Heads up on Brain Injury assessments

Jackie Burt BA Hons. CQSW

Social worker, Case manager

Why are cases complicated?

What are the pitfalls and possibilities for assessment?

What is so special about brain injury?

Traumatic [TBI] or Acquired Brain Injury [ABI] can affect one specific area

But very often the whole brain is affected with diffuse damage across all areas

Brain injury can happen to anyone

The brain

Areas of the Brain Explained

RTA - [ TBI]

Don - motorbike accident, working man, husband, father.

Rob- 20 years , out clubbing , hit by fire engine. Both suffered frontal and cerebellar damage D was able to claim compensation R was not

Causes and Case Studies

Dee , existing MH problems , jumped from a bridge .

Scott , fell from bridge on a night out . Both suffered physical and cognitive damage

. D’s pre-existing problems led to added stress

for carers. Conflict for social work over who is responsible for after care .

•Falls

Mike – carbon monoxide poisoning Brian – heart attack , Global brain damage, diffuse difficulties . Memory badly affected. Families of both struggle to cope. M > compensation B > not applicable

Anoxia

Gary – 23 years – haemorrhage. Jim – 25 years -stroke following IV drug use

Both left with communication difficulties G > no speech and unable to read . J > pre existing drug dependency. Both > anger , frustration Both received inappropriate support following

SSD assessment .

Haemorrhage /Stroke

Steve , beaten with baseball bat by drug gang

Pete - beaten by gang, mistaken identity Both > major frontal lobe damage , reduced

insight . No physical damage . Both > very vulnerable and at risk . Pete had help to apply for Criminal Injuries

Compensation

Assault

N – RTA aged 3 L -- Swallowed adult medication aged 3

Children's brains have plasticity and can develop different neural pathways but often at the expense of other skills

But often long term problems exist which may not be obviously associated .

[ see research on prison population etc]

ABI in childhood

Cognitive changes . Poor memory Poor concentration Slower information processing. Difficulty with writing , reading . Impaired understanding / ability to think

logically. Fatigue

What’s the damage? And how does this affect

assessment?

The frontal lobes are the gatekeeper of the brain . Damage ---

Lack of forethought / consequences . Altered behaviour ,irritability, anxiety Lack of self restraint , disinhibition ,

inappropriate comments/ actions / humour Impulsive behaviour .

Personality /Emotional changes

Unrealistic ideas of their own abilities and difficulties.

Reduced understanding of the needs of others.

“ Damage to the frontal lobes is similar to how an 11 year old might function.ie OK until there is a need to problem solve and live within boundaries”

Reduced insight

Not reading notes and reports prior to assessment.

Relying on account of person with ABI[ client] Not appreciating extent of

impairment ,especially if client lacks insight. Pretending to understand when

communication is affected Assuming that when someone can’t speak that

they can’t understand.

Assessments - Common mistakes

Expecting to achieve full assessment in one or even two meetings [ many people with ABI can only concentrate for 10 – 20 minutes]

Assuming that reasoning will bring about changes in behaviour.

Expecting that 6 week programme of generic enabling will effect change .

Someone with a brain injury may not be able to manage Direct Payments or to retain support staff.

Common mistakes cont.

Check any notes [ not always easy with electronic recording]

Involve family/ significant others if appropriate . Recognise that assessments could be more time

consuming Brain injury is NOT the same as a learning

disability

Help ?

Many people with ABI have Case Managers , work with them to assess.

Many pw ABI will have lawyers / legal support. These people have a wealth of knowledge and can

assist with finances at all stages of Brain Injury . Consider encouraging clients/families to seek

legal advice . [CICA]

The current climate brings added pressures to Social Services departments .

Many authorities now prefer generic working instead of specialist .

ABI can bring with it particular difficulties for the pw ABI and those around them .

Many of these no longer meet the remit for help from SSD.

Pressures

But there are people who can help and advise and support .

Eg -Headway [ see website ] – excellent advice for professionals , see also their list of law firms

BISWG see website UKABIF , see website INSWABI see www.tbistafftraining.info

HELP !

And of course BIRT who have developed BINI a tool to assist with what is arguably the most important first step on the road to maximising potential for people with ABI.

A GOOD ASSESSMENT !!

Brain Injury Rehab Trust