MEMORANDUM BY JENNY GARBER (H34)
With a background in social work, I have 19
years experience of working with brain injured individuals and
their families at all stages of recovery. I have been employed
as a local authority social worker in Sheffield and as an NHS
case manager in Southern Derbyshire and currently in a community
brain injury service in Sheffield. I currently also have a private
practice as a head injury case manager.
I hold the position of Chair in the Brain Injury
Social Work Group (an informal national group providing support
and education for specialist and non specialist workers). In 2000
I was elected onto the executive committee of UKABIF.
I have a particular interest in the development
of services to meet family need after brain injury. The National
Traumatic Brain Injury Study (1992-97) funded the introduction
of a specialist head injury social work team in Sheffield, for
which I was able to design the family focussed service model.
This submission is based on the evidence from
my own case practice in Sheffield and Derby, and reported information
from a wide geographical area via members of the Brain Injury
Social Work Group.
I have focussed my information and recommendations
on the key areas of Family Services and Local Authority provision.
1. Family Impact
Well documented in research literature
Few service developments addressing family need
1.1 Extensive research literature indicates
that impact on family members following acquired brain injury
is profound and potentially damaging.
Ref: Neil Brooks The Head Injured Family Journal
of Clinical and Experimental Neuro Psychology 1991 Vol 13 No 1
"These data suggested that the impact of
a head injury was at least as great for family members as for
the patient, and often family members were far more distressed
than the injured person"
1.2 Specialist services targeted to brain
injury family need are under developed in the UK.
1.3 Services set up within the National
Traumatic Brain Injury Study (1992-1997) (eg the Head Injury Social
Work Team in Sheffield) are notable exceptionsremit and
service models differ.
1.4 Existing family focussed services have
yet to be fully evaluated.
1.5 Impact on children in brain injury families
is particularly damaging but this is rarely addressed, even by
family specialist services.
1.6 Geographical location determines the
likelihood of brain injury families receiving appropriate and
2. Local Authority Services
Given the identified need for lifetime support
after brain injury, demand will be placed on Local Authority services
following NHS discharge.
2.1 The number of brain injured individuals
in any Local Authority area is unlikely to be precisely quantified
due to poor incidence recordingaccurate service planning
is therefore difficult.
2.2 Brain injury may not be identified as
a distinct client group in the Community Care Plan and development
of specialist community services is rare.
2.3 Brain injury has historically been located
in physical disability servicesthis is not appropriatepredominant
psycho social difficulties require a different service delivery
2.4 Community social work and care management
teams may lack specialised skills for assessment of need, design
and monitoring of brain injury care packages.
2.5 Best value initiative directs local
authorities towards contracting with non-specialist care agencies
often lacking brain injury skills or knowledgeable management.
2.6 There is serious risk that rehabilitation
gains will be threatened by inadequate or inappropriate community
2.7 Many families report great difficulty
accessing appropriate services following NHS discharge.
2.8 Family care burden may be exacerbated
by lack of appropriate services.
3.1 Broader remit
Services should be planned for people who have
sustained traumatic and non-traumatic brain injury. The current
distinction is inequitable and clinically unhelpful.
3.2 Equity of Service Provision
To develop a national quality standard for Local
Authority assessment and service delivery to brain injured individuals
and their families.
3.3 Integrated Care Pathways
To be formulated jointly by each Health and
Social Services District, with particular attention to developing
protocols for the health and social service interface and joint
3.4 Addressing Family Need
To evaluate existing family specialist service
To develop provision of specialist family services
accessible to parents, spouses, children and siblings of brain
3.5 Specialist training
To initiative development of post qualification
training in brain injury for social work staff, establishing core
3.6 Specialist Support Workers
To develop quality standards for brain injury
support worker services in the public and private sector.
3.7 Recognition of Lifetime Need
To establish health and social service provision
accessible on a recurrent basis to meet changing family and individual
The key question to pose is "Would you
be happy to use the brain injury service in your area for yourself
or a relative?" With appropriate service development and
quality standards in place the answer can be affirmative.
19 February 2001