Community Reentry Training for Individuals with Traumatic Brain Injury

1. Community Reentry Training for Individuals with Traumatic Brain Injury Increasing community access and improving outcomes following discharge

2. The NeuroRehabilitation Center at Middleboro • NRC at Middleboro is a 121 bed long term care facility that specializes in the care of patients with subacute acquired brain injuries. • The facility is located in a rural area with limited access to public transportation and in a community with limited agency support for individuals with disabilities

3. The Community Reentry Group A program designed to: • Provide training to individuals with a discharge plan to return home following an extended period of rehabilitation and • To increase community access for individuals without a discharge plan.

4. Identify Target Population • Patients referred from known rehab caseload and also from other interdisciplinary team members including: nursing, social services, physicians, families, and neurobehavioral department. • Patients either had a discharge plan to go home or were long term residents who had the potential to access the community with support

5. SLP/OT performed initial evaluation • Level of cognitive-communication abilities were determined including skill levels in: organization, planning, memory, reasoning and problem solving • Standardized test measures were used in conjunction with evaluation of progress made toward therapeutic goals • Community Mobility was assessed as needed by Physical Therapy • A group of 6 residents were chosen to participate in the initial retraining program

6. Procedure • Short term objectives systematically targeted in biweekly meetings, co-led by SLP and OT, aimed at planning and preparation for community outings • First groups were focused on researching community resources and determining accessibility

7. A series of outings were outlined based on patient’s preferences • Preferences included: movies, restaurants, shopping malls, WalMart, and local zoos and museums.

8. During weekly group meetings patients planned for: • Locale • Budget • Time constraints and scheduling • Transportation • Meals • Medication needs • Caregiver notification

9. Cognitive-Communication Skills Targeted • Organization and planning • Money management • Short term memory • Compensation for deficits • Reasoning and Judgement • Community Mobility

10. Example Objectives for Restaurant Outing: Client will: • state obstacles to visiting a restaurant • categorize area restaurants by type, price and location • determine budget for lunch time meal w/review of menus • create a timeline for outing • w/rehearsal make a reservation via telephone • recall planned day/time of outing w/written cues

11. notify caregivers and make accomodations for medications w/assistance • arrive in appropriate clothing at scheduled time for outing • demonstrate mobility outdoors • determine and place appropriate order from menu within budget guidelines • demonstrate socially appropriate behavior in community setting • monitor time planned for outing

12. Obstacles • Transportation • Solutions: • GATRA • COA Dial-a-ride • Facility Van • Hired Wheelchair Transportation

13. Funding • Solutions: • Personal Needs Accounts • Family Council • Fundraisers • Coffee Shop

14. Coffee Shop • The Coffee Shop • Originated as a fundraising idea for Community Reentry Group to support community reintegration • Created a kiosk in the main lobby of our facility with generous funds from the Family Council • Established a contract with Green Mountain to obtain equipment and supplies • Visited with local bankers to establish a checking account, tax ID number and official business name • Staffed and run by residents with SLP/OT who are in training in the afternoon and by residents who are independent in the morning • Helped therapists address the following skills in a functional setting prior to entering the community: • Scheduling • Categorization • Following complex directions • Independent time management • Money management • Check writing and banking • Meal preparation • Problem solving/sequencing/organization • Social communication/pragmatic language • Expressive language, word finding skills • Receptive language

15. Outcomes • In the first group of 6 participants: • 2 patients achieved independent community access. They were able to plan weekly or biweekly outings to places visited while in the training program with funds raised through continued work at the Coffee Shop • The remaining 4 residents continued to raise funds through work at the Coffee Shop and participated in Supervised outings on a monthly basis

16. Evolution of the Program… • The Community Reentry Group and Coffee Shop have changed and expanded over the past few years and experienced positive growth. • Many changes have occurred to the format of the group. • Includes patients who may not be just returning home but plan to live with support (i.e: assisted living, mentor homes, etc) • New “levels” system to determine current independent training access • PT involvement for more community mobility issues • Patients now paying bills online, accessing internet for payment options, etc • We have serviced well over 20 patients who have returned home or to community based living with good results after experiencing functionally based skill-set practice in a realistic environment. We look forward to continuing to grow and servicing patients to help them learn skills to independently access the community.

17. Contact Information • KristenTucker MS CCC-SLP • MGH Institute of Health Professions Charlestown, Ma. • 617-724-9769 • ktucker@mghihp.edu Jaquelyn Thomson MS CCC-SLP NeuroRehabilitation Center at Middleboro 508-947-9295 marquette96@comcast.net