Lucy Wong Hernandez: Good morning, everyone, and welcome to the 2009 Southeast TACE webinar series. I am Lucy Hernandez, and I am the Project Director for the TACE Center in Region IV. The Southeast Region TACE Center's mission is to improve the quality and effectiveness of services and enhance employment outcomes for individuals with disabilities in eight southeastern states: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, Tennessee and South Carolina. TACE Center is in collaboration with the DBTAC Southeast ADA Center and both the TACE Center and Southeast ADA Center and are managed by the Burton Blatt Institute of Syracuse University, in New York. As part of the TACE Center's regional activities, we are hosting quite a series of training webinars this is year. If you already signed up for future training webinars, that is great. If not, please visit our website or our new TACE webinar room to see the many webinars that we are offering this year. Registration will open one month before the session is scheduled, so mark your calendars to sign up for those topics you are interested in when the registration opens. All instructions and materials for each training webinar are posted on our website. Familiarity with this information will greatly enhance your participation and learning experience.
The online conference system we use is fully accessible integrated data and voice medium that enables us to conduct Webinars over the internet from just about any computer with internet connection and web browsers. Please note that long distance charges may apply. There are many computer issues that are beyond our control but there are a few things that you must do to enhance your experience. It is really important that you check your system prior to the session we are unable to troubleshoot technical issues right before the Webinar is scheduled to begin. You can only ask questions by typing in the public chat area. I will follow these questions and direct them to our feature speaker at the appropriate time. I will voice all questions for the benefit of all participants the captioner and the transcript. Another thing to remember is that you should close all other applications and automatic system checks on your computer during the Webinar to eliminate potential interference. And finally, if your computer is connected to a network and has a fire wall, remember to press the spacebar during the Webinar to let the system know you are still present. Sometimes network computers shut down if their computer is idle for too long.
Today's format will be as follows. Our featured speaker will speak for about 60 to 70 minutes. During the presentation you can type in your questions in the chat area. And the presenter will stop and try to answer as many questions as possible as they come up. At the end of the presentation any remaining or new questions will be answered as time allows. Again, all questions will be read aloud for the benefit of the participants and also the captioner. Today's session is entitled Improving Case Management Skills for Effective Vocational Rehabilitation Services. We are privileged to be joined once again by our featured presenter Dr. Henry Wong. Dr. Wong is from the North Carolina Center for the Advancement of Teaching and he is also a professor at East Carolina University and a contributor to the TACE Learning Consortium. His bio is posted on the TACE website along with the webinar materials, so I hope that you had an opportunity to read them. And now I will ask Dr. Henry Wong to begin his presentation.
Henry Wong: Thank you for being with us this morning as we talk about improving case management skills. Let us see, if someone could bring up the PowerPoint slide for me please, we will begin in just a moment. Alright, thank you The next slide, slide two, Inquiry Based Questions, in this Webinar I will explore the concept of case management, the models, principles and competencies of case management, some of the federal legislations influencing vocational rehabilitation. I will also explore -- what are some of the basic principles of rehabilitation philosophy? What are the functions of case management? What are the rolls of the case manager and how can case management skills be improved? Next slide, slide 3.
The field of vocational rehabilitation has been influenced by numerous federal laws dating back to the Smith-Fess Act of 1920, which established the vocational rehabilitation for civilians. Also the Social Security Act, The Rehabilitation Act of 1973 and its subsequent amendments in 1992 and 1998, of course the Americans with Disabilities Act, the Individuals with Disabilities Education Act, the Workforce Investment Act of 1998, which, to my knowledge has still not been reauthorized as of this past April 2009. Hopefully, it will be. The importance of the Workforce Investment Act is that the Rehabilitation Act amendments have now been subsumed under this federal law. And lastly, the Ticket to Work and Work Incentives Improvement Act of 1999. Next slide, slide 4.
Disability is a natural part of the human experience and the federal laws have stated that persons with disabilities have rights to live independently, to enjoy self-determination, to make choices, to contribute to society, pursue meaningful careers and enjoy full inclusion and integration in economic, political, social, cultural and the educational mainstream of American society. Next slide, slide 5.
Every person has inalienable value and has a right to belong to society as a member, they are worthy of respect. The assets of persons with disabilities should be emphasized, rather than their limitations. Stress reality factors that help a person cope with his or her environment. Treatment should vary and be flexible to meet the needs of persons with disabilities. Each person should assume initiatives and participation in his or her rehabilitation plan. Next slide, slide 6.
Society should be responsible for providing services and opportunities to persons with disabilities. This is part of the American culture. Rehabilitation programs should be interdisciplinary with interagency integration. Rehabilitation is a continuous process and is quite complex. Psychological and personal reactions of persons with disabilities are always present and crucial in the counseling relationship. The severity handicap is increased or decreased by environmental conditions. Next slide, slide 7.
The significance of disability is affected by the person's feelings about himself or herself as well as their situation. The client is considered part of a larger group connected to the community and is not isolated. When reviewing research, it is important to use predictor variables of group outcomes in rehabilitation with caution. For example, looking at studies that use predictive variables like, age, gender, race, severity of disability, it is important to interpret the study's results with caution and to be critical of the research methodology that was used in making conclusions about persons with disabilities. Self-help organizations are important allies in the field of helping relationships. Rehabilitation professionals should ensure effective dissemination of information to persons with disabilities for their benefit. Persons with disabilities should serve as co-planners, co-evaluators and consultants to others. Next slide, slide 8.
We can define case management as a collaborative process, which assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs through communications and available resources to promote quality, cost-effective outcomes. Next slide, slide 9.
The process of case management may include but is not be limited to assessment of individual's needs, development of individualized case management planes, facilitation, implementation, and coordination of services, monitoring and evaluating services and outcomes, as well as, documentation of activities. If it is not written in the case record, then there may not be evidence that services have been provided. Consequently, documentation is very important. Next slide, slide 10.
Credentials or credentialing is a process of granting a practitioner a credential that designates that person as a professional and as having obtained a certain level of competence in a specific subject or area. There are three general types of credentialing. One is licensing which would include such things like Licensed Professional Counselor or Licensed Practical Nurse, Licensed Psychologist. The second form of credentialing would involve certification, for example, a Certified Rehabilitation Counselor, which is granted by the Commission for Rehabilitation Counselor Certification. There is also a Certified Insurance Rehabilitation Specialist, which is granted by that commission. That agency changed its name to Certification of Disability Management Specialist Commission in 1990 and the certification credential was a Certified Disability Management Specialist. Then again, in 1995, that commission changed its name again to the Commission for Case Manager Certification granting the Case Manager Certification credential. Next slide, slide 11.
Models, Principles and Competencies. Okay, let us move to slide number 12 to discuss these further.
There are three basic models for case management. The first is Role-Based Case Management. This focuses on the role of the case manager, for example, the rehabilitation counselor. The second model is called Organization-Based Case Management, which focuses on providing a set of comprehensive services within an agency. For example, a comprehensive rehabilitation center. Thirdly, the Responsibility-Based Case Management, which focuses on the transition of care from human service professionals to non-professionals, and functions performed by family, volunteers, support personnel, and the consumer with the disability. In reality, rehabilitation professionals will go back and forth across all three of these case management models. Next slide, slide 13.
There are also three mental health models. The first is the Standard Case Management model. This is where a case manager acts as advocate, purchaser, and arranger of services for the consumer with a disability. The second type of mental health model is the Rehabilitation-Oriented model focusing on the strengths of the person rather than on the pathology and it focuses on the collaborative working alliance between the case manager and the consumer. What I mean by a working alliance is the quality of that relationship between the rehabilitation professional and the consumer. It involves the bonds or quality of relationship between the two individuals; the goals that are set in partnership with the consumer, the tasks that are assigned to the consumer as well as the responsibilities of the counselor. Thirdly, the Intensive Case Management model. This emphasizes a team approach to meet multiple consumer needs, provide interventions in the consumer's home or work site, medication compliance, 24 hour care and daily living supports. It requires low caseloads and assertive outreach by the case manager. Next slide, slide 14.
Some of the ethical issues in case management may involve conflicts in expectations or values between the counselor and client. Secondly, there may be conflicts in responsibilities between the counselor and client, as well as variability in the roles of the counselor who may also act at times as an evaluator or a claims adjustor in processing payments for services. Moving to the next slide, slide 15.
Ethical decision-making then would include learning and using a common language of ethics and ethical decision-making by the rehabilitation professional. Determining some type of consensus when ethical problems arise in terms of how decisions should be made. It will also include being aware of how your personal and professional ethics differ and keeping them separate. And, of course, the importance of using professional codes by which to make decisions. However, professional codes may be insufficient to help us in reaching ethical decisions. Next slide, slide number 16.
So when professional codes of ethics are inadequate, we have to turn to something else. Research by Tarvydas in 2004 indicated the importance of using some type of model on which to make decisions. She called this an Integrative Decision-Making model of Ethical Behavior. This model involved interpreting a situation through awareness and fact finding where you gather the important information. You formulate an ethical decision; select an action by weighing competing, non-moral values and being aware of your personal blade spots or prejudices and then planning and executing a selected course of action. Next slide, slide 17.
There are three domains of competence that interact between the consumer and the case manager. These areas of competence include knowledge, which would involve an understanding of medical, psychological, vocational, counseling, assistive technology and cultural aspects of a client or person with a disability. The second domain of confidence includes skills, which is the application of that knowledge in case management practices. Skills also includes being culturally competent, being aware of different cultures and the attitudes, beliefs, values and behaviors of persons with different cultural backgrounds. Thirdly, the affective domain, this would include a case manager’s attitudes, philosophies and attitudes and values associated with service delivery to the consumer. Next slide, slide 18.
Leahy goes on to say there are certain knowledge domains for a case manager to possess. They include coordination and service delivery, physical and psychosocial aspects of disability benefit systems or cost benefit analysis, case management concepts, and community reentry and knowledge of community resources and comparable benefits. . Next slide, slide 19.
There are also eight functions of case management according to the research by Weil and Karls. Those functions include client identification and outreach, individual assessment and diagnosis, service planning and resource identification, linking clients to needed services, service implementation, monitoring service delivery, advocacy and evaluation. Next slide, slide 20.
Another hallmark of being an effective case manager is having interpersonal communication skills, which would include establishing a working alliance with a client, maintaining rapport with that client throughout the counseling relationship. The next three are what we would call person-centered elements that Carl Rogers emphasized as being important in those counseling relationships. They include empathy, the ability to understand the point of view from your client's eyes or perspective, warmth and genuineness. By genuineness, Carl Rogers referred to as your values and actions are congruent and you are able to express that in a genuine way to your client. Other elements of good counseling skills would include interviewing skills, conflict resolution, as well as being able to negotiate with and empower your clients to make decisions. Next slide, slide 21.
The public rehabilitation program is an eligibility program based on federal legislation. In order to be eligible for services through vocational rehabilitation a person must have a disability. They have a physical or mental impairment which constitutes or results in a substantial impediment to employment and they are presumed to be able to benefit from vocational rehabilitation services to achieve an employment outcome. They require vocational rehab services to prepare for, secure, retain, or regain employment. Next slide, slide 22.
The process of case management in the public sector may include but not be limited to the following. Assessment, which involves the determination of vocational rehabilitation, needs to establish eligibility, looking at such factors like medical, psychological, vocational, educational, and socioeconomic factors. Assessment then focuses on the strengths, resources, priorities, concerns, abilities, capabilities and interests of the client. Planning, this involves the Individualized Plan for Employment or IPE. It was formally known as the IWRP or Individualized Written Rehabilitation Program. The third phase of case management includes implementation of the IPE, which would include such services like counseling, physical and mental restoration, training, vocational aspects, rehabilitation engineering, assistive technology, job search and placement, interpreter services, reader services, personal care attendant, equipment supplies and tools. Monitoring is another important part of case management of the entire rehabilitation process to ensure that services are being provided in a timely manner. Lastly, evaluation. In evaluation, the hallmark in the public sector is the status 26, which is a successful case closure. But is that the only mark of success in vocational rehabilitation? I think there are many other marks of success throughout the entire rehab process. Some of those include a good quality counseling relationship with the client, the empowerment of those clients to help them be successful. Next slide, slide 23.
The case manager then has many different roles. They may include being an advocate, a broker or facilitator of services, coordinator, collaborator, consultant, counselor, evaluator, expediter, planner, record keeper, and teacher. Next slide, slide 24.
One of the hallmarks of documentation in the case management process includes the Individualized Plan for Employment, the IPE. This is defined as an initial written plan for rehabilitation services and amendments developed independently or jointly with technical assistance from a qualified vocational rehabilitation counselor or other source. It must be developed within a timely manner, that is, within 90 days of being determined eligible for vocational rehabilitation services or post employment services. Next slide, slide 25.
The purpose of the IPE is to achieve the specific employment objective of an eligible individual, which is a person with a disability, who can choose to develop all or part of the IPE independently or with assistance of the state vocational rehabilitation unit or other entity. Next slide, slide 26.
The state agency will provide the person with disabilities information about developing the IPE and a copy of the written assessment of vocational rehab needs. Clients should be given assistance by a qualified vocational rehabilitation counselor in developing all or part of the IPE and completion of forms. They should also be provided adequate information about using technical assistance. Be given state forms that are needed to develop or finalize an IPE, and be given information about the financial cost for services on the IPE, as well as, be given information on the state agency policies on their financial participation, comparable benefits and the purchase of service requirements. Next slide, slide 27.
The assessment then of a consumer's needs includes identifying the vocational rehab needs of the client and evaluating factors essential for developing the IPE. It is limited to necessary information to identify a person's rehabilitation needs. It uses existing information when possible to include data from the Social Security Administration, other providers and programs. It should also include information gathered from the client. It will also include information on a person's personality, interests, interpersonal skills, intelligence, functional capacities, education, cultural, social, recreational and environmental aspects. Next slide, slide 28.
The assessment should also examine the client's need for supported employment services or a job coach. It should include an appraisal of work behaviors and services needed to acquire occupational skills, develop work attitudes, work habits, work tolerance, and social skills for job success. It may also include a referral for assessment of rehabilitation technology services if they are needed. The IPE must be given in writing with a copy to the client under the federal law. Next slide, slide 29.
Under the federal law, the IPE must be agreed to and signed by the client or her or his legal representative. The qualified vocational rehabilitation counselor will review the IPE at least annually with the client. Any amendments to the IPE must be agreed to and signed by the client and approved by the rehabilitation counselor before being implemented. The written copy of the IPE and any amendments must be given to the client in their native language or preferred mode of communication, like Braille, large print, cassette tape and so forth. Next slide, slide 30.
The employment goal for the client is expected to be achieved as a result of services under the IPE. It should also include the timeline for achieving an employment goal which is realistic. It should be based on assessment of vocational rehab needs, reflect the person's strengths, resources, priorities, concerns, abilities, capacities, interests, and include informed choice, which I will describe in just a moment. It should also specify any training and employment in an integrated setting. Next slide, slide 31.
All services must be listed on the IPE that are necessary to achieve employment. These services may include counseling and guidance, physical and mental restoration services, referral, training and support, placement, as well as services of other agencies. The criteria to evaluate progress toward achieving an employment goal must be stated on the IPE, as well as a list of other service providers. Next slide, slide 32.
The IPE should also list the financial expectations of the client, explore comparable benefits and services. It specifies the counselor's and client's responsibilities like their attendance in training, maintaining a certain grade average if they are going to college, as well as meetings with the counselor. It should also include information on dispute resolution like how to access the Client Assistance Program (CAP), mediation; fair hearings and other contact information so that clients may contact those problems to resolve any disputes. It should also list any post-employment services that the client may need. Next slide, slide 33.
Informed choice is mentioned in the federal law. It is a legal concept. This legal concept involves that the rehab counselor must tell the client of his or her opportunity to exercise their informed choice throughout the rehabilitation process. The vocational rehabilitation counselor should assist the client in acquiring information to exercise their informed choice as well as the selection of his or her employment goal. And the vocational rehabilitation services needed are to achieve employment. Next slide, slide 34.
It should also include any providers who will deliver services; the cost of those services, how to access those providers, the duration of those services, the qualifications of providers, any consumer satisfaction surveys and outcomes. Informed choice also includes information on their proposed employment setting as well as the setting in which vocational rehab services will be provided; the methods to obtain those services and information provided in the client's native language or preferred mode of communication, and any support services necessary to exercise informed choice. And yes, the IPE must be signed by the client as evidence that the counselor has explored these previously mentioned areas with the client. Next slide, slide 35.
How can we do that? Well there is several ways of thinking about improving your case management. They include begin with the end in mind. That is, look at your results that are required for your caseload and work backwards from there. You might consider managing your caseload by objectives, either annually, monthly, or weekly for your referrals, your active cases, closures, and tracking your caseload budget. By having a plan and working a plan, you can be systematic in how your measure your progress, weekly, monthly, quarterly and annually regarding your objectives. Of course, it is important to know and follow your state agency’s mission and policy. Keep a checklist of requirements for each status. And make sure you visit that checklist from time to time to insure you are monitoring the requirements for each status and your time management. This is where you control your time rather than let time control you in such things like your appointments, meetings, conferences. Your paper work in the case record should be clear and concise and only include that information which is important like the who, what, where, why and how services were delivered. You might want to consider having some type of tickler system to monitor your cases over time that gives you information about cases based on time. Next slide, slide 36.
It is important as you look at your calendar to mark those important events, yearly, monthly, weekly, and daily so that you know what to expect next week, monthly quarterly, and as you look at the final goals and objectives for your fiscal year. Involve and give responsibility to your clients when possible. That is part of the federal law. Your clients can be very helpful in setting their own appointments, obtaining information to give you so that is part of the empowerment process throughout the whole rehabilitation process. Prioritize and organize your work. As you look at your workload to be done, one way of prioritizing your work is the ABC method with your paper work. The A stack of papers would be those things that absolutely must be done today. The B stack of papers would be those things that must be done this week. The C stack would be all other things that can either be done that month or put off to a later time.
Another useful technique for improving case management is using SOAP notes in the case record and follow-up. SOAP notes is an acronym where S stands for subjective comments that the counselor observes being made by the client. O stands for objective. That is the counselor's thoughts and feelings of what the problems are. A stands for assessment of the problem as the rehab professional observes it. Then P stands for your plan. This is a written plan of action, which is ongoing, which may specify a timeline of things to do so that consequently each time you review that case record, you are able to look at those SOAP notes and track the progress of those services and their timelines. Another technique that is being used is what we call AWARE software. This is an automated web-based activity and reporting environment in which counselors are given a type of tickler system for each case with important requirements based on timelines. Of course it is very important to develop relationships and network with your team and others. Next slide, slide 37.
It is important to respect your secretary or office manager. He or she controls information which comes to you ultimately as the rehabilitation professional and they can be very instrumental in helping you achieve your duties, especially regarding the paperwork. So whenever possible delegate your paperwork if it appropriate to your office manager. Touch your paper work only once on your desk if possible. The more times you touch your paperwork, the same paper on your desk you are not being effective with your time management. Either decide to file the paper or do some sort of action on the paper or toss it if it is appropriate. Economize and plan your field visits. If you have multiple clients in the field, it is important to plan your route for your travel as well as your time so that you can maximize seeing the most number of clients in the shortest amount of time. As an example, in large urban settings, some of the research that has been done with UPS, indicated that UPS drivers were able to save over 2 hours a day by only making right hand turns in large cities rather than waiting to cross the Highway to make left turns. Therefore, plan your field visits to maximize time. Another way is what we call "sandbagging," as a practice. Sandbagging is a practice where once the counselor has achieved all of his or her objectives at the end of the fiscal year, for example, case closures, that anything above that goal is held back until the new fiscal year. Some managers do not particularly like that, but it is a practice. It gives the rehab counselor a little head start on the new fiscal year when they are able to claim successful case closures at the start of the new year. Sometimes you may have conflicts with your clients and such resistance in their relationships that it is better to trade or refer some clients to other counselors in the client's best interest; referring those clients to other professionals who can establish a better working relationship with those clients. Next slide, slide 38.
Evidence-based practice. This is another technique that is used. This is a process of turning clinical problems or case management problems into questions and systematically locating, appraising, and using current research findings as the basis for making clinical decisions. It includes knowing what clinical questions to ask as well as how to find the best practice or practices in the community to meet the needs of your clients. Next slide, slide 39.
Evidence-based practice then includes a critical appraisal of the evidence for the validity and applicability to a specific care situation, either medically or psychologically. It evaluates the effectiveness of care and continual improvement of the process. The best evidence-based practice is derived from a series of research results forming an empirical basis for the effectiveness of a specific treatment, either medical or psychological. The gold standard for scientific evidence is randomized clinical trials and meta-analysis to determine effectiveness of the cumulative evidence of treatment. So as rehabilitation professionals, it is important to review the research literature, attend professional development as well as consult with your colleagues regarding the best clinical practices that are provided in your community. Next slide, slide 40.
Let us have some questions and answers and Lucy, if you will help facilitate those questions?
Question: Yes. There is a question about IPE and actually it comes from Florida. They want to know if taking 120 days which is something that they do in Florida -- if this is also a standard with other states as well? Could you give us some information on that?
Henry Wong: Yes. Regarding the timeline of the IPE, as I look at the federal legislation, I see or recall 90 days is the accepted timeline for developing the IPE from the date of determining a client's eligibility. Obviously, if Florida is using 120 days, this may be an acceptable practice for the state VR. I am not sure how the other states are responding to the IPE based on this timeline of 90 days. The law does say that the IPE must be reviewed for each eligible individual who is in a period of extended evaluation as often as necessary, but at least once every 90 days.
Question: Thank you Henry. The next question that I have is. Is it a requirement to give the client a copy of the IPE? It seems that in some states they may have a different regulation about this IPE issue.
Henry Wong: The federal law does say that the IPE is the written plan outlining the client's vocational goals and services and that must be provided in the form of a copy of the IPE to the client. This is as evidence that the client has been given this information, there is a section on the IPE for the client to sign. The statement usually includes something like, I have been informed about and involved in choosing my goals, services, providers, and methods used to procure services. So there is a place on the IPE for the client's signature, where the date is indicated, as well as the counselor's signature and a date for the counselor to indicate agreement on the IPE.
Question: Thank you, the other question is -- Is there a need to inform the consumer of the cost of the services? Is it a common practice?
Henry Wong: Again, under the federal law, when explaining the goods and services, it is important for the rehabilitation professional to share as much information about those providers as possible. This would include the cost of those services, how to access those services. But you know, each state may have a different process of how they handle that.
Question: The other question is -- Who should sign the IPE? You mentioned the QVRC signing it. Are there any circumstances in which perhaps the supervisor or manager also could sign the IPE?
Henry Wong: Yes. As long as they are considered qualified to do so by their state agency, the law says a Qualified Vocational Rehabilitation Counselor, but supervisor could also sign provided they are considered qualified to sign by the state unit. I am taking this from the federal law on the IPE from the Rehabilitation Act as amendments under the Workforce Investment Act of 1998.
Question: Thank you. Here is another question. You also mentioned the QVRC and some participants would like to know if there is a difference between QVRC and CRC.
Henry Wong: That is a good question. I think the federal law intends that the Qualified Vocational Rehabilitation Counselor or QVRC is someone designated by the state unit as being the person responsible to provide those services and sign the IPE. A QVRC is a certified VR professional, but there may be instances where they are not a Certified Rehabilitation Counselor but they may have some other type of credential, which gives them the legal right under the federal law to assist in developing and signing the consumer’s IPE.
Question: Thank you Henry. Could you expand a little bit more on time management? What other practices are there that counselors can utilize with time management? Nowadays processing cases, attending meetings, etc. it gets very hectic, and complicated. Do you have any other suggestions for time management?
Henry Wong: Again for time management, it is important to look at your total results for which you are responsible for annually and then break those annual objectives or results into quarterly, monthly and weekly results. Be able to prioritize your work, organize it using specific timelines or a tickler system that will help you manage each case as needed based on its status, either 30 days, 60 days or 90 days. Sorting out what has to be done daily, weekly or monthly, those things that can be put off. Those are some of the things I can think of off the top of my head for time management.
Question: Thank you. That information is very good. Now the other question has to do with giving the consumers a copy of the written vocational needs assessment this is different than the IPE. Should the counselors give a copy of the vocational needs assessment to their consumers?
Henry Wong: Well they are required to give a copy of the IPE to the client, but if we look at vocational assessment as the entire case record, clients can request that, but it is usually in writing, for them to get the entire case record. There may be some instances where there may be some information in that case record that might be considered harmful to the client and consequently the counselor should be very careful in terms of giving out information that may be harmful or upsetting to the client. I can think of one example in my personal experience many years ago, where a client had a potentially fatal kidney disease, cancer of both kidneys and they had come to me for services, but it was obvious in my conversation with the client that their physician had not talked about the prognosis of that kidney cancer with the client. So I referred them back to the doctor to get more information about the prognosis of that disability.
Question: I see another question; can a family member sign an IPE on behalf of the consumer?
Henry Wong: Provided that family member or significant other is a legal guardian of the client, yes, but otherwise, if the consumer has full legal rights and they have the capacity to understand the IPE, then the client is the one responsible to sign the IPE.
Question: Thank you Henry. That is very important. Another interesting question or comment is -- what should the counselor do when the consumer comes by and drops by the counselor’s office to meet with the counselor without previous notice or no appointment? What would be the right approach to follow in a situation like that?
Henry Wong: I think this should be determined on a case-by-case basis based on the counselor's ability to talk with that consumer at that particular time. Generally, for effective time management and case management it is polite to say yes -- what can I do to help or what do you need at this time? But if it involves a lengthy discussion it is important for the counselor to manage his or her time and tell the client to come back at a later date in which they can give more time for discussion. Otherwise, quite often, you may be getting into situations where there are multiple clients that come in every day that really disrupt the work flow of your workload and will not help you manage your time. If at all possible it is the counselor's choice. If they have the time to sit down yes, if not, just politely set an appointment time for the client to come back.
Question: Thank you Henry. Here is the last question and I think early on, you started talking about it, just give us a little more information of informed choice versus client choice. Just expand a little bit more on the similarities or difference for the two. Thank you.
Henry Wong: Informed choice is a legal concept based on the federal law. It means that an eligible person is given necessary information to make meaningful choices with his or her Qualified Vocational Rehabilitation Counselor in the selection of an employment outcome and in the specific rehabilitation services needed to reach that employment outcome. Those choices can also include who will provide those services, the settings in which they are provided, how those services can be obtained. Whereas the whole purpose of informed choice is to give the adequate information to the client so they can make choices in their vocational rehabilitation process. The concept of client choice is not so much a legal term based on federal law, it is more of a loose interpretation that the client has some choice in the selection of what is being presented to them. But there may be instances where the client does not have informed choice. That is, they have not been given adequate and sufficient information to base their decisions throughout the entire rehab process. There could be a difference between informed choice versus client choice.
Question: Great. Thank you. Here is another question. In reference to what you were just talking about Henry. Does that mean that the consumer has a choice to go outside the state where he is receiving services to receive the service that is available in his state?
Henry Wong: That is a good question. I would think and this is my personal opinion, the consumer does have a choice to go outside the state to receive services, but then the counselor has a decision to make whether or not they can fund services outside the state. It may require that the client apply for vocational services in the state in which they wish to receive services from. So going back and forth across state lines, there may be some legal requirements based on each state's policy regarding that. That is something each counselor would have to explore either through their state policy or consulting with their colleagues or supervisor regarding clients who come in to, for example, the state of North Carolina and then want to go out of state to obtain a service, their financial costs that have to be accounted for.
Question: The next question is -- what if the client wants to amend the IPE with a new goal? I guess the question would be -- Is it possible?
Henry Wong: Yes. The client has a right to amend that IPE. Then it is the counselor's responsibility to review any amendments to that IPE, either within a 90 day period or as needed depending on what that amendment involves.
Question: Okay. So now we have the last question. What about a client who wants to go to a state university when the same service will be available in the community college at a much cheaper cost -- What should a counselor do?
Henry Wong: Yes. Well considering as an example, the state of North Carolina has a $3.2 billion deficit, sometimes we cannot always accommodate the requests of our clients who come to us for services. In this case, I would think it is cost effective to say you can get the same service, same education at a community college rather than going to a university and based on our limited case dollars, this is what we can afford to assist you with. If you want to go to a university, that is your choice but we can only financially support you at this level of cost. It is important for the counselor to help those consumers explore comparable benefits and apply for Pell grants and other scholarship assistance if possible.
Question: Here is a very important question Henry that I guess we skipped before. All VR counselors should provide guidance and counseling to all consumers. When does it become a substantial service for the IPE and how should it be documented? I guess it would have to do with a lot of the good work that the counselors do and somehow it does not get to be reported within the IPE and it is not really reported in reference to budgets and everything else that is documented.
Henry Wong: Yes. Again, this idea of what is a substantial service to be documented on the IPE, as you look at the rehabilitation law; those substantial services are outlined to include such things like counseling, physical and mental restoration services, training and education. Interpreter services, tools and equipment. Things like that. So the specific services of the IPE are defined in the rehab legislation, and if they fall under those major services of an IPE, then yes, I would consider those as being the substantial service.
Lucy Wong Hernandez: I think we are running short of time. At this point, I do not see any other questions, so I would like to thank you Henry for this great presentation on this very educational topic that has provided us with a refreshing concept of Improving Case Management Skills for Effective Vocational Rehabilitation Services. Today we have covered very important points that will hopefully assist the VR professionals to keep the flow of individuals with disabilities moving smoothly through the VR process. Some of the points that we covered today are -- What is case management? What are the models, principles and competencies of case management? What are the federal legislations influencing VR? What are the basic principles of rehabilitation philosophy? What are the functions of case management and the roles of the case manager and how can case management skills with improved? All very important points to be covered within the voc rehab profession.
I also want to thank the participants of today’s session for their participation and the very interesting questions. As you know a transcript of the session along with all the handout materials will be posted and are available on the website within two weeks of the session at TACEsoutheast.org. Please remember to complete your evaluation of today's session. Your feedback is very important for our continued planning so that we can address your specific needs and comments. The link for the evaluation form is posted on the chat area so that you can go ahead and click on that site straight from the chat area and fill out the evaluation form when you are done with the session.
Today's session has been approved for .1 CEU and 1.5 CRCC credits. Please refer to the site coordinator instructions for additional information. Please note that in order to be eligible for CRCC credits, you must reside within the 8 southeast states served by the TACE Center also known as TACE Center: Region 4. If you are from state that is not within region, you may still apply for CEU credit but not for CRCC credit. Remember, if your questions are not answered today; please contact the Southeast TACE Center at 866-518-7750 or by sending an email to the TACEsoutheast@law.syr.edu.
The next upcoming Webinars for the month of May are: The Principle of Demand Side in Employment of Persons with Disabilities which will be on May 13 from 11:00 am to12:30; and the next one will be on Ethical Issues for Rehabilitation Counselors Related to Self-Management and Adherence to Treatment on May 27, from 11:00 am to 12:30.
This concludes today's session. I hope to see you back here in future TACE Webinars. Thank you and good-bye for now.
[Event Concluded -- May 6, 2009]