Community Reentry Training for Individuals with Traumatic Brain Injury

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Community Reentry Training for Individuals with
Traumatic Brain Injury

• Increasing community access and improving
  outcomes following discharge

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The NeuroRehabilitation Center at Middleboro

• NRC at Middleboro is a 121 bed long term care
  facility that specializes in the care of patients
  with subacute acquired brain injuries.
• The facility is located in a rural area with
  limited access to public transportation and in a
  community with limited agency support for
  individuals with disabilities

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The Community Reentry Group

• A program designed to
• Provide training to individuals with a discharge
  plan to return home following an extended period
  of rehabilitation and
• To increase community access for individuals
  without a discharge plan.

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Identify Target Population

• Patients referred from known rehab caseload and
  also from other interdisciplinary team members
  including nursing, social services, physicians,
  families, and neurobehavioral department.
• Patients either had a discharge plan to go home
  or were long term residents who had the potential
  to access the community with support

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• SLP/OT performed initial evaluation
• Level of cognitive-communication abilities were
  determined including skill levels in
  organization, planning, memory, reasoning and
  problem solving
• Standardized test measures were used in
  conjunction with evaluation of progress made
  toward therapeutic goals
• Community Mobility was assessed as needed by
  Physical Therapy
• A group of 6 residents were chosen to participate
  in the initial retraining program

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Procedure

• Short term objectives systematically targeted in
  biweekly meetings, co-led by SLP and OT, aimed at
  planning and preparation for community outings
• First groups were focused on researching
  community resources and determining accessibility

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• A series of outings were outlined based on
  patients preferences
• Preferences included movies, restaurants,
  shopping malls, WalMart, and local zoos and
  museums.

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• During weekly group meetings patients planned
  for
• Locale
• Budget
• Time constraints and scheduling
• Transportation
• Meals
• Medication needs
• Caregiver notification

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Cognitive-Communication Skills Targeted

• Organization and planning
• Money management
• Short term memory
• Compensation for deficits
• Reasoning and Judgement
• Community Mobility

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Example Objectives for Restaurant Outing

• Client will
• state obstacles to visiting a restaurant
• categorize area restaurants by type, price and
  location
• determine budget for lunch time meal w/review of
  menus
• create a timeline for outing
• w/rehearsal make a reservation via telephone
• recall planned day/time of outing w/written cues

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• notify caregivers and make accomodations for
  medications w/assistance
• arrive in appropriate clothing at scheduled time
  for outing
• demonstrate mobility outdoors
• determine and place appropriate order from menu
  within budget guidelines
• demonstrate socially appropriate behavior in
  community setting
• monitor time planned for outing

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Obstacles

• Transportation
• Solutions
• GATRA
• COA Dial-a-ride
• Facility Van
• Hired Wheelchair Transportation

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• Funding
• Solutions
• Personal Needs Accounts
• Family Council
• Fundraisers
• Coffee Shop

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Coffee Shop

• The Coffee Shop
• Originated as a fundraising idea for Community
  Reentry Group to support community reintegration
• Created a kiosk in the main lobby of our facility
  with generous funds from the Family Council
• Established a contract with Green Mountain to
  obtain equipment and supplies
• Visited with local bankers to establish a
  checking account, tax ID number and official
  business name
• Staffed and run by residents with SLP/OT who are
  in training in the afternoon and by residents who
  are independent in the morning
• Helped therapists address the following skills in
  a functional setting prior to entering the
  community
• Scheduling
• Categorization
• Following complex directions
• Independent time management
• Money management
• Check writing and banking
• Meal preparation
• Problem solving/sequencing/organization
• Social communication/pragmatic language
• Expressive language, word finding skills
• Receptive language

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Outcomes

• In the first group of 6 participants
• 2 patients achieved independent community access.
  They were able to plan weekly or biweekly
  outings to places visited while in the training
  program with funds raised through continued work
  at the Coffee Shop
• The remaining 4 residents continued to raise
  funds through work at the Coffee Shop and
  participated in Supervised outings on a monthly
  basis

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Evolution of the Program

• The Community Reentry Group and Coffee Shop have
  changed and expanded over the past few years and
  experienced positive growth.
• Many changes have occurred to the format of the
  group.
• Includes patients who may not be just returning
  home but plan to live with support (i.e assisted
  living, mentor homes, etc)
• New levels system to determine current
  independent training access
• PT involvement for more community mobility issues
• Patients now paying bills online, accessing
  internet for payment options, etc
• We have serviced well over 20 patients who have
  returned home or to community based living with
  good results after experiencing functionally
  based skill-set practice in a realistic
  environment. We look forward to continuing to
  grow and servicing patients to help them learn
  skills to independently access the community.

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Contact Information
KristenTucker MS CCC-SLP MGH Institute of Health
Professions Charlestown, Ma. 617-724-9769 ktucker_at_
mghihp.edu
Jaquelyn Thomson MS CCC-SLP NeuroRehabilitation
Center at Middleboro 508-947-9295 marquette96_at_comc
ast.net