Description and Phases of the Program
Intensive Remedial Treatment (First Phase)
The first phase is devoted to intensive remedial treatments designed to help patients compensate for cognitive/behavioral deficits caused by the brain injury. These treatments take place in the setting of a "therapeutic community." This therapeutic community consists of the patient peer-group, the patients' significant others, and a treatment staff of qualified psychologists specially trained in brain injury rehabilitation. The Brain Injury Day Treatment Program staff also includes a specially trained Vocational Counselor who executes the Guided Work Trials (Second Phase) of the program. The staff to patient ratio during the First Phase is one (1) psychologist per two (2) patients.
During the intensive remedial phase, treatments are provided in 20-week cycles. Based on the experience gathered over the past several years, approximately 40-50 percent of patients enrolled into the Brain Injury Day Treatment Program require two 20-week cycles of intensive remedial treatment before they are ready to advance to the next phase. For patients who must return for an additional cycle of intensive remedial training, treatments pick up where they left off at the end of the previous cycle. The treatments are tailor designed to each patient’s individual needs, the overall aim being to help the patient become ready to advance to the next phase of treatment.
The intensive remedial treatment is administered over a period of 20 consecutive weeks, during which a carefully coordinated “package” of treatments, consisting of individual (1:1 patient to staff ratio), individualized (2:1 ratio) and small-group cognitive/interpersonal remedial treatment, is delivered to the 13 patients ("classmates") who start and end the treatment cycle together.
During the intensive remedial phase, the treatment is provided 4 days per week, 5 hours per day, according to a set schedule and following a preplanned curriculum. The treatment takes place on Monday through Thursday, each week, from 10:00 a.m. to 3:00 p.m.
In addition to the daily routines, individual patients, with and/or without their family members, also receive a variety of individualized cognitive therapy, personal counseling, and/or other therapeutic interventions. These take place either during regular program days (after 3:00 p.m.) or on Fridays.
The combined minimum number of treatment hours per week is 20 and the total number of treatment hours for the 20-week cycle is 400. In terms of the categories of treatment (based on the staff to patient ratio per treatment hour), each patient receives, during a 20-week treatment cycle, a minimum of 23 hours of individual (1:1), 140 hours of individualized (1:2) and 237 hours of small-group treatment.
Remedial Contents: A brief description
Daily Orientation (1/2 hour) A small-group procedure, designed to: (1) foster the individual trainee's orientation, sense of purpose, and motivation; (2) promote awareness and acceptance of one's deficiencies, while retaining a sense of hopefulness; (3) promote the development and the use of compensatory mnemonic (memory) aids; and, (4) develop the habit of objectively assessing one's daily progress in the presence of one's peers and the staff.
Trainee peer group undergoing “exercise” in interpersonal
communication.
Daily Interpersonal Communications Skills
(1 1/2 hours) This is primarily an individualized cognitive/interpersonal
exercise. The training is carried out with each patient in
the presence of his/her peers, the staff, and significant
others. It is designed to improve interpersonal communications
skills, malleability (adaptability), and self-acceptance.
Each patient, in turn, is coached and receives organized
feedback from all members of the therapeutic community on
how to organize facts and/or ideas, monitor adherence to
a planned presentation, formulate ideas and communicate them
effectively, employ an appropriate affective tone and body
posture while communicating, and receive and assimilate verbal
feedback. While acting as observer/listener, the patient
is coached on how to critically analyze a peer's presentation
and how to communicate constructive criticism in an interpersonally
appropriate manner.
Trainee receiving systematic training to improve attention
and concentration.
Daily Cognitive Remedial Training (1 1/2 hours) Individual
or individualized systematic remedial training exercises
are carried out, in accordance with a set curriculum. Training
is provided in the areas of (1) attention, concentration,
and psychomotor responsiveness; (2) eye-hand coordination
and fine-motor dexterity; (3) visuo-constructional abilities;
(4) visual information processing (perceptual analysis and
spatial organization, as well as visual problem solving);
and, (5) logical reasoning. Cognitive training exercises
are individualized to fit each patient's unique constellation
of cognitive deficits.
Daily Community Meeting (1/2 hour) This daily small-group exercise is designed to (1) foster a sense of belonging; (2) improve social appropriateness of behavior; (3) increase sociability; (4) enhance the ability and willingness to comply with rules of conduct; and, (5) increase self-esteem and realistic acceptance of one's situation.
Trainee receiving feedback about the accuracy of his/her
response.
Weekly Multiple Family Group (1 1/2 hours) This weekly group
session is attended by all the significant others and the
staff. It is designed to provide (1) guidelines for managing
the patient at home; (2) an in-depth understanding of the
purpose, techniques, and outcomes of the program; and, (3)
mutual support among families.
Weekly Family/Significant Other Counseling (1-2 hours) The number of weekly family/significant other counseling hours over the 20-week period varies according to need.
Weekly Patient Counseling (2 hours) The patient receives counseling focused on his/her rehabilitation progress and continuing needs.
Special Presentations. Twice during each 20-week cycle of treatment (at the 10th and 19th weeks) each patient prepares, according to special assignment and with therapeutic assistance from the staff, carefully written and rehearsed presentations. These presentations are delivered by members of the patient group in front of an audience consisting of the significant others and other invited guests.
The special presentations serve an important
therapeutic purpose in that they constitute clinical vehicles
for demonstrating and consolidating competence in interpersonal
communications and social skills, as well as the proper
application of newly acquired reasoning skills. They also
serve as a means for demonstrating openness and willingness
to "come to grips" with
one's situation. The presentations are videotaped. The videotaped
performances of each patient are subsequently used (in small
group and/or individual therapy sessions) as a tool for enhancing
the patient's cognitive, behavioral, and emotional rehabilitation.
• Initial Comprehensive Evaluation
• Guided Work Trials (Second Phase)
• Intensive Remedial Treatment (First Phase)
• Post-Discharge, Maintenance/Follow-Up Therapy
(Third Phase)
