We recently connected with Julie Peterson and have shared our conversation below.
Julie, appreciate you joining us today. How did you get your first job in the field that you practice in today?
I always wanted to work with individuals who have survived brain injury. My Masters degree in Speech Pathology was very focused on neurogenic disorders, so my training was specialized in this area. At the time I received my first position working in a clinical environment, I was teaching a self contained classroom at a local high school which served adolescents with brain injuries. An opening for a Speech Language Pathologist at NCEP was posted, and I jumped at it! NCEP soon became the love of my life, and that was about 15 years ago,
Awesome – so before we get into the rest of our questions, can you briefly introduce yourself to our readers.
The Nevada Community Enrichment Program (NCEP) is a nonprofit, comprehensive rehabilitation facility specializing in neurological rehabilitation that is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). NCEP is a program of Accessible Space, Inc. (ASI), a nonprofit organization that has been involved throughout Nevada since 1990 in the development of accessible, affordable housing with supportive services for very low income individuals with severe physical disabilities, brain injuries, seniors and veterans.
NCEP’s day treatment facility (“The Loux Center”) is located on the campus of the College of Southern Nevada at 6375 West Charleston Boulevard in Las Vegas, Nevada. NCEP’s residential facility accommodates up to 10 bedrooms with single occupancy suites in a residence within an established residential neighborhood. The residence is 3 miles away from the Loux Center day treatment facility.
NCEP has established and maintained an excellent community reputation and is dynamically involved in community activities. NCEP and ASI are involved in state and local conferences; collaborate with other community service agencies including the Department of Veterans Affairs, Driven, the Engelstad Scholars Program, and the Brain Injury Association of America (BIAA). NCEP and ASI are sensitive to the basic human rights of dignity, health, and safety of those we serve. Persons served in our program are integrally involved in their treatment planning. This involvement occurs on a daily basis, with attention given to the unique needs of each individual. Treatment planning revolves around the abilities, realities, culture and support systems of each individual person served.
NCEP provides a continuum of services directed towards increasing an individual’s functional abilities within the home and community. The continuum of services includes both residential and day programs for neuro-rehabilitation as well as our new concussion program, NBICC (The Nevada Brain Injury and Concussion Center).
NCEP meets Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation standards for outpatient medical rehabilitation programs for adults, children and adolescents, as well as residential brain injury programs for adults; all with a client centered and holistic approach to rehabilitation. NCEP utilizes a program evaluation system that measures goal attainment outcomes, effectiveness, efficiency, and satisfaction of persons served, their families/support systems and referral/payer sources. Reports are generated, analyzed, and performance improvement goals are established based upon data gathered on clinical outcomes, quality of life and independence measures, program satisfaction, safety and clinical progress.
In April of 1995, NCEP was awarded its first three-year CARF Accreditation, becoming the first CARF accredited post-acute brain injury day and residential program in the state of Nevada, and has maintained accreditation since.
Consistent with our mission statement, NCEP is dedicated to providing a therapeutic environment that encourages evidenced based rehabilitation in a community based setting, while promoting training and education. Our focus is to ensure that all rehabilitation is person centered and driven, so that each individual may reach their highest individual level of independence.
Maximum independence, as well as a continual opportunity to progress, is made possible for the individual with a neurological impairment through NCEP’s interdisciplinary team approach, educational and service programs.
Individuals Served
Clients at NCEP are typically children and adults who have sustained a traumatic or acquired brain injury. Individuals with other neurological impairments are also appropriate for NCEP’s day treatment and/or residential services along with individuals who have sustained spinal cord injuries or orthopedic injuries and/or similar conditions. All candidates are evaluated prior to admission, and must be able to benefit from NCEP’s rehabilitation services. A letter of medical necessity or physician’s order is required prior to admission. While there is flexibility in admissions, candidates served are medically stable and able to tolerate a six hour program of rehabilitative and therapeutic intervention each day.
Specialized Brain Injury Rehabilitation Services
The range of services provided by NCEP includes preadmission evaluation, initial evaluation, day treatment, and residential treatment. Community integration services are also available on an individual basis based on funding availability. Because programs are tailored to meet the needs of the individual, the length of each program varies, and persons served may be involved in a combination of these programs.
NCEP’S Program includes:
A Comprehensive Evaluation is designed to determine the nature and scope of the impairments of the person served, strengths, barriers to functional independence, and the type of rehabilitation services that are appropriate and recommended. This evaluation process is accomplished through formal testing, functional evaluation, clinical observation, family/social history, past medical records, and team collaboration. A comprehensive report is generated from this information that details the individualized rehabilitation plan appropriate for each individual.
NCEP’s Comprehensive Day Treatment Program offers a full range of therapeutic services from 9:00 a.m. to 3:00 p.m., Monday through Friday. These services include, but are not limited to, physical, occupational, and speech therapies, nursing, behavior management, case management, life skills and functional skills training, health maintenance, education and recreational services. In addition, NCEP utilizes many recognized complementary therapies including, mind-body techniques such as massage, visual imagery, relaxation response training, Tai Chi, and yoga.
The Day Treatment Program is designed for those individuals who are able to live in their own homes, but who need access to intensive and comprehensive day treatment therapy which is individualized, client centered, goal-directed and outcome-oriented. The comprehensive program and integration of the therapies and the team approach of the therapists in analyzing each client sets NCEP’s comprehensive day treatment program apart from a traditional outpatient therapy program.
The Residential Rehabilitation component also provides intensive therapy and supervision in a home like environment on a 7-day a week/24 hours per day basis. The residence offers a natural living environment focusing on community training, activities of daily living, community independence and mobility training with varying degrees of supervision. Both day treatment and residential programs include a 5-day per week, 6 hour comprehensive day rehab program in a community setting. Utilizing this model, NCEP can provide individualized residential options that range from near independence to close supervision. Accessible vehicles provide transportation to and from community outings, with the incorporation of the public transportation system when available and appropriate.
Service Delivery Models and Strategies in both the day and residential programs are based on accepted practice in the field and incorporate current research, evidence-based practice, peer-reviewed scientific and health-related publications, clinical practice guidelines, and /or expert professional consensus.
Services offered to the community include family education, aphasia and peer support groups, interagency collaboration and in-services/training, student mentorship, and clinical and non-clinical internships.
Basic Admissions Considerations
The following are some basic criteria that may help to identify a person who could benefit from NCEP programming. This does not represent an exhaustive or all-inclusive list. Each potential client is carefully evaluated individually prior to admission. Please see our Scope of Service, as well.
Acquired and Traumatic Brain Injury: The individual has survived a traumatic brain injury (TBI), acquired brain injury (ABI), or some other major neurological accident or illness. It may have occurred recently or even many years ago. It may have been the result of a vehicular accident, fall, near drowning, stroke, aneurysm, encephalitis, tumor, IED blast injury, or other traumatic event.
Spinal Cord Injury: Individuals who have sustained spinal cord injuries, with or without concomitant brain injuries, are considered (C5-L5) and without need for trach, vent or other respiratory support, tube feeding or foley/suprapubic catheters. Complete and incomplete injuries are considered. Persons served are considered on an individual basis.
Orthopedic Injuries and/or Surgical Recovery: Individuals who have sustained complex orthopedic injuries, with or without concomitant other injuries, who require at least two of the three main disciplines (PT, OT, ST) are considered on an individual basis as well as individuals who are recovering from orthopedic and/or spinal cord surgeries are considered on an individual basis.
Age: Approximately 85% of our persons served range from ages 3 years through 59 years of age. NCEP provides day treatment services to children and adolescents. All potential persons served are evaluated on an individual basis. NCEP has served individuals as young as 2 and older than 85 years of age.
Rehabilitation Potential: The individual is considered to be capable of truly benefiting from the NCEP program and be deemed to have a good prognosis for progress in rehabilitation, in order to achieve significant gains in functioning and independence.
Stamina: The individual is able to tolerate at a minimum, three hours of therapeutic services per day.
Behavior: The individual is not believed to be a danger to self or others. Referrals will be evaluated on an individual basis in light of a person’s needs and available program resources.
Chemical Dependency: A history of drug/alcohol abuse may or may not be an issue, along with current use or potential abuse concerns. All of these factors are considered on an individualized basis.
Medical Stability: Since NCEP is a community-based program, an individual benefits most when medically stable for intensive rehabilitation as evidenced by the absence of medical conditions requiring acute medical interventions (e.g., acute infectious process, unstable diabetes mellitus requiring a sliding scale perscription, etc). NCEP does not serve individuals who require intensive wound care, are trach/ventilator dependent, require infusions, or tube feeding requiring administration by NCEP staff. NCEP staff coordinates access to many medical resources. The individual need of each potential referral is considered on a case by case basis.
Discharge Options: There should be a range of potentially viable discharge options for a person admitted to the program. These are likely to change over time; however, at least one potential discharge option should be identified. NCEP assists with and begins the discharge planning process upon admission.
Voluntary Involvement: Involvement in NCEP programming must be a personal choice on the part of the individual. The decision to enter the program, as well as continue the program, is up to the potential person served.
Staff/Treatment Team
The clinical team consists of licensed and/or certified clinicians, specialists and para-professionals. This includes physical therapists, occupational therapists, speech language pathologists, nurses, nurse practitioners, case managers, occupational therapist assistants, physical therapist assistants, rehab technicians, a medical physician, behavioral interventionists, dieticians, neuropsychologists and other physicians. Some of these services may only be available on a consultation or private pay basis.
Trained clinical assistants, under the direction of individual clinicians, support the team in various activities that are designed to specifically address individual treatment plans. Internal case management communicates and coordinates with all external case managers on an ongoing basis. The Case Managers, team members and persons served develop a comprehensive, individualized, functional and realistic set of rehabilitation goals. A comprehensive report outlining short and long term goals, objectives, treatment strategies and progress is produced by the team every two weeks for each person served. As the central member of the treatment team, the person served, (and their support system) assists with development and implementation of the entire rehabilitation plan. The person served, family, funding representative and team members meet monthly during a person centered conference to discuss progress and future treatment planning, focusing on desired discharge outcomes.
Training and knowledge matter of course, but beyond that what do you think matters most in terms of succeeding in your field?
Understanding that every person is uniquely created differently from the next. ” If you have seen and experienced one brain injury, then you have seen and experienced one brain injury.” In healthcare, we consistently utilize industry standards and evidenced-based practices to help our patients obtain the best outcomes. However, through my years of practice, I have learned that there is no one human who might not fully recover and/or make tremendous gains following either a mild or a catastrophic brain injury. There is no level of experience in this field that would help a professional clinician determine whether a certain patient can make significant progress or who can recover completely. We don’t give up on anyone and we are called to inspire every patient to give it all they have. It is through never giving up, a culture of kindness and respect, and very hard work that miracles happen at NCEP every day.
Can you tell us about a time you’ve had to pivot?
About fifteen years ago, I was a Speech Language Pathologist working at NCEP. After about four years, I was given an opportunity to work as a Rehabilitation Director in a for profit hospital system. From there, I advanced to a multi-site Director, and eventually the Western Regional Director of Operations over 26 hospitals. The for profit industry is another world. I had so much to learn about business, and everything I thought I knew about quality of care was being challenged. This experience was invaluable and taught me everything I ever wanted to know, plus some. Because of this, I became a ruthless healthcare operator, but at the same time, I found myself reflecting on what my professional core values and pillars of character were as a leader working in this industry. I realized that I needed to come back home to NCEP where the most significant return on investment was seen directly by the person served, first and foremost. I gave up a top level position where I was a top performer in order to bring some of my skills back to the non-profit world to serve those most in need, and this made me very happy. Is it still a business? Of course; we have to keep our doors open. But, I now lay my head, peacefully, on my pillow each night knowing that what my team members do make a profound difference in the lives of each and every person who comes through our doors.
Contact Info:
- Website: https://NCEPRehab.com
- Facebook: Nevada Community Enrichment Program