Post-Concussion
Interview Guide
HEDCO Clinic University of Oregon
Basic InformationName / Birth Date / Today’s Date / Clinician
Grade / School / Date of Most Recent Injury / Clinic Supervisor
Referral:
Introduction/Orientation
· Appreciate the opportunity to work with you today—any special needs? Light/water/break/seating
· We like to start with orienting you a bit to this clinic—provide brief overview of BrICC and nature of training clinic
· Give context for referral and our consultation goals—does this fit with your expectations? Anything else you would like us to address?
Course of Injury
· Can you give me an overview of what happened [only if you don’t have information in file]
· Can you describe recovery over time? What’s improved the most? What is still most concerning
· What treatments are you receiving?
· What seems to help or not help?
· If you could wave a magic wand and change one thing—what would that be?
Possible Mediators (just ask about ones that make sense based on file)
History of prior concussions? / Yes No Dates:
Loss of consciousness after incident? / Yes No
History of migraines? / Yes No
History of depression/anxiety / Yes No
History of LD/developmental conditions / Yes No
Other: / Yes No
Other: / Yes No
Current medication/relevant medical history:
PCSS/HBI Score and elevated somatic symptoms:
Academic Functioning
School/Year:
· What are your areas of interest? Strengths? What do you see yourself pursuing in the future?
· What were your grades like before this happened?
· Any current formal accommodations?
· How motivated do you feel to do well in school?
· I’m interested in how you do on basic school functions such as reading/writing/test taking.
o What happens when you read?—Understanding? Retention? Use of strategies?
o How is your ability to listen to lecture-- Understanding? Retention? Use of strategies?
o What happens when you write?—Ability to think of what to write? Organization? Use of strategies?
o Describe your ability to remember what you learn and take tests? Test taking strategies? / History of learning disabilities or ADHD?
Yes No If yes, describe:
Course Inventory (if relevant)
Current Classes / Difficulty Level / Estimated Grade Prior to Injury / Expected Current Grade / Primary Challenges
(if any) / Current Study Approaches
Possible accommodations/skills/tools that would assist with identified concerns:
Cognitive Symptoms
Tell me about your thinking—you have mentioned that ______is easy/hard. Can you tell me more about that?
Attention Symptoms: I’m going to quickly ask you some questions about your attention and you can just say yes/no if you this is an area that bugs you.
Increased problems paying attention/concentrating in school? / Yes No
Easily distracted in class? / Yes No
Miss important details in class that everyone else seems to catch? / Yes No
Trouble paying attention in class if there is background noise? / Yes No
Difficulty switching between two activities (e.g. switching between listening to the teacher explain a math problem and working on the math problem)? / Yes No
Trouble reading for long periods of time without getting distracted? / Yes No
Memory Symptoms: I’m going to quickly ask you some questions about your memory and you can just say yes/no if you this is an area that bugs you.
Forget events from yesterday? / Yes No
Forget people you used to know? / Yes No
Trouble remembering reading from earlier, even if it was understood at the time? / Yes No
Trouble remembering information for tests, even if studied the night before? / Yes No
Trouble remembering what the teacher said in class, unless the information is written down immediately? / Yes No
Executive Functioning Symptoms: I’m going to quickly ask you some questions about your organization and ability to get stuff done. and you can just say yes/no if you this is an area that bugs you.
Forget to do assignments? / Yes No
Forget to turn homework in? / Yes No
Trouble finding homework? / Yes No
Trouble keeping desk, locker, and personal space neat and clean? / Yes No
Forget to bring needed materials home/to class to complete assignments? / Yes No
Difficulty arriving to class on time? / Yes No
Difficulty making decisions (e.g. what to have for lunch, which essay topic to write on) / Yes No
Explore any other cognitive issues that get brought up or may need to be looked at.
Home/Community Functioning
· Tell me about your living situation:
· Who are your primary supports?
Recreation
· What are your current recreational pursuits?
· What has changed since your injury?
· Tell me about your home management or personal management—things like doing chores, errands, self-care like grooming. / Social emotional functioning
· I’m interested in knowing a bit more about your friends/social situation.
· Is this a change?
· Do you feel understood by others?
· Any specific emotional concerns like irritation, depression, mood issues?
· On a scale of 1-10 with 1=to completely discouraged and 10=I’m positive it’ll get better, how hopeful do you feel about your ability to recover?
Management
· How motivated do you feel to address ____ concern?
What have you tried? / Management
· How motivated do you feel to address ____ concern?
· What have you tried?
Yes No Decrease in pursuing activities of interest / Yes No Feel less interested in social engagement
Yes No Increased problems completing chores or home tasks / Yes No Feel like people don’t understand concussion effects
Yes No Reduced organization of room or personal space / Yes No Easily irritated with friends/family
Yes No Reduced attention to personal grooming / Concussion Symptom Score: Dates:
Primary extracurricular activities before and after injury: / Primary social outlets before and after injury:
Prevention Counseling/Psychoeducation
Do you feel like you have been given information about concussion?
[provide reassurance—people get better; lots you can do; interconnection between mood/behavioral health and cognitive symptoms]
You probably know this but when you are symptomatic, you have a risk of repeated injury
[review detriment of alcohol and contact sports before being cleared as relevant to client]
Use of helmet for sports / Yes No / Use of seat belt / Yes No
Use of alcohol / Yes No / High risk behaviors / Yes No
Use of recreational drugs / Yes No / Notes:
Treatment Options
Really appreciate your open sharing. I am impressed with ______. Is there anything I did not ask about today that might be helpful?
We’ve touched on a few areas that you indicated might be helpful:
Do these feel like they might be worth giving a try?
Some other options I’d like to share
Overall on a readiness scale of 1-10—how ready do you feel to do this type of therapy? Or I like to ask students how motivated they feel to do therapy. Where would you put yourself on a 1-5 rating scale 1 = just don't even want to deal with it 5 = I’m all over it.
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