Transcript Strategies to Enhance Successful Closure Outcomes for

Strategies to Enhance Successful
Closure Outcomes for Individuals
with Disabilities with Traumatic
Brain Injuries
Dr. Thomas Upton
Southern Illinois University-Carbondale
Heaven Hollender
Neurorestorative -Chicago, IL
March 21, 2012
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Dr. Thomas Upton’s background
Past vocational rehabilitation counselor in two comprehensive
centers (PA and IA) specialized in serving persons with brain
injury; Sr VR counselor in Florida; Developed and provided
innovative VR services 98-2000 in Iowa; 2000-present Faculty
member in Rehabilitation Institute at Southern Illinois UniversityCarbondale, 2000-present Private Vocational Consultant for
SSA, IL WC, etc, and 2005-present member of IL State
Rehabilitation Council and Chair of State Plan Committee.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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Heaven Hollender’s background
MS and doctoral student in rehabilitation at SIUC. Ms. Hollender
will complete her Ph.D. at SIUC, specializing in brain injury.
Concurrently, she has been a full time counselor and cognitive
therapist in a post-acute brain injury facility. Now, she works for
the same facility and is the Director of a post-acute residential
facility for adults with brain injury located in Chicago, IL.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
4
Definition of TBI
• Review the definition of TBI and differentiate TBI from other
disabilities
• Acquired Brain Injury (ABI), TBI, and brain injury are largely
used interchangeably. For this for this webinar we will use TBI
or brain injury.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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As such, a brain injury is…
• Brain injury is not an event or an outcome. It is
the start of a misdiagnosed, misunderstood,
under-funded neurological disease. Individuals
who sustain brain injuries must have timely
access to expert trauma care, specialized
rehabilitation, lifelong disease management and
individualized services and supports in order to
live healthy, independent and satisfying lives
(biausa.org, 2012).
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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Nervous System
• The Central Nervous
System:
 Brain
 Spinal Cord
• Main "processing center" for
the whole nervous system
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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Functional Limitations
• One way to define a functional limitation is how the disability
interferes with the person's physical, mental or cognitive
ability.
• Next slide common functional limitations that counselors in the
State/Federal VR system are aware of while working with
customers with various disabilities.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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DRS functional limitations
1.
2.
3.
4.
5.
6.
7.
mobility
self care
self-direction
work skills
work tolerance
interpersonal skills
communication
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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Common residuals
• Caveat-No two injuries are exactly the same; Therefore
individual evaluation of each customer and his/her abilities is
imperative
• However, residual tend to cluster around three themes which
are physical, psychological, and psychosocial (personality and
emotional) changes
• Overall functioning linked to type of injury (focal vs. diffuse),
location and severity of injury, age, premorbid abilities, family
support, etc.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
10
Physical changes
•
•
•
•
•
Balance
Mobility
Motor coordination
Spasticity/tremors
Language-receptive
and expressive
aphasia
• Taste and smell
• Seizures-range in
frequency and scope
• Hearing (tinnitis)and
visual (diplopia)
changes
• Fatigue and/or
general weakness
• Association with
physical trauma, TBI
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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Thinking changes
•
•
•
•
•
Memory, short-term
Persistence
Self-perception
Inflexibility
Decreased processing
speed
• Poor organization
• Poor planning and
sequencing
• Impaired problem
solving and decision
making
• Poor judgment
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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Psychosocial (personality and
emotional) changes
• Depression
• Mood swings
• Inability to inhibit
remarks
• Lack of response to
social cues
• Poor social skills
•
•
•
•
Low initiation
No assertiveness
Low self-esteem
Difficulty forming and
maintaining
relationships
• Poor conflict
management skills
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
13
Post injury changes
• Changes are typically noted in the order presented.
Individuals are noted to have different physical abilities.
Then their thinking skills may have changed in the overall
speed and efficiencies.
• Lastly, the psychosocial challenges became apparent to
those around and interact with persons who have
experienced a brain injury.
• Extremely important to comprehensively review each
person with brain injury.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
14
Co-occurring disorders
• TBI many times occurs
with other disorders
• Functional limitations may
seem similar to other
disorders (e.g.,
depression, bipolar
disorder, learning
disability, substance
abuse, intellectual
disability, etc.)
•
•
•
•
•
Depression
Bipolar Disorder
Learning Disability
Substance Abuse
Intellectual Disability-Each
share overlapping
functional limitations, but
they are not the same
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
15
Holistic treatment
• Each disorder and brain
injury have
distinguishing features
and all must be treated
in a holistic manner
• Wright (1983)
Somatopsychological
approach-intertwining of
the physical,
psychological, and
social implications to
holistically understand
the disability experience
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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Treatment Protocol for TBI
• Medical Services:
Medical personnel provide
emergency services to
preserve life
• Goal: To facilitate
physical survival.
• Acute Rehabilitation:
Provision of
comprehensive
rehabilitation services
(physiatrist, PTs, OTs,
speech, VRCs, etc)
• Goal:
To eliminate/negate post
BI residuals
• Post-Acute
(Community Re-entry
rehabilitation services)Outpatient comprehensive
rehabilitation services,
public rehabilitation
services (State/Federal
VR-IL DRS), and
community-based
practitioners Adapt I and
Adapt II
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
17
Delve into current demographic data
pertaining to customers with TBI
Defined
Traumatic brain injury (TBI) is a serious public health
problem in the United States. Each year, traumatic brain
injuries contribute to a substantial number of deaths and
cases of permanent disability. Recent data shows that, on
average, approximately 1.7 million people sustain a
traumatic brain injury annually (Centers for Disease Control
and Prevention, National Center for Injury Prevention and
Control; 2010).
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
18
Who acquires a brain injury?
TBI by Age
• Children aged 0 to 4 years, older adolescents aged
15 to 19 years, and adults aged 65 years and older
are most likely to sustain a TBI.
• Almost half a million (473,947) emergency
department visits for TBI are made annually by
children aged 0 to 14 years.
• Adults aged 75 years and older have the highest
rates of TBI-related hospitalization and death.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
19
TBI by Gender
• In every age group, TBI rates are higher for males than
for females.
• Males aged 0 to 4 years have the highest rates of TBIrelated emergency department visits, hospitalizations,
and deaths.
(Centers for Disease Control and Prevention, National
Center for Injury Prevention and Control; 2010).
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
20
How acquire a TBI?
• Motor vehicle accidents #1
• Falls, bicycle crashes, and sports and recreational
vehicles crashes; Violence
• AVMs and (CVAs?)
• Anoxia-heart attack, carbon monoxide poisoning,
suffocation, diabetic coma
• toxins- substance abuse, huffing, etc.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
21
Closure outcomes for customers
with TBI
• Discover current statistics on closure outcomes for
customers with TBI-Review two years of data for State of
IL Division of Rehabilitation Services (DRS)
• RSA 911 data is best source of information, these data
are from IL data for 7/1/05-6/30/07 (fiscal years 20062007)
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
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One state’s example over one year
Illinois
•
•
•
•
Fiscal year 06-07
N=345 customers with traumatic brain injuries
Functional limitations:
80.8 % in work tolerance; 65% in interpersonal skills,
52.5% in communication; 50.8% in work skills, 45% in
mobility; 39% in self-care; and 33% in self-direction.
• Most (79%) had 3 limitations=most severe disability
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
23
What did state sample look like?
• 71% male; 29% female
• Most were 16-26: 38% and 27-38: 22%
• Caucasian=76%, African American=15%, Latino 7%,
other=2%
• Most were urban dwellers (80%) of sample
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
24
Successful closures
• N=180-closed in status 26 competitive employment
(n=171) and fewer (n = 9) in noncompetitive employment,
supported employment
• Spent $6500 or less on 75% of cases (Mean $5578)
• Variety of customary services: referral, assessment, job
search, job placement, etc.
• 180/345=52% successful rehabilitation rate
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
25
Reasons for closure of eligible
customers with TBI
• Unable to locate (35%), refused services (23%),
failure to cooperate (17 %), disability too severe
(8%), no transportation (2%), and other reasons,
including death (15%)
• Personal recollection of relevance of vocational
impairment to organic change, post-TBI
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
25
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Linkage between substance
abuse and employment
• Historically speaking, there has been a strong
association between substance abuse and the
acquisition of a TBI
• Studies estimate in the range of 65-85% of TBI
are linked to substance abuse
• Clear consensus that the majority of persons
with TBI sustained one while involved in
substance abuse activities
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
26
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Substance Abuse (SA)
• The exact number is inconsequential, but it is clear that
SA treatment is needed for persons with TBI
• Morale stance of Rehabilitation Counselors and agency
may impact the treatment of persons with TBI and
substance abuse
• Treatment options: Residential inpatient treatments,
intensive outpatient
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
27
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Options
• Basis of inpatient treatment centers –Minnesota ModelCognitive behavioral orientation
• Or 12 step programs (e.g., AA, NA)-learning about 12
steps and generalizing to one’s life
• Premises of programs-ability to abstractly think, be aware
of one’s behavior, and generalize to one’s own life--problem with assumptions due to organic changes
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
28
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Need for protocols
• Need for protocols that are specific, concrete,
and very learnable for persons with differing
cognitive abilities
• Examples young males successfully attending
AA; very bright and sober while there, but
outside the meeting…lack of generalization
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
29
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Predictors of employment
• Strong predictor of employment following TBI is
employment prior to TBI
• In the IL 911 study, the factors of job placement
assistance, on the job supports, and socioeconomic
status were significant predictors of the employment of
customers with TBI
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
30
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Strategies and Recommendations
• Provide strategies and offer recommendations
for vocational rehabilitation counselors (VRCs)
• Reviewing anecdotal information and data on
customers with TBI
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
31
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Goals:
• Enhance short term memory. How?
• Speech therapy, cognitive retraining, compensation
strategies…
• Enhance communication skills. How?
• Outpatient speech, re-entry services, intensive social
skills training (Adapt I and Adapt II)
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
32
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Conclusion
• Enhance functional skills for employment. How?
Be creative and use your specialized knowledge,
skills, and abilities.
• Remain engaged in continually learning ‘what
works’ to best meet the evolving needs of your
customers with TBI.
• Thank you for your attention and participation.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
33
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What we covered today…
• Introductory brain injury webinar.
• Brief review of overview of TBI and standard functional
limitations.
• Reviewed one state’s outcomes for customers with TBI.
• Highlighted linkage between employment and substance
abuse.
• Suggested a few ways to enhance customer outcomes.
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
34
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Comments & Questions
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
36
Contact Information
Dr. Thomas Upton
Associate Professor
Southern Illinois University, Carbondale
Email: [email protected]
Heaven Hollender
Program Director at NeuroRestorative
Chicago, Illinois
Email: [email protected]
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
37
Upcoming Webinars
Helping Your Team Improve Employment Outcomes for
Individuals with the Most Significant Disabilities–
Traumatic Brain Injury (TBI)
• May 14, 2012 – Hiring Individuals with Traumatic
Brain Injuries (TBI)
• July 30, 2012 – Traumatic Brain Injury (TBI): Coping
with Loss and Grief –VR Implications
• September 6, 2012 – VR Implications of Working with
the Family of Individuals with TBI
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
38
Education Credits
CRCC Credit - (1.5)
Approved by Commission on Rehabilitation Counselor
Certification (CRCC)
• By March 31, 2012, participants must score 80% or
better on a online Post Test and submit an online
CRCC Request Form via the MyTACE Portal.
My TACE Portal: TACEsoutheast.org/myportal
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
39
THANK YOU!
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
40
Southeast TACE (Region IV)
Toll-free: (866) 518-7750 [voice/tty]
Fax: (404) 541-9002
Web: TACEsoutheast.org
My TACE Portal: TACEsoutheast.org/myportal
Email: [email protected]
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012
41
Disclaimer
This presentation was developed by the TACE Center:
Region IV ©2011 with funds from the U.S. Department
of Education, Rehabilitation Services Administration
(RSA) under the priority of Technical Assistance and
Continuing Education Projects (TACE) – Grant
#H264A080021. However, the contents of this
presentation do not necessarily represent the policy of
the RSA and you should not assume endorsement by
the Federal Government [34 CFR 75.620 (b)].
TACE Center: Region IV, a project of the Burton Blatt Institute.
Funded by RSA Grant # H264A080021. © 2012