skills retraining using the hhr model (handout)

Anita Hamilton1MOccThy, Richard Tang

1, Matthew Fong

1, Lily Ma

2 MScOT

1University of Alberta, Canada ,

2 Brain Care Centre, Alberta Canada

Skills retraining using the Holistic Habit Retraining (HHR) model: A program for family members of persons with Acquired Brain Injury

Action Research Cycle Informing Development of the program

Identify caregiver needs Approach to exploring the research literature

Databases: CINAHL, Scopus (MEDLINE and EMBASE) Search terms: acquired brain injury, ABI, stroke, cerebral vascular accident, cerebrovascular accident, CVA, traumatic brain injury, TBI, brain injury, AND issue, concern, difficult, burden, strain, impact, AND caregiver, family, carer, personal care attendant, informal caregiver, caretaker, spouse, partner, AND community, home

Develop a survey of caregivers Survey topics developed based on findings from the literature. Topics included: caregiver competence and confidence levels, new roles and managing relationships, financial strain, trust between caregiver and ABI survivor, and role of community supports.

Consult with stakeholders (staff & caregiver representative) Format of meeting: review processes involved in design and development of caregiver survey followed by a summary of the critical findings of the survey.

Recommendations to stakeholders Summary of recommendations based on findings from the survey: Establish seminars aimed to establish expectations of caring for someone with an ABI; provide knowledge and skills as ABI survivors transition across stages of recovery; financial counselling and management for caregivers; develop program utilizing Holistic Habit Retraining (HHR) model or educate caregivers on the principles of the HHR model.

Plan the program Identify issues for skills re-training applicable for using HHR model approach

Family caregivers find that their own frustration and brain injury survivors’ behavioural difficulties are common occurrences, and find the role of caregiving to be overwhelming. Some family caregivers possess knowledge of how to teach skills, but many do not. Caregivers feel that being provided with more information is helpful, especially information on how to facilitate new skill learning for brain injury survivors when community program participation has not fully met their needs. The HHR model is designed to identify skills for training, devise appropriate skill training schedules using a task analysis-based breakdown of skills, and promote survivors’ continued use of learned skill components through positive support of the survivor.

Identify outcomes and create logic model See a summary of the logic model on back of this hand-out

Develop the program using HHR principles Provide lay background information on how learning occurs through neuroplasticity. Caregivers identify salient tasks and skills they want to help survivors learn to do or do better, as well as barriers they encounter with this aspect of caregiving. Provide practical education on task analysis for breaking skills down into skill components. Provide practical education on importance and incorporation of a promoting attitude to enable survivors’ learning. Mini-programs are developed and used by caregivers to begin skills training with brain injury survivors.

Re-consult with stakeholders Format of meeting: discussion of program format, supporting evidence for program components and design choices, recommendations for timing of evaluation, consultation regarding desired changes, and round-table finalization of program format for pilot implementation.


1, Matthew Fong

1, Lily Ma

2 MScOT



Implement the program Run a pilot program with existing group at BCC (e.g. the new post-concussion group)

Program to be run by Brain Care Centre staff

Offer program at times when caregivers available (e.g. offer day and evening programs)

Evaluate the program Using standardized evaluation tools and qualitative interviews:

Determine if planned outcomes were reached

Evaluate findings to determine improvements for next iteration/cycle of the program

About the Action Research Cycle Action research is a methodology which has the dual aims of action & research1, p. 6:

• action to bring about change in some community or organisation or program • research to increase understanding on the part of the researcher or the client, or

both (and often some wider community)

About the Holistic Habit Retraining model The Holistic Habit Retraining (HHR) model2 aims to generate practical, utilitarian strategies for retraining adaptive cognitive, emotional, behavioral and social skills, as well as strategies for overcoming common obstacles to utilizing methods that promote effective skills acquisition.

About the Program Logic Model The program logic model3 aims to describe the following:

• The main components (major activities) of a program. • The implementation objectives (translating the main components into objectives

that describe what the program is expected to do). • The program outputs (indicators of a program’s implementation and information

about the delivery of the services and characteristics of people receiving the service.

• The short-term/medium-term and long-term outcome objectives relate to what is expected to change resulting from the program. (HOW to measure the outcome objectives is not listed in the model but it does suggest WHAT needs to be measured).

References:

1. Dick, R. (1993). You want to do an action research thesis? — How to conduct and report action research (Including a beginner’s guide to the literature). Chapel Hill, Qld.: Interchange.

2. Martelli, M.F., Nicholson, K., & Zasler, N.D. (2008). Skill reacquisition after acquired brain injury: a holistic habit retraining model of neurorehabilitation. NeuroRehabilitation, 23(2), 115-126.

3. Letts, L., Law, M., Pollock, N., Stewart, D., Westmorland, M., Philpot, A., & Bosch, J. (1999). A programme evaluation workbook for occupational therapists: An evidence based practice tool. Ottawa, ON: CAOT Publications ACE.


1, Matthew Fong

1, Lily Ma

2 MScOT



Presenting the process of developing the program using the Logic Model

skills retraining using the hhr model (handout)

Education