p) Practice tools  Next q)

i) Introduction

There are a variety of practice tools that people working with people with ABI can use.

They are grouped by role.

There are links to the tools.

All the tools can be downloaded as part of the PDF "Working with people with ABI: Training materials Handouts, Worksheets & Tools"

 

Review all the tools and find the ones that may be useful to you.
Review each of them and how you could use it in your work.

All staff

The following tool will be useful for all staff working with people with ABI

   TOOL 12: Essential survival tips for working with people with ABI


l) Tool 12: Essential thriving guide   

Some of the essential survival tips when you are working with people with ABI are:

Getting to know the person with ABI

Understand:

  • What is the injury?
  • What is the effect?
  • How is the effect expressed in behaviour?
  • What are strategies for managing the behaviours?
  • How the person with ABI is dealing with this change
  • The impact of their ABI on family and friends.

Realistic expectations

Set realistic expectations:

  • People with an acquired brain injury can grow in their skills for independence in the short and long term (except where the ABI is caused by a degenerative disease).
  • The rate of development can be slow and so not noticed. People give up too soon.
  • Most people with a traumatic brain injury and many with others forms of ABI are young - they have a lot of life ahead of them and plenty of time to develop.

Know yourself

  • What pushes your buttons?
  • How do you respond appropriately when your buttons are pushed?
  • How do you sustain yourself when the day to day work stresses build up?

Be part of a team

  • See yourself as part of a team.
  • Who's in the team?
  • What are their roles?
  • Who can I get support from...in regards to what?

Notice signs of disillusionment and identify strategies for dealing with it

What best describes your current work with this person / these clients:

  • Enthusiasm
  • Stagnation
  • Frustration

What do you need to do to build a relationship and set realistic expectations?

Notice signs of stress and identify strategies for dealing with it

  • What's your level of stress in working with this client / these clients?
  • What strategies work for you in reducing stress?

 

 

A case manager said:

One message that we repeat often is not to personalise the behaviours of the clients. There are good days and bad days for everyone and for the client sometimes they can be having a bad day. Something can happen in the morning that upsets them and puts them right off for the rest of the day and it is important for the support worker to know that next week when they come back at the same time they might meet a different person and not to take that on board.

Another important message is that to understand that when you are supporting a client you are a guest in their home. So be very courteous about moving around the home. Always let them know what you are doing. It can be a very intrusive thing for some people to have support within their home but it is a necessary thing, so to always be mindful you are in someone else's home.

Another message is to work alongside the client rather than do things for people. We are about enabling independence not about doing things for people. It is about getting them involved and assisting them to meet their goals.

We make everyone aware of the client's individual goals so everyone knows what they are working towards. The rewards come from those small gains and moving along to the bigger picture.

All of our clients are at different stages according to their injuries and how long it has been since their injury so the nature of the work is that every day you get something different because of those unique client needs.

 

 

 

ii) Information and referral workers

Two common situations information and referral workers and others need to address are:
a) If you don't know the person has an ABI what should you be alert to that may indicate an ABI
b) If you do know the person has an ABI and there are communication difficulties - what are some conversation tips.

For practical tips see for example:

   Tool 1 : A person may have an ABI 

a) Tool 1 : A person may have an ABI 

All staff in services, especially those on reception or information and referral workers need to be open to the possibility of a person having an ABI.

Principles

Useful principles to underpin your interactions with people are:

  • Treat people with respect
  • Be non-judgemental
  • Be open
  • Listen
  • Be patient

Noticing

What do you notice?

  • A person having difficulty finding words
  • A person regularly forgetting appointments
  • A person getting agitated when things aren't going right
  • A person slurring their words not speaking properly.

Tips

Ask the person's permission to ring a family member, friend, or key contact (to ask for more information)
Use direct questions e.g.

  • Have you got an acquired brain injury?
  • Do you have difficulty finding the right words?
  • Do you have a memory problem?

Question your assumptions

  • Not keeping appointments - intentionally OR could there be a memory problem
  • Difficulty finding words - not understanding what's said - OR understanding what's said but has difficulty finding the right words to verbalise an answer.
  • Getting agitated - an irritable client OR - a person with an ABI who gets stressed when routine breaks down
  • If someone regularly forgets appointments - could they have a memory problem?
   Tool 2: Conversations tips


b) Tool 2: Conversations tips  

People with ABI often have difficulty with communication and language. Here are come conversation tips.

To help the person's expression

  • Give the person plenty of time to respond
  • Encourage all attempts to communicate
  • Do not interrupt or answer for the person
  • Give questions or choices to clarify what the person means, for example:
    o "Do you mean … ?"
    o Ask what their topic is
    o Give a choice of two options ("Do you want to watch TV or go outside?")
  • The most important thing is the meaning behind the communication, not how well the person can put a sentence together

To help the person's understanding

  • Avoid background noise
  • Speak naturally but clearly
  • Ensure eye contact
  • Speak in short, simple sentences
  • Try rephrasing what you said if the person does not understand
  • Talk about events, objects and people in the here and now
  • Clearly identify people and topics
  • Do not change topic quickly
  • Be aware that the person will understand better when they are not tired

Tips to help manage difficult social situations

Problem: Poor conversational turn-taking

  • Give feedback about the need for people to take turns in conversation.
  • Say "It's ____'s turn now. Let them finish and then you can say what you want to say".

Problem: Talking about the same topic for too long.

  • Give feedback that the topic is finished.
  • Have an agreed upon non-verbal signal to prompt the person to move on (e.g. tapping your watch discreetly).
  • Say "We've talked about _______, and now we're talking about _______".

Problem: Talking about inappropriate topics/giving too much personal information.

  • Give feedback that this is inappropriate.
  • Say "It's not appropriate to talk about _________ in this situation/with this person".

Problem: Invading people's personal space.

  • Give feedback that the person is too close, direct them where to stand./sit.
  • Change the environment (e.g. have a table between you and the person, position the chairs in the room before the person arrives).

Problem: Inappropriate eye contact (staring or avoiding eye contact during conversation).

  • Position yourself in the person's line of sight.
  • Give verbal prompts to make eye contact and give praise when it is done.
  • Look away and don't engage someone in conversation if they are staring.

(c) Copyright - See: Module 2: Communication - www.TBIStaffTraining.info

iii) Support workers

Two common situations for support workers are:
a) Building rapport with people with ABI and
b) Dealing with behaviours arising from cognitive impairments.

For practical tips see for example:

  Tool 2: Conversations tips


b) Tool 2: Conversations tips  

People with ABI often have difficulty with communication and language. Here are come conversation tips.

To help the person's expression

  • Give the person plenty of time to respond
  • Encourage all attempts to communicate
  • Do not interrupt or answer for the person
  • Give questions or choices to clarify what the person means, for example:
    o "Do you mean … ?"
    o Ask what their topic is
    o Give a choice of two options ("Do you want to watch TV or go outside?")
  • The most important thing is the meaning behind the communication, not how well the person can put a sentence together

To help the person's understanding

  • Avoid background noise
  • Speak naturally but clearly
  • Ensure eye contact
  • Speak in short, simple sentences
  • Try rephrasing what you said if the person does not understand
  • Talk about events, objects and people in the here and now
  • Clearly identify people and topics
  • Do not change topic quickly
  • Be aware that the person will understand better when they are not tired

Tips to help manage difficult social situations

Problem: Poor conversational turn-taking

  • Give feedback about the need for people to take turns in conversation.
  • Say "It's ____'s turn now. Let them finish and then you can say what you want to say".

Problem: Talking about the same topic for too long.

  • Give feedback that the topic is finished.
  • Have an agreed upon non-verbal signal to prompt the person to move on (e.g. tapping your watch discreetly).
  • Say "We've talked about _______, and now we're talking about _______".

Problem: Talking about inappropriate topics/giving too much personal information.

  • Give feedback that this is inappropriate.
  • Say "It's not appropriate to talk about _________ in this situation/with this person".

Problem: Invading people's personal space.

  • Give feedback that the person is too close, direct them where to stand./sit.
  • Change the environment (e.g. have a table between you and the person, position the chairs in the room before the person arrives).

Problem: Inappropriate eye contact (staring or avoiding eye contact during conversation).

  • Position yourself in the person's line of sight.
  • Give verbal prompts to make eye contact and give praise when it is done.
  • Look away and don't engage someone in conversation if they are staring.

(c) Copyright - See: Module 2: Communication - www.TBIStaffTraining.info

  Tool 4 - Strategies for dealing with cognitive and behavioural changes 


d) Tool 4 - Strategies for cognitive changes 

Cognitive Impairment

Problems arising

Management strategies

Attention and Concentration

  • have difficulty concentrating
  • being distractible
  • finding it hard to cope with more than one thing at once
  • getting bored quickly
  • switch off and appear not to listen
  • not remembering what others have said
  • not completing things they start
  • changing the subject often
  • reduce distractions (e.g. noise, other people)
  • use short, simple sentences
  • encourage the person to stay with the activity for longer periods
  • change activities when necessary
  • when distracted, interrupt and bring back to task
  • give reminders of next step
  • keep to a routine

Speed of information processing

  • taking longer to complete tasks
  • unable to keep track of lengthy conversations and instructions
  • make allowances and give the person extra time
  • present information slowly
  • present information in chunks
  • present one thing at a time
  • check that the person is keeping up

Fatigue

  • having an overall reduced ability to cope
  • getting irritable and distressed
  • having other problems exacerbated
  • encourage the person to take rest breaks
  • schedule more demanding tasks when the person is at their best (often mornings)

Memory

  • finding it hard to remember new things
  • forgetting appointments
  • forgetting things people say
  • frequently losing things
  • give reminders
  • repeat information when necessary
  • encourage person to rehearse and repeat information
  • encourage use of external reminders, i.e. diaries, post-it notes
  • structure a routine by breaking tasks into small steps
  • keep belongings in regular places

Problem solving

  • reduced ability to find solutions to problems
  • train the person to approach new tasks in a systematic manner, e.g. break the task into small parts
  • reduce the demands made on the person
  • help educate the family and others about the person's problems
  • avoid giving the person open-ended tasks

Planning and
organisation

  • having difficulty working out the steps involved in a task
  • not considering the end result of their actions
  • having trouble organising their thoughts and explaining things to others
  • avoid becoming frustrated with the person
  • give prompts for the following steps
  • provide a written list which outlines the steps in order

Rigid and
concrete thinking

  • taking statements literally
  • insensitive and unable to consider feelings of others
  • having a simplistic understanding of emotions
  • being resistant to change
  • keeping doing things incorrectly despite feedback
  • use simple and direct language, avoid abstract terms
  • avoid using hints or sarcastic humour
  • encourage person to imagine how they would feel in other situations
  • explain any change in routine in advance, giving reasons

Disinhibition

  • being impulsive and act without thinking of consequences
  • making rash decisions
  • acting inappropriately toward people (including sexually)
  • behaving in a silly, flippant or childish way
  • disclosing personal information too freely
  • give immediate feedback, briefly
    asking person to stop behaviour
    and explain why
  • provide appropriate external
    controls e.g. over finances
  • remind person of the sensitive
    nature of some information,
    giving clear examples
  • ignore the behaviour where
    possible

Reduced self-control

  • losing temper quickly
  • being physically/verbally abusive
  • having a lower frustration tolerance
  • distract or remove the person from anger-provoking situation
  • withdraw attention when appropriate
  • try not to escalate the situation by shouting back
  • identify anger-provoking triggers and avoid when possible

Egocentricity and
self-absorption

  • not considering consequences of their behaviour on others
  • being unable to 'put themselves in someone else's shoes'
  • appearing selfish to others
  • not appreciating carers
  • try to explain situation from another's or your point of view
  • try not to take offence, understand why the person is like that

Emotional lability

  • laughing and crying inappropriately
  • changing moods quickly
  • try to identify triggers which result in mood swings
  • be prepared for changes by having alternative plans

Perseveration

  • talking about the same topic repeatedly
  • returning to the preferred topic when doing something else
  • remind person gently they've told you the information before
  • distract the person back to the preferred activity
  • ignore, as much as possible, future references to the topic
  • try not to get into arguments, walk away if you're getting irritated

Reduced insight

  • being unaware of both cognitive and physical limitations
  • having unrealistic goals, plans and expectations
  • resisting efforts of carer/staff
  • not realising that they have made errors because they haven't checked their work
  • gently remind person of deficits
  • explain why proposed action is useful, reason through the steps
  • point out possible negative consequences of person's unrealistic plans
  • place external limitations where necessary (e.g. removal of driver's licence/access to car)
  • gradually expose person to reality testing experiences

Poor self monitoring

  • not realising that they are 'hogging' conversations
  • being verbose and keep talking when others are no longer interested
  • encourage them to check over their work
  • use signals, agreed in advance, to let them know they're talking too much
  • encourage turn-taking in conversation
  • use external aids, e.g. graphs and tables to help the person monitor their behaviour

Reduced social
skills

  • interacting poorly with others because of all the above problems
  • losing their ability to relate well with others
  • not picking up the usual social cues (e.g. looking at watch)
  • teach specific strategies like maintaining eye contact, asking questions of others, turn taking in conversation
  • try to encourage awareness of others' reactions

Inertia

  • appearing to have no motivation and seem apathetic
  • not acting until prompted
  • not completing tasks
  • knowing how to do something, but not doing it spontaneously
  • encourage person to commence activity
  • prompt first step of the task
  • try to find things that are most interesting for the person
  • reward and encourage any self-initiated activity and persistence
  • accept that the person may need less activity to keep them occupied and happy

Restlessness

  • complaining of boredom and be
    restless and agitated
  • remind person of activities they usually enjoy
  • promote physical activity which may expend some energy

(c) Copyright - See: Module 4: Understanding and managing cognitive changes following an TBI - www.TBIStaffTraining.info

 

 

 

 

 

iv) Program staff

Program staff can have three common situations:
a) If you don't know the person has an ABI what should you be alert to that may indicate an ABI
b) If you do know the person has an ABI and there are communication difficulties - what are some conversation tips?
c) If you know the person has an ABI what do you need to know to help understand the person and their needs?

For practical tips see for example:

   Tool 1 : A person may have an AB


a) Tool 1 : A person may have an ABI 

All staff in services, especially those on reception or information and referral workers need to be open to the possibility of a person having an ABI.

Principles

Useful principles to underpin your interactions with people are:

  • Treat people with respect
  • Be non-judgemental
  • Be open
  • Listen
  • Be patient

Noticing

What do you notice?

  • A person having difficulty finding words
  • A person regularly forgetting appointments
  • A person getting agitated when things aren't going right
  • A person slurring their words not speaking properly.

Tips

Ask the person's permission to ring a family member, friend, or key contact (to ask for more information)
Use direct questions e.g.

  • Have you got an acquired brain injury?
  • Do you have difficulty finding the right words?
  • Do you have a memory problem?

Question your assumptions

  • Not keeping appointments - intentionally OR could there be a memory problem
  • Difficulty finding words - not understanding what's said - OR understanding what's said but has difficulty finding the right words to verbalise an answer.
  • Getting agitated - an irritable client OR - a person with an ABI who gets stressed when routine breaks down
  • If someone regularly forgets appointments - could they have a memory problem?

 

   Tool 2: Conversations tips  


b) Tool 2: Conversations tips  

People with ABI often have difficulty with communication and language. Here are come conversation tips.

To help the person's expression

  • Give the person plenty of time to respond
  • Encourage all attempts to communicate
  • Do not interrupt or answer for the person
  • Give questions or choices to clarify what the person means, for example:
    o "Do you mean … ?"
    o Ask what their topic is
    o Give a choice of two options ("Do you want to watch TV or go outside?")
  • The most important thing is the meaning behind the communication, not how well the person can put a sentence together

To help the person's understanding

  • Avoid background noise
  • Speak naturally but clearly
  • Ensure eye contact
  • Speak in short, simple sentences
  • Try rephrasing what you said if the person does not understand
  • Talk about events, objects and people in the here and now
  • Clearly identify people and topics
  • Do not change topic quickly
  • Be aware that the person will understand better when they are not tired

Tips to help manage difficult social situations

Problem: Poor conversational turn-taking

  • Give feedback about the need for people to take turns in conversation.
  • Say "It's ____'s turn now. Let them finish and then you can say what you want to say".

Problem: Talking about the same topic for too long.

  • Give feedback that the topic is finished.
  • Have an agreed upon non-verbal signal to prompt the person to move on (e.g. tapping your watch discreetly).
  • Say "We've talked about _______, and now we're talking about _______".

Problem: Talking about inappropriate topics/giving too much personal information.

  • Give feedback that this is inappropriate.
  • Say "It's not appropriate to talk about _________ in this situation/with this person".

Problem: Invading people's personal space.

  • Give feedback that the person is too close, direct them where to stand./sit.
  • Change the environment (e.g. have a table between you and the person, position the chairs in the room before the person arrives).

Problem: Inappropriate eye contact (staring or avoiding eye contact during conversation).

  • Position yourself in the person's line of sight.
  • Give verbal prompts to make eye contact and give praise when it is done.
  • Look away and don't engage someone in conversation if they are staring.

 

(c) Copyright - See: Module 2: Communication - www.TBIStaffTraining.info

 

   Tool 3: Looking for indicators of ABI 


c) Tool 3: Looking for indicators of ABI  

If you think a person may have an ABI you may need to ask questions to help understand the person, their ABI and their needs.
Asking these questions can be useful to get a sense of the client's cognitive status, and information about prior accidents, etc.
You may need to ask these questions of a family member or friend. A person with cognitive deficits may not be able to give you an accurate answer to these questions.

The following questions are not a diagnostic tool. They are intended only to identify the possibility of an ABI.

Considering the possibility of an ABI

Cognitive status

1. Does he/she have problems with day-to-day memory?
2. Does he/she have problems with attention/concentration (e.g. while reading a book, watching TV or watching a movie)?
3. Does he/she make a mess of simple tasks they could previously complete?
4. Does he/she get easily confused when things are explained?
5. Does he/she get stuck on a point and become unable to think or talk about anything else?
6. Does she/he find it hard to change their opinions or their routine, and become easily upset by small changes?
7. Does he/she generate unrealistic plans?
8. Does he/she act before they think?

A prior accident?

1. Have you ever had an injury to your head because of a car accident, fall, fight, blow to the head, or gunshot? If so, when did this happen?
2. Did you get knocked out or lose consciousness? If so how long did this last?
3. Did you experience confusion after the injury? Is there a gap in your memory for events that happened around the time of the injury?
4. Did you go to hospital?
5. Did you receive treatment?
6. Have you noticed changes in your emotional functioning since the injury? If so what changes have you noticed?

A prior stroke?

1. Have you ever had a stroke?
2. Did you lose consciousness? If so how long did this last?
3. Did you experience confusion after the stroke? Is there a gap in your memory for events that happened around the time of the injury?
4. Did you go to hospital?
5. Did you receive treatment?
6. Have you noticed changes in your emotional functioning since the stroke? If so what changes have you noticed?

Alcohol related brain injury?

1. Do you drink alcohol? If, so how much?
2. Cognitive status questions as above

b) When you know the person has an ABI from trauma, stroke, hypoxia or anoxia

1. Date and type of incident

2. Did you lose consciousness? If so how long did this last?

3. How long did you have post-traumatic amnesia (PTA)?

4. Did you go to hospital? For how long?

5. Did you receive treatment? What kind?

3. Rehabilitation history

• Acute
• Post-acute rehabilitation/community re-settlement
• Social rehabilitation

4. What types of impairments?

• Cognitive
• Communication/language
• Physical/sensory
• Emotional/behavioural/personality

5. What level of functioning?

• Self-care
• Living skills
• Work/study
• Relationship skills
• Behavioural problems (e.g. aggression, sexuality, disinhibition)

6. What level of functioning before the injury?

• Self-care
• Living skills
• Work/study
• Relationship skills
• Behavioural problems (e.g. aggression, sexuality, disinhibition)

7. Current social situation

• Accommodation
• Finance
• Social supports
• Current support

8. Compensation status

9. Other agencies involved

 

 

 

 

v) Case managers

There are different models of case management.

ADHC has two types of case management services - one offered through HACC services and the other through ADHC Disability Funding. It is important for case managers to understand their own model and other's models of case management.

When case managers are working with people with ABI it is useful in setting goals and developing individual program plans to be aware of:

  • the range of issues that may need to be considered in setting goals and developing plans
  • the sources of information that are available that may help set goals and develop plans
  • the elements of an individual program plan
  • tips for setting goals for people with ABI.

See for example:

   Tool 5 - Case managers issues checklist 


e) Tool 5 - Case managers issues checklist  

For sudden onset ABIs

The following is a checklist a case manager can use to ensure they have considered all the relevant issues with a person with ABI when they are setting goals and developing plans.

History of accident and recovery

  • date of injury
  • type of injury
  • period of unconsciousness/post traumatic amnesia (if TBI)
  • type of accident (if TBI)
  • rehabilitation history

Rehabilitation

  • rehabilitation reports
  • rehabilitation goals
  • rehabilitation contact

Pre-morbid status

  • pattern of behaviour
  • education/employment
  • social background
  • medical issues

Status post-injury

  • activities and daily living skills
  • communication/language difficulties
  • cognitive impairments
  • personality/behaviour problems
  • emotional states (depression, anxiety, anger)
  • adjustment difficulties
  • awareness of disability
  • sexuality issues
  • relationship issues
  • medical issues (brain-injury related and non brain- injury related)
  • medication
  • substance use or abuse
  • psychiatric status

Client's needs and goals

  • identify and establish

Family and significant other assessment

  • impact on the family
  • relationship issues
  • behavioural issues
  • adjustment to disability issues, including understanding of disability

Issues

  • recreation/leisure
  • work/education
  • accommodation
  • respite care
  • finances
  • legal
  • compensation
  • other agencies.

(c) Copyright - See: Module 7. Case management - www.TBIStaffTraining.info

   Tool 6 - Sources of information 


f) Tool 6 - Sources of information  

When a case manager is setting goals and developing individual program plans there are multiple sources of information that may be relevant.

Agency reports

Obtain copies from family, hospitals, legal representatives

Discharge summaries - can be obtained from acute hospitals or rehabilitation services, Commonwealth Rehabilitation Service, private rehabilitation providers.

Neuropsychological reports – done by neuropsychologists or clinical psychologists. Usually focus on changes to cognitive function. Some assessments include I.Q. score, usually not very helpful as the overall score does not usually vary greatly from the preinjury score.

Rehabilitation/medical reports – done by rehabilitation specialists, physiotherapists, speech pathologists, social workers, rehabilitation counsellors.

Other therapist reports – include occupational therapy, physiotherapy, speech pathology, social work and rehabilitation counsellor reports.

Self report

Pre-morbid functioning vs. current status - It is important to get an idea of a person's ability before the injury and compare that with current functioning. Otherwise you can make any number of erroneous conclusions about the impact of the TBI.

Verbal vs functional ability - Some people are verbally articulate, but still have significant problems at a practical level that may be identified in an interview.

Difficulties with insight - Some people have reduced awareness about their needs, and may not fully understand the level of support being provided by key people in their lives.

Family report

Impact on the family - Families are often a key support for people with ABI. Information from families can provide valuable additional information in making an assessment.

Under reaction vs over-reaction - Family members sometimes minimise or over-emphasise the disabilities of their relative.

Others

Other people may have valuable additional information - This may include agency/staff/friends/ employers, etc. The more sources of information, the better the quality of the assessment.

Where relevant sources of information are not available
Case managers may need to make arrangements to have a person with an ABI assessed appropriately.

(c) Copyright - See: Module 7. Case management - www.TBIStaffTraining.info

   Tool 7 - Individual program plan 


g) Tool 7 - Individual program plan  

An individual program plan could include:

1. Physical/mobility/transport

  • Physical abilities, driving ability, public and alternative transport

2. Relationships

  • Maintenance of existing relationships, sexuality
  • Support to develop new relationships

3. Accommodation

  • Pre injury arrangements may not be appropriate so new options need to be explored.
  • Includes respite

4. Autonomy

  • Goals regarding decision-making

5. Communication

  • Speech, non-English-speaking background, phone, reading, writing, computers

6. Living skills

  • personal care – showering/shaving/grooming/dressing/eating/hair and nail care
  • health – health and medication/substance use/abuse issues
  • food preparation
  • household chores – washing dishes/vacuuming/bed making/washing and ironing
  • money management – budgeting
  • time management – organising and keeping appointments

7. Social and personal skills

8. Recreation and leisure

9. Vocational

  • education and training

(c) Copyright - See: Module 7. Case management - www.TBIStaffTraining.info

   Tool 8 : Tips for setting goals


h) Tool 8 : Tips for setting goals 

The following are tips for setting goals when working with people with ABI.

There are more tips and resources in Toolkit B - “Getting it all Together” Working Together Promoting Independence This is a resource for workers working with people with TBI. It is on the wet site www.TBIStaffTraining.info The Kit contains practical information and tools the worker can use to assist an individual with a brain injury to:

  • Identify issues and set priorities
  • Set goals
  • Develop strategies to achieve the goals
  • Monitor progress.

Factors to consider when developing goals

  • Client centred not staff actions
  • Goal development vs goal imposition
  • Giving exact behavioural description of goals
  • Stating goals positively rather than negatively
  • Creating short-term goals vs long-term goals
  • Looking at improvement vs maintenance.

Writing goals

Remember: Goals need to be specific, measurable and time limited.

Some examples are:

I will remember all my appointments in 2 weeks
I will have enough food in my house for all my needs for 2 weeks.
I will keep track of when my bills are due and pay them on time within two weeks.
I will identify places to keep things in my house so I don't lose them, in one month.

To achieve each of these goals would require developing strategies (and identifying any necessary resources).
For example to achieve: I will have enough food in my house for all my needs for 2 weeks
will require:

  • menu plan
  • shopping list
  • work with support worker
  • etc

The following are too broad and general to be useful goals:

  • independently use public transport
  • increase opportunities for social interaction
  • improve arm function
  • improve personal hygiene
  • improve cooking skills

How to deal with unrealistic goals

  • allow learning through experience (consistent with cognitive abilities and achievable goals)
  • develop compensatory strategies
  • investigate alternatives
  • set priorities
  • break into smaller steps
  • give clear feedback about progress/lack of progress
  • don't challenge unrealistic goals, try and focus on achievable smaller goals
  • link achievable goals with unrealistic goals (rather than challenging unrealistic goals)

(c) Copyright - See: Toolkit B. Working Together Promoting Independence - www.TBIStaffTraining.info

 

 

 

 

vi) Managers

Where the staff are working with people with ABI two interconnected issues that managers need to be particularly aware of are:

  • The disillusionment process that can happen when staff are working with people with ABI
  • Preventing stress

as these are common issues for support staff working with people with ABI.
These issues needs to be addressed through having good management and supervision practices.

See for example:

   Tool 9 : Managing and supervising staff 


i) Tool 9 : Managing and supervising staff   

Good staff management and supervision includes:

How to get the right person for the job

  • Recognise the value of the recruitment process
  • Identify important criteria in selecting staff to work with people with ABI.

Developing and retaining staff

  • identify key strategies to retain and develop staff working with people with ABI.
  • – orientation
    – training and education
    – performance management

Good management practice

  • Identify key issues in working with clients with a brain injury
  • Identify strategies and good practices for effective supervision and support of staff working with people with ABI
  • Identify good management practices
  • Explore basic concepts in the provision of client services
  • Identify the value of policies and procedures
  • Recognise the stressors that often exist for staff due to the nature of brain injury
  • Identify management strategies in response to staff stress.

The role of the manager

  • Identify essential skills and responsibilities for managers
  • Link recruitment with a Management Framework.

Good management practices

  • consistent approach to client management
  • good communication, written and verbal,
  • clinical and critical pathways
  • develop and foster a team approach
  • hold regular meetings to review and monitor and evaluate plan
  • provide in service education and training to staff
  • provide crisis management, intervention and debriefing
  • rotate staff to prevent burnout and stress
  • OH&S issues for staff – safe workplace
  • accessible and user-friendly policies and procedures
  • recognise staff stress – disillusionment process and stress.

(c) Copyright - See: Module 8. Supervising staff / Managing staff - www.TBIStaffTraining.info

   Tool 10: The disillusionment process 


j) Tool 10: The disillusionment process   

Staff working with people with ABI can experience a disillusionment process - especially when staff management practices are not working

The disillusionment process moves through the following phases:

Enthusiasm

  • Unrealistic expectations for the client
  • Inadequate skills
  • Over identification with the client - not professional relationship
  • Over investment of self - personally involved.

Stagnation

  • Lose enthusiasm with client due to unrealistic expectations
  • Other needs assume greater importance
  • Sense of unfulfilled expectations - feeling of non-achievement

Frustration

  • Questions effectiveness - feels client is not achieving
  • What's the point
  • Staff member loses respect for the client
  • Hostility towards colleagues and superiors

Apathy

  • Staff member does the minimum
  • Disinterested
  • Its only a job
  • Emotional detachment

Staff member leaves with negative experience

Strategies for preventing the disillusionment process

Some of the strategies for preventing the disillusionment process from setting in are:

  • Realistic expectations for the client
  • Staff understanding of ABI generally
  • Staff understanding each clients ABI - injury - effects - behaviour
  • Staff training with the skills to manage the behaviours for each of the clients they work with.

(c) Copyright - See: Module 8. Supervising staff / Managing staff - www.TBIStaffTraining.info

 

  Tool 11: Preventing stress 


k) Tool 11: Preventing stress  

Good management processes will prevent stress and the disillusionment process from occurring. Understanding the causes, symptoms and prevention strategies for staff stress enables the manager to act early. Positive staff management practices within an organisation maintain enthusiasm and involvement of staff with the client and the organisation. It is the key to retaining staff:

Symptoms of staff stress

  • absenteeism and poor time keeping
  • regular extended breaks
  • high Staff turnover
  • tiredness, apathy, depression, avoidance of clients and colleagues
  • extreme cynicism
  • no team work
  • negativity
  • loss of professionalism.

Causes of staff stress

  • working in isolation without support
  • long periods of intensive work with little relief
  • aspects of work tasks which assault personal dignity, individual differences coping with stress
  • exposure to pressure when least able to cope
  • lack of training
  • no crisis intervention or debriefing from Managers
  • lack of communication, direction and responsibility from Managers
  • no plan or goals to work toward
  • lack of understanding & acceptance of capabilities & limitations of other.

Stress prevention

  • provide relevant training and orientation
  • remove staff from the stressful situation, encourage them to leave their work at work
  • provide crisis intervention, support and counselling
  • have clear OH&S policies and procedures
  • expand on the staff member's individual skills
  • approve leave and roster changes
  • provide opportunities for peer support and working with a more skilled colleague
  • involve staff in decision making, to contribute ideas and problem solving
  • hold regular meetings where grievances can be aired constructively and support refocused
  • communicate realistic expectations, from the perspective of staff
  • assume responsibility for and deal with organisational matters that create stress
  • communicate clear organisational aims and have written policies and procedures
  • set up a method of evaluation and review related to client goals and aims.

(c) Copyright - See: Module 8. Supervising staff / Managing staff - www.TBIStaffTraining.info