Katie Pinn, Senior Cognitive Rehab Assistant at BIS Services.
My week really starts on a Sunday as this is when I plan my upcoming week, I check to see if any clients have appointments during the week, what goals we are working on, where we are in each and make sure there’s lots of variety within sessions.
My first client on a Monday I must check in on their well being, ascertain level of productivity over the weekend and schedule the new week. This particular client I’ve had to provide with much support due to shielding during both the 1st and the second lockdown.
During the first lockdown many clients’ support went virtual, however due to vulnerability support had to be given face to face. One major barrier to delivering virtual support was teaching the client how to use new technology, this can be difficult for anyone, however the extra challenges caused by brain injury exacerbated the difficulties. When teaching someone with a brain injury something new repetition is key, I model how to use WhatsApp video and Zoom practice with the client regularly and created simple and clear visual instructions.
This particular week I am meeting a new client in preparation so spend a long time reading the referral form and speaking to management. During meet and greets it’s really important to try and build rapport with client and family ascertain the client’s interests, consider how these could be linked into support and try to open their mind to the idea of working with you. It’s quite a skill and I think I’ve become quite adept at building rapport quickly. It really is key to future engagement and can make or break starting a new package.
Tuesdays I’m working with a different client and again it’s important to plan and structure our week, with this particular client I also support budgeting skills. After a brain injury many clients can also be financially vulnerable and are patients of the Court of Protection and under Deputyship and are provided with a weekly budget. It is important to make sure this is spent sensibly. Enough money has to be left for food, for themselves and any pets, transport fees and bills if this is something the client is able to manage.
It’s important to encourage clients to save, and this allows exploration of executive functioning skills. One of these client’s goals focus is around decorating their home. We want to encourage clients to maintain goals independently if possible in order for clients to engage and have a sense of autonomy and also achievement. Practical support is needed in this case as my client had impaired sight as well as coordination difficulties, which makes tasks like painting very difficult. However, I didn’t want to complete this task for them so I focus my help with small fiddly bits encourage them to paint the large areas.
Our work is not about completing tasks for them, far from it; it involves teaching, encouraging, motivating and so on. If we need to actually get our hands dirty and pull our sleeves up to do that, that’s what we do! After sessions it’s important to complete our sessional reports ASAP and update multidisciplinary team on any important information.
This is particularly important with clients struggling with their mental health, which has been pertinent this last year more than ever. Communication has always been of upmost importance, and now more than ever. At BIS Services our supervisors and managers are available for us to contact all the time if we need some advice or are concerned.
Wednesday I’m back in Ramsgate. In the early stages of rehab, clients often lack insight into their brain injury and consequences, which creates hurdles for support. It is challenging to teach clients strategies to compensate for brain injuries if there’s a lack of understanding why it’s needed. I do a lot of work around insight, particularly with one of my clients where I provide education and as difficulties arise I highlight and then help problem solve in the moment.
Immediate feedback is really important and it must be approached in a sensitive and cautious manner. Insight changes can also trigger a shift in mood, which is inevitable after any injury and emotional support and empathy is required. I liaise frequently with Neuro Psychologists as most clients also receive psychological support, but not all the time. In those cases our input is even more challenging as we can often be the only person clients have to talk to, and this again has increased through the pandemic.
My second client has better awareness of his brain injury and is able to engage in cognitive and audio visual exercises. This is great for stimulating neural pathways strengthening connections and ultimately improving function. We practice functional transfer and tasks to practice new skills and cement more familiar ones.
Late afternoon I plan activities for my last few clients for the week. With another client we focus on functional skills and their hobbies. These sessions are always fairly fun, often involving baking, crafts, or photography.
in the evening I may I have an MDT meeting online. Again, this is a chance to speak to the professionals in the team, incorporate any advice and get feedback.
Thursday mornings I’m doing a few shops with the client. Lots of planning is involved before going out. Meal planning, simple recipes, cupboard checking when ingredients are needed and so on. Plans and lists are written down for the client and support is given around journey planning as well as problem solving in the shops, if an item is out of stock and substitute needs to be found, which is often difficult for my client.
Many clients can also find the hustle and bustle of the supermarket stressful or anxiety inducing, so it is important to help clients, especially those who have difficulty emotionally. I assist with encouraging and regulating breathing techniques and calming in the moment.
In the afternoon I had a supervision with the educational psychologist for a new client, to teach me about assistive technology and how to incorporative in sessions and manage fatigue. My Fridays are quite hard and they’re not the ideal end to the week but i try to incorporate fun activities and manageable tasks as clients could be quite fatigued by the end of the week.
My first client I actually do their food shop on their behalf as they’re not able to access the communities themselves due to lockdown. I still have to pre-plan their shop and cash handling needs to be looked at. My next client we actually do quite a lot of work around relaxation.
In the first lockdown BIS Services set up a virtual timetable and we’ve kept a library of resources so I sometimes accesses the hypnotherapy recorded sessions and use this so that my client is in the right frame of mind for their psychology session in the afternoon. This is their opportunity to talk through the week. I prompt them to think about any stressors and we set mindset for the weekend. A lot of work is done around building resilience and perspective with this client.
My final client then sees me in another county (we get around a lot!) The first thing we focus on is community access for this younger client. What may be as simple as buying a coffee for you and I becomes a challenge someone with brain injury. I motivated and supported the client to order and pay for their own items. Functional practice of independent living tasks, activities of daily living and hobbies and interests are all considered. On Friday I get home about 7:30 just in time to travel to my stable, feed the animals and hope the Gin and Tonic fairy has left me something for when I return home!
