Developing Training and Education Curriculum for Direct-Care Staff (Part 1)
An Interview with Walter Harrell, Ph.D.

As we define our roles in acquired brain injury rehabilitation, it is important to evaluate our front line. The training direct-care staff receives has a substantial impact on the quality of rehabilitation services for persons with brain injury. As we develop a way to inform and educate direct-care staff, we face the future of rehabilitation clearly.

Although the idea of creating a unified body of information to educate staff in this country has been discussed for the past twenty years, little was done until major changes in rehabilitation services began taking place.

Dr. Walter Harrell, who discussed his role in the survey of professional and paraprofessional training needs in the field of traumatic brain injury, provided insight for this article. He noted that in recent years an increasing number of funding sources have grown reluctant to pay for long-term care.

“What acquired brain injury rehabilitation was forced to face in the last part of this century was the uncertainty of rehabilitation,” stated Dr. Harrell. "With more individuals surviving acquired brain injury and resources decreasing, the need for costeffective paraprofessional caregivers was growing.”

This was confirmed in a survey conducted by Dr. Harrell with Heather Becker, Ph.D., and Letitia Keller, B.A., from the Center for Health Care Research and Evaluation at The University of Texas at Austin.

The survey was sent to rehabilitation program managers and found that over three-fourths of the programs use paraprofessional staff, defined as persons without professional degrees in allied health fields.

Seventy percent of all those responding indicated that it was possible that their programs would increase the use of paraprofessionals in the future.

With the increased use of paraprofessional staff, training to meet the needs of persons with brain injuries became a focus. Stanley Seaton, M.D. and George Neimann, Ph.D. were among the first to discuss training guidelines for acquired brain injury rehabilitation.

It was with the support of the Seaton Foundation that the survey, described above, was developed to formally explore specialized training needs in brain injury rehabilitation.

The survey was designed for program managers of acute, subacute, and postacute acquired brain injury rehabilitation programs to obtain feedback about the training needs of their staff. As noted in the article in the Journal of Head Trauma Rehabilitation, “It was believed that program managers were the individuals with the direct-care facilities who could best respond to questions about training needs and what the organizations were willing to invest to address these needs.”

Eighty-four percent of respondents indicated that specialized training in brain injury is “definitely needed” for paraprofessional staff; 100% indicated training was “somewhat needed.” The curriculum content considered most important for paraprofessionals was behavior modification; role of the transdisciplinary team; family, psychological, and social issues; treatment of cognitive deficits; treatment of physical deficits; and treatment of language deficits.

Using the results of this survey and additional information obtained during conferences and educational seminars, the core curriculum for training in the field of brain injury rehabilitation began to take shape. In 1996, the Brain Injury Association established the American Academy for the Certification of Brain Injury Specialists (AACBIS). This standing committee operates under its own bylaws approved by the Board of Directors of the Brain Injury Association. In May 1996, the initial meeting of AACBIS established the committee for Curriculum, Credentialing and Examination. Guidelines were developed for Brain Injury Specialist certification.

In 1996, pilot programs were implemented by Dr. Seaton and Dr. Neimann to develop training curriculum. At Tangram Rehabilitation Network (now Tangram Premier) in San Marcos, Texas, a course book was generated and seven individuals metduring the evening over a period of several weeks for training. An examination was conducted at the completion of the training. After approximately a year during which the committee standardized the
educational guidelines, these seven individuals were among the first to receive certification as Brain Injury Specialists. Since that time, more than 135 individuals across the United States have received training and certification.

To obtain CBIS certification, individuals study at their own pace using a course book provided by AACBIS. An examination is then administered either during state or national BIA conferences or at specific sites proctored by a clinical examiner. Once certified, a Brain Injury Specialist must obtain Continuing Education Units (CEUs) to maintain certification.

The CBIS certification process goes a long way toward assuring quality services are available to persons with acquired brain injuries. Through training opportunities, AACBIS impacts our front line - - the individuals who provide directcare to persons with acquired brain injury. This education and training makes the future of rehabilitation more certain and expands options for provision of quality services as we move forward into the next millennium.

Part 2 of this article, Implementing Training and Education, will appear in the next issue of Premier Outlook.

Glossary of Terms

Paraprofessional - a person without a professional degree in an allied health field who provides care and assistance to participants.

Acute rehabilitation - medical care, evaluation, and intensive rehabilitation
services provided in a hospital setting

Subacute rehabilitation - less intensive level of rehabilitation services usually provided over an extended period of time. May be provided in a hospital or a skilled nursing facility.

Postacute Rehabilitation - community-based residential program providing training for living in a setting of greater independence. Focus is on teaching functional skills and developing compensatory strategies.

Transdisciplinary- group of persons with various allied health degrees who
provide integrated, functional treatment to participants.

Definitions adapted from the National Brain Injury Association Directory of Brain Injury Rehabilitation Services, 2000.

For more information about the Brain Injury Assoc./AACBIS: AACBIS c/o Brain Injury Association
105 North Alfred Street
Alexandria, VA 22314
Phone: 703/236-6000 ext. 109
FAX: 703/236-6001

www.biausa.org
The AACBIS web page provides “Guidelines for Certified Brain Injury Specialists”

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