ST JUDE MEDICAL CENTERS BRAIN INJURY NETWORK 714

ST. JUDE MEDICAL CENTER’S BRAIN INJURY NETWORK 714. 446. 5626 DAVID BOGDAN (DAVID. BOGDAN@STJOE. ORG) DANIEL IGNACIO (DANIEL. IGNACIO 2@STJOE. ORG) ST. JUDE’S BRAIN INJURY NETWORK WWW. TBIOC. ORG @TBIOC

TBI Statistics Courtesy of California Traumatic Brain Injury (CATBI) Incidence Rates in the United States (excluding military/veteran’s hospitals): Estimated 1. 7 million TBIs occur each year (Vanderploeg, Belanger, Curtiss, Bowles, & Cooper, 2019) 70 -90% are “mild” in severity (Faul, Xu, Wald, & Coronado, 2010) ST. JUDE’S BRAIN INJURY NETWORK 5/16/2019 WWW. TBIOC. ORG Incidence of TBI in California (2010 -14): ◦ non-fatal TBI ER visit: 652, 198 ◦ “Treat/Release” TBI: 478, 750 (73%) ◦ Medi-Cal: 87, 835 (18%) ◦ Uninsured: 122, 183 (26%) Orange County Population (2013): 3, 114, 000 ◦ Brain Injury Cases (2010 -14): 97, 110 (3%) ◦ Estimating from “Treat & Release” rate for California (73%): 70, 890 @TBIOC

What is the Brain Injury Network? q. When somebody enters a hospital or medical center with a brain injury… § he or she still has a brain injury upon discharge. ü 73% is the “Treat and Release” rate of California ü 43% of survivors have a related disability after one-year (Selassie et al. , 2008). § Orange County: 97, 110 survivors (2010 -2014), therefore 41, 758 survivors related disability § Treat & Release estimates (n = 70, 890) This is where we hope to provide service: ØWe are an outpatient, community-based agency Øthat provides advocacy, information, and referrals Øat no-cost to survivors and their families. ST. JUDE’S BRAIN INJURY NETWORK 5/16/2019 WWW. TBIOC. ORG @TBIOC

St. Jude Brain Injury Network AREAS OF CONCERN: We are dedicated to advocacy in 3 primary areas: 1. Community Reintegration 2. Education 3. Housing HOW WE ADDRESS: We provide assistance including, but not limited to: 1. Social Security, Medi. Care, Medi-Cal, & legal advocacy a. Getting back to work/resume writing/interview b. support phone calls, outings, establishing relationships 2. Providing information on therapy (counseling), doctor referral support groups, professional speakers, research a. Tutoring/task completion/technology assistance 3. Applications, talking to programs/offices, advocacy ST. JUDE’S BRAIN INJURY NETWORK 5/16/2019 WWW. TBIOC. ORG @TBIOC

Common Referrals & Areas of Involvement 1. Applying for Social Security benefits (SSI & SSDI) 2. Neuropsychological testing 3. Cognitive Training (ABI programs) 4. Vocational rehab (Department of Rehabilitation) 5. SROs, Assisted Living, SNFs, affordable housing 6. Career counseling/counseling 7. Survivor education programs 8. Traumatic Brain Injury Support Groups & education programs ST. JUDE’S BRAIN INJURY NETWORK 5/16/2019 WWW. TBIOC. ORG @TBIOC

Support Groups & Psychoeducation 1. For over 30 years, group psychotherapeutic services have been successfully implemented with TBI survivors 1. (Delmonico et al. ; Prigatano, Fordyce, Zeiner, Roueche, Peppring, & Wood, 1984) 2. Reduces PCS in civilian populations - Neurobehavioral Symptom Inventory 1. (Comper et al. , 2005; Cooper et al. , 2015) 3. Psychotherapy effectively treats affective disturbances in the group format 1. (Block & West, 2013) ST. JUDE’S BRAIN INJURY NETWORK 5/16/2019 WWW. TBIOC. ORG @TBIOC

ST. JUDE’S 5/16/2019 BRAIN INJURY NETWORK WWW. TBIOC. ORG @TBIOC

ST. JUDE’S 5/16/2019 BRAIN INJURY NETWORK WWW. TBIOC. ORG @TBIOC

CSU System: Estimated 447, 000 students & 45, 000 faculty/staff across 24 CSU campuses (Ortega & Larsen, 2014) 18, 625 students and 1, 875 faculty/staff per campus (est. ) ST. JUDE’S 5/16/2019 BRAIN INJURY NETWORK WWW. TBIOC. ORG @TBIOC

Cognitive Rehabilitation 1. 2 kinds: Compensatory & Restorative 2. Compensatory (Cog. SMART) represents techniques that improve cognitive functioning by teaching strategies (Storzbach et al. , 2016) 3. Restorative (Brainwave-R) refers to activities that aim to strengthen functioning through repetitive training (Raymond, Bennett, Malia, & Bewick, 1996). ST. JUDE’S BRAIN INJURY NETWORK 5/16/2019 WWW. TBIOC. ORG @TBIOC

Pilot Cognitive Rehabilitation Classes from Fall 2018 Compensatory Rehabilitation ONLY: 1. St. Jude Brain Injury Network 2. OMID Institute

SPRING 2019: Compensatory & Restorative ST. JUDE’S 5/16/2019 BRAIN INJURY NETWORK WWW. TBIOC. ORG @TBIOC

Fall 2019: Compensatory & Restorative ST. JUDE’S 5/16/2019 BRAIN INJURY NETWORK WWW. TBIOC. ORG @TBIOC

Reported “Brain Injury” Themes from Support Group Attendees: 1. Acceptance from the self: ◦ “I seem to be terrified to try to allow myself to get too close to someone because I’m too confused as far as where I am right now, about what I’m thinking right now, it’s just too confusing. ” 2. Intimacy & Ambiguous loss: ◦ “I have difficulties trusting… how do I know that you accept me for who I am… when I don’t even know who I am” 3. Acceptance from society & “Walking Wounded: ” ◦ “It’s hard it’s so hard to be accepted, because a brain injury is not enough to society to be accepted as a disability” 4. Belonging: ◦ Camaraderie, trust emphasizes the importance of treating comorbidities. ST. JUDE’S BRAIN INJURY NETWORK 5/16/2019 WWW. TBIOC. ORG @TBIOC

Working with TBI (Folzer, 2001; Prigatano & Klonoff, 1988, p. 247) When delivering therapeutic services, facilitators should assist in: 1. 2. 3. 4. 5. coping with the loss of identity Development of a new adaptive “self” increase awareness of the survivors’ own emotions provide psychoeducation to increase recognition of symptoms in a non-confrontational way provide opportunities to rehearse regulatory social skills The facilitator may want to: 1. 2. 3. 4. Model patience and sensitivity repeat information several times (the clients’ failure to remain engaged may be mistaken for resistance – cognition) always encourage clients to be writing notes remember that education is a critical function: ◦ an effective facilitator modeling desirable behavior and teaches compensatory strategies ◦ while mediating emotional reactions of members to direct feedback. ST. JUDE’S BRAIN INJURY NETWORK 5/16/2019 WWW. TBIOC. ORG @TBIOC

References Block, C. K. , & West, S. E. (2013). Psychotherapeutic treatment of survivors of traumatic brain injury: Review of the literature and special considerations. Brain Injury, 27(7 -8), 775 -788. doi: 10. 3109/02699052. 2013. 775487 Comper, P. , Bisschop, S. M. , Carnide, N. , & Tricco, A. (2005). A systematic review of treatments for mild traumatic brain injury. Brain Injury, 19(11), 863– 880. Cooper, D. B. , Bunner, A. E. , Kennedy, J. E. , Balldin, V. , Tate, D. R. , Eapen, B. C. , & Jaramillo, C. A. (2015). Treatment of persistent postconcussive symptoms after mild traumatic brain injury: A systematic review of cognitive rehabilitation and behavioral health interventions in military service members and veterans. Brain Imaging and Behavior, 9, 403 -420. Coronado, V. G. , Mc. Guire, L. C. , Sarmiento, K. , Bell, J. , Lionbarger, M. R. , Jones, C. D. , Geller, A. I. , Khoury, N. , & Xu, L. (2012). Trends in traumatic brain injury in the U. S. and the public health response: 1995– 2009. Journal of Safety Response, 43, 299– 307. Delmonico, R. L. , Hanley-Peterson, P. , & Englander, J. (1998). Group psychotherapy for persons with traumatic brain injury: Management of frustration and substance abuse. Journal of Head Trauma Rehabilitation, 13(6), 10 -22. Faul, M. , Xu, L. , Wald, M. M. , and Coronado, V. G. (2010). Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002– 2006. Centers for Disease Control and Prevention: Atlanta, GA. Folzer, S. M. (2001). Psychotherapy with “mild” brain-injured patients. American Journal of Orthopsychiatry, 71(2), 245 -251 Lerner, H. (2005). The dance of anger: a woman’s guide to changing the patterns of intimate relationships. New York, NY: Harper. Collins Publishers. . ST. JUDE’S 5/16/2019 BRAIN INJURY NETWORK WWW. TBIOC. ORG @TBIOC

References (cont. ) Ortega, J. , & Larson, B. (2014). Concussion: Fitting the pieces together for a best practices model [Power. Point slides]. Retrieved from http: //www. calstate. edu/risk_management/conferences/FTPT/documents/CONCUSSION_AWARENESS. pdf Prigatano, G. P. , & Klonoff, P. S. (1988). Psychotherapy and neuropsychological assessment after brain injury. The Journal of Head Trauma Rehabilitation, 3(1), 45 -56. Raymond, J. M, Bennett, L. T, Malia, K. , & Bewick, C. K. (1996). Rehabilitation of visual processing deficits following brain injury. Neuro. Rehabilitation. 6, 229 -39. 10. 3233/NRE-1996 -6309. Selassie, A. W. , Zaloshnja, E. , Langlois, J. A. , Miler, T. , Jones, P. , & Steiner, C. (2008). Incidence of long-term disability following traumatic brain injury hospitalization in the United States, 2003. Journal of Head Trauma Rehabilitation, 23(2), 123 -131. Sosin, D. M, Sniezek, J. E. , Thurman, D. J. (1996). Incidence of mild and moderate brain injury in the United States. Brain Injury, 10(1), 47– 54. Storzbach, D. , Tawmley, E. W. , Roost, M. S. , Golshan, S. , Williams, R. M. , O Neil, M. , Jake, A. J. , Turner, A. P. , Kowalski, H. M. , Pagulayan, K. F. , & Huckans, M. (2016). Compensatory cognitive training for Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans with mild traumatic brain injury. Journal of Head Trauma Rehabilitation. doi: 10. 1097/HTR. 0000000228 Vanderploeg, R. D. , Belanger, H. G. , Curtiss, G. , & Bowles, A. O. (2019). Reconceptualizing rehabilitation of individuals with chronic symptoms following mild traumatic brain injury. Rehabilitation Psychology, 64(1), 1 -12. Vos, P. E. , Alekseenko, Y. , Battistin, L. , Ehler, E. , Gerstenbrand, F. , Muresanu, D. F. , Potapov, A. , Stepan, C. A. , Traubner, P. , Vesei, L. , & von Wild, K. (2012). Mild traumatic brain injury. European Journal of Neurology, 191 -198. doi: 10. 1111/j. 1468 -1331. 2011. 03581. x ST. JUDE’S 5/16/2019 BRAIN INJURY NETWORK WWW. TBIOC. ORG @TBIOC