The child’s voice: how it shapes the rehabilitation of children’s personal injury and impact on mental health


Feb 7, 2024


HCML Rehabilitation Case Manager Gina Barker explains how the child’s rehabilitation journey involves actively listening to them and communicating in a way that they can understand.

Why is it important to listen to what the child wants during their rehab journey? How does this impact their mental health and overall rehab?

I don’t see children as being different to adults. They are little people. Just as with any rehabilitation, the rehabilitation client is at the centre, and I see the child in the same way, right in the middle of it all. I therefore believe that it is essential to give children a voice, to actively listen and to engage with them throughout the process. Sometimes in the beginning, before a direct relationship is developed with the child, you rely on the family and those who know the child to best guide you. Sometimes they don’t know what they want as they don’t know what will help them.

It is important to me that the child understands, as appropriate, the journey, as this directly affects outcomes and their experience of the rehabilitation process. Validation, reassurance, education, and normalisation are part of the regular conversation with my paediatric clients.

I actively look to get the ‘buy in’ of the child, making the rehabilitation plan relevant and the goals meaningful. If children are kept in the dark, overlooked or on the outskirts of all the voices, their engagement deteriorates, their psychological wellbeing is impacted, and progress is limited. I am a firm believer in the power of the therapeutic relationship and endeavour to build clinical teams with the same values.

The research shows that children learn if they feel cared about, have an emotional connection to the subject matter and are exposed to repetition. I take this research into my work as I see children having to learn to adjust following injuries. I look for the best outcomes and look to inspire my paediatric clients through collaboration which of course involves active listening.

How do case managers ensure the child’s voice is heard and acted on?

Alongside developing working relationships with the family and clinicians involved in caring for the child, I foster a relationship directly with my paediatric clients. This has involved face to face visits, WhatsApp or text messages, virtual meetings, and phone calls. I endeavour to remember important things, building trust by noticing and following up on past conversations. I look to connect with the child’s interests, using humour and play as appropriate. I ask questions. I spend time reflecting on the information that is apparent, and seek clarity where needed. Working with all those around the child is important when looking to act on the child’s behalf. In my mind, the case manager is liaising, overseeing, discussing, highlighting, sharing information, connecting people, facilitating and supporting – all with the child in the centre

How does the case management process advocate for the child?

There are usually a large number of people involved with children. Firstly, the immediate family, sometimes the extended family, followed by the school, the NHS, statutory services in the community and private clinicians. Coordinating and collaborating as a team across the different spheres is an art. Helping the child and the family feel supported rather than overwhelmed is an aim. Advocating for a child requires initiative, leadership, multi-faceted thinking, sensitivity, and focus. My point of beginning is assessment, obtaining a clear picture of everything; this involves listening to the child. If you know what is needed, you can plan and start to act. Reflecting and reviewing are essential to ensure changes are being made along the way to achieve the best outcomes for the child. It’s a forward projecting circular process rather than a linear process.

How do case managers balance the wants/needs of the child with their parent’s wishes and the case manager’s own expert recommendations? How do they protect the child’s mental health?

This is a journey and requires sensitive and confident navigation. Time, perseverance, and patience with lots of communication help keep the balance. I have learnt each family is different and thus the journey and navigation course with each client is different and requires flexibility and a gracious attitude.

If barriers are present, I collaborate with the treating team to problem solve. In considering mental health, keeping things simple with a nurturing environment, adequate sleep and healthy nutrition as well as getting into nature and facilitating self-efficacy, are my go-tos. Sometimes, it is one step at a time over a period of time, rather than everything all at once.

Considering the context is important when protecting the child’s mental health. Children are often anxious about the unknown, pain or because of the trauma. Low mood can come in swings and roundabouts particularly if the injuries are catastrophic. Processing grief and adjusting to functional change is not an immediate fix and requires being comfortable with uncomfortable feelings. Being able to hold, contain and support during the process of healing, takes skill and resilience.

What happens if a child’s wants are not in line with rehab goals – how do case managers work with the child and family to ensure this does not have a detrimental effect on the child’s mental health? 

Sometimes the child’s goals are not in line with the rehab goals but can run alongside, and sometimes they are directly opposed. If they can run alongside, it can help if the case manager supports these goals as it has a knock-on effect in terms of engagement, rapport, and a sense of wellbeing which all positively affect progress with rehab goals.

If they directly oppose the rehab goals, understanding the underlying driving factors is helpful to know how to tackle the situation. A team approach is best to work with the child to shift the goals. They may require psychological intervention or education or an ‘outside the box’ approach to engage the child. I think it is important to note that feelings are fluid, particularly with children, who developmentally have not reached full maturity, and thus it’s not a fixed presentation, but fluid and dynamic which means looking for the gaps or junctions to affect positive change.