ABI Neurobehavioral & Neurocognitive Program (NB/NC)

1. ABI Neurobehavioral & Neurocognitive Program (NB/NC) Massachusetts Brain Injury Commission August 1, 2011

2. Acquired Brain Injury (ABI) An insult to the central nervous system which includes brain injury due to one or more of the following: traumatic, vascular, metabolic, infectious, neo-plastic or toxic insults. It does not include degenerative or dementing disorders, or congenital brain injury.

3. ABI NB/NC Program Goal Provision of individualized neurobehavioral and neurocognitive rehabilitation services that enable individuals with ABI to regain functional abilities, lost as a result of their injuries, to re-enter the community.

4. ABI NB/NC Program Objectives To: • establish the qualifying standards for Nursing Facility ABI Provider participation and specifications on the services to be purchased; • provide for increased access to neurobehavioral and neurocognitive services for MassHealth Members with ABI; and • ensure that the neurobehavioral/neurocognitive services are customized to each MassHealth Member’s needs and are the most cost-effective and appropriate option available to meet the health care needs of each MassHealth Member with ABI.

5. Population Focus Individuals who: • have sustained an ABI; • present with significant neurobehavioral sequelae; • exhibit neurocognitive capacity to participate in and benefit from neurobehavioral and neurocognitive treatment, as evidenced in neuropsychological test findings and review of the medical and clinical records; • exhibit a reasonable expectation for measurable improvement as determined by the Program Staff and clinical team in their neurobehavioral and neurocognitive status, as evidenced by progress toward clearly defined and documented goals and outcomes prior to and during the program; and

6. Population Focus (Continued) • require a short-term intensive program of neurobehavioral and neurocognitiveservices. • Do not have access to other publicly-funded services (e.g., Chapter 766, MR/DD Specialized Services); • Do not have dementia or degenerative disorders of the Central Nervous System (CNS) or congenital brain injury; • Do not have significantly and irreversibly compromised ability to learn as evidenced by neuropsychological test results; • Are not in a coma, persistent vegetative state (PVS) or emerging from coma; • Are not actively engaged in substance abuse; • Do not present an unmanageable threat to the physical safety of themselves or others; or • Do not have a primary diagnosis of only mental illness

7. General Program Description The NB/NC program must encompass all of the following: • NB/NC services available six (6) days per week and integrated into the comprehensive nursing facility plan of care and activities during waking hours to ensure that skills and strategies are reinforced and complemented; • an available and accessible individualized daily activities schedule; • demonstrated coordination within the interdisciplinary team, ensuring that daily nursing and general therapeutic services reinforce and complement programming; • clearly identified goals and services to meet appropriate level of therapy (PT, OT, ST)services; • a developed ABI program of NB/NC services, with monitoring protocols;

8. General Program Description (Continued) • individualized and integrated services to ensure that medical needs, cognitive needs, behavioral needs, and services are customized to each individual; • access to and a contractual relationship with a neuropsychiatrist to assist the facility staff and ABI program director in support of the ABI services and programming particularly in the area of psychopharmacological assessment and monitoring; and • a social services department that specializes in discharge planning and follow-up including: • the coordination and integration of community based services; • the preparation of participants to achieve the program goal of community re-entry achieved through services that improve cognitive functioning; and • periodic follow-up assessments to determine service integration success at the community based level.

9. Design Elements & Service Requirements The NB/NC program is a short-term intensive rehabilitation program intended to thoroughly examine and assess individual functioning, with the therapeutic purpose of progress toward individualized neurobehavioral/neurocognitive goal attainment. The goal of the program is community re-entry achieved through services which improve the individual’s cognitive, functional, motor, perceptual or sensory, and communication and language deficits, personality or psychiatric changes, social difficulties, regulatory disturbances and inappropriate behavior.

10. Design Elements & Service Requirements(Continued) Each ABI Providermust ensure that eligible members with ABI: • have neurological assessment and neurology consultation; • have a NB/NC service plan developed and monitored by the Program Director, in consultation with the licensed neuropsychologist, and delivered by a cognitive behavioral specialist; • have a psychopharmacological assessment with updates to the plan of care as needed; completed, on a monthly basis, or more frequently as specified by the neuropsychiatrist, • have in place physical therapy (PT), occupational therapy (OT) and speech therapy (ST) service plans developed by a licensed therapist. Therapies must be integrated into all programming and services to reinforce and complement daily activities; • have comprehensive care plans and documented care plan meetings that demonstrate coordination between neurobehavioral/neurocognitive staff, nursing staff, and therapy staff with defined outcomes; • receive a minimum of six and one-half hours (6.5) per week of intensive NB/NC treatment evenly distributed over six (6) days per week.

11. Design Elements & Service Requirements(Continued) • receive a minimum of three(3) thirty(30) minute sessions ofneeded therapy servicesdelivered by a therapist or trained Certified Occupational Therapy Assistant (COTA) or Physical Therapist Assistant (PTA) or Speech Therapy Assistant (STA) meeting competencies for caring for patients with ABI; • receive daily a minimum of 2, 15 minute sessions of active or passive range-of-motion (ROM) activities, monitored by a licensed therapist; and • receive and attend mainstream nursing facility activities that are appropriate and meaningful, at least 5 times per week along with a community-based occupational service activity at least once/ week to support community integration or discharge from the contract and/or nursing facility; and • receive ongoing assessment for discharge potential and a comprehensive discharge plan.

12. Staffing Requirements The program requires the following specialized staff: Program Director: Masters degree in psychology or related field; be a Board Certified Behavior Analyst, as certified by the Behavior Analysis Certification Board (registered trademark) OR a Certified Brain Injury Specialist (CBIS), certified by the American Academy for the Certification of Brain Injury Specialists (AACBIS); and have at least 5 years of experience working with ABI. Licensed Neurophychologist: Neuropsychologist PhD. Doctorate Cognitive Behavioral Therapist: Masters level professional with ABI experience Social Worker: LICSW and Experience working with ABI Therapist ( PT, OT and Speech combined): Rehabilitation professional with ABI experience preferable

13. AppendixStaff Qualifications & Duties Position: Program Director Minimum Qualifications Specialized Training: Masters degree in psychology or related field; be a Board Certified Behavior Analyst, as certified by the Behavior Analysis Certification Board (registered trademark) OR a Certified Brain Injury Specialist (CBIS), certified by the American Academy for the Certification of Brain Injury Specialists (AACBIS); and have at least 5 years of experience working with ABI. Responsibilities: • Conceptualize, develop, monitor and supervise NB/NC treatment program; • Assess participant’s skills, deficits and support requirements; • Develop, in consultation with the licensed neuropsychologist, the member’s NB/NC treatment plan; • Integrate neurobehavioral treatment/activities into all care delivery and disciplines; • Monitor psychopharmacology regimen as prescribed by a psychiatrist or neurologist; • Participate in interdisciplinary planning and meetings and discharge plan development and follow-up; • Design NB/NC program trainings and train all staff; and • Supervise cognitive behavioral specialist.

14. Position: Licensed Neurophychologist Minimum Qualifications Specialized Training: Neuropsychologist PhD. Doctorate Responsibilities: • Conduct functional neuropsychological evaluations; • Translate assessments into behavioral, cognitive and therapeutic interventions; • Interpret assessments done by outside providers as part of pre-admission screening; • Provide input to the Program Director in development of the neurobehavioral plan; • Develop and monitor cognitive re-training; • Consult with team members in individual and team/group settings regarding shaping interventions; • Develop interventions that maximize learning potential in cognitive and rehabilitation therapies; • Develop program strategies in behavioral, cognitive and therapeutic areas in team based setting; • Assist with supervision of cognitive therapist; and • Participate in interdisciplinary planning and meetings.

15. Position: Cognitive Behavioral Therapist Minimum Qualifications Specialized Training: Masters level professional with ABI experience Responsibilities: • Provide individual & group NB/NC treatment, programming and therapy in accordance with the NB/NC service plan; • Conduct functional assessments; • Develop individual cognitive and behavior programs designed to help patients regain skills and improve behaviors; • Prepare and integrate teaching modules/activities for NC programming pursuant to neuropsychological assessment; • Provide integration of cognitive and behavioral strategies into the treatment plan; • Participate in interdisciplinary planning and meetings; • Design and implement community based activities including communications, social and community integration and work or educational skill development; • Collect and interpret data to adjust behavioral interventions; • Train all unit staff in NB/NC programming; • Train and supervise CNA’s and team members on ABI behavioral program and crisis intervention; • Train individual caregivers in the discharge environment on techniques needed as they transition out of the program; • Meet with Program Director and Nursing Director to review and modify, patient supervision protocols, incidents and risk management programs; and • Assess program effectiveness and report results back to Program Director.

16. Position: Social Worker Minimum Qualifications Specialized Training: LICSW and Experience working with ABI Responsibilities: • Provide input to the individual service plan including most likely discharge scenarios; • Obtain information from current caregivers and/or family members and evaluate and propose options for the individual to return to a community setting; • Research and coordinate community based support including housing options; • Determine health, ABI rehabilitative, behavioral health and vocational/educational assessments as inputs to the care plan; • Provide ongoing input and assessments into the service plan; • Work with family and caregivers to develop effective discharge plan; • Monitor residents progress in community post discharge; • Counsel members, family, next of kin in ABI and its lifelong applications; and • Participate in interdisciplinary planning and meetings.

17. Position: Therapist ( PT, OT and Speech combined) Minimum Qualifications Specialized Training: Rehabilitation professional with ABI experience preferable Responsibilities: • Perform evaluations; • Provide therapy services; • Train, monitor and supervise staff specific to therapy plan; • Train and monitor restorative aides; and • Participate in interdisciplinary planning and meetings.