Behavioral strategies for assessing and promoting community readiness in brain injury rehabilitation

Abstract

Individuals with acquired brain injuries often display problematic behaviors, such as impulsivity, disinhibition, lack of initiation, isolation, and aggression, that impact their readiness to return to home and/or the community. The occurrence and treatment of these behaviors is often complicated by impairments in cognition and self-awareness, as well as by co-occurring issues including substance abuse. Community reintegration for these individuals is a goal that can be both hazardous and difficult to attain. This article briefly reviews the literature and describes a treatment philosophy and methodology by which an interdisciplinary team can employ evidence-based behavioral principles and procedures to assess and promote behavioral stability toward the goal of community readiness within a residential rehabilitation setting. Assessment includes a comprehensive evaluation of individual strengths and barriers across all disciplines as well as an analysis of the function of problematic behaviors. Based upon these assessments and analyses, integrated interdisciplinary treatment efforts then support the development and implementation of specific strategies and tools to promote community readiness and ultimately reentry. These strategies and tools are intended to provide direction and support to the client and include prompts and cues to self-manage, as well as ways to assist clients and staff to collect and reflect upon relevant data. Additionally, other methods of data collection, techniques to develop self-management skills, and the use of contingencies as part of a community reentry plan are discussed.