Case Management

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Case Management

• Lecture 17, November 4, 1998
• Wrap-up Assessment

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Review Categorical Ordering of Major Counseling
Dynamics...

• ...that Occur Throughout Levers Recursive Stages
• Stage 1
• professional disclosure
• client role induction
• establishing trust
• data collection
• identifying problems-identifying purpose
• conceptualizing the case
• initiating the working alliance

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cont.

• Stage 2
• developing the working alliance
• refining case conceptualization/diagnosing
• setting goals-marking purpose
• planning interventions
• meaning-making
• checking progress

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cont.

• Stage 3
• facilitating client-acquisition of therapeutic
  gain
• determining an end point
• planning termination
• potential referrals for additional or ongoing
  services
• termination
• Sequential progression through stages is always
  recursive

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R R Rehabilitation Counselors Vocational
Counseling

• Rehabilitation counselors need to be skilled in
  vocational counseling
• Create experiences that allow a person to
  explore self within the context of work
• Knowledge of self, educational options,
  vocational possibilities enhance outcomes
• Persons with disabilities job satisfaction was
  strongly related to appropriate interest match
  with specific vocational area

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Review Assessment

• Levels of Assessment
• Global level
• Basis of service plans
• Specific level
• Strategies in response to encountered barriers
• More specific level
• Moment-by-moment interactions, e.g., determining
  an appropriate verbal response in a given context
  that will produce an intended response or outcome

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Review Cronbachs Conceptualization (1990)

• Maximum performance
• Used to predict best performance
• ability, aptitude, achievement
• Typical performance
• How an individual might typically behave in
  various situations
• interests, values, personality characteristics

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Reliability Validity

• Reliability
• Degree to which scores are free from errors of
  measurement
• Consistency of scores obtained by the same
  persons when reexamined on different occasionsor
  under other variable conditions
• Validity
• What the test measures, and how well it does so
• Tells us what can be inferred from scores

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Standardization

• Established normative sample
• Carefully specified procedure for administration
  and scoring of each member of the normative
  sample
• Standardized administration of the test to others
  can be scored and results compared to the
  normative sample

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Assessment Methods

• Interviews
• Standardized Tests and Inventories
• Simulations of Work and Living Tasks
• Simulated and Real Environments
• Functional Assessment
• Systemic approach to describing skill, current
  behavior, or both
• Integration of interviews, observation,
  self-report, examinations

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Interpretation and Synthesis of Assessment
Information

• Interpretation Degrees of Inference
• Lowest Samples of behavior in their own right
• Next higher level Bits of information are
  interrelated in search of consistencies and
  generalizations
• Next higher level A hypothetical construct
  (e.g. depression) may be used to describe the
  essence of the consistencies or generalizations
  identified

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Note

• Interpretation can often be far removed from the
  original data source
• Keep this in mind when consuming and interpreting
  data

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Organization of Assessment Information

• Assets
• Limitations
• Preferences
• Information that addresses the individual AND the
  environment

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Synthesis of Information

• Comprehensive working model of the individual
• Begins with INDUCTIVE reasoning
• inferences are drawn about individual bits of
  information and apparent consistencies between
  them
• ...then DEDUCTIVE reasoning is used...
• formulate and test hypotheses regarding the
  usefulness of the working model (accounting for
  already available info as well as predictions

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Working Model revisions

• To the extent that the model does not account for
  or predict relevant information, the model is
  revised based upon new data gathered

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Danger! Bias in Interpretation and Synthesis

• Nezu Nezu, 1993
• Availability heuristic
• Readily recalled past experience exerts undue
  influence, fail to consider other explanations
• Representativeness heuristic
• Belief about individuals who share one feature
  will likely share another (stereotypes)
• Anchoring heuristic
• Initial impressions that are resistant to change

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Final Phase of Assessment Clinical and Service
Decisions

• Common to RC practice (detail in chapter)
• Selection for service
• Establishment of vocational objectives
• Identification of needed interventions
• Formulation of case service plan
• Disability determination
• Make use of the working model of the individual
  to make predictions corresponding to the above
  areas

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Future Perspectives

• Number of assessment tools available is
  ever-increasing
• Tests in Print IV (1994) indicated over 3,000
  commercially available
• Work sample/related systems 18 (Brown et al.,
  1994)
• Job Search software systems 12 (Berven, 1997)
• These numbers will likely increase dramatically
  in the years ahead

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Computerized Assessment

• Burkhead and Sampson (1985) reviewed applications
  in rehab counseling
• Recent advances include the use of Adaptive
  Testing for tests like the GRE, Marriage and
  Family Therapy Board Exam, and even State Drivers
  License Bureaus
• Adaptive testing decreases the number of items
  administered, and bases each subsequently
  administered item upon the response to the former

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Systematic Practice Case and Caseload Management

• Cassell, Mulkey, Engen, in Maki Riggar, Ch 14
• Roessler Rubin, Ch 10
• November 5, 1997

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Systematic Practice

• Counseling
• The recursive dynamic chapter (11)
• Management
• Working in synergy
• balance principle

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Management Skills

• Cassell Mulkey(1985)
• it is evident that even the most
  counseling-oriented rehabilitation practitioner
  cannot survive without implementation of a t
  least minimal skills in management (p. xiv)
• Greenwood (1992)
• Caseload management emanates from a managing role

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Rehabilitation Caseload Management (CLM)

• Five point model
• 1. boundary definitions
• defines actions, micromanagement, macromanagement
• 2. skill clusters
• planning, organizing, coordinating, directing,
  controlling
• 3. personal control
• drives the system

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cont.

• 4. action decisions
• set objectives, proactive, outcome focus
• 5. systems approach
• politico-mandated
• These five points affect case load management
  skills

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The Paradigm

• Know the definitions that guide your performance
• Develop the necessary management skills
• Use time management skills to manage
  responsibilities
• Setting objectives and making good decisions
• Systems approach to managing complex information

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1. Boundary Definitions

• Personal and professional definitions of identity
  and purpose (scope of practice)
• ...a systematic process which assists persons
  with physical, mental, developmental, cognitive,
  and emotional disabilities to achieve their
  personal, career, and independent living goals in
  the most integrated setting possible through the
  application of the counseling process. The
  counseling process involves communication, goal
  setting, and beneficial growth or change through
  self-advocacy, psychological, vocational, social,
  and behavioral interventions

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Styles of Management

• Proactive
• Anticipate problems before they happen or become
  a crisis. Assertive, in charge, risk taker,
  problem preventer (not just problem solver).
• Reactive
• Low initiative, nonanticipatory, low personal
  control over various aspects of management tasks.

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Certified Case Manager (CCM)

• Introduced in 1993, sponsored by the
  Certification of Insurance Rehabilitation
  Specialists Commission (CIRSC), now the
  Certification of Disability Management
  Specialists Commission (CDMSC).
• CIRSC had a CIRS credential, which was renamed
  the Certified Disability Management Specialist
  (CDMS).

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CCM Certification Guide

• Case management is not a profession in itself,
  but an area of practice within one's profession.
  Its underlying premise is that when an individual
  reached the optimum level of wellness and
  functional capability, everyone benefits the
  individual being served, the support systems, the
  health care delivery systems, and the various
  reimbursement sources. Case management serves as
  a means for

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• achieving client wellness and autonomy through
  advocacy, communication, education,
  identification, of services resources, and
  service facilitation. The case manager helps
  identify appropriate providers and facilities
  throughout the continuum of services, while
  ensuring that available resources are being used
  in a timely and cost-effective manner in order to
  obtain optimum value for both the client

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• and the reimbursement source. Case management
  services are best offered in a climate that
  allows direct communication between the case
  manger, the client, and appropriate service
  personnel, in order to optimize the outcome for
  all concerned. Certification determines that the
  case manager possesses the education, skills, and
  experience required to render appropriate
  services based on sound principles of practice.

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Case Management

• a collaborative process which assesses, plans,
  implements, coordinates, monitors, and evaluates
  the options and services to meet an individuals
  health needs, using communication and available
  resources to promote quality, cost-effective
  outcomes.

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Case management process

• Case identification and selection
• Identifying clients who will benefit from case
  management
• Objective assessment
• Develop a plan of care
• Implement the plan
• Monitor and reevaluate plan
• Evaluation of outcome re goals

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Caseload management (CLM)

• how to work with more than one case at a time,
  how to select which case to work with, how to
  move from one case to another, how to establish a
  system to insure movement of all cases, and how
  to meet the objectives one has established, in
  terms of numbers served.

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Caseload versus Case Management

• CM is the process, CLM is the gestalt
• CLM is Macromanagement
• Large scale or system management
• CM is Micromanagement
• Managing smallest of details

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2. Skill Clusters

• Planning
• Taking obscure or incomplete information and
  making good predictions on outcome
• Use a calendar
• Use anticipatory decision making
• Make planning a part of each day
• Use strategic planning
• Successive plans, one building upon the other

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Organizing

• Set ABC priorities
• Learn to ICE problems
• Insulate (be selectively unavailable)
• Concentrate (Block out times to concentrate on
  the A category things)
• Eliminate (avoid nonessential activities)
• Use a tickler system
• Helps you to jog your memory (planner, calendar,
  etc.)

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Coordinating

• Counselor AND Coordinator
• Continuity
• bring together assessed needs, develop
  interventions
• Concatenation
• focus on linking elements (entities that are cost
  effective)
• Power Communication
• Contacting organizational leadership effectively

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Directing

• Keeping the consumer perspective in mind
• Assertiveness Ability to say no
• Do it now! Overcoming action inertia
• Five levels of initiative
• Must transfer initiative to the consumer (p. 228)
• Waiting to be told what to do
• Asking what next?
• Recommending a course of action, then acting
• Taking action independently, reporting
  immediately
• Independence, report routinely

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Controlling (last of skill cluster)

• Pulls together the other skill clusters to work
  as a functional whole.
• Tickler system (p. 229-230)
• 1. Prioritize cases
• 2. Set up weekly cycle for entire caseload
• 3. Initiate the tickler system on your planner
• 4. Keep the cycle going (use good notes, p. 230)
• Youll need a system in order to be successful!

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3. Personal Control

• The fuel that drives the skill cluster
• Internal vs. external control orientation
• Internal take charge, take risks, manage time
  appropriately, respond assertively, and apply
  self-motivation and rewards for outcomes
• External confusion over priorities,
  procrastinates, not a risk taker, easily
  manipulated by assertive or aggressive people,
  unable to establish systematic approach to case
  management

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Action Decisions

• Apex of decision making initial choice to act
  or not act
• Procrastination is the greatest threat to any
  action decision
• Action decision solution
• Need accurate, adequate information
• Set objectives compromise is an important part
• Specific, measurable, achievable, relevant, time-
  specific (SMART)
• Be proactive Select your action decisions
• Maintain outcome focus

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4. Systems Approach

• You must have a self-constructed system of
  operations in place to be effective
• Systematic weighing and judging of competing
  demands
• Consistency and effectiveness are key!

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Roessler Rubin Chapter

• Systematic Caseload Management
• Planning for effective allocation of counselor
  functions and tasks
• Managing the implementation of the plan
• Evaluating the effectiveness of the plan and
  implementation

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Planning

• R R list 9 aspects of planning in case
  management
• These issues were reviewed earlier

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Managing Time Allocations

• Intake Interviewing
• Rapid follow-up for new referrals in prompt
  fashion
• Counseling Planning
• At least hour process time for assessment
  information and minimum of hour of face-to face
  counseling depending on the needs of the client.

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Managing time allocations cont.

• Arranging, Coordinating, and Purchasing Services
• Make time allotment for arrangement after the
  intake interview (example 30 minutues after the
  initial interview to make arrangements).
• Devote time to processing client information to
  develop other possibilities for the client to
  consider.
• Interaction with community service providers
• Purchase of rehabilitation services

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Managing time allocations cont.

• Placement and Follow-up Services
• Monitoring and Problem Solving
• Business Management
• Budget management, funds reallocated to more
  pressing needs.
• Case recording or reporting insurance agency,
  community service providers

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Time Management Principles

• R R provide a nice description of specific
  instances in a state-federal VR setting where the
  principles reviewed earlier are operationalized

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Evaluation Monitoring, Judging, and Changing

• Evaluation of case management takes the form of
• Monitoring Time map
• Judging Analyze unmet goals, re-prioritize
• Changing Determine what should be done to
  accomplish goals

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