Case Management

1. Initial comprehensive assessment of the client’s needs:

• In-depth evaluation of all issues that impact the short and long term well-being of the client and their household system. This is the basis for the development of the Individualized Plan of Care (IPOC)

2. Development of a comprehensive Individualized Plan of Care:

• access to neurological care
• access to Anti-epileptic Drugs (AED)
• transportation
• epilepsy education
• fundraising and awareness participation
• other areas such as access to other medical care, mental health, psychosocial, vocational/educational, employment, financial, legal, dental, housing, transportation issues etc. are also evaluated if identified as a need

3. Coordination of services required to implement the plan:

• This entails the step by step actions taken to assist the customer achieve the goals set in the IPOC. Internal and external referrals are made utilizing the agency and community resources as needed.

4. Monitoring to assess the efficacy of the plan:

• Customers are subject to a minimum of two (2) contacts per year. At least one of these interactions is solely devoted to review of the IPOC progress.
• Hardships and issues preventing goal compliance/achievement are evaluated, and goals are redirected as necessary
• Contacts are usually via phone, emails or fax since case management services are provided virtually. Other opportunities such as support groups and organized events are also used as forums to monitor client’s overall progress.

5. Periodic re-evaluation and revision of the plan as necessary over the life of the client: This may include client-specific advocacy and/or review of utilization of services.