Building an effective MDT that stands the test of time
In every case, building an effective Multi-Disciplinary Team (MDT) around the client is vital and happens day in and day out but when working with children and young people, that team built in the early days following injury or major trauma needs to stand the test of time.
Angela Molnar, Bush & Co Case Manager and Occupational Therapist is well known for the effective teams she shapes around children and young people as they grow, develop and transition and here she shares the recipe she follows for the best results.
We asked Angela the most obvious question around the importance of building an effective MDT when managing paediatric cases.
"Firstly, working with children and young people can be a very different experience to working with adults from a case manager’s perspective. When considering the goals for an adult case we can review their functioning level the day prior to the incident and the goal would always be to return them to that level of function however, this is much more difficult with a pediatric case as children and young people present a very different picture. The difficulty is that we do not really know what their potential would have been. Their parents will always have aspirations, desires and ambitions that all parents have for their children and it is the responsibility of the case manager and MDT to manage these expectations appropriately. The difficulty for parents is coming to terms with and accepting that their hopes and dreams for their child may no longer be realistic and dealing with this in an empathetic, caring way. Therefore, the role of the case manager is not only to support the client, the child, but also support parents to come to terms with the impact of the trauma on their child and address their own grief while still offering hope and a positive future.
“In cases of birth injury parents may have been managing to cope with no or very little additional support and this adds to a very difficult, stressful and tiring situation; parents trying their very best but at the same time struggling. This can often cause issues with the family dynamics, their fatigue, stress levels and impact on both their mental and physical health. Therefore, the effectiveness of the MDT needs to be quick but also carefully planned and introduced with the family; ensuring that input is not initially overwhelming. The input for the MDT is clearly based on the child’s clinical needs, supporting parents and the child to achieve the best possible outcome.”
The role of a case manager is to identify potential as well as current and future needs through the Immediate Needs Assessment (INA). According to Angela it is this INA that then acts as the starting point for building the scaffolding, and in many cases the life line, for the child and their family.
“As a children and young people case manager my role is to work closely with the parents to guide them and ensure that we not only build a good professional relationship but that we also work together as a successful team in order to identify the child’s and family’s needs. The MDT is essential in meeting the identified needs of all and recommendations for therapeutic intervention need to be considered very carefully, this is reflected within the Initial Needs Assessment report. In an ideal world my INA recommendations would be implemented without delay and the team would commence working with the family immediately, clinicians are fully aware that early intervention is the key to promoting skills. However, for many reasons immediate approval doesn’t always happen and therapies and interventions may be delayed or even declined.
“As a case manager, my early role is to identify appropriate therapists that I feel would be suitable to work with my client. My approach is to make sure I utilise a UK-wide network of amazing therapists who are reliable, proactive and who will be able to gain an excellent understanding of the child’s needs and the family dynamics. My go-to providers have been built over time but essentially they are professionals who are committed, see the long-terms needs of the child and don’t take an ‘in and out approach’. They are experts in the real needs of a child including areas such as physiotherapy, occupational therapy, behaviour therapy, speech and language for example. The clinical operations managers at Bush & Co also provide a valuable outreach to discuss particular gaps in the MDT.
“Once the team is built it’s about working on addressing the child’s physical, mental, medical, housing needs, helping the child to enjoy and thrive in childhood and as far as possible, returning the family dynamic to one of connection, empowerment and focus.
“I have worked with families who have moved home to the opposite side of the country and while the wish to move was an initial shock to all members of the MDT, the family were listened to and fully supported in their decision, a new home was located, the family successfully moved and the child was enrolled in a new school. The decision for the family has ended up being a very positive step in the child’s progress and although questions were raised by the team initially the move has clearly been the right thing for the whole of the family. The mother of the child reports frequently that she is extremely proud of her son’s progress and I think it’s fair to say that he’s excelled far beyond the level that we initially expected. This clearly proves the importance of working alongside the parent’s ensuring that their views are always considered, it is not my role to come in and disregard the needs and wants of the family as a whole."
As a child grows up, the MDT must evolve around them for continued success. Once a child and their family has stabilized somewhat we often find that schools play a greater role and, if the right school and therapies are in place, we often see that private therapy shifts to the educational setting. Input with children and young people’s cases from the original MDT is always longer in paediatric cases though.
Angela says “Whilst some of the initial MDT will remain in place throughout the case management process it is also necessary to review the team on a regular basis, reviewing appropriate input. As the child progresses through education it may be possible they have access to appropriate support within school or via statutory services. We may consider that support workers take on a greater role as parents begin to feel comfortable handing some responsibility over to others. So while I acknowledge that the team will change over time it is essential that the MDT remains connected and adapts.’’
Things don’t always run smoothly straight away and many times an effective MDT cannot be assembled until a professional relationship has been secured and the parents are willing to initially put their trust in someone and also be willing to accept support; something that they may not have had for some time. Angela tells us of a case she has worked with the family on since 2017; a young boy with Cerebral Palsy who was nine years old when Angela met him and his family.
"At times it can be difficult to engage parents, this may be due to past experiences that they have had with other professionals, statutory services or case managers, being let down with people promising them the help they need etc. The mum of the child is a very strong lady who had battled with statutory services for support for her son over the years.
“Throughout the whole process Mum has kept her child’s potential centre stage. I feel that over the years we have built up a huge amount of trust and respect for each other as well as an excellent professional relationship. I think it’s fair to say we have all come a very long way together both geographically and emotionally. The case management process has worked with the family to identify therapists, locate alternative, more appropriate housing and give the family the support that they need at very challenging times. It has to be recognised that although therapeutic intervention is necessary to promote skills it can also be intrusive to home life as often the therapy sessions may be completed after school, at a time when the family would like to chill and relax following a busy day. It has been essential to acknowledge that the family need ‘downtime’, they need to enjoy spending time together and settle into family life. Taking this feedback on board alternative arrangements were put in as much as possible allowing the family to enjoy the privacy and freedom that many of us enjoy with our own children.
“There have been challenges along the way for the child involved, needing to address issues such as increased behaviour, conflict and frustrations; all of which tended to manifest itself with bouts of anger with siblings and parents. We worked together to identify the therapists that needed to be involved to assess the issues, plan the therapy and empower parents to deal with individual scenarios effectively.
“The difference that the MDT has made to the family is huge, the family celebrate every single achievement. The parents are now at ease when working with the case manager, knowing that any problems that arise can be discussed and resolved effectively. They understand that the support is always at the other end of the phone should they need someone to trouble shoot or just to share some really great, positive news!
“The goals for this young boy and his family were to promote his physical and mental health, support social engagement and promote safety awareness, at the same time as allowing him space to grow as an individual. His team both past and present have built on great relationships, we have grown with the family and we celebrate all of the family’s achievements.
“The question now is what does the future hold for this amazing young man who is continuing to smash all his goals? We will continue to work with him and his family and ensure that he reaches his true potential and enjoys life to the full."
Angela Molnar | Case Manager and Occupational Therapist | North East
Angela is a caring, calm, understanding and pragmatic Case Manager and Occupational Therapist with over 10 years' extensive experience of working with children and their families following birth injuries, developmental delays, ABI, stroke, genetic disorders, life limiting conditions and sensory processing disorders. Her experience working with adult clients includes Acquired brain injury; stroke, complex orthopaedic, spinal injuries, amputation, musculoskeletal, birth injury; complex learning disability; sensory processing, hemiplegia.
View Angela's full CV online: Angela Molnar