JCPSLP July 2014_Vol16_no2

Policy and practice

Consumer-focused practice and service perceptions in brain injury rehabilitation units Kerrin Watter, Paula Addis, Anna Copley and Emma Finch

The present study investigated the service provision of speech-language pathologists (SLPs) working in brain injury rehabilitation units (BIRUs), including aspects of consumer- focused service delivery. Currently, there is little published research within SLP BIRU services regarding consumer-focused service delivery models (including client and family education and services to families) and SLP perceptions of services. These areas were investigated via team-based surveys, with SLP teams from eight Australian BIRUs participating. Similarities were found across services in liaison services and methods of education, while differences were evident in regularity of education provision and SLP service perceptions. Consumer-focused service delivery was influenced by service differences (including staffing), the characteristics of BIRU state-wide services and SLPs’ perceptions of services. Barriers and potential solutions to providing increased consumer-focused services in BIRU are presented. Introduction The importance of the role of consumers (i.e., patients, family and carers) in health care is increasingly recognised in Australia. “Ideal” health care provides a people/family- centred service and involves families and carers to assist clients to achieve their maximum potential (National Health and Hospitals Reform Commission, 2009). It also maximises consumer involvement and is responsive to meeting consumers’ needs (Australian Commission on Safety and Quality in Health Care, 2011). Consumer-centred care is recognised as a specific aspect of quality health care, leading to improvements in the quality and outcomes of care, with key principles including dignity and respect, participation in decision- making, communication and collaboration regarding services (Australian Commission on Safety and Quality in Health Care, 2013). Involving families in the rehabilitation process is an important aspect of brain injury rehabilitation (American

Speech-Language-Hearing Association [ASHA], n.d.a; Fleming, Sampson, Cornwell, Turner & Griffin, 2012; MacDonald & Wiseman-Hakes, 2010; Royal College of Physicians and British Society of Rehabilitation Medicine, 2003). Patients have identified that involving their families and peers in rehabilitation, and providing them with education and support is a key component of client-centred rehabilitation (Cott, 2004). Best practice recommendations for delivering consumer- focused speech-language pathology (SLP) services in acquired brain injury (ABI)/traumatic brain injury (TBI) rehabilitation include working with families and carers, and providing education and context-specific services (ASHA, 2004; ASHA, n.d.a; ASHA, n.d.b; Katz et al., 2002; Royal College of Speech Language Therapists [RCSLT], 2006; Ylvisaker, Hanks & Johnson-Greene, 2003). Consumer- focused interventions include communication partner training, skills training, empowering clients and families (MacDonald & Wiseman-Hakes, 2010). Given the range of communication impairments that can arise following ABI/ TBI and the resulting changes to activity and participation, working with clients and their families aims to maximise communication skills and resulting community integration and participation for people with ABI/TBI. It is unknown, however, how SLPs working in specialised sub-acute ABI/TBI rehabilitation (i.e., a brain injury rehabilitation unit [BIRU]) provide consumer-focused services and what influences their practice. Working with families Fleming et al. (2012) investigated the experience of patients and their caregivers/families within a metropolitan BIRU prior to their discharge from the unit (i.e., in the final week of inpatient rehabilitation) via semi-structured interviews. They identified that families of patients in BIRU want increased contact with therapists and increased involvement in therapy activities. Kreutzer, Gervasio and Camplair (1994) examined the psychological functioning of caregivers of adults with TBI, recommending they should have an increased role in rehabilitation, with increased support and participation within the rehabilitation process. A recent study investigating SLP service delivery in Australian BIRUs found varying involvement of families in SLP interventions (Watter, Addis, Copley & Finch, 2014). BIRU SLPs were asked to rate their intervention frequency across a range of interventions, including “family therapy sessions (active family involvement)”. A 5-point descriptive rating scale of “never”, “rarely”, “sometimes –

KEYWORDS BRAIN INJURY CONSUMER SERVICE DELIVERY SPEECH PATHOLOGY SUB-ACUTE REHABILITATION THIS ARTICLE HAS BEEN PEER- REVIEWED

Kerrin Watter (top) and Paula Addis

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JCPSLP Volume 16, Number 2 2014

Journal of Clinical Practice in Speech-Language Pathology