Treatment Approaches for Individuals with Brain Injury. Welcome!

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1 5/10/16 Treatment Approaches for Individuals with Brain Injury Help for Today, Hope for Tomorrow. Welcome! Todays training is the last in a four part series on brain injury. Todays training will cover: how brain injury impacts a client s ability to access services how services can be adapted to accommodate individuals with brain injury 1

2 No magic wand! Remember. Every brain injury is unique While the rest of the world is trying to get ahead of the ball, the brain injured person is trying to determine what the ball is, where the ball is, and perhaps even why the ball is. Survivor WHO is your client? Your real client maybe the caregiver. The caregiver or individual Both may need coping strategies and may benefit from education 2

3 Don t Assume Most services use cognitive-behavioral approaches that assume intact cognitive capability. Traditional services place a high premium on the will to change Treatment readiness or "Treatment motivation All of which are contingent on a reasonably intact capability to have goals and to decide to change goals. # 1 Difficulty Deficits in Self Awareness 3

4 Self Awareness The ability to assess your own abilities and limitations, and then see the resulting implications. Self awareness applies to everything we do. People can be at various stages in the self awareness process and be at different stages for different areas of their life. Impaired Self Awareness Deficits in Self Awareness come across as: Thinking everything is fine My friends are lying, your just exaggerating about... Blaming others for their problems I tried to work with, but they refused to help me. Not using compensatory tools I don t need to set my alarm to take my meds Wanting to change but not following through I am going to be on time to my appointment 4

5 Awareness-Acceptance-Adjustment Three part process: 1. Objective knowledge of existence own deficits Awareness 2. Understanding of significance of those deficits Acceptance 3. Making changes in personal behavior in response Adjustment Awareness-Acceptance-Adjustment ACCEPTANCE Full Anticipatory Growing Emergent None Intellectual AWARENESS Adjustment/ Accommodation 5

6 Awareness Intellectual Recognize a deficit after it has occurred Basic Understands they have deficit with individuals activities I forgot my appointment Intermediate Understands that deficits are related I have problems with my memory Highest Understands implications of deficit Problems with my memory makes it hard for me to do my job Does not doing anything to stop the problem! Awareness Emergent Recognize a deficit while it is occurring without feedback I can t remember what I needed to get here at the store Anticipatory Anticipate difficulties before they happen because of on-going deficit Going to the store is hard for me because I often forget what I needed. 6

7 Acceptance-Adjustment Acceptance-Extent the individual believes the problem requires change in their behavior. Growing I made a list of what I need at the store so I don t forget Full I keep track of what I need to buy so when I go to the store I always have a list ready. Adjust Expectations This is NOT to suggest having no expectations for change. It IS to remember to have realistic expectations for incremental change. 7

8 Whys to Help Keep it simple Small steps Clear and consistent feedback Finding hidden message to behavior Focus on the positive Redirection Keep it Simple Focus on one or two issues Don t make it too complicated Ask simple, short questions Use open-ended questions -NOT questions that can be answered with yes or no responses 8

9 Example of what NOT to do: Question: How are things at home now that your wife is working more hours and your mother is helping out with the child care? Are things settling down for you now your anxiety doing better? Way to Complex 1. It s too much information to process 2. It ended with a close-ended question 3. The person may be unable to follow what the intent of the question is and be confused about the expected answer: Is the topic anxiety or greater financial security or how mother and wife are working out? 4. If working memory is impaired, then a sentence of more than about 10 words is lost. 9

10 Simplify and Wait Example of the right way to ask the question: Questions: How is it with your wife working? Next question: How do you like her work hours? Next question: How helpful is your mother right now? Next question: How nervous or worried are you now? Next question: What is making you nervous? Next question: What can we do to change that? Small Steps and Pacing Extra time to process ideas and to work them through with multiple examples Going over it, re-working it, and then coming back to it again Pace it break it into workable pieces Keep meetings short if necessary, consider more meetings, but for shorter amounts of time 10

11 Visual Aids Use visual aids to help make your point Give hard copies of items Write out a summary of what was said and next steps Challenging Behaviors Physical or verbal aggression Property destruction Impulsive behavior Sexual disinhibition Argumentative Sometimes the absence of a behavior can count as a challenging behavior Refusing to complete tasks, not responding when spoken to 11

12 Get to the Why? Three main messages behind behavior: 1. An unmet need Emotional discomfort, physical pain, lack of resources 2. Expression of mood Angry, frustrated, sadness, confusion, loneliness 3. Response to stimulation Too little (boredom) Too much (over-stimulation) Messages Behind Behavior Challenges Too many demands on me at once I am tired This is an unfamiliar activity and I am confused I am frustrated by my lack of control I don t have the social skills for this situation I've got sensory overload 12

13 ABCs of Behavior Antecedents the before Triggers-emotions, social relationships, environment, events Behavior the actual behavior Able to SEE or OBSERVE Anger is not a behavior yelling, swearing, hitting are Consequences the afterward Can either increase or decrease Focus on the Positive Individuals with brain injury respond best to positive reinforcement Negative reinforcement and punishment are the least effective Notice and encourage appropriate behavior FREQUENTLY 13

14 Giving Feedback Do not ignore the behavior Be as immediate as possible Clear, Simple & Direct "I do not like when you didn't talk about..." "You are staring at that woman... she might feel uncomfortable." Giving Feedback Be specific about why change is needed Give clear information about how their behavior impacts others Provide a positive model for behavior Don t assume they know they right way Watch for things reinforcing the challenging behavior 14

15 Don t be a Jellyfish! Concrete and Consistent Schmoozing it along with brain injury clients is a recipe for disaster Redirection Usually and on-off quality to behavioral challenges Explosive outburst one minute, but calm shortly after Redirecting individuals back to more positive behavior Switch topics, offer alternative plans, focus on what they have accomplished 15

16 CEUs and Handouts All the handouts and links to sign in for CEUs are available at Training Recorded A recording of this training will be available after May 18 th at: = guest@dhs.com Password = dhs1 16

17 5/10/16 Contact us today! Funded by: 17