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What we've learned in lockdown

As we begin to see lockdown restrictions easing around the UK, and the first steps towards a return to ‘business as usual’, the RWW team have been reflecting on some of the unexpected positives to have come from case managing in lockdown, and what we can learn from them going forward…

Being creative

At RWW, we pride ourselves on our ability to ‘think outside the box’ when the situation demands it. Our motto ‘whatever it takes’ refers to our commitment to creative problem-solving and this situation has called on us to use every ounce of that creative thinking!

With clients stuck at home, some of them isolated and many of them with much more time on their hands than usual, our team have been very conscious of how important it is to keep them positive, engaged and mobile. We have worked with families, support workers and therapy teams to come up with activities and resources we can introduce that meet their needs, abilities and interests.

Claire Morris client is a young lady with a passion for baking. She is an avid fan of Great British Bake Off and she and her support worker regularly try out the recipes from the show. With a family member on hand to help out with opening packets and putting things in the oven, they have managed to continue this in lockdown, with a weekly virtual bake-along.

Following the success of this, she has been encouraged to try making evening meals for her family, which she is now doing 3 times a week with minimal assistance, giving her a real sense of purpose and accomplishment.

Her sister also came up with the brilliant idea of adapting our client’s favourite game – Guess Who – using the faces of people she knows. She even made a duplicate board for her support worker, so she could play along remotely!

Julie Day’s client has been keeping in touch with his support team virtually. It’s very important that this young man is kept engaged, so Julie and the team have thought creatively and worked with him to come up with ideas that he can get excited about. He has particularly enjoyed hosting a comedy chat show for his support workers, as well as taking part in quizzes and connecting virtually with friends from the brain injury group he usually attends.

He has also been persuaded to use his time at home productively, and has started taking an interest in his house and garden for the first time, getting into landscaping.

With some careful planning, Julie has also managed to get a client who is unable to leave the unit he is in to take up woodworking!

Using technology to promote independence (sometimes reluctantly!)

We’re delighted with the success we’ve had convincing many of our previously technophobic clients to try out some tech options for keeping in touch with their families and friends, support workers, case managers and therapists, and making life in lockdown a bit easier and more entertaining.

Claire Morris was inspired by her client’s love of music to persuade him to try an Echo Dot. As he struggles to learn interfaces and has limited function in his hands, Claire felt the Echo Dot was a good match with his abilities and interests. He was initially reluctant, but when Claire explained that he would be able to hear his favourite 70s tunes just by asking for them he was sold!

We arranged for it to be set up for him and were delighted to see how well he took to it! As well as being able to hear ‘Three Little Birds’ whenever he likes, he asks Alexa all kinds of questions and get her to tell him jokes. As someone who is used to having everything done for him, this small addition to his life has added a great deal of independence.

Having shown him that change doesn’t have to be scary, Claire is hoping the next step will be to get him using an iPad…

Lynn Goodall’s client lives alone, with a 24-hour care package. His family, who live nearby, are very involved with his care and were extremely anxious when lockdown came that they were not able to oversee the care staff, particularly as a new agency had recently been introduced.

Lynn spent time working with them and the care team to develop ways that they could feel reassured that their loved one was being well cared for. One of the most effective methods was the use of Portal. The family found that they were able to contact him more easily and that he would engage with them more fully than he had ever been able to do using a mobile phone, which he had a tendency to throw across the room.

Lynn worked with them to understand the need to prearrange the calls with the care team so that the client was in the right chair or standing frame and able to engage, and they were delighted with the positive and interactive calls they were able to have, and how they could see that he was happy and engaged in activities.

One family member told Lynn “If you’d said to me that I would be able to not visit ‘Bruce’, I would have said he would be depressed and I would be upset, but having done this, I can see that the agency have made sure he is happy and well cared for.”

This realisation that she doesn’t need to be so involved with the care team and is able to pull back a bit has allowed her to think differently about the future. She is now looking forward to finding a new balance and enjoying wider family relationships that she previously didn’t feel she had enough time for.

Stripping back

Of course, the lockdown has presented numerous challenges for clients whose therapy and support packages have been severely impacted by social distancing guidelines and our case managers have worked hard, alongside therapy providers and support staff to find creative solutions to bridge these gaps.

In some cases, however, we have noticed clients responding positively to a stripped back, hands-off approach and a simplified weekly schedule.

Rachel Gannon’s client, a 30-something man with TBI, who RWW has recently started working with, had a high level of therapy input prior to lockdown, often traveling to multiple sessions a day. With the closure of the gyms and clinics, his therapy package changed drastically. Therapy sessions went virtual and most were cut back, reducing the time he spent travelling and allowing him to focus on speech and language therapy which continued regularly.

Rachel quickly noticed a positive change in her client. His behaviour and his mood improved, he was more focussed, more relaxed and much less fatigued. His speech also dramatically improved.

The parents of one of Lucy Wood’s clients told her that having reduced support, they have realised they don’t need as much as they thought and that their daughter doesn’t need to be out doing things all the time. This enforced break has given Lucy and her client’s parents a chance to review their previous routine and make decisions about how it could be rebuilt differently as we come out of lockdown.

Our case managers have also taken satisfaction in going back to basics, stepping in to provide for their clients’ most basic needs, and ensuring that shielding clients were able to get essentials like food and prescriptions. One case manager went out to do her client’s food shopping, while another called in a favour from a contact volunteering near her client to deliver a loaf of bread to him.

Being more responsive – real-time problem solving

As anyone who has ever been part of an MDT planning email chain will attest, it can be very difficult to find the perfect time and place to get a large team of busy professionals together to discuss a client’s progress.

With the increasing use of Zoom and Microsoft Teams in lockdown and everyone being more available than usual however, all of our team have commented on how much easier it has been in lockdown to arrange meetings to respond to issues in real time. They have also noticed that this new way of working has changed the nature of these meetings in many cases.

Tony Finnigan has set up weekly team meetings including the therapists and the support team, to help manage the risks presented by one client who has a complicated family situation and has been extremely unwilling to follow lockdown guidance. This has ensured that they are all working together to deliver a multi-disciplinary risk management plan.

Tony observed that working together in this way has strengthened the team immeasurably and allowed them to manage the situation in the best possible way. He also paid tribute to the vital role the support workers played in the team, leading discussions and raising issues as needed. Most importantly, Tony has noticed a really positive change in the client resulting from the way the team worked together to support him through difficult times. He is now back to being the charming, polite young man he was before.

Steve Pimm has found it useful to be able to arrange team meetings at short notice to deal with specific issues as they arise, particularly with behaviourally high-risk clients with large teams. Steve has been able to bring together more targeted groups of relevant people for short, issue-specific meetings as frequently as needed to respond to rapidly evolving situations.

Steve says “These virtual troubleshooting meetings add another string to our bow in managing complex rehabilitation and support packages. Going forward, larger MDT meetings held in person will still have an important role to play, but it’s helpful not to need to rely on them so much.”

Julie Day said being able to hold more spontaneous and reactive meetings has enabled more dynamic goal planning. She has been able to gather the team to review goals and set new ones as the lockdown situation has changed, helping her clients to continue moving forwards as best they can.

Kate Lewisclient was disengaged with therapy prior to lockdown and struggling to make progress, but has responded really well to a new virtual therapy timetable of shorter, more frequent sessions.

Kate also realised that virtual therapy made it possible for her to join a session, which she wouldn’t usually have been able to do, giving her more insight into the work the therapist was doing.

Building relationships…

Curiously, our case managers have discovered that in many cases their relationships with clients, referrers and other professionals have actually been strengthened during this time of necessary physical distancing.

The increased use of video conferencing means that, in many cases, contact is more often ‘face-to-face’ than it would be under normal circumstances and the shared experience of this global pandemic has created common ground for building bonds.

…With referrers and other professionals

Case managers, therapists and solicitors all dialling into zoom calls from the kitchen table or the spare bedroom with increasingly wild lockdown hairstyles and the obligatory pair of tracksuit bottoms out of view has been a very humanising experience.

Previously established professional boundaries and perceptions have been broken down to an extent, creating room for increased understanding and openness in working relationships.

Kate Lewis has found going through the shared experience of balancing work with home-schooling has really helped her get to know some of her instructing solicitors better. She also feels that it has been good for referrers to see her in this working environment, reassuring them that she is a safe pair of hands for their clients, by showing an ability to cope with difficult situations and to multitask.

Jude Goody discovered early on how much difference having a great network of professionals makes, when OT Carolyn Lovell, of Quality Independence stepped up to help out a client. Having recently had a hydrotherapy pool installed in the garden, a cabin/gazebo was purchased for it on Carolyn’s advice, but by the time it was delivered we had gone into lockdown and there were no companies operating who could provide the 3-person team needed for construction.

Carolyn promptly took control of the situation, enlisting the help of her husband and daughter to visit the client’s garden on a Sunday and safely install the cabin, without compromising social distancing guidelines.

…With clients

Julie Day and her client both agree that using Skype has really improved their relationship. Without the travel element of a home visit, Julie has been able to hold more frequent meetings with him on Skype. Her client appreciated feeling that she was more available and the regular face to face contact has helped to develop more trust between them.

Julie feels that Skype has struck a good balance between the full engagement of face to face meetings and the immediacy of a phone call. She is able to pick up visual clues from him that she might miss on the phone, but without the formality and structure of an in-person meeting, which he does not generally respond well to. As he has shared developments with his garden or problems with his bike, Julie has been able to get to know him better and this has enabled them to have some very honest and frank discussions that would have been more difficult in the past.

Julie observed that by doing video calls from home, you are inviting a client into your personal space in a way that may break down some barriers and help them to see you as more human and approachable.

Pam Clarke agrees that the pandemic has broken down barriers and created more common ground, saying, “For the first time I’ve found myself in the same situation as someone I case manage.”

One of Joyce Tavengwa’s clients is so happy with video calls that she has asked Joyce to use this in place of phone calls from now on. Joyce says their conversations are more relaxed and they really don’t feel the distance. Her client likes to be able to show Joyce things she isn’t able to describe and says it really feels as if she is in the house. Prior to lockdown, they would meet once a month, for a longer meeting to cover a range of matters. Using video calls, however, they are able to have much shorter, more frequent conversations.

With this change in their pattern of communication, Joyce has found that they talk about all sorts of things, rather than just rehab, which opens the door to her client sharing things she’s worried about and asking questions. Her client says it gives her peace of mind knowing Joyce is there to provide reassurance and expertise when she needs it.

Joyce has also discovered that the shared situation has increased some of her clients’ empathy, often asking how she is coping with lockdown herself. Two of her clients now regularly call her if they haven’t heard from her for a few days – “Just checking on you!”

For one teenage client, Kate Lewis has found lockdown school closures have provided an opportunity for her to get to know her client better, rather than communicating almost exclusively with his parents. As he is at home, his parents have been encouraging him to speak to Kate when she calls and to understand that she is a resource he can depend on. This has been an important turning point in his perception of case management and the role a case manager might play in his future.

 

Looking ahead…

As we look towards the future, we are in no doubt that the experience of the last few months has given us some new tools and ideas that will help to evolve and strengthen our case management practice.

Across the team, there is broad agreement that video conferencing has added a useful tool in our communication with clients, therapy teams, referrers and support staff.

Many clients have responded well to this form of communication which can balance the engagement of face to face meetings with the spontaneity and informality of a phone call.

In team meetings and client contact alike, the ability to hold shorter, more frequent meetings than before has proved effective – improving communication, strengthening working relationships and enabling issues to be dealt with quickly and effectively as they arise.

While the team strongly believe that virtual contact cannot completely replace the insight gained from meeting a client in their own home, or gathering a team together for a formal meeting, it has proved a more than adequate substitute during lockdown and, we are certain, has a role to play in the post-Covid world.