Testing of an intervention for adolescents with Acquired Brain Injury (ABI)

1. Testing of an intervention for adolescents with Acquired Brain Injury (ABI) 2008 CTN Symposium “Working Together for Kids & Teens with Disabilities” Kathy Gravel, MSW, RSW, AAMFT Clinical Member June 16, 2008

2. Presentation Overview • Pediatric Acquired Brain Injury (ABI) • Bloorview Kids Rehab Outpatient Services for Children & Teen with ABI & their Families • BIFI-A Testing for adolescents with ABI & their families

3. What is Acquired Brain Injury (ABI)? • Brain injuries are difficult to understand, you can’t see them but their impact can be complex & long-lasting. The injury affects everyone in the family of the injured person • Brain injuries maybe due to injury from trauma, tumour, stroke or illness

4. Pediatric ABI Sequelae • Children & adolescents with brain injuries likely to experience cognitive, physical, academic, emotional & psychosocial sequelae • All ABIs are not the same • “Growing into the Injury” phenomenon

5. What Publicly Funded Outpatient Pediatric ABI Services Exist Now in Toronto? For people living in Toronto (416 area code) at Bloorview Kids Rehab: • Brain Injury Rehab Team (BIRT) Outpatient & Community Service Program (for clients 6 months – 18 y/o & their families) • Family Support Service (FSS, for clients 16-25 y/o & their families)

6. BIRT Outpatient Program Staff at Bloorview Kids Rehab • Ambulatory-care nurse • Psychologist • Occupational Therapist • Physicians • Physiotherapist • Psychology Assistant • Social Workers/Community Developers • Speech-language pathologist *Professionals work with each client & family to develop an individualized plan to address unique needs

7. FSS Staff at Bloorview Kids Rehab Individual/Family Clinician Psychologist Social Worker(s) Client 16 y/o + & Family Psychology Intern Individual / Family Clinician Student(s) Manager Consultant in Pediatrics Secretary

8. Services offered by BIRT Outpatient Program & FSS at Bloorview Kids Rehab • Follow-up Clinic • Community outreach, development, & consultation (beyond the Toronto Region) • Individual Counselling • Family Counselling • Resource Counselling • Group Therapy • Support Groups • Workshops (i.e. on ABI & sexuality, parenting, social skill development) • Planning for transitions (i.e. regarding medical, academic, community issues)

9. For Service-Providers and/or Professionals or Organizations • Upon request from the community: • Education about the needs of people with Acquired Brain Injuries and their families • Consultation about community reintegration • Development of partnerships as identified by the community

10. How to Contact BIRT Outpatient or FSS Program for Further Consultation Please call: (416) 425-6220, ext. 6460

11. What is BIFI-A? • Brain Injury Family Intervention-Adolescent Version (BIFI-A) • Empirically-based intervention for adolescents (13-19 y/o) with ABI & their families • Derived from Jeffrey Kreutzer’s BIFI for use with adults with ABI & their families • Targets family system, providing fundamental information about common symptoms & challenges after brain injury • Utilizes structured, manualized block treatment approach covering 11 topics over 7-10 sessions • Curriculum currently being delivered by 3 test clinicians, involving 9 families in Toronto, Simcoe & Muskoka

12. BIFI-A Program Objectives • Provide information about common symptoms & challenges after Brain Injury • Help family members better understand how the injury has affected each member of the family & the family as a whole • Teach coping strategies to facilitate emotional recovery • Teach effective communication skills • Teach a variety of problem solving strategies

13. BIFI-A Investigative Team Caron Gan, Bloorview Kids Rehab Virginia Wright, Bloorview Research Institute Kathryn Boschen, Toronto Rehab Institute Jeffrey Kreutzer, Virginia Commonwealth University Judy Gargaro, Bloorview Kids Rehab Funded by Bloorview Research Institute

14. How was the BIFI-A used in Simcoe & Muskoka? • The BIFI-A is a publicly funded ABI-focused psychoeducational & psychotherapeutic family intervention program that has been provided to children under age 16 & their families who live in Simcoe & Muskoka • This intervention was recently tested on 3 families in this region • At this stage, the BIFI-A is a research intervention

15. BIFI-A Test Clinicians Brain Injury Service of Simcoe County: • Rebecca Swift-Weir, RN Bloorview Kids Rehab: • Valerie Lusted, MSW, RSW • Kathy Gravel, MSW, RSW

16. BIFI-A Intervention Curriculum • Effects of Brain Injury on the survivor & family • Is it Brain Injury or Adolescence? • Understanding recovery • Managing intense emotions & stress • Setting goals & solving problems • Preparing for school & work • Where do we go from here?

17. BIFI-A Session Format • Check-In • Family Barometer Question • Today’s Topic(s) • Questionnaires, worksheets & interactive discussion • Wrap Up & Evaluation

18. What did the Test Clinicians Say about the BIFI-A? • Clinicians using BIFI-A require sound knowledge of ABI (& ABI-adolescent issues) to competently deliver & clarify information • Clinicians using BIFI-A must have training in providing family therapy, and there must be access to clinical supervision • Families tell us that it has been beneficial to have as many family members as possible participating in the sessions • It is helpful to have a structured, focused intervention that provides relevant, easy-to-understand information & resources for families

19. What did Simcoe & Muskoka Test Families Say About the BIFI-A? • Families reported that it was beneficial to be able to take part in the intervention in their home communities in Simcoe / Muskoka • Families reported that they likely would not have participated if they had to drive outside of Simcoe County for the intervention • One family found sharing BIFI-A information on ABI with their child’s school very helpful

20. Next Steps for BIFI-A • Refine BIFI-A protocol based on results from feasibility testing • Develop final version of BIFI-A manual • Promote use of BIFI-A through collaboration with Best Practice Committee of Toronto ABI Network • Anyone interested in implementing BIFI-A in York Region are encouraged to contact Caron Gan, who will be VERY happy to collaborate & support the development of services in York & Simcoe regions

21. Relevance of BIFI-A for Other Diagnostic Groups • Provides a model of intervention protocol that can aid in the design & implementation of other forms of psychosocial block treatments for a variety of ‘special needs’ youth & their families

22. Questions & Comments

23. Presenter’s Contact Information Kathy Gravel, MSW, R.S.W., AAMFT Clinical Member Social Worker / Community Developer Brain Injury Outpatient Team Bloorview Kids Rehab Tel: (416) 425-6220, ext. 6402 Toll-free: (800) 363-2440 Fax: (416) 424-3880 kgravel@bloorview.ca

24. Lead Researcher’s Contact Information Caron Gan, RN, MScN, AAMFT Clinical Member & Approved Supervisor Brain Injury Rehabilitation Team (BIRT) - Family Support Service Bloorview Kids Rehab 150 Kilgour Road Toronto, Ontario M4G 1R8 Phone: 416-425-6220, ext. 3514 Fax: 416-424-3880 cgan@bloorview.ca