Commonwealth Neurobehavioral Project Karen W. Brown, Executive Director Brain Injury Services, Inc....
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Transcript of Commonwealth Neurobehavioral Project Karen W. Brown, Executive Director Brain Injury Services, Inc....
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