BRAIN INJURY SUPPORT BRAIN INJURY SUPPORT SERVICESERVICE

South and East Belfast Health and South and East Belfast Health and Social Services TrustSocial Services Trust

BRAIN INJURY SUPPORT BRAIN INJURY SUPPORT SERVICESERVICE

South and East Belfast Health and South and East Belfast Health and Social Services TrustSocial Services Trust

Dr. Marie Goss. NORTH SOUTH BRAIN INJURY CONFERENCE SEPT 2006

Dr. Marie Goss. NORTH SOUTH BRAIN INJURY CONFERENCE SEPT 2006

BRAIN INJURY SUPPORTBRAIN INJURY SUPPORT SERVICESERVICE

• MAINE NEUROBEHAVIOURAL UNIT

• MOURNE DAY SUPPORT UNIT

• COMMUNITY BRAIN INJURY SERVICE

CORE ISSUES IN SERVICE PROVISIONCORE 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

short lived in early recovery ongoing/interfere with rehabilitation long term

- limit/prevent community reintegration

- cause major challenges to those providing care and support

short lived in early recovery ongoing/interfere with rehabilitation long term

- limit/prevent community reintegration

- cause major challenges to those providing care and support

Challenging Behaviours can be

Challenging Behaviours can be

IMPACT OF SOCIAL AND EMOTIONAL AND IMPACT OF SOCIAL AND EMOTIONAL AND BEHAVIOURAL PROBLEMS ARISING POST BRAIN BEHAVIOURAL PROBLEMS ARISING POST BRAIN

INJURYINJURY

• 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

Maine neurobehavioural unit

Post acute rehabilitation

slow stream rehabilitation

long term care

day care respite care crisis intervention

Post acute rehabilitation

slow stream rehabilitation

long term care

day care respite care crisis intervention

MAINE NEUROBEHAVIOURAL UNITMAINE 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 UNITMAINE NEUROBEHAVIOURAL UNIT SOURCE OF REFERRALS

• Neurosurgery• Acute hospital settings• Neurorehabilitation settings• Mental Health services• Acute Psychiatric units• Residential facilities• Home• Social services

MAINE MAINE

NEURONEURO

BEHAVIOURALBEHAVIOURAL

UNITUNIT

FOCUS OF FOCUS OF INTERVENTIONINTERVENTION

GOALSGOALS

Post Acute Post Acute RehabilitationRehabilitation

Risk Management

Skills Development

Discharge to NeuroRehabilitation in-patient or community setting

Slow Stream Slow Stream RehabilitationRehabilitation

Risk ManagementSkills DevelopmentBehavioural Management

Discharge to home/supported living.Care in a less restrictive setting.

Long Term CareLong Term Care Risk Management

Skills Maintenance

Minimise risk.Maximise and maintain optimal levels of functioning.Maximise quality of life.Care in a specialist care setting.

Multidisciplinary teamMultidisciplinary 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 GROUPMOURNE 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 UNITMOURNE DAY SUPPORT UNITreferral 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 PROJECTMOURNE DAY PROJECT SOURCE OF REFERRALS

• Community brain injury teams / EHSSB

• Social services

• Mental health services

• G.P.s

• Regional Acquired Brain Injury Unit

MOURNE DAY MOURNE DAY PROJECT PROJECT

FOCUS OF FOCUS OF INTERVENTIONINTERVENTION

OUTCOMEOUTCOMEGOALSGOALS

ASSESSMENTASSESSMENT RiskCommunity ADLPhysicalMental stateCognitive skills

etc

To contribute to the development of a comprehensive treatment /care /support plan

REHABILITATIONREHABILITATION Risk ManagementSkills trainingBehaviouraltreatment

To facilitate community reintegration

SUPPORT SUPPORT /RESPITE/RESPITE

Risk Management

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 PROJECTMOURNE DAY PROJECT STAFFING

– Unit Manager– Senior Day care Worker– Day Care Workers– Administrative Staff– Neuropsychologist– Psychology Assistants– Occupational Therapist

– Unit Manager– Senior Day care Worker– Day Care Workers– Administrative Staff– Neuropsychologist– Psychology Assistants– Occupational Therapist

MAINE NEUROBEHAVIOURAL MAINE NEUROBEHAVIOURAL UNIT & MOURNE DAY UNIT & MOURNE DAY

PROJECTPROJECT

• 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

ASSESSMENTASSESSMENT

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

FORMULATIONFORMULATION

Difficulties resulting from :• physical impairment• sensory impairment• medical condition• cognitive capacity eg.attention, understanding,

judgement• mental disorder eg perception, ideation,moodstate• psychological reaction

INTERVENTIONINTERVENTION

Skilled Staff• observation and

assessment skills• communication

& interpersonal skills

• prompting, feedback

Structured Day• Activities/routines

Environmental

Management• level of stimulation• cues

INTERVENTIONINTERVENTION

• Risk management

• Skills training, e.g., planning skills, social skills

• Therapies

Occupational therapy

Speech and Language therapy

Physiotherapy

• Treatments pharmacology behavioural therapy CBT