BrICC Brain Injury & Concussion Clinic CLINICIAN TRAINING

1. BrICCBrain Injury & Concussion Clinic CLINICIAN TRAINING Fall 2019 Communication Disorders & Sciences University of Oregon

3. Before we start the training… • Pre-practicum survey • Knowledge questions

4. Training Overview Pre-Practicum Survey & Knowledge Pre-Test Welcome & Introductions Logistics Processes: Documentation Assessment Treatment Transitions Questions

5. Learning Objectives By the end of today’s training, you should be able to… • Describe the purpose of BrICC and characteristics of client populations. • Locate checklists, templates, and instructions on infoCDS to assist you in preparing for rounds, consults, treatment, and completing required documentation. • Describe components of an initial cognitive consultation and how to prepare. • Explain guiding principles of treatment selection and delivery for cognitive rehabilitation.

6. BrICC Purpose Complete initial consultation to assessacquired cognitive impairments and identify client desired outcomes Identify nature of cognitive impairments and impact on activities and participation Provide cognitive rehabilitation and/or counseling for individuals experiencing impact on function Facilitate attainment of desired outcomes in desired contexts or settings - getting back to valued roles/activities

7. Cognitive domains addressed in BrICC • Attention • Memory • Executive Function • Social communication (e.g. pragmatics, theory of mind, social problem solving)

8. Populations Acquired brain injury (ABI) - mild, mod, severe Acquired cognitive impairments Traumatic brain injury (TBI) Concussion/mild traumatic brain injury Anoxic event Neurogenic populations with progressive cognitive impairments e.g., Parkinson’s, Huntington’s, stroke, primary progressive aphasia

9. Population Characteristics • Cognitive symptoms • --Impaired attention, memory, executive function • Somatic symptoms • --Headache, light sensitivity, nausea, dizziness • Psychosocial changes • --Decreased social engagement, irritability, flat affect

10. Additional complications Cognitive symptoms may be exacerbated by many factors, which may include • Mental health issues, e.g. anxiety, depression, PTSD • Sleep difficulties • Substance use disorders • Life stressors • Physical pain How to proceed • Focus on facilitating the recovery process • Create a context for working through difficulties and moving forward (Clinician's Guide to Cognitive Rehabilitation in mTBI, 2016)

11. Consultation with Center for Healthy Relationships • Consulting therapist may address psychosocial and emotional concerns for BrICC clients • Consulting therapist may attend individual sessions per client need and clinician request • BrICC clinicians report relevant observations and consult clinical supervisor prior to seeking consultation

12. Crisis Management When a client expresses suicidal thoughts... • Avoid expressing shock or alarm • Calmly talk to the person • Ask if they have a plan • Let it be OK to talk about it • Offer resources (next slide) • Notify supervisor as soon as feasible • *Immediate risk of harm = emergency = Call 911*

13. Resources for clients in crisis • For non-UO students • Crisis Intervention Line – White Bird Clinic (24 hours / 7 days) • (541) 687-4000 / 800-422-7558 • http://whitebirdclinic.org/crisis • Cahoots mobile crisis services: • Call police non-emergency numbers 541-726-3714 (Springfield) and 541-682-5111 (Eugene). • Campus resources for students • After-Hours Support and Crisis Line – 541-346-3227 • UO Counseling Center http://counseling.uoregon.eduhttps://healthcenter.uoregon.edu/Services/Suicide-Prevention • https://oregon-advocate.symplicity.com/care_report/index.php/pid934179?

14. Logistics: Prior to First Session • Check your schedules • Have scheduled meeting with supervisor: questions/concerns • Confirm session times with clients • Ask clients if/how they prefer to get reminders before each session • Submit initial CHARTR for every client

15. Logistics: BrICC Meetings • Tuesdays 10:30-12:30 in HEDCO 370/371 • Discussion of cases • ITP and EBP training 10/8/19 • EBP presentations 10/15/19 • Last week (12/3) of meetings: video rounds • Meetings: 10/8/19 – 12/3/19

16. Video Rounds Presentation • More details during BrICC meeting 10/8/19 • You will each sign up for a time to present during the last week of rounds • Choose a client • Show a video clip of your client implementing your chosen treatment approach for the term

17. Documentation Due Dates • Lesson plans due 48 hours after the previous session concludes • SOAPs due 24 hours after the session concludes • Self-reflections due after first week of working with clients, prior to midterm meeting, and prior to final meeting • Initial draft of Assessment Report due within a week of the consult • Initial draft of the ITP due: by Noon Sun. October 20th • Final ITPs due by Noon Sun. November 17th • MANDATORY TO EMAIL US WHENEVER AN RDS DOCUMENT IS READY FOR REVIEW

18. Self-Reflections • Prompts will be available on InfoCDS • Self-Reflections will be due: • After your first clinic week (10/13 @ noon) • Prior to midterm grades being input (11/3 @ noon) • Prior to your final meeting (12/8 @ noon) • Please send your self-reflections to all supervisors who work with you

19. BrICC Rounds

20. Rounds • The purpose of rounds is to support one another, share clinical information on your clients, and problem solve together to improve your clinical sessions • Two types of Rounds Presentations: • Group Rounds – open discussion of your weekly assigned case (1-3 minute case presentation followed by approximately 5 minute Q&A discussion) • Lightning Rounds – after group presentation, you will all sum up your weekly assigned case in a 30 second (approximately 2 sentences) description of your client

21. Rounds Presentation Example • Show videos from Jim’s computer

22. Documentation & Resources on InfoCDS

23. Finding Resources on InfoCDS • In response to past student feedback, we’ve made all of our procedures and expectations available on infoCDS. • We aim to be completely transparent and explicit with our instructions • Please ask for clarification if anything is unclear • You should read and be familiar with: • BrICC Documentation Checklist • BrICC Report Writing – what works and what doesn’t • Rounds and consult materials • Intervention Selection Table

24. Locations of Key Resources on InfoCDS • “Assessment” page • Psychometric conversion table • Follow checklists/guides on infoCDS under Student Preparation and Planning Materials >Consults • “Student Preparation and Planning Materials” page • Rounds (instructions for rounds) • Consults • Documentation (checklist; what works and what doesn’t) • BrICC Goal-Setting Worksheets • “Treatment Approaches and Intervention Materials” page • Intervention Selection Table

25. Assessment:Initial Cognitive Consults

26. Clinical interview (45 min) Learn about presenting concerns, impact of sx on routine Motivational interviewing + eGAS Present possible treatment options to address concerns Standardized battery/other protocols (1 hr, 15 min) RBANS – every consult TEA/TEA-Ch, BRIEF, D-KEFS, LASSI – as needed based on file review PCSS, HIT – somatic sx after concussion Consultation Overview

27. Consult Templates in RDS • CDS > CDS Templates > BrICC > BrICC eval templates shortcut • Adult and Adolescent ABI cases • Adult neurodegenerative (use for Parkinson’s, Alzheimer’s, dementia, etc.) • Use the Consult Checklist to prep for consults • Use complete sentences, narrative format

28. Standardized Batteries • RBANS • http://www.pearsonclinical.com/psychology/products/100000726/repeatable-battery-for-the-assessment-of-neuropsychological-status-update-rbans-update.html#tab-training • Refer to presentation titled ‘RBANS Update: Repeatable Battery for the Assessment of Neuropsychological Status’ by Anne-Marie Kimbell, PhD • TEA/ TEA-Ch – Versions A, B & C – begin with version A – administer full test • Course content – Management of Acquired Cognitive Disorders • BRIEFhttp://www4.parinc.com/Products/Product.aspx?ProductID=BRIEF • LASSI http://www.hhpublishing.com/_assessments/lassi/ • FAVRES-Adult http://www.ccdpublishing.com/favres.aspx • D-KEFShttp://www.pearsonclinical.com/psychology/products/100000618/deliskaplan-executive-function-system-d-kefs.html#tab-training • Refer to training by Gloria Maccow, PhD

29. Interpretation • So much data, so little time! What does it all mean? • What hypotheses did you have at the start of the assessment? • Return to your hypotheses when interpreting data

30. Interpretation • Interpretation should be based on hypothesis testing • Integrate data from multiple sources • Summarizing is useful and necessary, but insufficient • How are data consistent or inconsistent across sources (interview, testing, observation, etc.)? • For example - Does standardized testing data support interview data? Are data from the BRIEF consistent with test data and presenting concerns?

31. Treatment

32. Treatment Options • Direct attention training combined with strategies (APT-3, AIM) • Functional skills training • Metacognitive strategy instruction • Training assistive technology for cognition (ATC) • External cognitive aids • Goal Management Training (GMT) • Personalized education • Environmental modifications/support

33. Using CHARTR Process for clinical thinking • Consider • Client data - concerns, characteristics & desired outcomes • Evidence-based practice - refer to the literature • Expert knowledge - consult your supervisor • Ask • What is the rationale for selecting this approach for this client? • What barriers exist to implementing this treatment approach? • What will you measure to determine progress toward goals? • How will you take session data? • How will you measure progress toward the desired outcome?

34. Measuring Progress • You will collect two types of data: • In-session data (corresponds to STOs), e.g.: • Steps performed accurately during probe using systematic instruction • Time to complete task • Accuracy • Impact or generalization data, usually measured/tracked by the client or caregiver during the week (corresponds to LTG)

35. Treatment Delivery • Determine treatment approach in collaboration with your supervisor • Refer to infoCDS, BrICC “Treatment Approaches and Intervention Materials” > “bricc-intervention-selection-table_2016_final” • Individual or group delivery options

36. Transitions: End of Term • Involve the next clinician to facilitate a smooth transition • When sharing final progress with your client, take a collaborative approach • ask them what worked • how the strategies worked

37. Transitions: End of Therapy • Start preparing the client early in the term for possible dismissal if this might be the last term • Connect your client to community resources • Develop a maintenance plan or check-in plan

38. Learning Objectives Checkpoint • Make sure you achieved the learning objectives today! • Describe the purpose of BrICC and characteristics of client populations. • Locate checklists, templates, and instructions on infoCDS to assist you in preparing for rounds, consults, treatment, and completing required documentation. • Describe how cognitive domains operate in daily life and offer examples of how impairments to cognitive domains interfere with functioning. • Describe components of an initial cognitive consultation and how to prepare.

39. References • Clinician's Guide to Cognitive Rehabilitation in Mild TBI: Application in Military Service Members and Veterans (In submission).  Rehabilitation and Reintegration Division, Office of the Surgeon General, United States Army. • Sohlberg, M. M. & Ledbetter, A. K. (2016). Management of Persistent Cognitive Symptoms After Sport-Related Concussion. American Journal of Speech-Language Pathology, 25, 138-149. DOI: 10.1044/2015_AJSLP-14-0128 • Sohlberg, M. M., & Mateer, C. A. (2001). Cognitive rehabilitation: An integrative neuropsychological approach. New York: Guilford Press. • Sohlberg, M. M., & Turkstra, L. S. (2011). Optimizing cognitive rehabilitation. New York: Guilford Press.