Revitalizing the Role of the Psychologist in the Case Management System in DSWD Centers and Residential Care Facilities

February 12, 2008

DSWD MEMORANDUM CIRCULAR NO. 02-08

 

I. RATIONALE

The DSWD envisions a society where the poor and vulnerable individuals, groups and communities are empowered for an improved quality of life. One of the major organizational competencies of the Department that responds well to this vision is its capacity to deliver services directly to its constituents through its centers' and institutions' various programs and services such as provision of temporary care and shelter, building and enhancing capacities, and providing opportunities for healing, self development as well as empowerment.

For the past two years (CY 2005-2006), the Department's centers and institutions have served an average annual number of 14,500 clients, while its community-based protective and rehabilitative services served an average of 65,300 clients annually. In addition to this, DSWD's crisis intervention units served an average of 289,111 individual clients and 26,677 families annually. This presents the variety of social protection services delivered as well as the bulk of clients that went thru the DSWD case management system.

The DSWD's case management system adopts a multi-disciplinary team approach which recognizes and utilizes the most effective interventions that evidence-based practice has to offer. Thus, social work technology blends with the most current learning that the fields of psychology, psychiatry, education, medicine, science and other allied fields have to offer, based on researches and best practices. TSEAaD

In 2006, the Department received a generous one-time endowment from the family of DSWD's former Secretary and the Philippines' first clinical psychologist, the Hon. Dr. Estefania Aldaba-Lim, to enhance the competencies of its psychologists as critical components in the case management system. In close consultation with Dr. Aldaba-Lim herself, prior to her death, the Department developed, and started implementing, a five-module Comprehensive Continuing Education Program (CCEP) for Psychologists. This effort was aimed at (a) institutionalizing a quality assurance program which will ensure that the identified needs of DSWD clientele are adequately met, and that (b) DSWD psychologists continue to be competent in delivering the range of services expected of them as practitioners, within the context of the Department's case management system. Along this line, the department created a composite team that will define the role of DSWD psychologists in the case management process.

With this scenario and to facilitate, as well as to systematize, the operationalization of the role of the DSWD psychologist in the DSWD Case Management System, the following guidelines are hereby issued for the guidance of all concerned.

II. OBJECTIVES

These Guidelines have been developed to achieve the following objectives:

a. To enhance the DSWD's case management system's effectivity, with focus on the multidisciplinary approach in general and to psychological services and interventions in particular; SDHacT

b. To ensure that DSWD's clients receive the best possible interventions to address their needs, particularly in the areas of behavioral and emotional dysfunction;

c. To identify and gain deeper appreciation for the contributions of the psychologist as an integral part of the DSWD's case management system;

d. To enhance the DSWD's delivery of psychosocial rehabilitation services;

e. To contribute to the development of best-practice models of psychosocial interventions.

As part of the case management system, the psychologists are expected to:

a. Assist the case manager (social worker) in the assessment of the client's overall functioning (strengths, external resources, and needs);

b. Assist the case manager in the identification of priority areas for case management;

c. Formulate and implement relevant clinical intervention plans that are consistent with DSWD standards in coordination with the case manager;

d. Assist the case manager in strengthening DSWD's advocacy role on the type of clients being served;

e. Assist the case manager in the re-assessment of client's overall functioning to determine suitability for termination, referral or continuation of DSWD intervention.

III. OPERATIONAL DEFINITION:

Ø Case Management Team (CMT) — refers to the members of the rehabilitation team/multi-disciplinary team headed by the case manager/social worker. It is composed of social workers, psychologists, psychiatrists, physicians/doctors, nurses and other allied professionals committed to work together to help individuals regain, maintain and enhance their social functioning. cTAaDC

Ø Case management — refers to the interactive process in which the client and the workers consciously work together toward a reasonable resolution of the client's problem(s).

Ø Case Manager — refers to the social worker identified by the team members to facilitate and oversee the case management process in accordance with DSWD's established standards, policies and procedures. She/he leads and directs the members of the CMT and the client in the helping process.

Ø Psychologist — refers to a B.S. Psychology graduate who is competent in psychological clinical assessment and intervention. She/he is responsible for providing appropriate psychological services to client/s in coordination and collaboration with his/her family and members of the case management team. IaEHSD

Ø Psychological Services — refers to activities to include but not limited to: administration of psychological tests, evaluation and interpretation of results, report writing, conduct counseling and therapy sessions.

Ø Activity Therapy — refers to activities to include but not limited to, counseling, play therapy, art therapy, occupational therapy and psychotherapy. Activity therapy is defined to differentiate it from medical therapy, which is a non-activity therapy intervention and an exclusive domain of medical doctors/psychiatrists. acHITE

IV. OPERATIONAL GUIDELINES:

As member of the case management team, the psychologist is expected to actively take part in the case management process and complement the other members of the team and ensure that the client is given the appropriate intervention. It is also the psychologist's role to communicate to the case management team on the progress on the psychological intervention on the client (or lack thereof) as necessary. Please refer to Annex 1 on the Role Delineation Between the Social Worker and the Psychologist in the DSWD Case Management Process.

The specialized clinical training of the psychologist puts him/her in a unique position to serve as the CMT's resource in the evaluation of psychological clinical intervention programs for clients. The psychologist is expected to maintain a roster of external professional resources that might be tapped for referrals. In recognition of the specialized competencies that a psychologist possesses, the DSWD requires its Field Offices to maintain a psychologist or a number of psychologists to cater to clients in centers/institutions and those in the community needing psychological intervention.

A. Role of the Psychologist in the Case Management Process

The role of the Psychologist in the case management team is important as it provides the psychological perspective in understanding the situation of the client. The tasks of the psychologist are as follows: conduct clinical interview, behavioral observation, test administration and interpretation, intervention planning, case recording and report writing, crisis intervention and assessment of violent behavior towards oneself and others, conduct of counseling and therapy sessions, attend case conferences and team meetings, conflict resolution, stress debriefing, as well as monitoring and evaluation of the psychological intervention on the case. TCcDaE

1. Assessment of the Problem. The case manager/social worker shall determine the need for an initial psychological assessment of the case. She/he shall make the referral to the DSWD psychologist. The psychologist shall conduct the following:

1.1. Problem Identification. Verifies the presenting psychological problem based on the information gathered by the social worker during the intake interview, inputs/observation/initial impressions and diagnosis by other members of the case management team. The psychologist coordinates with other members in the case management team as she/he analyzes pertinent data in determining:

• Significance of the psychological problem

• Psychosocial functioning

• Causes, onset and precipitating factors of the problem

• Frequency, intensity and duration of the problem

• Efforts to cope with the difficulties and current level of social functioning

 The psychologist shall participate in the pre-admission conference by sharing her initial assessment of the client. DcITaC

1.2 Data Gathering. The case manager upon recommendation during the pre-admission conference may refer the case to the psychologist to gather more information regarding client's feelings, behaviors, personality problems or clinical disorder (if any), interpersonal skills, adjustment difficulties, potentials, limitations, stressors, inner resources, and barriers to the desired change through the following:

• Interviews with client and significant others

• Review of case file

• Psychological tests

• Behavioral observations

• Other appropriate approaches as the case may require.

 The psychologist may use a variety of assessment methods such as, but not limited to interviews, questionnaires, testing (oral and written), psychosocial and multi-modal techniques. For purposes of these Guidelines, a psychologist is deemed competent if she/he has successfully completed the required education and specialized training to administer specific assessment protocols and/or conduct specific therapeutic approaches. EScAID 

1.3 Diagnostic Assessment. The psychologist shall utilize the data gathered by the case management team in preparation for the writing up of a diagnostic statement indicating cognitive capacity and style (e.g., recall and discrimination, concrete and abstract thinking), ability to adapt past learning to new situation, motivating factors, relational style, emotional resources and coping mechanisms The diagnosis shall include judgment about the seriousness of or urgency of the problem (using frequency, intensity, duration and situation of the behavior; or the diagnostic classification of the client into categories, depending on the results of the testing, informal assessment, and other clinical data).

 The DSWD psychologist shall communicate the assessment results to the Case Management team. As the case may require, the psychologist shall present the assessment results during case conferences.

 In the case of clients who are victims of abuse (physical, emotional, or sexual) or trauma, the psychologist shall conduct a crisis assessment and implement an appropriate crisis intervention.

 Should the psychologist determine that the case requires further testing/intervention that is beyond his/her professional capacity, the case shall be referred to a testing facility or a more expert psychologist or psychiatrist, in coordination with the case manager.

2. Intervention/planning. This is a participatory process which involves the client (and/or his legal representative) and the case management team. The psychologist shall recommend to the CMT appropriate intervention strategies through the entire cycle of the helping process in which the client is involved (e.g., residential, vocational, school). The psychologist shall also develop a rehabilitation plan, incorporating objectives and therapeutic activities or intervention modalities, and a monitoring process for concurrence of the client (and/or his legal representative). This shall be integrated in the treatment plan of the case management team.

The psychologist is expected to be guided by the ethical guidelines followed by social work, psychology, and other helping professions.

3. Plan Implementation: In all aspects of intervention, the case management team shall always be guided by what is the best interest of the client.

3.1 In the case of clinical intervention, the psychologist shall adopt measures that are appropriate to the client in collaboration with the case manager such as, conduct of individual or group counseling session, play therapy, ventilation and/or debriefing session's systematic desensitization, self management programs, reinforcement modeling, etc. aScIAC

3.2 The psychologist through the case manager may delegate specific clinical intervention activities to other members of the case management team who have been adequately trained, either by the psychologist himself or by other qualified practitioners.

3.3 On behalf of the client, the psychologist shall advocate for the support of its team members such as, technical and financial support among others.

4. Monitoring and Evaluation: The psychologist in coordination with the CMT shall closely monitor the clients' behavioral progress as agreed at the beginning of the intervention process. The psychologist shall maintain an updated individual case record and adhere with DSWD's case management polices and standards.

The case recordings shall be forwarded to the case manager indicating results of the intervention, assessment and recommendation regarding the client's psychological and mental health status or well being.

5. Termination. The Psychologist and members of the CMT reviews the indicators and other documents to assess whether the case is to be terminated or not. She/he may also choose to conduct a re-test of the client's overall functioning. The recommendation is submitted to the case manager and shall form part of the agenda during the pre-discharge conference.

Please refer to the Case Management Process Flow starting from the pre-residential phase up to the post-residential phase. aCITEH

• Caring for Caregivers

In the course of the case management process, the CMT members might be affected psychologically and emotionally while dealing with the clients' problems. Thus, the psychologist may be called upon to develop and implement a stress management program for the case management team.

B. Staffing for Psychologist Positions

The position levels of the psychologists' staff complement is a manifestation of the current requirement of the center or institution having enormous bulk of residents.

These are as follows:

1. Psychologist I — Shall be based at the center and/or residential facility, and handles at least 25 caseloads; undertake the roles/functions mentioned in Annex 2; report to the case manager and/or center head and if available, to the Psychologist II; and perform other related tasks assigned by the center head.

2. Psychologist II — At least one (1) Psychologist II per region and shall be based at the Field Office; provide technical assistance and act as program monitor to the Psychologist I assigned in centers/residential care facilities; handle cases and act as Psychologist I in case where the center does not have a Psychologist I or if said staff is temporarily unavailable; perform the roles/functions mentioned in Annex 2 and extend her/his expertise as needed within the scope of the region.

 She/he is also expected to monitor, and evaluate the quality of psychological services delivered/implemented in center's/residential facilities' in the region and submit a report to the Regional Director on gaps identified and recommended improvements copy furnished the Psychologist III for consolidation, analysis improvements or modifications.

3. The Psychologist III — Shall be based at the Program Management Bureau of the DSWD Central Office; serve as program monitor for the Psychologists I & II; provide technical assistance (coaching and/or mentoring) to the psychologists assigned at the region, centers and residential care facilities; identify component areas, recommend modifications, and/or develop program framework and design on the nature of psychological service and social service delivery system appropriate to the clients and perform other tasks indicated in Annex 2.

4. Psychologist II and III are permanent items. Psychologist I can be employed on a regular or contractual scheme.

C. Qualification/Competency Standards — the following are the minimum qualification requirement of the position.

1. Psychologist I — at least a B.S. Psychology graduate; Civil Service eligible with six (6) months experience.

2. Psychologist II — at least a B.S. Psychology graduate; Civil Service eligible with one (1) year experience.

3. Psychologist III — a B.S. Psychology graduate, Civil Service eligible with 2 years or more experience, and with post-graduate units in clinical psychology. ADSTCa

V. EFFECTIVITY

This order takes effect immediately and revokes all previous orders contrary hereto.

Issued in Quezon City, this 12th day of February 2008.

(SGD.) ESPERANZA I. CABRAL

Secretary

Department of Social Welfare and Development

ANNEX 1

Role Delineation between Social Worker and Psychologist in the DSWD Case Management Process
Case Management		Case Manager/Social		Psychologist's Role
Process		Worker's Role
Assessment:
1)	Identification of	•	Conducts the intake interview	•	Verifies the presenting
	the Problem		determining the needs, problems,		problem considering the
			and help sought by client		information gathered by
			vis-à-vis center or residential		the social worker during the
			care facility's services.		intake interview,
		•	Clarifies the background		inputs/observation/initial
			of the problem as well as the		impressions and diagnosis by
			difficulty the client faces		the other members of the case
			indicating history and		management team.
			background of the presenting	•	Coordinates with other
			and underlying problems		members in the case
		•	Writes the initial case study		management team as he/she
			report or process recording or		analyzes pertinent data
			progress journal		in determining:
						•	Significance of the problem
						•	Behavioral manifestations
						•	Causes, onset and
							precipitating factors
						•	Frequency, intensity and
							duration of the problem
						•	Efforts to cope with the
							difficulties and current level
							of social functioning
						•	Appropriate intervention
							strategies
2)	Data gathering	•	Decides to probe deeper and	•	Gathers in-depth information
			gets to know the specifics of		(in coming up with a diagnostic
			the problem and relevant		assessment) regarding child's
			information needed for		feelings, behavior, personality
			diagnostic assessment		problems, interpersonal
			through conducting:		relations, adjustment
			•	Home Visits		difficulties, potentials,
			•	Collateral interview with		limitations, sources of strengths
				significant others		and stress, resources for
		•	Ascertain the need (social		change, and barriers to desired
			worker should be aware/		change through:
			knowledgeable of the normal		•	Clinical interviews with
			or abnormal manifestations of			client and significant others
			the client) for a psychological		•	Review of case file
			or psychiatric assessment to		•	Psychological tests and
			avoid evaluation referrals when			Behavioral observations
			there is no need to do so.		•	Engage in play, story
		•	Share client's information to			telling, etc.
			referred professionals	•	Explain to the client the
			(psychologist, psychiatrist,		objectivity of the assessment
			medical doctor, etc.).		and the role of the psychologist
						in the case management team.
3)	Diagnostic	•	States the problem based on the	•	Utilizes data gathered in
	Assessment		consolidated data gathered,		writing up a diagnostic
			indicating immediate and		statement indicating learning
			underlying problem to be		capacity and style, ability to
			worked out.		adapt past learning to new
		•	Leads the intake conference		situation, recall and
			with the case management team		discrimination, concrete and
			to discuss the situation of the		abstract thinking, motivating
			child and their plans.		factors, relational style,
		•	Writes or prepares the case		emotional resources and
			study report and shares the		coping.
			report with the other members	•	Participates in the intake
			of the team for proper		conference by sharing
			management.		information with the team
						about the client.
Intervention	•	Formulates goal/s and relative	•	Sets objectives based from the
Planning:		indicators which refer to		agreed recommended
			some type of improvement of		goals of the intervention plan
			social functioning or change in		as well as indicate specific
			client's life situation or problems		activities and strategies
			at hand as prioritized by the		(therapeutic modalities) to meet
			concurrence of the client.		the objectives.
		•	Sets up a continuous assessment	•	Sets up a continuous
			mechanism for quality assurance		assessment mechanism for
			indicating the progress of the		quality assurance indicating
			client vs. plans.		the progress of the client vs.
		•	Recommends the goal/s and		plans.
			indicator/s to the team
		•	Gets the concurrence and
			commitment of the client in the
			intervention plan by signing the
			plan as a contractual obligation
			between the team and the client
			for implementation.
Plan Implementation:	•	Provides direct services to the	•	Conduct of individual or group
			client as planned and at the		counseling sessions, play
			same time, leads the team by		therapy, ventilation and/or
			coordinating each team		debriefing sessions, systematic
			member's involvement in the		desensitization, self
			implementation of the plan.		management programs,
		•	Monitors and takes note of the		reinforcement, modeling, etc.
			progress of the client (current	•	Prepare progress notes and
			state vs. admission state).		records what to do, what is
		•	Recommends succeeding		being done and will be done
			actions (continue, transfer or		(possibly integrated in the
			termination) after the plan		monitoring tool).
			implementation.
		•	Conducts periodic case
			conferences and facilitative
			meetings with the client and
			the team.
Case Review and	•	Leads the team in reviewing the	•	Feedbacks to the team the
Evaluation:		client's case after implementation		result of the interventions
			of intervention plans (looking		applied to the client and
			back at the problem and		provide an assessment of the
			interventions applied, input and		client's current psychological
			output).		and mental health as well as
		•	Takes note of developments that		his/her recommendation for the
			may have occurred since the		client's further well being.
			definition of the problem.
Termination:	•	Consults the team and the client	•	Works hand in hand with the
			in the decision of whether or		social worker in the preparation
			continue, transfer, or terminate		of the case study report
			the helping relationship.	•	Provides adequate
		•	Case study report is updated,		information of success
			finalized and submitted to		indicators on the client's
			the concerned unit.		progress during the helping
		•	Process of reintegration of the		process
			client to his/her family and
			community is worked out.

 

ANNEX 2

		Duties and Responsibilities
Psychologist I — Salary		Psychologist II — Salary	Psychologist III — Salary
Grade 11-(Based in		Grade 15 ( Based in	Grade 18-(Based at
Centers/Residential Facilities)		the Regional Office)	Central Office
-	Administers psychological	-	Monitors, provides technical	-	Conducts regular
	tests appropriate to clients		assistance and acts as peer		monitoring and
	in centers & residential		coach to Psychologists I		technical assistance
	facilities, interprets and		assigned in centers and		to Psychologist I and
	evaluates test results		residential facilities		Psychologist II
	conducted and submits	-	Administers psychological	-	Administers clinical
	report to the social		test to cases referred by		psychological test to
	worker or the case		DSWD regional office,		special cases referred
	manager.			interprets and evaluates		at DSWD central
-	Discusses the results of		results and prepares		office, interprets and
	the tests and recommends		reports.		evaluates test results
	action to be taken with the	-	Handles cases in centers		and prepares report
	rehabilitation team.		without a psychologist	-	Acts as resource
-	Assists in the formulation		and does the work/		person to
	of rehabilitation plans,		function of the		rehabilitation team
	attends rehabilitation		Psychologist I.		meetings, case
	meetings and case	-	Acts as resource person		conferences &
	conferences.			to rehabilitation team		trainings
-	Conducts interview to		meetings, case	-	Demonstrates with
	clients to appraise their		conferences & trainings		other psychologists
	personality structure,				the following:
	studies and analyzes their				-	Conduct of
	life and family history.					individual/group
-	Conducts psychotherapy					sessions,
	through individual and					psychotherapeutic
	group sessions with					and behavior
	clients and their parents					modification
	in coordination with					techniques,
	the social worker						interviews and
-	Gives lecture on						counseling skills
	understanding the				-	Use of group
	behavior of clients					process as a tool for
-	Advises parents on the					diagnosis/screening
	proper management of				-	Conduct of crises
	clients						intervention,
-	Provides guidance and					conflict resolution,
	counseling to clients who					enhance
	has personal, occupational,					self-awareness and
	social and emotional					interpersonal
	problems						relationship, short
-	Provides counseling to					term therapy and
	other caregivers assigned					psycho-education
	in centers and residential
	facilities
-	Refers client for further
	psychiatric treatment thru
	the case manager for those
	who manifest more
	serious behavioral
	problems
-	Attends seminars,
	workshops and does
	other related task

 

ANNEX 3

CASE MANAGEMENT PROCESS FLOW

 

Published in the Official Gazette, Vol. 104, No. 20, p. 3749, May 19, 2008.