Praxis Care Group:
Brain Injury Services
Vision
To provide a diverse range of long term supports in a community setting for adults and
children who have sustained a traumatic or acquired brain injury, in an environment that
respects their wishes, upholds their dignity, provides excellence and innovation in service
delivery and fosters a partnership approach to the support of vulnerable people with complex
needs.
Aims and Objectives
Brain Injury Services aim to provide a nationwide support for individuals who have
suffered an acquired brain injury and will require long-term care in the community.
We will endeavour to work in partnership with individuals, families, carers and the full
range of networks to develop a continuum of services that will best represent the needs
and rights of adults and children with a Brain Injury and allow them to participate in a
full and active way that is reflective of their wishes and abilities.
We believe all services should be person centred, inclusive and empowering and we will
endeavour to continue to provide services which uphold these values, irrespective of a
person’s personal circumstances or status.
As a partnership we are committed to supporting vulnerable people with complex needs
and are dedicated to developing and providing a high quality service, which is of the
highest standards of best practice, excellence and innovation.
Nature of a Brain Injury
“The effects of a head injury depend not only on the nature of the Brain Injury but also on
the head it happens to”.
A head injury is an overwhelming and frightening experience for any individual or family
to cope with, taking seconds to occur but leaving the individual person with a lifetime to
adjust to its devastating consequences and its myriad of symptoms, including physical,
cognitive, emotional, behavioural and social factors.
Brain Injury is also more common than we think. It is the largest cause of death and
disability amongst young people and children. In Ireland over 13,000 people will suffer
from an Acquired Brain Injury every year and over 1 million will attend hospital in the
United Kingdom. Though most people will recover with no physical or external signs of
injury, this ‘hidden disability’ with its subtle cognitive and behavioural components can
become incapacitating causing misunderstanding and misinterpretation on society’s part
and frustration to the individual who may not be able to perform the same independent
tasks again.
Brain Injury Services recognise the effects an Acquired Brain Injury can have on an
individual and their family, that these symptoms may last a lifetime and that those needs
will require varying levels of support at different stages in their life.
Developments in medical and technological services also create their own dilemmas.
Today seven out of ten people survive a severe Brain Injury, but this can leave them
compromised, as it does not adequately provide for their long-term care, support or
rehabilitation. Advances in Health Care may also save lives but it does not allow them to
go on and live those lives in a meaningful way. It is this challenge of developing and
providing adequate long-term care, which the partnership of Brain Injury Services wishes
to address, as a life worth saving must be a life worth living.
History of Organisation
Praxis Care Group
Praxis Mental Health was established in 1981 and is one of Northern Ireland’s largest
charitable organisations. It provides services to people who have experienced mental ill
health, Acquired Brain Injury and learning disability, and older people in society with
dementia.
Praxis currently operates in Northern Ireland, the Isle of Man, England and the Republic
of Ireland and employs in excess of 800 people.
Praxis Care Group was established in 2002 with the merging of its 3 well-established
services:
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Praxis Mental Health
Respond - Services for Older People
Challenge
- established 1981
- established 1993
- established 1993
Aim is to assist children and adults with an Acquired Brain Injury and learning
disability to live in an appropriate community setting.
Services include:
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Accommodation and support services both in residential facilities, flat clusters
and dispersed intensively supported housing.
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Home Response Domiciliary Services
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Volunteer Befriending Schemes
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Day Centres/Workskills projects. - This has led to the development of Challenge
Cookie Companies, a horticultural project, coffee shops and house-building
project.
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Children’s Residential and Domiciliary Respite Schemes.
Unmet Needs
Despite a substantial body of clinical research showing conclusively that Brain Injury
often results in a variety of chronic impairments, individuals with a head injury and their
families continue to experience considerable distress at the lack of care in the community.
Many reports including the Mental Health Review, the United Kingdom Acquired Brain
Injury Forum and work from America show significant unmet needs remain. These
needs include:
1. A lack of residential facilities for long term care, particularly for young people.
This results in people being admitted to nursing homes; elder care residential
homes or psychiatric units.
2. A lack of specialised Day Care and Respite Care, particularly for those with
cognitive and behavioural problems.
3. A lack of appropriate secure management for people with challenging behaviour.
4. A lack of supported housing with independent living accommodation.
5. A lack of co-ordination between statutory, voluntary and private sectors, and poor
pathways between the acute and post rehabilitative stages and care in the
community.
6. Lack of specialist providers, particularly for children.
7. Significant waiting lists for current services and a lack of diversity in those
providers.
8. A ‘one fit’ approach to all care needs.
9. A significant urban/rural divide. This is particularly relevant within the border
counties.
10. A need for specialised training, knowledge and skills for staff.
11. A need for quality outcomes/procedures.
12. Limited home supports.
13. Limited transitional living arrangements.
14. Need for long-term case management.
Benefits of Brain Injury Services
Brain Injury Services have a long-term vision of working with Acquired Brain Injury and
of making a contribution to their care.
They recognise the needs of Brain Injured people cannot be met by one single agency or
professional group. Effective responses require collaborative working, innovative
approaches and shared solutions.
Praxis Care Group is a leading figure in supporting disabled people and it is expected the
skills, experience and networks established over the last 20 years in managing the needs
of individuals with complex needs and challenging behaviour will make it ideally suited
to supporting people with an Acquired Brain Injury in the community. Some of these
benefits would include:
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Extensive experience of providing Brain Injury Services on an all Ireland basis to
people with a mental health, learning disability and an Acquired Brain Injury.
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A commitment to working collaboratively with the providers, and co-ordinating
individual packages through skilled and well trained staff.
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Work focused on community inclusion, social integration, personal care planning,
respect, dignity, choice and empowerment.
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A wide range of experience in identifying needs and developing innovative and
community based supports.
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Developed infrastructures in:
Management systems
Training and research
Human resources
Finance
Information dissemination
Relevant Experience in Brain Injury care
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Experience in developing new ideas and best practice models, and proven and
established track record in delivering schemes.
Experience in establishing and implementing residential, day care services and
the development of appropriate organisational policies and procedures.
Experience at developing appropriate interventions that enable service users to
achieve their optimum level of independence.
Experience in the development of new projects and project management.
Experience in establishing networks, identifying key stakeholders and inter
agency workings.
Experience in contracting with Health Boards, Social Services, Trusts and
local authorities throughout Ireland and the United Kingdom.
Experience in managing challenging behaviours.
Experience in assessment and care planning processes.
Experience in developing quality assurance strategies and ensuring quality
through:
1. Valuing Staff
Brain Injury Services operate in a culture in which staff are valued, their views sought
and achievements recognised.
2. User Focused
The needs, views and aspirations of service users and families are central to service
developments and delivery. Service users views are actively sought, engaged, and
implemented.
3. Partnerships
Brain Injury Services have a commitment to collaborative working and partnerships
will continue to be explored with all relevant people and stakeholders.
4. Training and Research
Brain Injury Services have a strong commitment to training and research. In
recognition of the importance of these two areas it has two separate departments to
ensure appropriate training and evidence based research underpins the work of its
services. Brain Injury Services have clear vision of a training strategy for Brain
Injury and are committed to continuous professional development.
5. Striving for Excellence
Brain Injury Services believe in the necessity to continuously improve services. This
is done through explicit standards setting, effective monitoring and striving to surpass
expectations. This is achieved through:
Complaints procedures
Consumer Surveys
Supervision
Policies and Procedures
6. Cost effectiveness
Brain Injury Services is committed to ensuring value for money through maximising
the use of resources, auditing out comes and focusing service delivery to meet
purchaser and user requirements.
7. Best Practice
Brain Injury Services aim to establish a bench marking process with other
organisations providing similar services and facing similar issues. It is hoped this
process will allow Brain Injury Services to learn from other organizations and so
create a culture of Best Practice” by sharing knowledge, improving performance and
developing new initiatives. This will be done on either a national United Kingdom or
international basis.
Legislation
Brain Injury Services will comply with all statutory regulators, both within Northern
Ireland, the Republic of Ireland and the United Kingdom. This will include:
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Mental Health (Northern Ireland) order (1986)
Chronically sick and disabled persons (Northern Ireland) Act (1998)
Disabled persons (Northern Ireland) order 1998
Health and P.S.S. (Northern Ireland) order (1991 and 1994)
Children’s order (Northern Ireland) (1995)
(Northern Ireland Act (1998)
Human Rights Act
Carers Recognition and Service Act (1995)
Community Care Direct Payments Act (1996)
Data Protection
COSHH Regulations
European Directives
Health and Safety at Work
Current Services
Brain Injury Services provides a wide range of supports for individuals with an Acquired
Brain Injury and will expect to continue to develop the full spectrum of support in the
future, in partnership with users, Trusts, Health Boards and other key stakeholders.
These services include:
Residential Accommodation/Housing
Brain Injury Services has a number of residential units within the challenge programme
of care, which currently offer long-term care for people with an Acquired Brain Injury
and learning disability. At present we are able to offer individual placements to people
with an Acquired Brain Injury in these units and we have the capacity to develop a
specialist unit specifically for people with an Acquired Brain Injury.
Respite and Holiday Breaks
Brain Injury Services can currently offer respite and holiday relief for children within its
residential units in Northern Ireland, and is currently engaged in looking at possible
options within the Republic of Ireland.
Volunteer Supports
Brain Injury Services have an extensive volunteer supports system within Northern
Ireland it is hoped to extend this to Brain Injury Services both within the north and south
of Ireland.
Future Developments
Over the coming 12 months Brain Injury Services will continue to look at developing
partnerships with a wide range of people which will expand our services and make these
more inclusive, relevant, accountable and sustainable. These partnerships and services
will include:
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The development of a range of models of supports for adults and children with an
Acquired Brain Injury.
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Development of specialist residential units for Acquired Brain Injury – Western
Board (NI), Midlands HSE.
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Development of respite services for children within existing residential services in the
north and south of Ireland
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The continuation of establishing links with relevant networks and service providers
throughout Ireland and the United Kingdom
Links currently established include:
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Kemsley Unit
Children’s Brain Injury Trust
Headway Ireland
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Jason Clarke Foundation
Health Service Executives (ROI)
Department of Health (NI) – working party
Housing agencies – Strategic Property Solutions
Development of Training Packages for Brain Injury
Development of a 2 day International Brain Injury Conference - September 2006
Brain Injury Services
Brain Injury Services will continue to work with all organisations either formally or
informally in developing services for adults, children and families with an Acquired
Brain Injury. We look forward to working with all community Brain Injury teams,
Trusts, HSEs and Health Boards throughout Ireland, and we are currently member of the
United Kingdom Acquired Brain Injury Forum, the Traumatic Brain Injury Forum in
Northern Ireland and the Brain Injury Social Work Group (UK). We are also currently
involved with the Department of Health (NI) as a member of a working group to explore
Brain Injury needs.
Model of Transitional
Living Unit
Case
Management
Team
Referral Process
24 Hour
Supervised
Support
Day Treatment,
Activity
Programmes
Transitional Living Unit
Supported
Apartments for
Independent
Living
Family Therapy
Supports
Case Management Team
Community Care Co-ordinator
Residential
Long Term Care
Care in the
Community
Family
Supports
Home to
Family
Respite
Full
Independence
Community
Brain Injury
Day Care
Supported
Housing
Outreach
Supports
Community Brain
Injury Day Care
Community
Brain Injury
Day Care
Long Term Placement
or
Return to Local
Community
Family Therapy Supports
The above model provides a seamless pathway from post acute rehabilitation within hospital to
care in the community, through a range of service options, which can be accessed at any point
by clients throughout their journey from dependence to independence.