Kate Gould on acquired brain injury, cybersafety, challenging behaviour and coproduction

An international episode with Dr Kate Gould from Monash University, Australia. Kate talks about her work in understanding and providing positive support in addressing challenging behaviour after acquired brain injury. She talks about her extensive collaborative research with Professor Jennie Ponsford and Dr Tim Feeney amongst others. 

Transcript

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Ingram Wright: So I have the pleasure of Dr Kate gould and the is joined me in the euro clinic all the way from Australia so Kate you're at monash university, but before I suppose I.

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Ingram Wright: Miss introduce you i'm going to allow you to introduce your yourself.

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Kate Gould: Thanks ingram thanks so much for having me on the podcast very exciting to be here.

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Kate Gould: So I am a research fellow at monash university and a clinical neuropsychologist working in private practice and also working as a neuro psych in a new training clinic we set up at the turn of clinics, called the positive behavior service.

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Ingram Wright: So you're very welcome, Kate and i'm particularly grateful to you for publicly agreeing to join the podcast on there on Twitter.

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Ingram Wright: But you're right.

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Kate Gould: That was a bold move either.

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Ingram Wright: was a bold move.

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Ingram Wright: And you subsequently couldn't regulated, it could you and I understand you you you've done a bit of podcasting yourself we've been offline we've been talking about the various technical wizardry that goes into putting podcasts together but you've got some experience of this.

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Kate Gould: yeah a few times as a guest, which has been fun on a few different podcast and i'm also in the background, working on a series of podcast episodes.

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Kate Gould: For our research that explores the experiences and the strategies we use in a positive behavior support intervention for challenging behavior after brain injury and that's called relentless optimism and it will come out fingers crossed later this year.

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Ingram Wright: So that's working progress is it or if you've done all the recording so.

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Kate Gould: Where are you at with yes, all of the episodes are recorded we just editing them and some of them are very complex to edit because we have.

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Kate Gould: Sometimes, for people on the episode, a person with severe brain injury family member a clinician and myself.

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Kate Gould: And so we're just finishing the edits and we're checking with all of our participants that they're Okay, with everything because it's going to be obviously public.

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Kate Gould: And yeah we're almost there and that we are holding off from releasing them until we have a few other elements about translation ready to go.

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Ingram Wright: And how did you find it making them.

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Kate Gould: It was a steep learning curve and I have full appreciation for how much work, this is, for your podcast as well and.

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Kate Gould: it's been really fun actually i've enjoyed trying to extend myself to.

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Kate Gould: I think what's really important is to connect with the broader public rather than looking at our research in terms of getting it out there and just.

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Kate Gould: conference papers and manuscripts, this is a way to really ensure there's a real kind of equitability in accessing clinical and research information.

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Ingram Wright: What some what lets you have enough, I guess during sort of covert and lockdowns and things people were doing podcasts and finding different ways to connect, but this was something that was an idea that predated the pandemic, was it.

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Kate Gould: yeah absolutely it was we actually recorded I think three episodes before the pandemic kick ass in earnest, and the reason that we decided to do a podcast is because.

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Kate Gould: We have our research has shown that clinicians really want to learn how to do behavior interventions, there are a lot of barriers in the way for them in terms of time and money.

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Kate Gould: So we we did surveys, where we identified those barriers, and then we did qualitative in depth interviews with clinicians to really explore how they would like to.

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Kate Gould: Learn and one of the great suggestions from our research that came through was a podcast.

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Kate Gould: And I think that just goes to I guess the benefits of co design is us as researchers on the project we can't have.

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Kate Gould: The expectation that we're going to have all the great ideas, but by doing the interviews and learning from paper what they want, you were able to.

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Kate Gould: come up with with this approach of a podcast and it makes sense that, for a lot of us Community providers we're often in the car driving out to see people.

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Kate Gould: And that's time that could be well spent, listening to a podcast and also a way that's a bit more informal I think in conversational, which is a really nice way to learn, particularly getting your head into a an approach that can be.

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Kate Gould: Sometimes inaccessible or hard to really understand will have yeah This all sounds great, but how do you actually do it, what does that require.

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Ingram Wright: And I suppose what you were saying earlier about, we need to get out of that kind of rather austere conference presentations manuscripts where we're kind of hide behind the safety of having prepared something and having explicit control over it.

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Ingram Wright: A podcast is a little bit more exposing isn't it to to do this kind of conversational style feels a little bit more risky.

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Kate Gould: yeah for sure, and I think there's also just you know the the desire to make really good quality content as well there's some so many amazing podcasts out there and then you say that.

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Kate Gould: That they have you know, a whole team of 20 or 30 people working by the scenes, and so you know we don't have all of those facilities, but we have been very lucky that.

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Kate Gould: we've had some grants that do enable us to get some editing help and multimedia support that makes all the difference so.

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Kate Gould: yeah I hope it's something that is really valuable when we do put them out and and a really nice compliment to the other more traditional resources of workshops then intervention sort of manuscripts and manuals.

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Ingram Wright: I suppose I hope I hope through having these kinds of conversations we can tempt others to.

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Ingram Wright: Because there are lots of things out there, but there's still gaps in the market until there's still space to have these kinds of conversations and for us to have these conversations with.

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Ingram Wright: With with each other and, as you say, with with the with the public and to share your psychology a little bit more widely.

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Kate Gould: yeah absolutely I think that so.

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Kate Gould: So many neuroscience doing amazing work, but often not very publicly and I think it's really good to get some more exposure about what is in your psychologist what can we offer what what are our strengths and skills next yeah a really great way to do it.

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Ingram Wright: I guess.

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Ingram Wright: i'm so drawn to the tech we've already compared microphones and and you have a very impressive design for a sound booth involving towels and various other things that so.

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Ingram Wright: That sounds like a great idea, but I guess, one of the key elements of your podcast is the Co design side of things, now I I hear people talk about co design, but what does what does co design mean to you what what does it involve or What did it info from from your perspective.

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Kate Gould: So i've got a few different topics of research that I investigate so one we've already talked about is challenging behavior and.

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Kate Gould: Interventions for that, and now the area of work that's very related is looking at a specific type of behavior challenge which is cybercrime vulnerability and so i'm using car designing in both of those research topics and.

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Kate Gould: I think it's really opening up the doors to the people that we're trying to serve without research now products and and inviting them to be at this at the table with us on on an equal footing.

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Kate Gould: So that rather than us, creating things that we think you will be useful for people with brain injury, for example, the people with brain injury themselves part of the research team part of.

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Kate Gould: Examining whatever got the research questions we're going to investigate what is the method we're going to use, how will this research be used.

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Kate Gould: How is it going to look where's it going to go who's going to promote it so really ideally that it's someone with the living expert experience or living expertise is involved through all stages.

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Kate Gould: And that's that kind of ideal end of the spectrum and then you can kind of move all the way down sort of to a more kind of consultative approach and then everything in between.

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Kate Gould: So it can seem like a really intimidating thing just all of a sudden, with your work, try to bring in people when you haven't necessarily had experience doing that or.

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Kate Gould: It could be seen as like well how do you do that with someone needs to be brain injury or communication difficulties and they can be a lot of barriers and challenges and place.

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Kate Gould: So we try to maximize the Co designing every opportunity we have, so we do qualitative research interviews and surveys, but as we've gone on and become more confident.

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Kate Gould: We do have, for example, with my cyber ability project that is actually co lead with one of my clients with severe brain injury.

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Kate Gould: And I think it's a really great example to show that, yes, people have severe cognitive impairment behavior impairment emotional issues physical communication issues.

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Kate Gould: But they can still contribute and not only contribute in a way that's helpful, but can actually be really mind blowing at the.

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Kate Gould: The learnings and the inspiration and the ideas and it becomes a really authentic and genuine product at the end of that that i'm really proud to be part of, and I can't imagine doing research in any other way now so i'm really sort of yeah trying to promote it.

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Kate Gould: Because I think it's so important that that's what we're doing moving forward.

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Ingram Wright: I This is great you've dived in and speaking so enthusiastically about that, I mean I can I can feel a pull towards doing more of that.

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Ingram Wright: That kind of work but, as you say there's some anxiety that maybe pulls me back into the security of being able to plan and do things myself and and work on my powerpoints without without.

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Ingram Wright: without interruption, but I suppose once we let go without security, I mean what you're describing sounds like there's some great ideas that get generated through that through that interaction.

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Kate Gould: hmm absolutely so the podcast is one where you have the person with the injury and experience or the end the family members.

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Kate Gould: speaking out and sharing what their expertise is what their strategies are, and I think I think I think that's really important from an audience perspective and what we've seen in our research is that we think that because we're professionals that everyone hangs on out every word.

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Kate Gould: But when you have somebody who's been in the same boat as as a public that's actually what they connect to it.

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Kate Gould: And that's what they relate to so, for example.

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Kate Gould: My cyber ability my scam research that originated, because my one of my clients i've been working with colon.

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Kate Gould: We identified that he'd been in a romance scam online and he'd lost 10s of thousands of dollars.

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Kate Gould: And whilst it was a pretty straightforward exercise to stop him having access to any more money to give the scammers the emotional and cognitive side of it was really challenging for me and for him.

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Ingram Wright: yeah.

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Kate Gould: And we didn't really know how to help him disengage and recognize fully fully recognize that this person he felt real feelings for of love where.

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Kate Gould: That there wasn't a real person at the other side of that that was a manipulation and grooming.

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Kate Gould: And they've done such a good job, such a number on him that it was really hard for him to separate that, and so we work together to learn about scams and.

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Kate Gould: We tend to find that there was nothing out there in terms of how should a psychologist or another professional help someone with this game.

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Kate Gould: And so we we learned about it, together we created a presentation together, and this was part of his therapy and when we.

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Kate Gould: got a lot of encouragement from our colleagues, we ended up as the keynote address for brain injury australia's national conference and in the audience another man who.

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Kate Gould: Had a brain injury out he heard colon and my my talk, but mostly Collins talk and he said to his care of next to him what Colin saying what he's talking about that's happened to me too.

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Kate Gould: And that was a real light bulb moment for him and for his team and yeah we've identified that many others experienced that when we have.

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Kate Gould: evaluated at car designs we've brought a lot of people together who's experienced that brain injury and scams and they've helped us to develop training content.

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Kate Gould: and shed videos of their own experiences and what we found in the co design process is not actually what we thought we were going to find.

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Kate Gould: When we've conducted interviews and ask people What was it like to help us design the training content to us which platform it's going to be on help us with the artwork.

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Kate Gould: Think about a promotion plan like what was that experience like expecting we'd get some information about all the practicalities and their.

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Kate Gould: Contributions what we actually heard from them was that they didn't really want to talk about the designing of the intervention materials all that much what they really wanted to talk about was the impact it had on them personally and therapeutically.

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Kate Gould: That they felt that this was a place where they could work through this sense of shame, where they could feel.

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Kate Gould: A sense of connection a sense of empowerment and agency and autonomy and actually process their emotional.

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Kate Gould: Issues from beings scanned because of the appears being there, so it had all the elements of really group therapy, but also that they weren't there to to receive, but there were there to create their own therapy.

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Kate Gould: Is.

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Kate Gould: very powerful.

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Ingram Wright: One of the great things about about.

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Ingram Wright: That strand of work evolving as it came to you and you work the expert right so so when Colin came to you and said hey this has happened to me what what am I going to do about it, you are kind of discovering new things together about what you can do.

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Ingram Wright: Which is a great place to start isn't it, I suppose I mean maybe if you kind of had some particular expertise you wouldn't have been drawn quite so much into the Co design side of things.

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Kate Gould: differently yeah potentially I mean funnily enough as as times gone on week my my dad has reminded me that my you know and science project was on a cyber safety video.

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Okay.

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Ingram Wright: Nine expertise at least.

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Kate Gould: That was my level of expertise, you know, on in the in the 90s, as well, so before there was.

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Ingram Wright: Before there wasn't intimate.

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Kate Gould: So yeah I think sorry, and I think that that kind of equal leveling was really important and call it also has he's he's background before his injury was in it, so he had some expertise as well.

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Kate Gould: And we could look at that, as a real sort of shared project and that's brought incredible value to both of us to him it's it's now a volunteer and.

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Kate Gould: A racer troll as well, and for me it's a whole strand of my research also that i'm both really proud of and has you know led to we've got a few published papers out now on the topic and it's just growing we've got a couple of PhD students now and.

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Kate Gould: Some funded projects and right yeah now we're developing an actual psychological intervention for recovery.

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Ingram Wright: In case it sounds such an port, well, I suppose, maybe you could speak to the importance of it, but it seems to me sort of having heard about your work that.

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Ingram Wright: it's such an important area to support people it's so important isn't that we connect with each other and we're able to use.

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Ingram Wright: The Internet, you know sort of tools that are available to us to interact and socially connected in a safe way but it probably isn't something mom would naturally.

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Ingram Wright: stumble across well, you did stumble across it, but it isn't something one would naturally explore as a as a rehabilitation psychologist.

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Kate Gould: Exactly and that's what we sort of realized that in other aspects of our life we were we're now seeing that online life and offline life we're really blurred there's a real lack of distinct separation of what's happening online and offline like right now we're online and.

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Kate Gould: There wasn't really anyone in the rehab space talking about cyber safety and once we realize that we're like oh my gosh there's such a need for us to talk about this because we don't have the statistics on.

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Kate Gould: Whether people with brain injuries specifically targeted, or whether the rights of scams or the degree of losses more or worse than the general population.

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Kate Gould: We need measures to be able to identify that so that's what one of my students child commonality is is working on a Co designed to measure of cyber safety and then, then we can start to.

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Kate Gould: Ensure that we're offering the right levels and means of support for people, because we do want to encourage independence.

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Kate Gould: And what we're finding with our research is that many people were being scammed particularly romance scams was the number one which is slightly different to what we see in Australia, where it might be more investment scans.

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Kate Gould: yeah and the romance scams can go on for months or years and be very emotionally distressing and for many people it's sort of interfered with their rehab.

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Kate Gould: All the other goals went out the window and the whole team needed to focus on all of the impacts of the scam because they're they're kind of social, financial psychological functional.

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Kate Gould: The person is now spending all their time online chatting to the romance gamma they're not having shower they're not engaging in their sort of Community activities they've lost their money, so now they can't go to the footy.

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Kate Gould: That can't play that pay their bills and and so, and so that yeah it's had a really big impact on on the many individuals who have spoken to and some really concerning impacts where.

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Kate Gould: They admit you know we've had women with brain injury who've met people they've made online that and then registered sex offenders and they've been taken advantage of.

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Kate Gould: we've had another woman who went overseas to an African country to make the Scammer.

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Kate Gould: And you know, without any funds or know how of how to manage really tricky situations where police at to be called to rescue them so really extreme.

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Kate Gould: disadvantage on top of losing money, so it is, it is something that it is important that we're aware of, and I think.

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Kate Gould: neuropsychologists or chase be cheese, we could all be checking in with our clients and understanding how are they using the Internet to where they chatting to are they making new friends and how do they know them and what kind of understand that they have about safety online.

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Ingram Wright: And there's something about I mean I guess everybody's vulnerable to an extent on a to these kinds of these kinds of scams, and I was thinking about some.

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Ingram Wright: adults with learning disability, who may grow up with particular additional phone abilities to scam us but there's there's obviously something quite particular to an acquired brain injury that renders you particularly vulnerable to these these kinds of scams that.

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Kate Gould: We don't we don't actually know how each different.

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Kate Gould: Disability group might be differentially vulnerable, but certainly there's some research i'm sort of involved with in Australia, that the government's conducting as well with intellectual disability.

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Kate Gould: And I did to find that they have a lot of risks as well when they're online, and so I think yeah the end of the day, we are all at risk there's a scam for everyone.

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Kate Gould: You know there's scams that are targeting.

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Kate Gould: academics for this predatory journals there's dodgy COMP conferences there's all sorts of vulnerabilities, so I think I think I guess because that's my area i'm really interested in.

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Kate Gould: In supporting Safe Internet use for people with brain injury, but I think that what we're learning can definitely be applied to people without the vulnerabilities that might be cognitive or language based or culture based.

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Kate Gould: we've all guess.

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Kate Gould: No, I think we need to realize just that the Internet is a great great for so many things, but it can be unsafe in so many ways to.

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Ingram Wright: i've certainly received a couple of keynote speaker invitations that i've been a little bit suspicious about.

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Kate Gould: Good a little bit suspicious is the perfect thing today.

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Kate Gould: that's a great level.

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Ingram Wright: hey we've we've sort of we sort of started back to front, because this is the kind of latest area of research isn't it, but one of the things that.

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Ingram Wright: i've talked about with everybody who's come on the podcast is is is what sparked your interest in your psychology I mean we're probably not going to go as far back as year nine or we or maybe we maybe we are but.

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Ingram Wright: Do you remember when you kind of first.

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Ingram Wright: kind of probably knew that you were interested in your psychology.

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Kate Gould: yeah I think I did start in my school days a couple of elements to this is that one I started with an interest in psychology and that was because I.

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Kate Gould: people tend to gravitate towards me with their problems, their life problems at school, my friends sought me out to their relationship advice and someone made the link hey you know, maybe, be a really good psychologist and I thought that's a great idea and I enjoyed.

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Kate Gould: The psychology subjects I was lucky enough to study and my university that i'm still at monash university actually came to my school and showcase some of the cool new degrees that we're offering.

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Kate Gould: And one of them really sparked my interest which was a bachelor of behavioral neuroscience and I thought neuroscience sounds really cool.

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Kate Gould: What a great way to be a SEC good psychologist if you've got a good understanding of the brain.

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Kate Gould: So that's what I went on to study and it was a great course we got to do neuroanatomy and undergrad level so that was pretty exciting and.

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Kate Gould: From there I learned about neuropsychology and I was became really interested in that and I realized, since that I grew up with a family friend who.

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Kate Gould: had been in it is very significant car accident and his wife had died in the accident and he had a.

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Kate Gould: Sound the same age as me and we kind of grew up together and T the dad had a this to be writing jury from that and so i'm sort of grown up with someone with an open API and took a real interest in that so from my undergraduate degree I studied honors and then that was looking into.

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Kate Gould: parkinson's disorder and then yeah then went into the doctorate of clinical neuropsychology, which is very lucky to to be accepted into.

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Ingram Wright: That training in Australia, I mean we have some listeners in Australia, who will, who will know intimately that.

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Ingram Wright: Particular routes that that they're following obviously or followed, but some the route that you fall, is no longer available is, that is, that is, that is, that right they've broken the.

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Kate Gould: mold yeah so that degree, I did that behavioral neuroscience degree isn't isn't there anymore, but.

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Kate Gould: I still offers some really fantastic training in psychology and Office now neuro psychology undergrad subjects which is pretty cool.

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Kate Gould: And now, just at the time I graduated you could, if you did it if you do a doctorate now you have to do, then have a registrar program on the job training, so I didn't have to do that, but some slight tweaks.

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Ingram Wright: Things that things are changing and, hopefully, improving on in terms of the quality of training that people can get access to.

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Kate Gould: yeah exactly.

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Ingram Wright: I guess, I guess, we have to be very careful with that because we don't want to have a similar pathway existed in the UK where we've now introduced it a two year.

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Ingram Wright: sort of practice dimension it's been in place for some time, but it wasn't in place when when I trained, so I managed to slip in just before just before that particular route was.

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Ingram Wright: was opened up, but it's important isn't it's important that we focus on the quality of training in your psychology and.

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Ingram Wright: And although it it costs, it costs individuals, it costs institutions in order to train people.

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Ingram Wright: I think things are changing the way that you described, and I suppose the way that we go about practicing your psychology needs to move with the times.

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Ingram Wright: and not to not to imply Kate that you're in any sense out of out of date because you've just demonstrated that you're you're clearly not but, having trained in your psychology you went on to.

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Ingram Wright: And in your postdoc one of the things that we we've talked about again in sort of thinking about topics for today was about your your work, looking at challenging behavior and acquired brain injury.

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Ingram Wright: So that was kind of one of the sort of key starting points wasn't it with regard to your research and could you tell me a bit a bit more about what how how did that idea come to you.

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Kate Gould: Well, I have to acknowledge that my working challenging behaviors part of a broader team across monash university University of Melbourne University of Queensland and even in the states as well, so.

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Kate Gould: The transport accident Commission have funded our work and they are a state based accident, ensure that that.

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Kate Gould: Has a no fault accident insurance game, so people who are tsa clients from a road traffic accident coverage for their therapy, essentially for life.

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Kate Gould: And they took a particular interest in challenging behaviors because they recognize that it's quite costly to their insurance game people with challenging behaviors such as verbal aggression so shouting yelling swearing threats and physical aggression and grabbing.

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Kate Gould: hurting and injuring people throwing objects and socially inappropriate behavior so.

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Kate Gould: Poor sort of nonverbal communication or being patient or frustrated.

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Kate Gould: All of those sorts of behaviors mean that it's harder for somebody to engage in the Community and participate meaningfully.

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Kate Gould: And what often happens is that when they do go into the Community they require attended care support or within the home because potentially.

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Kate Gould: becomes really challenging for families and all those things, lead to increased costs and, of course, lower life satisfaction and meaningful engagement so to see through their.

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Kate Gould: Accident rehabilitation and recovery insurance game they funded us to do some work to understand this issue.

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Kate Gould: So we did some scoping interviews and surveys, with people with brain injury family members and clinicians.

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Kate Gould: To really understand what were the service needs what were the kind of key issues going on for this this.

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Kate Gould: These individuals and we found that in the people we surveyed we found about 70% of people with brain injury were having challenging behavior and issues related to that in the first couple of years, so it's quite a significant number, and many of those people would not getting support.

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Kate Gould: And the people that weren't getting support quite satisfied with the support it was predominantly neuropsychologists and other psychologists so getting help from, and so we explored, you know what kinds of supports people wanted and they wanted more behavior intervention support.

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Kate Gould: So when you look at the evidence for behavior dimensions is there's been a real shift over the last few decades from contingency management approaches approaches that really focused on consequences rewards token economies.

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Kate Gould: To more antecedent focused approaches so applied behavior analysis and positive Peggy supports and so we're very lucky to work with TIM finis his.

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Kate Gould: World expert in in behavior ISM from New York state and he is and he's mentor makarova Socrates passed away some years ago they had have spent decades exploring this topic and taking from their clinical expertise.

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Kate Gould: Some large scale projects and program evaluations and single case studies that there hasn't really been any randomized control trials of positive behavior support in brain injury.

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Kate Gould: So, with the funding we received we conducted what we understand to be the world's first trial randomized control trial of positive behavior support in adults with challenging behavior after brain injury.

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Kate Gould: And so that's what we've spent quite a few years, doing and we've just really finished that trial.

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Kate Gould: And all our sort of publications are now out in neuropsychological rehab and archives of physical and rehabilitation medicine.

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Kate Gould: And yeah we're now at the stage of now that we've found that PBS did lead to improvements in behavior and particularly improvements in the self efficacy and confidence at family members and carers, to actually address behavior change now we're focused on translating that into practice.

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Ingram Wright: So I was going to ask about that So what are the challenges I suppose, in terms of recognizing that there's a prevalent problem and it's a problem that's well not specific to this population is certainly one that impedes and is detrimental to quality of life.

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Ingram Wright: What were the challenges around translating that into clinical interventions for individuals.

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Ingram Wright: I see individuals that may not have been individuals, presumably the system around this individuals is something which you crucially target right.

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Kate Gould: yeah so in terms of what the intervention involves itself it's a very individualized process.

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Kate Gould: So it's really looking at the behavior not as the initial target of the intervention, but understanding it as an obstacle to helping the person achieve a meaningful life.

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Kate Gould: So we start with the person themselves and they identify the important people in their life to be involved in these conversations.

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Kate Gould: and looking at where their life is that and where they want their life to be heading what's important to them and identifying really an aspirational life outcome for them, based on and.

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Kate Gould: it's often a series of conversations because it's it's a hard thing to be put on the spot and say what do you want, for your life, not everyone thinks about their life in that way.

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Kate Gould: And then, once we've got a good relationship with them we've built trust we know who is important in their life and those people are part of those those collaborative discussions, we can start to sort of step down from.

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Kate Gould: What those meaningful outcomes will be deal's off and for them and start to identify okay well, what are the things you need to help you get there, what are those steps where those goals.

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Kate Gould: And what's been getting in the way let's look at how the behavior is actually a barrier or an obstacle to you, achieving what you want, and.

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Kate Gould: Looking at theories for why these behaviors that are carrying what's the function of them what's what and how they've been serving you and how could we look at.

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Kate Gould: skilling you up in other ways, and making environmental modifications so that we can help you achieve what you want.

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Kate Gould: And then yeah we're building on the person's strengths and supports as well, to come up with quite an individualized plan for the person and the important people in their lives.

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Ingram Wright: I suppose i'm thinking about em you know some cases I work in pediatrics case so it's it's just you know, obviously slightly different landscape, but i'm i'm.

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Ingram Wright: The one or two cases i've been involved in where.

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Ingram Wright: The challenging behavior has been regarded as.

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Ingram Wright: As not behaviourally amenable to to remediation of any of any kind, I mean do you come across that i'm just wondering whether that's a sort of prevalent challenge in the kind of work that you do.

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Ingram Wright: Because they may well be sort of counter arguments so actually what we need to do is to is to put high levels of care high levels of constraint in in place and, obviously, as you say that that kind of leads to someone being further isolated from a meaningful life.

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Kate Gould: and

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Ingram Wright: i'm just wondering about whether you experience that kind of challenging in the work that you do.

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Kate Gould: So obviously there is no intervention, which is 100% effective to everyone.

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Kate Gould: And we certainly did have some people in the program that didn't respond and this wasn't the right fit, so I think that's important to acknowledge that this isn't a cure all for every challenge and challenging behavior now.

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Kate Gould: That being said, I think what this approach brings is in there's a structure and a system in place.

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Kate Gould: To understand behaviors and to come up with an intervention plan, but there's also the individuality requires some creativity as well.

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Kate Gould: And so working creatively with the people that know the person best so it themselves and their family there's often a lot that can come from that expertise and so.

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Kate Gould: We are, I think, throughout this one of the things that we can offer them bring is a sense of optimism and hopefulness.

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Kate Gould: that there will be something that works, it might be really hard to get there, and sometimes that that person comes to you with some restrictive practices in place and that you can look at reducing them.

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Kate Gould: Over time, as you kind of build up an understanding and build up some other ways to support that person, and I think that that is really important that we are looking.

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Kate Gould: primarily at ways that are not diversity of or restrict us.

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Kate Gould: And when we we did interviews very early, as I mentioned in this in this body of work where we actually did interviews with people is.

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Kate Gould: For any injury and that behavior but I hadn't really been done before, no one had spoken to the person themselves about behavior is often coming from clinicians and family members.

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Kate Gould: And what that research enabled us to see was that, yes, we understand this, a lot of external reasons for behavior like lack of meaningful engagement environmental issues and difficulties in interpersonal relationships, but there's also all these internal reasons as well.

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Kate Gould: You know, understandably around the mood is a big one, but we also identifying things like the person's sense of identity and this sense of control around their lives.

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Kate Gould: were really important factors for understanding why the behaviors occur also what the behaviors impact on so having experienced aggression someone you know inside like I was always the quiet guy.

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Kate Gould: And now I yell and i'm the last one at the party and that's changed, who I am.

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Kate Gould: and control was another aspect, you know that they sort of losing control of their behavior because they don't feel like they're in control of any part of their lives.

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Kate Gould: So when we're engaging it's quite restrictive practices with sort of fading into another reason for that person to feel frustrated and angry about their lives.

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Kate Gould: And by giving the person, a sense of control autonomy choice and and valuing what they want, for their lives that can be often very instrumental in helping the person feel more days feel more positive and not need to engage in those challenging behaviors.

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Ingram Wright: was one of the questions that came up for me is is when you talk about having conversations with individuals who experienced brain injury.

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Ingram Wright: who have some insight into what you can do to help them, it seems like an obvious thing to do, but I was just wondering why, and I was thinking about insight I was wondering why is it that we've been so reluctant to have those conversations, thus far.

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Kate Gould: it's a really good question, and I mean, I think that I feel that neuropsychology such an exciting profession to be in clinically and research wise because there's so much, we still need to do.

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Kate Gould: we're very busy, and we just haven't done it, yet I don't think there's necessarily been a reason that we haven't I think I think it's part of a wider trend and a positive trend of.

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Kate Gould: As we spoke about it, the stock code is on about moving from what I see is been a lot of really rhetoric about being person centered.

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Kate Gould: To actually embedding that in a more meaningful way in a more authentic way in the way that we operate so that it's actually person driven.

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Kate Gould: that the person with the injury is driving the discussion, the focus the strategies and that may mean that the person doesn't have a lot of insight into the situation and that's something that.

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Kate Gould: That is certainly come up for our clients as well, but the way we work in a really systematic way where the person is valued for what where they're at now is it does enable that supportive development of the insight over time.

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Kate Gould: That we're not coming in and saying well that's not a realistic goal and that's never going to happen, and you know.

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Kate Gould: don't you know that you're actually quite limited and disabled.

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Kate Gould: And we don't do that instead it's like okay that's a really exciting thing that you want to do what would we need to do to get there and.

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Kate Gould: Why don't we start along the way, and why don't we check in in a couple of weeks and see how that's going, and then we can you know reevaluate and say.

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Kate Gould: We still on the right track, this is still something we're working towards on how us want to go about it and you're coming along with them.

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Kate Gould: meeting them where they're at and that that gives the person, a really I think good sense of respect and value, and that is therapeutic in and of itself.

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Ingram Wright: Okay, there are some really strong themes that I can certainly take throughout the work that you've undertaken, but I mean it's really powerful to hear you talking about.

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Ingram Wright: The value and importance of listening to individuals who have experienced brain injury and what they can do to transform the way we work, this neuropsychologists.

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Ingram Wright: it's the end of a long day for you and it's the beginning of one for me, but i'm i'm incredibly grateful to you for giving up your time to speak to me thank you very much katie.

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Kate Gould: Thank you, such a pleasure to chat with you on the podcast.

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Ingram Wright: Thank you.