Needs Led Individual Assessment and Therapy (N = 94, December 2010 – June 2013) 5031 individual contacts and: there was a wide spread of need with several clients only having one or two face to face contacts and

one client receiving 95 face to face contacts over 30 months.

Goals Identified by clients at Initial Assessment (N = 94)

0

5

10

15

20

25

30

35

40

Nu

mb

er

of

clien

ts i

den

tifi

ed

go

al

N = 100, 71:29 Male: Female

0

5

10

15

20

25

< 20 21 - 30 31 - 40 41 - 50 51 - 60 > 60

Nu

mb

er

of

clien

ts

Age

Age at injury

Clients age range was relatively young; 16 –

70 years, (Mean=39, SD = 16). 35 clients were seen within 6 months of injury

while 28 were referred more than two years after

injury.

Initial Assessment Results – MPAI-4 (N = 84)

The MPAI-4 was scored jointly with the client, a family member and the assessing clinicians. No one reached ceiling or plateaued on the MPAI-4; mean total T score 41.64 (SD 10.87), (mild-moderate limitations relative to USA outpatient ABI

population).

AIMS; To characterise the rehabilitation needs of people referred to a newly established County Wide Community Head Injury Service and explore how the team have developed the service in response to those needs.

METHODS; The team of Rehabilitation Consultant, Clinical Psychologist; Psychology Assistant; OT (0.7 WTE) ; SLT ( 0.6WTE) ; Admin ( 0.6WTE) were in post by Nov 2010. They linked closely with locality Rehab teams.

After referral from the Regional Neurotrauma clinic, clients attended for an initial assessment. The Mayo Portland Adaptability Inventory – fourth edition1 (MPAI-4) and the Hospital Anxiety and Depression Score2 (HADS)

were used as part of a semi structured interview to identify problems across all functional domains. Individual clinical sessions for further assessment and treatment were offered according to need. Groups were devised

and delivered as cohorts of clients presented with similar problems. Activity data was collected prospectively using our community services IT system: systm-one and analysed using SPSS.

We review the demographics and rehabilitation needs of the first 100 referrals, and report on the nature of the individual and group interventions that they received.

Conclusions The semi structured interview and assessment battery identified a wide range of impairment, ability and participation after head injury with considerable psychological distress.

Many with mild injury presented with significant rehabilitation needs. Initial goals were related to work, everyday function and mood rather than more abstract ideas such as identity.

There was considerable time needed for non face to face working. Much of the teams time was needed to facilitate informed engagement with other relevant services and agencies and to

support families and carers. Recognition of this “non contact time” will be key to ensuring effective service planning and commissioning.

These data suggest that any county wide specialised team should have sufficient knowledge, experience and skill to deliver a wide range of complex individual and group interventions. We would like to acknowledge that this activity has only been possible because of the considerable help from several volunteers and enthusiastic support from other services and agencies

References 1Malec, J. F., Kragness, M., Evans, R. W., Finlay, K. L., Kent, A., & Lezak, M. D. (2003). Further psychometric evaluation and revision of the Mayo-Portland Adaptability Inventory in a national sample. The Journal of head trauma rehabilitation, 18(6), 479-492. 2Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta psychiatrica scandinavica, 67(6), 361-370.

HADS (N = 80)

There was significant emotional morbidity at assessment, with 53% of 80 who completed

the HADS, scoring in the mild–severe range for anxiety, and 41% for depression.

Number of clients (N) who needed the following :

Neuropsychological Assessment, N = 49:

45 new, 4 reassessments, 10 assessed pre-referral

Occupational Therapy, N = 57

Work Visits, N = 29

Speech and Language Therapy, N = 18

Multi Agency Case Conferences N = 9 (28 conferences )

Discharge planning from specialist rehab service N = 10

Headway Joint Reviews with Social Services N = 10

Carer training for daily care packages, N = 8

Client specific discussion in MDT meeting: 30/week

Needs Led Groups / N= number of clients who attended each type

52 people have attended one or several of 23 different Groups that were set up

All sessions were run by the team clinicians with volunteers and ran for two hours each with a short break.

Each group included a series of between five and nine weekly sessions.

All Groups have been evaluated and will be reported elsewhere

A User Group meets three times per year and is attended by past and current clients and family members .

Information 6 x Brain Injury Information for clients (BIIG), N = 33

The BIIG group originally ran for 6 weeks, based on client feedback it now runs for 9 weeks and includes a

goal setting and rehabilitation session. Two sessions were added for clients to make posters about their own

injuries to encourage making sense of the information and how it relates to their own situation

1 x

Me

mo

ry

N =

11

2 x

Fa

tig

ue

N =

15

1 x

Atte

ntio

n

N =

8

1 x

Co

mm

un

ica

tio

n

N =

7

1x E

mo

tio

na

l

Re

gu

latio

n ‘K

ee

p

Ca

lm a

nd

Ca

rry O

n’

N =

11

6 x Relatives

Information

N=38

Run monthly

1 x

Exe

cu

tive

Fu

nctio

n

‘Le

ts T

ake

Actio

n’

N =

15

1 x

Yo

un

g P

ers

on

s

Str

ate

gy N

= 8

In C

olle

ge

va

ca

tio

n

*

* On average Face to Face Contact time was >20 hours per client for 72 clients. Range 5 min – 8 hours / contact

Good

group,

interesti

ng

people.

I would

like to

keep in

touch.

I

enjoyed

the

experie

nce

Good,

confide

nt and

comfort

able,

will

miss

the time

with

you all.

Family

to my

TBI

Chance

to talk

thorugh

all the

areas and

improve

my

understan

ding

Really

good,

useful

informat

ion,

nice to

meet

other

people

with the

same

problem

0

1

2

3

4

5

6

7

8

StronglyAgreeTend toAgreeTend toDisagree

After 5 weeks I

feel it would be

helpful to have

some form of

support network

or group

So helpful I am

so pleased I

have attended

It's very

beneficial to

hear new ways

to deal with

things.

Brilliant.

Very positive.

It's OK and

interesting.

Meeting people

like myself very

helpful (to feel

better about

myself. Less on

my own. Helped

my confidence

to see there are

other people like

me.

It's very helpful.

Five very

worthwhile

sessions - I'm

sure everyone

will take

something away

from the group

which will

enhance and

improve each

person's daily

life.

Hearing the way

others cope has

given me ideas

to put into

practice

Ways to deal

with tiredness

that aren't

sleeping.

So much. That

I'm not alone.

Certain things I

could do to help

- felt completely

helpless before.

Nutrition sheet

handout.

The handouts to

read at home -

take it in. The

relaxation and

pacing. I have

been able to put

this into practice

at home.

Allowing self to

sleep/rest.

Shorted breaks

better than one

long break.

Smaller group

work.

How nutrition,

eating regularly

and drinking

water can help.

The handouts at

the end of each

session and the

opportunity to

study these in

own time. Being

in the company

of others with

similar problems

and sharing

experiences.

In day to day life I think this

group will be invaluable,

especially the lessons I have

learnt here

I very much enjoyed the session last night and

found it most instructive and helpful. This sort

of information helps me to support # and

encourage # usefully, and helps me to

maintain an optimistic and realistic attitude

towards the issues we are facing. It also helps

me to reassure the other members of my

family who are concerned about #. I am

looking forward to the next session.

That the things that I have gone

through are 'normal' for

someone with a head injury

The hand-outs at the end of each

session and the opportunity to

study these in own time. Being in

the company of others with

similar problems and sharing

experiences.

Relatives Compassionate mind Information

N=4

Adjustment /Psychotherapy Group

N=5

Strategies

Support

0

5

10

15

20

25

30

35

40

<6 6-12 12-24 >24 DNA

Nu

mb

er

of

Cli

en

ts

Months

Time between injury and initial assessment

Attention and Concentration (N = 43)

Memory (N = 42)

Novel Problem Solving (N = 29)

Family and Significant Relationships (N = 39)

Fatigue (N = 32)

Anxiety (N = 31)

Further analysis of the data allowed us to ascertain how many people reported difficulties interfering with activities more than 25% of the time. The most frequently reported difficulties were:

Leisure and Recreational activities (N = 48)

Social Contact (N = 41

Paid Employment (N = 38)

0

5

10

15

20

25

Face to Face Group Telephone Calls

Average Time (Hours) Average Contacts (Number)

Mean time and mean number of contacts / client

Range

1-144

Range

1-30

sessions

ECHIS Liaised with all clients

primary care doctors (GPs)

and….

Univ

ers

itie

s

In p

atie

nt s

erv

ice

s

The Evelyn Community Head Injury Service is generously supported by a grant from the Evelyn Trust. This is an NHS service and is a partnership between: Cambridge University Hospitals NHS Foundation Trust; University

of Cambridge; Headway Cambridgeshire; NHS Cambridgeshire; The Oliver Zangwill Centre – part of Cambridgeshire Community Services NHS Trust.

The Development of a county wide Community Head Injury Service;

How the characteristics and needs of the first 100 clients have shaped the service- Judith Allanson, Kate Psaila, Sarah Moss, Kerrie Bundock, Nicola Metcalf, Andrew Bateman, Donna Malley, Fergus Gracey, Clare Keohane, Peter Hutchinson

Results 4; Difficulties reported at Assessment

Results 5; Individual Client interventions

ECHIS ;INTERDISCIPLINARY WORKING

INDIVIDUAL

Assessment

+Therapy

Psychol/ OT

Med / SLT

OTHER

SERVICES Comm Team

Headway

OZC

Mental Health

GROUPS Brain Injury Info.

Fatigue

Mood Management

Communication

Cognitive

Family workshops

INITIAL Holistic ASSESSMENT/Advice Formulation / Goal planning

Rehab plan at weekly team meeting

REVIEW

Complex Case Discussion

Case Conferences

Family sessions

1 x

Mo

vin

g to

Un

ive

rsity

N =

6

Results 6; Group interventions

Results 1; Demographics Results 2; Initial Goals

Results 3; Emotional Morbidity

ECHIS Liaised

with all clients primary

care doctors (GPs)

and….

Univ

ers

itie

s /

Colle

ges

In p

atient

Reha

bili

ation s

erv

ices

Results 7; Multi agency working

Range

0-95