A qualitative study of providers’ decision-making for cases involving neurobehavioral issues

Figures & data

Figure 1. Neurobehavioral issues that may manifest following brain injury.

Table 1. Open-ended response prompts

Scenarios:
You currently serve a 24-year-old individual living with their family in the Commonwealth of Virginia who attends a clubhouse/day program during the week. Recently, this individual is exhibiting escalating agitation, aggressiveness, and apathy consistent with a neurobehavioral profile. The day services provider has called to tell you this behavior is now manifesting in yelling and an inability to be consoled. Given this scenario, what do you perceive as the best course of action?
You currently serve a 45-year-old individual who sustained an injury to the frontal lobe as a result of a car accident. This individual has completed an inpatient rehabilitation program but continues to exhibit impulsivity and memory loss with intermittent spells of depression. This individual now resides in a group home that accepts their Medicaid coverage. Given this scenario, what do you perceive as the best course of action?
A social worker contacts you as a recognized expert on brain injury in the Commonwealth of Virginia. She has an individual with severe neurobehavioral issues; the individual has been accepted and discharged from four nursing homes based on unmanageable behaviors. What suggestion do you have for this individual?

Figure 2. Flowchart of research methodology and approach.

Table 2. Operational definitions for providers responding to the case scenarios

Term	Definition
Acquired brain injury (ABI)	Acquired brain injury refers to brain trauma that occurs after birth. ABI does not include diseases that are a result of a progressive loss of cells in the nervous system such as Alzheimer’s, Parkinson’s, and ALS. Two of the leading causes of acquired brain injury are stroke and trauma brain injury (TBI). However, acquired brain injury can also be caused by oxygen deficiency, infectious diseases (e.g., meningitis), toxic chemical exposure, electrical shock, and brain tumors (O’Donoghue et al., 2015). Acquired brain injury is an inclusive term that refers to any damage to the brain that is not of a developmental or neurodegenerative cause.
Neurobehavioral	Neurobehavioral refers to the way the brain affects emotion, behavior, or learning (Centers for Disease Control and Prevention, 2016)
Neurobehavioral needs	Neurobehavioral needs refer to the compromising cognitive, behavioral, and/or social changes that result from an acquired brain injury (ABI). Although these needs and their duration vary depending on the severity of the injury, individuals with both mild and severe brain trauma may experience changes in their personalities, find problem solving difficult, experience a lack of motivation, or act impulsively. Neurobehavioral needs for individuals with persistent neurobehavioral issues often stem from compromised functional abilities that limit an individual’s ability to engage in professional, social, and educational activities. Additionally, co-morbid psychiatric and mental health diagnoses are not uncommon while persistent neurological disabilities may lead to under-employment and increased rates of government financial assistance and incarceration (Baddeley, 1986, DeGuise et al., 2008, Evans, 2001, Johnstone et al., 2003, Wood, 2001, Zasler et al., 2013).

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