Adult Case Study 1

Adult with acquired brain injury and complex family dynamics

Peter sustained a severe brain injury when he was involved in a road traffic accident as a pedestrian. A 30% reduction in compensation was agreed due to contributory negligence. He was referred to Ainscough Associates by his deputy following a breakdown of the family relationship with the previous case manager.

Peter has many different family members, all of whom have strong views on his care and rehabilitation, often opposing each other and in conflict. We were told that the previous case manager was unable to be sufficiently assertive and robust enough with the family in order to maintain clarity about Peter's best interests.

We carefully matched one of our case managers with Peter and his family, someone that not only had significant clinical experience but also had very senior NHS management experience and we felt that she would have the right skills to handle the complex family dynamics. Peter's deputy had been struggling with the family to the point where she was considering formal care proceedings, so it was a welcome relief to appoint a strong and dynamic case manager.

Our case manager developed a close working relationship with the deputy and began to set firm boundaries regarding roles and responsibilities for the family. She spent a lot of time reviewing existing services that Peter was receiving and sourcing additional professionals to ensure that he received a full programme of focused rehabilitation.

We very quickly realised that Peter's residential placement was far from ideal as it did not specialise in the rehabilitation of acquired brain injury. However, after giving careful consideration to the possibility of challenging the PCT on moving Peter to a more appropriate placement, we decided that this was going to cause him significant distress and, therefore, it was more important that we sourced additional privately funded therapy to support the placement.

Eventually things settled down and the family learnt to trust the case manager, spending less time trying to intervene regarding decisions about Peters care and rehabilitation. The deputy received fewer phone calls from the family and knew that she could rely on our case manager to keep Peter and all of his family on track for the planned process of rehabilitation and the long-term plan of moving into his own home in the community.