Bringing Services to the Community: Successful Training in Remote Locations
Julie Krieger, Program Director
Ruth Estes, Ph.D.
ResCare Premier, MO, ON
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Julie Krieger is a graduate of Brock University St. Catharines, Ontario where she obtained her degree in Linguistics and Psychology. She is certified as a Clinical Instructor by the American Academy for the Certification of Brain Injury Specialist. Ms. Krieger is a Program Director at Anagram Premier in Ontario, Canada.

Ruth Estes, Ph.D., received her doctoral training in Clinical Psychology at the University of Health Sciences/The Chicago Medical School where she specialized in medical psychology/behavioral medicine. Dr. Estes is on the Board of Directors of the Brain Injury Association of Missouri and is the Chair of the Program and Service Development Committee of that organization. She also serves as a surveyor for CARF—The Rehabilitation Accreditation Commission. Dr. Estes is the Director of Training, Research, Accreditation, and Compliance for Rescare Premier.

The wave of the future in ABI rehabilitation is to bring services to people rather than bring them to the services. In order to deliver high quality services, the rehabilitation provider must meet the challenge of providing training in remote sites.

As providers attempt to bring services to persons with ABI, rather
than bring the persons to the services, we must find ways to
successfully train support staff in remote sites.

75% of ABI rehabilitation programs use paraprofessional staff. Rehabilitation program directors indicate that to meet client needs, specialized training is needed in:
• Behavior modification
• Understanding the role of the transdisciplinary team
• Family, psychological, and social issues
• Treatment of language disorders and cognitive and physical deficits
• The subtleties of relationship building
• Using goal plans to encourage productive activity

Difficulties Reported in Training in Remote Sites:
• Scheduling
• Securing persons with expertise to provide training
• Addressing the great variety of client needs
• Identifying community resources (or lack of them)

Often no formal training occurs or training is done on an as-needed basis and is not consistent.

Technology Solutions:
• Comprehensive computer-based training programs supplemented with demonstrations
and face-to-face interactions with off-site experts

Requires:
• Computer and internet access-offers a flexible system of information collection, delivery, and tracking
• Videoconferencing capacity-- creates "real time" capabilities for communication between instructors and employees without the expense of paying internal experts to travel or hiring external consultants to come to your facility

Addresses Problems of Remote Site Training through:
• Flexibility-computer based training can be completed whenever the staff member is available
• Accessibility-videoconferencing provides access to experts throughout the system that can address the wide-ranging issues confronted in acquired brain injury rehabilitation

Allows:
• The most qualified persons to provide training. Select the best of the best. Supervisors and employees become responsible for teaching material in which they have demonstrated strengths and skills. For example, the physiotherapist or kinesiologist instructs a course about body mechanics and transferring clients for back safety.
• Off-site supervisors to monitor training activities via computer tracking systems

Fundamental Courses to Include in Training Material:
• Health and safety topics - First Aid, CPR, non-invasive crisis intervention, emergency and evacuation procedures
• Medical topics - seizure disorders, swallowing and aspiration precautions
• Brain injury basics- neuroanatomy, functional consequences of brain injury
• Treatment - interventions for cognitive, physical, communication, behavioral, and social impairments
• Relationship building
• Customer relations
• Company-specific policies and procedures

Assessing Training Effectiveness

It is essential that employees be assessed for skill competencies to ensure that
material is understood and can be implemented effectively.
• Demonstrations: exhibition of skills during training sessions
• Testing: written tests on material covered (quizzes, comprehensive exams)
• Performance evaluations: evaluation of practical application of materials learned
• AACBIS certification: achievement of nationally established standards

Advantages of Comprehensive Technology-Based Training Program:

• Clients receive better, more consistent services
• Staff members feel better-prepared, reducing burn-out and turn-over
• All staff members obtain equivalent training and access to experts
• Employee training and competencies are well documented
• Purchasers of services and accrediting bodies (i.e. CARF or CCHSA)
can easily review training provided and recognize the increased
effectiveness of well-trained staff
• Training can be readily monitored

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