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Challenging Behaviours, Co-morbidities, Service Utilisation and Service Access among Community-dwelling Adults with Severe Traumatic Brain Injury: A Multicentre Study

Published online by Cambridge University Press:  14 May 2014

Grahame K. Simpson ,
Mark Sabaz ,
Maysaa Daher ,
Robert Gordon  and
Barbara Strettles
Grahame K. Simpson*
Affiliation:
Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia John Walsh Centre for Rehabilitation Research, Sydney School of Medicine, University of Sydney, Australia Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia
Mark Sabaz
Affiliation:
Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia
Maysaa Daher
Affiliation:
Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia
Robert Gordon
Affiliation:
Australian Health Services Research Institute, University of Wollongong, Australia
Barbara Strettles
Affiliation:
Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia Agency of Clinical Innovation, Sydney, Australia
*
Address for correspondence: Grahame Simpson, PhD, Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, NSW, Australia. E-mail: [email protected]
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Abstract

Objective: To examine patterns, predictors and unmet needs of service utilisation and access to mental health and/or drug and alcohol services among community-dwelling adults with severe traumatic brain injury, and compare those who displayed challenging behaviours with those not displaying challenging behaviour.

Design: Retrospective multicentre study.

Subjects: All active clients (n = 507) of the New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP) community rehabilitation teams.

Methods: Clinician-rated data were collected on client challenging behaviours, mental health and functional status, service utilisation and unmet needs. Between-groups analyses (challenging behaviour versus no challenging behaviours) were conducted to examine patterns of service utilisation and unmet needs. Predictors for service utilisation were tested by multiple linear regression.

Results: Challenging behaviours were associated with higher use of BIRP and non-BIRP services and greater levels of unmet needs. Challenging behaviour was an independent predictor of higher levels of service utilisation, in conjunction with pre- and post-injury mental health and drug and alcohol co-morbidities and geographic location. Only 15.3% of the 111 clients with challenging behaviours and co-morbid drug and alcohol problems accessed a drug and alcohol service, while another 32.4% had unmet needs for such services.

Conclusion: Challenging behaviours make an independent contribution to increased levels of service utilisation after severe traumatic brain injury.

Keywords

challenging behaviourstraumatic brain injuryservice utilisationneedsmental healthdrug and alcohol abuse
Type
Articles
Information
Brain Impairment , Volume 15 , Issue 1 , May 2014 , pp. 28 - 42
Copyright
Copyright © Australasian Society for the Study of Brain Impairment 2014 

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References

Agency for Healthcare Research and Quality. (2011). Traumatic brain injury and depression. Nashville, TN: Vanderbilt Evidence-based Practice Center.Google Scholar
Alderman, N. (2007). Prevalence, characteristics and causes of aggressive behaviour observed within a neurobehavioural rehabilitation service: Predictors and implications for management. Brain Injury, 21 (9), 891–911.Google Scholar
Alderman, N., Knight, C., & Brooks, J. (2013). Rehabilitation approaches to the management of aggressive behaviour disorders after acquired brain injury. Brain Impairment, 14 (1), 5–20.Google Scholar
Baguley, I.J., Cooper, J., & Felmingham, K. (2006). Aggressive behavior following traumatic brain injury: How common is common? Journal of Head Trauma Rehabilitation, 21 (1), 45–56.Google Scholar
Belanger, H.G., King-Kallimanis, B., Nelson, A.L., Schonfeld, L., Scott, S.G., & Vanderploeg, R.D. (2008). Characterizing wandering behaviors in persons with traumatic brain injury residing in veterans health administration nursing homes. Archives of Physical Medicine and Rehabilitation, 89 (2), 244–250.Google Scholar
Bogner, J., & Corrigan, J.D. (2013). Interventions for substance misuse following TBI: A systematic review. Brain Impairment, 14 (1), 77–91.CrossRefGoogle Scholar
Burke, B.L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71 (5), 843.Google Scholar
Coetzer, R., & Du Toit, P.L. (2001). HoNOS—ABI; A clinically useful outcome measure? Psychiatric Bulletin, 25 (11), 421–422.Google Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112 (1), 155–159.Google Scholar
Colantonio, A., Howse, D., & Patel, J. (2010). Young adults with traumatic brain injury in long-term care homes: A population-based study. Brain Impairment, 11 (1), 31–36.Google Scholar
Corrigan, J.D., Whiteneck, G., & Mellick, D. (2004). Perceived needs following traumatic brain injury. Journal of Head Trauma Rehabilitation, 19 (3), 205–216.Google Scholar
Eames, P., & Wood, R. (1985). Rehabilitation after severe brain injury: A follow-up study of a behaviour modification approach. Journal of Neurology, Neurosurgery and Psychiatry, 48 (7), 613–619.Google Scholar
Fann, J.R., Bombardier, C.H., Richards, J.S., Tate, D.G., Wilson, C.S., & Temkin, N. (2011). Depression after spinal cord injury: Comorbidities, mental health service use, and adequacy of treatment. Archives of Physical Medicine and Rehabilitation, 92 (3), 352–360.Google Scholar
Feeney, T.J., Ylvisaker, M., Rosen, B.H., & Greene, P. (2001). Community supports for individuals with challenging behavior after brain injury: An analysis of the New York State Behavioral Resource Project. Journal of Head Trauma Rehabilitation, 16 (1), 61–75.Google Scholar
Feinstein, A. (2002). An examination of suicidal intent in patients with multiple sclerosis. Neurology, 59 (5), 674–678.Google Scholar
Fleming, J., & Ownsworth, T. (2006). A review of awareness interventions in brain injury rehabilitation. Neuropsychological Rehabilitation, 16 (4), 474–500.Google Scholar
Fleminger, S., Leigh, E., Eames, P., Langrell, L., Nagraj, R., & Logsdail, S. (2005). HoNOS—ABI: A reliable outcome measure of neuropsychiatric sequelae to brain injury? Psychiatric Bulletin, 29 (2), 53–55.Google Scholar
Grafman, J., Schwab, K., Warden, D., Pridgen, A., Brown, H., & Salazar, A. (1996). Frontal lobe injuries, violence, and aggression. Neurology, 46 (5), 1231–1238.Google Scholar
Heinemann, A., Sokal, K., Garvin, L., & Bode, R.K. (2002). Measuring unmet needs and services among persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 83 (8), 1052–1059.Google Scholar
High, W.M., Gordon, W.A., Lehtnkuhl, L.D., Newton, C.N., Vandergoot, D., Thoi, L., & Courtney, L. (1995). Productivity and service utilisation following traumatic brain injury: Results of a survey by the RSA regional TBI centres. Journal of Head Trauma Rehabilitation, 10 (4), 64–80.Google Scholar
Hodgkinson, A., Veerabangsa, A., Drane, D., & McCluskey, A. (2000). Service utilization following traumatic brain injury. Journal of Head Trauma Rehabilitation, 15 (6), 1208–1226.Google Scholar
Jackson, H., & Manchester, D. (2001). Towards the development of brain injury specialists. NeuroRehabilitation, 16 (1), 27–40.CrossRefGoogle ScholarPubMed
James, A.I., & Young, A.W. (2013). Clinical correlates of verbal aggression, physical aggression and inappropriate sexual behaviour after brain injury. Brain Injury, 27 (10), 1162–1172.Google Scholar
Kelly, G., Brown, S., Todd, J., & Kremer, P. (2008). Challenging behaviour profiles of people with acquired brain injury living in community settings. Brain Injury, 22 (6), 457–470.Google Scholar
Kelly, G., & Parry, A. (2008). Managing challenging behaviour of people with acquired brain injury in community settings: The first 7 years of a specialist clinical service. Brain Impairment, 9 (3), 293–304.Google Scholar
Kelly, G., Todd, J., Simpson, G., Kremer, P., & Martin, C. (2006). The Overt Behaviour Scale (OBS): A tool for measuring challenging behaviours following ABI in community settings. Brain Injury, 20 (3), 307–319.Google Scholar
Koponen, S., Taiminen, T., Portin, R., Himanen, L., Isoniemi, H., Heinonen, H., . . . Tenovuo, O. (2002). Axis I and II psychiatric disorders after traumatic brain injury: A 30-year follow-up study. American Journal of Psychiatry, 159 (8), 1315–1321.CrossRefGoogle ScholarPubMed
Manchester, D., Hodgkinson, A., & Casey, T. (1997). Prolonged, severe behavioural disturbance following traumatic brain injury: What can be done? Brain Injury, 11 (8), 605–618.CrossRefGoogle Scholar
Marwitz, J.H., Cifu, D.X., Englander, J., & High, W.M. (2001). A multi-center analysis of rehospitalizations five years after brain injury. Journal of Head Trauma Rehabilitation, 16 (4), 307–317.Google Scholar
National Trauma Research Institute. (2012). Developing a research program to address behaviours of concern after traumatic brain injury – briefing document. Melbourne, Australia: NTRI.Google Scholar
Pickelsimer, E.E., Selassie, A.W., Sample, P.L., Heinemann, A.W., Gu, J.K., & Veldheer, L.C. (2007). Unmet service needs of persons with traumatic brain injury. Journal of Head Trauma Rehabilitation, 22 (1), 1–13.Google Scholar
Ponsford, J.L., Downing, M.G., Olver, J., Ponsford, M., Acher, R., Carty, M., & Spitz, G. (2013). Longitudinal follow-up of patients with traumatic brain injury: Outcome at 2, 5, and 10-years post-injury. Journal of Neurotrauma, 31 (1), 64–77.Google Scholar
Prang, K.-H., Ruseckaite, R., & Collie, A. (2012). Healthcare and disability service utilisation following transport-related traumatic brain injury. Brain Injury, 26 (4–5), 441–442.Google Scholar
Price Waterhouse Coopers. (2012). A joint agency ABI challenging behaviour intervention and support service: feasibility study. NSW, Australia: Department of Family and Community Services.Google Scholar
Rao, V., Rosenberg, P., Bertrand, M., Salehinia, S., Spiro, J., Vaishnavi, S., . . . Miles, Q.S. (2009). Aggression after traumatic brain injury: Prevalence & correlates. Journal of Neuropsychiatry and Clinical Neurosciences, 21 (4), 420–429.Google Scholar
Rappaport, M., Hall, K.M., Hopkins, K., Belleza, T., & Cope, D.N. (1982). Disability rating scale for severe head trauma: Coma to community. Archives of Physical Medicine and Rehabilitation, 63 (3), 118–123.Google Scholar
Sabaz, M. (2010). NSW Brain Injury Rehabilitation Program Challenging Behaviour Project: Adults. Using the analysis of prevalence, course, co-morbidity and burden to inform the model of care. Sydney, Australia: NSW Agency for Clinical Innovation.Google Scholar
Sabaz, M., Simpson, G.K., Walker, A.J., Rogers, J.M., Gillis, I., & Strettles, B. (2014). Prevalence, comorbidities, and correlates of challenging behavior among community-dwelling adults with severe traumatic brain injury: A multicenter study. Journal of Head Trauma Rehabilitation, 29 (2), E19–30.Google Scholar
Simpson, G., Simons, M., & McFadyen, M. (2002). The challenges of a hidden disability: Social work practice in the field of traumatic brain injury. Australian Social Work, 55 (1), 24–37.Google Scholar
Simpson, G., & Tate, R. (2007). Suicidality in people surviving a traumatic brain injury: Prevalence, risk factors and implications for clinical management. Brain Injury, 21 (13–14), 1335–1351.Google Scholar
Simpson, G.K., Sabaz, M., & Daher, M. (2013). Prevalence, clinical features, and correlates of inappropriate sexual behavior after traumatic brain injury: A multicenter study. Journal of Head Trauma Rehabilitation, 28 (3), 202–210.Google Scholar
Sloan, S., Winkler, D., & Callaway, L. (2004). Community integration following severe traumatic brain injury: Outcomes and best practice. Brain Impairment, 5 (1), 12–29.Google Scholar
Teasdale, G.M. (1995). Head injury. Journal of Neurology, Neurosurgery and Psychiatry, 58 (5), 526–539.Google Scholar
Todd, J., Loewy, J., Kelly, G., & Simpson, G. (2004). Managing challenging behaviours: Getting interventions to work in nonspecialised community settings. Brain Impairment, 5 (1), 42–52.Google Scholar
Turner-Stokes, L., & Nyein, K. (1999). The Northwick Park Care Needs Assessment (NPCNA): A directly costable outcome measure in rehabilitation. Clinical Rehabilitation, 13 (3), 253–267.CrossRefGoogle ScholarPubMed
Willemse-van Son, A.H., Ribbers, G.M., Stam, H.J., & van den Bos, G.A. (2009). Is there equity in long-term healthcare utilization after traumatic brain injury? Journal of Rehabilitation Medicine, 41 (1), 59–65.Google Scholar
Winkler, D., Sloan, S., & Callaway, L. (2010). People under 50 with acquired brain injury living in residential aged care. Brain Impairment, 11 (3), 299–312.CrossRefGoogle Scholar
Wood, R. (1987). Brain injury rehabilitation: A neurobehavioural approach. London: Croom Helm.Google Scholar
Wood, R., & Liossi, C. (2006). Neuropsychological and neurobehavioral correlates of aggression following traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 18 (3), 333–341.Google Scholar
Wood, R.L., & McMillan, T.M. (Eds.). (2001). Neurobehavioural disability and social handicap following traumatic brain injury. East Sussex, UK: Psychology Press.Google Scholar
Ylvisaker, M., & Feeney, T.J. (1998). Collaborative brain injury intervention: Positive everyday routines. San Diego, USA: Singular Publishing Group.Google Scholar