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Case management

Research shows effectiveness of remote case management

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Remote working in case management can be a safe and effective means of interacting with clients, new research has found.

Three research projects commissioned and funded by CMSUK analysed how effective remote working and use of telerehabilitation could be in case management.

The projects – which assessed the barriers and challenges of remote working, the safety and quality of telerehabilitation, and its effectiveness – have demonstrated how effective it can be, supported by training for case managers where needed.

Case managers across the UK have been forced to resort to remote working during the COVID-19 pandemic, meaning many have had to adapt and learn as they go, while also supporting their clients in adopting technology as a means of communication.

CMSUK commissioned the research projects as a result of the lack of existing guidance available to case managers.

Each year, the organisation funds a research project, but due to the unprecedented circumstances of 2020, decided to commission three smaller projects to assess the full spectrum of telerehabilitation.

“This has been a very important project and we have shown that remote working can work very well for case managers,” says Dr Devdeep Ahuja, director of CMSUK.

“Previously, it was widely thought that delivering rehab intervention remotely was only suitable for minor injuries, and that it didn’t work for complex cases, but we are showing that it can. We look at key aspects of where it works and where it doesn’t, and there are many ways in which remote working can be just as effective as in-person.

“It is important that proper training is given if necessary to ensure it is safe to deliver case management remotely, but providing that is done and proper procedures are followed, then we have found it can be very effective.”

CMSUK’s commitment to researching and sharing best practice with its membership and wider case management community was at the root of its review of remote working, says Dr Ahuja.

“Our focus is on promoting research to create evidence-based practice and when COVID-19 came, and we had to quickly adapt to online remote working, it became clear that there wasn’t enough guidance out there,” says Dr Ahuja, who leads the CMSUK research sub committee.

“That is why we wanted to take action and create some research. Remote working will probably be in existence for some time to come, so it was important we acted on this, that is what we do at CMSUK.

“By creating practical strategies, we can then help deliver them. By identifying what steps we need to take, we can then help to ensure these are put in place, and support our case managers with the practical steps and caveats they need to consider.”

The annual grant made by CMSUK to fund a research project – including its funded systematic review made in 2019,The effectiveness of a case management approach to care for adults who suffer trauma through injury: protocol for a systematic review by Heidi Stevens, which is set to be published imminently – was given to three applicants instead of one to aid the creation of a comprehensive review in a shorter timescale.

“By splitting the grant three ways, we could look at multiple aspects of remote working and collect the findings in a relatively short period of time, so we could share this research for the benefit of our case managers,” adds Dr Ahuja.

“Given the circumstances and the need to support case managers with research and best practice evidence going forward, it was important we did this. We hope our projects will be of great benefit to case managers in their ongoing use of remote working.”

For further findings from the research projects, visit www.cmsuk.org.

Case management

‘Yes we can, bring it on’

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Louise Sheffield - founder of Active Case Management

Ten years ago, Louise Sheffield established Active Case Management, despite having no background in case management. Here, she reflects on the growth of the company in terms of size, reach and reputation and how they are entering their second decade with positivity.

“Very refreshing but completely terrifying.”

Louise Sheffield’s early experience of setting up on her own in case management was a far cry from her career to date.

“I’d worked in the NHS and at the time there weren’t many people doing the work I did,” reflects Louise, whose background is in occupational therapy specialising in brain injury.

“But then here I was setting up a business in this new area of case management – I’d never been a case manager, although my service co-ordinator role in the NHS had drawn on the same skills of assessment and planning through a multi-disciplinary rehabilitation programme.

“I’d gone from being in the NHS and knowing everyone at every event I went to, to going to events as a case manager and knowing no-one.

“It was a strange time at first, and I did think I must’ve been mad. But my instinct then was the same as it is now – just to crack on.”

And the determination of Louise – with her years of experience as an NHS rehabilitation co-ordinator – to make her mark has paid off, with her business, Active Case Management, marking its 10th anniversary.

With a team of 13 people covering the Midlands, North West and North East from its Wigan head office, its reach continues to grow.

“For the first few years it was only me and it was a learning process in many ways, but I wanted to learn, I was starting with a blank slate,” says Louise.

“It was a very different mentality to working in the NHS. While I was there, we were very conscious of waiting lists and our targets and whether a different service was more appropriate than ours. I was the gatekeeper of the service – but for me, from the outset with my business, it was a case of I’ll take on any client, as long as it’s within my capability.

“I didn’t always know if I was doing things right, but the solicitors seemed to be happy, the clients were happy, so I thought it must be right.

“But as you grow and create relationships and build a team, you find you have the benefit of the expertise and experience of those around you. That continues to help me.”

Having built a strong reputation for its support of, and dedication to, clients, Active is also known for its intermediary work.

Louise herself is a registered intermediary, a role she has now established as her niche in case management, but was something she was unsure how to incorporate into Active’s offering in the early days.

“I actually saw it as a potential threat to my case management work at first – I’m always cautious if someone claims to be an expert in too many things,” says Louise.

“But actually, I needn’t have been so conscious of that, as it’s become something we’re now known for and I’m very proud of our reputation.

“My favourite kind of client is one who is a bit cheeky, bit naughty, who maybe sails a bit close to the wind. There will be some challenging behaviour alongside the bags of character – but that often comes with disinhibition and impulsiveness and that can often get people into trouble with the law.

“And that is where our specialism can be really important.”

While fulfilling both roles concurrently, case manager and intermediary work are very different, says Louise.

“If I put all my files together for my case management work, they would fill an entire wall of the office, whereas my intermediary work would fit into one filing cabinet,” she says.

“With case management, you learn a huge amount about your clients, and you’ll know their shoe size, you’ll know their aunty’s name, you’ll know that with some clients you’d better answer the phone to them at 2am or else they’ll have called another 10 times before 3am.

“But with intermediary work, it’s very narrow remit but very deep. I like how it doesn’t take up the huge amount of brain space you need for your clients and their lives.

“But the roles definitely complement each other and the skills you need for one do help you with the other.”

Going forward, Active continues to progress and Louise’s can-do attitude is at the heart of that.

“This was a different world at first, but it’s a great one to work in. I’ve got a great team of 13 people now and we’ll keep on doing the best we can for our clients,” she says.

And the ethos of the team as they enter their second decade is more determined than ever before.

“For us, it’s all about saying ‘Yes we can, bring it on’,” adds Louise.

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Case management

Pandemic has ‘significant impact’ on case management

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Case management company BABICM helped produce the report

The COVID-19 pandemic has had a “significant impact” on case management practice and the lives of those living with brain injuries, early findings of a UK-wide research project have revealed.

Last year, BABICM launched a study among its members to discover the true impact of the pandemic, and how case managers and clients alike are adapting to the ongoing restrictions.

The study has gathered the personal accounts of people with brain injuries across the country, and their support networks, to understand how lives and working practices have changed since March last year.

The project, which is being completed by BABICM and the University of Plymouth, has now moved into the focus group phase, which will explore the experiences of brain injury case managers.

Areas of interest include changes of practice, the impact on their clients, their families and support networks, and access to services.

While fact finding is still ongoing, with two of the five scheduled focus groups now completed, trends are already emerging.

“We have already noticed some interesting trends amongst the case managers – but what is becoming abundantly clear is that the COVID-19 pandemic has had a significant impact on case management practice and the lives of those who have sustained a brain injury,” says Ben Needham-Holmes, a member of the BABICM research subgroup who is spearheading the project.

“Our thanks go out to all of those who are taking part in this study. Without their participation, this study would not be possible.”

Following the culmination of the focus group phase, the project will then move into interviews with clients and/or their family members or support networks to learn about their experiences.

This is expected to conclude by May, after which time the data analysis will take place, which will draw out the key themes from the research.

The final research will be shared in academic and professional forums, to help shape future case management practice.

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Case management

‘I’m proud of how we have all pulled together’

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Telerehab has become the new normal since the pandemic

Case management has faced unprecedented challenges during the past year, which has seen it respond with positivity and agility to ensure service to its clients could be maintained. In the latest in our Q&A series, Sarah Cooke from Bush & Co shares her experiences, and how the newly-adopted telerehab will undoubtedly play a role going forward.

Can you summarise how the past few months have been for you

It’s certainly been the biggest challenge of my career! But I feel proud of how we have all pulled together, in whichever capacity we work with our clients, so they have been able to continue their rehabilitation.

How did you adapt to the restrictions of lockdown? Were you able to do this quickly or did it take a bit of time?

I adapted pretty quickly to the lockdown restrictions as I already worked remotely from home so my office space was set up. It was also normal to communicate with colleagues and clients by email and telephone. The strangest part was going from a quiet house to having my family at home either working from home or furloughed. I’m sure this affected the internet connection at times!

I think working within a supportive team has been really important. By supporting each other we have looked after each other’s well-being which, in turn, has enabled us to continue delivering a first class service to our clients. It is important to remember we are clinicians but also have personal lives and have been affected like everyone else.

At the beginning of lockdown the Bush & Co management team reacted quickly to the situation and put a Covid-19 risk assessment in place, supported us with increased communications and the relevant, latest guidance. This enabled me to decide how to complete Immediate Needs Assessments and reviews and ensured good communication with clients and stakeholders was maintained. We also put new initiatives in place quickly such as loaning out tablets to clients who had little or no access to technology. This meant Immediate Needs Assessments could be completed remotely but also meant ongoing case management could continue.

What have been the main challenges – were you able to overcome them? 

Initially the access to PPE caused a challenge. However for those clients that the Covid-19 risk assessment identified still needed home visits, Bush & Co were able to provide PPE packs for each visit. I think social media also helped at this time as I received additional face masks from LinkedIn connections who shared what they could spare.

At the beginning of the pandemic we were faced with how to keep our clients’ rehabilitation going. NHS departments had closed and important surgery cancelled. Plus service providers needed to convert to new ways of working. My main focus was preventing clients from deteriorating and enabling them to maintain during this period. This was where the stakeholders stepped in and ensured funds where available to support our clients. For example, one of my clients’ pain had increased so the stakeholders funded an electric profiling bed to keep her at home and comfortable whilst she waits for surgery. Another example is how the pandemic has hit a lot of our clients psychologically. The stakeholders have secured funding for telephone or virtual treatment sessions.

Has the use of ’telerehab’ been of benefit to you? 

Yes absolutely! It has enabled our teams to keep in touch with each other in a more personal way. I must admit to preferring to be able to see people rather than telephone conferencing. It feels a little bit more like a face-to face meeting. I definitely think the use of online technology has proved to be a real asset during the pandemic. Professionally I have used Zoom, Microsoft Teams and Air Meet. These platforms have been great for attending meetings and staying connected with colleagues. I’ve also had access to lunchtime yoga and mindfulness training delivered by Bush & Co and webinars kindly hosted by law firms.

How have your clients responded? Was it difficult for them to adapt to? 

Most of my clients have been open to communicating via telerehab. One of the issues we have encountered is that they are often using mobile phones or tablets and their devices have been unable to open the meeting links to Zoom. Generally, my client group have preferred to use the camera feature on social media apps, such as, WhatsApp or speak over the telephone.

Do you feel the lack of face-to-face contact with clients or/and colleagues has been damaging?

If face-to-face contact has been identified as needed by the risk assessment and it’s been clinically safe and appropriate to meet in person, I have continued to visit clients so this has avoided causing any damage. I must say I have certainly missed seeing my colleagues in person but don’t think it has been damaging because we have used the virtual resources. Bush & Co has introduced ‘Happy Post’ so we’ve been connecting through good old fashioned letterbox mail as well as electronic ‘Postcards from Home’ which have been a way to see how other people’s lives have changed during the pandemic.

How central do you think the use of telerehab will be for you going forward? 

I think telerehab will change our working practices and we will attend more virtual team meetings, multi-disciplinary team meetings, webinars and training sessions etc.  Moving forward I will definitely consider telerehab for my clients but I don’t think it is a replacement for face-to-face client visits because of the nature of our work. I think a blended work approach is definitely the way forward.

How do you think the future of case management has been shaped by the pandemic? 

I think there is a much better understanding of what home working is; the challenges, opportunities, limitations and rewards that it brings. Pre-pandemic I would use telephone or face to face client contact. The pandemic has made us aware of a third option – telerehab. It’s also opened up access to new providers of therapies and rehabilitation which would have normally been restricted due to distance from the client.

Will you be doing anything differently within your business going forward compared to pre-pandemic? 

I have learnt during the pandemic the importance of physical contact with my clients. This is something I have probably taken for granted throughout my career. Some clients need this more than others, for example, because of lack of IT skills or cognitive impairment. There are clients though that engage really well using telerehab so moving forward I will definitely be embracing a blending working approach. Ultimately the clients’ needs have always been at the heart of the decisions we make and so going forward we’ll be taking our learnings forward in terms of telerehab needs too. Our clients are often vulnerable and may be anxious or reluctant to get back to ‘normal’ so we won’t be rushing.

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