THE BIO-PSYCHO-SOCIAL EFFECT OF REHABILITATION OF INDIVIDUALS WITH ACQUIRED BRAIN INJURY MEDIATED BY

COORDINATED INTERVENTIONS

ECP 2013 IN STOCKHOLM

C H A L O T T E G L I N T B O R G , C G L @ H U M . A A U . D KA N E S Ø N D E R G A A R D T H O M S E N , A N E S T @ H U M . A A U . D K

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• Background• Timef ra ime• The program eva lua ted• Th is s tudy

• Research des ign – quant i t a t i ve e f fec t s tudy• Organ iza t i ona l eva lua t ion

• Ar t i cu la ted log ic beh ind in te rven t ions• Ha l fway / p re l im inary resu l ts

Agenda

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

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• In 2010 19 .543 Danes acqu i red a b ra in i n j u ry (ABI )• Approx . 125 .000 peop le in Denmark l i ve w i th an ABI

• In Denmark there i s no research on the coord ina t ion o f b ra in in ju ry in te rven t ions a t the mun ic ipa l l eve l o r the e f fec ts o f ear l y, f ocused and coheren t rehab i l i t a t i on

• Being ab le to o f fe r an ev idence-based i n te rven t ion w i l l have a huge p rac t i ca l impac t on peop le su f fe r ing f rom ABI as we l l as economic bene f i t s i n the mun ic ipa l p rov id ing the serv i ces . An eva lua t ion o f p rac t i ce ass is t s admin is t ra to rs in mak ing p rogram- leve l dec is ions

Background

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

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Timefraime

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

2012 2013 2014 2015

Project start

Program theory(august)

Organizational halfway status (april)

Implementation(april)

Pretest Posttest

Organizational posttest

Project end

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• Heigh ten ing the leve l o f the neuro sc ien t i f i c knowledge

• Coord ina t i on in terna l l y a t the mun ic ipa l l eve l (es tab l i sh a coord ina t ion cente r and new ways o f work ing toge ther )

• In te rd i sc ip l i na ry coord ina t ion o f p rocesses ac ross the p r imary and secondary sec to rs

• Uni ted e f fo r ts ( j o in t ou tcome measures , tes ts and rehab i l i ta t i on p lans)

The program evaluated

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

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2 in tegra ted p ro jec ts :

a) An e f fec t s tudy o f the coord ina ted in terven t ions (CI ) on adu l t i nd iv i dua l s su f fe r i ng f rom ABI and the i r f ami l i es

b) An o rgan iza t iona l s tudy o f the co l labora t i ve e f fo r ts and o rgan i za t iona l change

This study

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

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Mixed method des ign :

• Mul t ip le measures f rom more than one source

• A pre- and pos t tes t qua l i t a t i ve s tudy i s conduc ted focus ing on bo th the emp loyee sa t i s fac t ion and the c i t i zens own perspec t i ve on the rehab i l i ta t i on p rocess

• A quant i ta t i ve s tudy measures the e f fec t be fo re and a f te r imp lement ing coord ina ted rehab i l i ta t i on regard ing

• Dura t i on o f rehab i l i t a t i on• Leve l o f se l f - re l i ance a f te r rehab i l i t a t i on• Retu rn to work

This study - continued

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

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Cont ro l g roup 2011

In te rven t ion g roup 2013

Research design – quantitative effect study

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

N=110 (55 Adult ABI survivors,

55 relatives)

TAU N=?

N=200 (100 Adult ABI survivors,

100 relatives)

CI N=?

9D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

Aalborg

Control 2011BNC, pretest

N=55

Intervention: TAU (treatment as usual)

2013, posttest N=55

2013BNC, pretest

N=60

Intervention: CI(coordinated

intervention, type 1)

2014, posttest N=?

Jammerbugt(control)

2013BNC, pretest

N=15-20

Intervention: CI(coordinated

intervention, type 2)

2014, posttest N=?

Vesthimmerland(control)

2013BNC, pretest

N=5-10

Intervention: CI(coordinated

intervention, type 3)

2014, posttest N=?

Brønderslev(control)

2013BNC, pretest

N=10-20

Intervention: CI(coordinated

intervention, type 4)

2014, posttest N=?

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• Qua l i t y o f L i fe (WHOQOL)• Depress ion (MDI )• Func t iona l i ndependence (F IM)• Par t i c ipa t ion and au tonomy ( IPAQ)

Test measures

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

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• Gather i n fo rmat ion to he lp peop le improve the i r e f fec t i venes and to ass is t admin is t ra to rs to make program- leve l dec is i ons

• Cont r i bu te to the p rov is ion o f qua l i t y se rv i ce to peop le in need

Organizational evaluation

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

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• Focus on bo th p roces and resu l t /e f f ec t• I nvo l ve s takeho lde rs

• Deve lop the i r p rog ram theor ies (mode l , concep tua l f ramework l i nk ing the i n te rven t i ons t o t he p ro jec ted ou tcomes , a r t i cu la ted l og i c o f p rog rams)

• Use t ha t theory o r mode l t o choose t he c r i t e r i a wh ich a re to be measured and tha t w i l l i nd i ca te succes fu l l imp lementa t i on and des i rab le ou tcomes

• Detec t imp laus ib le assumpt ions• Iden t i f y the i n te rmed ia te resu l t s ra the r yhan j us t t he f i na l

ou tcome

Organizational evaluation - continued

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

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Articulated logic

D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

Koordinationscenter

En indgang for borgeren

”kustodefunktion”, hjælp

Øget tilfredshed hos borgeren

Ro til at koncentrere sig om

rehabilitering

Intern koordinering hos fagpersoner

Bliver kendt i organisationen

Bryder mure ned

Effektiv sagsbehandling

Bedre økonomi

Ensartede tilbud

Øget tilfredshed hos borgerne

Vidensdeling (eksterne til

interne)

Lettere sektorovergange

Tryghd for eksterne samarbejdspartner

e

Uddannelsesaktivitet

Udpeg nøglepersoner

Lettere at spotte behov

Bedre visitering (til koordinationscenter

)

Højere vidensniveau

1 4D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

Joint objectives Uniform line of direction

Joint use of instruments

Meet the citiczens with one united

package of instruments

Continuous sequence of steps

Easier to involve the citizen

Frees resources from repeated tasks

Efficient service

Better refferals

Purposive use of resources

Possiblity of joint accumulation of

experiences

Identify indicators of rehabilitation-

potential

Easier knowledge transfer

A gradual transision across the primary

and secondary sectors

Using the same language / Joint understanding

Understand one another

Easier and better co-operation

Rapid decision making

Easier access for the citizen

Articulated logic - continued

Joint rehabilitation plans and tests

1 5D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y

Joint rehabilitation plans and tests

Joint objectives Uniform line of direction

Joint use of instruments

Meet the citiczens with one united

package of instruments

Continuous sequence of steps

Easier to involve the citizen

Frees resources from repeated tasks

Efficient service

Better refferals

Purposive use of resources

Possiblity of joint accumulation of

experiences

Identify indicators of rehabilitation-

potential

Easier knowledge transfer

A gradual transision across the primary

and secondary sectors

Using the same language / Joint understanding

Understand one another

Easier and better co-operation

Rapid decision making

Easier access for the citizen

Halfway evaluation

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Questions?