An Interdisciplinary Resource Pack for working with Child Relatives of Adults with Brain Injury

Introduction and Description: In the NRH brain injury rehabilitation programme, an interdisciplinary team works with persons with acquired brain injury and helps them to achieve goals in order to improve their quality of life. While some consideration is given to child relatives, the process has been largely client and carer centred. Many injured persons have young children, and there has been an inconsistent approach across the service in terms of helping children cope with and adjust to their brain injured parent or relative. A resource pack for all members of the inter-disciplinary team in the NRH brain injury programme was designed and provided to all staff, in order to offer guidance and advice on working with child relatives and including them in the rehabilitation process. Work on developing the pack was funded through the Dr Tom Gregg Bursary Fund. Aim and theory of change: There has been a new emphasis in recent years on the importance of family focussed rehabilitation, with the UK’s ‘Think Family’ policy, as well as research from various authors, such as Audrey Daisley. To date in Ireland, rehabilitation has been more client and carer focussed, so the aim of the resource pack was to strengthen the family approach to rehabilitation. The objective of the pack was to support staff to be more inclusive of child relatives; and to help them see the importance of including child relatives when working with adults with an acquired brain injury. It was also hoped that the resource pack would provide staff with the tools and confidence to work with children. The majority of staff in the adult brain injury programme had experience of working with adults only, and lacked the confidence to work with children. The aim of the pack was to serve as a tool kit with suggestions and ideas on how to work with children, as well as provide information on the developmental stages of children and how they are impacted by brain injury. Targeted population and stakeholders: The resource pack was for all members of the Brain Injury Programme interdisciplinary team in the NRH, both inpatient and outpatient. There are 4 brain injury wards in the NRH, which adds up to 57 patients at any one time. The number of physios, occupational therapists, speech and language therapists, social workers and nursing staff averages 70. The resource pack also included fact sheets to be administered to patients and their families. Timeline: The timeline for the production of the pack was 5 months, with a review of outcomes scheduled for 6 months following its distribution. Highlights: Research has shown that children with brain injured parents can have significantly more emotional and behavioural problems than children in the general population. Involving child relatives in the rehabilitation process impacts on their adjustment and consequently has a positive impact on the whole family. Including child and family centred goals in a rehabilitation programme can help an injured parent’s programme to be more helpful on a practical level as well as helping the non-injured parent learn how to deal with their child’s adjustment to the brain injury. Following a pilot release of the resource pack, outcomes will be measured in autumn 2017, with a view to making any changes necessary. Sustainability: Although a review of the effectiveness of the pack has yet to be undertaken, the notion of helping staff to be more family focussed has been evidenced in the literature as having positive outcomes for patients and therefore is a focus which should be encouraged and maintained in the NRH brain injury programme. Transferability: It is hoped that while this resource pack was initially targeted towards NRH staff on the brain injury programme, it could be transferable to brain injury rehabilitation teams across Ireland. It is also hoped that in the future the pack could be adapted for the spinal injury programme. Conclusions: The resource pack represents a move toward child and family focussed rehabilitation, which has been shown to have a positive impact on both patients and families. It is also a useful tool for members of the interdisciplinary team, enhancing their skills and confidence when working with child relatives. Discussions: The recognition of the impact of brain injury on child relatives will have benefits in supporting families as a whole and should help to reduce the negative impact of brain injury on children. Lessons learned: A review of the impact of the resource pack will be important to ascertain its benefits and problems, and if it should be adapted or adjusted. The importance of including this neglected population of children is a welcome development within the NRH.