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One week left for CMSUK Awards nominations

Case managers and those in supporting sectors still have time to make their submissions

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Case managers have a week left to submit nominations for the CMSUK Awards 2022, which this year focus on recognising innovation and commitment to clients in the ever-changing world.

The awards have already received strong levels of entries, but with the closing date set at next Friday – June 24 – there are only a few days remaining for any last-minute submissions. 

Categories open for entry are:

The theme of ‘Overcoming challenges in an ever-evolving world’ has been chosen to recognise the turbulent times in which we live and work, and how the dedication of case managers and other professionals to achieving the best outcomes for clients only increases.

The awards are open to case managers and those working in supporting sectors whose work contributes to delivering the best outcomes for clients. 

Having been a virtual occasion last year due to the ongoing restrictions of COVID-19, with a reduced number of categories open for submission, the awards return to an in-person celebration event in London with nine accolades to be won.

The deadline for entries comes ahead of the judging process, announcement of the finalists, and winners being named at the celebration lunch on September 23. 

“It is fantastic to see how case managers are using innovation and reflection to maximise outcomes for clients in this ever-evolving landscape,” says Niccola Irwin, director of CMSUK. 

“The world is changing all the time, with challenges constantly arising in addition to everything we have been through over the past two years, and case managers are doing some great work in helping clients through this. 

“Having had a very pared back awards last year, we are now able to return to being able to give recognition in more areas – for example, we realise that catastrophic work is very different with its own challenges, so we have the opportunity to acknowledge that. 

“We also have the external and internal awards, as well as the partnership award, which are able to showcase a portfolio of work and demonstrate multi-agency input, which can be hugely effective. 

“We also have the large and small case management company awards, which again acknowledges that both companies work in very different ways, with different practices and approaches. We are very pleased to be able to recognise this again. 

“We are looking forward to being back together in-person at what promises to be a lovely afternoon and hope to see many of our colleagues there.”

Case management

Deadline tomorrow for CMSUK Awards entries

Nominations can be received until the end of Friday

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Only 24 hours remain for nominations for this year’s CMSUK Awards. 

The CMSUK Awards 2022 this year focus on recognising innovation by those working in case management in the ever-changing world, and commitment to clients. 

The awards have received a strong response from case managers and those working in associated sectors, but any last-minute entries can still be made ahead of tomorrow’s deadline. 

Categories open for entry are:

The theme of ‘Overcoming challenges in an ever-evolving world’ has been chosen to recognise the turbulent times in which we live and work, and how the dedication of case managers and other professionals to achieving the best outcomes for clients only increases in the face of that.

Having been a virtual occasion last year due to the ongoing restrictions of COVID-19, with a reduced number of categories open for submission, the awards return to an in-person celebration event in London.

The deadline for entries comes ahead of the judging process, announcement of the finalists, and winners being named at the celebration lunch on September 23. 

“It is fantastic to see how case managers are using innovation and reflection to maximise outcomes for clients in this ever-evolving landscape,” says Niccola Irwin, director of CMSUK. 

“The world is changing all the time, with challenges constantly arising in addition to everything we have been through over the past two years, and case managers are doing some great work in helping clients through this. 

“Having had a very pared back awards last year, we are now able to return to being able to give recognition in more areas – for example, we realise that catastrophic work is very different with its own challenges, so we have the opportunity to acknowledge that. 

“We also have the external and internal awards, as well as the partnership award, which are able to showcase a portfolio of work and demonstrate multi-agency input, which can be hugely effective. 

“We also have the large and small case management company awards, which again acknowledges that both companies work in very different ways, with different practices and approaches. We are very pleased to be able to recognise this again. 

“We are looking forward to being back together in-person at what promises to be a lovely afternoon and hope to see many of our colleagues there.”

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Should I stay or should I go?

ILS Case Management looks at supporting the whole family when a young person with brain injury leaves home

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Case manager Jessica Heather looks at how ILS Case Management and the MDT gave Martin the confidence to fly the nest and his family the reassurance to let him go

 

As a case manager working in the world of personal catastrophic injury, I never know what a case is going to involve. Each case is as individual as each client – some of their needs may be similar, but the complex picture is unique.  

The nest, and a family changed

Martin sustained a traumatic brain injury (TBI) as a passenger in a car which collided with a telegraph pole. He was in his early 20s at the time of the injury, and when the case manager was introduced, he was only a few months post injury.  

Martin was living with his parents, Sarah and David, as he had been at the time of the injury. He was the youngest of three boys and the only one still living at home – Sarah was in no rush for her baby to fly the nest. 

Jessica Heather

David was working in the transport industry with shift patterns that meant he was often either working or asleep, therefore it was Sarah who was the main support for Martin – whilst juggling her part time role in a care home – although she was on compassionate leave at the start of my involvement. 

Martin was experiencing difficulties with motivation, memory executive functioning, anger management and reduced physical abilities. 

He was bored, despondent, and often quite rude to his family. He had no purpose in life and tended to drink too much and was thought to have been dabbling in recreational drug use, although this was never proven. 

Taking practical steps

The first role for me as case manager was to carry out a detailed assessment and identify what input Martin needed. I then progressed to build a team of skilled professionals to work with Martin to understand his difficulties, gain some insight, and increase his participation in everyday life. 

I recruited an occupational therapist (OT), shortly followed by a neuropsychologist and a physiotherapist.  I used my skills gained from many years working as an OT and then a case manager to identify the impact that the situation was having on family dynamics and initially, I spent time supporting Sarah, as well as Martin. 

During the first year, the team carried out assessments, both standardised and functional. 

I recruited a rehab assistant (RA) to support Martin to develop more routine and structure to his week and to supplement the therapy intervention. Martin started to volunteer in the grounds of a local stately home and the RA would support and feedback to the team. 

Martin was desperate to find paid employment and having concluded that garden work was not for him, he volunteered in a local charity shop, where he was loved by the older volunteers – ultimately, he landed his “dream job” working in clothing retail. 

It was important for Martin to obtain the job without them knowing the details of his injury, but following on from this, he consented to the OT meeting with his manager to give him some informal training as to the difficulties that Martin might encounter and how best his manager could support him if needed. 

After approximately a year of MDT working (OT, physio and neuropsychologist, coordinated by the case manager) the team had reached the situation where Martin was becoming difficult to engage in some aspects of rehab, saying there was no point in doing certain things (e.g. cooking, budgeting, shopping) as his mum did it, but the team were concerned that he’d struggle to do these things when he moved out of the family home – whilst holding down a job. 

In essence, the team felt that his true difficulties were being masked by the support he had around him, which impacted on his ability to gain insight into his difficulties.  

I recall a meeting with the solicitor where I found myself saying the words “independent living trial” (ILT) before I could stop myself. I wasn’t sure what it would involve, but it felt that it was what was needed in this case. The solicitor and team agreed, and I later met with the occupational therapist and neuropsychologist to work out more details. 

We spent a couple of hours brainstorming what we would want from and ILT, how it might work, who would need to be involved, what would be needed to enable it to happen and we came away with the outline of a plan. 

I then spent time putting the detail to the plan. Time scales, level of support, costs, frequency of therapy visits, outcome measures and how we would know what we wanted to know – whether Martin could live independently, or not. I shared this with the solicitor and funding was agreed. 

The best laid plans

Like so many things, the plan needed to be tweaked. It took months to find a suitable rental property. I asked the OT to take the lead on this, as a cognitive exercise for Martin – an example of ongoing assessment. It took multiple viewings and much compromise to find a suitable property.  

By the time the right flat had been identified, the treating OT was on sick leave for long-awaited surgery, the client was in a new relationship, and we needed to set boundaries around her input, so we weren’t getting a false picture of Martin’s abilities.  

Regardless, I drew on my skills to problem solve. I recruited a new OT and found a rehabilitation assistant to be the team’s eyes and ears. The MDT devised feedback forms for those around Martin so the team could paint the full picture of what support, formal or informal, he was receiving. 

I agreed ground rules with Martin, and gave his partner Pippa and Martin’s family some training as to what we were trying to achieve and introduced the feedback forms. 

Following extensive liaison with the litigation team regarding finances, guarantors, furniture acquisition and moving costs, and the ongoing negotiations with the estate agents, Martin moved into his flat and finally the ILT was launched.

Meanwhile Sarah had grown increasingly anxious about Martin leaving home, and I decided to source support for her from a clinical psychologist, separate from Martin’s therapy team, to address her emotions regarding the trauma of the initial injury, adjustment to the person that Martin had now become and her concerns regarding her youngest, more vulnerable son, leaving home.

Able to fly

Martin was brilliant – he excelled in his new home thanks to all the careful preparation that we’d put in place. 

He used OT strategies and kept the flat clean and tidy, he didn’t have all his mates over drinking, as had been one of the many concerns, and the team were able to scale down their input more and more as time progressed. 

The bird’s eye view

Martin, his partner and family completed feedback forms, and the RA fulfilled their role as the eyes and ears of the team to enable a comprehensive picture to be painted of how Martin was managing – living independently. 

The feedback forms were critical, so that the team could identify what Martin was completing independently and what, if any, support he was getting from those around him. 

Was his Mum giving him extra money, or cooking for him every night? Was he on the phone to her all the time for reassurance? Was his partner actually doing the cleaning and not him? 

We made it clear that we didn’t want to stop support, it was his first time living away from home, but that we needed to know it was happening so we could gauge how dependent he was on that support and what formal support might need to be kept in place longer term. 

Six months passed and many of the fears that the team, the solicitor and his parents had experienced, were not borne out and Martin himself was delighted with his achievements.  

The ILT had served its purpose, given him insight into what strategies he needed, such as a weekly planner, meal planning and shopping tools, and a reminder for household chores such as cleaning and putting the bins out. His family, in particular his mum, were reassured that he could manage independently and the team had scaled back the support to the bare minimum. 

Flying – but now back home

At the end of the six months trial, the client and the family were confident in his abilities. He opted to move back home (and his partner moved in) so they could save for their own property. 

Flown the nest

Eighteen months after the ILT, at a case management review, Martin was living in his own home with his partner, working, and still using some of the strategies learned during rehabilitation. He invited his parents over for lunch on a regular basis and was looking forward to starting a family.  

I clearly recall the sense of satisfaction driving away from that review visit. 

It has been quite an uncomfortable visit – for all the right reasons. It felt intrusive. Martin was no longer that lost, vulnerable, angry young man. He was living with his partner in their own home, he was working, he was contributing to running the household with his partner and they were planning to start a family. 

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Pain management – reflections of a case manager

Sophie Lester at ILS Case Management shares one client’s experience of life-changing injury and the impact of pain

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Dealing and living with pain can be a debilitating and traumatic process, particularly when the person lives with life-changing injury. Here, Sophie Lester, a case manager with ILS Case Management, shares the story of a client with spinal cord injury and her experience of pain

 

I have worked in case management for seven years and come from a background of spinal cord injury. Working as a case manager with an individual who has persistent neurogenic pain can be daunting for both the case manager and the individual. 

From my perspective, I view it as a jigsaw puzzle; a good metaphor for explaining it. You need to find and analyse the individual jigsaw pieces, establish if they fit or if it isn’t quite right and then need to explore another puzzle piece. The result is the full jigsaw puzzle completed, only possible through careful examination of all of the individual pieces.   

Sophie Lester

I have been working with a young lady in her late 20s who sustained a T12 incomplete spinal cord injury as the result of a road traffic accident. She is independently mobile with crutches and orthotics and has pain, sleep, and fatigue as major contributors to her presentation and disability. 

As a case manager, my role was focused on supporting her to develop her independence, confidence and return to a life that she wanted following her injury. 

The young lady’s perception, views and beliefs on disability and symptoms of her spinal cord injury were very dominant and were significant on her behaviour. 

For example: she believed that disabled people have less worth than abled bodied individuals, she did not want to share that she had a spinal cord injury or the true impact of her disabilities, she did not want to maintain contact with friends who knew her pre-injury and isolated herself away from others. 

The pain experienced was neurogenic in nature and was predominately focused in her legs, feet, and bottom. She described it as burning, like red hot pokers and throbbing. It significantly impacted her function daily and her sleep pattern and quality at night-time. However, due to her desire to improve in her abilities, she worked and pushed through the pain with rehabilitation activities. 

The key areas that were explored with this client were:  

  1. Understanding of what pain is and beliefs around pain – what does it signify? 

Understanding how this young lady saw, perceived, and understood her pain was crucial as well as understanding the significance of her pain and what it represented for her. For this young lady, this took some time to explore due to her needing to feel safe and secure in sharing her beliefs and perceptions, which were very personal. Through discussions, it became clear that she believed that the pain was a symptom of neurological recovery and that her disabilities would improve to allow her to recover to be ‘normal’. She didn’t want to share her pain as she believed people would patronise her as she had a disability and see her as less worthy as an individual. Understanding this allowed it to be shared with the wider Multi-Disciplinary Team to establish an approach that was specific and meaningful to her as an individual. 

  1. Multi-Disciplinary Team approach 

A consistent Multi-Disciplinary Team approach to pain management with good communication between team members and regular team meetings was established quickly for this young lady. A psychologist was an active and early part of this team, which was crucial in helping the team understand the beliefs, behaviours, triggers and negative coping strategies that were in place. The work completed together was to talk about these, look at positive coping strategies, self-help strategies and challenge the beliefs and the reasoning behind these behaviours and beliefs.

Other team members involved in the care were: physiotherapist, occupational therapist, medics, massage therapist and a consideration of acupuncture.

The aim as a team was to work consistently together to improve this young lady’s understanding and beliefs around pain, help her build resilience, resources, and positive coping strategies. It ensured that the teams’ goals, whilst all specific to her, worked well together. 

  1. Language around pain and pain management, expectations and education

For this young lady, it was evident that language and discussions previously had been with a focus on ‘medication increases and changes in medication to improve’ as well as the need to ‘speak to a consultant’ about pain management.’ Different language was introduced in relation to pain management across the multi-disciplinary team to include words and thoughts such as ‘long term pain management’ ‘focus on managing the pain’, ‘acceptable level’, ‘coping strategies’, ‘understanding the pain’ and the concept that pain was a ‘multi layered’ and overlaid on many other different elements and vice versa e.g. stress, sleep, fatigue etc. The aim of this was to help the young lady understand the expectations of pain management, start to understand more about the pain experienced and to help educate her as part of her rehabilitation.  

  1. Identifying interrelated elements

Exploring the correlation between pain, fatigue, sleep and activity levels was a big focus for the team and the young lady. She had a tendency to push herself physically as she believed she would continue to improve in her abilities. This exacerbated her fatigue, poor sleep patterns and pain symptoms. Identifying, tracking and challenging this through fatigue, pain and sleep diaries allowed an understanding to develop about how to help her with managing her pain levels. For example: challenging her to take an activity out in order to experience the positive impact on these symptoms, encouraging and giving her permission to take a rest etc. This helped further build her understanding of her own symptoms and self-management. This helped to improve areas relating to pain, as well as fatigue and sleep management for her. 

  1. Medication Review

The young lady noticed, as did her family, that she was having some increased memory difficulties as well as finding waking up difficult. She also described the feeling of having ‘brain fog’ and that her ‘brain didn’t work properly’. Regular medication reviews to look at the current medication, side effects and impact on her presentation occurred as part of the multi-disciplinary team. Changes in these helped to improve the symptoms she was experiencing, helped her feel clearer in her mind and improved her self-esteem. This dovetailed back into her progress within her daily life and rehabilitation. 

This young lady does still experience neurogenic pain; however, she now feels more positive and is starting to accept that this will continue to be part of her long-term future. 

Her own language has changed when discussing pain – she talks about managing her pain as opposed to it ‘disappearing’. The young lady is now going out more regularly with friends and family and has developed a greater understanding of how different elements of daily life impact on her pain. She is actively using positive coping strategies and self-help strategies to help with this.

Research shows that acceptance of living with pain can make a big difference. People are often looking for complete pain relief, but by seeing that pain is a part of daily life – not something that can be erased – they often become more resilient” – Dr Jasmine Hearn via The Backup Trust. 

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