Practice issue:

Client aged 17 years.  Client had acquired brain injury age 5 years.  Parent very used to making decisions for client.  Parent attends all meetings with the client.  Parent contacts education setting several times a week regarding small issues occurring.  Parent liaises with all professionals involved.

Due to client’s age, he is due to transition to adult services.  Case Manager aware that parent will find this difficult.  Of concern is that client takes controlled medication in relation to his mood.  The child and adolescent mental health service (CAMHS) are involved in managing his medication and mood.  However, they will discharge client upon reaching age 18 years.  Client has been deemed to have capacity to make decisions in association with parent/ professionals regarding his health / therapy needs.

Case manager considers client requires an advocate from statutory services to ensure that his views are heard and to ensure that he is managed in terms of his mood and medication.  Case manager would like to ensure that the client steers his own decision making as he reaches age 18 years and is not just led by parent indefinitely.  She would like parent to be able to trust that if the client meets a professional alone it is okay.  Parent will not accept case manager making a referral to social care for a social worker.  CAMHS plan is for the GP to monitor her medication.

Case manager would like to ensure medication is properly monitored because she does not want an over reliance on this.


Case Management Actions:

  • Communication and negotiation skills with NHS professionals to develop a rapport and clinically reason why medication should be monitored by psychiatry.
  • Liaison with social worker regarding benefits of advocacy for client within transition meeting setting rather than direct referral from case manager.
  • Reference to the law to help parent to understand changes for a young person and further changes upon reaching age 18 years. Discussion with young person regarding how things start to change with regard to parents making all decisions at age 18.
  • Advocating on client’s behalf to avoid reliance on medication and ensure specialist timely reviews and monitoring
  • Collaborative working with deputy and joined approach to discussion with client and family around this issue.
  • Liaison with rehabilitation team and education to ensure a cohesive approach to the issue.
  • Liaison with young person to gain his views and priorities.
  • A social worker is now involved.
  • Adult psychiatry will now monitor the medication rather than GP.
  • Client and parent have more understanding of adult services.


Skills used from Competency 5:

  • 5a) Client focused
  • 5b) Advocacy
  • 5c) Guiding decision making
  • 5d) Risk management


Positive indicators demonstrated:

Client was listened to by the Case Manager.

Case manager developed excellent liaison with NHS services and attended transition review meeting.  This led to adult psychiatry monitoring client’s needs rather than GP.  Case manager was able to ensure that services worked in line with Carers Act 2014.

Use of law to help parent to understand transition to adulthood and changes that this brings with rehabilitation.

Social worker now involved and aware of the situation.


Bear traps avoided:


  • Parent and client feeling process was not transparent.
  • Not recognising client’s right to make decisions at age 18 and guide the process.
  • Parent feeling out of control with client’s care.
  • Client worrying about reaching age 18 years and changes to her support.
  • Parent and client disengaging.
  • Medication not being closely monitored and risk of client being on medication long term.





Coordination and management

Duty of Care


  • BABICM Code of Ethics and Conduct in Case Management Practice
  • Child and Family Act 2014
  • Children’s Act 1989
  • Carers Act 2014
  • Mental Capacity Act 2005 and Deprivation of Liberty Safeguards





Practice reflections:

Developing a rapport with existing NHS services and providing clinical reasoning to them regarding the client’s needs was fundamental to the client having been referred to adult psychiatry.

On-going informative approach to parent and client regarding how the law changes at age 18 allowed them to understand the need to allow the client to become more involved in their decision-making and rehabilitation.