Residential Treatment and Rehabilitation
within the Continuum
Massachusetts Brain Injury Association
24th Annual Conference - Call for Papers
March 7, 2005
Prepared by Jeremiah
A. Donovan, MBA
President, Robin Hill Farm
"Post acute treatment primarily
involves residential programs that functionally apply
and adapt treatment into everyday activities. Treatment
environments are normalized, highly structured and functional".
- American Academy
For The Certification of Brain Injury Specialists
(AACBIS) Training Manual, 2nd Edition, 1998
The Residential Treatment and Rehabilitation model is designed
for the individual with a brain injury who requires and
benefits from 24 hour supervision or support. Our particular
model represents a continuum within a continuum; that is,
there are 5 different program levels, so as to insure, to
the greatest extent possible, the most functionally appropriate
placement in the least restrictive setting.
This type of program serves two purposes; First, as a long
term option it represents an alternative to institutional
living; Second, on a shorter term basis, it provides a curriculum
designed to teach someone the skills necessary to maintain
themselves in the least restrictive environment.
Attributes of a Residential Treatment and Rehabilitation
Program
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I.
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RTR program should be licensed
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a.
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Programmatic Integrity
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b.
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Life Safety Issues
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|
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II.
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Community Based Setting
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a.
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Regular access to true community based activities
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b.
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Guard against social isolation
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c.
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The living environment is the program
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d.
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Maintain low stimulus environment
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III.
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Socially Based Model of Rehabilitation
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a.
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Written rehab. plan with functional goals
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b.
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Reject "custodial care" label
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c.
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Promote social interaction among residents
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d.
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Allows people to "live again"
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e.
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Rehab focuses on achieving independence in
ADL's
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IV.
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Least restrictive environment
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a.
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Continually assess progress to determine if
higher level can be achieved
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b.
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Appropriate placement- don't stress out client
with unrealistic expectations
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c.
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Develop internal culture that promotes choice
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d.
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Involve families in all aspects, whenever possible
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V.
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24 Hour Care
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a.
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Supervision is 24 hr. active monitoring /
assistance
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b.
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Support is 24 hr. guidance / assistance
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c.
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Assistance with medications
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VI.
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Vocational Element
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a.
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Avocational training - develop outside interests,
i.e. gardening
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b.
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Supported employment - do whatever it takes
to secure wanted employment
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c.
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Therapeutic riding program
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d.
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Employment may help validate rehab plan
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To benefit from a RTRF, an individual
must:
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1.
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Be diagnosed with a brain injury;
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2.
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Be medically stable;
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3.
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Not represent a consistent threat to self or others;
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4.
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Need and benefit from 24 hr. support
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Typical RTRF activities:
In general, a true RTR Program must offer, as a cornerstone,
consistent exposure to the community, utilizing appropriate
supports so as to insure, to the greatest degree possible
that trips into the community are successful. Conversely,
natural consequences (within reason) should be endured,
with the objective being a heightened understanding of appropriate/inappropriate
behavior by the resident. In a program such as this, daily
activities may include:
- Morning orientation - Housemates go over day, date and
current events. Also review the schedule;
- Activities of daily living - don't forget the extra
time it may take someone with a brain injury to complete
these tasks;
- Shopping for the house, or individual menu planning
if in an individual apartment;
- Banking / Money management - budgeting for social outings,
personal needs, etc.
- Medical Appointments - Resume the more traditional role
of going to Dr's appointments, rather than having the
Dr. / Healthcare professional come to you;
- Social trips, such as lunch / dinner out, movies, art
exhibits, visits with family, shopping
In the final analysis, this socially based model is a structured,
low stimulus replica of everyday life. A passage from "It
takes WIT!", notes "An injury to the brain may
cause difficulty transferring learning from one situation
to another, referred to as generalizability. The practical
approach to generalizability problems is to teach skills
in the specific situation in which they will be used. Certainly,
it can never be taken for granted that a skill or behavior
learned in one setting will automatically be applied in
another. Treatment planning should always address just how
learning will be generalized to a person's everyday life".
Respectfully submitted,
Jeremiah A. Donovan, MBA
Robin Hill Farm
It
takes WIT!, Brainstorm, Alabama Department of Rehab Services,
1998
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Post
Acute Continuum Care Options