This fact sheet aims to describe overarching principles and themes that should be applied by all health professionals providing rehabilitation to teenagers living with an acquired brain injury (ABI).

Background

While working with a teenager living with an ABI, it is important to understand and consider the roles and developmental stages of adolescence.  This ensures your assessment and intervention has meaning for the teenager’s function in everyday life, while also facilitating their development.  Broadly, adolescence is preparing for adulthood by developing life skills and autonomy which includes:

• study skills
• independent living skills
• risks and responsibility with drugs and alcohol
• work readiness skills
• driving
• social skills
• navigating puberty
• developing relationships
• sexuality.

It is also important to be aware of when the teenager sustained their ABI, the type and severity of their ABI, and whether they had any learning difficulties/disability prior to their ABI.  This helps you understand how much focus should be on restoring function as opposed to using strategies to compensate for, and lessen the impact of permanent impairments. This information also gives you a better understanding of what the teenager’s likely impairments are, their longer-term prognosis, and what level of independence may be realistic for them to achieve.  See the fact sheet, ‘Recovery after ABI’ for more information.

Goal setting

Rehabilitation for teenagers living with an ABI should always focus on maximising function in activities the teenager wants to do, needs to do, or is expected to do in their everyday life. It should also help them develop the skills they need to live the life they want as a young adult.

It is best practice to use assessment tools that help the teenager (and their family) both identify problems with performance and participation, as well as set goals. As much as possible, the teenager should be the leader of their goal-setting. However, where the child has limited decision-making skills (i.e. unable to make weigh up risks/ benefits, communicate a decision, or stick to a decision), and/or insight into their difficulties, their parents may have to act as the drivers of the goal setting process. The information obtained through these assessment tools reflects motivation to improve performance and participation in real-life activities. When these assessment tools are not used, health professionals risk focusing on interventions that the teenager and/or family are not motivated to improve on, thus having little to no impact in their everyday life.

Client and family-centred, occupation-focused/function-based assessments that assist with goal setting, include:

1. • Canadian Occupational Performance Measure (COPM)
   • The Family Goal Setting Tool
   • Routines Based Assessment

In a multidisciplinary team, an occupational therapist typically performs these assessments and broad goal setting tools. The occupational therapist then provides the results, which describe the performance problems, priorities, and broad goals, to the rest of the multidisciplinary team. The multidisciplinary team can then start hypothesis testing to identify why these barriers to performance and participation are present – i.e. external factors such as the social and physical environment and/or how function is impacted by impairments in performance components.

Performance components are assessed by different health professionals within the multidisciplinary team. However, function in a role, activity or task, is often impacted by a combination of performance components and external factors. It is therefore important to collaborate with the multidisciplinary team, teenager, family and school to provide intervention that has a real impact for the teenager’s participation. Please refer to the fact sheet “Goal Setting and Collaborative Treatment Planning” for more detailed information and examples.

Principles of intervention

Refer to the fact sheet “Intervention Planning” which describes:

• various performance components that can be impaired from an ABI
• disciplines involved in providing assessment and intervention for impairments in performance components
• examples of evidence-based interventions that can be used to help maximise function in a role, activity or task, which is currently limited by impairments in performance components.

Facilitating development of life-skills and autonomy

While the focus throughout childhood is on reaching developmental milestones, and developing independence with self-care activities, the focus of adolescence is to develop the life-skills and autonomy needed for life after school.  As the adolescence stage of development is about preparing for adulthood, all intervention should be focused on enhancing performance and participation in everyday activities. Whether the teenager is in the ‘restorative’ phase of rehabilitation or not, interventions for impairments should always be practiced in functional activities.

Providing contextual rehabilitation

Further to this, interventions should be practiced in context as much as possible (e.g. in the teenager’s home, local shops, on public transport, in their sports team, etc.).  With the rollout of the NDIS, teenagers living with an ABI now have more access to support workers. Time with support workers should be utilised as an opportunity to work on developing independence skills in real-life activities, such as gaining independence with their morning routine – preparing breakfast independently, packing their lunch, planning an excursion, and catching public transport.  As a health professional, you will need to conduct an assessment of the teenager performing these real-life activities then provide recommendations/training to the teenager, family and support workers to support practice in context.

ABI describes a wide spectrum of disability. Some teenagers with an ABI may exhibit little to no difficulties physically, but have significant social, emotional and cognitive difficulties. On the other hand, other teenagers may have significant physical, cognitive and speech impairments. For this reason, independent living may not be possible for many teenagers living with an ABI. However, the focus of intervention for these teenagers remains to maximise independence and prepare for adulthood. For teenagers with significant physical and cognitive impairments, intervention may be more centred around education, identifying appropriate support services, equipment prescription and environmental modifications to support the their participation and quality of life.

Supporting adjustment

Another important component of working with a teenager living with an ABI is supporting their adjustment to being labelled with a disability and being different from their peers. Hidden disabilities can often be difficult for a teenager’s peers to understand and accept. Encouraging and supporting the child to be able to explain what’s happened to them is an important part of intervention.

Working with teachers

School is also an important part of a teenager’s life and plays an important role in preparing them for adulthood. School support staff (e.g. special education teachers, guidance officers, and teacher aides) can support the implementation of strategies in context to maximise the teenager’s performance and participation in learning, social, and extra-curricular activities. The school environment offers the opportunity for the teenager to develop more autonomy – such as organisational and self-regulation skills. Support staff can assist the teenager living with an ABI participate in a modified curriculum, work experience and transition programs to support their transition from school to adulthood. It is therefore important to form collaborative relationships with school support staff.

Adolescent and teenage issues

Interventions for teenagers need to include support for typical young adult issues such as sexual health, drug and alcohol use, driving, vocation etc. It is beneficial for the teenager to build a relationship with the teenager’s GP as they will be the gateway to health services as they become adults. Building skills for work (including work readiness, transport use etc.) may involve a number of disciplines. It is best started with parent education at home, programs at school and through the teenager’s GP. Additional support can be provided through QPRS, psychologists and family planning services if needed.

Information regarding transitioning from adolescence to adulthood can be found on the QPRS website – in the “Growing up ready”, transition pack:

• Timetable for growing up
• Developing the skills for growing up (checklist)

Measuring outcomes

Using outcome measures, and re-assessing at a given point in time is important to evaluate the impact of intervention. As much as possible, use function/performance-based and participation-based assessments. Function-based outcome measures that can be applied to all disciplines include:

• Canadian Occupational Performance Measure (COPM)
• SMART goals
• Goal Attainment Scale (GAS).

Contact us

Queensland Paediatric Rehabilitation Service
Queensland Children’s Hospital
Level 6, 501 Stanley Street, South Brisbane 4101
t: 07 3068 2950
t: 07 3068 1111 (general enquiries)
f: 07 3068 3909
e: qprs@health.qld.gov.au