The keys to identifying and prioritising issues are:

• Coming up with ideas - how do you help the individual do this?
• Recognising the skills and strengths of the individual
• Supporting the individual in prioritising issues

 

Helping the individual identify what they want to work on

The first step is to identify issues the individual wants to work on or areas they want to improve. The more meaningful or relevant the issue or activity is to the individual the greater the chance of success. When trying to enable the individual to identify areas to work on, ask an open question.

For example,

• "What would you like to work on?"
• "What do you think stops you from doing what you want to?"

Open ended questions provide the individual with the most control and helps independent decision making.

If the individual is not able to generate their own ideas or issues or areas to work on, you need to ask a question that has an option or alternative.

For example,

• "What is a bigger issue, your temper or your memory?"
• "Would you prefer to work on being able to prepare an evening meal or get your washing done?"

These questions still allow the individual to make their own decision. The number of options that are provided depends upon the individual's ability to manipulate information, reason and remember the options provided.

If the individual cannot remember information, another strategy is to write down the issues or alternatives and then work through them on paper. This allows the individual to refer to the information independently as required. This decreases their dependence upon the worker's memory and equips them with another strategy they can use in situations whenever their memory limits what they are doing.

Questions that might help you help the client identify their issues

These questions assist the support worker to understand the barriers to independence for the individual with a brain injury. However, it is essential that they identify their own issues and give them a priority for goal setting. The worker takes a supportive, not directive role in the complete process.

TIME MANAGEMENT:

• Do they get up in the morning by themselves. What time?
• Do they know what is going on, are they oriented to day of the week, month, etc?
• Do they refer to their timetable? By themselves?
• What do they spend their spare time doing?
• Do they carry their diary, do they look at it, write in it? By themselves?
• If they say they will be back in ten minutes are they?
• Are they slow to get ready? Do they leave themselves enough time?

DAILY ROUTINE:

• Do they tidy their room, clean up after themselves? Without prompting?
• When do they shower, how often? Do they need prompting?
• Do they sleep at night?
• Do they take rest breaks during the day, sleep?

ROOM TIDINESS:

• Is the bed made? Can they make the bed from scratch themselves?
• Are there things on the floor?

SELF CARE:

• Do they initiate showering? Need assistance bathing? Toileting? Do they forget things and have to go back for them? How do they set themselves up, set the bathroom up, get things to and from the bathroom?
• Do they wear appropriate clothes for the weather?
• Can they do up their shoes, buttons?
• Do they change into clean clothes?
• Do they wash their face, practice personal hygiene?

MEDICATION:

• Do they remember to take it?
• Do they come to you to get it or do they have it in a special place?
• Do they know what medication to take and what it is for?
• Do they recall they have taken it?
• Do they use their diary or timetable to cross off when they have taken it?
• Can they fill their scripts themselves? Do they have money to pay? Do they monitor how much medication they have left?

EATING:

• What is their posture like? Do they slouch or sit up straight?
• Ability to use cutlery e.g. bilaterally use knife and fork, what hand do they spoon with? Can they stir, spread and cut? What is their grip like?
• Do they need adaptive equipment e.g. rocker knife, non-slip mats
• Ability to bring food to mouth - are they messy, what hand do they use?
• Can they open jars, cartons, can they lift and pour?
• Do they eat fast or slow?
• Do they stick to a special diet if they are on one?
• How often do they eat? What do they eat?
• Are they safe in how they eat?
• Are they easily distracted?
• Do they communicate with others while they are eating? Appropriately?

MEAL PREPARATION:

• Do they leave enough time to prepare the meal?
• Do they get meat or frozen food out beforehand?
• Do they locate the recipe, is there a menu plan and do they refer to it?
• Do they get out all the ingredients and equipment prior to starting, or as they go? Does this affect their performance?
• Are they distracted in the kitchen? Can they focus on more than one thing at once e.g. cooking a stir fry and rice, grilling meat and boiling vegetables.
• Can they follow the recipe? Is it a picture one, written, small print with others on the page, does it have an equipment list, ingredient list?
• Are they safe using sharp utensils or hot equipment?
• Do they need adaptive equipment e.g. one handed chopping board?
• Do they sit or stand to prepare the food? What is their endurance like? How long could they concentrate for?
• Can they perform bilateral tasks? Use equipment?
• Do they monitor the cooking process?
• Are they fast or slow?
• Do they measure things accurately?
• Are they safe getting around the kitchen?
• If it is something they have prepared before, can they remember how? In detail?

MENU PLANNING:

• Can they think of meals to cook? Are they the same each week? Do they need to use a recipe book? What recipe book-? Pictures, writing only?
• Do they need prompts to think of lunch and breakfast meals?
• Do they come up with the right amounts of food for the number of people?

SHOPPING LIST PREPARATION:

• Can they identify all the ingredients needed for the meal preparation?
• Can they look into the cupboards or fridge and search for the ingredient and determine whether or not it is there. Is there enough of it for the meal or until the next shopping day?
• Can they identify other foodstuffs always needed i.e. milk, coffee, tea, butter, spreads, biscuits, breakfast cereal, bread, orange juice etc.?
• Do they remember to check for other items like toilet paper, washing powder, soap, tissues, serviettes?
• Can they write the items needed into a categorised shopping list i.e. meat together, pantry items together, fridge/freezer items etc.? If they can't do this can they identify where different foodstuffs should go on a categorised shopping list?
• Do they write down the number or quantity of foodstuffs needed?

SHOPPING:

• Can they remember where the supermarket is?
• Do they remember the layout?
• Do they initiate getting a trolley and pushing it around?
• Do they clearly ask for items at the deli or seek assistance if they can't find something?
• Do they use overhead signs?
• Do they scan the list frequently, cross items off as they collect them?
• Can they identify items to be bought independently? Do they need prompting to look to one side of the aisle, or to look at one shelf etc?
• Can they make a decision about what is the best buy and what is the most appropriate buy? Do they reason or take the first one they see?
• Do they fatigue or work best with smaller lists? Are they best getting just fruit or can they get a bit of everything? After how long do they tire? How many items can they manage to find by this time?
• Do they logically go up and down each aisle or do they miss one and go back on themselves?
• Can they reach all of the shelves?
• Do they wait at the cashier?
• Do they load the items onto the register independently without prompting?
• Do they push the trolley to the car? Do they help unload?
• Do they know where things go? Do they need prompting to help put things away?

HOUSEHOLD CHORES:

• Do they initiate their performance?
• Do they need help to set the activity up? Do they look for things themselves or ask straight away for help to locate things?
• Do they know what has to be done?
• Do they do it properly, slowly, quickly?
• What is their attitude to doing it?
• Do they clean up afterwards?
• Have they done all the different chores e.g. bathroom, kitchen, mopping, sweeping, bathrooms, etc.?

LAUNDRY:

• Do they recognise they have to wash their clothes, bath towel and bed linen?
• Do they initiate using the washing machine?
• Do they recall how to use it after being shown once?
• Do they know generally how to use it?
• Do they remove the clothes when finished without prompting?
• Do they hang the clothes on the line or put them in the dryer?
• Do they need assistance to get the clothes to the clothes line and hang them? What kind of assistance?
• Do they remember to get them in when dry. Or do they need prompts?
• Do they fold up their clothes and put them away? Do they iron? Are they safe in using the iron, know how to use it, not leave it on, put things away?

EMERGENCY SITUATIONS:

• Do they respond to smoke or an alarm going off? What do they do? Do they move quickly or slowly?
• Are they aware of whom to call in an emergency if they are there by themselves?
• Do they know what to do if they burn or cut themselves?

INTERPERSONAL INTERACTIONS:

• Do they talk with others, do they start the conversation?
• Do they stay on track, exaggerate, talk non-stop?
• Who do they talk to?
• How do they go buying things in public, asking for assistance?
• Do they see another person's point of view?
• Do they pick up on others? Verbal and non-verbal cues?
• How do they act under pressure?

INTRAPERSONAL SKILLS:

• Are they confident in doing things around the house, in the community?
• Are they motivated to do things?
• Do they have insight into what they have difficulty with?
• How do they accept feedback about their performance or behaviour?
• Do they seek help?
• Are they egocentric, considerate of others?
• Are they responsible for what they do?
• Can they give themselves praise when they do something well?
• Do they reflect upon different things that have changed their performance?
• Do they monitor what they are doing?
• What is their mood like? Does it affect what they do?

BANKING:

• Can they find their bank or ATM?
• Can they follow instructions or complete the form or use EFTPOS?
• Do they know how much is in their account?
• Do they interact with the teller appropriately?
• Do they put their money in their wallet or purse prior to leaving the bank or walking away from the ATM?
• How often do they go to the bank?

MONEY MANAGEMENT/BILL PAYMENT:

• Do they recognise coins and notes?
• Can they predict how much change they will get from a transaction?
• Can they do this fast enough to be able to be functional?
• Do they spend their money impulsively?
• Can they identify how much a bill is for? Where to pay it? How to pay for it?
• Do they keep the receipt?

COMMUNITY ACCESS/ROAD SAFETY:

• Do they cross roads safely? Stop at the kerb, look in both directions before crossing?
• Do they use traffic lights? Initiate pressing the button? Wait for the walk signal and check before stepping out?
• Can they walk on paths, up and down kerbs?
• In car parks are they aware of traffic?
• Are they familiar with the local area?
• Can they go to the local shops by themselves? Do they know the route? Do they recall what they have to get when they get there?
• Can they use store directories or street directories to identify routes to their destination? Can they recall the route? Do they recall the route over time?
• Can they talk and cross the road?

FUNCTIONAL MOBILITY:

• How do they get around?
• Are they safe in transfers e.g. sitting to standing, from the lounge, kitchen chair with arms, toilet, front and rear seats of a car?
• Can they bilaterally carry things and walk when inside/outside? Can they carry things in one hand and get around inside?
• Are they aware of becoming tired?
• Do they look out for spills in the home or community?
• Can they get things off the floor or from down low in cupboards, out of the washing machine?
• Do they overbalance? When? What doing?
• Do they use both hands to reach for things?
• Do they use correct manual handling techniques?

PUBLIC TRANSPORT:

• Can they use a timetable to find out when to leave and plan the trip?
• Do they think of cost? Do they have money?
• Can they identify when the transport will be arriving, identify the correct transport to get on? Attend to environmental cues e.g. bus stops, platform boards for trains, taxi stands? Keep checking them to make sure they get on the right one?
• Can they purchase their ticket?
• Do they monitor the journey?
• Can they physically and safely access the transport? Are they seated by time of movement?
• Do they have their ticket to reproduce at the other end?
• Can they find their way from where the transport lets them off to their destination?
• Do they behave appropriately? Are they easily distracted?

 

Always recognise the skills the person has and try and find out how they previously performed the activity. Ask them to describe the process they would go through to do an activity. Again start with open ended questions.

For example,

• "How would you go about doing that?"
• "What do you think you need to do that?"
• "Have you done it before?"
• "How have you done it previously?"
• "Can you remember how you have done it before?"

Asking open ended questions like this enables the individual to have control and demonstrates that support workers recognise the individual has abilities. It shows those working with the individual how much of an idea they have. Support or assistance needs can then be determined. If necessary provide simple or brief plans and ask them for more information.

For example,

• "How are you going to do this?"
• "What did you mean when you said this?"
• "How are we going to do it?"
• "What do you need to do it?"
• "Is there anything you can look at that will give some help?"

Such questions enable the individual to organise themselves and their environments. This provides them with the opportunity to share their knowledge. Insight can be gained into how they used to do things so they can be helped to do these things this way again, if it is feasible.

 

 

Where to begin?

The important question! The first step to getting started is to STOP, and THINK about what you want to achieve or identify an issue you want to work on.

An issue can be something you might be having difficulty with.

These may be simple things, like remembering to set the alarm each night to wake you in the morning, or to identify activities to do in spare time. They may be more specific. For example, gaining a better understanding of your injury, working on your speech or fitness, or dealing with issues associated with changes in your behaviour, like managing your anger.

Using Worksheet 1 you need to identify what issues are most important to be worked on straight away. These will become goals.

On Worksheet 1 write down: different issues stopping you from doing what you want, and different activities or goals you want to achieve. Examples of issues may be forgetting appointments or not being able to concentrate. An activity you want to achieve may be shopping or reading.

You need to PRIORITISE your list of issues and goals.

Here are some helpful questions to ask yourself.

Is it something you have to do?
For example, eat breakfast. Put an E beside it. This means it is essential for your survival. This has a high priority.

Is it something you need to do?
For example, shower daily. Put an N beside it. This means it is necessary for you to do it to fit in with others and society. This has a high priority.

Is it something you want to do?
For example, going to the movies. Put a W beside it. This means it is something you would like to do. Although it is important to you, it does not affect your safety or survival. It is a medium priority.

Is it something that is potentially dangerous or unsafe for you, others or your environment?
For example, not remembering to turn the iron off. Put a D beside it. This means it places you at risk or in danger. This is a high priority.

Is it something urgent that has time limits?
For example, paying a bill on time. Put an E beside it. This means it is essential for your survival and wellbeing.

Is it something to do with your future?
For example, living by yourself in the community; Put an F beside it. This means it is possibly going to take a long time to achieve and you might need smaller goals to work on first. This is of medium priority;

Is it something that interferes with you doing other things?
For example, forgetting to meet friends for lunch. Put an N beside it. This means it is necessary for you to do it to fit in with others and what society expects.

Issues that compromise your safety and basic lifestyle are high priorities!

These are the codes "E" "N" "D". These are your first priority to achieve. Code these as 1.

"W" and "F" issues will enable you to balance your goals and make these a second priority. Code these as 2.

Once you have coded your issues, and then priority coded them, you may have more than one issue coded as 1 or 2. If this is the case you will need to rank them or put them in an order that you think is most important.

Sometimes to establish priorities, you work out what you need to do after something happens. For example,

• Something urgent or dangerous happens. For example, you fall in the bathroom and realise you need a chair to sit on .
  
  
• Something that you have to do or need to do doesn't get done and you suffer the consequences. For example, not having enough money to buy the groceries, or forgetting to pay the telephone bill and the telephone is cut off. After these are addressed you can then move onto goals for something you want to do or would like to do in the future.

On Worksheet 1, number your list of issues into a list of importance. Prioritise your list. This makes it easier to know what you should be working on. You can then move down the list as you resolve each issue, achieve your goal or your priorities change.