Practice issue:

Client is currently 19 years having sustained an acquired brain injury age 2 years.  Client lives at home with parents and sibling.  She attends local college 3 days per week where she has input from the college MDT. In addition she also has private input from a speech and language therapist (SALT), occupational therapist and physiotherapist at home.  A joint working approach is taken by the two therapy teams.  Parents contact the case manager regularly to raise issues they have regarding college input, particularly around speech and language therapy.  Parents also raise issues regarding goals from private SALT and assistive technology practitioner.

Parents want the client to use a more high-tech communication device both at home and in college and they feel there is a lack of clarity around the client’s communication goals. The client is becoming frustrated and lacking motivation with communication goals and her relationship with the private SALT is at risk of breaking down due to this.  Parents are very used to making decisions for the client; they are reluctant to communicate directly with the college team.

Case management actions:

  • Liaises with all professionals involved to ensure collaborative working.
  • Arranges MDT meeting with all professionals from private team and college team to review all of the client’s therapy goals.
  • Supports client and parents in the MDT meeting.
  • Ensures all goals are evaluated and reviewed and adjusted accordingly to ensure they are client focused and realistic.
  • Ensures parents have a clear understanding of all short and long term goals and link between therapy at college and at home to enable client to progress with goals.
  • Uses this opportunity to review clients long term goals on completion of college.
  • Regular MDT’s and reviews now established between private therapy team and college.


Skills used from Competency 4:

  • 4a) Analysis
  • 4b) Facilitating change


Positive indicators demonstrated:

  • Demonstrated ability to review and analyse information from all parties to work towards a solution to issues and re-establish collaborative working.
  • Adjusted style when working with parents on engagement in goal setting and liaison with college team.
  • Showed confidence in challenging parents around understanding of some of the issues to ensure a client focus remained.
  • Change was facilitated and case manager time was reduced as issues resolved so case management was more cost effective.
  • The case manager promoted sharing of information within the MDT and with client and parents.
  • Meeting minutes provided accurate records of discussions and actions to be taken and were shared with all to promote collaborative working.


Bear traps avoided:


  • Following same case management approach for all.
  • Continuing with ineffective goals.
  • Parents and client disengaging.
  • Requirement for Best Interests meeting
  • Having to change SALT which would have led to a lack of continuity for the client


Competencies demonstrated:




Duty of Care


  • BABICM Code of Ethics and Conduct in Case Management Practice
  • BABICM Competencies for case managers and standards for case management practice


Practice reflections:

Adapting the case management approach when working with the client’s parents was essential to ensuring a collaborative approach and gaining their trust, engagement and their understanding of the team approach. Parents required an understanding of the joint working between school and home to ensure the best outcome for client.

The client’s voice was heard within the case management process and she became less frustrated and more motivated.

Resolving issues via collaboration can reduce case management time and is more cost effective in the longer term.  Monitoring and reviewing of goals with the client, parents and the wider team is invaluable to ensure goals are smart and client focused.  Clear and accurate recording of goals and meetings enables all to have a clear picture of plans, goals, progress and actions.