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