BINI support for professionals

If you’re new to the BINI we recommend you watch our short introductory video.

The Brain Injury Needs Indicator (BINI) is a tool developed by the Brain Injury Rehabilitation Trust (BIRT) to assist with identifying the deficits of people with a suspected or diagnosed acquired brain injury. One of the major symptoms of a brain injury is a person’s lack of insight or self-awareness into their abilities or actions post-injury. Lack of insight is normally coupled with retained intellect and ability to, for example, hold a conversation but can also mean some people overstate or understate their abilities or needs based on their understanding of their brain injury.

This ‘lack of insight’ may not be captured by a standard assessment, which can lead to misinterpretation of their social care needs and to increased vulnerability and risk for that individual. The main focus of the BINI is to give the assessor the tools to interpret lack of insight so they gain a more accurate picture of someone’s true needs and risk to themselves, or, possibly, others.

You can find answers to our most frequently asked questions below. While it is not possible for us to provide clinical guidance without an in-person assessment, we can answer any other questions you may have on the BINI please email us at: bini@thedtgroup.org.

1) Can I use the BINI and keep using my own assessment tools?

Yes. The BINI is not intended to replace your standard social care assessment, but to complement and work alongside your existing framework and toolkit. The BINI identifies deficits and needs associated with brain injury but does not provide an all-round assessment on general need, carers’ needs, eligibility or funding for care packages.

2) Can I use the BINI if I’ve never been trained on brain injury?

Yes. The BINI was specifically designed to be used by professionals who may not have had previous experience in working with people with brain injury. However, we recommend that the BINI is only used by social workers or other professionals who have experience of conducting social care assessments

The BINI is a self-contained document with supporting information included to guide you through the process of assessing someone with a brain injury. BIRT has a number of resources introducing brain injury including a short video explaining some of the common causes and effects. The BINI can, of course, also be used by professionals with an in-depth knowledge of brain injury, such as clinicians and case managers.

3) Can the BINI be used as supporting evidence (e.g. for benefit claims)?

Yes, although the BINI was not explicitly designed for this purpose. Information gathered through using the BINI can be used to indicate needs arising due to brain injury which may be of use in other types of assessment, such as for statutory benefits. If you choose to use the BINI as evidence for benefit claims, we would like to learn more about your experiences – you can contact the BINI team at bini@thedtgroup.org to arrange an informal chat.

4) How does the BINI relate to the Care Act in England?

The BINI is referenced in the Care Act guidance (point 6.43) as ‘a tool that can be used as part of the assessment to help identify deficits of people with a suspected or diagnosed brain injury’. During the development of the Care Act, BIRT ensured the guidance highlighted the complex and specific needs associated with brain injury, and the need for a supportive assessment process. The Care Act and statutory guidance encourage rigour and evidence of assessment and the BINI is a systematic tool that supports gathering information of this information in relation to brain injury. The BINI can also be used outside England as the information contained is not specific to the Care Act.

5) Can the BINI be used with people with other co-existing conditions such as dementia, learning disability etc.?

Yes. The BINI was designed to assess the impact of all forms of a single or multiple brain injuries, including traumatic brain injury, stroke, neoplasm, brain injuries due to anoxia, intoxication, bacterial or viral infections, and in the context of other co-existing conditions. The tool will help you evaluate the impact of factors associated with brain injury on a person’s needs. However, by itself, it will not enable you to discern the exact nature of the injury or the primary cause of such needs, which would require full assessment by a clinical specialist (e. g. clinical neuropsychologist).

6) Can a brain injury appear to be a psychiatric condition or mental health problem?

Yes. Both brain injury and psychiatric or mental health problems affect a person’s behaviour and well-being, and there may be considerable overlap in symptoms (e. g. poor attention, poor memory, emotional disregulation, etc.). Brain injury has also been found to increase the risk of developing mental health problems (e. g. Hart et al., 2016; Holsinger et al., 2002; Robinson & Jorge, 2016; Scholten et al., 2016; van Reekum, Cohen, & Wong, 2000) such as anxiety and depression. In addition, psychiatric or mental health problems are sometimes present prior to, but can deteriorate as a result of a brain injury. The recommended treatment, however, may differ in each of these situations. A full assessment by a clinical specialist (e. g. clinical neuropsychologist) is recommended in these cases.

7) If someone has had multiple brain injuries, would I need to complete multiple BINIs?

No. When you complete Section 1 ‘Brain injury history’ take note of the nature and date of each brain injury. Brain injury can have a cumulative effect, meaning it can be difficult to separate out symptoms caused by each injury. However, if the individual sustained another brain injury after your initial assessment we would recommend carrying out a new assessment using the BINI in case their needs or level of insight have changed.

8) Do the needs of people with brain injury change with age – would I need to do another BINI over time?

Yes. There is some evidence that brain injury may increase the risk of developing other conditions such as dementia 6–10, which could change their support needs. Under the Care Act guidance, individuals should have a review assessment annually to see if their needs have changed. You can continue to incorporate the BINI as part of this assessment process.

9) Can I use the BINI with someone if I don’t know their full medical history?

Yes. You may be able to source medical history by consulting their GP or another medical professional, but in some cases a history of brain injury may not have been formally recorded. Research has shown that a significant proportion of people (42%; 11) does not seek medical help following injury. This is possible if they have sustained numerous mild injuries that did not require hospitalisation, or there may be gaps in their medical history. Complete Section 1 ‘Brain injury history’ as best as you can, then complete the rest of the BINI as normal.

10) How should I complete the BINI if there is no family or support network (e.g. if the individual is homeless, a refugee etc.)?

As with the previous question, complete the BINI as best as you can with the information you have available. It is likely that the person will have a range of relationships with people who currently know or support them, although it may be more difficult to determine changes before and after the brain injury if this is a new relationship. It should still be possible to identify areas they need support with and gauge their level of insight into their condition.

11) Can I use the BINI with children?

The BINI is based on existing clinical tools for assessing brain injury in adults and was designed for use with adults. BIRT has not evaluated the validity of the BINI when used with children with brain injury and we would not encourage its use with children at this stage. BIRT specialises in services for adults with brain injury, but other organisations such as the Child Brain Injury Trust (www.childbraininjurytrust.org.uk/) can provide information for professionals working with children with brain injury.

12) What if someone developed their brain injury as a child and is now an adult?

In this instance it would be possible to use the BINI to assess support needs and level of insight. However, it may be difficult to determine to what extent the brain injury has caused need, as there may be limited recall of ‘before’ the injury, and some of the questions (e. g. about working, shopping or living independently) may not be relevant. This could also apply to people who sustained their injury a long time (e.g. decades) ago. As with any BINI assessment, we would encourage you to consult the support network and medical professionals in order to form a full picture of the needs and deficits associated with the brain injury, and a full assessment by a clinical specialist (e. g. clinical neuropsychologist) may be recommended in some cases.

References

  1. van Reekum R, Cohen T, Wong J. Can traumatic brain injury cause psychiatric disorders? The Journal of Neuropsychiatry and Clinical Neurosciences. 2000;12(3):316–27.
  2. Holsinger T, Steffens DC, Phillips C, Helms MJ, Havlik RJ, Breitner JCS, Guralnik JM, Plassman BL. Head injury in early adulthood and the lifetime risk of depression. Archives of General Psychiatry. 2002;59(1):17.
  3. Robinson RG, Jorge RE. Post-stroke depression: A review. American Journal of Psychiatry. 2016;173(3):221–231.
  4. Hart T, Fann JR, Chervoneva I, Juengst SB, Rosenthal JA, Krellman JW, Dreer LE, Kroenke K. Prevalence, risk ractors, and correlates of anxiety at 1 year after moderate to severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 2016;97(5):701–707.
  5. Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: A systematic review. Journal of Neurotrauma. 2016;33(22):1969–1994.
  6. Perry DC, Sturm VE, Peterson MJ, Pieper CF, Bullock T, Boeve BF, Miller BL, Guskiewicz KM, Berger MS, Kramer JH, et al. Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis. Journal of Neurosurgery. 2016;124(2):511–526.
  7. Gardner RC, Burke JF, Nettiksimmons J, Kaup A, Barnes DE, Yaffe K. Dementia risk after traumatic brain injury vs nonbrain trauma. JAMA Neurology. 2014;71(12):1490.
  8. Gardener H, Wright CB, Rundek T, Sacco RL. Brain health and shared risk factors for dementia and stroke. Nature Reviews. Neurology. 2015;11(11):651–7.
  9. Zhou J, Yu J-T, Wang H-F, Meng X-F, Tan C-C, Wang J, Wang C, Tan L. Association between stroke and Alzheimer’s disease: systematic review and meta-analysis. Journal of Alzheimer’s Disease. 2015;43(2):479–89.
  10. Li Y, Li Y, Li X, Zhang S, Zhao J, Zhu X, Tian G. Head injury as a risk factor for dementia and Alzheimer’s disease: A systematic review and meta-analysis of 32 observational studies Lifshitz J, editor. PLOS ONE. 2017;12(1):e0169650.
  11. Setnik L, Bazarian JJ. The characteristics of patients who do not seek medical treatment for traumatic brain injury. Brain Injury. 2007;21(1):1–9.