Case Management Research in Rehabilitation

1. Case ManagementResearch in Rehabilitation Lecture 19, November 11, 1998 Wrap-up Assessment

2. Research in Rehabilitation Counseling You can make a difference! (Bolton & Parker, 1992, in Parker & Szymanski)

3. The Value of Research: Barriers • The language • Quantitative Analysis and Statistical Data Presentation [Williams, F. (1992). Reasoning with statistics: How to read quantitative research (4th ed.). Fort Worth: Harcourt.] • Application to practice

4. Your Professional Responsibility • Consumer of research • Communicate ideas to researchers • Facilitate research efforts • Apply research to daily practice

5. The Scientific Method • Knowledge, self correction, elaboration • Five Steps • Problem identification • research question/hypothesis formation • design and conduct research • hypothesis testing • interpretation and theory development and evaluation

6. A Brief Overview of Measurement and Statistics • Test stimuli, standardized situations, responses, raw scores, derived scores • Reliability of Tests • Consistent levels of performance across time • Test-Retest, alternate forms, split-half, and Kuder-Richardson (KR) reliability (all based on correlation) • See Anastasi (1988), Chronbach (1984)

7. Validity: Single Most Important Quality of a Test • Validity of Tests • Does the test measure what it was designed to measure? • Content Validity • Covers relevant material • Criterion-related Validity • Correlation between scores on test and criterion for performance (concurrent and predictive) • Construct Validity • Measures vary according to theoretical expectations

8. Statistical Analyses • Probability values in support of hypotheses • The Null Hypothesis • Summary Indices • Central Tendency: Mean, Median • Variability and dispersion: Range, Standard Deviation • Covariation and Correlation • Multivariate relationships

9. Research Design • Variables: Observable, unobservable • Independent, Dependent • Confounding Variables: Error • Validity of Research • Internal: Control of error** • External: Generalizability of findings • Statistical Conclusion: Correct use of stats • Construct: Define & measure IV and DV

10. Experimental Designs • Random assignment of participants to treatment and control groups • Pre-test post-test • Post-test only design • Solomon four group design • Combines the benefits of the previous two designs

11. Quasi-Experimental Design • Random assignment of participants to treatment and control groups is not conducted. • Helpful when random assignment is not possible • May use statistical controls to compensate

12. Ex Post Facto Design • “after the fact” • Independent variable not under the control of the experimenter • Cannot interpret causality • Most common design in rehabilitation counseling research • Ethical, legal, and moral concerns of manipulating some variables

13. Multivariate Strategies • Univariate: artificial situations • Analyzing dependence • 2 or more IVs and one DV • Analyzing interdependence • No distinction between IVs or DVs • If manipulation of IV is not ethical • Examines covariation and summarizes relationships among variables

14. Ten Categories of RC Competence: Vocational Counseling Assessment Planning and interpretation Personal adjustment counseling Case management Job Placement Group and Behavioral Techniques Professional and community involvement Consultation Job analysis Assessment Administration Example of Clustering Technique

15. Single Subject Research • Oldest Form of Research • Psychometric, nonmanipulative • Intervention: Measures of Change • Directly applicable to counseling practice

16. Quick review of BIAS • 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

17. Systematic Practice: Case and Caseload Management Cassell, Mulkey, & Engen, in Maki & Riggar, Ch 14 Roessler & Rubin, Ch 10 November 11, 1998

18. Systematic Practice • Counseling • The recursive dynamic chapter (11) • Management • Working in synergy • “balance” principle

19. 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

20. 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

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

22. 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

23. 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”

24. 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.

25. 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).

26. 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

27. 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

28. 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.

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

30. 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

31. 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.

32. 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

33. 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

34. 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.)

35. 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

36. 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

37. 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) • You’ll need a system in order to be successful!

38. 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

39. 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

40. 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!

41. 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

42. Planning • R & R list 9 aspects of planning in case management • These issues were reviewed earlier

43. 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.

44. 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

45. 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

46. 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

47. 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