CASE MANAGEMENT DEFINITIONS

• A way of helping people identify the areas where they need help and connecting them to the personal and community resources that will help them (Rubin, 1984)

• A systematic problem-solving process that enables and facilitates individuals in their interaction with their environment (NASW, 1984)

TWO MAJOR GOALS OF CASE MANAGEMENT

• Help people connect to the personal and interpersonal resources that will help them resolve problems

• Teach them to become their own case managers – able to identify and solve their problems independently (empowerment)

CASE MANAGEMENT POPULATIONS

• Developmental disabilities• Health care and chronic illness• Mental health and chronic illness• Addictions• Social Welfare/Child welfare• Geriatrics• Criminal justice• HIV/AIDS• Homeless

CASE MANAGEMENT PROCESS

• Outreach • Referral• Prescreening• Assessment• Care/Case Planning• Monitoring• Reassessment• Disengagement/follow-up

INTERVENTION FOCUS

Direct Intervention

Outreach/

Advocacy Intervention

INTERVENTION FOCUS

Micro Mezzo Macro

Direct intervention

Crisis intervention

Help clients form group (support)

Organize clients to voter

Outreach/

Advocacy

Intervention

Referral to an agency for therapy

Make a contract with agency for referrals

Advocate for passage of legislation

HISTORY OF HUMAN SERVICES

EARLY HISTORY

• 1500-1600 First human service workers (St. Thomas and St. Francis)

• The church provided relief to the poor (the tithe considered a public tax)

• Mental illness - evil spirits (sawing holes in the head - exorcising evil spirits

• Elizabethan Poor Law of 1601

ELIZABETHAN POOR LAW OF 1601

• Compulsory taxation to raise funds for needy

• Dependents classified according to ability to work (children, able-bodied, “impotent poor”)

• Responsibility first and primary the family (government help when family cannot)

• Law of Settlement (residency requirement)

HUMAN SERVICES IN COLONIAL AMERICA

• Four principles (influenced by Elizabethan Poor Laws)– Poor relief a public responsibility– Legal residence– Family member responsibilities (denied to

those with parents, grandparents, adult children, or grandchildren)

– Children of paupers were to be apprenticed in exchange for care

THE 19TH CENTURY

• Destitution was viewed as the fault of the individual, and public aid was thought to cause and encourage poverty

• Poor Law Reform Bill of 1834 (limited the expansion of services provided to the poor)– Introduced the concept of “less eligibility” -

assistance to a person in need must be lower than the lowest working wage paid

SOCIAL PHILOSOPHIES

• Individualism (hard work is the road to success and poverty a sign of spiritual weakness)

• Laissez-faire (an economic concept- the most desirable government is the one that governs least)

• Social Darwinism (attempts to help less fortunate would impede survival of fittest)

20TH CENTURY

• The development of social work profession • A reexamination of the causes of poverty

– Poverty caused by social and economic conditions, not by the individual

– Poverty prevented people from reaching their potential

– Proposed that improvements in housing and working conditions could help eliminate poverty

20TH CENTURY

• Mental health & public welfare movements (Clifford Beers)– National Committee for Mental Hygiene, 1909 (Today

it is the Mental Health Association)– American Public Welfare Association founded in 1930

(Now American Public Human Services Association)

• Social Security Act of 1935 – Cornerstone of present American social welfare system

SOCIAL SECURITY ACT

• Americans had the right to protection from economic instability. Federal government assumed responsibility for economic security.

• Expanded welfare services-established a new alignment of responsibility in public welfare (federal aid and/or grants to states)

SOCIAL SECURITY ACT

• Social insurance programs (old-age, survivors, disability, and unemployment insurance. A right to benefits regardless of need.

• Public assistance helped states establish programs for needy (ex Aid to Families with Dependent Children).

• Health and welfare services – areas such as public health, vocational rehabilitation and child welfare.

1960’S

• Kennedy’s policies to assist unemployed and persons with mental illness and mental retardation

• Johnsons’s “Great Society” and War on Poverty (Head Start, Job Corps, College Work Study)

• Medicare (health insurance for those over 65) and Medicaid (medical and hospital care for the poor)

• Older Americans Act (created Administration on Aging)

1970’s

• Juvenile Justice and Delinquency Prevention Act of 1974– Deinstitutionalization of Status Offenders– Separation of adults from youth in prison

• Child Abuse Prevention and Treatment Act (CAPTA, 1974)

1970’s

• U.S. Dept. of HEW funded demonstration projects to improve coordination of programs (emphasized case management and expanded community based services)

• Older Americans Act of 1978 (amendments) allowed Area Agencies on Aging to provide case management services

• De-institutionalization movement begins and an increased emphasis on community-based care

1980’s

• Retrenchment of human services funding• High caseloads • Increase in non-profit and private agencies

(public sector “contracted out” many services)• Human service “failures” more visible• Case management recognized as one strategy

to deal with service fragmentation• 1981 Omnibus Budget Reconciliation Act

emphasized case management. Medicaid funds used for in-home and comm.-based services

1990’s

• Violence Against Women Act, 1994– National hotline for protection of victims and funding

to states for law enforcement and prosecution and data collection

• Personal Responsibility and Work Opportunity Reconciliation Act, 1996 (Welfare Reform) – State control, work requirements, time limits, and

sanctions• Adoption and Safe Families Act, 1997

– Child safety is paramount– Shorter time limits for temporary custody