|
Home
> Information Bulletin
> A Therapeutic Community for Traumatic Brain Injury
 
A Therapeutic Community for Traumatic Brain Injury
By Gerry Brooks, MA, CCC,
CBIT
Director of Brain Injury Programs, Northeast Center for Special Care
From
the planning stages The Northeast Center for Special Care was intent
on using every possible means to bring about positive changes in
individuals who survived traumatic brain injury (TBI). We knew that
if we relied exclusively on traditional therapy methods that we
would not accomplish our Mission to help those who had been
abandoned by the healthcare system. Our observation was, and
continues to be, that modern healthcare exhibits little
understanding of the needs of traumatic brain injury survivors and
is poorly suited to meet these needs. We believed then and believe
now that many TBI survivors can benefit from treatment that extends
beyond the 100 days or so that most get through the traditional
system, and that the methods and concepts used to determine
prognosis are more about the economics of cost-saving than the
science of people-saving.
Our beliefs are no longer a matter of serious debate. Today’s
science clearly shows us that survivors of traumatic brain injury
can continue to improve for months or years post-injury. This gives
us hope that services for the brain injured will improve both in
type and in number and that research dollars, virtually non-existent
now, will become more plentiful in the near future. This seems
especially critical in view of the many returning Veterans who will
add to the demand for services. Hopefully our legislators will do
the right thing and insist on the very best our science and society
has to offer for the returning Veterans and the many individuals
already in the system.
Northeast Center for Special Care made a dramatic commitment
almost a decade ago to show leadership by beginning to fill the
enormous gap in services for survivors of brain injury. The
Northeast Center for Special Care accepts individuals with TBI at
all levels of severity and the Center is meticulously designed to
provide every possible opportunity to bring about positive changes
in physical, cognitive, and behavioral function. Northeast Center
presumes the potential of each individual and assumes the
responsibility to find a way to unlock that potential. One of the
basic ingredients of the Center’s approach is to provide a
vibrant, natural living environment and a therapeutic community as
the setting for the program.
We are often asked, “Just what is a therapeutic community?”
Simply put, a therapeutic community is a place where people feel
better just by being there. The Northeast Center for Special Care is
such a place. It’s almost impossible to get the effect of the
Center by reading about it. You have to visit. The virtual tour on
this website is a beginning. Even a virtual tour makes it clear that
this is not a typical health care environment. The colors and the
space are astonishing. The sounds and activities of life are
everywhere.
Certainly a smaller facility would have been less expensive to operate,
leading some to ask why we need four, five thousand square foot,
sun-drenched spaces atrias and why we have a Neighborhood Store, a
Cafe, an Art, Music, and Writing studio, and a gym, a fully equipped
hair salon, Bank, Post Office, and Library. The Community feel of Northeast Center was developed because we understand that
helping a person overcome the trauma of devastating loss isn’t
accomplished with only a schedule of therapies, no matter how good
they are. People who have suffered such extreme loss have to feel
safe, liked, and like they matter. None of this is so simple to
accomplish. Progress is often slow and arduous. You can’t just
line up therapies and think that someone is going to recover enough
dignity, hope, and belief in themselves to keep them motivated and
engaged in the treatment process. Northeast Center for Special
Care is uniquely designed to deal with these emotional and spiritual
consequences of traumatic brain injury.
Northeast Center for Special Care admits hundreds of traumatic
brain injury survivors that began treatment at some of the finest
acute rehabilitation programs in the country. It is important to
understand, however, that at the point they were admitted to the
Northeast Center for Special Care “the system” was done with
them. According to the rules of reimbursement and associated
guidelines for determining prognosis, many of the individuals
admitted to the Northeast Center had improved as much as could be
expected physically and cognitively. Yet in fact the most important
phase of recovery to address cognitive, social, and remaining
physical deficits was only beginning for many of them, recovery that
would not have been possible without Northeast Center.
We also admits a number of individuals each year
from the Community who were failing there because a critical part
piece of their rehabilitation was never completed due to limitations
of the current healthcare system. That critical missing piece was psychosocial
rehabilitation.
Cnaan and associates defined psychosocial rehabilitation in 1988 as
“The process of facilitating an individual's restoration to an
optimal level of independent functioning in the community ....
psychosocial rehabilitation invariably encourages persons to
participate actively with others in the attainment of mental health
and social competence goals... The process emphasizes the wholeness
and wellness of the individual and seeks a comprehensive approach to
the provision of vocational, residential, social/recreational,
educational and personal adjustment services.” (Cnaan, et al,
Psychosocial Rehabilitation Journal, Vol. 11, No. 4: April 1988,
p.61).
Psychosocial rehabilitation cannot be accomplished in a traditional
healthcare environment. It requires a therapeutic community. What
you can’t experience by visiting our website is the social
atmosphere, a critical component of any truly therapeutic Community.
This is a place where, like at Cheer’s, everybody knows your
name...and if we don’t, we’ll soon learn it. Moving down a
hallway without being greeted is nearly impossible. You don’t get
a tepid, professional nod and reserved “hello” either. It’s
often a big, loud “Hey, Billy, how the heck are you? It’s great
to see you. How’s the writing going?”
Our staff is trained to do these things. They are expected to
do these things and evaluated on whether or not they do them
consistently and well. Moment to moment, hour to hour, all day,
every day engagement by every staff member is an essential part of
the program. It’s another thing we do, that we spend a lot of time
and energy on, that doesn’t show up on any Medicaid or Medicare or
private insurance bill, but it’s an essential part of the
treatment. We intensify this approach by employing a specialized
staff of individuals whose specific job it is to circulate and
provide assistance, or just a kind word to those who need it, and to
help each of them keep moving through their day by providing any
needed guidance.
In this way survivors of brain injury do move through their
day, essentially under their own physical and cognitive "steam,”
about a sizeable, living Community environment, doing things that
interest them, making friends and meeting people, while practicing
skills they are learning in their therapies. This kind of all
day/every day therapy is an integral part of our program and we do
it by helping this person remember someone’s name, another to
remember to look at their schedule, another to recall who to see,
where to go, or how to get there, by helping someone manage a
transaction or a social interaction along the way, always with as
much help as needed but never more than absolutely necessary.
Some people call this “executive coaching,” but this clinical
term doesn’t tell anything about the heart and soul that our staff
put into each day, one person at a time, to support everyday
functional abilities that might be re-trained in a therapy session
but that must be applied to everyday life in this type of ongoing,
fluid, natural, empowering and uplifting fashion.
And that’s a therapeutic community!
|
Back
|
