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02 – Report Template Case Management

Service Group B: Case Management

Intensive CASE MANAGEMENT

B-2 Intensive Case Management - This category of services includes Veterans who need substantial assistance to achieve rehabilitation goals and/or those in short term rehabilitation programs, such as certificate training programs, extended evaluation programs, etc. Personal contact must be made on a frequent basis to ensure close monitoring of progress and quick response to need for services, interventions, or referrals. At least one personal contact per month (no more than 30 days between each meeting) must be face-to-face. Monthly reports will also document on-going intervention as needed. The average hours per month to provide intensive case management is two (2).

Narrative Format (shall include, but is not limited to)

Contractor company name/address/phone

Referral Source:

Veteran Name:

VA File (Last 4):

Address:

Dates Seen: Current ____________ Next Scheduled _____________

In-person meeting: ( Yes ( No

Counselor:

This section’s content includes current rehabilitation services activities, progress toward successful completion of the goals and objectives, assessment of progress through in-person meetings, objective progress reports, subjective input by the Veteran and/or family members, and other appropriate input depending upon the rehabilitation service setting. It will also present personal, socio-economic, family, and medical issues that the Chapter 31 participant is experiencing.

The services report will address circumstances that affect the Chapter 31 participant’s ability to succeed with his or her goals, and will identify resources that will improve successful completion of the rehabilitation plan.

Review of Plan

The report narrative will be expansive enough to comprehensively address the overall plan, progress toward goals and objectives, incremental accomplishments, any urgent needs for additional services, complications that may interfere with the plan’s progression, and subjective input from the Veteran. Refer requests to change plan goal, and/or incremental objectives to the VR&E Vocational Rehabilitation Counselor.

▪ Plan Goal

▪ How do the provided services contribute to the accomplishment of the objectives?

▪ Progress toward accomplishing objectives (fragment, unclear)

▪ What is the anticipated completion date?

▪ Facility – rehabilitation, medical, assessment programs

▪ Monthly plan review and changes Yes ο No ο

▪ Annual plan review and changes Yes ο No ο

▪ Change in enrollment status (increase/decrease in rate of pursuit)

▪ Readiness to return to plan (following a period of interruption)

▪ Supply/equipment needs

▪ Transportation

▪ Legal issues that may interfere with progression

▪ Physical or mental health issues that may interfere with progression

Personal

The report narrative will document the Veteran’s contact information and address personal issues the Veteran is experiencing.

▪ Confirm mailing and e-mail address, phone number, and any updates/changes.

▪ Change in dependents – (if Ch 31 subsistence allowance is payable, follow procedures for adding/removing dependents)

▪ Change in address

▪ Overall living arrangements

o Satisfactory/unsatisfactory – explain with details

o Housing accommodations – use of VHA HISA grant; use of VBA Special Adapted Housing grant; community resources for accommodations

o In-house assistance – schedule, provider, service (i.e., home health, personal care attendant, etc.)

o Does the Veteran feel safe in his/her home and community – explain with details – alert VR&E of any potential danger situation

▪ Is the Veteran experiencing any personal or family adjustment problems?

▪ Is the Veteran encountering any physical stamina or strength problems?

▪ Is the Veteran experiencing any memory, concentration or communication problems?

▪ Does the Veteran require help in moving around in his/her home and/or community?

▪ Does the Veteran feel a need, and have the interest and the ability to improve his/her level of physical activity and personal fitness?

▪ Is the Veteran socially isolated?

▪ Does the Veteran wish to be more socially active?

▪ Are there any architectural barriers in the Veteran’s home?

▪ Other

Financial

The narrative scope of report will identify any financial issues that may affect the Veteran’s ability to participate in a program of rehabilitation and/or live independently. It will identify state, federal, and community resources to mitigate financial problems. It will assess need for more in-depth financial counseling assistance and available resources.

▪ Sufficient finances to pay for housing, food, utilities, commuting, childcare, etc.

▪ Sufficient finances to support lasting maintenance costs of assistive technology or accommodation devices

▪ Other

Medical

This report will address the impact of service-connected and non-service-connected disabilities on the Veteran’s ability to progress toward goals and objectives. It will dentify the need for referral for medical support services (VA Medical Center), and identify the need for rehabilitaiton support and/or accommodations.

▪ Need for medical/psychiatric care

▪ Urgent medical needs

▪ Rehabilitation medicine needs (i.e., Occupational Therapy, Physical Therapy, Speech Therapy, etc.)

▪ Accommodation needs

o Available through training institution

o Available through medical facility

o Available through rehabilitation facility

Recommendation

A timely report is necessary to ensure that Chapter 31 participants receive all of the rehabilitation resources they are entitled to. Needs that are identified during the monthly and annual rehabilitation assistance meeting must be documented and communicated to VR&E Vocational Rehabilitation Counselors as quickly as possible to ensure that the Veteran’s benefits are administered in a timely and accurate manner, that vendor payments are made on schedule, and that support services are acquired when needed.

The case management report should include any specific recommendation for VA follow-up i.e., tools, equipment, specific licensure/certification, uniforms, subsistence allowance, personal follow-up, support services referrals. Additionally, information regarding vendor (school/training facility/service provider, etc.) costs and payments will be addressed in the narrative. Specific documents will be attached to the report, and VR&E will be notified of any issues requiring immediate VA action. The assessment from case management will include recommendations regarding accomplishment of objectives; interruption from the plan, and reasons for interruption such as relocation, medical, and other issues that arise and impact the Veteran’s Chapter 31 services. Issues requiring action by VA must be referred immediately.

If the Veteran has completed all goals, or as many as he/she will be able to complete, provide a recommendation for case closure as “Rehabilitated” to the VR&E Vocational Rehabilitation Counselor.

Signature/credentials of Rehabilitation Counselor

INTERRUPT FOLLOW-UP SERVICES

B-3 Interrupted Follow-Up Services – This category of services is provided to Veterans who need ongoing follow-up services during a period of medical or other interruption to ensure that service needs are met. Frequency of contact is dictated by Veteran needs and circumstances. This level of service requires a minimum of at least one monthly verbal contact (no more than 30 days between each contact). More frequent contact by phone and/or e-mail is recommended. Face-to-face contacts are preferred, but not required. If attempts to provide verbal and/or face-to-face contact are unsuccessful, documentation will reflect follow-up by mail and other appropriate avenues. Billing for this package will be considered if the file demonstrates sufficient effort for follow-up; however, failure of the Veteran to cooperate must be staffed with the VA at least monthly for consideration of payment beyond the first 30 days when the Veteran is not cooperating. The average number of hours per month to provide follow-up services is one (1).

Narrative Format (shall include, but is not limited to)

Contractor company name/address/phone

Referral Source:

Veteran Name:

VA File (Last 4):

Address:

Dates Seen: Current ____________ Next Scheduled _____________

In-person meeting: ( Yes ( No

Counselor:

This section’s content includes current rehabilitation services activities, progress toward successful completion of the goals and objectives, assessment of progress through in-person meetings, objective progress reports, subjective input by the Veteran and/or family members, and other appropriate input depending upon the rehabilitation service setting. It will also present personal, socio-economic, family, and medical issues that the Veteran is experiencing.

The services report will address circumstances that affect the Veteran’s ability to participate in rehabilitation programming, and will identify resources that will improve successful completion of the rehabilitation plan.

Review of Plan

The report narrative will comprehensively address the overall plan, progress toward goals and objectives, incremental accomplishments, any urgent needs for additional services, complications that may interfere with the plan’s progression, and subjective input from the Veteran. Refer requests to change plan goal, and/or incremental objectives to the VR&E Vocational Rehabilitation Counselor.

▪ Plan Goal

▪ How do the provided services contribute to the accomplishment of the objectives?

▪ Progress toward accomplishing objectives (fragment, unclear)

▪ What is the anticipated completion date?

▪ Facility – rehabilitation, medical, assessment programs

▪ Monthly plan review and changes Yes ο No ο

▪ Annual plan review and changes Yes ο No ο

▪ Change in enrollment status (increase/decrease in rate of pursuit)

▪ Readiness to return to plan (following a period of interruption)

▪ Supply/equipment needs

▪ Transportation

▪ Legal issues that may interfere with progression

▪ Physical or mental health issues that may interfere with progression

Personal

The report narrative will document the Veteran’s contact information and address personal issues the Veteran is experiencing.

▪ Confirm mailing and e-mail address, phone number, and any updates/changes.

▪ Change in dependents – (if Ch 31 subsistence allowance is payable, follow procedures for adding/removing dependents)

▪ Change in address

▪ Overall living arrangements

o Satisfactory/unsatisfactory – explain with details

o Housing accommodations – use of VHA HISA grant; use of VBA Special Adapted Housing grant; community resources for accommodations

o In-house assistance – schedule, provider, service (i.e., home health, personal care attendant, etc.)

o Does the Veteran feel safe in his/her home and community – explain with details – alert VR&E of any potential danger situation

▪ Is the Veteran experiencing any personal or family adjustment problems?

▪ Is the Veteran encountering any physical stamina or strength problems?

▪ Is the Veteran experiencing any memory, concentration or communication problems?

▪ Does the Veteran require help in moving around in his/her home and/or community?

▪ Does the Veteran feel a need, and have the interest and the ability to improve his/her level of physical activity and personal fitness?

▪ Is the Veteran socially isolated?

▪ Does the Veteran wish to be more socially active?

▪ Are there any architectural barriers in the Veteran’s home?

▪ Other

Financial

The narrative scope of report will identify any financial issues that may affect the Veteran’s ability to participate in a program of rehabilitation and/or live independently. It will identify state, federal, and community resources to mitigate financial problems. It will assess need for more in-depth financial counseling assistance and available resources.

▪ Sufficient finances to pay for housing, food, utilities, commuting, childcare, etc.

▪ Sufficient finances to support lasting maintenance costs of assistive technology or accommodation devices

▪ Other

Medical

This report will address the impact of service-connected and non-service-connected disabilities on the Veteran’s ability to progress toward goals and objectives. It will dentify the need for referral for medical support services (VA Medical Center), and identify the need for rehabilitation support and/or accommodations.

▪ Need for medical/psychiatric care

▪ Urgent medical needs

▪ Rehabilitation medicine needs (i.e., Occupational Therapy, Physical Therapy, Speech Therapy, etc.)

▪ Accommodation needs

o Available through training institution

o Available through medical facility

o Available through rehabilitation facility

Recommendation

A timely report is necessary to ensure the Veteran receives all of the rehabilitation resources needed. The report will include recommendations regarding accomplishment of objectives; interruption from the plan, and reasons for interruption such as relocation, medical, and other issues that arise and impact the Veteran’s Chapter 31 services. Issues requiring action by VA must be referred immediately.

If the Veteran has completed all goals, or as many as he/she will be able to complete, provide a recommendation for case closure as “Rehabilitated” to the VR&E Vocational Rehabilitation Counselor.

Signature/credentials of Rehabilitation Counselor

STANDARD case management

B-1 Standard Case Management - This category includes Veterans pursuing long-term training programs who are in need of on-going support toward achievement of employment goals. Personal face-to-face contact must be made at least once per school term or more frequently if the Veteran’s circumstances dictate. The school term is defined by the training facility. Average face-to-face contact is once every 4 months, with routine support provided in an ongoing manner. The average number of hours per month for standard case management is one and a quarter (1.25).

Narrative Format (shall include, but is not limited to)

Contractor company name/address/phone

Referral Source:

Client:

VA File (Last 4):

Address:

Case Number:

Dates Seen: Current ______________ Next Scheduled _________________

In Person Meeting: ( Yes ( No

Counselor:

This section’s content includes current Rehabilitation Services activities; progress toward successful completion of the goals and objectives of the rehabilitation plan; assessment of progress through grade reports, training reports, and other appropriate input depending upon the rehabilitation service setting; presenting issues; and personal/socio-economic/family/medical issues that the Ch 31 participant is experiencing.

The case management report will address training circumstances that affect the Ch 31 participant’s ability to succeed with his/her training and employment goals, and identify resources that will improve successful completion.

Review of Rehabilitation Plan

The report narrative will be expansive enough to comprehensively address the overall rehabilitation plan, evaluate the progress toward achieving goals and objectives, and document incremental accomplishments and readiness for employment. Additionally, the report will highlight any urgent needs for additional services, outline any complications that may interfere with plan progression, and describe any subjective input from the Veteran. The following list of items is not all-inclusive, but represents the types of items the report will contain:

▪ Vocational Goal

▪ Progress toward accomplishing objectives

▪ Anticipated Completion Date

▪ Facility

▪ Semester/Term Review and discussion of any changes

▪ Annual Review of entire rehabilitation plan and discussion of any potential changes

▪ Change in enrollment status (increase/decrease in rate of pursuit)

▪ Readiness to return to school enrollment (following a period of interruption)

▪ School enrollment certification

▪ Grade report

▪ Supply/equipment needs

▪ Transportation

▪ Legal issues that may interfere with progression

▪ Physical or mental health issues that may interfere with progression

If employed, the report will identify the job title, company name, position description, start date, and salary. It will also describe how the position relates to the Ch 31 participant’s vocational rehabilitation plan. If the Veteran is working part time, is it part of his future goals or employment to supplement his overall income? Is the employment suitable?

Any requests to change employment goals and/or incremental objectives will be referred to the VR&E Vocational Rehabilitation Counselor.

Employment information

▪ Employer

▪ Job Title and Position Description

▪ Location

▪ Point of Contact

▪ Wages

▪ Hours of work

▪ Compensation (pay and benefits)

▪ Start-work date

Personal Data

Confirm mailing and e-mail address, phone number, and any updates/changes.

▪ Change in dependents – procedures for adding/removing dependents on Ch 31 subsistence allowance

▪ Change in address

▪ Other

Financial

Identify any financial issues that may affect the Veteran’s continued job search and employment. Identify state, federal, and community resources that may help mitigate financial issues. Assess the need for more in-depth financial counseling assistance and apply available resources as necessary.

▪ School Financial Aid

▪ Subsistence Allowance

▪ Other educational programs

▪ Sufficient finances to pay for housing, food, utilities, commuting, childcare, etc.

Medical

Address the impact of service-connected and non-service-connected disabilities on the Veteran’s ability to progress toward goals and objectives. Identify the need for referral for medical support services (VA Medical Center). Identify the need for rehabilitaiton support and/or accommodations.

▪ Need for medical/psychiatric care

▪ Urgent medical, dental or visual needs

▪ Rehabilitation medicine needs (i.e., Occupational Therapy, Physical Therapy, Speech Therapy, etc.)

▪ Accommodations

o Available through training institution

o Available through medical facility

o Available through rehabilitation facility

Employment Readiness Assessment

Assess each Veteran who is pursuing employment through a Ch 31 rehabilitation plan for job readiness during rehabilitation assistance case management meetings. Narrative will address whether the Veteran is ready to begin an employment search prior to development of employment assistance plan. Capture the Veteran’s subjective input regarding suitability of employment and whether he/she identifies a need for additional services.

▪ Has the Veteran acquired competitive work skills?

▪ Will the Veteran participate in an internship, volunteering or paid employment which will relate in some way to the ultimate employment goal?

▪ Are there employers in the local/distant labor market?

▪ What barriers to employment exist?

▪ Are additional training, licensure, certification, tools, equipment, etc., necessary to achieve job readiness?

▪ Is adjustment to the rehabilitation plan needed to meet current job market demands?

▪ Are accommodations needed to meet current job market demands?

Recommendation

A timely report is necessary to ensure that Ch 31 participants receive all of the rehabilitation resources they are entitled to. Needs that are identified during the semester/term and annual rehabilitation assistance meetings must be documented and communicated to VR&E Vocational Rehabilitation Counselors as quickly as possible to ensure that the Veteran’s benefits are administered in a timely and accurate manner, and that support services are acquired when needed.

The rehabilitation assistance case management report should include any specific recommendations for VA follow-up (i.e., tools, equipment, specific licensure/certification, uniforms, subsistence allowance, personal follow-up, support services referrals). Additionally, information regarding vendor’s (school/training facility/service provider, etc.) costs and payments will be addressed in the narrative.

Specific documents will be attached to the report, and VR&E will be notified of any issues requiring immediate VA action. The case management assessment will include recommendations regarding job readiness and development of Individualized Employment Assistance Plan, interruption from Individualized Written Rehabilitation Plan, relocation for training or employment, and other issues that arise and impact the Veteran’s Ch 31 services.

Signature/credentials of Rehabilitation Counselor

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