Program Components

Not every program component is addressed here. The components below are those which tend to have broad implications. You should also ask questions about the philosophy and methodology of specific disciplines central to your situation.

• Aesthetics
• Experience
• Administration and Organization
• Medical Services/Medications
• Cognitive Services
• Behavioral Interventions
• Vocational Services
• Educational Services
• Community Re-entry
• Recreation

Aesthetics

• Are the facilities clean?
• Are the people being served clean and dressed in a manner you are comfortable with? Do they seem well cared for?
• Does the staff seem attentive, to know people by name, and to genuinely care about people in the program? For example, do they stop in the hall to say hello or joke?
• Is the food appealing? How does the program accommodate special diets, personal preferences, and requests for a different meal schedule? Is there a charge for this?
• Do the people being served seem comfortable with the way they are being treated? (Ask them!)

Experience

• How many people with brain injuries has the program worked with in the past year? How many total individuals have they served?
• What is the average staff turnover rate? Do they recruit people who have experience in serving people with brain injury? What staff training is provided?
• How long has the program been in existence? When did it begin to serve people with brain injury? Why was it established?

Administration and Organization

• Who is responsible for the overall supervision of services? How often are they there? How much direct contact do they have with the program participants?
• What types of people are part of the team? What are the state training and licensure requirements for staff? Does the staff meet these standards?
• How does the program integrate an individual's expressed desires and goals into service planning? For example, if it takes a person three hours to feed themselves, and they decide this wastes energy they want to use in another manner, how will the program support them in this decision?
• Is there a consistent schedule for an individual's day? What involvement does the person have in directing the schedule and selecting the program components?
• What do people generally do during unscheduled times?
• What is the evening schedule?
• What is the weekend schedule?
• How is the need for specialized adaptive equipment identified? How is the equipment provided and paid for?
• What access do people being served and their families have to their records? What must they do to see the record? What recourse is available if they disagree with something in the record?

Medical Services/Medications

• Who is responsible for providing medical services? What is their background? Is the same person available at different times, or are multiple medical practitioners used?
• How is the personal physician included in providing medical services?
• How are medical emergencies handled?
• How are routine medical issues, e.g., regular dental and ophthalmology services, provided?
• How does the program manage special medical needs that result from an injury?
• How does the program prevent bedsores?
• What is the policy for the use of psychotropic or other mood-altering medications? What role does the individual have in these decisions? What does the program do if the person declines, against medical advice?
• Who monitors medications and medication interactions? How often is this reviewed? What steps are taken to assure that therapeutic levels of medications are maintained and not exceeded?

Cognitive Services

• How does the program address cognitive strengths and limitations?
• Is neuropsychological testing done? How much emphasis is placed on recommendations to build on an individual's cognitive strengths? How much emphasis is placed on reporting test scores and the person's limitations? When is retesting conducted?
• If a "cognitive therapist" or "cognitive remediation specialist" is a member of the team, what particular qualifications do they have? How is the effectiveness of cognitive services measured?

Behavioral Interventions

• How does the program address behavioral concerns? What role do the individual and their family play in determining the types of behavioral interventions used?
• How does the program ensure that behavioral interventions are clearly understood by all staff, and that the plan is being implemented consistently-even at 3:00 in the morning?
• How is the effectiveness of behavioral interventions measured?
• What role does medication play in "behavior management"?
• Are physical restraints used? In what circumstances? What policies or protocols exist for the use of physical restraints? Can I see a copy of them?
• Is a "secure" or locked unit available? When does the program recommend its use? Who decides when a person is ready for an open unit after being on a secure unit? How?
• At what point is an individual's behavior deemed unacceptable to the program? How much notice does the program give the individual and their family? What efforts are made by the program to assist in locating a comparable program that can better meet the needs of the person?

Vocational Services

• What is the extent of vocational services provided by the program?
• How are situational vocational evaluations conducted? How are job trials, training, or placement provided? How are job coaches used? For how long?
• What interface is there between the program and state vocational rehabilitation services?

Educational Services

• What educational services are offered-to children, college students, or adults?
• Does the program have a teacher on staff with expertise in educating children and adolescents with brain injury?
• What is the interface between the program and the person's school?

Community Re-entry

• What components of the program take place in the community? How frequently is the individual in the community?
• How does the program evaluate and address the person's ability to get around and use community services and resources?
• What local resources are used by the program to address the needs of the individual?
• How does the program accommodate an individual's request to participate in community activities, such as AA or league bowling?
• What outreach does the program do to help educate the community about brain injury and its consequences?
• What does the program do to learn about the individual's home community and to identify resources and contacts there? What linkages are made with these resources and contacts prior to discharge?
• What efforts are made to work with the person in their home, even if the program is "facility-based"? How often can this be expected-once for evaluation only, or multiple times to prepare the person for the return home?
• What is the interface between the program and the local Independent Living Center?

Recreation

• How does the program accommodate the individual's continued involvement in recreational interests and activities? Are modifications of activities or equipment suggested? Are there opportunities to test the effectiveness of those modifications?
• What does the program do to support the individual's desire to pursue new recreational activities?
• How does the program help the individual identify ways to participate in recreation and social opportunities in their community?
• What interface does the program have with the local recreation department? With community therapeutic recreation services? With social support and activity groups?