REHAB PIONEERS

‘Survivors have a life - we help them live it’

As one of the pioneers of case management in the UK, Community Case Management Services has played a significant role in helping to revolutionise community brain injury support.

As the business marks its 30th anniversary, NR Times meets its founder Maggie Sargent and learns more about the life-changing work of Community Case Management Services and its commitment to enabling people to rediscover a ‘normal’ life

From its origins in summer 1992, helping to pave the way for the acceptance and recognition of case management in the UK, Community Case Management Services has grown into one of the key players in the sector. Supporting people with brain injury and other complex needs to maximise their potential and rediscover independence and the joy of life, many clients have been with the business across the three decades it has been in existence. And keen to show what is possible in their recovery, Community Case Management Services has become known throughout the neuro-rehabilitation sector for its adventure trips - taking clients with complex needs on holidays that offer the chance to surf and ski remains unique, and has seen countless life-changing moments for people living with severe disability. For Maggie Sargent, award-winning founder of family-owned Community Case Management Services, the principle of the business is simple. “Our clients just want to be normal - and that's what we try to create,” she says. “That's really where we come from. Our model is to create a life that is active, that is enjoyable, that is ‘normal’. Life is for living is what we say. “And that is a baseline for what we do, because we find that is so important in clinical growth. They have lives to live and we help them do that. I can’t say that enough really, because that is what we are all about.”

Community Case Management Services - setting new standards in brain injury support

While a new phenomenon in the UK in 1992, case management was established practice in the United States - and through the creation of Community Case Management Services as an extension of care reporting business Maggie Sargent & Associates, the foundations for case management were being laid on this side of the Atlantic, too. “Community Case Management Services was formed at exactly the same time that the role of the case manager became accepted in this country,” says Maggie. “I asked some of the people who I worked with at that time who were doing reports with me to become case managers, because they were really experienced in setting up care packages. There was a huge need to do follow-up work. “This was at a time when more and more brain injury rehab centres were being set up, but what was happening with them (the patients) afterwards? Nothing. And they were being re-admitted because there wasn’t any follow-up. “So there was a clear need for something to support these people.” And from the desire to create a business to do that has come one of the best known and most dynamic clinical case management companies in the sector, which has supported several of its clients for almost its entire three decade history. Community Case Management Services as a business has grown significantly during that time, with clients coming from across the UK and even Europe, with cases from locations including Poland, France and Ireland. Kate

Russell joined Maggie as a director in 2002, and a hugely capable and continually developing management team has been formed to give the infrastructure needed to deliver the high-quality service it does. Maggie names two things as her proudest achievements - the clinical governance of Community Case Management Services and the relationships it builds with clients. “We have very strong clinical governance, every single incident that happens within our group of clients is reported to me as head of clinical governance - that is a role I have played from the start,” she says. “I always know what is happening within our clients’ homes, and this is discussed as a team each week. Obviously, we act immediately if necessary, but we discuss with the case managers weekly. And I’m very proud of that clinical governance, we involve our case managers and have got very good experience at the top of the team and a very good mixture of disciplines within it. That is very important. “Also, the fact that some of our clients have been with us for 30 years. We have known them in hospital as children and now they are middle-aged adults. They are very much part of our family, we have come to know who they are, they have been on many trips with us, and we have helped them to live their life.

“The team we have is central to us being able to support them as we do. The support workers are key people, they’re guided by the therapists, but when it comes to doing things like our trips, the family feels safe for their loved one to go away with the support team. And that’s what we are - we’re one family.” The family ethos is very much a feature of Community Case Management Services. The close-knit team clearly know their clients extremely well, with Maggie’s own family also being willing to lend a hand in the support the business provides. Her three children - Annabelle, an upholsterer; William, owner of Accessible Dreams, which enables the case management company’s adventures for people with disabilities; and lawyer Francesca - are also involved in supporting the work of Community Case Management Services with its clients. “Annabelle has a disabled-friendly studio that we can go and visit, the plan is that we're going to do more in Brighton so that people can do a bit of vocational work there,” says Maggie. “William has worked for us as a support worker, he’s very good at working with people with brain injury, they enjoy the young company. He runs the trips and comes on them with us, he’s very involved. He’s now studying for an MBA so he can learn more about the business side. “Francesca worked for us as a carer during her time at university, and while she’s a lawyer now, she’s around if there is anything we want to talk to her about, she’ll always support us from the legal perspective. “But while this is my family, Community Case Management Services is a family and everyone is part of that, clients, the team, we all are part of this.”

Life-changing trips and exhilarating adventures

In a unique approach to rehabilitation and in showing what is possible, Community Case Management Services has become known far and wide for the adventure trips it arranges for clients. Surfing trips are commonplace - four will run this year - as are trips to the Community Case Management Services house in Normandy, France. Two trips to safari in Africa, where participants will also help in an orphanage, are planned for next year. While the trips have run for several years, but were forced to pause during COVID, happily they are now back with a vengeance. Throughout her career as a nurse, Maggie has passionately believed in giving people living with brain injury and other disabilities the opportunities to thrive, to live their lives - and, crucially, to feel ‘normal’ again. This is something that runs throughout Community Case Management Services - and their trips are a prime example of this. For the client on the ventilator, whose dreams of becoming a ski instructor were cruelly dashed by spinal cord injury, skiing was something he never imagined he would ever do again. But for Maggie, the ‘impossible’ is very rarely that, and sure enough, she and the team found a way. “We want to prove within this organisation that anything can be done,” she says. “This young man really wanted to go, so we found a way. He didn't have a claim, so my daughter ran a marathon to get money and we persuaded some solicitors to help sponsor the trip. “We took the team of nurses, he had a spare ventilator, we did it all properly. The most important thing was to maintain his breathing and everything was fine. It was all possible. And he had the most wonderful time. He was up before me every morning, it was exhausting! He was the first man on the mountain and the last one off.” Such life-changing experiences are precious for the client, their family, and for the Community Case Management Services team too, says Maggie. “They are the best moments - they’re certainly my best moments,” she says.

“But it’s about more than the trip, more than the experiences. The point for us is to show that anyone can move forward if you give them goals. They need their own individual dreams. Seeing them smile is everything.” Inclusion is hugely important to Maggie, and enabling people to rediscover the joy of life after injury or disability. “What we want to do is to give them another life,” she says. “They love having the opportunity of meeting other people and of getting a life back. A lot of people we work with have lost their network. They may be very disabled, they may have communication problems - but they need to live and have dreams and aspirations. “They need every year to think, as we all do, ‘What’s the aim? What do we want?’ When we get to January, it’s good to plan a holiday or activities, and that’s what we do. It’s not just the humdrum - we want to give people something to really look forward to. “In the early stages, it’s about coming out of hospital, it's about getting your therapy, and the therapy needs continue. But they move out into the community, and what then? How can you boost their serotonin levels? How can you get more from them? “And that’s why we do the trips. We don't make any money, they’re not commercial trips. There isn't a profit margin on it. We want to be able to take anyone, I won't do any trips that are not wheelchair accessible, because everyone has to be able to go, if that is what they want to do. “But for us, we do need to hold our nerve - it’s a big undertaking to do these trips. You’re arriving at the airport with 12 wheelchairs, you’re first on the plane and have already upset everyone because they’ve got to wait for you and we’re an hour late taking off. But the camaraderie between us when we’re first on the plane is great.” The roots of the trips can be traced back to Maggie establishing the Oxford and Bristol group of the Silverlining Charity, which proved to be a hugely effective way of bringing people together in activities and enjoying life. “There was a client who I wanted to go to London, but he wouldn’t go. So I thought ‘Well if he won’t go there, we’ll bring the Silverlining to him’. And we set up the group. He is now so proud of being the founder member. Previously he didn’t do anything and was very, very lonely. But the impact of him being part of this group has been huge for him,” says Maggie. “It was a very good way of getting people to socialise and enjoy a normal life. We’ve done art, fashion shows, all things that people might want to do with their lives. “You've got to do as much as you possibly can. I think people often don’t realise how much untapped potential there is out there. We’ve got people writing songs, painting pictures, doing very creative activities. It can be very hard for people to motivate themselves after an injury, but that is where we as a team can really help.”

Leading the development of case management

As the founder of one of the UK’s first case management businesses, Maggie has been at the forefront of the vast progress of the sector from the very beginning. Using her background as a nurse, she took inspiration from the work being done in case management in the United States to drive forward the creation of a new profession - and with it new levels of support nationally for people living with brain injury and other conditions and disabilities. “I came at it from a care perspective, I was a nurse who worked with clients in the community and I saw the difficulties in accessing the services. I saw that we needed a label so we could have a professional role in changing this,” says Maggie. “We weren’t a nursing agency - we were much more than that. We saw the need for our role in discharge planning, future care planning, making provision for people’s future. We were people who were interested in making sure there was provision for proper brain injury rehab.” Having laid the foundations of case management, others were keen to follow Maggie’s lead, with many of today’s bestknown and respected case managers and case management businesses being supported by her and Community Case Management Services at early stages of their development. “I couldn't do it all on my own, at first there was only me doing my bit with a couple of other case managers, and obviously we've grown over the years. Both as Community Case Management Services, but importantly collectively in case management,” says Maggie. “Case management has changed completely. I think it's a fantastic service which has developed its clinical roots, which has come through having CQC registration and is probably one of the most important things to happen. “The way we work has moved on a lot. For example, in the very early days it was frowned upon that you would get your clients together, which might sound rather strange now. But thinking and practice moves on, and we now have regulation and standards. “I think the litmus test of a case manager could be: ‘Do you have their mobile number? Can you contact them 24 hours a day?’ It was always meant to be a 24-hour service, with the kind of clients we deal with, it’s not a Monday to Friday role at all.” Maggie was also fundamental to the creation and growth of the British Association of Brain Injury and Complex Case Management (BABCIM), and has played a role in its ongoing development - and that of case management - ever since. Recently, she returned to be part of its Council. “We needed BABICM and I helped to set up the first steering groups. I was at the BABICM table from the very beginning and am one of the very few that are left as a sole owner of a company that is still a family company doing case management,” she says. “Thirty years later, I’m back on Council because of the fact that I still believe so passionately that we're doing the right thing. There have been a lot of changes in case management, a lot of the family firms have disappeared. And I feel very strongly that we have to fight for the standards. “I don't want to see any reduction in stance, I think BABICM standards are brilliant. We now have proper systems in place, we are regulated, and there’s a wide range of case management too. “There have been so many changes in case management that I’m glad we have BABICM. We were always worried that the market for case management would change, and people would see it as an opportunity to make money, there can be a tendency for people to look at financial targets rather than clinical ones - but clinical governance is very important to me, and I think BABICM has a very important role to play in ensuring this remains the priority.”