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THE BIO-PSYCHO-SOCIAL EFFECT OF REHABILITATION OF INDIVIDUALS WITH ACQUIRED BRAIN INJURY MEDIATED BY
COORDINATED INTERVENTIONS
ECP 2013 IN STOCKHOLM
C H A L O T T E G L I N T B O R G , C G L @ H U M . A A U . D KA N E S Ø N D E R G A A R D T H O M S E N , A N E S T @ H U M . A A U . D K
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• Background• Timef ra ime• The program eva lua ted• Th is s tudy
• Research des ign – quant i t a t i ve e f fec t s tudy• Organ iza t i ona l eva lua t ion
• Ar t i cu la ted log ic beh ind in te rven t ions• Ha l fway / p re l im inary resu l ts
Agenda
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
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• In 2010 19 .543 Danes acqu i red a b ra in i n j u ry (ABI )• Approx . 125 .000 peop le in Denmark l i ve w i th an ABI
• In Denmark there i s no research on the coord ina t ion o f b ra in in ju ry in te rven t ions a t the mun ic ipa l l eve l o r the e f fec ts o f ear l y, f ocused and coheren t rehab i l i t a t i on
• Being ab le to o f fe r an ev idence-based i n te rven t ion w i l l have a huge p rac t i ca l impac t on peop le su f fe r ing f rom ABI as we l l as economic bene f i t s i n the mun ic ipa l p rov id ing the serv i ces . An eva lua t ion o f p rac t i ce ass is t s admin is t ra to rs in mak ing p rogram- leve l dec is ions
Background
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
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Timefraime
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
2012 2013 2014 2015
Project start
Program theory(august)
Organizational halfway status (april)
Implementation(april)
Pretest Posttest
Organizational posttest
Project end
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• Heigh ten ing the leve l o f the neuro sc ien t i f i c knowledge
• Coord ina t i on in terna l l y a t the mun ic ipa l l eve l (es tab l i sh a coord ina t ion cente r and new ways o f work ing toge ther )
• In te rd i sc ip l i na ry coord ina t ion o f p rocesses ac ross the p r imary and secondary sec to rs
• Uni ted e f fo r ts ( j o in t ou tcome measures , tes ts and rehab i l i ta t i on p lans)
The program evaluated
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
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2 in tegra ted p ro jec ts :
a) An e f fec t s tudy o f the coord ina ted in terven t ions (CI ) on adu l t i nd iv i dua l s su f fe r i ng f rom ABI and the i r f ami l i es
b) An o rgan iza t iona l s tudy o f the co l labora t i ve e f fo r ts and o rgan i za t iona l change
This study
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
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Mixed method des ign :
• Mul t ip le measures f rom more than one source
• A pre- and pos t tes t qua l i t a t i ve s tudy i s conduc ted focus ing on bo th the emp loyee sa t i s fac t ion and the c i t i zens own perspec t i ve on the rehab i l i ta t i on p rocess
• A quant i ta t i ve s tudy measures the e f fec t be fo re and a f te r imp lement ing coord ina ted rehab i l i ta t i on regard ing
• Dura t i on o f rehab i l i t a t i on• Leve l o f se l f - re l i ance a f te r rehab i l i t a t i on• Retu rn to work
This study - continued
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
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Cont ro l g roup 2011
In te rven t ion g roup 2013
Research design – quantitative effect study
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
N=110 (55 Adult ABI survivors,
55 relatives)
TAU N=?
N=200 (100 Adult ABI survivors,
100 relatives)
CI N=?
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9D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
Aalborg
Control 2011BNC, pretest
N=55
Intervention: TAU (treatment as usual)
2013, posttest N=55
2013BNC, pretest
N=60
Intervention: CI(coordinated
intervention, type 1)
2014, posttest N=?
Jammerbugt(control)
2013BNC, pretest
N=15-20
Intervention: CI(coordinated
intervention, type 2)
2014, posttest N=?
Vesthimmerland(control)
2013BNC, pretest
N=5-10
Intervention: CI(coordinated
intervention, type 3)
2014, posttest N=?
Brønderslev(control)
2013BNC, pretest
N=10-20
Intervention: CI(coordinated
intervention, type 4)
2014, posttest N=?
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• Qua l i t y o f L i fe (WHOQOL)• Depress ion (MDI )• Func t iona l i ndependence (F IM)• Par t i c ipa t ion and au tonomy ( IPAQ)
Test measures
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
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• Gather i n fo rmat ion to he lp peop le improve the i r e f fec t i venes and to ass is t admin is t ra to rs to make program- leve l dec is i ons
• Cont r i bu te to the p rov is ion o f qua l i t y se rv i ce to peop le in need
Organizational evaluation
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
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• Focus on bo th p roces and resu l t /e f f ec t• I nvo l ve s takeho lde rs
• Deve lop the i r p rog ram theor ies (mode l , concep tua l f ramework l i nk ing the i n te rven t i ons t o t he p ro jec ted ou tcomes , a r t i cu la ted l og i c o f p rog rams)
• Use t ha t theory o r mode l t o choose t he c r i t e r i a wh ich a re to be measured and tha t w i l l i nd i ca te succes fu l l imp lementa t i on and des i rab le ou tcomes
• Detec t imp laus ib le assumpt ions• Iden t i f y the i n te rmed ia te resu l t s ra the r yhan j us t t he f i na l
ou tcome
Organizational evaluation - continued
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
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Articulated logic
D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
Koordinationscenter
En indgang for borgeren
”kustodefunktion”, hjælp
Øget tilfredshed hos borgeren
Ro til at koncentrere sig om
rehabilitering
Intern koordinering hos fagpersoner
Bliver kendt i organisationen
Bryder mure ned
Effektiv sagsbehandling
Bedre økonomi
Ensartede tilbud
Øget tilfredshed hos borgerne
Vidensdeling (eksterne til
interne)
Lettere sektorovergange
Tryghd for eksterne samarbejdspartner
e
Uddannelsesaktivitet
Udpeg nøglepersoner
Lettere at spotte behov
Bedre visitering (til koordinationscenter
)
Højere vidensniveau
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1 4D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
Joint objectives Uniform line of direction
Joint use of instruments
Meet the citiczens with one united
package of instruments
Continuous sequence of steps
Easier to involve the citizen
Frees resources from repeated tasks
Efficient service
Better refferals
Purposive use of resources
Possiblity of joint accumulation of
experiences
Identify indicators of rehabilitation-
potential
Easier knowledge transfer
A gradual transision across the primary
and secondary sectors
Using the same language / Joint understanding
Understand one another
Easier and better co-operation
Rapid decision making
Easier access for the citizen
Articulated logic - continued
Joint rehabilitation plans and tests
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1 5D E P A R T M E N T O F C O M U N I C A T I O N A N D P S Y C H O L O G Y
Joint rehabilitation plans and tests
Joint objectives Uniform line of direction
Joint use of instruments
Meet the citiczens with one united
package of instruments
Continuous sequence of steps
Easier to involve the citizen
Frees resources from repeated tasks
Efficient service
Better refferals
Purposive use of resources
Possiblity of joint accumulation of
experiences
Identify indicators of rehabilitation-
potential
Easier knowledge transfer
A gradual transision across the primary
and secondary sectors
Using the same language / Joint understanding
Understand one another
Easier and better co-operation
Rapid decision making
Easier access for the citizen
Halfway evaluation
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Questions?