Vocational Resources Plus LLC Disclaimer, My Very Own Personalized Version!

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My Very Own Disclaimer!

The website I own and maintain www.lcpresourcesplus.com is a personal blog with stories and views all written and edited by me; and it is always in transition! Just like me, too! Note: the URL address stands for l~life c~care p~planning resources plus. I should someday obtain a domain that is easier on the thinker! Reflected in those 3 letters, LCP, is my love to prepare life care plans for people. 

SunflowersMy blog is a medium for me to connect with my readers and build relationships. I enjoy creative writing and sharing my talents!

The information I publish, mostly on work and life, while offering ways to help attorneys help their clients, does not reflect the views of anyone else but me unless I’ve won you over! (And I will!) All opinions are my own! I treat my site like gold and do whatever I can to protect it and sincerely don’t want any content to be nothing other than a masterpiece. Because sources, information and links change over time, I’ll do what I can to track the natural evolution of content on my site.

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I’m a rehabber and it’s in my nature to improve things…absolutely every single day!

If a post or something on my blog just doesn’t make sense to you or you see a typo or a problem referenced within my writing, please let me know. Provide me the information and I’ll see what change needs to happen. I do accept responsibility for the personal views and information I have control over, but as you and I both know, what really is under our control?

And of course, I like to add and display media ~ pictures, images, downloads, etc. Although some of these creative beings are mine, many are not, and those that are not, I do not own although I’d like to feel as though I do as they help me feature my blog. I certainly don’t make any money off this blog…because there is nothing for sale!

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My intention is to of course do no harm, and again it’s my opinion and advice, not counsel.

Although I am a counselor, my blog is not used to convey a fact nor absolute nor shape a counseling relationship with my readers. (Sorry, that doesn’t sound too nice, but this is a disclaimer!) Whatever advice, tips, techniques, and recommendations I make are meant solely to help others. I am not responsible nor will I be held liable for any unapproved or inappropriate comments. Further, I am also not responsible for mistranslation or interpretation of my site’s content.

And once again, the content on this blog is the opinion of the blogger, who is me, Amy! and it is not intended to “malign any religion, ethnic group, club, organization, company, or individual,” or anyone or thing, especially those with the ability and desire to fight back! If there is concern or any copyright issue, again, let me know and I’ll make amends.

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Whew, and I thought a couple of sentences would do it!

I’ll continually edit this disclaimer and re-post as time progresses and I learn more about myself and my work, as well as the world of small business blogging and website maintenance. Thank you for reading! ~ Yours truly, Amy E. Botkin

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

 

 

Happy Martin Luther King, Jr. Day ~ Thank Our City Workers!

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A few years back, Des Moines Public Schools had planned to use MLK day as a snow make up, but it was overturned by the school board based on good speaking and listening skills of many people.

MLKDr. King  would be proud of the process involving our community and his holiday!

I also think he would appreciate students being in the classroom on the 3rd Monday in January learning and growing! He obviously had a passion for education, as did his wife Coretta, and knew how important learning is at every age. I totally agree!

At the end of July of 2019, my husband and I visited the Martin Luther King National Civil Rights Museum at the Lorraine Motel in Memphis and found it to be a special place filled with thoughtful, soulful and educational experiences. 

Dr. King and his life continues to evolve throughout communities across our country. 

The evening before he was assassinated, Dr. King was preparing to lead a protest march to help support striking sanitation workers.  Dr. King was hard at work doing his job to help others do their hard jobs.

Green garbage truckThankfully, every Tuesday morning the garbage in my hood gets picked up!

Thank you to the city sanitation workers and thank you to the city street sweepers. I appreciate your work. Des Moines is a beautiful city filled with people who care about our community and I’m proud to live here.

Street sweeperI hear the sweeper on my street quite a few times throughout the year and rush to watch it pass by my house!

Thank you Dr. King for all you’ve done, especially for your call to service helping working people across the nation. I’m particularly fond of this quote:  

“If a man is called to be a street sweeper, he should sweep streets even as a Michaelangelo painted, or Beethoven composed music or Shakespeare wrote poetry. He should sweep streets so well that all the hosts of heaven and earth will pause to say, ‘Here lived a great street sweeper who did his job well.” ~ a quote by Dr. Martin Luther King.

Be the best you can be at what you do as an attorney. Let me know if you’d like my help to help you help your client on a case involving work and disability!! I’ll strive to be of valued service to your case.

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

Central Value of Consulting with Me, What An Attorney Will Find!

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I provide forensic vocational rehabilitation consulting services and work with attorneys with passion; those who truly care about their clients. Trust me, I care about my customers and you will find that I too am passionate about my work and will help you as much as I can so you can help your clients.

You’ll find we make a nice pair when we focus on your client!

Please take your time to review information about my professional services. Life care planning and forensic rehabilitation counseling are unique to vocational rehabilitation. That’s why I chose to work in this field! It takes a lot of knowledge yet common sense to truly help others.

Work Hard Stay HumbleYou’ll also find I work hard for you and just as hard for your client!

If you, Attorney Person, need help with how to quantify AND qualify an individual’s earning capacity within a life care plan, I am the consultant you’re looking for. If you need a report explaining a person’s vocational background and earnings potential, I am the consultant you’re looking for. If you need an expert to serve on the stand in your case, I am the consultant you’re looking for. Want me to continue on about my work? 

I believe work is central to the existence of adult functioning. It provides funds needed to live and supplies status and security for an individual. You’ll find value in how I approach my own work in a qualitative way. You’ll see I’m grounded in neutrality, sincerity and resolve to never give up until the facts make sense.

Ask me some questions and learn what I, Amy E. Botkin, can do to help you help your clients.

Amy Pic 9-29-15

You’ll receive a humble reply!

Vocational Resources Plus, LLC * lcpresourcesplus.com * 515-778-0634  

amyebotkin@lcpresourcesplus.com

 

Thank you for reading my post and checking out my website where you can read about my services and find my disclaimer for your reading pleasure!

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

People and Their Pets…Got Cat? A Good Vocational Assessment Question to Ask

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Originally published on: Dec 17, 2012 And updated on December 17, 2019

When I meet with an individual to perform a vocational assessment, I ask questions to gather information about their work and life background. One question I ask, underlying other questions regarding psycho-social factors, is about pet ownership. Asking about pet ownership during an evaluation can tell me a lot about a person!

Got Cat? Dog? Rabbit? Snake? Fish? Iguana? Bearded Dragon? Horse?

Of course pet ownership is not for everyone, but if the individual is a pet owner, and a discussion develops about the topic, it offers me insight about the person. Pet ownership allows for psycho-social benefits accruing within an individual from the one-to-one type interactions with their pets.

Pet ownership can also influence broader social interactions and perceptions, experiences of sense of community (you recognize the dog going for a walk in your hood!), and social capital at the neighborhood level.  (Ever been to a dog park? Or even to the pet store that allows pets! You’ll know what I’m referring to!) In addition, a pet owner’s sense of health and well-being often emerges as a valuable and positive feature of daily living.

SamiJo The Love of My Life!
SamiJo The Love of My Life!

This is SamiJo, the Love of My Life!

Okay: At one point in my life, just a few years back I had 3 cats (Felix, SamiJo and Alaska*), a dog (Bella*), a guinea pig (Peggy), and a fish (Bluebee). Oh, and a hedge hog (Sandslash). My beloved rabbit, (a mini rex named Patches) died last week.

*Update as of 12/17/19: Alaska is now the #1 puddy in the house, and Bella has penetrated the interior as well (she used to be an outdoor dog). And along with these two loves, I’m also the pet mother to a fish named Focus and a rabbit named Mollie.

It’s a big responsibility to own a pet. You must provide basic care which includes food, water, shelter, veterinary care, and exercise for your pet. And you must abide by the City’s bylaws around pets and animals.  Another view into pet ownership is that of having the physical ability or mental capacity to care for something other than yourself. In fact, this could change in a positive or a negative way based on experiences in your life.

For Bella’s 5th birthday awhile back, she received a dog pass to the Riverwalk Dog Park!  Another update as of 12/17/19: Bella  no longer likes dog parks…at age 15 she mostly just likes to be fed treats, be petted and beloved by those who she knows and likes how they smell!  In May of this year, she experienced an old dog condition and was diagnosed with idiopathic vestibular disease.  (Inner ear problem leading to dizziness…just like a human can experience.)  It was very distressful to witness my dog going through the acute stages of this condition, because I thought she was experiencing a stroke. I had to take her to the emergency vet clinic where she received this diagnosis, and then back to our vet for follow-up. Currently she is on medications as needed. Whew!

Patches
Patches

Patches was a grateful rabbit

Patches had plush, velvet like fur and a happy personality. He was a mini rex, a small rabbit, weighing 3-4 pounds. A mini rex is known as “The Velveteen Rabbit”.  Patches liked to lunge out of his wooden hut when his cage door was opened. Some people (like my husband) got a little frightened of this burst out, thinking they were in danger! But I saw his behavior as a great show of energy! I also loved his happy hops!

Patches loved rose petals…He ate them! 

Patches always was thankful when he was fed (and especially when he received a treat!) with a little snorty sound. I had noticed he was getting very thin, however he still was eating. And then one morning, he was not lunging out of his hut, and he was very still, yet he was breathing. I checked on him several more times.

Later in the afternoon he did lunge out, although it was a very unusual lunge. He bonked off his litter box and landed on his side. I started to pet him…continuing to stroke his very soft fur…until he died. And the whole time this was happening, my daughter was also experiencing this loss. She, in fact, took on the responsibility (age 15 at the time) to plan a service and bury him.

Think about pets you’ve known and understand why I find it important to ask about pet ownership. Back to the dog park experiences, you learn the dogs’ names, but never ask the owners for theirs, right!? How about the observations of the behaviors (both dogs and the owners) you arrive at to compile evidence about your theory of dog parks!?!

In a previous post on April 2nd 2012, I blogged about another question I ask about the person’s nutritional intake and habits. Want to Heal that Injury? Focus on Your Nutrition!  Healthy nutritional intake is just as important for your body as it is for your pets. Please feed everyone well!

For You Patches. I Loved You!

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And for you Mollie, she prefers grapes!

Let me know if you have questions about how I perform a vocational assessment. You can also click over under documents for download to see a sample vocational assessment and evaluation report.

Give me a call at 515-778-0634 or email me amyebotkin@lcpresourcesplus.com to discuss your case and how I could help you help your client. 

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Alaska and Her Rehabilitation Plan…Patience Beyond that of a “Normal” Cat Owner!

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Okay, another cat blog! Yes, I’m a cat lover and I love all pets and I care for all living creatures! I’m not a cat fanatic, it’s just that felines have been an important part of my life since my teens, and I love cats! I love to write too. I love my work. I love my family. I love my life! I love a lot actually! Amy means beloved, so it’s reciprocated in many ways : ) Read on please! I’d love it!

Cat Plate
Cat Plate

Little did we know that 3 months after Max my manx was murdered in early 2002 by something in the street, (I don’t love creatures who kill pets, and on the other hand I don’t like it at all when my pets kill creatures), a tiny meow would emit from our neighbor’s garden. Oh my, this long haired kitten was awesome! Felix! Welcome! (Okay, this blog is not about Felix today!)

Max, (nope this blog not about you either, meooowww) a dearly beloved yet wild cat, found me in ~1987 when I was renting the basement of a brick home in Windsor Heights (it had a pool in the back yard.) Speaking of cat claws! A word of advice from a long time cat owner, (counselors shouldn’t give advice, but in this case, listen to me!): Don’t think it’d be fun to give a cat a ride on an air mattress in a pool. Trust me. Sure looked like I had open heart surgery!

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Alaska, when she was skinny

Now, here’s a blog devoted to Alaska. She’s the cat who strutted on down the street one Spring evening in 2012 (following my son Jacob and his friend Josh) directly into our house and to a bowl full of cat food. Score!

I recall saying “Wow I’ve always wanted a white cat!” She’s all white with beautiful eyes (I love the green one; no, I love the blue one!). Oh dear, upon her arrival she was a very thin stray!

And oh dear, oh my, oh dear, I would have no idea what trouble she would end up causing over the next year or two (…). You really don’t want to know all the horrid details, but just know her behavior  involved lots of $$$$ due to her destructive nature of clawing at furnishings (another word of advice regarding leather furniture and cat claws, expect your sofa to be a target!) and depositing her scent in various places throughout the house. 

Plus there were even more costs $$$ over veterinary bills due to her actions toward the existing female feline (my love of all cat loves SamiJo.) But Alaska was still a cat I had no plans to give up on! To this day, she’s definitely not the perfect puddy and I don’t expect she ever wants to be in “her eyes”!

When she arrived, she looked like a kitten, however our vet, Dr. Michael Forret, said she was about 7 months old when she decided to ditch being a stray and choose our home. She was hungry and dirty! Even her ears where filthy. Jacob named her and she has a middle name too, but I don’t think I should let you on to that just yet!

Alaska Our Putty TattyI rehabilitated Alaska TF into one big healthy white cat!

Part of Alaska’s rehabilitation included a lot of touch. She didn’t like being touched much, probably because she had not experienced much touch. To this day, she still will allow being touched only upon her terms and conditions, but I like to make her think she loves being petted which she really does but tries to hide it (cats).

kitten-in-toteAJ & AK bonding!

ArinJune figured out a way to carry her around in a tote bag (and to this day I often find her lounging in one of these she found!) to feel safe. With ongoing rehab,  regular vet care, good food and water, and lots and lots of love and attention, she thrives! Treats are nice too!

AK is much calmer of late into her more mature cat years. She loves the freedom to do what felines do (….sleep…and read above [hunt]…). She continues to be “a wild one” however and she herself does her share of “killing and delivering….” But, how can I stop a cat from that? Her hunting is actually of value to where we live because of an unkept property or two in the hood. But the dismembered gifts by the back door, come on! Enough. I purchased her a new collar with a loud bell that will hopefully help plus she only goes outside about once or twice a day. 

Update, Alaska has not gone outside for the last several years, so no more worrying about what she’s killing. Plus, after that one cat fight many moons ago (which lead to another visit to the vet, and resulted in stitches and a chipped ear), she prefers the indoors! And that’s where I like her to be!

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Alaska helping me on a case!

Good communication and problem-solving skills are required in order to counsel others. In my role as a rehab counselor, I truly want to be empathetic and reveal my desire to help people fulfill their goals. Counselors need good listening skills, compassion, and patience while working with individuals who have suffered serious injury and disability.

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She found this case interesting and pauses to reflect!

I know I have patience beyond that of a normal cat owner! Thank you my felines for teaching me how to listen and show my true self.

If I can help you help your client with a life care plan that includes vocational rehabilitation, please let me know! Contact me at 515-778-0634 or email  amyebotkin@lcpresourcesplus.com

Thanks for reading! I hope you “loved it!”

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My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Rights of the Expert Witness ~ I’ll Take a Veggie Slice, Please

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Rights of the Expert Witness

expert

I continually assess and evaluate (there I go again!) my rights, values, professionalism, and of course ethics (which I really enjoy!?!) and am hopeful to write more on these topics and my career in the field of forensic rehabilitation consulting.

As far as rights, I found this great listing online (website is referred to below), and yes I added the graphics! I agree with the following essential considerations for taking on the role of expert witness:

  1. I have the right to be paid for my work.  Dream of Getting Paid
  2. I have the right to be prepped in advance of my testimony.
  3. I have the right to ask questions about the case.
  4. I have the right to work for either side, without fear of retribution.
  5. I have the right to change my opinion from previous testimony, as long as my opinion is evolving (based on new information, science and/or experience) rather than revolving (based on which side I’m working for). 
  6. I have the right to say “I don’t know”, if in fact, I don’t know. Just because I’m the expert doesn’t mean I have all the answers. I am clearly okay to say “I’m sorry, that’s outside my scope of practice”.
  7. I have the right to solicit objective feedback about my testimony from  the attorney who has called (and of course, they have the right to  decline to give it).
  8. I have the right to set limits with counsel about the scope of my testimony. 
  9. I have the right to disagree with another expert’s practices or  conclusions, even when I perceive that expert to be: a.) more educated;  b.) more famous; or c.) more experienced. 
  10. I have the right to disregard the initial instinct to view opposing counsel’s expert as the enemy, but instead recognize everyone’s role in the process and share pizza and a bottle of wine with that expert after trial is over.

Pizza

 Truly, it’s all good work!

I am glad my career continually evolves! I accept responsibility when providing forensic services to be clear, truthful and comprehensive in my evaluation and report products, and in my role as an expert witness. Thank you for reading!

Please contact me Amy Botkin for more information ~ 515-778-0634 or amyebotkin@lcpresourcesplus.com

I’ll take a veggie slice and a glass of Chardonnay please. You?

Source for Rights: http://www.forensichealth.com/2011/07/13/10-things-the-fho-expert-witness-bill-of-rights/

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Here to Help The Passionate Attorney Help Your Client ~ Life Care Planning Services

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Along with vocational consulting services, I offer you life care planning services. Life Care Planning Services are valuable to passionate attorneys such as yourself: One who works to your fullest potential for your clients; One who truly cares about your client; and One who strives to maximize the best outcome for your client.

A Life Care Plan will help you help you help your client.

cartoon lawyer  Are You a Passionate Attorney?  Image result for woman attorney cartoon

Comprehensive Life Care Planning Services focus on the individual who sustained a personal or catastrophic injury, has a congenital disease or acquired illness, or suffered a traumatic event that altered his or her life leaving them with a disabling condition. The individual and his or her family is in need of planning how to live with these ongoing life changes.

Image result for passionate attorney cartoon   Are You a Passionate Attorney? Image result for group of attorneys cartoon

A Life Care Plan outlines an individualized holistic program that documents your client’s specific healthcare needs and a projection of what it costs for that care over their lifetime. An economist reviews the plan to determine the present value of the costs.

Even more, a Life Care Plan  helps prevent medical complications, enhances community and society participation, considers quality of life issues, and assists in maintaining emotional and psychological health. 

The person’s life now has important healthcare needs and significant costs are associated with those needs. How can you, the person’s caring and passionate attorney prove this, or show this to others, and why would you need to do so?

A Life Care Plan is helpful in many ways, here are three,

  1. to facilitate decision making relating to the individual’s health care, long-term care, and special needs; and perceive the related costs;
  2. to identify and obtain good care in the individual’s community, whether at home, an assisted living facility, or, if necessary, a nursing home; and perceive the related costs;
  3. to help move the litigation process forward, and ultimately to settle or win a case justifiably at the highest level possible using real data!

A Life Care Plan involves a systematic process (I do that part!) of developing a “road map” of the care, goods and services the person will need to ensure optimal health, safety and life satisfaction. A plan also highlights what it is the person will need to restore or improve their life activities to their maximum potential.

Keep in mind that while most Life Care Plans are developed for people who have suffered a traumatic injury, Life Care Plans are increasingly used for older adults with chronic conditions to anticipate their health and financial needs in later years. Do you have a client in this elite category? If so, be prepared for more future that focuses on healthy living! (Hint: Get a Life Care Plan!)

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The standard definition of a Life Care Plan is a “dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research, which provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs. (IALCP – International Academy of Life Care Planners, 2003. Definition established during the 2000 Life Care Planning Summit.)

Please visit Dr. Deutsch’s webpage for much more information on Life Care Planning. Dr. Deutsch was on my training team!


Above is my most recent CRC Certificate and below is my most recent CLCP  Certificate

I am a Certified Rehabilitation Counselor (CRC) and a Certified Life Care Planner (CLCP).  As a professional in rehabilitation, I am able to develop a plan using  advanced knowledge of specific disabilities, established treatment care resources, and a consistent objective approach toward the practical and functional elements involved in providing the treatment of catastrophic injuries and diseases. 

Communication and negotiation skills are essential (so true) while working with patients, families, caregivers and treatment teams. Keep on perusing my website, which is mainly a relationship building blog, and read my writings. I’d be happy if you would truly consider how Life Care Planning Services will help you help your clients.

Contact me ~ Amy Botkin, MS, CRC, CLCP ~ at 515-778-0634 or by email at amyebotkin@lcpresourcesplus.com  so we can start discussing your case.

I’m here to help you help your client!

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Hello My Attorney Reader! Want to Buy Some TIME From Me…a Consultant and an Educator?

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You’re a good attorney, and you care about the people you represent. You’re busy working on cases and spend a lot of time on time. In fact, you even buy TIME! And, I’m writing to help you make a more comfortable TIME purchase from me, a consultant who is also an educator!

MoneyTime

I fully realize attorneys buy TIME

Time – Because you bill by the hour (and so do I), I promise to help you be more productive and, thus, more successful by providing value laden services.

Pinky SwearI promise to always respect your time.

 

Information – Because I totally understand why you HATE looking stupid (and so do I), I will provide accurate information that you want or need.

Pinky SwearI promise to always ensure you have a good reason for working with me.

 

Money – Because saving money and making money are the goals for almost every law firm (and for every consulting firm too), I will effectively use all the resources available to help with your case.

Pinky SwearI promise to be accurate and fair with my billing.

 

Education – Because lawyers always need continuing education (and so do I) to maintain your license, I am available to present to any group that would benefit from learning about my work and rehabilitation consulting. In addition, as I’m a well-trained educator and counselor, I can help you and your client in many ways throughout the case and onto trial, where my educational background is useful in front of a jury.

Pinky SwearI promise to bring new light to your litigation strategies.

 

Time on HandsHow much TIME would you like to have on your hands, especially when working on a complex case that has to do with work and disability? So there it is!  But wait, there’s more:

I, Amy, promise to Always Be True at My Core, Apple Butterflybecause that’s all I have ever had and have ever needed and I’m willing to share what I know is true.

Enjoy a piece of quality fruit (I love organic apples) and then contact me, Amy E. Botkin, to discuss your case. I’m here to help you help your client!

Email me at amyebotkin@lcpresourcesplus.com to connect so we can discuss your case and how I might help! Thank you for reading.

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

Randy and His Perpetual Flip Off! Need an Expert on Your Case Involving Work & Disability?

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The evening before my dad’s funeral in May 2016, my husband Randy walked our dog Bella.  Holding his cell phone in one hand while talking to my mother about his part in the service, the other hand held the leash. Bella’s a big Aussie girl, weighing in around 60 pounds;

and from what I hear, a huge raccoon made an appearance near a sewer opening down the street just as they were walking by. This appearance led Bella to lurch towards the coon…pulling hard on the fingers grasped around the leash, and breaking husband’s finger in the process. Ouch.

Early the next morning, we had to hit the road to make the trip to Iowa Falls and, well, experience what would transpire during my father’s service…and beyond in this world for those of us who loved him and enjoyed his company.  

Here’s one of my favorite photos of my dad!

Randy never saw a doctor for his finger injury. I wish he would’ve though. I performed my version of physical therapy and Healing Touch on him, but to this day…well, Randy has a broken middle finger that sticks up in such a way it resembles the image below!

Get my drift?

The funeral service was nice, and my mom did a great job choosing the readings and what to sing! Randy read the first reading, my sister Julie the second and Father Tony the Gospel, of course! I was a communion minister for dad’s friends!

Many of dad’s church friends were involved in the Mass Mass and he would’ve loved that! In fact, one of his buddies told me my dad was like a brother to him. At that moment, my heart grew stronger knowing my dad was very special to another person. Clearly, that was God’s presence, and one of many experiences I feel during life!

One good thing was my dad was cremated, so no handling of a heavy casket with a broken finger!  Afterwards, we had a nice lunch that my dad would’ve enjoyed as well. Love You Dad!

So, to this day, Randy’s finger exhibits a perpetual flip off! Pretty cool huh?  When certain people, like a friend he hasn’t seen in a while, questions why he’s flipping them off, instead of going into detail, he just says “I dunno”.  Just recently, he came home from his job and remarked one of his fellow teachers wanted to know why he flipped her off.  He smiled and replied ~

 dunno!

A great memory from October of 2016 was of Randy driving into and out of the parking area of the Kansas City Chief’s Arrowhead stadium pre-and post game (they won!).  Soo many people, staffers, and cops too! Well, they all got the flip off! But, no one noticed, which to me made it quite comical! 

It’s a “I do know” factual concept for me to tap into emotional intelligence when I’m being deposed or testifying (I believe it’s okay to flip someone off under a table or in your mind as a form of mental exercise!!). So contact me, my Attorney Reader, if you need an expert and I’ll offer my complete time and attention  as an consultant and an educator for your case.

Keep me in mind as I also offer consulting services to help attorneys come up with good questions to help you prepare for a deposition and/or cross examination in a courtroom on cases involving work and disability.

I’m Here to Help You Help Your Client!

The best way to contact me is by email at  amyebotkin@lcpresourcesplus.com

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.

 

How to Handle Conflicting Medical Opinions? With a Forensic Approach, of Course!

Reading Time: 8 minutes

Upon referral of a vocational case, I review a variety of  medical data (for example: treating physician reports, Functional Capacity Evaluations, Independent Medical Evaluations) and/or psychological data (for example: psychometric testing, psychological evaluations, psychiatric evaluations) found within the file. During a workers’ compensation litigated claim, and for that matter, any claim that involves work and disability, it’s important for me to understand the individual’s medical situation based on the data contained in these records.

Related image

Good thing I’ve had medical records training and enjoy the review!

If a file contains more than one FCE and/or IME, I can expect the reports to have conflicting opinions. For example, one physical therapist will recommend the claimant has the physical capacity for light work, while the other physical therapist says medium work. Often the therapists also have conflicting information about the individual’s maximal (or lack of) effort put forth during the evaluation.

I Did My Best

The claimant needs to say honestly and sincerely  “I Did My Best!”

Assisting the individual (who can be referred to as the injured worker, the claimant, the patient, the testee, the evaluee, and potentially the client)  in returning to work following an injury is a central role in my specialty of placement. This involves finding the best occupational match within the individual’s own labor market. A person’s “doctor imposed restrictions based on an FCE” should not direct the provision of placement services. A person’s knowledge, skills, interests and abilities should!

Image result for opinionWith conflicting opinions from professionals, what data should I rely upon to perform a beneficial service?

I understand conflicting opinions are influenced by components of context and can be derived from subjective views. 

To resolve discrepancies I first ask myself, why is an FCE being used for this specific claim? The utility of this type of scientifically based evaluation, the training sources, performance methods, test protocols and standards to measure them are numerous. Professionals may have opposing views for their own reasons but I must be able to articulate their reports into vocationally-relevant terminology and tell a story about meaningful and gainful work. And it can be challenging to do this if I don’t understand the conclusion of the FCE report to begin with!

WORK

I love reading medical data rich in detail about a person’s world of functioning!  And I love writing reports rich with detail about a person’s world of work! 

A functional capacity evaluation is actually a term with various definitions, purposes and constructs. The purpose is to  evaluate an individual’s capacity to perform work activities related to his or her participation in employment. It seems that in essence, by having a functional capacity evaluation a person is likely to be put in an unfortunate position of deciding whether he or she is willing to return to work.  If willing, there’s a way. If not, there’s no way.

From what I know, there are approximately 10 different types of commonly used functional capacity evaluations. Here in Iowa, I am most familiar with FCEs with names like the Isernhagen Work System, the Blankenship, Matheson, WorkWell and X-RTS. The reliability or validity of any system is somewhat irrelevant to me because the testing is already entered into “evidence”. What is relevant to me is whether or not I comprehend the results and recommendations contained within the evaluation.

Sometimes I can, sometimes I cannot. I always use a “Does This Make Sense to Me? test!

Image result for conflictingIt’s up to the dualing physical therapists to make their best points during litigation, I’m not in that ring!

I feel fortunate of connections with several physical therapists allowing insight into their clinical practice. I attend continuing education programs, and recall one that helped me understand various approaches to FCE’s specifically the X-RTS Lever Arm.

Thinking Cap

The X-RTS Lever Arm passes my make sense test!

So within the context of my vocational consulting work while cautiously putting any judgment aside (which seems hard when I know I know certain things), I analyze and compare each FCE while considering the testing results.

I analyze and compare FCEs! Whoa!

I note whether the FCE report is readable and user friendly. I assess if I understand terminology and methods used, how long testing was administered, what actually was administered, the claimant’s behavior during the test, and how the evaluator came to his or her conclusions. Does it make sense?

I look for descriptors regarding the results of testing in relation to real jobs. Are there concrete and realistic recommendations regarding strengths and weaknesses in relation to performing physical demand levels of various work situations? I definitely look for the goals and expectations for the evaluation, and whether maximum and consistent effort was made by the evaluee. Comments on the suitability of the testee’s future employment options along with the evaluator’s observations are valuable and should be included.

Thinking Cap

Continuing on with analyzing and comparing FCEs! Whoa! It’s important to note what body part/extremity the therapist focuses on in relation to what body part/extremity was injured. For example in one report, the therapist discussed lower extremity activities, when in fact it was an upper extremity injury. If the report cites examples or uses too many percentages, it’s important to understand how the therapist justifies examples. I’m familiar with a therapist who changes the percentages of the same examples from report to report. That doesn’t make sense to me.

I try really hard to make sense of most things and situations!  No sense

If I am able to square an FCE in my mind after careful and prolonged study, is it possible the claimant could do the same? That  would be  fortunate, especially if the therapist offers good recommendations that make sense!

How does the evaluee, when not truly the therapists’  patient when referred for an FCE by their own work comp attorney; with an additional FCE visit to a different physical therapist by the defense attorney  (that makes 2 different reports prepared by 2 different therapists) perceive discrepancies in the results? Sadly, in my eyes the FCE often gets “interpreted” through an attorney. The repeated pattern of thinking of one’s functional capacity as “poor” does not help anyone return to work.

If there is an IME (Independent Medical Exam), it may seem more geared towards one of the FCEs. Regardless, I try to comprehend all reports, noting the one I understand the most. I’m not so sure that an IME is really a “fresh set of eyes” in the workers’ compensation cases I’ve worked on. This topic is another blog in itself.

Putting both, or multiple opinions in a vocational report and making use of other documentation to support my ultimate and final opinion is a great idea, however I have to be cautious to not put myself in a role that isn’t mine (which is making a medical opinion which I can’t do).

If I am able to provide a doctor (ideally the most recent treating occupational health or rehabilitation doctor) detailed information directly related to a specific occupation or line of work and any resources that could help the doctor understand how such work is performed in a smart, safe and effective manner, many benefits arise.

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Clean your lenses!

There’s a clearer understanding of the vocational rehabilitation process and with agreement from all involved, there’s a higher likelihood one could see a successful common outcome (return to work). This certainly helps solidify my vocational opinion and make reasonable recommendations. Yet, this type of opportunity is not frequently available (it is for me to though through processing a life care plan!). Please know I always search for a way to best express my vocational opinion.

In my reports, I document what medical records I’ve reviewed and then use the actual words from the individual during an interview (or deposition review) describing how s/he details their physical impairment.  Often I hear verbatim what one doctor wrote in their restrictions. The evaluee will respond to my open questioning about any physical limitations (sometimes after the evaluee refers to his/her doctor’s letter) and read or have it memorized saying: “no lifting over 20 pounds, avoid twisting, bending, stooping, sit and stand as needed.”  No sense

What do those words really mean in real life? The individual doesn’t seem to know either. Ask an employer if they have a job that involves no lifting over 20 pounds, no twisting, no bending, no stooping, no this, no that…and that’s not talking their language!

The evaluee who responds to me in this fashion (using verbatim restrictive words) needs future vocational counseling. Vocational counseling (which may or may not be provided depending on the nature of the litigation) helps to gain a clearer understanding of how the person’s medical situation has changed their daily living (especially in the context of their own world of work). This understanding leads to the ability to articulate the individual’s capacity for success to others (family, friends, job interviewers, etc.).

Please keep in mind, the term “restriction” is not conducive to a successful job search. The ability to explain who you are and what you can do from a functional perspective to help a business make or save money is what is conducive to a successful job search. Restrictions should never be the focus of job placement. Skills are!

Rehabilitation counseling is especially important if the individual is searching for a job, requiring job seeking skills training on how to or (how not to) disclose disability or any functional limitation. The personal attributes gained from training helps the placement process move forward with common goals avoiding getting stuck within a few words that don’t apply to working reality.

WORKWhile staying true to my convictions and firm beliefs that a person can work if the person wants to work and has the capacity to work, I need to understand the dichotomy between science and clinical practice is more imagined than real.

If healthcare professionals submit conflicting reports on the same individual, I need to be able to resolve inconsistencies to better understand and appreciate the opinions offered. It is not my role to determine which opinion is correct. It is my role to utilize available information, provide a beneficial service, and make a sound vocational opinion regarding the individual’s strengths and weakness in relation to work capacity and employability.

Matching People With Their World of WorkIt’s rewarding when I can clarify a person’s sense of their own world of work.

I strive to extend the value of FCEs in the litigation process. I am trained not only in understanding a client’s functional abilities at work, but at home and at leisure. (Need a life care plan?) Together my knowledge with those of other experts, contributes to decisions about the economic losses, or damages, for which the person receives compensation.

Thank you for reading this long post! I’m here to help attorneys like you help your client. Contact me at amyebotkin@lcpresourcesplus.com  and let me get to work for you!

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 My professional rehabilitation counseling practice is focused on helping people participate in the world around them, particularly in their own world of work.