BrICC CASE PORTFOLIO CLIENT (Dx, age, primary concern) INTERVENTION VARIABLES OUTCOME MEASUREMENT Cognitive Domain Functional Domain Approach Check all that apply; fill in the blanks with specific approach where indicated How to measure progress in the session Note: Standardized tests may be used pre/post if intervention was impairment-based. How to measure generalization or impact on daily life Specify what the client or caregiver is tracking or rating where indicated by blank lines GIAD ABI (tumor removal) Male 30 Attention Orientation Memory Executive Function Problem Solving Self-Awareness Academic: Reading Writing Note-taking Attending to lecture Homework completion Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Other academic strategy instruction Computer-based prompting for writing Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at _________________ Tracking filled out by client: _________________ Tracking sheet filled out by caregiver: independent task completion and calendar use Self-rating scale:
Other Functional Domain: necessary for returning to school Environmental modification: Other: MANO Multiple concussions Male 15 Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other: tolerating being in class for a longer time Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning: leisure activities DAT w/strategies Metacognitive strategy instruction: strategy resource for maintaining focus in classroom SRSD for writing Other academic strategy instruction Computer-based prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at demonstrating knowledge and use of strategies in session _________________ Number of correct information units recalled Self-rating scale: _________________ Tracking sheet filled out by client: time able to focus in class (GAS); use of strategies Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________ Other: _________________
Vocational: Job task completion Speed/Accuracy of performance Other: writing book of short stories Other Functional Domain: _________________ Psycho-educational support/counseling Environmental modification: Other: _________________ SCCY Concussion 58 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Other academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition performed accurately during probe using systematic instruction Time to complete task Accuracy at _________________ Number of correct information units recalled Self-rating scale: _________________ Tracking sheet filled out by client: _________________ Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________
Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion of performance Other Functional Domain: _________________ Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: _________________ Videofeedback _________________ Psycho-educational support/counseling Environmental modification: Other: _________________ _________________ Other: _________________ OHRO Concussion Attention Academic: Reading Writing DAT w/strategies Steps performed accurately during Tracking sheet filled out by client:
35 Female Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms (nausea) Behavioral health Increasing social/community functioning Self care (physical activity) Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Metacognitive strategy instruction: increasing daily activities—"pause, identify barriers, identify solution, complete task” SRSD for writing Other academic strategy instruction Computer-based prompting for writing External aid training:/Assistive Technology for Cognition (audio recorder for task completion & general memory of events and dreams) Functional skills instruction: Spaced Retrieval Training probe using systematic instruction Time to complete task Accuracy at: understanding and use of metacognitive strategies Number of correct information recalled Self-rating scale: _________________ Other: number of job sessions per week (GAS) Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________ Other: Increase in amount of work and tolerance of physical activity (impact measure)
Parenting Scheduling Other_________________ Vocational: Job task completion (sessions per week) Speed/Accuracy of performance Other Other Functional Domain: _________________ GMT Social communication intervention: _________________ Videofeedback _________________ Psycho-educational support/counseling Environmental modification: _________________ LELI ABI (ruptured aneurysm) 43 Attention Orientation Memory Executive Function Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Steps performed accurately during probe using systematic instruction Time to complete task Tracking sheet filled out by client: reading Tracking sheet filled out by caregiver: _________________
Problem Solving Self-Awareness Social Communication Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care (medications and activities of living) Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Other academic strategy instruction Computer-based prompting for writing External aid training:/Assistive Technology for Cognition (systematic instruction) Functional skills instruction: Spaced Retrieval Training (and Systematic Instruction) GMT Social communication intervention: _________________ Videofeedback Accuracy at _________________ Number of correct information units recalled Self-rating scale: _________________ Other: _________________ Self-rating scale: Direct Observation: _________________ _________________ _________________
Job task completion Speed/Accuracy of performance Other Functional Domain: _________________ _________________ Psycho-educational support/counseling Environmental modification: Other: _________________ WIRI Parkinson’s disease 86 Male Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ DAT w/strategies Metacognitive strategy instruction: comprehending and remembering information gained through reading through PQRST approach SRSD for writing Other academic strategy instruction Computer-based prompting for writing Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at understanding strategies Number of correct information recalled Self-rating Tracking sheet filled out by client: _________________ Tracking sheet filled out by caregiver: use of strategies and external aid Self-rating scale: Direct Observation: _________________
Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: _________________ External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: _________________ Videofeedback _________________ Psycho-educational support/counseling Environmental modification: _________________ Other: _________________ _________________ Other: _________________
Other: _________________ YOAL TBI 4 years ago 16 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Other academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at _________________ Number of correct information units recalled Self-rating _________________ _________________ Tracking sheet filled out by client: _________________ Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________ Other: _________________
Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: _________________ Social communication intervention: role plays Videofeedback _________________ Psycho-educational support/counseling Environmental modification: Other: BARU CVA (secondary to surgery) 76 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition DAT w/strategies Metacognitive strategy instruction: self-monitoring and self-regulation SRSD for writing academic strategy instruction Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at demonstrating knowledge and Tracking sheet filled out by client: conversation practice at home Tracking filled out by caregiver: _________________ Self-rating 1-5 scale of communicative success at home
_________________ Environmental modification: DUAL Multiple concussions 23 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ DAT w/strategies Metacognitive strategy instruction: reading comprehension (CampusReader) _________________ SRSD for writing Other academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at knowledge and use of metacognitive strategies _________________ Number of correct information recalled Self-rating scale: _________________ Tracking filled out by client: Increasing time able to read (GAS) Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ Other: _________________
Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: _________________ Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback _________________ Psycho-educational support/counseling Environmental modification: Other: Other: _________________ RATI TBI, drug use 47 Female Attention (ADHD) Orientation Academic: Reading Writing Note-taking Attending to lecture DAT w/strategies Metacognitive strategy instruction: Steps performed accurately during probe using Tracking sheet filled out by client: calendar “bloopers”
Memory (prospective and delayed) Executive Function Problem Solving Self-Awareness Social Communication Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores & organized house) Shopping/Errands Parenting SRSD for writing academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition (calendars) Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback systematic instruction Time to complete task Accuracy at completing calendar steps and setting reminders for events _________________ Number of correct information units recalled Self-rating scale: _________________ Other: GMT homework modules Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ Other: pre-post scores on functional activity subtest of BRIEF; GMT homework completion _________________
Scheduling (work schedule, remaining employed) Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Functional Domain: _________________ _________________ Psycho-educational support/counseling Environmental modification: Goal Management Training (impairment-based, across contexts and activities) SASO Multiple concussions 15 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Other academic strategy instruction Computer-based prompting for writing Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at knowledge and use of strategies Tracking sheet filled out by client: Ability to Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation:
Communication Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: _________________ External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback _________________ Psycho-educational support/counseling Environmental modification: Number of correct information units recalled Self-rating _________________ Other: _________________ _________________ _________________ _________________
Other: FRJA Cerebral infarction 77 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning: navigating Safari and Google sheets Self care Other_________________ Community/Home: Transportation Recreation DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Other academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Steps performed accurately during probe using systematic instruction Time to complete task (navigating to complex websites) Accuracy at navigating to complex websites _________________ Number of correct information units recalled Self-rating scale: _________________ Other: _________________ Tracking sheet filled out by client: Number of searches Tracking sheet filled out by caregiver: _________________ Self-rating scale: time to complete searches, confidence rating Direct Observation: _________________ _________________ Other: _________________
Social Communication Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: Computer-based prompting for writing External aid training:/Assistive Technology for Cognition: calendar reminders Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback _________________ Psycho-educational support/counseling Number of correct information recalled Self-rating _________________ Other: _________________ Direct Observation: _________________ _________________ _________________
Executive Function Problem Solving Self-Awareness Social Communication Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care focusing on and maintaining tasks despite noise Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ SRSD for writing Other academic strategy instruction Computer-based prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback Time to complete task Accuracy at: knowledge and use of metacognitive strategies (e.g., steps, purpose) Number of correct information recalled Self-rating scale Other: _________________ Tracking sheet filled out by caregiver: _________________ Self-rating scale: 0=always distracted; 5=never distracted (GAS) Direct Observation: _________________ _________________ _________________
Vocational: Job task completion Speed/Accuracy of performance Other Functional Domain: _________________ _________________ Psycho-educational support/counseling Environmental modification: Other: SPHU Concussion 18 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms DAT w/strategies Metacognitive strategy instruction: reading comprehension (individualized; based on CampusReader computer program) SRSD for writing Other academic strategy instruction Computer-based prompting for writing Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at knowledge and use of metacognitive strategies Number of correct information units recalled Self-rating scale: Tracking g sheet filled out by client: Metacognitive strategy usefulness Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________
Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: _________________ External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback _________________ Psycho-educational support/counseling Environmental modification: _________________ Other: _________________ Other: rating scale of usefulness
Other: CASA Concussion 15 Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other: recalling classroom content; studying for tests Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation DAT w/strategies Metacognitive strategy instruction: internal memory strategies SRSD for writing Other academic strategy instruction Computer-based prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at _________________ Number of correct information units recalled Self-rating scale: strategy use _________________ Other: _________________ Tracking sheet filled out by client: Frequency of metacognitive strategy use Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________ Other: _________________
Bill paying: Cooking management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: _________________ Social communication intervention: Communication Partner Training Videofeedback _________________ Psycho-educational support/counseling Environmental modification: WEKA TBI sustained in MVA 19 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition DAT w/strategies Metacognitive strategy instruction: strategies for emotion regulation SRSD for writing Other academic strategy instruction performed accurately during probe using systematic instruction Time to complete task Accuracy at knowledge and use of strategies Tracking sheet filled out by client: _________________ Tracking sheet filled out by caregiver: _________________ Self-rating scale:
Social Communication Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other: managing medications Vocational: Job task completion Speed/Accuracy of performance Other Functional Domain: Computer-based prompting for writing External aid training:/Assistive Technology for Cognition: managing medications Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback _________________ Psycho-educational support/counseling Number of correct information recalled Self-rating scale: _________________ Other: _________________ Direct Observation: use of strategies in practice _________________ Other: _________________
_________________ Environmental modification: WHST ABI (tumor removal) 76 male Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Other: (language) Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ DAT w/strategies Metacognitive strategy instruction: planning and executing daily activities; and SRSD for writing Other academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at: use of strategies for word-finding difficulties Number of correct information units recalled Self-rating scale: _________________ Other: Tracking sheet filled out by client: Independent completion of functional daily tasks Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________
GIAR Concussion 14 Female Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other: comprehending spoken classroom instruction Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: DAT w/strategies Metacognitive strategy instruction: self-monitoring and self-regulation for increasing concentration in the classroom; listening comprehension strategies for synthesizing/making meaning of classroom content SRSD for writing academic strategy instruction Computer-based prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at knowledge and use of strategies during structured conversations and scenario-based roleplays Number of correct information units recalled Self-rating scale: _________________ _________________ Tracking sheet filled out by client: Self-monitoring in Tracking sheet filled out by teacher: comprehension demonstrated on personalized writing prompts (1-5) Self-rating scale: Direct Observation: _________________ _________________ _________________
Cooking management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Functional Domain: _________________ Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback _________________ Psycho-educational support/counseling Environmental modification: Other: YWCG (DUAL, 23 & WIKA, 24) Concussion Female Attention Orientation Memory Executive Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Steps performed accurately during probe using systematic instruction Tracking sheet filled out by client: _________________ Tracking sheet filled out by caregiver:
Function Problem Solving Self-Awareness Social Communication Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms (anxiety, integrating back into previous life roles, building and advocacy) Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking management Household chores Shopping/Errands Parenting Scheduling academic strategy instruction Computer-based prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: Communication Partner Training Videofeedback _________________ Time to complete task Accuracy at _________________ Number of correct information units recalled Self-rating scale: _________________ Other: qualitative data (recovery statements, areas of need) _________________ _________________ Self-rating scale: Direct Observation: _________________ _________________ Other: HBI, PCSS, clinician-created rating scales of emotional regulation and social interaction _________________