Dr. Marie Goss. NORTH SOUTH BRAIN INJURY CONFERENCE SEPT 2006 BRAIN INJURY SUPPORT SERVICE South and East Belfast Health and Social Services Trust Dr. Marie Goss. NORTH SOUTH BRAIN INJURY CONFERENCE SEPT 2006

BRAIN INJURY SUPPORT SERVICE MAINE NEUROBEHAVIOURAL UNIT MOURNE DAY SUPPORT UNIT COMMUNITY BRAIN INJURY SERVICE

CORE ISSUES IN SERVICE PROVISION UNIQUE SERVICES IN N.I. CONTEXT WORK WITH PEOPLE WITH COMPLEX NEEDS FOCUS IS ON PROVISION OF A THERAPEUTIC APPROACH MINIMISING RISK, DEVELOPING SKILLS, COMPENSATING FOR DISABILITY THROUGH CHANGES WITHN THE CLIENT AND THE ENVIRONMENT, MAXIMISING QUALITY OF LIFE

Challenging Behaviours can be short lived in early recovery ongoing/interfere with rehabilitation long term - limit/prevent community reintegration - cause major challenges to those providing care and support

CAN PREVENT SUCCESSFUL COMMUNITY REINTEGRATION POST BRAIN INJURY IMPACT OF SOCIAL AND EMOTIONAL AND BEHAVIOURAL PROBLEMS ARISING POST BRAIN INJURY CAN PREVENT SUCCESSFUL COMMUNITY REINTEGRATION POST BRAIN INJURY CAN PREVENT ACCESS TO SERVICES eg REHABILITATION, VOCATIONAL TRAINING, DAY CARE, SUPPORTED HOUSING, RESPITE. CONTRIBUTE TO FAMILY/CARER STRESS ADVERSLY AFFECT FAMILY COPING AND ADAPTATION

Maine neurobehavioural unit Post acute rehabilitation slow stream rehabilitation long term care day care respite care crisis intervention

MAINE NEUROBEHAVIOURAL UNIT ADMISSION CRITERIA Male , 17 - 65 years, ABI. Requires specialist inpatient assessment . Difficult to manage in other settings due to challenging behaviour. Risk to self or others. Requires a rehab programme focussing on social, emotional and behavioural functioning. Does not require secure provision.

MAINE NEUROBEHAVIOURAL UNIT SOURCE OF REFERRALS Neurosurgery Acute hospital settings Neurorehabilitation settings Mental Health services Acute Psychiatric units Residential facilities Home Social services

Post Acute Rehabilitation Risk Management MAINE NEURO BEHAVIOURAL UNIT FOCUS OF INTERVENTION GOALS Post Acute Rehabilitation Risk Management Skills Development Discharge to Neuro Rehabilitation in-patient or community setting Slow Stream Rehabilitation Behavioural Management Discharge to home/ supported living. Care in a less restrictive setting. Long Term Care Skills Maintenance Minimise risk. Maximise and maintain optimal levels of functioning. Maximise quality of life. Care in a specialist care setting.

Multidisciplinary team Nursing Nursing assistants Occupational therapy Social work Clinical neuropsychology Medical (Neuropsychiatry, G.P) [Physiotherapy, Speech and Language therapy] [Artscare, artist,musician,dance]

MOURNE DAY PROJECT TARGET GROUP Adults who present with significant social dysfunction after brain injury Those who require highly individualised treatment/rehabilitation and care plans to enable and maintain community participation and reintegration. Those whose needs cannot be met in mainstream settings, due to risks associated with behaviour and who require a high staff /client ratio.

MOURNE DAY SUPPORT UNIT referral criteria Male or female, 18 – 65 years,ABI. Resident within the community Requires specialist assessment Requires a rehabilitation programme in a specialist setting focussing on social emotional and behavioural functioning Requires specialist support to maintain functioning and enable community participation Difficult to manage in other settings due to challenging behaviour Requires a high level of staff support and supervision

MOURNE DAY PROJECT SOURCE OF REFERRALS Community brain injury teams / EHSSB Social services Mental health services G.P.s Regional Acquired Brain Injury Unit

etc MOURNE DAY PROJECT ASSESSMENT OUTCOME GOALS Risk Community ADL FOCUS OF INTERVENTION OUTCOME GOALS ASSESSMENT Risk Community ADL Physical Mental state Cognitive skills etc To contribute to the development of a comprehensive treatment /care /support plan REHABILITATION Risk Management Skills training Behavioural treatment To facilitate community reintegration SUPPORT /RESPITE Skills Maintenance Engagment in meaningful activity Enable social participation Minimise risk. Maintain optimal levels of functioning. Maximise quality of life. Reduce caregiver stress. maintain community living.

MOURNE DAY PROJECT STAFFING Unit Manager Senior Day care Worker Day Care Workers Administrative Staff Neuropsychologist Psychology Assistants Occupational Therapist

MAINE NEUROBEHAVIOURAL UNIT & MOURNE DAY PROJECT ASSESSMENT eg.Cognitive,behavioural, ADL social skills, communication, risk assessment REHABILIATATION / TREATMENT DEVELOPMENT OF NEW SKILLS MAINTENANCE OF EXISTING SKILLS SUPPORT TO ENABLE SOCIAL PARTICIPATION CRISIS INTERVENTION RESPITE CARE

ASSESSMENT Level of ADL functioning Behaviour Cognition Social functioning Emotional functioning Mental State RISK NEEDS ( future support )

Difficulties resulting from : FORMULATION Difficulties resulting from : physical impairment sensory impairment medical condition cognitive capacity eg.attention, understanding, judgement mental disorder eg perception, ideation,moodstate psychological reaction

INTERVENTION Skilled Staff observation and assessment skills communication & interpersonal skills prompting, feedback Structured Day Activities/routines Environmental Management level of stimulation cues

INTERVENTION Risk management Skills training, e.g., planning skills, social skills Therapies Occupational therapy Speech and Language therapy Physiotherapy Treatments pharmacology behavioural therapy CBT