BrICC Brain Injury & Concussion Clinic - PowerPoint Presentation

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BrICCBrain Injury & Concussion Clinic CLINICIAN TRAINING

Winter 2020Communication Disorders & Sciences University of Oregon

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Before we start the training…

Pre-practicum survey

Knowledge questions

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Training Overview

Pre-Practicum Survey & Knowledge Pre-Test

Welcome & Introduction

s

Logistics

Processes: Documentation

Assessment

Treatment

Transitions

Questions

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Learning Objectives

By the end of today’s training, you should be able to…

Describe

the

purpose of BrICC and characteristics of client populatio

ns.

Locate checklists, templates, and instructions on

infoCDS

to assist you in preparing for rounds, consults, treatment, and completing required documentation.

Describe components of an initial cognitive consultation and how to prepare

.

Explain guiding principles of treatment selection and delivery for cognitive rehabilitation.

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BrICC Purpose

Complete i

nitial

consultation

to assess

acquired

cognitive impairments and identify client desired outcomes

Identify nature of cognitive impairments and impact on activities and participation

Provide cognitive rehabilitation and/or counseling

for

individuals

experiencing impact on function

Facilitate attainment of desired outcomes in desired contexts

or

setting

s

-

getting back to valued roles/activities

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Cognitive domains addressed in BrICC

Attention

Memory

Executive Function

Social communication (e.g. pragmatics, theory of mind, social problem solving)

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Populations

Acquired brain injury (ABI) - mild, mod, severe

Acquired cognitive impairments

Traumatic brain injury (TBI)

Concussion/mild traumatic brain injury

Anoxic event

Neurogenic

populations with progressive cognitive impairments

e

.g.,

Parkinson’s,

Huntington’s,

stroke, primary progressive aphasia

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Cognitive symptoms --Impaired attention, memory, executive functionSomatic symptoms --Headache, light sensitivity, nausea, dizzinessPsychosocial changes --Decreased social engagement, irritability, flat affect

Population Characteristics

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Additional complications

Cognitive symptoms may be exacerbated by many factors, which may include

Mental health issues, e.g. anxiety, depression, PTSD

Sleep difficulties

Substance use disorders

Life stressors

Physical pain

How to proceed

Focus on facilitating the recovery process

Create a context for working through difficulties and moving forward

(Clinician's Guide to Cognitive Rehabilitation in mTBI, 2016)

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Consultation with Center for Healthy Relationships

Consulting therapist may address psychosocial and emotional concerns for BrICC clients

Consulting therapist may attend individual sessions per client need and clinician request

BrICC clinicians report relevant observations and consult clinical supervisor prior to seeking consultation

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Crisis ManagementWhen a client expresses suicidal thoughts...

Avoid expressing shock or alarm

Calmly talk to the person

Ask if they have a plan

Let it be OK to talk about it

Offer resources (next slide)

Notify supervisor as soon as feasible

*Immediate risk of harm = emergency = Call 911*

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Resources for clients in crisis

For non-UO students

Crisis Intervention Line –

White Bird Clinic

(24 hours / 7 days)

(541) 687-4000 / 800-422-7558

http://whitebirdclinic.org/crisis

Cahoots mobile crisis services:

Call police non-emergency numbers 541-726-3714 (Springfield) and 541-682-5111 (Eugene).

Campus resources for students

After-Hours Support and Crisis Line – 541-346-3227

UO Counseling Center

http://counseling.uoregon.edu

https://healthcenter.uoregon.edu/Services/Suicide-Prevention

https://oregon-advocate.symplicity.com/care_report/index.php/pid934179?

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Logistics: Prior to First Session

Check your schedules

Have scheduled meeting with supervisor: questions/concerns

Confirm session times with clients

Ask clients if/how they prefer to get reminders before each session

Submit initial CHARTR for every client

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Logistics: BrICC Meetings

Mondays 1:00-3:00 in HEDCO 258

Discussion of cases

ITP and EBP training 1/13/20

EBP presentations 1/27/20

Rounds CANCELLED 1/20/19 (MLK Day)

Last week (3/9) of meetings: video rounds and real-world preparation Q&A

Meetings: 1/13/20-3/9/20

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Video Rounds Presentation

More details during BrICC meeting 10/8/19

You will each sign up for a time to present during the last week of rounds

Choose a client

Show a video clip of your client implementing your chosen treatment approach for the term

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Documentation Due Dates

Lesson plans due

48 hours after the previous session concludes

SOAPs due

24 hours after the session concludes

Self-reflections due after first week of working with clients, prior to midterm meeting, and prior to final meeting

Initial draft of Assessment Report due

within a week of the consult

Initial draft of the ITP due:

by Noon Sat. February 1

st

Final ITPs due

by Noon Sat. February 29

th

MANDATORY TO EMAIL US WHENEVER AN RDS DOCUMENT IS READY FOR REVIEW

Failure to provide email notice when documentation is ready for review may result in a critical concern

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Self-Reflections

Prompts will be available on

InfoCDS

Self-Reflections will be due:

After your first clinic week (1/18 @ noon)

Prior to midterm grades being input (2/8 @ noon)

Prior to your final meeting (3/7 @ noon)

Please send your self-reflections to all supervisors who work with you

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BrICC

Rounds

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The purpose of rounds is to support one another, share clinical information on your clients, and problem solve together to improve your clinical sessionsTwo types of Rounds Presentations:Group Rounds – open discussion of your weekly assigned case (1-3 minute case presentation followed by approximately 5 minute Q&A discussion)Lightning Rounds – after group presentation, you will all sum up your weekly assigned case in a 30 second (approximately 2 sentences) description of your client

Rounds

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Rounds Presentation Example

Show videos from Jim’s computer

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Documentation &

Resources on

InfoCDS

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Finding Resources on InfoCDS

In response to past student feedback, we’ve made all of our procedures and expectations available on infoCDS.

We aim to be completely transparent and explicit with our instructions

Please ask for clarification if anything is unclear

You should read and be familiar with:

BrICC

Documentation Checklist

BrICC Report Writing – what works and what doesn’t

Rounds and consult materials

Intervention Selection Table

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Locations of Key Resources on InfoCDS

“Assessment” page

Psychometric conversion table

Follow checklists/guides on

infoCDS

under Student Preparation and Planning Materials >Consults

“Student Preparation and Planning Materials”

page

Rounds (instructions for rounds)

Consults

Documentation (checklist; what works and what doesn’t)

BrICC

Goal-Setting Worksheets

“Treatment Approaches and Intervention Materials”

page

Intervention Selection Table

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Assessment:

Initial Cognitive Consults

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Clinical interview (45 min) Learn about presenting concerns, impact of sx on routineMotivational interviewing + eGASPresent possible treatment options to address concernsStandardized battery/other protocols (1 hr, 15 min)RBANS – every consultTEA/TEA-Ch, BRIEF, D-KEFS, LASSI – as needed based on file reviewPCSS, HIT – somatic sx after concussion

Consultation Overview

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Consult Templates in RDS

CDS > CDS Templates > BrICC > BrICC eval templates shortcut

Adult and Adolescent ABI cases

Adult neurodegenerative (use for Parkinson’s, Alzheimer’s, dementia, etc.)

Use the Consult Checklist to prep for consults

Use complete sentences, narrative format

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RBANShttp://www.pearsonclinical.com/psychology/products/100000726/repeatable-battery-for-the-assessment-of-neuropsychological-status-update-rbans-update.html#tab-trainingRefer to presentation titled ‘RBANS Update: Repeatable Battery for the Assessment of Neuropsychological Status’ by Anne-Marie Kimbell, PhDTEA/ TEA-Ch – Versions A, B & C – begin with version A – administer full testCourse content – Management of Acquired Cognitive DisordersBRIEF http://www4.parinc.com/Products/Product.aspx?ProductID=BRIEFLASSI http://www.hhpublishing.com/_assessments/lassi/ FAVRES-Adult http://www.ccdpublishing.com/favres.aspxD-KEFS http://www.pearsonclinical.com/psychology/products/100000618/deliskaplan-executive-function-system-d-kefs.html#tab-trainingRefer to training by Gloria Maccow, PhD

Standardized Batteries

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Interpretation

So much data, so little time! What does it all mean? What hypotheses did you have at the start of the assessment?Return to your hypotheses when interpreting data

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Interpretation

Interpretation should be based on

hypothesis testing

Integrate

data from multiple sources

Summarizing is useful and necessary, but insufficient

How are data

consistent or inconsistent

across sources (interview, testing, observation, etc.)?

For example - Does standardized testing data support interview data? Are data from the BRIEF consistent with test data and presenting concerns?

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Treatment

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Treatment Options

Direct attention training

combined with strategies (APT-3, AIM)

Functional skills training

Metacognitive strategy instructio

n

Training assistive technology for cognition (ATC)

External cognitive aids

Goal Management Training (GMT)

Personalized education

Environmental modifications/support

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Using CHARTR Process for clinical thinking

Consider

Client data - concerns, characteristics & desired outcomes

Evidence-based practice - refer to the literature

Expert knowledge - consult your supervisor

Ask

What is the rationale for selecting this approach for this client?

What barriers exist to implementing this treatment approach?

What will you measure to determine progress toward goals?

How will you take session data?

How will you measure progress toward the desired outcome?

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Measuring Progress

You will collect two types of data:

In-session data (corresponds to STOs), e.g.:

Steps performed accurately during probe using systematic instruction

Time to complete task

Accuracy

Impact or generalization data, usually measured/tracked by the client or caregiver during the week (corresponds to LTG)

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Determine treatment approach in collaboration with your supervisor Refer to infoCDS, BrICC “Treatment Approaches and Intervention Materials” > “bricc-intervention-selection-table_2016_final” Individual or group delivery options

Treatment Delivery

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Transitions: End of Term

Involve the next clinician to facilitate a smooth transition

When sharing final progress with your client, take a collaborative approach

ask them what worked

how the strategies worked

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Transitions: End of Therapy

Start preparing the client early in the term for possible dismissal if this might be the last term

Connect your client to community resources

Develop a maintenance plan or check-in plan

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Learning Objectives Checkpoint

Make sure you achieved the learning objectives today!

Describe

the

purpose of BrICC and characteristics of client populatio

ns.

Locate checklists, templates, and instructions on

infoCDS

to assist you in preparing for rounds, consults, treatment, and completing required documentation.

Describe how cognitive domains operate in daily life and offer examples of how impairments to cognitive domains interfere with functioning.

Describe components of an initial cognitive consultation and how to prepare

.

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References

Clinician's Guide to Cognitive Rehabilitation in Mild TBI: Application in Military Service Members and Veterans (In submission).  Rehabilitation and Reintegration Division, Office of the Surgeon General, United States Army.

Sohlberg, M. M. & Ledbetter, A. K. (2016). Management of Persistent Cognitive Symptoms After Sport-Related Concussion.

American Journal of Speech-Language Pathology, 25,

138-149.

DOI: 10.1044/2015_AJSLP-14-0128

Sohlberg, M. M., & Mateer, C. A. (2001).

Cognitive rehabilitation: An integrative neuropsychological approach.

New York: Guilford Press.

Sohlberg, M. M., & Turkstra, L. S. (2011).

Optimizing cognitive rehabilitation.

New York: Guilford Press.