Vocational Rehabilitation Outcomes for Native American … · Vocational Rehabilitation Outcomes...
Transcript of Vocational Rehabilitation Outcomes for Native American … · Vocational Rehabilitation Outcomes...
Vocational Rehabilitation Outcomes for Native American and Alaskan Native Individuals with Traumatic Brain Injury
Presenters: Franklin J. Elliott (LU-Fellow)
Dr. Priscilla R Sanderson (Mentor) & Dr. Myra Rosen Reynoso (Mentor)
September 28-29, 2017 Atlanta Georgia
Franklin J. ElliottAssociate Professor: ECME (AS & BS)
Navajo Technical University: Chinle Instructional SiteFaculty Chair
Presentation Objectives
Establish a greater understanding of with is Traumatic Brain Injury (TBI).
Identify services, education, and training provided for Native Americans & Alaskan Natives.
Present historical data of TBI
LU-RRTC State-of-the-Science ConferenceSeptember 28-29,2017 Atlanta Georgia
BACKGROUND
LU-RRTC State-of-the-Science ConferenceSeptember 28-29, 2017, Atlanta Georgia
Research Questions
1. Is there a difference in reasons for unsuccessful closures for American Indian/Alaska Natives with TBI?
2. Is there a difference in acceptance rates for VR services among American Indian/Alaska Natives with TBI?
3. What are the obstacles in providing an effective VR?
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
METHOD
The focus of this analysis is on the Native American and Alaskan Native population with TBI.
A literature review was conducted in examining the breath of what is TBI.
A literature review was conducted to understand the process of neuroplasticity in relations to TBI.
Examination of Historical Data and Trends
An analysis of the RS-911 data to determine the Amount of VR Services Provided by Race/Ethnicity and Cross-tabulation of Race/Ethnicity by Reason of Closur
LU-RRTC State-of-the-Science Conference September 28-19, 2017, Atlanta Georgia
KEY INFORMANT CHARACTERISTICS Amount of VR Services Provided by Race/Ethnicity
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
KEY INFORMANT CHARACTERISTICS Amount of VR Services Provided by Race/Ethnicity)
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Fuentes, M. M., Jimenez, N., Apkon, S. D., & Ravara, F. P. (2016). Functional outcomes during inpatient rehabilitation of American Indian and Alaska
Native children with traumatic brain injury. Journal of Pediatric Rehabilitation Medicine. DOI: 10.3223/PRM-160376.
KEY INFORMANT CHARACTERISTICS Cross-tabulation of Race/Ethnicity by Reason of Closure
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Fuentes, M. M., Jimenez, N., Apkon, S. D., & Ravara, F. P. (2016). Functional
outcomes during inpatient rehabilitation of American Indian and Alaska Native
children with traumatic brain injury. Journal of Pediatric Rehabilitation Medicine.
DOI: 10.3223/PRM-160376.
KEY INFORMANT CHARACTERISTICS Demographic Information
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Dillahunt-Aspillaga, C., Smith, T. J., Hanson, A., Ehlke, S., Stergiou-Kita, M., Dixon, C. G., & Quichocho, D. (2015). Exploring vocational evaluation practices following traumatic brain injury. Behavioural Neurology, doi:10.1155/2015/924027
KEY INFORMANT CHARACTERISTICS Demographic Information
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Traumatic Brain Injury Among American Indians/Alaska Natives — United States, 1992–1996. (2002). Morbidity and Mortality Weekly Report, (14), 303.
External Cause:
Unspecified: Recreational, at home incidents, Others: unreported but later referred/reported
Regions:Indian Health Services Provided: Southwest Region
RESULTS
Type here
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Research Question Identified Challenges
1. Is there a difference in reasons for unsuccessful closures for American Indian/Alaska Natives with TBI?
▪Return to work is identified as a complex and challenging process due to injury.
▪Although individuals are given support for rehabilitation•Employment rates are lower •Need to understand the key processes and relevant factors important for a thorough and rigorous vocational evaluations.
•Further research is needed to formally examine the success for the framework among a diverse group of vocational rehabilitation providers.
•Place on Physical Theory appointments and end after or partial visits completed.
•Referred by medical providers to SSDI
RESULTS (continued)
Research Question Identified Facilitators
2. Is there a difference in acceptance rates for VR services among American Indian/Alaska Natives with TBI?
Lack of FundingIndividual and Family
Lack of PreventionBy local, State, Federal agencies
Lack of IHS servicesrehabilitation & treatment
Lack of Agency Visibilitystate, Federal, National agencies
Lack of Culture and Spiritual Care for Brain Injury
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Research Question Identified Facilitators
3. What are the obstacles in providing an effective VR?
▪ TBIs among AI/NA have serious consequences for patients, their family, and health-care delivery systems.
▪Number of hospital days with TBI▪Lost of quality of life▪Physical, cognitive, and psychosocial impairments that require long-term rehabilitation therapy.
▪Local medical services and rehabilitation service are limited/distance▪Transportation to and from treatment centers are limited▪Lack of TBI knowledge of the people and providers▪TBI hospitalizations among AI/AN might be underreported because of use of non-IHS or tribal facilities ▪Medicare, Medicaid, or private insurance might not cover▪Access to advanced emergency medical care due to rural areas – limit the chances of survival▪Risk taking behaviors (not all is seen or reported)▪Alcohol and Drug/substance abuse (meth)▪Suicide
RESULTS (continued)
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Translations/Recommendations for Future Research Leaders
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Strategies Translations/Recommendations
▪ Understand of Neuroplasticity
•The influence with sensory development and learning to reformat and reestablish neural pathways. Learn alternative functions & operations.
▪Education of family and friends on TBI and recovery procedures.
•Provide training to understand what TBI is and how to cope with training and rehabilitation at home on a daily basis.
Translations/Recommendations for Future Research Leaders
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Strategies Translations/Recommendations
▪ Understand of TBI •Further research is needed to formally examine the success
▪Preventive Measures •Alcohol /Substance Abuse•Suicide
▪Examine sensory development processes
•Central nervous system compensation linked to improved rehabilitation •(triggers compensatory neural plasticity)
Knowledge Translation Resources & Deliverables
TBI Research
Catroppa, C., Anderson, V. A., Morse, S. A., Haritou, F., & Rosenfeld, J. V. (2008). Outcome and Predictors of Functional Recovery 5 Years Following Pediatric Traumatic Brain Injury (TBI). Journal Of Pediatric Psychology, 33(7), 707-718. doi:10.1093/jpepsy/jsn006
Dillahunt-Aspillaga, C., Smith, T. J., Hanson, A., Ehlke, S., Stergiou-Kita, M., Dixon, C. G., & Quichocho, D. (2015). Exploring vocational evaluation practices following traumatic brain injury. Behavioural Neurology, doi:10.1155/2015/924027
Fuentes, M. M., Jimenez, N., Apkon, S. D., & Ravara, F. P. (2016). Functional outcomes during inpatient rehabilitation of American Indian and Alaska Native children with traumatic brain injury. Journal of Pediatric Rehabilitation Medicine. DOI: 10.3223/PRM-160376.
Peach, R. K. (2013). The cognitive basis for sentence planning difficulties in discourse after traumatic brain injury. American Journal Of Speech-Language Pathology, (2), 285. doi:10.1044/1058-0360(2013/12-0081)
Traumatic Brain Injury Among American Indians/Alaska Natives — United States, 1992–1996. (2002). Morbidity and Mortality Weekly Report, (14), 303.
Whitfield, H. W., & Lloyd, R. (2008). American Indians/Native Alaskans with Traumatic Brain Injury: Examining the Impairments of Traumatic Brain Injury, Disparities in Service Provision, and Employment Outcomes. Rehabilitation Counseling Bulletin, 51(3), 190-
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
References (continued)
Brain Injury Research
Finnanger, T. G., Olsen, A., Skandsen, T., Lydersen, S., Vik, A., Evensen, K. I., & ... Indredavik, M. S. (2015). Life after adolescent and adult moderate and severe traumatic brain injury: self-reported executive, emotional, and behaviouralfunction 2-5 years after injury. Behavioural Neurology, doi:10.1155/2015/329241
Hsieh, T., Kang, J., Lai, J., Huang, Y., Rotenberg, A., Chen, K., & ... Peng, C. (2017). Relationship of mechanical impact magnitude to neurologic dysfunction severity in a rat traumatic brain injury model. Plos ONE, 12(5), 1-18. doi:10.1371/journal.pone.0178186
Massenburg, B. B., Veetil, D. K., Raykar, N. P., Agrawal, A., Roy, N., & Gerdin, M. (2017). A systematic review of quantitative research on traumatic brain injury in India. Neurology India, 65(2), 305-314. doi:10.4103/neuroindia.NI_719_16
McInnes, K., Friesen, C. L., MacKenzie, D. E., Westwood, D. A., & Boe, S. G. (2017). Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. Plos ONE, 12(4), 1-19. doi:10.1371/journal.pone.0174847
Patel, A., Vieira, M. C., Abraham, J., Reid, N., Tran, T., Tomecsek, K., & ... Staton, C. A. (2016). Quality of the Development of Traumatic Brain Injury Clinical Practice Guidelines: A Systematic Review. Plos ONE, 11(9), 1-17. doi:10.1371/journal.pone.0161554
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
References (continued)
LU-RRTC State-of-the-Science Conference September 28-29, 2017, Atlanta Georgia
Brain Injury Research
Roy, A., Bernier, R. A., Wang, J., Benson, M., Jr.French, J. J., Good, D. C., & Hillary, F. G. (2017). The evolution of cost-efficiency in neural networks during recovery from traumatic brain injury. Plos ONE, 12(4), 1-26. doi:10.1371/journal.pone.0170541
Wilson, N. M., Gurney, M. E., Dietrich, W. D., & Atkins, C. M. (2017). Therapeutic benefits of phosphodiesterase 4B inhibition after traumatic brain injury. Plos ONE, 12(5), 1-30. doi:10.1371/journal.pone.0178013
von Steinbüchel, N., Real, R. L., Sasse, N., Wilson, L., Otto, C., Mullins, R., & ... Gibbons, H. (2017). German validation of Quality of Life after Brain Injury (QOLIBRI) assessment and associated factors. Plos ONE, 12(5), 1-22. doi:10.1371/journal.pone.0176668
FUNDING AGENCY ACKNOWLEDGEMENT
The contents of this presentation were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RT5024-01-00). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this presentation do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.
Contact Information
Rehabilitation Research and Training Center (RRTC)
On Research and Capacity Building for Minority Entities
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