Case Management

1. Case Management Carla Wilhite Occupational Therapist R/L Oklahoma AgrAbility Project Oklahoma State University

2. Principles of Service Delivery • Informed choice. • Confidentiality • Client centered planning

3. Ethical principles to follow • Beneficence. • Do good. • First, do no harm.

4. Coordination of Case Management Service Delivery • Assessment • Planning • Implementing • Coordinating, again and again • Monitoring • Re-evaluation • Revise plan or “discharge”

5. 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.

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

7. 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.

8. 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.

9. 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.

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

11. Assessment • Styles of assessment: • Interview • Observations • Testing and measurement • Eclectic (elements of all three)

12. 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 Assessment: “OT Style”

13. 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)

14. Functional assessment cont. • Sensory evaluation (vision, hearing, touch, smell, taste) • Posture and postural deviations • Gait and balance • Pain scale

15. 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.

16. 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

17. OT assessment cont. • Work-site: • Environmental conditions • Building access • Workbenches • Equipment access • Seating in agricultural machinery • Terrain • Fences/gates • Tools

18. OT assessment cont. • Miscellaneous: • Cognitive assessment • Visual-perceptual assessment • Use of time worksheets • Depression scale • Other assessment tests as needed

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

20. 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.

21. 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

22. Client- centered goal • Goal: Farmer John will demonstrate the ability to safely drive a tractor with hand control modifications.

23. 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.

24. 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?

25. 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.

26. Know your resources: • Continuous and ongoing activity to locate and be able to refer people to the right agencies, services, etc.

27. Coordinating • Phone calls • “Checking in” • Facilitating decision-making • Advocating • Tasking others

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

29. 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.

30. 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).

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