Day programs bridge gap between hospital, school

Therapy, schoolwork, community re-entry

There’s a dramatic difference between life in the hospital and life at home for young, severely injured patients. When released from the rehab hospital, these patients often need a lot of help to make the transition back to the school and the community. A day treatment program helps hone in on adjustment issues that crop up after a patient is released from the hospital, explains Donna Gregory, program director of Bryn Mawr Rehab’s adolescent day program in Malvern, PA.

"Patients need a transition from the hospital setting to a more normalized environment," Gregory says. "When they are inpatients, their understanding of the effect a brain injury will have on their lives is limited, but when they get home and find out what a difference it will make, they have trouble adjusting."

In the inpatient setting, the staff try to involve the parents from day one and encourage having one family member at the hospital at all times to train the family to take care of the child’s needs. But, when the child makes the transition back to school, the family can’t go with him, adds Els VanDeneynde, OTR/L, lead therapist in the inpatient unit at Scottish Rite Children’s Medical Center in Atlanta.

That’s why the day treatment program is necessary to help children learn to cope on their own before they go out into the real world, VanDeneynde points out.

At Scottish Rite, the family is not involved in the day rehab program. Instead, the staff tries to acclimate the patients to an atmosphere more like the school setting.

Patients at Bryn Mawr Rehab’s adolescent day program go through a tailored program of individual therapy, classroom training, and community and school re-entry activities. The program is designed to meet the needs of traumatic brain injury patients but can be used for spinal cord injury patients and amputees.

"The needs of adolescents ages 12 to 18 are unique. We are looking at the whole development process of that age group and what their issues might be prior to brain injury," Gregory says.

A comprehensive program with a staff dedicated just to that program helps the patients make the adjustment, she adds.

"Patients with brain injuries have trouble adjusting to new situations and changes. Having a core group of therapists to treat them really helps with consistency in care," Gregory says.

The treatment team includes a physical therapist, occupational therapist, therapeutic recreation specialist, speech therapist, child life therapist, psychologist, and special education teacher.

A transdisciplinary approach

Bryn Mawr’s program includes a transdisciplinary team approach that focuses on the patients’ outcome goals rather than what each discipline should do individually, Gregory says.

"The physical therapists may address cognitive challenges as they treat the kids, and the special education teacher may help them ambulate during a classroom activity," she explains.

Patients typically do not receive nursing care, although there is a nurse on staff. "At this level, they need more of a functional approach than a medical approach. They are stable but aren’t ready to be back in the school setting because of cognitive, physical, and behavioral issues," Gregory says.

The staff looks at the problem areas the family has identified and bases a treatment plan on overcoming the barriers to school re-entry.

For instance, a brain-injured patient could have problems with memory. In that case, the day treatment staff will concentrate on cognitive issues and compensatory strategies. "The goal is to get them back into the school as soon as possible, and to set up a safety net and support system at the same time," Gregory says.

The Scottish Rite program is geared toward treatment in groups of two or three. There are two teachers who give the young patients a full load of academic work. Much of the program is geared toward community re-entry and includes a lot of community outings. The cost of the program is about half the cost of inpatient rehab, VanDeneynde says.

The Scottish Rite program is set up like a school. Children are picked up by a bus in the mornings and returned home in the afternoons. Families who live a long way from the hospital stay at a Ronald McDonald House near the hospital while the child attends day treatment.

The program is run by a transdisciplinary treatment team that provides therapy in groups and on an individual basis, as called for by each child’s individual treatment plan. There are two teachers on staff who help the patients keep up with the academic work from their home schools.

In summer, there may be as many as 25 child-ren in the program. Local school systems refer brain injured patients to Scottish Rite to ensure they don’t lose ground while school is out, VanDeneynde notes.