case management
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Chapter31.pptxRHB 3040 Case Management
Chapter Notes
Chapter Three
Chapter 3 Helpful Tip
Chapter 3 may seem overwhelming and sometimes out of order. If you understand the following chapter notes on important concepts, the instructors explanation, as well as the supplemental examples to assist you, you will have the necessary info for this section and do fine on the exam.
You will get a better feel of this process in your job shadowing as well.
Case Management Process
Case Finding and Targeting
Gathering and Assessing Information
Planning
Reporting
Obtaining Approval
Coordination of Plan
Follow-up
Evaluation
Case Finding and Targeting
Depending on the population, you may have to find cases (private rehab CM) but will more likely be referred consumers (nonprofit agencies). (P 39)
Referral sources
Hospitals/MDs/PTs to Ind. Living Centers
State Vocational Rehabilitation or Worker’s Comp
Psychiatric Hospitals/Psychiatrists/Mental Health Agencies
Homeless Shelters
Court Systems (Adult and Juvenile)
Gathering and Assessing Info
Talking with Referral Sources
Generally the referral source will provide information on the consumer, why the consumer was referred (homelessness, injury at work, etc.), and expectations for services or outcomes.
Fees and chargeable expenses, time frames, expected reports/assessments, and other pertinent information is upfront information necessary for CM services.
Gathering and Assessing Info
Talking with Referral Sources
Understand what your payer (referral source) expects as far as contact (in person, over the phone), with whom, and how quickly (24 hours after referral, etc.)
Understand what is the purpose of your assistance (employment, housing, Ind. Living, mental health management)
Understand how long the case is expected to last. Some agencies work with individuals for as long as they need assistance, as long as they are alive, or only for a specific about of time such as until suitable employment is reached and maintained for a specified amount of time.
P 123-124
Initial Meeting
Please review in PILOT my Instructor Explanation for information on the initial meeting or intake of a consumer and examples of forms to assist in gathering information.
Review the example of a professional letter template on p 59 for an intake.
Interviewing Method
R.I.P. Method of Conducting Interviews
Rapport (Build a connection)
Information (Obtain specific information or complete objective of contact)
Plan (Verbally communicating the next step)
Using your RHB 4070 skills
(I jumped ahead- P 123)
Meeting with a Consumer
First ascertain their understanding of the disability or life situation that has resulted in the referral.
Determine if they understand the implications of diagnoses, limitations, and recommendations.
Some consumers have their own set limitations for the condition, either less or more than doctor’s recommendations.
Never go beyond a doctor’s release
If a consumer says they can’t lift over 10 lbs, even if they can, they likely won’t so it probably won’t do you any good to go beyond it.
P 62-71
Meeting with a Consumer
Learn about past medical issues/hospitalizations and current medications (and if they take the meds as directed)
Some consumers are not the best historians so medical records should be obtained and possible interviews with family members
I suggest a full health checklist because consumers often do not connect conditions and limitations, as well, even if a pre-existing condition is not related to the current reason for the referral, it does not mean that it will not affect your case.
Meeting with a Consumer
Beyond the medical information, a CM will need to know:
Insurance info (SSI/SSDI, Veterans benefits, Insurance through themselves or a family members)
Income
Family situation (for transportation and issues)
Vocational past and interests
Contact info
360 Analysis of Family
Obtaining info from family about the consumer
Obtain info from family about the roles and current status of family obligations (and how they may have changed)
If the consumer has a care taker, how have those responsibilities been managed and what has been changed to provide assistance?
Obtain how the family is doing physically and emotionally
P 71-72
Talking with MDs and other Professionals
This section provides examples of phone calls and letters.
Please review as you never know when a question will pop up on the exam about connecting with medical and other professional personnel.
P 73-98
Assessments
Often a case manager can get information to assist with assessing a consumer’s abilities and needs.
Medical Exam (MD)- diagnoses and meds
Functional Capacity Evaluation (MD/PT)- physical limitations and abilities
Psychological Evaluation (Psychologist)- mental health diagnoses, meds, history, and concerns
Neuropsychological Eval (Psych)- assessment of learning disabilities, traumatic brain injury, and brain functioning
Vocational Assessment- community based assessments of skills, vocational interests, temperaments, abilities, etc.
Assessing a Consumer
Assessment is good for:
Determining Eligibility
Determining strengths and areas of need
Determining what is covered by CM (pg 42)
Next steps to be built into the plan
Please review in PILOT a) Instructor Explanations, b) Assessments across Settings, and c) examples of assessment reports typical in this field.
Planning
CM services that rehab students provide often occur throughout or after “treatment” is provided and someone has reached his or her maximum physical and emotional abilities. Reviewing and providing feedback on current medical treatments is not likely going to occur.
However, CMs will need to know the current abilities and limitations, as well as any progressive limitations or symptoms that may occur.
Planning – p 98-102
Planning
Planning will focus on the actual outcome goal that is outlined. Some areas of assistance include:
Homeless = finding safe housing and income.
An injured worker = accommodations or new employment or training then new career, home and vehicle modifications
A stroke survivor = independent living skills training and community resource assistance
Person with severe mental health or development disability = all of the above
Planning
CMs are mediators between other professionals assisting consumers to locate needed services, provide information on service providers so the consumer can make informed choices, coordinate appointments and transportation, monitor the receipt of needed services, advocate for consumers when needed, as well as evaluate how effective those services are for the individual.
Planning
Cost is a factor
If insurance is covering the bill, there will be requirements for duration, cost, and what is covered.
There is a good chance you will be working with individuals who do not have medical insurance or are covered under Medicaid due to disability or poverty. In this instance, free services, county services, etc.– all must be taken into consideration as referring someone for services that they cannot afford is not helpful.
Case Reporting
Rule of thumb is document with a case note at the time of any contact (don’t wait until the next day or end of week or you will forget)
Also, most payers expect a report monthly through pre-approved forms with pre-approved required information
Case Notes and reports should always be objective not subjective (client’s clothes were stained and hair uncombed vs client was nasty/unprepared today)
P 102-116
Recommendations
Recommendations are where needs are addressed.
Based on (specific need), it is recommended that Ms. Jones gets (further info needed, service, equipment, training, etc. based on financial constraints/referrer’s rules, geographic location, community resources, consumer’s agreement, CM judgment, etc.)
Options should be provided so there is choice and room for discussion about pros and cons in regards to the best fit for the situation and consumer.
See Comprehensive Assessment
Obtaining Approval
Everyone must be on board.
People get on board by having an effective report that is based on a thorough intake/assessment phase and solid, justifying recommendations.
P 116
Coordinating
Your consumer, due to medications, illnesses, depression, confusion, feelings of being overwhelmed, not understanding the system, pressures from family and payers (and the list could go on), will not be able to monitor everything going into a plan. This is how you will be essential to the process and to the consumer’s success.
P 117-119
Follow-Up
CMs need to make sure that not only are the services being provided, but that they are being effective.
Is the consumer following through, are the services meeting the needs of the consumer, are the services high quality, etc.?
If something is not working, the CM needs to find out what is not working and why (medication change, change in staff, overcommitted facility, etc.).
P 120
Evaluating the Plan
Has the person received a specific service for the typical amount of time with no movement or minimal movement towards the goal?
Is the service not necessary, is the goal not reasonable, or is the service provider not performing appropriately?
Is he or she on the preset schedule or falling behind?
If the plan is not on schedule, is there a reasonable explanation (sickness, unexpected car accident in family) or does the CM need to inquire?
121-122
