Planning Support for Persons with At-Risk Behaviors in the Community

Setting

Jacquelyn Solomon, M.S. LPA

Purpose of Training

• Addressing At-Risk Behaviors and Planning for Everyone’s Safety

– Assessing the elements of an effective understanding of the level of supervision and support that a person with a brain injury may need when transitioning into the community.

Agenda

• At-Risk Behaviors–What do they look like? – Examples

• How to Assess and Address– Discuss assessments for each at-risk

behavior– How do we address these issues?

• Resources

At-Risk Behaviors

At-Risk Behaviors

• Substance Abuse History– Alcohol– Other drugs

• Premorbid use• Post-injury use• Previous treatment?• Triggers– Less in residential facility

At-Risk Behaviors

• Mental Health Issues– Premorbid– Post-injury

• Personality Changes– Behavioral Issues due to changes?• How will this affect their transition to

community?

• Impulsivity• Social Interaction – Appropriate?

At-Risk Behaviors

• Memory– Short-term memory– Long-term memory

• Can be dangerous

At-Risk Behaviors

• Medication Management– Take medication appropriately?• Time• Amount• Dosage

• Memory can affect this greatly• Missing doses or taking too much can

have serious side effects

At-Risk Behaviors

• Hygiene– Showering– Oral care

• Sequencing• Initiation• Lack of proper hygiene can have

serious side effects with time

At-Risk Behaviors

• Household Tasks– Laundry– Cooking– Organization• Safety

– Ex: Know where the fire extinguisher is?– Fall Risks

• Misplaced items

– Nutrition

At-Risk Behaviors

• Transportation– Access to transport?– Have to use public transportation?

At-Risk Behaviors

• Risk of Exploitation– Sexual– Financial– Resources

At-Risk Behaviors

• Community–Where is the residence?– Is it a safe environment?–What needs to be known about the

area?

How to Assess and Address At-Risk Behaviors

Assess and Address

• Substance Abuse History– Assess• History• Counseling

– Address• Support system when in community• Attend meetings • Continued treatment

– Resources• AA/NA• Counseling Services

Assess and Address

• Mental Health Issues– Assess• History• Counseling

– Address• Continue providing counseling services• Educate on coping mechanisms• Educate support system

Assess and Address

• Memory– Assess• While at our facility, Speech and OT assess

memory throughout length of stay

– Address• Memory strategies:

– Taking notes; keeping track in a planner or tablet– Visual cues

• Educate family members and support system

Assess and Address

• Medication Management– Assess• Know medication?

– Dosage, Time, Amount

– Address• Work on becoming independent with

medication while still in treatment facility• Have companion/family member organize

medication in pill organizers for them once out in community

Assess and Address

• Hygiene– Assess• OT assesses at residence while in treatment

and determines what level of assistance pt needs• Assessment continues throughout treatment

– Address• While in treatment, OT works with pt to

increase their level of independence• If still needs assistance when transitioning

into community (i.e. with family member) educate the family members who pt will be living with

Assess and Address

• Household Tasks– Laundry– Cooking– Organization• Safety• Misplaced items

– Nutrition

Assess and Address

• Transportation– Assess• Does participant have access to

transportation?• Do they know how to safely utilize public

transportation?

– Address• Work with them while still at facility

– Make schedule; call for rides

• Educate family members/support system

Assess and Address

• Risk of Exploitation– Assess• Give scenarios• Look at history

– Address• Provide education• Make reminder cards for participant• Work with them to put them on a no contact

list

Assess and Address

• Community– Assess• Therapist will assess the surroundings of the

residence participant is moving to

– Address• After assessment, discuss and teach

participant about surrounding area

We wish to provide each participant with the ability to be as independent as possible and to succeed when they transition out of our program.

Identifying, assessing, and addressing potential at-risk behaviors is paramount to transitioning our participants as safely as possible.