The document outlines the development of a skills retraining program for caregivers of individuals with acquired brain injury using the Holistic Habit Retraining model. It describes conducting a literature review to identify caregiver needs, developing and administering a survey, and receiving stakeholder feedback to inform the program. A logic model was created to identify the program components, objectives, outputs, and short and long-term outcomes. The program was then implemented as a pilot and evaluated using standardized tools to identify areas for improvement.

1. Skills retraining using the Holistic Habit Retraining
(HHR) model: A program for family members of persons with
Acquired Brain Injury
Action Research Cycle
Informing Development of the program
Identify caregiver needs
Approach to exploring the research literature
Databases: CINAHL, Scopus (MEDLINE and EMBASE)
Search terms: acquired brain injury, ABI, stroke, cerebral vascular accident, cerebrovascular accident,
CVA, traumatic brain injury, TBI, brain injury, AND issue, concern, difficult, burden, strain, impact, AND
caregiver, family, carer, personal care attendant, informal caregiver, caretaker, spouse, partner, AND
community, home
Develop a survey of caregivers
Survey topics developed based on findings from the literature. Topics included: caregiver
competence and confidence levels, new roles and managing relationships, financial strain, trust
between caregiver and ABI survivor, and role of community supports.
Consult with stakeholders (staff & caregiver representative)
Format of meeting: review processes involved in design and development of caregiver survey followed
by a summary of the critical findings of the survey.
Recommendations to stakeholders
Summary of recommendations based on findings from the survey: Establish seminars aimed to establish
expectations of caring for someone with an ABI; provide knowledge and skills as ABI survivors transition
across stages of recovery; financial counselling and management for caregivers; develop program
utilizing Holistic Habit Retraining (HHR) model or educate caregivers on the principles of the HHR model.
Plan the program
Identify issues for skills re-training applicable for using HHR model approach
Family caregivers find that their own frustration and brain injury survivors’ behavioural difficulties are
common occurrences, and find the role of caregiving to be overwhelming. Some family caregivers
possess knowledge of how to teach skills, but many do not. Caregivers feel that being provided with
more information is helpful, especially information on how to facilitate new skill learning for brain injury
survivors when community program participation has not fully met their needs. The HHR model is
designed to identify skills for training, devise appropriate skill training schedules using a task analysis-
based breakdown of skills, and promote survivors’ continued use of learned skill components through
positive support of the survivor.
Identify outcomes and create logic model
See a summary of the logic model on back of this hand-out
Develop the program using HHR principles
Provide lay background information on how learning occurs through neuroplasticity. Caregivers
identify salient tasks and skills they want to help survivors learn to do or do better, as well as barriers they
encounter with this aspect of caregiving. Provide practical education on task analysis for breaking skills
down into skill components. Provide practical education on importance and incorporation of a
promoting attitude to enable survivors’ learning. Mini-programs are developed and used by caregivers
to begin skills training with brain injury survivors.
Re-consult with stakeholders
Format of meeting: discussion of program format, supporting evidence for program components and
design choices, recommendations for timing of evaluation, consultation regarding desired changes,
and round-table finalization of program format for pilot implementation.
1 1 1 2
Anita Hamilton MOccThy, Richard Tang , Matthew Fong , Lily Ma MScOT
1 2
University of Alberta, Canada , Brain Care Centre, Alberta Canada

2. Implement the program
Run a pilot program with existing group at BCC (e.g. the new post-concussion group)
Program to be run by Brain Care Centre staff
Offer program at times when caregivers available (e.g. offer day and evening
programs)
Evaluate the program
Using standardized evaluation tools and qualitative interviews:
Determine if planned outcomes were reached
Evaluate findings to determine improvements for next iteration/cycle of the program
About the Action Research Cycle
Action research is a methodology which has the dual aims of action & research1, p. 6:
• action to bring about change in some community or organisation or program
• research to increase understanding on the part of the researcher or the client, or
both (and often some wider community)
About the Holistic Habit Retraining model
The Holistic Habit Retraining (HHR) model2 aims to generate practical, utilitarian strategies
for retraining adaptive cognitive, emotional, behavioral and social skills, as well as
strategies for overcoming common obstacles to utilizing methods that promote effective
skills acquisition.
About the Program Logic Model
The program logic model3 aims to describe the following:
• The main components (major activities) of a program.
• The implementation objectives (translating the main components into objectives
that describe what the program is expected to do).
• The program outputs (indicators of a program’s implementation and information
about the delivery of the services and characteristics of people receiving the
service.
• The short-term/medium-term and long-term outcome objectives relate to what is
expected to change resulting from the program. (HOW to measure the outcome
objectives is not listed in the model but it does suggest WHAT needs to be
measured).
References:
1. Dick, R. (1993). You want to do an action research thesis? — How to conduct and report action research
(Including a beginner’s guide to the literature). Chapel Hill, Qld.: Interchange.
2. Martelli, M.F., Nicholson, K., & Zasler, N.D. (2008). Skill reacquisition after acquired brain injury: a holistic
habit retraining model of neurorehabilitation. NeuroRehabilitation, 23(2), 115-126.
3. Letts, L., Law, M., Pollock, N., Stewart, D., Westmorland, M., Philpot, A., & Bosch, J. (1999). A programme
evaluation workbook for occupational therapists: An evidence based practice tool. Ottawa, ON: CAOT
Publications ACE.
1 1 1 2
Anita Hamilton MOccThy, Richard Tang , Matthew Fong , Lily Ma MScOT
1 2
University of Alberta, Canada , Brain Care Centre, Alberta Canada

3. Presenting the process of developing the program using the Logic Model
1 1 1 2
Anita Hamilton MOccThy, Richard Tang , Matthew Fong , Lily Ma MScOT
1 2
University of Alberta, Canada , Brain Care Centre, Alberta Canada