Resource Facilitation for Return to Work following Brain ... · Resource Facilitation for Return to...

Lance E. Trexler, PhD, FACRMRehabilitation Hospital of Indiana

Indiana University School of Medicine

Resource Facilitation for Return to Work following Brain Injury: Evidence to Practice

1

Systematic ReviewVan Velzen, Van Bennekom et al (2009)

• 40.8 % of the participants with traumatic brain injury were able to return to work two years post-injury

• 39.3 % of the participants with non-traumatic brain injury were able to return to work two years post-injury

2

Systematic ReviewVan Velzen, Van Bennekom et al (2009)

• This study however was not able to separate outcomes by severity

– One study1 with a 12 year follow-up found 84% RTW rate which included mild head injury

– One study2 that only included mild TBI found a 78% RTW rate – Three studies3,4,5 looked at only severe TBI and found 0-18% RTW

• Therefore, the 40% RTW overall rate may overestimate rates of RTW for moderate to severe TBI

3

1. Groswasser Z.,et al.(2002).Quantitive imaginginlateTBI.PartII:Cognitionandworkafterclosedandpenetrating headinjury:Areport oftheVietnam headinjurystudy.BrainInjury;16:681-690.

2. Hanlon,R.E.,Demery, J.A.,Martinovich, Z.,Kelly,J.P.(1999).Effectsofacuteinjurycharacteristics onneuropsychologicalstatusandvocationaloutcomefollowingmildTBI.BrainInjury;13:873-887.

3. Dikmen,S.,Machamer, J.,Temkin,N.(1993).Psychosocialoutcomeinpatientswithmoderatetosevere headinjury:2yearfollow-up.BrainInjury;7:113-124.

4. Bounds,T.A.,Schopp,L.,Johnstone B.,Unger,C.,Goldman,H.(2003).Genderdifferences inasampleofvocationalrehabilitationclientswithTBI.NeuroRehabilitation; 18:189-196.

5. Ruff,R.M.,etal.(1993).Predictorsofoutcomefollowingsevereheadtrauma: Follow-updatafromthetraumatic comadatabank. BrainInjury;7:101-111.

TBIMS

• 3121 subjects identified in the TBIMS-NDB admitted and discharged between October 1, 2001 and December 31, 2010

• TBIMS-NDB data was weighted to obtain population estimates were obtained to match the US TBI Rehabilitation population based on UDS and eRehab data

4

TBIMS

• Sample:– < 60 years of age at injury (75,411)– Not retired at injury (72,165)– Alive at two years post-injury follow-up (64,081) Employed =

25,399 (39.6%)• Unemployed = 38,682 (60.4%)• Employment = paid legal or illegal work, with or without

accommodations• 65% were full-time

5

Indiana Vocational Rehabilitation Services successful closure (return to work) rate for brain injury = 18% in 2009

• VRS gets the most complex cases:– Were not able to return to work– Brain damage was sustained early in life– Psychiatric co-morbidities – Diminished family support– Increased involvement with the criminal justice system– Loss of social supports

6

Why, at best, do only 40% of people with brain injury return to work?

7

What are the Barriers to Return to Work?

• Individual and Family:– Persisting Cognitive & Behavioral Impairments caused by brain injury– Co-Morbidities (e.g., depression, social isolation)– Family burden, over-commitment and fatigue

• Social - Environmental:– Availability Brain Injury Specific Expertise– Lack of Awareness of What Services do Exist– Access to Services that do Exist


• Systemic:– Fragmentation and gaps between systems:

• Medical• Rehabilitation• Vocational Services

– Different Funding Mechanisms • About which awareness is limited• That are hard to understand and access


• System: – Fragmentation and gaps between systems:

Medical Rehabilitation Vocational

RF

Comm.Provider

What are the Consequences?

• Loss of pre-injury vocational skills, relationships and networks• Increased risk for co-morbidities (e.g., depression, anxiety)• Loss of economic productivity and financial stress for the patient and

family• Increased family burden• Increased cost to society (e.g., disability, health care expense)

What is Resource Facilitation?

12

Resource Facilitation Defined

• individualized assessment• provide brain injury specific education and promote awareness of

resources• proactive navigation to community-based supports, resources and

services • remove instrumental barriers (e.g., housing) as well as brain injury-

specific barriers (e.g., memory impairment) to successful community re-integration and return to work.

13

First Randomized Controlled Trial of Resource Facilitation(Trexler, Trexler, Malec et al., (2010) JHTR, 25; 440-446)

• 23 people with acquired brain injury recruited from RHI (12 RF, 11 Con)

• Six months of Resource Facilitation (Connors, 2001)• Team= Neuropsychologist, VR TBI Specialist, Resource Facilitator,

BI Therapist

14

Diagnoses by Group

15

Results

• No differences between RF and Control groups for:– Age– Sex– Education– Severity of cognitive impairment– Diagnosis (TBI, stroke, etc.)

16

Results

• 64% of the RF group was employed at follow-up compared to 36% of the control group (Wald-Wolfkowitz Z = -3.277, p < .0001)

• Participation increased significantly for both groups (F = 60.65, p < .0001), but the interaction between groups and time demonstrated greater improvement for the RF group relative to controls (F = 9.11, p < .007).

17

Results

• Participation increased significantly for both groups (F = 60.65, p < .0001)

• interaction between groups and time demonstrated greater improvement for the RF group relative to controls (F = 9.11, p < .007).

18

Participation Index

19

Indiana Vocational Rehabilitation Services authorized a Prospective Clinical Trial in

2011

20

Prospective Clinical Cohort Study of Resource Facilitation

• 161 patients initiated services– 25 never started services– 10 did not finish services (moved, expired, changing goals)– 57 cases are still active (at time of analyses)

• 69 cases analyzed

21

Sample Demographics

• Time since injury was on average 9.28 years• Average age for this sample was 38 years• 78% male• 53.8% of the sample had greater than a high school level of

education• Predominantly white

Results

• 67% returned to work or school

67%

33% RTW

NoRTW

Economic Impact Study(Reid, McGeary & Hicks, 2011)

• Total Economic Impact in Lost Wages (Annual)– $31,017,775

• Does not include annual losses – to business ($10 million) – personal tax revenues ($4.8 million)– Fringe benefits, Medicare, Medicaid, Disability

• Based on 64% RTW

25

Randomized Controlled Trial 2(Trexler, Parrott and Malec, Archives of PMR, 2016)

• Replication Study with larger sample size and longer treatment duration– 44 people with acquired brain injury recruited from RHI (22 RF

treatment, 22 Control)– 15 months of Resource Facilitation Services

27

Sample Demographics

• On average, patients were 64 days post injury• Average age was 37 years• 62% Male• 13.62 average years of education• Predominantly white

28

Results

• Similar to RF 1, no differences between RF and Control groups on demographic variables– Age– Sex– Education– Time since injury– Diagnosis

• Significant group differences were found on VIQ WAIS III.

29

Diagnoses by Group

0

2

4

6

8

10

12

14

TBI ICH Stroke Other

ResourceFacilitationControl

30

Vocational Independence Scale-R

5. Competitive: Community-based work without external supports for more than 15 hours/week. Full-time school enrollment without external supports.

4. Transitional: Community-based work with temporary supports (eg. job coach, reduced hours) fewer than 15 hours/week. School enrollment with temporary supports or less than full-time student course load.

3. Supported: Community-based work, including volunteering, with permanent supports. School enrollment with permanent supports.

2. Sheltered: Work in a sheltered workshop

1. Unemployed/not in school31

VIS-R by Group

• Significant group by time interaction (p = .027)

• On average, the treatment group was 0.13 points higher than the control group on the VIS-R

• On average, the treatment group improved 0.17 points at each measurement while the control group only improved by 0.10 points

32

1

1.5

2

2.5

3

3.5

4

4.5

VIS-RScore

Follow-up Period

ResourceFacilitation

Control

Results: Community-Based Work

• The odds ratio from the logistic regression found that RF participants were 7.0 times more likely to participate in productive community-based work than the control group.

• Relative risk analysis showed that the risk of no productive community-based work was 75% higher in the control group than the treatment group

33

Types of Jobs by Group

0

1

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5

6

Executive ProfessionalSpecialty

Technicians AdministrativeSupport

Service PrecisionProduction

Handlers,EquipmentCleaners

ResourceFacilitationControl

34

2014 Policy Decision

Based on the 2 RCT’s, Prospective Clinical Cohort, and the Economic Impact Study, Indiana Vocational Rehabilitation Services decides to provide resource facilitation services to all of Indiana for

– People with acquired brain injury and– Who want to return to work or school that will

lead to return work

35

I n d i a n aState BoundariesCounty Boundaries

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Brazil

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Decatur

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Kendallville

Mount Vernon

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PrincetonSellersburg

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Salem

Linton

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North Manchester

Rochester

Lowell

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Mitchell

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Austin

Sullivan

North Vernon

Ellettsville

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Clinton

New WhitelandRushville

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Tipton Alexandria

Winchester

Gas City

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Garrett

Porter

Whiting

Rockport

Corydon

Petersburg

Paoli

Brownstown

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Spencer

Rockville

Covington

FowlerDelphi

Winamac

Albion

Lagrange

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Morocco

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Brook

La Fontaine Poneto

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Monroe

RoannMacy

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Mentone

Hamlet

Grabill

North Webster

Hudson

Orland

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Vincennes

Washington

Bedford

Madison

Seymour

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FranklinShelbyville

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Speedway

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Huntington

New Haven

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Warsaw

Plymouth

Griffith Hobart

Chesterton

Auburn

La Porte

JeffersonvilleNew Albany

Columbus

Greenwood

Lawrence

FishersCarmel

Richmond

Noblesville

LafayetteWest Lafayette

Kokomo

Marion

Merrillville Valparaiso

Portage

East Chicago

Michigan City

GoshenMishawaka

Elkhart

Bloomington

Terre Haute

Anderson

Muncie

Hammond

South Bend

Evansville

Fort Wayne

Gary

Indianapolis


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F l oy d

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A l l e n

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W h i t l ey




L a Po r t e


Wabash

R.

Wabash

R.

Ohio R.

Granger

Beal Otisco

CornettsvilleHuron

Kurtz

Harrodsburg

Canaan

Sedalia

Star City

Fair Oaks Gifford

Lake Village

Shelby

Tyner

Newville

Metz

Howe

Tell City

Brazil

Harrison


Westfield

Elwood

Bluffton

Decatur

Cedar Lake

Kendallville

Mount Vernon

Boonville


Charlestown

Salem

Linton

Zionsville

Hartford City

North Manchester

Rochester

Lowell

Columbia City

Angola

Huntingburg

Mitchell

Scottsburg

Austin

Sullivan

North Vernon

Ellettsville

Lawrenceburg

Edinburgh

Batesville

Clinton


Danville Cumberland

CiceroYorktown

Tipton Alexandria

Winchester

Gas City

Portland

Monticello

Rensselaer

DeMotte

Knox

Winona Lake

Westville

Bremen Nappanee

Garrett

Porter

Whiting

Rockport

Corydon

Petersburg

Paoli

Brownstown

Bloomfield

Spencer

Rockville

Covington

FowlerDelphi

Winamac

Albion

Lagrange

Cannelton

VevayWarsaw

Rising Sun

Versailles

Williamsport

Kentland

English

Shoals

Vernon

Nashville

Newport

Brookville

Newburgh

Chandler


Oakland City

French Lick

Orleans

Bicknell

West Terre Haute

Hope

Cloverdale

Centerville

Sheridan

AtticaShadeland

Fairmount

Flora

Greentown

Berne

Ossian

Hebron



Owensville

New Pekin

Odon

Worthington

Farmersburg

Saint Paul

Bargersville

Fairview Park

Ladoga

Knightstown

Ingalls

Thorntown

Lynn

Mulberry

Farmland

Oxford

Russiaville

Eaton Redkey


Remington

Walton

Montpelier

Monon

Warren

Morocco

Markle

Akron

North Judson

Monroeville

South Whitley

Culver

Kouts

Argos

Woodburn



Chrisney

Elberfeld

Laconia

New Amsterdam


Hazleton

MilltownGreenville

Hardinsburg

Monroe CityLivonia

Oaktown

Little York

Elnora Crane

Carlisle

Medora

Lyons

Dupont

Hymera

Clay City

Holton

Elizabethtown

RileyGosport

Center Point


CarbonStilesville

Laurel

Bainbridge

Bloomingdale

Morristown

Russellville

Kingman

Lizton

Boston

Shirley Greensboro

Hillsboro



Colfax Kirklin

Blountsville

Kempton

Sharpsville

Gaston

Battle Ground

Ridgeville

Fowlerton

Earl Park

Bryant

Brook

La Fontaine Poneto

Royal Center

Monroe

RoannMacy

Kewanna

Medaryville

MontereyClaypool

Mentone

Hamlet

Grabill

North Webster

Hudson

Orland

Jasper

Clarksville

Vincennes

Washington

Bedford

Madison

Seymour

Martinsville

Greensburg

FranklinShelbyville

Plainfield

Connersville

Speedway

Brownsburg

Greenfield


New Castle

Frankfort

LogansportPeru

Wabash

Huntington

New Haven

Crown Point

Warsaw

Plymouth

Griffith Hobart

Chesterton

Auburn

La Porte


Columbus

Greenwood

Lawrence

FishersCarmel

Richmond

Noblesville


Kokomo

Marion


Portage

East Chicago

Michigan City

GoshenMishawaka

Elkhart

Bloomington

Terre Haute

Anderson

Muncie

Hammond

South Bend

Evansville

Fort Wayne

Gary

Indianapolis


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I n d i a n a



F l oy d

H a r r i s o n


G i b s o n

P i ke

C l a r k




O h i oJ a ck s o n




M o n r o e

D e c a t u r

O w e n






Pa r ke

Way n eH e n r y

Verm

illi

on





T i p p e c a n o e


G r a n t





A l l e n

J a s p e r

W h i t l ey




L a Po r t e


Wabash

R.

Wabash

R.

Ohio R.

Granger

Beal Otisco

CornettsvilleHuron

Kurtz

Harrodsburg

Canaan

Sedalia

Star City

Fair Oaks Gifford

Lake Village

Shelby

Tyner

Newville

Metz

Howe

Tell City

Brazil

Harrison


Westfield

Elwood

Bluffton

Decatur

Cedar Lake

Kendallville

Mount Vernon

Boonville


Charlestown

Salem

Linton

Zionsville

Hartford City

North Manchester

Rochester

Lowell

Columbia City

Angola

Huntingburg

Mitchell

Scottsburg

Austin

Sullivan

North Vernon

Ellettsville

Lawrenceburg

Edinburgh

Batesville

Clinton


Danville Cumberland

CiceroYorktown

Tipton Alexandria

Winchester

Gas City

Portland

Monticello

Rensselaer

DeMotte

Knox

Winona Lake

Westville

Bremen Nappanee

Garrett

Porter

Whiting

Rockport

Corydon

Petersburg

Paoli

Brownstown

Bloomfield

Spencer

Rockville

Covington

FowlerDelphi

Winamac

Albion

Lagrange

Cannelton

VevayWarsaw

Rising Sun

Versailles

Williamsport

Kentland

English

Shoals

Vernon

Nashville

Newport

Brookville

Newburgh

Chandler


Oakland City

French Lick

Orleans

Bicknell

West Terre Haute

Hope

Cloverdale

Centerville

Sheridan

AtticaShadeland

Fairmount

Flora

Greentown

Berne

Ossian

Hebron



Owensville

New Pekin

Odon

Worthington

Farmersburg

Saint Paul

Bargersville

Fairview Park

Ladoga

Knightstown

Ingalls

Thorntown

Lynn

Mulberry

Farmland

Oxford

Russiaville

Eaton Redkey


Remington

Walton

Montpelier

Monon

Warren

Morocco

Markle

Akron

North Judson

Monroeville

South Whitley

Culver

Kouts

Argos

Woodburn



Chrisney

Elberfeld

Laconia

New Amsterdam


Hazleton

MilltownGreenville

Hardinsburg

Monroe CityLivonia

Oaktown

Little York

Elnora Crane

Carlisle

Medora

Lyons

Dupont

Hymera

Clay City

Holton

Elizabethtown

RileyGosport

Center Point


CarbonStilesville

Laurel

Bainbridge

Bloomingdale

Morristown

Russellville

Kingman

Lizton

Boston

Shirley Greensboro

Hillsboro



Colfax Kirklin

Blountsville

Kempton

Sharpsville

Gaston

Battle Ground

Ridgeville

Fowlerton

Earl Park

Bryant

Brook

La Fontaine Poneto

Royal Center

Monroe

RoannMacy

Kewanna

Medaryville

MontereyClaypool

Mentone

Hamlet

Grabill

North Webster

Hudson

Orland

Jasper

Clarksville

Vincennes

Washington

Bedford

Madison

Seymour

Martinsville

Greensburg

FranklinShelbyville

Plainfield

Connersville

Speedway

Brownsburg

Greenfield


New Castle

Frankfort

LogansportPeru

Wabash

Huntington

New Haven

Crown Point

Warsaw

Plymouth

Griffith Hobart

Chesterton

Auburn

La Porte


Columbus

Greenwood

Lawrence

FishersCarmel

Richmond

Noblesville


Kokomo

Marion


Portage

East Chicago

Michigan City

GoshenMishawaka

Elkhart

Bloomington

Terre Haute

Anderson

Muncie

Hammond

South Bend

Evansville

Fort Wayne

Gary

Indianapolis


0

0 50 Miles

50 KM

25 Miles

25 KM

10 Miles

10 KM

11

127

135

135

15

15

15

1818

2

25

25

25

25

29

29

3

3

3

3

3

32

32

37

37

37

37

37

37

37

37

38

38

38

43

45

46

46

46

46

46

54

56

57

57

57

62

62

62

62

6262

63

63

66

66

67

67

67

67

67

7

7

9

9

9

9

9

9

9

136

150

20

20

231

231

231

24

27

27

30

30

31

31

33

33

35

35

35

36

40

40

41

41

41

421

421

50

50

52

52

6

6

Toll Toll

164

65

65

69

74

74

80

80

I n d i a n a



F l oy d

H a r r i s o n


G i b s o n

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C l a r k




O h i oJ a ck s o n




M o n r o e

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T i p p e c a n o e


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L a Po r t e


Wabash

R.

Wabash

R.

Ohio R.

Granger

Beal Otisco

CornettsvilleHuron

Kurtz

Harrodsburg

Canaan

Sedalia

Star City

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Metz

Howe

Tell City

Brazil

Harrison


Westfield

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Danville Cumberland

CiceroYorktown

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Monticello

Rensselaer

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Knox

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Garrett

Porter

Whiting

Rockport

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Paoli

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Spencer

Rockville

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FowlerDelphi

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VevayWarsaw

Rising Sun

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English

Shoals

Vernon

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Chandler


Oakland City

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Hope

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AtticaShadeland

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Flora

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Berne

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Hebron



Owensville

New Pekin

Odon

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Saint Paul

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Ladoga

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Ingalls

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Lynn

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Oxford

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Eaton Redkey


Remington

Walton

Montpelier

Monon

Warren

Morocco

Markle

Akron

North Judson

Monroeville

South Whitley

Culver

Kouts

Argos

Woodburn



Chrisney

Elberfeld

Laconia

New Amsterdam


Hazleton

MilltownGreenville

Hardinsburg

Monroe CityLivonia

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Little York

Elnora Crane

Carlisle

Medora

Lyons

Dupont

Hymera

Clay City

Holton

Elizabethtown

RileyGosport

Center Point


CarbonStilesville

Laurel

Bainbridge

Bloomingdale

Morristown

Russellville

Kingman

Lizton

Boston

Shirley Greensboro

Hillsboro



Colfax Kirklin

Blountsville

Kempton

Sharpsville

Gaston

Battle Ground

Ridgeville

Fowlerton

Earl Park

Bryant

Brook

La Fontaine Poneto

Royal Center

Monroe

RoannMacy

Kewanna

Medaryville

MontereyClaypool

Mentone

Hamlet

Grabill

North Webster

Hudson

Orland

Jasper

Clarksville

Vincennes

Washington

Bedford

Madison

Seymour

Martinsville

Greensburg

FranklinShelbyville

Plainfield

Connersville

Speedway

Brownsburg

Greenfield


New Castle

Frankfort

LogansportPeru

Wabash

Huntington

New Haven

Crown Point

Warsaw

Plymouth

Griffith Hobart

Chesterton

Auburn

La Porte


Columbus

Greenwood

Lawrence

FishersCarmel

Richmond

Noblesville


Kokomo

Marion


Portage

East Chicago

Michigan City

GoshenMishawaka

Elkhart

Bloomington

Terre Haute

Anderson

Muncie

Hammond

South Bend

Evansville

Fort Wayne

Gary

Indianapolis

2009 RCT’s

Begin State-wide Roll-Out Early 2014

2013 Clinical Trial

2015

Resource Facilitation Growth: 2009-2015

Late 2014

New Prospective Clinical Cohort(June, 2016; n = 141)

37

Results

Variable Mean(sd)

Age 38.97(13.87)

MPAIParticipation Index 43.71(7.88)[moderatedisability]

TimeSinceInjury(Years) 10.10(11.25)

%Male 63.8%

YearsofEducation 13.34(2.34)

38

Results

70% Successfully Placed in Competitive Employment

Mean hours per week = 25

39

Activities of Daily Living Scale

• Self Care Activities• Household Care• Employment and Recreation• Shopping and Money Management• Travel• Communication• Total

ResultsdemonstratedastatisticallysignificantdecreaseinthereportedamountofassistancerequiredtocompleteactivitiesofdailylivingafterRF(t=5.35,p=.000).

•Johnson, N.,Barion, A.,Rademaker,A.,Rehkemper, G.,&Weintraub, S.(2004).TheActivitiesofDailyLivingQuestionnaire:avalidationstudyinpatients withdementia.Alzheimerdisease&associateddisorders, 18(4),223-230.

Survey of Unmet Needs and Service UseHeinemann, A.W. et al. (2002). Measuring unmet needs and services among persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 83, 2052-1059

• Developed specifically for brain injury• Variety of instrumental and service needs• Addresses both what they are receiving and perceived needs

Survey of Unmet Needs

• Numberofservicesuseddeclinedsignificantlyfrombaselinetodischarge(t=2.83,p=.005).• Desiredservicesdeclinedsignificantlyfrombaselinetodischarge(t=13.53,p=.000).• ExamplesofneedsthatweremetthroughRF:– controllingalcoholand/ordruguse,– increasingindependenceineating,

dressing,andbathing,and– findinghousingthatisaffordableand

accessible.

Mayo-Portland Results

MPAI-4 results show a significant decline in level of disability across all subscales: • abilities (e.g., mobility, memory), • adjustment (e.g., depression

social interaction), and • participation (e.g., managing

money, transportation) after RF (t=4. 07, p=.000).

Results Across RCT’s and Prospective Clinical Cohorts

PresentSample

RCT1(TreatmentGroup

Only)

RCT2(TreatmentGroup

Only)

ProspectiveClinicalCohort

SampleSize 137 12 22 69Age 37.27(15.43) 43.18(11.97) 33.00(10.83) 37.46(15.86)%Non-White 12 0 5 5.6%Male 64 55 62 78YearsofEducation 13.19(2.14) 13.27(2.10) 13.75(1.94) 14.89(15.86)

TimeSinceInjury(days) 3482(4055)[years:9.54(11.11)]

64.50(46.93) 63.21(19.59) 3388(3369)[years:9.28(9.23)]

%EmployedPre-Injury 67 100 100 59

MPAIParticipationIndex(T-Scores)

51.0(10.57)(moderate)

63.90(5.20)(severe)

52.59(8.74)(moderatetosevere)

49.28(5.92)(moderate)

Employment/SchoolOutcomes

70% 64% 69% 67%

RHI Resource Facilitation: Structure and Program Model

45

What is Resource Facilitation?

• To provide brain injury specific education and promote awareness of resources to individuals with brain injury, their families, other providers and the community

• To proactively navigate the person and their family to needed instrumental, brain injury-specific, community and vocational supports and services

• To ensure collaboration, integration and coordination between providers and community-based resources

46

Resource Facilitation Services and Supports

• Housing• Food• Transportation

47

• InstrumentalExamples

• Brain-InjurySpecificExamples

• StrategiesforManagingCognitive/BehavioralImpairments

• Patient-FamilyEducationaboutBrainInjury

• ConsultingwithotherProvidersabouthowtomodifyservicesforBrainInjury

Percent of Total RF Time by Activity

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

48

Resource Facilitation Clinical Timeline

49

ResourceFacilitationAssessment

ResourceFacilitationServices

- Contactwithclienteverytwoweeks- - - - - - - - - - - - >- Monthlyteamconferences- - - - - - - - - - - - - - - - - - - >

Placementand90Follow-up

• ResourceFacilitator• LocalSupport Network Leader• RehabilitationNeuropsychologist• ClinicalTherapist

Resource Facilitation and the Post-Acute Continuum

50

ACUTE AND CLINICAL

VOCATIONAL AND COMMUNITY-BASED

- - - - - - - - RESOURCE FACILITATION - - - - - - - -

FOLLOW-UP

FOLLOW-UP

FOLLOW-UP

FOLLOW-UP

E.G., EMPLOYMENT SERVICES

E.G., NEUROPSYCHOLOGICAL TREATMENT

Two Levels of Intervention in Resource Facilitation

Environmental and Social Barriers (Systems Level): The Local Support Network Leader

– Community brain injury education and awareness for providers, state agencies, etc

– Identification of private and public resources & services applicable to brain injury (e.g., health & mental health care, rehabilitation, state agency, transportation, employment services)

– Coordination and partnerships to promote seamless continuum from acute and clinical organizations to vocational and Community-based organizations

Two Levels of Intervention in Resource Facilitation

• Individual and Family Barriers (Service Level): • The Resource Facilitator works with the person with brain injury and

their family to provide:– Brain injury education

– Facilitation of access to and coordination of services, systems and supports applicable to each person as derived through the initial evaluation for instrumental, brain injury-specific, and vocational needs

– Ongoing assessment of progress towards goals

– Monthly team conferences

Resource Facilitation Initial Assessment

• Resource Facilitation Intake • NeuroVocational Evaluation• Community Resources Assessment• Initial Team Conference

53

Contact Methods

In-Person57%

Telephone30%

Email13%

54

Contact with Whom

Survivor/Client51%

Family6%

VRC9%

Other(i.e.jobcoach,

employer)34%

55

Vocational Placement

• Follow up LSN/RF services for 3 months post-employment or academic placement

• Employer/educator contact/consultation every 2 weeks• Sustain/revise community supports and family stability• Sustain cognitive or behavioral strategies to maintain

work/school performance• Collection of Quality Assurance/Program Evaluation

Data• 90-day Employment Final Report

56

Brain Injury Takes an Integrated Village

57

• PhysicalMedicineandRehabilitation

• Neuropsychology• RehabilitationTherapists• EmploymentSpecialists• VocationalRehabilitation

Counselors• MentalHealth/Substance

Abuse• PrimaryCare• Other

Brain Injury Village

• RehabilitationServices

• EmploymentSpecialist

• VRS• ResourceFacilitation

NVErecommendsfindsdecreasedattentionand

memoryskillsandreducedvocational

readiness;TheRFishelpingtoconnect thepieces

DevelopmentofIPEandensuresplanisfollowed /revisedas

needed

Speechtherapistteaches

compensatorystrategiesfor

attention&memory

Helpsclientincompletingjobapplications and

practicinginterviewskills

Working as a Team

Why is it important to collaborate as a team when working with individuals with

brain injury?

Working as a Team

• Because…– Brain Injury is a complex condition– Every brain injury is different– The client may have difficulties generalizing from one setting to another– Each provider offers a unique contribution – Each provider has a specialization that cannot be fully addressed by another

team member– Each provider relies on the others to enhance their own interventions and efforts

Working as a Team

Counseling&accesstoresources

SpecialtyBIknowledge

Vocationalreadinesstraining

VRS RF ES MH

Counselingand

medications

Working as a Team

• Each provider brings unique contributions to the team– Expertise / specialized knowledge– Provider resource network

• Each provider needs the other team members in order to do their jobs well– E.g., MH provides treatment for active substance abuse issue which is interfering

with the client’s ability to attend appointments with ES and VRC

– E.g., RF team conducts an NVE which then provides objective evidence of functional deficits and how those may pose barriers to vocational goals

Brain Injury takes a Village

63

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