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Immediate Needs Assessment: The Blueprint to Rehabilitation

For a person living with a catastrophic injury, an Immediate Needs Assessment (INA) is an opportunity to talk about their injury, their life and hopes for the future. For a legal team it’s a clear picture of the client and the road ahead but what can it achieve? In this article we explore the role of an INA within rehabilitation and the Bush & Co way.

Assessment of a client by a case manager should start as soon as possible after the letter of claim so that rehabilitation can start as early as possible. Following assessment, the INA report is the first clear picture of a client; sometimes whilst they are still in hospital and on occasion, it may be months or sometimes years post-injury.

The INA will identify the immediate needs of a client following the incident, how they were before and identify any rehabilitation barriers. Pre-existing conditions will be listened to and recorded.

INAs the Bush & Co way

At Bush & Co we understand and embrace the individuality of the client. Where a client’s list of injuries may be identical to another’s we ensure that our case managers respect the individuality of the client and our reports reflect the unique way the injury has impacted on them, their families and their quality of life.

Our case manager will assess a client for a number of factors within the INA to establish clear and effective recommendations. Throughout the whole of the assessment they will observe the injuries sustained, having reviewed any medical records provided. The INA ensures that the client’s self-reporting of the impact of the injuries is reported.

Case managers will identify certain issues or barriers for the client including mobility, pain management, sleep, speech, cognitive function and psychological challenges and will include key sections including benefits, function, behavioural, vocational, accommodation, social, care and travel/transport.

Overall and secondary goals for the client will be clearly defined and whilst these will be revisited prior to ongoing case management beginning, give a clear overview of the priorities within rehabilitation.

Past medical history, any inpatient and community intervention to date and the client’s social situation will also be assessed.

At Bush & Co we believe our INAs provide the best picture of a client and their needs to support the litigation process but in doing so our case managers play a unique role; a role that listens but remains impartial. The INA appointment may be a huge moment for the client and the first opportunity to sit down and be heard by someone outside of their clinical treating team about the incident. They may have spent weeks or months writing down what happened, what they were doing at the time of the incident, who was driving the car, what the weather was like and how they felt and so on. This may be recorded in the INA as ‘client was travelling in a car along High Street’ and our case managers sensitively explain that we do not discuss liability and remain impartial.

How is need assessed?

Despite the pandemic forcing case managers to carry out remote assessments where appropriate, face-to-face assessment will always be best practice at Bush & Co. The vast majority of time the INA takes place in the client’s home which gives the case manager the best opportunity to see their life and how they live. Video or telephone assessments don’t give the opportunity to really see the true impact of their injury or condition; stacks of unopened mail because they’re struggling to cope remains unseen, seeing them make a cup of tea and how they can function in the home remains a missed opportunity and not making the trip to where they live makes understanding how isolated or connected they are difficult.

Assessing a child is significantly different from our adult assessments and every report we write is written with the child in mind. We include EHCP considerations, childhood milestones, transition into adulthood and goals set are appropriate to the child; getting back to work is replaced by having a play date with their best friend and so on. We use pictorial diagrams and child friendly language so they can be as engaged as possible and know that their voice is heard but we also consider not only the impact on the child, but of the family too.

What does good look like?

At Bush & Co we believe the INA is a blueprint for rehabilitation and for that reason needs to make a representation of the individual and their circumstances by way of a pen picture. It is about getting the best for the client but should have a balance of statutory and private provision, include sound clinical reasoning that follows NICE guidelines and include reasonable goals.

Those goals need to be negotiated with the client and the role of the case manager is not to set the goals but to work with the client to identify their goals.

The gold standard should also represent a mix of statutory and private provision. Not only does this ensure funds are spent on the most vital needs that cannot be met by statutory provision but that the client is protected for any changes further down the line when ongoing case management commences.

“One client I worked with had significant mental health challenges following his accident and statutory provision was recommended and put in place. During litigation liability was denied and funding was no longer available. The private physiotherapy we had in place could not be moved however because his mental health treatment was statutory provision the client’s treatment was not interrupted . We’d kept his GP informed at regular intervals and were able to ensure the duty of care remained with them.”

Ensuring quality and safety

All of our INAs go through a quality check internally prior to you receiving the report. These checks ensure the letter of instruction has been responded to and that all recommendations are based on sound clinical reasoning.

These quality checks are carried out by our clinical management team who guide and support our case management network.

Our dedicated safeguarding team, qualified to Level 4 support and our case managers watch for risks and safeguarding issues identified at assessment are actioned immediately and recorded.