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Seeing brain injury clearly

Dr Gemma Costello introduces SPECS, a psychosocial training package for professionals working with children and young people with acquired brain injury.



SPECS is an acronym for core psychosocial factors that are important to address in successful neurorehabilitation: social, physical, emotional, cognitive and spiritual.

Very few training packages exist for professionals that specifically address the unique psychosocial needs of children and young people (CYP) with severe acquired brain injury (ABI), as well as their families and staff looking after them.

In line with the core principles behind the international classification of functioning: disability and health, children and youth version (ICF-CY; WHO, 2007); SPECS is a training package that aims to increase the skills and confidence of professionals working directly with children and young people with acquired brain injury and their families – supporting the ultimate purpose of increasing meaningful participation in life. SPECS is designed to promote psychosocial rehabilitation, reflective practice and self-care in teams.

Dr Gemma Costello

The importance of addressing the holistic needs of children and young people with long-term neurological conditions through specialist rehabilitation is a major motivator of the Annual Report of the Chief Medical Officer (2012), “Our Children Deserve Better”.

Psychosocial factors are major predictors of long-term outcomes in this population (Ross et al, 2011).

If psychosocial stressors are buffered and resiliencies increased, even those who are living with a severe acquired brain injury (ABI) can achieve a high quality of life. In other words, quality of life does not decrease in a linear fashion with increased severity of ABI.

It is imperative that professionals are trained to work to rehabilitate not only the cognitive and physical deficits but understand the intricate interplay between psychosocial support, cognitive recovery and long-term life course outcomes.

SPECS was made collaboratively with staff and parents of the children and young people supported by The Children’s Trust, the UK’s leading charity for children with brain injury. We were enabled to commission valuable input from an external consultant through the award of £2,000 from New Look Ltd.

SPECS comprises an introductory (day 1) and advanced day (day 2) training programme each concentrating on different aspects of psychosocial care, including:

Introductory day

  • Thinking more deeply about children/young people and their context
  • Maintaining personhood/individuality
  • Understanding children/young people and family in the context of ABI
  • Family habits and values
  • Preparing to meet a new child/young person and family: practice examples
  • Beginnings and endings
  • “Seeing yourself in a new light”
  • Siblings and relationships
  • Insight
  • Top tips

Advanced day

  • What does ‘culture’ mean?
  • Working with families to support their cultural needs
  • Insight of the child/young person and parents/families
  • Risks of Insight
  • Self-Care
  • Adjustment, grief and loss
  • Managing expectations and transitions
  • Managing social situations
  • Responding to looks, stares and comments
  • Coping with difficult questions “what shall I say?”
  • Complex presentations and situations that challenge us
  • Managing difficult questions and feelings
  • Active listening and communication skills
  • Non-verbal communication
  • Working with parents effectively
  • Lots of practice examples, group reflective tasks and discussion
  • Top tips

SPECS is designed to take what we know theoretically and to scaffold the competencies that underpin successful pragmatic practice. The aim of the programme is to promote an environment that supports skill-sharing, honest discussions, reflective practice, personal and professional development.

It is hoped that providing high quality psychosocial support will significantly help children/young people and their families in the post-acute phase of rehabilitation.

It also provides staff with the opportunity to scaffold a sense of what the future may hold for families in the longer-term as they adjust to life following an acquired brain injury.

The training is currently provided to interdisciplinary groups at The Children’s Trust in order to support shared learning and explore multiple perspectives.  SPECS has been evaluated as being accessible to staff across both clinical and non-clinical backgrounds who are supporting families following acquired brain injury.

The delivery includes multi-model learning methods (didactic approach, films, reflective exercises, TED talks, parent and children/young people pieces, self-directed learning, group learning), with a balance of practical information and non-technical use of language.

The key benefits to professionals have been reported as enhanced awareness, knowledge, confidence and skills to work effectively with children/young people and families affected by acquired brain injury. In turn families have reflected on the abilities of staff to support them in increasing their knowledge of acquired brain injury, enhancing coping, adjustment and adaptation and reducing a sense of isolation.

Figure 1

Developing the SPECS model has included incorporating it into everyday clinical practice. SPECS now contributes a range of perspectives when exploring formulation with teams and families (see figure 1.). It enables teams and families to reflect on the strengths, resources and needs of our children, young people and families in order to support the goals and inform the most effective approaches to neurorehabilitation.

The SPECS formulation has also been adopted within models of supervision. Staff are encouraged to reflect on their own SPECS needs, as well as those of the families and young people they may bring for discussion. This promotes self-care, awareness of resources, strengths, skills and any challenges that might be faced within the context of supporting young people and their family following acquired brain injury. It also promotes a holistic way of exploring the needs of the families and young people we support during this stage of their rehabilitation.

In summary, SPECS supports the notion that comprehensive paediatric neurorehabilitation involves a holistic approach inclusive of cognitive, physical and psychosocial rehabilitation.

Future developments include the potential for using the supervision frameworks alongside video enhanced reflective practice. SPECS has been presented at conference to a range of audiences with feedback often exploring the potential for its application in a range of settings.

The Children’s Trust will be hosting its first external training day for SPECS on Monday 22 July 2019 at its national specialist centre in Tadworth, Surrey. Delegate places for this training course are £130 including lunch and can be booked online at www.thechildrenstrust.org.uk/SPECS. For further information on SPECS please contact Dr Gemma Costello on 01737 365 000.

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