notebook to help an individual with a memory deficit stay on schedule; the provider also instructs the family member to provide prompts for use of the reminder notebook at home. Clinicians provide educational, skill-building, and psychological support components to the family as well as the patient. Results of a few studies have reported benefits to families such as

•  A greater number of met needs and perception of fewer obstacles to receiving services post-treatment (Kreutzer et al. 2009),

•  Improvement in psychological distress (Brown et al. 1999; Sinnakaruppan et al. 2005), and

•  Reduced burden, improved satisfaction with caregiving and increased perception of caregiving competency (Albert et al. 2002).

Delivery of CRT

When, where, and how long CRT is provided are interrelated factors that vary depending on the patient’s needs and means for participating in rehabilitation (e.g., willingness, affordability, family support). Currently, depending on the severity of injury and the patient’s acute recovery, CRT typically includes a wide range of therapeutic ingredients and is practiced by professionals with specific expertise in different settings or environments. The current state of health care provision in the United States, with myriad payers for care, affects how patients receive care. Patients who would benefit from treatment, according to their physicians or ongoing research, may not receive prescribed treatments due to limitations in payer plans. Furthermore, when treatment is available, policies unique to individual payer plans may impact treatment type, timing and duration of delivery, the setting in which the treatment is provided, and the professional who provides it. As such, payment policy may affect how treatment is labeled. When delivered by a member of one of the disciplines described in this chapter, a treatment may be identified as “speech therapy,” even though activities meet the definition of CRT. This may occur when health benefits provide coverage for speech therapy but not CRT.

Treatment approaches may include comprehensive inpatient or outpatient CRT programs, outpatient CRT delivered by a sole practitioner, or comprehensive CRT programs with multiple providers working together on a team. The individual treatment ingredients of comprehensive, interdisciplinary rehabilitation programs are not typically recorded. Therefore, ingredients delivered through these programs are harder to quantify for comparison purposes than modular CRT, which is more singularly focused, as described in the prior chapter. There is debate about when and where to deliver CRT. Some advocate for early intervention, while others call for intervention at more chronic recovery stages (Ben-Yishay and Diller 1993).



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