l) Case management for 'life' - as needed   Next m)

i) Case management as needed

As noted above people who have damage to the frontal lobe of the brain often have difficulty with:

  • planning
  • coordinating
  • initiating.

One of the consequences of this is that often people who have frontal lobe damage are also the ones who need ongoing case management. In these situations the Case manager's roles is to act as their frontal lobe.

One case manager noted:

When everything is running smoothing the person can seem to be functioning well. They may hold down a job, be able to get themselves to and from work. But if their job role were to change or if they had to decide whether or not to sell a property they are no longer able to cope. Case management is needed at this point.

Many people with an acquired brain injury and particularly those with frontal lobe damage will effectively require case management for life. In these situations case management is often not continuously required. It is required from time to time when planning, coordinating, decision making are required during periods of transition or change in circumstances (e.g. change of job, death of a carer).

Rules of thumb

1. Get to know the person both over time and also for a period of time. Build trust and understanding. See how they are when they are fatigued and upset.

2. Identify the kinds of situations where case management will be required.

3. Ensure the person has ease of access back to case management if these kinds of situations arise.

A case manager said about her role as a case manager:

My role as a case manager entails managing a case load of clients with acquired brain injury and what that means is setting up individual programs for those clients.

So within that the central part of my role is to set up their individual service plans and for the clients, that means identifying their goals for the coming year. We do it on a yearly basis. And from that I can then plan their supports.

Beyond that my role also encompasses staffing. So I am involved in rostering, hiring and training new staff members, also in providing supervision. Within my role I also liaise with all the relevant bodies relating to a client. So that would mean medical practitioners, it would mean funding bodies, it would mean families, it would also mean any significant person to that client's life and coordinating services to them. So we set up appointments, we attend appointments and pass on relevant information as required.

We also are responsible for maintaining their budgets. We liaise with their funding body so we have to have an understanding of the financial aspects of their situations and then delivering services within those to meet their needs.

I spend some time out in the community supporting the clients and in that way I get a good grass roots understanding of the clients' needs and what it means to be a support worker out with those clients and how to direct new staff when they are first meeting that client.



ii) Case management : Graphic

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iii) Clip 2 : BIU Case Managers : Role & service process (2 min)

Being a Brain Injury Unit case manager: roles and service processes


iv) Clip 4 : BIU Case Managers : Specialist Roles. (1 min 45 sec)

The specialist roles working with people in the Brain Injury Unit and also in moving back into the community


v) Tools for case managers

Case managers working with people with ABI may find the following tools useful:

Tool 5: Case management issues checklist - for identifying issues

Tool 6: Sources of information - for identifying sources of information that will be useful

Tool 7: Individual program plan - suggested outline

Tool 8: Tips for setting goals - for people with ABI



vii) Questions

The person

You are working with a person with acquired brain injury who has made quite a remarkable recovery. He has returned to work. He has returned to driving. He does have higher level cognitive impairments.

He can use the bus and train. He has a lot of procedural memory about daily activities and driving and work.

He didn't progress up to his pre-injury level of activities but nonetheless he is working full time and his company is satisfied with him and he appears to be reasonably satisfied.

His cognitive impairments have been mainly with the executive functioning so he has got very low level of insight into his impairments which affect his memory. He doesn't have the capacity to take in new information and use that information and process that information and then develop a plan of action and then initiate it.

Answer the following questions:

You are working with a case management service that you want to case manage this client. The service is a generic case management service. It has no experience with clients with ABI. They have a policy of time limited case management. When case management is finished the client has to be reassessed and put back in the queue (with a long wait) before case management can start again.

You want the service to case mange this client. You are talking with the manager. What points do you make?

Check your answers here:

1. This client has a frontal lobe injury.

2. He has difficulties planning and coordinating his life. He has difficulties with new situations.

3. New situations will continue to arise in his life - moving house, changing job, getting sick.
When these situations arise he will require case management - someone to be a proxy for his frontal lobe for the times when he needs it.

4. He will need this for the rest of his life.

5. His case management will be episodic, as needed, for life.

6.For him to be reassessed and join the queue for case management each time he needs it will be very detrimental for him.
When he needs case management he will need it quickly. If it doesn't happen quickly his life will spiral out of control.
You need to change your polices and procedures to effectively meet his needs.