Paediatric Case Management After Catastrophic Injury: Building Rehabilitation Around the Child

By Rosy Edwards, Clinical Manager and Paediatric Case Manager at Harrison Associates

Catastrophic injury affects every person differently, but paediatric case management brings an additional dimension: the person and their family at the centre of the rehabilitation process is still developing. A child’s physical abilities, communication, cognition, education, relationships and independence are all changing over time. Rehabilitation therefore cannot simply address the needs identified at one point following injury. It has to evolve alongside the developing child.

At Harrison, our paediatric case management service is clinically led by Rosy Edwards, Clinical Manager and Paediatric Case Manager, who works alongside our case management team to support children, young people and their families following catastrophic and life-changing injury.

For Rosy, effective paediatric case management starts with understanding the child and their family rather than viewing rehabilitation simply through the diagnosis.

Paediatric case management is different!

Many of the principles of good case management apply equally to adults and children: identifying needs, coordinating rehabilitation, establishing clear goals and bringing the right professionals together. In paediatric cases, however, those needs sit within a constantly changing developmental picture.

A child may need support with:

• Physical rehabilitation.
• Play.
• Communication.
• Cognitive development.
• Behaviour and emotional regulation.
• Education and learning.
• Equipment and mobility.
• Personal care and independence.
• Social participation.
• Family relationships.
• Access to activities appropriate to their age.
• Transition into adolescence and adulthood.

The challenge is not simply to establish what support is required today. The case manager must also consider how the child’s needs may change as they grow.

Catastrophic injury can bring a large number of professionals into a child’s life. Depending on the circumstances, this might include physiotherapists, occupational therapists, speech and language therapists, neuropsychologists, medical consultants, education professionals, support workers and other specialists. All may have an important role.

Without coordination, however, rehabilitation can become a collection of individual interventions rather than one coherent plan. The paediatric case manager helps bring those different strands together around the child. This means understanding not only clinical needs but also what matters to the young person: attending school, seeing friends, participating in activities, gaining independence and being part of family life.

Rehabilitation should support life rather than gradually becoming the child’s and family’s life. Following catastrophic injury, parents and other family members can suddenly find themselves coordinating appointments, therapies, equipment, education and care while also dealing with the emotional consequences of what has happened. Families may also require significant amounts of support themselves, sometimes without recognising how extensive that the injury has impacted upon them. The aim is not to replace the family but to make sure that responsibility for coordinating complex rehabilitation does not fall entirely upon them. It also means recognising that what is clinically possible is not always practical for a family living with the realities of catastrophic injury every day.

For a child or young person, education is not separate from rehabilitation. Returning to school, maintaining relationships with peers and continuing to play and learn can be fundamental parts of rebuilding life following injury. The educational environment can also provide valuable information about how the child is functioning outside the home. Difficulties with fatigue, concentration, behaviour, mobility, communication or sensory processing may become particularly apparent at school. Effective paediatric case management therefore often involves close communication with education professionals alongside the clinical multidisciplinary team.

Rehabilitation has to change as the child grows, one of the defining features of paediatric case management is that yesterday’s solution may not remain appropriate tomorrow. Equipment is outgrown, educational demands change, social expectations change. A young person may begin seeking greater independence from their parents. Support arrangements that worked well in childhood may feel increasingly restrictive during adolescence. This means that rehabilitation planning cannot remain static.

Regular review allows the case manager and multidisciplinary team to consider whether the current arrangements remain appropriate and where the next stage of rehabilitation should be focused. Independence in paediatric rehabilitation does not necessarily mean doing everything without assistance. It means helping the child or young person develop as much autonomy, choice, control and participation as reasonably possible. For one young person this might involve developing independent mobility.

For another it may mean learning to communicate their own preferences, using assistive technology, participating in social activities or gradually taking greater responsibility for aspects of their own care. The appropriate goals will be different for every child and family. Good paediatric case management should therefore be ambitious without becoming unrealistic and supportive without creating unnecessary dependency.

Complex paediatric rehabilitation rarely depends upon one professional. The quality of the multidisciplinary team and the way that team works together can have a significant effect on progress. The role of the case manager includes identifying where specialist input may be required, coordinating communication between professionals and helping ensure that recommendations translate into practical action. It can also mean identifying when an approach is not working. Rehabilitation plans sometimes need to change. Goals may need to be reconsidered, a different professional approach may be required, or a previously unidentified issue may become more important. Clinical oversight is therefore an important part of maintaining direction.

Paediatric case management also requires a long-term perspective. The needs of an eight-year-old following catastrophic injury will not necessarily resemble their needs at 13, 18 or 21. Planning for these stages does not mean predicting every detail of the future. It means recognising that rehabilitation should be proactive to prepare the young person and their family for change rather than responding only when that change arrives. Consideration may eventually extend to:

• Further education.
• Employment or vocational activity.
• Independent living.
• Relationships.
• Transport.
• Personal assistance.
• Managing healthcare.
• Community participation.
• Transition from children’s to adult services.

As Harrison’s Clinical Manager and a practising Paediatric Case Manager, Rosy Edwards leads the clinical development of our paediatric case management proposition.  Her role combines direct understanding of case management practice with clinical oversight of the wider service, helping ensure that our approach remains focused on quality, rehabilitation and the individual needs of children and young people. For Harrison’s, paediatric case management is not simply a separate category of case. It requires specific understanding of development, family dynamics, education, rehabilitation and the transition towards adulthood.

The objective remains straightforward: to help create the conditions in which a child or young person can achieve as much independence, participation and quality of life as possible following catastrophic injury.

How Harrison Associates supports solicitors

Harrison Associates provides Expert Witness and Case Management services for solicitors handling serious injury, catastrophic injury, complex personal injury and clinical negligence claims.

Our Expert Witnesses provide independent opinion on function, rehabilitation, care, therapy, prognosis and future needs. Our Case Managers coordinate rehabilitation, support injured people and families, liaise with professionals and help ensure practical needs are identified and addressed.

Where a claim requires clear evidence, structured rehabilitation input or a better understanding of future provision, Harrison Associates can help solicitors identify the right expertise at the right stage.

To discuss expert witness evidence or case management support for a serious injury claim, contact us today.  

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