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Brain injury case management

Meet the case manager: Amy Warren, HCML

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In this edition of Meet the Case Manager, we hear from Amy Warren, neurological case manager with specialist expertise in spinal and brain injury at HCML.

Hi Amy. How would you describe your role?

As a rehabilitation case manager at HCML, I work with individuals who have sustained brain or spinal cord injuries, helping them gain access to the right treatment, at the right time, to ensure their recovery is the best it can be.

Following instructions from solicitors and insurers, I meet with the client and assess their needs.

Based on their medical status and potential, I recommend a rehabilitation pathway and then once approved, I work with healthcare providers to input the interventions and equipment they require, reviewing their goals and outcomes regularly.

How did you get into case management?

I initially wanted to be a physiotherapist, but following work experience, I decided that I wanted to do something that enabled more variety in my day to day role. Someone suggested occupational therapy.

After looking into it more I realised that it would give me that variety, and that no two patients were likely to be the same.

I did a placement and immediately loved it.

I knew I wanted to help people and I had always had an interest in the human anatomy and biology, so this immediately felt like a natural fit. 

I went on to do an undergraduate degree at Oxford Brookes University and once qualified, began working in neurology as a band 5 occupational therapist.

After four years, I was very fortunate to be selected to do a Master’s Degree in Occupational Therapy at Tufts University in Boston, USA through The Elizabeth Casson Trust scholarship scheme, which included studying at Harvard.

I took a year’s sabbatical from my work at The National Spinal Injuries Centre at Stoke Mandeville Hospital and completed my studies, whilst getting to experience how occupational therapy works in other parts of the world and developing my professional skills. 

How vital a role does case management play in the rehabilitation process?

For anyone who has suffered a traumatic brain or spinal cord injury, getting the right case manager to help advocate for you is vitally important to ensure the best outcomes possible.

Once funding from the insurer has been approved, my role is to put my recommendations in place and support the rehabilitation client through the process.

I work really closely with my clients to ensure they get the best care and support available. 

Having a case manager means being recommended for treatments that clients and their families/carers might not have known existed otherwise, and being sign-posted to specialists in specific areas that they might not have been able to access otherwise.

We know from first-hand experience that having a specialist rehabilitation case manager who builds trust with the rehabilitation client and focuses on advocacy for them, is hugely beneficial in enabling them to achieve their rehabilitation goals.

How do you work collaboratively with other services?

The best way to treat a client and to get the best results for them, is to spend time at the beginning of the relationship really getting to know them and building that trust.

I try to learn more about what their life was like before the accident to determine how best to help them. 

Being a case manager means that we can bring the whole multi-disciplinary team (MDT) together to ensure everyone is informed and that everyone understands what each other is doing to support the client and how that all fits together in their overall rehabilitation.

We liaise with a range of specialists about the treatment the client is getting in each different area to find out how they are progressing and whether the treatment is working or not.

That way we know when it’s time to try something else, rather than wasting time on a treatment or intervention that isn’t really helping them.

We request regular reports and with our understanding of what sort of progress should be expected within certain timeframes, we are able to determine the effectiveness. 

Case managers are really the people that have oversight on all aspects of the client’s health and wellbeing, and we encourage the whole MDT team to come together to do joint reports, joint meetings and take a more collaborative approach. It keeps everyone informed so all clinicians know what’s going on.

Can you share an example of a particularly memorable outcome for a client?

I have seen some horrific injuries in my time as a rehabilitation case manager.

Sometimes while you know they may never walk again, you can help them gain some independence and achieve things that might be small, but make a world of difference.

For example, I worked with a young man who sustained catastrophic injuries which meant he had very little movement and had lost his ability to communicate through speech.

With the help of an occupational therapist, he eventually managed to hold and use a pen. This small action opened up his whole world.

In being able to write, he was able to communicate with the people around him again.

Often it’s what feels like the smallest thing that has the biggest impact to someone’s life.

Can you share an example of how you have overcome a challenge with client rehabilitation.

Often helping clients change their mindset can be the toughest challenge. You understand why.

They have just been involved in a horrific injury, probably spent months in hospital recovering and are looking at a different life path to the one they had planned.

They often come to us thinking they will never get back to work or get to play their favourite sport again, feeling like life is over.

It’s really important to show them there is life to be had, even if this may look different.

A lot of my clients will be young men who feel like their worlds are crashing down, but then you engage them in  rehabilitation and they see that there is some light at the end of the tunnel.

The treatment we suggest won’t always be easy. It might involve physio treatment that is particularly painful or opening up emotionally to a therapist.

But when they are able to return to work or do something they love again, it’s extremely rewarding.

Would you recommend a move into case management? What skills do you need?

I love my role in case management and couldn’t imagine doing anything else.

Being a rehabilitation case manager is a natural progression for an OT. The ability to help people and make a difference to their lives is a position of privilege.

To be a case manager you need to have strong people skills and the ability to build relationships quickly.

It’s really important your client trusts you to take your advice on board.

They might not always agree with you, but you really need them to understand why you are suggesting certain things.

You also need to be a good listener to determine how best to help them and respect their decision when they don’t want to do something.

You must be patient, compassionate, empathetic while also being enthusiastic and help to keep them motivated.

On a practical level you also need to be organised, with good time management.

It’s likely that you will be managing several cases at one time, and you need to be able to keep on top of them all and ensure everyone is getting the support they need. 

Can you tell us something interesting about yourself?

Somehow, I’ve found myself to be an expert in helping rehabilitation clients with their sexual function.

It’s something that isn’t talked about very often and can be considered a ‘taboo’ subject, but it can be so important.

There are lots of things you can do and people who can help.

It really helps clients if they can see a future with things like relationships and fertility, yet it’s not talked about as much as it should be.

Through my experience I’m able to direct clients to people that can help and provide the right support. 

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