ABI Screening for Nebraska VR Applicants

• All Nebraska VR applicants will be screened for a lifetime history of potential acquired brain injury (ABI).
• Participation in the ABI Interview is voluntary – an applicant may decline to participate.
• Nebraska VR staff are required to complete the “ABI Interview Form” with the applicant and will not ask an applicant to complete it on their own.
• Additional ABI Interviews may be completed at any point in the VR process as warranted.
• The “Nebraska VR ABI Interview Form” is NOT a clinical or diagnostic tool.

1. Pre-screen on Application

• Applicant answers the ABI pre-screening question on the Nebraska VR application.
  • If "No" - No further action needed.
  • If "Yes" or "Not Sure" - Staff must complete the ABI Interview process.
    • If applicant declines the ABI Interview, (See Step 5, QE2 Documentation).
• After application data is entered in QE2, a notice will remind VR staff to complete the ABI Interview. It remains until the Interview is completed and all data is entered.

2. Complete the ABI Interview

Note: Do not ask the applicant to complete a "Nebraska VR ABI Interview Form" on their own. (See Background & Training Information, Tips For Best Results).

• Share the "What to Expect During the ABI Interview" handout before proceeding.
• Document the applicant’s responses.
  • Directly in QE2, or
  • On PDF or paper form (for later entry in QE2).
• Using sample questions provided, ask about possible:
  • Injuries from external, physical forces (head, face, neck)
  • Repeated impacts (e.g. sports, violence, military, etc.)
  • Internal illnesses or health conditions (e.g. stroke, cancer, seizure disorders, etc.)
• Complete the Challenges Checklist section to determine the functional impact of reported injuries, repeated impacts, illnesses or health conditions:
  • Complete it WITH the applicant.
  • Note a frequency or “Not Answered” for each Challenge.
  • If a challenge occurs in certain situations or environments, select Depends and add a description.
• After entering all data in QE2, click “Create ABI Interview Form” to save (See Step 5, QE2 Documentation).
• Download the "ABI Challenges, Accommodations & Compensatory Strategies Summary" and provide a copy to the applicant (print or email).

3. Discuss ABI Interview Results

• When discussing the ABI Interview results, emphasize:
  • The Nebraska VR ABI Interview is NOT a diagnostic tool.
  • It helps identify incidents that MAY have resulted in ABI and long-term challenges.
  • Only licensed and qualified healthcare professionals may diagnose ABI.
  • Interview results alone do NOT confirm a disability resulting from ABI.
• Review the noted Challenges and their potential impact on career planning and employment with the applicant.
• Obtain a signed release of information to request medical, psychological, or neuropsychological records that may confirm the reported injuries, repeated impacts, illnesses or health conditions.

4. Next Steps

• Use these tools on the QE2 ABI Interview Forms page to understand and apply the ABI Interview results:
  • Summaries of completed ABI Interview metrics
  • WORST, FIRST, MULTIPLE, RECENT and OTHER SOURCES are noted, indicating the likelihood of long-term cognitive challenges.
  • Hover cursor over any icon for a description.
  • Challenges frequency is color-coded for quick reference.
  • Challenges are grouped by cognitive domain and cross-referenced with Functional Capacities for supporting Priority Group determination.
  • The “ABI Challenges, Accommodations & Compensatory Strategies Summary” lists supports to consider in career planning. 
• See the reminder on the Functional Capacities screen to ”Check ABI Interview Form and Summary for Challenges impacting Functional Capacities that result from medically documented ABI."
• In planning, consider the need for further cognitive assessment using one or more of these options (See Background & Training Information, Guide to Cognitive Assessment Options):
  • Montreal Cognitive Assessment (MoCA)
  • Functional Cognitive Assessment
  • Neuropsychological Evaluation
• Include the completed “ABI Interview Form” and “ABI Challenges, Accommodations & Compensatory Strategies Summary” with referrals for cognitive assessment, vocational evaluation or assistive technology evaluation.
• Consider the applicant’s ABI Interview results, recommended accommodations and compensatory strategies in Priority Group designation, career planning activities and IPE development.

5. QE2 Documentation

• ABI Interview Declination:
  • If the applicant answered "Yes" or "Not sure" but does not wish to participate, or if the application was marked incorrectly:
    • From the Assessment tab on applicant's case home screen - Select “ABI Interview Form”.
    • Click "+ New ABI Interview Form".
    • Choose the appropriate response:
      • Application marked incorrectly
      • Did not wish to participate
    • Scroll to the bottom and click “Create ABI Interview Form” to save. This will remove the notice from the case home screen.
• Enter ABI Interview Data:
  • From the Assessment tab on the applicant's case home screen - Select “ABI Interview Form”.
  • Click “+ New ABI Interview Form”.
  • Fill out fields for:
    • Interview completion date
    • VR Specialist completing Interview
    • Employment status and School/Training status
  • Enter the Injury, Repeated Impacts, and Illness fields:  
    • Source - Choose from the drop down menu items; if not listed choose "Other" and enter the source in the text box.
    • Age at the time of injury, repeated impact, or illness.
    • Select “Yes” or “No” for Hospital/ER.
    • Select length of time they reported being unconscious.
    • Select length of time they reported being dazed or having a memory gap. 
  • Complete Challenges Checklist:
    • Select the frequency each challenge occurs.
    • If Depends is selected, add a description of the situations or environments in which it occurs.
  • Add Comments/Observations, if any.
  • Click "Create ABI Interview Form" to save.
  • QE2 redirects to the ABI Interview Forms page.
  • Click on the "Strategies" button to download the “ABI Challenges, Accommodations & Compensatory Strategies Summary”.
    • Provide a copy to the applicant (print or email).
  • Summarize notable ABI Interview results and discussion in a task note.
     

 

 

Why Nebraska VR Screens for Acquired Brain Injury (ABI)
Many people who have had an injury to their head like a concussion or an illness don’t know how serious it might be or fully understand how it affects them. They may or may not have received a diagnosis consistent with ABI. Having several injuries over time can add up and make it difficult to:

• Remember appointments or assignments
• Pay attention or focus on tasks
• Learn new tasks
• Organize and get things done
• Follow conversations
• Feel motivated and make decisions
• Manage emotions and behavior
• Relate to family or coworkers

Nebraska VR screens for a lifetime history of potential ABI because it can lead to long-term cognitive, physical, emotional or behavioral challenges. The ABI Interview helps uncover these “hidden” challenges so they can be addressed while planning for VR services and employment.

 

Tips For Best Results

• Always complete the ABI Interview with the applicant - never ask them to complete the “ABI Interview Form” on their own.
• Use a quiet, private space.
• Build trust before starting.
• Invite a family member or close support person (with permission) if the applicant has limited information about their history of injury or illness.
• Ask follow-up questions if needed for more detail.
• Review and double-check any notes before entering data in QE2.

Guide to Cognitive Assessment Options
For a brief, objective assessment of cognitive performance, refer for the:

• Montreal Cognitive Assessment (MoCA):
  • Administered by a trained VR Specialist.
  • A free, clinical tool used to screen for mild cognitive impairment and dementia.
  • Tests gross performance on memory, executive functioning, attention, language, visuospatial skills and orientation.
  • Not as detailed as other assessments, but may confirm self-reported challenges and the need for accommodations.

For a thorough, professional assessment to support job goal and career planning decisions, consider authorizing for one of the following Assessment Support Services:

• Functional Cognitive Assessment:
  • Administered virtually by licensed clinicians with Kintinu Telerehab (a Quality Living, Inc. program).
  • To refer, consult with the Program Director for ABI. Complete the “Functional Cognitive Assessment Referral" form on VRIS and submit it with other required documents listed on the form.
  • Authorize as an Assessment Support Service.
  • Assessment of strengths and deficits in attention, language, memory, executive functioning, problem-solving, decision-making, processing speed and other skills on everyday functioning.
  • Includes pre- and post-assessment meetings with the referring VR Specialist, a thorough intake interview, medical records review, and online testing.
  • Report addresses referral questions, includes assessment results and recommended accommodations and compensatory strategies for work, health and wellness goals.
  • NOT recommended if:
    • A formal diagnosis of ABI or cognitive impairment is needed.
    • There has been a recent, notable decline in the applicant’s physical health or cognitive functioning.

• Neuropsychological Evaluation:
  • Administered by a qualified, licensed neuropsychologist (see QE2 for Providers).
  • Clinical evaluation may be comprehensive or partial depending on referral questions, to address strengths and deficits in attention, executive functioning, learning and memory, language and communication, sensory and perceptual skills.
  • Detailed report includes testing results, conclusions and recommendations.
  • To refer, include a letter with specific referral questions to be addressed in the report.
  • Authorize for testing services according to the Nebraska Medicaid Fee Schedule Allowables for all established rates [471 NAC], including pre- and post-test consultation services.
  • Include the "VR Psychological Narrative Report Guidelines" form with referral and authorization.
  • Best used when:
    • A formal diagnosis of ABI or cognitive impairment is needed.
    • There has been a recent, notable decline in the applicant’s physical health or cognitive functioning.

Summary of Key Takeaways
•    Many people may have long-term cognitive challenges from diagnosed or undiagnosed ABI.
•    These challenges can create barriers to employment and independence.
•    Nebraska VR screens for challenges associated with potential ABI to better understand and support the people we serve.
•    The ABI Interview is a screening tool, not a clinical or diagnostic tool.
•    Follow-up testing (like MoCA, Functional Cognitive Assessment, or Neuropsychological Evaluation) helps guide career planning, services and supports.
 

For help or more information, contact the Nebraska VR Program Director for ABI.

 

Functional Cognitive Assessment Referral

Nebraska VR ABI Interview

What to Expect During Nebraska VR ABI Interview