7.2 Tri-level approach and case manager's checklist

The tri-level approach

The tri-level approach is a way of looking at the person and their environment. It focuses on three systems:

  • personality systems include impairments, mood, adjustment, insight about brain injury, beliefs, values and hopes
  • interactional system includes family, rehabilitation, environment, relationships with spouses or partners, children, friends
  • socio-cultural system includes cultural background, community issues and supports for people with disabilities

The tri-level approach (DeHoyos, G. 1989) acknowledges the importance of the person and their environment for the assessment process.

It also recognises that a person's psycho-social functioning is influenced by both internal and external factors.

Focusing on the three systems this structure helps the case manager to organise the information they gather during the assessment process, develop goals and plan resources.

(DeHoyes, G. (1989). Person-in-environment: A tri-level practice model. Social Casework, 70, 131–18)

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7.2b Case manager's checklist

Within the context of the tri-level approach here is a checklist case managers can use when thinking about case management of people with TBI.

History of accident and recovery
  • date of accident
  • period of unconsciousness/post traumatic amnesia
  • type of accident
  • rehabilitation history
  • rehabilitation reports
  • rehabilitation goals
  • rehabilitation contact
Pre-morbid status
  • pattern of behaviour
  • education/employment
  • social background
  • medical issues
Status post-injury
  • activities and daily living skills
  • communication/language difficulties
  • cognitive impairments
  • personality/behaviour problems
  • emotional states (depression, anxiety, anger)
  • adjustment difficulties
  • awareness of disability
  • sexuality issues
  • relationship issues
  • medical issues (brain-injury related and nonbrain-injury related)
  • medication
  • substance use or abuse
  • psychiatric status
Client’s needs and goals
  • identify and establish
Family and significant other assessment
  • impact on the family
  • relationship issues
  • behavioural issues
  • adjustment to disability issues, including understanding of disability
  • recreation/leisure
  • work/education
  • accommodation
  • respite care
  • finances
  • legal
  • compensation
  • other agencies