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Reconstructing Lives : A Case Manager's ToolKit By Vicki Gilman Case managers often work with clients whose injuries have brought great complexity to their lives and where on initial assessment, there seems to be a plethora of aspects to capture in the initial report plus a raft of recommendations to put forward to support progress toward agreed goals or objectives. It is not a surprise therefore, for clients and families who may be faced with reading the reports to themselves feel quite overwhelmed by their complexity. Then comes the point where recommendations and costs are agreed, and the case manager can start working with the client and their family to improve their situation. Sometimes the start point is clear but a lot of the time it can be hard to know where to begin. There is an implicit expectation and need for change and progress to happen quickly across many aspects of the client’s life. For some clients, the reality of being able to start planning to engage in some rehabilitation or to pursue a new work or social avenue does not feel easy. It is certainly harder for most to turn their goals into reality than it is to discuss them in the abstract. it is not uncommon that the client may themselves find it hard to get motivated to overcome barriers. The case manager can feel a weight of responsibility to create some difference, to act, to implement… after all, they wrote a report with recommendations – a ‘clinical promise’ of sorts. Their notes and progress reports will of course be scrutinised along the way. Many case managers began their careers in health or social care settings where there is a limited timeframe to make a difference for
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each person – patients in an NHS rehabilitation unit or on a ward predictably have to move on so that each service can take new patients and focus what it offers to best effect across a population of patients. Unavoidably, this creates pressure to support as much achievement and progress as is possible in whatever time can be had. This is the way many of us became used to working and the shift in focus when becoming a case manager can feel exciting but very different.
Working as a case manager in the independent sector offers a different opportunity, where what is provided can be shaped around each client and where the timeframe and approach can be tailored to the individual’s needs, aspirations, and abilities.