Heads up on Brain Injury assessments Jackie Burt BA Hons. CQSW Social worker, Case manager

 Why are cases complicated?  What are the pitfalls and possibilities for assessment? What is so special about brain injury?

 Traumatic [TBI] or Acquired Brain Injury [ABI] can affect one specific area  But very often the whole brain is affected with diffuse damage across all areas Brain injury can happen to anyone

The brain

Areas of the Brain Explained

 RTA - [ TBI]  Don - motorbike accident, working man, husband, father.  Rob- 20 years, out clubbing, hit by fire engine.  Both suffered frontal and cerebellar damage  D was able to claim compensation  R was not Causes and Case Studies

 Dee, existing MH problems, jumped from a bridge.  Scott, fell from bridge on a night out.  Both suffered physical and cognitive damage.  D’s pre-existing problems led to added stress for carers. Conflict for social work over who is responsible for after care. Falls

 Mike – carbon monoxide poisoning  Brian – heart attack,  Global brain damage, diffuse difficulties.  Memory badly affected.  Families of both struggle to cope.  M > compensation  B > not applicable Anoxia

 Gary – 23 years – haemorrhage.  Jim – 25 years -stroke following IV drug use  Both left with communication difficulties  G > no speech and unable to read.  J > pre existing drug dependency.  Both > anger, frustration  Both received inappropriate support following SSD assessment. Haemorrhage /Stroke

 Steve, beaten with baseball bat by drug gang  Pete - beaten by gang, mistaken identity  Both > major frontal lobe damage, reduced insight. No physical damage.  Both > very vulnerable and at risk.  Pete had help to apply for Criminal Injuries Compensation Assault

 N – RTA aged 3  L -- Swallowed adult medication aged 3  Children's brains have plasticity and can develop different neural pathways but often at the expense of other skills  But often long term problems exist which may not be obviously associated.  [ see research on prison population etc] ABI in childhood

 Cognitive changes.  Poor memory  Poor concentration  Slower information processing.  Difficulty with writing, reading.  Impaired understanding / ability to think logically.  Fatigue What’s the damage? And how does this affect assessment?

 The frontal lobes are the gatekeeper of the brain. Damage ---  Lack of forethought / consequences.  Altered behaviour,irritability, anxiety  Lack of self restraint, disinhibition, inappropriate comments/ actions / humour  Impulsive behaviour. Personality /Emotional changes

 Unrealistic ideas of their own abilities and difficulties.  Reduced understanding of the needs of others.  “ Damage to the frontal lobes is similar to how an 11 year old might function.ie OK until there is a need to problem solve and live within boundaries” Reduced insight

 Not reading notes and reports prior to assessment.  Relying on account of person with ABI[ client]  Not appreciating extent of impairment,especially if client lacks insight.  Pretending to understand when communication is affected  Assuming that when someone can’t speak that they can’t understand. Assessments - Common mistakes

 Expecting to achieve full assessment in one or even two meetings [ many people with ABI can only concentrate for 10 – 20 minutes]  Assuming that reasoning will bring about changes in behaviour.  Expecting that 6 week programme of generic enabling will effect change.  Someone with a brain injury may not be able to manage Direct Payments or to retain support staff. Common mistakes cont.

 Check any notes [ not always easy with electronic recording]  Involve family/ significant others if appropriate.  Recognise that assessments could be more time consuming  Brain injury is NOT the same as a learning disability Help ?

 Many people with ABI have Case Managers, work with them to assess.  Many pw ABI will have lawyers / legal support.  These people have a wealth of knowledge and can assist with finances at all stages of Brain Injury.  Consider encouraging clients/families to seek legal advice. [CICA]

 The current climate brings added pressures to Social Services departments.  Many authorities now prefer generic working instead of specialist.  ABI can bring with it particular difficulties for the pw ABI and those around them.  Many of these no longer meet the remit for help from SSD. Pressures

 But there are people who can help and advise and support.  Eg -Headway [ see website ] – excellent advice for professionals, see also their list of law firms  BISWG see website  UKABIF, see website  INSWABI see HELP !

 And of course BIRT who have developed BINI a tool to assist with what is arguably the most important first step on the road to maximising potential for people with ABI. A GOOD ASSESSMENT !! Brain Injury Rehab Trust