RIDING THE STORM

How can case management address the crisis in recruiting and retaining support workers for people recovering from acquired brain injury?

Louise Sheffield, clinical case manager and director of Active Case Management, and Keith Cundall, partner at Fieldfisher LLP, assess the situation for NR Times

Recently, case management has focused on the difficulties in recruiting and retaining skilled support workers, following the results of a BABICM survey which identified issues including low pay, unsociable hours, the perceived value of the role and the requirement of skills as reasons why recruitment and retention is more difficult than ever before in this sector. The results are concerning but they do not cause surprise. Rather, they lay bare the experience of those of us 'on the ground' in case management and related therapeutic roles. The recruitment and retention of support workers, whether through agencies or else directly employed is challenging, but the role of high quality support workers within the rehabilitation process is as vital as it has ever been.

So what is to be done?

Here, we look at ways of overcoming some of the problems identified in the BABICM survey through stressing the importance of openness and frank dialogue at the recruitment stage, and forging an open and honest relationship with the support worker team from the very beginning of their involvement.

Recruit: For cases with ongoing litigation, the case manager should be considering recruitment at the point of completing the Immediate Needs Assessment. Factors to consider should include: Are there features particular to the client which mean that recruitment will need to be more complex? Are there aspects to the client’s presentation which would indicate that particular characteristics are required in a support worker? Does the client have challenging behaviour? Are there religious considerations or is the gender of the support worker a factor? Where does the client live? Small rural communities may have a smaller pool of potential candidates than a busy town. These issues should be flagged in the INA report and consideration given to the potential that the recruit process for this client could be longer than ordinarily expected. It may be that a rehabilitation assistant should be considered instead of a support worker and the cost calculations in the INA report should reflect this. Be bold and be honest when drafting the advert. Those reading it must be given information about what the role entails, including: information on the shift pattern, likely challenges of the role and, importantly: rates of pay. This is not a time to sugar coat the difficulties of the role, but it is an opportunity to introduce the sense of the support worker being a valued member of a bigger team; not just a team of support workers but also family members, clinicians and the case manager. The advert needs to highlight the message that the position requires a special person to be a valued part of a special process. Give reassurance that there is a strong network of support and that high quality training is provided. The wording and placement of the advert should be bespoke to the client; a generic advert which is placed on a recruitment website is less likely to attract the right candidate than a well-crafted advert which is placed on a specialist website.

For example: G lives in a small village in Cumbria. He enjoys fell running and has dysexecutive problems meaning that he cannot plan his route or what safety equipment he may need to take with him. An advert placed on a generic recruitment site was unsuccessful, but a card on the notice board of a running club yielded better results. It was possible to recruit someone who shared G’s interest in fell running and was the right ‘fit’ for the role despite having no experience as a support worker; arguably the right person can be taught about brain injury and record keeping but a knowledgeable person cannot always be taught to be the right fit. The interview should be a two-way process; an opportunity for the client and case manager to evaluate if the candidate has the required qualities and for the candidate to get a feel for what the role entails. Either side can reject and be rejected. Consider the setting for an interview. The client’s home would show the candidate the real work environment but introduces confidentiality issues and potential risks. However a formal interview may not be the most conducive for comfortable conversation, especially if a client is involved and this is an alien environment to him/her. A recent successful interview involved the client and case manager meeting the candidate in an office meeting room. After ten minutes of chatting, the client and candidate went for a walk to get to know each other. This enabled the client to know if he would ‘click’ with the candidate while case manager picked up on skills and experience from the application form, references and in a telephone call. Similarly, shadow shifts with current support workers can be valuable in the two-way interview process. The diversity of backgrounds among team members should be seen as an asset. A client may enjoy certain activities with one support worker and other activities with another support worker. In recruitment we should avoid looking for a replica of someone else.

Retain: The value of good support workers cannot be underestimated. They provide consistency and stability for clients whose lives can otherwise be chaotic. They can give reassurance and peace of mind to family members. Their observations and reports add immeasurable value to the litigation process by evidencing the client’s real experience of life. We know this. The client often knows this. Family members know this. But does the support worker? Support workers need to be given a clear understanding of how they fit into the bigger team around the client and the high value that is placed on them. They should have a place at Multi Disciplinary Team meetings with status which is different from but equal to the professionals around the table. The additional costs of including support workers in such meetings should be included in the INA Report. Training should be of high standard and specific to the client. Regular contact with support worker colleagues, clinicians and the case manager can promote the sense that a support worker is part of something bigger, something meaningful. There should be a clear route for the support worker to seek advice and support outside of their regular supervision sessions. When used appropriately, a WhatsApp group can be a useful tool for sharing information and ideas. In addition to an ethos of inclusivity and positive regard, there are practical measures which can assist with retention of support workers. Predictability of the rota as well as plenty advanced notice of rota changes can give assurance to the support workers and help them to manage their own well-being and work / life balance. Furthermore, if a case manager can alert the support worker from the outset that there will be ‘bumps in the road’ and that there is a contingency plan, a support worker is less likely to be derailed when problems do occur. The work environment should be as comfortable as possible for the support worker; a safe place is important, especially where a sleeping night shift is required and the accommodation for the support team needs to be clean and comfortable. This should be identified by the case manager as early as the INA report stage so that funding can be requested to provide a suitable working environment for the support workers. Career progression for support workers can raise conflicts of interests for a case manager. In a situation where a support worker has brought about stability for client x, a case manager should not transfer the client to a promotion for client y. However it is known for clients to thrive from the stability of a strong support team to the point where the level of support can be reduced which can provide opportunities for career progression. The BABICM survey identified the low status of employment as one of the reasons given for recruitment problems. A case manager who explicitly asserts the high value placed on good support workers can hope to quash this perception, however words must be backed up by deeds. The case manager must encourage an environment of open communication and work to integrate the support worker into the rehabilitation package and wider MDT. Support workers are special people, and the role does not suit everybody. Effective recruitment starting at the content of the advertisement, can find those who are vocationally suited to the role and who will thrive in an environment which is nurturing and supportive. Recruitment is an expensive process in terms of case manager’s time, but investment in systems such as supervision and training will reduce the need for recruitment while also enhancing the service received by clients.