Brain Injury Professional, vol. 4 issue 2

BRAIN INJURY professional vol. 4 issue 2

The official publication of the North American Brain Injury Society

Brain Injury Training and Education

AACBIS TBI TAC NABIS GW SCR

BRAIN INJURY PROFESSIONAL

1

LAKEVIEW ...

It’s About Life!

From Coma To Community

Long-Term Acute Care Hospital Specializing in Coma Recovery Neurobehavioral Programs • Children • Adults Special Education Accredited School Grades 1 - 12 Rehabilitation and Transition Programs Community Integrated Residential Programs Supported Apartments and Home Programs Outpatient Clinics

The Lakeview AfÀliated Programs - now located in New Hampshire, Maine, Rhode Island, Wisconsin and Virginia.

Call 1-800-4-REHAB-1 For More Information or Visit our Web Site at: www.lakeviewsystem.com

contents

BRAIN INJURY professional vol. 4 issue 2, 2007

The official publication of the North American Brain Injury Society

north american brain injury society

departments 4 Executive Vice President’s Message 6 Guest Editor’s Message 29 Book Review

chairman Robert D. Voogt, PhD treasurer Bruce H. Stern, Esq. family liason Julian MacQueen executive vice president Ronald C. Savage, EdD executive director/administration Margaret J. Roberts executive director/operations J. Charles Haynes, JD marketing manager Joyce Parker graphic designer Nikolai Alexeev administrative assistant Benjamin Morgan administrative assistant Bonnie Haynes

brain injury professional

32 Non-Profit News

BR A I N I NJ URY professional

publisher Charles W. Haynes publisher J. Charles Haynes, JD Editor in Chief Ronald C. Savage, EdD founding editor Donald G. Stein, PhD design and layout Nikolai Alexeev advertising sales Joyce Parker

"RAIN )NJURY 4RAINING AND %DUCATION

EDITORIAL ADVISORY BOARD

vol. 4 issue 2

The official publication of the North American Brain Injury Society

AACBIS TBI TAC NABIS GW SCR

BRAIN INJURY PROFESSIONAL

1

features 10 The American Academy for the Certification of Brain Injury Specialists

by LINda E. Mackay, MA, CCC-SLP, CBIST 14 Traumatic Brain Injury Training for Professionals in the States

By Amy G. Horn, BSW 18 BIP Expert Interview With Dr. Ann Glang, Teaching Research Institute 20 Developing Professional Education and Training in Brain Injury

by Janis K. Ruoff, Phd 26 TBI Training in Kansas

BY Janet Tyler, PhD 28 Certification in Cognitive Rehabilitation

Michael Collins, PhD Walter Harrell, PhD Chas Haynes, JD Cindy Ivanhoe, MD Ronald Savage, EdD Elisabeth Sherwin, PhD Donald Stein, PhD Sherrod Taylor, Esq. Tina Trudel, PhD Robert Voogt, PhD Mariusz Ziejewski, PhD

editorial inquiries Managing Editor Brain Injury Professional PO Box 131401 Houston, TX 77219-1401 Tel 713.526.6900 Fax 713.526.7787 Website: www.nabis.org Email: contact@nabis.org

advertising inquiries Joyce Parker Brain Injury Professional HDI Publishers PO Box 131401 Houston, TX 77219-1401 Tel 713.526.6900 Fax 713.526.7787

national office

North American Brain Injury Society PO Box 1804 Alexandria, VA 22313 Tel 703.960.6500 Fax 703.960.6603 Website: www.nabis.org Brain Injury Professional is a quarterly publication published jointly by the North American Brain Injury Society and HDI Publishers. © 2007 NABIS/HDI Publishers. All rights reserved. No part of this publication may be reproduced in whole or in part in any way without the written permission from the publisher. For reprint requests, please contact, Managing Editor, Brain Injury Professional, PO Box 131401, Houston, TX 77219-1400, Tel 713.526.6900, Fax 713.526.7787, e-mail mail@hdipub.com

BRAIN INJURY PROFESSIONAL

3

executive vice president’s message

Staff Education + Training = Program Quality For the many professionals who have provided brain injury services and/or who have managed brain injury programs, the formula above rings true. With a well

Ronald Savage, EdD educated and well trained staff, the quality of our services and outcomes soars.

Without an educated and trained staff, the quality of services suffers. Of course who really suffers are the individuals and families we serve.

In the past, many of us operated from the best information we had at the time and developed unique service delivery models. Can we set up special-

4

BRAIN INJURY PROFESSIONAL

ized TBI programs in rehabilitation hospitals? Can we develop “rehab without walls” and serve people in their homes?

Can we create innovative communitybased and vocational services in the real world? Each time professionals pushed the envelope they also recognized that it took staff with specialized training to deliver those services. Unfortunately, some people simply “hung a shingle on the wall” and announced that they provided brain injury services. In other situations, facility money was spent on new paint for the walls, or new glossy brochures, or shiny pieces of new equipment without regard to what really made a difference, i.e., a well educated staff that received continual training and support. Furthermore, we all recognized that education and training about brain injury needed to reach “far and beyond” just BI service providers – we needed to “reach and teach” into federal and state agencies, into other community and vocational organizations, and even into Congress.

Thus, in 1996 the Brain Injury Association of America (BIAA) recognized the need for well-trained staff years ago and formed the American Academy for the Certification of Brain Injury Specialists (AACBIS). Prior to AACBIS, numerous brain injury rehabilitation programs and post-acute programs offered in-service training to their staff. In fact, Dr. Stanley Seaton, M.D. and his staff led the way in the 1990’s to develop

a standardized training curriculum in brain injury which would later become the foundation for AACBIS training and certification. In the past several years, the North American Brain Injury Society (NABIS) has focused on professional training and offers annual conferences and this magazine to support that need.

We also have a Traumatic Brain Injury Technical Assistance Center (TBI TAC) at the National Association of State Head Injury Administrators (NASHIA) to support education and training in the states. Several colleges and universities offer on-campus and on-line courses in TBI treatment and services (e.g., The George Washington University). Lastly, several states have even launched their own state specific BI training programs.

We have made progress in educating and training staff and others about brain injury, but we still have a long way to go.

This issue of BIP is focused on this very important professional challenge – how do we best educate and train ourselves and our staff.

Therefore, it is with great appreciation that we thank Dr. Janis Ruoff for her time and energy to serve as our Guest Editor for this special issue of Brain Injury Professional on Brain Injury Training and Education. We also thank our guest writers for their dedication and expertise.

Ronald Savage, EdD

Acquired Brain Injury Services Building Relationships.

Enhancing Lives. x NeuroRehabilitation x NeuroBehavioral x Supported Living x Outpatient Services x Day Treatment x Respite Program Locations: CCS-Carbondale, Il, CCS-Kentucky, CCS-Tennessee, CCS-Florida, CCS-New England, REM IA, REM CO, REM MN, NJ MENTOR Brain Injury Services and CareMeridian-CA.

www.mentorabi.com

800-203-5394

guest editor’s message This may be the first publication ever solely on the topic of professional education and training about brain injury. For that reason, and because of how important I believe this work is, I am honored to be the Guest Editor for this issue of Brain Injury Professional.

cation about brain injury and in research in special education and brain injury. Her interview provides information that I believe is important to help us move forward in a growing field of education and training about brain injury.

My article on what developing preservice and in-service training programs includes is one I have always wanted to write.

The irony of being involved on a daily basis in continual development of education and training about brain injury is that it keeps me so busy with my students and university activities that I neglect putting it into writing to share with others.

Valuable education about brain injury also comes from the many DVDs, public broadcast television shows, news items, and from people who come forward to tell their stories. A powerful example recently is the information about their personal experiences with brain injury that Bob Woodruff and his wife, Linda, have made available through television, books, and public appearances.

The courage of people like the Woodruffs and others to open their lives for others to Janis K. Ruoff, PhD learn from may be the most valuable type of education and training because it is meanWhen my teenage son was in a car ac- ingful and brings it from a clinical topic to cident in 1989, and sustained a severe TBI, one that compels that we pay attention.

I began to understand first hand why profesSeveral years ago I decided to ask a quessional education and training was needed, as tion of: What is the current status of educado all family members and people with brain tion and training in brain injury? I sent out injuries. At that time there were only a small e-mail inquiries on list serves, distributed a number of people trying to “get the word short questionnaire at a few conferences, and out.” How time has changed that scenario, interviewed people working in high places. but we still have a long way to go. To con- I found that the answer was hard to come tinue the progression, we need to share with by because no one was keeping track, and no each other what we do, the results, and the one could figure out how to systematically challenges. gather the information. So, the simple anObviously we could not capture all the swer to this question is that we do not really excellent work that people are doing now know. throughout the United States and in other We do know, however, from list serves, countries to teach professional service pro- promotional materials, and reports that nuviders about the needs of people with brain merous workshops, continuing education injuries. But we have attempted to pull programs, and in-service training have been together some of the national picture by provided during the past ten years by the including articles on the state training pro- states through grant money from the Trauvided through grants from the U.S. Health matic Brain Injury Act. Community-based Resources Services Administration (HRSA), services, recognizing the need for professionand the national training in brain injury al development in this area, have also develoffered by the Brain Injury Association of oped wonderful in-service training programs America’s Academy of Certified Brain Injury and materials. Continuing education about Specialists (ACBIS). brain injury is now offered at a variety of proWe have also included a special BIP fessional conferences.

Expert Interview with Dr. Ann Glang who We also know that a few universities have brings to her work a dual expertise in edu- begun to offer courses or seminars in brain

6

BRAIN INJURY PROFESSIONAL

injury within their departments of medicine, special education, psychology, social work, speech-language pathology, vocational or rehabilitation counseling, and other related fields of study. And some universities, such as the George Washington University (GW) where I work, have begun to develop degree programs in brain injury.

The design and content for the training seems to vary according to available funding, the interests of the people who have received the funding, some urgent and politically hot topics in the media, or the background and experience of an individual or group of people in a university setting, state agency, school, rehabilitation program, or hospital. In designing education and training about brain injury, people have drawn from antidotal information from individuals with brain injuries and family members who constantly remind us that “they (a counselor, teacher, doctor, or other professional) just did not seem to get it.” Because there is no research base on training about brain injury, we have turned to the related research and literature on teaching and learning and drawn from the intuitive understanding and experience of seasoned professionals about what type of training is needed.

Because of the role I play in developing and managing graduate programs in brain injury at GW, people ask me all the time how to find funding and how to get administrative support to start a training program in brain injury. I think that, to improve the lives of people living with brain injuries and their family members, we need to improve professional practices. To bring about that needed change, however, we need to work together to create more funding opportunities for this type of training for everyone. The reality is that administrative support and funding go hand in hand.

My hope is that this publication will launch a new networking of all of the many creative and dedicated people teaching about brain injury, and that there will be other articles, research, and publications on this topic.

I hope that the information provided to you in this issue of BIP will help, and I would love to hear from anyone working to educate people about brain injury. I’d like to think of this issue of BIP as a call to action to work together to address this need.

Janis K. Ruoff, PhD

2!2% $%$)#!4)/.

#

7

9

%

!

2

3

8

#RAIG (OSPITAL IN $ENVER IS

EXCLUSIVELY DEDICATED TO SPECIALTY REHABILITATION AND RESEARCH FOR PERSONS WITH SPINAL CORD INJURY AND TRAUMATIC BRAIN INJURY #RAIG IS COMMITTED TO HELPING REBUILD LIVES FOLLOWING CATASTROPHIC INJURY AND TO UNSURPASSED CLINICAL OUTCOMES

PATIENT AND FAMILY SATISFACTION

AND FINANCIAL VALUE FOR THE INSURANCE INDUSTRY AND SOCIETY

!S AN INTERNATIONAL LEADER IN THE FIELD #RAIG SERVES MORE THAN INPATIENTS AND OUTPATIENTS

FROM TO STATES AND SEVERAL FOREIGN COUNTRIES EACH YEAR #RAIG IS FEDERALLY DESIGNATED BY .)$22 AS A -ODEL 3YSTEMS #ENTER FOR 3#) AND 4") AND IS THE .)$22 4") .ATIONAL $ATA AND 3TATISTICAL #ENTER #RAIG HAS BEEN RANKED IN THE 4OP 2EHAB (OSPITALS SINCE THE RANKINGS BEGAN IN

AND IS ONE OF ONLY A FEW -AGNET 2ECOGNIZED REHABILITATION HOSPITALS IN THE 5 3

4HE SUCCESS OF OUR PATIENTS IS DUE TO #RAIG S FOCUSED EXPERTISE AND RESOURCES REMARKABLE

LONGEVITY OF STAFF AND PHYSICIANS LARGE PATIENT MILIEU FAMILY SERVICES AND ON SITE HOUSING FINANCIAL STABILITY AND AN UPBEAT CULTURE OF CONTAGIOUS CARING AND COMPASSION

!S A NON PROFIT INDEPENDENT HOSPITAL GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS THE #RAIG

hFAMILYv IS DEDICATED TO DELIVERING THE HIGHEST QUALITY OF REHABILITATION TREATMENT AVAILABLE ANYWHERE !SK ANYONE WHO HAS EVER BEEN ASSOCIATED WITH #RAIG (OSPITAL AND YOU LL RECEIVE A CONSISTENT ANSWER #RAIG IS A VERY SPECIAL PLACE 7E LOOK FORWARD TO SERVING YOU

#RAIG (OSPITAL

A Century of Rebuilding Lives 1907-2007 3OUTH #LARKSON 3TREET \ %NGLEWOOD #OLORADO \ WWW CRAIGHOSPITAL ORG

8

BRAIN INJURY PROFESSIONAL

www.mentorabi.com

HomeLife, Inc.

HOME Dedicated long term care in a client friendly home setting, for individuals coping with the lingering effects of brain injury.

HomeLife, a place of specialized residential care for ongoing rehabilitation.

For more information:

(800) 774-5516 425 Kings Highway East, P.O. Box 20 Haddonfield, NJ 08033-0018 USA

www.talkhome.net Rebuilding lives, restoring joy.

www.bancroftneurohealth.org Bancroft NeuroHealth, a New Jersey Non-Profit Corporation

c

DIRECTO state-of-t habilitatio the-art h programs other ne physical in the co Located Most Liva ety of rea 5 state a and recre with little clinical e sure. Str proven le and throu (404) 364

Building futures…

a place TO CALL

Located in Kalamazoo, Michigan

staff PT’s program To apply AdcockB

Toll Free: 800.203.5394

For more than 120 years, Bancroft NeuroHealth has helped people with brain injuries rebuild their lives, step by step.

Our person-centered programs are based on the needs of each individual, with the goal of helping each person reach his or her maximum level of independence and lead the most fulfilling life possible.

With a range of community-based and campus-based options, Bancroft provides a full continuum of life skills rehabilitation at several locations in New Jersey. These include a return to school, work, social and recreational activities.

Our outcomes-oriented planning encourages personal achievement — leading to both greater independence and reduced costs.

OCCUPA with clien vidual wi and licen Director Postoffic 797-1445 org. ww

OCCUPA cated in integratio Greenvil largest h medical SC Licen pist posi brain inju package and inter at www.g immedia ment Sp To list Joyce

1-888-825-5466 12 BRAIN INJURY PROFESSIONAL

d 1/6 Page; 2-3/8 x 4-7/8” 8046 Homelife 6thPgAd3bFnl.ai 2.9.07 jsteen@allied-art.com

BRAIN INJURY PROFESSIONAL

9

The American Academy for the Certification of Brain Injury Specialists

LINda E. Mackay, MA, CCC-SLP, CBIST In the late 1980’s, prominent leaders in the field of brain injury rehabilitation gathered to discuss the importance and need for education and training of persons providing brain injury services. These leaders anticipated the many changes and challenges that would emerge and they envisioned a dynamic process that would support, foster, and communicate relevant and current information. Their valiant efforts led to the Brain Injury Association of America establishing the American Academy for the Certification of Brain Injury Specialists (AACBIS) in 1996. The ongoing mission of AACBIS is to improve the quality of care given to individuals with brain injury through the education, training, and certification of those who work in brain injury services. More than a decade later, AACBIS remains the prominent recognized national leader in brain injury education and training.

History In 1990, a survey was completed of 565 acute, sub-acute and post-acute programs regarding the training needs of licensed and non-licensed staff providing brain injury services. The results of that survey provided the building blocks for the establishment of a voluntary national certification program that establishes best practices for the training of individuals working with this population. Certification was not restricted to any one profession or discipline. Rather it was intended for any person who delivers services specific to brain injury. The initial program placed emphasis upon building strong foundations in knowledge and clinical application in brain injury rehabilitation, as well as emphasizing the importance of maintaining ongoing education within a rapidly changing and advancing profession.

The AACBIS Program has seen tremendous growth and 10 BRAIN INJURY PROFESSIONAL

undergone extensive evolution since its inception. The program, through a voluntary Board of Governors, strives to meet the changing needs of its constituents, stay abreast of theoretical, medical and clinical advances, and incorporate technological advances to meet learning needs.

Current Certification Program Description Currently the program offers two certification options representing distinct levels of experience and supervisory skills: Certified Brain Injury Specialist (CBIS) and Certified Brain Injury Specialist/Trainer (CBIST). Certification is based on comprehensive knowledge and application of an array of topics crucial to effective brain injury rehabilitation across the spectrum. Those topics are listed in Table 1.

Certified Brain Injury Specialist (CBIS) Applicants for this certification must have one year full-time or two years part-time experience directly with individuals with brain injury. They must have a high-school diploma or equivalent. Applicants must pass a national examination which assesses the comprehensive knowledge topics listed above. Individuals can choose to attend a training course to better prepare for this examination, although this is not required. A manual is available through AACBIS as an option to assist in the preparation for the examination.

Arrangements are made through the AACBIS office to apply for the national written certification examination. A passing score is 80%. Specific information regarding the application process, certification examination, and fees are posted on the AACBIS website (aacbis.net). The certification period is one year.

Certified Brain Injury Specialist/Trainer (CBIST) Advanced certification is provided as a Certified Brain Injury Specialist/Trainer. A Specialist/Trainer is able to provide training courses to individuals who are preparing for the examination. Applicants must have a bachelor’s degree and: • • •

5 years direct clinical experience in brain injury with at least 2 years at a supervisory level OR 3 years direct research experience in brain injury OR 3 years experience developing and/or implementing (i.e., as director) brain injury rehabilitation programs or units in hospital, residential, school, or community settings

Applicants must demonstrate skills in the areas of training, supervision, and/or teaching within the brain injury field. Applicants must demonstrate experience in each of these skill areas and must provide documentation that those skills are being maintained through continuing education. A passing score of 80 must be achieved on the national certification examination.

Prior to conferring certification as a CBIST, an individual must attend a CBIS training course and participate in a telephone CBIST Training Session. The certification period is one year.

Renewals and a Focus on Continuing Education The AACBIS Program was built upon the premise that knowledge in brain injury is an ongoing process and must be supported by participation in continuing education. Yearly renewals are required with verification of continued experience providing brain injury services. Documentation of ongoing continuing education requirements must be submitted every 2 years.

One of the strengths of the AACBIS program is commitment to certified individuals in maintaining quality continuing education. The David Strauss Memorial Lectures are one example of that commitment. These telephone lectures are provided quarterly to certificants at a nominal fee. Topics cover a wide range of knowledge from theoretical, clinical and research perspectives. Speakers are nationally and internationally recognized experts who volunteer their time and expertise to advance the knowledge level of persons working within the field of brain injury. Efforts are currently underway to expand the number of lectures annually, as well as introducing web conferencing technology. As continuing education budgets for professionals face continuing restraints, these advances are helping to meet the ongoing needs for quality continuing education for many of our constituents.

Program Statistics The volume of applicants that have successfully completed the certification program continues to grow. As of February 2007, the AACBIS Program has certified a total of 2417 individuals over 11 years. Table 2 outlines the yearly growth in the certification rate. Individuals conferred either a CBIS or CBIST now represent 46 of 50 states. Table 3 outlines the total number of certificants by geographical region. The state of Michigan has the largest number of AACBIS certified individuals, followed

by Pennsylvania, New Jersey, Minnesota and Illinois. The Academy also has a percentage of international persons that have been certified. Countries include Canada, Saudi Arabia, Singapore and the United Kingdom.

Michigan’s overwhelmingly large volume of AACBIS certi-

fied individuals is impacted by the commitment of the Brain Injury Association of Michigan and the state providers. Michigan’s no-fault insurance policy provides resources that other states do not have in terms of number of providers and clients served.

The collaborative efforts made in Michigan include providing 3 educational training opportunities throughout the state each year. This successful collaboration stands as a formidable model for other states.

As previously stated, the AACBIS Program is applicable to all professions within the domain of brain injury services. Table 4 lists some of the diverse professions that are represented by persons who are AACBIS certified. These professions cover the full spectrum of recovery from acute medical/surgical care through community reintegration, and incorporate medical rehabilitative models and educational settings. Professionals at all stages of recovery can benefit from the program curriculum and from certification. Feedback from programs has demonstrated that certification of staff has lent an air of significant credibility to many programs.

Specialized Program Features In recent years, the AACBIS Program has developed specialized features to improve aspects of the program, better meet the needs of certificants, and continue to improve quality of services provided to persons with brain injury.

Self-Study slides Individuals vary in their learning styles. Some individuals learn best through didactic lectures, others from reading materials/ articles, and others from interactive technologies. Recently, the AACBIS Program made available an interactive CD as an alternate or augmentative learning methodology in preparation for national certification. This CD provides comprehensive knowledge on brain injury similar to the published manual through the use of interactive computer technology.

Topics crucial to effective brain injury rehabilitation across the spectrum

Table 1 • • • • • • • • • • •

Table 2

Incidence and epidemiology of brain injury Continuum of services Philosophy of rehabilitation Brain anatomy and brain-behavior relationships Medication and medical management Functional impacts on brain injury Effective treatment approaches Children and adolescents with brain injury Health and medical management Family issues Legal and ethical issues

Yearly AACBIS Certification Growth

800 700 600 500 400 300 200 100 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 BRAIN INJURY PROFESSIONAL

11

Training Curriculum Ongoing feedback from applicants indicated that there was significant variability in the content and quality of training courses provided by Certified Brain Injury Specialists/Trainers. In preparation for national certification, it is important to maintain consistency in education and content. Providing trainers with options for teaching styles and opportunities for interactive learning modules better prepares individuals for success in the certification process.

The AACBIS Program, in concert with an outside consultant, developed a course curriculum for applicants preparing for the national certification. The course provides detailed instructions to both the trainers and the participant. The course utilizes combinations of didactic lectures, scenario-based practicums, and interchangeable review activities. These interchangeable activities allow the instructor to customize the learning needs and styles of the audience.

This training curriculum has been met with very positive feedback from both trainers and applicants. Two important needs are met with this program.

1. It provides a consistent structure base for knowledge crucial to effective brain injury rehabilitation across the spectrum.

2. It provides versatility to utilize different supportive learning activities based upon the needs and desires of the audience.

Future Development and Direction: Stepping Out of the Box In order for a certification program with education/training components to be successful, it must evolve and change over time. Changes within the practice of brain injury rehabilitation must be reflected on an ongoing basis within the content and educational components of the program. Changing roles and needs of constituents (i.e. individuals certified through the program) must also be reflected in ongoing program improvements. Without these ongoing revisions, a certification program may become quickly outdated. Certification Boards, such as the American Board of Internal Medicine and the American Board of Surgery have infrastructures to improve and update the certification process on an ongoing basis. The AACBIS Program is on the forefront of significant expansion and growth. Projects to meet the changing needs of the program that are currently being addressed are listed in Table 5.

The Brain Injury Association of America receives frequent requests for training of family members and caregivers. Although current AACBIS curriculum is applicable to many clinical environments, it does not specifically meet the education needs of those persons. This past fall, the AACBIS program secured budgetary support to develop a new curriculum and training program for family members and caregivers. Careful consideration is being taken to include input on the specific educational needs of family members and caregivers through the BIAA State Affiliates. Once completed, this curriculum will complement the existing professional curriculum in the overall AACBIS program.

The AACBIS Program receives numerous inquiries regarding expansion of the current program to different markets. Discussions between the AACBIS Board of Governors and other associations outside of the United States are looking to expand this certification program to international markets. Several states are exploring links between licensure and AACBIS cer12 BRAIN INJURY PROFESSIONAL

Geographical Distribution of AACBIS Certified Individuals

Table 3

Total Number of both CBIS and CBIST • • • • •

Northeast Southeast Midwest Northwest Southwest

467 500 827 67 247

Northeast: ME, VT, NH, MA, CT, RI, NY, NJ, PA, Southeast: NC, AR, WV, TN, AL, GA, LA, FL, SC, MD, MS, KY, VA, DE Midwest: ND, SD, NE, KS, MO, IA, MN, WI, IL, IN, MI, OH Northwest: AK, ID, MN, OR, WA, WY Southwest: CA, NV, AZ, NM, TX, OK. UT, CO, HI

Varied Disciplines Currently AACBIS Certified

Table 4 • • • • • • • • • • • • • • • •

Behavioral Analyst Case Manager Certified Occupational Therapy Assistant Clinical Specialists Developmental Disability Specialist Dietician Disability Management Specialist Independent Living Specialist Lawyer Massage Therapist MD, DO Mental Health Counselor Mental Health Professional Mental Retardation Professional Neuropsychologist Nurse (RN, LPN)

Table 5

• • • • • • • • • • • • • • • •

Rehabilitation Nurse Nurse Practitioner Nursing Assistant Occupational Therapist Occupational Therapy Assistant Physical Therapist Physical Therapy Assistant Physician Assistant Psychologist Rehabilitation Counselor Respiratory Therapist Social Worker Special Educator Speech/Language Pathologist Therapeutic Recreation Specialist Varied Administrative Positions

Future AACBIS Developments • • • • • •

Introduction of Caregivers Track Online Application System Expansion to international markets Partnering/Affiliation with regulatory agencies, i.e. CARF Establish mentoring program for community providers to partner with colleges/universities regarding training/education Institutional Training program

tification, as well as insurance reimbursement and certification.

Additionally, AACBIS is developing a mentoring protocol for community providers to partner with colleges/universities to provide training in the area of brain injury through the use of the AACBIS certification program. The linking of training curriculums, such as the AACBIS program, with regulatory agency program requirements (i.e. CARF) is being explored.

The next decade will continue to be as productive and busy for AACBIS as the first decade has been. While the AACBIS Program continues to move forward, it has not forgotten its past. Current board members carry on the rich traditions initiated by a multitude of brain injury pioneers involved in AACBIS over its history. These persons have shared their knowledge and given of their time to foster a belief in the importance of professional education and training in the field of brain injury.

About the Author

Linda E. Mackay is the Manager of Rehabilitation Medicine at Saint Francis Hospital and Medical Center/Mount Sinai Rehabilitation Hospital in Hartford, Connecticut. She is Assistant Professor of Surgery at The University of Connecticut School of Medicine. Linda has numerous publications and presentations including author of a text entitled “Maximizing Brain Injury Recovery: Integrating Critical Care and Early Rehabilitation”. Her areas of expertise include early TBI intervention in the trauma center, mild brain injury, and dysphagia. She is currently Chairperson of the AACBIS Board of Governors. She has been involved with this Board since 2002.

Lash & Associates Publishing/Training Inc.

Visit our website at www.lapublishing.com for Information and Resources on Brain Injury and Concussion in Children and Adults Lash & Associates Publishing/Training Inc. provides practical, user friendly information for families, individiuals, clinicians, therapists, and educators that is based on the latest research and best clinical practices in acquired brain injury. Our authors are leading experts in the field. What’s different about us?

We’re not just another publisher. We take out the jargon and condense information into user friendly formats for tip cards, manuals, and special kits so that information can be readily applied in the classroom, used in rehabilitation programs, at home and in the community.

Special offers on our website include...

9 Our full 32 page color catalog (request by mail or download it) 9 Free tip card offer - choose one from over 50 topics on children and adults 9 Monthly specials with discounts only for website visitors 9 Electronic newsletter for What’s New at Lash and Associates?

9 New products page - You will find new products not in the catalog.

Browse our bookstore... over 135 items on brain injury and concussion 9 Search by topics - you will find our products organized by these areas... behavior, concussion, rehabilitation, cognition, family, safety, communication, learning/school and work.

9 Our products on brain injury and concussion include... books, special tool kits, rehabilitation manuals, DVDs and CDs, tip cards, and attention memory training programs.

Free information on living with brain injury includes...

9 Articles to download for information packets 9 Survivor Forum and Family Forum 9 Expert Forum on various topics & News and Events

Lash &Associates Publishing/Training Inc.

708 Young Forest Drive, Wake Forest, NC 27587-9040 (919) 562-0015

Visit our Web site at www.lapublishing.com for a free catalog

BRAIN INJURY PROFESSIONAL

13

Traumatic Brain Injury Training for Professionals in the States

By Amy G. Horn, BSW Acknowledgement This article is based on observations of the Traumatic Brain Injury Technical Assistance Center’s (TBI TAC) work with the States. Special thanks to the TBI TAC Technical Assistance and Knowledge Exchange Team members for their leadership, comments, and edits.

Introduction Traumatic brain injury (TBI) is a major public health concern with a broad spectrum of causes, consequences, and patterns of recovery. The Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control estimates that at least 5.3 million children and adults in the United States have experienced a TBI significant enough to create a long-term or lifelong need for help in performing daily activities (Thurman D, Alverson C, Dunn K, et al., 1999).

Of the 1.4 million who sustain a TBI each year in the United 14 BRAIN INJURY PROFESSIONAL

States, 50,000 die; 235,000 are hospitalized with TBI and survive; and 1.1 million are treated and released from hospital emergency departments (Langlois JA, Rutland-Brown W, Thomas KE, 2004).

Because brain injury is so prevalent in our society, it is essential that professionals providing services and supports to individuals with brain injury become well-informed about the complex consequences of brain injury. Often professionals rely on in-service trainings to keep abreast of the latest developments and practices in their fields. To learn about an unfamiliar topic, one might attend a presentation, comparable to an introductory course, which covers the fundamentals of a given topic. A “TBI 101” program or presentation (hereafter referred to as TBI 101) is no different in that it is designed to cover the basics of TBI. TBI 101 training programs define TBI, speak to its incidence and prevalence, describe its causes and consequences, and illustrate brain/behavior relationships.

These trainings have the potential to improve the recognition of brain injury as a major public health problem. TBI 101 trainings provide a base of knowledge from which professionals providing services can begin to improve interactions with and address the needs of individuals with TBI. In fact, education and training is often one of the first areas States focus on to enhance local and statewide capacity to provide services for individuals with TBI and their families.

Training provides a foundation from which to build stronger systems of services and supports as well as to open the door for collaboration across systems. TBI training provides an opportunity for providers to become more aware of how TBI can affect the individuals they serve, to understand and recognize that each brain injury has its own unique consequences, and to learn about services available from other agencies and organizations.

Identification of TBI Training Priorities Many States identify and prioritize TBI training needs with the assistance of their TBI Statewide Advisory Board/Council and TBI Needs and Resources Assessment process. TBI Statewide Advisory Boards comprised of individuals with TBI and family members, providers, key State agencies, and the disability community at large lead and direct TBI systems development issues. Members work as a unified Board/Council and as individual liaisons to and from their respective agencies, associations, or advocacy groups in carrying out the mission of the Board/Council. Established work groups, committees, or other working bodies share the work, build broader involvement, and increase the visibility of TBI issues. Conducting a TBI Needs and Resources Assessment is a formal process used to facilitate the State’s ability to develop policy and deliver appropriate services to meet the needs of its citizens with TBI. The TBI Needs and Resources Assessment process assists States in identifying existing services, gaps, or barriers to services and resources in both the private and public sectors. Conducting this ongoing assessment is the mechanism by which States identify TBI education and training needs, among many other needs. TBI Statewide Advisory Boards/Councils and the TBI Needs and Resources Assessment process have existed for years in a number of States, though many were developed within State governmental systems through State grants funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) Federal TBI Program. The Federal TBI Program, created by the TBI Act of 1996 (Public Law 104-166) as amended, is designed to improve access to health and other services for all individuals with TBI and their families through grants to State Agencies and Protection and Advocacy Systems. Currently, there are many Federal TBI Program State grantees focusing on training of professionals.

As an example, South Carolina, as part of two separate Federal TBI Program grants, began to address the serious need for systematic training of professionals and providers to work more effectively with the TBI population. A “TBI Training Institute” was established as part of the University of South Carolina School of Medicine’s Center for Disability Resources (CDR), a University Center for Excellence in Developmental Disabilities. The SC Brain Injury Leadership Council, through its Training and Conference Committee, directly assisted

CDR in developing the TBI Training Institute. An assessment was conducted of the training needs of relevant professionals and specific agency staff. The TBI Training Institute provided extensive training opportunities to increase general capacity of provider agencies and professionals in SC to effectively work with individuals with TBI. The TBI Training Institute routinely offers continuing education credits to a variety of professionals. It also collaborates with the American Academy for the Certification of Brain Injury Specialists (AACBIS) to provide training to prepare people for AACBIS certification.

The SC TBI Training Institute can be accessed at http://uscm. med.sc.edu/cdrhome/tbitraininginstitute.htm.

TBI Training Audiences Target audiences vary according to identified needs and focus areas, though many fall into broader categories, such as caregivers, service coordinators, vocational rehabilitation counselors, education and school personnel, and mental health and substance abuse providers. States must define their target audience(s) to ensure success. Grantees of the Federal TBI Program often direct their attention first towards internal project or departmental staff, moving outward to sister agencies and organizations and then into the community to address basic TBI 101 training needs. See Table 1 for a more detailed breakdown of States’ targeted audiences. Many State training programs and presentation materials are designed for a single audience, although some may be appropriate for more than one specific target audience. Many training materials, particularly PowerPoint presentations, might easily be adapted to meet the needs of other audiences. An essential tenet of the Federal TBI Program is to use existing research-based knowledge, state-ofthe-art systems development approaches, and the experience and products of fellow grantees, as well as relevant resources from the broader field.

Scope of TBI Trainings The TBI Technical Assistance Center (TBI TAC) at the National Association of State Head Injury Administrators (NASHIA), which is supported by the Federal TBI Program, has clustered TBI trainings into three categories: TBI 101, TBI 101 Plus, and TBI 201. Basic TBI 101 trainings and preAudiences

Table 1 General Professional Caregivers Peer Mentors State Agency Personnel Case Management Personnel Correctional/Law Enforcement System Personnel Domestic Violence System Personnel Educational/School System Personnel Housing Personnel Mental Health/Substance Abuse System Personnel Vocational Rehabilitation/Employment System Personnel State and Private Providers Hospital/Healthcare Providers Veterans Healthcare Providers EMS Providers Waiver Providers

BRAIN INJURY PROFESSIONAL

15

sentation materials describe the essential characteristics of TBI in that they generally cover one or more of the following topics: brain anatomy, types of brain injuries, epidemiology, causes, pathophysiology, and long-term consequences. TBI 101 Plus trainings and presentation materials cover at least some of the Basic TBI 101 topics as well as one or more additional focus areas, such as communication; compensation strategies and accommodations; identification and screening; neuropsychological assessments; transition-to-school; neuropsychiatry; psychopharmacology; co-occurring disorders; cognitive rehabilitation; vocational rehabilitation; waiver services and documentation; available services and supports; emotional health; health and nutrition; sexuality; related policies and legislation; and legal issues. TBI 201 training programs and materials presume the above information is known and focus on areas and principles beyond Basic TBI 101 and TBI 101 Plus training, such as person-centered planning, self-determination, full participation, and promising practices.

As brain injury affects not only the individual, but also the family, it is important that professional training programs and presentation materials that are 101 Plus and beyond include strategies for working with and supporting families. Families have a different set of needs than the individuals who have sustained a brain injury and often are vital members of an individual’s care and support team. Their ability to participate in education and training, process information, and cope with the devastating emotional and financial impact of brain injury are all important factors that professionals need to be equipped to recognize and address. The following materials include strategies for working with and supporting families: • Kentucky’s ABI Waiver Training Modules The “Family Interactions” section presents six stages family members experience when they have a family member with a brain injury. www.tbitac.nashia.org/tbics/download/kyabiwaive-rmodules.ppt • New Jersey’s Brain Injury Awareness Presentation The “How Brain Injury Affects Families” section covers the emotional impact, financial cost and family relationships. www.tbitac.nashia.org/tbics/download/njbi101.ppt • U.S. Department of Veterans Affairs’ Traumatic Brain Injury Independent Study Course Section 8 “Living with Traumatic Brain Injury” answers some frequently asked questions and discusses sexuality and anger issues. www.tbitac.nashia.org/tbics/download/TBI%20Independent%20Study%20Course%20--%20Vets.pdf TBI Training Formats Training programs and presentation materials range from those that allow for self-study to those that require an instructor, trainer, or presenter. Training formats range from a formal class, PowerPoint presentation, CD, DVD, VHS, or manual to an online course or training package. Which training format is best depends, in large part, on the audience and their needs and availability. Trainings are most effective when adaptable and sustainable. The TBI TAC encourages grantees to research and identify existing trainings and any lessons learned from other programs or models before developing a training pro16 BRAIN INJURY PROFESSIONAL

gram or presentation as there is an abundance of products and resources to draw upon. Many other complementary materials exist that can be used in conjunction with training programs and presentation materials. While they have not been listed here, the reader may find examples (e.g., guides, fact sheets, and reference booklets) in the TBI TAC’s on-line TBI Collaboration Space (TBICS). TBICS is a learning, collaboration, and benchmarking tool open to the grantees and others affiliated with the Federal TBI Program at http://tbitac.nashia. org/tbics.

Telehealth, the delivery of health related services and information via telecommunications technologies, reflects an efficient way to provide training and education to providers, individuals with TBI and family members, and State agency personnel, particularly in rural areas where providers are scarce and facilities are miles away. The Traumatic Brain Injury Virtual Grand Round Series, produced by Idaho’s TBI Virtual Program Center at Idaho State University’s Institute of Rural Health, addresses the need for continuing education and provides support for rural health professionals. Virtual Grand Rounds bring current, evidence-based practice to the rural professional rather than leaving their community to access the same information (Stamm and Rudolph, 1999). Information about this Series can be found at http://www.idahotbi.org.

Web-based training provides easy access and great flexibility in its use. Michigan’s TBI Web-based Training Site, “Traumatic Brain Injury & Public Services in Michigan”, provides both basic clinical information about TBI and treatment hints.

The training, which is publicly available at no cost with user registration, includes four, easy-to-use modules. The training is self-paced, such that it can be completed over the course of multiple sittings, and is approved for continuing education credits for social workers and contact hours for nurses. Michigan’s web-based provider training was developed with the participation of TBI project leaders in Nebraska and its content drew upon the work of two other States, Florida and Minnesota. This training was developed in collaboration with many organizations and was funded in part by the Health Resources and Services Administration and the State of Michigan. The training site can be accessed at http://www.mitbitraining.org.

Challenges Embarking upon training is not without its challenges and the need for training can seem never ending. Local and regional needs may differ. It can be difficult to find a time when professionals are available for training as many have a limited number of days and/or hours to devote to attend training. Frequent staff turnover requires that trainings be repeated to keep providers attuned to TBI. Professionals may not be able to use their new TBI knowledge as frequently as needed to maintain competency as many may not support a large number of individuals with TBI. It can be difficult to keep TBI at the forefront, particularly if there are many competing priorities in the delivery of services and supports. Training programs cost money and there are limited amounts of State resources for training. Despite the ongoing need for training, it can often be one of the first casualties of budget cuts. Developing broader resources for training would be easier if the effectiveness of the training, specifically positive outcomes, could be addressed and identified for State policy makers. Currently, most training events are evaluated by asking participants about what they learned

the day of the training through the use of written pre-and-post tests. A few States have begun to follow-up with professionals six months post training to ascertain whether or not they have been able to use their new TBI knowledge. What has not been addressed as successfully is whether the desired outcomes of the trainings have been met. The purpose of training professionals is to ensure that individuals with TBI are identified and receive the most appropriate services and supports. States have yet to develop measures that focus on this ultimate goal.

Outcomes Institutionalizing TBI training via new-hire orientation, inservice training, and professional and community development opportunities across new and existing service delivery systems carries the promise of many long-term benefits. With increased understanding of TBI and its potential effects, individuals with TBI will experience improved access and eligibility as well as assessments that incorporate meeting needs and providing services specific to the effects of TBI. Service providers can use information from TBI screening training in combination with other assessments and information to determine if referrals for further assessments or other more suitable services are appropriate. Caregivers educated about TBI will have information to utilize in assisting individuals with TBI live independently. Most importantly, individuals with TBI will experience a higher quality of care as a result of providers and caregivers having access to information, tools, and resources specific to TBI and its effects.

LiveOakLiving.com

For those interested, the Traumatic Brain Injury Technical Assistance Center (TBI TAC) at the National Association of State Head Injury Administrators (NASHIA) has assembled ‘Traumatic Brain Injury 101: A Collection of Training Programs and Presentation Materials for Professionals’. ‘Traumatic Brain Injury 101’ describes 82 TBI 101 training programs and presentation materials that were developed by State agencies, the Brain Injury Association of America and its chartered State affiliates in 26 States, as well as by the Centre for Neuro Skills, the Mayo Clinic, Mt. Sinai, the National Association of State Head Injury Administrators, the Ohio Valley Center for Brain Injury Prevention and Rehabilitation, and the U.S. Department of Veterans Affairs.

While written for grantees, others may find it useful: http://www. tbitac.nashia.org/tbics/download/ 101packet.pdf.

About the Author

Amy G. Horn is a Technical Assistance Field Specialist at the Traumatic Brain Injury Technical Assistance Center (TBI TAC) at the National Association of State Head Injury Administrators (NASHIA). She serves as lead for the TBI TAC’s Public Education & Training Benchmark. The Federal TBI Program supports TBI TAC to assist State and Protection and Advocacy System Grantees. NASHIA assists state government in promoting partnerships and building systems to meet the needs of individuals with brain injury and their families. If you have benefited from a TBI training, tell us about it: who conducted the training and what did you learn? Tell us why it resonated with you. Contact aghorn@tbitac.nashia.org.

For Adults with Cognitive Disabilities

References

Langlois JA, Rutland-Brown W, Thomas KE Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2004.

Stamm B H, Rudolph J M. Changing Frontiers of Health Care: Improving Rural and Remote Practice through Professional Conferencing on the Internet. Journal of Rural Community Psychology., 1999.

Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic Brain Injury in the United States: A Public Health Perspective. Journal of Head Trauma Rehabilitation 1999; 14(6):602-15.

David Seaton, Owner/CEO • ds@tc-tx.com • 512.371.1078 4314 Medical Parkway, Suite 101, Austin, Texas 78756

BRAIN INJURY PROFESSIONAL

17

bip expert interview Dr. Ann Glang, Teaching Research Institute In general, do you think that there has been a slow growth of professional education and training programs in brain injury – and if so, why do you think this is the case?

AG: TBI is still “off the radar screen” for most school professionals. As a result, students aren’t identified as needing supports, and there aren’t as many training opportunities. Lack of identification/ awareness has also contributed to the lack of funding for research and training efforts.

In addition, many states provide special education services noncategorically, and much of the federal funding is not provided by disability category. TBI was not as prevalent during the days of categorical funding, and is subsumed under other categories now.

Why do teachers lack training in TBI? AG: Again, there’s a general lack of awareness, still, about the needs of this population. Like the general public, there’s a sense among educators that TBI is a low incidence disability. Because of this, university pre-service teacher preparation programs have not typically included much training in TBI. Most special education texts, for example, devote very little space to the topic.

What TBI topics do teachers need the most?

AG: In needs assessments that we have done in Oregon, teachers and administrators say that they need basic information about how TBI impacts school performance (cognition, behavior, social interaction, communication), and then more in-depth information on strategies to support students—particularly in the area of social behavior. I also think it’s very important to provide information to teachers about the effect of TBI on the family, and to provide training in parentprofessional collaboration. There’s a lot of data to show that when parents and teachers work together to support students in school, child outcomes improve.

What’s the best way to get training to teachers: workshops, college courses, or web instruction?

AG: Research in professional development has consistently demonstrated that in order for teachers to learn and apply new skills with students, they need intensive, sustained, site-based training. That pretty much rules out one-day workshops, and traditional forms of staff development in school. I think any approach that integrates content with hands-on practice shows promise. That could be webbased delivery, college courses, seminars with assignments and practice activities.

What has Teaching Research and the state of Oregon done that other states could replicate?

AG: Over the past 14 years, we have worked with the Oregon Dept. of Education to train and support a cadre of TBI consultants (TBI Consulting Team). This interdisciplinary group of school-based con18 BRAIN INJURY PROFESSIONAL

sultants provides training and consultation to local schools. Their activities include attending IEP meetings, observing students and working with school teams to generate recommendations for behavioral and educational interventions.

How do you evaluate your training programs, and how do you use the evaluations to improve the training?

AG: We evaluate our program on several levels. First, to determine if we’re addressing perceived training needs of our team members, we interview team members on an annual basis. We modify our training content based on their input. We also ask participants at statewide trainings (offered several times a year to increase awareness and knowledge in TBI) to complete standard questionnaires about the efficacy of trainings. One of the key questions we ask team members and training participants is: how will you use the information you learned today? At follow-up trainings, we review this question to get at the impact, according to the training recipients, of the training content on their work with teachers, students and families. Information from responses to this question helps us determine if we’re designing the training to be as relevant and hands-on as possible. When possible, we try to get at the most important level of impact: did the training make a difference for the student with TBI and their family? We have interviewed teachers who have received consultation by team members, and have also spoken with families about how helpful this consultation was. This is harder to do, as it really requires a more substantive evaluation effort — which hasn’t been possible with our funding.

Do you have recommendations to the fields that work with people with brain injuries about increasing professional education and training?

AG: I’d first suggest working with state and local education agencies to increase awareness of TBI. In many cases (such as with autism) families and caring professionals have been extremely successful in bringing training and service needs to the attention of educational leaders. Another suggestion is to connect with others around the country who are doing this work. Staff development activities in TBI are occurring in many states – for example, the states of Arizona, Tennessee, Kansas, Iowa, Hawaii, Oregon, and Nebraska all have trained TBI consulting/resource teams. Other states have done excellent regional trainings in TBI (e.g., Colorado, Ohio).

Ann Glang

Since 1987 Dr. Glang has worked as a researcher and educational consultant in the field of childhood TBI. She has developed and evaluated a range of training tools on TBI for parents and teachers, including an internet-based training program for parents coping with the effects of childhood TBI and educational videotapes and manuals for educators. Dr. Glang has published a number of articles in refereed journals, edited two books on her work with children with TBI, and co-authored five manuals for educators serving children and youth with TBI.

Developing Professional Education and Training in Brain Injury

Janis K. Ruoff, Phd

The importance of increased professional training is well established through personal accounts by people with brain injuries and their families, reports from state organizations and state traumatic brain injury (TBI) projects, and reflections and evaluations from people who attend training on brain injury. But there is almost no literature base pertaining specifically to professional development and training about brain injury.

This article explores the relationship of relevant theory, describes principles of adult education, and examines some of the challenges related to the education and training of professional service providers about brain injury. A unique pre-service university training model from the George Washington University is provided and recommendations for further research and program development are offered.

Moving Forward but Not Fast Enough Interest in the scientific study of the brain and brain abnormalities is documented back to the Middle Ages when Hippocrates studied epilepsy and announced the brain as being the greatest source of power for man. Centuries later, people are still fascinated by the brain, its power and role in our lives, and the impact of brain injury or brain-related disease. However, there is still no one field of study called Brain Injury, and we have only just begun to provide the 20 BRAIN INJURY PROFESSIONAL

needed formal education and training programs to the professionals who serve people with brain injuries.

Since the early 1980’s we have seen a rapid growth of brain injury rehabilitation programs, medical research, and advocacy. The National Head Injury Foundation (now the Brain Injury Association of America) was born; the Traumatic Brain Injury (TBI) model systems program was created through funding from Congress to the National Institute on Disability Rehabilitation and Research (NIDRR); the Traumatic Brain Injury Act was passed in 1996; and state programs and projects in brain injury spread due to funding from the TBI Act. And yet, we continue to face a lack of awareness about brain injury, and a lack of coordinated professional services and resources as demonstrated clearly with recent media attention to the problems of returning wounded veterans from the war in Iraq.

As a professional community concerned with the impact of brain injury on individuals and society, we need to ask ourselves and others: why has public awareness about brain injury, and the needs of people with brain injuries and their families, spread so slowly in spite of the past 25 years of dedicated advocacy? One theoretical explanation may be found in the literature on “diffusion of innovation” (Rogers, 2003) which notes that innovation is communicated through certain channels over time among members

of a social system. According to Rogers, “An innovation is an idea, practice, or object that is perceived as new by an individual or other unit of adoption.” (p. 11) he also points out, however, that “an important dimension of the compatibility of an innovation is the degree with which it meets a felt need.” (p. 228) To what degree do people perceive a need for education and training about brain injury? With little or no demand by professional accrediting and licensing organizations, this need may need to be created before we can expect to see a spread in funding and resources for, and commitment to, this type of training.

The notion that we can and should help people with brain injuries be all they can be, and make improvements to our system of service delivery, may be thought of as an innovation which requires new thinking. And new thinking may be the result of the gradually developing idea of education and training about brain injury.

The good news is that some signs of a growing professional “field of Brain Injury” are emerging. In recent years new professional journals about brain injury have developed, and professional societies and organizations have sponsored conferences that offer continuing education credits and learning opportunities for a variety of professional disciplines to learn about brain injury. Some preservice professional development programs in colleges and universities have incorporated classes, special seminars, and programs that focus on brain injury for related fields such as medicine, rehabilitation, neuroscience, speech-language pathology, special education, social work, psychology, and others.

However, compared to the research and professional study about other disabilities and health concerns, we still have long way to go in teaching professional service providers at the pre-service or in-service levels about best practices within the various disciplines. We need increased research to draw from about medical interventions, teaching strategies, and other services and supports that are best able to assist people with brain injuries in returning to full and productive lives.

The problem may simply be that people with brain injuries being productive citizens is still new thinking, and we have not diffused the new thinking broadly enough or fast enough. It is new thinking, for example, for vocational rehabilitation counselors to address the employment problems of people with brain injuries who might return to work and be medically stable yet continue to change neurologically, psychologically, and in many other ways. It is new thinking for teachers in schools to help students with TBI through new instructional methods such as teaching the pre-requisite learning of an educational task that would previously have been no problem for that same student.

It is even new thinking for many people to expect that someone with a severe brain injury may be able to survive numerous medical procedures, complete high school, go to college, develop or regain a career, live independently, marry and have children. And for many people it is new thinking to believe that brain injury could happen to them or a close relative or friend, and therefore that it is impor-

tant to think and learn about.

Preconceived ideas about people with brain injuries and their potential may also help to explain why it is difficult for administrators of universities or other training organizations to believe that there is a need to provide education to professionals in their fields about the needs of people with brain injuries and a target population of people to recruit for the training. This may help to explain why so few preservice training programs have been developed thus far.

Challenges to Developing Brain Injury Education and Training The business of providing education and training to professionals who serve people with brain injuries is challenging for a variety of reasons: (a) limited funding for such training; (b) lack of understanding among the general population of the needs of people with brain injuries; (c) limited preparation of those planning and providing the training in how to design instruction; and (d) almost no research base to draw from that identifies competencies, theoretical considerations, or even appropriate learning objectives for such instruction.

The limited research on best practices, and professional competencies, is a critical problem for education and training programs about brain injury. How can we train people toward learning objectives when we are uncertain about what those objectives should be?

In any professional discipline, professional competencies are closely tied to standards, and standards are impact policy and regulations for provision of professional services Therefore, a key question that must be addressed when designing professional education and training in brain injury is whether or not to incorporate a competency based approach. This approach is behavioral in nature and involves conducting a functional analysis of occupational roles, determining outcomes, and assessment of some measures of demonstrated performance of these outcomes.

Competency based instruction is linked to standards and a movement toward professional accountability that has grown over the past several decades. Legislation such as No Child Left Behind (NCLB), developed by the Bush Administration, have imposed regulations and new standards upon our nation’s schools for example and demand that schools meet new targets for competencies of teachers.

While it may seem, at first thought, that we obviously need such an approach, it is somewhat controversial. The controversies over competency based training seem to be that it can lead to minimal standards rather than excellence, and that it can reduce motivation to excel and to reach beyond those standards. A training program that teaches only competencies may be limited in other words, and may not encourage new thinking.

Another challenge is that of infusing understanding about brain injury into established professional domains that already have a full training agenda and that are concerned with other problems of humans. A barrier to diffusion of innovation, as described by Rogers, can be a lack of affiliation or linkages within a key network.

BRAIN INJURY PROFESSIONAL

21

If an education and training program in brain injury in a university, for example, is led by someone perceived to be an outsider to that community, it may be more difficult to diffuse the new thinking into that community. Friendships and social networking play a key role in opinion leadership.

This same problem is sometimes encountered when training is brought in “from the outside” by a brain injury expert, a state BIA, or a grant funded project. People may come to the training program, collect their CEUs, and then go back to their work and do not integrate new learning into what they do on a daily basis.

Using the concept of diffusion of innovation, the way to change the opinions of others about how to best serve and support individuals with brain injuries and their families, is not through a detached, impersonal presentation on the subject. To really make change, we have to provide education and training through ongoing, long-term influence of a social network. This takes time and may involve stepping out of the usual comfortable inner circles of a network we know.

Where do we Begin in Designing Professional Training about Brain Injury?

In establishing the program design and curriculum for the training within any discipline, we need to identify overarching objectives for the training. (Saphier and Gower, 1997) These are the big picture outcomes for our learners that we want to address to shape core practices. Overarching objectives answer the question of what we want participants to carry away from the training experience. These outcomes should be focused on three areas of knowledge (what I want them to understand), skills (what I want them to do), and dispositions (what new thinking, attitudes, and feelings do I want them to leave with).

Since professional education and training usually targets adults, we need to understand the principles and related theories about adult education. Caffarella (1994) has proposed five possible purposes of adult education as follows.

1. To encourage continuous growth and development of individuals 2. To assist people in responding to practical problems and issues of adult life 3. To prepare people for current work and future work opportunities 4. To assist organizations in achieving desired results and adapting to change 5. To provide opportunities to examine community and societal issues Once we know the purposes of the education and training program we intend to provide, we then look to possible outcomes that may guide us in designing the curriculum and conducting training evaluation. O’Shea (2005, p. 132) has outlined the following basic time-honored principles of adult learning that can help to guide us.

1. Relate knowledge and skills of the program to the professional’s current responsibilities and activities 22 BRAIN INJURY PROFESSIONAL

2. Describe new knowledge and skills in terms of actions or decisions that the professional usually makes 3. Illustrate ideas and principles with practical applications likely to develop in the implementation process, Show the relationship of new skills and ideas to the systemic change process in the organization 4. Focus instruction on the learner, with opportunities to practice new skills in a supported, collaborative process 5. Acknowledge the learner’s existing skills and experience and relate the new skills and activities to them.

Using a Backward Design for Teaching and Learning Keeping these purposes and principles of adult education in mind, and with our overarching, big picture objectives and enduring understandings clearly thought out, we then turn to the work of Wiggins and McTighe (1998) who propose that all instruction should begin with identifying how learner understanding will be assessed and then working backwards to design the training that will facilitate that desired learning.

They suggest that the designer of instruction is an architect who must begin by imagining how the education program and instructors will assess whether students have reached a point of enduring understanding. This is a concept that differs from simply teaching information about brain injury, and proposes that learners should reach a point of deep understanding in order to satisfactorily provide the required assessment and to create long lasting changes in thinking.

Using a backward design means that we start with askTable 1

The Evolution of Brain Injury Programs at George Washington University

Dates

GW Program Evolution

1992-1994

GW faculty obtained a 2 year grant from the U.S. Department of Education to prepare 10 graduate students in special education and brain injury at the master’s level.

This project was in response to the new provisions of the Individuals with Disabilities Act of 1991 that included special education categorical placement for students with traumatic brain injury (TBI) and was the first program of its kind in the nation.

1994-1998

GW faculty obtained a 4 year grant to prepare a new cohort of master’s degree students and to revise and update the curriculum. A total of 17 students received financial support from this grant.

2001

A private donation from the Jason Foundation in Roanoke, Virginia assisted in developing new Research Assistantships for graduate students in a master’s degree program in Transition Special Education: Emphasis in Acquired Brain Injury. The funds also supported start-up of a new Center for Education and Human Services in Acquired Brain Injury at GW which was chartered by the university administration (and re-chartered in 2004).

2001-present

A five year grant was obtained to further support tuition for graduate students in the MA program, and for a pilot group of students in an education specialist (Ed.S) program in special education and brain injury. The curriculum was updated and revised, and new research projects were added. The program was granted a one year no-cost extension by OSEP in 2006.

2002

A new Graduate Certificate program in Special Education and Brain Injury was proposed to the university administration and approved. The Certificate program is offered through on campus coursework for students who live in the metropolitan Washington D.C. area and through Distance Education for others around the nation. A partnership with the Hawaii Department of Health, through a grant to the DOH from the U.S. Health Resources Services Administration, supported tuition for a pilot group of 8 scholars to participate in the program.

2003

A 5 year grant for the U.S. Department of Education was obtained to support students in the new Graduate Certificate program with a focus on capacity building around the nation.

2006

The GW Master’s degree program in Transition Special Education: Emphasis in Acquired Brain Injury participated in a national program review by the National Council on Accreditation of Teacher Education (NCATE) and was nationally recognized by NCATE and the Council of Exceptional Children.

SPED 223

Introduction to Brain Injury: Programs, Policies, and Resources

An overview of acquired brain injury and its effects; current trends in the field, related policy, research, and development of new resources

SPED 224

A Model of one University Program in Professional Education in Brain Injury: The George Washington University Experience The Individuals with Disabilities Education Act (IDEA) was passed in 1990, creating a new special education category of Students with Traumatic Brain Injury (TBI). In keeping with the theory of diffusion of innovation, this new legislation created a perceived need for a new type of professional preparation in the field of education.

Reacting to this need, in 1992, the Department of Teacher Preparation and Special Education (DTPSE) of the George Washington University (GW), in Washington D.C., began a new and innovative master’s degree program in special education with an emphasis in traumatic brain injury (TBI) through a grant from the U.S. Department of Education’s Office of Special Education Programs (OSEP).

The purpose of the new program at GW was to train special education personnel for the schools who could address the needs of students with TBI. Since1992, the curriculum for the GW master’s degree program has been revised several times to keep up with current research and understanding of the needs in serving individuals with brain injuries, and the program has developed new directions to meet the emerging needs of a developing field of brain injury. The history of development of the brain injury programs at GW is described in Table 1.

In 2002, a Center on Education and Human Services in Acquired Brain Injury (CEHSABI) was begun by the Graduate School of Education and Human Development

GW Brain Injury Curriculum

Brain Function and Impact of Brain Injury on Learning and Education

Provides an in-depth understanding of neuroanatomy related to the impact of brain injury on child and adolescent development and learning to prepare education and related service providers to participate in educational assessment and planning.

SPED 225

Too often the design of professional education and training begins at the end of this process of planning, with setting up learning objectives, and neglects the important first few steps. And too often the important step of formative evaluation is ignored, and the same training program is continued regardless of whether it makes a difference or not.

Table 2

Family Partnership for Systems Change

Applies a family systems perspective to prepare educators to establish and maintain partnerships with families of individuals with brain injuries to improve access to services and supports. Family roles in individualized education planning and service system coordination are addressed.

SPED 231

1. What enduring understandings do I want my learners to have when they complete this training program?

2. What overarching objectives do I have for the training?

3. How will I assess whether participants in the training have achieved these overarching learning objectives?

4. Based on that assessment plan, what do I need to include in the curriculum?

5. What are the specific learning objectives needed for each course or module of the curriculum?

6. What strategies can I use if the learning objectives are not met to improve my curriculum and instruction?

(GSEHD) at GW to conduct and integrate applied research with professional preparation, and to develop new projects and programs related to brain injury.

Through the efforts of the CEHSABI, the DTPSE now offers three options for people wishing to pursue studies in brain injury: (1) a master’s degree in transition special education (MA) with emphasis in acquired brain injury; an educational specialist program (EdS) with emphasis in brain injury, and a Graduate Certificate program offered both on campus and on-line. In addition, new initiatives have begun to infuse brain study and research into the curriculum of the doctoral program in special education.

In 2006 the MA program participated in the DTPSE’s accreditation site visit by the National Council on Accreditation of Teacher Education (NCATE) and received

Instructional Methods in Special Education and Transition for Students with TBI

Techniques and processes used in teaching and programming for the needs of individuals with brain injuries as they prepare for transition to postsecondary programs and employment. Emphasis on skills related to professional liaison and support roles in the design of instructional arrangements and cooperative training.

SPED 255

ing ourselves how we would evaluate the learning we desire that our students of brain injury to possess after completing their educational program. What knowledge, skills and dispositions are we aiming for, and how will we know when the learner has obtained them? Using this approach, the planners of instruction might ask the following questions when planning an education and training program about brain injury.

Interdisciplinary and Interagency Services Coordination for Special Populations: Focus on ABI

Overview of models and strategies for coordinating services across disciplines and among school and community agencies for special populations. Emphasis on interdisciplinary team coordination, communication, decision making, planning, and follow-up for individuals with brain injuries.

national recognition as a program of teacher preparation.

The professional competencies and standards addressed in the program report were based on those of the Council for Exceptional Children (CEC) since there is no national organization with standards for brain injury.

The Students and Graduates of the GW Program: Pioneers for a New Professional Field Students in the brain injury programs at GW include people with brain injuries, family members of people with brain injuries, and professionals or pre-service aspiring professionals from an education or related disciplines. They are from racially and culturally diverse backgrounds. They come into the program from a variety of professional fields including teaching, psychology, educational administration, psychiatry, university faculty, rehabilitation counseling, consulting, occupational therapy, physical therapy, and speech-language pathology. This variety of participant experiences enriches the program and contributes toward a focus on multicultural understanding about the problems associated with brain injury recovery, the impact of brain injury on individuals and families, and the needs of the education community..

Graduates of the master’s degree program typically work in teaching or related services, or advocacy and service coorBRAIN INJURY PROFESSIONAL

23

dination, and those who complete the education specialist program have leadership roles in education or a related field.

Those who complete the Graduate Certificate program use their training in brain injury for increasing their professional opportunities within their field, and developing a specialized professional niche in brain injury. Many of the students and graduates of the on-line Graduate Certificate program are already leaders in their states or organizations, and their increased understanding of the problems faced by people with brain injuries arms them with information and new skills to be able to make systems improvement and address professional competencies in brain injury within their specific disciplines.

The Curriculum of the GW programs The GW programs include five core courses in brain injury that are listed in Table 2 with a brief description of each course and its purpose. For the Graduate Certificate program, these five courses are all that are included and there is no internship requirement.

The MA degree program is comprehensive and requires students to complete 42 to 48 credits of coursework, including 9 credits of internship. Students have the option to pursue teacher certification in special education or not if they either already have certification or do not need it to reach their professional goals. For those pursuing certification, 6 credits of internship is their student teaching experience and the other internship is in a brain injury rehabilitation or advocacy setting. For those not pursuing certification, all 9 credits of internship are done in a brain injury related national, state, or local organization or agency. For the EdS degree, students are required to complete 30-36 credits of coursework including the core courses in brain injury and 6 credits of internship in a leadership role within a brain injury advocacy organization, state agency, or direct service setting. Examples of internship sites include hospitals and medical rehabilitation programs in the Washington D.C. area, special schools, community-based case management or programs, national organizations (such as the BIAA, NASHIA, and others), and with state BIAs or the state TBI projects funded through HRSA grants.

All coursework for all of the GW brain injury programs involve a number of field-based activities in the local community such as case studies, special projects, conducting an in-service in local schools, family interviews, and others to allow students to become familiar with the needs and resources in their states, and to encourage participation in capacity-building for those states in which graduate students live and work. Student learning outcomes are assessed primarily through assessments designed for each course, based on the objectives for that course, and through a final Portfolio requirement. The students are asked to include in their Portfolio reflection papers, and artifacts demonstrating their growth within the major areas of professional competency outlined by the CEC. For the graduating student who is not working in special education, and does not plan to enter that field, some leniency is allowed to demonstrate competency for that student’s professional goals.

24 BRAIN INJURY PROFESSIONAL

At this time over 100 students and graduates of the GW programs are living and working around the country, and doing outstanding advocacy and professional work in education, rehabilitation, or related settings. They are strong advocates and leaders in their states, caring and knowledgeable teachers in public schools, managers of independent consulting companies specializing in brain injury, program directors for rehabilitation programs specialized in brain injury, and some have gone on for doctorates, medical degrees, or other advanced education after completing their work at GW. Where Do We Go From Here?

As we continue to develop programs of professional education and training to improve the lives of people with brain injuries and their families, there are research and programmatic goals that we should consider.

1. One of those aspects of a more mature professional field of study is a solid literature base about professional standards, competencies, and administrative issues related to education and training of professionals in that field. We need to demand funding to support that type of research if we are to move forward.

2. The continued evolution of a field of Brain Injury must include a cohesive and far-reaching effort, with increased funding for programs that offer professional pre-service, in-service, and continuing education and training to all professionals who touch the lives of people with brain injuries and their families.

3. We need to continue to share examples of education and training programs at conferences, in journals, and perhaps through establishment of a formal network of those who do this type of work.

4. We need to create linkages with national organizations that are concerned with standards, professional development, and professional competencies.

5. We need to diffuse innovative thinking about brain injury within many different professional fields. Only by moving beyond our comfortable circles can we promote understanding of the problems associated with brain injury and to discuss infusion of training on this topic throughout related curriculum and development of training materials.

As Hippocrates said, there is great power in the brain.

There is also great power in furthering education about the brain and about brain injury.

References

Caffarella, Rosemary S.: Planning Programs for Adult Learners. San Francisco: Jossey-Bass Publishers. 1995.

O’Shea, Mark R.: From Standards to Success: A Guide for School Leaders. Alexandria: Association for Supervision and Curriculum Development. 2005.

Rogers, Everett M.: Diffusion of Innovations (4th Ed). New York: The Free Press. 1995.

Saphier, Jon and Gower, Robert.: The Skillful Teacher (5th Ed). Acton, MA: Research for Better Teaching. 1997 Wiggins, Grant S. and McTighe, Jay: Understanding by Design. Alexandria, Association for Supervision and Curriculum Development. 1998.

Energize the Body

TRAUMATIC BRAIN INJURIES

Enrich the Mind

WORKMAN’S COMP

Inspire the Soul.

SPINAL CORD INJURIES OCCUPATIONAL THERAPY

People come to Universal from all over

SPEECH THERAPY

the world seeking optimal recovery and deluxe accommodations.

ADDICTIONS COUNSELING

Universal has been providing the finest services to the individuals that need

PHYSICAL THERAPY

them most since 1989

COMPREHENSIVE

Our goal from the beginning has been

MEDICAL DEPARTMENT

to maximize progress through a comprehensive program of care .

COGNITIVE THERAPY We offer daily rehabilitation programs,

PREMIERE HOUSING

residential programs and complete medical care services .

PRIVATE ROOMS

We specialize in Individualized / Custom

Rehabilitation Programs .

ACCESSIBLE SPA Universal was founded “by people

BATHROOMS

with disabilities, for people with disabilities” LOCATIONS THROUGHOUT NEW JERSEY

U N I V E R S A L I N S T I TU T E I N C .

Lighting the way to a new beginning

1-(800) 468-5440 EXT 34 !

www.uirehab.com BRAIN INJURY PROFESSIONAL

25

TBI Training in Kansas

To ensure that students with traumatic brain injury (TBI) are served by educators who are trained to meet their needs, the state of Kansas has a well established statewide system of TBI miniteams that provide technical assistance, consultation, and awareness level training to educators in their local districts.

Through funding from Kansas State Department of Education Student Support Services (KSDE-SSS) and the United States Office of Special Education, the first TBI miniteams were established in the early 1990’s and have been continuously supported by KSDE-SSS since that time. Kansas currently has 358 TBI miniteam members who are dedicated to helping ensure that students with TBI receive an appropriate education.

The TBI miniteams consist of a variety of educational personnel (e.g., teachers, administrators, school-based therapists, nurses, social workers, and psychologists) who received intensive training to enable them to understand the unique characteristics and educational needs of students with TBI. TBI miniteam members provide assistance with identification of students, school re-entry planning, IEP development, scheduling modifications, educational programming, and long-term monitoring of students. Miniteam members also provide local districts with TBI professional development training, which may include general TBI awareness training or training focused on the specific needs of an individual student (e.g., when a student is returning to school following an injury).

To keep miniteam members functioning at the highest level, after receiving initial TBI training, miniteam members receive ongoing training (e.g., yearly conferences, workshops) and dissemination of information (e.g., summaries of recent research, links to websites, new materials) to enhance and update their skills and knowledge. Workshops to train new miniteam members are held periodically to replace team members who were lost to attrition or job changes. Additionally, continuous support in the form of technical assistance from a statewide TBI coordinator has been provided to ensure miniteam members have available expert assistance if they require help with a particular case. These interactions provide additional training experiences for team members. This type of ongoing support and training is necessary to keep the miniteam teams functioning effectively.

Janet Tyler, Ph.D. University of Kansas Medical Center, Department of Special Education jtyler@kumc.edu Or visit their web site: www.kstbi.org 26 BRAIN INJURY PROFESSIONAL

Our comprehensive continuum of care ensures that progress is never interrupted 1.800.28.BRAIN www.rescarepremier.com San Marcos, Texas 78666

'RADUATE 3CHOOL OF %DUCATION AND (UMAN $EVELOPMENT

%JE ZPV LOPX UIBU B CSBJO JOKVSZ DBO PDDVS BU BOZ UJNF !N - ! OR #ERTIl CATE IN 3PECIAL %DUCATION WITH AN %MPHASIS

IN !CQUIRED "RAIN )NJURY WILL ALLOW GRADUATES TO 'ENEROUS TUITION SUPPORT MAY BE AVAILABLE FOR QUALIl ED STUDENTS

s !DVANCE QUICKLY IN THIS RAPIDLY GROWING l ELD s #REATE A PROFESSIONAL NICHE s 3ERVE STUDENTS WITH BRAIN INJURIES IN A SCHOOL OR CLINICAL SETTING

╤о F (FPSHF 8BTIJOHUPO 6OJWFSTJUZ .BTUFS T %FHSFF 1SPHSBN JO 5SBOTJUJPO 4QFDJBM &EVDBUJPO &N QIBTJT JO "DRVJSFE #SBJO *OKVSZ UIF POMZ POF PG JUT LJOE JO UIF 6 4 JT OBUJPOBMMZ SFDPHOJ[FE CZ UIF $PVO DJM GPS &YDFQUJPOBM $IJMESFO $&$ BOE BDDSFEJUFE CZ UIF /BUJPOBM $PVODJM GPS "DDSFEJUBUJPO PG 5FBDIFS &EVDBUJPO /$"5&

-ASTER S PROGRAM STUDENTS MAY OPT TO EARN INITIAL TEACHER LICENSURE

4HE CREDIT 'RADUATE #ERTIl CATE 0ROGRAM IS OFFERED BOTH ONLINE AND ON CAMPUS

!PPLY NOW FOR &ALL 4O LEARN MORE VISIT WWW GWU EDU ^ABICTR ACADEMIC HTM

OR CONTACT US ABICTR GWU EDU GW is an equal opportunity/afямБrmative action institution.

BRAIN INJURY PROFESSIONAL

27

Certification in Cognitive Rehabilitation The Society for Cognitive Rehabilitation (SCR) offers certification in cognitive rehabilitation therapy to professionals from various disciplines who treat clients with cognitive deficits. Cognition is a complex collection of mental skills that include attention, perception, comprehension, learning, remembering, problem solving, reasoning and executive functioning abilities, which allow us to understand our world and to function within it. Cognitive rehabilitation is the art and science of optimizing these mental processes. The Brain Injury Association of America (BIAA) has defined cognitive rehabilitation as “a systematically applied set of medical and therapeutic services designed to improve cognitive functioning and participation in activities that may be affected by difficulties in one or more cognitive domains�.

Recommendations for the practice of Cognitive Rehabilitation Therapy (CRT) The Society for Cognitive Rehabilitation recommends a standard battery of assessments sufficient to form hypotheses about the underlying cognitive impairments and deficits that interfere with cognitive functioning. The battery should be sufficient as to enable decision making about which treatments are necessary. In rehabilitation settings, standardized psychometric assessments, questionnaires, structured interviews and be28 BRAIN INJURY PROFESSIONAL

havioral observations across a range of functional settings with equal emphasis should be used. Results of various measures should be cross-referenced with each other and across environments and testing times and dates. Results should be shared with the person being tested and that person should participate in design of the treatment program whenever possible. Reassessment should be undertaken at regular intervals to monitor and report progress. Evaluative results and treatment plans should also be reviewed with the caregiver. Evaluative results should be used to make prognostic statements which should also be shared with the client. Treatment goals should be created arising from the assessment and should include outcome goals, long-term goals and short-term goals. All goals should be shared with and agreed to by the person with a brain injury (Malia et al., 2004).

Evidence for efficacy Experts from the Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine (ACRM) published an evidence-based review of the cognitive rehabilitation literature in 2000 and a comprehensive updated review in 2005. The review was led by Keith Cicerone, Ph.D., and encompassed 171 articles in the first report and an additional 87 studies in the update. Overall, there were 46 Class I

studies (prospective, randomized controlled methodology) and 43 Class II studies (prospective cohort studies, retrospective case-controlled studies or series with well-designed controls).

For Class I studies involving both patients with stroke and patients with brain injury, 78.7% of the comparisons demonstrated a benefit of cognitive rehabilitation over the alternative treatment. They concluded that “there is substantial evidence to support cognitive rehabilitation for people with brain injury.”

What is Cognitive Rehabilitation Therapy (CRT)?

Cognitive Rehabilitation Therapy (CRT) focuses on the (re) attainment of cognitive skills lost or altered as a result of neurological trauma. The aim of treatment is the enhancement of the client’s functional competence in real-world situations.

The process includes (re)attainment of skills through direct training, use of compensatory strategies, and use of cognitive orthotics and prostheses.

CRT may be administered in the acute hospital setting, inpatient rehabilitation or long-term care facility, skilled nursing facility, outpatient rehabilitation clinic, community based, residential facility or at the client’s home. Interventions may be applied in individual and group treatment sessions and should be incorporated into supervised activities, counseling and education programs.

Who is a Cognitive Rehabilitation Therapist?

A variety of clinical disciplines possess the skills necessary to provide cognitive rehabilitation therapy (CRT), including Psychology, Speech-Language Pathology, Occupational Therapy, Physical Therapy, Special Education, Nursing, and Therapeutic Recreation. This therapist assesses cognitive skills within their area of expertise and provides direct services to individuals. The Cognitive Rehabilitation Therapist targets goals, selects tasks and strategies, and monitors progress.

What is the purpose of certification?

• International credentialing that recognizes your expertise in the field of cognitive rehabilitation • Improves the quality of therapy provided to clients with neurological trauma • Increases visibility and advances the professionalism of Cognitive Rehabilitation Therapy (CRT) to clients, facilities, third party payors and the public • Entitles the clinician to use the designation “Certified in the Practice of Cognitive Rehabilitation Therapy” (CPCRT) • Recognition in a community of professionals who are willing to uphold a special Code of Ethics The goal of credentialing is to improve the quality of CRT offered. To this end, the reviewers can provide you with feedback to help you improve your skills as well as the profession.

For more information or an application packet, go to www.cognitive-rehab.org.uk Or contact the SCR Credentialing Chair, Lane Sidebottom, CPCRT, lanesideb@cox.net

book review Brain Injury Medicine Eds. Nathan D. Zasler, Douglas I. Katz and Ross D. Zafonte.

Published by Demos Medical Publishing, NY, NY. 2007.

Drs. Zasler, Katz and Zafonte have assembled 135 national and international experts to create their textbook, Brain Injury Medicine. A total of 66 chapters and over 1200 pages cover a full range of topics, including rehabilitative care and research,

epidemiology and neural recovery, neuroimaging, acute care management, prognosis and outcome, and post-acute problems such as cognitive and behavioral issues, neurologic and neuromusculoskeletal problems, speech and language problems, motor functioning, pharmacological treatments, social and vocational issues and medico-legal challenges.

Drs. Zasler, Katz and Zafonte begin their textbook with their chapter on “Clinical Continuum of Care and Natural History. This chapter presents the enormous challenges of brain injury services and systems, given the large numbers of individuals with TBI and the possible life-long effects, and it sets the stage for the other chapter topics. Particularly interesting and informative are chapters written by Dr. Bigler “Neuroimaging Correlates of Functional Outcome”; Drs. Dijkers and Greenwald “Functional Assessment in TBI Rehabilitation”; Dr. Cicerone “Cognitive Rehabilitation”; Dr. McAllister “Neuropsychaitric Aspects of TBI”; Dr. Wang “Traditional Chinese Medicine in the Mechanism and Treatment of TBI”; and Dr. Iverson et al “Mild TBI”.

Brain Injury Medicine is clearly a “go to” textbook that belongs on the shelves of brain injury professionals across the board – physicians, psychologists, therapists and treatment specialists. It contains a depth and breadth of information on the science of brain injury and the state of the art in treating individuals with brain injuries. The Editors and chapter authors of this excellent textbook deserve to be complimented for their expertise and commitment to helping professionals expand their knowledge of brain injury research, treatment and service delivery.

Ronald C. Savage, Ed.D. BRAIN INJURY PROFESSIONAL

29

REHABILITATION CENTER A HISTORY OF SHARED SUCCESS For a free professional assessment and excellent treatment you can count on, call us.

• Fully accredited for Brain Injury, Spinal Cord Injury, Chronic Pain, and Stroke • Full spectrum of in- and outpatient services • Return of patient to highest level of function Call 897-8565 for a confidential professional consultation free of charge.

1401 Foucher Street • New Orleans, LA 70115 www.touro.com

Putting Lives In Motion for 21 Years

30 BRAIN INJURY PROFESSIONAL

WHAT MAKES

a personal injury law firm different?

RICH VANDERWAL

WE

Rehab Consultant

WERE

DIANNE HENDERSON R.N., B.A. Psych., M.Ed.,

THE

Medical Consultant

FIRST

CHARLES GLUCKSTEIN

OUR

in combining more than

J.D., LL.B

a century of legal expertise BERNARD GLUCKSTEIN,

with medical & rehab

QC

TURN WE ENSURE THAT

you and your loved ones receive the absolute best in health care delivery.

Gluckstein

“OUR MULTIDISCIPLINARY teams’ goal is to protect your rights while advocating for maximum compensation and recovery of lifestyle.”

P E R S O N A L

ARE

IN

consultants.

& A SS OCI AT E S

WE

EXTENSIVE

knowledge and skill sets in the areas of spinal cord and brain injury allow GLUCKSTEIN & ASSOCIATES LLP to consult directly with all of the healthcare providers.

I N J U R Y

LLP

L A W Y E R S

GLUCKSTEIN & ASSOCIATES LLP, and there is no such thing as business-as-usual here.

TELEPHONE

416.408.4252

toll-free

1.866.308.7722

E-MAIL

info@gluckstein.com

WEBSITE

www.gluckstein.com

non-profit news Brain Injury Association of America Crazy Busy. That’s the best way to describe what’s happening at the Brain Injury Association of America. On June 6, 2007, the Wall Street Journal published the second in a series of front-page stories on brain injury. The article, After Brain Injury, A Business Plan, featured the challenges in productive living faced by individuals with brain injury. BIP readers can meet Tom Burton, WSJ’s Pulitzer Prize-winning journalist, when he delivers the keynote address at the Brain Injury Business College, November 5-7, 2007 at the Westin in Las Vegas.

BIAA was honored to partner with Home Box Office (HBO) on the Washington, D.C. screening of the forthcoming documentary, COMA, which premiers in primetime nationwide on July 3, 2007.

Each Congressional office will receive a complimentary copy of the film on DVD. BIAA is reminding lawmakers that our nation has committed vast resources to saving lives; it is now time to commit equal resources to maximizing the quality of life for those who are saved.

In April, BIAA hosted a very successful Congressional Fly-in calling for public and private cooperation in treating returning service members with TBI. Thirty of the nation’s top brain injury care providers participated in the two-day event that featured a very-well attended briefing for Hill staffers and nearly 80 visits to targeted Congressional offices. We are grateful for the in-kind support we received from CARF in briefing fly-in participants.

The Congressional Fly-in resulted in a coveted invitation to testify before the Dole-Shalala Commission, which was ably managed

by BIAA Board member Dr. Brent Masel, and invitation to participate in a forthcoming Capitol Hill symposium on TBI, now being planned by the House Veterans Affairs Committee. Watch BIAA’s website for more details on the event and for announcements of additional fly-ins.

In the meantime, please join BIAA in advocating for access to comprehensive post acute rehabilitation and long-term supports, including family caregiver training, through (1) reauthorization and full funding of the TBI Act; (2) line-item funding with a substantial increase for the TBI Model Systems; and (3) endorsement of several legislative proposals now pending in Congress.

Like the rest of the nation, BIAA deeply mourns the death of Mitch Rosenthal. He was a first generation giant in our field and we will miss him terribly.

Brain Trauma Foundation BTF has a new look that encompasses its wide range of online continuing education activities. Our new website, www.btflearning. org, provides access to online education and training that aim to enhance the knowledge and skills of healthcare professionals in all aspects of TBI, from the scene of injury through the emergency room and intensive care unit to recovery. The courses are based on the latest evidence-based TBI Guidelines.

Through an educational grant from Codman, BTF launched 12 online modules based on the 3rd edition of the Guidelines for the 32 BRAIN INJURY PROFESSIONAL

Management of Severe Traumatic Brain Injury (J. Neurotrauma, May 2007). This series is designed specifically for critical care nurses. The course modules include: 1. Correlative Neuroanatomy and Physiology for Severe TBI Injury Management 2. Critical Care Assessment of the Adult Patient with Severe TBI 3. Effect of Guidelines-Based Protocols in the ICU 4. Initial Resuscitation and Postoperative Management of the Patient with Severe TBI 5. Advanced Cerebral Monitoring of ICP/CPP in Severe TBI 6. The Use of Hypothermia for Treatment of Severe TBI 7. CNS Infections and Infection Prophylaxis 8. DVT Prophylaxis, Prevention of PE and Complications of Immobility 9. Benefits and Guidelines for Hyperosmolar Therapy 10. Acute Care Interventions: Anaesthetics, Analgesics, and Paralytics 11. Patient Refractory to ICU Management: Barbiturate Therapy 12. Guidelines for Seizures and Nutrition to Improve Outcomes With an education grant from Integra Foundation, BTF is now able to provide its ICP Monitoring Course online. By focusing on the insertion and use of ICP, brain tissue PbtO2, and other ancillary monitoring systems in the acute care of severe TBI patients, BTF hopes to reach a wider audience of neurosurgeons, PAs and neurocritical care nurses on a topic for which it has many requests.

Additional courses on prehospital, ICU, surgical management, pediatric and prognostic topics are being added to the learning portal on a regular basis. We also offer a monthly Lunchtime Lecture series. Taught by medical experts on wide variety of topics related TBI, these live, interactive lectures are complete with slides and audio and easily accessible through an Internet browser and a toll-free phone call. Participants can register at https://braintrauma.webex.com. CE credits are available for participating nurses, physicians, and EMS providers upon completion of an evaluation and post-test.

Finally, BTF continues to offer on-site training on TBI care.

With funding from the National Highway Traffic Safety Administration, BTF trained over 6,500 licensed prehospital instructors and taught over 45,000 emergency service technicians in all 50 states to promptly identify, treat and transport brain injured patients. BTF has also developed extensive training materials for medics and military surgeons that are being used throughout the Armed Services.

Hospital personnel in over one hundred hospitals have benefited from BTF’s on-site lectures and case reviews. Its “how to” Quality Assurance Action Manual is used in hospitals throughout the U.S. BTF’s qualifications as an educator have been acknowledged by three major accrediting agencies (ACCME, AANS and CECBEMS) thereby giving us the authority to award continuing education credits to all medical personnel enrolled in its classroom, conference and online courses.

International Brain Injury Association The International Brain Injury Association’s Call for Papers for our Seventh World Congress on Brain Injury is now open. Multidisciplinary professionals are encouraged to submit their research through our on-line system by visiting our website, www.internationalbrain.org.

We would like to invite the participation of all professionals involved with serving persons with acquired brain injury to this international Congress and meeting of minds. We are very excited about having the meeting in Lisbon which, historically, has been the center of one of the biggest empires of all time with colonies in the Americas, Asia and Africa. Lisbon’s sophisticated shopping centers, fine hotels, gastronomy, and culture, combined with the climate will make this a superb destination for our biennial World Congress.

Aside from the wonderful scientific program with world renowned experts in the field of brain injury, we are also introducing at this World Congress a number of new events including candlelight sessions with experts, among others, and several new awards, including the Henry Stonnington Award for best review article in Brain Injury, IBIA’s officially endorsed organizational research journal, and the Jennett & Plum award for clinical achievement in the field of brain injury medicine. There will also be a pre-conference, full-day symposium on mild traumatic brain injury co-sponsored by the International Brain Injury Association and the World Federation of Neurological Rehabilitation, in addition to post-conference workshops. We are also planning a number of wonderful social events, as well as touring opportunities to further explore and appreciate the culture of our host country, Portugal.

Please visit www.internationalbrain.org often for Congress news and updates. We look forward to seeing you in Lisbon!

National Assciation of State Head Injury Administrators Join us at our 18th Annual State of the States in Head Injury Conference September 5-8 in St. Louis “Gateway to Solutions: Doing What Works”. This meeting will feature the latest efforts of state government brain injury administrators in improving services and supports for individuals with TBI and their families. Speakers and sessions will address Federal legislation, national trends and cross cutting issues in services delivery. Check out the brochure and registration information at www.nashia.org.

National attention has focused on the need for improved treatment and care for soldiers returning from Iraq and Afghanistan with traumatic brain injuries. Most of the focus has been on acute and rehabilitation care and transitioning between different systems.

While this attention is certainly well deserved, little commentary has been provided on those soldiers who require long-term care, services and community supports offered by state and local governmental programs. NASHIA is moving to further collaboration among all federal, state and local entities to ensure that returning soldiers receive the necessary services in a coordinated fashion, and that all local, state and federal resources are maximized and used effectively.

NASHIA will hold a preconference workshop on “Seamless Transi-

tions…Supporting our Veterans and Families” to focus on the need for improved identification, treatment and support of returning soldiers with TBI from the Iraq and Afghanistan wars. See www.nashia. org for registration information.

NASHIA is also collaborating with other organizations to present the September 19, 2007 JMA Foundation Town Hall MeetingSoldiers with TBI: Is America Meeting Their Needs A National Debate. This is the first in a series of three meetings to address public policy issues to ensure optimal community reintegration and support for soldiers with TBI. Check out www.nashia.org for registration information.

We are asking Congress for an increase in funding to $21 million for the HRSA Federal TBI Program to provide funding for States ($15 million) and Protection & Advocacy Systems ($6 million); and $9 million for the Centers for Disease Control and Prevention TBI Program. Please join us in convincing Congress of the importance of these appropriations amounts and in reauthorizing the TBI Act. The latest information is available at www.nashia.org.

North American Brain Injury Society The North American Brain Injury Society has posted the programs for our two concurrent meetings, the 5th Annual Conference on Brain Injury and the 20th Annual Conference on Legal Issues in Brain Injury on our website, www.nabis.org. Over 55 nationally recognized speakers will present on cutting-edge research, treatment techniques and advances in rehabilitation. The Conferences will take place September 27-29, 2007, in the historic city of San Antonio, Texas.

We are proud to announce that these Conferences also will mark the official launch of the NABIS Blast Injury Institute (BII). This new initiative seeks to provide leadership in the area of brain injury caused by exposure to blasts. Through basic science, applied research, multidisciplinary collaboration, conferences and events, the BII will provide a fact-based perspective on innovative approaches to help organizations, public entities and the media address the challenges presented by the growing issue of brain injury caused by blasts. Mariusz Ziejewski, PhD, will serve as the BII’s Founding Chair. More information will be available in the coming months at www.blastinjuryinstitute.org.

NABIS has officially endorsed the International Brain Injury Association’s Seventh World Congress on Brain Injury scheduled for April of 2008. NABIS members are entitled to a 55 Euro discount off of the regular registration fee and are encouraged to attend this important biennial event.

In cooperation with MCC Association Management, this summer will be launching our new Brain Injury Career Center. Accessible through the NABIS website, this new resource will allow professionals to post their resumes, browse job openings and share information with other job seekers active in the brain injury field. Visit www. nabis.org in July for more information.

NABIS joins the brain injury community in remembering Mitch Rosenthal, PhD. Mitch was a true pioneer whose contributions to the brain injury field have been immeasurable. He will be sorely missed.

BRAIN INJURY PROFESSIONAL

33

More than

conferences

Traumatic Brain Injury Serving the community for two decades, Beechwood has expanded its TBI offering to encompass broad neurological services as well as new Behavioral Remediation and Late Adolescent programs.

In addition to TBI, we serve individuals with brain damage due to: • Anoxia/Hypoxia due to drowning, heart attack, drug overdose, alcohol poisoning, anesthesia errors, etc.

• Electric shock/lightning strike • Degenerative diseases • Infectious diseases • Early stage moderate dementias • Tumors • Brain surgeries • Many neurological disorders

• Stroke For information and admissions, call 1-800-782-3299.

Our facilities are adapted to accommodate all levels of accessibility.

2007 AUGUST 25-28 – 11th Congress of the European Federation of Neurological Societies, Brussels, Belgium. Contact: headoffice@efns.org, web: www.efns.org/efns2007.

SEPTEMBER 5-8 – NASHIA 18th Annual State of the States Annual Meeting, St. Louis, MO. Contact: www.nashia.org.

27-29 – 5th Annual NABIS Conference on Brain Injury, San Antonio, TX. Contact: conference@nabis.org, www.nabis. org.

27-29 – 20th Annual Conference on Legal Issues in Brain Injury, San Antonio, TX. Contact: conference@nabis.org, www.nabis.org.

27-30 – 68th Annual Assembly of the AAPM&R, Boston, MA. Contact: www.aapmr.org.

OCTOBER

REHABILITATION

SERVICES

A Community-Integrated Brain Injury Program An affiliated service of Woods Services, Inc. www.beechwoodrehab.org

Langhorne, PA • Bensalem, PA

7-10 - American Neurological Association’s 131st Annual Meeting, Washington DC. Contact: www.aneuroa.org.

NOVEMBER 2-4 - Pediatric Brain & SCI Conference, Miami, FL. Contact: www.pedibrain.org.

3-7 - Society for Neuroscience, 37th Annual Meeting San Diego, CA. Contact: www.sfn.org.

5-7 – BIAA’s Brain Injury Practice College, Westin Casuarina Resort & Spa, Las Vegas, NV. Contact: www.biausa.org.

14-18 – National Association of Neuropsychology Annual Meeting, Scottsdale, AZ. Contact: www.nanonline.org.

2008 APRIL 9-12 – The International Brain Injury Association’s 7th World Congress on Brain Injury, Pestana Palace Hotel, Lisbon, Portugal. Contact: mjroberts@aol.com, www.internationalbrain.org.

JUNE 4-7 - European Congress on Physical Medicine & Rehabilitation, Brugge, Belgium. Contact: www.medicongress.com.

SEPTEMBER 18-21 – 7th Mediterranean Congress of Physical Medicine & Rehabilitation Medicine, Potorose, Slovenia. Contact: marincek.crt@mail.ir-rs.si.

24-27 – 5th World Congress for NeuroRehabilitation, Rio de Janeiro, Brazil. Contact: traceymole@wfnr.co.uk. tion, Rio de Janeiro, Brazil. Contact: traceymole@wfnr. co.uk.

OCTOBER 22-25 - National Association of Neuropsychology Annual Meeting, New York, NY. Contact: www.nanonline.org.

34 BRAIN INJURY PROFESSIONAL

A Continuum of Care for Adults & Children with Brain Injuries.

Improving

Lives.

Locations throughout Southeastern Michigan.

Brain Injury

Rehabilitation Programs Rainbow Rehabilitation Centers has been helping adults and children recover from with the challenging effects of brain injury since 1983.

Rainbow’s unique “Continuum of Care” approach to brain injury rehabilitation offers a variety of programs providing residential, day treatment and outpatient services for individuals of all ages.

Our professional staff, specially trained in brain injury treatment, consistently provides understanding, supportive and progressive rehabilitation at every stage of the recovery process.

To receive a free copy of Rainbow’s Brain Injury Rehabilitation “Continuum of Care” brochure call...

1.800.968.6644 Or log on to:

www.rainbowrehab.com

2EPRESENTING 0ERSONS WITH .EUROLOGIC )NJURIES #ARING %VERY 3TEP OF THE 7AY

4/2!,,!7 WWW TORALLAW COM

3TIRLING 2OAD 3UITE &ORT ,AUDERDALE &LORIDA 4HE HIRING OF A LAWYER IS AN IMPORTANT DECISION AND SHOULD NOT BE BASED SOLELY UPON ADVERTISEMENTS "EFORE YOU DECIDE ASK US TO SEND YOU FREE WRITTEN INFORMATION ABOUT OUR QUALIFICATIONS AND EXPERIENCE

36 BRAIN INJURY PROFESSIONAL