Samantha Grant - Arbias ABI Specialist Services - A Practical Guide to Supporting People with...
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Transcript of Samantha Grant - Arbias ABI Specialist Services - A Practical Guide to Supporting People with...
INTERACTIVE TRAINING - A PRACTICAL GUIDE TO SUPPORTING
PEOPLE WITH COGNITIVE AND BEHAVIOURAL IMPAIRMENTS AFTER
ACQUIRED BRAIN INJURY
Samantha Grant, arbias Ltd 2nd Annual National ABI Conference
Isn’t all training the same?
Why develop more training on ABI?
What is different about this training?
Was this training effective?
What made it that way?
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Why address challenging behaviours?
Prevalence of challenging behaviour among people with TBI known to rehabilitation services to be over 50% (Sabaz, 2012).
For people with TBI, challenging behaviour is a major contributor to poor outcomes - ↓ participation, ↑levels of care and support need and demand on services, and ↓ levels of unmet need (Sabaz, 2012).
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Why address challenging behaviours?
A study of disability workers in Victoria - high exposure to challenging behaviour either directed at themselves or another (Koritsas, Iacono, Carling-Jenkins, & Chan, 2010).
2/3 - exposure to physical aggression resulting in injury
Up to 97% reported being exposed to other categories of challenging behaviour such as non-compliance
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
So what could we do differently?
Address the lack of research on DSWs working with people with ABI
Evaluate the effectiveness of the workshop developed
Improve participants’ confidence and self-efficacy, knowledge and practice for working with ABI.
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
The formal training we offered
2 day training for attendant care workers (and others)
Delivered by an occupational therapist (Inbal Luft) and clinical psychologist (Samantha Grant)
Designed for small-medium groups (up to 20 people)
Intentionally practical to encourage people to learn and ‘think differently’
Comprehensive training manual (approx 60 pages) Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Training content
Day 1 Background to ABI, cognition, behaviour, rehab
team, types of assistance Common cognitive impairments and strategies
Day 2 Common behavioural impairments and strategies
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Training Tools
- Demonstrating a clear link between cognition and behaviour, and referring to this throughout the training
- Clear lists of common impairments and then strategies
- Practical activities that involved the participants actively engaging in support activities
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Training Tools
- Practical activities that challenged the participants own cognitive capacities
- Visual examples of the issues they face, i.e. videoes
- Opportunity to discuss relevant examples, and instant advice/feedback
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Examples of Training Tools
The next slides (11 – 25) are from the actual training slides and manual.
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
relationship between cognition and behaviour
Thoughts and feelings influence behaviour, e.g... Reduced initiation not starting or completing activities
Poor planning / problem solving impulsive behaviour, disinhibition, social /criminal issues, safety concerns / vulnerability
Good insight increased frustration, depression
Reduced insight increased risk taking / safety issues/ failure to achieve goals or succeed frustration
Poor memory repetition of information social issues
Cognitive communication issues frustration, irritability, aggression
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
why is it different to work with people with cognitive impairments?
Example 1 – “Needs assistance with preparing meals”
Could mean:
Physical Assistance
Prompting (verbal, written, gestural)
Set up of environment to provide cues
Supervision
Providing Feedback
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
why is it different to work with people with cognitive impairments?
Example 2 – “Needs assistance to complete personal care tasks (showering, dressing, grooming)”
Could mean: Physical Assistance
Prompting (verbal, written, gestural)
Set up of environment to provide cues
Supervision
Providing Feedback A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
example of team approach
Person with ABI
GOALS
Rehab Team (including
carers)
Person is more
independent = less need for CARE
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
planning and organisational difficulties
Strategies:
• Get organised
• Timetable / Routine
• Lists / Checklist (what’s next)
• Written Instructions / Structure / Systems
• Simplify
• Alarms
• Getting Ready
• Assistance and prompting
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
planning and organisational difficulties
Common Difficulties:
Planning activities / tasks Disorganised
Incomplete tasks
Incorrect sequencing Allowing enough time
Unstructured time Miss appointments / events at
scheduled time
Inappropriate clothing for weather
Community access difficulties (plan how to get somewhere)
Run out of food/medication
Poor multitasking Judgement / decision making
Budgeting /money management issues
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
rigid thinking / inflexibility
Common Difficulties:
Rigid / inflexible thinking
Fixated
Difficulty changing train of thought / perseveration
Can’t see other points of view
Find change challenging
Reasoning / Decision Making Issues
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
rigid thinking / inflexibility
Strategies:
• Don’t argue
• Acknowledge and redirect
• Manage Change
• Use clear, direct language
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
meaning of behaviour
Why do you do the things you do?
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
on the footy field
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
on stage
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
in the name of entertainment
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
reinforcement
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
impulsiveness / disinhibition / reduced self control
Common Difficulties:
Filtering system in brain doesn’t work
Act without thinking or can’t stop themselves
Say inappropriate things (may know it’s inappropriate but can’t stop themselves)
Safety issues
Social issues (may be partly pre-morbid)
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
impulsiveness / disinhibition / reduced self control
Examples:
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
“I think you’re really hot and would be great in bed”
impulsiveness / disinhibition / reduced self control
Strategies:
• STOP-THINK-DO
• Immediate feedback
• Praise / Reward
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
video: A18
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments after Acquired Brain Injury | © Arbias Pty Ltd 2012
So what did we find?
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
1. Help ACWs understand their clients
We achieved this through: Education about common impairments after ABI Teaching about the relationship between cognition
and behaviour Explaining what “person centered” means? (e.g.
ask clients what they want. Don’t assume they have been asked)
Reinforcing that people with ABI may not have the skills to do certain things (e.g. regulate their behaviour) due to cognitive and behavioural impairments
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Evidence of the need and impact: 1
ACWs and others may lack ‘basic’ knowledge: I used to think… the person understands or don’t… a sandwich short of a picnic… didn’t you get an education… now… you can’t just label them as dimwits… maybe you can help ‘em (P90)
Training addresses specific knowledge gaps:
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Cognitive Psychological / Behavioural Memory impairment Slowed info processing Difficulty with new learning Planning and organisation
Reduced insight/awareness Irritability / Agitation Aggression Depression Socially inappropriate behav.
2. Give ACWs new strategies to use
We achieved this by: Getting people to think about what strategies they use
Highlighting the concept of different types of assistance (not just physical)
Conveying how providing assistance may in fact be limiting someone from developing their skills
Emphasising the environment = many factors, including people within it
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Evidence of the need and impact: 2
They need practical strategies they can’t get from written material (esp. the internet)
I've just basically said to the staff … go to the ABI info website… in the past it was fumbling around…
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
3. Apply multiple teaching techniques
We included in our training: Case examples (videos, experience)
Discussion and generation of ideas (they are also experts)
Role play
Written supports (workbook)
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Evidence of the need and impact: 3
Everyone said that these were the best They remembered the videos and activities They drew on knowledge from analogies They referred to the workbook repeatedly
It increased their confidence and self-efficacy!
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
4. Make it accessible
We did this by: Using simplified terminology to cut through jargon
(e.g. goals = what people want)
Talking about context of support / care provision as being within the rehab team
Conveying understanding of the role of all rehab team members and where to turn for support / clarification when issues arise
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Evidence of the need and impact: 4
Most have not worked with a rehab team, and only a minority have worked with an OT
In many cases you cannot assume prior – even basic – training and information Whilst, like I said, I had a very practical knowledge previously, this gives me the, the right words to use for certain professions. (P78)
Support arrangements can be complex and inadequate, if they exist at all – particularly if there are multiple agencies involved
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
Acknowledgements
The wonderful people who have provided their experiences to us, including those who agreed to be filmed
Inbal Luft, Occupational Therapist, Vanessa Aird, Speech Pathologist and the arbias Case Managers
Jennie Brentnall, Occupational Therapist and Researcher
LTCS The participants who wanted to learn more!
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference
For more on the formal training…
A Practical Guide to Supporting People with Cognitive and Behavioural Impairments After
Acquired Brain Injury
Contact: Samantha Grant arbias NSW 02 9644 2869 [email protected]
Samantha Grant , arbias Ltd – 2nd Annual National ABI conference