1. Planning Support for Persons with At-Risk Behaviors in the Community Setting Jacquelyn Solomon, M.S. LPA

2. Purpose of Training Addressing At-Risk Behaviors and Planning for Everyone’s Safety – Assessing the elements of an effective understanding of the level of supervision and support that a person with a brain injury may need when transitioning into the community.

3. Agenda At-Risk Behaviors – What do they look like? – Examples How to Assess and Address – Discuss assessments for each at-risk behavior – How do we address these issues? Resources

4. At-Risk Behaviors

5. Substance Abuse History – Alcohol – Other drugs Premorbid use Post-injury use Previous treatment? Triggers – Less in residential facility

6. At-Risk Behaviors Mental Health Issues – Premorbid – Post-injury Personality Changes – Behavioral Issues due to changes? How will this affect their transition to community? Impulsivity Social Interaction – Appropriate?

7. At-Risk Behaviors Memory – Short-term memory – Long-term memory Can be dangerous

8. At-Risk Behaviors Medication Management – Take medication appropriately? Time Amount Dosage Memory can affect this greatly Missing doses or taking too much can have serious side effects

9. At-Risk Behaviors Hygiene – Showering – Oral care Sequencing Initiation Lack of proper hygiene can have serious side effects with time

10. At-Risk Behaviors Household Tasks – Laundry – Cooking – Organization Safety – Ex: Know where the fire extinguisher is? – Fall Risks Misplaced items – Nutrition

11. At-Risk Behaviors Transportation – Access to transport? – Have to use public transportation?

12. At-Risk Behaviors Risk of Exploitation – Sexual – Financial – Resources

13. At-Risk Behaviors Community – Where is the residence? – Is it a safe environment? – What needs to be known about the area?

14. How to Assess and Address At-Risk Behaviors

15. Assess and Address Substance Abuse History – Assess History Counseling – Address Support system when in community Attend meetings Continued treatment – Resources AA/NA Counseling Services

16. Assess and Address Mental Health Issues – Assess History Counseling – Address Continue providing counseling services Educate on coping mechanisms Educate support system

17. Assess and Address Memory – Assess While at our facility, Speech and OT assess memory throughout length of stay – Address Memory strategies: – Taking notes; keeping track in a planner or tablet – Visual cues Educate family members and support system

18. Assess and Address Medication Management – Assess Know medication? – Dosage, Time, Amount – Address Work on becoming independent with medication while still in treatment facility Have companion/family member organize medication in pill organizers for them once out in community

19. Assess and Address Hygiene – Assess OT assesses at residence while in treatment and determines what level of assistance pt needs Assessment continues throughout treatment – Address While in treatment, OT works with pt to increase their level of independence If still needs assistance when transitioning into community (i.e. with family member) educate the family members who pt will be living with

20. Assess and Address Household Tasks – Laundry – Cooking – Organization Safety Misplaced items – Nutrition

21. Assess and Address Transportation – Assess Does participant have access to transportation? Do they know how to safely utilize public transportation? – Address Work with them while still at facility – Make schedule; call for rides Educate family members/support system

22. Assess and Address Risk of Exploitation – Assess Give scenarios Look at history – Address Provide education Make reminder cards for participant Work with them to put them on a no contact list

23. Assess and Address Community – Assess Therapist will assess the surroundings of the residence participant is moving to – Address After assessment, discuss and teach participant about surrounding area

24. We wish to provide each participant with the ability to be as independent as possible and to succeed when they transition out of our program. Identifying, assessing, and addressing potential at-risk behaviors is paramount to transitioning our participants as safely as possible.