The Programme for Engagement, Participation and Activities (PEPA)
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The PEPA is a manualised intervention that has been designed specifically to assist people with traumatic brain injury increase their everyday activity in a meaningful way. For many people with brain injury, return to paid employment is not possible, and they are often left with a “24/7” void to fill. PEPA aims to provide new activities and participation that are engaging, enjoyable and meaningful to help fill this void. While designed for people with acquired brain injury PEPA is suitable for anyone who has cognitive, behavioural and/ or physical impairment and limited capacity for paid employment as a result. PEPA can be used in the acute stages after the injury, or many years later, depending on when the person is ready and considers increasing their meaningful activity to be a priority.
The over-arching structure of the programme has three stages (1) assessment and goal setting (three weeks); (2) implementation of meaningful activities to meet an agreed goal (normally five weeks) and (3) forward planning/maintenance. Further goals for participation and engagement can be pursued subsequently. The intervention is enacted through weekly, one hour sessions and inter-session homework. It is built upon the premise of a therapist-client partnership where the clinician provides the structure but the client plays an essential active role in their participation along with other key people such as family members.
The key approach used in PEPA is meta-cognitive strategy instruction which addresses the client’s capacity to analyse, set goals and plan, while providing direct feedback to increase awareness and training to improve self-monitoring. The PEPA program has been empirically evaluated (Tate, Wakim, Sigmundsdottir & Longley, 2018). In this study it was demonstrated to be successful in assisting people disabled by brain injury increase leisure and purposeful activity in their lives. The flow on effects of increased meaningful activity were also seen in improved self-esteem, mood, community integration and quality of life.