Transcript DISABILITIES & CASE MANAGEMENT

DISABILITIES & CASE
MANAGEMENT
ALABAMA VETERANS
CONFERENCE
MAY 2012
Profile of
Today’s Soldiers
All Volunteer
Average Age 27 – 28
Many Married With Families
High Number of Guard and Reservists
Profile of
Today’s Soldiers
More Women in Combat
More Than One Deployment
Technology Improvements On & Off The Field
High Number of Survivors
Nam killed
1 soldier killed
WWIIViet
1 soldier
= 2.6 wounded
= 1.6 wounded
OIF/OEF 1 soldier killed
= 16 wounded
Better care on the field & better armor
High Number of Survivors
Transport field to U.S. Hospitals
Viet Nam 35 – 40 days
OIF/OEF 35 – 40 hours
QUOTE
 "In the history of the Republic, never has so much
been placed on the shoulders of so few for so long,"
said Brigadier General Loree K. Sutton, director of
the Defense Centers of Excellence for Psychological
Health and Traumatic Brain Injury, "We have no
reference population to compare with the addiction
and mental-health problems facing today's military
personnel.”
Frequent Types of Disabilities
Amputations
Hearing Loss
Visual Impairments
Mental or Emotional Disorders
~ Anxiety Disorders -including PTSD
~ Depression
Traumatic Brain Injury
Burns
Amputations
High tech prosthetics
Above the knee/elbow compared to
Below the joint
Most have multiple prosthetics
In demand by employers
Never assume limitations without
discussion
Hearing Loss
Technology getting
better
Many hearing aides
only amplify sound
Communication adds
to frustration
May be more difficult
to place on a job
May interfere with
retention
Visual
Impairments
Common problem
with soldiers
May be associated
with other issues
Many
devices/agencies to
help
JAN would be a good
resource for
placement issues
Mental
/Emotional
• Anxiety
disorders,
including PTSD
• Depression
• Could be in
combination
Anxiety
Unlike the relative mild, brief
anxiety caused by such a
stressful event such as
business presentations or a
first date, anxiety disorders
are chronic, relentless and
can grow progressively worse,
if untreated. Included: Panic,
obsessive-compulsive, PTSD,
phobia’s, & generalized
anxiety disorder.
Depression
An illness that involves the
body, mood and thoughts,
that affects the way a
person eats and sleeps, the
way one feels about
oneself, and the way one
thinks about things.
Without treatment,
symptoms can last for
weeks, months or years.
Depression Symptoms
Loss of interest in activities
Weight loss or gain
Poor concentration/memory
Social withdrawal
Unusual fatigue
Feelings of worthlessness, sad
Flat affect
Post Traumatic Stress
Disorder
Exposure to an event that
causes intense horror, terror,
or fear of death.
After the event, the person:
persistently re-experiences the
event, attempts to avoid memory
or images of the event, and
suffers distress or impairment.
PTSD
Many do not seek help-they do not want to
be seen as “weak”
May feel great guilt, just for surviving
Do not recognize own symptoms
for a long time
Often a major event will bring it
to surface
A Whole body-mind disorder
PTSD Symptoms
Sleep Problems
Restlessness
Overly watchful or hyper vigilant
Social withdrawal
Headaches or unexplained personality changes
Anger outbursts-out of character
Risk taking behavior
PTSD Symptoms
Distrust of authority
Socially disconnected/emotionally
numb
Depressed/anxious
Problems with memory, attention,
follow through
Poor frustration tolerances
Traumatic Brain Injury or
Concussive Blast Injury
Estimates of over 30% from
OIF/OEF have TBI
Most resolved in 90 days
60% of bomb blast victims have
TBI
80% with TBI also have PTSD
Many avoid screening and do
not disclose
TBI Common Symptoms
Symptoms depends on part of
the brain injured
Fatigue
Headaches
Alertness/concentration
Lack of Self Awareness
TBI/PTSD
Share many
symptoms
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Sleep problems
Depression
Anger/irritability
Concentration
Memory
Planning
Attention
Poor frustration tolerance
What to Do?
Listen carefully
Don’t try and diagnose
Be consistent
Ask what would help-memory
aides are important
Be Patient
Make appropriate referral if they are
undiagnosed and you suspect an issue
COPING
Denial/Isolation
Anger
Depression
Acceptance
Hope
CASE MANAGEMENT
USING THE SERVICE DELIVERY STRATEGIES
TO PLACE WITH WARRIORS
J
Assessment
Red Flags
Strategies
Elements of Case Management
 Assessment
 Case Notes
 Develop and Document a Plan
 Case Notes
 Referral to Support Services
 Case Notes
 Follow up and Modification
 Case Notes
 Facilitate Job Placement
Definition:
Case Man-age-ment
Case Management , as the framework for Intensive Services
is the facilitation and coordination of services at the
community level.
The purpose of case management is to provide an individual
with specific resources to take control of his / her life.
It requires the case manager to focus on the long and short
term goals an individual has and empower him / her to make
educated decisions about his or her future.
Nine Key Concepts
1. Comprehensive and client centered
2. The service provider and the client are
partners
3. There is mutual respect between
clients and service provider.
4. A client has only one IDP
Nine Key Concepts
(Continued)
5. Relates the client’s actions to outcomes
6. Involves creative problem-solving
7. Relies on a network of services and
support
8. The service provider and the system are
accountable
9. Requires partnership at the systems
level
INITIAL ASSESSMENT
 Gather Relevant Information
 Establish Rapport
 Use Whole Person Concept
 Analyze Information
 Identify Barriers to Employment
One on One facilitation skills
 Body Language
 Reflection
 Open-Ended Questions
 Closed-Ended Questions
 Active listening
 Non Judgemental
 Para-Phrasing
 Taking Effective Case Notes
EDUCATION
& TRAINING
TRANSFERABLE
SKILLS
SOCIAL &
ECONOMIC
FACTORS
PERSONAL
TRAITS
INTERESTS
POTENTIAL
SKILLS
LEISURE TIME
ACTIVITIES
PHYSICAL
CAPACITIES
Case Notes
S
S
S
S
S
DATE anything you write
QUOTE exactly as stated
Recognize PERTINENT information
Write in SPECIFIC, OBSERVABLE and
MEASURABLE terms
If your OPINION, say so
Writing The Individual Plan
 Determine Employment Barriers to Address
 Set Goals
 Establish Plan as a Team
 Review
 Implement
 Monitor
 Modify If Needed
Criteria For Goals
S-M-A-R-T
Specific
Measurable
Attainable
Realistic
Trackable
1. Change problem statements
into goal statements
2. Brainstorm solutions and
options
3. Balance options with reality;
Choosing one or more
options
4. Sequence and assign
responsibility on the IDP
FACILITATING JOB PLACEMENT
 Establishing Business Relationships
Through the Business Services Team
Through the Local Veterans Employment Representative
On Your Own
Critical when placing individuals who have been in Case
Management
Critical when working with someone who has a disability needing
accommodations
COMMENTS FROM BUSINESSES
 Veterans may need more time after returning home
 Awareness of the needed mental and physical skills of
a job
 Be there after the hire
 New challenges may arise for the veteran
 Be willing to educate my staff and/or supervisors
 Are absent from work for on-going treatment, not
disclosed
 *INSTITUTE ON REHABILITATIVE ISSUES
Concern
All
Small
Medium
Large
companies
(5–14)
(15–249)
(250 or more )
%
Rank
%
Rank
%
Rank
%
Rank
It costs more to employ workers with disabilities
58.1
1
64.0
1
54.4
1
39.7
5
Workers with disabilities lack the skills and experience to do our jobs
49.4
2
52.1
2
47.6
2
41.5
4
People with disabilities may not be as safe and productive as other workers
45.7
3
49.9
3
42.7
4
35.0
6
Supervisors are not sure how to take disciplinary action
44.3
4
44.4
4
43.6
3
47.6
1
Supervisors are not sure how to evaluate
40.7
5
39.8
5
41.3
5
43.1
3
Table 12. Percent of companies citing hiring strategies that would be helpful in hiring people with disabilities, by company size
Strategy
All
Small
Medium
Large
companies
(5–14)
(15–249)
(250 or more)
%
Rank
%
Rank
%
Rank
%
Rank
Employer tax credits and incentives
69.2
1
66.8
1
70.5
1
77.1
5
Disability awareness training
64.3
2
59.1
5
66.9
2
82.8
3
Visible top management commitment
64.2
3
59.4
4
65.8
3
84.9
1
Mentoring
63.4
4
60.7
2
62.3
4
84.3
2
Assistive technology
61.1
5
59.1
5
59.7
6
80.3
4
Using a specialized recruiting source
60.8
6
57.3
7
61.8
5
76.6
6
Flexible work schedule
60.0
7
59.7
3
58.1
7
71.8
12
Training existing staff
57.9
8
54.7
8
58.0
8
76.1
7
On-site consultation or technical assistance
57.1
9
54.5
9
57.0
9
73.1
9
Disability targeted internship program
55.4
10
53.0
10
54.4
11
74.3
8
Short-term on the job assistance with job coach
54.3
11
50.5
11
55.2
10
72.4
10
Alternative Job Development
Techniques
Mentors
Supported Employment
On the Job Training
Specialized Programs
Creating Jobs
Mentors
Mentors are normally from inside
the organization
Become the go to person for the
veteran
Meetings are held regularly, maybe
daily in the beginning then less and
less
Supported Employment
Using employment coaches
The coach learns the job
The coach coordinates with the
supervisor
The coach teaches the veteran the job
They work side by side as needed
A contract often defines the roles
Possible Coaches
Retirees
Graduate Students in Counseling or Rehabilitation
Disability Navigators
Through VR&E or State Rehabilitation
programs
On the Job Training
A contract is established with the
employer, the veteran and the
placement specialist
Time frames are established
along with expected knowledge
to be gained
Normally pay increases at each
step of the process
Specialized Community
Organizations
Placement is in a controlled
environment
Supervisors work for the agency
Work is carried on at the agency or in the
field under agency supervision
Many communities have these
organizations: Goodwill, Compensated
Work Therapy, etc.
Alternative Job Development
Technique
Business Perspective
Connecting with the
Business Community
Being Aware
Creating a Job
Developing Proposals
The
Business Proposal
Provide a
Explain description of
Identify
Enclose
how
someone
problem /
a
list
Contact
you know
this
issue within
of
Information
who
could
fill
could be
a business
the proposed references
addressed
position
POSSIBLE ACCOMMODATIONS
 Several Apps for the Phone
 Reduce Distractions
 Provide Private Space
 Lighting
 Divide Work into Smaller Tasks
 Work from Home
 Allow for Flex Time
 Disability Awareness Training to Co-Workers
What is Your Role?
 Recognize possible problems, if un-diagnosed and
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
make referrals
Know the resources and options for employment in
your area
Help research accommodations
Understand the frustrations
Be creative when thinking employment
QUESTIONS?
SUGGESTIONS?
IDEAS?
RESOURCES?