1. Occupational Therapists as CCAC Case Managers Occupational Therapy Promotions Inc. Tammy Balaban, Angie DeGiacomo, Vivian Ip, Lyndsay McTaggart, Daniella Pratt, and Carolyn Taylor

2. PRESENTATION OUTLINE  Purpose  Job description of a case manager  How an OT is qualified to be a case manager  Discussion  Questions

3. PURPOSE  Most case managers of CCACs are nurses, in fact, in some CCACs, only nurses can become case managers. Explain to the director of one such CCAC why OT’s are ideal CCAC case managers.  To illustrate to the CCAC why occupational therapists make ideal case managers

4. http://www.ccacrenfrew.org/Casemanagers.html SCHEMATIC REPRESENTATION OF CCAC CASE MANAGERS POSITION

5. taken from a variety of CCAC websites DUTIES OF A CASE MANAGER  Assess client eligibility and needs  Provide information and referrals  Appropriately manage all resources  Able to establish Goals with clients  Service Monitoring, reassessment, and evaluation  Discharge Planning

6. ASSESSMENT What is Required:  Assess clients’ eligibility and service needs  Work with clients to coordinate services  Provide direction for those clients not eligible for service How an OT can do it:  Trained to assess client needs  Use tools such as:  Target Complaints Assessment tool  Patient Specific Functional Scale  Occupational Performance History Interview (Donnelly and Carswell, April 2002, 84-92)

7. INFORMATION AND REFERRALS What is Required:  Provide information to individuals, community groups, families and other social/health service providers about available services in their community  Refer client to the appropriate professionals How an OT can do it:  OT’s work in a multidisciplinary setting and therefore have an understanding of many health care professions  Information and referrals to other professionals will be provided if the client requires services outside the scope of OT practice

8. How an OT can do it:  “All OT’s participate in managing materials and equipment for their clients, and in ensuring that they are cost-effective and used safely” (Townsend, 123, 2002) RESOURCE MANAGEMENT What is required:  To make good (efficient and effective) use of available resources to support client goals

9. GOAL SETTING What is Required:  Collaborate with clients, caregivers and families to establish goals of care that support and reflect client centered outcomes.  Established goals are kept within the resources of the CCAC (Hamilton CCAC). How an OT can do it:  Use “client centered practice” to determine client needs and goals in the context of the individual and their environments (Law, Polatjko, Baptiste, & Townsend, 2002).  Ultimate goal and focus to enable clients to “do the things they want, need or are expected to do” H. Polatajko (personal communication Sept 13 2004)

10. SERVICE MONITORING, REASSESSMENT AND EVALUATION What is Required:  Monitor program implementation  Evaluate client satisfaction with services  Identify opportunities to improve delivery of services How an OT can do it:  5 types evaluation process Process evaluation Evaluating individualized outcomes Case studies Program implementation Quality improvement (Corcoran, M., 59-60, 2002)

11. DISCHARGE PLANNING What is Required:  Planning for discharge from services at different times as specific goals are achieved (Thunderbay CCAC, 2004)  To address ethical issues: autonomy non-maleficence beneficence justice (Atwal & Caldwell, 2003) How an OT can do it: “underlying client – centred practice is a recognition of the autonomy of the individual person” (Law, Polatajko, Baptiste & Townsend, 2002, p. 49) OTs work along with clients to allow them to set their own goals and help them fulfill each and every one of them

12. DISCUSSION  Why are most case managers nurses in the CCAC?

13. WHY NURSES?  Clinical Practice Base  Regulated much longer CCAC work must be done by a regulated professional. CCAC Peel Human resources (personal communication September 29 2004)  Number of professionals Administrators within the CCAC may not hire an OT as a case manager in order to keep them in the pool of available practicing therapists. I. Greenspoon (personal communication Sept. 30 2004)  Rehabilitation is a small part of the services provided by the CCAC. Much more financial resources are directed at nursing, which promotes the nursing profession as dominant within these organizations. I. Greenspoon (personal communication Sept. 30 2004)

14. DISCUSSION  What are other ways that OTs can advocate for case manager positions in the CCAC?

15. QUESTIONS???

16. REFERENCES Atwal, A., & Caldwell, K. (2003). Ethics, occupational therapy and discharge planning: Four broken principles. Australian Occupational Therapy Journal, 50(2), 244-251. Christiansen, C. H & Townsend, E. A (2004). Introduction to Occupation: The Art and Science of Living. (p. 123). Upper Saddle River, N.J.: Prentice Hall. Corcoran, M. (2002).Using Qualitative Measurement Methods to Understand Occupational Performance. In, Measuring occupational performance: Supporting best practice in occupational therapy (pp. 59-60). Thorofare, NJ: Slack Inc. Gilkeson, G.E. (1997). Occupational Therapists and Teams. In, Occupational therapy leadership: Marketing yourself, your profession, and your organization (pp. 97-111). Philadelphia, PA: F.A. Davis. Hamilton Community Care Access Centre Case Manager Position Description. Retrieved September 28, 2004 from http://www.hamilton.ccac-ont.ca/careers.html http://www.hamilton.ccac-ont.ca/careers.html Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, 9-23. Law, M., & Baum, C. (2002). Measurement in Occupational Therapy. In, Measuring occupational performance: Supporting best practice in occupational therapy (pp. 3-19). Thorofare, NJ: Slack Inc. Law, M., Polatjko, H., Baptiste, S., & Townsend, E. (2002). Core Concepts of Occupational Therapy. In, Enabling occupation, An occupational therapy perspective Revised Edition (pp. 29-32). Ottawa, ON: CAOT Publications ACE. Stanton, S., Kramer, C., Thompson-Franson, T. (2002). Linking Concepts to a Process for Organizing Occupational Therapy Services.Enabling occupation, An occupational therapy perspective Revised Edition (pp. 122-123). Ottawa, ON: CAOT Publications ACE. Vrkjan, B., & Polgar, J. (2001). Meaning of occupational engagement in life-threatening illness: A qualitative pilot project. Canadian Journal of Occupational Therapy, 68, 237-246. Mamom, J., Steinwarks, K., Fahey, K., Bone, M., Oktay, J. & Klein, L. (1992). Impact of hospital discharge planning in metting patients needs after returning home. Health Service Research, 27, 155 – 175.