Stacey, 26, is living with a below knee amputation following a road traffic accident in which she was a moped rider. Before her accident, Stacey was also living with Type 2 Diabetes, had a long history of drug and alcohol misuse and was a heavy smoker.
Prior to the injury, Stacey was trying to find stability and direction in her adult life. She had been unemployed for many years and relied on welfare benefits. She was known to be a 'sofa-surfer', often relying on people she had not long known for a place to stay, as well as periods of staying in hostels or temporary shared accommodation. Substance misuse was a coping mechanism for Stacey due to pre-injury trauma and instability.
Stacey's Type 2 Diabetes was always poorly managed, and she had experienced episodes of diabetic instability due to her chaotic lifestyle, inconsistent meals and lack of routine.
Despite her challenges, those who met Stacey would describe her as streetwise, resourceful and resilient. Her accident, however, has seen that resilience fade and has led to poor motivation and low mood.
The solicitor was mindful that Stacey's turbulent background would likely influence her compliance in rehabilitation, her early progress and her long-term success. It was, therefore, of critical importance that the right case manager was identified from the very beginning; at Bush & Co, we understand this well, given the depth of clinical knowledge and experience within our case management team.
Our case management enquiry process includes a triaging clinician, who is able to explore individual nuances, ask the right questions at the right time, and anticipate the types of needs that may emerge as the client progresses through their recovery.
Through an exploratory conversation with the solicitor, the triaging clinician was able to glean the unique details of Stacey's circumstances, which led to her being paired with Anabelle.
Anabelle, a Physiotherapist, had extensive clinical experience of individuals with lower-body amputations, and was well-versed in prosthetics and prosthetic management. She had worked in both community healthcare and NHS settings and so had developed a strong understanding of the importance of a multi-disciplinary team.
During her time in community healthcare, working with patients from deprived local areas that experienced a high volume of anti-social behaviour, Anabelle had developed a significant background in supporting individuals affected by substance misuse and alcoholism. Her subsequent NHS experience further strengthened her clinical skillset, enabling her to effectively monitor wound care, diabetes management and medication adherence.
The first step in Stacey's rehabilitative journey is an Immediate Needs Assessment. This assessment, also known as an INA, aims to identify Stacey's immediate circumstances, needs and any barriers to rehabilitation, so that a clear picture of her ongoing and future requirements can be built.
INA's are specific to the individual. Stacey's included:
Anabelle also identified the need for some immediate referrals, which included:
Following the completion of the INA, and in line with the recommendations made, early rehabilitation commenced.
Anabelle began arranging appointments, organising services and planning provisions for Stacey, whilst also setting goals and targets with her.
As evidenced by the detailed and individualised support that significantly injured clients like Stacey need, a fully supported case management service like ours is invaluable.
It ensures that the case manager has easy and consistent access to services and provisions required for progression, and also that the case manager is supported in the timely and conscientious handling of the many factors potentially affecting the rehabilitative journey.
Rehabilitation continued as Stacey began to adjust to her injury. Anabelle continued to reassess goals, targets and services, altering plans as required.
Stacey and Anabelle began to look towards longer-term progression and goals.
Anabelle recognised early that Stacey's comorbidities and psychosocial wellbeing needed to be considered and cared for, and so these continued to be significant areas of focus.
Stacey's legal case settled, and she was progressing well. Post-settlement, Stacey and Anabelle continued to work together. They arranged driving lessons, and made a Motability application for an adapted car, which allowed her to be more independent.
This led to a Vocational Assessment with Bush & Co, which considered Stacey's suitability for employment. Stacey continued to work with an occupational therapist to manage her fatigue levels, ensuring that the transition into a part-time employment opportunity identified by the vocational case manager would be successful.
Stacey continued to access a local support group for substance misuse, where she had formed positive relationships with several other members who had integrated into Stacey's wider support network. She also continued being open with Anabelle about her fluctuating mood levels, and regularly utilised the practical exercises that she had learned with her talking therapist.
Case manager Anabelle worked with the Local Authority to secure a long-term property that was well-adapted for Stacey's needs. She continued to schedule client visits and meetings with the multi-disciplinary team.