RECONSTRUCTING LIVES

Reconstructing Lives : A Case Manager's ToolKit

By Vicki Gilman

Case managers often work with clients whose injuries have brought great complexity to their lives and where on initial assessment, there seems to be a plethora of aspects to capture in the initial report plus a raft of recommendations to put forward to support progress toward agreed goals or objectives. It is not a surprise therefore, for clients and families who may be faced with reading the reports to themselves feel quite overwhelmed by their complexity.

Then comes the point where recommendations and costs are agreed, and the case manager can start working with the client and their family to improve their situation. Sometimes the start point is clear but a lot of the time it can be hard to know where to begin. There is an implicit expectation and need for change and progress to happen quickly across many aspects of the client’s life. For some clients, the reality of being able to start planning to engage in some rehabilitation or to pursue a new work or social avenue does not feel easy. It is certainly harder for most to turn their goals into reality than it is to discuss them in the abstract. it is not uncommon that the client may themselves find it hard to get motivated to overcome barriers. The case manager can feel a weight of responsibility to create some difference, to act, to implement… after all, they wrote a report with recommendations – a ‘clinical promise’ of sorts. Their notes and progress reports will of course be scrutinised along the way. Many case managers began their careers in health or social care settings where there is a limited timeframe to make a difference for each person – patients in an NHS rehabilitation unit or on a ward predictably have to move on so that each service can take new patients and focus what it offers to best effect across a population of patients. Unavoidably, this creates pressure to support as much achievement and progress as is possible in whatever time can be had. This is the way many of us became used to working and the shift in focus when becoming a case manager can feel exciting but very different. Working as a case manager in the independent sector offers a different opportunity, where what is provided can be shaped around each client and where the timeframe and approach can be tailored to the individual’s needs, aspirations, and abilities.

The ascent can be tackled another day, with good strategy and in small stages. Success may be positively impacted by waiting until the time is right, careful pacing, alternative routes, and a creative methodology.

Alongside the experience, skills, clinical and professional knowledge exemplified in the CVs of case managers it is important to utilise powerful ‘tools of the trade’ including

TIME AND PACING – for many and often very individual reasons recognising the value of time, grading, and pacing in the pursuit of positive change is important.

DEGREE SHIFTS AND INCREMENTAL

CHANGE – one small shift of the right kind carried forward can result in great change down the line. Very small, stepped changes can be a powerful way to build progress.

QUICK WINS AND LOW HANGING

FRUIT – targeting priority areas which can be quickly and effectively addressed helps to build momentum. It also, importantly creates motivation as well as trust and belief in the case manager and the process of case management.

INDIVIDUAL AND COLLECTIVE

THINKING - case managers often either form or join the MDT around the client. Apparently, it was Aristotle who coined the phrase “The whole is greater than the sum of the parts”. Never is this more so than with an active and free-thinking MDT where the case manager can promote and facilitate collaborative thinking, whilst supporting the development of individual ideas and plans and bringing this all together to benefit each client. The ascent can be tackled another day, with good strategy and in small stages. Success may be positively impacted by waiting until the time is right, careful pacing, alternative routes, and a creative methodology. A team approach to tackle the journey with an inquisitive, innovative, and hopeful, but realistic outlook that balances the risks helps stack the chips toward a safe and positive result.

Vicki Gilman Founder of Social Return Case Management and BABICM Advanced Case Manager

CURIOSITY AND INVENTIVENESS –

an open minded and constant curiosity, coupled with innovative approaches which flex in response to individuality and context are needed in order to provide unique and tailored solutions to enhance a client’s rehabilitation progress.

That mountain of potential for change, documented in the case management assessment report, does not all have to be conquered immediately. After all, as mountaineers know, making it to basecamp is an achievement in and of itself.

The case manager can promote and facilitate collaborative thinking, whilst supporting the development of individual ideas and plans and bringing this all together to benefit each client.