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Case Management Human Services 325 Essay

Abstract

The case management process is client-driven and driven by client need. (Siegal, H., 1998) For the Vocational Rehabilitation and Employment program and the Disabled American Veterans group this is very true even though they both perform case management differently. Both agencies do their best to deliver the common goal of quality care and service to veterans and their families, the main difference is how each of them gets to that goal. 

Vocational Rehabilitation and Employment

Case management is more that theory and concepts that you lean in a book or class, and I had no real idea when I started this research project how correct that statement is. I chose the Vocational Rehabilitation and Employment (VRE) program because that is where I discovered that I would like to make a difference in helping fellow veterans cope and deal with life after the military. I thought that when I went to the VRE office that they would help me get a degree and that would be that, but after taking this class I realized that all of the “Hoops” I had to jump through, it is a carefully designed process.

“Vocational Rehabilitation and Employment programs primary benefit is vocational rehabilitation services for veterans who

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have a service-connected disability. The outcome of these services leads to suitable employment that is consistent with their aptitudes and interests, or achieving independence in their daily living.” (Personal communication, November 5, 2008) So that degree that I wanted wasn’t the only service that VRE provided. I didn’t realize this until I completed what I would find out later was my application for services and interview/assessment phase.

During the interview was where I meet Clayton Schirmer, my case manager and later the person whom I would interview for this paper. During the interview process I decided that I wanted his job and started the process of service delivery where he scheduled me for an assessment of skills and interests and to explore options of how to achieve those goals. At the time it seemed like a mishmash of things I had to do but I just didn’t understand the process that Clayton was taking me through until later.

Principles and goals of case management

As a case manager Clayton stated that “ The Goal of the case manager here at the Department of Veterans Affairs is rather simple it is to ensure that the veterans that come in for help become self sufficient, we do this through empowering the client by setting up a treatment plan that they build (with a little guidance from us).( Personal communication, November 5, 2008) The Vocational Rehabilitation and Employment case managers see more than people who want to get a better education a lot of veterans that come through the door have multiple problems from physical disabilities to mental health issues and the Vocational Rehabilitation and Employment office is trying to get the service member to cope and manage these disabilities. They accomplish this mainly through the integration of services and continuity of care.

The components of case management

The case review is done in my case after the application/intake and assessment phase. “In your case we had to find out what fit you best in the terms of interests and goals before we could actually review your case and make the decision whether you would be accepted as a client.”(Personal communication, November 5, 2008) Once the assessment is done then the case review is done between the client (myself) and case manager (Clayton), this is where the client file is initiated and the documentation process is started. “I have on average about thirty five to forty case files that I have to update every week with e-mails, evaluation reports, grades, receipts etc… everything that comes to me goes into the client’s case file.” (Personal communication, November 5, 2008)

Models of case management

Of the three models of case management that are found in our text, Role-based case management, Organization-based case management, and responsibility-based case management the Vocational Rehabilitation and Employment program really only fits into the role-based case management profile. “The Department of Veterans Affairs does not actually provide the any services, it is all contracted out, unless there is a disability that precludes the client from cretin physical activities such as loss of limb or confined to a wheel chair then I guess you would say that we tend to shift to a responsibility-based case.” (Personal communication, November 5, 2008) Sometimes the family is enlisted to help with the daily care of veterans that have severe disabilities and the case managers can often provide access to training that will assist those family members in learning new skills to help.

Most of the people who use the Vocational Rehabilitation and Employment program are able to function in a normal everyday manor and the case manages are there as a single point of access for the client. A lot of the time it is linking these clients to services and monitoring their progress so that they meet the prescribed time frames for their program. I like this model because it gives me that one phone call or e-mail option to solve an issue or ask a question, this allows the case manages to build a bond with the client and that allows them to have a vested interest in their success.

The roles of the case manager

Since the Vocational Rehabilitation and Employment program does not provide direct service delivery I asked Clayton what his actual role in the case management process is, “it fits along the lines of Coordinator, problem solver, broker and even a little advocacy within the department.” (Personal communication, November 5, 2008) The Coordinator and problem solver role from what I see are the most used roles that the case managers at Vocational Rehabilitation and Employment office fill. They have to coordinate services that a client might need in order to be able to achieve an independent and self sufficient lifestyle. For example a client who is physically disabled may need to have their house adjusted, doors widened, ramp, counters that move up and down etc… and it is the case manager at VRE that sets up those services to complete. Although the problem solver may be designed to make the client self-sufficient and learn how to solve their own problems the Department of Veterans Affairs is a large organization and most problems that arise have to be dealt with through the VA and the case manager is there to troubleshoot those issues for you.

The phases of case management

The three phases of case management, assessment, planning, and implementation are on average a little different than what we learn about in our text. The assessment and planning are almost one in the same for the Vocational Rehabilitation and Employment program. A client will meet with a case manager after the application process is completed usually via the internet then during the intake interview which is usually conducted by the clients’ case manager they will review eligibility. There isn’t too much information gathering during the intake interview, the Department of Veterans Affairs has most everything already on file, what the case managers are doing is getting a feel for what the client expects and wants.

After all of that a personality assessment is completed and the planning begins, this is very detailed and in most cases consists of the type of profession you would like help in attaining, the schools or certifications needed to achieve that goal, how long it will take, the cost, and any extras that you might need along the way. Once the client has complied all of that information then they will meet with the case manager and they will go over the plan and see if it meets the Vocational Rehabilitation and Employment guidelines.

The implementation process is both client and case manager in this agency, because the client has already done the planning and now it’s time to actually go and get things started. The case manager like I stated before deals with implementing your plan through the Department of Veterans Affairs. Overall the responsibility for the plan and follow through is the responsibility of the client, “this places a greater emphasis on self-reliance and empowerment for the client.” (Personal communication, November 5, 2008)

The Disabled American Veterans

The Disabled American Veterans (DAV) is a group that like the Vocational Rehabilitation and Employment helps veterans achieve the help and benefits that were earned for serving their country. There are quite a few chapters throughout the country and once again they do a lot more that what I thought when I went to see them. I retired last year and like every good sailor I went to the retirement transition assistance program class and took note and listened to what was about to befall me in the dark retirement years. There was a speaker from the local Disabled American Veterans office that talked about disability compensation claims that everyone is entitled to and all we had to do was come on in and see him to get the ball rolling. His name was Perry Fernandez, a retired sailor himself and soon to be my case manager and one that I didn’t even knew I had until I took this course.

Principles and goals of case management

The main issues my local Disabled American Veterans office deals with is disability compensation, surviving spouse issues and medical issues. Perry stated “We don’t consider ourselves case managers, we prefer to say veterans advocate and our main goal is quality care, access for all veterans, their families, and children.” (Personal communication, November 6, 2008) The Disabled American Veterans deals with the Department of Veterans Affairs and other government agencies, and they make sure that the services that are provided by those agencies are appropriate for their clients. “We want to make sure that these agencies just don’t shuffle our clients in and out or let them get lost so we make sure that the care that they do receive is the right care and that it is effective.” (Personal communication, November 6, 2008) The Disabled American Veterans case managers focus is on quality care mainly and equal access to veterans, their families and their children.

The components of case management

Case review is done during the intake interview with Perry and “his crew” as he likes to call them. During the intake interview various professionals look through your files and examine it for services that you might need or want. After the quick interview you sign a document that allows the Disabled American Veterans to speak on your behalf and to provide service appointments, and the clients’ case file is started. “We use an electronic format for our case files because we keep them indefinitely, when a client brings us documentation of some sort we scan it into their file for future reference, it also allows us to send it to another chapter in the event that the client might move away.” (Personal communication, November 6, 2008)

Models of case management

The Disabled American Veterans is a responsibility-based case management model, although do not transition care to nonprofessionals they do network with other human service delivery systems to provide access to needed specialists and services. (Personal communication, November 6, 2008) The Disabled American Veterans does not provide any direct service delivery but they do coordinate services that the client may need. I am not a big fan of this type of model mainly because there doesn’t seem to be any accountability for the service delivery process. Yes they monitor the services that are being provided but those providing them are not answering to the Disabled American Veterans office they answer to their chain of command and that does not give much leverage to get the best services available.

The roles of the case manager

The case managers at the Disabled American Veterans fill many different roles when dealing with their clients, the main role according to Perry is coordinator. “We do a lot of interfacing with other agencies, mainly the Department of Veterans Affairs, but a lot of times our clients come to us with a myriad of problems and they have no idea of where or how to get the help that they need.” (Personal communication, November 6, 2008) I found out that my local DAV office not only coordinates other agencies for service delivery but they also offer to take them there through a shuttle service, since we life over two hours from any Veterans Affairs hospital that in its self is a nice touch.

Another major role that the case managers fill is that of advocate. This has to be the one thing that I think would be considered a direct service. Part of Perry’s team, or crew is a lawyer, and his main job is to find if during the disability claim has been denied they can help you directly with the review process and if during that process it is denied they can represent you in the court of appeals. Webster’s defines advocate as “One who pleads the cause of another before a tribunal or judicial court.” (Merriam-Webster) and Perry’s team defiantly fits the role of advocate.

The phases of case management

The phases of case management, the assessment, the planning, and the implementation are pretty straight forward at the Disabled American Veterans office. “It depends on the clients’ situation really, we do a simplified intake type interview but the assessment of the clients’ situation could be done by another agency or by us, it just depends.” (Personal communication, November 6, 2008) During the disabilities’ claim the Disabled American Veterans does most of the records assessment and then has the Department of Veterans Affairs provide the physical assessment. After the assessment phase Perry stated that “there really isn’t much in the way of planning in cases like these because they are pretty straight forward with procedures already in place and it is just a matter of implementing the course of action which we discuss during the initial meeting.” (Personal communication, November 6, 2008) In these disability claims cases the client’s case file is usually closed because they are done and have their rating.

When the Disabled American Veterans office deals with issues other than disability claims then the phases of case management become a little more clear and defined, “We have an older retired community here and being so far away from a VA hospital can be challenging, so we have to get creative in ways to make it a little easier for our older clients.” Most of the older clients that Perry is referring to are known to the case managers due to the fact that it is such a small community and everybody tend to know everybody else. The clients are usually referred to the Disabled American Veterans office from another agency, so for the most part the assessments have usually been completed, “it’s just a basic medical and welfare history and background that we are looking for.” (Personal communication, November 6, 2008) There is a planning stage with this type of client and it requires a lot of input from the client to put together an effective plan and from what I have been told a lot of times the clients don’t realize the amount of work that they will have to put into the planning because it sometimes becomes very detailed.

The implementation phase is pretty straight forward, the Disabled American Veterans office contacts the various agencies and arranges everything from transportation to health care for their clients and the rest is up the client. On a personal note one of the other case managers the works with Perry told me during a break that there have been a few times the Perry himself has driven a client two hours each way for a thirty minute appointment because the client missed their ride and it might take months to get another appointment. This to me is the ultimate in both implementation and quality of care and I hope that we in this community have more people willing to do those kinds of things for people in need.

Summary

Both of the agencies that I interviewed have the same basic goal and that is to help the Veterans of military service. What I didn’t realize during this class is that in both agencies the implementation of case management functions varies depending on the type of agency that provides the case management, and other factors. (U.S. Congress, 1990) The Vocational Rehabilitation and Employment has a more classic approach to case management in my mind over the Disabled American Veterans in many ways.  The Vocational Rehabilitation and Employment and the Disabled American Veterans provide case management while the Disabled American Veterans is both short term as well as long the VRE is mainly long term, but case management is a dynamic process of continuous assessment; therefore, assessment does not stop when treatment begins. (Schuster, C., 1990) and this can be seen in how both of these case managers conduct business.

Our text is a great learning tool for the theories and general practice but getting out and seeing how these theories and practices are actually implemented were a real eye opener. I have learned over the years that what you read and learn is not always what happens in the “real world” and by getting out there and meeting with a couple of case managers (although Perry still insists he is not a case manager) I did learn that case management does not fall into nice neat little packages it is kind of a mishmash of all of the methods that we learned in class. After interviewing Clayton and Perry I realized that I could fit each of them into a specific model or role but that they also fit into many others, The style that each of us have is different with each client, why? Because each client is different, they have different wants, needs, and values, and no one approach is going to fit each client the same, we have to be flexible.” (Personal communication, November 5, 2008)

References

Clayton Schirmer, Personal communication, November 5, 2008.

Perry Fernandez, Personal communication, November 6, 2008.

U.S. Congress, Office of Technology Assessment, (1990) confused minds, burdened Families:   Finding Help for People with Alzheimer’s and other Dementias. P. 235. Retrieved on December 3, 2008 from: http://books.google.com/books?id=9zeFJu2ocDAC&pg=PA235&dq=components+of+case+management&as_brr=1#PPP2,M1

Schuster, C. (1990). Drug Abuse Curriculum for Employee Assistance Program Professionals, p. VI9. Retrieved December 3, 2008, from http://books.google.com/books?id=eB3GfosZsBAC&pg=PT446&dq=phases+of+case+management&as_brr=1#PPT445,M1

Siegal, H.A. (1998). Comprehensive Case Management for Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, p. 13. Retrieved on December 4, 2008 from: http://books.google.com/books?id=uXRM25LIXrYC&printsec=frontcover&dq=case+management&as_brr=1#PPA30,M1

Advocate. (N.D.) In Merriam-Webster Online. Retrieved December 7, 2008, from http://www.merriam-webster.com/dictionary/advocate

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