Joanna’s reflection: how UPL case management can thrive even in a crisis

As a Rehabilitation Case Manager, I was used to working from home and keeping in regular contact with clients by telephone in between visits.  So, in many ways, when we went into the first few days of social distancing due to the Covid pandemic, it didn’t feel too different for me.  Aside from the fact that my usually quiet home office was suddenly a little overcrowded with the husband and three kids now also working from home and invading my workspace!  I noticed some irritating technical issues with poor mobile phone signals and Wi-Fi connectivity issues, as the country seemed to be suddenly overloading the networks.  When things progressed from the 23rd March to the point of all clinics closing and face to face treatment sessions being cancelled, that is when the challenges really began.

I think as a case management company we have a major advantage in that our Clinical Managing Director Jo Evans is such a positive, energetic and proactive leader who instils a company culture of creative thinking and collaborative MDT working to overcome challenges that come our way.  The clients’ needs are always the focus and driving force.  From the very beginning of this Covid crisis, our leadership team acted swiftly to support us in being able to continue working to ensure our clients received the rehabilitation and support they needed.

I had a situation where a private physiotherapy company suddenly furloughed its staff and so access to vital physiotherapy was suddenly cut off for a client.  We were able to act quickly to find a private physiotherapist who was willing to offer a remote service and by ordering a cheap tripod stand and Kindle Fire tablet (around £69 for an 8” device), we ensured that weekly sessions could continue via Zoom video call with the physiotherapist providing a graded home training plan for the client to follow at home between sessions.

One of my clients suddenly was unable to have her osteopathy, and massage treatment sessions and could no longer work with her personal trainer at the gym as all these facilities had closed.  Jo advised we approach highly skilled Rehabilitation Specialist Personal Trainer Jason Pinniger-Clair to continue the personal training aspect of her rehab remotely.  Jason was on board with the idea straight away and we quickly established the best remote platform for the client to use. We agreed on Zoom as this had the added function of allowing him to video record sessions so that he could share the recordings with the client following each session and she could practice things they had worked on between sessions.  He also used the videos to highlight to her some of the postural problems he was observing during the video calls.  It was a bit like having her very own one-to-one Joe Wicks but her sessions with Jason were completely interactive and tailored to her needs.  Jason advised on a kit comprising simple items of equipment and our dedicated Rehabilitation Coordinator Claire Richards had the challenge of trying to source these items and get them delivered quickly before they went out of stock.  We found that exercise equipment was becoming as sought after as toilet roll and pasta during lockdown!  As the personal trainer couldn’t make use of the gym equipment that provides a means of collecting important measurement data, he found various apps that the client was able to install on her smart watch and mobile phone to collect useful measurement data that could be shared in real time to an app on his phone.  This allowed him to track progress on a regular basis and adapt and grade the training plan accordingly.  This client made significant improvements over a relatively short period of time, evidenced by increased levels of function across several domains of the AIFE assessment.

The great thing about remote rehabilitation is that it removes the barrier of distance being a problem. I have gone on to refer several other clients located in the Midlands to work with a particular rehabilitation specialist based in London.  I trust that he can provide a service that will get significant results and his travel time and travel costs are no longer a barrier to engaging him to work with these clients who live halfway across the country.

I had completed an INA with a young client just before the Covid pandemic escalated in the UK.  When the INA recommendations were approved during lockdown, he presumed that all rehabilitation referrals and case management interventions would be put on hold as he had received cancellation letters for his NHS therapy provision.  However, he was really surprised that we were able to set up a comprehensive package right away.  This included weekly remote CBT sessions with a psychologist via Skype, having equipment delivered to his home, and setting up remote physical rehabilitation training sessions three times per week via Zoom video call.  He is soon to have a remote video call assessment with a British Association of Hand Therapists (BAHT) accredited clinical specialist.

I have also found Update Assessments and INAs to be possible during this time of social distancing.  Not only have these assessments been possible, but I feel perhaps even enhanced.  Rather than going out to see the client once for several hours and then compiling a report based on a one off meeting; I find that I get to know the client and their family and gain a greater insight into their situation, clinical needs, and goals over time.  Following the remote INA/update report guidance I have made an initial introductory call, encouraged the client and/or their family to share copies of any clinic notes by email, had several shorter assessment calls and video calls to gather the necessary information, and encouraged the client to send over photos or short video clips to illustrate particularly challenging ADLs.  I believe that this more drawn out process of remotely assessing the client’s needs has resulted in establishing rapport and gaining their trust far more quickly than when working under “normal” non-Covid circumstances.

I think what I’ve learnt from this awful situation, is that where there are problems, there are always possibilities, and we have the enviable position of being able to make a really positive difference to people’s lives during this difficult time.  We have incredible resources available to us and more importantly we have an awesome bunch of people all working towards the shared goal of providing all UPL clients with a person-centred, holistic rehabilitation package and the optimum chance of recovery and well-being.

Keep up the good work Team UPL!

Best wishes,

Joanna Fletcher-Smith