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Brain injury case management

The role of case management – Corporé’s approach

Corporé discuss their approach to navigating bespoke case management services in neuro-rehab

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Conor McCann, clinical delivery manager at Corporé, discusses the vital role of a case manager in neuro-rehab and the approach the Corporé team takes to secure the best outcome for its clients

 

How vital a role does case management play in neuro-rehab?

Complex neurological injuries require a holistic, multi-disciplinary approach to achieve the best possible rehabilitation outcomes for the individual and their families. This is best achieved by utilising an appropriately qualified and experienced case manager to identify the overall goals, assemble the right multi-disciplinary team (MDT) and resources, co-ordinate and oversee performance, and support the individual and their family from the acute phase in hospital, through discharge and right to the end of their rehabilitation.

Whilst there are many different clinical services available that can provide individual parts of this care pathway, it is our case managers who draw all this together to deliver the best outcomes.

Our dynamic and bespoke service is able to adapt to changes in the pace of recovery and/or other external factors, whilst maintaining high clinical quality standards, to ensure individuals continue to receive the most appropriate care they need to achieve optimum and agreed rehabilitation outcomes. 

What are the main factors to consider when assessing clients?

A good assessment is an essential first step in good case management and therefore good rehabilitation. So much of the process stems from excellent assessment skills. Corporé has a person-centred approach from assessment and throughout the rehabilitation journey. This means that the individual’s rehabilitation needs remain at the heart of the services we provide. This also ensures that the individual has ownership of their rehabilitation, maximising their continued focus on, commitment to and trust in the process.

The majority of clients are assessed in a home setting which enables us to involve family members and partners in the process from day one. This encourages involvement and commitment to the process, highlighting the key role family members have in supporting injured parties. Along with our case managers and the injured client, they’re also involved in the development and agreement of rehabilitation goals that will shape the case management journey. Gaining support and understanding for different rehabilitation decisions from family members / partners and making goals personal to every individual encourages adherence to the rehabilitation process.

We conduct assessments process as soon as possible following instruction from relevant parties to ensure we initiate rehabilitation therapies quickly, avoiding prolonged delays in accessing care which may cause further issues for a person’s injuries and recovery journey.

Our assessments cover both psychological and physical considerations to determine both the type and extent of treatment and support needed in rehabilitation and when this should be provided in the process. Detailed knowledge and understanding of clinical conditions is considered and integrated into our assessment along with a wider understanding about the client’s life stage, relationships, family, spiritual beliefs, and social and economic factors. All of these considerations give us a better understanding of an individual’s health and wellbeing at the start of the rehabilitation journey and indicates what should continue to be measured in the process.

What assessment tools do your case managers use?

Our Initial Needs Assessment (INA) involves the use of clinically validated questions about physical and psychological health. In addition, our case managers can deploy a wide range of assessment tools to build the most comprehensive picture of the individual client’s injury, its impact and their current state.

It’s important to highlight that the case manager uses their clinical skills to determine which tools are most appropriate for each client. This in-depth assessment is taken at the client’s pace and typically lasts around three hours.

Some of the assessment tools used include:

  • The Visual Analogue Scale (VAS) which measures pain in different areas of the body
  • Patient Health Questionnaire (PHQ-9) to measure depression
  • General Anxiety Disorder (GAD7) questionnaire to provide insight into a person’s mental wellbeing and to determine the level of psychological support required, and when this should be offered in the rehabilitation process. 
  • Brain injury checklists and the Rivermead Post Concussion Questionnaire
  • Chronic Pain Acceptance Questionnaire (CPAQ)

Assessment tools are also used as clinical prompts to ensure we have fully covered all areas impacted by the injury. This is useful where the client lacks insight into their difficulties or don’t always volunteer information regarding certain areas unless specifically prompted. These prompts can be helpful in assessing delicate issues such as sexual function or intimacy in relationships following an injury which, if not addressed, can have a devastating effect on clients. 

However, one of the key assessment tools a case manager has is observation. The ability to observe a client in their own environment is so valuable in looking at how they function and determine what motivates them.

Other assessment tools include Functional Capacity Evaluations to understand an individual’s mobility, dexterity and ability to manage everyday activities and work activities.

These in-depth assessments support our clinical reasoning in devising an appropriate rehabilitation plan that will secure the client’s commitment to the process. They can also provide baseline measures from which to gauge progress and/or validate a need to change treatment or therapy options to achieve the best possible outcomes.

It is important for us that assessment is not something that only happens at the start of the case management process – assessment (and re-assessment) is ongoing throughout the process. As needs change, so too must our assessment of those needs. It is essential that we look at the work we are doing and seek to measure the impact of that input – if it’s not working, why not and what do we need to change?

How do you coordinate multi-disciplinary teams?

Case managers have extensive clinical experience and are adept at coordinating MDT. They draw on this experience to coordinate and liaise with therapy and treatment providers, ensuring input is delivered at the most appropriate time in the rehabilitation process.

They remain in constant contact with the client and hold regular meetings with the MDT team, where clients and families are involved to ensure continued commitment to the process. Updates on progress and discussion among the team determine any necessary changes needed on a collaborative and coordinated basis throughout, feeding back all information to all stakeholders, including instructing parties. 

In terms of treatment and therapy input, as well as using clinical reasoning, we can access specialist support through our sister company, The Treatment Network (TTN).

TTN has a wide-ranging national network of specialists able to support many different treatment needs. By selecting specialists through TTN, we have easy access, and confidence in their robust clinical due diligence processes of every provider. This ensures that the services and treatments we provide clients are of the highest clinical quality.

It is important that communication between all members of the team is on point, that every member of the team understands that overall rehabilitation goals and work in a coordinated manner to achieve those goals.

How do you see assistive technology enhancing rehabilitation case management?

In a world of accelerating technological and digital advancements, it would be foolish not to accept and welcome these developments as part of our clinical best practice.

Governing bodies, including Health and Care Professions Council (HCPC), promote digital approaches in their standards of best practice to better improve clinicians support of their clients.

Now is the time for case managers to not only welcome new technological advancements, but actively seek out, learn and discover new systems that will support their practice.

That’s why at Corporé, we’re constantly evaluating new technologies that will make us better at providing expert case management services. From advanced robotic limbs, to using big data and proprietary apps, these can help shape an injured party’s rehabilitation journey or warn of the threat of relapse.

Providing more tailored 24/7 support, accessible online through the client’s own mobile device, we use the smartphone based musculoskeletal support application, Phio. This tool can both recommend the most appropriate treatment pathways for motor accident related injuries from answers to a clinical ‘decision tree’ algorithm and provide clients with clinically validated and curated programmes of self-management tools, including daily exercises and check-ins to support optimum recovery.

The use of apps for memory prompts, diary entry or task planning for vulnerable clients are becoming a frequently used tool in providing round the clock support for clients in managing day-to-day life. 

We also see greater opportunities for client engagement and customer transparency through the use of client and customer portals to ensure increased accessibility to details of a case, providing key data in one robust and confidential system. 

Technology is changing clinical and we are enthusiastically embracing those tools that enhance our person-centred approach to better shape our clients rehabilitation outcomes.

With its growing profile and creation of the IRCM bringing new levels of professional accreditation to the profession, what do you think is the outlook for case management? 

I think the future has never looked brighter for case management. With the advent of Institute of Registered Case Managers (IRCM), case management has an elevated clinical backing from a professional body. Members will be expected to maintain a high level of clinical quality in their practice, ensuring that they continue to expand their knowledge and development to improve their rehabilitative approaches.

This is the most positive development in case management since it became part of the clinical approach in the UK. IRCM will provide access to support for case managers, allowing them the space to ask questions and seek advice when needed, whilst ensuring high clinical quality is maintained through rehabilitative practice. This means our clients, instructing customers and other clinical professionals will have even greater confidence in the service we, as Case Managers, provide.

Coupled with their memberships of other professional bodies, such as Case Management Society UK (CMSUK) or the British Association of Brain Injury and Complex Case Management (BABICM), our case managers now not only have the support but also quality assurance for their focused specialisms whilst also being protected by a broader case management professional body.

What does success in rehabilitation case management look like?

Success at Corporé is different in every case and cannot be defined or described in one rigid format. Every case is personal to the client. Our objective is to provide the tools, adaptations, appropriate treatment or support to help our clients regain independence, control and agency in their lives. 

It’s about having clients who are safe, secure and happy. Clients that achieve their goals, whatever they may be, while ensuring those who refer to us are kept in the loop throughout, have open dialogue with us and are happy to continue to entrust their clients’ rehabilitation to us. 

Of course, the best person to answer this question is the client. If they feel their rehabilitation has been a success, then it has.

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