June 6, 2025 • 44 mins
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/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:00):
Music.
Taylor Bauer, CRCC (00:04):
Welcome back in for another episode of
(00:34):
likely to result in death orpermanent disability, making
research and a deepunderstanding of how to navigate
services for those impacted byTBI vital.
Dr.
Shannon Juengst is a certifiedrehabilitation counselor
currently serving as clinicalinvestigator and senior
scientist at TIRR MemorialHermann and an adjunct associate
(00:55):
professor at UT Health ScienceCenter in Houston.
Her research career, which youcan find in the show notes, is
expansive and her work has mademajor contributions Thank you.
Thank you.
Thank you.
Dr.
(01:24):
Yates, thanks so much forjoining us today on Inside
Rehabilitation Counseling.
I want to start our discussiontoday with a question I ask
everybody who comes on the show.
When did you first learn aboutcertified rehabilitation
counselors or the rehabilitationcounseling profession?
Can you walk us through thepersonal journey that led you to
the career you have today?
Shannon Juengst, PhD, CRC (01:42):
Sure.
It's actually kind of aroundabout story.
I've As long as I can remember,I've been really interested in
working with people with braininjury, really interested in
just the way that the mindworks, the way people think.
I was drawn towards psychologybecause I'm more interested in
supporting people and kind oftaking a humanistic perspective
(02:05):
to how people function and arein the world.
And so out of college, I...
knew that I needed some moreresearch experience in order to
get into grad school.
I thought I was going to gointo clinical psychology.
I started working for aneuropsychologist on an HIV
study and worked with him for acouple of years as I was
(02:27):
thinking about applying for gradschool.
And one day, he pulled me asideand he said, Shannon, here's
your problem.
I was like, please tell me.
What's my problem?
He said, you have aresearcher's mind and you think
about things like a researcher.
But you like people.
And I laughed.
I was like, that's a problem.
(02:47):
He's like, well, it'schallenging because a lot of
people who go into moreservice-oriented and helping
fields are those who likepeople.
And it's like, that's notalways us researchers or
neuropsychologists.
And he was the one who told meto go talk to a colleague of his
who was also aneuropsychologist but was chair
of the Department of RehabCounseling at the University of
(03:08):
Pittsburgh.
And this was in early August.
I went and met with him andspoke with him about what is
this rehabilitation counselingthing.
I had never heard of it beforeand had a really great meeting
and realized that it was verymuch what I was looking for.
And he said, well, our programstarts in two weeks.
(03:29):
Are you interested?
And two weeks later, I startedthe program to become a rehab
counselor.
I hadn't heard about it, andthen I did, and then very
quickly kind of thrown into thatworld.
Taylor Bauer, CRCC (03:42):
Wow.
And I think it's so interestingto have that, you know, at the
top of your answer, thediscussion over kind of
researchers and wanting to beinvolved and integrated into
working directly with people.
I feel like there's probably agreat need for that.
I would assume from a researchperspective, sometimes maybe...
distance or separation isimportant, but also there's a
unique perspective I think yougain when you're so
(04:04):
people-oriented in your researchmethods and things like that.
And I'm sure it has lent itselfto you having a very successful
career in terms of research.
Shannon Juengst, PhD, CRC (04:13):
Yeah, yeah.
You know, after doing themaster's training in
rehabilitation counseling, I didwork for a couple of years
before I went back to do my PhD.
And I knew that I always wantedto get involved in research,
but I wanted to go out andpractice and work with people
for a while to just get thatexperience.
And it was during that timethat I really saw the need for
(04:39):
exactly what you were justtalking about, that integration
of research and practice and notonly practice as a provider,
but bringing in the perspectivesof the people that we're trying
to help into what is needed andhow best to get that to people
and taking that back to theresearch world and informing the
research from that end.
Taylor Bauer, CRCC (05:01):
And I think that's something that we hear a
lot that appeals to people aboutrehabilitation counseling once
they learn about it as aprofession is that kind of like,
client or consumer-centeredservice and focus specifically
on disability, its functionallimitations, and how do we
navigate those with a client oron behalf of a client alongside
(05:22):
them.
So it's fascinating.
And in doing some of theresearch ahead of our
conversation and reading some ofthe things that you study, I
mean, first of all, way over myhead in a lot of ways where I
was like learning a lot at once.
And I was like, wow, this islike such good information that
would be wonderful to have youcome talk about on the show.
And I think it's alwaysinteresting to me for people who
(05:43):
are in research fields and havea specific area of research
within a profession or a fieldthat calls to them, finding out
why it is in particular thatthat really resonates with them.
And you touched on that alittle bit, but were there
elements of studying traumaticbrain injury and things like
that from either a researchperspective or just in general
that really felt like that'swhere you were going you feel
(06:06):
the most fulfilledprofessionally?
Shannon Juengst, PhD, CRC (06:07):
Yeah.
I've worked with people withcognitive disability due to a
number of different things.
I started out in research inthe HIV and aging world.
I did some work during mymaster's training clinically
working with transition ageyoung adults with cognitive
(06:28):
disability.
ADHD, learning disabilities,autism, brain injury, spina
bifida, cerebral palsy, kind ofacross the board, helping them
prepare for success invocational or post-secondary
education training.
I worked with individuals kindof in that same age group,
working towards more independentliving skills and moving out
(06:50):
from being with their parentsand having that support.
So I think the overarching kindof cognitive challenges changes
that occur after a number ofdisabilities was always what
interested me.
And the thing about traumaticbrain injury that I think I was
so drawn to is that it's suddenand it can happen to anyone.
(07:13):
And there is a big differencebetween those who have sort of
grown up with and developed withthe disability that they have
versus those where it is a verysudden onset, of course.
And so I was very drawn to thatbecause as you noted, so much
of my work focuses oncommunity-based outcomes,
(07:37):
getting people back to thethings in their life that they
want to do and that aremeaningful to them.
And for somebody that has livedtheir life for many years with
a cognitive disability, that'smore integrated into who they
are and the things that they doin life.
And it's a little bit of adifferent approach than when a
person has a very establishedlife and activities and
experiences.
something like a traumaticbrain injury happens that really
(08:00):
completely disrupts that.
And they have to figure outwhat it means after the injury
and how to get back to thethings they want to do that were
important or cover new thingsthat might be different but
still fulfill whatever that wasthat gave them meaning in the
activities they did before.
And so I think that sort ofunderlies what drives me, what
(08:24):
drives my work, and why TBI hasjust always been a population
that I think there's such a needand such an opportunity to
really do that kind of work.
Taylor Bauer, CRCC (08:38):
Absolutely.
Yeah.
And we know just in general,humans are pretty averse to
uncertainty and change in a lotof ways.
TBI seems like one of the mostextreme versions of that, where
every element of your life, andI guess that's true for any
disability that you may acquire,but some of the things we'll
talk about today in yourresearch with TBI, it's so
deeply rooted in every aspect ofwho someone is and how they
(09:01):
spend their life and having thatbe something that you don't
live with for years decadeshowever long it might be that
all of a sudden reroutes youknow the journey that you're on
feels to me as something thateven with all the research that
that is already happening umrequires even deeper investment
in researching these things andtheir their effects because yeah
(09:22):
it completely changes somebodyand the more time we can
understand that the better and ithink CRCs like yourself who
have that expertise indisability and the counseling
elements of the work, as well asthat drive to research what it
is that or what the extents areof experiencing something like
this.
That's such a vital work andI'm very grateful that there are
(09:44):
people like you who areinterested in that, let alone
doing it so well.
One interesting focus of yourresearch on TBI is the methods
by which people with TBI andtheir care partners can use
behavioral health interventionsto manage problems they
experience due to theircondition.
With any disability, we knowthat there are specific
behavioral and cognitiveimplications, but what unique
(10:06):
elements of TBI influence themethods by which you would seek
to address the things thatthey're experiencing?
Shannon Juengst, PhD, CRC (10:12):
Yeah, that's a good question.
I think that there are someunique things.
Again, that's sort of thecognitive changes, the executive
changes that may not be they'renot visible.
They may not be obvious.
They may not occur or manifestin every situation, but they're
(10:32):
there.
They're kind of hard toexplain.
Even people who areexperiencing them often will
sort of attribute everything topoor memory.
You know, I just, I forgot mymemory's not good because that's
an easy thing to understand.
Whereas things like initiatingactivities or organizing your
thoughts or organizing yourschedule or time management or
(10:54):
some of these other executivefunctions are much harder to
kind of put your finger on andunderstand and explain to people
when you struggle with them.
It can look like you're lazy orit can look like you have no
motivation when really it's nota choice.
It's not something that isabout what the person wants or
if they're driven, it's reallytheir ability and the struggles
(11:16):
that they have just managingthose things cognitively.
And that's where I think thebehavioral health really comes
into play because those kinds ofinterventions are all about
helping whoever you are, whetheryou've had a brain injury or
not, to manage your life.
And so much of the work I'vedone is in behavioral health
(11:37):
that either directly addressesor or supports self-management
and how do we manage in ourday-to-day lives?
Because that's where peoplespend most of their time.
We know that, you know,initially after an injury, you
might get a lot of support and alot of medical care, a lot of
counseling care.
If you are fortunate enough togo through inpatient
(11:58):
rehabilitation, you get yourtherapies, but not everyone's
fortunate to go through thatpathway.
And even those who are, after acertain amount of time, you
sort of discharge out of it andyou're navigating on your own.
And we hear from people withbrain injury, and we hear that
from their care partners, thatincreasingly over time, as they
(12:18):
get out further from the initialinjury, they are left to manage
on their own.
And so how do we empower themwith the tools and the skills to
do that successfully?
In an ideal world, we'd bethere.
We would have thousands ofrehab counselors who could be
somebody's on-call coach andwork them through whatever they
(12:39):
encountered, but we know thatthat's not realistic.
So how do we provide skillstraining so that people are able
to manage on their own?
And I think that that kind ofunderlying strengths-based
perspective, understanding thatpeople have strengths and what
can we do to promote thestrengths as opposed to taking a
(13:00):
deficits-based approach.
It's very much therehabilitation world.
I think it's what really drewme to rehab counseling over some
of the psychology fieldsbecause it was more about what
do you want to do and how do weget you there with the strengths
that you have rather than let'sfigure out what's wrong and how
do we fix it.
And so I think that that'swhere, again, that kind of
(13:24):
behavioral health is about.
Behavior is what you do in yournatural environment in response
to the things that youencounter.
So how do we set people up tobest function that way?
And so I think there are someunique things about TBI because
of the cognitive and theemotional and the physical
consequences that can occur, butalso that it's so unique to
(13:48):
every person.
The kind of cliche is, onceyou've met a person with TBI,
you've met a person with TBI.
It doesn't really apply acrossthe board.
So I do think that's somewhatunique.
But I also think that so muchof what we do is, it really is
beneficial to everybody We mightjust have to adapt it so that
(14:09):
it can be beneficial for peoplethat need information in a
little bit of a different way orneed to do things a little
slower with a little moresupport.
And so a lot of the work thatI've done is not TBI specific.
It's work that could helpanybody.
It's just done with a TBIpopulation so that we know how
we can adapt it to meet theirneeds.
Taylor Bauer, CRCC (14:32):
I mean, first and foremost, I think the
empowerment aspect of theresearch you do.
And then also when we talk toother CRCs about the work that
they do, that empowerment partis so important because like you
said, depending on someone'sjourney with their disability,
whether it's been a lifelongcondition or something that
they've acquired, there is aprocess at some point maybe
where there are a lot of peopleinvolved in helping them
(14:54):
navigate what the future isgoing to look like.
And that's not always going tobe permanent for everybody.
And then having that space tothen say, OK, now it's up to me
to manage some of this and leavepeople, I would imagine,
emotionally, psychologicallyfeeling a little maybe out on a
limb and stranded and and andunder supported after going from
(15:16):
maybe a place hopefully rightthat they have been very
supported in all of the thingsthat they're navigating i think
about somebody who maybe hasgotten injured and is going
through a rehabilitation processand you know you have sometimes
an entire team on your side forthat and then when that process
becomes okay now you're goingto manage the last steps of
recovery or maybe an ongoing umway that that injury is going to
(15:38):
stay with you for the rest ofyour life but all of a sudden
it's like okay well have youbeen working with someone who's
helping you build up thatconfidence that you have the
skills possible to navigate thison your on your own for from a
day-to-day perspective and so ithink like the counseling part
of rehabilitation counseling issomething from a marketing
perspective i try to um reallylean on heavily for folks who
(15:59):
have never heard about what weuh what you all do and uh as you
can imagine there are a lot ofpeople who go i don't know what
rehab counseling is so usuallytry to give them the elevator
pitch and then find out whereyou know maybe that message is
resonating with them so we candeep dive further but yeah that
that question of empowerment isso important and giving people
the skills to navigate things ontheir own is much better recipe
(16:22):
than saying okay like we haveall the answers kind of like you
said with the psychologyperspective sometimes here's
what's wrong with you here's howwe fix it go on your your life
and you know, best of luck.
I think there's something veryhuman about wanting to partner
with someone to not only helpthem navigate an experience, but
empower them to navigate it ontheir own to the best of their
(16:42):
ability.
That is very unique from a lotof professions that are, you
know, tangential to rehabcounseling.
And of course we know,hopefully in a lot of cases,
folks who are experiencingdisability or TBI have, you
know, care partners in theirlife who are part of that
process of navigating, you know,of return to some sort of
independence, whatever thatmight be for that individual.
(17:04):
I liked what you said aboutonce you've met someone with
TBI, you've met someone withTBI.
It is not going to be a, oh,okay, I know exactly what you're
experiencing because I'm awareof what that is.
But a lot of your research, asyou kind of alluded to, includes
work empowering not only peoplewith disability, but their care
partners so that they areparticipating meaningfully,
(17:24):
which I thought was a reallyinteresting term.
Can you kind of define thatconcept and why it's so
important?
Shannon Juengst, PhD, CRC (17:30):
Easy question.
You know, I think that thisconcept has actually been a
backbone of the disability worldand the rehab world for a
really long time.
And it's only really recentlysort of coming into the
mainstream.
In research, we see it withthis shift towards emphasis on
(17:52):
patient-centered outcomes andthis whole idea of what are the
things that are important to,and in medical research, I never
use patient because people thatI work with are usually so far
beyond their kind of medicalcare that they're not patients
anymore.
They're people.
They might be clients.
They might be consumers.
whatever we call them, they'repeople out in their lives.
(18:14):
And so it's a veryperson-centered concept.
And I think this idea ofmeaningful participation is that
we can't really define what isgood participation in the
community.
I do a lot of work withinstrumentation and measurement,
(18:36):
and this is always a questionwhere we're trying to measure
community integration,participation, whatever term you
want to use, is that how do wemeasure it in a way in research
where you have to measure it thesame way for everybody, but
that's meaningful for everyone.
And traditionally we, and thisis true of a lot of how we
measure outcomes, it's based onhow much you do.
(18:57):
So the idea being that the moreyou participate, the better.
And that's not entirely wrong.
If you're looking at having ajob and interacting with friends
and family or going out anddoing activities in the
community, how much you're ableto do it is one indicator, but
(19:20):
it doesn't take into accountwhat's the quality of that
participation?
Is that value consistent withwhat the person wants and is
meaningful?
Is that consistent with theirphase of life and thinking about
Rehabilitation, I think, reallytakes a lifespan perspective
(19:41):
into account and understandingthat what is meaningful and
important to you changes overthe lifespan, both just
developmentally, there's kind ofnatural progression as we age
into different kinds of liferoles, but also just people
change over time and people growand develop and people are,
(20:02):
their values are different.
I've done some work moreespecially since coming to Texas
with Hispanic individuals andsome of the values that they're
from the cultural backgroundsthat they come from.
And there's huge diversitythere as well.
But some of those values arevery different than the kind of
(20:24):
traditional American US values.
So independence is actually notnecessarily the top value.
But in rehab, that's what we gofor is independence.
And independently participatingmight not actually be what that
person wants.
If they need support, but itallows them to do the specific
(20:47):
activities that are important tothem, then that's fine.
And I think as you talk withpeople, you hear that.
You hear that in their stories.
You hear that in...
the choices that they make forwhat they want to do, where they
want to put their energy.
A lot of my work with bothcaregivers and care partners and
individuals with TBI and otherdisabilities is really focused
(21:09):
on how do we help people achievegoals that are meaningful to
them.
And when you do work where youallow individuals to choose
their own goals, you start tosee what's important to them,
which is very differentsometimes than what's important
to the providers or what wethink should be important.
And so I think this whole ideaof meaningful participation is
kind of a mix and a blend ofdoing as much as you want to do.
(21:34):
So there's your frequencycomponent, having the quality
that you want, that when you'redoing it, it is satisfying to
you.
So I've looked at this conceptof satisfaction with your
participation as a way ofgetting at that a little bit.
Are you doing things that areimportant to you?
And it might be importantbecause it's something you need
(21:54):
to do.
And we all have those things weneed to do.
Versus also there's things youwant to do.
And things like leisure andsocial goals need to be part of
that.
And so it really is sort of amix of those.
And then kind of overlaying allof that is also how empowered
or capable do you feel of doingthat in your community and how
(22:18):
much a part of your community doyou feel?
And this has been calledenfranchisement, it's been
called a lot of other things,but do you feel like you belong
in your community, like you'revalued by your community?
And community can be family, itcan be neighborhood, it can be
however church, it can beschool, it can be however you
kind of define that, but that'sfeeling like a valued and
(22:41):
contributing member is also key.
as part of this
Taylor Bauer, CRCC (22:44):
concept.
Absolutely, yeah.
I think there was aconversation just for a lot of
different pauses or experiencesor demographics people might
find them in of kind of liketrying to achieve acceptance,
right?
And I think something likeintegration or value is such a
deeper, more meaningful way toview that because when we talk
about someone with a disabilitytrying to navigate a community,
(23:07):
feeling accepted is one thingthat, you know, almost like
you're allowed to be here kindof thing.
feeling valued and that you areyou know integral to that
community and to other peoplewho live in it is such a deeper
thing that i think a lot ofpeople who don't have to
navigate a disability don't eventhink about because for the
most part they're not having tonavigate those those stereotypes
(23:27):
um for someone maybe with anindivisible disability or a
non-visible disability you knowwhat they're going through isn't
obvious to other folks so maybethey get treated in a way where
they don't really get toactually experience their
community that way.
And it's so important to focuson those deeper goals of true
(23:48):
integration and value than it isto just try to say, And that
goes for job placements too,right?
Or like you said, trying toachieve the ability to
participate in leisureactivities.
It shouldn't just be like,okay, you can do it.
It's like, are you able to doit to a level where it's still
fulfilling to you?
And what is that extent thatyou were able to achieve with
(24:09):
what you're navigating?
But also like, how do you goabout integrating that into your
life, into this new livedexperience that you're going
through?
So I think that that it wasvery illuminating to hear you
talk about that.
So thank you.
Um, what it's certifiedrehabilitation counselors, such
a vital team member alongsideother professionals for an
(24:30):
individual navigating atraumatic brain injury.
Shannon Juengst, PhD, CRC (24:33):
Yeah.
I, I think on the, on the onehand, it's unfortunate that
often they are not part of theteam.
Right.
Um, and I've always been anadvocate that we should have
rehab counselors be part of theteam.
And when I've seen, um,settings and organizations that
have that, you really can seethat benefit.
And unfortunately, it's justnot always the case.
(24:56):
I think that there's a coupleof really important perspectives
and skills that CRCs bring.
One is that, I mean, it is thatcounseling background, right?
Like that coaching, counseling.
I think that that's a reallyimportant support that people
need And we hear from peoplethat they need it and they don't
(25:20):
have it.
So I think that's one piece.
I think the ability to speakacross disciplines, and it's a
little bit of that casemanagement skill, but just being
able to come into a team andhave that holistic perspective,
so understand...
(25:41):
what each of the other teammembers are doing and how it all
fits together.
I see CRCs as being reallyuniquely able to do that,
whereas on teams that I've beenpart of before, everybody has
their expertise and they comeand that is their wheelhouse and
that is their focus and itneeds to be.
(26:01):
And having somebody who canstep back and see that kind of
bigger picture and how thosefolks can work together is
really important.
And I think CRCs are reallyuniquely qualified for that.
I also think that thedisability understanding is so
important.
So why is a CRC different thana psychologist or a master's
(26:24):
level counselor, therapist, asocial worker?
I think in a lot of settings,we see social workers taking
that role and social workers arewonderful.
And I cannot speak highlyenough about having a social
worker on your team, but theirperspective again is, is not the
disability specifically.
And it's not always that sortof holistic, again, meaningful
(26:50):
participation and function asthe end goal.
So I think that's the importantpart that they bring to the
team.
Maybe put more simply, when youwork with folks, especially
where TBI in particular haslargely until recently been
considered an injury, a medicalcondition.
(27:11):
So it's kind of steeped in themedical model.
And it's very deficits-based.
It's very recovery-based ratherthan based in adaptation and
function.
It's very bottom-up.
So how do we figure out what'swrong and fix it so that then
people go out and do better inthe world?
Which I think is reallyimportant, but you also have to
(27:33):
have that top-down.
Where is it we're trying to getto?
And does it actually matter?
Why?
Or, you know, I've kind ofalways had the perspective of
where's the person right now?
And we need to understand whatwe need to move them forward.
And it doesn't matter so muchunderstanding how they got there
(27:54):
if what they need to moveforward isn't based on that.
So I think having that kind oftop down, where are we trying to
get people to perspective isimportant.
And that's something that a CRCbrings forward.
because of that social model,disability model perspective and
strengths-based perspectivethat they're bringing to the
(28:14):
team.
Taylor Bauer, CRCC (28:15):
We have a lot of folks who have told us
they listen to the podcastregularly who are new to the
field or maybe in a graduateprogram getting ready to enter
their chapter as a CRC.
So I'm curious for folks whoare new to the field or just
getting started, what doessomeone need to know about the
variations in satisfaction thatone might experience when
(28:35):
navigating a traumatic braininjury?
There was a lot of research Icame across that you've done on
life satisfaction trajectories,and I found that really
interesting.
If I I was new to the field andjust about to get started maybe
in my first position post gradschool.
What are some considerations Imight want to sit with?
Shannon Juengst, PhD, CRC (28:55):
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 withyour life?
is that for the most part, formost people, it's a pretty
stable thing, not for everyone.
And there are certain thingsthat can change that trajectory.
We see changes, again, acrossthe lifespan that people kind of
(29:18):
in middle adulthood tend tohave the lowest life
satisfaction.
And this is true in braininjury.
This is true in generalpopulation.
It makes sense.
It's a phase of life when youhave the most demands.
You're working, you might havechildren, you might have aging
parents.
It's a very kind of high demandphase of life.
And for people who have a braininjury or really any acquired
(29:41):
disability in that phase wherethat kind of high demands, the
challenges that they have aregoing to be magnified when
there's more demands put onthem, that can be a particularly
challenging time.
So I think that as far as fromthe practicing side of things, I
think it's really important tounderstand where a person is
(30:06):
developmentally in their life asan adult, to understand what
all of those life roles are thatare important to them.
And that's something we keptseeing come up over and over is
that life satisfaction is so, somuch more tied to life roles
and participation in meaningfullife roles than it to how severe
(30:28):
your injury is or howindependent you are.
It really is, it has such asocial component too.
Relationships are a huge partof that.
And we know that after a TBI,social relationships are often
very affected because a personcan experience personality
changes or because just how theyfunction in the world and day
(30:54):
to day changes so dramaticallyand but they look the same and
so they lose friends that theyhad before who don't understand
and they have challenges ifthey're a little bit more
disinhibited if their emotionalregulation is not as good they
have challenges in closerelationships as well and so i
(31:16):
think that those are reallyimportant things to to pay
attention to and be aware ofmore so than what is again the
sort of consequence of theinjury itself but more how does
it affect those relationshipsand how does it kind of interact
with where you are and whatphase of life you're in um i
(31:39):
think that the more having morerehab counselors out there who
understand brain injury and justunderstand those cognitive and
emotional aspects of anydisability that affects kind of
how you think, how you interactwith people is really important
because that's, there's not alot of practitioners out there,
(32:00):
especially kind of that master'slevel therapist, counselor.
I get calls all the timesaying, do you know somebody who
understands brain injury?
I need to refer someone tothem.
They've gone to psychologists.
They've gone to counselors whoare perfectly wonderful
practitioners and people whokeep just telling them they're
depressed and they're notdepressed.
(32:21):
They're like, I'm not sad.
I'm happy.
exhausted and I can't seem toget off the couch, but it's not
sadness.
This is like initiation.
Well, that's not an emotionalthing.
That's a cognitive thing.
So I think there is such a needto have people out there who
understand kind of thosecognitive effects and how those
(32:45):
affect those socialrelationships.
Taylor Bauer, CRCC (32:47):
Yeah, I'm really fascinated at the
concept.
We might need to have you backon at some point to explore this
further, but I'm reallyinterested in the concept of
someone who's experiencing TBIgetting sent to different
professionals who are equippedand knowledgeable.
The question, like you said,with social workers or
psychologists or anybody, it'snot like, oh, they don't know
what they're doing.
It's more so that there's justsuch a unique experience of
(33:11):
having some of those cognitiveeffects come from experiencing a
disability.
And it's not as simple as like,oh, like depression, like you
said, even though folks might beexperiencing depression
alongside a disability, butbeing able to navigate where
that intersection sets, as wellas where they are distinctly
different things, or the samething, maybe just through the
(33:34):
lens of disability is such acrucial capability that I think
in the work that I do with CRCC,we can be articulating a little
bit more clearly of why that'sso important to have.
So it's like your answers aremaking me think of more work
that I get to do.
So I'm kind of excited aboutthat.
That's good.
Yeah, right.
It keeps me busy, right?
Out of trouble.
You have a lot of research toyour name.
(33:57):
And I know that there are lotsof people who research TBI and
brain injury and things likethat.
But I'm curious what elementsof TBI you think still need the
most investigation regardingeither the injury itself or the
individual's experience duringand post-injury?
I
Shannon Juengst, PhD, CRC (34:16):
do think the work that's being done
to try to identify effectivetreatments early on after injury
is really important.
If there's things that we coulddo right after injury that
helped to prevent the long-termconsequences and prevent
disability.
(34:37):
That is really important.
That's not the work I do, but Iwork with people who do that
work and I've kind ofperipherally touched on it.
And I think that is incrediblyimportant.
On the flip side, there isn'tthat, right?
And we have all of these peopleliving with the consequences of
TBI and needing support who,even if we have kind of the, you
(35:02):
know, miracle treatment thatcan help treat the actual injury
itself early on, they're notgoing to benefit from.
And so I think a lot more workneeds to be done looking at how
we actually help the people whoare experiencing those
consequences of brain injury outin their communities and out
(35:25):
where they are and out beyondthat first year post-injury,
which is when they get the mostsupport.
And I think that the field ismoving in that direction.
It was just very recently thatCMS recognized TBI as a chronic
condition.
And that has really importantimplications for things like
(35:46):
reimbursement and services beingcovered.
But also just even on the sortof attitudinal level, just the
recognition that there arelong-term consequences and
people are going to be dealingwith some of them for the rest
of their life is is reallyimportant as a way to just
promote that they need, thatmeans they need help.
So that is the area that I seeso much potential for more work
(36:11):
to be done is, you know, how dowe help them and more so not
just how do we do it?
Because I think we have a goodunderstanding of if you can get
a person in front of you, likewhat are the supports and what
is the training and what is itthat you need to do to help
them?
It's more how do we get thestuff we know works In the
research world, you might callthis implementation science and
(36:33):
implementation anddissemination.
But that's where I think verylittle has been done and that we
really need the most workbecause we have good research.
We have good evidence.
We have good behavioralinterventions that we know help.
But there's all these peoplethat don't have access to that.
(36:56):
Who's going to provide it?
How are people going to accessit?
How's it going to bereimbursed?
So these are all kind ofimplementation, dissemination
questions that I think we reallyas a field need to be embracing
and tackling while we're stilltrying to figure out all of
those other things that aregoing to work best to prevent as
(37:19):
much as possible these kind oflong-term consequences.
I think the other...
area and you touched on this alittle bit before talking about
stigma and stigma disability andwhen a disability is invisible
but in tbi we also have foundthat most people don't identify
as being disabled so they willtell you that they have function
(37:41):
many functional consequencesand challenges relating from
their injury um they may saythey may be unable to work even
if they want to But they don'tidentify as having a disability.
And I think a lot of that isthat so much of the work coming
(38:02):
out of TBI is that, again, inthe kind of medical model, it's
been viewed as this very acutecondition.
And as a result, a lot ofindividuals are not plugged into
the disability community and todisability resources.
They don't even know to lookfor them.
They don't think they qualify.
Even vocational rehabilitation,which is such a great support
(38:24):
for people who are looking to beemployed and to work, often
people with TBI don'tnecessarily qualify because they
have to get that disabilitydesignation.
And when you have that higherlevel executive dysfunction,
that's a really hard thing toidentify and quantify and to get
(38:46):
that designation.
So I think that's another...
area where understanding whatthose barriers are and why
people are not finding theservices that are out there, I
guess this may be part of thesame big picture of
implementation.
But I think that's anotherreally important area that needs
to be studied more.
Again, TBI can happen toanybody at any time.
(39:08):
And so many people that haveone TBI have another TBI.
And we know that multiple braininjuries can have cumulative
effects in different ways,different areas.
There's been a lot of worklooking at even milder injuries
that don't result in loss ofconsciousness can have long-term
effects.
And what are the consequencesof multiple injuries?
(39:29):
And at what point in your life,if you have a pediatric brain
injury versus an adult braininjury or a pediatric injury,
and then an adult injury later,what does that mean?
And what are the consequencesof that?
So again, really starting tolook at broader lifespan
perspectives to brain injury andits consequences is another
(39:51):
area that really needs a lotmore work, especially if we are
going to embrace that TBI is achronic health condition.
Taylor Bauer, CRCC (40:00):
Absolutely, yeah.
All of those points that youjust made require our advocacy
for...
continued support ofresearchers like yourself
exploring these things, becauseit 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 weassess and approach working with
(40:21):
TBI patients, but that there'smore that we can continue to
deep dive.
And then from an awarenessperspective, just getting the
word out of what this researchis discovering and getting that
information to the right peopleis vital.
With all of the incredibleresearch you do and the work
you've dedicated yourprofessional life to, what
(40:42):
brings you joy in the work thatyou do?
Shannon Juengst, PhD, CRC (40:45):
I love what I do.
I really do.
I think that in the short timethat I was practicing not doing
research, I saw such a need forbetter research and research
getting out there.
I think that providers are outthere doing the best they can
with what they know and whatthey have.
And there's so much better thatwe could do.
(41:07):
And so the thing that reallydrives me is that kind of
practical, like how do we getsupport to the people who need
it?
And I've been really fortunatein everything that I've done to
always have the opportunity tobe touching base and working
with people in the community,people with brain injury and
(41:28):
their care partners.
And those are always themoments that kind of bring me
the most joy.
They'll sort of refill my cup,so to speak.
And it's because I think thoseare the moments that, one, it
reaffirms that this is neededand it reaffirms that this is
important.
And it also, those are themoments where I see how big a
(41:50):
difference it can make and thedifference that it's made in
even just those lives of thepeople that I've worked with
most immediately.
And that's the part that reallybrings me joy and is
invigorating.
And most recently, a projectthat is ongoing, it's taking
(42:11):
what's called a community-basedparticipatory research approach.
And so essentially what thatmeans is that We have people
with brain injury, people withlived experience of other
disability, care partners,providers, all of these people
who are sort of involved in theexperience of brain injury
coming together with us asresearchers and really
(42:36):
co-creating intervention,collaborating as equal partners.
And that's been a really...
kind of perspective changingmoment for me.
And doing that kind of work,I've always involved people.
I've gotten their feedback.
I've gone back and presented mywork.
But this is the first timewhere we're really working hard
(43:00):
to try to really share the powerin research, to share the
decision-making.
And it's been a...
an exercise in letting go forme as a researcher to say
there's certain things aboutevidence we have to hang on to,
but there's also things that wehave to be able to let go if
(43:20):
they're not practical, ifthey're not wanted by the
population.
And that, those conversationsand that give and take and the
kind of collaboration and comingto these shared decisions has
just been a really, really greatexperience.
And I think in the end, it'screated something that is going
to be beneficial And we aregoing to be able to get out
(43:42):
there because as we've developedit, as we've done the work,
we've been talking to people andthinking about those things.
You know, where do we want tobe in 10 years?
We're thinking about that nowand how do we set things up?
So I think that's the part.
It's just always been the goingback and kind of seeing how
this actually can make adifference for people.
Taylor Bauer, CRCC (44:03):
huge thank you to Dr. Juengst for that
informational and engagingconversation.
In the show notes, you can findlinks to helpful resources
Dr. Juengst provided, includingTBI fact sheets for a number of
topics and resources that couldbe very helpful for certified
rehabilitation counselors.
If you have any takeaways orinsights on topics covered in
this episode, email us atcontactus at
(44:26):
crccertification.com.
Be sure to subscribe to thisshow on Apple Podcasts, Spotify,
or wherever you're listeningto us today.
You can find us on Facebook andLinkedIn at CRC Cert, and our
website is crccertification.com.
Until next time, I'm CRCCDirector of Communications and
(44:46):
Marketing, Taylor Bauer.
Thank you for listening toInside Rehabilitation
Counseling.
Music.
Taylor Bauer, CRCC (00:04):
Welcome back in for another episode of
(00:34):
likely to result in death orpermanent disability, making
research and a deepunderstanding of how to navigate
services for those impacted byTBI vital.
Dr.
Shannon Juengst is a certifiedrehabilitation counselor
currently serving as clinicalinvestigator and senior
scientist at TIRR MemorialHermann and an adjunct associate
(00:55):
professor at UT Health ScienceCenter in Houston.
Her research career, which youcan find in the show notes, is
expansive and her work has mademajor contributions Thank you.
Thank you.
Thank you.
Dr.
(01:24):
Yates, thanks so much forjoining us today on Inside
Rehabilitation Counseling.
I want to start our discussiontoday with a question I ask
everybody who comes on the show.
When did you first learn aboutcertified rehabilitation
counselors or the rehabilitationcounseling profession?
Can you walk us through thepersonal journey that led you to
the career you have today?
Shannon Juengst, PhD, CRC (01:42):
Sure.
It's actually kind of aroundabout story.
I've As long as I can remember,I've been really interested in
working with people with braininjury, really interested in
just the way that the mindworks, the way people think.
I was drawn towards psychologybecause I'm more interested in
supporting people and kind oftaking a humanistic perspective
(02:05):
to how people function and arein the world.
And so out of college, I...
knew that I needed some moreresearch experience in order to
get into grad school.
I thought I was going to gointo clinical psychology.
I started working for aneuropsychologist on an HIV
study and worked with him for acouple of years as I was
(02:27):
thinking about applying for gradschool.
And one day, he pulled me asideand he said, Shannon, here's
your problem.
I was like, please tell me.
What's my problem?
He said, you have aresearcher's mind and you think
about things like a researcher.
But you like people.
And I laughed.
I was like, that's a problem.
(02:47):
He's like, well, it'schallenging because a lot of
people who go into moreservice-oriented and helping
fields are those who likepeople.
And it's like, that's notalways us researchers or
neuropsychologists.
And he was the one who told meto go talk to a colleague of his
who was also aneuropsychologist but was chair
of the Department of RehabCounseling at the University of
(03:08):
Pittsburgh.
And this was in early August.
I went and met with him andspoke with him about what is
this rehabilitation counselingthing.
I had never heard of it beforeand had a really great meeting
and realized that it was verymuch what I was looking for.
And he said, well, our programstarts in two weeks.
(03:29):
Are you interested?
And two weeks later, I startedthe program to become a rehab
counselor.
I hadn't heard about it, andthen I did, and then very
quickly kind of thrown into thatworld.
Taylor Bauer, CRCC (03:42):
Wow.
And I think it's so interestingto have that, you know, at the
top of your answer, thediscussion over kind of
researchers and wanting to beinvolved and integrated into
working directly with people.
I feel like there's probably agreat need for that.
I would assume from a researchperspective, sometimes maybe...
distance or separation isimportant, but also there's a
unique perspective I think yougain when you're so
(04:04):
people-oriented in your researchmethods and things like that.
And I'm sure it has lent itselfto you having a very successful
career in terms of research.
Shannon Juengst, PhD, CRC (04:13):
Yeah, yeah.
You know, after doing themaster's training in
rehabilitation counseling, I didwork for a couple of years
before I went back to do my PhD.
And I knew that I always wantedto get involved in research,
but I wanted to go out andpractice and work with people
for a while to just get thatexperience.
And it was during that timethat I really saw the need for
(04:39):
exactly what you were justtalking about, that integration
of research and practice and notonly practice as a provider,
but bringing in the perspectivesof the people that we're trying
to help into what is needed andhow best to get that to people
and taking that back to theresearch world and informing the
research from that end.
Taylor Bauer, CRCC (05:01):
And I think that's something that we hear a
lot that appeals to people aboutrehabilitation counseling once
they learn about it as aprofession is that kind of like,
client or consumer-centeredservice and focus specifically
on disability, its functionallimitations, and how do we
navigate those with a client oron behalf of a client alongside
(05:22):
them.
So it's fascinating.
And in doing some of theresearch ahead of our
conversation and reading some ofthe things that you study, I
mean, first of all, way over myhead in a lot of ways where I
was like learning a lot at once.
And I was like, wow, this islike such good information that
would be wonderful to have youcome talk about on the show.
And I think it's alwaysinteresting to me for people who
(05:43):
are in research fields and havea specific area of research
within a profession or a fieldthat calls to them, finding out
why it is in particular thatthat really resonates with them.
And you touched on that alittle bit, but were there
elements of studying traumaticbrain injury and things like
that from either a researchperspective or just in general
that really felt like that'swhere you were going you feel
(06:06):
the most fulfilledprofessionally?
Shannon Juengst, PhD, CRC (06:07):
Yeah.
I've worked with people withcognitive disability due to a
number of different things.
I started out in research inthe HIV and aging world.
I did some work during mymaster's training clinically
working with transition ageyoung adults with cognitive
(06:28):
disability.
ADHD, learning disabilities,autism, brain injury, spina
bifida, cerebral palsy, kind ofacross the board, helping them
prepare for success invocational or post-secondary
education training.
I worked with individuals kindof in that same age group,
working towards more independentliving skills and moving out
(06:50):
from being with their parentsand having that support.
So I think the overarching kindof cognitive challenges changes
that occur after a number ofdisabilities was always what
interested me.
And the thing about traumaticbrain injury that I think I was
so drawn to is that it's suddenand it can happen to anyone.
(07:13):
And there is a big differencebetween those who have sort of
grown up with and developed withthe disability that they have
versus those where it is a verysudden onset, of course.
And so I was very drawn to thatbecause as you noted, so much
of my work focuses oncommunity-based outcomes,
(07:37):
getting people back to thethings in their life that they
want to do and that aremeaningful to them.
And for somebody that has livedtheir life for many years with
a cognitive disability, that'smore integrated into who they
are and the things that they doin life.
And it's a little bit of adifferent approach than when a
person has a very establishedlife and activities and
experiences.
something like a traumaticbrain injury happens that really
(08:00):
completely disrupts that.
And they have to figure outwhat it means after the injury
and how to get back to thethings they want to do that were
important or cover new thingsthat might be different but
still fulfill whatever that wasthat gave them meaning in the
activities they did before.
And so I think that sort ofunderlies what drives me, what
(08:24):
drives my work, and why TBI hasjust always been a population
that I think there's such a needand such an opportunity to
really do that kind of work.
Taylor Bauer, CRCC (08:38):
Absolutely.
Yeah.
And we know just in general,humans are pretty averse to
uncertainty and change in a lotof ways.
TBI seems like one of the mostextreme versions of that, where
every element of your life, andI guess that's true for any
disability that you may acquire,but some of the things we'll
talk about today in yourresearch with TBI, it's so
deeply rooted in every aspect ofwho someone is and how they
(09:01):
spend their life and having thatbe something that you don't
live with for years decadeshowever long it might be that
all of a sudden reroutes youknow the journey that you're on
feels to me as something thateven with all the research that
that is already happening umrequires even deeper investment
in researching these things andtheir their effects because yeah
(09:22):
it completely changes somebodyand the more time we can
understand that the better and ithink CRCs like yourself who
have that expertise indisability and the counseling
elements of the work, as well asthat drive to research what it
is that or what the extents areof experiencing something like
this.
That's such a vital work andI'm very grateful that there are
(09:44):
people like you who areinterested in that, let alone
doing it so well.
One interesting focus of yourresearch on TBI is the methods
by which people with TBI andtheir care partners can use
behavioral health interventionsto manage problems they
experience due to theircondition.
With any disability, we knowthat there are specific
behavioral and cognitiveimplications, but what unique
(10:06):
elements of TBI influence themethods by which you would seek
to address the things thatthey're experiencing?
Shannon Juengst, PhD, CRC (10:12):
Yeah, that's a good question.
I think that there are someunique things.
Again, that's sort of thecognitive changes, the executive
changes that may not be they'renot visible.
They may not be obvious.
They may not occur or manifestin every situation, but they're
(10:32):
there.
They're kind of hard toexplain.
Even people who areexperiencing them often will
sort of attribute everything topoor memory.
You know, I just, I forgot mymemory's not good because that's
an easy thing to understand.
Whereas things like initiatingactivities or organizing your
thoughts or organizing yourschedule or time management or
(10:54):
some of these other executivefunctions are much harder to
kind of put your finger on andunderstand and explain to people
when you struggle with them.
It can look like you're lazy orit can look like you have no
motivation when really it's nota choice.
It's not something that isabout what the person wants or
if they're driven, it's reallytheir ability and the struggles
(11:16):
that they have just managingthose things cognitively.
And that's where I think thebehavioral health really comes
into play because those kinds ofinterventions are all about
helping whoever you are, whetheryou've had a brain injury or
not, to manage your life.
And so much of the work I'vedone is in behavioral health
(11:37):
that either directly addressesor or supports self-management
and how do we manage in ourday-to-day lives?
Because that's where peoplespend most of their time.
We know that, you know,initially after an injury, you
might get a lot of support and alot of medical care, a lot of
counseling care.
If you are fortunate enough togo through inpatient
(11:58):
rehabilitation, you get yourtherapies, but not everyone's
fortunate to go through thatpathway.
And even those who are, after acertain amount of time, you
sort of discharge out of it andyou're navigating on your own.
And we hear from people withbrain injury, and we hear that
from their care partners, thatincreasingly over time, as they
(12:18):
get out further from the initialinjury, they are left to manage
on their own.
And so how do we empower themwith the tools and the skills to
do that successfully?
In an ideal world, we'd bethere.
We would have thousands ofrehab counselors who could be
somebody's on-call coach andwork them through whatever they
(12:39):
encountered, but we know thatthat's not realistic.
So how do we provide skillstraining so that people are able
to manage on their own?
And I think that that kind ofunderlying strengths-based
perspective, understanding thatpeople have strengths and what
can we do to promote thestrengths as opposed to taking a
(13:00):
deficits-based approach.
It's very much therehabilitation world.
I think it's what really drewme to rehab counseling over some
of the psychology fieldsbecause it was more about what
do you want to do and how do weget you there with the strengths
that you have rather than let'sfigure out what's wrong and how
do we fix it.
And so I think that that'swhere, again, that kind of
(13:24):
behavioral health is about.
Behavior is what you do in yournatural environment in response
to the things that youencounter.
So how do we set people up tobest function that way?
And so I think there are someunique things about TBI because
of the cognitive and theemotional and the physical
consequences that can occur, butalso that it's so unique to
(13:48):
every person.
The kind of cliche is, onceyou've met a person with TBI,
you've met a person with TBI.
It doesn't really apply acrossthe board.
So I do think that's somewhatunique.
But I also think that so muchof what we do is, it really is
beneficial to everybody We mightjust have to adapt it so that
(14:09):
it can be beneficial for peoplethat need information in a
little bit of a different way orneed to do things a little
slower with a little moresupport.
And so a lot of the work thatI've done is not TBI specific.
It's work that could helpanybody.
It's just done with a TBIpopulation so that we know how
we can adapt it to meet theirneeds.
Taylor Bauer, CRCC (14:32):
I mean, first and foremost, I think the
empowerment aspect of theresearch you do.
And then also when we talk toother CRCs about the work that
they do, that empowerment partis so important because like you
said, depending on someone'sjourney with their disability,
whether it's been a lifelongcondition or something that
they've acquired, there is aprocess at some point maybe
where there are a lot of peopleinvolved in helping them
(14:54):
navigate what the future isgoing to look like.
And that's not always going tobe permanent for everybody.
And then having that space tothen say, OK, now it's up to me
to manage some of this and leavepeople, I would imagine,
emotionally, psychologicallyfeeling a little maybe out on a
limb and stranded and and andunder supported after going from
(15:16):
maybe a place hopefully rightthat they have been very
supported in all of the thingsthat they're navigating i think
about somebody who maybe hasgotten injured and is going
through a rehabilitation processand you know you have sometimes
an entire team on your side forthat and then when that process
becomes okay now you're goingto manage the last steps of
recovery or maybe an ongoing umway that that injury is going to
(15:38):
stay with you for the rest ofyour life but all of a sudden
it's like okay well have youbeen working with someone who's
helping you build up thatconfidence that you have the
skills possible to navigate thison your on your own for from a
day-to-day perspective and so ithink like the counseling part
of rehabilitation counseling issomething from a marketing
perspective i try to um reallylean on heavily for folks who
(15:59):
have never heard about what weuh what you all do and uh as you
can imagine there are a lot ofpeople who go i don't know what
rehab counseling is so usuallytry to give them the elevator
pitch and then find out whereyou know maybe that message is
resonating with them so we candeep dive further but yeah that
that question of empowerment isso important and giving people
the skills to navigate things ontheir own is much better recipe
(16:22):
than saying okay like we haveall the answers kind of like you
said with the psychologyperspective sometimes here's
what's wrong with you here's howwe fix it go on your your life
and you know, best of luck.
I think there's something veryhuman about wanting to partner
with someone to not only helpthem navigate an experience, but
empower them to navigate it ontheir own to the best of their
(16:42):
ability.
That is very unique from a lotof professions that are, you
know, tangential to rehabcounseling.
And of course we know,hopefully in a lot of cases,
folks who are experiencingdisability or TBI have, you
know, care partners in theirlife who are part of that
process of navigating, you know,of return to some sort of
independence, whatever thatmight be for that individual.
(17:04):
I liked what you said aboutonce you've met someone with
TBI, you've met someone withTBI.
It is not going to be a, oh,okay, I know exactly what you're
experiencing because I'm awareof what that is.
But a lot of your research, asyou kind of alluded to, includes
work empowering not only peoplewith disability, but their care
partners so that they areparticipating meaningfully,
(17:24):
which I thought was a reallyinteresting term.
Can you kind of define thatconcept and why it's so
important?
Shannon Juengst, PhD, CRC (17:30):
Easy question.
You know, I think that thisconcept has actually been a
backbone of the disability worldand the rehab world for a
really long time.
And it's only really recentlysort of coming into the
mainstream.
In research, we see it withthis shift towards emphasis on
(17:52):
patient-centered outcomes andthis whole idea of what are the
things that are important to,and in medical research, I never
use patient because people thatI work with are usually so far
beyond their kind of medicalcare that they're not patients
anymore.
They're people.
They might be clients.
They might be consumers.
whatever we call them, they'repeople out in their lives.
(18:14):
And so it's a veryperson-centered concept.
And I think this idea ofmeaningful participation is that
we can't really define what isgood participation in the
community.
I do a lot of work withinstrumentation and measurement,
(18:36):
and this is always a questionwhere we're trying to measure
community integration,participation, whatever term you
want to use, is that how do wemeasure it in a way in research
where you have to measure it thesame way for everybody, but
that's meaningful for everyone.
And traditionally we, and thisis true of a lot of how we
measure outcomes, it's based onhow much you do.
(18:57):
So the idea being that the moreyou participate, the better.
And that's not entirely wrong.
If you're looking at having ajob and interacting with friends
and family or going out anddoing activities in the
community, how much you're ableto do it is one indicator, but
(19:20):
it doesn't take into accountwhat's the quality of that
participation?
Is that value consistent withwhat the person wants and is
meaningful?
Is that consistent with theirphase of life and thinking about
Rehabilitation, I think, reallytakes a lifespan perspective
(19:41):
into account and understandingthat what is meaningful and
important to you changes overthe lifespan, both just
developmentally, there's kind ofnatural progression as we age
into different kinds of liferoles, but also just people
change over time and people growand develop and people are,
(20:02):
their values are different.
I've done some work moreespecially since coming to Texas
with Hispanic individuals andsome of the values that they're
from the cultural backgroundsthat they come from.
And there's huge diversitythere as well.
But some of those values arevery different than the kind of
(20:24):
traditional American US values.
So independence is actually notnecessarily the top value.
But in rehab, that's what we gofor is independence.
And independently participatingmight not actually be what that
person wants.
If they need support, but itallows them to do the specific
(20:47):
activities that are important tothem, then that's fine.
And I think as you talk withpeople, you hear that.
You hear that in their stories.
You hear that in...
the choices that they make forwhat they want to do, where they
want to put their energy.
A lot of my work with bothcaregivers and care partners and
individuals with TBI and otherdisabilities is really focused
(21:09):
on how do we help people achievegoals that are meaningful to
them.
And when you do work where youallow individuals to choose
their own goals, you start tosee what's important to them,
which is very differentsometimes than what's important
to the providers or what wethink should be important.
And so I think this whole ideaof meaningful participation is
kind of a mix and a blend ofdoing as much as you want to do.
(21:34):
So there's your frequencycomponent, having the quality
that you want, that when you'redoing it, it is satisfying to
you.
So I've looked at this conceptof satisfaction with your
participation as a way ofgetting at that a little bit.
Are you doing things that areimportant to you?
And it might be importantbecause it's something you need
(21:54):
to do.
And we all have those things weneed to do.
Versus also there's things youwant to do.
And things like leisure andsocial goals need to be part of
that.
And so it really is sort of amix of those.
And then kind of overlaying allof that is also how empowered
or capable do you feel of doingthat in your community and how
(22:18):
much a part of your community doyou feel?
And this has been calledenfranchisement, it's been
called a lot of other things,but do you feel like you belong
in your community, like you'revalued by your community?
And community can be family, itcan be neighborhood, it can be
however church, it can beschool, it can be however you
kind of define that, but that'sfeeling like a valued and
(22:41):
contributing member is also key.
as part of this
Taylor Bauer, CRCC (22:44):
concept.
Absolutely, yeah.
I think there was aconversation just for a lot of
different pauses or experiencesor demographics people might
find them in of kind of liketrying to achieve acceptance,
right?
And I think something likeintegration or value is such a
deeper, more meaningful way toview that because when we talk
about someone with a disabilitytrying to navigate a community,
(23:07):
feeling accepted is one thingthat, you know, almost like
you're allowed to be here kindof thing.
feeling valued and that you areyou know integral to that
community and to other peoplewho live in it is such a deeper
thing that i think a lot ofpeople who don't have to
navigate a disability don't eventhink about because for the
most part they're not having tonavigate those those stereotypes
(23:27):
um for someone maybe with anindivisible disability or a
non-visible disability you knowwhat they're going through isn't
obvious to other folks so maybethey get treated in a way where
they don't really get toactually experience their
community that way.
And it's so important to focuson those deeper goals of true
(23:48):
integration and value than it isto just try to say, And that
goes for job placements too,right?
Or like you said, trying toachieve the ability to
participate in leisureactivities.
It shouldn't just be like,okay, you can do it.
It's like, are you able to doit to a level where it's still
fulfilling to you?
And what is that extent thatyou were able to achieve with
(24:09):
what you're navigating?
But also like, how do you goabout integrating that into your
life, into this new livedexperience that you're going
through?
So I think that that it wasvery illuminating to hear you
talk about that.
So thank you.
Um, what it's certifiedrehabilitation counselors, such
a vital team member alongsideother professionals for an
(24:30):
individual navigating atraumatic brain injury.
Shannon Juengst, PhD, CRC (24:33):
Yeah.
I, I think on the, on the onehand, it's unfortunate that
often they are not part of theteam.
Right.
Um, and I've always been anadvocate that we should have
rehab counselors be part of theteam.
And when I've seen, um,settings and organizations that
have that, you really can seethat benefit.
And unfortunately, it's justnot always the case.
(24:56):
I think that there's a coupleof really important perspectives
and skills that CRCs bring.
One is that, I mean, it is thatcounseling background, right?
Like that coaching, counseling.
I think that that's a reallyimportant support that people
need And we hear from peoplethat they need it and they don't
(25:20):
have it.
So I think that's one piece.
I think the ability to speakacross disciplines, and it's a
little bit of that casemanagement skill, but just being
able to come into a team andhave that holistic perspective,
so understand...
(25:41):
what each of the other teammembers are doing and how it all
fits together.
I see CRCs as being reallyuniquely able to do that,
whereas on teams that I've beenpart of before, everybody has
their expertise and they comeand that is their wheelhouse and
that is their focus and itneeds to be.
(26:01):
And having somebody who canstep back and see that kind of
bigger picture and how thosefolks can work together is
really important.
And I think CRCs are reallyuniquely qualified for that.
I also think that thedisability understanding is so
important.
So why is a CRC different thana psychologist or a master's
(26:24):
level counselor, therapist, asocial worker?
I think in a lot of settings,we see social workers taking
that role and social workers arewonderful.
And I cannot speak highlyenough about having a social
worker on your team, but theirperspective again is, is not the
disability specifically.
And it's not always that sortof holistic, again, meaningful
(26:50):
participation and function asthe end goal.
So I think that's the importantpart that they bring to the
team.
Maybe put more simply, when youwork with folks, especially
where TBI in particular haslargely until recently been
considered an injury, a medicalcondition.
(27:11):
So it's kind of steeped in themedical model.
And it's very deficits-based.
It's very recovery-based ratherthan based in adaptation and
function.
It's very bottom-up.
So how do we figure out what'swrong and fix it so that then
people go out and do better inthe world?
Which I think is reallyimportant, but you also have to
(27:33):
have that top-down.
Where is it we're trying to getto?
And does it actually matter?
Why?
Or, you know, I've kind ofalways had the perspective of
where's the person right now?
And we need to understand whatwe need to move them forward.
And it doesn't matter so muchunderstanding how they got there
(27:54):
if what they need to moveforward isn't based on that.
So I think having that kind oftop down, where are we trying to
get people to perspective isimportant.
And that's something that a CRCbrings forward.
because of that social model,disability model perspective and
strengths-based perspectivethat they're bringing to the
(28:14):
team.
Taylor Bauer, CRCC (28:15):
We have a lot of folks who have told us
they listen to the podcastregularly who are new to the
field or maybe in a graduateprogram getting ready to enter
their chapter as a CRC.
So I'm curious for folks whoare new to the field or just
getting started, what doessomeone need to know about the
variations in satisfaction thatone might experience when
(28:35):
navigating a traumatic braininjury?
There was a lot of research Icame across that you've done on
life satisfaction trajectories,and I found that really
interesting.
If I I was new to the field andjust about to get started maybe
in my first position post gradschool.
What are some considerations Imight want to sit with?
Shannon Juengst, PhD, CRC (28:55):
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 withyour life?
is that for the most part, formost people, it's a pretty
stable thing, not for everyone.
And there are certain thingsthat can change that trajectory.
We see changes, again, acrossthe lifespan that people kind of
(29:18):
in middle adulthood tend tohave the lowest life
satisfaction.
And this is true in braininjury.
This is true in generalpopulation.
It makes sense.
It's a phase of life when youhave the most demands.
You're working, you might havechildren, you might have aging
parents.
It's a very kind of high demandphase of life.
And for people who have a braininjury or really any acquired
(29:41):
disability in that phase wherethat kind of high demands, the
challenges that they have aregoing to be magnified when
there's more demands put onthem, that can be a particularly
challenging time.
So I think that as far as fromthe practicing side of things, I
think it's really important tounderstand where a person is
(30:06):
developmentally in their life asan adult, to understand what
all of those life roles are thatare important to them.
And that's something we keptseeing come up over and over is
that life satisfaction is so, somuch more tied to life roles
and participation in meaningfullife roles than it to how severe
(30:28):
your injury is or howindependent you are.
It really is, it has such asocial component too.
Relationships are a huge partof that.
And we know that after a TBI,social relationships are often
very affected because a personcan experience personality
changes or because just how theyfunction in the world and day
(30:54):
to day changes so dramaticallyand but they look the same and
so they lose friends that theyhad before who don't understand
and they have challenges ifthey're a little bit more
disinhibited if their emotionalregulation is not as good they
have challenges in closerelationships as well and so i
(31:16):
think that those are reallyimportant things to to pay
attention to and be aware ofmore so than what is again the
sort of consequence of theinjury itself but more how does
it affect those relationshipsand how does it kind of interact
with where you are and whatphase of life you're in um i
(31:39):
think that the more having morerehab counselors out there who
understand brain injury and justunderstand those cognitive and
emotional aspects of anydisability that affects kind of
how you think, how you interactwith people is really important
because that's, there's not alot of practitioners out there,
(32:00):
especially kind of that master'slevel therapist, counselor.
I get calls all the timesaying, do you know somebody who
understands brain injury?
I need to refer someone tothem.
They've gone to psychologists.
They've gone to counselors whoare perfectly wonderful
practitioners and people whokeep just telling them they're
depressed and they're notdepressed.
(32:21):
They're like, I'm not sad.
I'm happy.
exhausted and I can't seem toget off the couch, but it's not
sadness.
This is like initiation.
Well, that's not an emotionalthing.
That's a cognitive thing.
So I think there is such a needto have people out there who
understand kind of thosecognitive effects and how those
(32:45):
affect those socialrelationships.
Taylor Bauer, CRCC (32:47):
Yeah, I'm really fascinated at the
concept.
We might need to have you backon at some point to explore this
further, but I'm reallyinterested in the concept of
someone who's experiencing TBIgetting sent to different
professionals who are equippedand knowledgeable.
The question, like you said,with social workers or
psychologists or anybody, it'snot like, oh, they don't know
what they're doing.
It's more so that there's justsuch a unique experience of
(33:11):
having some of those cognitiveeffects come from experiencing a
disability.
And it's not as simple as like,oh, like depression, like you
said, even though folks might beexperiencing depression
alongside a disability, butbeing able to navigate where
that intersection sets, as wellas where they are distinctly
different things, or the samething, maybe just through the
(33:34):
lens of disability is such acrucial capability that I think
in the work that I do with CRCC,we can be articulating a little
bit more clearly of why that'sso important to have.
So it's like your answers aremaking me think of more work
that I get to do.
So I'm kind of excited aboutthat.
That's good.
Yeah, right.
It keeps me busy, right?
Out of trouble.
You have a lot of research toyour name.
(33:57):
And I know that there are lotsof people who research TBI and
brain injury and things likethat.
But I'm curious what elementsof TBI you think still need the
most investigation regardingeither the injury itself or the
individual's experience duringand post-injury?
I
Shannon Juengst, PhD, CRC (34:16):
do think the work that's being done
to try to identify effectivetreatments early on after injury
is really important.
If there's things that we coulddo right after injury that
helped to prevent the long-termconsequences and prevent
disability.
(34:37):
That is really important.
That's not the work I do, but Iwork with people who do that
work and I've kind ofperipherally touched on it.
And I think that is incrediblyimportant.
On the flip side, there isn'tthat, right?
And we have all of these peopleliving with the consequences of
TBI and needing support who,even if we have kind of the, you
(35:02):
know, miracle treatment thatcan help treat the actual injury
itself early on, they're notgoing to benefit from.
And so I think a lot more workneeds to be done looking at how
we actually help the people whoare experiencing those
consequences of brain injury outin their communities and out
(35:25):
where they are and out beyondthat first year post-injury,
which is when they get the mostsupport.
And I think that the field ismoving in that direction.
It was just very recently thatCMS recognized TBI as a chronic
condition.
And that has really importantimplications for things like
(35:46):
reimbursement and services beingcovered.
But also just even on the sortof attitudinal level, just the
recognition that there arelong-term consequences and
people are going to be dealingwith some of them for the rest
of their life is is reallyimportant as a way to just
promote that they need, thatmeans they need help.
So that is the area that I seeso much potential for more work
(36:11):
to be done is, you know, how dowe help them and more so not
just how do we do it?
Because I think we have a goodunderstanding of if you can get
a person in front of you, likewhat are the supports and what
is the training and what is itthat you need to do to help
them?
It's more how do we get thestuff we know works In the
research world, you might callthis implementation science and
(36:33):
implementation anddissemination.
But that's where I think verylittle has been done and that we
really need the most workbecause we have good research.
We have good evidence.
We have good behavioralinterventions that we know help.
But there's all these peoplethat don't have access to that.
(36:56):
Who's going to provide it?
How are people going to accessit?
How's it going to bereimbursed?
So these are all kind ofimplementation, dissemination
questions that I think we reallyas a field need to be embracing
and tackling while we're stilltrying to figure out all of
those other things that aregoing to work best to prevent as
(37:19):
much as possible these kind oflong-term consequences.
I think the other...
area and you touched on this alittle bit before talking about
stigma and stigma disability andwhen a disability is invisible
but in tbi we also have foundthat most people don't identify
as being disabled so they willtell you that they have function
(37:41):
many functional consequencesand challenges relating from
their injury um they may saythey may be unable to work even
if they want to But they don'tidentify as having a disability.
And I think a lot of that isthat so much of the work coming
(38:02):
out of TBI is that, again, inthe kind of medical model, it's
been viewed as this very acutecondition.
And as a result, a lot ofindividuals are not plugged into
the disability community and todisability resources.
They don't even know to lookfor them.
They don't think they qualify.
Even vocational rehabilitation,which is such a great support
(38:24):
for people who are looking to beemployed and to work, often
people with TBI don'tnecessarily qualify because they
have to get that disabilitydesignation.
And when you have that higherlevel executive dysfunction,
that's a really hard thing toidentify and quantify and to get
(38:46):
that designation.
So I think that's another...
area where understanding whatthose barriers are and why
people are not finding theservices that are out there, I
guess this may be part of thesame big picture of
implementation.
But I think that's anotherreally important area that needs
to be studied more.
Again, TBI can happen toanybody at any time.
(39:08):
And so many people that haveone TBI have another TBI.
And we know that multiple braininjuries can have cumulative
effects in different ways,different areas.
There's been a lot of worklooking at even milder injuries
that don't result in loss ofconsciousness can have long-term
effects.
And what are the consequencesof multiple injuries?
(39:29):
And at what point in your life,if you have a pediatric brain
injury versus an adult braininjury or a pediatric injury,
and then an adult injury later,what does that mean?
And what are the consequencesof that?
So again, really starting tolook at broader lifespan
perspectives to brain injury andits consequences is another
(39:51):
area that really needs a lotmore work, especially if we are
going to embrace that TBI is achronic health condition.
Taylor Bauer, CRCC (40:00):
Absolutely, yeah.
All of those points that youjust made require our advocacy
for...
continued support ofresearchers like yourself
exploring these things, becauseit 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 weassess and approach working with
(40:21):
TBI patients, but that there'smore that we can continue to
deep dive.
And then from an awarenessperspective, just getting the
word out of what this researchis discovering and getting that
information to the right peopleis vital.
With all of the incredibleresearch you do and the work
you've dedicated yourprofessional life to, what
(40:42):
brings you joy in the work thatyou do?
Shannon Juengst, PhD, CRC (40:45):
I love what I do.
I really do.
I think that in the short timethat I was practicing not doing
research, I saw such a need forbetter research and research
getting out there.
I think that providers are outthere doing the best they can
with what they know and whatthey have.
And there's so much better thatwe could do.
(41:07):
And so the thing that reallydrives me is that kind of
practical, like how do we getsupport to the people who need
it?
And I've been really fortunatein everything that I've done to
always have the opportunity tobe touching base and working
with people in the community,people with brain injury and
(41:28):
their care partners.
And those are always themoments that kind of bring me
the most joy.
They'll sort of refill my cup,so to speak.
And it's because I think thoseare the moments that, one, it
reaffirms that this is neededand it reaffirms that this is
important.
And it also, those are themoments where I see how big a
(41:50):
difference it can make and thedifference that it's made in
even just those lives of thepeople that I've worked with
most immediately.
And that's the part that reallybrings me joy and is
invigorating.
And most recently, a projectthat is ongoing, it's taking
(42:11):
what's called a community-basedparticipatory research approach.
And so essentially what thatmeans is that We have people
with brain injury, people withlived experience of other
disability, care partners,providers, all of these people
who are sort of involved in theexperience of brain injury
coming together with us asresearchers and really
(42:36):
co-creating intervention,collaborating as equal partners.
And that's been a really...
kind of perspective changingmoment for me.
And doing that kind of work,I've always involved people.
I've gotten their feedback.
I've gone back and presented mywork.
But this is the first timewhere we're really working hard
(43:00):
to try to really share the powerin research, to share the
decision-making.
And it's been a...
an exercise in letting go forme as a researcher to say
there's certain things aboutevidence we have to hang on to,
but there's also things that wehave to be able to let go if
(43:20):
they're not practical, ifthey're not wanted by the
population.
And that, those conversationsand that give and take and the
kind of collaboration and comingto these shared decisions has
just been a really, really greatexperience.
And I think in the end, it'screated something that is going
to be beneficial And we aregoing to be able to get out
(43:42):
there because as we've developedit, as we've done the work,
we've been talking to people andthinking about those things.
You know, where do we want tobe in 10 years?
We're thinking about that nowand how do we set things up?
So I think that's the part.
It's just always been the goingback and kind of seeing how
this actually can make adifference for people.
Taylor Bauer, CRCC (44:03):
huge thank you to Dr. Juengst for that
informational and engagingconversation.
In the show notes, you can findlinks to helpful resources
Dr. Juengst provided, includingTBI fact sheets for a number of
topics and resources that couldbe very helpful for certified
rehabilitation counselors.
If you have any takeaways orinsights on topics covered in
this episode, email us atcontactus at
(44:26):
crccertification.com.
Be sure to subscribe to thisshow on Apple Podcasts, Spotify,
or wherever you're listeningto us today.
You can find us on Facebook andLinkedIn at CRC Cert, and our
website is crccertification.com.
Until next time, I'm CRCCDirector of Communications and
(44:46):
Marketing, Taylor Bauer.
Thank you for listening toInside Rehabilitation
Counseling.
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