Providing the right support for individuals with an ABI

PROVIDING THE RIGHT SUPPORT FOR INDIVIDUALS WITH AN ABI

Samantha Grant is a registered Clinical psychologist based in Sydney with over 17 years’ experience in Clinical Psychology services to adults (16 – 65) following complex and catastrophic injuries, particularly acquired brain injury.

In the lead up to the 4^th National Acquired Brain Injury Conference taking place on 8-9 November 2016 at the Royal Rehab in Ryde, Sydney, I had the opportunity to discuss with Samantha about some of the important elements of supporting individuals with an ABI. I hope that you enjoy the interview.

Informa: What are some of the key elements to providing the right support for individuals with an ABI?

Samantha: In my experience, no matter what individual differences exist in terms of cognitive and physical capacity, there are 5 key strategies that are essential for providing the right support for individuals with an ABI.  These are:

–          Communication

–          Choice and Control

–          Types of Support

–          Environmental factors

–          Planning.

If those supporting an individual with an ABI, whether that be formal or informal supports, can get these elements right, then the impact of the cognitive limitations can be reduced.

So what do I mean specifically? I can’t do these topics justice in a short interview, however, in summary I am suggesting that if Communication approaches are considered; Choice and Control is optimised; The types of support provided meet all the needs of the individual; that careful consideration is made to the impact of environmental factors and changes to these have on one’s actions; and that where possible all interactions and potential barriers are planned, then the well-being of an individual can be optimised as they are supported to achieve their goals. 

Informa: How can families and carers (who are supporting individuals with an ABI) manage challenging behaviours?

Samantha: Ah, this is the big question that everyone wants to know because it has the biggest impact on the outcomes and successes for an individual with an ABI, however there is not a straightforward answer, and not one I can do justice to in a short interview.

However, I will start by emphasising that my pet hate is the phrase “challenging behaviours”. The word behaviour has a connotation that there is choice behind the action. Individuals with an ABI, act in certain ways due to the reduced or limited cognitive resources they now possess. Limitations in areas such as reasoning and judgement, impulse control and flexibility, amongst others, impact on an individual’s capacity to interact with those around them in ways that are considered “acceptable” or “helpful”. These actions are not necessarily conscious, nor are they within the person’s control to change. Therefore, supporting someone to achieve their goals, which needs to be the focus, is about limiting the impact of the cognitive changes.

As I said above, if you can address the 5 key strategies outlined in question 1, you can make a huge difference to how an individual with an ABI can be enabled to interact with those around them, and hence act in ways considered more acceptable or helpful.

If families and carers are keen to make a difference, then my suggestion is “education not assumption”. Understand what is going on for the person from a cognitive perspective, and then you can better understand how you can interact differently with them. Actions are always a form of communication, so find out what the person is trying to communicate and then respond accordingly. These responses could be direct or indirect, and may be through changes to the environment, or through other approaches such as reinforcement.

If people are interested to know more, together with a colleague Inbal Luft, Occupational Therapist, I run a one-day workshop, on exactly this, “ Putting the pieces of the puzzle together: A practical approach to understanding cognitive and behavioural impairments after brain injury”.

Informa: In your experience, what are the key factors to an effective multi-disciplinary team?

Samantha: That is such an important question, because the key to successful support for someone with an ABI is the team approach. Ideally these teams, should be in fact, inter-disciplinary, that is there shouldn’t be a divide where one role ends and another begins, because there is so much overlap between them.

The most important factor in an effective team, which includes the individual with the ABI and the people who are supporting them (both formal and informal supports), is communication. Everyone needs to be on the same page with the person with the ABI in the centre of it.  That doesn’t mean they all must agree with each other on everything and every detail, but they need to act in ways that do not sabotage the efforts of others.  And everyone needs to know what their role is, which can vary from case to case, but can also vary from time to time with the same case.

From my experience, the best teams I have worked with, are ones where myself and colleagues from other disciplines work jointly to the support the person, such as me going to the gym with the physiotherapist, or me going shopping with the person with the ABI and the Occupational Therapist.

Informa: With over 17 years’ experience in Clinical Psychology services to adults (16 – 65) following complex and catastrophic injuries, particularly ABI, what advice would you have for anybody who is thinking of a career in this area?

Samantha: If you like your days to be routine, structured, and predictable, then this isn’t the area for you.  No two brain injuries are the same, no two people are the same, and no two circumstances are the same, so every day you are doing something different.  If you have the passion to make a difference, are good at communicating both verbally and in written format, and enjoy working with amazing people then this is an area to consider.  However, this is not an easy job, and there is no perfect recipe for “fixing the problem”, so it can be very challenging at times.

Actually, your question above is very relevant to this question.  This is an area that anyone thinking of making a career in this area, should as their first step, ensure they are working in a position that has a strong multidisciplinary team, so that you can not only have great support around you, but also that you can learn from others in other disciplines.

I honestly believe that what has enabled me to get to where I am today is from the knowledge and skills I have learnt from my many amazing colleagues across the field of brain injury along the way.

Informa: You are co-presenting with Robina Moubarak at the 4^th Annual National Acquired Brain Injury Conference. Without giving too much away, what do you hope the attendees will take away from your presentation ‘How to Cope with a Stranger in your Lounge Room – Challenges of Receiving & Providing a Care Program at Home’?

Samantha: As you can imagine, It’s not a usual place of employment to be working in someone’s home nor is it always the case that you would have people in your home who are paid to be there but you may not be the one employing them and have responsibility for them, yet it is often expected that all those involved will just get on with it and do what they need to do, without thinking about the many issues this can raise.

So I guess the main thing we want to impart is a greater awareness of the need to think about the impact having attendant care workers has on all involved, not just the individual with the ABI but also their family members.  Further to this, we want to draw attention to the mental health of all those involved, not just the individual with the ABI who often has many supports in place, but for the paid and unpaid carers.

Informa: What elements of the 4^th Annual National Acquired Brain Injury Conference taking place on 8 – 9 November 2016 at the Royal Rehab, Ryde, Sydney, are you most looking forward to, and why?  

Samantha: Would it be a cop out to say all of it? In all seriousness, for me, I feel I can always learn something new, as this is a field that keeps changing and as new technology, knowledge and ideas come to light, then those working in the field need to keep changing their practice.

Recently I have been providing services to more young people (under the age of 16) and so I am looking forward to hearing about Paediatric ABI – Service Provision recommendations for return to school.  For me, a good conference is one that I can go away, being able to reflect on my own practice, and add new tools to my toolkit, so any of the talks focusing on approaches, particularly psychological aspects, I will be eager to attend.

For more information about detailed conference agenda and to register, please visit the 4^th Annual National Acquired Brain Injury Conference website.