Full Lives for People with Disabilities - Addressing Traumatic Brain Injury

undefined
Substance Use Disorders
and
Cognitive Deficits
Presented by:
Thomas G. Beckers BS, LADC
Program Services Manager
Vinland National Center
Goals
 
 
Recognize common symptoms of traumatic
brain injury (T.B.I.) – and Cognitive Deficits
 
Incorporate compensatory practices to modify
Substance Use Disorder (S.U.D.) Treatment
“Traumatic Brain Injury is an important public health
problem in the United States. Because the problems
that result from TBI, such as those of thinking and
memory, are often not visible, and because awareness
about TBI among the general public is limited, it is
frequently referred to as the “silent epidemic”.”
Marilynn Lash: 
The Essential Brain Injury Guide 
(4
th
 Edition) The Brain
Injury Alliance of America, 2007.
Traumatic Brain Injury
Prevalence
 
SAMPLE:
295 people with co-occurring mental health and substance use
disorders enrolled in a prospective study of integrated treatment of
substance abuse.
 
SETTING:
Outpatient community mental health center in Washington, District of
Columbia.
 
MAIN MEASURES:
The Ohio State University 
TBI Identification Method
. Standardized
measures assessed psychiatric diagnoses, symptom severity, current and
lifetime substance use, and history of institutionalization.
 
Prevalence
 
RESULTS:
80% screened positive for TBI, and 25% reported at least 1 moderate or
severe TBI.
TBI was associated with current alcohol use and psychiatric symptom
severity and with lifetime institutionalization and homelessness.
More common among participants with post-traumatic stress disorder,
borderline personality disorder, and antisocial personality disorder.
Men (vs. women) and participants with psychotic disorders (vs those with
mood disorders) had an earlier age of first TBI with loss of consciousness.
 
The Prevalence of Traumatic Brain Injury Among People with Co-Occurring Mental Health and
Substance Use Disorders
McHugo GJ, KrassenbaumS, Donley S, Corrigan JD, Bogner J, Drake RE.
Head Trauma Rehabilitation 2017 May/Jun;32(3):E65-E74
.
Leading Causes of TBI
 
1.) Falls
:
 
Leading cause of TBI
 
Account for 47% of all TBI related ED visits, hospitalizations 
 
and
deaths in the US in 2013
 
 
 
2.) Being Struck by or against an object
:
 
Second leading cause accounting for 15% of ED visits, 
 
hospitalizations,
and deaths in the Us in 2013
 
Leading Causes of TBI
 
3.) 
Motor Vehicle Accidents:
 
Third overall leading cause of TBI related ED visits, hospitalizations 
 
and
deaths accounting for 15%  in 2016
 
 
Taylor CA, Bell JM, Breiding MJ,XuL.
Traumatic Brain Injury-Related Emergency Department Visits, hospitalizations, and Deaths –
United States, 2007 and 2013
MMWR Serveil Summ 2017;66(No.ss-9):1-16.
DOI: 
http://dx.doi.org/10.15585/mmwr.ss66609a1
Challenges with Providing SUD Treatment
to TBI Clients
 
Problems with self regulating thoughts, feelings and behaviors
 
Difficulty benefiting from experience and remembering
information from one session to next
 
Intention and behavior may be disconnected
 
Difficulty maintaining relationships due to problems with
perceiving, understanding and behaving according to Norms
 
Wide variance in expressive and receptive abilities
Challenges with Providing SUD Treatment
to TBI Clients
 
 
Lack of experienced staff and referral sources who understand
how to adjust their approach
 
Misinterpretation of symptoms: labeled as “noncompliant” or
“resistant”
 
Lack of varied forms of stimulation, structure and support
 
Alternative forms of curriculum
 
Assessing Learning and
Communication Style
 
Ask how well the person reads, writes, observe through examples. Which do they
prefer?
 
Ask about and observe a person’s attention span. Be attuned to whether attention
seems to change in different environments
 
Ask about what other people say about their learning/communication style
 
Ask about previous IEP’s or tutors when engaged in past education environments
 
 
Assessing Learning and
Communication Style
 
 
What helps you with___________________?”
Remembering new material
Remembering Names
Finishing your work
Staying on Track
Paying attention
Remembering things you see or hear
Making choices that keep you healthy and safe
 
Cognitive Processes
 
Alertness
 
Attention
 
Processing
 
Memory
 
Executive Functioning
Problem > Alertness 
 
Schedule cognitive heavy or intense groups during optimal
hours
 
Allow clients to move around if needed
 
Use peppermint oil
 
Practice sleep hygiene
 
In residential sites, allow people to move rooms if necessary to
achieve compatible environments
Problem > Attention
 
Important to consider because it affects downstream cognition
 
Look for:
Client being “checked out”
History of “thrill-seeking”
History of need for sensory stimulation
 
Accommodations
:
Use space and movement to grab attention
Begin groups with active participation
Have simple cues to reduce distractions
Keep instructions simple!
Use curriculum that can be converted into games
Problem > Processing
 
Slower processing does not mean they cannot comprehend – they just
need more time.
Look for:
May tire easily
Difficulty tracking conversation – watch them in groups
They may report difficulty with comprehension
 
Accommodations:
Keep emotional tone “cool”. When doing more emotional work, allow for time to
process
Stress goes up – processing speed slows down
Break instructions/homework down into smaller parts
Keep instructions simple
Take breaks – low intensity options for groups
 
 
Problem > Memory
 
Making choices based on previously learned information is
compromised when a memory deficit exists
 
Look for:
Inconsistent performance on a task
What works best ? – verbal memory? – written ?
What is a past example of learning and how did it occur?
 
Accommodations:
Use visual field to support memory
Bring a note book to session - write down key points of session
Create repeatable routines
Use of reminders and ringtones through digital devices
 
 
 
Problem > Executive Functioning > Initiation
 
Sometimes a client can tell you what they want to do but struggle to
begin the steps necessary to complete a task
Look for:
Set a task and see if they begin
Notice how often you need to prompt for behavior
History - either through client or collaterals
 
Accommodations:
Simplify – break down into small, manageable pieces
Assign only manageable piece – hold back some of the materials
Place reminders of needed behaviors in places that can be seen
Use timers and auditory cues to begin and end behaviors
Use motivational incentives – ‘Fishbowl’
Problem > Executive Functioning > Impulsivity
 
Impulsivity is very common. Hard to stop a particular behavior. Very
small gap from thought to behavior.
Look for:
May do or say things without recognizing effect on others/self
A lot of personal information, very early on in sessions
May interrupt conversations regularly
 
Accommodations:
The talking stick – helps shape behaviors in groups
Using timers to measure clients ability to complete a task
Using motivational incentives to shape pro community behaviors - Fishbowl
pulls weekly
Clear direct feedback that is directed at behavior, not client
Clear and direct expectations with limits and consequences
Problem > Executive Functioning > Planning & Organizing
 
Many people with TBI struggle to hold or organize information and
need support  to plan and organize certain tasks
Look for:
Lacks significant future focus
Misses deadlines
Often late or does not show up for appointments
 
Accommodations:
Stressing the need to develop and maintain routines throughout day
Use visual cues to find place to keep important things in order
Use a system that matches the needs of the person
Write down key points of session. Bring a note book to session
Remind the person of the point – what to expect and goal of the session. 
Have
them repeat the instructions back
Problem > Executive Functioning > Mental Flexability
 
The trouble with adjusting to changing situations and unfamiliar
circumstances
Look for:
Agitation and irritation when things unexpectedly change
Perseveration
Has difficulty with ideas about a plan B – “plan A will work !”
 
Accommodations:
Rehearse different strategies in different environments to increase ability to
generalize skills
Create or support the biggest support system possible. Think “safety net” first
Allow plenty of time for sessions regarding transitions
Problem > Executive Functioning > Self Awareness
 
People with cognitive deficits may not be aware of how they are being
experienced by others
Look for:
May dominate interactions with others
Low awareness of problems or lacks a desire to change
Often sets unrealistic goals
 
Accommodations:
Identify and use appropriate self disclosure – “ This is my experience
when______________.”
Motivational incentives for behaviors that support community
Being clear about wanted behaviors and unwanted behaviors
Coaching clients to provide positive feedback regarding behaviors
In closing…
 
People with Brain Injuries do
benefit from treatment
when compensatory skills
are taught and practiced
 
Teaching non-brain injury
peers about brain injury
helps with group cohesion
by helping those with
injuries feel 
accepted
 
People suffering from brain
injuries 
are participating
 in
traditional programs
 
Staff members of these
programs can benefit from
further education, which can
lead to a heightened sense
of empathy
Thank You for Your Attention and Interest!
Don’t hesitate to
contact me directly if
you would like more
information about this
topic:
tbeckers@vinlandcenter.org
Slide Note
Embed
Share

Traumatic Brain Injury (TBI) presents a significant public health concern in the United States, often termed as the silent epidemic due to its hidden nature. This condition affects thinking and memory, impacting individuals' lives profoundly. Resources such as "The Essential Brain Injury Guide" shed light on TBI's implications. Studies highlight the prevalence of TBI among those with co-occurring mental health and substance use disorders. Efforts are crucial to enhance awareness and support for individuals facing TBI to ensure they lead fulfilling lives.


Uploaded on Sep 19, 2024 | 0 Views


Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

E N D

Presentation Transcript


  1. Full lives for people with disabilities Presented by:

  2. Full lives for people with disabilities

  3. Traumatic Brain Injury is an important public health problem in the United States. Because the problems that result from TBI, such as those of thinking and memory, are often not visible, and because awareness about TBI among the general public is limited, it is frequently referred to as the silent epidemic . Marilynn Lash: The Essential Brain Injury Guide (4th Edition) The Brain Injury Alliance of America, 2007. Full lives for people with disabilities

  4. Full lives for people with disabilities

  5. The Prevalence of Traumatic Brain Injury Among People with Co-Occurring Mental Health and Substance Use Disorders McHugo GJ, KrassenbaumS, Donley S, Corrigan JD, Bogner J, Drake RE. Head Trauma Rehabilitation 2017 May/Jun;32(3):E65-E74. Full lives for people with disabilities

  6. Full lives for people with disabilities

  7. Taylor CA, Bell JM, Breiding MJ,XuL. Traumatic Brain Injury-Related Emergency Department Visits, hospitalizations, and Deaths United States, 2007 and 2013 MMWR Serveil Summ 2017;66(No.ss-9):1-16. DOI: http://dx.doi.org/10.15585/mmwr.ss66609a1 Full lives for people with disabilities

  8. Full lives for people with disabilities

  9. Full lives for people with disabilities

  10. Full lives for people with disabilities

  11. Full lives for people with disabilities

  12. Full lives for people with disabilities

  13. Full lives for people with disabilities

  14. Full lives for people with disabilities

  15. Full lives for people with disabilities

  16. Full lives for people with disabilities

  17. Full lives for people with disabilities

  18. Full lives for people with disabilities

  19. Full lives for people with disabilities

  20. Full lives for people with disabilities

  21. Full lives for people with disabilities

  22. Full lives for people with disabilities

  23. Full lives for people with disabilities

Related


More Related Content

giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#giItT1WQy@!-/#