Improving Community Integration after Traumatic

Brain Injury

Successful completion of this training meets one hour of the four hour annual training requirement for Personal Attendant Services direct care staff as

provided through the WV TBI Waiver Program

Disclaimer

Information included in this presentation was current at the time it was developed

Presentation materials are reviewed on an annual basis

12014 West Virginia TBI Waiver Program direct care staff annual training

Author

MELODEE A HURSEY, MSW, LSW, CBISTAPS HEALTHCARE, INC.TBI WAIVER PROGRAM PROVIDER EDUCATOR

Ms Hursey is a Certified Brain Injury Specialist Trainer through the Academy of Certified Brain Injury Specialists and a West Virginia Licensed Social Worker. She has more than 17 years of brain injury experience in a variety of areas including rehabilitation, waiver, support group facilitation, training, and program development.

CONTACT INFORMATION:

mhursey@apshealthcare.com

304-964-9007

22014 West Virginia TBI Waiver Program direct care staff annual training

Learning Objectives• Describe community integration in a comprehensive

way

• Describe two methods that can be used to help persons with brain injury return to their home and community

32014 West Virginia TBI Waiver Program direct care staff annual training

Overview of Traumatic Brain InjuryTraumatic Brain Injury (TBI) is

an insult to the brain not of a degenerative or congenital nature caused by an external physical force,

that may produce a diminished or altered state of consciousness resulting in an impairment of cognitive

abilities or physical functioning. It can also result in the disturbance of behavioral or emotional

functioning, may be temporary or permanent and cause partial or total functional disability or

psychosocial maladjustment.

National Head Injury Foundation

(now the Brain Injury Association of America)

42014 West Virginia TBI Waiver Program direct care staff annual training

Medicaid TBI Waiver Definition

A non-degenerative, non-congenital insult to the brain caused by an external physical force resulting in total or partial functional disability and/or psychosocial impairment

52014 West Virginia TBI Waiver Program direct care staff annual training

Overview of Traumatic Brain Injury

In 2010, about 2.5 million emergency department visits, hospitalizations, or deaths were associated with TBI—either alone or in combination with other injuries—in the United States

Centers for Disease Control and Prevention

62014 West Virginia TBI Waiver Program direct care staff annual training

Overview of Traumatic Brain Injury

• Falls were the leading cause of TBI-related ED visits for every age group

• Motor vehicle crashes were the leading cause of hospitalizations for adolescents and young adults ages 15-44 years

Centers for Disease Control and Prevention

72014 West Virginia TBI Waiver Program direct care staff annual training

Why the focus on Community Integration?

• Advances in acute care medicine means higher survival rates after TBI

• Changes in the health care climate means shorter rehabilitation stays or no rehabilitation at all

• People with TBI are being discharged with greater disability

• People are being cared for in the community

82014 West Virginia TBI Waiver Program direct care staff annual training

What is Community Integration?

The opportunity to live in the community and be valued for one's uniqueness and abilities, like

everyone else (Salzer, 2006)

92014 West Virginia TBI Waiver Program direct care staff annual training

What is Community Integration?

• Housing

• Employment

• Education

• Health Status

• Leisure/Recreation

• Spirituality/Religion

102014 West Virginia TBI Waiver Program direct care staff annual training

• Peer Support

• Valued Social Roles (e.g., marriage, parenting)

• Self-Determination

• Citizenship and Civic Engagement

What is Community Integration?

• Independence

• Relationships

• Meaningful activities to engage in

“. . . having something to do, somewhere to live, and someone to love” (Jacobs, 1993)

112014 West Virginia TBI Waiver Program direct care staff annual training

Decreased Role Functions After TBI

• High incidence of unemployment

• Decreased independence

• Financial

• Transportation

• Supervision

• Decision making

• Decreased social network size

• Decreased intimacy

• Decreased participation in leisure activities

122014 West Virginia TBI Waiver Program direct care staff annual training

Successful Community Integration Is

• ACTIVE participation in a broad range of community involvement

• It is NOT a narrow series of opportunities such as employment or independent living

132014 West Virginia TBI Waiver Program direct care staff annual training

Important Roles in Our CultureOUR ROLES ARE SYMBOLS OF NORMALITY AND ALLOW US TO FEEL PART OF THE LARGER COMMUNITY. THESE MIGHT INCLUDE:

• Work

• Love

• Play (leisure and creative)

142014 West Virginia TBI Waiver Program direct care staff annual training

Social and Emotional Impact of TBI

• Decreased social network size and loss of pre-injury friendships

• Loneliness

• Family often becomes the primary source of social and leisure activity

• Close relationships with others is a key component of community integration

• Decrease in these relationships is most often listed as the reason for a lack of integration

152014 West Virginia TBI Waiver Program direct care staff annual training

Read this articleCLICK THE LINK BELOW TO GO TO THE CARRICK BRAIN

CENTER BLOG

HOW TO HELP TBI SUFFERERS NAVIGATE SOCIAL AND LEISURE ACTIVITIES AFTER INJURY

162014 West Virginia TBI Waiver Program direct care staff annual training

Approaches to Successful Community Integration

• Take a comprehensive view of community integration• What are the priorities, values, and interests of the person• Include social and leisure interests

• Focus on personal choice & empowerment• What the member does in the community is for THEM not

you• Emphasize sustainability beyond the waiver program

• Support the person making new connections and friendships that will continue even if they are not in the waiver program

• Emphasize changing the environment to maximize integration• This includes the home AND the community

172014 West Virginia TBI Waiver Program direct care staff annual training

Improving Community Integration• Increase family and community awareness of

community integration and brain injury

• Develop and use peer support programs

• Social activities

• Workplace

• Partner with community organizations to increase understanding of TBI

182014 West Virginia TBI Waiver Program direct care staff annual training

Training Family Members as Paraprofessionals

• Family members often become the sole source of support after a TBI

• Family members have first-hand knowledge of functional needs and environmental obstacles

• Consistent carryover means a greater opportunity for successful integration

192014 West Virginia TBI Waiver Program direct care staff annual training

Rosemary and Hugh Rawlins’ life was turned upside down on April 13, 2002, when Hugh was hit by a car while riding his bicycle.

Click on the link to one of Rosemary’s blog entries on brainline.org to see how this family is a resource in community integration.

http://www.brainline.org/content/2013/09/pebbles-of-progress.html

Families as a Resource

202014 West Virginia TBI Waiver Program direct care staff annual training

• Differs from traditional peer mentor programs

• Primary purpose is to EXPAND the social network rather than to provide other types of assistance (e.g., providing education about TBI resources, support in adjustment to disability, etc.)

Social Peer Mentors

212014 West Virginia TBI Waiver Program direct care staff annual training

• A friend• A role model• A resource• Committed to making consistent, regular contact

NOT . . .

• A romantic partner• Respite care or “sitter”• A credit card or ATM• A therapist• Judge, moralist, or savior

A Social Peer Mentor is . . .

222014 West Virginia TBI Waiver Program direct care staff annual training

• Community integration should • be defined in a comprehensive way• address all aspects that are important to the

person • Partner with organizations in the community

• to increase integration• develop meaning for persons with injury

• Focus on increasing sustainability beyond the waiver program• Train/support

• Family members• Social peer mentors

Summary

232014 West Virginia TBI Waiver Program direct care staff annual training

Additional Resources and ReadingsYOU MAY WANT TO EXPLORE ADDITIONAL RESOURCES TO EXPAND YOUR KNOWLEDGE BASE AND JOB SKILLS*

Here are just a few:

• brainline.org

• Brain Injury Association of America

• Centers for Disease Control and Prevention: TBI

• National Directory of Brain Injury Services

• National Resource Center for Traumatic Brain Injury

• TBI Services at Center for Excellence in Disabilities

1-877-724-8244 TBI@hsc.wvu.edu

24

2014 West Virginia TBI Waiver Program direct care staff annual training

*If you are seeking formal training please check with your employer to make sure the internet training provider has been approved by APS Healthcare before you take the training

Next Steps• To receive your certificate of successful completion

you must first pass the test and complete an online evaluation

• A score of 70% or higher is required

• Once you have successfully completed this training module you will receive an email with your certificate of completion

• Click this link to go to the test:http://tbi.cedwvu.org/trainings/community-integration.php

252014 West Virginia TBI Waiver Program direct care staff annual training

Thank You for Your Thoughts

• Please click this link to go to the online evaluation http://tbi.cedwvu.org/trainings/community-integration.php

• Your thoughts and comments are very important to us

THANK YOU!

262014 West Virginia TBI Waiver Program direct care staff annual training