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The skill of brain injury support work

Providing support for people with brain injury can be both challenging and rewarding. Anita Pascoe, Clinical Lead and Case Manager at Westcountry Case Management, looks at how people’s lives can be improved by support workers who are trained and have the tools to monitor progress and help people achieve their goals.

Many people who have sustained a brain injury have support workers to assist them. They provide so much more than ‘care’, and might be thought of as assistants, enablers, professional companions or ‘support workers’. They have multiple roles and can have an important part to play in supporting someone to manage their ongoing difficulties on a day-to-day basis. But what is it they achieve? Why are they so important? And what is the role of a brain injury case manager?

Think about how you define yourself. Are you a parent? A spouse? Part of a team? What is your job? How do you spend your free time? All of these roles make us the person we are, and a life changing brain injury has the potential to change all of that – sometimes irreversibly. The brain injury not only affects skills and abilities, it might alter the very essence of who a person is, and it might be very difficult to find a place in the world again; or to regain what is defined as our ‘occupational balance’. This is where a skilled support worker can make a real difference. They can understand, assist, accompany, support, coax and encourage, depending on exactly what a person needs.

Supporting support workers

Support workers need to be empowered to work in sometimes challenging situations by providing a nurturing and supportive environment which enables them to be innovative in their work and see the benefits of positive risk taking. The case manager will co-ordinate regular supervision and team meetings to ensure that the support workers and the client have opportunities to discuss problems and ideas to facilitate change so the whole team can work in a consistent way.

Training is essential to underpin skilled support, and must include training in a person’s specific needs, as well as training which is mandatory within CQC (Care Quality Commission) regulations. For a complex brain injury, this may include understanding personality change, the impact of cognitive changes on behaviour and how to support decision making within the context of a person’s abilities and needs. Some support, such as limiting choices to facilitate decision making, can seem counterintuitive, and so needs to be well understood.

There will be times when support workers manage unplanned or unexpected events, or when risk taking has had a negative outcome.

It is important that they have somewhere to discuss and reflect after the event, and have the opportunity for involvement in shaping support plans going forward.

Measuring the impact of support

Measuring the impact of support can inform goal setting, help track rehabilitation and also justify the support being in place and funded. The use of bespoke, electronic support records, allows support programmes to be tailored according to assessed needs and client centred goals, and their efficacy trialled and reviewed in an objective fashion. Well trained support workers will have the skills to fill in records in an objective and concise way. These can then be used to provide feedback which can be a great motivator and can be presented in a way that is engaging and meaningful to both parties. Within the medico-legal arena or when applying for statutory service funding it can also show the benefits to the individual of having a well-managed package, or identify hidden needs and justify the level of support required.

The ‘art’ of support work

In addition to the theoretical basis and objective measure of support, there is the ‘art’ of engagement. Unfortunately, some people experience diminished insight following an ABI, and may therefore be reluctant to accept and engage with paid help. A skilled support worker will be personable, approachable, easy-going and yet able to maintain boundaries. They will understand a person’s needs and anticipate when to step in and when to draw back, while making their support appear effortless. They will find some common ground, establish a working relationship and be able to get along with a person for the duration of shifts, over extended periods of time. The best support workers will genuinely care about their work and initiate good practice and forethought. For example, they may know that the person they support struggles to process information on a menu when in a noisy environment, so might look at meal choices online beforehand, to enable their client to make a decision at a restaurant later in the day. Or they will spot the signs of when their client feels overwhelmed and unable to inhibit responses, and intervene to avoid or de-escalate a potentially tricky situation.


There is more to support work than meets the eye. Their work has the potential to make a significant positive impact on a person’s ability to fulfil their potential to engage in their own life following brain injury. Their range of knowledge and skills should be underpinned by careful selection, robust training, and ongoing supervision and review. There is a learned art to good support, and the right person must be identified for each support role. But when a person is paired with just the right support worker, together they can achieve great things!

You can download a Brain Injury Group guide about what to expect of a case manager and how they might help below.

The role of a Case Manager (470.1 KiB)

About Westcountry Case Management

Westcountry Case Management is a specialist case management service for adults and children with complex needs. Their expertise has been built up since 1991. They cover the South West of England up to Gloucestershire, Warwickshire and Wales. See more about Westcountry Case Management.

About Brain Injury Group

Brain Injury Group was set up in 2011 to provide people affected by brain injury with a focal point to find people with specialist knowledge of brain injuries to assist them with legal, financial and welfare advice.

In addition to our legal and welfare advice service, our popular website features an A-Z of services and goods specifically of interest to those affected by brain injury, their families and the professionals who support them.

Brain Injury Group is a provider of training to solicitors, case managers, health and social care professional on an array of brain injury topics.

How can we help?

Whether you are considering making a claim, need other specialist legal advice, are looking for information on continuing healthcare funding or welfare benefits, or access to a broad range of services and professional support through our online directory, the Brain Injury Group provides a gateway to the support you need.

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