Current Issues in Brain Injury Case Management
A case manager led team can help those who have sustained TBI achieve and maintain a reasonable quality of life in the community. Such a team can also provide time-limited community based rehabilitation aimed at achieving specific gains. Frontal and planning deficits mean this client group may need the guidance and prompting of a case manager while limited insight may inhibit their acceptance of such help.
Case managers need a system which provides support, guidance, and peer review in order to cope with the potentially difficult issues arising, including review of goal-setting, and balancing the case manager’s goals with those of client and family.
Brain injury case management, at least in the UK, remains a largely unregulated ‘profession’ although the burden of relevant legal requirements to be negotiated is on the increase. However, decisions about recruitment, training, support systems, continuing professional development, and registration of UK case managers have still to be finalized.
Other issues often not capable of a simple solution include liaison with court-appointed “guardians”, and whether to employ support staff directly or use agencies. Recent research on very late outcome raises concerns about injury-driven decline many years after TBI and also presents challenges for future service planning.