Case Management

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Case Management

• Carla Wilhite
• Occupational Therapist R/L
• Oklahoma AgrAbility Project
• Oklahoma State University

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Principles of Service Delivery

• Informed choice.
• Confidentiality
• Client centered planning

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Ethical principles to follow

• Beneficence.
• Do good.
• First, do no harm.

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Coordination of Case Management Service Delivery

• Assessment
• Planning
• Implementing
• Coordinating, again and again
• Monitoring
• Re-evaluation
• Revise plan or discharge

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Assessment

• Intake Preliminary information used to determine
  eligibility for services or referral to others
  for service.
• Assessment Observing and analyzing the barriers
  the person is facing in the farm or ranch
  operation. May involve just an interview or
  specific functional tests, measurements, etc.

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Intake

• Must be farming or wanting to farm.
• Must have a disability.
• Must need accommodations

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Definition of farming

• Broadly defined as cultivating, operating, or
  managing a farm for profit. A farm can include
  raising stock for food or fiber, dairy, poultry,
  fish, fruit, produce, orchards, providing range
  or pasturage, growing and harvesting forages,
  crops, grains, and ag-horticultural products.

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Farmers

• A farmer is defined as a person who is
• Actively engaging in farming
• Deriving income from such activity
• Or retired from farming.
• For AgrAbility purposes includes people who want
  to work in agriculture and family members of
  farmers.

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Definition of disability

• A disability is identified as a physical or
  mental impairment that substantially limits a
  major life activity. A substantial impairment
  is one that significantly limits or restricts a
  major life activity such as hearing, seeing,
  performing tasks, walking, caring for oneself,
  learning, or working.

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Accommodations

• Modifications to the work environment
• Accessibility issues
• Job re-structuring
• Modified work schedule
• Modified equipment
• Assistive technologies or adaptive devices.

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Assessment

• Styles of assessment
• Interview
• Observations
• Testing and measurement
• Eclectic (elements of all three)

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Assessment OT Style

• OT Bag
• Blood-pressure cuff and stethoscope
• Pulse-oximeter
• Strain gauge
• Dynamometer
• Goniometer
• Disc-criminator

• 9-hole peg board
• Tuning forks
• Heat/cold tubes
• Tape measure
• Digital camera
• Gait belt
• Resuscitation mask

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Assessment OT Style

• Functional assessment
• Health history, previous level of function,
  pulse, respiration rate, O2 sat, blood pressure,
  medications.
• Manual muscle testing (upper and lower)
• Hand function (prehension, fine motor, gross
  motor)

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Functional assessment cont.

• Sensory evaluation (vision, hearing, touch,
  smell, taste)
• Posture and postural deviations
• Gait and balance
• Pain scale

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OT assessment cont.

• Activities of daily living self-care, work,
  communication, driving status, leisure, etc.
• Home safety trip hazards, clutter, bathroom
  safety equipment, electrical cords and plug-ins,
  fire alarms, fire extinguishers, emergency
  egress, etc.

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OT assessment cont.

• Psycho-Social assessment
• Adjustment grief, anger, acceptance
• Depression, anxiety, suicidality
• Adaptability flexible vs. rigid
• Evidence of motivation
• Financial position or stressors
• Social support
• Community participation

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OT assessment cont.

• Work-site
• Environmental conditions
• Building access
• Workbenches
• Equipment access
• Seating in agricultural machinery
• Terrain
• Fences/gates
• Tools

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OT assessment cont.

• Miscellaneous
• Cognitive assessment
• Visual-perceptual assessment
• Use of time worksheets
• Depression scale
• Other assessment tests as needed

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Reporting

• Report should be ability focused, not deficit
  focused.
• Organized in an understandable format Intro,
  assessment, findings, recommendations, plan

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Reporting

• Uses of the report
• For goal-setting.
• For making referrals.
• For staying focused on the plan.
• For persuasion of third party payers or funding
  sources.

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Planning Goal-setting and prioritization of goals

• Goal-setting
• Client-centered goals/functional goals
• Versus
• Organizational goals
• All goals should be RUMBA
• Relevant,Understandable,Behavioral,and
• Achievable

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Client- centered goal

• Goal Farmer John will demonstrate the ability to
  safely drive a tractor with hand control
  modifications.

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• Objectives
• John will verbalize understanding the types of
  hand control adaptations available for
  agricultural machinery.
• John will acknowledge the pros and cons of
  commercial adaptations vs. local fabrication of
  controls.
• John will choose the hand control modifications
  needed for his tractor.
• John will select a strategy for financing hand
  controls.
• John will arrange for installation of devices to
  control the tractor.
• John will seek appropriate guidance or teaching
  for using hand controls to operate his tractor.

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• Activities
• Provide John with information on hand controls
  for operating tractors.
• Provide John with information on liability,
  pros/cons of locally fabricated solutions.
• Discover possible sources for local fabrication
  and commercial fabrication.
• Discuss financial resources for paying costs of
  hand controls (self-pay, DRS, combination of
  sources)
• Provide examples of a standard of safe operation
  of tractor.
• Driving instruction?

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Implementing the Plan

• Assisting the client as they enter vast
  bureaucratic systems and making sure they come
  out alive on the other end.
• Providing reliable information on which to make
  decisions.
• Assist in putting together the right array of
  resources.

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Know your resources

• Continuous and ongoing activity to locate and be
  able to refer people to the right agencies,
  services, etc.

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Coordinating

• Phone calls
• Checking in
• Facilitating decision-making
• Advocating
• Tasking others

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Monitoring

• How is it going as changes are implemented?
• Tweak, tweak, tweak as needed

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Re-evaluation

• Are the goals met? If not, why?
• Are new needs identified?
• Or is it time for closure?
• Send satisfaction survey or conduct interview?
• Document outcomes.

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Two Best Practice Tips

• Become a master of observation
• Verbal and non-verbal communiction
• Function, function, function
• Focus on what the individual wants and needs
  (client-centered), not on what you see they need
  (expert-centered).

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• Recognition
• This material is partially based on the training
  module in Case Management developed by Mary Beck,
  National AgrAbility Staff