As a case manager our role is to advocate for our clients and represent their needs effectively. This in itself can be complex, especially when working with clients who are less able to share their thoughts, for example those in a disorder of consciousness with little or no ability to communicate.
In these cases, having an ability to know what the client would want to happen in any of the events life throws at them is crucial. Despite always holding the best interests of the client at heart, the case manager co-ordinates support and intervention, there are many conflicting roles which may get in the way of truly advocating for the client. On these occasions it is necessary to have someone in the MDT whose only role is to represent the client’s voice.
It is sometimes necessary to consider which role might be most suitable to represent the client’s voice. Whilst and IMCA is available to anyone who lacks capacity and is unbefriended (that is, they have no relative or friend that it would be appropriate to consult with about those decisions), an advocate may be more appropriate and a closer look at the roles helps in making that decision. It is unusual that a client would require the services of both an advocate and an IMCA simultaneously.
What do IMCA’s and Advocates do?
Role of the IMCA
The Mental Capacity Act 2005 introduced the role of the independent mental capacity advocate (IMCA). IMCAs are a legal safeguard for people who lack the capacity to make specific important decisions including making decisions about where they live and about serious medical treatment options.
In particular, and IMCA should be instructed where there is a serious exposure to risk, for example:
The IMCA role would be focused on the protective measures being considered and is likely to end when decisions have been made regarding these.
Role of the Advocate
Like and IMCA, Advocates provide a crucial role in assisting people to express their views and wishes, secure their rights, access information and to be involved in decisions that are being made about them and their situation. This is however a wider reaching role than safeguarding and protection, and can be relevant to many life decisions that a client faces.
When a client is unable to share their wishes, an advocate’s role is to collect and represent the person’s prior expressed values and beliefs. Using this information they will then ascertaining proposed courses of action in order to share these with the MDT.
Our clients benefit from the statutory provision that the IMCA brings but sometimes the role is not far reaching enough in the context the litigation process. There are often complex and ethical decisions to be made with the view of returning the client back to as close as they can be if it were not for the index accident, which are out-with the role of the IMCA. On these occasions a specialist Advocate experienced in working with this client group can be incredibly beneficial for all involved in the MDT.
As part of the sharing of learning ethos within our training strategy at Social Return, we held an open course on Motivational Interviewing. We were able to welcome Verna Morris, (Brain Injury Specialist OT and Counsellor) and a wide audience of people who work in neurology services in the northern area including nurses, advocates, client liaison officers, therapists and third sector partners. We also enjoyed excellent opportunities for networking and developing relationships in addition to learning, and this has a beneficial effect for our clients as they travel along their rehabilitation pathway.
What is Motivational Interviewing?
Motivational Interviewing seeks to facilitate and engage the client’s intrinsic motivation in order to elicit change behaviour. The use of goals is key to the process, helping clients to explore and resolve ambivalence. The examination and resolution of ambivalence is a central purpose, and the counsellor is intentionally directive in pursuing this goal.
Acceptance of the fact that clients approach therapy at different levels of readiness to change their behaviour in key. In order for a therapist to be successful at motivational interviewing, four basic interaction skills should first be established. These skills include:
These skills are used strategically, to increase the client's awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behaviour in question.
The course gave an excellent opportunity to understand why we act the way we do when working with clients, and to explore the spirit of MI in order to underpin learning of the 4 processes of MI.
The concept of Motivational Interviewing is such a vast one and the tools provided in the teaching sessions were excellent – and put to use the very next day by our case managers wishing to enhance engagement. Practising use of the tools was valuable in the safe environment created within the group, enabling discussion and support.
Delegates were able to take away skills, resources and a well put together booklet to use as a tool to develop and reflect on their practise. The feedback received was resoundingly positive and this is a direct reflection on the organisation, presentation and content of the course.
Some feedback received on the day included:
“Kept me interested and challenged throughout”
“Informative, knowledgeable and personal approach”
The 2 day course was such an enjoyable and successful training opportunity that we aim to hold further training to build on the knowledge already gained later on in the year.