Generalist Case Management A Method of Human Service Delivery 5th Edition Marianne R. Woodside Tricia McClam Photo used with permission by Marianne R. Woodside Copyright © 2018 Cengage Learning. All Rights Reserved. CHAPTER 2 Historical Perspectives on Case Management Copyright © 2018 Cengage Learning. All Rights Reserved. Introduction • Modern-day case management reflects many changes such as: changing needs of individuals served, financial constraints on the human service delivery system, increasing number of people needing services, and the growing emphasis on client empowerment, evaluation of quality, and service coordination. • Much of the foundation of case management developed when it was used to serve people with mental illness who were deinstitutionalized in the 1970s. Copyright © 2018 Cengage Learning. All Rights Reserved. Perspectives on Case Management • Four perspectives have shaped case management since the 1970s: • Case management as a process • Client involvement • The role of the case manager • Utilization review and cost-benefit analysis Copyright © 2018 Cengage Learning. All Rights Reserved. Case Management as a Process, Slide 1 • The 1970s brought deinstitutionalization to the mental health community and changes to case management practice. • Deinstitutionalization: the movement of large numbers of people from self-contained institutions to community-based settings such as halfway houses, family homes, group homes, and single-residence dwellings. • During deinstitutionalization, case managers had to help determine which residents could live outside of an institution, and then they had to help such clients transition into new settings. Sam’s case (2.1 & 2.2) illustrates the issues that could arise during these two tasks. • An early definition of case management came from the American Psychiatric Association’s Ad Hoc Committee on the Chronic Mental Patient. In summary, case managers helped persons with disabilities access and use resources; case managers played a key role in service integration. Copyright © 2018 Cengage Learning. All Rights Reserved. Case Management as a Process, Slide 2 • The three key elements for success in the case management process include: • Responsibility for assessing the client’s problem and developing a responsive plan. • Continuity in planning care and implementing the case plan through aftercare time periods. • Accountability for tracking and updating the case plan, helping the client gain independence, and incorporating the client’s voice during plan-of-care decision-making. • These elements ensure that a client’s problem is assessed, appropriate plans are put in place for the duration of treatment, and the client’s ability to function independently and to assume self- responsibility are increased. • Case management provides a focus and oversees the delivery of services in an orderly fashion. Copyright © 2018 Cengage Learning. All Rights Reser.

1. Generalist Case Management A Method of Human Service Delivery 5th Edition
Marianne R. Woodside Tricia McClam
Photo used with permission by Marianne R. Woodside Copyright © 2018 Cengage Learning.
All Rights Reserved.
CHAPTER 2
Historical Perspectives on Case
Management
Copyright © 2018 Cengage Learning. All Rights Reserved.
Introduction
• Modern-day case management reflects many changes such as:
changing needs of individuals served, financial constraints on the
human service delivery system, increasing number of people
needing services, and the growing emphasis on client
empowerment, evaluation of quality, and service coordination.
• Much of the foundation of case management developed when it was
used to serve people with mental illness who were
deinstitutionalized in the 1970s.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Perspectives on Case Management
• Four perspectives have shaped case management
since the 1970s:
• Case management as a process
• Client involvement
• The role of the case manager

2. • Utilization review and cost-benefit analysis
Copyright © 2018 Cengage Learning. All Rights Reserved.
Case Management as a Process, Slide 1
• The 1970s brought deinstitutionalization to the mental health
community and changes to case management practice.
• Deinstitutionalization: the movement of large numbers of people
from self-contained institutions to community-based settings
such as halfway houses, family homes, group homes, and
single-residence dwellings.
• During deinstitutionalization, case managers had to help
determine which residents could live outside of an institution,
and then they had to help such clients transition into new
settings. Sam’s case (2.1 & 2.2) illustrates the issues that could
arise during these two tasks.
• An early definition of case management came from the American
Psychiatric Association’s Ad Hoc Committee on the Chronic Mental
Patient. In summary, case managers helped persons with
disabilities access and use resources; case managers played a key
role in service integration.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Case Management as a Process, Slide 2
• The three key elements for success in the case management
process include:

3. • Responsibility for assessing the client’s problem and developing
a responsive plan.
• Continuity in planning care and implementing the case plan
through aftercare time periods.
• Accountability for tracking and updating the case plan, helping
the client gain independence, and incorporating the client’s
voice during plan-of-care decision-making.
• These elements ensure that a client’s problem is assessed,
appropriate plans are put in place for the duration of treatment, and
the client’s ability to function independently and to assume self-
responsibility are increased.
• Case management provides a focus and oversees the delivery of
services in an orderly fashion.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Client Involvement
• During the 1980s, client involvement came to be emphasized more
strongly.
• A new model of case management was proposed, giving clients a
more active role in their development.
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The Role of the Case Manager, Slide 1
• Traditionally, terms such as caseworker and case manager
described the efforts of helpers.

4. • Today, job titles include service coordinator, liaison worker,
counselor, case coordinator, health-care case manager, and care
coordinator.
• This range of titles reflects the diversity of service delivery today
and the broader range of responsibilities and perception of roles.
The emphasis shifted from the skills of managing someone to
terminology reflecting a more equitable relationship
Copyright © 2018 Cengage Learning. All Rights Reserved.
The Role of the Case Manager, Slide 2
• Changes placed an emphasis on working with other professionals,
coordinating care and other services, and empowering individuals to
use the system to help themselves.
• For the client, the focus became the ability to develop skills needed
to work within the human services network.
• For the case manager, the focus shifted from management to
coordination.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Utilization Review and Cost-Benefit Analysis
• One result of the spiraling cost of medical and mental health
services is 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. An emphasis is placed on
the efficient use of resources.

5. • Case managers, working in managed care, are involved in
utilization review and have the responsibility to authorize and deny
services.
• Case managers are also responsible for cost-benefit analysis, which
focuses on the financial matters of the case, specifically the cost
and efficiency of services.
Copyright © 2018 Cengage Learning. All Rights Reserved.
The History of Case Management
• First used in institutional settings, case management included the
responsibilities of intake, assessment of needs, and assignment of
living space.
A Pioneering Institution
• An early example of such an institution was the Massachusetts
School for Idiotic and Feebleminded Youth, established in 1848.
• The school provided services in case management such as tracking
student progress, providing follow-up services, and managing
information.
• Other practices at this school (aftercare, evaluation of services, and
advances in recordkeeping) contributed to case management as we
know it today.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Early Pioneers, Slide 1
• Early case management took either of two forms: a multiservice center

6. approach or a coordinated effort of service delivery.
• Jane Addams, Lillian Wald, and Mary Richmond were three early
pioneers who contributed to the development of the emerging case
management process.
Hull House
• Jane Addams founded Hull House in Chicago (1889), committed to
sharing a love of learning.
• As services expanded, the need for effective administration and
recordkeeping increased resulting in the collection of information about
demographics, participation, and attendance.
• Advocacy was also integrated into the work of Hull House.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Early Pioneers, Slide 2
Henry Street Settlement House and Contributions to Case
Management
• Lillian Wald and Mary Brewster established the Henry Street
Settlement House in New York (1895), and created a system for
nursing the sick in their own homes, promoting the dignity and
independence of the patient.
• The work at Henry Street led to two significant innovations: the
designation of the visiting nurse and the development of the Red Cross.
Mary Richmond and Contributions to Case Management
• Mary Richmond was a social reformer who promoted the idea that each

7. person was a unique individual whose personality, family, and
environment should be respected.
• She believed that professionals should work with clients rather than
“doing things― to them.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Early Pioneers, Slide 3
Mary Richmond (continued)
• Social diagnosis: developed by Richmond, is a systematic way for
helping professionals to gather information and study client problems.
• Richmond established a series of methods for gathering information
about individuals, assessing their needs, and determining treatment.
• She recognized that gathering data is a complex process and urged the
use of different methods for different individuals.
• She also believed in multiple sources of information and warned that
data gathering was an often incomplete process.
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Impact of World Wars I and II/The Red Cross
• During the First World War, the American Red Cross—in response to
an increased interest in Mary Richmond’s style of casework—used
casework to address individuals’ problems and their psychological
needs.
• The Home Service Corps helped address the needs of the families of
military personnel (those experiencing problems such as illness and

8. marital difficulties).
• The Home Service Corps made two important contributions:
1) Extended help was offered to individuals and their families.
2) Volunteers became brokers of services, coordinating
communications and requests between families and agencies.
Copyright © 2018 Cengage Learning. All Rights Reserved.
The Impact of Federal Legislation, Slide 1
Contributions to Case Management: The Older Americans Act of
1965
• Focused on providing services for older individuals in order to
improve their quality of life.
• Contributed to case management by emphasizing the multiplicity of
human needs and recognizing the need to coordinate care.
Contributions to Case Management: Rehabilitation Act of 1973
• This act and its subsequent amendments emphasized client
involvement and satisfaction, consumer choice, and control in
setting goals and objectives.
Copyright © 2018 Cengage Learning. All Rights Reserved.
The Impact of Federal Legislation, Slide 2
Contributions to Case Management: Children with Disabilities,
Education for All Handicapped Children Act of 1975
• Included an explicit case management process to treat the client
as a customer.

9. • 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.
Contributions to Case Management: The Family Support Act of
1988/The Personal Responsibility and Work Opportunity Act
• Mandated that case management be applied to the process of
serving those who were deemed eligible for welfare.
• Case managers became a key component in welfare-to-work
programs by developing the case plan and coordinating services.
Copyright © 2018 Cengage Learning. All Rights Reserved.
The Impact of Managed Care, Slide 1
History of Managed Care
• The emergence of managed care has increased the demand for case
management services and provided new models and definitions of
service delivery.
• Fee-for-service: an early provision of medical care; each patient was
assessed a fee for each health or mental health service provided by a
professional.
• In the 1930s, physicians implemented prepaid group plans or
managed plans for medical services.
• The basic concept of a prepaid plan was to guarantee a defined set of
services for a negotiated fee.

10. • The prevalence of managed care is now commonly regarded as being
connected to the rising cost and decreasing quality of health care and
mental health care.
Copyright © 2018 Cengage Learning. All Rights Reserved.
The Impact of Managed Care, Slide 2
Defining Managed Care
• Managed care: an organized structure that uses prepayment rather
than fee-for-service payment.
• It can designate the array of different payment plans, such as
prepayment and negotiated discounts.
• Policies restrict clients’ access to providers such as physicians and
other health professionals.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Models of Managed Care, Slide 1
• Pharmacy benefits management (PBM) : focuses on controlling
prescription costs through negotiations, use of generic treatments,
and mail delivery of prescriptions. Managers review drug benefits and
determine payments.
• HMO (health maintenance organization): a generic term covering a
wide range of organizational structures; combines delivery and
financing into one system.
• HMOs provide health care or assure health care delivery in a
geographic area, have an agreed-upon set of health maintenance

11. and treatment services, and involve groups of voluntary enrollees.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Models of Managed Care, Slide 2
• PPO (preferred provider organization): plan that falls between the
traditional HMO and the standard indemnity health insurance plan.
• PPOs have established contracts with designated (preferred)
medical providers. Clients receive better benefits when care is
received from a preferred provider.
• POS (point-of-service): allows for more flexibility than HMO or PPO
plans provide.
• Coverage is reduced for out-of-plan providers and clients pay
higher premiums, deductibles, and pay a higher percentage of
medical fees.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Models of Managed Care, Slide 3
• Health Savings Account : high-deductible but lower-premium health
care plans that were developed in 2003.
• Employers and employees make tax-free contributions, up to
$2,500, to a savings plan that can be used for qualified medical
expenses
• Employees decide what qualified services they want to purchase
• Unspent funds in the plan roll over to the next year
• Health Reimbursement Arrangements: similar to health savings

12. account, without the cap on employer contributions.
• Plans Offered Under the Health Care Exchanges: these plans are
mandated by the Affordable Care Act and provide a set of minimum
services while covering varying percentages of medical costs, at
either 60, 70, 80 or 90%.
Copyright © 2018 Cengage Learning. All Rights Reserved.
Managed Care: Summary
• 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.
• All managed-care plans emphasize management of medical cases,
review and control of utilization, and incentives for restrictions on
providers and clients to reduce costs and maintain quality.
• Clear advantages and disadvantages of these plans have emerged.
• Case managers play a critical role in management of care.
Organizations have developed to establish standards for case
management in these settings, such as the Case Management
Society of America.
• In response to professional and client frustrations, several advocacy
efforts have evolved.
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Professionalization of Case Management and
Expanding Responsibilities • The professionalization of case management within human
service

13. delivery includes a national certification offered by several
professional organizations and states.
• The Human Services Board-Certified Practitioner requires
demonstrated competence in case management, professional
practice, and ethics and requires several practitioner
competencies that are related to case management.
• The National Association of Social Workers (NASW) offers a
credential for case managers with a bachelor’s of social work
degree.
• As the care environment continues to shift, the case managers’
responsibilities and accountability through certification will increase.
Copyright © 2018 Cengage Learning. All Rights Reserved.
References
Ozarin, L. (1978). The pros and cons of case management. In J. Talbott (Ed.),
The chronic mental patient (pp. 165–170). Washington, DC: American
Psychiatric Association.
 Slide 1: Generalist Case Management A Method of Human Service Delivery 5th Edition
 Slide 2: CHAPTER 2
 Slide 3: Introduction
 Slide 4: Perspectives on Case Management
 Slide 5: Case Management as a Process, Slide 1
 Slide 6: Case Management as a Process, Slide 2
 Slide 7: Client Involvement
 Slide 8: The Role of the Case Manager, Slide 1
 Slide 9: The Role of the Case Manager, Slide 2
 Slide 10: Utilization Review and Cost-Benefit Analysis
 Slide 11: The History of Case Management
 Slide 12: Early Pioneers, Slide 1
 Slide 13: Early Pioneers, Slide 2
 Slide 14: Early Pioneers, Slide 3

14.  Slide 15: Impact of World Wars I and II/The Red Cross
 Slide 16: The Impact of Federal Legislation, Slide 1
 Slide 17: The Impact of Federal Legislation, Slide 2
 Slide 18: The Impact of Managed Care, Slide 1
 Slide 19: The Impact of Managed Care, Slide 2
 Slide 20: Models of Managed Care, Slide 1
 Slide 21: Models of Managed Care, Slide 2
 Slide 22: Models of Managed Care, Slide 3
 Slide 23: Managed Care: Summary
 Slide 24: Professionalization of Case Management and Expanding Responsibilities
 Slide 25: References