CARF Update

© 2012 CARF International. All rights reserved.© 2012 CARF International. All rights reserved.

CARF Update

Brain Injury Association of Maryland

April 19, 2013


CARF Standards Development

• International Standards Advisory Committee (ISAC)

• International Advisory Council (IAC)

• Field Review

• Printed January 2013

• Used on all surveys July 1, 2013 - June 30, 2014


BI ISAC

• 8 countries represented• Entire continuum of services

represented– CIIRP, OMR, HCS, Residential, Voc,

CM

• Requirement of “if you provide…..must seek accreditation” maintained

• “If you see the occasional…” was added


Brain Injury Specialty Programs (BISP)

3.HNew 2013 Standards


3.H. BISP Description

• Services focus on unique needs:– Medical– Physical– Cognitive– Communication,– Psychosocial– Behavioral– Educational – Accessibility– Leisure/recreation



• Integrates services to:– Minimize impact of impairments

and secondary complications

– Reduce activity limitations

– Maximize participation, including wellness, quality of life, and inclusion in community

– Decrease environmental barriers

– Promote self-advocacy



• Recognizes individuality, preferences, strengths and needs of:– Persons served– Families/support systems

• Provides access to :– Information– Services– Resources available



• Services enhance lives of persons served within their :– Families/support systems– Communities– Life roles

• Supports efforts to:– Promote personal health and wellness– Improve quality of life throughout their

lifespan



• Demonstrates commitment, capabilities, and resources to maintain itself as a specialized program

• Utilizes current research and evidence to provide effective rehabilitation

• Supports future improvements by advocating for or participating in brain injury research


3.H. BISP Description• Partners with person served,

families/support systems and providers from emergency services through community-based services to foster an integrated system of services that optimizes:– Recovery– Adjustment– Inclusion– Participation– Prevention



• Engages and partners with providers within and outside of rehabilitation to increase access to services by advocating for persons who have sustained an ABI to:– Regulators

– Legislators

– Educational Institutions

– Research funding

– Payers

– Community at large


3.H. BISP

• Program seeking accreditation as a Brain Injury Program must include in its Intent to Survey all portions of the programs (CIIRP, HCS, OMR, Residential, Vocational) that the organization provides and that meet the CARF program description


3.H. BISP

• Interventions:– Preventing brain injury– Recognizing,

assessing, treating conditions related to BI

– Preventing complications and co-morbidities

– Identifying and reducing risk factors for recurrent BI

• Interventions:– Facilitating:

• Functional independence

• Performance• Psychological well

being• Social coping• Adjustment• Community inclusion• Participation in life

roles


3.H. BISP

• Interventions:– Assistive technology

– Services for families/support systems

• Facilitating advocacy the BI program demonstrates knowledge of:– Regulations

– Legislation

– Financial issues

– Funding availability


3.H. BISP

• Facilitating advocacy BI program demonstrates knowledge of:– Service availability– Protection and advocacy

resources– Healthcare delivery system– Resources and services related

to aging


3.H. BISP

• Facilitates collaboration with person served and family/support system in decision making through:– Accessible information– Timing for exchange of information– Identification of their level of:

• Understanding of the rehabilitation process

• Health literacy


3.H. BISP

• Initial and ongoing assessments document info:– History

– Status in:• Behavioral

• Cognitive

• Communication

• Decision-making capacity

• Dual Diagnosis

• Status in:– Educational– Functional– Leisure/recreational

activities– Medical– Physical– Psychological– Sexual– Social– Spiritual– Vocational


3.H. BISP

• Initial and Ongoing assessments document:– Important events and life

experiences– Life routines– Usability of the living

environment


3.H. BISP

• Assess impact of behavior, cognition, communication, medical and sensory deficits on the following:– Physical function– Social function– Vocational function– Education– Family dynamics– Participation


3.H. BISP

• Initial and ongoing risk assessments are incorporated into:– Assessment process– Individual program

planning– Discharge/transition

planning


3.H. BISP

• Risk assessments address:– Behavioral– Cognitive– Communication– Developmental– Emotional– Environmental– Medical


3.H. BISP

• Risk assessments address:– Physical– Vocational– Capacity of the family/support

system– Financial resources– Legal– Other, as appropriate


3.H. BISP

• Assesses need for resources, services, supports and/or interventions:– Community access:

• Driving• Mobility• Transportation needs


3.H. BISP

• Assesses need for:– Life roles:

• Basic life skills• Life-long learning• Parenting skills• Spousal/significant other

relations• Work re-entry


3.H. BISP

• Assesses need for:– Adjustment to

disability:• Aging with a disability• Insight• Supervision needs

– Medical:• Co-morbid conditions• Falls

• Medical:– Medication– Nutrition– Secondary

complications– Seizures


3.H. BISP

• Assesses community participation:– Advocacy– Fitness– Leisure/recreation– Socialization– Volunteerism– Wellness

• Mental health

• Provides or arranges for these


3.H. BISP

• Dependent on needs, provides or arranges for:– Assistive technology– Audiology services– Chaplaincy services– Dialysis– Driver rehabilitation

• Dependent on needs:– Durable medical

equipment– Dysphagia

management– Environmental design– Medical consultative

services


3.H. BISP

• Dependent on needs:– Medical nutrition

therapy– Neurobehavioral

services– Neuropsychological

services– Orthotic services– Ostomy/wound care

• Dependent on needs:– Peer support

– Prosthetic services

– Psychiatric services

– Psychological services

– Rehabilitation engineering


3.H. BISP

• Dependent on needs:– Respiratory therapy– Sexual education– Spasticity management– Substance misuse, counseling, treatment– Total parenteral nutrition– Vestibular assessment– Visual assessment– Vocational rehabilitation


3.H. BISP

• Provide or arranges for diagnostics to screen for and assess status of:– Bladder function

– Bowel function

– Cardiac function

– Cognitive function

– Mental health

– Metabolic function

– Musculoskeletal function


3.H. BISP

• Provide and/or arrange :– Neurological function– Obstetric and gynecological health– Pulmonary function– Sensory function– Skin integrity– Swallowing– Thromboembolic disease– Other common secondary conditions


3.H. BISP

• Demonstrates knowledge and coordination with local, regional, provincial, national, or international networks or agreements to facilitate:– Specialized brain injury services– Use of appropriate

subspecialties– Advocacy


3.H. BISP

• Program demonstrates knowledge and application of clinical research to treatment practices

• Prior to implementation of specific treatments, personnel provide the rationale for those treatments to the:– Person served– Family/support system

• Provide options, as appropriate based on feedback received


3.H. BISP

• Organized education program to meet the needs of person served and family/support system

• Education program includes but is not limited to:– Neuroanatomy– Etiology and

epidemiology of ABI

• Education program:– Communication with

providers– Active involvement in

service delivery– Behavioral supports– Cognitive interventions– Communication

interventions– Developmental/life

transitions


3.H. BISP

• Education for person served and family/support system:– Community resources– Recognition and reporting of suspected

abuse and neglect– Boundaries– Medical complications– Risks associated with BI– Self advocacy– Psychological issues after BI


3.H. BISP

• Education for personnel at orientation and regular intervals includes but is not limited to:– Neuroanatomy– Etiology and epidemiology of ABI– Communication with person served and

family/support system– Communication with other providers serving

person served


3.H. BISP

• Education continued:– Facilitating active involvement of person

served and family/support system in service delivery process

– Facilitating behavioral supports– Facilitating cognitive interventions– Facilitating communication interventions– Handling developmental/life transitions


3.H. BISP

• Education continued:– Knowledge of community resources– Recognition and reporting of suspected

abuse and neglect– Setting and maintaining professional

boundaries– Medical complications– Special populations– Risks associated with BI– Psychological issues following BI


3.H. BISP

• Program identifies and supports preferences of the person served around:– Lifecycle events– Community events– Cultural events– Spiritual events


3.H. BISP

• Consistent with personal preferences persons served are provided with opportunities to:– Share their talents and skills– Mentor– Teach


3.H. BISP

• Consistent with personal preferences, program supports the persons served in developing, maintaining, and/or increasing their social contacts and relationships with:– Families/support systems– Friends– Significant others

• Within the program and external to program


3.H. BISP

• Program addresses the impact of brain injury on the family/support system of the person with ABI including but not limited to the person’s:– Children– Siblings– Spouse/significant other– Parents– Other members of the support system


3.H. BISP

• Program creates an environment that supports appropriate relationships between personnel and the persons served

• Based on need and preferences of person served the program addresses:– Self awareness– Social awareness– Peer relationships


3.H. BISP

• Based on needs and preferences program addresses cont:– Relationship issues– Sexuality– Reproductive issues


3.H. BISP

• Wellness promoted through activities:– Based on input from

persons served– Consider input from

family/support system– Provide for daily

structured and unstructured activities

• Wellness:– Promote healthy

behavior– Reflect their choices– Align with their

cognitive capabilities– Align with their

communication capabilities


3.H. BISP

• Wellness:– Promote their personal growth– Promote self-responsibility– Enhance their self-image– Improve or maintain their functional levels– Allow for social interaction– Allow for autonomy– Include opportunities for community

interaction


3.H. BISP

• Wellness:– Documented in the individual

plan for the person served

• Addresses prevention of:– Onset or progression of co-

morbidities– Substance misuse– Injury– Falls


3.H. BISP

• Addresses prevention of:– Abuse– Complication related to:

• Disability• Aging

• Program minimizes complications related to:– Family/support system dynamics– Discharge/transition planning– Follow-up


3.H. BISP

• Educates person served and family/support system on respite care

• Provides, arranges for or assists with arrangements for respite care

• If it provides respite requires the person served to bring the following if applicable:– Adaptive equipment– Assistive technology


3.H. BISP

• Bring to respite care of applicable:– Emergency contact information– Information on everyday routines– Information/instructions on special needs– Instructions of specific healthcare

procedures– Medications– Pertinent health/medical history


3.H. BISP

• For persons served longer than one year or upon a request the program offers a comprehensive annual review for person served and family/support system and provides findings and reommendations

• Annual review addresses:– Academic education needs– Behavior status– Cognitive status


3.H. BISP

• Annual review:– Education needs

– Equipment

– Financial resources

– Function

– Housing

– Leisure/recreational activities

– Life-long planning

– Medical status


3.H. BISP

• Annual review:– Psychological needs– Relationship resiliency– Respite– Substance misuse– Technology status– Transportation– Vocational status


3.H. BISP

• With in its scope of practice and expertise the program acts as a resource to providers from emergency through community-based services

• Demonstrates efforts to educate the community about:– Prevention of TBI– Impact of ABI


3.H. BISP

• Educate community on:– Need for BI rehabilitation– Accessibility/reasonable

accommodations– Inclusion


3.H. BISP

• Resource for information for:– Person served– Family/support system– The community

• On:– Advocacy opportunities– Consumer organizations– Disaster planning


3.H. BISP

• Resources on:– Peer opportunities– Respite care– Specialist in brain injury services– Support groups

• To advance field of BI leadership supports:– Program’s participation in

research opportunities


3.H. BISP

• To advance field BI leadership has to provide to person served and family/support system information about available:

– Research opportunities – Clinical trials


3.H. BISP

• To promote seamless delivery the program proactively coordinates, facilitates and advocates for appropriate transitions

• Discharge/transition planning addresses:– Life routines– Level of understanding

of the family/support system regarding current status of person served

– Contingency plans


3.H. BISP

• Discharge/transition planning addresses:– Expectations of person served,

family/support system– Environment of next component

of continuum of services or discharge location including:

• Facilitating factors

• Barriers


3.H. BISP

• Discharge/transition planning addresses:– Self-advocacy– Capability of the

family/support system– Financial resources– Access to healthcare– Transportation


3.H. BISP

• Discharge/transition planning addresses:– ID of resources in community that are or

will be involved with person served– Mechanisms fro coordination with other

resources– Follow-up plan for each person– Follow-up services including for those that

leave the geographic service area


3.H. BISP

• Discharge/transition planning addresses:– Designation of individual(s) who will be

responsible for coordination of the follow-up plan of the person served

• Provisions for contact as appropriate between person served and/or family/support system and the program after discharge/transition


3.H. BISP

• Program gathers information on satisfaction including satisfaction with:– Clinical practices/behavior– Degree of inclusion of the person served in

their program– Outcomes achieved– Information received about the program,

including:• Accuracy of information• Usefulness of information


3.H. BISP

• Gather satisfaction information from:– Persons served

– Families/support systems

• A least annually addresses:– Trends in relationship to established

targets in each area

– Trends

– Actions for improvement

– Results of PI actvities


3.H. BISP

• On annual basis:– Necessary education and

training of:• Persons served• Families/support systems• Healthcare providers• Personnel


If you serve the occasional person with ABI• These are applied to:

– CIIRP– OMR– HCS– Residential Rehabilitation


If you serve the occasional person with ABI

• Assesses impact of behavior, cognition, communication, medical and sensory deficits on:– Physical function– Psychological function– Social function– Vocational function– Education– Family dynamics– Participation


If you serve the occasional person with ABI• Initial and ongoing risk

assessments are incorporated into:– Assessment process– Individual program

planning – Discharge/trnsition

planning


If you serve the occasional person with ABI• Risk assessments address

following areas:– Behavioral– Cognitive– Communication– Developmental– Emotional– Environmental


If you serve the occasional person with ABI• Risk assessments address

following areas:– Medical– Physical– Capability of the family/support

system– Financial resources– Legal– Other, as appropriate


If you serve the occasional person with ABI• Knowledge of and

coordination with local, regional, provincial, national or international networks or agreements to facilitate:– Specialized brain injury services– Use of appropriate

subspecialties– Advocacy


If you serve the occasional person with ABI• Addresses impact of brain injury

on family/support system of the person with ABI but not limited to person’s:– Children– Siblings– Spouse/significant other– Parents– Other members of the support

system


If you serve the occasional person with ABI• Program creates environment

that supports appropriate relationships between personnel and person served

• Program minimizes complications related to:– Family/support system dynamics– Discharge/transition planning– Follow-up


If you serve the occasional person with ABI

• Personnel education at orientation and regular intervals includes:– Neuroanatomy– Etiology and

epidemiology of ABI– Facilitating

behavioral supports

• Education:– Facilitating

communication interventions

– Recognition and reporting of suspected abuse and neglect

– Setting and maintaining professional boundaries


If you serve the occasional person with ABI• Education:

– Medical complications– Risks associated with brain

injury


3.M Independent Evaluation Services (IES)

• Coordinate and facilitate objective, unbiased evaluations based on:– Individualized referral questions– Effective and efficient use of

resources– Regulatory, legislative, and financial

implications– Relevant communication with

stakeholders


3.M IES

• In view of multiple stakeholders involved, IES support transparency and exchange of information

• May be completed by a variety of professionals who are not involved with the care of the person served for the purpose of clarifying clinical and case issues

• Delivery may be in a variety of settings


For more information

• Chris MacDonell– [email protected]– 866-888-1122 Ext. 5007– www.carf.org– www.uspeq.org

CARF Update

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