Case Study Sessions

We invite you to join us as we talk about practical, actionable steps towards improving patient-centered, collaborative care through the lens of case study examinations. See you at the sessions!

What are Case Study Sessions?
One-hour live discussions between people of different disciplines that examine and discuss a case study from a collaborative, interdisciplinary perspective.

What’s the goal?
To promote critical thinking and discussion. We believe that there are no “right” answers when it comes to patient care. Rather, there are a million shades of grey and we must be open to being comfortable with uncertainty and curiosity. These sessions promote thoughtful, complex dialogue about the many ethical, moral, societal, spiritual, and cultural dimensions that are a fundamental part of the care and recovery of human lives.

Who is in on the discussion?
Each session hosts two guests, each from different disciplinary backgrounds who come together to dissect a case study.

Where can I watch? How can I participate?
Sessions are hosted live via Zoom with the opportunity to participate in the discussion as our guest. The recorded versions are made available on YouTube.


In this case study we discuss:

  • How SLP/OT/PT can be an advocate for social services.
  • The revolutionary Community HUB model.
  • How to build relationships with social workers.
  • Privacy/patient-choice and community assistance. At what point do we need to respect people’s wishes, even if that puts them in a high risk situation?
  • How our social service system works and what we can do to make it better.

Case Study: Alejandro

Note that all case studies are 100% fictional.

Alejandro is a 55 yo male who was first diagnosed with Parkinson’s at the age of 48. He was taken to the emergency room due to a fall in his home that resulted in mild head trauma as well as a broken wrist. A friend hadn’t heard from him in a couple of days and found him on the floor. After his acute stay in the hospital, he was taken to a post-acute care facility. While working with a team of speech, occupational, and physical therapists, the therapy team learns that he has no running water at home and that he uses a bucket for a toilet. He has a dog that he has been unable to get outside recently and so urine and feces has been collecting in the house. Alejandro is also worried about his dog and is wondering if anyone is taking care of him. When asked what he eats at home, it’s unclear if he has consistent access to food. He is quite private and is wary of others entering his home and is not willing to do a home eval. He wants to go home as soon as possible.

    Guest co-host: Emily LoPiccolo received her Masters in Social Work from Boston College in 2015, and has been a Licensed Independent Clinical Social Worker (LICSW) since 2018. She is currently employed as a Clinical Manager within the Addictions Division at North Suffolk Mental Health Association in Boston, Massachusetts. Emily supports a dual diagnosis co-occurring enhanced residential treatment program and outpatient addiction services. She is also embedded in the communities of Chelsea and East Boston, where she provides community oversight and outreach to high risk individuals as part of an interdisciplinary treatment team. Additional special interests of hers include trauma and racial justice.

    Megan Berg is the founder of Therapy Insights and PRN SLP in western Montana.

    In this case study we discuss:

    • Productivity and where it came from.
    • The landmark switch to PDPM.
    • The residual crisis: Why productivity still exists in PDPM.
    • Point of care documentation- the pros and the cons and why this isn’t a solution.
    • Collective hands in the air: SNF brain drain, lack of cohesive solution, and… are unions the answer?
    • 5 things therapists can do to push back and turn the conversation in a different direction.
    • 5 ways leaders can communicate how they value employees beyond a productivity number.
    • The future of rehab medicine and how we measure efficacy of clinicians: What we want to see if we could wave a magical wand.

    Case Study: Emily

    Note that all case studies are 100% fictional.

    Emily is a new clinician and just started her first job at a skilled nursing facility with an attached post-acute care wing. She is thrilled to have this job and excited to begin her new career in rehabilitation therapy. The first few months went really well as she got trained and acclimated to her job, but now she is facing increasing pressure to meet a productivity requirement of 90%. As each week passes, she feels less and less capable of her job because her manager is writing down her productivity percentage on a sticky note and leaving it on her desk each morning. Throughout the day, she struggles to find ways to increase her productivity. She finds that the only feasible way to do this is to fudge the number of minutes that she is spending with patients by billing for time she spends looking for them. This makes her feel slimy, but she doesn’t know how else to achieve 90% without clocking out for bathroom breaks and paperwork sessions. All of the other clinicians seem to be able to achieve it, so why can’t she? After a few months, she starts to dread going into work. Seeing the sticky note at her desk each morning makes her feel frustrated, resentful, and unappreciated. Fudging her billable minutes makes her feel like a fraud, and she starts to notice other slides in ethical decision making, such as ignoring an urgent call light or telling a family she doesn’t have time to talk with them because she knows she can’t bill for that time. She is starting to wonder if she made a mistake with this career choice. After work, she is turning to more and more coping strategies, including drinking more than she ever has each night, binge-watching TV, and venting about her job to whoever will listen. She does not feel that it’s safe to bring up the topic of productivity with her boss because anyone else who has tried to do so only has stories of how badly the conversation went. She feels stuck, ashamed, and burned out.


    Ashleigh Kearney, RN
    Union member

    Shelby Midboe, SLP
    Union Representative

    Megan Berg, SLP
    Founder, Therapy Insights

    In this case study we discuss:

    • Clinical recommendations and patient choice
    • How SLP documentation impacts dietitians
    • Therapeutic variance forms
    • The state surveyor dilemma
    • Patient-centered documentation
    • Women’s bodies in the healthcare system
    • SLPs, dietitians, and diet upgrades/downgrades
    • How to build SLP+dietician relationships

    Case Study: Anju

    Note that all case studies are 100% fictional.

    Anju is a 62 year old female s/p anterior spinal surgery. Per MBSS report, she is aspirating on thin liquids. Various strategies were trialed. The only successful strategy was small sips, which reduced the risk, though did not completely resolve it. The evaluating SLP did try nectar thick liquids, which did resolve the risk of aspiration. The report concluded that the patient should be on a softer diet with nectar thick liquids. Anju is unhappy with this and does not want to drink thickened liquids. She is dehydrated and at risk for UTI.


    Emily McKey, RD

    Megan Berg, SLP

    In this case study we discuss:

    • The word compliant and where it came from
    • The traditional medical model
    • The social/empowerment medical model
    • Who decides length of stay?
    • Brain injury, insight, and patient choice
    • Insurance companies and patient goals
    • Incorporating quality of life measures in addition to deficit-based tests

    Case Study: Brian

    Note that all case studies are 100% fictional.

    Brian is a 38 yo male who survived a traumatic car accident resulting in damage to right frontal lobe and a broken leg. He has spent the past three weeks in rehab therapy working on left neglect, insight, impulsivity, safety awareness, and mobility. He is emotionally ready to go home and return to work, but physically and cognitively, there are concerns that this isn’t a good option right now. He is married with two children and works as a programmer. Due to the nature of his injury, he does not exhibit the ability to have accurate insight into his limitations and prognosis. His short-term memory is impaired and there is concern of safety limitations in a home environment when he is alone or sole caregiver of the kids. The therapy team believes he would benefit from an additional 9 weeks of therapy before going home.


    Nathan Guza, PTA

    Megan Berg, SLP