Appendix D-BIFI Fidelity Index
Session Date: ___/___/20___
Rating Date: ___/___/20___
Participant ID# __________
Reviewers Initials _______
BIFI Session I
Therapist Evaluation Form
Part I: Critical Actions List
Session Overview (score: __ / 3 events)
The therapist …
 completed family status check-in and update
 provided general introduction to BIFI
 provided brief introduction to session topics (Topic 1, Topic 2)
Topic 1 (score: __ / 6 events)
The therapist …
 introduced Brain Injury Problem Checklist (BIPCL)
 distributed BIPCL to all family members and instructions provided
 reviewed family members’ responses each of the four problems areas
 asked each family member to identify areas of least and greatest concern
 lead discussion with family members reviewing similarities and differences in opinions
 normalized family members’ responses
 concluded discussion of Topic 1 by reading wrap-up statement (see manual, p. 19)
Topic 2 (score: ___ / 8 events)
The therapist …
 introduced the Family Change Questionnaire and distributed copies to each family
member
 read the FCQ question 1 out loud, solicited responses, and facilitated discussion among
family members
 read the FCQ question 2 out loud, solicited responses, and facilitated discussion among
family members
 read the FCQ question 3 out loud, solicited responses, and facilitated discussion among
family members
 read the FCQ question 4 out loud, solicited responses, and facilitated discussion among
family members
 read the FCQ question 5 out loud, solicited responses, and facilitated discussion among
family members
 noted that each family member is going through difficult changes
 concluded the discussion of topic 2 by reading wrap-up statement (see manual, p. 25)
Concluding Activities (score: ___ / 5 events)
The therapist …
 provided a brief overview of topics to be covered in next session
 asked family members to complete the BIFI Session Report Form
 asked family members to complete the Learning Survey for Session 1
 reviewed the homework sheet and assignments to be completed before next session
 reminded family that homework will be reviewed at beginning of next session
Total Score: _____ /22 events; Fidelity Index = ____ %
Participant ID# __________
BIFI Session I
Part II: Written Feedback for the Therapist
Overview
Topic I
Topic 2
Concluding Activities
General Comments
Session Date: ___/___/20___
Rating Date: ___/___/20___
Participant ID# __________
Reviewers Initials _______
BIFI Session II
Therapist Evaluation Form
Part I: Critical Actions List
Session Overview (score: __ / 3 events)
The therapist …
 completed family status check-in and update
 reviewed homework assigned during previous session
 provided brief introduction to session topics (Topic 3, Topic 4, Topic 5)
Topic 3 (score: __ / 5 events)
The therapist …
 asked family members to define physical recovery and provided a definition
 asked family members to discuss emotional impact of injury
 asked family members to define emotional recovery and described the difference
between emotional and physical recovery
 asked family members to describe factors that have held up recovery
 concluded the discussion of topic 3 by reading wrap-up statement (see manual, p. 31)
Topic 4 (score: ___ / 5 events)
The therapist …
 asked the family to discuss their feelings, expectations, and what they have been told
about recovery
 asked the family to provide a definition of patience and discuss why being patient is hard
 helps the family appreciate that patience is a skill that can be learned
 review Tips for Remaining Patient handout and discussed the family’s idea
 concluded the discussion of topic 4 by reading wrap-up statement (see manual, p. 37)
Topic 5 (score: ___ / 3 events)
The therapist …
 reviewed survivor/family versions of the Coping with Loss and Change HYN guides
 helped family members identify which coping strategies might work best for them
 concluded the discussion of topic 5 by reading wrap-up statement (see manual, p. 39)
Concluding Activities (score: ___ / 5 events)
The therapist …
 provided a brief overview of topics to be covered in next session
 asked family members to complete the BIFI Session Report Form
 asked family members to complete the Learning Survey for Session 2
 reviewed the homework sheet and assignments to be completed before next session
 reminded family that homework will be reviewed at beginning of next session
Total Score: _____ / 21 events; Fidelity Index = ____ %
Participant ID# __________
BIFI Session II
Part II: Written Feedback for the Therapist
Overview
Topic 3
Topic 4
Topic 5
Concluding Activities
General Comments
Session Date: ___/___/20___
Rating Date: ___/___/20___
Participant ID# __________
Reviewers Initials _______
BIFI Session III
Therapist Evaluation Form
Part I: Critical Actions List
Session Overview (score: __ / 3 events)
The therapist …
 completed family status check-in and update
 reviewed homework assigned during previous session
 provided brief introduction to session topics (Topic 6, Topic 7)
Topic 6 (score: __ / 5 events)
The therapist …
 asked the family what it means to set an unreasonable goal and provided a definition
 asked the family what they think the dangers of setting unreasonable goals are and
offered examples of potential pitfalls
 asked family members how they can tell if a goal is reasonable and discussed qualities of
reasonable goals
 provided the family with a copy of the Tips to Setting Reasonable Goals handout
 concluded the discussion of topic 6 by reading wrap-up statement (see manual, p. 45)
Topic 7 (score: ___ / 9 events)
The therapist …
 normalized the existence of problems and challenges after brain injury
 introduced and asked the family to complete the Obstacles to Problem Solving
Questionnaire handout
 asked family members to identify the biggest two or three problem solving obstacles and
explained why solving problems after injury can be difficult (using examples from manual)
 helped family identify effective and ineffective problem solving strategies and discussed
the Problem Solving Personality Questionnaire handout
 provided family with the Qualities of Effective and Ineffective Problem Solvers handout
 helped the family understand the benefits of structured problem solving
 distributed and explained the Steps for Effective Problem Solving Flow Chart handout
 introduced the More Ideas for Effective Problem Solving handout and encouraged family
to consider factors when completing the structured problem solving homework task
 concluded the discussion of topic 7 by reading wrap-up statement (see manual, p. 51)
Concluding Activities (score: ___ / 5 events)
The therapist …
 provided a brief overview of topics to be covered in next session
 asked family members to complete the BIFI Session Report Form
 asked family members to complete the Learning Survey for Session 3
 reviewed the homework sheet and assignments to be completed before next session
 reminded family that homework will be reviewed at beginning of next session
Total Score: _____ / 22 events; Fidelity Index = ____ %
Participant ID# __________
BIFI Session III
Part II: Written Feedback for the Therapist
Overview
Topic 6
Topic 7
Concluding Activities
General Comments
Session Date: ___/___/20___
Rating Date: ___/___/20___
Participant ID# __________
Reviewers Initials _______
BIFI Session IV
Therapist Evaluation Form
Part I: Critical Actions List
Session Overview (score: __ / 3 events)
The therapist …
 completed family status check-in and update
 reviewed homework assigned during previous session
 provided brief introduction to session topics (Topic 8, Topic 9)
Topic 8 (score: __ / 8 events)
The therapist …
 normalized stress after brain injury and asked how the family defined stress
 asked the family members to complete the 13 Item Stress Test and asked them to
identify the numbers they endorsed as true
 helped family understand the importance of early identification of stress and encouraged
family to check their pressure gauges often
 assisted family in identifying stressor “red flags”, completing the Identify the Signs of
Stress for You handout, and discussing “signs” family has observed in one another
 distributed and discussed the Stress Management Worksheet handout
 reviewed survivor/family versions of the Effective Stress Management HYN guides
 helped family members identify several strategies that might work best for them
 concluded the discussion of topic 8 by reading wrap-up statement (see manual, p. 61)
Topic 9 (score: ___ / 8 events)
The therapist …
 normalized the experience of strong emotions after brain injury
 distributed and discussed the Feelings Questionnaire handout
 helped identify commonalities of emotional states among family members and
underscored the importance of identifying strong emotions early
 introduced and discussed the Communication Questionnaire handout
 reviewed survivor/family versions of the Effective Anger Management HYN guides
 helped family members identify several strategies that might work best for them
 introduced and reviewed the Important Things You Can Do To Deal With Emotions
handout
 concluded the discussion of topic 9 by reading wrap-up statement (see manual, p. 68)
Concluding Activities (score: ___ / 5 events)
The therapist …
 provided a brief overview of topics to be covered in next session
 asked family members to complete the BIFI Session Report Form
 asked family members to complete the Learning Survey for Session 4
 reviewed the homework sheet and assignments to be completed before next session
 reminded family that homework will be reviewed at beginning of next session
Total Score: _____ / 24 events; Fidelity Index = ____ %
Participant ID# __________
BIFI Session IV
Part II: Written Feedback for the Therapist
Overview
Topic 8
Topic 9
Concluding Activities
General Comments
Session Date: ___/___/20___
Rating Date: ___/___/20___
Participant ID# __________
Reviewers Initials _______
BIFI Session V
Therapist Evaluation Form
Part I: Critical Actions List
Session Overview (score: __ / 3 events)
The therapist …
 completed family status check-in and update
 reviewed homework assigned during previous session
 provided brief introduction to session topics (Topic 10, Topic 11)
Topic 10 (score: __ / 4 events)
The therapist …
 distributed and discussed the How Well Am I Taking Care of Myself Questionnaire
handout
 asked the family about the benefits of taking care of themselves and highlighted key
benefits listed in the manual
 reviewed the 10 Very Important Ways to Take of Yourself handout
 concluded the discussion of topic 10 by reading wrap-up statement (see manual, p. 75)
Topic 11 (score: ___ / 10 events)
The therapist …
 normalized the experience of frustration after brain injury
 stated that noticing progress after brain injury can be difficult and highlighted key reasons
families have trouble appreciating progress
 helped the family understand that focus on negative/limitations can bring disappointment
 distributed the Progress Worksheet handout and asked families to list 10 areas of
progress they have noticed
 asked each family members to read their areas of progress out loud and solicited family
members for progress that family member may not have noticed
 completed and discussed the therapist version of the Progress Worksheet handout
 asked family how it felt to focus on the positive accomplishments
 distributed the Important Things Your Family Can do to Keep Getting Better and Better
Worksheet handout
 asked family members to read their important goals for getting better and better out loud
 concluded the discussion of topic 11 by reading wrap-up statement (see manual, p. 79)
Concluding Activities (score: ___ / 5 events)
The therapist …
 provided a brief overview of topics to be covered in next session
 asked family members to complete the BIFI Session Report Form
 asked family members to complete the Learning Survey for Session 5
 reviewed the homework sheet and assignments to be completed after the session
Total Score: _____ / 21 events; Fidelity Index = ____ %
Participant ID# __________
BIFI Session V
Part II: Written Feedback for the Therapist
Overview
Topic I0
Topic 11
Concluding Activities
General Comments