Running Head: COMMUNITY ASSSESSMENT

Volunteers of America Western Washington Community Assessment

Shamila Hashimi and Christan Mulder
Western Washington University

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Volunteers of America Western Washington Community Assessment
Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an
external force (Brain Injury Association of America, 2012). The brain is a highly complex system
which makes every TBI different in regards to how it alters brain function. According to the
Center for Disease and Control (CDC), there are 1.4 million new cases of brain injury each year
in the U.S. and many people who experience a TBI will sustain some type of cognitive
impairment (Radomski, Anheluk, Bartzen, & Zola, 2016). TBI survivors require extensive
assistance with completion of daily living activities post injury and unfortunately many
individuals will require assistance for the rest of their life. When planning and providing care, its
important for caregivers to have an understanding of the patients current medical status versus
severity of negative impact that occurred immediately after injury. This is crucial to provide safe
and effective nursing care for TBI patients. (Kay, 2013).
In June 2015, the Volunteer Services of America Western Washington (VOAWW) began
a project to build a house for three individuals who sustained a TBI prior to age 18. The
VOAWW has recently hired ten-fifteen new employees to provide direct patient care within the
newly constructed home. The new employees have attended new hire orientation and will
undergo the core training components of all hired staff. The VOAWW is a well-known agency,
providing assistance to Western Washington residents for over one hundred years. The
organization offers assistance in six different programs, the largest being personal support
services and supported living. The purpose of this paper is to describe what two Registered
Nursing students from Western Washington University did to assist the VOAWW in
implementing their new program and how our work positively impacts TBI survivors. The goal
of this project was focused on improving care provided by the VOAWW caregivers.

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Assessment Data Summary and Analysis
Data Collection
Our data collection began with general research on TBI and the impact brain injuries
have on individuals, families and the community. We began our research by searching general
statistics relating to TBI. Prior to data collection we defined our community as the VOAWW
which operates primarily within Snohomish County Washington. The community consists of the
VOAWW employees and patients with TBI. After conducting research we were prepared to
begin the assessment phase of our community assessment and ask relevant questions to the
VOAWW during informal interviews. Dr. Janet Mott, a rehabilitation counselor and case
manager with a great background in TBI began to assist us in data collection at this point in our
project. Dr. Mott is a highly respected community leader who is also the Clinical Case Manager
for the Brain Injury Alliance of Washington. Dr. Mott served as a wonderful resource for us
during this project. She supplied us with websites, documents, books, and additional types of
literature on traumatic brain injury. The CDC and the Washington State Health Department
provided us with the majority of our statistical data. Data collection during this assessment was
both qualitative and quantitative findings.
Interviews
After reviewing our data collection and developing interview questions for Brian Smith
(VOAWW Senior Director of personal care services) and Dr. Mott, we began to identify which
areas of improvement within the community we felt were appropriate and where the greatest
need for change was located. Sample interview questions included: What financial resources are
available to provide additional training to your caregivers? In what areas do you see your
employees requiring additional training and education? Are there certain unwanted behaviors
that TBI patients demonstrate that you feel would be most important to address? We were

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fortunate enough to visit a home that is currently supported by the VOAWW, we conducted an
informal interview with the caregiver who works within the home. We did not receive any
information in regards to TBI patient care or if she would be interested in increasing her training
opportunities, but we were introduced to the flow of a VOAWW household and how day to day
operations are conducted. We spent some time observing the current clients within the home and
explored different items like laundry facilities, door locks and the computer program in which
care is documented on. This observational and informal interview provided us with a basic
understanding of how the VOAWW operates its homes and what training/educational materials
were available to staff.
During our interview with Brian Smith we began to understand a little more about the
new client population being introduced to the VOAWW and that the organizations biggest
concern is caregiver education. Currently there is one TBI patient who is receiving services
through the VOA and they are planning to move the next two individuals into the home in the
coming months. All three individuals are in their 50s, without family support. The two that are
not yet under the VOAWW reside at rehabilitation facilities (B.S., personal communication, May
5, 2016). All caregivers who work for the VOAWW must assist these individuals to strive for
independence within a supported living environment by providing choices that embrace
components of self-determination.
Identification of interventions
System Level Intervention
Based on the results of our community assessment we developed three recommendations
for this community. At the system level a policy change is recommended by changing the

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training materials provided to new hires with the VOAWW. This recommendation may require
employees to have additional training hours and would focus primarily on the challenges of
caring for a patient with a TBI and how to manage the emotional and behavior changes that often
occur.
Up to 70% of patients with TBI experience episodes of agitation and crisis (Luaut,
Plantier, Wiart, & Tell, 2016). The duration of the agitation, external triggers, and type of episode
depends on the patient and may include: motor agitation, projection against bed rails, and the
patient getting up from the bed and sitting back down continuously. External triggers that may
heighten agitation include: pain, contention, excessive stimulations, an aggressive attitude from
healthcare personnel or caregivers and psychotropic drugs (Luaut et al., 2016). Appropriate
interventions are crucial when dealing with individuals experiencing an episode as risks to the
patient and caregiver may occur. Falls, self-inflicted harm, aggressive feedback, physical
violence, and burnout of caregiving staff are all complications of unmanaged behavioral
episodes. Research indicates that managing episodes of crisis or agitation is often times the most
complex aspect of TBI patient care drugs (Luaut et al., 2016).
In order for the VOAWW to provide safe and effective patient care to TBI patients, the
caregivers must be equipped with a strong foundation of knowledge regarding the common
cognitive, memory and sensory impairments. The caregivers should be educated on ways to
manage the negative behaviors that may develop post TBI. This would be a primary prevention
intervention. People who are cognitively impaired have altered self-reliance and ability to
appropriately react to their environment (Siriluck, Achara, Suparat, & Chawapornpan, 2015).
As each TBI patient may experience unique changes in physical, emotional and cognitive

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functioning depending on the severity of the brain injury and location within the brain, its
important the VOAWW staff be prepared for a variety of difficult patient situations. Proper
interventions when providing care is essential to the overall well-being of both the VOAWW
staff and the TBI patients. In conversation with Dr. Mott during this project, a recommendation
that she suggested was ensuring that caregivers are keeping track of the behaviors demonstrated
and if possible record if anything triggered this incident to occur (Dr. J.M, personal
communication, May 25, 2016).
Community Level Intervention
An intervention at the community level requires environmental change within the homes
of the TBI patients. A peaceful and reassuring environment may lead to less incidence of difficult
or challenging patient behaviors. The patients moving into the new home were independent
individuals and now are relying on assistance from caregivers every day. Refusal of cares and
medications as well as increasing agitation and anxiety can be decreased by environmental
modifications. Ensuring a safe environment for TBI patients may include bedroom modifications
to reduce risk of falls; installing safety rails on beds and in bathrooms and possibly utilizing door
alert systems (Luaut et al.,2016). This is a good example of a secondary prevention
intervention.
An additional community level intervention may include raising awareness of incidence
of TBI. This may be accomplished as the VOAWW continues on with their project and continues
to take on additional TBI clients. During this project we were able to introduce Brian Smith and
Dr. Mott by conferencing all together one afternoon. Creating community partnerships

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such as this one can raise the awareness of TBI and can promote success in the VOAWWs new
program.
Individual Level Intervention
At the individual level, an appropriate intervention would include changing attitudes or
beliefs associated with challenging TBI behaviors. Its important that caregivers understand that
when unwanted behaviors begin to appear, its critical to eliminate possible underlying processes
that may be triggering the behaviors such as pain, metabolic disorders or complications as severe
as sepsis (Siriluck, et al.,2015). Acute medical problems or illness may be the reason a TBI
patient becomes suddenly agitated or anxious. Changing beliefs or attitudes and seeking to find
possible cause during sudden behavioral episodes is an example of tertiary prevention
intervention.
Identification of the intervention to be implemented
As the number of TBI survivors increases, the need and demand for highly trained
caregivers will continue to rise. The Washington State Department of Health states that every
year Washington State residents have approximately 5,500 TBI hospitalizations and if the
national estimates hold true in Washington State, there are a total of nearly 123,750 residents
with TBI-related disabilities.
Based on the findings of our community assessment, the intervention that would be most
appropriate for the VOAWW would be modification in training components for the VOAWW
staff caring for TBI clients. Our deliverable for the agency includes educational materials and
online resources collected and identified by ourselves and many supplied by Dr. Mott with a

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primary focus on managing the difficult and challenging behaviors that accompany TBI.
Prevention of agitation/frustration and the promotion of independence is an example of whats
included in documents collected. Many organizations who focus on TBI have published
educational materials that the VOAWW may review and utilize to increase knowledge and
implement effective care technique. It is critical that these caregivers are able to receive proper
and adequate training to provide safe patient care. We will deliver what we have learned about
safe and effective TBI implementation strategies to the VOAWW directors; Brian Smith and
Justin Krupa. The information we provide them will assist in educating the caregivers and benefit
the VOAWW in becoming successful with their new project.

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References
Brain Injury Alliance of Washington. (2015). Retrieved from http://biawa.org/
Brain Injury Association of America. (2012). About brain injury. Retrieved from
http://www.biausa.org/about-brain-injury.htm
Centers for Disease Control and Prevention. (2016). Injury Prevention & Control: Traumatic
Brain Injury & Concussion. Retrieved from
http://www.cdc.gov/TraumaticBrainInjury/index.html
Kay, Anita. (2013). Strategies for Surviving and Thriving. Retrieved from
http://tbiwashington.org/professionals/documents/TBI_video_workbook22713.pdf
Luaut, J., Plantier, D., Wiart, L., & Tell, L. (2016). Care management of the agitation or
aggressiveness crisis in patients with TBI. Systematic review of the literature and practice
recommendations. Annals of Physical and Rehabilitation Medicine, 59(1), 58-67.
doi:10.1016/j.rehab.2015.11.001
Radomski, M. V., Anheluk, M., Bartzen, M. P., & Zola, J. (2016). Effectiveness of Interventions
to Address Cognitive Impairments and Improve Occupational Performance After
Traumatic Brain Injury: A Systematic Review. American Journal of Occupational
Therapy, 70(3), p1-p9 9p. doi:10.5014/ajot.2016.020776
Siriluck, K., Achara, S., Suparat, W., & Chawapornpan, C. (2015). Sensory Stimulation Process
and Cognitive Function among Persons with Traumatic Brain Injury: A Case Study.
Pacific Rim International Journal of Nursing Research, 19(1), 45-57 13p.

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Washington State Department of Health. (2007). Traumatic Brain Injury. Retrieved from
http://www.doh.wa.gov/Portals/1/Documents/5500/IV-TBI2007.pdf