Shownotes
Case Management: A creative and flexible way to work for psychologists with Dr Shabnam Berry-Khan
Today I am talking to Dr Shabnam Berry Khan about her business, Psych Works. Shabnam is a Clinical Psychologist and member of the Do More Than Therapy membership so I have been wanting her to come on the podcast since I met her on a coaching call last year because she works in an area of psychology that I didn’t know much about and it sounds really exciting.
The highlights
- Shabnam tells us how she got into the niche area of psychology led case management 01:02
- Shabnam explains what case management is, and who it is there to help 04:42
- Shabnam talks about what elements the work involves, and how that’s related to costings 08:61
- We discuss how psychologists are well placed to carry out case management 11:00
- Shabnam tells us how her business evolved after starting this type of work in an employed role 14:53
- We talk about imposter syndrome and holding your own as a psychologist with other professions that seem more self assured 18:58
- Shabnam tells us how she’s looking for more case management associates, and also those interested in broad range private practice within the medico-legal field, and what you need and don’t need for that 24:51
- Shabnam tells us where people can find her if they want to connect 31:08
Links to find Shabnam
https://www.instagram.com/adminpsychworks.org.uk/
https://www.linkedin.com/in/dr-shabnam-berry-khan-135a6753/
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TRANSCRIPT
SPEAKERS
Shabnam Berry-Khan, Rosie Gilderthorp
Rosie Gilderthorp 00:01
Welcome to the Business of Psychology podcast, the show that helps you to reach more people, help more people and build the life you want to live by doing more than therapy.
Rosie Gilderthorp 00:16
Today I'm talking to Dr. Shabnam Berry-Khan about her business, Psych Works. Shabnam is a clinical psychologist and a member of Do More Than Therapy, who I've been wanting to come on the podcast since I met her on a coaching call last year, because she works in an area of psychology that I really didn't know much about, and it sounds really exciting. So welcome to the podcast Shabnam.
Shabnam Berry-Khan 00:38
Yeah, thanks, Rosie, that was lovely. Yeah, thanks for being here. Actually, it's, it's a really nice opportunity to talk a little bit about sort of an area of the application of psychology that I think people may have some misconceptions about. And, or may just not know an awful lot about. So I really appreciate the opportunity. So thank you.
Rosie Gilderthorp 01:02
Yeah, I'm really pleased that you're here. Because, as I mentioned, as a member of Do More Than Therapy, I had the chance to kind of see some of your work, and you're on the blogging challenge, and I could see some of the stuff that you're writing about. But really, I don't think I'd ever heard of case management before. Even though I've done, I've probably done a little bit and been managed by a case manager when I look back at it, because I've done a bit of treatment work for medico-legal, the medico-legal system. But yeah, I really didn't understand anything about how that system works, it's been fascinating to get to know you a bit. And I think you've got a really great example of a niche, because I believe that you're the only psychology led case management service in the UK. Is that right?
Shabnam Berry-Khan 01:46
I think we are and not by design, I have to say, as many great things, you know, may may may be, you know, maybe may may have come down that pathway, but very much so, it's very unusual to find psychologists in the case management world, it's not like I'm the only one, there are a number of us, a small handful actually, but you find that people are either case managers, or they are psychologists, and what we've tried to do is kind of combine the two. So the, the thing about the case management is that I fell into it anyway. So accidentally, having felt very oppressed, you know, in a sort of NHS role and thinking that oh, gosh, is this what clinical psychology is all about? So that took me about a year, year and a half to work out. This was very different to what I thought it would be like. And I saw an advert in a BPF magazine, one of the BPF publications at the time saying, you know, would you like to be a case manager and I thought, you know what, I'm just going do it. And I was working in a neurodevelopmental service at the time, so it felt like it wasn't a massive leap into what is sort of brain injury, a lot of personal injury clients are brain injured. So we are talking about some, some very sort of neuro based interventions and thinking about people in a very sort of systemic way. And I, I just thought, I'm going to do it, I found out I was really... my friend, my colleague and I were the only team psychologists really doing it. And psychology was so misunderstood. I think. It's probably the best way to describe it in the case management world. Because I guess, because psychologists don't tend to do case management, because they, I think traditionally it's come very much so from a background of practical functional, physical, rehabilitation. So a lot of case managers are OTs, physiotherapists, you do get a number that sort of social work, public social work, background, speech and language therapists, but not really anything that is like what we do in terms of our training. So when we joined, there were quite a few questions around, you know, how can a psychologist be helpful and I'm thinking how can we not be helpful? You know, from the individual to the system, working with carers, thinking about the professional network, holding all those dynamics that we know from the research does very much so facilitate or indeed impede the process of rehabilitation.
Rosie Gilderthorp 04:42
Yeah, so I mean, I think I can see so clearly how our skill set would be really valuable for that system. And but let's go back a couple of paces. And could you just describe, you know, what case management is and the people that it's there to help.
Shabnam Berry-Khan 04:59
Sure, that's a good question. And I, sometimes I get, you know, often I think I know what the answer is. And then I think, oh gosh, it's actually more nuanced than that, or it's more complex than that. So on the in a very brief description, a case manager is someone who supports the client through their personal injury journey, their personal injury journey is one that has altered their life so significantly that pretty much every aspect of their life needs some kind of input. So a case manager supports that package of care and therapy very broadly speaking, in order to achieve those rehabilitation goals. The twist on that is that you are working very much so within that medico-legal framework. So you are very much so in touch with solicitors, if it's an unsettled case, which means that the solicitors are still building the quantum, the financial claim element of the case, what that, you end up working very closely with them. In the event that the case is settled, and there perhaps is a deputy for someone who's holding that claim money that has been awarded, it's a horrible word, but awarded to the client, you then end up liaising with them very much so about what is required and why. So there's a clinical element in terms of justification, in terms of being able to demonstrate the progress, the progress that the client would have with that support. And there's an element of sort of the people management, if you like, of it, the care teams are in place, and they need to know what they've got to do. And there's multidisciplinary teams that need to be chaired, and the input that they provide, and the minutes that you create as a result of those meetings and interactions need to be fed back in a way to the legal folk so they understand what's going on, either to support the claim being built up, or to know that the money is being spent sensibly. Ultimately.
Rosie Gilderthorp 07:12
So that's the element, isn't it, which seems a bit different, because I think, you know, when you describe the role, having worked in learning disability, it's kind of reminding me of the case coordination, care coordination role.
Shabnam Berry-Khan 07:25
Key-worker, I think as some people used to be called
Rosie Gilderthorp 07:27
Yeah, it was different in several different teams I was in but but basically a person who oversees the package of care and checks that it's, it's meeting all of the identified needs. And I remember when we were a bit resistant about taking on that role, and I was particularly resistant was about costing things up. Because that felt like something I wasn't equipped to do. And of course, sitting in an NHS job, you're really not equipped, I had no idea, especially, you know, I was band seven I was like, right, I literally don't have a clue how much it's gonna cost to do this or that or the other. And it felt like something a social worker was better equipped to do than me. But is that, is that an element of the work that you've sort of had to develop over time?
Shabnam Berry-Khan 08:16
There is an element of costing for sure. But it's not perhaps as you might imagine it to be in terms of, you know, kind of getting it right and getting it to the penny. So the pre... there isn't a lot of pressure to to be able to, I guess, come up with that costing for that package of care and therapy. But there, because you're often advised by the expert witnesses. So that's an important distinction to make as well, that we you know, that case managers are... the work we do is shaped by those people who have the expertise and the specialisms to say, okay, I've met the client, albeit for two, three hours, something like this, I think for the lifetime of this client, they need a, b and c across their lifetime, and at the stage that they are now you would go to that part of their report and say, right, okay, they're recommending a, b and c. So the costings are part of their report, what you have to do as a case manager is very much so find the right fit for the client and try and work within that very basic parameter that the expert has suggested. But of course, they're not on the ground. So they don't necessarily know that what they are recommending is appropriate or it may not be as easy to implement for various reasons, you know, COVID is a very good example. Everything has been thrown, costings are all over the place. Your job as a case manager is, is that very basic you know, at our job, you have to just communicate it. You have to say, look, we're working with a speech and language therapist, for example, and this has happened, it's been really tricky, you know, I appreciate that the costings are going to be different as a result or the or the costings are not necessarily different, but they're going to be lagged in a way so, you know, they're not going to start for three months, because of the circumstances that the family are in. So as long as you can communicate what's going on on the ground, to those who are very much so pushing the paper around about the clients, you are, you know, you're doing your job. And he might come back to you, those lawyer types, may come back to you and say, ah, could you get some costings, you know, and, and a better time scale? Fine, go ahead and do that, because you've been instructed to do that. And while it's so, while there's an element of proactivity, there is also some direction from the legal teams. So you know what you're doing, you're not left alone, really, with it. But it, but it is, you've got to have a little bit of savvy about it, I suppose, but you pick that up as you're going along.
Rosie Gilderthorp 11:00
It just sounds, it sounds really fulfilling, and actually, you know, thinking about it, if I was in that horrific situation where somebody I cared about had been badly injured, knowing that there was somebody like you with your background, sort of putting together that package of care and overseeing it, would be hugely reassuring. Because you know, from the clinical side, where I've seen it go a little bit wrong it's because the human side has been missed sometimes in the package. So I'm thinking of a client that I provided some psychological treatment for, had had a horrendous injury. And she was very young, she was only about 18. And the family were living in poverty. And my therapy room was only accessible by two buses, and she couldn't afford the bus. And it's obviously pre COVID so none of us had figured out how to do this particular type of work online, I doubt she would have had the tech anyway, to have been able to access it, but that, that made the treatment in accessible for her. And I went back to the solicitor who had instructed me and said, look I, she can't afford to get here, can you release any more money? And I just didn't hear back from them. Yeah, that's the kind of thing which I'm like, that would not have happened if Shabnam had been there.
Shabnam Berry-Khan 12:25
No, it wouldn't have, frankly. But actually, even anyone in a sort of coordinating role would have heard you because that's the beauty as a treating therapist, you go to someone who isn't exactly the purse string holder, who is almost an objective, other sort of overarching viewpoints person who can say actually, that is valid, that is necessary, and I would support that request, you know, from Dr. Rosie, because it is absolutely vital, and we need to do something about it. They're more likely to hear what's needed, you know, to do what's required. Because I think solicitors are they are, they do want to do what they're meant to do, which is help the client get back to the life level that they would have had, had it not been for the injury, and some of so passionate about it, which is amazing. But I think that human element that you highlighted is exactly what I think we as psychologists can very much say bring to the table. I'm not saying that OTs and speech and language therapists and physiotherapists and the likes, don't have that human touch, but for us, it's so second nature, it's so inbuilt in any clinical work we do, as soon as someone has a need, an emotional need, we switch into place and we just get it. And we're able to see beyond that emotional need to perhaps the impact it's having on parents, or partner, or siblings, often the other victims of this whole process, sort of unheard victims, I just think it's... you've got to be able to hold all of that in mind. And you know, on again, on a very basic level, we know that family functioning is affected by anything, and certainly something as big as a personal injury will absolutely be a big thing that can impact on family functioning, you can, you're not going to get the goals that you want, it's going to have an impact on you as a treating clinician, it's going to have an impact on you as a case manager and certainly the legal folk are not going to be able to get the best claim they can get that client. So your role as a case manager with a psychological background with psychological training is absolutely crucial to me, in my opinion, in terms in terms of getting the absolute best and the broadest of need that this client had, that any client has really.
Rosie Gilderthorp 14:53
So you mentioned that you started out doing this work in an employed role. How did that evolve? into the business that you have now?
Shabnam Berry-Khan 15:02
Yeah, I was actually an associate for a case management company, quite a big one, from the research I did at the time. And I learned an awful lot with them, I have to say, and but it gets to a, I think it gets to a point where you think, gosh, bigger organisations in case management, as I understand it, they are often led, not necessarily by the clients experience and the clients needs, much more by sort of admin structures. So, in the same way we've got Ofsted for schools, we have CQC, which is the Care Quality Commission for case management now. It's a relatively new thing, but some of the bigger organisations have already had CQC registration for a number of years, and I joined an organisation that very much so had that. It was, there was lots of paper pushing, there was lots of needing to understand the client on paper, which is massively minimising, it just doesn't capture all of the nuances and the, the softness of the work that you would do, in, you know, where the clients who have such significant and widespread trauma in its entire family system. And, for me, I remember feeling quite, I just felt like that's not really the practitioner I want to be. And I, as it happens, I was running the the psychology side of the business, so Psych Works Associates was born, while I was an associate still, at this case management organisation, because, you know, as I was sort of talking more about psychology, I was getting kind of more referral, which is brilliant, and kind of felt like I was really doing a good thing for case management, getting psychology known and, you know, value out there and in this medico-legal world, as a treatment, as opposed to, as we said before expert witness work. And it just, it really just occurred to me that if I want to be the kind of clinician I want to be, marrying up the psychology, thinking about...
