Measuring outcomes from a peer-led social communication skills intervention for adults following brain injury

Acquired brain injury is a principal cause of life-long disability worldwide. Chronic cognitive and communication problems can follow injury, adversely impacting previous relationships and the ability to build new ones. Reduced social acceptance and social isolation are commonly reported problems. Intervention for social communication skills is recommended as a practice standard in programmes of rehabilitation, but the evidence of gain from more traditional models of intervention is mixed. In particular, automatic transfer of skills learned in the training setting to everyday life cannot be assumed. Community re-integration entails the ability to build relationships with other people independently of family members and professionals. In order to play a valued social role, the person needs to be able to engage as an equal partner in conversation, and have an ability to speak on their own behalf.

My PhD research developed and investigated the efficacy of a new approach, training a peer with a severe ABI to facilitate communication in an expert discussion group. Outcomes were compared to a control group (a traditional staff-led social activity group for individuals with severe ABI). Existing outcome measurement tools are designed to evaluate change in paired conversations rather than groups, so a new digital measurement tool (the INT) was developed and tested, using social network methodologies, to quantitatively measure change in group social participation over time.

Results showed that a trained peer can successfully facilitate group interaction without direct support from a neurotypical communication partner. The intervention group showed an improved ability to socially connect and participate collaboratively over time. Conversely, there was no change over time in the staff-led group. Overall, these findings show initial evidence of benefit in independent relationship-building within complex encounters and in new social networks with multiple communication partners, consistent with the communication demands of everyday life.

Developing findings from this PhD research has the potential to inform clinical practice in the following ways. It meets current recommendations for new interventions that address communication needs in real-world environments and a fully powered study is now required to increase confidence in these initial findings. A key objective for this fellowship is to produce a grant application for a multi-centre trial. Measurement of change in group social interaction is a new field of investigation and the INT meets current recommendations for new tools to measure social participation outcomes. My first mentor, Professor Joseph Devlin, as Vice Dean of Innovation and Enterprise is well placed to advise me on networking opportunities and the formulation of a contact plan to develop the INT. The measure also requires validation to demonstrate reliability and responsiveness with increased volumes of data, and to test its application to wider clinical contexts and groups. My secondary mentor, Dr Joshua Stott, brings experience of managing grant funded projects in dementia and mental health conditions