Chair: Jackie Dean
Members: Ben Needham-Holmes, Jo Clark-Wilson, Mark Holloway, Philippa Feltham-White, Alyson Norman and Andrew Patterson
The BABICM Research Group is able to offer a ‘signposting’ service, providing members with ideas as to how they may progress any research projects and can provide academic references of interest.
The group is open to approaches to talk about research projects and ideas of relevance to brain injury and brain injury case management.
The Research Group is currently in the process of developing guidelines for submissions of articles to the BABICM website which will be circulated to the membership in due course.
We encourage members to use the Members Log In section on our website to view the latest BABICM research, some of which focuses exclusively on Brain Injury Case Management as well as the care of brain injured clients.
December 2019
Delivered by: BABICM and Plymouth University
Author: Phillipa Feltham-White
In this article, Philippa Feltham-White, an experienced brain injury case manager, will provide her experience and thoughts on the importance of engaging in research.
The British Association of Brain Injury and Complex Case Managers (BABICM) Research Group is encouraging all case managers to make the leap back into research. Engaging in research and staying up to date in evidence-based practice is fundamental to BABICM’s competency framework, which is required for effective practice for all case managers. This ensures case managers continue to enhance service user’s outcomes and experiences.
My research journey started by identifying a gap in knowledge, and a lack of research in a specific topic and from this I was able to form a broad research question. I had always anticipated completing a PhD, post Master’s, and had a “if not now, then when?” moment. I approached the research school at my local University for their advice and after an interview, they accepted me onto their MPhil/PhD research programme. The next step was to shape the methodologies (which I found quite daunting), and so I ended up completing a Post Graduate Certificate in Research Studies at the University of Worcester. Post Graduate Certificates can be undertaken full time or part time, with modules spread out over one/two years, sometimes at weekends, ensuring professionals in full time employment can access them (albeit with multiple cups of coffee to hand !). I would highly recommend either this option or completing a Master in Research (MRes) degree. A MRes degree can be undertaken as either a one-year full time or two years part time taught post graduate degree, during which you will complete a large research project. I recommend contacting any University’s research school or look out for Post Graduate Research Conferences which may help shape your research ideas.
Some professionals can apply for funding through their professional body for research grants. In addition, health care professionals who work within the NHS can also access internships/bridging awards, and NIHR/HEE ICA Fellowships. Further details can be found at www.nihr.ac.uk.
The annual BABICM conference has a ‘research slot’ alongside an opportunity to present a poster of completed research or a single case study. Case studies provide a wealth of qualitative data and are a good way to approach research from a clinical standpoint. Linking in with professionals within your organisation or peer group and looking at research development in your area of practice can also be an excellent way of shaping initial ideas.
Research remains at the heart of what we do as professionals, with benefits to clients and improving better outcomes for all. BABICM research group are happy to talk further with anyone interested in beginning a research journey and can provide a research signposting service for interested members. Equally we would love to see any poster presentations at the next BABICM conference on the 10 and 11 June 2020 in Birmingham.
Delivered by: BABICM and Plymouth University
Author: Ms Sophie Moore, University of Plymouth
This article aims to summarise the research completed by BABICM and Plymouth University which explored the experiences of BICMs and the use of the MCA.
Acquired brain injury (ABI) is one of the leading causes of disability within the UK and can have a significant impact on the daily lives of survivors and their families (Khan et al., 2003). Difficulties include physical, emotional, cognitive and behavioural changes, and with many experiencing little or no physical impairment, ABI is often referred to as a “silent epidemic”.
Case management is dedicated to supporting and coordinating the rehabilitation and care of individuals with complex needs including ABI. The British Association of Brain Injury and Complex Case Management (BABICM) is made up of registered professionals with a health and social care background from a range of professions, including occupational therapy, nursing, and social work (Holloway and Fyson, 2016).
Brain injury case managers (BICMs) offer support to survivors with mental capacity issues and problems with informed decision-making. The cognitive impact of ABI, namely executive dysfunction, can impact many skills such as planning, inhibition and controlling emotions; all of which can hinder the ability to make informed decisions. Executive dysfunction is also linked with increased risky behaviour; substance and alcohol misuse, criminal involvement and suicidality, which raises further concerns around capacity.
The Mental Capacity Act (MCA) is a legal framework designed to guide the assessment of an individual’s capacity to make decisions. The House of Lords Select Committee (HoLSC, 2014) highlighted that the MCA does not meet the needs of those with specific conditions, including ABI.
The current study explored BICM’s views and experiences of working with brain-injured clients with capacity issues. A total of 93 BICMs took part in a survey, with 12 taking part in further interviews. All respondents had experience of working with ABI and capacity issues. A total of 62% reported having clients make repeated unwise decisions but be deemed to have capacity, and 92% reported disagreements with other professionals regarding the outcome of capacity assessments.
Disagreements with other professionals were mirrored in the interviews, with one participant stating they “happen on a day-to-day basis”. Five main causes of disagreements were reported; a lack of brain injury knowledge by other professionals, a lack of collaboration with individuals who know the client well, the framing of the questions, professionals having their own agenda, and the “cloak of competence” that can mask difficulties that manifest outside of the assessment environment; while clients often appeared to have capacity within an interview context, many were unable to adapt their behaviour accordingly in real-life situation due to executive dysfunction.
Three other main themes were identified; implementation of the MCA and capacity assessments, ABI as a hidden disability, and the vulnerability of ABI survivors. Participants reported risky situations their clients had found themselves in despite being assumed to have capacity because their cognitive impairments had been disregarded. One of the principles of the MCA is not to assume a lack of capacity due to unwise decision-making. Concerns were raised around the Act’s description, or lack of “unwise decision-making”, with 92% of survey responses reporting the Act to be unclear. Changes within the guidance for the MCA, with a focus on description and clarity, should be considered to make it more applicable to brain injury.
The research also recommended the importance of health and social care professionals having an in-depth knowledge of the invisible consequences of ABI before commencing capacity assessments; a recommendation supported by the updated guidelines for the MCA (NICE, 2018). Where possible assessments should not be conducted in isolation, rather take place in collaboration with others who know the client well, and should involve real-world observations of functioning.
Khan, F. Baguley, I.J. and Cameron, D. (2003), Rehabilitation after traumatic brain
injury. MJA Practice Essentials, 178, 290-295.
Holloway, M and Fyson, R (2016), Acquired Brain Injury, Social Work and the
Challenges of Personalisation. British Journal of Social Work, 46(5),1301-1317.
House of Lords Select Committee on the Mental Capacity Act 2005. (2014), Mental
Capacity Act 2005: post-legislative scrutiny. House of Lords: London, UK.
National Institute for Clinical Excellence (NICE). (2018). Decision-making and mental
capacity. NICE guideline [NG108]. Available at:
https://www.nice.org.uk/guidance/ng108/chapter/Recommendations-forresearch#
1-training-and-support-for-practitioners. (Accessed 22 December
2018).
Following the House of Lords Select Committee request for information regarding the use of the Mental Capacity Act (MCA) with clients with ABI, the British Association of Brain Injury & Complex Case Managers (BABICM) undertook a very successful response, members’ evidence playing a significant part in the report that their Lordships produced. We are aware from our practice and our colleagues that issues relating to the assessment of mental capacity, to supported decision-making and supporting people in the community remain a key area of concern. Brain Injury Case Managers (BICMs) have significant experience that will be invaluable in this regard.
This research aimed to gain a greater understanding of the experiences and knowledge of BICMs of the issues presented by mental capacity and the application of the MCA. The intention of undertaking this research was to utilise the knowledge and experience of BICMs to inform policy makers, support improvements in the services provided to brain injured people and their relatives and to support BABICM members by the sharing of knowledge and experience.
‘Recommendations for action following the House of Lords Select Committee Post-Legislative Scrutiny Report into the Mental Capacity Act.’
The Acquired Brain Injury and Mental Capacity Act Interest Group was a group of experienced brain injury specialists formed an email-based interest group during the recent House of Lords select committee investigation into the workings of the Mental Capacity Act. BABICM members (including those who were Council members) significantly contributed to the report.
The group provided evidence in person and in writing to the committee and this evidence formed part of the findings of the eventual report and recommendations. The group is made up of a mixture of case managers, psychologists, psychiatrists, medics, lawyers and others, all with extensive brain injury experience.
On the advice of Lord Hardie QC, chair of the committee, this work was followed up with the Department of Health which is responsible for co-ordinating a response to his Lordships’ report.
The report “Making the Abstract Real” is culmination of this work and made six recommendations for action that will specifically address difficulties associated with using the Mental Capacity Act on behalf of people with an acquired brain injury.
We recommend reading it as an insight into the very specific problems posed by ABIs in the context of the MCA 2005.
