Case Management
Carla Wilhite
Occupational Therapist R/L
Oklahoma AgrAbility Project
Oklahoma State University
Principles of Service Delivery
• Informed choice.
• Confidentiality
• Client centered planning
Ethical principles to follow
• Beneficence.
• Do good.
• First, do no harm.
Coordination of Case
Management Service Delivery
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Assessment
Planning
Implementing
Coordinating, again and again
Monitoring
Re-evaluation
Revise plan or “discharge”
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.
Intake
• Must be farming or wanting to farm.
• Must have a disability.
• Must need accommodations
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 aghorticultural products.
Farmers
• A farmer is defined as a person who is:
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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.
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.
Accommodations
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Modifications to the work environment
Accessibility issues
Job re-structuring
Modified work schedule
Modified equipment
Assistive technologies or adaptive devices.
Assessment
• Styles of assessment:
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Interview
Observations
Testing and measurement
Eclectic (elements of all three)
Assessment: “OT Style”
• OT Bag:
 Blood-pressure cuff
and stethoscope
 Pulse-oximeter
 Strain gauge
 Dynamometer
 Goniometer
 Disc-criminator
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9-hole peg board
Tuning forks
Heat/cold tubes
Tape measure
Digital camera
Gait belt
Resuscitation mask
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)
Functional assessment cont.
• Sensory evaluation (vision, hearing,
touch, smell, taste)
• Posture and postural deviations
• Gait and balance
• Pain scale
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 plugins, fire alarms, fire extinguishers, emergency
egress, etc.
OT assessment cont.
• Psycho-Social assessment:
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Adjustment: grief, anger, acceptance
Depression, anxiety, suicidality
Adaptability: flexible vs. rigid
Evidence of motivation
Financial position or stressors
Social support
Community participation
OT assessment cont.
• Work-site:
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Environmental conditions
Building access
Workbenches
Equipment access
Seating in agricultural machinery
Terrain
Fences/gates
Tools
OT assessment cont.
• Miscellaneous:
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Cognitive assessment
Visual-perceptual assessment
Use of time worksheets
Depression scale
Other assessment tests as needed
Reporting:
 Report should be ability focused, not
deficit focused.
 Organized in an understandable
format: Intro, assessment, findings,
recommendations, plan
Reporting:
• Uses of the report:
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For goal-setting.
For making referrals.
For staying focused on the plan.
For “persuasion” of third party payers or
funding sources.
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
Client- centered goal
• Goal: Farmer John will demonstrate the
ability to safely drive a tractor with hand
control modifications.
• 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.
• 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?
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.
Know your resources:
• Continuous and ongoing activity to
locate and be able to refer people to the
right agencies, services, etc.
Coordinating
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Phone calls
“Checking in”
Facilitating decision-making
Advocating
Tasking others
Monitoring
• How is it going as changes are
implemented?
 Tweak, tweak, tweak as needed
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.
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).
• Recognition:
 This material is partially based on the
training module in Case Management
developed by Mary Beck, National
AgrAbility Staff