Services – NeuroBehavioral Rehabilitation
CareOne Massachusetts NeuroBehavioral Rehabilitation provides services to individuals with the following conditions:
At CareOne Massachusetts, our experienced Healthcare Professionals coordinate their efforts to meet the specific goals of each Resident. All Staff is trained in approach styles, behavioral care plans, and therapeutic interventions that limit behavioral disturbances often associated with brain injury or disease, and all Residents are maintained on dynamic levels of supervision to assure safety. Our own behavior data collections system captures weekly group attendance and participation, Activities of Daily Living (ADL’s) completion and frequency of behavioral disturbances. Therapeutic community outings are provided as well as facility and community-based AA and NA meetings if appropriate.
For more information about our Neurobehavioral Rehabilitation services, please contact us directly at: 1-800-811-3535.
The most important feature at CareOne Massachusetts NeuroBehavioral Rehabilitation is our dedicated, professional Staff who recognize the importance our Residents place on staff responsiveness and competencies. At CareOne Massachusetts NeuroBehavioral Rehabilitation, we are committed to a Culture of Excellence that offers unparalleled service, unsurpassed in the industry.
About our Interdisciplinary Team:
Our Interdisciplinary Neurobehavioral Team (IDT) includes but goes well beyond traditional PT, OT, and SLP models, adding:
• In-house masters-level therapists
• Masters-level case managers/social workers
• Certified Brain Injury Specialists (CBIS), under the auspices of the Brain Injury Association of America/BIAA
• Group Leaders, Therapeutic Specialists, and Therapeutic Assistants
• Weekly consulting regional neuropsychiatrist and neuropsychologist, employing principles of behavior-analytic neuro-psychopharmacology and neuropsychological rehabilitation, respectively
• A robust and unique Therapeutic Services Department run by both a Program Director and Assistant Program Director, with departmental staff well exceeding typical SNF standards – typically this is groups each in the AM & PM, 1 optional leisure activity in the evening, and 3-4 leisure activities available on weekends; for those able and where indicated, individual counseling and/or brief therapeutic encounters are also scheduled daily/weekly as needed
• Enhanced Supervision, as participants with cognitive impairments and behavioral disturbance require varying degrees of guidance, cueing, re-direction, re-approaching, supervision, teaching/teachable moments, reinforcement, calming, and de-escalation through the course of a typical day.
Program services vary by Center and each Center has mulitple “tracks of care” based on clinical presentation and severity of impairments, but all include core components.
About the core components of our program:
In addition to standard, required, SNF-based admission assessments that include metrics on categories such as Vital Signs, skin integrity, fall risk, brief mental status, and overall ROS/Review of Systems, the individualized program schedule of therapeutic groups and individual therapies is developed based upon enhanced pre- and post-admission assessments performed by the neurobehavioral IDT, and include:
• Expanded taking of a biopsychosocial history
• Elaborated Mental Status Exams
• Community Skills Assessments
• Safe Smoking and other modified risk assessments (if applicable)
• Mood & Psychiatric inventories
• Mayo-Portland Adaptability Inventory – 4th Edition (MPAI-4)
• Neuro/psychological testing upon referral.
Our sensitive, effective neurobehavioral care planning takes into consideration much more than the traditional A-B-C (antecedent-behavior-consequence) behavior-analytic paradigm: we consider developmental, neurobiological, motivational, and broader, culturally-informed psychosocial factors, ensuring our shared objectives are reasonable for both the Resident and the support staff.
Our ADL re/training, cueing, reinforcement, and supervision, program is supported by an ADL recording system that encourages optimal self-sufficiency.
Our behavior data collection system allows us to identify patterns and circumstances of problematic behaviors: who, what, where, when, why information is recorded; e.g., if Johnny develops a pattern of yelling at Mary at 3:07 in the 2nd floor day room on Mondays because he mistakes her appearance for an incoming afternoon shift nurse from a previous placement he didn’t like, we will have the data to support it!
Perhaps the greatest impact on promoting positive behavior is our Point Reward program, which sets an integrative motivational framework: routine, structure, support, teaching, and tangible as well as positive social reinforcement for engagement in healthy, productive, leisure and therapeutic activities. The points reward program is based upon the following three metrics: ADLs/self-care completion, therapeutic and leisure participation percentage, and aberrant behaviors, and sourced from a token economy model. The Points Store is coordinated by the program, using elements of the Resident Council and the Pre-Vocational program, to teach money management, community skills/shopping, stocking and inventory, customer service, record keeping, etc.; Resident’s attend the Resident Council and select/vote on what they would like to have stocked in the Points Store; these typically include assorted sundries, batteries, clothing, Dunkin Donuts gift cards, $10 towards ordering out on a Friday night, etc.
As with all other health care entities, discharge planning starts upon, if not before, admission. The goal is to engender a transfer back to community of origin as soon as neurobehavioral and/or neuropsychiatric stability has been continually established, and/or the Resident is at their rehabilitative end-point. Having had multiple, often exhaustive denial lists for placement prior to arriving, the best sign of discharge readiness is when our referrals to eligible programs and placements now lead to a “clinical accept”.