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As has been well documented in the literature, individuals with brain injury and their families seek an array of services and supports from a variety of State Agencies. While there may be limitations on services or other requirements imposed by individual States, the definitions below do not reflect any limitations.

Assessment/Evaluation

Assessment/evaluation refers to the use of a test or scale or battery of tests or scales; observation(s); and may include physical assessment to determine: (1) the extent of injury and prognosis for recovery; (2) deficits as the result of the injury as opposed to preinjury conditions that contribute to functional status; (3) strengths in cognitive, psychosocial, vocational and other skills; (4) specific treatment/rehabilitation or support needs and objectives; (5) objectively-based prognosis for return to work, school, and other activities of daily living; and (6) the basis for determining other needs in planning for lifelong care.

Assisted Living

An assisted living program is a congregate residential setting that provides housing, supportive services, personalized assistance, 24-hour care supervision, and health care assistance designed to meet the individual's needs on a daily basis. These needs may include assistance with bathing, dressing, balancing a checkbook, medication rooms, suites, or apartments, or they may share their quarters with their spouses or roommates.

Assistive Technology Devices

Assistive technology devices refer to any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of an individual with a disability, including an individual with a TBI.

Behavioral Programs/Services

Behavior programming or services is an individually-designed strategy or approach intended to improve an individual's adaptive social behavior and to decrease any maladaptive behaviors that interfere with the individual's ability to remain in the community. This may include, but is not limited to the following: clinical redirection, token economies, reinforcement, extinction, modeling, and over-learning. This service may include: (1) a complete assessment of behavior; (2) development of a structured behavior intervention plan; (3) implementation of the behavior plan; (4) ongoing training and supervision to caregivers and others; and (5) periodic reassessment of the plan. Behavioral programs and services may be provided in a structured residential program specifically designed to address behavior issues, a rehabilitation setting or by a professional or team of professionals assisting the individual with a TBI, and/or family, caregiver, employer or others in order for the individual to live in the community.

Case Management/Service Coordination

Case Management/Service Coordination services are designed to assist the individual with a TBI in maximizing services and resources in order to achieve the highest level of functioning. Case management/service coordination services may include: (1) information, education, and referral; (2) assessment of the individual's needs and goals; (3) identification of programs, services, resources, and funding options; (4) coordination and monitoring of services; (5) ongoing evaluation of current and future needs; and (6) advocacy. The case manager/service coordinator collaborates with an interdisciplinary treatment/ rehabilitation team and external entities and providers to assess, coordinate, implement, and evaluate all services required to meet the individual's needs.

Community and Family Education

This service offers training and education to instruct a parent, spouse, another family member, or primary caregiver about treatment/rehabilitation regimens, as well as use of adaptive equipment. Training generally consists of assisting and improving the caregiver's ability to give care (e.g., instruction, behavioral intervention strategies, community integration, and stress management).

Companion/Homemaker Services

Companion services are non-medical supervision and socialization services designed to assist an individual in maintaining community living. A companion may assist the person with such tasks as meal preparation, laundry and shopping, but does not perform these activities as discrete services. A companion may also perform light housekeeping tasks that are incidental to the care and supervision of the individual and also may accompany the individual into the community. Homemaker services are provided by a trained homemaker when the individual with a TBI, family member(s), or primary caregiver regularly responsible for these activities is temporarily absent, or unable to manage the home and care for himself/herself or others in the home. Homemaker services are generally directed toward enabling an individual to remain in the community and thus avoid institutionalization. Homemaker services include meal preparation, routine household care, shopping and errands, assisting with daily activities, arranging transportation, providing emotional support and social stimulation, and monitoring safety and well being.

Comprehensive Facility-based
Rehabilitation-Acute

Acute rehabilitation is a highly intensive skilled service delivered in the hospital setting during the inpatient admission to optimize the individual's medical condition and to improve functional status. Focus of therapies is usually on development of bowel and bladder control, communication, mobility, basic hygiene, orientation, and learning.

Comprehensive Facility-based
Rehabilitation-Post-Acute

Post-acute rehabilitation services are advanced rehabilitation services provided through an interdisciplinary team approach that assesses and coordinates a rehabilitation plan to assist the individual in returning to the community, school, and/or work. Services are based on an assessment of the individual's cognitive, physical, and emotional deficits and may include cognitive rehabilitation services, behavior management, and the development of coping skills and compensatory strategies Post-acute rehabilitation services are generally provided by a rehabilitation agency or in a rehabilitation setting within a hospital staffed by an array of professionals. These services include psychologists or neuropsychologists, therapists (e.g., speech/language, physical and occupational), special educators, social workers, and counselors. These services are offered once the individual is medically stable and ready for community integration. The individual usually participates in two to four types of therapy, three to five times per week, generally from three months to six months.

Day Services-Medical Model

Day services (medical model) refers to a nonresidential or outpatient program intended to improve the functional ability of the individual through therapeutic interventions and supervised activities to facilitate successful community integration. The program is generally designed to assist an individual in maximizing functional skills and addresses psychological and behavioral adjustment and vocational rehabilitation needs. Professional staff, which may include nursing staff to administer or assist with medications, administer the program.

Day Services-Social Model

Day services (social model) refers to a structured community-based program that offers services in a group setting to improve and maintain the individual's community living skills. The program is designed to meet the needs of adults who are not employed fulltime by providing health, social, recreational and therapeutic activities; supervision; support services; and personal care.

Environmental Modifications

Environmental modifications include physical adaptations to an individual's home which are necessary to ensure the health, welfare, and safety of the individual; to help that individual function with greater independence in his/her own home; and/or which are necessary to accommodate medical equipment and supplies that may be required for the individual's welfare. Such adaptations may include, but are not limited to, the installation of ramps and grab-bars and widening of doorways.

Facility-based Sub-acute Care

Facility-based sub-acute care is a hospital-based or skilled nursing-based residential program that focuses on providing comprehensive medical assessment, nursing care, rehabilitation, and therapeutic activities to individuals who are medically stable and/or who have complex nursing needs. The facility offers nursing care and related services to individuals seriously injured, including those who are ventilator dependent or who have had a tracheotomy and require tube feeding.

Housing Supplements/Subsidies

Housing supplements and subsidies provide the individual or family with financial assistance to either supplement or pay for full cost of living in one's own home or apartment, including money for rent or mortgage, rental deposits, utilities, utility deposits, housing maintenance, or other items associated with maintaining a home.

Independent Living Skills Training

Independent living skills training provides training and assistance to an individual with a TBI with activities related to daily living and maintenance of a household. These skills are taught either in an environment that most closely resembles an individual's home, or in the environment in which he/she will use these skills. Instruction/training may also be provided to the family to assist the individual in the learning process and/or to reinforce the learned skills in the natural environment. Examples of training activities include: directing personal care, performing household management chores, menu planning, grocery shopping, meal preparation, budgeting, auto/lawn care, creating and maintaining a weekly schedule, arranging and accessing public transportation, and scheduling and keeping appointments with social service agencies, attorneys, physicians, etc.

In-Home Nursing

In-home nursing services are professional services provided by licensed staff relevant to the medical needs of the individual with TBI. Such services are provided through direct intervention or consultation. Services are generally designed to protect the individual's well being; restore, rehabilitate and/or maintain maximum level of health and independence; and prevent hospitalization. Nursing services include direct interventions that are within the scope of professional practice of the Registered Nurse and are generally provided face-to-face. These services may include medication management; nutrition and feeding; ventilator care, tracheotomy care and suctioning; bowel and bladder care; hygiene; assessing skin integrity; and immobility management. Nursing services may be provided by a home health care agency or individually by a licensed nurse.

Long-term Residential Services

Long-term care services are generally provided in a nursing facility, residential care facility, or other structured residential program that provides either skilled nursing care and related services or supervision and related services to individuals who are unable to live independently in the community with or without supports.

Personal Care Assistance

Personal care services include assistance with eating, bathing, dressing, personal hygiene, and activities of daily living. This service may also include meal preparation and such housekeeping chores as bed making, dusting, and vacuuming, which are incidental to the care provided and essential to the health and welfare of the person. These services may be provided by an individual or agency, such as a home health care agency, depending on the individual's needs and desires. Self-directed personal care services allow the individual with a TBI to direct his or her own care, hire/fire the personal care assistant, train the personal care assistant, and to decide the level and intensity of care that will be provided.

Personal Emergency Response System

A Personal Emergency Response System (PERS) provides immediate assistance in case of physical, emotional, or environmental emergency through a community-based electronic communications device. This service provides a direct link to health professionals to secure immediate assistance by the activation of an electronic unit in the individual's home. The unit is connected to the telephone line and is programmed to send an electronic message to a community-based, 24-hour emergency response center. There is also a personal "help" button that can be either carried or worn by the subscriber.

Pre-Vocational Services

Pre-vocational services prepare an individual for paid or unpaid employment by teaching such concepts as compliance, attendance, task completion, problem solving, and safety. This service uses actual work experience to promote the individual's use of behavioral and/or cognitive compensatory strategies in a facility-based or community site work setting. Specific target goals are identified for intervention such as production rate, inappropriate social behavior, or fatigue. These goals are intended to address the individual's identified barriers to direct vocational placement or entry into vocational rehabilitation services. These services are generally not covered under the Rehabilitation Act of 1973 as amended.

Recreation

Recreational programs or services offer opportunities for individuals with TBI to participate in social and recreational activities and/or the development of recreation skills. The service may include assessment of leisure function; therapeutic recreation services; recreation programs in community agencies; and leisure education. These services may be segregated services that offer a structured recreational or social opportunity specifically for individuals with brain injury; or the service may provide an opportunity to participate in recreational and social opportunities that may be available to the public at large.

Respite Services

Respite services provide time-limited and temporary relief for emergency situations or from the ongoing responsibilities of caregiving by the family or other primary caregiver. These services may be offered in a structured setting where the individual with a TBI may leave his or her home to stay or may be provided by someone staying in the home to allow that individual to remain at home.

Specialized Medical Equipment & Supplies

Specialized medical equipment and supplies are items that are of direct medical or remedial benefit to an individual with a TBI.

Substance Abuse Services

Substance abuse services may be provided in a structured day program or through individual treatment to help the individual to reduce or eliminate substance abuse. Substance abuse services may offer (1) prevention services to motivate a person to choose not to use, or resume use following brain injury; (2) intervention activities that facilitate the acceptance of professional help for a substance use problem; and (3) treatment to motivate a person with a substance use problem to consider, achieve, and maintain abstinence. Follow-along or follow-up services may be provided to support the individual after he or she returns to work, home, and community.

Support Groups

Support groups help individuals, family members, and friends cope with and become more educated about issues related to brain injury. Support group members may provide emotional support, information and resources, and an opportunity to network and learn what other people have done in similar situations.

Supported Employment

Supported employment refers to the training, placement, and follow-up or "extended" services necessary for the individual to remain employed. Supported employment services provide supervision and training to an individual with a TBI in a competitive work setting or in a non-competitive, integrated setting which focuses on skills that lead to competitive work. Individuals in competitive employment must earn at least the minimum wage. To achieve successful employment placements, short-term vocational rehabilitation services provided by the State vocational rehabilitation agency, are augmented with ongoing support provided by other public or nonprofit agencies or organizations (extended services). State vocational rehabilitation agencies provide time-limited services for a period not to exceed 18 months, unless a longer period to achieve job stabilization has been established in the individualized plan for employment. Once this period has ended, the vocational rehabilitation agency must arrange for "extended services" provided by other appropriate State Agencies, private nonprofit organizations, or other sources for the duration of that employment.

Therapy (Individual)-Alternative

Alternative or complementary therapies are therapies that are outside the field of traditional Western medicine. They are used as an adjunct to traditional medical treatment and include such practices as yoga, tai chi, acupressure, and acupuncture. Other examples include therapeutic massage, meditation, biofeedback, and homeopathic treatment (e.g., natural pharmaceuticals derived from plants, minerals, and animals).

Therapy (Individual)-Cognitive

Cognitive therapy assists an individual in the management of specific problems in perception, memory, thinking, and problem solving. The purpose of cognitive therapy is to enhance an individual's functional competence in real-world situations. The process includes direct retraining, use of compensatory strategies, and/or use of cognitive tools. Skills are practiced and strategies are taught to help improve function and/or compensate for remaining deficits. The interventions are based on an assessment and understanding of the person's brain-behavior deficits and services are provided by qualified practitioners.

Therapy (Individual)-Occupational

Occupational therapy is provided by a qualified occupational therapist to improve, develop, or restore functions impaired or lost through injury. It is a skilled service designed to treat upper extremity motor dysfunction and cognitive dysfunction that affect performance of activities of daily living. The service includes evaluation, identification of adaptive equipment and/or energy conservation strategies that facilitate performance of daily living tasks, task analysis to facilitate planning and organization, and therapeutic activities directed toward instrumental activities of daily living. Therapeutic activities may be conducted in a variety of settings.

Therapy (Individual)-Physical

Physical therapy is provided by a qualified physical therapist to assist the individuals to return to the highest possible degree of personal independence. The physical therapist plans and administers individualized treatment programs that are designed to restore functional movement, relieve pain, promote healing and recovery, and, when necessary, help individuals with TBI adapt to permanent disability. The service includes evaluation through tests, observations, and interviews that provide vital information about an individual's strength, reflexes, sensory perception, posture, gait, cardiopulmonary endurance, and daily living activities. Treatment includes various forms of exercise and physical modalities, including heat, cold, ultrasound, electricity, and hands-on manual techniques.

Therapy (Individual)-Speech, Hearing & Language

Speech and language services are provided by a qualified speech therapist/pathologist to maximize an individual's language, pragmatic, and cognitive skills. The therapist evaluates and treats disorders of speech and language that affect the individual's ability for functional communication. These therapeutic services are to improve the individual's ability to use verbal or non-verbal commands, improve receptive and expressive language functions, and improve or correct deficits in voice, articulation, rate, and rhythm.

Transportation Services

Transportation services assist individuals with brain injury in getting to and from medical/ health care appointments, specific rehabilitation and community programs, or to conduct business errands, essential shopping, and socialization activities. The service may be provided by a program provider as a part of its service package, an authorized transportation service, or through financial reimbursement for purposes of purchasing private transportation (e.g., taxi) or for reimbursing a family member, care provider, or non-professional (e.g., neighbor or friend) to transport an individual with a brain injury as needed.

Vehicle Modification

Vehicle modifications allow the individual to be able to transport him or herself or the family or caregiver to transport the individual. Such modifications may include wheelchair lifts, adapted seating, installing hand-controlled gears, and wheelchair securing devices.

Vocational Services

Vocational services offer employment-related services that go beyond those found in routine job training programs. These services may include vocational evaluation, occupational skill training, job counseling, medical and therapeutic services, work adjustment, job training, job placement, job coaching, sheltered and/or supported employment, and job clubs. These services may also include assessment for and provision of assistive technology, such as customized computer interfaces for persons with physical or sensory disabilities. These services are often provided by community vocational agencies that specialize in job training and placement, as well as other professionals who conduct assessment or other services as needed for vocational training.

Click here to order a copy of our latest "Guide to State Government Brain Injury Policies, Funding and Services" to learn more about rehabilitation services and other State systems components.