The Ins & Outs of BIRP

What Patients Should Expect

While every BIRP patient and their treatment is different, the program generally includes four steps:

1. Step 1: Evaluation
   
   Before starting the program, every patient completes a two-day evaluation to determine their needs and fit for the program. Day one of the evaluation typically includes:
   
   • A physical evaluation with a medical provider
   • Cognitive testing with a neuropsychologist
   
   And day two includes:
   
   • Meetings with therapy providers
   • Goal setting and needs assessment
   
   Once the evaluation is complete, the entire team meets to discuss findings and build a treatment plan. A follow-up phone conference is then scheduled with the patient (and family, if desired) to walk through recommendations, discuss next steps, and address any concerns or barriers to participation—whether that’s transportation, childcare, or anxiety about starting.
2. Step 2: Full-Time Program
   
   Once approved and authorized through Washington Labor & Industries, patients begin the structured day program. A typical day includes:
   
   • Morning: Individual or small-group therapy (PT, OT, or Speech)
   • Late morning: Group education sessions with other patients
   • Lunch break
   • Afternoon: More therapy, followed by a second group session
   
   Each session lasts about an hour. Early in the program, therapy is often one-on-one to support goal-setting and orientation. As patients progress, small group work helps integrate skills in more complex settings and fosters peer support.
   
   During the program, it’s common for patients to build strong connections with others. For those traveling from out of town, we offer apartment housing—available only to program participants—which creates a supportive environment outside of therapy hours as well.
3. Step 3: Family Support
   
   During the second-to-last week of treatment, we invite family members or support persons to attend a Family Conference. This meeting helps:
   
   • Review patient progress
   • Discuss post-program plans
   • Educate families on how to support recovery at home or during the return-to-work process
   
   We find that when families are involved and informed, outcomes improve. Patients also feel more confident as they transition out of full-time rehab.
4. Step 4: Transition and Return to Work
   
   After the full-time portion of BIRP, patients typically enter a transition phase. This gives them the chance to apply what they’ve learned in their daily lives while still receiving ongoing support.
   
   Options include two days/week for three weeks (for local patients), or one full week of follow-up after time at home (for those traveling) depending on patient needs.
   
   For patients preparing to return to work, we offer Gradual Return-to-Work (GRTW) planning. This might look like:
   
   • Part-time work combined with continued therapy
   • Adjustments to workload or environment
   • Ongoing communication with providers and case managers
   
   The goal is to build up hours and reduce support gradually, so patients transition successfully—not just quickly.
   
   For referrers, meanwhile, BIRP is a strong option for injured workers who:
   
   • Are struggling to return to work due to cognitive or functional limitations
   • Have persistent symptoms following a mild or moderate brain injury
   • Need coordinated, interdisciplinary care to address complex recovery needs
   
   Our staff prides itself on case management, and outside of coordinators our medical team can support services not provided at RIW, including driving evaluations or specialty appointments. 
   
   The director also supports coordination of return to work or advancement of the claim to support a patient in maintaining gains and progressing towards engagement in meaningful activity. Referring is easy.