How To Live With A Brain Injury

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1 Goole Neuro-Rehabilitation Centre

2 We aim to provide the best quality neurobehavioural rehabilitation for people with complex and challenging needs after brain injury. Ultimately, we want to enable service users to participate in life as fully as possible, needing the least possible assistance. Professor Michael Oddy, Director of Clinical Services, BIRT 2

3 What is Goole Neuro- Rehabilitation Centre? Opened in 2007, Goole Neuro-Rehabilitation Centre (GNRC) is a specialist service that provides residential rehabilitation for people with acquired brain injury. GNRC is a partnership between The Brain Injury Rehabilitation Trust (BIRT) and Northern Lincolnshire and Goole Hospitals NHS Foundation Trust (NLAG). What does it do? GNRC provides a very different service to other BIRT rehabilitation centres as it is able to take people more immediately post-acute with greater medical and nursing needs. GNRC also works with people who have to cope with a range of cognitive, physical and/or emotional symptoms following a severe brain injury, as well as other neurological conditions including Guillain-Barré syndrome, multiple sclerosis and lupus. Rehabilitation is based on a neurobehavioural approach and focuses on enabling service users to function more independently and to participate in as many of their previous roles and activities as possible, while developing their lives with privacy, dignity and respect. 3

4 Facilities Located in Goole and District Hospital, Lincolnshire, GNRC offers a modern and superbly equipped environment for rehabilitation, complemented by spacious and wellappointed communal areas for dining and relaxation, its own gym and a pleasant landscaped garden. Accommodation comprises 14 bed spaces, with a fourbedroom transitional living unit which is 10 minutes walk from the main service and offers accommodation for both short term and longer term service users who require ongoing rehabilitation. This enables residents to develop their independent living skills in a community environment. Service users enjoy access to a wide range of therapeutic groups, such as management of stress and anxiety, memory, brain injury awareness, social skills, fitness, healthy eating and recreational activities, including daily living skills, such as laundry, budgeting, menu planning and gardening. 4

5 Environment Access to the wider community forms an important part of rehabilitation. GNRC is ideally situated close to the centre of Goole, and service users have easy access to local shops and supermarkets, a leisure centre with swimming pool and other community facilities. Family support GNRC operates a family support group for relatives of service users to provide education and emotional support, both individually and within a group setting. 5

6 Assessment When a service user is admitted to GNRC they undergo a 12 week neurobehavioural assessment to determine their potential for social reintegration and increased independence. This includes assessments of, for example, cognitive skills, the nature and frequency of any challenging behaviour and the service user s ability to engage with the community and complete functional daily tasks. At the end of the assessment period, a meeting is held at which family, funders and other involved parties join the team to discuss the results. This enables the team to identify any barriers to recovery and link these with a course of rehabilitation and support, while also taking into account the aspirations of the service user and family members. 6

7 Rehabilitation If a formal course of rehabilitation is recommended, the service user begins an individualised treatment programme. This includes learning and therapeutic sessions, personal, social and domestic skills, guided leisure time, community access, behavioural management and vocational training and support. Service users are actively involved in reviewing their progress against preagreed outcomes. The average length of a residential placement varies depending on an individual s needs, with many of our service users moving on to live in a more independent supported environment in the community. 7

8 This service has a very professional multi-disciplinary team, headed by a very knowledgeable neuro-psychologist. Referrer Clinical practice and clinical team The clinical team at GNRC comprises professionals from a wide range of disciplines, all of whom are recognised in their field as having special expertise in the management of brain injury. The team is led by a consultant in neuropsychology and rehabilitation and includes clinical psychologists, a speech and language therapist, physiotherapists, occupational therapists, nurses and rehabilitation support teams. Clinical practice is based on a neurobehavioural approach and focuses on a combination of social and behavioural interventions to aid recovery of independence. The emphasis of assessment is on a systematic and structured observation of behaviour and skills in everyday situations and tasks. Clinical governance is promoted through BIRT s Clinical Executive, a national forum comprising consultants in neuropsychology and rehabilitation from across BIRT s services. Led by Professor Michael Oddy, the Clinical Executive is committed to promoting clinical governance, training and research, as well as developing and reviewing clinical policies and procedures. Accreditation GNRC has been awarded full accreditation with the Commission on Accreditation of Rehabilitation Facilities (CARF), and is registered with the Care Quality Commission (CQC), receiving consistently excellent reports. 8

9 Continuum of care BIRT offers a nationwide continuum of services for people with acquired brain injury including postacute hospital-based rehabilitation, assessment and rehabilitation, continuing rehabilitation and community support services. The duration of placements at GNRC varies, depending on the service user s level of need and their potential for rehabilitation. 9

10 Dominic s story In January 2011, Dominic Conlan was found unconscious following a violent assault at his home. He had suffered a severe brain injury. He was admitted to hospital where he was treated in the Intensive Care Unit for two weeks. During this time he was very confused and disorientated, unaware of his support needs and at risk from falls due to mobility problems. Due to his challenging behaviours, when he left hospital Dominic was initially referred to York House, an intensive neurobehavioural assessment and rehabilitation service operated by BIRT. While there he underwent a joint pre-admission assessment, completed by staff from both York House and Goole Neuro Rehabilitation Centre. At this point Dominic was more aware of his circumstances and it was decided that he could be supported at Goole Neuro Rehabilitation Centre. He was admitted to GNRC in April 2011, where he underwent a series of clinical assessments and completed an eight-week daily rehabilitation programme as part of his recovery. Dominic made rapid progress, and in June 2011 was moved to the transitional living unit at Goole, enabling him to develop his independent living skills in a community environment. He has settled in well and is involved in all aspects of his daily life, from planning his weekly programme to meal preparation and shopping. Dominic is now in a continuing rehabilitation bed until a placement closer to his family becomes available. 10

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12 We ve had good results; I have a lot of respect for the staff. They respond quickly to referrals and keep me updated without me having to chase. Referrer Outcomes for service users BIRT uses a series of standardised rating scales to assess cognitive, emotional and behavioural changes over time. Each service user is assessed during their first month of admission. These results are then compared with the same measurements sampled during the last month prior to discharge. This includes monitoring of mood, behaviour and motivation, together with any demonstration of verbal or physical aggression. As well as enabling us to measure service users progress, the outcome measurement system also acts as a valuable tool for individual goal setting during the rehabilitation programme and informs the ongoing care pathway. During 2011, 31 service users were admitted to GNRC and 23 service users were discharged. Service users at GNRC can be admitted directly from neurosurgical or acute medical/surgical services. Over the course of rehabilitation, they move from being closely monitored and supervised to being largely independent. 74% of those discharged in 2011 required full time supervision on admission, after a period of rehabilitation only 26% required full time support. At the time of admission, 84% of service users were not engaged in any productive activity. Following rehabilitation, 21% were in education, employment or training and a further 47% were involved in regular structured recreational activity or voluntary work. 12

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14 Quality and value for money BIRT s continuum of care ensures that in most cases a reduction in costs occurs as a service user moves towards greater independence. On average, the lifetime cost savings are between 800,000 and 1 million, if a service user is admitted within one year of brain injury.* Reducing costs through the BIRT continuum - a case study: When Steven came to BIRT, any attempt to engage with him resulted in outbursts of violence and aggression. After moving through BIRT s continuum of services, costs were reduced as follows: Challenging Behaviour Assessment & Rehabilitation Centre Reduction of 750 per week or 39k per annum Challenging Behaviour Continuing Rehabilitation Centre Reduction of 438 per week or 22k per annum Assessment and Rehabilitation Centre Reduction of 712 per week or 37k per annum Community Supported Housing scheme The savings shown are the costs that would have been incurred had Steven not moved through the BIRT continuum. Coupled with the high satisfaction ratings from service users, families and referring agencies, research data confirms that BIRT delivers quality and value for money from admission to discharge. 14 * Peer-reviewed research data references are available at Fees correct at time of print.

15 Where we are Goole Neuro-Rehabilitation Centre is located approximately two miles from Goole town centre. It benefits from ample car parking and a regular bus service into Goole, which is served by good mainline rail links. Service Manager Goole Neuro-Rehabilitation Centre Woodland Avenue Goole DN14 6RX Tel [email protected] For further information about Goole Neuro-Rehabilitation Centre please contact the service manager at the address above. Referrals Referrals should be made directly to Goole Neuro- Rehabilitation Centre. We accept referrals from a wide range of agencies including health, social services, medico-legal and other specialist providers. The staff gave me really terrific support. I now realise just what an invaluable resource BIRT is. Luke 15

16 The Brain Injury Rehabilitation Trust The Brain Injury Rehabilitation Trust (BIRT) provides a continuum of care for people with acquired brain injury, from post-acute hospital based rehabilitation, assessment and rehabilitation, continuing rehabilitation and supported housing and home support. Through our range of specialist services, we aim to enable people to function more independently in the wider community and develop their lives in ways they choose. For more information about our work please contact: The Brain Injury Rehabilitation Trust 60 Queen Street, Normanton, Wakefield, WF6 2BU Tel: Fax: [email protected] The Brain Injury Rehabilitation Trust is a division of The Disabilities Trust and the means by which it provides its brain injury services. Founded in 1979, The Disabilities Trust is now established as one of the UK s leading charities, offering imaginative, progressive services to people with autism, brain injury, physical disability and learning disability. The Disabilities Trust First Floor, 32 Market Place, Burgess Hill, West Sussex, RH15 9NP Tel: Fax: [email protected] The Disabilities Trust is a company limited by guarantee incorporated in England and Wales under and registered as a charity in England and Wales under and in Scotland under SC Registered office as shown.