Program elements that promote successful management of brain-injury related behaviors: Qualitative survey of providers

Research Objectives: Identify program elements that promote access to successful management of challenging behaviors after brain-injury.

Design: Observational cohort study using anonymous provider responses to a national survey.

Setting: Brain-injury treatment centers.

Participants: Respondents (N=302) included behavioral health providers (52%), medical providers (18%), and rehabilitation therapists (30%). Majority of providers work with adults (95%) in inpatient settings (62%).

Interventions: N/A

Main Outcome Measures: Open-ended responses to ”How effective do you feel your team/program is at managing brain-injury related challenging behaviors” were coded using rapid content analyses. Responses were mapped to dimensions from a conceptual framework reflecting the supply and demand aspects of healthcare access.

Results: Perceived team effectiveness at managing behaviors following brain-injury ranged from limited (27%), effective (36%) to very effective (37%). From healthcare infrastructure standpoint, facilitators of successful programs for managing challenging behavior included a culture that prioritized staff collaboration and communication (69%), specialized staff treating individuals with brain-injury (61%),
and a highly trained workforce (57%). Effective/very effective teams reported use of environmental strategies (68%), individualized care plans (67%), use of medications (47%) and implementation of objective measures to monitor progress (35%). From the consumer or demand viewpoint, facilitators of successful programs involved inclusion of caregivers in treatment planning (48%). Identified barriers of less effective programs included poor team collaboration and communication (71%), lack of workforce skill (65%), lack of specialized staff (53%) and inconsistent treatment strategies (35%).

Conclusions: Prior work has associated managing challenging behaviors with poor system and patient outcomes. Results highlight key facilitators and barriers that impact access to effective care. Findings provide intervention targets to inform treatment planning, program development, and educational programming for the delivery of effective healthcare for this high risk population.

Author(s) Disclosures: Authors have no conflict of interest to disclose. Material is result of work supported with resources at James A. Haley Veterans’ Hospital. Views expressed in this presentation are those of the authors and do not necessarily represent the official policy or position of the Department of VA, DHA, DoD, or any other U.S. government agency.