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Clients with more severe deficits will begin therapy in the
Day Treatment Program if they meet criteria for admission.
These include potential for improvement with participation,
stable medical status, no serious behavior problems, and no
evidence of ongoing substance abuse. They must be functioning
at a minimum of Level V on the Rancho Los Amigos Cognitive
Scale. They must be able to communicate functionally and have
adequate receptive skills. They must have supervision and
support in the home environment, and a family member or significant
other must be willing to participate actively with the rehabilitation
program.
In the Day Treatment Program, therapies are integrated across
programs. Cognitive rehabilitation and compensatory strategies,
including behavior management and modification, are included
in all phases of therapy. Family members observe some of the
sessions, and they learn techniques to transfer therapy activities
to the home environment so that therapy continues during the
client’s entire waking day. Home visits are made by
the team, as needed, but most therapy sessions occur in the
clinic. Psychological services staff members meet regularly
with family members to provide education about neurological
dysfunction and techniques that will help family members deal
with the client’s emotional/behavior needs and issues.
The continuum of care continues as the focus of the Day
Treatment Program changes to the Community Reintegration phase
of the program. Community Reintegration involves the direct
application of skills acquired in the clinic to the community—that
is, into the real world environment. Family members will take
a more direct role in therapy as they help the client, with
staff guidance, to deal with real-world challenges. Communication
between the family and the staff is facilitated by use of
a family journal in which family members keep a record of
the client’s progress in his or her daily activities.
The family journal also provides a mechanism for communication
between the staff and family members.
The majority of clients with mild-moderate impairments will
enter the program at the Outpatient Rehabilitation Phase.
Day Treatment “graduates” will also progress to
the limited treatment status when appropriate. Purposeful
rehabilitation extends beyond the clinic into community settings
(e.g., gyms, pools, health clubs, restaurants, grocery stores,
work, home). As in rehabilitation for the severely impaired
client, working with the client who has mild-moderate impairments
requires a generalization of treatment and transfer of learning
that is addressed within the process of a multi-contextual
treatment approach. In the Outpatient Phase, schedules for
individual therapies can range from one to three sessions
per week per modality to less contact, as appropriate, as
the person nears completion of the program or she or he transitions
back to work or school and only requires follow-along services.
Some individuals who are able to function fairly well independently,
after completing their program, still need minimal follow-along
support to live independently in their own home or apartment
in the community. A follow-along specialist can work with
such clients, under supervision of an occupational therapist
or a speech-language therapist. The goal of this process is
to help the client meet challenges of daily living, facilitate
peer contacts and relationships, become involved in community
activities, exercise choices in his or her life, and gain
greater status and respect in the community. In such cases,
contact with the client could vary from two to three visits
each week, to a visit every several months, or only as needed.
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