In this case study, we share the inspiring story of Elaine, who endured a life-altering accident in her early 20s and faced numerous physical, emotional, and cognitive challenges.
Elaine is now 35 years old.
Elaine’s Accident and Injuries
In 2006, Elaine experienced a life-altering hit-and-run accident that resulted in severe injuries. While on her way home from a night out with friends, she was struck by a car and sustained multiple severe injuries, predominantly affecting the left side of her body. These injuries included a traumatic brain injury (though this was missed at the time), a C2 fracture, left-sided haemopneumothorax, multiple rib fractures, a left scapula fracture, diaphragm laceration, an open fracture of the left humerus, a left scaphoid fracture, and a left sacral fracture. Following the accident, Elaine had a week-long stay in intensive care and faced a long road to recovery.
After being discharged from the hospital, Elaine moved in with her parents and embarked on her challenging path to recovery. She faced the possibility of losing her left arm and spent approximately 1 ½ years in a wheelchair. As she began her gradual return to work, difficulties started to emerge. Elaine’s husband, Carl, reported concerning observations, including poor hygiene practices, wearing pyjamas under her work clothes, and eventually missing multiple workdays, leading to her dismissal.
Twelve years after her accident and following a successful personal injury litigation claim, Elaine was struggling with complex difficulties, including emotional, cognitive, and behavioural complications. This was compounded by a negative cycle of drug and alcohol abuse. Recognising the need for support, she had reached out to her financial deputy team for help, who contacted, Chris Dindar, Case Manager for assistance.
Elaine’s Emotional Journey
Case management undertook an initial needs assessment and highlighted that Elaine was struggling with motivation, domestic chores, historic back pain (exacerbated by sitting on a broken sofa). Additionally, she struggled with, mood swings, and difficulties regulating her emotions as well as anxiety and depression. In an attempt to cope with these intense feelings, she turned to cocaine and alcohol. Elaine was also experiencing multiple cognitive problems, in particular, difficulties with impulsivity, poor judgement, and poor problem solving.
Her emotional state, combined with her cognitive problems led to instability within her relationships, particularly with her husband and her father, impacting her ability to maintain sobriety. Although she wasn’t actively contemplating suicide, she was impulsive and highly distressed, and this combined with a lack of a reliable support network and her abuse of drugs and alcohol made her a risk to herself, necessitating close monitoring. This proved challenging, as due to Elaine’s memory problems, she was not an accurate first-hand source, as there were often discrepancies between what she recalled and what her family reported. Elaine’s family and partner remained dedicated to supporting her recovery journey.
Overcoming Her Drug Addiction
Elaine needed specialist support for her drug addiction and a personal commitment to go through with the programme. Case management sourced a local and free substance misuse rehab service that promised confidential support, advice, and information, a personalised recovery plan, as well as group programmes, one-on-one support, and an array of lunch clubs and evening activities.
To create an environment where Elaine to felt comfortable being honest about her substance use and allowing herself to be helped, case management invested several weeks of groundwork with her, building trust and developing rapport. At each meeting, case management would leave detailed notes of the meeting and agreed action plans with Elaine for her to review at her leisure. Delivering on agreed actions consistently and by being able to review what had been agreed previously demonstrated to Elaine that the case management plan was something she could trust.
A comprehensive approach was needed to address her complex difficulties, including the collaborative efforts of therapists, support workers, and community organisations. A privately instructed MDT was put together by case management, comprising a neuropsychologist, an OT, and an agency neurorehabilitation support worker. Case management also introduced Elaine to a local head injury support group.
Helping Elaine Regain Motivation
Elaine’s OT recommended and sourced ergonomically appropriate furniture for her to use, which helped alleviate her back pain. This was a simple intervention with far-reaching benefits, as pain was one of her triggers for abusing cocaine and alcohol. The OT also assisted with finding suitable voluntary opportunities for Elaine, eventually leading to her volunteering at a local pet shop three times a week. This was a huge milestone for her, as she had not had any kind of work, paid or otherwise, since having to stop working 10 years previously (18 months after her injury).
The psychologist, using a compassion-focused therapeutic approach, helped Elaine develop an understanding of her emotions, enabling her to gain insight into the thoughts and feelings she experienced and the behaviours that were linked to each emotion. This massively improved Elaine’s emotional regulation and facilitated huge improvements in her relationships with her husband and wider family.
The support worker was instructed for 3 days per week and helped Elaine regain motivation for tackling domestic chores and assisted her to become independent with planning (shopping and excursions) and budgeting. She also began helping Elaine regain the confidence she needed to get out and about so that Elaine could begin to look forward to and enjoy long dog walks and trips into the city to visit museums and galleries.
Elaine’s Recovery Through Case Management
Over the course of weeks and months, Elaine was able to notice how her engagement with the MDT was having positive benefits, and she came to trust and embrace the case management recommendations and those of the professionals around her. Though there were a few bumps in the road, with difficult domestic circumstances and an occasional lapse back into drug taking and drinking, Elaine was on an upward trajectory.
She continued to work hard and engaged enthusiastically with her MDT and with a local brain injury support group, where she was able to meet and socialise with others in a similar position. She drew a great deal of comfort from this, as she responded well to talking with people who had experienced brain injuries similar to hers.
Slowly, Elaine grew in confidence, celebrated her successes, and talked things through when she felt it wasn’t going so well. She gradually reduced and eventually stopped using drugs completely, which allowed her to fully focus on her engagement with the MDT, who worked collaboratively and transparently with her, which meant that she maximised her potential to become more independent and enjoy a hugely improved quality of life. So much so that after 2 years of working closely with her case manager and the MDT, she was able to take the decision to ‘fly solo’ and is still going strong several years later, remaining sober, having rebuilt previously damaged relationships, thriving in her new found confidence and abilities, enjoying looking after a small vegetable patch, a beloved dog, and continuing to volunteer in a local pet store several times a week.
Elaine’s journey demonstrates the power of resilience, personalised support, trust, rapport, and a collaborative multidisciplinary team (MDT) approach in facilitating recovery and improving quality of life.