Case Management and Service Coordination: Analysis of Contextual Factors

Length expectation: 1,500 words not including title page, appendices, and references (APA format) with 25% leeway over or under (1125-1875 words). Submitted assignments outside this range may be docked marks depending on the discretion of the professor.

This assignment provides hands-on experience implementing and monitoring a case management plan. We walk through the initial intake and assessment stages. The information and issues that the case manager would be identifying are provided. Assume you are a disability management professional (DMP) employed in a specialized supportive program for teachers. This is a program similar to the Enhanced Disability Management Program (EDMP) for health professionals in British Columbia. You have a referral to provide case management for a teacher attempting a return to work (RTW) after major physical illness.

The assignment steps include the following:

Read Part 1: Background for Livia’s case below.

Read Part 2: Conference Meeting below.

Write and submit a (~1500 word) paper as outlined below:

Analyze contextual factors utilizing the occupational competence model, Finland model, or chosen strategies. Include apparent resources, strengths, and barriers.

Postulate priorities of needs to be addressed (expand on basic goal areas provided).

Formulate long-term goals, short-term goals, and related objectives.

Select resources pertinent to achieving the objectives and provide justification.

Postulate RTW strategies following the case conference meeting. Construct a five week return to work schedule chart incorporating work hours, times of day, activities and potential meetings as well as the integration of ongoing recovery related activities. State any assumptions made and provide rationale for your plan.

Briefly document qualitative and quantitative means to monitor your plan.

Note that the plans will be revisited in Session 10 discussion on ‘Outcomes’

Part 1: Background for Livia’s Case

Livia is fifty-five-year-old kindergarten teacher. She has been a teacher for 30 years.

Up until the end of June, she had been teaching kindergarten full time. Livia’s pre-existing lifestyle involved a tendency to over work. She was constantly evolving the kindergarten’s themes and activities and outings. After working on activity preparation and planning all evening, she would usually have difficulty sleeping. Livia is married to Ron, a factory worker.

Livia and Ron own their home. Livia had been considering retirement but has not made a formal decision. Livia is concerned for the financial implications of early retirement. Worry over long term finances for the family, having few friends outside work, and a lack of planned activities to substitute for her sixty-hour self-imposed workweeks all play a factor in the decision.

The school district administrator has grown less and less sympathetic with her frequent sick time over the past few years. Livia perceives that the administrator would be happy to see her retire and have the usual substitute teacher take on her role. The younger teacher is very keen, would be at a much lower pay scale, and would allow for hiring a new part-time educational assistant. This would no doubt reduce ongoing parental complaints about the lack of resources for special-needs students.

In late July, Livia had emergency surgery. She is lucky to be alive. She experienced extreme abdominal pain in August but ignored the symptoms. Two days later, with symptoms increasing, Livia was rushed to hospital where she underwent emergency surgery for a ruptured bowel. She remained in hospital for two weeks. Discharge instructions stated that she could expect a follow up a phone call from the hospital’s dietician and an appointment letter for a follow up colonoscopy.

The referral is dated August 30th and states that Livia’s last day worked was June 30th. She is currently on sick leave and has sixty sick days remaining in the bank. When these are depleted, there will be two weeks without pay and then short-term disability status will commence. The referral states that Livia is scheduled to RTW in mid-October. Assistance in setting up a Graduated Return to Work (GRTW) and “other’ supports as determined is required. The surgeon has provided a medical leave form extending to October 1st.

First Meeting with Livia

Your first meeting with Livia is on September 15th at her home by request. She is receptive to discussing the events leading up to, during, and subsequent to her hospitalization. However, she is clearly not feeling well, is having difficulty walking, and reports that she is mostly resting and sleeping during the day. You explain the program and secure the usual baseline written consent to communicate with the treating physician, hospital dietician, local union representative, and school district human resources representative. You also receive written consent to obtain and review copies of medical, hospital, vocational, and other related records. A second home visit is scheduled in order to complete the initial assessment. Despite Livia’s compromised physical status, she indicates to you that she has been on the phone to the substitute teacher each evening as she is “just learning” the routines and there had been no time to leave things in order. The principal is new also and she feels guilty for not helping get things off to a smooth start.

Second Meeting with Livia

At your next home visit on September 22nd, you continue to gather information and assist Livia to set up an appointment for September 26th, to see her general practitioner who has taken on her care from the surgeon. Livia openly discusses the trauma associated with her acute illness and surgery, her anxiety about RTW, and her difficulties leaving work at work while always working late into the evening. She indicates receptiveness to seeing an Employee and Family Assistance Program (EFAP) counsellor to address these concerns.

As per procedure, you then fax a letter to the general practitioner introducing yourself, explaining the enhanced RTW program provided to the teachers. You indicate that you will be involved in planning steps and resources for recovery and eventual RTW

GP Response

Following the September 26th appointment, the GP responds to your introductory fax, indicating that the medical leave has been extended to tentative work hardening status for the week of October 30th. The GP has completed a referral to physiotherapy due to Livia’s slowed recovery of strength and endurance and also queries continued poor food reabsorption. Twenty minute walks are encouraged. He books an appointment to see her the week of October 23rd in order to assess readiness for progression to work hardening.

Job description

Livia’s job description includes physical activity such as bending, reaching, and lifting. Expectations include moving furniture, conducting gym programs, and taking regular shifts at playground duty. Livia has expressed fears that often the children will grab onto her and this is a concern given her recent surgery. There are 20 students in the kindergarten class. A new computerized report card system is being introduced this term.

Regular case management meeting with school district administrator and union representative

During your regular monthly meeting to discuss all teachers involved in RTW processes on September 30th, you provide an update on Livia’s functional status. You do not include medical information. You explain the current timelines provided by the physician. The administrator explains that the current covering teacher has a permanent position pending in January. He asks you if the RTW looks solid as he does not want to have three teachers involved if this goes on too long.

After the information gathering and rapport building steps above, an initial case management plan could be completed collaboratively with Livia. Selected foundational information from the above would be included. Examples of barriers and goals are provided below, but do not limit elements of plan creation.

Identification of Barriers to the Rehabilitation Process

Need for further physical recovery including building of general strength and endurance, re-establishing sleep patterns and integrating dietary recommendations.

Need for recovery from the trauma of the illness.

Need for integration of strategies for establishing healthy work behaviours and routines.

General Case Management Goals

Support improved physical endurance and mobility

Support lifestyle management

Support Ongoing RTW

On October 23rd, Livia was cleared by the physician to progress to RTW planning. Guidelines include a week of work hardening with 4 x 1/2 days, no lifting or strenuous activities. Physical restrictions expected to be lifted after four weeks following GP re-evaluation. Predicted GRTW hours (teaching on own) are the following:

2nd week- 4x ½ days GRTW

3rd week- 1 full day and 3 x ½ days

4th week- 2 full days and 2x1/2 days

At this point the long-term goal of return to work can be clearer and would fit into the accommodations hierarchy under ‘Same employer, same job – transitional return to work program’. Still the details of specific activities, timelines and resource availability (see SMART goals) criteria need further clarification.

Part 2: Conference Meeting

At this point on October 24th there is a formal RTW case conference to address Livia’s RTW plan. Let’s look at what the standpoints of the stakeholders would likely include:

Livia

How to manage twice per week gym class and yard duty.

Concerned about new computer program for report cards. Has been hearing that colleagues having difficulty with this and she will have enough on her plate to reintegrate with her energy deficits.

Worried about integrating back at work in terms of the students’ responses, the impression of the new principal, and interviews pending the week of November 23rd.

School District Administrator

Concerned about disruption to adjusting K students and parental response as students are just starting to settle into routines.

Need to adjust the yard duty schedule temporarily and how to obtain the cooperation of co-workers.

Union Representative

Is the RTW going to be a solid one as the covering teacher has an opportunity for a permanent job in two months, and while she likes this position, she does not want to remain at part-time to cover if there is a prolonged recovery.

There is a lot of physical activity that can be unavoidable in the classroom with new kindergarten students, such as needing to assist with donning/doffing clothing and bending down to assist with light activities.

Union regulations allow for coverage of yard duty and changes to gym routines when teacher’s abilities are compromised temporarily.

Concerned about schedule and learning new computer report card program - other teachers have had a half day inservice training- how to make this equitable for Livia?

Case Manager

How to ensure that the GP guidelines are followed?

Which non-strenuous duties will be acceptable to make a workable balance between the covering teacher and Livia?

Livia’s recovery may not be straightforward and she has a right to recover occupational performance as the bottom line.

During the meeting, it is clear that there will need to be some collaboration with the Teacher on Call’s needs, the need to involve the principal given the flexibility and complexity of the RTW schedule, and the need to promote rapport building with the teacher and the principal who have not met yet. The school district administrator provides permission for the DMP to meet with the principal and the teacher together and to work out a schedule integrating the recommendations of the physician in terms of work hardening and GRTW (Graduated Return to Work) hours. Following the meeting, and based on the information gathered to date, the case manager constructs a tentative RTW plan based on the input of all stakeholders.