Case Management Standards
Eligibility for Service
Case management is a reimbursable service for individuals age 18 or older who have intellectual disabilities, and who live at home with a specified adult relative. Case management is reimbursable by MaineCare when provided by employees of the Office of Aging and Disability Services, or by staff of provider agencies under contract with OADS.
Community Case Management: Defining the Service
Using a person-centered planning process, the community case manager will work with the participant, and others identified by the participant, in the development of an individualized support plan which will reflect the participant’s personal vision for a desired life. The case manager will assist the participant, and others, in identifying support strategies that can be implemented to guide the participant to reach (attain) self-identified goals and wishes. Support strategies must incorporate the principles of empowerment, community inclusion, health and safety assurances, and the use of natural supports. The community case manager will work closely with the participant to assure his/her ongoing satisfaction with the process by making sure that the activities selected always reflect the supports and services desired, and needed, by the participant. In addition, the case manager will analyze the outcomes of the supports and services implemented, and will monitor available resources to support the participant’s plan. Strategies and implementation plans must be comprehensive and address the following: health and safety of the participant; housing and employment; social networking; scheduling and documentation of appointments and meetings, including on-going person-centered planning; utilization of natural and community supports; and the quality of the various supports and services utilized by the participant.
Community Case Management Service Delivery Model.
This model identifies various components associated with support coordination. It identifies services as Essential and Optional. This model allows persons who are eligible for services to fashion support coordination in a manner that maximizes the participant’s control by creating a flexible service menu therefore fashioning support coordination in a manner that focuses effort towards the individual’s personal vision for his/her life.
Essential services are not intended to be intrusive. Rather the services are tailored to focus on the health and wellness of all participants and to offer assistance, guidance and support around skill development designed to help keep the participants safe from harm and exploitation.
Optional services are designed to promote the participant’s priorities and thus be a reflection of the participant’s future planning process.
Health and Wellness:
Health and Wellness involves activities designed to promote, support and maintain the participant’s overall health. When necessary and indicated *, activities may include:
- Coordination and arrangement of medical and dental appointments and treatments
- Coordination and arrangement of mental health treatment and services
- Coordination and arrangement for nutritional/fitness support
- Coordination and arrangement for any therapies needed (i.e.PT, OT, speech, etc)
- Assistance in acquiring and usage of any needed medical equipment
- Assistance with the management of chronic illnesses and condition
- Assistance with grief counseling as needed
* Necessary and indicated refers to activities identified and documented as such in the person-centered planning process, and with which the participant will require assistance in order to achieve. Ex. A person with diabetes who is not able to independently coordinate and arrange for needed medical care, and requires additional supports to maintain health.
Quality of Life:
Quality of Life is a category of service that balances freedom of choice and individual lifestyle, with personal responsibility and system accountability. The focus should always be on promoting the participant’s personal competencies that would result in safety and freedom from abuse, neglect and exploitation. Such activities could include:
- Assist, coordinate and secure information on services and options that are available so that decisions are informed choices.
- Offer assistance and coordination obtaining legal resources such as partial or full guardianship.
- Assist in the coordination and/or mediation of problem resolutions that may arise with housing, employment, community membership and day support services.
- Coordinate services, or engage directly with the participant, to avoid or resolve a crisis, or any other challenging personal situation.
- Assist, coordinate or complete any required reporting obligation.
Community Membership is a group of services designed to assist the participant in understanding and accessing the neighborhood and community in which one lives. In essence, the purpose of Community Membership services is to locate, and connect the participant, to sources of personal support in their community that enhance the participant’s vision for a desired life. Services may include:
- Assist, coordinate or introduce the participant to community groups, agencies and organizations that reflect the participant’s personal interest and vision for a desired life (churches, Weight Watchers, hiking clubs as examples)
- Assist, coordinate or arrange opportunities for the participant to volunteer in activities that reflect the participant’s personal interest
- Assist, coordinate or provide information and training on local resources and how to use those resources
- Assist, coordinate or locate support groups that may reflect the participant’s interest
- Assist, coordinate or arrange for cooperatives or similar self-help activities
Information and Referral:
Information and Referral is a group of services designed to ensure that the participant has access to information. When necessary and indicated* services may include:
- Obtaining information and assisting, coordinating or making referrals to federal programs such as SSI and housing programs
- Obtaining information, and assisting the participant in obtaining benefits from the state to which they are entitled, i.e. MaineCare (formerly Medicaid), Medicare, prescription drug programs, welfare, vocational supports, educational supports as examples
- Obtaining information, and assisting or coordinating in the making of referrals for medical and or mental health services
- Obtaining information, and assisting or coordinating in the making of referrals for membership in local support or self-help groups
- Obtaining information, and assisting in the participant’s ability to understand the support system including their rights, responsibilities, grievance options and the decision-making process
Personal Support and Coordination
Personal Support and Coordination is a group of services designed to offer assistance and supports to promote the participant’s articulation of a personal vision for a desired life in the community. When necessary and indicated*, services in this category may include:
- Assist, coordinate or facilitate the participant’s future planning process
- Assist in coordination of opportunities for the participant to attend preferred community activities;
- Assist in the coordination of opportunities for the participant to attend those activities with people who are friends and allies rather than agency staff;
- Assist in the coordination of options that offer a greater variety of activities in which the participant can become engaged;
- Assist in the coordination of opportunities for the participant to engage in more activities with friends and allies and without paid staff
- Assist in the coordination of the expanding the network of the participant’s social relations to include more individuals who are not agency staff.
Personal and Social Relationships
Personal and Social Relations is a group of services designed to connect the participant to sources of personal support in the community. When necessary and indicated* services and supports may include:
- Assist in, coordinate or arrange the provision of instruction, guidance, modeling and mentoring
- Assist in the coordination, or facilitate referrals for adult education, memberships in community groups, agencies or organizations and or volunteering with community projects
- Assist in the coordination or provision of physical and or other support that may be necessary to participant in community events
- Assist in the coordination and arranging of one to one relationship building, with a decided preference for natural supports from family, friends, neighbors and allies,
- Assist in the coordination and arranging of modeling, mentoring and support from people associated with other generic community and civic organizations
- Assist, coordinate, facilitate, desired outcomes such as connections to sources of support through families, friends, allies or people associated with community or civic organization
Case Management Standards
Developmental Services adheres to a set of Case Management Standards that are very closely based upon the National Association of Social Workers (NASW) Standards approved by the NASW Board of Directors in June of 1992. The interested reader is referred to www.naswdc.org/practice/standards/casemgmt.htm. Following is a presentation of the 10 standards, in some cases modified slightly in order to be maximally applicable to the consumers whom we serve.
Note- The bullets following the standard and descriptions if necessary are policies found in the Case Management Policy Section that reflect theses standards.
Standard 1. The Case Manager shall meet the standard set forth in the job description of a community case manager for Developmental Services.
Standard 2. The Case manager shall use his or her professional skills and competence to serve the consumer, whose interests are of primary concern.
Case Managers have two sorts of ethical obligations. First: to resolve all scheduling and procedural conflicts by giving preeminent consideration to the concerns of consumers and their families. While the convenience of a Case Manager is a legitimate concern, during the workday it is secondary to the convenience of the consumer. As professionals, Case Managers are obligated to hold both themselves and their agency to the highest possible ethical standards.
- Consumer/Individual Support Coordinator Relationship
- Client rights
- The Rights of Maine Citizens With Intellectual Disabilities/Autism
Standard 3. The Case Manager shall ensure that consumers are involved in all phases of case management practice to the greatest extent possible.
The primary vehicle for assuring that consumers achieve this autonomy is the Person Centered Plan. However, some consumers elect not to have a Plan, and the Case Manager has the same obligations in these cases.
- Personal Planning Process/Protocol PCP
- Mission Statement
Standard 4. The Case Manager shall ensure the consumer’s right to privacy and ensure appropriate confidentiality when information about the consumer is released to others.
Case Managers are reminded that even in cases where a particular consumer appears to be unconcerned or uninterested in issues of privacy and confidentiality, Case Managers are still obligated to adhere to a high standard.
- Release of information
Standard 5. The Case Manager shall intervene at the consumer level to provide and/or coordinate the delivery of direct services to consumers and their families.
Developmental Services in the State of Maine are highly integrated with community resources. For this reason, the particular shape of case management services will differ greatly from one consumer to the next. In some instances, the Case Manager may be virtually the only liaison for the consumer and their family, while in other cases a consumer may be receiving a wide variety of services from an established agency or provider. Accordingly the Case Manager may be operating as a direct Social Worker in one case, as a service coordinator in another, and as a quality assurance monitor in another. In all likelihood, a given Case Manager will have the whole spectrum of types of cases, and will need to develop skills in a variety of areas. Standard 5 speaks primarily to the direct service category, while the following standards address coordination and quality assurance. In addition to possessing good interpersonal and communication skills, a Case Manager needs to develop, through education or experience, an understanding of interpersonal and family dynamics, as well as a good background in the nature and needs of various disabilities. This is particularly true since many of the consumers whom we serve have secondary diagnoses related to mental health, substance abuse, or physical disabilities. Further, some consumers have children, with whom they may need assistance. Others may be involved in difficult family situations. This manual cannot comprehensively identify all the areas in which a Case Manager may be called upon to act, but it is nonetheless an expectation of the Department that Case Managers will strive to expand their skill base across this entire spectrum of topics.
- Referral and Intake
- Personal Planning Process
- Access to services and supports
- Developmental Services Policies
Standard 6. The Case Manager shall intervene at the service systems level to support existing case management services and to expand the supply of and improve access to needed services.
Case Managers are expected to become progressively more knowledgeable about resources available to consumers throughout their communities, to assist the participant in understanding and accessing the neighborhood and community in which they live. In essence the primary responsibility is to locate and connect people to sources of personal support in the community that enhance the participant’s vision for a desired life. It is expected that Case Managers will take every opportunity to share any information that they gather with all of their colleagues, in order to strengthen the service coordination and delivery system for the system as a whole.
Standard 7. The Case Manager shall be knowledgeable about resource availability, service costs, and budgetary parameters and be fiscally responsible in carrying out all case management functions and activities.
- Family Support Program
- Financial Procedures, community resources, department resources, entitlements
Standard 8. The Case Manager shall participate in evaluative and quality assurance activities designed to monitor the appropriateness and effectiveness of both the service delivery system in which case management operates as well as the case manager’s own case management services, and to otherwise ensure full professional accountability.
- Quality Improvement Activities
- Grievance and Appeal
Standard 9. The Case Manager shall carry a reasonable caseload that allows him to effectively plan, provide, and evaluate case management tasks related to consumer and system interventions.
Standard 10. The Case Manager shall treat colleagues with courtesy and respect, and strive to enhance interprofessional, intraprofessional, and interagency cooperation on behalf of the consumer.