Developing Training and Education Curriculum for Direct Care Staff (Part 2)
Editorial Staff

Twenty years ago, individuals with acquired brain injury faced institutionalization in nursing homes, or hospital settings. Medical innovations and improved emergency room care resulted in dramatic increases in the life span and quality of life for these individuals. As the need for quality rehabilitation grew, more rehabilitation services emerged. The American Academy for the Certification of Brain Injury Specialists (AACBIS), provides guidelines for quality care in a variety of settings, no matter what level of service is being administered.

Most acquired brain injury rehabilitation programs, whether offering several hours of in-home rehabilitation, or residential rehabilitation, have basic training standards. Like most jobs, new employees are given policy and procedure training; and cautioned about safety standards. State and local health requirements are explained and posted where employees can clearly access them. At this point, in-depth training on acquired brain injury, with its short and long-term affects, family dynamics, and rehabilitation strategies, may or may not be presented. The vocabulary and techniques of a brain injury rehabilitation may overwhelm a new employee.

To a person with acquired brain injury, the road to rehabilitation is confusing enough without wondering about the training that the individual helping them possesses. While relearning basic activities like brushing teeth, or combing hair, it is unlikely that a staff member will be asked, “Do you know what part of my brain was injured - and how that affects the way I learn things?” As a family member or professional, you are in the position to ask that question. Once someone begins rehabilitation, you wonder, “Who is qualified enough to take care of my loved one?” One of the first questions you should ask a rehabilitation director or admissions coordinator should be “What kind of training or education do you provide for your staff?”

According to AACBIS, the “certification program is based on the belief that well-trained staff are necessary to provide the wide array of services required in brain injury rehabilitation. It is a first step towards creating a recognized profession specific to brain injury rehabilitation. The AACBIS program provides recognition of advanced studies in brain injury rehabilitation, not verification that an individual is suitable for employment. Certification is not restricted to any one profession or discipline. It is intended for anyone who delivers services specific to brain injury rehabilitation.”

The mission statement of AACBIS states, “The American Academy for the Certification of Brain Injury Specialists (AACBIS) recognizes and values the rights and worth of persons with brain injury.” To that end, AACBIS offers a national certification program that improves the quality of care by establishing accepted competency standards for the education and training of individuals working in brain injury rehabilitation.

The training that an individual receives at his or her program is vital. Each program works with different employees or volunteers at different stages - but the need for a standardized level of competency, whether working at a day program, acute-care hospital, or community based group home, is the same.

When uncertain, we find ourselves looking to the “authority” in any field. When buying a new home, we look to the expert Realtors. In shopping for a new car, we may look over consumer reports and safety records. We manage to do this while juggling our jobs, civic duties, volunteer work, and families. As families, professionals, and caregivers who lead busy lives we find ourselves slowing down for the really important things - an anniversary, graduation, career move, and unfortunately, illnesses and accidents.

Unlike many medical events, acquired brain injury is life altering and life-long. We are accustomed to the co worker who leaves for surgery, and returns, whole and familiar. This is frequently not the case with brain injury. Families and caregivers must plan for rehabilitation. That word, “rehabilitation,” brings up an important issue: Who are the people working with your loved one? If not trained doctors or therapists, what kind of training do they have?

Before AACBIS and the CBIS training program, that question could be answered with astounding variety. Although minimum requirements for health-care employees vary from state to state, the bare minimum could sometimes be frightening: a high-school diploma or its equivalent - period. By establishing these standards for education and training, the basic levels of quality care for persons with acquired brain injury have been established.

The role of AACBIS
In learning what an individual stands to gain from CBIS training, it is vital to understand the objectives of the program:

· To improve the quality of care delivered in brain injury rehabilitation;

· To develop a competency-based curriculum specific to brain injury rehabilitation;

· To provide training standards for persons working primarily in areas of brain injury rehabilitation that will assure delivery of quality services;

· To supply individuals providing direct care with a portable credential indicating a specialty in brain injury rehabilitation.

With these objectives as a guide, rehabilitation facilities may offer nationally recognized training that provides the basic framework for quality rehabilitative care. Of course, many rehabilitation programs provide internal training, and perform credibly in this area. A major hurdle to overcome is the microscopic training some individuals receive. For example, a rehabilitation program that specializes only in acute rehabilitation issues may not provide training on community reintegration.

An individual who “keeps a secret” between a participant and family members may not realize the importance of sharing this information with other members of the treatment team.

In the authors survey, the editorial board of Premier Outlook interviewed 25 individuals who have completed CBIS training. We asked them what they thought about their training, if it benefited them, and affected their job performance.

Joe M, has over seven years experience in direct-care and management. Although he was very familiar with much of the information about brain injury presented in the CBIS manual, he appreciated learning different views on treatment. He stated, “If you work at a facility, you get trained using their methods. A supervisor may find it hard to review all aspects of care, and consistently cover that information with each new employee. After reading through my CBIS manual, it was apparent they’d gotten a lot of feedback from different individuals, and created a global approach.” Many individuals who responded to our informal telephone interview felt that the CBIS training manual provided a strong foundation to enhance their own training. Like Joe, others stated the manual presented a firm foundation of topics, and opened the doors for further questions and training.

As a director of training and education at your program, you should ask yourself, “Would I like to have the most highly trained staff possible?” As an employee, “Are there aspects of this job that I might deal with better if I had more information?” It is common knowledge in any field: if you treat your employees well, and provide them with the best information, hopefully they will do the best job they can with the information they’ve been provided.
How does training allow an individual to grow and advance in the field of acquired brain injury? Susie W., working in a fast paced vocational rehabilitation program, commented, “I felt my employers cared about me when they asked me if I’d like to go through the training. I felt like I knew how to handle things a little better.”

Albert G., a program director at a rurally-based program, was asked how he felt about investing in a new employee’s CBIS Level I Training. He replied, “Well, the cost is not an issue at all. You want to get a feel for where the employee is going. I like to give them a little time out at the program, supervised and mentored with an experienced staff member, and then get their feedback.” He also commented, “It’s a little like learning a foreign language - you have to hear it and see it in action before you actually start to learn it, so it makes sense”.

Madelyn P., an employee at a large, community-based program said, “After five years, I can tell you this - when I first got here, they gave me a month of training. I was overwhelmed. Words and examples bewildered me, and I couldn’t apply what they were saying to what was happening at the program. That was back in 1994. In 1997, when I went through the CBIS training, it was great. I know a lot of the stuff, but there was so much in that manual that helped me deal with families, case managers, and members of our medical treatment team.”

In our interviews, a consistent number of respondents stated that CBIS training was more effective when offered to individuals who had working experience in the field. All of our respondents agreed that CBIS training provided each employee a solid level of basic skills. Employees reported a feeling of “validation” and commitment on the part of their employer for provided CBIS training.

To date, over 155 CBIS-Level 1, 85 clinical instructors and 51 clinical examiners, with over 800 in the process in the training and testing. As a family member, we hope this helps you understand when an admissions coordinator tells you “Our staff are Certified Brain Injury Specialists”, they have met basic, professional guidelines for brain injury rehabilitation. As professionals, we hope you are reassured by your peers who are investing in CBIS training. To individuals who have become certified, we congratulate you for completing your training, and hope that you apply this knowledge fairly and compassionately.

CBIS Certificates:
Certified Brain Injury Specialist - CBIS Level I
Has met basic Level I requirements, and passed both a written National Examination and the performance based assessment (PBS) .

Certified Brain Injury Clinical Instructor - CBIS CI
Clinical Instructors are professionals certified to provide training in the field of brain injury. The Clinical Instructor position is open to any individual meeting the requirements of AACBIS. Clinical Instructors may become Clinical Examiners

Certified Brain Injury Examiner - CBIS CE
Clinical Examiners are Clinical Instructors who have received additional training in how to administer the Performance Based Assessment and who have been designated Examiners by AACBIS. Clinical Examiner training is provided periodically by AACBIS. * * Certified Clinical Examiners are all certified Clinical Instructors

All instructors and all examiners have basic level 1 certification

Dialogue:
How will certification benefit our profession?
As the brain injury field evolves as a profession, certification provides minimum guidelines for education and practice, promotes increased accountability among practitioners, offers a competitive edge in the market place, and creates a better bond between consumers and third party payers.

Is the CBIS designed just for post-acute rehabilitation?
No. While issues and topics in the curriculum and training are applicable to post-acute rehabilitation, the information is useful and helpful in other settings as well. The CBIS does not intend to duplicate the education and training that is already required of licensed staff, but to complement other training with information specific to brain injury.

Who are the Clinical Instructors and how are they selected?
AACBIS Clinical Instructors come from across the country. These individuals are selected based upon: applications, paying appropriate fees, recommendations, length of experience, professional reputation in brain injury rehabilitation, and passing the Clinical Instructor Examination. Individuals meeting the requirements and competency may apply.

Are there any plans to develop the CBIS specific to professional therapists (P.T., O.T., Nursing, Speech, etc.)?
No. CBIS is designed to be Brain Injury specific. The professional therapists are well-trained and supervised by their respective disciplines. The CBIS is designed to complement existing licenses. All professional therapists are welcomed and encouraged to apply for certification. It is believed that the diverse information available in CBIS is beneficial to anyone with direct client contact with people with Brain Injuries.

Are practical skills part of the certification?
Yes. A major emphasis of the CBIS is performance-based. This is to ensure that the certification goes beyond traditional testing to include ones ability to apply their knowledge in clinical and work settings.

Why is BIA involved in the certification?
For many years, various groups have proposed developing a brain injury certification program. BIA has assumed a leadership role to promote the awareness of brain injury and develop a respected industry and profession. BIA is an organization that serves all people interested in brain injury and does not represent any particular group or point of view. The organization seeks to promote appropriate services that enhance the quality of life at all levels of need and to promote prevention of injury.

What is CARF’s view of the CBIS?
Society has adopted a variety of credentialing mechanisms that serve to better protect the public. One mechanism is certification of individual practitioners, which addresses their qualifications to provide a service. Another mechanism is accreditation, which addresses the process and outcome achieved by a program, service, or organization. Professional certification and accreditation may be seen as complementary strategies or approaches. Both attempt to influence positively the quality and effectiveness of services provided to individuals with brain injuries and other disabilities.

With its over thirty-year history, CARF is the preeminent standard setting and accrediting body, promoting the delivery of quality rehabilitation services. With its consumer-centered focus, the accreditation process promotes and enhances professional practice and cooperation within the program itself. In addition, it creates partnerships between the programs and the community it serves, including employers and funding sources. The standards strongly support the concept of qualified and educated personnel in all programs. For example, standards require in-service education to establish, maintain, and enhance competencies in the rehabilitation of persons with brain injuries. Standards also require that untrained staff, who lack prior experience in serving individuals with brain injury, should be mentored by qualified brain injury professionals.

CARF applauds the effort of BIA to develop a Brain Injury Specialist certification process. Identifying core competencies and skills necessary to provide quality rehabilitation to people with brain injuries is certainly the mutual goal of both organizations. CARF works with BIA and individual professionals who work in brain injury programs to improve the rehabilitation care of people with brain injuries.

Source: BIA AACIBS Guidelines

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