Conference Highlights

Thursday, October 8, 2009

1:30 PM – 3:00 PM
Sheldon Berrol Memorial Chautauqua
Assessing Safety Risk after Brain Injury—Ethical and Practical Dilemmas
Faculty: Ronald Seel, PhD, Stephen Macciocchi, PhD, ABPP, David Sleet, PhD

Healthcare professionals are faced daily with making safety risk determinations related to driving, falls, use of electronic and motorized equipment, recreation, responding to emergencies, avoiding harmful social situations, money and medication management, and the potential for aggressive or violent behavior. Surprisingly, while safety is the “holy grail” of rehabilitation, safety research following TBI has been largely neglected.
Safety risk plays a primary role in determining rehabilitation treatment, discharge, and home supervision recommendations. Stakeholders (clients/patients, family members, and health providers) have varying perspectives and biases that come into play when assessing risk and making or choosing whether to follow recommendations. Health providers sample a limited subset of client behaviors and are often faced with a high degree of uncertainty with regard to client injury risk. Providers can also become concerned about liability in addition to clients’ safety (Banja, 1994). As a result of liability fear and the desire to “do no harm”, providers may conservatively assess clients with TBI as unsafe, recommend greater levels of supervision, and limit clients’ personal autonomy (Banja, 1994; Macciocchi and Stringer, 2001).

Family members and persons with TBI face challenges similar to professionals with regard to inferring safety ability and supervision needs from a limited set of observations. Family members’ safety determinations are sometimes compromised by practical considerations such as their need to return to work, which requires leaving loved ones alone in circumstances that may or may not be safe. Conversely, family members sometimes have overwhelming fears about loved ones becoming re-injured. Family judgments of clients’ safety risk can be susceptible to an “all or nothing” bias. Thus, some persons with TBI who are at high risk for harm may be under-supervised while others who are a low safety risk may be “over-restricted” and feel patronized (Durgin, 2000).

The “Assessing Safety Risk after TBI—Ethical and Practical Dilemmas” Chautauqua will assemble a small panel of expert stakeholders to discuss clinical considerations and dilemmas associated with assessing safety risk after TBI. The format for the symposium will be a brief (15 minute) overview of safety risk followed by case study dilemmas to facilitate participant discussion.

Saturday, October 10, 2008

12:30 PM – 2:30 PM
John Stanley Coulter Lecturer Luncheon
J. Stanley Coulter Lecturer: Robert “Bobby” Silverstein, BS, JD

This distinguished lectureship was created to honor John Stanley Coulter, MD in celebration of his many contributions to rehabilitation. To be named the Coulter Lecturer is to be recognized for professional achievements that have contributed significantly to the field of rehabilitation. This year’s lecturer is Robert “Bobby” Silverstein, BS, JD. Mr. Silverstein has more than 30 years of experience in analyzing complex public policy issues and is recognized as the behind the scenes architect and driving force behind the passage of the Americans with Disabilities Act when he served as Staff Director and Chief Counsel for the United States Senate Subcommittee on Disability Policy chaired by Senator Tom Harkin. He was also a key player in several other pieces of legislation impacting the lives of individuals with a disability including IDEA and the Rehabilitation Act of 1986 and 1992. After leaving his position with the Senate Mr. Silverstein was an Associate Professor of Health Care Sciences and Health Services Management and Policy at George Washington University and the Director of the Center for the Study and Advancement of Disability Policy. He has written more than 70 papers and articles on public policy from a disability perspective and was the recipient of a Distinguished Service Award from the President of the United States and been the recipient of research grants on employment of individuals with disabilities from NIDRR.