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Resilience & Adjustment Intervention FAQ

1. What are the topics that are covered in the RAI program?
2. What techniques are used in the RAI to facilitate a resilient response to TBI?
3. What populations might benefit from participating in the RAI program?
4. What accommodations are provided for individuals with special learning needs?
5. Who is qualified to implement the RAI?
6. How can a clinician get trained to implement the RAI?
7. How was the RAI developed?
8. What are the primary principles guiding the RAI?
9. I am a clinician interested in implementing the RAI. How can I purchase the program for use in my practice?
10. How can I get regular updates on conferences, trainings, and research conducted by VCU researchers that relate to the RAI?
11. What are the Recommended RAI Provider Qualifications?

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1. What are the topics that are covered in the RAI program?
The seven session program covers between one to three of the following sixteen topics in each session:

Session I: Understanding the Effects of Brain Injury
Topic 1: Typical consequences of brain injury.
Topic 2: Differences between emotional and physical recovery.
Topic 3: Coping effectively with loss and change.

Session II: Active Engagement in Recovery
Topic 4: The importance of you in your recovery.
Topic 5: What you can do to help yourself and feel better.

Session III: Setting Reasonable Goals
Topic 6: Success is relative.
Topic 7: Strategies for being patient.
Topic 8: Implementing effective goal setting strategies.

Session IV: Solving Problems Effectively
Topic 9: Learning and using effective problem solving strategies.

Session V: Managing Stress, Anger, and Other Intense Emotions
Topic 10: Managing stress more effectively.
Topic 11: Managing intense emotions including frustration, anger, and fear.

Session VI: Communicating Effectively and Rebuilding Relationships
Topic 12: Rebuilding relationships and overcoming loneliness.
Topic 13: Establishing effective post-injury communication skills.
Topic 14: Strategies for discussing your injury with others.

Session VII: Maintaining a Positive Outlook
Topic 15: Avoiding a negative focus, feeling guilty, and blaming others.
Topic 16: Positive aspects of your new life and how to develop a positive attitude.
*Although the RAI is typically administered in this order, the program can and should be tailored to meet the needs of each survivor. For example, clinicians may choose to: 1)allocate one topic to each session andextendtheprogramto 16 sessions, 2)extend discussion of asingletopic to more than one session because the topic is difficult or important, or 3)focus on a subset of topics, to the exclusion of others.

2. What techniques are used in the RAI to facilitate a resilient response to TBI?
The RAI is delivered in the Curriculum-Building (C-B) format. The C-B approach to intervention has shown positive outcomes for TBI survivors and their families in areas as diverse as return to work, met family needs, and inpatient neurobehavioral functioning. In keeping with the C-B structure, the program is built on a framework of psychological support, psychoeducation, and skill building. Additionally, questionnaires and worksheets are used in many of the sessions to facilitate self-examination which is a crucial first step in promoting positive changes. Discussion of responses with an experienced clinician enables survivors to effectively identify their own concerns, feelings, opinions, and ideas, while also improving their communication and problem solving skills in real time. Finally, homework assignments are also an important component of the RAI. To reinforce learning, survivors are asked to read materials, complete questionnaires, discuss topics with others, and apply skills during the five to say day interval between sessions.

3. What populations might benefit from participating in the RAI program?
The RAI was designed to be implemented with survivors of TBI. Program content may also be appropriate for individuals adjusting to challenges after stroke, anoxic brain injuries, non-progressive brain tumors, and other acquired, non-degenerative neurocognitive impairments. Moreover, many modules contain content appropriate for use with a wide range of patient populations, irrespective of neurological functioning (e.g. stress management, goal setting, problem solving, etc.).

Additionally, the RAI topics and materials can be used effectively in a number of different settings, and with a variety of therapy modalities. Settings which can appropriately infuse RAI content and techniques include: individual, couples, and family therapy sessions, therapeutic counseling groups, multi-family therapy groups, support groups, health education classes, and occupational and speech therapy sessions. Clinicians are encouraged to modify and adopt the materials to fit the needs of their specific population and setting.

4. What accommodations are provided for individuals with special learning needs?
The RAI addresses special needs in the following ways:
· Written materials were developed in large print to accommodate visual impairments.
· The materials are written at a fifth grade reading level to accommodate individuals with limited reading skills.
· Information is presented with written, oral, and visual methods / aids to accommodate those with different learning styles.
· Many of the important ideas and instructions presented are repeated to facilitate learning and recall. In addition, copies of all materials used in session are provided to survivors in a binder for future review.
· When participants have motor, reading, or writing deficits, surveys and questionnaires should be read aloud and responses recorded by the clinician.
· The program is flexible, allowing the clinician to follow the learning pace of the survivor and to meet adjustment challenges as they arise.

5. Who is qualified to implement the RAI?
As a whole, the program is designed to be implemented by licensed mental health clinicians, such as psychologists, counselors, social workers, marriage and family therapists, psychiatric nurses, or psychiatrists, who:
· have completed the minimum degree and certification requirements for their discipline;
· have experience working with patients who have TBI and appreciate their special needs; and,
· are trained to perform individual counseling or psychotherapy

However, there are some modules within the RAI that may be independently implemented by health educators and non-mental health therapists (i.e. occupational therapists, recreational therapists, etc.). A chart detailing RAI modules and the level of training required to implement each module can be found here.

6. How can a clinician get trained to implement the RAI?
VCU offerscustomized training experiencesfor organizations or clinical practices interested in training a number of staff members at one time. Trainers are available to visit your organization and provide either two or three day training experiences. If your organization is interested in purchasing a customized training seminar, please visit our Trainings Info / Registration page for more information.

7. How was the RAI developed?
Based upon the success of the BIFI, VCU developed the RAI in order to provide clinicians with an individualized approach to resilience promotion after TBI. Topics were identified for inclusion as a result of VCU research which identified a set of frequently cited TBI symptoms which directly correspond with skills that are necessary to generate a resilient response to trauma (e.g. TBI challenge – diminished communication abilities; resilience skill needed – effective communication skills.)

Program efficacy evaluation is currently underway as part of VCU’s NIDRR-funded TBI Model System program. Pre-post results as compared to control subjects will be published at the conclusion of the current 5 year TBI Model Systems grant cycle (National Institute on Disability and Rehabilitation Research grant# - H133A120031)

8. What are the primary principles guiding the RAI?
Clinicians implementing the RAI should guide their practice by following these important principles:
· Successful survivorship is based in individual resilience. Survivors who embody, or who learn to adopt traits identified as key to resilient living will find increasing success in their recovery, and growing satisfaction with their postinjury lives.
· Achieving emotional wellness after TBI requires a clear understanding of injury-related symptoms, commonly encountered challenges, and the recovery process.
· A key feature of resilience is developing insight into one’s own behavioral response to trauma. Survivors who are more aware of their strengths and limitations are more likely to lead productive and meaningful lives.
· Resilient individuals are adept at problem-solving, goal setting, communication, and managing stress and intense emotions. Helping survivors develop these skills benefits their ability to be productive and maintain quality relationships.
· Survivors are more likely to improve when they develop resilient traits, such as being actively engaged in recovery, and are able to maintain a positive outlook.

9. I am a clinician interested in implementing the RAI. How can I purchase the program for use in my practice?
First, VCU strongly recommends training in implementing the RAI. Trainings include a copy of the RAI Manual and a number of additional resources and materials that are useful in practice with survivors recovering from brain injury. To attend or schedule a training, please visit the RAI trainings page.

However, RAI Kits are available for purchase outside of trainings. Please visit the National Resource Center (NRC) website for a description and pricing of the RAI Kit. Or, visit the main store page to view other valuable resource materials created by TBI clinician researchers at VCU.

10. How can I get regular updates on conferences, trainings, and research conducted by VCU researchers that relate to the RAI?

Please sign up for our Listserv via the link on this website or through our "Contact Us" page. Emails generated for the Listserv will pertain to the trainings, conferences, publications, and research conducted by VCU researchers investigating TBI, resilience, and family systems. All emails will be kept strictly for the purpose of this Listserv and no email information will ever be sold or distributed.

11. What are the Recommended RAI Provider Qualifications?
Please see our recommended qualifications here.