Page 19 - PIC Magazine Issue 21
P. 19

Starting a clinical case management company in an increasingly busy marketplace is no mean feat and particularly when supporting clients who have experienced catastrophic, life-changing injuries. When Keystone Case Management (KCM) launched in 2021, Niccola Irwin, Managing Director, had to consider many aspects. Aside from all the business components required, such as identifying a mission and values, gathering a team, and devising an infrastructure, a clinical framework was needed to guide frontline service delivery.
   Niccola Irwin, Managing Director at Keystone Management. Autumn & Winter 2023 PARTNERS IN COSTS 19
  In the context of case management,
a framework is essential to align
the approach of clinicians who may come from different professional backgrounds. For them, its application to all stages of the case management process – assessment, goal setting, intervention, evaluation of outcomes
– provides clarity. For managers, it can inform the choice of clinical tools which also reflect the values and ethos of the organisation and the current evidence. In short, an underpinning framework
of practice provides the foundation from which all processes and tools
can evolve, and the means by which
to clearly communicate the needs and progress of clients. Additionally, the style and format of these tools become recognised as ‘templated’ to a company and intrinsically express to clients and customers what the company is ‘about’, or what differentiates it in the market.
The formal written output of case management and expert witness work, for which services KCM was started, overtly reflects where any framework has been applied. Like it or not, such output will often provide the reader with a first impression of the company. As such, it is essential that it not only communicates a clear response to an instructor’s request but also, the ethos and quality by which the company wants to be known and build its reputation.
An example of output includes the Immediate Needs Assessment (INA) Report which is written when assessing a client for the first time, or the initial report commissioned from the expert witness. In case management, the
INA assists case managers to logically structure and assimilate the information they have gathered when assessing
and prioritising any new client’s needs. It needs to clearly express to the client (the injured person), the fee payer
and all other stakeholders, what the intention of the case management is, the expected benefits for the person, the level to which it is client-centred, what is the likely duration of service provision and what are the likely outcomes.
A new company status provided the KCM team with an opportunity to begin with a fresh approach by adopting
an evidence-based framework,
the World Health Organisation’s
(WHO) International Classification
of Functioning, Disability and Health (ICF) (WHO ICF, 2001), and using this
to inform the development of clinical practice templates. The ICF, as it is known, is a classification of health and health-related domains which help to describe changes in body function and structure (such as experienced following an accident or injury), and a person’s level of capacity and performance in daily life tasks or occupations.
As clinicians, the KCM team are well- used to the concept of an individual performing ‘occupations’ of daily
life in the context of their social or physical environment. They are skilled in understanding how any underlying difficulty a person might have in
their body systems (resulting from
an accident or injury), has on their ability to ‘perform’ tasks effectively, independently and/or safely. For clients who experience catastrophic events,
they often encounter wide-ranging dysfunction within their body, as
well as in the psychological and social aspects of their well-being.
As therapists we also know that two people experiencing a similar physical trauma can react and recover in potentially very different ways - one becoming fully independent and regaining their previously enjoyed life roles and another being permanently less able and requiring life-long assistance. As Lukersmith et al. (2016) point out, the ICF articulates the biopsychosocial model of health,
this interaction of the person’s impairments of body functions and structures, their activity limitations and restrictions for participation in life. Adopting this model aligned with KCM’s values and ethos. Additionally, by being clinically-led and focused and using tools grounded in clinical evidence, it has helped KCM create
a strong foundation from which to deliver a quality service where the client maintains centrality.
KCM is a London-based case management company offering expertise in the management of catastrophic injuries to clients in London and the surrounding Home Counties. For enquiries contact 020 3793 7424
    Lukersmith, S., Fernandez, A., Millington, M. and Salvador-Carulla, L. (2016) ‘The brain injury case management taxonomy (BICM-T); a classification of community-based case management interventions for a common language’, Disability and Health Journal, 9, pp. 272-280.
WHO ICF (2001) International Classification of Functioning, Disability, and Health: ICF. Geneva: World Health Organization. Available at: https://www.International Classification of Functioning, Disability and Health (ICF) (

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