Research Article
An Intervention program of Enhancement on Knowledge and Skills of Social Work Case
Managers with Persons with Disabilities
Le Thi Nhung
Head Division of Science & International Cooperation, University of Labor & Social Affairs Campus 2, Vietnam nhunglt@ldxh.edu.vn
Article History: Received: 10 January 2021; Revised: 12 February 2021; Accepted: 27 March 2021; Published Online: 20 April 2021.
Abstract: Although case management has been playing a crucial role in different social work settings and specialties including
disabilities, this practice has been newly applied in Vietnam. In the current situation, there is a strong need for the capacity building of social workers who work as case managers. This study examined how effective the intervention program was to improve their foundational and functional competencies in terms of knowledge and skills. The pretest and posttest of the intervention were measured to identify its effectiveness towards 30 participants. The results indicate a remarkable increase in their understanding and attainment. Therefore, the study comes up with some implications for research and education or training
Keywords: Social work, case manager, persons with disabilities, knowledge, skills
1. Introduction
Case management is a part of many social work careers (National Association of Social Workers [NASW], 2013) and “significant numbers of social workers report spending more than half their time” on case management responsibilities (Whitaker, Weismiller, & Clark, 2006). There are other practitioners such as nurses, peer counsellors and volunteers joining this practice. However, social work (SW) case managers have a wide range of operations across specialties, sectors, organizations, and geographical areas (NASW, 2013). The expertise in improving support systems and promoting therapeutic relationship positions the SW profession as a leader within the field of case management (NASW, 2013).
Since case management and social work started in the early 20th century (Federal Interagency HIV/AIDS Case Management Work Group, 2008), among a various array of practice settings, SW case management with disabilities (cognitive, developmental, physical, and psychiatric) has been becoming a common and compatible specialty. SW case managers are expected to carry out different roles and responsibilities in “a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services” (Case Management Society of American, 2014).
In Vietnam, SW case management first piloted with drug users at their residence in 2006 (Hai, Mai, Linh, Thuy, Tuan, & Long, 2015) then with children and their families since 2009 (Nguyet, 2016; Nhung, 2017) and official lyre commended and guided in working with PWDs by the government (Vietnam Ministry of Labour, War Invalids and Social Affairs, 2015). The other legislations on the rights of PWDs that have been declared through Vietnam’s Law on PWDs No.51/2010/QH12 and its guidelines of Government’s Decree No. 28/2012/ND-CP as well as Vietnam's ratification of Convention on the Rights of PWDs, on one hand, affirm the right of the marginalized clients; on the other hand, it requires SW to respond promptly. Almost at the same time, when the National Scheme No. 32 of Developing Social Work Profession from 2010-2020 was announced as it smiles stone, a large number of social workers & collaborators at communal levels are required to be professionally trained up to 60.000 persons (Vietnam’s Government, 2010). Meanwhile, it showed that 52% of clients seeking social work services, 82% of them seeking certain services through case management (Ho Chi Minh City People’s Committee & UNICEF, 2015).
In this context, capacity building for SW case managers is essential to provide support services for PWDs. The intervention program was carried out as an experimental study to measure the outcomes of improving the knowledge and skills of SW case managers with PWDs.
2. Literature Review
There is different research-based evidence on the influencing factors of SW case managers in the quality of the practice. In terms of knowledge, disaster recovery depends on case managers with disability expertise of knowledge about the needs of individuals with disabilities and disability-related services (Stough, Sharp, Decker & Wilker, 2010). The level of performance in the process of administration of patients with hemodialysis disabilities could be improved through the chances of case managers to learn about dialysis (Sugisawa, Shimizu, Kumagai, Sugisaki, Ohira, & Shinoda, 2017). Similarly, case management with PWDs is affected by the knowledge of social workers (Thang, 2016; Kiet, 2017). The other influencing factors involve professional skills, enthusiasm, empathy and communication skills (Kiet, 2017).
Another tendency of research denotes the different roles and tasks of SW case managers. Mixed research of secondary data, observations, and interviews of Laima S., Ligija S. & Jūratė G. (2003) indicated crucial roles of
social workers in a home-based rehabilitation team as a broker, facilitator (Huong, 2014, chap 4) and educators. The other roles include advocate and service navigator (Huong, 2014, chap 4). With clients with substance abuse, they also perform as service navigators, advocate, facilitator and mobilizer (Loan, Hai, Hoa, Lien, Tien, & Thuong, 2013; Hai, Mai, Linh, Thuy, Tuan, & Long, 2015). Social workers play such key roles rather than a therapist (Kham, 2015). As an individual facilitator, they help clients organize their lives for CBR on housing aspects, neighbourhood contact, community-based voluntary organizations, provision of life-based services, consultation on rehabilitation and providing or connecting services. In a broader context of the community, they mobilize and distribute supporting services and sources for PWDs as well as community development in turns. Besides, other roles of social workers are mentioned in social policy assessment, development, and advocacy for PWDs (Trang & Lien, 2014, chap 3). To conduct these roles, SW case managers are expected to master skills in facilitation and information provision, empowerment (Kham, 2015), assessment and navigation on local resources, networking (Nhung, 2014; Kham, 2015) and case profiling (Nhung, 2014).
Meanwhile, there are different research on current situations on how social workers are involving in case management. Almost all interviewed respondents (70 social workers) in different provinces have been working as case managers with children and adolescence in special circumstances (Nhung, 2016). In another report of 05 years between 2013 and 2018, the agency has been providing case management for 700 children with difficulties in the community (Ho Chi Minh City Social Work Center for Children, 2018). However, other research that focuses on competencies and needs of capacity building of SW case managers reveals their limited understanding and training needs. As Kiet (2017) reported, there were little and low levels of understanding about case management wt PWDs ranging from 22% to 45%, even about 15% of case managers without understanding. The tasks including collecting information, assessment, intervention planning, and implementation were fulfilled on a frequent and sufficient ratio from 26.7% to 33.3%. On the other hand, more than three-fourths of respondents said they need to be trained in SW case management (Disability Research and Capacity Development Center &Ho Chi Minh City Club of Social Workers, 2019).
Thus, previous studies suggest about competencies of SW case managers and what their expected roles and tasks are. This research comes up with a conceptual framework as follows:
Figure 1. Conceptual framework of the intervention program
It is believed that when SW case managers are well aware of the nature and disciplines of SW case management with PWDs, acquired of WHAT (roles and tasks) and equipped with HOW (essential skills to conduct WHAT), they can enhance their capacity on performing their jobs.
3. Methodology 3.1. Participants
3.1.1. Job title
They are social workers, collaborators, labour and social affairs staff who are working directly with PWDs. These people are supposed to work as case managers due to the regulation of the government.
3.1.2. Educational background
The largest percentage of participants (40%) is constituted by those with the highest degree at vocational levels while those at college level and university level count for the same percentage of 23.3% and just 3.3% getting masters degrees. Respectively, about 15% finished high school only.
Among them, there are up to 26.7% having been trained neither SW, particularly SW with PWDs nor SW case management. At the same time, one-third have been trained through short courses, 26.7% through vocational or college training and just 13.3% through bachelor’s programs.
3.1.3. Age
More than half of respondents are the ages between 30 and 40 years old, nearly a quarter are at young ages from 18 to 30 and the left amount from 40 to 55 years old. It is implied that the majority of case managers are of working ages with high potentialities and somehow relevant to their working experience.
3.1.4. Working experience
The largest proportion of over one half is constituted by those with over seven-year- working experience, especially one-third with over 10 years. Only a small percentage of 10% have started their working for less than 3 years while another proportion of one-third have taken part in for 3 to 7 years
3.1.5. Gender
Among them, 66.7% are female and 33.3% are male. It might be implied for unbalanced gender issues in the labor patterns of SW.
3.2. Description of the intervention program
The intervention program includes a ten-session- training course with 04 subtopics SW case management with PWDs, including nature and disciplines, roles and tasks and essential skills
Table 1. Major content of intervention program
Topic Major content Timeline
1 Introduction to SW case management with PWDs
- How to classify PWDs
- Nature of SW case management
- Core principles of SW case management
Session 1
2 Expected roles of SW case managers - Counselor - Broker - Service navigator - Facilitator - Educator - Advocate Session 2 and 3
3 Core tasks during a progress of SW case management with PWDs
A progress with 5 steps attaching with 7 core tasks:
- Collecting information - Assessing needs
- Making an intervention plan - Carrying out an intervention plan - Monitoring and evaluating - Terminating the case
- Recording, reporting and documenting
Session 4, 5 and 6
4 Essential skills for SW case management with PWDs
- Holistic assessment
- Trustful therapeutic relationship building with clients
- Planning
- Networking, reference, and navigation of services and resources
- Resource mobilization - Counseling
- Advocacy
- Record, report and documentation
Session 7, 8, 9 and 10
3.3. Measures
Five scales were developed to measure which levels of understanding that participants gave feedbacks at the pretest and posttest. For all scale items, before and after the intervention program, they were asked to respond to each statement with a 5-point scale with anchors, 1 (not knowing/unsure)
to 5 (knowing very well/completely confident). All variable items were kept the same at the pretest and the posttest. For data analysis, the SPSS software was used with Mean (μ) and Standard Deviation (SD) to measure Mean differences. Finally, for interpretation, the range of mean (1.00 to 5.00) was divided for ranking levels from very poor to excellent.
Table 2. Mean scales of study variables
Range of mean Ranking For knowledge
1.00 – 1.80 Very Poor Not knowing /never hearing/not understanding (no information) 1.81 – 2.60 Poor Hearing but not understanding (some information)
2.61 – 3.40 Moderate Somewhat knowledgeable (knowing)
3.41 – 4.20 Good Knowing well
4.21 – 5.00 Excellent Knowing very well
the proportion of over one half constituted by those with over seven-year- working experience, especially one-third with over 10 years. Only a small percentage of 10% have started their working for less than 3 years while another proportion of one-third have taken part in for 3 to 7 years.
4. Results and Discussion
The key findings investigate outcomes of the intervention program based on the self-evaluation of the participants in terms of knowledge about roles, tasks, and skills of SW case managers with PWDs at the pretest and posttest.
4.1. The knowledge about roles of SW case managers with PWDs
Table 3 indicates the means, standard deviations and mean differences of study variables before and after the intervention program. As shown in Table 3, understanding about roles of SW case managers with PWDs were poor to moderate with all values lower than or around μ =3.00 at the pretest. The role as a service navigator was known at the lowest level with μ1= 2.70 followed by knowledge about the roles as an advocate, facilitator, broker, educator than a counselor.
Table 3. Knowledge about the roles of SW case managers with PWDs Knowledge
of roles
Pretest Posttest Mean difference
μ1 SD1 μ2 SD2 (μ2 - μ1) Counselor 3.07 .691 3.70 .596 .63 Broker 2.87 .776 3.77 .626 .90 Service navigator 2.70 .794 3.67 .606 .97 Facilitator 2.80 .887 3.80 .610 1.00 Educator 3.00 .830 3.73 .640 .73 Advocate 2.80 .805 3.70 .651 .90
However, the posttest proves that knowledge about all of 06 roles are greatly improved at good levels with means ranging from 3.67 to 3.80. Moreover, the mean of each role is much different compared to the pretest and posttest (.63≤ μ2 - μ1≤ 1.00). It is also implied that understanding about being a facilitator have been changing the most with μ2= 3.80 and μ2 - μ1 = 1.00.
4.2. The knowledge about roles of SW case managers with PWDs
Table 4 presents the means and standard deviations of knowledge about the tasks of an SW case manager with PWDs as well as mean differences of the pretest and posttest.
Knowledge of tasks
Pretest Posttest Mean
difference
μ1 SD1 μ2 SD2 (μ2-μ1)
Collecting information 3.00 .910 3.93 .521 0.93
Assessing needs 2.87 1.042 3.73 .521 0.86
Making an intervention plan 2.77 .898 3.77 .568 1.00
Carrying out an intervention plan 2.80 .961 3.83 .648 1.03
Monitoring and evaluating 2.83 .791 3.77 .626 0.94
Terminating the case 2.83 .791 3.80 .664 0.97
Recording, reporting and documenting
2.83 .834 3.80 .610 0.97
As can be seen, the respondents revealed they understood all major tasks at poor and moderate levels (2.77 ≤ μ1 ≤ 3.00) before the intervention. Respectively, they obtain knowledge about all tasks much better (3.73 ≤μ2≤ 3.93) after. On average, the task of collecting information gets the highest level of understanding (μ2= 3.93) while carrying out the interventional plan experiences the most significant change in understanding (μ2 - μ1= 1.03). The mean differences of other tasks between the pretest and posttest are also noteworthy from 0.86 to 1.00.
4.3. Acquirement of skills of SW case managers with PWDs
Table 5 demonstrates changes of acquirement in skills of a social work case manager with PWDs. Table 5. Knowledge about skills of a SW case manager with PWDs
Knowledge of skills
Pretest Posttest Mean
difference
μ1 SD1 μ2 SD2 (μ2 - μ1)
Holistic assessment 2.77 .817 3.83 .648 1.06
Trustful therapeutic relationship building with clients
2.67 .884 3.83 .592 1.16
Planning 2.73 .868 3.80 .610 1.07
Networking, referral, and navigation of services and resources
2.63 .890 3.80 .610 1.17
Resource mobilization 2.77 .935 3.77 .568 1.00
Individual counseling 2.77 .858 3.87 .681 1.10
Group counseling 2.70 .837 3.83 .699 1.13
Advocacy 2.67 .884 3.77 .626 1.10
Record, report and documentation 2.77 .971 3.77 .626 1.00
In the same tendency, attainment in essential skills has experienced a great change. Before the intervention program, it was found that all skills were supposed at poor and moderate levels (2.63 ≤ μ1≤2.77), generally lower than knowledge about the roles and tasks of SW case managers with PWDs. On average, skills at networking, referral, and navigation of services and resources were perceived at the lowest (μ1= 2.63), closely followed by skills in building trustful therapeutic relationships with clients and skills in advocacy with the same level with μ =2.67. Other skills including holistic assessment, resource mobilization, individual counselling and record, report and documentation could be grouped at the same moderate level with μ = 2.77.
However, after the intervention program, all skills are better self-evaluated by the respondents at good levels (3.77 ≤ μ2≤ 3.87). Individual counselling skills get the highest level of understanding (μ2= 3.87). While the pretest showed essential skills were commonly understood at the lower level than knowledge about roles and tasks, the mean difference in the acquirement of skills after intervention illustrates the most meaningful changes (1.00 ≤ μ2 - μ1≤ 1.16).
4.4. Differences among individual participants
Standard deviations (SD1 and SD2) can be implied for the differences among individual participants. In a general outlook of the pretest in all aspects of knowledge and skills of a social-work case manager with PWDs, the levels of differences among them were more significant (.691≤SD1≤1.042). It somehow presented a variety of understanding levels among learners. Besides, the result of knowledge about tasks was analyzed to experience the largest difference among learners (.791 ≤ SD1 ≤ 1.042). However, the posttest shows that the differences among individual participants become much less after (.521≤ SD1 ≤ .699).
5. Conclusion
Previous research demonstrates the need for enhancing the knowledge and skills of SW case managers with PWDs. Furthermore, the literature review constructs a theoretical framework on the intervention program of substantial foundational and functional competencies to fulfil these needs.
Remark able increase in understanding levels of respondents in a comparison between the pretest and the posttest significantly determines the effective outcomes of the intervention.
Fewer differences among individual learners somehow provedal though they might start at different points before the intervention program and acquire at different levels, they have reached almost the same levels of understanding after this.
Since the intervention program was a training course, other schools, trainers, and teachers are highly recommended to implement it for the capacity building of SW case managers with PWDs.
Future researchers are suggested to apply the program to validate its effectiveness for future use. They may use another kind of experimental studies such as controlled and uncontrolled groups or evaluations on participants' improvement in practical working after a specific period.
6. Limitation of the Study
Several limitations of this research should be considered when interpreting and generalizing the results. The quantitative method was used with a minimum sample size of 30 persons might lead to the results with less reliability. The reason is sample size calculations had to take into account available data and funding (Gogtav, 2010). Also, with the small sample size, we are not able to make relationships or causal conclusions about them between the study variables.
Furthermore, some self-evaluations of the respondents might be inflated or deflated due to the use of a cross-sectional methodology (Siemsen, Roth & Oliveira, 2010) or might not generate artefactual interactions (Evans, 1985).
The following up assessment after a period of intervention has not been conducted to check long-lasting effectiveness and practical application in their daily working with the clients.
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