8.3a Issues and strategies for managers

i) Introduction

Principles

Good management in this field is based on the following principles:

  • A person with a TBI has the right to choose what is most important to them. Assume they are competent to do this, unless a guardian has been appointed as a substitute decision-maker. (Contact the NSW Guardianship Tribunal and NSW Office of the Public Guardian or equivalent state offices for further information if needed.)
  • Be consistent in approach
  • Set goals according to the client’s issues
  • Facilitate the self-determination of people with TBI to the greatest extent possible, given their impairments
  • Form partnerships with staff and other agencies to achieve client outcomes
  • Take a holistic approach to the client, their family and their community.
Getting It All Together Kit

A valuable management resource is the Getting It All Together Kit, designed to enable people with brain injury to get the most out of their life, and to help them regain control and accept responsibility. The Kit provides a framework for clients that include a process of Identifying the Issues, Tackling the Issues and Making it Work. The Kit is designed for clients to use on their own or with support. The client decides the issues they wish to work on and the Kit gives them and their carer/worker a structure to enable this to happen. It assists the client to regain control of his or her life and accept responsibility for what he or she gets out of life. The accompanying booklet Promoting Independence provides family and carers/workers with information to assist them in their work with people with a brain injury and to enable the person to achieve their goals.

The managers role is often a juggling of responsibilities as a service provider to meet the needs of clients and the needs of staff. At times there is an imbalance in the situation. They key to good management is to keep these needs balanced so that it works effectively for both staff and client. At all times the client must remain the focus of what we do.

This section wil involve analysing the following case study, and then using it to determine the strategies that form the basis of good management practice.

ii) Case study: Jenny

Jenny was involved in a motor vehicle accident when she was 29 years old. She sustained a severe brain injury, which has left her extremely cognitively impaired. She has a without prejudice motor vehicle claim that has not been finalised. Jenny receives the disability support pension and has received a financial advancement earlier in her rehabilitation.

Now 32, Jenny has been living by herself with support from her elderly parents each day for the past 2 years. Due to ill health her parents are unable to continue the level of support she requires. Jenny’s behaviour has become less acceptable and causing her parents extreme stress. They have requested assistance. Jenny had been discharged from the Brain Injury Unit and has no continuing rehabilitation goals. She is unable to work or drive a car.

Jenny has extremely short memory, is unable to do most things without prompting and guidance, has issues with personal hygiene, refuses to do housework, can be extremely abusive toward anyone who wants to help her and provide support. She became increasingly bored and frustrated with her circumstances, and became involved with gambling and alcohol abuse. At these times she can be very disinhibited and sexually inappropriate, occasionally inviting unknown men into her home. Staff suspects that Jenny uses illegal recreational drugs.

Jenny was assessed as being unable to manage her money. The Office of the Protective Commissioner has this responsibility and she is constantly asking them for more money. She then gets upset when they refuse to give her the additional money.

Your agency received this referral a month ago and has been providing 6 hours support per day. The goal is to provide staff to assist in establishing routines and strategies to assist Jenny to manage her independence more effectively without support from her parents. Staff will also need to help assist Jenny reduce behaviour outbursts and not place herself in vulnerable situations. All staff has reported difficulty working with Jenny and you are finding it difficult to recruit, there is no formal plan in place and your time is spent on re-recruiting staff to work with Jenny.

iii) Managing staff working with Jenny                      

Imagine that you are managing the agency that is providing support to Jenny.

Your first step will be to identify all the issues for staff working with Jenny. These issues are listed in the first column of the table below.

Secondly, you must identify strategiesfor dealing with these issues. These are listed in the second column of the table.

These strategies will be based on good management practices, which are listed in the third column of the table.

Issues

Strategies

Good management practices

Jenny

Refuses to do housework

Abusive and threatening behaviour to staff and others

Problems with personal hygiene

Gambling problems, money issues

Disinhibited behaviour

Drug and alcohol issues

Other issues

Limited family involvement

No case manager involved

No clear direction for staff

Goal orientated plan – achievable

Timetable of routine activities

Behaviour management plan – consistent approach, least restrictive

Expenditure planning – budgets, identified activity costs

Policies and procedures for staff at risk

Monitoring and review

Consistent approach to client management

Good communication, written and verbal,

Clinical and critical pathways

Develop and foste a team approach

Hold regular meetings to review and monitor and evaluate plan

Provide inservice and training to staff

Provide crisis management, intervention and debriefing

Rotate staff to prevent burnout and stress

OH&S issues for staff – safe workplace

Accessible and user friendly policies and procedures

Recognising staff stress - disillusionment process and stress

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