January 27, 2017 0

Case Study

J was just 17 when she sustained a serious brain injury after being involved in a RTA in 2006. She had just left school and was living with her parents.

J was in hospital for many months and it was following her transfer to the local neuro-rehab ward that she was first introduced to her Case Manager.

The litigation process had only just begun and J was receiving only family support.  The CM’s Initial Assessment recognised that J was not yet ready to return to her parents’ home.  She was then able to negotiate with the Health Board for Continuing Health Care to fund 8 months’ further rehab at a BIRT centre outside the area.

J responded well to rehab, but on discharge still had significant cognitive and behavioural deficits which required further community therapy input and support: J had substantial short term memory deficit; disinhibition and impulsivity particularly in relation to men; little road sense and poor planning and organisational skills.

Prior to discharge, with the CM’s support, an interim payment was arranged to cover the costs of adapting and interlinking the property adjacent to J’s parents, previously her grandmother’s house, and making it safe and habitable for J.

The original plan was for BIRT to continue providing the community rehab support and to employ the support team, however, due to the impracticalities of working remotely, the CM took over the coordination and management of the MDT and Support Team.


Initially, two support workers were employed to provide day time care, Monday to Friday.  Although this arrangement was successful, J began to seek greater independence.  The decision was made to look for a rented property to trial independent living.  After viewing many properties, the CM found a suitable house, not too far from J’s parents and recruited a team providing 24 hours’ support.  J and her Mum played a pivotal role in the recruitment of the team and one of the original Support Workers was employed as Team Leader.

This trial period began in 2010 and having gone well, in 2012 the rental property was purchased, with much of the support team remaining in place today.

J now lives in her own, very comfortable, home, typical of any young woman and has a long-term boyfriend, whom she met at her skiing club.

Her week is structured and productive; Headway, Bingo, Skiing Club, cooking, housekeeping, shopping, meals out, gym and other social events

Throughout, J’s mood has remained good. She is consistently happy, content and outgoing and is making plans for the future which may include marriage and children.

J still needs significant support but within that has been able to develop herself, maintaining close links with family but not dependent on them in any way.

Why has this worked so well?:

– Understanding the culture and dynamics of the family and the need to work alongside the family to allay concerns.

– Establishing a good working relationship and effective channels of communication with the litigation solicitor, Deputy AND defendant solicitor

– The early appointment of the CM who coordinated all agencies involved, ensuring they understood the objectives, therefore allowing J to take advantage of all the opportunities offered.

– Knowledge and understanding of local statutory and voluntary sector services

– The ability to identify good specialist local therapists and to work closely as an MDT to move J’s rehab forward

– The adoption of a flexible and patient approach to CM, which in this case achieved better outcomes than being directive and dogmatic.

– The careful recruitment of the Support Team, involving J and her family. J identifies closely with people she associates with and therefore a broad mix of personality types were employed to give J balance; whilst all being of an appropriate profile to engage discreetly with J in social and community activities.

– A highly trained, motivated and valued support team which has led to excellent staff retention and as a result, consistency for J.


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