Specific Questions, Continued 2

PROGRAM

Every component of every program is not addressed here. For example, specific questions about physical therapy are not included. The components below are those which tend to have broad implications, that is, to touch more than one specific discipline, often simultaneously. You will also wish to ask questions about the philosophy and methodology used in specific disciplines that are central to the services needed in your individual situation.

  1. Observations to make about aesthetics:
    1. Are the facilities clean?
    2. Are people being served clean and dressed in a manner you are comfortable with? Do they appear to be well cared for?
    3. Does the staff seem attentive, to know people being served by name and to care genuinely about people in the program (i.e., do they stop in the hall to say hello or joke)!
    4. Is the food appealing? How does the program accommodate special diets, personal preferences and requests for a different meal schedule? Is there any charge for this?
    5. Do people being served seem comfortable with the way they are being treated? (It helps to ask them.)
  2. Experience with people with brain injuries:
    1. How many people with brain injuries has the program worked with in the past year? How many total individuals have they served?
    2. 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?
    3. How long has the program been in existence? When did it begin to serve people with brain injury? Why was it established?
  3. Program administration and organization
    1. Who is responsible for the overall supervision of the services rendered to people served? How often are they at the program? How much direct contact do they have with individual people served?
    2. 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?
    3. How does the program integrate the individuals expressed desires and goals in service planning? For example, if an individual dislikes to cook and will not be expected to cook at home, is cooking an expected program component? If it will take a person three hours to feed themselves, and they decide this wastes energy they would prefer to use in another manner, how will the program support them in this decision, and what assistance will be provided to find ways to have feeding done by someone else - both at the program and at home?
    4. 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?
    5. What do people generally do during unscheduled times?
    6. What is the evening schedule?
    7. What is the weekend schedule?
    8. How is the need for specialized adaptive equipment identified? How is the equipment provided and paid for?
    9. What access do people being served and their families have to their records? If I wanted to see my record now, what would I have to do? What recourse do I have if I disagree with something in the record?
  4. Medical services/medications
    1. 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?
    2. How is my personal physician included in providing medical services while I am in the program?
    3. How does the program handle medical emergencies?
    4. How are routine medical issues (i.e., regular dental and ophthalmology services) provided?
    5. How would the program manage the special medical needs which have resulted from the injury?
    6. I have heard that people can have trouble with bedsores. How does this program avoid or prevent this?
    7. 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 they decline, against medical advice?
    8. 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?
  5. Program components
    1. Cognitive services:
      1. What approaches does the program use to address cognitive strengths and limitations?
      2. Is neuropsychological testing done? How much emphasis is placed in test reports 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?
      3. 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?
    2. Behavioral interventions:
      1. What approaches does the program use to address behavioral concerns? What role do the individual and their family play in determining the types of behavioral interventions used?
      2. What steps does the program take to assure that behavioral interventions are clearly understood by all staff the person has contact with and that the plan is being implemented consistently by all staff (even at 3:00 in the morning)?
      3. How is the effectiveness of behavioral interventions measured?
      4. What role does medication play in "behavior management?"
      5. Are physical restraints used? In what circumstances? What policies or protocols exist for the use of physical restraints? Can I see a copy of these?
      6. Is a "secure" or locked unit available? When does the program recommend the use of these? Who decides when a person is ready for an open unit after being on a secure unit? How?
      7. 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?
    3. Vocational services:
      1. What is the extent of vocational services provided by the program?
      2. How are situational vocational evaluations conducted? How are job trials, training or placement provided? How are job coaches used? For how long?
      3. What interface is there between the program and state vocational rehabilitation services?
    4. Educational services:
      1. What educational services are offered? To children? To college students? To adults?
      2. Does the program have a teacher on staff with expertise in educating children and adolescents with brain injury?
      3. What is the interface between the program and the person's school?
    5. Community Re-entry:
      1. What components of the program take place in the community? How frequently is the individual in the community?
      2. How are the person's ability to get around and to use community services and resources evaluated and addressed?
      3. What local resources are used by the program to address the needs of the individual?
      4. How does the program accommodate an individual's request to participate in community activities (i.e., AA or league bowling)?
      5. What outreach does the program do to help educate the community about brain injury and its consequences?
      6. 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?
      7. 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?
      8. What is the interface between the program and the local Independent Living Center?
    6. Recreation:
      1. How does the program accommodate the individual's continued involvement in recreational interests and activities? Are modifications of activities or equipment suggested, and opportunity for situational exploration of the effectiveness of modifications included?
      2. What does the program do to support the individual's desires to become active in new recreational pursuits?
      3. How does the program help the individual identify ways to participate in recreation and social opportunities in their community?
      4. What interface does the program have with the local recreation department? With community therapeutic recreation services? With social support and activity groups?