Community Reentry TBI SCI

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Information Bulletin

How Northeast Center for Special Care Prepares Individual's with Brain Injury and Spinal Cord Injury for a Successful Return to the Community

In addition to medical, physical, pulmonary, cognitive and behavioral rehabilitation, the Northeast Center for Special Care mission is dedicated to making community reentry a reality for those individuals who have had the most difficulty leaving institutional settings and returning home to the community because of the severity of their impairments. Even though most individuals we serve and their families are focused on community reentry they may not realize what it will take to achieve that goal and to successfully reintegrate into the community.

We emphasize that the purpose of Northeast Center for Special Care is not just for people to "get out" into a home and community-based setting, but "to stay out" of institutional care by truly reintegrating within their home community. Northeast Center for Special Care's program is built around principles that we know will promote successful community reentry. The staff and programs at Northeast Center for Special Care helps each individual to learn and live by these principles through formal individual and group instruction and by day-to-day interactions with staff, family and other "Resident-Neighbors" in our therapeutic community. At Northeast Center for Special Care, the individuals we serve identify themselves as "Neighbors".

Virtually all of our Resident-Neighbors arrive with multiple reentry barriers - cognitive, physical, behavioral, and medical. We encourage our Resident-Neighbors to be realistic and to take stock of the particular barriers they will overcome. Our Interdisciplinary Team enables the individual neighbor to look especially hard at personal behaviors that can interfere with their re-integration into the life of their home community and that may put them at risk for re-institutionalization. We encourage and assist self-evaluation in several key areas: health, self-care, socialization, and community-transferable interests, as described in more detail below.

Health - Individuals are helped to learn about their personal medical conditions that require ongoing attention such as medication management, diabetic management, bowel and bladder care, seizure disorders, skin care, and more. Each individual is provided with training to (a) understand his or her particular conditions (b) to understand the necessity of the care required, and (c), to perform the care required to the extent possible. The Northeast Center’s health education program includes training in diet, sleep, exercise, and stress management. Our team also enables individuals to gain access to and training in all available assistive technology to enable the individual to effectively work around any barrier they may face here or in the community at large
Self Care - Self-care includes basic personal care such as grooming, bathing, dressing, and eating. We promote personal independence in all areas as much as possible. Individuals experiencing cognitive disorders may also benefit from self-prompting and/or behavior modification, combined with education aimed at re-sensitizing the individual to the social importance of good personal hygiene. For those who are not yet able to fully provide their own care, we stress the importance of establishing ongoing communication with those who assist with their care so that conflict is minimized and so that care is obtained in a way that is tailored to their unique needs and preferences.

The Northeast Center clinical staff provides training in other areas of self-care including independent mobility, communication, community travel, planning leisure activities, time and task management, and other skills required for successful community living. Our overall approach to self-care is based on both the freedom and related responsibility of independent living.

In addition to promoting maximum independence in the performance of daily life activities, we stress the importance of accepting help when it is needed. Not all of the individuals we serve are willing to accept help at first but gradually we enable them to understand that help may be needed in order for them to live successfully in the community in the least restrictive most independent setting.

Acceptance of help and of helpers is most likely if the individual is willing and able to self-advocate with the individuals who assist with their care and with the community-based support agencies who may be involved in coordinating that assistance. The programs at Northeast center for Special Care stresses self-advocacy from pre-admission to discharge by encouraging and stressing active participation by the individual in all phases of their treatment and discharge planning. This is accomplished throughout an individual's stay at the Center by an intensive formal self-advocacy program devoted to maximizing self-awareness, personal planning, and personal choice in working with helpers, such as family, professional staff and community agencies.
Socialization - We often observe a tendency of individuals who have survived brain injury or spinal cord injury, or who have a history of institutionalization, to avoid socialization with others, or to interact with others in inappropriate ways that can lead to social rejection. We ask individuals to place a high value on becoming socially connected to as many others, in as many ways as possible. We call this "good citizenship."

Northeast Center for Special Care is a therapeutic community. The community of staff, families and Resident-Neighbors collaborate in prompting and behavior modification programs to help extinguish maladaptive social behaviors and patterns of personal failure. Our community provides guidance and reinforcement of successful communication and social skills. The goal of Northeast Center is to enable each individual, as early and as often as possible, to realize the kinds of interactions and activities that are characteristic of life in the community at large.

We also address the high incidence of depression and substance abuse among the individuals we serve. We teach and reinforce positive patterns of socialization that are the key ingredients to maintaining personal mental health and living a successful, independent life in the community.
Community-transferable Interests - Successful community re-entry and re-integration often depends on the individual having one or more personal interests he or she wants to pursue upon return to the community. Simply put, one has to have a reason to want to get out of bed and "seize the day."

Our team has learned to nurture the embers of personal aspiration and fan these into the flame of personal achievement for each of our Neighbors. Many individuals look forward to returning to work as their primary preferred activity and we have assisted individuals to obtain the vocational assessments, training, assistance and community-based support that may be necessary to achieve their goal. We stress, however, that even if a return to work is not yet possible, each individual can explore a variety of other activities, continuing education opportunities, and community volunteerism as means of developing sustainable and personally meaningful activity in the community.

Northeast Center for Special Care community reentry staff has taken on the duty of systems advocacy for each of our Resident-Neighbors. We have advocated with the established community services delivery systems statewide and have caused them to become far more responsive to the actual needs of the disabled individuals we serve. When the situation calls for it, we work with advocates and attorneys to ensure that Neighbors are given every consideration and assert their every right

The Northeast Center for Special Care opened its therapeutic community, consisting of nine "neighborhoods" in March of 1999. Our first discharge to the community was in May of 1999. Since then we have assisted hundreds of our Resident-Neighbors to return to the community. Our mission since the inception of Northeast Center program in the mid-nineties was community reentry. Our focus on community reentry predates the Olmstead vs. LC Supreme Court Decision in June of 1999. We are the spirit of the Olmstead decision and proud of our dedicated and talented staff and the success achieved by our remarkable Resident-Neighbors and their families.