1. Case Management Chapter 19

2. Introduction  Renewal of interest in case management has been brought about by a fragmented and depersonalized social service system.  The purpose of case management is to assist clients to receive the services they need by linking clients to both the formal and informal helping-service networks within a community and then to follow up to ensure that the client has actually received the resources and social services required.

3. Introduction  Case management is viewed as a means of increase cost effectiveness and cost control.  The process of medical cost containment cost the American public $7 billion.  Case managers act as gatekeepers, resource managers, and decision makers for billion of dollars worth of care annually.

4. Historical Developments  Case management was identified as early as 1863 when the commonwealth of Massachusetts established programs under the Board of Charities to coordinate public services as well as to conserve public funds.  Case management has also been linked to the Mary Richmond era and the early settlement house developments.

5. Historical Developments  The Consolidated Omnibus Budget Reconciliation Act (Cobra), which was passed in l985, encouraged states to provide case management as an optional Medicaid service.  The Special Education Legislation of 1987 and the Family Support Act of 1988 included case management provisions. –The “JOBS” program which mandates case management as part of the Family Support Act.

6. Case Management Defined  In 1984 the board of directors of the National Association of Social Workers published Standards and Guidelines for Social Work Case Management for the Functionally Impaired.  Case management incorporates two central functions: –Providing individualized advice, counseling, and therapy to clients in the community –Linking clients to needed services and supports in community agencies and informal helping networks.

7. Case Management Defined  Key features: –Process based on a trusting and enabling client-social worker relationship –Utilizes the social work dual focus of understanding the person in the environment in working with populations at risk –Aims to ensure a continuum of care to clients with complex, multiple problems and disabilities –Attempts to intervene clinically to ameliorate the emotional problems accompanying illness or loss of function –Utilizes the social work skills of brokering and advocacy –Target clients who require a range of community-based or long-term care services.

8. Case Management Defined  Key features: –Aims to provide services in the least restrictive environment –Requires the use of assessment of the client’s functional capacity and support network in determining the level of care. –Affirms the traditional social work values of self-determination and the worth and dignity of the individual and the concept of mutual responsibility in decision making.

9. Practice Functions  Eight practice key skills: –Client identification and outreach –Individual and family assessment and diagnosis –Planning and resource identification –Linking clients to needed resources –Service implementation and coordination –Monitoring service delivery –Advocacy to obtain services –Evaluation

10. Case Management Research  Case management is not a well- defined service intervention.  More research is needed.  Rothman states that the major foci in case management measurement attempts are: –Social functioning or quality of life –Intrapsychic status –Behavioral indicators of experience with key institutions.

11. Case Management Research  Rapp and Wintersteen advocate the model of case management called the strengths model.  The Bear River Mental Health Center found that the case management group fared better than the control group in the following areas: –Higher levels of autonomy –Better mental and physical health –Less anxiety and lower psychiatric symptomatology.

12. Case Management Research  Continued research is necessary in case management to define the process more specifically and to test its effectiveness.