Case ManagementCase Management

Principles of Service DeliveryPrinciples of Service Delivery

• Informed choice.Informed choice.

• ConfidentialityConfidentiality

• Client centered planningClient centered planning

Ethical principles to followEthical principles to follow

• Beneficence.Beneficence.

• Do good.Do good.

• First, do no harm.First, do no harm.

Coordination of Case Coordination of Case Management Service DeliveryManagement Service Delivery

• AssessmentAssessment

• PlanningPlanning

• ImplementingImplementing

• Coordinating, again and againCoordinating, again and again

• MonitoringMonitoring

• Re-evaluationRe-evaluation

• Revise plan or “discharge”Revise plan or “discharge”

AssessmentAssessment

• IntakeIntake: Preliminary information used to : Preliminary information used to determine eligibility for services or determine eligibility for services or referral to others for service.referral to others for service.

• AssessmentAssessment: Observing and analyzing : Observing and analyzing the barriers the person is facing in the the barriers the person is facing in the farm or ranch operation. May involve farm or ranch operation. May involve just an interview or specific functional just an interview or specific functional tests, measurements, etc.tests, measurements, etc.

IntakeIntake

• Must be farming or wanting to farm.Must be farming or wanting to farm.

• Must have a disability.Must have a disability.

• Must need accommodationsMust need accommodations

Definition of farming:Definition of farming:

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

FarmersFarmers

• A farmer is defined as a person who is:A farmer is defined as a person who is: Actively engaging in farmingActively engaging in farming Deriving income from such activityDeriving income from such activity Or retired from farming.Or retired from farming. For AgrAbility purposes: includes people For AgrAbility purposes: includes people

who want to work in agriculture and family who want to work in agriculture and family members of farmers.members of farmers.

Definition of disabilityDefinition of disability

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

AccommodationsAccommodations

Modifications to the work environmentModifications to the work environment Accessibility issuesAccessibility issues Job re-structuringJob re-structuring Modified work scheduleModified work schedule Modified equipmentModified equipment Assistive technologies or adaptive devices.Assistive technologies or adaptive devices.

AssessmentAssessment

• Styles of assessment:Styles of assessment: InterviewInterview ObservationsObservations Testing and measurementTesting and measurement Eclectic (elements of all three)Eclectic (elements of all three)

Assessment: “OT Style”Assessment: “OT Style”

• OT Bag:OT Bag: Blood-pressure cuff Blood-pressure cuff

and stethoscopeand stethoscope Pulse-oximeterPulse-oximeter Strain gaugeStrain gauge DynamometerDynamometer GoniometerGoniometer Disc-criminatorDisc-criminator

• 9-hole peg board9-hole peg board• Tuning forksTuning forks• Heat/cold tubesHeat/cold tubes• Tape measureTape measure• Digital cameraDigital camera• Gait beltGait belt• Resuscitation maskResuscitation mask

Assessment: “OT Style”Assessment: “OT Style”

• Functional assessment:Functional assessment: Health history, previous level of function, Health history, previous level of function,

pulse, respiration rate, O2 sat, blood pulse, respiration rate, O2 sat, blood pressure, medications.pressure, medications.

Manual muscle testing (upper and lower)Manual muscle testing (upper and lower) Hand function (prehension, fine motor, Hand function (prehension, fine motor,

gross motor)gross motor)

Functional assessment cont.Functional assessment cont.

• Sensory evaluation (vision, hearing, Sensory evaluation (vision, hearing, touch, smell, taste)touch, smell, taste)

• Posture and postural deviationsPosture and postural deviations

• Gait and balanceGait and balance

• Pain scalePain scale

OT assessment cont.OT assessment cont.

• Activities of daily living: self-care, work, Activities of daily living: self-care, work, communication, driving status, leisure, etc.communication, driving status, leisure, etc.

• Home safety: trip hazards, clutter, bathroom Home safety: trip hazards, clutter, bathroom safety equipment, electrical cords and plug-safety equipment, electrical cords and plug-ins, fire alarms, fire extinguishers, emergency ins, fire alarms, fire extinguishers, emergency egress, etc.egress, etc.

OT assessment cont.OT assessment cont.

• Psycho-Social assessment:Psycho-Social assessment: Adjustment: grief, anger, acceptanceAdjustment: grief, anger, acceptance Depression, anxiety, suicidalityDepression, anxiety, suicidality Adaptability: flexible vs. rigidAdaptability: flexible vs. rigid Evidence of motivationEvidence of motivation Financial position or stressorsFinancial position or stressors Social supportSocial support Community participationCommunity participation

OT assessment cont.OT assessment cont.

• Work-site:Work-site: Environmental conditionsEnvironmental conditions Building accessBuilding access WorkbenchesWorkbenches Equipment accessEquipment access Seating in agricultural machinerySeating in agricultural machinery TerrainTerrain Fences/gatesFences/gates ToolsTools

OT assessment cont.OT assessment cont.

• Miscellaneous:Miscellaneous: Cognitive assessmentCognitive assessment Visual-perceptual assessmentVisual-perceptual assessment Use of time worksheetsUse of time worksheets Depression scaleDepression scale Other assessment tests as neededOther assessment tests as needed

Reporting:Reporting:

Report should be ability focused, not Report should be ability focused, not deficit focused.deficit focused.

Organized in an understandable Organized in an understandable format: Intro, assessment, findings, format: Intro, assessment, findings, recommendations, planrecommendations, plan

Reporting:Reporting:

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

funding sources.funding sources.

Planning: Goal-setting and Planning: Goal-setting and prioritization of goalsprioritization of goals

• Goal-setting:Goal-setting: Client-centered goals/functional goalsClient-centered goals/functional goals

• VersusVersus

Organizational goalsOrganizational goals

• All goals should be RUMBA:All goals should be RUMBA:RRelevant,elevant,UUnderstandable,nderstandable,BBehavioral,andehavioral,and

AAchievablechievable

Client- centered goal Client- centered goal

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

• Objectives:Objectives: John will verbalize understanding the types of hand John will verbalize understanding the types of hand

control adaptations available for agricultural machinery.control adaptations available for agricultural machinery. John will acknowledge the pros and cons of commercial John will acknowledge the pros and cons of commercial

adaptations vs. local fabrication of controls.adaptations vs. local fabrication of controls. John will choose the hand control modifications needed John will choose the hand control modifications needed

for his tractor.for his tractor. John will select a strategy for financing hand controls.John will select a strategy for financing hand controls. John will arrange for installation of devices to control the John will arrange for installation of devices to control the

tractor.tractor. John will seek appropriate guidance or teaching for using John will seek appropriate guidance or teaching for using

hand controls to operate his tractor.hand controls to operate his tractor.

• Activities:Activities: Provide John with information on hand Provide John with information on hand

controls for operating tractors.controls for operating tractors. Provide John with information on liability, Provide John with information on liability,

pros/cons of locally fabricated solutions.pros/cons of locally fabricated solutions. Discover possible sources for local Discover possible sources for local

fabrication and commercial fabrication.fabrication and commercial fabrication. Discuss financial resources for paying Discuss financial resources for paying

costs of hand controls (self-pay, DRS, costs of hand controls (self-pay, DRS, combination of sources)combination of sources)

Provide examples of a standard of safe Provide examples of a standard of safe operation of tractor.operation of tractor.

Driving instruction?Driving instruction?

Implementing the PlanImplementing the Plan

• Assisting the client as they enter vast Assisting the client as they enter vast bureaucratic systems and making sure bureaucratic systems and making sure they come out alive on the other end.they come out alive on the other end.

• Providing reliable information on which Providing reliable information on which to make decisions.to make decisions.

• Assist in putting together the right array Assist in putting together the right array of resources.of resources.

Know your resources:Know your resources:

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

CoordinatingCoordinating

• Phone callsPhone calls

• ““Checking in”Checking in”

• Facilitating decision-makingFacilitating decision-making

• AdvocatingAdvocating

• Tasking othersTasking others

MonitoringMonitoring

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

Re-evaluationRe-evaluation

• Are the goals met? If not, why?Are the goals met? If not, why?

• Are new needs identified?Are new needs identified?

• Or is it time for closure?Or is it time for closure? Send satisfaction survey or conduct Send satisfaction survey or conduct

interview?interview? Document Document outcomes.outcomes.

Two Best Practice TipsTwo Best Practice Tips

• Become a master of observationBecome a master of observation:: Verbal and non-verbal communictionVerbal and non-verbal communiction Function, function, functionFunction, function, function

• Focus on what the individual wants and Focus on what the individual wants and needs (client-centered), not on what needs (client-centered), not on what you see they need (expert-centered).you see they need (expert-centered).

• Recognition:Recognition: This material is partially based on the This material is partially based on the

training module in Case Management training module in Case Management developed by Mary Beck, National developed by Mary Beck, National AgrAbility StaffAgrAbility Staff