ECHIS Evelyn Community Head Injury Service poster first 100pts
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The document outlines a study of the initial assessments and rehabilitation needs of 94 clients referred to a community head injury service from December 2010 to June 2013. It highlights the diverse challenges faced by clients, including psychological distress and varied rehabilitation needs, with significant numbers requiring therapies like occupational and neuropsychological assessments. The findings emphasize the importance of tailored interventions and the need for adequate service planning to address the complexities of head injury rehabilitation.
ECHIS Evelyn Community Head Injury Service poster first 100pts
- 1. Needs Led Individual Assessment and Therapy (N = 94, December 2010 – June 2013) 1 individual contacts and: there was a wide spread of need with several clients only having one or two face to face contacts and client receiving 95 face to face contacts over 30 months. Goals Identified by clients at Initial Assessment (N = 94) 0 5 10 15 20 25 30 35 40 Numberofclientsidentifiedgoal = 100, 71:29 Male: Female < 20 21 - 30 31 - 40 41 - 50 51 - 60 > 60 Age Age at injury ts age range was relatively young; 16 – ears, (Mean=39, SD = 16). 35 clients were seen within 6 months of injury while 28 were referred more than two years after injury. Initial Assessment Results – MPAI-4 (N = 84) The MPAI-4 was scored jointly with the client, a family member and the assessing clinicians. No one reached ceiling or plateaued on the MPAI-4; mean total T score 41.64 (SD 10.87), (mild-moderate limitations relative to USA outpatient ABI population). AIMS; o characterise the rehabilitation needs of people referred to a newly established County Wide Community Head Injury Service and explore how the team have developed the service in response to those needs. METHODS; he team of Rehabilitation Consultant, Clinical Psychologist; Psychology Assistant; OT (0.7 WTE) ; SLT ( 0.6WTE) ; Admin ( 0.6WTE) were in post by Nov 2010. They linked closely with locality Rehab teams. fter referral from the Regional Neurotrauma clinic, clients attended for an initial assessment. The Mayo Portland Adaptability Inventory – fourth edition1 (MPAI-4) and the Hospital Anxiety and Depression Score2 (HADS) were used as part of a semi structured interview to identify problems across all functional domains. Individual clinical sessions for further assessment and treatment were offered according to need. Groups were devised nd delivered as cohorts of clients presented with similar problems. Activity data was collected prospectively using our community services IT system: systm-one and analysed using SPSS. We review the demographics and rehabilitation needs of the first 100 referrals, and report on the nature of the individual and group interventions that they received. Conclusions The semi structured interview and assessment battery identified a wide range of impairment, ability and participation after head injury with considerable psychological distress. Many with mild injury presented with significant rehabilitation needs. Initial goals were related to work, everyday function and mood rather than more abstract ideas such as identity. There was considerable time needed for non face to face working. Much of the teams time was needed to facilitate informed engagement with other relevant services and agencies and to support families and carers. Recognition of this “non contact time” will be key to ensuring effective service planning and commissioning. These data suggest that any county wide specialised team should have sufficient knowledge, experience and skill to deliver a wide range of complex individual and group interventions. We would like to acknowledge that this activity has only been possible because of the considerable help from several volunteers and enthusiastic support from other services and agencies HADS (N = 80) There was significant emotional morbidity at assessment, with 53% of 80 who completed the HADS, scoring in the mild–severe range for anxiety, and 41% for depression. Number of clients (N) who needed the following : Neuropsychological Assessment, N = 49: 45 new, 4 reassessments, 10 assessed pre-referral Occupational Therapy, N = 57 Work Visits, N = 29 Speech and Language Therapy, N = 18 Multi Agency Case Conferences N = 9 (28 conferences ) Discharge planning from specialist rehab service N = 10 Headway Joint Reviews with Social Services N = 10 Carer training for daily care packages, N = 8 Client specific discussion in MDT meeting: 30/week Needs Led Groups / N= number of clients who attended each type 52 people have attended one or several of 23 different Groups that were set up All sessions were run by the team clinicians with volunteers and ran for two hours each with a short break. Each group included a series of between five and nine weekly sessions. All Groups have been evaluated and will be reported elsewhere A User Group meets three times per year and is attended by past and current clients and family members . Information 6 x Brain Injury Information for clients (BIIG), N = 33 The BIIG group originally ran for 6 weeks, based on client feedback it now runs for 9 weeks and includes a goal setting and rehabilitation session. Two sessions were added for clients to make posters about their own injuries to encourage making sense of the information and how it relates to their own situation 1xMemory N=11 2xFatigue N=15 1xAttention N=8 1xCommunication N=7 1xEmotional Regulation‘Keep CalmandCarryOn’ N=11 6 x Relatives Information N=38 Run monthly 1xExecutiveFunction ‘LetsTakeAction’ N=15 1xYoungPersons StrategyN=8 InCollegevacation * n average Face to Face Contact time was >20 hours per client for 72 clients. Range 5 min – 8 hours / contact Relatives Compassionate mind Information N=4 Adjustment /Psychotherapy Group N=5 Strategies Support 0 5 10 15 20 25 30 35 40 <6 6-12 12-24 >24 DNA NumberofClients Months Time between injury and initial assessment Attention and Concentration (N = 43) Memory (N = 42) Novel Problem Solving (N = 29) Family and Significant Relationships (N = 39) Fatigue (N = 32) Anxiety (N = 31) Further analysis of the data allowed us to ascertain how many people reported difficulties interfering with activities more than 25% of the time. The most frequently reported difficulties were: Leisure and Recreational activities (N = 48) Social Contact (N = 41 Paid Employment (N = 38) Face to Face Group Telephone Calls Average Time (Hours) Average Contacts (Number) Mean time and mean number of contacts / client Range 1-144 Range 1-30 sessions How the characteristics and needs of the first 100 clients have shaped the service- Judith Allanson, Kate Psaila, Sarah Moss, Kerrie Bundock, Nicola Metcalf, Andrew Bateman, Donna Malley, Fergus Gracey, Clare Keohane, Peter Hutchinson Results 4; Difficulties reported at Assessment ults 5; Individual Client interventions ECHIS ;INTERDISCIPLINARY WORKING INDIVIDUAL Assessment +Therapy Psychol/ OT Med / SLT OTHER SERVICES Comm Team Headway OZC Mental Health GROUPS Brain Injury Info. Fatigue Mood Management Communication Cognitive Family workshops INITIAL Holistic ASSESSMENT/Advice Formulation / Goal planning Rehab plan at weekly team meeting REVIEW Complex Case Discussion Case Conferences Family sessions 1xMovingto University N=6 Results 6; Group interventions sults 1; Demographics Results 2; Initial Goals Results 3; Emotional Morbidity ECHIS Liaised with all clients primary care doctors (GPs) and…. Universities/CollegesInpatientRehabiliationservices Results 7; Multi agency working Range 0-95