by Mary Pender Greene, ACSW, NYC
(September 1996)

Though "Managed Care" has so far focused primarily on cost reducing means and methods, social workers should take heart that we are ready, willing and able to meet this challenge; in fact, we are poised and prepared. A review of our history in the practice of social work attests to our ability to address continuing changes--in social crisis, economic, and social conditions, the practical environment, as well as shifts in mental health and social welfare, philosophy, policy, and popularity.

Heretofore we (i.e. clients and social workers) believed that more was indeed better. Long term, intensive individual treatment that was dynamically oriented to the client's underlying personality difficulties was seen as the treatment of choice: chosen by the therapist and agreed to by the client. We didn't need managed care to tell us that this practice was not cost effective.

For many years now, short term treatment modalities with individuals, groups, and families have worked successfully to move us away from the more traditional course. The advent of the managed care system has forced us to focus more sharply on the time factor, and to engage the client in that concern: How long should treatment take? At what intervals should treatment take place? And perhaps most important, what does this client want to accomplish in that time? These are vital decisions that clients and social workers should make together, in as concrete a way as possible. "Symptom relief " are not the dirty words we used to consider them. Better functioning is a viable and worthwhile goal of any course of treatment, and may not depend on a "cure" of underlying problems.

I would love to hearken back to a time when a client was not a patient and was understood to have a wide context of supports in family, job, and community. The "whole person" concept was a rule of thumb. Perhaps it is fortuitous that managed care is aiding and abetting our return to that idea. We do need to look for other resources to help us, worker and client, to accomplish our goals. We are not alone, and we can all acknowledge our need to seek assistance from outside our immediate surroundings.

Managed care has also allowed us the opportunity to collaborate as a profession, to work with colleagues with whom our diverse interests had previously provided little contact.

In my own agency, The Jewish Board of Family and Children's Services, we have served New Yorkers for more than a century, providing the community with a continuum of mental health and social services. These services have always been shaped by the needs of our clients, from residential services to day treatment , to outpatient psychotherapy, for adults, children, and families.

While we have always been mindful of cost and time factors, this more recent managed care emphasis has catapulted us into a strategic planning process that has resulted in serious stages of change. Initially, at all levels, we mourned our more comfortable, traditional operating modes. We were accustomed to setting aside Wednesday mornings so hundreds of professionals from all five boroughs could converge on our main office for training seminars. We were proud of this all-encompassing and intensive commitment to in-house post-graduate education, and of the high level and quality care that resulted. Yet, as we examined the "cost and time factors" that managed care thrust upon us, we had to reconsider and reconfigure that almost sacrosanct training program.

We became painfully aware that while we needed to cut costs, both our management and staff required more training to meet the challenges of managed care. This resulted in a focus on time-effective treatment with individuals, couples and families and a profusion of group courses in our training. We kept in mind the usual resistance to time-effective methods and group treatment, particularly since we had been so settled in our more familiar ways of working long term with individuals couples and families.

This feeling of resistance extended to other aspects of our organization. We have begun to expand many aspects of our operations across geographic boundaries in order to extend our continuum of care. For example, we have created focus groups of multi-levels of staff from several geographic areas. We use these permanent task forces and temporary work groups to address such issues as: managed care, creating time-effective modalities for long term patients and meeting supervisors' needs, as well as diversity issues, staff morale and cutting down on paper work.

Because change is hard work and requires such fortitude, we must do everything we can to encourage and support our staff--both new professionals and experienced social workers and to keep our social work values and high standards in the forefront. We are all pioneers in this changing social work field, and our staff is our most important resource.