Improving Case Management Skills for Effective Vocational Rehabilitation Services

Henry Wong, Rh.D., C.R.C.

North Carolina Center for the Advancement of Teaching

and

East Carolina University TACE Learning Consortium

May 6, 2009

What is Case Management?
What are the models, principles, and competencies of Case Management?
What are the federal legislations influencing VR?
What are the basic principles of rehabilitation philosophy?
What are the functions of Case Management?
What are the roles of the Case Manager?
How can Case Management skills be improved?

Inquiry Based Questions

Smith-Fess Act 1920
Social Security Act 1935
Rehabilitation Act 1973
Rehabilitation Amendments (1992, 1998)
Americans with Disabilities Act 1990
Individuals with Disabilities Education Act 1997
Workforce Investment Act 1998
Ticket to Work & Work Incentives Improvement Act 1999

Legislative Foundation

Disability is a natural part of human experience

Persons with disabilities have rights to:

- Live independently
- Enjoy self-determination
- Make choices
- Contribute to society
- Pursue meaningful careers
- Enjoy full inclusion & integration in economic, political, social, cultural, & educational mainstream of American society (WIA 1998)

Basic Principles of Rehabilitation Philosophy

Every human has inalienable value, societal membership, worthy of respect
Assets of persons with disabilities should be emphasized
Stress reality factors that help a person cope with environment
Treatment should vary, and be flexible
Each person should assume initiative and participation in rehab plan

Basic Principles (cont.)

Society should be responsible for providing services/opportunities to persons with disabilities
Rehab programs should be interdisciplinary with interagency integration
Rehab is a continuous process & complex
Psychological and personal reactions of the persons with disabilities are always present and crucial
Severity of handicap is ↑ or ↓ by environmental conditions

Significance of disability is affected by person’s feelings about self & situation
Client is part of larger group & not isolated
Use predictor variables of group outcomes in rehab with caution
Self-help organizations are important allies
Ensure effective dissemination of information to persons with disabilities for their benefit
Persons with disabilities should serve as co-planners, co-evaluators, & consultants to others

Basic Principles (cont.)

“A collaborative process which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual’s health needs through communications and available resources to promote quality, cost-effective outcomes.”

The Case Manager, 1994, p. 59

Case Management

Assessment of individual’s needs
Development of individualized case management plans
Facilitation, implementation, coordination of services
Monitoring and evaluating services and outcomes
Documentation of activities

Case Management - Process

Credentials

Commission for Rehabilitation Counselor Certification (CRCC)
Certified Insurance Rehabilitation Specialist Commission (CIRSC)
Certification of Disability Management Specialists Commission (CDMSC)
Commission for Case Manager Certification (CCMC)

Models, Principles, and Competencies

Contemporary Models of Case Management – Basic models

Role-based Case Management - focuses on role of the case manager (Rehabilitation counselor)

Organization-based Case Management - focuses on providing a set of comprehensive services within an agency (Comprehensive rehab. center)

Responsibility-based Case Management – focuses on transition of care from human service professionals to non-professionals, and functions performed by family, volunteers, support personnel, & consumer

Mental Health Models

Standard Case Management Models – case manager acts as advocate, purchaser, and arranger of services for the consumer

Rehabilitation-Oriented Models – focuses on strengths of person rather than pathology and collaborative working alliance between case manager and consumer

Intensive Case Management Models – emphasizes a team to meet multiple consumer needs, provide interventions in consumer’s home or work site, medication compliance, 24 hour care, & daily living supports. Requires low caseloads and assertive outreach.

Ethical Issues in Case Management

Conflicts in expectations or values between counselor and client
Conflicts in responsibilities
Variability in roles of counselor, evaluator, claims adjuster

Ethical Decision-Making

Learn and use common language of ethics and ethical decision-making
Determine some type of consensus when ethical problems arise
Be aware of how personal & professional ethics differ
Importance of using professional codes

Integrative Decision-Making Model of Ethical Behavior

Tarvydas (2004)

Interpret situation through Awareness & Fact Finding
Formulate an Ethical Decision
Select an Action by Weighing Competing, Non-moral Values, Personal Blind Spots or Prejudices
Plan & Execute the Selected Course of Action

3 Domains of Competence

Interacting between Consumer & Case Manager

Knowledge – medical, psychological, vocational, counseling, assistive technology
Skills – includes cultural competence
Affective – case manager’s attitudes, philosophy, & values associated with service delivery to consumer

Knowledge Domains for Case Management – Leahy (1994)

Coordination & service delivery
Physical & psychosocial aspects of disability
Benefit systems/cost benefit analysis
Case management concepts
Community re-entry & knowledge of community resources, Comparable Benefits

8 Functions of Case Management – Weil & Karls (1985)

Client identification & outreach
Individual assessment & diagnosis
Service planning & resource id
Linking clients to needed services
Service implementation
Monitoring service delivery
Advocacy
Evaluation

Interpersonal Communication Skills

Establish working alliance with client
Empathy
Warmth
Genuineness
Interviewing skills
Conflict resolution
Negotiate and Empower your clients

Case Management in Public Rehabilitation - Eligibility

A person with a disability
Has a physical or mental impairment which constitutes or results in a substantial impediment to employment and can benefit from VR services to achieve an employment outcome
Requires VR services to prepare for, secure, retain, or regain employment

Case Management in Public Rehabilitation - Process

Assessment – determination of vocational rehab needs to establish eligibility (medical, psychological, vocational, educational, socio-economic). Focus on strengths, resources, priorities, concerns, abilities, capabilities, interests of client
Planning – Individualized Plan for Employment (IPE)
Implementation – IPE, counseling, physical/mental restoration, training, vocational, rehabilitation engineering, assistive tech, job search/placement, interpreter services, personal care attendant & equipment/supplies
Monitoring – the rehab process
Evaluation – Is “26” the only mark of success?

Roles of the Case Manager

Advocate
Broker/Facilitator
Coordinator
Collaborator
Consultant
Counselor

Evaluator
Expediter
Planner
Record Keeper
Teacher

The Individualized Plan for Employment (IPE)

An initial written plan for rehabilitation services and amendments developed independently or jointly with technical assistance from a qualified vocational rehabilitation counselor or other source. It must be developed within a timely manner (within 90 days of being determined eligible for VR services or post employment services).

To achieve the specific employment objective of an eligible individual who can choose to develop all or part of the IPE independently or with assistance of the State VR Unit or other entity.

Purpose of the IPE

Consumer Options – State agency will provide the person with disabilities

Information about developing the IPE
Copy of written assessment of vocational rehab. Needs
Assistance of a QVRC in developing all or part of the IPE & completion of forms
Information about using technical assistance
State forms needed to develop or finalize IPE
Financial costs for services on the IPE
State agency policies on financial participation, comparable benefits & purchase of service requirements

Assessment of Vocational Rehabilitation Needs

Identifies VR needs of client and evaluates factors essential for developing the IPE
Limited to necessary information to identify rehab. Needs
Uses existing information when possible to include: SSA, other providers, programs
Relies on information from client
Personality, interests, interpersonal skills, intelligence, functional capacities, education, cultural, social, recreational, & environmental

Assessment of Vocational Rehabilitation Needs (cont.)

Need for supported employment?
Appraisal of work behaviors & services needed to acquire occupational skills, develop work attitudes, work habits, work tolerance & social skills for job success
Refer for assessment of rehab. technology services if needed
Must be in writing with copy to client

IPE Development

Agreed to & signed by client or her/his representative
QVRC will review IPE at least annually with client
Amendments must be agreed to & signed by client & QVRC before implemented
Written copy of IPE & amendments must be given to client in the native language or mode of communication

Mandatory Components of the IPE

Employment goal client is expected to achieve as a result of services under the IPE
Timeline for achieving employment goal is realistic
Based on assessment of VR needs, reflects individual’s strengths, resources, priorities, concerns, abilities, capacities, interests & informed choice
Provide training & employment in an integrated setting

Mandatory Components of the IPE (cont.)

All services must be listed on IPE necessary to achieve employment
May include Counseling/Guidance, Physical/Mental restoration, Referral, Training & Support, Placement, Services of other agencies
Criteria to evaluate progress toward achieving employment goal
Service providers

Mandatory Components of the IPE (cont.)

Financial expectations of client, explore comparable benefits & services
Counselor’s and client’s responsibilities like attendance in training, maintain grade average, meetings with counselor
Information on dispute resolution like Client Assistance Program, mediation, fair hearing & contact information
Any post-employment services client may need

Informed Choice

QVRC must tell client of opportunity to exercise informed choice throughout rehabilitation process
Assist client in acquiring information to exercise informed choice
Employment goal
VR services needed to achieve employment

Informed Choice

Providers who will deliver services, costs, accessibility, duration, qualifications, consumer satisfaction, and outcomes
Employment setting & setting in which VR services will be provided
Methods to obtain those services
Information provided in native language or preferred mode of communication, & support services to exercise informed choice

Improving Case Management Practices

Begin with the End in Mind - manage by objectives, (annual, monthly, weekly for referrals, active cases, closures, track caseload budget)
Have a Plan – Work the Plan (Be Systematic & measure your progress)
Know & follow state agency mission, policy
Keep checklist of requirements for each status
Time management – control your time rather than let time control you (appointments, meetings, conferences, paper work is clear & concise, Tickler system to monitor cases)

Calendar events yearly, monthly, weekly, daily, (Know what to expect next week, monthly, quarterly)
Involve & give responsibility to your clients when possible
Prioritize and organize your work
Use SOAP notes for case record & follow-up
Automated Web-based Activity and Reporting Environment (AWARE)
Develop relationships & Network with your team and others

Improving Case Management Practices (cont.)

Respect your secretary/office manager
Delegate paperwork
Touch paper work on your desk once
Economize & plan field visits
“Sandbag” practice
Trade or refer some clients to other counselors in client’s best interest

Improving Case Management Practices (cont.)

Evidence-Based Practice
Process of turning clinical problems into questions and systematically locating, appraising, and using current research findings as the basis for clinical decisions
Know what clinical questions to ask
How to find the best practice

Improving Case Management Practices (cont.)

Improving Case Management Practices – Evidence-Based

Critically appraise the evidence for validity and applicability to a specific care situation
Evaluate the effectiveness of care and continual improvement of the process
The best evidence-based practice is derived from a series of research results forming an empirical basis for the effectiveness of a specific treatment
The gold standard for scientific evidence is randomized clinical trials and meta-analysis to determine effectiveness of cumulative evidence of treatment
Review the research literature, attend professional development

What are your issues regarding Case Management?

Questions & Answers with Discussion

THANK YOU!

Questions…

Contact:

Henry Wong, Rh.D., C.R.C.

North Carolina Center for the Advancement of Teaching and East Carolina University TACE Learning Consortium

Email: wongh@nccat.org

TACE Center: Region IV

Toll-free: (866) 518-7750 [voice/tty]

Fax: (404) 541-9002

Web: TACEsoutheast.org

My TACE Portal: TACEsoutheast.org/myportal

Email: tacesoutheast@law.syr.edu

Education Credits

Participants may be eligible for CEU and CRCC credits.

CEU Credit – Pending Approval (.10)
- Site Coordinators must distribute the CEU form to participants seeking CEU credit on the day of the webinar.
- Site coordinators must submit CEU form to the TACE Center: Region IV by fax (404) 541-9002 by Tuesday, May 12, 2009.
CRCC Credit (1.5 per session)
- By Tuesday, May 12, 2009, participants must score 80% or better on a online Post Test and submit an online CRCC Request Form via the MyTACE Portal.

My TACE Portal:

Disclaimer

This presentation was developed by the
TACE Center: Region IV ©2009 with funds from the U.S. Department of Education, Rehabilitation Services Administration (RSA) under the priority of Technical Assistance and Continuing Education Projects (TACE) – Grant #H264A080021. However, the contents of this presentation do not necessarily represent the policy of the RSA and you should not assume endorsement by the Federal Government [34 CFR 75.620 (b)].

Copyright Information

This work is the property of the TACE Center: Region IV.

Permission is granted for this material to be shared for non-commercial, educational purposes, provided that this copyright statement appears on the reproduced materials and notice is given that the copying is by permission of the authors. To disseminate otherwise or to republish requires written permission from the authors.