Physical Medicine and Rehabilitation in Minnesota

The Brain Injury Outpatient Program

Program Requirements
People who take part in the Brain Injury Outpatient Program must be able to:

• Move independently, using a wheelchair, walking aid or similar device if needed
• Manage bowel and bladder needs
• Demonstrate functional communication skills
• Show some carryover of new learning from day to day
• Manage themselves over the lunch hour when supervision is not available

To make sure that people meet these requirements before entry into the program, members of the professional team review medical records and evaluate potential program participants.

Coming to Mayo Clinic for an Evaluation
People who may benefit from the Brain Injury Outpatient Program come to Mayo for a two-day evaluation. This visit gives the person with brain injury and family members a chance to meet the professional team. When required, a neurologist, neuropsychiatrist, chemical dependency specialist or other professional takes part in the evaluation.

The evaluation ends with a conference that involves the professional team, the person with brain injury, family members, and other involved people. At this conference, the team presents its findings and makes recommendations for treatment. Recommendations may include admission to the Brain Injury Outpatient Program or other brain rehabilitation services or programs.

Potential participants who come to Mayo for an evaluation are responsible for themselves during the two-day evaluation process. Between appointments, Mayo does not provide direct supervision. It is best for the person with brain injury to attend the evaluation with a family member or other supportive person.

Setting and Meeting Goals
As soon as they enter the Brain Injury Outpatient Program, participants are assigned a team leader. Together with the program participants, team leaders develop a treatment plan. That plan includes long-term and short-term goals.

Weekly meetings with team leaders provide time to discuss participants' progress and related issues. In addition, the professional team holds formal conferences every two weeks to review short-term goals and measure progress towards long-term goals.

Through group activities and individual meetings with therapists, participants practice skills needed to meet their goals.

Numbers are small; only three to seven people take part in the program at any one time.

The length of stay is based on individual progress. After two months, the professional team schedules a family conference to decide whether the person with brain injury is benefiting. People usually stay in the Brain Injury Outpatient Program for six months.

Program Schedule
The program meets Monday through Friday from 8:30 a.m. to 2 p.m. in group sessions. Topics for these sessions include:

• Orientation — planning and organizing the day's activities or personal schedule
• Thinking skills — building attention, memory and problem-solving skills and compensation techniques
• Social and emotional skills — improving personal adjustment, social behavior and self-awareness through role playing and group interaction
• Communication skills — practicing reading, writing, speaking and listening skills needed for daily life
• Health skills — learning fitness, nutrition and other health habits
• Life skills — practicing skills for independent living and applying those skills in community activities
• Job skills — exploring work interests and preparing for a job in the community

Additional time is scheduled for individual activities based on personal needs. These activities may include:

• Physical, occupational or speech therapy
• Individual, family or marriage counseling
• More activities to build thinking, social, communication, health, life and job skills

Community Support
The Brain Injury Outpatient Program works with many community agencies to help people apply skills learned in the program. The professional team may refer program participants to:

• The Ability Building Center (ABC), which helps people prepare for jobs, find jobs and succeed at work
• The Southeastern Minnesota Center for Independent Living (SEMCIL), which offers training, support groups and peer mentors
• Abilities Unlimited, a structured day program
• State agencies for vocational rehabilitation
• Local education and social service agencies
• Assisted living facilities

Housing and Transportation
Because the Brain Injury Outpatient Program takes place during weekdays, people in the program must find local housing and transportation. The program's clinical social worker can help. Options include rooming houses, hotels, adult foster care homes, and assisted living facilities.

Outcomes
From 1988 through 1998:

• 113 people entered the Brain Injury Outpatient Program
• 96 people completed the program
• Those who completed the program met 81 percent of their major goals

Since 1988, Mayo Clinic has contacted participants one year after completing the program to find out how they are doing. Of those participants who completed the program, Mayo Clinic has found that one year after the program:

• 72 percent lived with complete independence
• Another 23 percent lived with limited support — for example, in a group home or foster care
• Only 5 percent required 24-hour supervision
• 39 percent were independently employed in the community
• 10 percent were in education or training in the community
• 18 percent were in supported or volunteer employment in the community
• 6 percent were in sheltered employment
• 27 percent were unemployed