Commonwealth Neurobehavioral Project Karen W. Brown, Executive Director

Brain Injury Services, Inc.July 24th, 2015

Joint Legislative Audit Review Commission (JLARC) 2007

Among the key findings included: the limited availability of services for individuals who have neurobehavioral consequences resulting from the brain injury.

Neurobehavioral Treatment for Virginians with Brain injury-”white paper”

• Ad hoc committee-May 2009/2010 (published)• Response to the DARS Commissioner• Three level systems of care-treatment options• Cost estimates at every level of demonstration

project

Collaborative project between Crossroads for Brain Injury Recovery and Brain Injury Services

Designed to increase access to critical supports for persons with brain injury who exhibit neurobehavioral symptoms

Utilizes an Inter-professional team Maximize independence and productivity in the

community

2012- Brain Injury Services received a three year grant through the Potomac Health Foundation for a Community Based Neurobehavioral Program

Therapist/Clinical Case Management Team

Interdisciplinary Team collaboration to replicate in-patient setting

Funds for Ancillary Services

Benefits from participants knowing they are part of a “program”

In 2009, Crossroads to Brain Injury Recovery received a CNI Trust Fund grant

Needs assessment based on providers’ perspectives on barriers to accessing services, particularly crisis intervention services for persons with brain injury

Concept of Inter-professional Triage Team grew out of this grant

VA Department for Aging & Rehabilitative Services (DARS)Commonwealth Neurotrauma Initiative Trust Fund

Brain Injury Services

Crossroads to Brain Injury Recovery, Inc.

James Madison University

Behavioral and cognitive issues are the most common debilitating consequences of brain injury

These issues may place persons at greater risk for:DisenfranchisementInstitutionalizationRepeat hospitalizationsIncarceration

Inter-professional triage team to assess risk and make treatment recommendations

Intensive case management and increased in-home supports

Providing / providing for evaluations, counseling, support and other interventions & facilitating access to specialists

Utilization of assistive devices / technology; tele-practice

Team building and education

Co-occurring condition(s) health, mental health and/or substance abuse condition

Behaviors are barriers to community integration ◦ Job loss, single or multiple◦ Loss of a primary relationship such as life partner or close

family member◦ Lack of friends or desired social life◦ Difficulty maintaining a volunteer job◦ Lack of or major difficulty with social skills◦ Difficulty maintaining or creating new friendships / relationships◦ Homeless or unstable / inappropriate housing situation

Improve access to services and resources

Increase quality of life for persons served

Address challenging behaviors that impede community integration / inclusion

Improve effectiveness and efficiency of service delivery

Pre- and post-intervention assessments and evaluations Identified assessment instruments Mayo-Portland Adaptability Inventory

Potential for risk assessment? In-house visual analog scale for perceived satisfaction with life

Participant goal achievement

Participant surveys

Reduced hospitalizations, incarcerations, and placements in other institutional settings

2 or more of the following in addition to basic case management:◦ Referred for additional evaluations, assessments◦ Specialist care including counseling, SA treatment,

psychiatry, neuropsychiatry◦ Therapies (SLP, OT, PT, etc.)◦ Community Support Services (life skills training)◦ Assistive technology◦ Behavioral supports◦ Job coaching◦ Life planning

Identified 52 individuals meeting our definition of having “neurobehavioral” needs.

75% will demonstrate a decrease in challenging behaviors and/or increase in positive behaviors

83.33% maintained or improved on total MPAI scores (increase in functioning)

75% will report satisfaction with the quality and type of services provided

75% of persons served rated their satisfaction with life more positively at post-test using the Visual-Analog Scale developed by the grant investigators

Those served will meet at least 75% of his/her goals as listed on ISP’s

95% of goals were achieved as listed on his/her services plans

75% will increase participation in productive activities 91.67% maintained or improved scores on the MPAI Q28

(employment) scale

At least 14 will maintain and/or improve his/her living situation

91.67% maintained or improved on the MPAI Q26 (residence) scale.

Twenty (20) clients participated in intensive Community Support Services in which they learned specific skills and strategies targeted to increasing independence (i.e. budgeting, organizing, cooking/meal preparation, cleaning).  

Ten (10) clients were provided with targeted behavioral supports (assessments and interventions), including therapeutic mentoring, positive behavior supports, brain injury life coaching, and behavior analytic services.

 

Nine (9) clients received neuropsychological evaluations.

Eleven (11) clients were referred for neuropsychiatric evaluations and consultation.

Home modifications were provided for six (6) clients in order to make their residences more accessible and safe. One was provided an auto-shut off device for her stove to ensure safety while cooking with memory loss.

Eight (8) clients were provided assistive devices (iPad, laptops, AAC devices) in order to improve communication and organization.

Fourteen (14) clients were referred for other general medical/specialist evaluations including obtaining a primary care physician, speech-language therapy, pain management, and dental services.

1 client received funds to complete several dog obedience classes to begin therapy dog training and volunteer for BIS.

4 clients received supports to obtain or maintain housing

Other services / supports provided include home organizing supplies, calendars, gas cards, transportation vouchers, eye glasses, gym / wellness program memberships, clothing, pottery class/art therapy, citizenship fee, educational supports, and groceries.

26 year old female- from India Injury from being pushed down stairs at 2

years old. Sustained a severe traumatic brain injury resulting in intellectual disabilities.

Received comprehensive neuropsychological evaluation, mental health therapy, nutrition counseling for thyroid problems, positive behavioral supports and vocational support.

Outcome: gainfully employed, living in community