1. Mayo Brain Injury Outpatient Program: Methods and Outcomes James F. Malec, PhD Professor, Professor, Mayo Clinic and Medical School Rochester, MN USA

2. Comprehensive-Integrated Postacute Brain Injury Rehabilitation n A cognitive and behavioral approach n Interdisciplinary team n Emphasis on self-awareness, adjustment, compensation and social skills n Low staff-to-patient ratio n Family involvement n Vocational and independent living trials n Systematic outcome assessment

3. Mayo Brain Injury Outpatient Program Patient Characteristics n Limited self-awareness of disabilities n Cognitive impairments: e.g., concentration, memory, generalization, problem-solving, initiation, reasoning, planning n Poor communication and social skills n Limited emotional/behavioral self-control n Unemployed or failing in employment n Not a danger to self or others

4. Mayo Brain Injury Outpatient Program Goals Improved n Self-awareness of strengths and weaknesses n Coping and compensation n Personal organization n Social skills and effectiveness n Emotional and behavioral self-management n Social, work, and leisure participation n Health maintenance

5. Mayo Brain Injury Outpatient Program Staff n Neuropsychologist n Physiatrist n Rehabilitation nurse n Social worker n Occupational therapist n Speech pathologist n Physical therapist n Recreation therapist n Vocational counselor

6. Mayo Brain Injury Outpatient Program Groups Daily n Orientation n Cognitive n Social Awareness n Communication n Life Skills Weekly n Health Education n Vocational Monthly n Patient/Family Group

7. Mayo Brain Injury Outpatient Program Methods n Group treatment u Peer feedback to increase self-awareness of deficits u Peer support to reduce distress and denial u Peer interactions to practice social skills and emotional coping skills u Failure of 1:1 therapy to address these issues effectively

8. Mayo Brain Injury Outpatient Program Methods n Attention process training n Systematized memory notebook n Problem-solving format n Cues and prompts n Assertiveness training n Pragmatic communication skill training n Supported feedback (peer, staff, videotape)

9. Mayo Brain Injury Outpatient Program Methods n Guided self-discovery n Supported risk-taking n Supported work/independent living trials n Training in community resource use n Consistent team approach n Family/significant other involvement

10. 96 Program Graduates n Sex: 73% Male 27% Female n Age: Mean = 34.2 y Median = 32 y Range = 18-69 y n Education: < 12 or spec ed = 16% 12-15 = 62% 16+ = 22% n Time Since Injury: Mean = 4.6 y Median = 1.5 y 38% within 1 year n Type of Injury: TBI = 72% CVA = 19% Other = 9% n Severity of Injury: Mild = 7% Moderate = 7% Severe = 82% Undetermined = 4%

11. Independent Living Status

12. Percent Living Independently by Time Since Injury

13. Program Outcomes Vocational Independence Scale n Competitive: Community-based work (at least 15 hours per week) without external supports. n Transitional: Community-based work (at least 15 hours per week) with temporary supports, such as, job coach, reduced hours OR enrollment in an educational or training program. n Supported: Community-based work with permanent supports or less than 15 hours per week OR volunteer work. n Sheltered: Work in a sheltered workshop. n Unemployed

14. Vocational Independence

15. Percent in Community-Based Employment by Time Since Injury

16. Program Outcomes Mayo-Portland Adaptability Inventory n Mobility n Use of hands n Audition n Vision n Motor speech n Pain n Communication n Memory n Attention/concentration n Novel problem solving n Visuospatial abilities n Fund of information n Irritability/aggression n Anxiety to agitation n Depression n Residence n Self cares n Work/school n Leisure activities n Driving n Family/significant relationships n Social contact n Appropriate social interaction n Indifference n Delusions and hallucinations n Paranoia n Initiation n Law violations n Alcohol use n Drug use

17. Program Outcomes (62 grads) Mayo-Portland Adaptability Inventory

18. Program Outcomes (96 grads) Goal Attainment Scaling

19. Other Program Information n Median Length of Stay = 190 days n Average Length of Stay = 191 days n Dropout Rate = 17%