1) Social/Interpersonal Learning Model

The RRS program is rooted in the tradition of social/interpersonal learning models that maintain that "controls" over behavior develop as one's innate drives and impulses are confronted with the demands of society. When these controls are lost as a result of the brain injury, they must be "re-wired" in the same manner that they were originally acquired, i.e., on the basis of the social rewards/ punishments resulting from one's social interactions. The Radical Rehab program provides for intensive social learning via two avenues:

a) Intensive Life Skills Training: Each program includes the presence of a one-on-one Life Skills Trainer to maximize the client's level of accountability, to provide ongoing feedback regarding cognitive and behavioral deficits, and to provide cuing and training in compensatory cognitive-behavioral strategies. In fact, Radical Rehab employs over 100 Life Skills Trainers to provide intensive one-on-one training to approximately 40 clients;

b) Therapeutic Community/Milieu: Clients participate daily in a process-oriented, cognitive re-training group that utilizes the power of the relationships in the group to reinforce desirable behavior and extinguish undesirable behavior. The group provides the opportunity for the client to learn how they are perceived by others and to practice new behaviors in a supportive environment. The group provides clients with intensive education to assist them in developing a working knowledge of their injury and its impact on their thinking and behavior, so that they may progress toward independently generating their own coping strategies. Further, clients set weekly attainable goals in the presence of the group and receive positive or negative feedback from the group when progress toward goals is reviewed each week.

2) Success-Oriented Rehabilitation

In the later stages of recovery after a brain injury, the careful and consistent application of positive and negative feedback forms the basis for increasing awareness of persisting deficits and "fine-tuning" behavior. As a result of carefully-orchestrated initial successes in the program, the individual experiences a boost in their sense of self-efficacy (their belief in their ability to cope with the brain injury) that enables them to be more open to negative feedback and to gradually gain insight into their behavior.

3) One-on-One Life Skills Training

All too often after an individual sustains a brain injury, their spouse or parent may be thrust into the awkward "dual role" of being both a family member and "therapist." Our model transfers the role of "full-time therapist" off of the family member and onto an appropriately-trained Life Skills Trainer (i.e., "Life Coach"). It is the strong, one-on-one therapeutic relationship with the Life Skills Trainer that provides the praise and encouragement necessary to attain one's goals and provides the safe milieu for receiving negative feedback.

4) Intensive Family Training and Education

Given that, ultimately, it is the family that bears the burden of coping with the long-term ramifications of a brain injury, our goal is to provide the family with intensive education regarding the management of the cognitive (i.e. thinking) and behavioral consequences of brain injury. Once the family has developed a functional understanding of brain-behavior relationships and of their role in managing problem behaviors, the management strategies that the family generates on its own are more likely to be appropriate and adaptive. As a result of intensive family involvement in the program, problem behaviors are not addressed "in a vacuum" but rather in the context of real-life situations with the family.

5) Local, Community-Based Intervention

One distinct advantage of the Radical Rehab transitional living program is the proximity of its services to West Virginia, Kentucky, and Southern Ohio. The various program locations facilitate intensive family participation in the rehabilitation program. By addressing behavioral difficulties in a home-like residential setting with active participation from the family, as opposed to a distant and "artificial" hospital setting, the common problem of "generalization" of gains to the home environment is avoided.