Frequently Asked Questions
What is Community Skills Program®?
Community Skills Program® is a private, non-residential community reentry program operated by Counseling and Rehabilitation, Inc. and Counseling and Rehabilitation of New Jersey, Inc. It was founded in 1981 to serve persons with traumatic brain injuries. Now in its 40th year of operation, the program also serves persons with other neurological and neurodevelopmental disabilities.
What is a community reentry program?
As the name implies, community reentry programs assist individuals to reenter the community. Many persons require extensive treatment following a brain injury and receive emergency treatment, acute care, and acute and post-acute rehabilitation. However, even after receiving extensive treatment, many individuals with brain injuries still need additional services to make a satisfactory transition from hospital- or facility-based services to their own homes and communities. Other individuals may have received only emergency treatment or minimal inpatient or outpatient treatment and then experience problems when they try to perform their usual roles at home, school, or work, or in the community at large. The services we provide are listed in our brochure (click here) and under Services (click here) on this website; individuals may receive any or all of the services, depending on their needs, and following approval by the funding source.
Is there a difference between a community reentry and a community-based program?
In the early to mid-1980s, when Community Skills Program® was growing, the terms community reentry, community reintegration, and community integration were frequently used to describe our type of program. Later, the term community-based was applied generically to various programs not on the grounds of a hospital or an institution. In 1992, the Commission on Accreditation of Rehabilitation Facilities (CARF) categorized brain injury programs as medical or community integrated and, in 1996, began using the term community integrative. Home and community services is currently being used by CARF. Our program fits the labels of community reentry, community-based, community integration, community reintegration, community integrated, community integrative and, of course, home- and community-based. We frequently use the term community reentry because our focus is on the individual, who is reentering the community, not the program, which is integrated in the community. When individuals enter our program, they are making the transition to their homes and communities; being integrated in the community is the goal. We provide services to facilitate this process.
At what point in this process are people referred to Community Skills Program®?
Depending on the individual’s circumstances, referral to Community Skills Program® may be appropriate following emergency or acute care; acute rehabilitation; outpatient services; day treatment; or transitional living/residential treatment. Our services are often requested concurrently with outpatient services or day treatment at a hospital or facility, to provide an opportunity for the individual to apply, in his/her real-life setting, the skills being addressed during facility-based treatment. This arrangement provides an excellent opportunity to make observations of the individual's functional capacities in the community, and to share this information with the therapists in the facility. Our services have also been requested many years following an individual’s brain injury and rehabilitation treatment; that usually happens when a family member or rehabilitation case manager believes the individual has the potential to engage in a more productive daily routine.
Why are the additional services necessary if quality treatment has been provided to a person with a brain injury prior to the individual’s discharge to his/her home?
The nature of brain injury itself is usually the reason. As a result of the brain injury, individuals frequently have difficulty transferring skills and knowledge from one setting to another, even despite a high level of motivation to do so. A smooth transfer of learning simply cannot be assumed. Services in the individual’s own home and community environment help the individual to apply skills and knowledge acquired or re-acquired during earlier phases of the rehabilitation process. These services are often crucial to the individual’s ability to preserve his/her level of functional capacity and make additional progress. Failure to provide the services needed at this critical point in an individual’s rehabilitation may result in regression. To assure that the dollars already spent on rehabilitation were a good investment, services to help individuals successfully manage this transitional period are strongly recommended.
How long are community reentry services needed?
The scope and duration of services depend on the individual’s needs as well as factors such as family and community resources and support. The goal is to provide the individual with services enabling him/her to meet the demands of his/her own environment (for example, using public transportation to get to work or to maintain a physical conditioning program at a local health or fitness center).
How long does it take for someone to be admitted to Community Skills Program®?
That varies, depending on when we receive the funding authorization, where the individual lives, and if a staff member is available to provide services in that community. If a staff member is available, services can begin immediately upon receiving an authorization from the funding source. If not, recruitment of a staff member will be necessary. The "match" between the individual and the staff member is very important; a good therapeutic alliance contributes to successful outcomes. It is important that as much advance notice of referrals as possible is given, to prevent a gap in services that could lead to regression.
How many people does Community Skills Program® serve?
Prior to the COVID-19 pandemic, Community Skills Program was serving approximately 95 people. The need for social distancing, fear of exposure to COVID-19, and the closing of community venues has had a significant impact on our client census. We are currently serving 35 people in Pennsylvania and 20 people in New Jersey. We anticipate an increase in referrals as more adults are fully vaccinated and social distancing guidelines are relaxed.
What are the qualifications of the Community Skills Program® staff?
The majority of the staff have a master’s degree in a rehabilitation or rehabilitation-related discipline. The staff members who have a bachelor’s degree are persons who have work experience, particularly in the field of brain injury rehabilitation, that has prepared them to provide treatment in a community-based program. Community Skills Program supports the preparation and application process for all staff to become certified as brain injury specialists (CBIS), and sponsors the memberships of all the neurorehabilitation specialists in their state brain injury association. The director and client services liaisons provide supervision on an ongoing basis, in addition to conducting regularly scheduled staff meetings (being held virtually at this time, due to COVID-19).
What treatment model or approach does the staff use?
The staff of Community Skills Program use a holistic, transdisciplinary approach, centered on the high-interest areas and personal goals of the individual (i.e., based on person-centered thinking and planning). The reason for this is that, at this stage in the rehabilitation process, a major goal is the integration of skills and abilities; a holistic, transdisciplinary approach facilitates this process.
I have heard the term “facilitator.” What is a “facilitator,” and are your staff considered “facilitators?”
The term facilitator has often been used in a generic sense because the focus of the treatment is on facilitating the individual’s successful return to his/her home and community. Facilitators facilitate the transfer of knowledge and skills from one setting to another. They also facilitate the adjustment of the individual to his/her post-injury environment and any disabilities.
We do not officially use the term facilitator for our staff, although we use the term generically and recognize that other persons use the term in describing our staff. It is important to note that the educational preparation and work experience of facilitators vary widely; some programs use paraprofessionals as facilitators. We do not classify our staff as facilitators, since doing so might lead one to assume that they possess a lower level of training and experience than is the case. To emphasize that we specialize in the rehabilitation of individuals following neurologic impairments, we use the job title of neurorehabilitation specialist. As mentioned above, the staff providing services are certified brain injury specialists and maintain their CBIS credential by participating in at least 10 hours of continuing education every two years.
Do you ever provide treatment to individuals receiving services from a home health aide?
Yes, and we expect that this may be the case more often in the future, given the trend toward referrals of individuals coming from acute care settings. If the individual requires supervision, it often makes good sense to supplement our services with home health services, especially if the individual does not have the physical and/or cognitive stamina to participate in our therapeutic services for a full day; using a home health aide for part of the day is a cost-effective approach. We have worked successfully with home health agencies and have provided training to their staff to promote a focus on goal-directed outcomes rather than custodial care.
Are family members involved in the treatment planning?
At the discretion of the person to be served, family members and significant others are involved in the pre-admission evaluation process and the development of the rehabilitation service plan (i.e., individualized program plan that guides the treatment). Then, usually once a month, a team meeting is held with each client, almost always at the client’s home. The client’s family members/significant others, case manager, insurance representatives, and other involved professionals are invited to participate. Family members’ input and feedback is sought during these meetings and is welcome at all other times. We believe family members and significant others play a vital role in treatment following brain injury. The way in which family members and significant others are involved should be at their choosing, however. Some persons (e.g., parents, spouses, siblings) want to be actively involved at every step in the rehabilitation process, while others may express the need for a respite. Community resources that will be available long-term must be developed to provide support for the individual with a brain injury and his/her family.
Does Community Skills Program® have case managers?
We take our responsibility for case management very seriously. Internal case management is handled by the staff member providing one-to-one treatment, as well as by our client services liaisons. We work closely with the external case managers (e.g., rehabilitation nurses), whom we regard as valuable members of the treatment team.
Who pays for Community Skills Program® services?
Services are paid for through a variety of sources, and funding can be blended as well. Because many traumatic brain injuries occur in automobile accidents, auto insurance has been a large source of funding. Funding has also come from state agencies, health insurance, workers’ compensation benefits, private pay, structured settlements, school districts, voluntary organizations (e.g., Catholic Social Services, the Catholic Archdiocese, and Rotary Club), and scholarships (e.g., Brian’s Run Fund). Community Skills Program is a provider for the Pennsylvania Department of Health's Head Injury Program and for the Pennsylvania Office of Vocational Rehabilitation. In New Jersey, we are a provider for the state's Division of Disability Services' Traumatic Brain Injury Fund.
What insurance carriers are funding your services at present?
As of March 2021, the following insurance carriers are currently funding treatment for individuals in Community Skills Program:
- Allstate Insurance Company
- Genex Services, LLC
- Liberty Mutual Insurance Company
- New Jersey Manufacturers Insurance Company
- New Jersey Property-Liability Insurance Guaranty Association (PLIGA)
- Selective Insurance
- State Farm Insurance Company
Does Community Skills Program® interface with any government agencies?
Yes. As noted above, in Pennsylvania, Community Skills Program is a provider of services for the Department of Health's Head Injury Program and for the Office of Vocational Rehabilitation. In New Jersey, Community Skills Program is a provider of services for the New Jersey Division of Disability Services' Traumatic Brain Injury Fund.
In what ways does Community Skills Program® measure its outcomes?
Community Skills Program measures its outcomes in several ways: the individual recipients' and the payers' satisfaction with the services; the level of functioning; the amount of supervision needed by the individual; and the individual’s quality of life. The Mayo-Portland Adaptability Inventory - 4 (MPAI-4) is routinely used pre-admission and at discharge.
How does Community Skills Program® differ from other community-based programs?
Community Skills Program® is different in the following ways:
- The degree to which the treatment is based in the individual's community, not simply the community of a facility
- The extent of involvement of family members and others in setting goals and reviewing progress, at the discretion of the person served
- The amount of in-service training and continuing education for staff, as well as certification as brain injury specialists
- The emphasis on inclusion and empowerment of persons with brain injury