Robin Hill Farm - Established 1983
Post Acute Continuum Care Options

Residential Treatment and Rehabilitation within the Continuum

Massachusetts Brain Injury Association
24th Annual Conference - Call for Papers
March 7, 2005

Prepared by Jeremiah A. Donovan, MBA
President, Robin Hill Farm

"Post acute treatment primarily involves residential programs that functionally apply and adapt treatment into everyday activities. Treatment environments are normalized, highly structured and functional".

- American Academy For The Certification of Brain Injury Specialists
(AACBIS) Training Manual, 2nd Edition, 1998

The Residential Treatment and Rehabilitation model is designed for the individual with a brain injury who requires and benefits from 24 hour supervision or support. Our particular model represents a continuum within a continuum; that is, there are 5 different program levels, so as to insure, to the greatest extent possible, the most functionally appropriate placement in the least restrictive setting.

This type of program serves two purposes; First, as a long term option it represents an alternative to institutional living; Second, on a shorter term basis, it provides a curriculum designed to teach someone the skills necessary to maintain themselves in the least restrictive environment.

Attributes of a Residential Treatment and Rehabilitation Program

I.

RTR program should be licensed

a.

Programmatic Integrity

b.

Life Safety Issues

II.

Community Based Setting

a.

Regular access to true community based activities

b.

Guard against social isolation

c.

The living environment is the program

d.

Maintain low stimulus environment

III.

Socially Based Model of Rehabilitation

a.

Written rehab. plan with functional goals

b.

Reject "custodial care" label

c.

Promote social interaction among residents

d.

Allows people to "live again"

e.

Rehab focuses on achieving independence in ADL's

IV.

Least restrictive environment

a.

Continually assess progress to determine if higher level can be achieved

b.

Appropriate placement- don't stress out client with unrealistic expectations

c.

Develop internal culture that promotes choice

d.

Involve families in all aspects, whenever possible

V.

24 Hour Care

a.

Supervision is 24 hr. active monitoring / assistance

b.

Support is 24 hr. guidance / assistance

c.

Assistance with medications

VI.

Vocational Element

a.

Avocational training - develop outside interests, i.e. gardening

b.

Supported employment - do whatever it takes to secure wanted employment

c.

Therapeutic riding program

d.

Employment may help validate rehab plan

To benefit from a RTRF, an individual must:

1.

Be diagnosed with a brain injury;

2.

Be medically stable;

3.

Not represent a consistent threat to self or others;

4.

Need and benefit from 24 hr. support

Typical RTRF activities:

In general, a true RTR Program must offer, as a cornerstone, consistent exposure to the community, utilizing appropriate supports so as to insure, to the greatest degree possible that trips into the community are successful. Conversely, natural consequences (within reason) should be endured, with the objective being a heightened understanding of appropriate/inappropriate behavior by the resident. In a program such as this, daily activities may include:

  • Morning orientation - Housemates go over day, date and current events. Also review the schedule;

  • Activities of daily living - don't forget the extra time it may take someone with a brain injury to complete these tasks;

  • Shopping for the house, or individual menu planning if in an individual apartment;

  • Banking / Money management - budgeting for social outings, personal needs, etc.

  • Medical Appointments - Resume the more traditional role of going to Dr's appointments, rather than having the Dr. / Healthcare professional come to you;

  • Social trips, such as lunch / dinner out, movies, art exhibits, visits with family, shopping

In the final analysis, this socially based model is a structured, low stimulus replica of everyday life. A passage from "It takes WIT!", notes "An injury to the brain may cause difficulty transferring learning from one situation to another, referred to as generalizability. The practical approach to generalizability problems is to teach skills in the specific situation in which they will be used. 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 just how learning will be generalized to a person's everyday life".(1)

Respectfully submitted,
Jeremiah A. Donovan, MBA
Robin Hill Farm


(1) It takes WIT!, Brainstorm, Alabama Department of Rehab Services, 1998