1. Investigating social work interventions to address the long term needs of people with acquired brain injury: Experience of the Royal Hospital for Neuro-disability Authors: Patti Simonson, Maysaa Daher, Grahame Simpson, Rosemary Jennings

2.  Little is known about social work interventions to address the long-term needs of people with acquired brain injury (ABI).  The Royal Hospital for Neuro-disability in London has had a long tradition of providing social work services to this group.  Aim: To investigate the social work interventions provided to patients with ABI at the Royal Hospital for Neuro-disability.

3.  Client data was reviewed over the period between July 2010 and February 2012.  The data collected included client demographics, injury/illness characteristics and types of social work interventions.  Episode of Care: the period between which a case was opened and subsequently closed.

4.  There were a total of 113 episodes of social work care provided to 87 individuals. Of these 87 individuals, 42 were male (48.3%) and 45 were female (51.7%).  The average length of EOC was 10.3 months (SD 13.9, Range 1-68)  29 cases (26%) were closed in less than one month  60 cases (53%) were closed in 4 months or less Number of EOC’sN (%) 165 (75%) 219 (22%) 32 (2%) 41 (1%) Table 1. Number of Episodes of Care (EOC) (n=87)

5.  Five categories were used to group the wards Table 2. Number of EOC’s broken down over ward categories (n=113) Ward CategoryNo. Of EOCs (%) Huntington’s Disease Unit5 (4%) Young Person’s Disabled Unit16 (14%) Ventilated and Higher Respiratory Needs Unit15 (13%) Complex Neurodisability Higher Independence Unit15 (13%) Complex Neurodisability62 (55%)

6.  There were 4 broad categories used to group the client’s referrers. Table 3. Number of EOC’s broken down over ward categories (n=113) ReferrerNo. Of EOCs (%) External agency7 (6%) Statutory service15 (13%) Family/friends/self21 (19%) Royal hospital staff70 (62%)

7.  The different reasons for referral were grouped into 5 categories. Table 4. Number of EOC’s broken down over ward categories (n=113) Reason for ReferralNo. Of EOCs (%) Healthcare needs9 (8%) Family/carers10 (9%) Accommodation adaptations/equipment11 (10%) Legal/financial/statutory benefits35 (31%) Future planning48 (43%)

8.  Average number of interventions across the 113 EOCs was 3.7 (SD 2.26, range 0- 11).  A total of 5 interventions or less were administered to approximately 80% of the clients. Figure 1. Frequency of interventions over all EOCs (n=113)  Length of EOCs were highly correlated with the number of interventions provided [Pearson’s product- moment correlations, r(113) =.63, p <.01].  The longer the length of EOC, the more interventions were used and vice versa.

9.  A wide range of interventions was administered to the clients regardless of their initial referral issue.  Those referred for future planning used the highest number of interventions, while those referred for family/carer issues had the lowest. Figure 2. Average number of interventions used across reason for referral categories

10.  Those in the Ventilated and Higher Respiratory Needs Unit had significantly longer average length of episode of care than those in the Complex Neurodisability unit (ANOVA, p <.05)  Those in the Ventilated and Higher Respiratory Needs Unit also used a significantly more number of activities than those in both the Complex Neurodisability Higher Independence Unit and the Complex Neurodisability Unit (ANOVA, P <.05).  There was no difference between the ward categories in terms of the referrer categories (chi square). Table 5. Average length of EOCs and average number of activities across ward categories WardLength of EOC in months, mean (SD) Average number of activities, mean (SD) Ventilated and Higher Respiratory Needs Unit20.9 (15.5)5.8 (2.2) Young Person’s Disabled Unit15.8 (22.1)4.0 (3.2) Complex Neurodisability Higher Independence Unit13.4 (16.0)3.3 (2.4) Huntington’s Disease Unit7.2 (8.2)2.8 (1.1) Complex Neurodisability5.9 (7.6)3.2 (1.7)

11.  People in the chronic phase of ABI have a broad range of psychosocial needs.  The interventions reflect the person-in-environment approach that underpins social work practice.  The findings reflect the importance of ensuring social work services are available over the long-term.

12. Thanks to the support from the following organisations  The Royal Hospital for Neuro-disability www.rhn.org.uk  Brain Injury Social Work Group (BISWG) www.biswg.co.uk  International Network of Social Workers in Acquired Brain Injury (INSWABI) www.biswg.co.uk/html/inswabi.html