Melissa Medeiros, Occupational Therapist and Team Lead

CARSU stands for ‘Cognitive Assessment and Rehabilitation for Substance Use’ related brain injury and is the only program of its kind in the world.

“I have the privilege of shaping [the program] from the very start,” says Melissa. “What makes CARSU unique from any other is that we take a harm reduction approach to substance use and accept clients who use any substance.”

Melissa’s professional background is working with clients post-concussion in private practice clinics and tertiary mental health. “I have developed programs for cognitive rehabilitation and loved seeing the difference it made for clients looking to get back to the activities they love,” she says. “The opportunity to get involved in a groundbreaking new program that bridges the gap between substance use, mental health, and cognition seemed like the perfect fit for me!”

She tells us that she feels very supported in her role at VCH. “Starting a new program is a large undertaking, but I’m not going at it alone. I have the support of my manager and a full steering committee. Regardless of what question comes up, there is always more than one person I can discuss it with.”

Melissa says she loves to learn and this role offers new learning daily. When starting any new program, one can expect to learn as you solve problems along the way. “With CARSU, every new referral has offered a learning opportunity,” she says. “We’re able to capture changes in cognition through different stages of substance use along the spectrum from active to abstinence.”

She notes that sometimes the findings aren’t what the team expects. “Factors aside from substance use can sometimes be identified as the primary drivers of cognitive impairment,” Melissa explains. “This could be anything from psychosis to a simple lack of sleep. No matter the finding, it’s always informative for the clients and their primary care providers.”

As a novel program, Melissa acknowledges it is critical to capture all their learning in data form to be presented in a research study or demonstration project. “We have had a lot of interest in the program, both from front-line clinicians and leadership. I look forward to presenting all our learning to the community in the coming year.”

Given that the program is brand new, Melissa says the team has not yet had the opportunity to see a full client journey from start to finish. “I anticipate some inspiring stories to come from experiencing the full journey,” she says. “Even without this time under our belt, I have witnessed the hope our program has given to clients from the very start. When explaining our program and the unique framework we bring, our clients have expressed gratitude to find a program that fits their unique needs.”

Melissa recognizes that offering a harm reduction approach has helped clients open up. “There is considerably less fear of stigmatization and shame regarding their substance use,” she says. “Building this trust and understanding while offering a pathway to improve their brain function has been very inspiring!”

The VCH values We Care for Everyone, We Are Always Learning, and We Strive for Better Results are incorporated into every aspect of Melissa’s role.

“Since CARSU is a specialty service, it might not be the right fit for everyone or it may simply not be the right time,” she says. “But because ‘We Care for Everyone’, the CARSU team does everything within our power to ensure no client is lost. If CARSU isn’t the right fit for the client for any reason, we are sure to connect them with a program that is the right fit.”

The value ‘We Are Always Learning’ is the value that resonates most for Melissa and at this point in CARSU’s development. “While developing a new program, it’s critical to look for learning opportunities every day,” she says. “By being open to learning from our clients, we’re able to hear exactly how we can best support them to reach their goals. As CARSU is still early in development, I’m able to take this feedback and build it directly into the DNA that makes up the program.”

For example, Melissa and the team originally planned to have all their clients complete formal cognitive assessments early on in their journey. However, given that these are time and energy-demanding, many of the clients have declined this part of the journey. Instead, Melissa simply observed her clients’ assessment through completing regular daily tasks, which can often provide different and sometimes richer information about their thinking skills. “Rather than rigidly requiring formal cognitive assessment, CARSU now has an option for clients to be assessed in a way that feels more natural for them.”

The team is striving for better results by preparing for program improvement in the development phase. From the start, the team has been collecting data on the client’s outcomes in the program. “Importantly, the primary outcome measure we are using to measure our clients’ results is the rating of their goal attainment. We can use this data to improve and grow our program to serve more and more clients!”

A fun fact about Melissa is that she can play the drums! “Music is so enriching to the brain on many levels, including cognitive, emotional, and even physical if you’re moving to the beat!” she says. “I like to bring music into my treatment with clients whenever I can. If clients are musicians themselves, it’s fun to create cognitive training exercises with their instruments. It’s a great way to train attention and memory in a meaningful context!”

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