Transcript Dr Marie Goss South and East Belfast Trust

BRAIN INJURY SUPPORT
SERVICE
South and East Belfast Health and Social
Services Trust
Dr. Marie Goss.
NORTH SOUTH BRAIN INJURY CONFERENCE SEPT 2006
BRAIN INJURY SUPPORT
SERVICE
• MAINE NEUROBEHAVIOURAL UNIT
• MOURNE DAY SUPPORT UNIT
• COMMUNITY BRAIN INJURY
SERVICE
CORE 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
Challenging Behaviours can be
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short lived in early recovery
ongoing/interfere with rehabilitation
long term
- limit/prevent community reintegration
- cause major challenges to those
providing care and support
IMPACT OF SOCIAL AND EMOTIONAL AND
BEHAVIOURAL PROBLEMS ARISING POST BRAIN
INJURY
• 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
Post
acute rehabilitation
slow
stream rehabilitation
long
term care
 day care
 respite care
 crisis intervention
MAINE 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 UNIT
SOURCE OF REFERRALS
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Neurosurgery
Acute hospital settings
Neurorehabilitation settings
Mental Health services
Acute Psychiatric units
Residential facilities
Home
Social services
MAINE
NEURO
BEHAVIOURAL
UNIT
FOCUS OF
INTERVENTION
GOALS
Post Acute
Rehabilitation
Risk Management
Discharge to
Neuro
Rehabilitation
in-patient or
community setting
Skills
Development
Slow Stream
Rehabilitation
Risk Management
Skills
Development
Behavioural
Management
Long Term Care
Risk Management
Discharge to
home/
supported living.
Care in a less
restrictive setting.
Minimise risk.
Maximise and
maintain optimal
Skills Maintenance
levels of
functioning.
Maximise quality
of life.
Care in a specialist
care setting.
Multidisciplinary team
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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 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 UNIT
referral criteria
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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 PROJECT
SOURCE OF REFERRALS
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Community brain injury teams / EHSSB
Social services
Mental health services
G.P.s
Regional Acquired Brain Injury Unit
MOURNE DAY
PROJECT
FOCUS OF
INTERVENTION
OUTCOME
GOALS
ASSESSMENT
Risk
Community ADL
Physical
Mental state
Cognitive skills
To contribute to
the development of
a comprehensive
treatment /care
/support plan
etc
REHABILITATION
Risk Management
Skills training
Behavioural
treatment
SUPPORT
/RESPITE
Risk Management
To facilitate
community
reintegration
Minimise risk.
Maintain optimal
Skills Maintenance
levels of
functioning.
Engagment in
Maximise quality
meaningful
of life.
activity
Reduce caregiver
stress.
Enable social
maintain
participation
community living.
MOURNE DAY PROJECT
STAFFING
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Unit Manager
Senior Day care Worker
Day Care Workers
Administrative Staff
Neuropsychologist
Psychology Assistants
Occupational Therapist
MAINE NEUROBEHAVIOURAL
UNIT & MOURNE DAY
PROJECT
• ASSESSMENT eg.Cognitive,behavioural, ADL social skills,
communication, risk assessment
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REHABILIATATION / TREATMENT
DEVELOPMENT OF NEW SKILLS
MAINTENANCE OF EXISTING SKILLS
SUPPORT TO ENABLE SOCIAL
PARTICIPATION
• CRISIS INTERVENTION
• RESPITE CARE
ASSESSMENT
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Level of ADL functioning
Behaviour
Cognition
Social functioning
Emotional functioning
Mental State
RISK
NEEDS
( future support )
FORMULATION
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Difficulties resulting from :
physical impairment
sensory impairment
medical condition
cognitive capacity
eg.attention, understanding, judgement
• mental disorder
eg perception, ideation,moodstate
• psychological reaction
INTERVENTION
Skilled Staff
• observation and
assessment skills
• communication
& interpersonal
skills
• prompting, feedback
Structured Day
•
Activities/routines
Environmental
Management
•
level of stimulation
•
cues
INTERVENTION
• Risk management
• Skills training, e.g.,
planning skills,
social skills
• Therapies
Occupational therapy
Speech and Language
therapy
Physiotherapy
• Treatments
pharmacology
behavioural therapy
CBT