Inside Rehabilitation Counseling
Inside Rehabilitation Counseling
TBI Deep Dive for Rehabilitation Counselors with Shannon Juengst, PhD, CRC
Traumatic Brain Injury is the leading cause of death and disability worldwide, with an estimated 5.3 million Americans living today with the disability. Of all types of injury, those to the brain are among the most likely to result in death or permanent disability, making research and a deep understanding of how to navigate services for those impacted by TBI vital.
Shannon Juengst, PhD, CRC, is a Senior Scientist and Clinical Investigator at TIRR Memorial Hermann and an Adjunct Associate Professor of PM&R at UT Houston Health Sciences Center.
On this episode of the Inside Rehabilitation Counseling podcast, Dr. Juengst shares insights into her work, including why it’s crucial to keep research human and where Certified Rehabilitation Counselors need to expand their TBI knowledge to be effective team rehabilitation team members.
Helpful Resources
TBI Fact Sheets: https://msktc.org/tbi/factsheets
Brain Injury Association of America Resource Center: https://biausa.org/brain-injury
Dr. Juengst's Bibliography: https://www.ncbi.nlm.nih.gov/myncbi/shannon.juengst.1/bibliography/public/
Music.
Taylor Bauer, CRCC:Welcome back in for another episode of likely to result in death or permanent disability, making research and a deep understanding of how to navigate services for those impacted by TBI vital. Dr. Shannon Juengst is a certified rehabilitation counselor currently serving as clinical investigator and senior scientist at TIRR Memorial Hermann and an adjunct associate professor at UT Health Science Center in Houston. Her research career, which you can find in the show notes, is expansive and her work has made major contributions Thank you. Thank you. Thank you. Dr. Yates, thanks so much for joining us today on Inside Rehabilitation Counseling. I want to start our discussion today with a question I ask everybody who comes on the show. When did you first learn about certified rehabilitation counselors or the rehabilitation counseling profession? Can you walk us through the personal journey that led you to the career you have today?
Shannon Juengst, PhD, CRC:Sure. It's actually kind of a roundabout story. I've As long as I can remember, I've been really interested in working with people with brain injury, really interested in just the way that the mind works, the way people think. I was drawn towards psychology because I'm more interested in supporting people and kind of taking a humanistic perspective to how people function and are in the world. And so out of college, I... knew that I needed some more research experience in order to get into grad school. I thought I was going to go into clinical psychology. I started working for a neuropsychologist on an HIV study and worked with him for a couple of years as I was thinking about applying for grad school. And one day, he pulled me aside and he said, Shannon, here's your problem. I was like, please tell me. What's my problem? He said, you have a researcher's mind and you think about things like a researcher. But you like people. And I laughed. I was like, that's a problem. He's like, well, it's challenging because a lot of people who go into more service-oriented and helping fields are those who like people. And it's like, that's not always us researchers or neuropsychologists. And he was the one who told me to go talk to a colleague of his who was also a neuropsychologist but was chair of the Department of Rehab Counseling at the University of Pittsburgh. And this was in early August. I went and met with him and spoke with him about what is this rehabilitation counseling thing. I had never heard of it before and had a really great meeting and realized that it was very much what I was looking for. And he said, well, our program starts in two weeks. Are you interested? And two weeks later, I started the program to become a rehab counselor. I hadn't heard about it, and then I did, and then very quickly kind of thrown into that world.
Taylor Bauer, CRCC:Wow. And I think it's so interesting to have that, you know, at the top of your answer, the discussion over kind of researchers and wanting to be involved and integrated into working directly with people. I feel like there's probably a great need for that. I would assume from a research perspective, sometimes maybe... distance or separation is important, but also there's a unique perspective I think you gain when you're so people-oriented in your research methods and things like that. And I'm sure it has lent itself to you having a very successful career in terms of research.
Shannon Juengst, PhD, CRC:Yeah, yeah. You know, after doing the master's training in rehabilitation counseling, I did work for a couple of years before I went back to do my PhD. And I knew that I always wanted to get involved in research, but I wanted to go out and practice and work with people for a while to just get that experience. And it was during that time that I really saw the need for exactly what you were just talking about, that integration of research and practice and not only practice as a provider, but bringing in the perspectives of the people that we're trying to help into what is needed and how best to get that to people and taking that back to the research world and informing the research from that end.
Taylor Bauer, CRCC:And I think that's something that we hear a lot that appeals to people about rehabilitation counseling once they learn about it as a profession is that kind of like, client or consumer-centered service and focus specifically on disability, its functional limitations, and how do we navigate those with a client or on behalf of a client alongside them. So it's fascinating. And in doing some of the research ahead of our conversation and reading some of the things that you study, I mean, first of all, way over my head in a lot of ways where I was like learning a lot at once. And I was like, wow, this is like such good information that would be wonderful to have you come talk about on the show. And I think it's always interesting to me for people who are in research fields and have a specific area of research within a profession or a field that calls to them, finding out why it is in particular that that really resonates with them. And you touched on that a little bit, but were there elements of studying traumatic brain injury and things like that from either a research perspective or just in general that really felt like that's where you were going you feel the most fulfilled professionally?
Shannon Juengst, PhD, CRC:Yeah. I've worked with people with cognitive disability due to a number of different things. I started out in research in the HIV and aging world. I did some work during my master's training clinically working with transition age young adults with cognitive disability. ADHD, learning disabilities, autism, brain injury, spina bifida, cerebral palsy, kind of across the board, helping them prepare for success in vocational or post-secondary education training. I worked with individuals kind of in that same age group, working towards more independent living skills and moving out from being with their parents and having that support. So I think the overarching kind of cognitive challenges changes that occur after a number of disabilities was always what interested me. And the thing about traumatic brain injury that I think I was so drawn to is that it's sudden and it can happen to anyone. And there is a big difference between those who have sort of grown up with and developed with the disability that they have versus those where it is a very sudden onset, of course. And so I was very drawn to that because as you noted, so much of my work focuses on community-based outcomes, getting people back to the things in their life that they want to do and that are meaningful to them. And for somebody that has lived their life for many years with a cognitive disability, that's more integrated into who they are and the things that they do in life. And it's a little bit of a different approach than when a person has a very established life and activities and experiences. something like a traumatic brain injury happens that really completely disrupts that. And they have to figure out what it means after the injury and how to get back to the things they want to do that were important or cover new things that might be different but still fulfill whatever that was that gave them meaning in the activities they did before. And so I think that sort of underlies what drives me, what drives my work, and why TBI has just always been a population that I think there's such a need and such an opportunity to really do that kind of work.
Taylor Bauer, CRCC:Absolutely. Yeah. And we know just in general, humans are pretty averse to uncertainty and change in a lot of ways. TBI seems like one of the most extreme versions of that, where every element of your life, and I guess that's true for any disability that you may acquire, but some of the things we'll talk about today in your research with TBI, it's so deeply rooted in every aspect of who someone is and how they spend their life and having that be something that you don't live with for years decades however long it might be that all of a sudden reroutes you know the journey that you're on feels to me as something that even with all the research that that is already happening um requires even deeper investment in researching these things and their their effects because yeah it completely changes somebody and the more time we can understand that the better and i think CRCs like yourself who have that expertise in disability and the counseling elements of the work, as well as that drive to research what it is that or what the extents are of experiencing something like this. That's such a vital work and I'm very grateful that there are people like you who are interested in that, let alone doing it so well. One interesting focus of your research on TBI is the methods by which people with TBI and their care partners can use behavioral health interventions to manage problems they experience due to their condition. With any disability, we know that there are specific behavioral and cognitive implications, but what unique elements of TBI influence the methods by which you would seek to address the things that they're experiencing?
Shannon Juengst, PhD, CRC:Yeah, that's a good question. I think that there are some unique things. Again, that's sort of the cognitive changes, the executive changes that may not be they're not visible. They may not be obvious. They may not occur or manifest in every situation, but they're there. They're kind of hard to explain. Even people who are experiencing them often will sort of attribute everything to poor memory. You know, I just, I forgot my memory's not good because that's an easy thing to understand. Whereas things like initiating activities or organizing your thoughts or organizing your schedule or time management or some of these other executive functions are much harder to kind of put your finger on and understand and explain to people when you struggle with them. It can look like you're lazy or it can look like you have no motivation when really it's not a choice. It's not something that is about what the person wants or if they're driven, it's really their ability and the struggles that they have just managing those things cognitively. And that's where I think the behavioral health really comes into play because those kinds of interventions are all about helping whoever you are, whether you've had a brain injury or not, to manage your life. And so much of the work I've done is in behavioral health that either directly addresses or or supports self-management and how do we manage in our day-to-day lives? Because that's where people spend most of their time. We know that, you know, initially after an injury, you might get a lot of support and a lot of medical care, a lot of counseling care. If you are fortunate enough to go through inpatient rehabilitation, you get your therapies, but not everyone's fortunate to go through that pathway. And even those who are, after a certain amount of time, you sort of discharge out of it and you're navigating on your own. And we hear from people with brain injury, and we hear that from their care partners, that increasingly over time, as they get out further from the initial injury, they are left to manage on their own. And so how do we empower them with the tools and the skills to do that successfully? In an ideal world, we'd be there. We would have thousands of rehab counselors who could be somebody's on-call coach and work them through whatever they encountered, but we know that that's not realistic. So how do we provide skills training so that people are able to manage on their own? And I think that that kind of underlying strengths-based perspective, understanding that people have strengths and what can we do to promote the strengths as opposed to taking a deficits-based approach. It's very much the rehabilitation world. I think it's what really drew me to rehab counseling over some of the psychology fields because it was more about what do you want to do and how do we get you there with the strengths that you have rather than let's figure out what's wrong and how do we fix it. And so I think that that's where, again, that kind of behavioral health is about. Behavior is what you do in your natural environment in response to the things that you encounter. So how do we set people up to best function that way? And so I think there are some unique things about TBI because of the cognitive and the emotional and the physical consequences that can occur, but also that it's so unique to every person. The kind of cliche is, once you've met a person with TBI, you've met a person with TBI. It doesn't really apply across the board. So I do think that's somewhat unique. But I also think that so much of what we do is, it really is beneficial to everybody We might just have to adapt it so that it can be beneficial for people that need information in a little bit of a different way or need to do things a little slower with a little more support. And so a lot of the work that I've done is not TBI specific. It's work that could help anybody. It's just done with a TBI population so that we know how we can adapt it to meet their needs.
Taylor Bauer, CRCC:I mean, first and foremost, I think the empowerment aspect of the research you do. And then also when we talk to other CRCs about the work that they do, that empowerment part is so important because like you said, depending on someone's journey with their disability, whether it's been a lifelong condition or something that they've acquired, there is a process at some point maybe where there are a lot of people involved in helping them navigate what the future is going to look like. And that's not always going to be permanent for everybody. And then having that space to then say, OK, now it's up to me to manage some of this and leave people, I would imagine, emotionally, psychologically feeling a little maybe out on a limb and stranded and and and under supported after going from maybe a place hopefully right that they have been very supported in all of the things that they're navigating i think about somebody who maybe has gotten injured and is going through a rehabilitation process and you know you have sometimes an entire team on your side for that and then when that process becomes okay now you're going to manage the last steps of recovery or maybe an ongoing um way that that injury is going to stay with you for the rest of your life but all of a sudden it's like okay well have you been working with someone who's helping you build up that confidence that you have the skills possible to navigate this on your on your own for from a day-to-day perspective and so i think like the counseling part of rehabilitation counseling is something from a marketing perspective i try to um really lean on heavily for folks who have never heard about what we uh what you all do and uh as you can imagine there are a lot of people who go i don't know what rehab counseling is so usually try to give them the elevator pitch and then find out where you know maybe that message is resonating with them so we can deep dive further but yeah that that question of empowerment is so important and giving people the skills to navigate things on their own is much better recipe than saying okay like we have all the answers kind of like you said with the psychology perspective sometimes here's what's wrong with you here's how we fix it go on your your life and you know, best of luck. I think there's something very human about wanting to partner with someone to not only help them navigate an experience, but empower them to navigate it on their own to the best of their ability. That is very unique from a lot of professions that are, you know, tangential to rehab counseling. And of course we know, hopefully in a lot of cases, folks who are experiencing disability or TBI have, you know, care partners in their life who are part of that process of navigating, you know, of return to some sort of independence, whatever that might be for that individual. I liked what you said about once you've met someone with TBI, you've met someone with TBI. It is not going to be a, oh, okay, I know exactly what you're experiencing because I'm aware of what that is. But a lot of your research, as you kind of alluded to, includes work empowering not only people with disability, but their care partners so that they are participating meaningfully, which I thought was a really interesting term. Can you kind of define that concept and why it's so important?
Shannon Juengst, PhD, CRC:Easy question. You know, I think that this concept has actually been a backbone of the disability world and the rehab world for a really long time. And it's only really recently sort of coming into the mainstream. In research, we see it with this shift towards emphasis on patient-centered outcomes and this whole idea of what are the things that are important to, and in medical research, I never use patient because people that I work with are usually so far beyond their kind of medical care that they're not patients anymore. They're people. They might be clients. They might be consumers. whatever we call them, they're people out in their lives. And so it's a very person-centered concept. And I think this idea of meaningful participation is that we can't really define what is good participation in the community. I do a lot of work with instrumentation and measurement, and this is always a question where we're trying to measure community integration, participation, whatever term you want to use, is that how do we measure it in a way in research where you have to measure it the same way for everybody, but that's meaningful for everyone. And traditionally we, and this is true of a lot of how we measure outcomes, it's based on how much you do. So the idea being that the more you participate, the better. And that's not entirely wrong. If you're looking at having a job and interacting with friends and family or going out and doing activities in the community, how much you're able to do it is one indicator, but it doesn't take into account what's the quality of that participation? Is that value consistent with what the person wants and is meaningful? Is that consistent with their phase of life and thinking about Rehabilitation, I think, really takes a lifespan perspective into account and understanding that what is meaningful and important to you changes over the lifespan, both just developmentally, there's kind of natural progression as we age into different kinds of life roles, but also just people change over time and people grow and develop and people are, their values are different. I've done some work more especially since coming to Texas with Hispanic individuals and some of the values that they're from the cultural backgrounds that they come from. And there's huge diversity there as well. But some of those values are very different than the kind of traditional American US values. So independence is actually not necessarily the top value. But in rehab, that's what we go for is independence. And independently participating might not actually be what that person wants. If they need support, but it allows them to do the specific activities that are important to them, then that's fine. And I think as you talk with people, you hear that. You hear that in their stories. You hear that in... the choices that they make for what they want to do, where they want to put their energy. A lot of my work with both caregivers and care partners and individuals with TBI and other disabilities is really focused on how do we help people achieve goals that are meaningful to them. And when you do work where you allow individuals to choose their own goals, you start to see what's important to them, which is very different sometimes than what's important to the providers or what we think should be important. And so I think this whole idea of meaningful participation is kind of a mix and a blend of doing as much as you want to do. So there's your frequency component, having the quality that you want, that when you're doing it, it is satisfying to you. So I've looked at this concept of satisfaction with your participation as a way of getting at that a little bit. Are you doing things that are important to you? And it might be important because it's something you need to do. And we all have those things we need to do. Versus also there's things you want to do. And things like leisure and social goals need to be part of that. And so it really is sort of a mix of those. And then kind of overlaying all of that is also how empowered or capable do you feel of doing that in your community and how much a part of your community do you feel? And this has been called enfranchisement, it's been called a lot of other things, but do you feel like you belong in your community, like you're valued by your community? And community can be family, it can be neighborhood, it can be however church, it can be school, it can be however you kind of define that, but that's feeling like a valued and contributing member is also key. as part of this
Taylor Bauer, CRCC:concept. Absolutely, yeah. I think there was a conversation just for a lot of different pauses or experiences or demographics people might find them in of kind of like trying to achieve acceptance, right? And I think something like integration or value is such a deeper, more meaningful way to view that because when we talk about someone with a disability trying to navigate a community, feeling accepted is one thing that, you know, almost like you're allowed to be here kind of thing. feeling valued and that you are you know integral to that community and to other people who live in it is such a deeper thing that i think a lot of people who don't have to navigate a disability don't even think about because for the most part they're not having to navigate those those stereotypes um for someone maybe with an indivisible disability or a non-visible disability you know what they're going through isn't obvious to other folks so maybe they get treated in a way where they don't really get to actually experience their community that way. And it's so important to focus on those deeper goals of true integration and value than it is to just try to say, And that goes for job placements too, right? Or like you said, trying to achieve the ability to participate in leisure activities. It shouldn't just be like, okay, you can do it. It's like, are you able to do it to a level where it's still fulfilling to you? And what is that extent that you were able to achieve with what you're navigating? But also like, how do you go about integrating that into your life, into this new lived experience that you're going through? So I think that that it was very illuminating to hear you talk about that. So thank you. Um, what it's certified rehabilitation counselors, such a vital team member alongside other professionals for an individual navigating a traumatic brain injury.
Shannon Juengst, PhD, CRC:Yeah. I, I think on the, on the one hand, it's unfortunate that often they are not part of the team. Right. Um, and I've always been an advocate that we should have rehab counselors be part of the team. And when I've seen, um, settings and organizations that have that, you really can see that benefit. And unfortunately, it's just not always the case. I think that there's a couple of really important perspectives and skills that CRCs bring. One is that, I mean, it is that counseling background, right? Like that coaching, counseling. I think that that's a really important support that people need And we hear from people that they need it and they don't have it. So I think that's one piece. I think the ability to speak across disciplines, and it's a little bit of that case management skill, but just being able to come into a team and have that holistic perspective, so understand... what each of the other team members are doing and how it all fits together. I see CRCs as being really uniquely able to do that, whereas on teams that I've been part of before, everybody has their expertise and they come and that is their wheelhouse and that is their focus and it needs to be. And having somebody who can step back and see that kind of bigger picture and how those folks can work together is really important. And I think CRCs are really uniquely qualified for that. I also think that the disability understanding is so important. So why is a CRC different than a psychologist or a master's level counselor, therapist, a social worker? I think in a lot of settings, we see social workers taking that role and social workers are wonderful. And I cannot speak highly enough about having a social worker on your team, but their perspective again is, is not the disability specifically. And it's not always that sort of holistic, again, meaningful participation and function as the end goal. So I think that's the important part that they bring to the team. Maybe put more simply, when you work with folks, especially where TBI in particular has largely until recently been considered an injury, a medical condition. So it's kind of steeped in the medical model. And it's very deficits-based. It's very recovery-based rather than based in adaptation and function. It's very bottom-up. So how do we figure out what's wrong and fix it so that then people go out and do better in the world? Which I think is really important, but you also have to have that top-down. Where is it we're trying to get to? And does it actually matter? Why? Or, you know, I've kind of always had the perspective of where's the person right now? And we need to understand what we need to move them forward. And it doesn't matter so much understanding how they got there if what they need to move forward isn't based on that. So I think having that kind of top down, where are we trying to get people to perspective is important. And that's something that a CRC brings forward. because of that social model, disability model perspective and strengths-based perspective that they're bringing to the team.
Taylor Bauer, CRCC:We have a lot of folks who have told us they listen to the podcast regularly who are new to the field or maybe in a graduate program getting ready to enter their chapter as a CRC. So I'm curious for folks who are new to the field or just getting started, what does someone need to know about the variations in satisfaction that one might experience when navigating a traumatic brain injury? There was a lot of research I came across that you've done on life satisfaction trajectories, and I found that really interesting. If I I was new to the field and just about to get started maybe in my first position post grad school. What are some considerations I might want to sit with?
Shannon Juengst, PhD, CRC:What we've generally found when we've looked at life satisfaction, which is a really kind of big global concept, right? Like how satisfied are you with your life? is that for the most part, for most people, it's a pretty stable thing, not for everyone. And there are certain things that can change that trajectory. We see changes, again, across the lifespan that people kind of in middle adulthood tend to have the lowest life satisfaction. And this is true in brain injury. This is true in general population. It makes sense. It's a phase of life when you have the most demands. You're working, you might have children, you might have aging parents. It's a very kind of high demand phase of life. And for people who have a brain injury or really any acquired disability in that phase where that kind of high demands, the challenges that they have are going to be magnified when there's more demands put on them, that can be a particularly challenging time. So I think that as far as from the practicing side of things, I think it's really important to understand where a person is developmentally in their life as an adult, to understand what all of those life roles are that are important to them. And that's something we kept seeing come up over and over is that life satisfaction is so, so much more tied to life roles and participation in meaningful life roles than it to how severe your injury is or how independent you are. It really is, it has such a social component too. Relationships are a huge part of that. And we know that after a TBI, social relationships are often very affected because a person can experience personality changes or because just how they function in the world and day to day changes so dramatically and but they look the same and so they lose friends that they had before who don't understand and they have challenges if they're a little bit more disinhibited if their emotional regulation is not as good they have challenges in close relationships as well and so i think that those are really important things to to pay attention to and be aware of more so than what is again the sort of consequence of the injury itself but more how does it affect those relationships and how does it kind of interact with where you are and what phase of life you're in um i think that the more having more rehab counselors out there who understand brain injury and just understand those cognitive and emotional aspects of any disability that affects kind of how you think, how you interact with people is really important because that's, there's not a lot of practitioners out there, especially kind of that master's level therapist, counselor. I get calls all the time saying, do you know somebody who understands brain injury? I need to refer someone to them. They've gone to psychologists. They've gone to counselors who are perfectly wonderful practitioners and people who keep just telling them they're depressed and they're not depressed. They're like, I'm not sad. I'm happy. exhausted and I can't seem to get off the couch, but it's not sadness. This is like initiation. Well, that's not an emotional thing. That's a cognitive thing. So I think there is such a need to have people out there who understand kind of those cognitive effects and how those affect those social relationships.
Taylor Bauer, CRCC:Yeah, I'm really fascinated at the concept. We might need to have you back on at some point to explore this further, but I'm really interested in the concept of someone who's experiencing TBI getting sent to different professionals who are equipped and knowledgeable. The question, like you said, with social workers or psychologists or anybody, it's not like, oh, they don't know what they're doing. It's more so that there's just such a unique experience of having some of those cognitive effects come from experiencing a disability. And it's not as simple as like, oh, like depression, like you said, even though folks might be experiencing depression alongside a disability, but being able to navigate where that intersection sets, as well as where they are distinctly different things, or the same thing, maybe just through the lens of disability is such a crucial capability that I think in the work that I do with CRCC, we can be articulating a little bit more clearly of why that's so important to have. So it's like your answers are making me think of more work that I get to do. So I'm kind of excited about that. That's good. Yeah, right. It keeps me busy, right? Out of trouble. You have a lot of research to your name. And I know that there are lots of people who research TBI and brain injury and things like that. But I'm curious what elements of TBI you think still need the most investigation regarding either the injury itself or the individual's experience during and post-injury? I
Shannon Juengst, PhD, CRC:do think the work that's being done to try to identify effective treatments early on after injury is really important. If there's things that we could do right after injury that helped to prevent the long-term consequences and prevent disability. That is really important. That's not the work I do, but I work with people who do that work and I've kind of peripherally touched on it. And I think that is incredibly important. On the flip side, there isn't that, right? And we have all of these people living with the consequences of TBI and needing support who, even if we have kind of the, you know, miracle treatment that can help treat the actual injury itself early on, they're not going to benefit from. And so I think a lot more work needs to be done looking at how we actually help the people who are experiencing those consequences of brain injury out in their communities and out where they are and out beyond that first year post-injury, which is when they get the most support. And I think that the field is moving in that direction. It was just very recently that CMS recognized TBI as a chronic condition. And that has really important implications for things like reimbursement and services being covered. But also just even on the sort of attitudinal level, just the recognition that there are long-term consequences and people are going to be dealing with some of them for the rest of their life is is really important as a way to just promote that they need, that means they need help. So that is the area that I see so much potential for more work to be done is, you know, how do we help them and more so not just how do we do it? Because I think we have a good understanding of if you can get a person in front of you, like what are the supports and what is the training and what is it that you need to do to help them? It's more how do we get the stuff we know works In the research world, you might call this implementation science and implementation and dissemination. But that's where I think very little has been done and that we really need the most work because we have good research. We have good evidence. We have good behavioral interventions that we know help. But there's all these people that don't have access to that. Who's going to provide it? How are people going to access it? How's it going to be reimbursed? So these are all kind of implementation, dissemination questions that I think we really as a field need to be embracing and tackling while we're still trying to figure out all of those other things that are going to work best to prevent as much as possible these kind of long-term consequences. I think the other... area and you touched on this a little bit before talking about stigma and stigma disability and when a disability is invisible but in tbi we also have found that most people don't identify as being disabled so they will tell you that they have function many functional consequences and challenges relating from their injury um they may say they may be unable to work even if they want to But they don't identify as having a disability. And I think a lot of that is that so much of the work coming out of TBI is that, again, in the kind of medical model, it's been viewed as this very acute condition. And as a result, a lot of individuals are not plugged into the disability community and to disability resources. They don't even know to look for them. They don't think they qualify. Even vocational rehabilitation, which is such a great support for people who are looking to be employed and to work, often people with TBI don't necessarily qualify because they have to get that disability designation. And when you have that higher level executive dysfunction, that's a really hard thing to identify and quantify and to get that designation. So I think that's another... area where understanding what those barriers are and why people are not finding the services that are out there, I guess this may be part of the same big picture of implementation. But I think that's another really important area that needs to be studied more. Again, TBI can happen to anybody at any time. And so many people that have one TBI have another TBI. And we know that multiple brain injuries can have cumulative effects in different ways, different areas. There's been a lot of work looking at even milder injuries that don't result in loss of consciousness can have long-term effects. And what are the consequences of multiple injuries? And at what point in your life, if you have a pediatric brain injury versus an adult brain injury or a pediatric injury, and then an adult injury later, what does that mean? And what are the consequences of that? So again, really starting to look at broader lifespan perspectives to brain injury and its consequences is another area that really needs a lot more work, especially if we are going to embrace that TBI is a chronic health condition.
Taylor Bauer, CRCC:Absolutely, yeah. All of those points that you just made require our advocacy for... continued support of researchers like yourself exploring these things, because it does impact so many people in many ways that, like you said, there's been a lot of progress in how we understand and how we assess and approach working with TBI patients, but that there's more that we can continue to deep dive. And then from an awareness perspective, just getting the word out of what this research is discovering and getting that information to the right people is vital. With all of the incredible research you do and the work you've dedicated your professional life to, what brings you joy in the work that you do?
Shannon Juengst, PhD, CRC:I love what I do. I really do. I think that in the short time that I was practicing not doing research, I saw such a need for better research and research getting out there. I think that providers are out there doing the best they can with what they know and what they have. And there's so much better that we could do. And so the thing that really drives me is that kind of practical, like how do we get support to the people who need it? And I've been really fortunate in everything that I've done to always have the opportunity to be touching base and working with people in the community, people with brain injury and their care partners. And those are always the moments that kind of bring me the most joy. They'll sort of refill my cup, so to speak. And it's because I think those are the moments that, one, it reaffirms that this is needed and it reaffirms that this is important. And it also, those are the moments where I see how big a difference it can make and the difference that it's made in even just those lives of the people that I've worked with most immediately. And that's the part that really brings me joy and is invigorating. And most recently, a project that is ongoing, it's taking what's called a community-based participatory research approach. And so essentially what that means is that We have people with brain injury, people with lived experience of other disability, care partners, providers, all of these people who are sort of involved in the experience of brain injury coming together with us as researchers and really co-creating intervention, collaborating as equal partners. And that's been a really... kind of perspective changing moment for me. And doing that kind of work, I've always involved people. I've gotten their feedback. I've gone back and presented my work. But this is the first time where we're really working hard to try to really share the power in research, to share the decision-making. And it's been a... an exercise in letting go for me as a researcher to say there's certain things about evidence we have to hang on to, but there's also things that we have to be able to let go if they're not practical, if they're not wanted by the population. And that, those conversations and that give and take and the kind of collaboration and coming to these shared decisions has just been a really, really great experience. And I think in the end, it's created something that is going to be beneficial And we are going to be able to get out there because as we've developed it, as we've done the work, we've been talking to people and thinking about those things. You know, where do we want to be in 10 years? We're thinking about that now and how do we set things up? So I think that's the part. It's just always been the going back and kind of seeing how this actually can make a difference for people.
Taylor Bauer, CRCC:huge thank you to Dr. Juengst for that informational and engaging conversation. In the show notes, you can find links to helpful resources Dr. Juengst provided, including TBI fact sheets for a number of topics and resources that could be very helpful for certified rehabilitation counselors. If you have any takeaways or insights on topics covered in this episode, email us at contactus at crccertification.com. Be sure to subscribe to this show on Apple Podcasts, Spotify, or wherever you're listening to us today. You can find us on Facebook and LinkedIn at CRC Cert, and our website is crccertification.com. Until next time, I'm CRCC Director of Communications and Marketing, Taylor Bauer. Thank you for listening to Inside Rehabilitation Counseling.