Kelly’s Story

Prior to her accident, Kelly worked as a chef and described herself as a bubbly, fun loving person who had an active social life and a close relationship with her daughter. She described her daughter as being ‘her whole world’. In January 2006, she sustained a brain injury as a passenger in a road traffic accident. She said everything changed as a result. Kelly started work with Lynn Hodge, one of our case managers, in April 2008 when Kelly was 27 and lived in a rented flat with her 6 year old daughter.

Assessment:

Lynn met with Kelly and carried out an assessment before case management could start. At the initial assessment Kelly described the following problems:

Physical problems:

Kelly had frequent seizures and also suffered from frequent migraines. She reported problems with sleeping, and dizziness when tired.

Cognitive problems:

Kelly reported memory problems, difficulty with planning, organising, and problem solving. She had difficulties with concentration, and could be easily distracted. Kelly said she frequently became frustrated and angry with herself when she was unable to perform basic tasks. This compounded the problem.

Emotional problems:

Kelly said she had become unpredictable and volatile. She said she was more irritable and her mood could change from happy to angry in seconds. She reported feeling that she “doesn’t know where her anger will stop”. She was learning to walk away from situations. She was easily irritated by her daughter and said that she couldn’t tolerate her constant noise and questioning. She also felt unable to show her daughter any affection. Kelly recognised that the relationship with her daughter had completely changed but did not know how to go about improving this. Kelly also reported feeling anxious most of the time and that she had a tendency to think too much about things that have happened and to overanalyse them.

Goal Setting/Treatment Plan:

Initial case management focussed on:

  • Help at home. This would provide Kelly with the additional support she required and time to focus on her rehabilitation. This involved recruiting and training a support worker.
  • Seeking local support and joined up agency working. Lynn liaised closely with the Social Work department and all other agencies to ensure that Kelly was getting the right support. This included providing brain injury specific training to the local providers.
  • Rebuilding relationships: Lynn, together with a clinical psychologist and family liaison worker, provided support to Kelly and her daughter to rebuild their relationship.
  • Direct support for her daughter. Play opportunities were set-up for Kelly’s daughter to socialise with other children such as after school clubs/activities. She also attended Young Carers meetings.
  • Treatment for anxiety/anger management difficulties. Kelly was referred to a private clinical psychologist who provided treatment to help Kelly manage her feelings of anxiety and anger.
  • Memory retraining programme. Lynn set up a rehabilitation programme to teach compensatory memory strategies and helped Kelly tailor these to her needs.
  • Improving sleep/treatment for migraines. Lynn contacted Kelly’s GP to arrange to review of her sleep pattern and requested further investigation into her migraines.
  • Improving structure: Lynn began work with Kelly to exploring options for volunteer work and college.
  • Progress in rehabilitation
A support worker from Sue Ryder Care was recruited to assist Kelly around the house, take her daughter to and from school, help prepare an evening meal and assist with bedtime routine. Over time, this support was eventually withdrawn as Kelly became more confident and independent. Lynn worked with professionals from other agencies to help them understand the effects of Kelly’s brain injury and how this affected her ability to undertake what appeared to be simple day to day tasks. This enabled Kelly to receive the right support from local providers. Regular meetings were held with Kelly’s social worker and a family liaison worker was allocated to Kelly and her daughter. Kelly’s daughter was also supported to regularly attend the local young carers group and to become involved in activities with other children in the area, such as the local theatre group. As a result of the above support, Kelly began focusing on her own rehabilitation goals. She learned to use compensatory strategies to manage the difficulties she faced with memory on a daily basis. She also worked with a private clinical psychologist who provided treatment to help her manage her feelings of anxiety and anger. Kelly was supported to apply for a basic course in Mental Health at Angus College in Arbroath. Over the year, Lynn held regular meetings with the course tutor to review Kelly’s progress and provide guidance on study skills and how best to support her. At exam time she was given a quiet place to sit exams and was allowed additional time. After completing her course, Kelly was keen to start volunteering in a local nail salon. Lynn liaised with the shop owner and Kelly initially worked on the reception desk. Kelly really enjoyed the experience although she found it tiring. Her hours were reduced to ensure that she didn’t become fatigued. She decided to train as a nail technician and completed several nail technician courses during which time she built up a client base by doing people’s nails voluntarily in the salon.

Discharge and Outcomes for Kelly

Around this time Lynn considered that many of the problems identified at the start of case management were either resolved or had greatly reduced. Kelly was more independent and was managing to hold down a regular volunteer post. Her relationship with her daughter had also greatly improved. The discharge process was commenced and it was agreed that Kelly would contact her case manager whenever she needed to. She has continued to do so after formal discharge, although contact is now infrequent. Kelly continued to volunteer in the nail salon for over a year and then decided to leave and start her own business, initially working out of her kitchen. She continued to train and is now a master nail technician. This involves training other technicians and this year Kelly won an industry award. She opened her own salon last summer and this has been very successful.

What Kelly says:

Kelly reports that she is busy but is now able to recognise when things are becoming too much. She recognises when she is struggling and will take a step back or ask for help

and adjusts her hours accordingly. Her relationship with her daughter is back on track and Kelly reports that they have a normal mother/ daughter relationship. She said that although things are going well career wise, she still has bad days but copes with these better. Kelly believes that without case management input she wouldn’t be doing what she is now, and states that although she always had the potential to make positive changes in her life, it is unlikely that she would have made such progress without a kick-start from case management.

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