The Intersection Of Behavioral Health, Brain Injury And .

2y ago
13 Views
2 Downloads
983.55 KB
36 Pages
Last View : 1m ago
Last Download : 2m ago
Upload by : Elise Ammons
Transcription

The Intersection of Behavioral Health,Brain Injury and SuicideKris Wright and Anastasia EdmonstonOctober 7, 2020

Session Objectives How can the Daily Living Skills (DLA)-20 assessment inform functionalsupports and service for individuals living with brain injury and/orbehavioral health conditions Looking for clues of suicide risk utilizing the DLA-20 Understanding post brain injury behavioral health conditions and theelevated risk of suicide among those living with a history of brain injury Being brain injury informed-tips for screening and assessment Incorporating supports and strategies for individuals living with functionalchallenges related to behavioral health, including a history of brain injury2

TBI vs. ABITBI DefinedABI DefinedTraumatic Brain Injury (TBI) is aninsult to the brain caused by anexternal physical force, such as a fall,motor vehicle accident, assault,sports-related incident, or improvisedexplosive device (IED) exposureAcquired Brain Injury (ABI) is aninsult to the brain that has occurredafter birth, such as TBI, stroke, nearsuffocation, infections in the brain, oranoxia or hypoxia secondary to;cardiac events, near drowning andopioid overdose(s)Both mechanisms of injury can result in a chronic disability that may get worse with age.3

Brain Injury SeverityDistribution of severity: Mild injuries 80 percent(Loss of consciousness (LOC) 30 minutes, post traumaticamnesia (PTA) 1 hour) Moderate 10–13 percent(LOC 30 minutes to 24 hours, PTA 1 to 24 hours) Severe 7–10 percent(LOC 24 hours, PTA 24 hours)4

TBI “Fingerprints”Our frontal lobe and the temporal lobes are key to managing behavior andemotions.Thus, damage to these regions can contribute to mental health and/or addictionproblems. Damage to these lobes is considered the “Fingerprint of TraumaticBrain Injury.”There are two other lobes in the brain, the occipital and the parietal lobes.5

Updating the Brain Injury Fingerprint: ABI Secondary to OverdoseWhat is known and observed regarding the impact of opioid overdose and the brain: Sudden loss of oxygen to the brain has the greatest effect on parts of the brain that are high oxygenusers such as the hippocampus, basal ganglia and frontal region among others These areas of the brain are oxygen “hogs” and are critical to memory, learning and attending to newinformation, problem solving and the ability to manage our emotions and impulses — in other words,they are responsible for our adult thinking skills aka “executive functioning” Individuals who experience multiple overdoses from opioids may experience symptoms similar tothose who experience multiple concussionsThe ability to self-regulate is notably impacted by both Traumatic and Acquired Brain Injury whenthese critical areas are damaged, the functional manifestations can include:Lability, impulsivity, irritability, and apathy6Source: Adapted from Ohio Brain Injury Program/John Corrigan PhD, 2017

Daily Living Activities-20 (DLA) Functional Assessment Reminder:The Functioning is the Functioning Assess level of functioning/impairment compared to generalpopulation (not your caseload) The DLA-20 score will not alwayscorrelate with consumer’s selfreport Evaluate based on past 30 days (nothistory/future) Consider functioning problemsrelated to physical limitations &mental impairments If functioning varied in the last 30days, rate lowest score of the morefrequent pattern of behavioralresponses to symptoms7 DO NOT change scores due toenvironmental limitations or culturalnuances

DLA-20 through a brain injury informed lens: Health PracticesDLA-20: Health Practices How are people at taking care of illnessesand chronic conditions – appointments,treatment, meds?Brain Injury Mood-Behavioral Regulation Challengessecondary to either Traumatic orAcquired Brain Injury. What are the Behavioral Health (BH) Undiagnosed or unrecognized brain injurysymptoms and how/when do they show up?can lead to inappropriate behavioralhealth diagnosis and treatment Do absent or negative practices indicateconcern for self or others? Imminent risks?8

DLA-20 through a brain injury informed lens: Housing Stability,MaintenanceDLA-20 - Housing Stability Is the housing stable? Does it meet theirneeds? Living alone, with family/friend(s), or in acongregant setting, are they contributing asexpected? Does the person find it difficult tocook, clean, find critical documents? Are billspaid on time or lost?9 Is there conflict with others in the residence?Brain Injury Due to memory, problem solving, impulsecontrol challenges it is difficult for somepeople with a history of brain injury tomanage the responsibilities associatedwith housing independence withoutsupports

DLA-20 through a brain injury informed lens: CommunicationDLA-20: -ommunication Look at verbal and nonverbalLanguage and Speech problems are common Are people able to listen andafter either a TBI or an acquired BI (stroke,communicate their needs? How much do they rely on assistance toget a full and complete story across? Is communication dysfunctional orantagonistic?10Brain Injuryopioid overdose(s) ). Language issues includeword finding (aphasia), difficultycomprehending and organizing written andspoken language. Speech problems includearticulation and swallowing issues.

DLA-20 through a brain injury informed lens: SafetyDLA-20: Safety Are there recent instances ofsuicidal/homicidal ideation, intent,attempts? Assess situational awareness and makingsafe decisions If they are needed, are the able to safely useassistive technologies for vision/hearing Safe use of tools and appliances?11Brain Injury Safety concerns can arise from bothphysical challenges such as reducedbalance and coordination as well asbehavioral dysregulation secondary toinjury to the frontal and temporal lobes. Incidences causing TBI/ABI may alsoimpact vision or hearing

DLA-20 through a brain injury informed lens: Managing TimeDLA-20: Managing TimeBrain Injury Is sleep sufficient for their needs in Sleep disorders are common after brainduration (7-9 hours/night for averageinjury as is being mindful of/tracking theadult) and is it restful?passage of time Timeliness of daily tasks – meds, meals Are they showing up for work,appointments, and activities on time? Look at intentionality andimplementation12 If a person is experiencing both, adverseconsequences can include; exacerbatedmood disorders, irritability and the abilityto meet expectations on the job

DLA-20 through a brain injury informed lens: NutritionDLA-20: Nutrition Independence/participation in shopping A history of brain injury can impact thefor, planning and preparation of at least 2ability plan purchases, get to a grocerybasically nutritious meals a day?store, have the budget to purchase If eating what is available, are they atleast nutritious choices vs just sustaincalories?13Brain Injuryadequate and nutritious food as well asplan and cook regular meals

DLA-20 through a brain injury informed lens: Problem-SolvingDLA-20 - Problem-solvingBrain Injury Are they able to gather information Frontal and temporal lobe damages canfrom reliable sources? How often is decision-makinginformed and intentional vs impulsiveor delegated? Are expectations set clearly andconsistently14result in impaired executive skillfunctioning, impacted is the ability toassess a problem or situation and create aplan to address the problem of situation,execute the plan and THEN modify theplan as circumstances dictate

DLA-20 through a brain injury informed lens: Family RelationshipsDLA-20 – Family relationships Quality of interactions with identifiedfamily – they get to identify family Look for relationships that are strained,dysfunctional, unreliable, superficial ordestructive Dependency – unwanted or unnecessary?Brain Injury Family members take on the role of caregiver,especially if the individual has physical disabilities.If the individual is living with behavioral healthchallenges, mental health and/or substance usedisorders, the stress on families can lead to anerosion of relationships, this may be more so ifsubstance use factored into the circumstances ofthe injury15

DLA-20 through a brain injury informed lens: Alcohol/Drug UseBrain InjuryDLA-20: Substance Use Knowing signs of and avoidingabuse About half of all individuals with a history of brain injury had alcohol in theirsystem at the time of injury. With childhood Traumatic Brain Injury’s (TBI’s), evenif considered mild at the time, there is a high risk of Substance Use Disorder Self-control with use Avoiding misusing and/or(SUD) by late adolescence or early adulthood 70-80% of individuals discharged from a rehabilitation setting with a moderate tocombining meds with alcoholsevere brain injury will be prescribed a opioid. People with brain injuries oftenand other drugshave difficulty engaging in recovery programs and treatment because of brain Includes legal and illegalsubstances16injury related cognitive difficulties such as memory, attention and comprehensionissues

DLA-20 through a brain injury informed lens: leisure, communityresources and social networks including sexual healthDLA-20: Leisure, Community Resourcesand Social Network Assess factors related to isolation/withdrawalBrain Injury The common constellation of challenges in theareas of physical, cognitive and behavioral Leisure activities – connection and copingskills Connections with friends, neighbors, peersand services Sexual health – both the physical and mental17aspectsof safe and appropriate behaviorhealth can interfere with an individual’s ability,in general to access resources, leisureopportunities and make and/or maintain socialconnections with others including current orpotential sexual partners

DLA-20 through a brain injury informed lens: ProductivityDLA-20: ProductivityBrain Injury Having a primary role where one’s efforts Unemployment and underemployment is veryhave tangible outcomes (products) Successes and/or challenges in working,volunteering, homemaking or in school Nature of supports and accommodationsand whether they’re effectively used18common after brain injury, up to 80% of individualswith a known history of brain injury are unemployed As learning new information and executive skillfunctioning are critical to academic success, withoutappropriate supports individuals with brain injury mayhave experience challenges returning to or enteringeducational settings

DLA-20 through a brain injury informed lens: Personal Hygiene,Grooming and DressDLA-20: Personal Hygiene, Groomingand Dress Are they regularly seeing to personalBrain Injury Challenges with physical and cognitivefunctioning may impact these areas. It is notcleanliness including bathing anduncommon for individuals to have fine andbrushing teethgross motor skill impairment post TBI Assess tidiness of hair, hands and general Leading to difficulties with conducting personalappearance Look at clothing’s cleanliness, fit andappropriateness to context19care activities This is especially true if an individual’sdominant side is affected

Ask the DLA-20 Supplemental Questions!Brief TBI Screen: Part of aComprehensive Person CenteredAssessment

Ohio State University Traumatic Brain InjuryQuick Screen (OSU TBI-ID)OSU TBI-ID Quick Screen Questions:1. Ever knocked out or lost consciousness? (Yes, No, Not screened)2. Longest time knocked out? (Less than 30 minutes, 30 minutes–24 hours, 24 hours)3. Age (1–99) when first knocked out or lost consciousness?21

Interpreting FindingsThe OSU-TBI Short Screener is NOT a diagnostic tool. Instead, it provides a means toestimate the likel rebral contusions ortraumatic intracranial hemorrhages A substantial contribution to risk of suicide for study participants wassubstance misuse Mortality rates for suicide are greater among patients who havetraumatic brain injuries between the ages of 20-60 (suggests injuriesincurred younger due to sports/play and not associated with alcohol use)29Source: Teasdale and Engberg

Brain Injury and Suicide A study of homeless veterans with and without a history of TBI foundamong these very vulnerable groups, those with a history of TBI met thecriteria for more psychiatric diagnoses and more likely to be at risk forsuicide (Brenner et. al. 2017) The TBI Model Systems National Database has over 7,000 people livingwith a moderate to severe Brain Injury, many who have beensuccessfully followed for over 20 years. In this study of the ModelSystems participants, researchers found “compared to the generalpopulation, people with TBI are at greater risk for depression andsuicidal behavior many years after TBI.30

Concussion and SuicideThe results of a 2016 Canadian study published in a Washington Postarticle by Erin Blakemore in February 2016 found the following: The long-term risk of suicide increases three-fold among adults whohave had concussions Found suicide rate of 31 deaths per 100,000 —three times thepopulation norm In the meantime, between a mild concussion and suicide was 5.7years with each additional concussion raising risk of suicide31

Concussion and Suicide Among those who had a concussion and later completed suicide, 52percent were men, 86 percent lived in an urban area, and their meanage was 41. Those who sustained their concussion on a Saturday orSunday were four times more likely to complete suicide than thegeneral public About half of the individuals who completed suicide saw a health careprovider within the last week of their lives32Source: Washington Post 2016

TBI and Suicide RiskWhat can precipitate suicidal thoughts in people living with TBI: LonelinessLack of connection/supportBad news about prognosisHolidays Social anxietyJob/employment issuesLack of resourcesFrustration over tasksSource: Adapted from Traumatic Brain Injury and Suicide, Information and resources for clinicians, VISN 19 Mental Illness, Research, Education, and Clinical Center,Denver VA Medical Center (from a Colorado survey of individuals living with brain injury)33

TBI and Suicide RiskThings that are helpful: Distractions such as havingPsychotherapysomething to do first, TV,Medicationcomputer, etc.Support Groups Having a responsibility such as aHaving accessible providerspet or a jobHaving a belief system/spirituality Family/friends that careSource: Adapted from Traumatic Brain Injury and Suicide, Information and resources for clinicians, VISN 19 Mental Illness, Research, Education, and Clinical Center,Denver VA Medical Center (from a Colorado survey of individuals living with brain injury)34

Be Brain Injury Informed Screen for a history of Brain InjuryLook for signs and symptoms of brain injuryDon’t assume poor follow through and/or engagement in services is volitionalEducate program participants about the risk of acquired brain injury secondary toopioid use as well as the increased risk of traumatic brain injury secondary to alcoholuse related falls, fights and motor vehicle/pedestrian accidents Offer and model simple strategies (see handouts) “When you think you are done, you are not” individuals living with brain injury and cooccurring substance use related disorders benefit from long term follow up andsupports Make appropriate referrals for specific brain injury related supports and services whenindicated35

Thank youAnastasia Edmonston MS CRCTBI Partner Project CoordinatorMD Behavioral Health his product was supported, in part by grant number90TBSG0027-01-00 from the U.S. Administration for CommunityLiving, Department of Health and Human Services, Washington,D.C. 20201. Grantees undertaking projects with governmentsponsorship are encouraged to express freely their findings andconclusions. Points of view or opinions do not, therefore,necessarily represent official ACL policy.”Kris Wright, MS LCPCTrainer ConsultantEvidence-Based Practice CenterDepartment of PsychiatryUniversity of Maryland School ofMedicinekris.wright@som.umaryland.edu

TBI vs. ABI 3 TBI Defined ABI Defined Traumatic Brain Injury (TBI) is an insult to the brain caused by an external physical force, such as a fall, motor vehicle accident, assault, sports-related incident, or improvised explosive device (IED) exposure Acquired Brain Injury (ABI) is

Related Documents:

May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)

Silat is a combative art of self-defense and survival rooted from Matay archipelago. It was traced at thé early of Langkasuka Kingdom (2nd century CE) till thé reign of Melaka (Malaysia) Sultanate era (13th century). Silat has now evolved to become part of social culture and tradition with thé appearance of a fine physical and spiritual .

On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.

̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions

Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have

Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được

Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.

Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.