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CARF Update

CARF Update. Brain Injury Association of Maryland April 19, 2013. CARF Standards Development. International Standards Advisory Committee (ISAC) International Advisory Council (IAC) Field Review Printed January 2013 Used on all surveys July 1, 2013 - June 30, 2014. BI ISAC.

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CARF Update

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  1. CARF Update Brain Injury Association of Maryland April 19, 2013

  2. CARF Standards Development • International Standards Advisory Committee (ISAC) • International Advisory Council (IAC) • Field Review • Printed January 2013 • Used on all surveys July 1, 2013 - June 30, 2014

  3. BI ISAC • 8 countries represented • Entire continuum of services represented • CIIRP, OMR, HCS, Residential, Voc, CM • Requirement of “if you provide…..must seek accreditation” maintained • “If you see the occasional…” was added

  4. Brain Injury Specialty Programs (BISP)3.H New 2013 Standards

  5. 3.H. BISP Description • Services focus on unique needs: • Medical • Physical • Cognitive • Communication, • Psychosocial • Behavioral • Educational • Accessibility • Leisure/recreation

  6. 3.H. BISP Description • Integrates services to: • Minimize impact of impairments and secondary complications • Reduce activity limitations • Maximize participation, including wellness, quality of life, and inclusion in community • Decrease environmental barriers • Promote self-advocacy

  7. 3.H. BISP Description • Recognizes individuality, preferences, strengths and needs of: • Persons served • Families/support systems • Provides access to : • Information • Services • Resources available

  8. 3.H. BISP Description • Services enhance lives of persons served within their : • Families/support systems • Communities • Life roles • Supports efforts to: • Promote personal health and wellness • Improve quality of life throughout their lifespan

  9. 3.H. BISP Description • Demonstrates commitment, capabilities, and resources to maintain itself as a specialized program • Utilizes current research and evidence to provide effective rehabilitation • Supports future improvements by advocating for or participating in brain injury research

  10. 3.H. BISP Description • Partners with person served, families/support systems and providers from emergency services through community-based services to foster an integrated system of services that optimizes: • Recovery • Adjustment • Inclusion • Participation • Prevention

  11. 3.H. BISP Description • Engages and partners with providers within and outside of rehabilitation to increase access to services by advocating for persons who have sustained an ABI to: • Regulators • Legislators • Educational Institutions • Research funding • Payers • Community at large

  12. 3.H. BISP • Program seeking accreditation as a Brain Injury Program must include in its Intent to Survey all portions of the programs (CIIRP, HCS, OMR, Residential, Vocational) that the organization provides and that meet the CARF program description

  13. 3.H. BISP • Interventions: • Preventing brain injury • Recognizing, assessing, treating conditions related to BI • Preventing complications and co-morbidities • Identifying and reducing risk factors for recurrent BI • Interventions: • Facilitating: • Functional independence • Performance • Psychological well being • Social coping • Adjustment • Community inclusion • Participation in life roles

  14. 3.H. BISP • Interventions: • Assistive technology • Services for families/support systems • Facilitating advocacy the BI program demonstrates knowledge of: • Regulations • Legislation • Financial issues • Funding availability

  15. 3.H. BISP • Facilitating advocacy BI program demonstrates knowledge of: • Service availability • Protection and advocacy resources • Healthcare delivery system • Resources and services related to aging

  16. 3.H. BISP • Facilitates collaboration with person served and family/support system in decision making through: • Accessible information • Timing for exchange of information • Identification of their level of: • Understanding of the rehabilitation process • Health literacy

  17. 3.H. BISP • Initial and ongoing assessments document info: • History • Status in: • Behavioral • Cognitive • Communication • Decision-making capacity • Dual Diagnosis • Status in: • Educational • Functional • Leisure/recrea- tional activities • Medical • Physical • Psychological • Sexual • Social • Spiritual • Vocational

  18. 3.H. BISP • Initial and Ongoing assessments document: • Important events and life experiences • Life routines • Usability of the living environment

  19. 3.H. BISP • Assess impact of behavior, cognition, communication, medical and sensory deficits on the following: • Physical function • Social function • Vocational function • Education • Family dynamics • Participation

  20. 3.H. BISP • Initial and ongoing risk assessments are incorporated into: • Assessment process • Individual program planning • Discharge/transition planning

  21. 3.H. BISP • Risk assessments address: • Behavioral • Cognitive • Communication • Developmental • Emotional • Environmental • Medical

  22. 3.H. BISP • Risk assessments address: • Physical • Vocational • Capacity of the family/support system • Financial resources • Legal • Other, as appropriate

  23. 3.H. BISP • Assesses need for resources, services, supports and/or interventions: • Community access: • Driving • Mobility • Transportation needs

  24. 3.H. BISP • Assesses need for: • Life roles: • Basic life skills • Life-long learning • Parenting skills • Spousal/significant other relations • Work re-entry

  25. 3.H. BISP • Assesses need for: • Adjustment to disability: • Aging with a disability • Insight • Supervision needs • Medical: • Co-morbid conditions • Falls • Medical: • Medication • Nutrition • Secondary complications • Seizures

  26. 3.H. BISP • Assesses community participation: • Advocacy • Fitness • Leisure/recreation • Socialization • Volunteerism • Wellness • Mental health • Provides or arranges for these

  27. 3.H. BISP • Dependent on needs, provides or arranges for: • Assistive technology • Audiology services • Chaplaincy services • Dialysis • Driver rehabilitation • Dependent on needs: • Durable medical equipment • Dysphagia management • Environmental design • Medical consultative services

  28. 3.H. BISP • Dependent on needs: • Medical nutrition therapy • Neurobehavioral services • Neuropsychological services • Orthotic services • Ostomy/wound care • Dependent on needs: • Peer support • Prosthetic services • Psychiatric services • Psychological services • Rehabilitation engineering

  29. 3.H. BISP • Dependent on needs: • Respiratory therapy • Sexual education • Spasticity management • Substance misuse, counseling, treatment • Total parenteral nutrition • Vestibular assessment • Visual assessment • Vocational rehabilitation

  30. 3.H. BISP • Provide or arranges for diagnostics to screen for and assess status of: • Bladder function • Bowel function • Cardiac function • Cognitive function • Mental health • Metabolic function • Musculoskeletal function

  31. 3.H. BISP • Provide and/or arrange : • Neurological function • Obstetric and gynecological health • Pulmonary function • Sensory function • Skin integrity • Swallowing • Thromboembolic disease • Other common secondary conditions

  32. 3.H. BISP • Demonstrates knowledge and coordination with local, regional, provincial, national, or international networks or agreements to facilitate: • Specialized brain injury services • Use of appropriate subspecialties • Advocacy

  33. 3.H. BISP • Program demonstrates knowledge and application of clinical research to treatment practices • Prior to implementation of specific treatments, personnel provide the rationale for those treatments to the: • Person served • Family/support system • Provide options, as appropriate based on feedback received

  34. 3.H. BISP • Organized education program to meet the needs of person served and family/support system • Education program includes but is not limited to: • Neuroanatomy • Etiology and epidemiology of ABI • Education program: • Communication with providers • Active involvement in service delivery • Behavioral supports • Cognitive interventions • Communication interventions • Developmental/life transitions

  35. 3.H. BISP • Education for person served and family/support system: • Community resources • Recognition and reporting of suspected abuse and neglect • Boundaries • Medical complications • Risks associated with BI • Self advocacy • Psychological issues after BI

  36. 3.H. BISP • Education for personnel at orientation and regular intervals includes but is not limited to: • Neuroanatomy • Etiology and epidemiology of ABI • Communication with person served and family/support system • Communication with other providers serving person served

  37. 3.H. BISP • Education continued: • Facilitating active involvement of person served and family/support system in service delivery process • Facilitating behavioral supports • Facilitating cognitive interventions • Facilitating communication interventions • Handling developmental/life transitions

  38. 3.H. BISP • Education continued: • Knowledge of community resources • Recognition and reporting of suspected abuse and neglect • Setting and maintaining professional boundaries • Medical complications • Special populations • Risks associated with BI • Psychological issues following BI

  39. 3.H. BISP • Program identifies and supports preferences of the person served around: • Lifecycle events • Community events • Cultural events • Spiritual events

  40. 3.H. BISP • Consistent with personal preferences persons served are provided with opportunities to: • Share their talents and skills • Mentor • Teach

  41. 3.H. BISP • Consistent with personal preferences, program supports the persons served in developing, maintaining, and/or increasing their social contacts and relationships with: • Families/support systems • Friends • Significant others • Within the program and external to program

  42. 3.H. BISP • Program addresses the impact of brain injury on the family/support system of the person with ABI including but not limited to the person’s: • Children • Siblings • Spouse/significant other • Parents • Other members of the support system

  43. 3.H. BISP • Program creates an environment that supports appropriate relationships between personnel and the persons served • Based on need and preferences of person served the program addresses: • Self awareness • Social awareness • Peer relationships

  44. 3.H. BISP • Based on needs and preferences program addresses cont: • Relationship issues • Sexuality • Reproductive issues

  45. 3.H. BISP • Wellness promoted through activities: • Based on input from persons served • Consider input from family/support system • Provide for daily structured and unstructured activities • Wellness: • Promote healthy behavior • Reflect their choices • Align with their cognitive capabilities • Align with their communication capabilities

  46. 3.H. BISP • Wellness: • Promote their personal growth • Promote self-responsibility • Enhance their self-image • Improve or maintain their functional levels • Allow for social interaction • Allow for autonomy • Include opportunities for community interaction

  47. 3.H. BISP • Wellness: • Documented in the individual plan for the person served • Addresses prevention of: • Onset or progression of co-morbidities • Substance misuse • Injury • Falls

  48. 3.H. BISP • Addresses prevention of: • Abuse • Complication related to: • Disability • Aging • Program minimizes complications related to: • Family/support system dynamics • Discharge/transition planning • Follow-up

  49. 3.H. BISP • Educates person served and family/support system on respite care • Provides, arranges for or assists with arrangements for respite care • If it provides respite requires the person served to bring the following if applicable: • Adaptive equipment • Assistive technology

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