Presented By: Amy Karas, MS, CCC-SLP Janet McBride-Roy, CTRS Community Rehab Care, Inc. March 27, 2014

Definition Characteristics Types Co-Morbitities: Intellectual functioning Past medical history Learning style Mental health Substance abuse Statistics

Cognitive Communication Social Pragmatics Emotional Behavioral Physical

Impulsivity Poor decision making Inability to advocate for self Social isolation Feelings of hopelessness or disinterest Withdrawal from interests Changes to relationships Modifications or inability to work Modifications or inability to drive NEED FOR CASE MANAGEMENT!

Ability to develop a therapeutic relationship Understanding of client skills, challenges and barriers to progress Recognition of change and ability to adjust and adapt to needs Flexible thinking Ability to advocate for client and with client/family as needed Knowledge of your limits and when to seek assistance

Trust Honesty Patience Ability to listen Compassion Providing support documentation/literature Integration of strategies Determine best mode of communication Follow through Frequency of check-ins

Interview Demographics Diagnosis/ Present illness Past Medical History Social/Vocational History Legal Status/Guardian Medical Providers/ Insurance Financial Resources Client/Family goals Daily Structure Behaviors/Mental health Physical Abilities/Safety Risk Cognitive Skills Communication Skills Recommendations

Family Friends Medical/ rehab providers Case management - ongoing Counseling Support groups (Survivor, Care Giver, AA/ NA) Local community resources/supports Money/insurance/rep payees PCA/home health aides/home makers

Premobid living environment New apartment (elderly/disabled housing, subsidized) Rooming/boarding house Friends apartment Shelter/streets Sober house Skilled nursing facility Assisted living facility Adult Foster Care Rest Home Residential/group home Set back/modifications/improvements

Refer back to assessment. Create an open dialogue. Request input from client caregivers, family and other close providers. Identify key team members and roles. Create short and long term goals that are client – centered. S.M.A.R.T. Goals: S = Specific M = Measurable A = Attainable R = Realistic T = Timely / Tangible 10

Ongoing training and communication needs Type of brain injury Functions of the brain Signs and symptoms Living with brain injury Specific strengths and weaknesses Accommodations/ modifications/ strategies Identify Red Flags

Calendar: track appointments, orient to day/date Smart Phone: track appointments, set alarms, take notes, memory log Notebooks: track appointments, phone log, transportation needs, things to do, medical timelines Establishing Routines: increase organization (sorting mail, filing paperwork), increase involvement (meal prep, ALDs, IADLs) Phone Log: expressing needs, recording information, for follow up, returning calls Internet: set up banking, explore resources, job hunt, self advocacy and collaboration on goals

Involve others to assist with sharing information Offer opportunities to provide education and training How to communicate and share information accurately? Establish best modality: verbal or written Determine amount of assistance needed Establish frequency of contact and how to maintain

Establish systems for medical appointments -Determine amount of assistance with preparing for appointments -Develop written template -Rehearse script prior to appointment -Identify what to bring (medical timeline, notebook, tape recorder, etc.) -Communicate with medical team prior to appointment -Attend together How feedback will be provided after appointments -Who calls who after appointment (you, client, medical provider) -Establish systems for processing & fine tuning systems

Donald T. Stuss and Robert T. Knight. Principles of Frontal Lobe Function (Oxford University Press, 2002).