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Category: Division of Neuropsychology
Clinical Neuropsychology and Rehabilitation Services for Adults with Acquired Brain Injury (2004)
Clinical Neuropsychology and rehabilitation services for adults with acquired brain injury
Executive summaryIn 1989 the British Psychological Society proposed a model of services for people with acquired brain injury (BPS, 1989). Since publication of that document, a number of other reports on the management and rehabilitation of people with acquired brain injury have been published and considerable advances have taken place in our scientific understanding of rehabilitation following brain injury. There have been developments in service provision, but we suggest that service provision remains patchy across the UK and does not yet fully meet the needs of people with acquired brain injury. We identify a number of reasons why comprehensive acquired brain injury services have not been established in a consistent manner across the UK.
The reasons include:
- the wide range of potential needs of people with brain injury;
- a lack of specialist knowledge and skills;
- the needs of people with brain injury can fall between the criteria for currently established services;
- a lack of effective coordination of services between agencies and lack of inter-agency planning.
We outline a comprehensive service model, based on proposals by McMillan (2003) and Herbert (2004). The model has a network of services designed to meet the wide range of potential needs of people with an acquired brain injury. We make the following recommendations, which are consistent with many of the recommendations made in the report of the House of Commons health select committee’s (2001) inquiry into head injury rehabilitation:
- We recommend that all health authorities identify a brain injury service network, with care pathways between elements of the network, to ensure that people with acquired brain injury can move through the system as smoothly as is possible. It is recognised that there will be a wide range of possible pathways because of the huge range of potential needs of people who have suffered brain injury and hence an integrated network of services is required.
- It is imperative that people with a suspected brain injury are assessed and treated by specialist rehabilitation staff as soon as possible after medical stabilisation. We recommend that early management and rehabilitation wards are established for those people staying in hospital more than 48 hours.
- We recommend that specialist facilities should be identified in the service network to provide rehabilitation for those patients with high levels of physical dependency, those who are minimally responsive or those who present with severe challenging behaviour.
- We recommend that the central component of the post-acute community rehabilitation service should be a non-residential community brain injury rehabilitation centre, housing a community brain injury rehabilitation team. This centre would provide day rehabilitation programmes, community treatment interventions, provide a minor head injuries service as well as providing an information resource for families and carers.
- We recommend that there is more effective integration of community brain injury rehabilitation teams and vocational rehabilitation services. Where possible, we believe it would be optimal for a job coach or employment facilitator to be based within the community brain injury centre, working as part of the rehabilitation team.
It is recognised that within local areas various aspects of service will already be provided, but that there will be gaps. It is proposed that by reconfiguring existing provision identified needs may often be met more effectively, without necessarily requiring significant additional funding, though in some cases major gaps in service provision may exist, requiring new investment. Since the previous BPS report, there have also been a number of developments in the training of clinical neuropsychologists in the UK. We therefore also discuss in this report the specific contribution that is, or could be, played by clinical neuropsychologists within brain injury rehabilitation services.
The tasks undertaken by clinical neuropsychologists include:
- assessment of cognitive functioning;
- assessment of mood and emotion;
- treatment and management of cognitive impairment;
- treatment of mood disorder;
- management of behaviour problems;
- education for relatives, carers and other professionals on brain injury and its consequences;
- research and audit - for example, evaluations of outcome of rehabilitation.
With regard to research, it is noted that the House of Commons health select committee report (2001, para. 41) recommended that the Department of Health allocates more of the R&D budget to research into traumatic brain injury rehabilitation. Clinical neuropsychologists are at the forefront of research in brain injury rehabilitation. Nevertheless, there is a great deal of potential for more research to improve our understanding of how to improve the quality of the lives of people with acquired brain injury.
Commisioning Child Neuropsychology Services Document (added 7th August 2006)
This document addresses the following issues
1. What do child neuropsychologists do?
2. Who are child neuropsychologists?
3. How many child neuropsychologists do you need and at what grade?
4. How do child neuropsychologists fit in to other services?
5. What do child neuropsychologists need?
6. What happens if you do not have a child neuropsychologist?
7. Who manages child neuropsychologists?
8. How do you ensure quality services from child neuropsychology?
Commissioning Clinical Neuropsychology Services (added June 2004)
This document addresses the following questions.
1. What do clinical neuropsycologists do?
2. Who are clinical neuropsychologists?
3. How many clinical neuropsychologists do you need and at what grade?
4. How do clinical neuropsychologists fit in to other services?
5. What do clinical neuropsychologists need?
6. What happens if you do not have a clinical neuropsychologist?
7. Can other professions carry out these roles?
8. Who manages clinical neuropsychologists?
9. How do we ensure that we get good service from our clinical neuropsychologist?
Division of Neuropsychology Professional Practice Guidelines (added August 2003)
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