1. The Long Term Impact of Brain Injury on Children & Families Martine Simons &Suzanne Benson Senior Social Worker Senior Clinical Psychologist and Clinical Neuropsychologist Brain Injury Service, Department of Rehabilitation

2. Rehabilitation at CHW Brain Injury Service is part of the Rehabilitation Department State wide service providing inpatient and outpatient rehabilitation services to approximately 600 children. The team consists of medical, nursing & allied health professionals.

3. Overview Impact of Brain Injury on children Long term issues for children & families

4. Factors impacting on families Immediate: –Injury & hospitalisation –Medical –Legal –Highly charged emotional situation –Disruption to family life –Being away from community and supports

5. Factors impacting on families Emerging picture of long term consequences Process of change and adaptation for the family

6. NAI/SBS Mostly injured under 12 months Often show good physical recovery in early stages after injury Problems emerge as neurodevelopment does not proceed in typical pattern

7. Early NAI Research Kriel, Kruch & Panser (1989) Bonnier (1995) Duhaime et al (1996) Haviland J, Ross, Russell RI (1997) Ewing-Cobbs et al (1998;1999) Kyriagis, Waugh & Epps (2003) Barlow (2005)

8. Summary “…inflicted TBI has a very poor outcome.” “…deficits in preschoolers are often underestimated.” Barlow, KM et al, (2005)

9. Changes in child Physical and medical problems –post trauma epilepsy –hemiplegia –coordination problems –headaches –physical and cognitive fatigue –sensory deficits (vision, hearing, smell)

10. Cognition Cognitive deficits –Learning and memory –Speed of processing –Language –Attention –Executive functions –Intellectual impairment

11. Cognitive problems Executive problems –working out solutions –planning and organisation –inhibition –perseveration –lack of flexibility –concrete reasoning

12. Behavioural Problems Non-compliance Overactivity Lack of persistence Physical aggression Verbal aggression Sleep & bedtime problems

13. Social Issues Social problems –poor communicator –lack of friends –rejected by others –Bullying / teasing

14. Emotional problems Anger –low frustration tolerance –overly sensitive –impulsive Depression –feeling helpless –feeling different Anxiety –ability to complete work –future –dependence on others

15. Behaviour & Emotions Difficult behaviour is the result of the interaction of many factors No particular behaviour is “all brain injury” or “not brain injury”

16. Behaviour & School Emotional and behavioural issues may not be present at school Environment will impact on manifestation of problems Family coping will depend on many factors

17. Families & Coping Stress on families tends to increase, not decrease Supports in community and school tend to decrease Unfavourable family circumstances exacerbate problems from TBI

18. Family Stressors Role changes –who has paid work? (at home, community) –therapy needs Carers Family structure –losses/absences –location Nature/cause of TBI Financial burdens

19. A multidisciplinary team approach Case managers Allied health Nursing and medical response

20. Interventions Support Therapeutic needs –behavioural interventions –emotional support –individual therapy –family therapy

21. Schooling All children return to school –Crucial part of child’s reintegration and ongoing development –Engagement and connectedness

22. Implications Non accidental brain injury is a serious form of child abuse Long term costs to individuals, families and communities Prevention programmes are essential