The document outlines training for direct care staff in the West Virginia TBI waiver program, focusing on community integration for individuals with traumatic brain injury (TBI). It highlights objectives such as defining community integration, understanding TBI's impacts, and strategies for improving support and involvement in the community for those affected. The document emphasizes the importance of promoting independence, social connections, and meaningful engagement to facilitate better outcomes for individuals with TBI.

1. Improving Community
Integration after Traumatic
Brain Injury
Successful completion of this training meets one hour of the four hour annual
training requirement for Personal Attendant Services direct care staff as
provided through the WV TBI Waiver Program

2. Disclaimer
Information included in this presentation was
current at the time it was developed
Presentation materials are reviewed on an
annual basis
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2014 West Virginia TBI Waiver Program direct care staff annual training

3. Author
MELODEE A HURSEY, MSW, LSW, CBIST
APS HEALTHCARE, INC.
TBI WAIVER PROGRAM PROVIDER EDUCATOR
Ms Hursey is a Certified Brain Injury Specialist Trainer through the Academy of Certified Brain Injury
Specialists and a West Virginia Licensed Social Worker. She has more than 17 years of brain injury
experience in a variety of areas including rehabilitation, waiver, support group facilitation, training,
and program development.
CONTACT INFORMATION:
mhursey@apshealthcare.com
304-964-9007
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4. Learning Objectives
• Describe community integration in a comprehensive
way
• Describe two methods that can be used to help
persons with brain injury return to their home and
community
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2014 West Virginia TBI Waiver Program direct care staff annual training

5. Overview of Traumatic Brain Injury
Traumatic Brain Injury (TBI) is
an insult to the brain not of a degenerative or
congenital nature caused by an external physical force,
that may produce a diminished or altered state of
consciousness resulting in an impairment of cognitive
abilities or physical functioning. It can also result in
the disturbance of behavioral or emotional
functioning, may be temporary or permanent and
cause partial or total functional disability or
psychosocial maladjustment.
National Head Injury Foundation
(now the Brain Injury Association of America)
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2014 West Virginia TBI Waiver Program direct care staff annual training

6. Medicaid TBI Waiver Definition
A non-degenerative, non-congenital insult to the
brain caused by an external physical force
resulting in total or partial functional disability
and/or psychosocial impairment
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2014 West Virginia TBI Waiver Program direct care staff annual training

7. Overview of Traumatic Brain Injury
In 2010, about 2.5 million emergency department visits,
hospitalizations, or deaths were associated with TBI—
either alone or in combination with other injuries—in
the United States
Centers for Disease Control and Prevention
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2014 West Virginia TBI Waiver Program direct care staff annual training

8. Overview of Traumatic Brain Injury
• Falls were the leading cause of TBI-related ED visits
for every age group
• Motor vehicle crashes were the leading cause of
hospitalizations for adolescents and young adults
ages 15-44 years
Centers for Disease Control and Prevention
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2014 West Virginia TBI Waiver Program direct care staff annual training

9. Why the focus on Community Integration?
• Advances in acute care medicine means higher
survival rates after TBI
• Changes in the health care climate means shorter
rehabilitation stays or no rehabilitation at all
• People with TBI are being discharged with greater
disability
• People are being cared for in the community
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2014 West Virginia TBI Waiver Program direct care staff annual training

10. What is Community Integration?
The opportunity to live in the community and be
valued for one's uniqueness and abilities, like
everyone else (Salzer, 2006)
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2014 West Virginia TBI Waiver Program direct care staff annual training

11. What is Community Integration?
• Housing
• Employment
• Education
• Health Status
• Leisure/Recreation
• Spirituality/Religion
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2014 West Virginia TBI Waiver Program direct care staff annual training
• Peer Support
• Valued Social Roles
(e.g., marriage,
parenting)
• Self-Determination
• Citizenship and Civic
Engagement

12. What is Community Integration?
• Independence
• Relationships
• Meaningful activities to engage in
“. . . having something to do, somewhere to live, and someone
to love” (Jacobs, 1993)
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2014 West Virginia TBI Waiver Program direct care staff annual training

13. Decreased Role Functions After TBI
• High incidence of unemployment
• Decreased independence
• Financial
• Transportation
• Supervision
• Decision making
• Decreased social network size
• Decreased intimacy
• Decreased participation in leisure activities
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2014 West Virginia TBI Waiver Program direct care staff annual training

14. Successful Community Integration Is
• ACTIVE participation in a broad range of community
involvement
• It is NOT a narrow series of opportunities such as
employment or independent living
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2014 West Virginia TBI Waiver Program direct care staff annual training

15. Important Roles in Our Culture
OUR ROLES ARE SYMBOLS OF NORMALITY AND ALLOW US TO
FEEL PART OF THE LARGER COMMUNITY. THESE MIGHT
INCLUDE:
• Work
• Love
• Play (leisure and creative)
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2014 West Virginia TBI Waiver Program direct care staff annual training

16. Social and Emotional Impact of TBI
• Decreased social network size and loss of pre-injury
friendships
• Loneliness
• Family often becomes the primary source of social
and leisure activity
• Close relationships with others is a key component of
community integration
• Decrease in these relationships is most often listed as
the reason for a lack of integration
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2014 West Virginia TBI Waiver Program direct care staff annual training

17. Read this article
CLICK THE LINK BELOW TO GO TO THE CARRICK BRAIN
CENTER BLOG
HOW TO HELP TBI SUFFERERS NAVIGATE SOCIAL AND
LEISURE ACTIVITIES AFTER INJURY
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2014 West Virginia TBI Waiver Program direct care staff annual training

18. Approaches to Successful Community Integration
• Take a comprehensive view of community integration
• What are the priorities, values, and interests of the person
• Include social and leisure interests
• Focus on personal choice & empowerment
• What the member does in the community is for THEM not
you
• Emphasize sustainability beyond the waiver program
• Support the person making new connections and
friendships that will continue even if they are not in the
waiver program
• Emphasize changing the environment to maximize
integration
• This includes the home AND the community
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2014 West Virginia TBI Waiver Program direct care staff annual training

19. Improving Community Integration
• Increase family and community awareness of
community integration and brain injury
• Develop and use peer support programs
• Social activities
• Workplace
• Partner with community organizations to increase
understanding of TBI
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2014 West Virginia TBI Waiver Program direct care staff annual training

20. Training Family Members as Paraprofessionals
• Family members often become the sole source of
support after a TBI
• Family members have first-hand knowledge of
functional needs and environmental obstacles
• Consistent carryover means a greater opportunity for
successful integration
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2014 West Virginia TBI Waiver Program direct care staff annual training

21. Rosemary and Hugh Rawlins’ life was turned upside
down on April 13, 2002, when Hugh was hit by a car
while riding his bicycle.
Click on the link to one of Rosemary’s blog entries on
brainline.org to see how this family is a resource in
community integration.
http://www.brainline.org/content/2013/09/pebbles-
of-progress.html
Families as a Resource
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2014 West Virginia TBI Waiver Program direct care staff annual training

22. • Differs from traditional peer mentor programs
• Primary purpose is to EXPAND the social network
rather than to provide other types of assistance
(e.g., providing education about TBI resources,
support in adjustment to disability, etc.)
Social Peer Mentors
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2014 West Virginia TBI Waiver Program direct care staff annual training

23. • A friend
• A role model
• A resource
• Committed to making consistent, regular contact
NOT . . .
• A romantic partner
• Respite care or “sitter”
• A credit card or ATM
• A therapist
• Judge, moralist, or savior
A Social Peer Mentor is . . .
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2014 West Virginia TBI Waiver Program direct care staff annual training

24. • Community integration should
• be defined in a comprehensive way
• address all aspects that are important to the
person
• Partner with organizations in the community
• to increase integration
• develop meaning for persons with injury
• Focus on increasing sustainability beyond the
waiver program
• Train/support
• Family members
• Social peer mentors
Summary
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2014 West Virginia TBI Waiver Program direct care staff annual training

25. Additional Resources and Readings
YOU MAY WANT TO EXPLORE ADDITIONAL RESOURCES
TO EXPAND YOUR KNOWLEDGE BASE AND JOB SKILLS*
Here are just a few:
• brainline.org
• Brain Injury Association of America
• Centers for Disease Control and Prevention: TBI
• National Directory of Brain Injury Services
• National Resource Center for Traumatic Brain Injury
• TBI Services at Center for Excellence in Disabilities
1-877-724-8244 TBI@hsc.wvu.edu
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2014 West Virginia TBI Waiver Program direct care staff annual training
*If you are seeking formal training please check with your employer to make sure the internet training
provider has been approved by APS Healthcare before you take the training

26. Next Steps
• To receive your certificate of successful completion
you must first pass the test and complete an online
evaluation
• A score of 70% or higher is required
• Once you have successfully completed this training
module you will receive an email with your certificate
of completion
• Click this link to go to the
test:http://tbi.cedwvu.org/trainings/community-
integration.php
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2014 West Virginia TBI Waiver Program direct care staff annual training

27. Thank You for Your Thoughts
• Please click this link to go to the online evaluation
http://tbi.cedwvu.org/trainings/community-
integration.php
• Your thoughts and comments are very important to
us
THANK YOU!
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2014 West Virginia TBI Waiver Program direct care staff annual training