Eric Powell was told he likely would never walk or talk again after a severe car wreck almost seven years ago. A semitruck jackknifed on I-95 and spilled its payload of several tons of lumber across the median and on top of Powell's car, crushing him and causing a traumatic brain injury (TBI). His condition was thought to be so bad that a local TV news reporter announced he had died. Powell lived but underwent several years of intense rehabilitation, and he could no longer retain his job as a project manager with BellSouth because of short-term memory loss.
“I forget too much stuff,” Powell explains. “I'll never be the executive that I was before, but I'm not dead.”
Powell's days of working on the computer aren't over though, thanks to a new program in Jacksonville, Florida, that gives people with brain injuries a pathway to community reintegration.
The Brooks Clubhouse is a full-time day program helping with the long-term recovery needs for those with TBI. The Clubhouse, which abides by the International Brain Injury Clubhouse Alliance's (IBICA) standards, is a recent expansion of the continuum of care provided by Brooks Health, which operates a 143-bed post-acute rehabilitation hospital in Jacksonville, more than 25 outpatient facilities across the state, and a home care agency.
Clubhouse members acquired brain injuries through stroke, anoxia (severe oxygen deprivation), and central nervous system dysfunctions. Members have to be partially or fully independent in activities of daily living, have a desire to help themselves and others, and provide the necessary funding.
“We're not a day care,” Powell says. “[The Clubhouse] is a segue back into the community.”
The Clubhouse, open five days a week, allows individuals an opportunity to enhance their social, physical, cognitive, and vocational outcomes following brain injury. Although many patients continue with outpatient rehab for several months, the recovery process extends longer for many brain injury victims, and the need to relearn vocational and social skills is crucial for community reintegration.  Eric Powell helps a fellow clubhouse member learn computer skills. Photographer: Dave Strupp
“The Clubhouse is seen as a bridge between rehabilitation and community reintegration,” says Kathy Martin, the Clubhouse's manager and a certified rehabilitation counselor, certified provider of cognitive rehabilitation, and certified brain injury specialist trainer who has worked with brain injury patients for nearly 30 years.
Opportunities and interaction
Programs like the Clubhouse yield some of the best results for patients recovering from TBI, Martin says.
“The Clubhouse is a service that paves the road for [TBI patients] and gives them the support they need to succeed in the future,” she explains. “For some people that's a shorter bridge than others.”
Anyone who becomes a Clubhouse member does so by choice, meaning he/she does not need a clinician's referral. For members interested in vocational reintegration, the Clubhouse offers three primary work units, which include culinary, business/clerical, and facilities maintenance and product production.
“The goals are set by the members themselves, so they recover at their own rate,” Martin notes. “The only expectation is that people put their best foot forward.”
Members seem to respond well to this mentality, as everyone tries to encourage and push others to work harder to achieve their goals and discover new abilities. “No one comes here and sits on their butt,” Powell points out. “You're not judged here, but if you want to have a pity party, go somewhere else. The motto here is, ‘If you want it, go do it.’”
Social interaction also is a key element in the progress of patients with TBI. For many the recovery process can be quite boring and often causes depression.
“I lost my social life after my car wreck,” says Justin Meridith, who travels from Southeast Georgia to work at the Clubhouse. “I was bored out of my mind at home. Now I do maintenance around the clubhouse. I look forward to coming here instead of sitting at home all day.”
Challenges
While the Clubhouse serves an obvious community need, the young program still faces challenges, most notably involving transportation and funding. Many members are not fully recovered physically and still use wheelchairs and walkers, and many are not able to drive. Thus, members use public transportation or rely on family and friends.
The Clubhouse charges members $140 a day to cover the cost of providing services, but a sliding fee scale based on household income offers significant discounts for those who lack third-party coverage or cannot afford the full rate. Many are unemployed, and most insurance plans do not cover the Clubhouse's costs. Only a limited number of spots are available for people with a Medicaid waiver so “that leaves good candidates for the Clubhouse stuck with private payment,” Martin explains. “Even with our most minimum payment, it can still provide a financial challenge.”
The Clubhouse supplements some of its operating cost through sales from its product production program, in which members create and sell ceramic goods and other gifts. It also charges $2 for lunch, which helps to offset some operating costs. Additional funding likely will be procured through grants and fund-raising, but Martin ultimately would like to expand product production to sufficiently supplement the operating costs.
A nationwide need
As only one of 16 IBICA clubhouses in North America, Brooks Clubhouse is filling a significant service gap. In 2006, more than 3,200 individuals could have benefited from the services the clubhouse began offering this past October, according to area acute discharges from local hospitals. In fact, about 95% of brain injury patients facing disability fail to obtain the necessary long-term care and support that a clubhouse environment can offer, according to the Brain Injury Association of America. Brooks Clubhouse is the only one of its kind in Florida, but Martin points out that the need is great and she sees much potential for expanding the service to other communities.
“We could expand and accommodate more people over time, because there is an obvious need,” she notes.
That need remains for Powell, as he continues to participate at the Clubhouse and help others with computer training.
“They told me I wouldn't be able to walk and talk, but now I get to come to this place and help people learn on the computer,” he says. “I'm doing good, but I'm not where I want to be. I have a concept of what I want to do, but I'm not there yet.”
Dave Strupp is Marketing Communications Coordinator for Brooks Rehabilitation in Jacksonville, Florida. To contact him, e-mail dave.strupp@brookshealth.org. Behavioral Healthcare 2009 March;29(3):40-42
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