First Client Contact

The first contact sets the tone.

Start with warmth, clarity, and patience. Explain who you are, why you are reaching out, and what BIA-NE can do.

Keep it simple:

• introduce yourself & BIA-NE

• explain how you received the referral

• briefly describe Resource Facilitation

• ask what is most important to the client right now

• schedule a longer conversation, if needed

Clients may not answer right away. That does not always mean they are not interested.

Try more than one method when possible:

• phone call

• voicemail

• text 

• email

• letter, if appropriate

If a client does not respond, continue outreach while keeping the tone supportive and respectful. In general, make at least 3 contact attempts before closing a case. 

For domestic violence clients, make at least five attempts.

Before closing a case, let the client know:

• you have been trying to reach them

• you will close the case if you do not hear back by a certain date

• they are welcome to contact BIA-NE again in the future

Building Rapport

Start where the client is. Listen more than you talk. Be curious before you are corrective. 

Many clients are dealing with more than brain injury alone. Brain injury often overlaps with trauma, behavioral health, poverty, housing instability, substance use, family conflict, disability, or involvement with other systems.

Do not assume someone is "noncompliant," "lazy," or "not trying." Brain injury can affect memory, organization, communication, emotional regulation, attention, follow-through, and stamina.

A client may need:

• extra time

• repetition

• breaks

• written follow-up

• a smaller next step

• help making a call or filling out a form

When in doubt, slow down.

A Quick Overview Of Screenings vs. Assessments

RFs use screenings to better understand a client's history, strengths, challenges, and possible needs.

A screening is not the same as a clinical assessment.

All screening should be:

• brain injury-informed

• trauma-informed

• person-centered

• flexible based on the client's communication style, stamina, & readiness

Screenings

RFs use screenings to:

• identify possible brain injury history

• better understand symptoms and functional challenges

• guide referrals and next steps

• track changes over time

Screenings can happen during intake, after rapport is established, or anytime a client reports new concerns or significant changes.

Assessments

Assessments are completed by licensed professionals, such as physicians, psychologists, neuropsychologists, or therapists.

Assessments are used to diagnose, determine severity, and guide treatment.

RFs do not conduct clinical assessments. Our role is to use screening information to guide referrals, education, advocacy, and support.

BIA-NE's Preferred Screening Tool : OBISSS

The OBISSS (Online Brain Injury Screening & Support System) is BIA-NE's preferred screening tool and should be used in most situations where screening is needed.

The OBISSS:

• captures lifetime brain injury history

• screens for current symptoms & functional challenges

• uses the validated OSU TBI-ID method

• includes the Symptom Questionnaire for Brain Injury (SQBI)

• generates individualized Tip Sheets for the client and RF

• can be completed independently or with RF support

• is appropriate for ages 10+

Use the OBISSS:

• at intake, whenever possible

• when a client reports new symptoms or changes

• when you need a more complete picture of the client's history and functioning

If a client cannot complete the OBISSS independently, complete it together.

When using OBISSS:

• Explain why you are using it

• Remind the client they can take breaks

• Watch for fatigue, frustration, or emotional distress

• Avoid pushing for more detail than the client is ready to share

Other Screening Tools (AKA - What Else Is Available?)

Use additional tools when the OBISSS is not available, is not appropriate, or when you need more information.

Modified OSU TBI-ID

Use when you need a quick, conversation screen of lifetime brain injury history.

MPAI-4

Use when you need a better understanding of physical, cognitive, emotional, behavioral, and social functioning, especially at intake or when changes occur.

ACEs

Use only with adults, only after rapport is established, and only when understanding trauma history would help guide support.

WHODAS 2.0

Use when you need a broader picture of how disability is affecting day-to-day functioning.

SAFE Child

Use with children and youth when there are concerns about possible brain injury and its effects.

Identifying & Prioritizing Client Needs

After screening and intake, work with the client to identify what matters most right now.

In Salesforce, these priorities are entered as “Needs.” (We'll talk about that more in Section #4!)

Start with no more than five active needs at one time. Too many goals at once can feel overwhelming and make follow-through harder.

The client decides which needs are most important.

Additional needs can be documented as “Identified But Not Active” until the client is ready to work on them.

As goals are completed, revisit the list together and decide what should happen next.

Good goals are:

• realistic

• specific

• client-driven

• broken into manageable steps

For example, instead of “find housing,” smaller goals may include:

• call two housing programs

• gather required paperwork

• complete one application

If a client stops responding, make at least three contact attempts before closing the case. For domestic violence clients, make at least five attempts.

Before closing the case, let the client know:

• you have been trying to reach them

• you will close the case if you do not hear back by a certain date

• they are welcome to reconnect with BIA-NE in the future

Coordination Of Care

RFs help connect the dots.

Care coordination means helping the client access the right services, at the right time, from the right people.

This may include helping coordinate:

• medical care

• therapy and rehabilitation

• behavioral health services

• school supports

• vocational services

• benefits and waiver programs

• housing, transportation, and other basic needs

The goal is to reduce confusion, avoid gaps in care, and help everyone involved work toward the same priorities. 

Working With Other Providers

RFs often work alongside doctors, therapists, social workers, schools, attorneys, probation officers, case managers, housing staff, and family members.

When a Release of Information is in place:

• communicate clearly and professionally

• share only the information that is necessary

• clarify who is responsible for what

• keep the client informed about what is being discussed

• avoid duplication, overlap, or confusion

RFs should stay within their scope. If a client needs something outside the RF role, connect them to the appropriate professional.

Sometimes your role is to make the introduction. Sometimes it is to stay involved and help everyone stay on the same page.

Working Through Common Client Challenges

Missed Appointments Or No Follow-Through

If a client misses an appointment or does not follow through, do not assume they do not care.

Brain injury, transportation issues, anxiety, memory problems, unstable housing, lack of technology, or everyday life can all get in the way.

Reach back out. Keep the door open. Be supportive, but also clear.

Try:

• sending a reminder

• breaking the task into smaller steps

• simplifying the plan

• asking what got in the way

• offering a different approach

Clients Who Say "Yes" To Everything

Some clients agree to every idea in the moment, but do not follow through later.

This may reflect memory problems, overwhelm, wanting to please you, or not fully understanding the plan. 

Slow down. Focus on one or two next steps. Ask the client to repeat the plan back in their own words.

Frustration, Anger, Or Escalation

Clients may become frustrated, angry, tearful, or overwhelmed.

Stay calm. Do not argue or match their energy.

Instead:

• listen

• validate the feeling

• lower the temperature

• focus on one immediate next step

• take a break or reschedule if needed

Family Involvement

Family members can be helpful, but they may also have different opinions, expectations, or frustrations.

Whenever possible, keep the client at the center of the conversation. 

Include family or other supports only when the client wants them involved and there is appropriate consent.

Advocacy In Action

Advocacy is one of the most important parts of Resource Facilitation.

RFs help clients:

• understand their rights

• ask questions

• speak up for themselves

• access services and accommodations

• navigate systems that may feel confusing or overwhelming

Our goal is not to speak for clients forever. Our goal is to help them find their voice and build confidence over time.

Advocacy may include:

• helping a client apply for benefits or services

• explaining ADA rights or accommodation options

• supporting a client in school, work, housing, healthcare, or court settings

• helping prepare for appointments or difficult conversations

• helping the client understand options and make informed decisions

Always involve the client as much as possible.

Boundaries In Real Life

Boundaries are not just an idea - they show up in day-to-day situations. 

You may need to:

• say no to giving rides, lending money, or running errands

• redirect a client who wants emotional support beyond the RF role

• remind a client that you are not available nights, weekends, or 24/7

• keep communication on approved work platforms

• avoid connecting with clients on personal social media

You can be kind and still set limits.

For example: "I want to help, and I also want to make sure you are connected to the right kind of support."

Crisis Situations

RFs are not crisis counselors, and your safety matters too.

In any crisis situation, always prioritize your own safety first, along with the safety of the client and others involved. Do not put yourself at risk in an attempt to help.

If you ever feel unsafe:

• leave the situation

• end the visit or call if needed

• move to a safe location

• contact your supervisor

• call 911 if there is immediate danger

You are never expected to enter an unsafe environment, stay in a dangerous situation, break up an argument, physically intervene, or handle a crisis alone.

A crisis may involve:

• suicidal thoughts or self-harm

• threats of harm to others

• severe mental health symptoms

• abuse or neglect

• homelessness or lack of food, water, medication, or safety

• a medical emergency

• a natural disaster or other emergency affecting the client

When a client is upset, overwhelmed, or escalating, your role is to stay calm, listen, and help identify the most immediate need.

Try to:

• speak slowly and clearly

• ask simple questions

• lower the temperature, not raise it

• offer choices when possible

• focus on one next step at a time

For example: “It sounds like you have a lot happening right now. Let’s slow down and figure out what feels most urgent.”

Suicide, Self-Harm, or Threats of Violence

If a client says they want to hurt themselves or someone else, take it seriously.

If there is immediate danger:

• call 911, or help the client contact 911

• encourage the client to call or text 988

• stay on the line or with the client if it is safe to do so

• contact your supervisor as soon as possible

If the client disconnects and you believe there is an immediate risk, contact local law enforcement and request a welfare check.

Do not promise to keep threats of self-harm, suicide, or violence a secret.

Mental Health Emergencies

Some clients may experience panic, confusion, severe anxiety, psychosis, or other mental health symptoms.

Your job is not to diagnose or provide therapy. Your job is to:

• stay calm

• help the client feel safe

• avoid arguing or trying to “talk them out of it”

• encourage connection to crisis services, a trusted support person, 988, or emergency care

Abuse, Neglect, or Exploitation

RFs are mandatory reporters.

If you have reason to believe that a child or vulnerable adult is being abused, neglected, or exploited, you must make a report.

This includes concerns about:

• physical abuse

• sexual abuse

• emotional abuse

• neglect

• financial exploitation

If the client is in immediate danger, call 911.

Otherwise, make a report to the Nebraska Child and Adult Abuse and Neglect Hotline at 800-652-1999 as soon as possible.

You do not need proof. If you have reasonable concern, report it.

Social Determinants of Health Emergencies

Sometimes the crisis is not clinical. It may be that the client has nowhere to stay, no food, no transportation, no medication, or no way to meet basic needs.

Examples include:

• homelessness or risk of homelessness

• no food or water

• no heat, electricity, or safe housing

• inability to obtain needed medication

• loss of transportation

• financial crisis

In these situations:

• identify the most urgent need

• help the client connect to immediate resources

• use tools such as FindHelp or 211 to locate local support

• follow up quickly

Useful categories on FindHelp include:

• food

• housing

• money

• transportation

• health

• legal

• safety

• Natural Disasters and Community Emergencies

During tornadoes, severe storms, floods, shootings, industrial accidents, or other emergencies, stay in contact with leadership and follow any guidance from BIA-NE.

When checking in with clients during a disaster:

• start with concern and empathy

• ask whether they are safe

• explain any changes to appointments or services

• offer resources or flexibility when possible

• use more than one communication method if needed

For example: “We wanted to check in and make sure you are safe after the storm. Please let us know if you need help finding resources or need to adjust an upcoming appointment.”

After the Crisis

After any crisis situation:

• notify your supervisor

• document what happened in Salesforce as soon as possible

• record only the facts, not opinions

• document what actions were taken and any follow-up needed

• create a follow-up task if ongoing support is needed

You are not expected to manage a crisis alone. When in doubt, ask for help.

Closing Thought