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Section VI: Training – Competency and Fidelity Considerations

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MyBRAIN and MyBRAIN Now are relatively new products, and as such, the education and training protocols, while based on training methods published by the American Congress of Rehabilitation Medicine Cognitive Rehabilitation Training Manual, will require a trial of the training, and an evaluation of effectiveness. 

Individuals participating in the training will review the Orientation and Training Manual, provide feedback on training materials and techniques, participate in competency testing following initial training, and participate in fidelity evaluations on an ongoing basis, all to accomplish the following:

  1. To gather trainee reactions to the Orientation and Training Manual, and to the training procedures
  2. To measure comprehension, competency, and comfort with techniques immediately following initial training
  3. To inform orientation and training protocol and manual adjustments 
  4. To measure the trainee’s fidelity to techniques on an ongoing basis 
  5. To identify additional trainee education and training needs 
  6. To provide feedback to trainee regarding skill development 

Including competency and fidelity testing will allow the authors to evaluate the effectiveness of the original Orientation and Training Manual and to adjust education and training materials accordingly, all to enhance MyBRAIN participant outcomes. As research has demonstrated that trainer confidence affects participants’ utilization of assistive technology, it is imperative that the trainer is well informed and supported throughout the training process. 

ACL RF Treatment Program Fidelity Methods and Metric 

Assessment Phase

  1. ACL Program Manager and ACL RF  will review 10% of all neurocognitive assessments performed by ACL RF 
    • All assessments were delivered; if not, reason was provided
    • All components of all assessments were delivered; if not, reason was provided 
  2. ACL Program Manager and ACL RF will review 10% of all ACL RF Intakes
    • All Intake elements were completed; if not, reason was provided
    • Motivational interviewing, person centered planning techniques were utilized as demonstrated by the documentation of participant preferences, participant identified circle of support, and more (to be fleshed out). 
    • ACL RF drafted a comprehensive care plan, including goals, recommended resources, initial BI education needs, for participant and care team review 

Intervention Phase 

  1. RF Tasks:  ACL Program Manager and ACL RF will review 10% of activity logs to identify 
    • Frequency of contact w/participant (minimum of two times a month; unless unable to reach participant; attempts documented). 
    • Completion of satisfaction surveys with participant at a minimum of one time every other month; unless unable to reach participant; attempts documented 
    • Collaboration with other entities and identification of resources
    • Identification of and addressing ongoing BI Education needs for participant and care partners
  2. RF Therapeutic Techniques:  ACL Program Manager and ACL RF will observe staff and participant interactions (telephone or zoom – HIPPA protected platform) at a minimum of 1 time each quarter of care, on 10% of cases, to identify
    • Methods used to facilitate and sustain a person centered plan
      • Reference Person Centered Planning and Practice, National Quality Forum, 2020 report 
    • Methods used to facilitate and sustain a therapeutic alliance and use of Motivational Interviewing techniques
      • References to be identified
  3. Team Conference: ACL Program Manager, and a core team care member (consider rotation) to track the following fidelity measures at a minimum of 1 time per quarter, on 10% of the cases to identify: 
    • The extent to which the RF provided a comprehensive review of the case and the goals (addressing goals established at outset, as well as goals and recommendations from last case conference)
    • Advocated for the participant’s goals, needs, preferences
    • The extent to which the team:
      • Reflected on participant preferred goals and needs
      • Considered the complete scope of RF recommendations that may be appropriate and needed according to any new information, 
      • Considered  adjustments to assessments and self-management interventions based on participant preferences/needs and change in case or clinical status   

Discharge Planning Phase

  1. RF Tasks: ACL Program Manager and RF will review 10% of activity logs to identify:
    • Discussion of upcoming discharge from services, with an exploration of participant’s reaction and perceived needs, at a minimum of 1 month prior to discontinuation of services, unless unusual circumstances dictated inability to do so (reasons provided)
    • Review of current resources and supports, while identifying new, specific resource needs, at a minimum of 1 month prior to discontinuation of services, unless unusual circumstances dictated inability to do so (reasons provided)
  2. RF Tasks: documentation
    • Preparation of discharge case conference document, prior to discharge conference
    • Preparation of discharge letter, at a minimum, 2 weeks prior to discharge, to include established and new recommended resources. 
    • Discharge letter mailed to participant within 1 week of discharge

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