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Rehab Conference 2024: navigating a crisis

By Ben Harding

Published In: Brain and Spinal Injury

We were joined by expert case manager Olivia Dennison, at our recent rehabilitation conference.  Olivia delved into the pivotal role of case managers in crisis intervention, emphasising their adeptness in conducting immediate needs assessments, forming multidisciplinary teams, and effectively managing crise s.

In her talk Olivia explained how, initially, case managers carry out assessments to discern the urgent needs of individuals in crisis, swiftly identifying risks and vulnerabilities.  She also highlighted the benefits of multidisciplinary teams, harnessing diverse expertise to tailor holistic interventions.

The immediate needs assessment

In the realm of rehabilitation and case management, the initial step of conducting an Immediate Needs Assessment holds significant importance. This vital phase serves as the cornerstone upon which the entire rehabilitation journey is built.

An Immediate Needs Assessment, commonly referred to as an INA, is carried out by a case manager, and allows them to evaluate the effects of injuries on the individual’s life. This might include physical condition, emotional wellbeing, social support system and environmental factors.

The theme of the conference centred around ‘Steve’ a fictional client who experienced catastrophic injuries, including brain injury, after a road traffic accident.

Discussing ‘Steve’s’ rehabilitation plan Olivia focused on the importance of the INA, putting particular focus on who a client ‘once was to who they are now’. She stated that by examining this in more detail, case managers will be able to identify the specific needs of the client, both physically, psychologically, and practically.

‘Steve’s' goals for rehabilitation included:

  • Return to work
  • Return to driving
  • Return to ‘normal’ life
  • Regaining confidence

In order to achieve his goals, Olivia identified three overarching priorities, which emerged within the INA. First, ensuring the safety and wellbeing of the client. Second, well-organised resource allocation was a critical factor, establishing the utilisation of available resources to maximise their impact on the client's rehabilitation journey. Third, that timely intervention proves indispensable in the pursuit of optimal outcomes.

With the input of the case manager, it also became apparent that ‘Steve’ would require assistance with managing his mood, enhancing mobility, refining speech, and addressing challenges.

Olivia applied the process of an INA to ‘Steve’s’ journey, recognising the complexities presented by his brain injury. By doing this Olivia was able to identify ‘Steve’s’ top priorities:

Personal support: Foremost among these priorities it was imperative to mitigate Steve's seizure activity, a pressing concern that demanded immediate attention to ensure his safety and wellbeing. By enacting the INA the case manager is able to tailor support services, and ensure personalised assistance is given. Other challenges that were highlighted for ‘Steve’ included fatigue, as its impact was considerable on Steve’s once busy and active lifestyle. Lastly, Olivia pinpointed the restoration of Steve's sense of taste and smell as a vital component of his rehabilitation; Steve identified that he once enjoyed cooking for family and friends.

Resource allocation: Once ‘Steve’s’ personal support requirements were determined, Olivia as the case manager then would need to allocate essential resources, equipment, and adaptations for the client’s well-being.  For ‘Steve’ this could include appropriate care, occupational therapists, and social workers.

Financial planning: The INA will also include a cost forecast for the recommended care plan. This will help ensure funding options are secured to meet the identified needs effectively.

Olivia also recognised the potential limitations that a case manager can often face. She highlighted that it can be common for there to be long periods before seeing their clients again after the initial INA due to funding issues. The importance of signposting towards services was shown to be essential for clients to rely on in the meantime.

The multidisciplinary team formation

Multidisciplinary team (MDT) formation involves assembling a group of individuals from diverse backgrounds, expertise, and skill sets to work collaboratively on a specific project or task. For ‘Steve’ this would include a variety of different therapies including neuro-occupational therapy, neuropsychology, speech and language therapy, ENT and general professional support.

Olivia highlighted the potential issues of overlapping roles and responsibilities of the different parties within an MDT. It was highlighted that problems could arise because of the following:

  • Duplication of effort: When multiple team members are working on the same task or aspect of the project, it can lead to duplication of effort, wasting time and resources
  • Confusion and disorganisation: Overlapping roles and responsibilities can cause confusion about who is responsible for what, leading to disorganisation and inefficiency within the team
  • Communication breakdowns: If team members are unclear about their roles or if there is ambiguity about who should be handling certain tasks, it can result in communication breakdowns and coordination problems

The potential issues can be mitigated by clarifying roles, and defining what each member of the team’s responsibilities are. The case manager is also essential for establishing transparent communication and collaboration between team members. Olivia highlighted the importance of regular reviews, adding that a case manager must find the right team for each client. She highlighted the need for therapists to be matched with the client, their family and importantly other therapists on the team. She also underlined the importance of strategic planning, recognising that the entire process should remain client centred.

Dealing with crisis as a case manager

Whilst discussing the risk of crisis within a client’s rehabilitation journey, Olivia pointed out that this can cause panic for a case manager. She argued that we should view crisis points not as a place of panic but instead an opportunity to improve the client’s rehabilitation journey. Within ‘Steve’s’ journey, there were several points of crisis including marital issues, , reduced insight impacting the ability to implement the teams’ recommendations, and mood and motivation issues.

Olivia went on to discuss the ways to prevent or mitigate the impacts of a crisis. This included clear communication within the team, risk assessments evaluating the likelihood of a crisis point, resource allocation, and leadership and decision making. Linking back to her previous point Olivia suggested that the crisis point can often be a good point of reflection for the MDT and, with the correct leadership from the case manager, could increase team cohesion.

When crises emerge, good case managers adeptly navigate the complexities, offering immediate support, coordinating resources, and liaising with various stakeholders to ensure swift resolution. Through adept coordination and compassionate intervention, case managers emerge as anchors in guiding individuals through tumultuous times, offering comprehensive support to foster resilience and recovery.

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Ben is a trainee solicitor. His current seat is in our Family Law team.

Trainee Solicitor

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