n) Key messages for working with people with ABI Next o)

i) Key messages

The nature of ABI has implications on how to work with people with ABI.

There are three sets of key messages.

These are explored in detail in Module 2. Working with people with ABI (opens in new window):

A. Unique individuals building independence
B. Working through emotions and relationships
C. Working with services

 

 

ii) Not personal - Support worker reflections - Clip 9 (1 min 45 sec)  

     

iii) A. Unique individuals building independence

a) Uniqueness of the individual

All people are unique individuals. Yet the most important message for people working with people with ABI is: people with ABI are unique individuals. The specific effects of ABI on an individual depend on, for example, the severity of the ABI, the location of the brain damage, the length of time since brain injury, the extent a person has been able to integrate back into the community and the support available to the person.

b) Injury- effect - behaviour - strategies

People with an ABI have a brain injury. The injury has an effect on the working of the brain. The working of their brain affects their behaviour. People working with people with an ABI have to manage behaviours. The effects of the injury are unique to the person.

c) For many people with ABI - being the proxy for the frontal lobe

People who have damage to the frontal lobe of the brain often have difficult with planning, coordinating, getting started, sticking to the task, finishing the task and so on.
One of the consequences of this is that people who have frontal lobe damage need someone to be the proxy for their frontal lobe. They need someone to help them with planning and coordinating, making important decisions. Often this is a family member's role. Sometimes it is the case manager's role.

d) Building independence

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 others are young - they have a lot of life ahead of them and plenty of time to develop. People with ABI may need support to manage independent skills for life when they can't maintain a skill on their own.

iv) B. Working through emotions and relationships

e) The person with the ABI - the effects of the injury and dealing with the effects of the injury

A person with an acquired brain injury has had a life before the injury. Unless they are very young when they had the injury they will remember the life they had.

The acquired brain injury may have effected their thinking skills, communication/language, physical/sensory and emotional/behavioural/personality. In addition to experiencing these changes the person with the ABI has to respond to and come to terms with their new life situation. They also have to deal with their family members and friends coming to terms with the changes in them. As with any major life change loss, grief and rediscovery are part of the process.

f) Family members

Family members have also to be able to deal with: the changes in the family member because of the ABI; the responses to the family member in coming to terms with the ABI; their own coming to terms with all of this, and the impact of the change on the family.

Family members have a key role in helping the person with the ABI recover. Loss, grief and rediscovery are part of the process.

g) Workers - Building relationships and looking after oneself (including self-understanding about handling own stress, what pushes your buttons).

A key to working with a person with an ABI is building a relationship with them. Working with people with acquired brain injury can be difficult.

  • It can be hard to get to know them.
  • It can take time to get to know them.
  • Behaviours can be difficult to deal with.
  • They can be different from other people you have worked with.

Workers need self-understanding about handling their own stress and what pushes their buttons.

v) C. Working with services

h) Pathways for life after an ABI (including rehab, moving into community, etc)

Unique individuals mean that service pathways are unique. At the same time staff need to be aware of typical service pathways; local barriers to pathways and strategies for dealing with pathway barriers.

I) Case management 'for life' as required

As noted above people who have damage to the frontal lobe of the brain often have difficulty with planning and coordinating. One of the consequences of this is that often people who have frontal lobe damage are also the ones who need ongoing case management. In these situations the case manager's roles is to act as their frontal lobe by adding the structure needed to make sense of different situations.

j) The family, community and support staff are where change happens

Change happens in the day to day. If a person without an ABI goes to see a psychologist a lot of progress can be made in the interview. The person generates their own plans for integrating therapy in day to day life. If a person with an ABI goes to see a psychologist, and they have for example problems with planning, coordinating, memory then they will need additional support for these impairments in order to make progress. The support will be to provide day to day strategies, processes and systems - e.g. putting memory aids in place to enable a person with ABI to integrate the therapy into their everyday life.

k) Part of a team - who's who - including accessing specialist assessments

Working with a person with an acquired brain injury often means being part of a team. It is important to understand everyone's role. There can be different teams at different stages in the process: acute care staff and family and friends; rehabilitation team; community living team.

l) Working with the services network

The services network of people with ABI is imperfect. There are some great parts. There are good parts. There are missing parts. The primary drivers for working with the services network are:

  • What are the person with ABI's goals?
  • What does the person with ABI want in order to achieve their goals?

The approach is: Do what it takes - to meet the goals of the person with the ABI
The priorities for services are:

  • Generalist services where possible
  • Disability services where necessary
  • Specialist ABI services where necessary.