TRAUMA FOCUS

Placing trauma at the heart of neuro-rehab

From a realisation that case management needed more focus on emotional rehabilitation, particularly with regard to client trauma, Psychworks Associates was born.

NR Times meets the founders of the fastgrowing venture and learns how their desire for change extends beyond neuro-rehab and into their passions of diversity and sustainability. Through recognising a lack of focus on emotional responses experienced by clients among case managers working with clients with life-changing injuries, Dr Shabnam BerryKhan established a business that continues to push for positive change within the neurorehab sector. Having moved into case management in 2010, clinical psychologist Shabnam quickly identified that the variety from her doctorate level clinical skills were being used even outside of the boundaries of treating therapy, and were hugely relevant to supporting clients in their everyday lives - but this was not a view shared by everyone. “My experience was - certainly back then, when case management was still finding its feet in terms of holistic support - that it was medically-driven in the main, with physical rehabilitation goals as the main focus. The concept of understanding trauma and how that actually gets in the way of rehab seemed to be missing to me,” she recalls. “For a long time, I thought ‘Am I missing a trick here? Have I missed out on where trauma has been talked about for clients, family and care/therapy teams, or where we address the concept of adjustment and think about the grief journey systemically?’ “I remember a senior case manager saying to me ‘What can a psychologist really do to help a two-year-old with brain injury?’ I was honestly speechless. “But while there were some people who just didn’t get it, others did, and I got a bit more confidence to talk more about what I knew. It did seem to resonate with solicitors and case managers, and I started getting referrals.” And from there, PsychWorks Associates was born - a unique and brave medico-legal focused business which delivers treating psychology services and case management support to serious and catastrophically injured clients, as well as training to personal injury lawyers and those working within a InterDisciplinary Team (IDT). The fast-growing venture, run by Shabnam and husband Gabriel, has become an established presence in London and the South East since its foundation in 2014, and is seeing ongoing expansion across the country. But with its growth comes responsibility, and its values of sustainability and diversity are central to the PsychWorks Associates operation. And at the heart of its service delivery is the focus on trauma, to actively challenge the situation Shabnam faced and make positive difference to clients’ rehabilitation experience and the impact professionals and the IDT can make. “We are all about focusing on the trauma, for both the client and their family, and how that then looks to the professional network supporting them,” she says. “The family involvement is hugely important, and it doesn’t make sense to me when people don’t see that especially as there is so much literature supporting this idea. “How can you not see that having a system around the family to address their trauma, to deal with the sadness of what has happened to their family member, could be helpful to the client, who is trying to engage with rehab and relies heavily on the people around them? “It's about working within an IDT, and helping an understanding of the emotional response to the injury filter through these different layers, and then communicating that in such a way that not only makes sense to the clients and those that we're working with, but also to the solicitors who instruct us.” To deliver a multi-systemic service that serious personal injury work is effectively, Shabnam and her team of litigation-informed treating psychologists adopt a formulation approach, which they are committed to delivering differently to the vast majority of other nonspecialist psychology providers - in the client’s own environment. “I would say at least 95 per cent of independent psychologists are set up to be run from a clinic of some description, the idea being that a client would go to them,” says Shabnam.

“But immediately, you can see that doesn't work with the serious and catastrophic injury cohorts of client that we work with – it is simply not appropriate or helpful to understand a client need outside of their complex contexts. “If you do not consider incorporating the family and professional network into the work you offer, you are not going to be able to answer the psychological questions posed to you to be able to help quality of life and the rehabilitation outcomes that need to be worked on. “Because of the way we work at PsychWorks Associates, we use the full breadth of clinical skills we were trained in from observing the care team, talking to key players in the professional network so they understand a little bit more about what's going on, communicating with the case manager regularly to help inform the coordination of the role, inter-agency working with schools and attending meetings, as required. “When seeking a treating therapist, case managers and solicitors need to look beyond the role and registration, and to look for a psychologist who has the capacity to work right in the community, where the client is. And that’s what we are committed to delivering at PsychWorks Associates.” Also working under the PsychWorks Associates umbrella are traumainformed case managers, putting trauma at the heart of its approach in a way that remains absent in large areas of case management. “When a case manager comes in at the beginning, it’s often about the physical rehabilitation” says Shabnam. “But we aren’t addressing the fact that this life-changing situation has just happened to them, and it’s going to get in the way if we don’t talk about the elephant in the room. “It’s what we informally call ‘baggage’ - and the heavier it is, the harder it becomes to engage with everyday life. And if you’re working with people who have had traumatic experiences, which is pretty much any client or family who has been affected by catastrophic injury, then that is going to weigh heavily and a lot of support is needed to offload the weight. “And rather than saying ‘I had a conversation with them about it, tick the box, let’s move on’, we need to create the foundation to allow ongoing conversations to happen around how it feels and how difficult it must be, and be able to signpost them to resources or services that are going to help. “If you do this, then the impact is often indirectly felt. Suddenly communications are a use simply do not fit,” says Shabnam. lot easier with the client or family members for “There are a disproportionate number of all involved, because there’s somewhere non-white and non-English clients in personal to go with all about emotion. And the way injury, particularly in the South East and forward becomes easier to talk about and London, and other bigger cities where we are clearer for everyone involved.” beginning to work with our service, and it’s Through Shabnam’s near-20 years of working very important that any professional has an in client-focused psychology work, and the understanding of their world as that will impact expertise of the growing team, PsychWorks on their rehabilitation. Associates has also begun to deliver training “We work in people’s private homes with their to other professionals working in the field. families often, which is a massive intrusion “It’s mainly for case managers and solicitors, anyway, and suddenly there are rules that may but is also relevant to others in the IDT,” or may not fit the lifestyle they would choose to says Shabnam. have and so difficult conversations are needed. “We’re looking how to get the best out of your And these may or may not happen depending on care team, thinking about how to conceptualise how empowered clients feel. Those conversations the client case that you’re working on, and even might be about how they want people to respect how to promote self-care and avoid burnout, a dress code in their home, understanding which is a huge issue in care. different food habits, how religious practices happen, without facing judgement and without being ignored. This is the

We are all about backdrop many minorities have focusing on the trauma, experience of, making these moments potentially feel like ‘micro-traumas’. for both the client and “With the longitudinal context of trauma, their family, and how pretty much anyone you speak who is non-white will talk about racial trauma that then looks to the in some way - we need to acknowledge professional network and understand how this can be triggered in our communications and practices in supporting them the name of rehabilitation.” Its commitment to sustainability is another issue which runs deep, and “We need to be doing everything we possibly in which PsychWorks Associates are keen to can to look at how we can get the very best for lead the way. the client and what is probably going to work Gabriel, who has worked extensively in or not at the case may be, while also thinking sustainability, says: “This fits with us personally, about the professional need in the medico- as directors, and with me from my career legal context.” background. But also, it fits with the general And while helping to transform traditional agenda of social responsibility that companies practice through the focus on trauma, increasingly now have, and we certainly have PsychWorks Associates is also leading the way as a business. in helping to shape the future of the industry Over the next year, we want to introduce a way with its deep-rooted commitment to diversity of reducing formal plan to reduce our impact and sustainability. on the environment in a way that's going to The clinical teams collectively speak over 15 be sustainable within itself, and be appealing languages, and the service is proud of its to clients looking for conscious responsibility ethnic representation to support their clients, throughout our operation. a significant proportion of whom are from Psychworks Associates is embodying in its diverse ethnic background. business focus the positive change it wants to “Case management and psychology are see in the world of personal injury rehabilitation. clearly white English, female-dominated However, its referrers and clients know it best professions, and the concepts we are taught as simply a reliable service offering high in mental health alone are very Euro-centric quality and cost-effective case management - and we therefore need to acknowledge that and treating psychology support. someone of colour may experience things very differently to someone who is white www.psychworks.org.uk English and sometimes the models we 07942 691070