CBIST Spotlight: Marty Van Dam

Marty Van Dam, M.S., CCC-SLP, CBIST, is a Speech-Language Pathologist with 14 years of experience providing services to persons with acquired brain injury (ABI). Marty received her undergraduate degree from Clemson University in Clemson, South Carolina, and her M.S. in Communication Disorders and Sciences from the University of Oregon in Eugene, Oregon. Marty has worked for the Roger C. Peace Outpatient Brain Injury & Young Stroke Program, a CARF-accredited community re-entry brain injury program, of the Greenville Health System in Greenville, South Carolina, since 2007 and was promoted to Supervisor of Therapies in 2014. Marty has served on the South Carolina Brain Injury Leadership Council’s (BILC) workforce development committee since 2009 and co-chairs a subcommittee of the BILC Executive Board. She recently was appointed to the American Speech-Language Hearing Association Governance and Public Policy Board for a three-year term. Marty has great passion for developing professionals who serve persons with head injury. She has maintained her CBIST certification since 2014 and is a coach for the Brain Injury Leadership Academy’s inaugural yearlong leadership development program.

Why is having a CBIST important to you and how has it benefited your practice and career?

Truthfully, I became a CBIS because it was another credential and it was an expectation for clinicians at Roger C. Peace Rehabilitation Hospital’s Outpatient Brain Injury & Young Stroke Program in Greenville, South Carolina. However, after having been a CBIS since 2009 and a CBIST since 2014, I realize the value of this certification. Brain injury rehabilitation needs to be an extremely specialized endeavor. Every brain is different and no two injuries are the same. The CBIS certification is a great starting point for professionals working with this population because it teaches core material (e.g., terminology, neuroanatomy, medical comorbidities, aging processes, rehabilitation principles, continuum of services, etc.) specific to understanding the needs of this population. It is important for professionals serving persons with brain injury to recognize that brain injury is a lifelong process and it is our role, no matter where one works on the continuum, to keep this in mind when utilizing benefits, proving therapeutic interventions, making recommendations, and preparing the patient for discharge. I value the emphasis that the CBIS certification places on the brain injury-specific continuing education requirement. I have most enjoyed my role as a CBIST. It has been exciting for me to share my experiences with the therapists, nurses, case managers, and psychologists who have participated in my classes. I find that the most valuable learning takes place through facilitated discussion in which class participants learn from each other.

What are some of the latest trends in the literature and practice that you are seeing in rehabilitation with survivors of brain injury?

One trend I am seeing that impacts service delivery and patient access to services is a steady increase in funding limitations over the past several years. This is especially concerning because with the advances in emergent medicine, we are seeing a wider range of patients in the outpatient setting, specifically lower functioning and medically complex patients and patients with higher level-mild cognitive impairments. These patients require a high degree of awareness, executive skill, and problem solving training that incorporates emotional self-regulation. Speech pathologists with a brain injury specialty and a high degree of skill in addressing these aspects of cognitive rehabilitation provide a unique and important perspective to the patients’ care. Reimbursement for speech therapy for patients on the higher functioning end of the spectrum is becoming an issue as it is trending that more and more payers are not reimbursing “cognitive therapy” especially for the higher functioning patients who are beyond the medical necessity classification.

Regardless of therapy discipline (PT, OT, ST), limited funding also greatly impacts a clinician’s abilities to follow evidence-based guidelines and creates a bit of a disconnect in our field between what we know we are capable of accomplishing with a patient and what we are actually able to accomplish with a patient. Clinicians are having to become more nimble in their therapy design and delivery. Developing plans and techniques that are focused on the patient’s awareness, teaching patients how to advocate for themselves, and patient and caregiver education and training so that therapy can continue in the home are paramount for successful functional outcomes with limited funding. No longer are the days when we are afforded months of therapy. Adapting best practice and practice-based evidence is crucial for successful outcomes beyond the clinic.

Additionally, in my opinion to be sustainable in this field in the future, self-awareness and a mindfulness approach is not only core to cognitive rehabilitation, it is necessary for neurorehabilitation clinicians. Over the past several years, the hospital system for which I work has adopted key principles called Conscious Professionalism. In very basic terms, conscious professionalism is a mindfulness-based approach to leadership (my awareness of how I show up in the world). I am continually learning and applying these principles myself. What encourages me to continue to explore these principles personally and professionally is that I have found great success using the same principles and tools with patients as the concepts nicely parallel neurorehabilitation constructs that are core to my training as a speech-language pathologist. When I am participating in clinical rounding with my staff, I find that much of the time when there is either a road block with a patient’s progress or a frustration on the part of the clinician, the principles of conscious professionalism are often my recommendation. The same tools that our hospital system uses to foster self-awareness and personal growth are often the missing link to a therapist being able to effectively communicate with a patient or tools patients can be coached to use to increase awareness or problem solving.

Why have you chosen a career in brain injury? What are you most passionate about in the field?

Practicing in the field of brain injury is not for everyone. It is hard. It is stressful. It can be exhausting. However, it is a skill and an art. It is a privilege to be given the trust and confidence from patients to allow me to look at their brains, their lives, their thoughts, their personalities (their cognitive linguistic strengths and weaknesses) and develop a plan to improve their life participation, their ability to advocate for them self, their ability to access the community safely, maintain and develop their relationships, go back to work or school, etc. There is nothing more powerful for my purpose than being able to help a patient work through the hardest challenges of their life and successfully discover or rediscover their purpose. This career continues to teach me endless lessons about myself both personally and professionally. Through these lessons I am learning to be a better therapist, peer, leader, and friend.