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Case management

‘The challenges have been many, but we’ve found ways to overcome them’

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"The demand for digital technology going forward should mean that we can develop a better working practice"

The COVID-19 pandemic has forced huge changes within case management and the traditional ways in which clients have been supported. In our continuing series of Q&A features with case managers across the country, Martin Gascoigne of Neuro Case Management UK (NCMUK) shares his experiences.

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

The past few months for NCMUK have been extremely challenging. This is due to the Government initially ring fencing all of the PPE supplies for NHS staff which made it very difficult for us to procure the necessary equipment. Also, due to our Paediatric Clients Parents furloughing, we have experienced different challenges with the type and level of care that they felt they would like us to provide whilst still working in accordance with National Minimum Standards.

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

We managed to adapt to all of the new guidelines effective immediately as we were informed by the Government that failure to conform with these would mean that we were no longer able to deliver the care needed. NCMUK therefore reassigned staff to new roles to deal with the new daily/weekly challenges set, identifying new sources of equipment provision, medication and standards of care.

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

The main challenges we found were that of procuring PPE at a clinical level. Unfortunately we could not identify or purchase any in the UK and so in order to overcome this it was necessary for us to establish a regular supplier overseas who was able to both meet our needs and the needs of our clients.

Has the use of telerehab been of benefit to you?

NCMUK has indeed benefited from digital technology including Zoom and Facetime. During this period of lockdown, telephone calls and digital contact was the only way the case managers/directors could maintain a high level of communication with our suppliers, clients and families.
At this time we also relied on a digital marketing organisation which made sure that our company stayed at number one on page one with Google. This meant that we could maintain our on line presence and as a result of this we would benefit from new referrals which continued to keep us busy.

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

Our clients did find it difficult just understanding the pandemic initially, as we all did, with the obvious additional worries that they would be infected by our carers. This concern, however, was alleviated as the NCMUK team provided all care in a fully barriered manner using face masks, aprons, gloves and hand wash following the Government guidelines set.

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

Our carers have been continuing to attend their home visits following the correct guidelines throughout the pandemic. This meant that they continued to have face to face contact. New links have been established via digital marketing and Zoom calls but this has been a positive addition to our communication network and as we already undertake telephone reviews with our staff, there was no change to our relationship with our colleagues.

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

The demand for digital technology going forward should mean that we can develop a better working practice combining the face to face home visits and the human side of our meetings/assessments alongside digital meetings. This has the benefit of reducing the carbon emissions of our team, whose level of travel is reduced.

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

The NCMUK team will have the opportunity now to work more from home, allowing them to complete basic administrative tasks within their own environment, thus reducing emissions due to unnecessary travel.
It will also mean that when completing some assessments, these can be carried out via Zoom/Facetime meaning that more out of reach areas throughout the England/Wales can be contacted more easily. It has been necessary for us to think of alternative methods of communication moving forward and these will probably be maintained in the future as they have been a success.

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

The pandemic has changed our business considerably as we are all now working more from home with the benefit of our staff reducing their overall carbon footprint. This will continue and streamline the industry as there will be more work undertaken on a virtual basis as staff are able to complete the basis administrative tasks within their own home environment in lieu of travelling to the office. It will also allow NCMUK to have clients referred to us who live in more inaccessible areas of the England/Wales which should provide more people access to more services.

Case management

Neurotechnology – life-transforming or an expensive white elephant?

Rachel Charles discusses the power and potential of technology in neurorehabilitation

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We are at an exciting time in neurorehabilitation, where we are discovering more and more about our brain and nervous system and how we can adapt to life-changing injuries by harnessing the potential of technology to push the boundaries of what is currently possible.

Our previously unseen electrical and brain activity can be enhanced to enable us to visualise our emotions, communicate when we can’t speak, lift limbs that we have difficulty moving. We can be transported to far off, fantastical lands from the comfort our armchairs by putting on a VR headset, and exercise on a treadmill without being able to walk.

This is not just the stuff of Hollywood movies and fantasy novels, but real life that can be seen, touched and used in rehabilitation centres across the world right now.

So, how do we ensure that this technology is accessible, appropriate and enables the people using it to achieve their goals and aspirations?  How we do prevent exoskeletons from gathering dust in cupboards or the corners of therapy rooms? How do we justify and prove that these technologies make a difference and are worth the investment?

Firstly, we need to keep in mind who the technology is for. We are adaptable, complex systems that require varied, intensive, targeted opportunities to refine and improve our abilities. We know about “practice makes perfect” – practice needs to be the right amount, in the right place, at the right time – for a purpose and have meaning, not necessarily helping us achieve perfection. One size definitely does not fit all.

Secondly, we need to coproduce, collaborate, and cooperate to share knowledge and skills – it is essential the end user is part of the team. It is totally possible to repurpose and adapt current technologies that are already in use such as robots and VR games for the rehabilitation market.  What works in one setting does not necessarily work in others. It is a great opportunity to design and manufacture technology that is fit for purpose, which can be updated and upgraded and recycled.

Thirdly, we will still need therapists and case managers.  (You probably think that this is because I am one…”so you would say this wouldn’t you”). Technology is not a magic bullet and will not replace therapists or therapy or the need for case management. It will enable more people to participate in high dose, high quality rehabilitation that is commissioned by case managers and structured by therapists as part of their individual rehabilitation programme.

Therapists need to be open-minded and given access to systems and training that enable them to use their clinical reasoning to consider technology as a viable option as part of their treatment plan. Case managers need to keep up to date with innovations and technologies by networking and sharing information so that our clients have the possibility of being able to access neurotechnology now and in the future when this is appropriate.

Lastly, technology has the potential to transform the rehabilitation experience of people affected by life changing injuries and our understanding of the brain and nervous system. By trialling available technologies with people who may benefit from them and being able to demonstrate tangible changes in function – enabling people to thrive, not just survive – we have the potential to create a very different future for all of us.

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Case management

BABICM – rising to the post-pandemic challenges and opportunities

Vicki Gilman, chair of BABICM, shares her priorities for the organisation as case management looks to a new future

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Vicki Gilman has taken up the post of chair of the British Association of Brain Injury & Complex Case Management (BABICM) at a hugely important time as case management moves into a new post-pandemic chapter, following an unprecedented period where case managers rose to the diverse challenges presented by COVID-19 and helped to create a new future. 

A future where technology and virtual communication will feature like never before; where the need to work in collaboration has never been greater; and where the creation of the Institute of Registered Case Managers (IRCM) will enable registration of case managers for the first time. 

While undoubtedly an exciting time with huge potential for case management, the challenges – and opportunities – for BABICM, as it too builds for the future on the foundations of its 25 years of expertise, are plenty. 

“Becoming chair was something that was first suggested to me about three years ago, and at that time I had no idea, as no-one did, that we would all see such huge change in our lives,” Vicki tells NR Times. 

“There were several things in the back of my mind then that I thought might be key themes – some of them remain the same despite what has happened since, although by no means all of them. I think a lot has been learned over the past 18 months that I don’t think we will go back from. So, in many ways, this marks a fresh start.

“I’m immensely proud of how the whole case management sector responded, how we stepped up to the challenges and with such speed. Case managers are used to looking at complex scenarios in unique circumstances and working to find ways forward within the context of each case.

“The pandemic served up additional challenges which prompted a lot of innovation and different and new thinking, with plenty of opportunities. 

“As ever in case management we have taken the learning from everything we do, but this time case managers – along with everyone else – were juggling the unique changes in their own lives such as homeschooling children and supporting friends, neighbours and family members whilst continuing with their highly complex and confidential work to support each individual case by case.”

Vicki, managing director of Social Return Case Management, takes over the BABICM chair from Angela Kerr, who is now chair of the IRCM. BABICM will continue to play a central role in the ongoing development of the body, as a founding member, which hopes to secure accreditation from the Professional Standards Authority (PSA) in the near future.  

An experienced case manager, health entrepreneur and clinical specialist neurophysiotherapist, Vicki spent six years on the BABICM Council, returning last year for a preparatory period before taking the chair.

Building on her experience of specialist rehabilitation, expert witness work and case management and being part of BABICM, while taking inspiration from the events of the past 18 months and impending future changes, Vicki has identified a number of priorities to address during her time at the helm. 

  • Equity and belonging 

“I have starting educating myself to a greater degree and have had a lot of conversations with people who know a lot more than me about equality, diversity and inclusion,” says Vicki.

“This is actually quite challenging and I don’t personally know enough yet. I do know that both the organisation and I need to do more. As I go on my journey, it is my aim to find allies and to bring other people into learning more with me. Together we can make BABICM better place.”

“It follows that our increasing membership means we have greater diversity, and it is not enough to say ‘We don’t discriminate’.”

Vicki says equity and belonging must be sentiments which underpin BABICM. “It is a really important to ensure a greater understanding is threaded through the work of BABICM,” she says. 

“For me, equity means more than equality, and we want to help people feel they belong here. It’s not enough just to say these words.” 

  • Collaboration

“We need to strengthen links we already have and collaborate with other organisations who are important to our members through the work they do,” says Vicki. 

“Angela has done an amazing job to strengthen and move the organisation forward, of identifying organisations and allies we should be working in collaboration with and creating links with people at the right level – organisations such as the CQC, Court of Protection, UKABIF, some education establishments, to name but a few. 

“There are lots of ways we can deepen and develop on that, and as we come out of the pandemic there will be more opportunities. Zoom calls are really time-saving and effective, but hopefully we will also have the option to do things in person again going forward.” 

  • The future as a profession with registration

One of the most significant changes in case management, the creation of the IRCM, is set to professionalise and regulate case managers in a sector-changing move. 

“We will continue to support the goals and development of the IRCM, it is by no means done and we need to continue the work here,” says Vicki. 

“We are fully supportive of the direction of travel and fully endorse registration for case managers. This is a way for the public to be protected specifically in the realm of case management and for case managers to be able to demonstrate that.”

  • Training and learning

“I want to continue the development of the high-quality learning and training opportunities available to our membership, but also to those outside,” she says. 

“We aim to keep it very relevant to current clinical and professional needs, keeping ahead of the curve and making sure that what we are offering is of the highest quality. As professionals working with complex cases, I can only see that need developing further. 

“In the last few years BABICM has really showed its strength as the leading provider of education and training for case managers working with complex cases. The feedback we’ve received for our courses has been tremendous and that has continued even during the pandemic. Training will remain key and grow in importance.”

  • Research 

“I’m very keen to increase the involvement of BABICM and its membership in research around case management related issues. I want us to lead the way in with research into evidence-based practice for people with complex needs,” says Vicki. 

BABICM has recently been involved in a number of research projects, working alongside the University of Plymouth. In yet to be published findings, the team has studied how case managers and clients alike have adapted to the pandemic. 

“There is research out there which supports the work of case management, but we are taking greater responsibility to add to that evidence base and that is something I foresee will increase and needs our members to be involved in,” she says.

“This will of course add even further to our library of resources to support the work of case managers.” 

  • Providing useful resources to members 

“I see us to stepping up in provision of information to assist across our membership within legal, clinical and professional aspects of their work,” says Vicki.

“Those involved in the case management of complexity and those working with case managers need resources that are tailored to their needs. 

“We already do this in many ways via our website with recorded webinar content, upcoming training and development events, publishing our standards and competencies and signposting and links to other sources of support regular bulletins. Our website is proving a very useful resource library which is seeing growing traffic, as it assists our members and others. 

“As our members apply for registration with the IRCM there will be an even greater requirement to demonstrate what case managers are doing and whether they are meeting the standards, so we need to continue to build relevant resources to support this need.”

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Case management

ILS Case Management – working in partnership with clients and their support network

Read the latest in our case management focus features.

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In the latest of our case management focus features, we meet ILS Case Management and learn more about its growth and development over a quarter of a century and how it continues to innovate to deliver the very best service to clients

Why was ILS Case Management established and what was the ambition at the outset?

ILS Case Management was established, over 25 years ago, by two occupational therapists to provide both case management and expert witness services for catastrophically injured adults and children. However, they quickly recognised the potential conflict of interest in providing both services and decided to focus solely on high quality case management services.  

The ambition from the outset was to develop a team of highly experienced therapists, who had existing expertise in brain and spinal cord injury and to provide bespoke, person-centred case management.  The clients have always been at the heart of our business and our case managers work closely with each individual to support them in achieving their unique goals.

How has ILS Case Management developed over time?

We now have a team of over 50 case managers providing tailored support to over 200 clients nationwide and manage more than 375 support workers. Each of our case managers are experienced health and social care professionals, who bring with them an amazing wealth of knowledge, experience and expertise.

Recognising the importance of peer review and clinical standards we now have a unique team of professional mentors who support our case managers with their clinical reasoning and reflective practice. They all have extensive experience as case managers, but no longer hold a case load of their own. Working closely with the case managers, they are able to provide continuity of case management for our clients when their case manager is on leave. This continuity is crucial for our clients, and their legal teams, due to the complex nature of the work that we do and has been invaluable during the pandemic.

As a business we also contribute to the standards and development of case management in the UK by having clinical staff on the boards of both BABICM and CMSUK.

In addition, ILS case managers are supported by a dedicated integrated team of client HR and payroll professionals. The client HR team provides support to the case managers with recruitment and management of support workers, while the client payroll team ensure client payrolls are effectively managed including calculating support worker sick pay and annual leave allowance together with pensions administration.

 

How did you adapt to the many challenges presented by COVID-19? 

We were quick to react to government advice, taking the information given to inform our practice and safeguard our staff and clients. We used our clinical experience and well-developed risk assessment skills to provide COVID safe client visits where necessary whilst making the most of virtual platforms to deliver our service. 

Understandably, working with a vulnerable client group, our approach was cautious; when visits were essential we made them as safe as we could through the use of PPE and lateral flow testing, as well as taking measures to maximise ventilation at the location. Person-centred practice remained at the centre of our work. Clients and those close to them were an intrinsic part of our risk assessment ensuring they were all consulted and supported throughout the restrictions.  

Recognising each client and their circumstances are unique, we were able to adapt our practice to ensure we could continue to meet their needs. We were pleasantly surprised with the ease in which practice could adapt to a virtual environment. Some clients relished the opportunity to embrace new ways of communicating, while, understandably, others preferred a face-to-face (or mask to mask!) visit. 

We will certainly continue to a make the most of the technology that we have become adept at using. We see the huge benefits in online professional and multi-disciplinary team meetings. By reducing the travel and associated costs, shorter meetings can be held more often which in turn has facilitated better communication and has resulted in improved cohesion and better outcomes for our clients.

What are your priorities going forward?

Our priorities remain the same; we are committed to providing excellent person-centred case management and how we deliver that has adapted to the environment that we find ourselves in. We continue to enable our clients to meet with case managers before they commit to engaging and to help facilitate this, we have adapted our online CVs to include a short introductory video presented by the case manager, which provides an insight into their experience and character as individuals. 

We will continue to use MS Teams, Zoom, WhatsApp and FaceTime to deliver virtual meet and greet sessions. These have been widely applauded, taking the pressure off the client to make their environment ‘visitor ready’ for each occasion. We have reverted to face-to-face INA’s wherever practicable, while an assessment can take place virtually, this stage, for us, is the beginning of the formation of the essential client/case manager rapport that will carry through the rest of their working relationship.

For the assessment, we feel the immersive experience of a client’s environment leads to a richer understanding of their needs, views, and aspirations.

What does the long-term future look like for ILS Case Management? 

Our mission remains true to the principles of the founders: to provide person-centred case management for children, young people and adults who have experienced catastrophic injury. We will work in partnership with them, their families, their support network, and our referrers to achieve outstanding client focussed outcomes. And, as our team continues to grow, we will be able to provide our unique, comprehensive service to more of the people who need us.

Our vision is to promote positive change to support everyone who has experienced a catastrophic injury. We will provide person-centred case management recognising that families are key players; contribute to the brain injury professional knowledge and research base; and actively promote inclusion and diversity.

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