact of the American Red Cross, and the influence of federal legislation. The chapter concludes with a discussion of case management as it is practiced today.

This Massachusetts school provided services in case management, such as tracking student progress, providing follow-up services, and managing information. Early services at the school included observation and diagnosis of physical and mental behavior. The helping professionals tracked clients’ progress, and they soon began differentiating and individualizing treatment: “… [W]e cannot properly care for a young and helpless idiot in the houses devoted to the brighter moron children” (Trustees, 1920, p. 17).

When demand for the services increased, the school established outpatient clinics in several cities (Trustees, 1919). These clinics supported families who cared for children at home. Aftercare was also an important service provided by trained “visitors” who helped plan the transition from the institution to the home or other setting. The visitor would gather information to determine whether the child should be sent home on trial or released for vacation with family or friends. They would also follow-up after transition to determine whether the release and placement were appropriate. This emphasis on aftercare was the forerunner of modern continuity of care and today’s commitment to provide services as the client makes a transition from the treatment setting to a less restrictive one.

In the early 1900s, the school made two improvements in the management of information, which is an important component of case management. In 1916, the institution began an evaluation of its services. This included a study of clients who had been discharged and those in aftercare. The information gathered included where patients lived, with whom they were living, whether they supported themselves, and, if so, how. The information was gathered first by survey, and then patients, families, and friends were interviewed in their homes. In 1919, new legislation established a Registry for the Feebleminded in an effort to catalog the state’s population of people with retardation (Trustees, 1920). These advances in recordkeeping and information management contributed to case management as we know it today.

Jane Addams and Ellen Starr, classmates at the Rockford Female Seminary, founded Hull House in Chicago in 1889. In their 20s, while traveling in England, they visited Toynbee Hall, a university club that had established a recreation club for the poor. Addams and Starr were committed to increased communication between social classes, and the activities of Toynbee Hall inspired them. They returned to America and moved into a poor section of Chicago, hoping to improve that environment (Addams, 1910).

They bought Hull House, an older home on Chicago’s West Side. Committed to sharing their home and their love of learning, they opened the house to the neighborhood. They acquired collections of furniture, art, and literature; soon, they became involved with music and crafts. The purposes of Hull House were three-fold: to provide a center for civic and social life, to improve conditions in the neighborhood, and to provide support for reform movements (Addams, 1910).

Contributions to Case Management

Lillian Wald and Mary Brewster, who were nurses, established the Henry Street Settlement House organization in 1895 in New York City. Early in their careers, they decided to provide services to the city’s Lower East Side, home to a large number of immigrants. Wald and Brewster lived in the neighborhood and provided healthcare services.

They established a system for nursing the sick in their own homes, thereby promoting the dignity and independence of the patient. According to Wald (1915), “the nurse should be as ready to respond to calls from the people themselves as to calls from physicians … she should accept calls from all physicians, and with no more red tape or formality than if she were to remain with one patient continuously” (p. 27). There was an explicit focus on accessibility.

Contributions to Case Management

The work at Henry Street led to two significant innovations: the designation of the visiting nurse and the development of the Red Cross. Both of these services were important in promoting public health. One important function of the visiting nurse was to establish an organized system of care and instruction for people with tuberculosis and their families. Early in its history, the Red Cross facilitated the use of the public schools as recreation centers, taught housekeeping skills to women, and provided penny lunches for children (Wald, 1915).

Mary Richmond

Mary Richmond, a social reformer at the turn of the century, had a similar commitment to bettering the lives of individuals and families living in poverty. She, too, made significant contributions to the development of case management. Richmond promoted the idea that each person was a unique individual whose personality, family, and environment should be respected. Working with immigrants, she emphasized the need for social workers to resist the tendency to stereotype or overgeneralize (Lieberman, 1990). Richmond wrote, “[T]he social adjustment cannot succeed without sympathetic understanding of the old world backgrounds from which the client came” (1917, p. 117). She also believed that professionals should work with clients rather than doing things to them.

Want More Information? Learning about the History of Case Management

The Internet provides in-depth resources related to the study of case management. Search the following terms to read more about individuals and agencies who provided the foundation for case management practice.

· Hull House

· Henry Street Settlement House

· Mary Richmond

Contributions to Case Management

After World War II, it became increasingly evident that many people needed assistance to improve their quality of life. In the early 1960s, the federal government became increasingly involved in helping people in need.

2-1eThe Impact of Federal Legislation

Federal Programs SSDI Program

Title II of the Social Security Act establishes the Social Security Disability Insurance Program (SSDI). SSDI is a program of federal disability insurance benefits for workers who have contributed to the Social Security trust funds and become disabled or blind before retirement age. Spouses with disabilities and dependent children of fully insured workers (often referred to as the primary beneficiary) also are eligible for disability benefits on the retirement, disability, or death of the primary beneficiary. Section 202(d) of the Social Security Act also establishes the adult disabled child program, which authorizes disability insurance payments to surviving children of retired or deceased workers or workers with disabilities who were eligible to receive Social Security benefits, if the child has a permanent disability originating before age 22.

Hereinafter in this policy brief, the term SSDI refers to all benefit payments made to individuals on the basis of disability under Title II of the Social Security Act.

SSDI provides monthly cash benefits paid directly to eligible persons with disabilities and their eligible dependents throughout the period of eligibility.

SSI Program

Title XVI of the Social Security Act establishes the Supplemental Security Income (SSI) Program. The SSI program is a means-tested program providing monthly cash income to low-income persons with limited resources on the basis of age and on the basis of blindness and disability for children and adults. The SSI program is funded out of the general revenues of the Treasury.

Eligibility for SSI is determined by certain federally established income and resource standards. Individuals are eligible for SSI if their “countable” income falls below the federal benefit rate ($512 for an individual and $769 for couples in 2000). States may supplement the federal benefit rate. Not all income is counted for SSI purposes. Excluded from income is the first $20 of any monthly income (i.e., either unearned, such as Social Security or other pension benefits, or earned) and the first $65 of monthly earned income plus one-half of the remaining earnings. The federal limit on resources is $2000 for an individual and $3000 for couples. Certain resources are not counted, including, for example, an individual’s home and the first $4500 of the current market value of an automobile.

The Ticket to Work and Work Incentives Improvement Act of 1999

On December 17, 1999, President Clinton signed into law the Ticket to Work and Work Incentives Improvement Act of 1999 (Public Law 106-170). Hereafter in this policy brief, Public Law 106-170 is referred to as the Act. The Act has four purposes [Section 2(b) of the Act]:

· To provide healthcare and employment preparation and placement services to individuals with disabilities that will enable those individuals to reduce their dependency on cash benefit programs.

· To encourage states to adopt the option of allowing individuals with disabilities to purchase Medicaid coverage that is necessary to enable such individuals to maintain employment.

· To provide individuals with disabilities the option of maintaining Medicare coverage while working.

· To establish a return-to-work ticket program that will allow individuals with disabilities to seek the services necessary to obtain and retain employment and reduce their dependency on cash benefit programs.

This Act improves work incentives under the SSDI and the SSI and expands healthcare services under Medicare and Medicaid programs for persons with disabilities who are working or who want to work but fear losing their health care.

Medicare

Medicare is a health insurance program for:

· People 65 years of age and older.

· Some people with disabilities younger than 65 years of age.

· People with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant).

Medicare provides hospital insurance. Most people do not have to pay for this insurance. Medicare also provides medical insurance and most people pay monthly for this insurance. There are several ways that individuals can access their Medicare benefits.

· The Original Medicare Plan—This plan is available everywhere in the United States. It is the way most people get their hospitalization and medical insurance benefits. They can go to any doctor, specialist, or hospital that accepts Medicare. Medicare pays its share and the recipient pays a share. Some services are not covered, such as prescription drugs.

· Medicare Managed Care Plans—These are healthcare choices (like HMOs) in some areas of the country. In most plans, individuals can only go to doctors, specialists, or hospitals that are part of the plan. Plans must cover all Medicare hospitalization and medical insurance benefits. Some plans cover extras, such as prescription drugs. Individual out-of-pocket costs may be lower than in the Original Medicare Plan.

· Private Fee-for-Service Plans—This is a new Medicare healthcare choice in some areas of the country. Individuals may go to any doctor, specialist, or hospital. Plans must cover all hospitalization and medical insurance benefits. Some plans cover extras like extra days in the hospital. The plan, not Medicare, decides how much you pay.

Medicaid

Title XIX of the Social Security Act is a program that provides medical assistance for certain individuals and families with low incomes and resources. The program, known as Medicaid, became law in 1965 as a jointly funded cooperative venture between the federal and state governments to assist states in the provision of adequate medical care to eligible needy persons. Medicaid is the largest program providing medical and health-related services to America’s poorest people. Within broad national guidelines that the federal government provides, each of the states:

· Establishes its own eligibility standards.

· Determines the type, amount, duration, and scope of services.

· Sets the rate of payment for services.

· Administers its own program.

Thus, the Medicaid program varies considerably from state to state, as well as within each state over time.

Contributions to Case Management: Rehabilitation Act of 1973

Client involvement, a basic principle of case management today, was also an important theme in the Rehabilitation Act of 1973 and its subsequent amendments through 1986. These pieces of legislation promoted consumer involvement while serving individuals with severe disabilities (Rubin & Roessler, 2001), particularly in eligibility determination and plan development. Client satisfaction and the adequacy of services also received attention. Client involvement was further strengthened when the Rehabilitation Act Amendments of 1992 and 1998, which emphasize consumer choice and control in setting goals and objectives, were passed.

Contributions to Case Management: Children with Disabilities, Education for All Handicapped Children Act of 1975

Public Law 94-142, the Children with Disabilities, Education for All Handicapped Children Act of 1975, included an explicit case management process to treat the client as a customer. The client was to be involved in identifying the problem, given complete information about the results of the assessment of needs, and empowered to help determine the type of services delivered. The client also participated in the evaluation of the helping process and in any decision to terminate or redirect activities (Jackson, Finkler, & Robinson, 1992).

The passage and subsequent implementation of this act serves as an excellent example of how federal legislation applies the case management process (Weil & Karls, 1985a). One tool to assist with planning, implementation, and evaluation is the individualized educational program (IEP). The IEP articulates a plan of intervention for each child based on goals and recommended intervention strategies. Although educational agencies have implemented the IEP in numerous ways, it has always been critical for the case manager to assume the leadership role on the team of participants who develop the IEP.

On June 24, 1997, President Bill Clinton signed into law the IDEA amendments. These amendments reflect changes in the values and process of case management and the planning and implementation of the IEP, focusing on four important areas: strengthening parental participation, creating accountability for student participation in general education, addressing remediation and behavior problems within the educational environment, and preparing students for independent living. Client empowerment was strengthened and there was an emphasis on client strengths. These are two values and goals of the case management process.

The values of the Individualized Education Programs continue to be at the heart of providing services for children who qualify for IDEA services (birth to 2 years old and from 3 to 21 years old). Working in teams and with the full participation of families and clients (children), dynamic programs help students’ participation in educational services that meet their needs within the “least restrictive environment.” The new changes to the IDEA affirm these values and these processes.

Contributions to Case Management: The Family Support Act of 1988 and the Personal Responsibility and Work Opportunity Act

The growth in prepaid group plans was relatively slow until the 1970s. Then, the Health Maintenance Organization Act of 1973 (Public Law 93-222) allowed managed medical plans to increase in number and expand the numbers of patients being served (MacLeod, 1993). The prevalence of managed care is now commonly regarded as connected to the increasing cost and decreasing quality of health care and mental health care. The escalation of costs reflects many trends: improved technology, shifting of costs from nonpaying patients to paying patients, an older population, higher expectations for a long and healthy life, increased administrative costs, and varying standards of efficiency and quality care.

Defining Managed Care

· There is no cap to employer contribution (Department of Treasury, 2015).

Plans Offered under the Health Insurance Exchanges

This category of managed care, mandated by the ACA, requires every state to offer its citizens a way to buy health insurance, optimally within a health exchange or marketplace for health insurance offered online. There are four designations of health care coverage available through the exchanges. Each offer minimum coverage and cover 60%, 70%, 80%, or 90% of medical costs. The minimum coverage includes:

· Ambulatory care

· Emergency care

· Hospitalization

· Maternity care

· Newborn care

· Mental health and substance abuse care

· Prescription drug care

· Rehabilitation services

· Preventive and wellness care

· Chronic drug management

· Pediatric services (Small Business Majority, 2015)

Summary

The types of managed care will continue to develop and change with the implementation of the ACA. In this section, we covered managed care as it relates to employers and employees. Under the ACA, many uninsured individuals will qualify for insurance under guidelines for Medicaid and Children’s Health Insurance Program (CHIP). Unemployed individuals not eligible for Medicaid or CHIP may buy their insurance on the “Marketplace” at an affordable price (Health care.gov, 2015).

Research and Practice: Case Management Society of America: Our History

The 
Case Management Society of America is an international, nonprofit organization founded in 1990 dedicated to the support and development of the profession of case management through educational forums, networking opportunities, and legislative involvement. Unique in its composition as an international organization with more than 70 affiliated and prospective chapters in a tiered democratic structure, CMSA gains its success and strength through a member-driven society.

CMSA’s emergence as a prominent national organization is in large part due to its unique and involved membership. To enhance this process, the society provides ongoing leadership training seminars geared toward the local leaders.

CMSA developed the nationally recognized Standards of Practice for Case Management. This publication was officially released in early 1995, and it is a forerunner in establishing formal, written standards of practice from a variety of disciplines. During that same year, the National Board approved a peer-reviewed Ethics Statement on Case Management Practice, a base foundation from which to apply ethical principles to the practice of case management. The Standards of Practice and Ethics Statement are both available from CMSA National.

In response to payer and purchaser expectations for demonstrating value in the marketplace, CMSA created the Council for Case Management Accountability. This new division of CMSA will establish evidence-based standards of practice and help its members achieve those standards through the measurement, evaluation, and reporting of outcomes.

Education, research, and networking continue to be top priorities sought by CMSA members. Proactive measures from grassroots lobbying to national briefings have been at the forefront of CMSA legislative activity. Government Affairs committees are currently active in most of the local and state chapters across the country.

Through the support of a certification program, CMSA continues to enhance the level of case manager professionalism, furthering the development of a new, higher level of industry expertise. For more information, please contact the Commission for Case Manager Certification at (856) 380-6836. CCMC is a separate entity and is independent from CMSA.

Ultimately, the quality and productivity of CMSA’s services rely on the commitment of its membership. Because case managers are effective communicators, problem solvers, and visionaries, CMSA offers an opportunity for members to utilize their skill sets and maximize their talents. The enormous success of the organization lies in one simple concept—professional leadership.

Historically, managed care has emerged as a response to the fact that employers, governments, payers, clients, and providers are all seeking ways of containing health care costs. The various types of plans emphasize management of medical cases, review and control of utilization, and incentives for or restrictions on providers and clients to reduce costs and maintain quality. Managed care systems are achieving many of these goals, but even in the environment and implementation of the Affordable Care Act some clear advantages and disadvantages have emerged. Proponents of the managed care systems point to the following advantages of managed care:

· For many individuals, accessibility to medical care has expanded.

· Providers, clients, and payers involved in health care prioritize among services, procedures, and treatments provided.

· Providers carefully consider any plan of action prescribed for the client because they must provide justification for each component of the plan.

· There is an efficiency of service delivery because services are to be provided in the shortest time needed to meet the goals established.

· Evidence-based practice standards articulate what defines quality care.

· From the client’s perspective, there is a single coordinated point of entry into the system.

· Resources are saved.

· Resources are spent according to priorities.

Those who question the virtue of the managed care system focus their concerns on two areas: the quality of services delivered and the efficiency of service. They see the following disadvantages of delivering services through managed care:

· Professionals do not believe that they are offering the best services available because they are constrained by resource limitations.

· Managed care staff are making judgments about the suitability of proposed treatment without adequate training or professional knowledge.

· Services are not delivered in a timely manner because of the extra layer of bureaucracy.

· Clients worry about the quality of the care they are receiving.

· Clients do not have access to all the services they believe they should have.

· Clients cannot choose their service providers.

Talking about Managed Care

Managed care is a relatively new component of the service delivery system. As a class, in small groups, or as an individual, describe the purpose of managed care and the way it influences the delivery of medical services. According to your understanding, describe the way that managed care might influence the work of the case manager.

Share this information with your classmates.

Deepening Your Knowledge: Case Study

Nancy, a 42-year-old White woman, began her career in case management 11 years ago in a welfare office in Cincinnati, Ohio. She earned her bachelor’s degree in sociology and married soon after college. She and her husband decided that they wanted to start a family soon after, so they agreed that he would work and she would stay at home to help with the children, who are now 17 and 15. When her youngest child was a year away from kindergarten and had settled into preschool, Nancy decided that she was ready to enter the workforce. She had thought a lot about the helping profession while her children were growing up and knew from her involvement in church and community service that she felt called to social work. With her education in sociology, she found a position working with the many clients who needed guidance and direction in navigating the welfare system.

After spending 3 years working with this population, she thought that she would be happier with more flexibility and diversity in her work. She enjoyed discussing approaches to working with clients with her coworkers and thought on many occasions that her direct supervisors did not do enough to help the case managers or the clients they served. Nancy began to realize that she desired to help clients and other social workers more fully by assuming a managerial role in the office.

At this time, Nancy decided to enroll in a local master’s of social work program and took classes at night over the next 3 years. During this time, she continued her work for 2 years at the welfare office until she became aware, through one of her professors, of an opening at a local center for adults with pervasive developmental disorders. She investigated this opportunity and realized that it would let her work with fewer clients in both group and individual settings; therefore, she could address their needs in greater depth and have more impact on their lives. Nancy interviewed and accepted the position with 1 year of coursework remaining on her master’s degree.

She loved the work and, upon completing her degree, made plans to pursue licensure with the National Association of Social Workers as a Certified Social Work Case Manager (C-SWMC). Her supervisor was supportive of this decision and helped her with the supervised hours requirement. By working with her previous supervisor at the welfare office as well as taking and passing the ASWB-BSW exam, Nancy was able to receive her certification 1 year after pursuing the credential. The license, coupled with her master’s degree, allowed Nancy to ascend to the level of program coordinator at the center during her ninth year as a social worker.

Discussion Questions about Nancy

1. Identify the key steps that Nancy took toward enhancing her professional identity as a social worker. What further steps could Nancy take to develop her role and career?

2. If Nancy had decided to explore work in substance abuse after the welfare position, how might her path toward enhancing her professional identity have differed?

3. Think about your current stage in your professional development. What steps would you like to consider and pursue over the next 10 years? Who might you consult to help you achieve these steps?

Author Note: We think that it is important for you to review the chapter you just read. We suggest the following.

· First, re-read the class discussion questions in the text and answer these as comprehensively as possible.

Methods of Delivering Case Management Services

· List reasons why it is important to understand the different methods that helpers use to deliver case management services.

· Illustrate four ways that case management services are delivered (e.g., comprehensive services.

· Illustrate what case management looks like when different individuals assume the role of case manager.

Roles in Case Management

· Identify the roles in the case management process. Provide an example of how a case manager might perform each of the roles.

Topics in Case Management Today

· List the topics that case managers identify when they talk about their professional work.

· Define what case managers mean by a Jack or Jill of all trades.

· Illustrate why communication is important in case management.

· Describe the use of decision making and critical thinking skills in case management.

· List three personal qualities that help case managers perform their jobs.

3-1Introduction

—Director, housing services nonprofit, New York, NY

Parole is an important part of the criminal justice system. We work hard to help parolees before they are released so they can have a smooth transition. Part of the information I use to support the release process is on the release plan. This is a form that inmates fill out; it helps me know about where they might want to live and work when they leave prison. Once I get this information, then I begin to explore living accommodations and possible employment opportunities. It is my job to make sure that rooms can be rented and the landlords will accept the ex-inmate. I also talk with the employer. It is important I find out if the work is legitimate. If I cannot verify housing or employment, then I contact the institutional parole officer and he or she helps the inmate submit another plan. We try to make sure that the parolee has an important responsibility during the transition process.

—Parole officer, adult corrections parole, Knoxville, TN

The preceding quotations relate to roles that case managers perform in service delivery, the different methods used to delivery services, and the topics that case managers describe when they talk about their work. The director of housing services in New York, who works with individuals and families affected by HIV/AIDS, supports clients by providing a variety of services, including housing, recreation, and vocational rehabilitation. The case managers at her agency serve as coordinators, planners, and problem solvers. This director talks about the multiple roles she performs and how important communication with others is. The rehabilitation agency provides services in the hospital and after hospital discharge. The program makes a long-term commitment to clients, regardless of their abilities or status. This requires case managers to be flexible in their roles to accommodate the needs of the client. Working from a very different method, the parole officer’s roles are defined by the state and shaped by her large caseload. Because the parolees assume most of the responsibility for themselves, the parole officer is primarily a recordkeeper, monitor, and problem solver. She has to keep her boundaries and allow her clients to succeed or, sometimes, fail.

3-1aMethods of Delivering Case Management Services

The organization of the agency provides comprehensive case management. Each client receives an individual assessment and plan, which may include social support, housing, recreation, work, and time to integrate into the community. The case manager’s responsibilities range from coordinating services (supervision of intake, assessment, planning, brokering, monitoring, and termination) to leading a team of professionals who provide services to the client. Sometimes there is a professional whose primary responsibility is management of the case, and at other times the one who initiates services also assumes the management role.

Primary Roles

A case manager is an advocate, broker, coordinator, planner, problem solver, and recordkeeper. You will learn more about these roles later in this chapter.

Length of Involvement

The duration varies. If the case is complicated and several specialists are needed, then services are provided for a longer time. In other cases, short-term service is adequate. For example, in terms of a crisis response, the care is short-term and clients are referred to longer-term care if needed.

Strengths

Services are provided on an inpatient, outpatient, or residential basis, but all are provided in one location. Client assessment is multifaceted, with a holistic approach. The plan is individualized and easily monitored. Staff members function as a team with a common goal and have regular meetings and a common reporting scheme.

Weaknesses

Resource availability may be a problem if the client needs services not available at the center. Service integration depends on clear organizational structure and lines of authority; the staff must agree on the problem, the plan, and the implementation. Resource availability can be a problem. The family of the client may be less engaged in the helping process because the staff role is strong. In addition, the client may become accustomed to the environment and never grow beyond it. We provide descriptions of the four types of organizational services delivery. However, remember that there may be many more.

One-Stop Comprehensive Services

One example of the comprehensive services that are provided is a program available in the state of Wisconsin. The Wisconsin Works (W-2) program provides services to parents with children. To be eligible for the program, these parents must earn a salary that is 115% below the federal poverty level. Case management is a key component of the services available to individuals who qualify for the program. Read further to understand the case management functions related to comprehensive case management for Wisconsin’s W-2 program.

3-1cComprehensive Case Management: Wisconsin’s Model Approach for W-2 Participants

Successful treatment programs that focus on recovery to work should not only offer a continuum of services but also integrate these services within the larger community. Because many factors affect a woman’s substance abuse problem, the purpose of a comprehensive case management approach is to address a woman’s substance abuse in the context of her health and her relationship with her children and other family members, the community, and society. This type of case management can generally be described as a coordinated approach to the delivery of health, substance abuse, mental health, vocational, and social services, linking participants with appropriate services to address specific needs and stated goals. All services and supports must be culturally competent and tailored to the unique values and cultural needs of the family and of the culture that the family identifies with. When implemented to its fullest, comprehensive case management will enhance the scope of substance abuse treatment and the recovery continuum, and it will stress the following goals:

· Provide the participant with a single point of contact for multiple health and social services systems

· Advocate for the participant

· Be flexible, community-based, and family-focused

· Assist the participant with needs generally thought to be outside the realm of employment and training and substance abuse treatment

· Develop a universal service plan that integrates activities from all service providers and is outcome-based (Wisconsin Department of Children and Families, 2015)

Class Discussion

Studying the One-Stop Comprehensive Services Method

The example of an interdisciplinary team providing services to a multiple-problem client is represented by a program in the United Kingdom that provides services for older people with mental health issues. In the United Kingdom, services to these individuals centers around Community Mental Health Teams (CMHTs) to help meet the wide variety of services required for clients. The teams include psychiatrists, mental health nurses, social workers, occupational therapists, psychologists, and counselors. Teams may add members depending on the needs of the client (Wilberforce et al., 2015). The aim of these teams is to provide services that allow adults, ages 18–65 years, with mental illnesses to remain in the community and to avoid unnecessary hospital stays. Individual mental health issues might include severe and persistent issues such as schizophrenia and manic-depressive psychosis. The work of the CMHT with each client is personalized. The care available includes: care management, mobile crisis response, community psychiatric nursing services, and community networking.

Urgency of care is important when considering serving this population, and the definition of urgency often determines the time of the first intervention and the type of intervention. The decision related to how urgent the care is from the CMHT often is made through referral. The team confirms the urgency of care needed. A few of the reasons to recommend urgency of care include suggested harm to self and others, a low-level ability to care for oneself (e.g., cognitive functioning), primary physician suspects mental illness and need for care, and client is at risk because of no or little support from others (Hilton et al. 2008).

Because the services that clients need vary, each of the clients receives very different services. Types of care included needs relating to their mental health diagnosis, their need for help with daily living activities, their behavior related to risk, and their behavior related to challenge (Wilberforce, 2015). For instance, clients who have mental health problems that influenced their daily function received more services, and they received those services for a longer period of time. These individuals, more than likely, also had complex mental health issues. This was especially true if the clients were assertive or aggressive.

Psychosocial Rehabilitation Center

A car hit John H., a senior at a college in New England, when he was attending Mardi Gras in New Orleans. After hospital discharge, John entered a rehabilitation center for the assessment of job skills and personal and social adjustment. The brain damage he suffered is permanent, and he must cope with a number of limitations. The center provides vocational assessment, counseling, independent living skills, and education. Staff also dispense medication and make referrals when necessary.

John has already been in the facility for 2 months. His parents live out of state. They are working to transfer him to another facility that is located in the town where they live. The staff believe that he will be able to transfer in approximately 60 days. They will begin to work with the staff in John’s hometown to provide continuity of John’s care. Because of John’s limited cognitive functioning, his need for comprehensive services will continue. What makes this type of care psychosocial rehabilitation is the emphasis on the goal of rehabilitation. This means returning the client to good health and the ability to work.

Crisis Response

Safe Horizon is an organization that addresses violence in our society and serves adults and children in New York City. One of its programs addresses domestic violence. It is a comprehensive program that supports women living in abusive situations. The agency is structured so that women and their children receive full support once they decide to leave their abusive relationships. Services delivered within the case management framework include short-term and long-term housing, child care, vocational support, legal aid, transportation, and other services. The case management also encompasses counseling and support groups. As stated, the services of Safe Horizon range from crisis support to more comprehensive, one-stop, long-term care (Safe Horizon, 2015).

Class Discussion

Determining the Best Method of Service Delivery

The involvement may be short-term, during a crisis or developmental problem, or long-term, as with a physical or mental illness, a disability, or geriatric problems.

Strengths There is flexibility in who assumes case management responsibilities, including family, neighbors, volunteers, and the client. In many cases, the designated case manager may already have an established relationship with the client. Involving family, neighbors, and volunteers at times improves client access to services. Under this model, service delivery is cost-effective, the community is involved, and independence is encouraged.

Weaknesses

In some cases, the person designated as case manager may not have the client’s best interests at heart, may lack the necessary knowledge and skills, or may be ineffective in monitoring service provision. Training and supervision may be costly. Accepting a family member or volunteer as a case manager may be difficult for the client. Case managers who are not part of the human services delivery system may have trouble coordinating and gaining access to services.

Helper as Case Manager

Audrey is a 78-year-old pensioner who lives alone in rural Victoria. Audrey has two daughters—one lives in another state and the other one lives overseas. Audrey has osteoarthritis, rheumatoid arthritis, cardiac problems, and glaucoma. Audrey suffers from insomnia, anxiety, and depression. Six months ago she fractured her hip, and she experiences chronic and ongoing pain as a result. The Office on Aging is 80 miles away. The outreach program provides case management for senior care in the more rural areas. Audrey has been assigned a case manager. The case manager is in touch with Audrey’s eldest daughter but works primarily with Audrey. The case manager is providing Audrey with care on a long-term basis.

Currently, Audrey has many medical appointments. Audrey has been missing appointments because she is unable to access public transportation. Her telephone has recently been disconnected because she has not been able to pay the bills. Audrey had been completely independent, but since fracturing her hip she has lost her confidence and has become overwhelmed and anxious in managing her day-to-day affairs.

Audrey’s general practitioner (GP) believes that she should be assessed for low-level residential care because he is concerned that she can no longer manage on her own. The GP contacted the local Community Options (COPS) package service, and after meeting Audrey they agreed to provide a package in the interim. As a result of this, Audrey was assigned a case manager. The case manager spent time getting to know Audrey and identifying the various issues that were making Audrey feel that she could no longer cope at home.

The case manager has three primary goals: to work together with Audrey to assess Audrey’s needs; to network to provide services to meet the established needs; and to communicate with Audrey on a regular basis to continue to assess Audrey’s needs and to problem-solve when issues change. Right now, Audrey is working with a physician who makes house calls once every month. Audrey also uses a telemedicine system to send reports to her doctor. The case manager has arranged for transportation for Audrey to see a counselor every 2 weeks. In addition, the case manager arranged for a home cleaning service to visit every 2 weeks and arranged for a financial counselor to work with Audrey to develop a budget.

Note: The idea for Audrey’s case began with her story presented by Aged and Community Services: Australia and Case Management Society of Australia, 2006. The authors adapted the case to reflect their experience with serving the needs of seniors.

Many professionals regard the approach to care that Audrey received as an excellent treatment approach. As with other organization-based services, the care is comprehensive and the client receives social support. Among the criticisms of these organizations are that they may resemble institutions and can be very expensive.

Family as the Case Manager

It is a current trend in human services to ask families to act as case managers and then provide them with the support to do so. With costs escalating and institutional care being replaced by community care, it is cost-effective for families to perform this central role. However, for such a system to be effective, the family must receive continuing education about the human services delivery system and must have professional help available when crises arise.

The family as the case manager is a model prevalent in cases of families who are meeting the needs of a child with a chronic illness. The child requires continual support from a medical team and there are also multiple needs that must be met. In addition, there are financial considerations for needed care and various psychosocial needs of the child. We present the case of “Evan” to illustrate the family as the case manager.

Evan was 6 years old when he was diagnosed with leukemia. He had been tired for approximately 3 months, so much so that his mother, Randy, took him to see the pediatrician 3 months before he was scheduled for his wellness check-up. The entire family, Evan’s father, Ivan, and his two older brothers, were in shock and grief after the diagnosis. Six months after the diagnosis and, in the middle of Evan’s treatment, the family and its routines and relationships had completely changed. The family managed its multiple needs, which included social, psychological, physical, financial, education, and spiritual needs of all five members of the family. Even though the majority of the time Randy and Ivan focused on what Evan needed, the needs of the two older boys, Stephen and Sevan, were also important.

In one of the first meetings that Randy and Ivan had with the oncologist, they received excellent advice about Evan, his condition, treatment options, and the medical demands of the next year. Their oncologist also learned about the importance of their assigned nurse case manager. The oncologist described the nurse case manager’s responsibilities as a coordinator of medical care. He also outlined the responsibilities of the parents and stressed the importance of the additional responsibilities they, as parents, would assume. After 2 months of Evan’s treatment, Randy outlined her responsibilities, Ivan’s responsibilities, and Stephen’s and Sevan’s new tasks.

Randy

· Coordinate Evan’s presurgery, surgery, and postsurgery physical needs

· Maintain contact with the nurse case manager

· Communicate with the school and maintain Evan’s continued school work (as well as possible)

· Support Stephen’s and Sevan’s school work and extracurricular activities

· Help all three boys maintain their friendships and peer obligations

· Arrange family counseling

· Attend a bi-weekly support group for parents

· Keep up with daily living responsibilities such as grocery shopping, errands, meals, and laundry

· Keep up with carpool responsibilities

· Support school work for Stephen and Sevan

Ivan

· Maintain good communication among family members

· Support school work for Stephen and Sevan

· Participate in carpooling

· Handle most of the financial arrangement and paperwork

· Attend family counseling

· Attend support group

· Support Randy

· Help Randy meet Evan’s physical needs

Stephen and Seven

· Assume more responsibility for household chores

· Spend time each day with Evan

· Communicate to each other and to Randy and Ivan when they need help

· Be honest about their feelings

· Attend family counseling

· Continue to participate in school and extracurricular activities

· Help Randy and Ivan arrange carpooling

Peers Performing the Case Management Function

Because of the increasing cost of service delivery, many agencies and communities have developed strong volunteer programs. The agencies provide excellent training, ongoing education, and good supervision, thus allowing volunteers to assume case management responsibilities. In this way, the volunteers are able to contribute to the welfare of their local community. In the following case, Elaine Mayer forms a case management team of her own.

Members of the team include the local pastor, her primary care doctor, her hairdresser (Sandy), and her attorney. Each of her team has specific responsibilities. And the youngest of her team is a teenager who lives across the street. He can drive and he comes over once every week to help her with a list of chores that she writes during the week. They call him the “everything else man.” Once every week, Sandy drives her to the dialysis clinic. Her pastor makes sure there are groceries in the house. She calls Sandy if a crisis arises. Each month, the team and Elaine go out to lunch. The lunch is more fun, but at times they also talk about Elaine and her care. Communication is the key to this type of peer or volunteer case management. To give back to the others for the help she receives, Elaine writes cards to those in her community who are sick or who have experienced loss. She says it is the least that she can do.

The Client as Case Manager

When the client serves as his or her case manager, the majority of the responsibility for providing services, advocating for needs, establishing a network of resources, and linking the client to resources are the responsibilities of the client. This approach develops the client’s maximum potential, which is emphasized by strengths-based case management (Rapp & Goscha, 2006). This type of case management stresses building on the strengths and resources of individuals, thus distinguishing it from more traditional approaches that focus on deficits and needs. Self-determination—the right to establish one’s own goals and to have an active role in problem resolution—is of primary importance here. The belief is that a client who has learned to act as manager can provide long-term care for himself or herself and for others.

Reynda was just accepted into transitional housing. She is allowed to stay in this housing for up to 2 years if she is able to follow the rules established for all residents. She must pay $85 each month for her room. And she has her own key to her room. Imgaine! She has not had a key, her own key, well, longer than she can remember. Right now, she has a job downtown. She is making minimum wage, but because her new room is downtown, she can walk to work. She doesn’t need a car! So to stay in her new residence, she needs to continue to pay her rent. She also needs to stay clean and to retain her good standing with the correctional system. That means she cannot have any felony charges brought against her. Reynda is amazed how much is under her direct control here. There are individuals on duty 24-7 in case she needs help. And there are group meetings once every week and exercise facilities in the building. But she does not have to use any of these services. She does complete a care plan once every 3 months and she reviews it with a social worker. But it is up to her to determine her own goals and to decide how she will meet them. And she can change her goals any time that she likes. Honestly, she is in charge of herself. Because Reynda has only been living in this facility for a month, she has decided she will not establish any goals until she has lived here for 3 months. She will concentrate on her work, staying clean, and keeping out of harm’s way. That seems like a lot for her to manage for now.

Susan Fields, Sharon Bello’s Case Manager, Entry 3.2

· Connect with others with a similar experience, regardless of location

· Set up a profile and personal blog to keep a record of their breast cancer journey

· Create and join online interest and support groups

· Use the privacy settings to control who can access their information and the content they create

BCNA has provided these projects as part of the Supporting Women in Rural Areas Diagnosed with Breast Cancer’ Program, which is funded by the Australian Federal Government.

Class Discussion

Discussing Who Should Assume the Role of Case Manager

Coordinator

The client has been referred to two services, one to address the pneumonia and the other to address the mental health issues. Both of these companies will prorate the cost of services: the insurance company will pay 90% of the services and the family will pay 10% of the services. Debbie helped her client complete the requests for services; otherwise, her client would have to return to the hospital. This case is typical for her and her work as a case manager.

Counselor

An increasing number of agencies use case managers to provide services for their clients. The vignettes in this chapter illustrate case managers working with the aging, those with developmental disabilities, youth and adults in the criminal justice system, children and families in foster care, families on welfare, and those in many other settings. Described here are two job announcements for case managers. Let us look at these to see what methods are used and what roles the case managers are being asked to assume.

Job Announcement #1: Case Manager

What Will I Be Doing?

Definition

This is mid-level professional case management work in the Missouri Department of Corrections, Division of Adult Institutions.

Job Duties

Serves on a classification team; evaluates the offender’s institutional adjustment attitude toward society and release plans; prepares Transition Accountability Plans (TAPS); and makes recommendations relative to job assignments, facility transfers, and disciplinary actions.

Secures, verifies, and evaluates information from incarcerated adult offenders concerning their home life, family relationships, work history, and other pertinent personal and social factors; develops, maintains, and reviews classification files.

Assesses classification status and prepares analysis for program eligibility determinations using Adult Internal Classification System (AICS), Reclassification Analysis (RCA), and Initial Classification Analysis (ICA) instruments.

Acts as grievance officer; processes and responds to Informal Resolution Requests (IRRs); and holds disciplinary hearings on conduct violations.

Processes offenders by completing initial file review and protective custody assessment; enters enemy waivers and updates enemy lists.

Maintains open-door office policy; handles offenders’ laundry, property, and financial concerns, as well as mail and censorship notices; and notifies offenders of the critical illness/death of immediate family members.

Participates and assists in the vocational, educational, and social adjustment planning for all assigned offenders; facilitates offender programs.

Evaluates civilian visiting applications and determines whether to approve or deny the individuals request to visit with an offender.

Cooperates with public and private agencies and law enforcement agencies in matters relating to assigned offenders; arranges and facilitates calls to attorneys, public agencies, law enforcement agencies, etc.

Provides pre-release counseling; researches and identifies community resources and services prior to processing offenders for release.

Participates in treatment team meetings.

Performs other related work duties as assigned.

Areas of Interest

Corrections and youth services

Do I Qualify?

(The following requirements will determine merit system eligibility, experience, and education ratings, and may be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers. When practical and possible, the Division of Personnel will accept substitution of experience and education on a year-for-year basis.)

One or more years of experience as a Corrections Case Manager I with the Missouri Department of Corrections.

OR

A Bachelor’s degree from an accredited college or university with a minimum of 15 earned credit hours in one or a combination of the following: Criminal Justice, Social Work, Sociology, Psychology, Counseling, Education, Political Science, or Pre-Law;

AND

One or more years of professional experience in corrections case management, adult probation and parole, or substance abuse counseling.

(24 or more earned graduate credit hours from an accredited college or university in the specified areas may substitute for the required experience.)

Experience as a Corrections Classification Assistant with the Missouri Uniform Classification and Pay System (work experience in substance abuse counseling or juvenile or social case management may substitute on a year-for-year basis for a MAXIMUM of 2 years of the required education.)

Can I Be Successful?

Intermediate knowledge of the general methods of social casework and job placement as applied to corrections case management.

Intermediate knowledge of the methods of obtaining reliable social and personal information and the development of classification files.

Intermediate knowledge of human behavior, attitudes, and motivation, and their applicability in the rehabilitation of criminal offenders.

Intermediate knowledge of the principles and procedures of offender classification in adult correctional facilities.

Intermediate knowledge of the general techniques of communicating with and advising offenders.

Intermediate knowledge of the methods used in the supervision of offenders.

Intermediate knowledge of the causes of crime and related issues of substance abuse and mental illness.

Ability to conduct effective interviews with hostile or reluctant individuals.

Ability to prepare accurate and complete classification files and reports.

Ability to develop and maintain effective working relationships with other employees, offenders, outside agencies, and the general public.

Summary

Oversees and administers all aspects of a specialized, community-focused case management program designed to serve the needs of a selected target population. Includes supervision, training, and support of the operational and administrative duties of case managers. Provides case management services to individuals referred from domestic violence shelters. Compiles and prepares educational materials as necessary.

Duties and Responsibilities

Supervises and trains case managers and associated support staff

Administers the day-to-day activities of the program

Oversees the quality of the case management program

Carries a caseload of clients as a case manager

Reviews case management records to evaluate quality

Maintains confidentiality of records

Develops educational materials

Supervises staff

Performs miscellaneous job-related duties as assigned

Minimum Job Requirements

Bachelor’s degree in human services, social work, psychology, nursing, or directly related behavioral health field; at least 3 years of experience directly related to the duties and responsibilities specified.

Knowledge, Skills, and Abilities Required

Administrative skills

Communication skills

Ability to understand and implement confidentiality policies

Ability to supervise case managers for organizational and time management skills

Knowledge of community resources and how to use them

Knowledge of case management skills and abilities

Ability to gather data, assess information, and write reports

Ability to supervise staff

Ability to prepare reports and other written documents

Ability to foster cooperation

The second job description is for an individual to work as an administrator of a case management service and as a provider of case management services for women and their children who are preparing to leave short-term shelters. This service illustrates case management whereby the case manager is the center point for these services. The case manager will work with the individual clients to determine needs. In this situation, the case manager serves as the link to a variety of needed services, provides therapeutic care, and monitors the efficiency and quality of services. What roles will the case manager be performing? This case manager has multiple responsibilities to plan and problem-solve, write and keep records, coordinate care, and broker additional services. Of course, the job is complicated by these additional administrative responsibilities.

What Roles Are Most Important?

After reading about the case management roles and thinking about the two job descriptions, as a class, in small groups, or as an individual, determine what roles appear to be most important for a case manager. List three roles and make a case for the importance of each role on your list.

When you have completed this exercise, share this information with your classmates.

3-1fTopics in Case Management Today

In the earlier sections of this chapter, we examined the methods of case management service delivery and described the many roles that case managers may be expected to assume. In this section, we present the voices of actual case managers working in social services agencies across the United States. They either identify themselves as having the job title of case manager or describe their primary job responsibility as case management. They may have different job titles, such as caseworker, social worker, family advisor, or behavior specialist. Our study of the interviews we conducted with more than 85 human service professionals resulted in the articulation of eight common topics. These topics help describe what they do and what they need to know how to do to be effective case managers. The topics respond to the complex and sometimes difficult situations case managers encounter as they cope with large caseloads, clients with multiple needs, and scarce resources. In addition, case managers often work with clients who are silent, reluctant, or resistant in a bureaucracy that requires detailed documentation for each interaction. The eight topics are:

· (1)

the performance of multiple roles;

· (2)

organizational abilities;

· (3)

communication skills;

· (4)

setting-specific knowledge;

· (5)

ethical decision making;

· (6)

boundaries;

· (7)

critical thinking; and

· (8)

What helps me manage all of this is a new computer system that I share with all of the other case managers and staff. We worked hard to develop a system where information only has to be entered once. If information changes, then we revise. We also have an office manager and several staff who help make my schedule. What works against this is, with several of us scheduling my time, well, it gets wild. Sometimes I am double scheduled and other times there are crises that I must attend to. Yesterday, one of my clients got hurt at his training site. During the day, I coordinated his care and filled out the paperwork; last night, I visited him in the hospital. But yesterday I was also scheduled to see six clients for their bi-monthly visit. All of those visits had to be re-scheduled. Thank heavens for such good office staff.

We talk about the concept of time in the next section. All I can say about my time is that it is too fast and too slow all at the same time. Or maybe I should say it goes quickly but I am still too slow to get everything done! My day is so fast-paced that my mind and body demand a break at the end of the day. Even though I do not have a moment to myself, it feels good to be working hard to help our clients.

The Concept of Time

The concept of time influences case management in a variety of ways: organizing, budgeting, scheduling, responding, balancing, and slowing down. Case managers recognize the need for time to “let things percolate,” “sit down and remember everything that was done during the week with that client,” and “take one step at a time.” Even though time management was consistently mentioned as a tool to alleviate stresses and pressures, many admitted that the workload is so “horrendous” that they never gain control over their work situations. They say that they are so busy that they do not have time to seek a resolution to a client’s problem. One participant said, “Clients have to come to me.” The difficulty with time management arises from several sources, including the unpredictability of the workday, external deadlines, and the ever-changing bureaucracy.

Topics for case managers (Woodside, McClam, Diambra, & Varga, 2012) related to the meaning of time center around pace, change, choices, and service delivery. All four of these topics relate to different facets of the work: the agency, the human service professional, and the client. Case managers talked about how their work on each level is significantly impacted by time as it relates to the “never-ending” pace of demands and pressures in their work; the “now and then” aspects of changes in protocol and policy over time; the “influence of time” on decisions about agency availability, caseloads, and policies; and the “one step at a time” notion of service delivery relating to repeated services and goal setting with clients.

What Are Your Strengths or Personal Qualities That Will Support Your Work as a Case Manager?

We confirm the importance of the multicultural perspective because it pervades each of the methods of case management presented in this chapter. We encourage you to give special attention to this critical aspect of your role and responsibility as a case manager.

Deepening Your Knowledge: Case Study

This chapter focuses on the methods used to deliver case management. The case study in this chapter reflects one aspect of human services: providing effective services for individuals involved in drug-related crimes. These efforts result from the Anti-Drug Abuse Act of 1988, an act that established the White House Office of National Drug Control Policy (ONDCP). The ONDCP’s mission is “to establish policies, priorities, and objectives for the Nation’s drug control program. The goals of the program are to reduce illicit drug use, manufacturing, and trafficking, drug-related crime and violence, and drug-related health consequences” (U.S. Department of Justice, National Drug Court Institute, 2011, first paragraph). Goals for the drug court programs include decreasing “illicit drug use, manufacturing, and trafficking, drug-related crime and violence, and drug-related health consequences” (U.S. Department of Justice, National Drug Court Institute, 2011, first paragraph).

Case management for clients involved with the drug court is the centerpiece of intervention services. According to Monchick, Scheyett & Pfeifer (2006) in a report published by the Department of Justice, “Case management is essential to carrying out the mandate of the key components of drug court. Without case management, the integration of AOD treatment services and justice system processing would be limited” (p. ix). Read through the Key Components of Case Management described in Drug Court Case Management: Role, Function, and Utility while keeping in mind the methods of case management described previously. Then, answer the questions that follow.

Key Components of Case Management

#1: Drug Courts Integrate Alcohol and Other Drug (AOD) Treatment Services with Justice System Processing

This component highlights the necessity of a multifaceted, collaborative “team” approach for integrating the delivery of services into the administration of justice and enhancing the justice and treatment systems’ joint mission of promoting abstinence and law-abiding behavior. It underscores the need for collaborative goal setting and program monitoring through ongoing communication and continuous processing of timely and accurate information about each participant’s performance in the program. It is the case manager who coordinates the flow of drug court information across and within the treatment and justice systems.

#2: Using a Nonadversarial Approach, Prosecution and Defense Counsel Promote Public Safety while Protecting Participants’ Due Process Rights

#3: Eligible Participants are Identified Early and Promptly Placed in the Drug Court Program

The case manager helps ensure the coordination of this process by “tracking” and facilitating the prompt sharing among the team of all relevant information arising from the initial referral, eligibility screening, and assessment process.

#4: Drug Courts Provide access to a Continuum of Alcohol, Drug, and Other Related Treatment and Rehabilitation Services

The case manager identifies and monitors each participant’s unique needs for support and rehabilitation services, coordinates participant access to these services, and ensures linkage and coordination among the drug court service providers. The case manager works closely with the clinical treatment provider(s) and community supervision officers to provide ongoing assessment and communication of the participant’s progress and to coordinate referrals to appropriate ancillary service providers.

#5: Abstinence Is Monitored by Frequent Alcohol and Other Drug Testing

The case manager ensures that drug test results, whether obtained by probation, treatment, law enforcement, or other court partners, are promptly and accurately recorded and disseminated to the drug court team.

#6: A Coordinated Strategy Governs Drug Court Responses to Participants’ Compliance

As the central person responsible for coordinating team information flow, the case manager tracks and monitors the court’s allocation of sanctions and incentives to each participant to help ensure that subsequent sanctions, incentives, and interventions are graduated, treatment-relevant, strengths-based, and otherwise consistent with the program’s philosophy.

#7: Ongoing Judicial Interaction with Each Participant Is Essential

As the primary link between the treatment and justice systems, the case manager serves as the bearer of much participant information and, in this role, can give critical insight and input to the drug court judge.

#8: Monitoring and Evaluation Measure the Achievement of Program Goals and Gauge Effectiveness

The case manager ensures that all relevant information is accurately, promptly, and systematically documented so that ongoing monitoring of the participants and evaluation of the program can occur.

#9: Continuing Interdisciplinary Education Promotes Effective Drug Court Planning, Implementation, and Operations

#10: Forging Partnerships among Drug Courts, Public Agencies, and Community-Based Organizations Increases the Availability of Treatment Services, Enhances Drug Court Effectiveness, and Generates Local Support

While all drug court team members contribute to the formation and maintenance of these critical partnerships, it is the case manager who sustains ongoing contact with key line staff of the partnering agencies and organizations. This consistent and direct contact with other community-based service delivery professionals puts the case manager in a position to learn about the policies, procedures, capacities, strengths, and limitations of existing support service organizations. With this knowledge base, the case manager is well positioned to identify service gaps and community needs, and to offer strategies to facilitate collaboration between the court and the community.

Case Study Questions about the Drug Court

1. Read each of the Key Components. Explain how each component relates to one or more methods described in Chapter Three.

2. List roles needed to perform each Key Component.

Author Note: We think that it is important for you to review the chapter you just read. We suggest the following.

· First, re-read the class discussion questions in the text and answer these as comprehensively as possible.