Cross-collaboration in case management

Occupational therapist and founder of COTA Case Management, Lauren McCluskey, speaks to NR Times about her journey from the NHS to specialising in amputations, emphasising the importance of collaboration between care teams.

Established in 2019, COTA (Complex Orthopaedic Trauma and Amputations) Case Management is based in Lancashire, and helps to support people’s immediate needs assessments, case management, and amputee mentor reviews, with 90 per cent of their clients being amputees.

The company has grown from a solo venture in 2019 to a team of 10 today, providing tailored rehab plans and addressing both practical and psychological needs.

Starting out as an occupational therapist in the NHS, McCluskey moved into a case management role ten years ago.

“The reason I set up was that I felt quite passionately about amputations and I thought there are a lot of specialists out there for brain injury and spinal cord injury, but nothing really specifically for amputation,” says McCluskey.

“We offer immediate needs assessments specifically for clients with complex orthopedic procedures and amputations, and that’s what no one else does as a specialism in terms of a company.”

“We also offer amputee mentor reviews. So, we do consultancy work on amputee cases. For example, where a client might have a brain injury and they’re being managed by brain injury case management, they might also have an amputation, but the case manager may not always know what to do.

“So, we will do some consultancy work as part of the reviews of what the client needs. We do a quick turnaround if a client is in hospital, for example, where we will turn it around in three days so they have got an overview of needs and costs to try and get early rehab in place.”

McCluskey’s specialist knowledge helps support clients with complications and needs, tailoring every rehab plan to an individual’s needs.

“You’ve got to have an understanding of the injury to be able to tailor a rehab plan,” says McCluskey.

“That’s why I felt so strongly about having case managers who’ve got a background in working with amputees, because then they can tailor that rehab plan to the need. For example, very specifically with an amputee who is a lower limb amputee – we want that client up and mobilising as soon as possible, and getting engaged in daily functional activities.

“There’s quite a lot of issues that you might have to navigate in terms of getting access to prosthetic rehab, getting a comfortable socket. It could just be functional things like donning and doffing the socket of your prosthesis, using that within everyday life.

“Often amputees have a lot of psychological needs – 50 per cent of people who have an amputation suffer some kind of psychological response, which is often loss. They have lost a body part so there can be quite a lot of emotional support needed.

“Then there are practical challenges as well such as getting to do your shopping, using public transport, returning to driving, returning to work. Just very practical everyday things, really, and that’s why the plans have to be tailored towards their needs – supporting their route back to independence.”

McCluskey emphasises that helping clients see that there is life after amputation is a vital part of her work, which can often be a catalyst for people changing.

“We always try to frame it in a very positive light,” explains McCluskey. “Instead of focusing on what they’ve lost, we focus on the future, and that you can have a good life as an amputee.

“You can still be really independent and do different things as well. I think it’s really important as case managers to frame this as an opportunity now – and there’s a skill to doing that.

“You’ve got to accept that people have to go through that grieving process for losing the leg or their arm but I think if you can support them through that you can help them see that there is a future – they may just do different things. We’ve got clients who are doing all sorts of sports that they may not have done before.”

A vital aspect of the work McCluskey highlights is cross collaboration between case management teams for clients that may have both an amputation and a brain injury, for example.

“The question is – how do you co-ordinate your support for amputations with the support for other injuries such as brain injury. We need cross collaboration to find out what support they’re getting around their brain injury, and incorporate that,” says McCluskey.

“The key to effective case management is collaboration. I’ve worked with some amazing case managers who are fantastically supporting their clients in terms of their brain injury and their rehab.

“In those scenarios where we’ve got involved, it has been because the case manager has picked up the phone and said they don’t know a massive amount about amputation, so they ask for help as they want the best for their client.

“I’ve been asked by barristers and solicitors to get involved in these sorts of scenarios as well, around introducing the right people to their MDT [multidisciplinary team], thinking about someone with a brain injury who maybe has significant cognitive deficits and issues with their balance or co-ordination.

“You work with the prosthetist, the case manager and the wider MDT to look at how you can maximise that person’s function while taking into consideration all their needs. So, it’s a lot of collaboration.”

McCluskey says she believes that occupational therapists (OT) make great case managers as they are trained to look holistically at someone’s needs, including psychological and social elements.

“That’s what makes a whole person,” says McCluskey. “You’ve got a very much holistic focus as an OT. There are very good case managers out there who are not OT’s, but I think for OTs, their background in working with the medical teams in the NHS means you’re used to collaborating with other professionals.

“You’re used to working within an MDT, so you have all of those skills of communicating, setting goals, making sure things are progressive, advocating for what the client needs, and that high level of clinical reasoning skills to interpret what different professionals are saying and pull it all together for the client to understand.”