ATU654 – Brain Injury Resource Facilitation with Amy Miller

Hi. This is Amy Miller, and I’m the director of the brain injury resource facilitation program at Easterseals Crossroads, and this is your Assistive Technology Update.

Hello and welcome to your Assistive Technology Update, a weekly dose of information that keeps you up-to-date on the latest developments in the field of technology designed to assist individuals with disabilities and special needs. I’m your host, Josh Anderson with the INDATA Project with Easterseals Crossroads in beautiful Indianapolis, Indiana. Welcome to episode 654 of Assistive Technology Update. It is scheduled to be released on December 8th, 2023.

On today’s show we’re super excited to welcome Amy Miller, the director of the Resource Facilitation Program here at Easterseals Crossroads. She’s here to tell us all about the program and the folks that they serve.

Don’t forget, folks, if you ever want to reach us, if you have an idea for a guest or a story you’d like to hear, or a comment, a question, anything at all, please do reach out. You can email us at tech@eastersealscrossroads.org. You can also call our listener line at 317-721-7124. For right now, let’s go ahead and get on with the show.

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Listeners, on today’s show we have Amy Miller from our Resource Facilitation Program here at Easterseals Crossroads. While the program is a little new to Crossroads, it’s been around for a while, and it’s there to really help individuals affected by traumatic brain injury in many different ways. The programs collaborate a lot, and I thought that it would be great to have her on the show so that we can all learn a little bit more about her and this wonderful program. Amy, welcome to the show.

Thank you. Thanks for having me.

Yeah. Yes, yes. I’ve been wanting to do it for a while, just haven’t had the time, but it finally caught up with me. So before we get into it, kind of talking about Resource Facilitation and everything, could you tell our listeners a little bit about yourself?

Sure. So I’ve worked in brain injuries for about eight years. I worked at the Rehabilitation Hospital of Indiana before Easterseals Crossroads. That’s where Resource Facilitation was housed at that point.

My background is in mental health counseling and harm reduction. I previously worked with HIV positive clients and those with substance abuse challenges. I’ve been a trainer and consultant for many years in motivational interviewing, client centered services, and also more recently certifying providers as brain injury specialists.

Awesome. There’s a lot of things I would like to dig into that, but we really have you here to kind of learn about Resource Facilitation. But I think maybe we should start with just maybe some kind of background on brain injury. Can you tell us just, I don’t know, kind of the 30,000 foot view, a little bit about kind of brain injury?

Sure. So brain injury is a relatively new field that… We haven’t really been researching the brain all that long, maybe since the 1960s, when they started getting imaging, we started getting a lot more sophisticated in diagnosing brain injuries.

We work with what we call acquired brain injury. Acquired brain injury is a chronic condition, so while the consequences and disability may fluctuate, it really needs to be managed throughout the lifespan.

Acquired brain injury includes traumatic brain injury, which traumatic brain injury is the result of an outside force to the head. So things like assault, auto accidents, falls, forced injury, things like that are traumatic brain injuries. However, we also work with people who’ve had strokes, people who have had brain infections and brain surgeries after cancer diagnosis, and then also overdose, people who have overdosed.

We work with a few people with dementia, but it’s not that common, probably because we’re funded by vocational rehabilitation, so it’s not common for those with dementia to be looking to get back into work. We also have some clients that were born with brain disorders, but we don’t work with a lot of those either.

Amy, what are maybe some of the kind of ways that a brain injury can affect an individual? And I know it’s a pretty big scale, pretty big spectrum, but what are maybe some different ways that a brain injury can kind of affect someone on a daily basis during their life?

So brain injury can really be very pervasive, and one of the things Dr. Trexler… Actually he and his wife started the Resource Facilitation Program, and one of the things I love, that he always says if you ask about a brain injury, to this person that has this particular brain injury, he’ll say, “Whose brain was it in,” because it matters, the person and their experience and how their brain functions.

All of that matters, and so there can be all sorts of different consequences, physical, emotional, cognitive. So we really try to have a holistic approach, where we work with all of these different areas. So someone can have executive and function impairment, which is organization and time management, maybe decision making problems. Abstract reasoning is a problem for a lot of people with brain injuries. A lot of them have difficult concentrating.

Lack of self-awareness is something that we see a lot, which often translates into poor understanding of what their limitations are, or really what they need to help them. Meta cognition is what we call it, but it’s like thinking about thinking is often impaired. And almost everyone we see has slow processing speed to some degree.

Well, I think that kind of brings us to what is Resource Facilitation?

Resource Facilitation is a community based public health intervention. We help participants return to work or school while trying to decrease disability and increase community participation. Anyone with a brain injury receiving both rehab services in the state of Indiana could qualify for Resource Facilitation, and it’s free of charge to them.

There’s a case management component to Resource Facilitation, where we help clients navigate systems and access resources, but we’re also working to build capacity in the community, as there are many resources that are needed but not available. Everyone’s needs are different, so there’s a lot of different things we do, from identifying impairments and working to integrate vocational goals, rehabilitation goals, improving community agency linkages with a team approach, kind of drawing people in, like Assistive Technology and employment services, speech therapists, occupational therapists, all the different agencies that would be working with the a client.

One of the main things that we do too is provide accommodation to help the client function in the community and also on a job. So we provide those accommodations, but then we also train the client, their family, other providers, employers, anyone who is going to be interacting with that client, to implement those accommodations.

I know the participants kind of in this program probably come with a decent amount of kind of goals maybe that they kind of want to accomplish through Resource Facilitation. I know you mentioned some of them, but what are some of the maybe common goals that individuals kind of come to Resource Facilitation looking to accomplish?

That really is… It varies. The distal goal, of course, is returning to work or school, or maintaining employment or participation in a educational program. However, the proximate goal, the things that we work on to get them there, are much more personal and nuanced. They can really include anything that the client believes will make their lives better or help them succeed.

So improving cognitive functioning, memory processing speed, things like that. Stabilizing emotional concerns, medication management, or they may have other medical needs. Housing. It could be social in nature. Anything really that the client feels is going to help them succeed ultimately.

That’s great. I love the way that you actually treat the whole person. So many times, you know, in our clinical AT program we see folks when they’ve got that vocational goal and we’re there to assist with that vocational goal, but there’s so much more that goes into well life, but also so much more that goes into the kind of healing and growing before you get to that point, so I love that you’re able to help them. There’s so many different things around that.

You mentioned the Trexlers, who kind of started this whole program. I know part of the whole Resource Facilitation Program is the neuro vocational evaluation. Can you tell us a little bit about it?

Okay. So our neuro vocational evaluation, I believe it is one of the most important services we offer, because it guides our work with the clients. It’s our roadmap for what we’re doing, but it’s also extremely helpful to every client and those that work with them long term for long term recovery, disability management. Even if they don’t access Resource Facilitation services, if they have that report it is very helpful for them to have that information.

The report that we do is a neuro vocational evaluation, and it was actually developed by Dr. Trexler. It encompasses components of a typical neuro psychological evaluation, but it also includes specific guidance in terms of return to work or school. The scope is very broad, so we map over a range of factors that can affect return to work and work stability, and as I said, whatever needs to be addressed in Resource Facilitation.

We start with an extensive history. It is an extensive process to gather a complete history of lifetime exposure to brain injuries, cognitive and executive function issues, any kind of psycho social functioning concerns, and kind of functional capacities. We also look at somatic and sensory concerns, pain interference, health locus of control, how in control do they feel or how able are they to address some of those things, any kind of adverse childhood experiences.

I mean just everything you could imagine, drug and alcohol screening, unmet needs, the burden of family members and caregivers, what their burden looks like. All of those things are assessed in the NVE.

Wow. Nice. And then kind of how is this information used by… Let’s say that they do go into Resource Facilitation. How is this information used by the resource facilitator?

One of the things that we make sure to do… It’s very difficult because we come from a medical model, but we’re trying to provide services in a more client centered way, so our NVE has a whole list of recommendations of different services and therapies and different things that the client could access that the neuro psychologist believes is going to help them succeed, and then also a whole list of accommodations, different things that are tactics or strategies that the client can use to succeed.

But the part that requires some finesse is determining what the client’s goals are and then helping them see how those recommendations can help them achieve their goals. Those recommendations are not the client goals, but they are ways that we are trying to help them achieve the goals that they do have.

So like I said before, it’s kind of like our roadmap. It’s what we use to help them determine what can get them where they want to be, but it’s not the whole picture. We have to spend a lot of time with clients in understand… You know, we have a whole list of accommodations, for example, but if the client isn’t going to use those accommodations then they’re worthless, and so we have to go back to the drawing board. So this isn’t working for the client. What will the client do, or what can the client utilize. So it’s really a working document in a lot of ways once we start interacting with the client.

I like that. Whenever you say medical model I don’t cringe, but I always sit there and think there’s so many times that this is what you need and this is what’s going to help you and go off in the world, and in my experience that ends up with, as you said, a lot of unused things, because either it’s not what the person wants or they don’t see the value in it, and then they’re going to abandon it. And that’s true for pretty much all human beings I feel like.

So I like that you are getting those, but you’re working with the individuals to show the value and to find out just what works best for them. Because it’s kind of like you said, not only does brain injury affect us all differently, life affects us all differently. We’re all kind of see life a little bit differently as well, so I like that you do take the time to use that information, but then use the input from the individual as well, and that’s probably why you’re actually successful with a lot of those folks.

A few other things that are kind of offered through Resource Facilitation to kind of help folks is the brain injury coping skills, or BICS, and the brain injury informed psycho therapy. Can you tell us a little bit about those and how they’re able to assist individuals with brain injuries?

Sure. We’re really proud of our brain injury coping skills group, which as you said we call BICS. It’s a 15 week psycho educational group. It meets remotely, so all of the groups are virtual, which allows a lot of people to participate. It helps clients and family members better understand their injury. They gain self-management tools for alleviating the consequences of their brain injury and they learn the best ways to advocate for themselves and the accommodations which they need, which is a big deal to a lot of clients and their families.

We also collaborate, as it were, with the AT department. If tech is a barrier for someone accessing that, then we of course collaborate with AT to make sure that they can participate and they have what they need, so that’s really been a great part of being at Easterseals.

I promise I was not asking that just to get the shout out, right? So I appreciate it completely. And then the brain injury informed psycho therapy, what about that? Is that different or-

Yes. So the brain injury focused psycho therapy is also completed via Telehealth. It’s mostly a short term intervention and kind of as a bridge for people who need psycho therapeutic services in the community but they’re either not available to them or they not quite ready to access in that way.

So we have psycho therapy that is focused around the consequences of their brain injury, understanding their brain injury in the context of psychological concerns and emotional concerns that they also have. So a lot of times what we were doing is working with a client on short term basis basis while we’re looking for someone in the community that we can hand off to provide those services long term and we can consult with that provider, and if the provider is unfamiliar with brain injury we can provide that education. If they’re unfamiliar with this particular client’s concerns or brain injury we can really give them specific information on how best to work with our client.

It’s relatively new. We’re developing it more as we go, but it’s a really exciting opportunity.

Sometimes just that little bit of extra information at handoff can really, really help out on success, and just not starting over anew. I know at least for one of the folks I work with, sometimes if you have to continuously tell people the same thing over and over again it gets a little frustrating, so it’s nice to be able to kind of do that, and I’m sure you have a ton of these.

While we’ve got some time left could you maybe tell me a story or two about someone’s experiences or success with Resource Facilitation Services?

Sure. This really is hard to narrow down success stories, because there’s just so many different ways to succeed and there’s so many different ways we help people.

One of the examples that I really like to use a lot is a gentleman who was in a car accident, and he was married, he was the primary provider for the family before his injury. Afterwards his wife then became the primary provider, and she also was his primary caregiver, and also was still doing all of the chores and things around the house that she did before, so really she took a two person job and it turned into a one person job and a little bit more, because she had to then take care of him.

He had some challenges with initiation. Impaired initiation often looks like someone who’s unmotivated, and it can be infuriating for someone to… You think that they don’t know or they don’t care what’s important or what they need to do. So his wife would leave in the morning to go to work and she would say, “While I’m gone do the dishes, clean up the living room, do these things because it’s very helpful,” and he said, “Yes. I’m going to do those things. I want to do those things.” She would come home and those things were not done, and often he would just be sitting the whole day. He would really accomplish nothing the whole day.

She was very frustrated. Their marriage was in trouble over this for sure. We did some testing with him. We realized that his initiation was impaired, so he was very motivated to do these things, but he was missing the mechanism that triggered those actions. So it never occurred to him to do the dishes. There was nothing that indicated to him he should do the dishes.

So we set up some strategies. We educated them about initiation, set up strategies that he could use, and of course he was doing things to help and really improved in that way. I love that story because that is so common. But the symptoms are so infuriating to other people, and until they understand them we can work on strategies to alleviate them.

Sure. Because I’m sure just yelling at him probably didn’t work very well. Or, kind of like you said, if you don’t know what’s going on there’s no real way to work with it. I mean I’m sure she was probably just getting frustrated as can be, that he didn’t want to do it or didn’t have the motivation to do it, and that wasn’t it at all. So once you… I don’t know, once you give something a name or at least know where it is, working around it becomes, just so much of a better process I’m sure, so that’s really awesome.

Yeah. Yeah. You know we’ve worked with so many people. Recently we had a… She was a social worker before her injury. Her injury was actually an assault. She was on a date and assaulted, and it was a very serious brain injury. She had severely impaired attention and concentration, so she couldn’t organize herself to do the things she needed to do.

She couldn’t stay on task and get things done. Her bills were out of control. Everything was really out of control. And on top of that she had PTSD from this assault, so she was really struggling. Everything was triggering, and so she was really struggling with that.

We worked with her to navigate systems and get things organized, worked with her to get advocacy that she could access before because she wasn’t organized enough to access the advocacy and PTSD treatment that she needed. I’m happy to say that she’s working now in a library. She loves her job. Everything is going well. That’s just a different example, but another example of how we help people get back to it, so to speak.

Most definitely. Well, we’ve got just a few more minutes. Do you have one more? I know you said it’s hard to narrow it down, so if you’ve got one more we can still work it in.

Yeah. Sure. Okay. So there was one particular client, she was I think 18 years old, and she was in a car accident, again, and she really didn’t have a filter. She came across very rude to other people, a lot of neural behavioral type issues. So we worked… She went through BICS, and with her speech therapist we really cross-trained her. Her goal was independence, but she had no work history at all because she was 18 when she had the accident.

So we cross-trained her with her speech therapist and worked to get her to a point where she was using a strategy called stop/think/do, to the point where she was able to start volunteering. She was volunteering at different places to even determine what type of job she wanted to do or could do.

But before that she was not really able to get there because she couldn’t interact in an employment situation, whether with the public or with coworkers or supervisor, because of neural behavioral concerns.

I love how the three stories are just almost completely different needs and just the way to address them and really get folks a lot more independent first and then kind of give them just the skills and the tools to really accomplish those goals that they might have.

Amy, if our listeners kind of want to find out more, what’s the best way for them to do that?

So they can go to Easterseals’ website, which is eastersealscrossroads.org, and they can… There’s like a contact form on there that they can fill out. There also should be a QR code on the website to our community referral page, so anyone in the community… Anyone with a brain injury could fill that out, a family member could fill that out because they want more information, or even a provider in the community could fill that out for someone.

If they’re already enrolled in voc rehab they can ask their vocational rehabilitation counselor about the program and how they can get involved.

Awesome. We’ll put that information down in the show notes. Well, Amy, thank you so much for coming on today to tell us about Resource Facilitation, for letting us learn a little bit more about brain injury, and just all the great things that your program does. It really is a great partnership. We love working with you and with your folks, both on your team and those that you serve, so we really do appreciate it, and really appreciate you coming on the show today.

Thank you so much. Thanks for having me.

Do you have a question about Assisted Technology? Do you have a suggestion for someone we should interview on an Assisted Technology Update? If so, call our listener line at 317-721-7124, send us an email at tech@eastersealscrossroads.org, or shoot us note on Twitter @INDATA Project.

Our captions and transcripts for the show are sponsored by the Indiana Telephone Relay Access Corporation, or InTRAC. You can find out more about InTRAC at relayindiana.com. A special thanks to Nicole Prieto for scheduling our amazing guests and making a mess of my schedule.

Today’s show was produced, edited, hosted and thought over by yours truly. The opinions expressed by our guests are their own and may or may not reflect those of the INDATA Project, Easterseals Crossroads, our supporting partners, or this host.

This was your Assisted Technology Update. I’m Josh Anderson with the INDATA Project at Easterseals Crossroads in beautiful Indianapolis, Indiana. We look forward to seeing you next time. Bye-bye.