NEWS

Housing for people with high and complex support needs

Since 2006, the Summer Foundation has been working to solve the issue of younger people with disabilities being forced to live in aged care because there is nowhere else for them to live. 

The Summer Foundation’s work includes research into outcomes for people with high and complex support needs – including people with neuro-degenerative conditions and acquired brain injuries – as well as building the capacity of the health and disability sectors to better support people in these cohorts.

Appropriate housing is central to achieving good outcomes for people with high and complex support needs, so in 2017 the Summer Foundation piloted the Housing Hub –www.housinghub.org.au – a website that advertises properties for people with disability.

From small beginnings, the Housing Hub is fast becoming the way for people with disability to find suitable housing. To date, almost 2,300 places to live have been listed on the Hub and around 147,000 people have visited the site. A recently-added feature is the ability for housing seekers to create a Housing Hub profile that details their environmental needs, as well as their preferences around location and property features. If a property is subsequently listed on the Hub that matches a person’s profile, the Housing Hub will notify them directly!

The Summer Foundation’s Housing Hub team also provides a service that supports people with high or complex disability support needs to access appropriate funding from the National Disability Insurance Scheme (NDIS) and connect with suitable housing opportunities.

The Housing Hub team is able to offer support to you with advice, housing resources and connection to appropriate sector professionals at no cost.

For more information phone Melody Carbans on 0499 111 848 or email info@housinghub.org.au

Clinical translation of Cognitive Behavioural Therapy for anxiety and depression - Adapted for Brain Injury (CBT-ABI): How do we train competent clinicians?

Dana Wong, Adam McKay, Nikolaos Kazantzis & Jennie Ponsford
International Journal of Cognitive Therapy
https://link.springer.com/article/10.1007/s41811-020-00079-2

What the study is about
Depression and anxiety are common following acquired brain injury (ABI) and can be effectively treated using cognitive behaviour therapy (CBT) that has been adapted to compensate for cognitive difficulties (CBT-ABI– as outlined in the CBT-ABI manual available from ASSBI Resources!) However, effective delivery of CBT-ABI requires a specialised skill set. Training clinicians to deliver CBT-ABI is therefore a crucial step in effective translation of this intervention into widespread clinical practice.

What we did
This study evaluated the outcome of didactic (instruction-based) and experiential (skill-based) training on competencies in delivering CBT-ABI.  Participants were 39 registered psychologists who attended a day-long ASSBI workshop on using CBT-ABI to treat anxiety and depression after brain injury, which included knowledge-building, observational learning (i.e., videos of CBT-ABI) and skill-based (e.g., role play) content. Fourteen participants completed three additional supervision sessions reviewing audio recordings of their use of CBT-ABI with clients they saw in their workplaces. Training outcomes were measured using surveys rating the usefulness of the various workshop components; a checklist of competencies in CBT-ABI on which participants rated themselves pre- and post-workshop and post-supervision; and the Cognitive Therapy Scale (CTS), used by supervisors and a blinded expert to evaluate supervisees’ skills.

What we found
Participant-rated confidence and competence in delivering CBT-ABI significantly improved following workshop training. Examples of CBT modifications for ABI, case descriptions and videos of CBT-ABI in action were consistently rated as the most helpful elements of the workshop.

Self-rated competencies did not show further change after supervision. CTS ratings of the supervisor, but not the blinded expert, showed significant improvement after short-term supervision. The authors surmised that a longer period of supervision may have been necessary for greater impact on competencies. Nevertheless, at 16-month follow up, self-rated competency gains were maintained; and encouragingly, therapist confidence and competence were no longer major barriers to using CBT-ABI in the workplace. These findings suggest targeted training that includes opportunities for observational and experiential learning is important for clinical translation of this evidence-based intervention.

Acknowledgements
The authors would like to acknowledge and thank the psychologists who participated in the study and the individuals with brain impairment who consented to have their therapy sessions recorded for supervision. We would like to thank Dr Kerrie Haines, who provided supervision for some of the study participants, and Dr Lillian Nejad, who was our expert CTS rater. This research was supported by the Moving Ahead NHMRC Centre of Research Excellence in Brain Recovery.

Brain Impairment is proud to announce its new 2019 impact factor of 1.356. Thank you to our special issue editors, authors, reviewers and readers!

On behalf of the organising committee, you are warmly invited to Melbourne, VIC, Australia, to participate in the 6th Pacific Rim conference. This is the first joint conference of three outstanding organisations: the International Neuropsychological Society (INS), the Australasian Society for the Study of Brain Impairment (ASSBI), and the Australian Psychological Society’s College of Clinical Neuropsychologists (CCN). To reflect the difference we can make when we join together, our theme is “Putting our heads together to change lives”. You are warmly invited to the vibrant metropolitan city of Melbourne to participate in an exciting, multidisciplinary, practically grounded, innovative program of presentations and events, including international and national speakers who will undoubtedly inspire us to reflect on our professions and how we can maximise our impact for people living with brain conditions.

Six half-day workshops will take place on Wednesday 30^th June. A broad range of papers will be presented from renowned international and national speakers on Thursday 1^st, Friday 2^nd and Saturday 3^rd July. There will also be the INS Presidential Address by Professor Skye McDonald, the ASSBI Presidential Address by Professor Olivier Piguet, and a professionally focused address by CCN Chair Dr Amy Scholes. In addition to platform presentations there will be “how-to” sessions, datablitz presentations and posters, together with a select number of invited symposia.
Dr Kerryn Pike, Dr Travis Wearne and Dr Dana Wong (co-convenors)

Positive behaviour support for challenging behaviour after acquired brain injury: An introduction to PBS + PLUS and three case studies

Kate Rachel Gould, Jennie Louise Ponsford, Amelia J. Hicks, Malcolm Hopwood, Belinda Renison and Timothy J. Feeney

Neuropsychological Rehabilitation

https://doi.org/10.1080/09602011.2019.1656647

What the study is about

Challenging behaviours, such as aggression, inappropriate social behaviours and lack of initiation are common following acquired brain injury (ABI). These behaviours may place the person and others at risk of harm, interfere with community participation and cause distress to family members. There are no evidence-based guidelines for managing challenging behaviours after ABI, leaving clinicians with few resources to guide practice. Over the last few decades, findings from case studies and single subject experimental designs have supported the use of positive behaviour support (PBS) interventions for challenging behaviour post-ABI. The key approach of PBS, which evolved from applied behaviour analysis, is that by proactively preventing challenging behaviours –

making them inefficient and ineffective – and systematically facilitating desired behaviours, challenging behaviours become unnecessary (Carr et al., 2002).

What we did

This paper introduces PBS + PLUS: a multi-component and flexible PBS intervention using a person-driven collaborative approach to build a meaningful life and self-regulate behaviour after ABI. This approach reflects  on the body of knowledge developed by Mark Ylvisaker and Tim Feeney. The efficaciousness of PBS + PLUS is currently being examined in a randomised controlled trial (RCT) conducted by our team, which will help to strengthen evidence-based practice. In the meantime, we have prepared three detailed pilot case studies from our trial to illustrate the highly individualised implementation of the program, delivered to the individuals with ABI and carers over 12 months by a transdisciplinary team including neuropsychologists, occupational therapists, and psychiatrists. These case studies will assist clinicians and service providers to implement PBS + PLUS in anticipation of the results of the RCT. Objective behavioural outcomes are reported for participants using the Overt Behaviour Scale (OBS) at baseline and four-monthly intervals for two years. Goal attainment scaling was used to measure personally meaningful goals.

What we found

The three participants presented with diverse behaviours, living situations, cognitive profiles, functioning levels, support networks and desired outcomes. Reese, Ethan and Ollie, along with their support networks, received 12 months of individualised intervention from transdisciplinary PBS + PLUS therapists. Through these varied cases, we demonstrate different aspects of the flexible and individualised PBS + PLUS approach. Visual analysis of the primary outcome measure, the OBS, indicated that whilst Ethan and Ollie made substantial improvements

in self-regulation of behaviour, which were maintained over time, Reese’s improvements in behaviour were not sustained beyond 8 months. The qualitative appraisals of the intervention by participants, families and carers, and 12-month follow-up outcomes are described in the article along with a discussion of the advantages and challenges of program delivery. The detailed description of the intervention and expansive case studies should assist clinicians in understanding how the PBS + PLUS principles, framework and strategies may be applied.

Acknowledgements

The authors would like to acknowledge and gratefully thank the generosity, time and effort of the participants, therapists (Dr Kate Gould, Dr Belinda Renison, Dr Kim Trezise, Dr Diane Parcell, Nadine Holgate, Cathy Bucolo, Sally Peterson, and Dr Clare Kempnich), research staff at the Monash-Epworth Rehabilitation Research Centre; our independent expert for integrity monitoring Melissa Capo, Albany, NY, USA; and Kat Orgallo, Teaching Resource Support Unit. This research was funded by the Transport Accident Commission (through the Institute for Safety Compensation and Recovery Research).

How our world has been turned up-side down this year with the COVID-19 pandemic!  Such public health devastation has not been seen in our lifetime.  As ASSBI members, we are lucky to be living in Australia and New Zealand, where our governments listened to expert advice and responded with timely and definitive action; where our communities adhered to government directives regarding lockdowns, social distancing and hand hygiene. The outstanding success of these strategies and the community’s adherence to them is on record: by the end of May 2020, Australia and New Zealand had respectively recorded 282 and 301 confirmed cases per million population, each country having 4 deaths per million population.  Both countries are well below the world average of 774 confirmed cases and 47 deaths per million population.  The pandemic is not only affecting personal health, well-being and social relations, but is causing widespread disruption in education, work and economically.  Again, we are fortunate that our governments, labour and liberal alike, have stepped up to the mark, putting policies and economic packages in place to support our communities. 

I had looked forward to writing this editorial, which traditionally would report on the annual conference.  This was to be held in May in Perth, co-convened by Janet Wagland and Michelle Kelly.  Regrettably, it, along with so many other conferences world-wide, had to be cancelled due to the pandemic.  So, did that leave me with nothing to write about for this Newsletter?  Not at all!  I have to say that, as ASSBI’s President, I have been so very proud of ASSBI’s responsiveness during the pandemic.  Barbra Zupan and Skye McDonald from ASSBI’s Professional Development Committee, converted the annual conference into a series of “ASSBI 2020 Conference Bite Size” webinars, being presented on a monthly basis from May to November via Zoom (see programme displayed in the Newsletter, or go to the website).   BRAINSPaN was quick off the mark in the early stages of the pandemic, providing a vital conduit for communication and sharing resources, including fact sheets from peak bodies.  Our speech pathology colleagues have been especially proactive in developing resources for people with communication impairments.  Lizzie Beadle and Travis Wearne are active on social media, promoting ASSBI and its offerings via Twitter.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

And speaking of Twitter - you know, one day I guess I will look back on this pandemic and ponder what I did during all that time of enforced staying at home.  One of the projects that engaged me during this time, has been teaching myself to use Twitter.  Being a latecomer to this medium, I had some degree of trepidation (needing yet another work task to do, like I need a hole in the head!), but the reason was to help advance the cause of raising the profile of ASSBI (and NeuroBITE).  I have to say how amazed I am at this medium, how engaging it is, discovering who is doing what, and its potential reach – and I take my hat off to all those active twitterers – what stamina you have!  In reading the tweets, I am so very proud of our ASSBI members and other Australian colleagues who are at the vanguard of developing telehealth and digital platforms for both assessment and interventions. Clinicians the world over are grabbing at such resources in these lockdown and social distancing times.  ASSBI Resources, of course, has a number of telehealth manuals available addressing different neurological conditions and presenting problems.  The ASSBI 2020 Conference Bite Size programme also features several webinars addressing telehealth.  So, well done, everyone!

But the pandemic is not over yet, in spite of the easing of restrictions in various countries. The consequences are likely to continue for some time. Moreover, it is now recognised that the coronavirus infection can cause secondary neurological sequelae. The implications for neurorehabilitation are obvious and are of vital concern to ASSBI, our brain impairment clinical and research society.

My very best wishes to you all,
Robyn Tate
President

The COVID-19 pandemic is sweeping through our nations with devastating effects on health that are escalating daily.  The impacts are severe and widespread - financially, vocationally, socially and personally, causing major disruption to everyday activities and people’s well-being.

ASSBI, like many other organisations, has had to cancel the annual conference for the first time in 43 years of the Society.  At the same time, BRAINSPaN has sprung into action, providing a vital conduit for communication and sharing of resources.  These include fact sheets from the World Health Organization, Australian Department of Health, National Disability Insurance Scheme, and the Australian Psychological Society tips for mental health, together with ASSBI Resources for telehealth delivery (Making the Most of Your Memory; TBIconneCT) and the Aphasia Centre for Research Excellence healthcare communication supports.

During these difficult and uncertain times, the ASSBI Executive will be continuing its activities.  We send our heartfelt wishes to members, colleagues, people with brain impairment and their families and hope that you stay well and remain safe.

Robyn Tate

President

 As I write my President’s report for this first issue of the Newsletter for the year, I reflect upon the ravages that have torn Australasia apart during 2019.  The toll from natural disasters alone was horrendous. 

After years of drought, Australia was a tinderbox waiting to explode.  It started in the spring of September 2019, when 50 fires were reported to be burning in the state of Queensland.  Later that month more fires ignited in far-flung areas across the country.  Come November, every state and territory in Australia was on fire.  By December, smoke and ash had drifted across the Tasman Sea to New Zealand, and even across the Pacific Ocean to South America.  The scale of the megafires, which raged for five months, was unprecedented, releasing 400 megatonnes of carbon dioxide into the atmosphere.  More than 12 million hectares of land was scorched - larger than the land-mass of Portugal, and an estimated 1.25 billion animals were burned alive – kangaroos and koalas, kookaburras and cockatoos.  People were stranded on beaches and rescued by navy ships.   More than 2,000 homes were destroyed. Many people lost their livelihoods; 33 lost their lives.

New Zealand also experienced wildfires during 2019.  The Pigeon Valley wildfire in Waimea Valley burned for three weeks over an area of 2,000 hectares and saw 2,500 people evacuated from their homes.  But it is New Zealand’s central position in the Pacific Basin “Ring of Fire” that makes it so prone to volcano and earthquake activity.  New Zealand has some 14,000 earthquakes each year, although only a fraction of them are strong enough to be felt.  We all remember the devastating earthquake of 2011 that almost ruined the city of Christchurch, including its beautiful Gothic revival cathedral; some 11,000 homes and buildings were destroyed, the death toll was 185, with thousands more people injured.  The volcanic eruption on White Island last year affected all 47 people present on the island at the time, mainly tourists, with 21 deaths and the remaining 26 survivors being critically injured predominantly by severe burns, rocks hurtled from the crater, and inhalation of toxic gases.

What is the role of natural disasters as a cause of acquired brain injury?  Impairment occurs not only in cognitive, neurobehavioural and motor-sensory function, but also secondary emotional consequences with anxiety, fear, stress, grief, depression.  Hypoxic brain injury and its characteristic features of compromised memory, vision, speech and motor function can occur after snow avalanches, near drownings in floods and tsunami, and inhalation of smoke and toxic fumes from wildfires, together with severe burns that may cause neuroinflammation.  Traumatic brain injury is a common consequence of falling debris in earthquakes, volcano eruptions, hurricanes and tornados.  Lightning strikes, the bolt from the blue, can have both transient and permanent effects on neurocognitive and motor function.   In our clinical practice, we should be aware that natural disasters can have potentially devastating effects not only emotionally, but also on cognition, behaviour, and motor-sensory function. 

On a final note, in the December 2019 edition of the Newsletter, I heralded that ASSBI is to undertake an external review – its first in 43 years of operation.  The ASSBI Executive is moving forward on planning for this event.  At the annual conference to be held in Perth in May, we will be conducting a survey of the membership.  The more responses we receive, the better we will be able to plan the review.  Do please respond!

My very best wishes to you all and looking forward to seeing you in Perth for the annual conference,

Robyn Tate, President

The Summer Foundation recently engaged people with disability in the development of our research program. Over two workshops, people with neurological disability and complex needs provided their wisdom and insights over a number of topics. A fantastic addition to these workshops was a Visual Storyteller, Paul Telling. We were introduced to Paul’s fabulous work at the ASSBI/NZRA Inaugural Trans-Tasman Conference in Wellington in 2019.

 Paul was engaged to summarize the content generated in the workshops in real time. There was terrific value in providing workshop participants with a live visual summary which utilised pictures and words to capture key points and make abstract concepts tangible. Paul produced accessible and inclusive summaries of the content from workshop activities, as well as visual representations of the links between topics that were discussed. The visual story-board also captured the emotion and energy of discussions through the use of captivating images. Importantly, the story-board created opportunities for people to provide feedback and input beyond the activities, therefore enhancing the accuracy of the insights gained from the workshops. Overall, the use of a visual storyteller enhanced collaboration, and allowed for real-time reflection and interpretation of workshop output. Click here for more information on Visual Storytellers.Click here for more information about the Summer Foundation research program. 

Living well after acquired brain injury (ABI) – a forum for anyone with an interest in long term management of ABI is being held on 

Wednesday 6^th May 2020. 10.30am to 4pm

This public forum will be held at Technology Park, 2 Brodie-Hall Dr, Bentley, WA

Everyone is welcome to attend part of, or the whole of the day which is being sponsored by Brightwater Care Group. If staying for the whole day please note that lunch will NOT be provided.

Please register your interest by

• ticking the box on the registration form or, if not attending the conference,
• by emailing Barby Singer at b.singer@ecu.edu.au

READ MORE HERE