"...the Society have been extremely helpful to so many families where a member has sustained a brain injury.." - J. Simpson

The Cheshire “Steps to Independence” program of service delivery has evolved over 20 years into a cost-effective continuum of services that assists acquired brain injury survivors to achieve their optimal level of independence in the community while acknowledging safety and awareness concerns. The Cheshire “Steps to Independence” program has been successfully duplicated in Scotland and has gained recognition in England and Ontario, reflecting both the capacity and ease of implementation of Cheshire’s unique program. A key success factor in our service delivery is the individualizing of services to ensure appropriately safe levels of support, while maximizing independence. Experienced staff and careful qualification, combined with regular in-house functional assessments, facilitate this process. Cheshire delivers positive outcomes, empowering clients to successfully survive their brain injuries.

All individuals entering our program are directed through the Cheshire head office. The Executive Director, Program Coordinator, or Rehabilitation Services Manager conducts the initial interview. Cheshire employs a highly effective referral tool that focuses on a person’s personal history, pre-morbid lifestyle, severity of injury, age and circles of support to help determine suitability, minimum levels of support required and potential outcomes. Often more than one interview takes place as the staff at Cheshire gathers information about the potential client. Once a client’s suitability for one of Cheshire’s programs is determined, a tour is set up with the prospective resident, his/her family and any involved parties to view the potential home and meet the manager and staff of the home. Following the tour, if the client and team commit to entering into a Cheshire program, a pre-admission meeting is set up where all program details and costs are outlined. At this meeting, the client is required to sign a pre-admission contract and code of conduct.

Once a client is admitted to a residential program, the first six to eight weeks are primarily focused on assessment and orientation to the facility and the immediate community. The client will begin to take part in routines of daily living tasks while establishing relationships with staff and other clients in the home.

During the assessment period, an individualized service plan is developed for the client, with treatment team input and involvement. The service plan focuses on psychosocial and functional skills rehabilitation, as well as transition management, to address the quality-of-life challenges that accompany an acquired brain injury. These include:

• Activities of daily living (ADL) management, including all aspects of personal and home management.
• Personal organization development through training of habituated routines and the use of tools for independent self-management. Techniques and tools include day planners, alarm watches, checklists and other external cuing options that can be replicated in any setting.
• Time management and leisure planning that can, if possible, lead to meaningful vocational opportunities.
• Medical, physical and fitness management and habituation to ensure a complete, holistic recovery and beneficial future health habits.
• Memory development and improvement through cognitive exercises, orientation exercises, problem solving and exercises specifically designed to address an individual’s cognitive impairments after brain injury.
• Emotional control and work on maintaining or developing interpersonal relationships through the re-learning of effective communication and social skills, that are often lost with frontal lobe syndrome.

At approximately eight to ten weeks, a team meeting is held to review the results of the assessment and the individual service plan, address rehabilitation goals and to adjust levels of support and schedules accordingly. At this meeting, discharge options are considered and time lines are established for probable goal fulfilment and for scheduling subsequent meetings and reports.

Through out this process, clients are accepted for who they once were, respected as the survivor they have become and given the support and encouragement to develop into the best person they can be. This is accomplished through the development of positive therapeutic rapport that maximizes staff collaboration and client choice. Staff is trained specifically to each client’s needs, goals and individual support plan in order to deliver responsive and client-centric care. Very often a client’s individual support plan will include the use of routine checklists, orientation checklists, behavioural reinforcement schedules (designed for errorless learning), and negotiated contracts. Consequences for non-compliance in the “Steps to Independence” program are either natural or negotiated, and are never arbitrarily imposed. It is our belief that all rehabilitation must be a matter of choice and collaboration for survivors, in order to provide truly meaningful outcomes.

Typically, reporting on client progress occurs on a quarterly basis. When the client has successfully progressed through as many phases of rehabilitation as possible, is as stable and independent as possible, long-term living arrangements are facilitated. The long-term placement depends on the client’s abilities, needs and budget and is approved by his or her therapeutic team. At the time of discharge, the client is provided with discharge goals, re-orientation training and a transition plan, if required.

Our “Step to Independence” program offers the steps in a continuum of service delivery. Direct care costs diminish as the client steps forward to independence, requiring less support. Depending on the needs of the client and his or her own ability to manage independently, many housing arrangements are possible. Cheshire Homes Society offers community rehabilitation workers who can assist clients with their daily living routines in a variety of settings, such as apartments in the community, in the client’s family home, and in long-term facilities.