Client C was 7 years old when Caroline became his Case Manager. All his family members were involved in a RTC in August 2018 all suffering various injuries. However, Client C who was seated behind the driver received the most severe injuries including a severe brain injury, multiple facial fractures and the loss of an eye. Fatigue and pain are also major components of his injuries and impact on his everyday life.
Client C is mobile, although he has some residual weakness, has severe cognitive problems and epilepsy. He is impulsive in his behaviours, is not able to sleep without medication and needs to be supervised with all his personal care. He is also not able to self-occupy and doesn’t like to be left alone in a room.
Client C returned to school a year after the accident on a part time basis. He has an EHCP and the teachers and LSA have received training on Fatigue management and his brain injury. He was attending school part time to allow for a rest day and also, he was still having lots of hospital appointments which took place on his ‘rest’ day along with 1:1 swimming lessons as he couldn’t swim with his peers.
When Caroline took over the case as Case Manager client C had private Occupational Therapy and Physiotherapy. The Local Authority had no therapists qualified to work with a child with complex Neurological injuries at the time. Client C had no psychological support as again no-one had been identified with the skills to work with a child with PTSD. He also had no Speech and Language Therapy.
Dad had returned to working in London, Mum had not been able to return to work due to her health issues and the need to co-ordinate all the medical appointments, etc that client C required. His sisters had returned to school.
The family lived in a semi-detached house with limited space for therapies / support or space for client C to rest when fatigued. It also did not have a downstairs toilet which client C found difficult due to his need to be supported to use the toilet.
Caroline identified the following: -
- The need to adapt the current Property or adapt a purchased property
- Safe play garden
- Support Worker recruitment
- Local Authority O.T and Physiotherapy if possible
- Orthoptist and low vision specialist
- Leisure activities that he could participate in with his peers
- Alternative therapies eg; Yoga, Rhythmic Movement Therapy
Covid has been challenging for the family. Client C was due to have major reconstructive surgery to his face which was cancelled 5 times. The family went into isolation to ensure that client C was well enough to have his surgery, his sister has been home schooled as well and Dad has been working from home. Mum’s health has been poor resulting in her having to be on bed rest most of the time increasing the demands on Dad.
Caroline has increased the support she gives to the client’s family virtually with video calls and on the telephone, especially as their responsibilities and routines have changed drastically. The emotional support given has been invaluable to ensure there has not been a detrimental effect that would affect the client’s rehabilitation journey.
Therapies have continued virtually including, Physio, OT, SALT and Music Therapy which have all been very successful. Client C has been home schooled using a visualiser and his Granny who is a retired SEN Teacher has been teaching him virtually. With this specialised, bespoke teaching client C is now at the same level as his peers in English and Maths. He has been attending the Local Authority science lessons with a small group of children which he has enjoyed. Caroline had researched and put in place all of the above therapies and services – ensuring that they were the right fit for the client.
Client C’s support worker, who was recruited just before the pandemic hit, has continued to support him virtually playing games and working on turn taking, not always having to be in charge, allowing others to win and choose the games and on his social skills. She has introduced other children to the games which client C has really enjoyed. Monitoring forms were put in place by Caroline to monitor client C’s responses, mood, fatigue, etc to ensure that the support was meeting his needs. The Music Therapist also worked with the support worker on monitoring emotional regulation.
A large part of Caroline’s role has been supporting client C’s parents, but also attending site meetings for a house that was identified as suitable for adaptation in November 2019 with the works starting in January 2020. As the parents have been unable to attend the site meetings, Caroline has attended on their behalf, video calling them during the meetings so that their voice can be heard and also writing up notes in layman’s language with the actions that they needed to complete and a timeframe.
Client C’s medical care has also been transferred to another hospital during Covid to enable his clinical care to be co-ordinated better and to reduce the amount of hospitals involved. This again has been very challenging with Caroline needing to co-ordinate this for the family, attending appointments if required to do so.
Client C successfully had his operation in May 2021 and is making a very good recovery. It is hoped that he may be recovered well enough to attend school at the end of term.
It is hoped the family will move into their new home by September 2021 with a fully adapted safe garden, researched and co-ordinated by Caroline.
Client C also identified that he would like an assistance dog. Due to his facial injuries he has had some ‘horrible’ comments from other children when he has been able to go to the local park to play. He has lost a lot of confidence due to this and lockdown. Caroline has started the assistance dog process which is very exciting for him. The dog will be trained to detect seizures which have increased recently due to him growing and the beginning of puberty.