By Dr. Ellen Fink-Samnick, DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM
March and Social Work Month provide an annual opportunity to ponder my professional heritage. I walk in several worlds as a doctoral-level integrated care professional, a licensed clinical social worker, and a board-certified case manager. It is common knowledge among peers that I view the established resources of guidance as a foundational pillar of my interprofessional roots in social work and case management. This support beam of our practice comprises laws and regulations, formidable accreditation competencies, the rigor of collective standards of practice, codes of ethics and professional conduct, and other guidance frameworks (Fink-Samnick, 2023).
However, an equally fundamental pillar has risen in recent years from society’s rubble of health disparities and inequities: that of seminal theory. There has been a recent re-emergence of the value of theoretical models to achieve social work and case management’s most coveted shared outcome: the commitment to serve and advocate for society’s vulnerable, minoritized, and marginalized populations, whether their identified needs reflect physical, behavioral, or psychosocial health realities. Theory and reality drive quality case management practice. That practice premise anchors case managers as they strive to stay afloat in the most tumultuous times.
Social Work Theory 101
Social work’s theoretical framework comprises six to eight foundational theories, depending on the source. These theories are taught within academia’s synthesis course requirements (e.g., human behavior in the social environment, social determinants of health) across health and human services’ interprofessional programming. Among the disciplines included in this educational specialty are criminal justice, global and community health, nursing, occupational therapy, physical therapy, pre-med, public health, and speech and language pathology, to name a few. Social Work Theory 101 is displayed in the table below and will most likely look familiar to many of you.
Table 1: Social Work Theory 101
| Theory | Focus |
| Biopsychosocial (Engel, 1977) | A model of disease that accounts for assessment of biological, psychological, and social domains of human functioning. |
| Deontology Ethics (Kant, 1785: Misselbrook, 2013) | Ethical actions are based on moral duties; the morality of action should be based on whether an action itself is right or wrong. |
| Humanistic or Client-Centered (Rogers,1959) | A perspective that looks from a client-centered vantage at the whole individual in the context of free will, self-efficacy, and self-actualization. |
| Person-in-Environment (Richmond, 1917) | A practice-guiding principle that highlights the understanding an individual and their unique behavior in light of the environmental contexts in which that person lives and acts. |
| Psychodynamic (Freud, 1890, 2012) | Psychological drives and forces within individuals explain human behavior and personality. |
| Psychosocial Development (Erickson, 1980) | Personality develops across eight distinct life stages, where each stage impacts each person’s success in advancing to the subsequent stage. |
| Social Exchange (Homans, 1958) | The interaction between the group and environment in which it operates shapes both the behavior of the group and its final outcomes. |
| Social Cognitive or Social Learning (Bandura, 1977) | People learn from each other through observation, imitation, and modeling |
| Systems (Bertalanffy, L. von., 1968) | Analyzes how each part contributes to the ways an individual functions within society, and how those parts might interact and compound issues. |
The application of social work’s theoretical foundation is vast and leverages case management intervention with individuals, couples, families, groups, and communities. Employing didactic knowledge from the humanistic, social exchange, and systems theories fuels a case manager’s efforts to target macro or meso-level systemic issues that impede care delivery (e.g., legislation, funding, reimbursement, structural racism). Engel’s Biopsychosocial model’s intricate weave of biological, psychological, and social factors intersects with the principles of person-in-environment, psychodynamics, social exchange, and social learning. This fusion advances a practitioner’s engagement at the micro level to assess conscious and unconscious behavior across the lifespan and the cultural nuances associated with those behaviors. Reconciling implicit biases stem from these theories. Whole-person care is equally leveraged through this lens and supports a case manager’s proficiency to address chronic illness, co-morbid physical and mental health, and other population-health realities.
Employing theories as a driver of practice helps case managers successfully identify, triage, and address the evolving areas of client need across demographic groups and populations. Knowledge acquisition through this pillar promotes the quintessential skills to forge meaningful client treatment relationships through engagement, informed consent, and shared decision-making toward treatment choice and adherence.
The Value of Ethical Theory
Ethical theories further strengthen this formidable pillar; you knew I’d weave ethics into this blog post somehow. I’ll save you from digging too deep into the ethical, theoretical weeds, but here’s the lowdown. Deontological ethics theory is a personal favorite and reflects that employees behave in a moral way at work, because of their obligation to do so, and especially when faced with ethical decision-making.
For example, case management’s interprofessional workforce members prioritize compassion and the importance of relationships through the foundational ethical tenets of autonomy, beneficence, fidelity, justice, and non-maleficence. The ethical principles of autonomy and worth of each person reign supreme for every case manager, or at least should. Care and treatment are based on client self-determination and heeding the wants and needs of each unique person versus those of each well-intended practitioner.
Both social work and case management make the most difficult decisions in navigating complex systems on behalf of clients and families. They strive to mitigate disparities and social injustices and ensure that quality North Star of quality-driven, inclusive, cost-efficient, and accessible patient—and family-centric care. Ethical foci of confidentiality, informed consent, and boundaries are paramount across every case management role and practice setting. Licensure regulations and case management certification entities delineate the mandate to work within legal and ethical guidelines.
Per CMSA’s Standards of Practice (2021), Case managers must “adhere to all applicable federal, state, and local laws and regulations…” (p. 23). We must “behave and practice ethically and adhere to the tenets of the code of ethics that underlie their professional discipline” (p. 24). All documentation should reflect the awareness and alignment of case management practice with our “five fundamental ethical principles .”All case managers must creatively advocate for clients’ best interests and through every standard of practice and phase of intervention. These span case management’s qualifications, professional responsibilities, and legal and ethical accountability, to client selection through to termination of the client relationship (CMSA, 2021).
Collaborative Expertise Drives Case Management’s Superpower
Social work and case management share the common goal of empowering individuals and communities to overcome challenges and improve their quality of life. A robust theoretical foundation empowers the workforce to promote positive client change and support the well-being of those who they serve. Theory, practice, and reality are inexplicably intertwined for every social worker, and especially those within case management roles. The dynamic energy of these constructs and their associated pillars sustain our professional superpower.
Join us for "Stop Telling Me About Self-Care! Case Managers and Self-Care Fatigue” with presenter Sarah Stevenson, LICSW, NSW-C, CCM; The presentation will unpack the healthcare delivery system and how it promotes self-care of staff while simultaneously imposing barriers that can thwart sustainable self-care practices. Free to members. $40 for non-members. https://www.pathlms.com/cmsa/courses/63859
Bio: Dr. Ellen Fink-Samnick is an award-winning industry entrepreneur whose focus is on competency-based case management, interprofessional ethics, wholistic health equity, quality, and trauma-informed leadership. She is a content-developer, professional speaker, author, and educator with academic appointments at Cummings Graduate Institute of Behavioral Health Studies and George Mason University. Dr. Fink-Samnick has served in national leadership and consultant roles across the industry, including as the current Vice-Chair for CMSA’s DEIB Core Committee. She is also first social worker inducted as a Fellow in Case Management by CMSA. Further information is available on her LinkedIn Bio or her website
References
Bandura, A. J. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice Hall
Bertalanffy, L. von. (1968). General system theory: Foundation, development, application. New York: George Braziller.
Case Management Society of America (CMSA) (2021). Standards of practice for case management; Brentwood, TN
Engel G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science (New York, N.Y.), 196(4286), 129–136. https://doi.org/10.1126/science.847460
Erikson, E (1980) Identity and the Life Cycle. New York: W. W. Norton & Company
Fink-Samnick, E. (2023). The ethical case manager: tools and tactics; Blue Bayou Press
Freud, S. (2012). A general introduction to psychoanalysis. Wordsworth Editions.
Homans, G. C. (1958). Social behavior as exchange. American Journal of Sociology, 63, 597–606.
Richmond, M. E. (1917). Social diagnosis. Russell Sage Foundation
Misselbrook D. (2013). Duty, Kant, and deontology. The British journal of general practice : the journal of the Royal College of General Practitioners, 63(609), 211. https://doi.org/10.3399/bjgp13X665422
Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal relationships, as developed in the client-centered framework. Psychology: A Study of a Science, 3, 184-256.