Poster 3: Comparing 2 Ontario Models of Community-Based Acquired Brain Injury Service Provision

Abstract

Objective: To compare outcomes for persons with acquired brain injury living in and around 2 small cities in Ontario, Canada, who are receiving publicly funded community services. Design: Repeated-measures face-to-face instrument administration by an independent research assistant at baseline, 1 year, and 2 years. Setting: Private homes in cities and surrounding rural areas. Participants: Adults with acquired brain injury and a designated family member, if available. Interventions: In 1 city, a specialized multidisciplinary team provides rehabilitation services directly to clients (acquired brain injury team). This team only provides service to acquired brain injury clients. The caseload is about 30 to 40 clients and is shared by the team. In the second city, a nurse case manager allocates contracted services to clients according to their support needs (generic service). The case manager and care providers work with a broad spectrum of clients and are not specialists in acquired brain injury. The caseload is about 120 clients and is the sole responsibility of the nurse case manager. Main Outcome Measures: Productivity status, Mayo-Portland Adaptability Index, Disability Rating Scale, 36-Item Short-Form Health Survey, version 2, Community Integration Questionnaire, Community Integration Measure, Burden Assessment Scale, goal attainment scaling, and family and client satisfaction with services. Results: 1-year follow-up data (n=42) indicate that both groups improved their community integration and showed expected improvement toward individual goal achievement. The acquired brain injury team clients showed improvement in health status and were more satisfied with the provided services over 1 year when compared with the generic service clients. Generic service clients showed a decrease in functioning and in health status over 1 year when compared with acquired brain injury team clients. 2-year follow-up data (n=30) are consistent with the 1-year data. Conclusions: It appears that specialized multidisciplinary teams are effective for meeting rehabilitation goals for acquired brain injury clients living in the community. Generic services are able to maintain clients in the community but they may experience some decline in functioning and health status.