Introducing Gina Barker, Occupational Therapist and HCML rehabilitation case manager

We welcome Gina Barker to HCML as our latest rehabilitation case manager. Gina specialises in mental health conditions and psychological injury, and has worked as an Occupational Therapist across the private sector, NHS and community settings. We find out more about Gina's skills and experience:

Were you a case manager prior to joining HCML?

I have worked as an Occupational Therapist (OT) across three continents over the last 20 years. My predominant areas of speciality have been in the mental health arena and with children, within the private sector and the NHS.

This is my first case management role. My husband, Steve, has worked for HCML as a Rehabilitation Case Manager for many years, and I started to see all the synergies with the work I was doing and how it applies to case management.

One of your specialisms is psychological injury. How does occupational therapy in general support people with psychological injuries?

Occupational therapy helps you ‘do’ life. Life is made up of all the activities and tasks you do every day, including looking after yourself, managing work or school, taking part in leisure activities, as well as simple things like using the bus or talking on the phone or even being social. We look at the whole person within their environment and look for ways to reach their goals.

OTs are strong believers that what you do can change who you are. We facilitate activity, offer support and help clients build the skills they need to achieve their own goals. We use meaningful and purposeful activities as a type of ‘medicine’. It requires good investigative skills to identify those magic activities that align with the skills of the clients, so they feel challenged but not overwhelmed. It makes achieving that goal all the more rewarding and supports good mental health. If you talk to anyone who has felt weighed down by life, if they succeed in doing something they set their mind to, they will usually feel more positive as a result. This also helps them develop resilience.

Incorporating activities into habits and routines helps clients maintain their wellbeing and transforms their identity. OTs have a lot to offer when it comes to supporting people with their psychological health.

Can you tell us a bit more about addressing trauma with psychological rehabilitation and how this might apply to case management?

Trauma is a fascinating subject. The Body Keeps Score by Bessel van der Kolk is a book I really enjoyed through exploring trauma in recent years. The research regarding the polyvagal theory (how our autonomic nervous system helps us read and respond to perceived danger) really resonates with me and adds to the ‘Fight or Flight’ response I first learned about at university back in the 90s!

I’ve looked into Judith Herman’s model of recovery from trauma too, where she raises the importance of reconnecting with others, and found it most helpful when working with clients to achieve their goals. When working with people who are struggling with psychological symptoms following trauma, it is good to have an understanding and knowledge base to draw on.

I have clinical experience of working across many spheres of mental health, so I’m able to identify which interventions are more appropriate when it comes to individual cases. What it’s really about is getting people engaged and supporting them to engage with society and life in a meaningful way that supports their wellbeing.

You’ve had a diverse international experience of coordinating care - how did practices and therapies differ between Hong Kong and the UK, and were there any that you’ve adopted to use over here?

In Hong Kong I was an independent practitioner, focusing on working with young children and their families on their development. I worked in local schools, running an enhancement programme for primary school children.

As a culture that is academically focused, children start learning maths and written skills from a very young age, which impacts on time spent playing and developing the underlying fine motor and perceptual skills required for maths and writing.

We worked with children, teachers and parents. We ran groups incorporating creativity and play in the development of fine motor, sensory, perceptual and social skills. We used a ‘bottom up’ approach which had fabulous outcomes as the children had so much fun. Handwriting, attention, emotional regulation, reading, mathematics and self-care skills were all improved.

We ran training sessions for the teachers, to upskill and equip them. We were available to problem solve and provide helpful strategies for children who were struggling. We ran workshops with the parents, to increase awareness and educate on child development, learning strategies and the benefits of play.

It is difficult to say how different Hong Kong is to England. All of life’s experience build you to who you are. The skills I have learnt, I carry with me now.

How does your experience of working in the private sector compare to the NHS, and how do you feel about working across both sectors within case management?

The private sector offers more flexibility because the nature of independent practice allows for more creative solutions that are tailormade to the needs of the client. There is generally less emphasis on timings, which enables practitioners to build a therapeutic relationship and develop creative interventions and strategies most suited to each individual, the benefits of which are reflected in the outcomes. As an independent practitioner, it takes time to network and develop relationships with other practitioners and professionals that need to work together to achieve the client’s recovery goals. In the NHS you have a multi-disciplinary team and work together closely in the best interests of the client. You’re working with an established team with all the relevant areas of expertise, and can call upon key professionals for input with the knowledge that the whole team is up to speed on the client’s circumstances and progress.

Having extensive experience and a strong understanding of both sectors, I’m able to draw on the practices and pathways I need to get the best outcomes for clients.

What methods of communication have you found useful when working with different clients?

Face to face is the best and having regular contact with people is important. Active listening is my gem – if people feel they’re being heard and believe you care, they will feel comfortable opening up and tell you a whole bunch more! I always say to my children that 80% of communication is non-verbal. You have to notice body language, tone, and other non-verbal cues. Being curious is a plus! But the foundation of communication is trust – if you say something you better do it and you better mean it.

What made you decide to transition from OT to case manager?

Prior to joining HCML I had a lead OT role – managing a team of ten and the Occupational Therapy service across 4 different sites. A lot of my time was spent ‘looking after’ my team of OTs- supporting, developing, training, inspiring, problem solving. As a Leadership team, we worked on service development and provision. My role contained very little patient contact.

The NHS is under a lot of pressure at the moment, especially after recent times and it made me think about what I value as an individual, and that’s supporting and caring for people. I wanted to be more ‘hands on’ and move to a role where I would be working with patients and clients directly again. It was Steve’s recommendation to join HCML – he knew that the company values and client focus aligned with my own values and goals.

Which three qualities do you think a case manager should have?

They should care, they should be proactive, and organised. And available! Problem solving is also a key attribute.

You’re experienced in working with clients with complex social circumstances. Can you tell us about some of the challenges you’ve had to overcome to ensure the best outcome for the client?

When working with individual clients, you have to account for the impact that those around them are having. Sometimes our work includes having to do a bit of work in their social setting to help them. For example, I was working with a young client, deploying psychological interventions to help manage his anxiety. The child’s mum was understandably extremely worried about her son, and during a family meeting with her husband, expressed her concern that she felt he wasn’t supporting her. You could see the strain this was putting on their relationship and the impact that was having on my client, and so it was necessary to mediate in the situation to navigate the issues between the parents in order to help and support the client.

All clients are not islands – they are part of a bigger picture, a wider social setting – their lives touch other people and vice versa. So sometimes you have to work with their wider network and give these people a chance to be heard and for their feelings to be validated in a safe space and help them gain perspective, in order to achieve the best outcome for their loved one.

The nature of different personalities sometime makes it tricky when it comes to relationships. One must try and keep perspective in professional relationships. It’s about building trust, communicating sincerely with respect but with gentle assertiveness. We are advocating for our clients’ needs, but we work to win families over to facilitate collaboration. It’s a dance of boundaries and generosity.

You’re used to working very closely with the families of patients – what kind of support do you find they need, and how do you balance their needs and expectations with clinical recommendations and process?

I myself am a parent of 4 so I can empathise with families of clients. Families are usually anxious and feel helpless when watching their loved ones struggle. They are concerned and usually benefit hugely with reassurance and guidance. I find education to be a helpful tool; knowledge is power, and I believe in sharing. Sometimes just listening, letting them know they are not alone, giving hope by sharing experience and expertise as well as acknowledging the impact the situation has on them, can be enough. If I feel the situation in the family requires professional intervention, signposting or facilitating engagement will be necessary. My clients always come first, but families are like scaffolding around the client, so by looking after them, you are inevitably looking out for the needs of your client.

What three words sum you up?

Passionate, colourful, compassionate.

As an OT specialising in mental health and psychological injury, you will have encountered many challenging and emotive situations. What do you do inside or outside of work to manage stress and remain resilient?

A lot of things! I’m one of those people – I bake, enjoy gardening, embroidery, crochet, sewing - anything creative really. I also like to run and paddleboard. I practice what I preach when it comes to activity. And I love to talk! And if any of those activities are not available, I’ll go for tea. But it has to be Twinings!

What keep you motivated and inspired?

Seeing the change in people I work with, the positive feedback from someone who has benefitted from my help. It’s great to see the outcomes and how all your support has helped people achieve their goals. And being creative.