ASSBI 2020 Conference Bite Size!

Skye McDonald

The Carers Way Ahead. A new on-line resource to assist families of people with traumatic brain injuries and challenging behaviour
McDonald, Skye1; Trimmer, Emily2; Newby, Jill1; Grant, Samantha2; Gertler, Paul2 and Simpson, Grahame3
1
School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
2
Private practice
3
Ingham Institute of Applied Medical Research

Background and Objectives:  On-going challenging behaviour following traumatic brain injury (TBI) is a major source of stress for families and can lead to deteriorating health, breakdown of relationships and, ultimately, lower quality of life for the person with TBI and their extended networks.   Providing expert clinical advice to manage challenging behaviours can be limited by availability of clinicians and geographic location. A solution is to provide on-line resources that can guide family members through identifying and managing common challenging behaviours.  That was the aim of the current project.

Method:  Six clinicians identified the most common complaints regarding challenging behaviour post TBI. An on-line survey also sought input from families regarding their concerns in dealing with challenging behaviour.  A draft set of modules were developed and two families worked through these to provide feedback on clarity.   This feedback was used to modify the content when necessary.

The final on-line program “The Carers Way Ahead” encompasses seven modules. The first two are education-based and designed to be completed first. The remaining five address: (1) Apathy, (2) Irritability/Aggression (3) Acting without thinking (4) Social difficulties and (7) Self-care (for the family member).   Each module is supplemented by more detailed notes and summaries of the sessions.

Six families with a family member with a brain injury (5 due to trauma, one due to stroke) piloted the program in 2018 over an 8 week period and provided feedback about acceptability and feasibility. They also completed measures of problem solving, family functioning, mood and the severity and nature of challenging behaviour in their person with brain injury.

Results:   Family members typically spent between 20 minutes to an hour on the program each week. They rated the content as logical. 5/6 families felt the program was successful in helping them manage behaviour.  5/6 families were highly likely to recommend the program to someone else and all families expressed high levels of satisfaction with the program. There was little change in mood, family function or reported behaviour after the intervention. This is not necessarily surprising as changes are often slow to emerge.

Conclusions:  The Carers Way Ahead has the potential to address a significant gap in resources for families trying to manage challenging behaviour post TBI.

Correspondence: Skye McDonald; s.mcdonald@unsw.edu.au

Alinka Fisher

Navigating the challenges in conducting behaviour intervention research with families
Fisher, Alinka1; Bellon, Michelle1; Lawn, Sharon2; Douglas, Jacinta3 and Sohlberg, McKay
1
Disability and Community Inclusion, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
2
Department of Psychiatry, Flinders University, Adelaide, Australia
3
School of Allied Health, La Trobe University, Bundoora, Australia
4
Communication Disorders & Sciences, University of Oregon, USA

Background and aims: The importance of involving families as active members in behavior support interventions following acquired brain injury (ABI) is widely acknowledged.  Effective behaviour support requires monitoring and modification over time and longitudinal studies are essential to program evaluation. Research in this area, however, has multiple challenges; families often experience significant burden and have limited time and reserve to participate in such interventions, despite being aware of the potential benefits. Our aim was to consider these challenges and their implications for research examining family involvement in behavioural interventions. 

Methods: The research team reflected upon the process of conducting two eight-month longitudinal behavior support studies (consisting of education and individualized sessions) and one education program pilot (involving four weekly sessions) with families following ABI, including recruitment, implementation and repeated assessments over multiple time points. The facilitator’s journal provided further insight into the complexities of conducting the research.

Results: Although families communicate their desire for behaviour support, the additional burden associated with conducting research (e.g., assessments and time commitment) may not be feasible. This raises important considerations regarding family-professional relationships, flexible modes of delivery, and meaningful, but limited assessments.

Conclusions: Longitudinal studies allow us to examine the long-term outcomes of behavioural interventions following ABI; however, recruiting and retaining families in this process can be challenging. Findings provide important insights and recommendations for future behaviour support research and practice seeking to focus on family involvement.

Correspondence: Alinka Fisher; Alinka.fisher@flinders.edu.au

Katherine Cameron and Nina Wegener

Now we’re home, how do we keep the conversation going?  An interdisciplinary approach to communication partner training
Cameron, Katherine1, 2; Wegener, Nina1, 2; Watter, Kerrin1, 2 and Kennedy, Areti1, 2
1Acquired Brain injury Transitional Rehabilitation Service, Division of Rehabilitation, Metro South Health, Brisbane Australia
2The Hopkins Centre, Division of Rehabilitation, Metro South Health and Griffith University, Brisbane Australia


Background and Objectives:
Following Acquired Brain Injury (ABI), between 60-80% of people experience cognitive-communication and interpersonal changes. International guidelines recommend educating and supporting those with ABI and their communication partners about communication change in a context-rich way. The Acquired Brain Injury Transitional Rehabilitation Service (ABI TRS) supports clients with ABI and their families during the transition from hospital to home. This is a time psychosocial distress and relationship breakdowns can occur, but also the first opportunity for contextual communication practice. To address these issues speech pathologists (SPs) commenced delivery of communication partner training (CPT), using components of the ‘TBI Express’ (Togher, et al). During early CPT, participants demonstrated increased awareness of changes and adjustment to injury.  They also frequently raised relationship strain, requiring social work (SW) support and counselling skills. As a result, we aimed to: a) develop a coordinated interdisciplinary (IDT) approach to CPT; and b) adapt CPT resources to meet client needs in a time-limited transitional phase of rehabilitation.

Method: A Knowledge Translation approach was used to apply TBI Express CPT to the time-limited early discharge context of ABI TRS; and a Quality Improvement (QI) approach was used to adapt the program and develop associated resources and processes to embed CPT within the service; allowing for interdisciplinary input. Participants were engaged on program structure and content to inform resource development and optimise participation.   

Results: A modified CPT program and resources were developed and embedded in the ABI TRS. The program is delivered by an IDT: SPs providing communication training / strategy identification; SWs providing support for relationships; allied health assistants helping embed strategies and act as partners (as required). It is delivered as a two-part education series with practical components (video recording and feedback) and follow-up therapy. The program has been successfully trialled across locations and contexts (clinic, home and community venues, and large group or individual / family sessions).  The program will be presented as well as a case study to demonstrate use in ABI TRS.

Conclusions: The modified IDT CPT is now core practice for ABI TRS. Clinical indicators suggest that this approach: addresses client and family needs related to raising understanding of communication change after ABI; and is helping to prevent relationship stress at a vulnerable point. It is hoped that by establishing better communication patterns early on it will protect against future relationship breakdowns. Future directions for the project will further investigate outcomes and benefits of IDT CPT and investigate how this CPT fits within the Brain Injury Rehabilitation continuum in QLD.

Correspondence: Katherine Cameron; Katherine.cameron@health.qld.gov.au and Nina Wegener; nina.wegener@health.qld.gov.au

Jaycie Bohan

“All the things that you don’t think about when you’re leaving hospital…”: client and family member experiences of an ABI transitional rehabilitation service pilot
Nielsen, Mandy1; Bohan, Jaycie1; Watter, Kerrin1 and Kennedy, Areti1
1
The Hopkins Centre and the Division of Rehabilitation, Metro South Health, Brisbane

Background and Objectives: The Acquired Brain Injury Transitional Rehabilitation Service (ABITRS) is a 5-year pilot program established in response to an identified unmet need in the continuum of acquired brain injury rehabilitation services (BIRS) in Queensland. To determine the impact of ABITRS, a mixed method evaluation is in progress. Exploring the experience of the ABITRS from client and family perspectives will highlight valued service design features that facilitate participant community reintegration and will contribute to evaluating whether the program is meeting the pilot project aims.

Method: Data was drawn from 2 qualitative arms of the mixed method evaluation: 1) semi-structured interviews with ABITRS clients (n=10) and their family members (n=10); and 2) an anonymous client satisfaction survey (assisted by family members as appropriate) provided to clients and family members at the end of the ABITRS program (n=60). Thematic interview transcript analysis was based on the Framework Method. Client satisfaction surveys were analysed using summative content analysis. Data triangulation will test for consistency in client and family perspectives and explore any inconsistencies in findings.

Results: Data analysis is still in progress. Preliminary analysis of the qualitative interviews indicate that clients and family members consistently value elements of the ABITRS service model which are congruent with pilot project aims: facilitating early community re-integration during transition from hospital to home; improved continuity between hospital and community services; and enhanced access to community rehabilitation. Results to be presented will include outcomes of the triangulation process.

Conclusions: Preliminary qualitative analysis indicates that client and family member experiences of the ABITRS complement the aims of the pilot project. Triangulation of this data with client satisfaction survey outcomes offers the opportunity for a deeper understanding of the service experience.

Correspondence: Mandy Nielsen; mandy.nielsen@health.qld.gov.au

 

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