Beyond the Headline Injury: Complexities in Case Management

Successful rehabilitation and strong case management is more than just the initial diagnoses. The reality is that case management is complex, filled with intricacies and obstacles that can often be difficult to anticipate or navigate and, in order to provide effective support to their client, case managers must be able to identify and address these factors alongside the headline injury.

It is because of the complexity of case management that we have developed our Rehabilitation Pathways, designed to follow the client’s journey from the index event through to settlement and long-term outcomes. Our first pathway follows Stacey, a 26 year old living with a below knee amputation following a road traffic accident. Stacey has Type 2 diabetes, a long history of substance misuse, no permanent accommodation or employment, and is reliant on welfare benefits.

Looking beyond the injury

Rehabilitation cannot address individual injuries, conditions or factors in isolation; clinical, psychological, social and economic needs are all interacting from the index event throughout the rehabilitation journey and beyond. It is because of these varied and complex elements that early intervention is crucial and, due to the Rehabilitation Code (2015), possible. Immediate Needs Assessments (INAs), are an early intervention measure that identifies the needs of the client along with any barriers to rehabilitation, allowing the case manager to begin planning for the road ahead as soon as possible; meaning that rehabilitation should not, and does not need to be, placed on hold pending legal outcomes.

Stacey’s INA had a lot to consider, and gave her case manager the opportunity to identify many early barriers that could affect her success if not managed over time: her diabetes and implementing effective wound care; substance misuse, smoking and mental health; and her unstable financial and living situation.

Diabetes and wound care: general health affects headline injuries

Co-morbidities such as diabetes can have a profound effect on general health, particularly when managed poorly as Stacey’s had been. Her turbulent and unstable lifestyle often meant that she missed GP reviews and routinely had a poor diet. Diabetes can negatively impact wound healing which could have implications for Stacey’s stump, and the circulatory issues that often accompany diabetes could become problematic for her intact leg if she experienced a prolonged period of reduced mobility. Effective management of her diabetes was identified early as a priority, as it had the potential to affect her recovery and long-term outcomes.

Considering Stacey’s diabetes is just one of the many elements that her case manager had to account for when initially formulating and routinely updating her rehabilitation plan. Alongside supporting Stacey’s amputation rehabilitation, her case manager needed to ensure appropriate wound care was in place, encourage engagement with the GP about her diabetes, monitor adherence to medical advice and maintain communication with medical professionals along the way.

Housing and finances: the importance of stability

Effective rehabilitation relies heavily on consistency. When important social factors, such as housing and finances, are unstable it can have a negative effect on overall mood, diet, hygiene and personal care. In cases of complex physical injury such as amputation, it is likely that accommodation needs to be reviewed for suitability and adaptations, meaning that the use of hostels, temporary accommodation and lodging with others becomes unsustainable.

Stacey’s case manager considered her accommodation and financial situation early on and throughout her journey, arranging occupational therapy and welfare benefit assessments to improve her overall situation and provide her with the stability and consistency required to ensure rehabilitative progression.

Mental health and substance misuse: making wellness
a priority

Whilst the main focus in rehabilitation should be on the primary physical injury, it shouldn’t be the only focus; an effective case manager understands that success in rehabilitation is derived from a holistic approach to the client as a whole. A life-changing injury has a much wider impact than only on physical health and it is often the case that a client’s mental wellbeing is negatively affected too.

Whilst described by others as streetwise, resourceful and resilient, Stacey experienced low mood and poor motivation following her road traffic accident. Having relied heavily on substance misuse as a coping mechanism historically, it was important that her case manager helped support these psychosocial factors from the earliest opportunity. Conducting a DASS (Depression Anxiety Stress Scale) assessment as part of the INA helped to define Stacey’s mood and gave her case manager an important picture of her state of mind.

Pre- and post-settlement: appropriate goal-setting

Through the constant reassessment of goals, targets and services, Stacey’s case manager provided the right support for each element of Stacey’s situation at the right time. They worked together to improve stability, manage clinical needs and enhance psychosocial wellbeing.

Once Stacey’s case settled, they began to look forward towards long-term outcomes; a driving licence and adapted vehicle, vocational opportunities and the chance at employment, continued support around Stacey’s historic substance misuse, and adapted permanent accommodation.

Stacey’s story illustrates the early considerations required to begin an effective rehabilitation journey, what should be considered and implemented ahead of settlement, and what can be achieved afterwards. Understanding the difference between immediate, short-term goals and long-term outcomes is a vital skill of a case manager.

Rehabilitation is a journey

Effective rehabilitation is about more than just treating the headline injury; it’s about the many varied and intertwining factors that are unique to each client, all of which have the potential to affect engagement and achievement with rehabilitation goals. For case managers, identifying and addressing these elements early is crucial for success. Long before legal outcomes are discerned, case managers have the opportunity to positively intervene and provide much-needed support to their clients. These early interventions lay the groundwork for long-term outcomes and future progress.

Supported by 40 years of industry-leading heritage and working alongside a nationwide network of case managers, we understand the importance of early clinical insight, a coordinated approach and the significance of case manager selection. This is why we have a robust clinical triage service at the first point of enquiry, ensuring that clients are paired with a the right case manager by identifying the individual complexities in each case from the first opportunity, and a fully supported case management service post-instruction.

You can read Stacey’s Road to Rehabilitation by clicking here.