Home
About Us
Substance Abuse
Agitation
Resource and
Service Coordination
Outcomes
Internet and TBI
Related Publications
Contacts
Site Map
Search
Substance Abuse and Brain Injuries
PDF Version of Whatever It Takes
Whatever It Takes (WIT)
Helping a person who has had a life-changing brain injury often calls for creative problem-solving to address complex needs with fragmented services and inconsistent funding mechanisms. Persons with traumatic brain injury present unique challenges for professionals in healthcare, human service agencies, and vocational rehabilitation because their abilities have changed and the person with a brain injury may or may not understand the differences caused by the injury. Meeting these goals calls for a strategy that Willer and Corrigan called "Whatever It Takes" (WIT). The following are 10 WIT principles to help guide professionals from various disciplines as they work with persons who have experienced serious brain injury.
WIT Principles
- No two individual with aquired brain injuries are alike.
- Skills are more likely to generalize when taught in the environment where they will be used.
- Environments are easier to change than people.
- Community integration should be holistic.
- Life is a "place and train" venture.
- Natural supports last longer than professionals.
- Interventions must not do more harm than good.
- Service delivery systems present many of the barriers to community integration.
- Respect for the individual is paramount.
- Needs of individuals with brain injuries last a lifetime: so should their resources.
PDF
Version of Whatever It Takes
1. No two individuals with acquired brain injury are alike.
There is a tendency to talk of brain injury as a singular impairment, but experience quickly reveals vast differences from person to person. People were different before they were hurt. After injury, individual differences are compounded by the injury severity and location of the damage to the brain, secondary medical complications, and how the individual adjusts to motor, cognitive, and emotional effects. The lifestyle and living environment that each person hopes to re-establish will call for different abilities and adaptations. And to make things more complicated, most of these issues continue to change in the months and years after injury. Because needs will differ greatly, services must be both individualized and flexible. Treatment plans must be developed for each person &emdash; one size doesn't fit all. Standardized programming or group activities may need to be adapted to be useful for the person with traumatic brain injury.
2. Skills are more likely to generalize when taught in the environment where they will be used.
An injury to the brain may cause difficulty transferring learning from one situation to another –"generalizability." Problems of generalizability may arise for routine skills like preparing a meal and are even more likely for complex social skills like those needed to refuse a drink of alcohol. The practical approach to "generalizability" problems is to teach skills in the specific situation in which they will be used. For instance, cooking skills should be taught in the kitchen where they will be used. Social skills may have to be learned in a person's own community with actual family, friends, and acquaintances. Certainly, it can never be taken for granted that a skill or behavior learned in one setting will automatically be applied in another. Treatment planning should always address how a learning will be generalized to a person's everyday life.
3. Environments
are easier to change than people.
Ameliorating deficits is an important part of the medical model of rehabilitation,
but in some cases it may be more practical to adapt a person's environment
than to push skill acquisition to the point of frustration. For example,
within months of injury it is more practical to teach someone with memory
problems to use written reminders than to continue to work directly on
improving the ability to recall. It may be more effective to help people
change who they live with than to teach them not to drink when house mates
are partying. Environmental changes like these lead to quick results and
allow more time and energy for other tasks.
4. Community integration should be holistic. Though professionals usually define their relationship with a client in terms of specific problems or needs, it is particularly important to maintain a holistic view of a person with serious brain injury. Problems in one area of life easily undermine treatment of another. The person starting a new job may not be successful if distracted by worries about their living situation. At the same time, a desired change in one domain; "I want to get a job";can be turned into motivation for another goal; "I'm going to stop drinking." Not only should each professional maintain a holistic perspective, but all the service providers working with an individual with brain injury should coordinate and collaborate.
5. Life is a
"place and train" venture.
Supported employment is a proven strategy in vocational rehabilitation,
both for persons with traumatic brain injury and others. In this strategy,
skills needed to perform a job are trained by a job coach or other support
person after placement. The worker is placed, then trained. In contrast,
the more traditional model of vocational rehabilitation first trains to
do a type of job then places in an actual work setting. A "place
and train" approach may be more effective because of problems in
generalizability, described above, as well as the frequent necessity to
address both obvious and subtle demands of a work situation. As with the
workplace, "place and train" may be a successful strategy for
other skills that have to be acquired after brain injury&emdash; independent
living, use of public transportation, or leisure pursuits. "Place
and train" also provides more immediate reinforcement for the individual
and is often a more efficient use of resources.
6. Natural supports
last longer than professionals.
Members of a person's social and natural environment will be involved
with them longer than any professionals. Professional involvement is temporary
and limited by time, financial constraints, professional ethics, changes
in professional duties,retirement, or other reasons. But support from
friends and families may also pose a problem for persons with brain injury.
Research has demonstrated that friends before the injury often do not
continue as friends after. Therefore, the role of the community professional
often is to help identify and facilitate new friends and unpaid social
supports. A rule of thumb is that interventions involving natural (unpaid)
supports should be encouraged over paid supports because they are more
likely to assist the individual for intrinsic reasons.
7. Interventions
must not do more harm than good.
There is a natural assumption that all professional intervention is helpful;
however, there is ample evidence that unintended side effects may cause
harm. For example, a living environment that provides for all of a person's
needs without their participation can be a barrier to developing independent
living skills. For persons with a substance abuse problem, getting back
to work may give them the financial resources to resume use of alcohol
or other drugs. For this reason, each and every intervention must be examined
to be certain that the benefits outweigh the harm and that unintended
side effects have not resulted.
8. Service delivery
systems present many of the barriers to community integration.
Service systems and funding sources present many of the biggest challenges
to community integration for persons with brain injury. For example, if
a health insurer refuses to reimburse for a certain useful service but
will pay for another, professionals and family members may find themselves
encouraging the less appropriate, but funded, alternative. More often
than not, the financial barrier to services is that nothing is covered,
a service is not available, or the individual with a brain injury does
not quite fit eligibility requirements. For services that are available,
an equally destructive barrier is the fragmentation of responsibility
among multiple service providers. Community professionals will often find
themselves acting as advocates, exploring ways to reduce barriers and
improve services.
9. Respect for
the individual is paramount.
Everyone accepts that an individual's dignity and self respect is important,
but, in the rush to rehabilitate, it is easy to bypass normal courtesies.
Normal infringements on dignity are inadvertent but still important to
avoid. Every individual deserves:
- the right to privacy,
- the right to courteous, person-first language, and
- the right to make personal decisions.
Community professionals must be always on guard against short-cuts or staff conveniences which rob the individual of dignity and self-respect.
10.Needs of
individuals with brain injuries last a lifetime: so should their resources.
Sometimes health insurance benefits, social programs settlements from
lawsuits have lifetime limits or icome in lump sums. Service providers
do not do an individual a favor by suggesting treatment that consumes
significant portions of such limited funds in a relatively short period
of time. After serious brain injury, disabling effects will be with individuals
for a lifetime, regardless of compensatory strategies learned to reduce
the effects. Resources to assist individuals should also last a lifetime.
Future needs may not always be obvious, but assistance for independent
living may be needed if family support changes. In addition, even if initial
vocational rehabilitation is successful, it may be needed again if an
employer goes out of business.
Substance Abuse Education Series
Substance Abuse and Brain Injury Toolbox
Utilities for Community Professionals"Lessons from Little Red Riding Hood"
"What Do We Do With A Drunken Sailor?"
Relationship Between Traumatic Brain Inury and Substance Abuse