Community Rehabilitation & Care Management support is extremely personal and individualized. Therefore, different levels and amounts of support are needed. Support provided may be short term, long term and move into fading or monitoring support. The intensity of the support is also variable. Some individuals are supported through one-to-one support while others are assisted through family, community or tertiary supports. The level of support is assessed on an ongoing basis, fluctuates based on the individual needs and is always focused on promoting independence. Care Management is an integral part of the holistic approach to Community Rehabilitation support.Some common presenting issues from people requesting NBIS rehabilitation service is the need to:

• Increase their ability to manage with greater independence in activities of daily living skills i.e. household management, financial management, personal hygiene etc.
• Access community resources independently - i.e. other support services, orientation to public transit, facilitation to participate in recreation/leisure activities.
• Improve ability to interact socially and address psychosocial issues or challenges.
• Develop meaningful compensatory strategies to cope with cognitive deficits.
• Develop an appropriate level of physical fitness while being aware of limitations.
• Provide education/information to aid the person, their family, friends and/or community to gain meaningful insight into the effects of acquired brain injury.
• Develop compensatory strategies in preparation for return to school or work.
• Meet with peers to normalize their experience and work through grief and loss issues.

The purpose of Care Management is to bring together all stakeholders in order to develop a care plan which is collaborative and does not duplicate service. Staff advocates for the development of a strong, sustainable support network for the individual within their community. Care Management is an integral part of the holistic approach to Community Rehabilitation support. Some common needs for care management are:

• To prevent service gaps and overlaps with other service providers resulting in greater service efficiency and reduction of unnecessary confusion and crisis.
• To clarify roles of stakeholders.
• When needed, actively participate as a member of the case management team.
• Forming and maintaining linkages with other supports and services within the community for continuity and sustainable supports for individuals with an ABI.
• To provide education and information to all stakeholder about the effects of an acquired brain injury.
• Advocate for the individual's needs within the community.
• Support provided to assist individuals to compensate for their losses included:
• Self esteem building
• Life skills re-training and development of compensatory strategies
• Family and relationship support
• Social skills re-training
• Developing strategies to cope with psychosocial / behavioral changes and challenges
• Exploring vocational interests
• Community access and integration
• Renewing Pathways peer support group
• Pathways through loss – 10 week grief and loss support group
• Liaising with community contacts to develop linkages for optimum
• sustainable supports and maximum independence
• Crisis intervention and stabilization support