JCPSLP July 2014_Vol16_no2

aphasia (Brown, Worrall, Davidson & Howe, 2011); use of alternative and communication devices in early intervention (Iacono & Cameron, 2009); the perceived barriers to the implementation of evidence based practice (O’Connor & Pettigrew, 2009); and the perspectives of clinical educators and students regarding SLP training and experience in clinical placements (Hall, McFarlane & Mulholland, 2012). However, SLP perceptions of current BIRU services and future service needs have not been formally investigated. It is possible that staff perceptions are well known at a local level, and recorded and addressed via service-specific activities (e.g., business planning, service development, quality activities), but have not been investigated or reported as a whole. Identifying current practice in these areas will provide a basis for future service development, and may lead to further research in these areas. Identifying BIRU SLP needs as a whole may provide a direction for whole-of-service changes and assist in the provision of a unified approach to rehabilitation and research; it may also help support the development of SLPs working in other services which also provide rehabilitation to adults with ABI/TBI (e.g., via general or regional rehabilitation units). This study aims to identify the practice of SLPs within Australian BIRU services in regards to aspects of consumer-focused service delivery and to explore the perspectives of BIRU SLPs on the needs and future development of their services. Methods This study has ethical clearance from the Queensland Health Metro South Human Research Ethics Committee. It is part of a larger study into SLP practice in sub-acute brain injury rehabilitation. The methodology used in this paper has been previously reported (Watter et al., 2014); a summary is presented below. Participants and procedure SLPs working in Australian BIRUs were identified from phone and email contacts, professional databases and interest groups, and contacted via email and/or telephone to participate in a survey of clinical practice. Ten centres were identified across five states in Australia. These centres consisted of nine BIRUs and one inpatient rehabilitation centre that identified itself as providing significant state- wide service to adults with brain injury, and included private and publicly funded centres. SLPs from all ten services agreed to participate in the study and were sent an electronic survey. Reminder emails were utilised to maximise the response rate. SLPs from eight units (encompassing 15.1 full time equivalent SLPs) returned completed surveys and consented to participate in this research, with one response from each BIRU obtained. Responses were completed by a member of the SLP BIRU team (including clinicians and managers) and identified the practice of the BIRU SLP team, not that of individual clinicians. Surveys were completed and returned to the investigator over a four-month period (October 2011 – January 2012). Survey instrument The survey was developed to investigate the service delivery and clinical practice of BIRU SLPs, and grew from a BIRU SLP benchmarking project and quality activity. Survey design was influenced by a study into SLP practice

in inpatient rehabilitation for adults with spinal cord injury (Brougham et al., 2011), and survey questions reflected key areas of SLP service delivery from international SLP ABI/TBI documents and guidelines (ASHA, 2004; RCSLT, 2006). The survey was piloted and reviewed by 2 SLPs who were clinical experts in the area of TBI/ABI rehabilitation. This resulted in changes and clarification to the wording of two questions in the survey. Five areas were investigated via 42 questions; these were: service data and demographics; SLP therapy/ intervention services; education, advocacy and liaison; service delivery and “ideal state” of BIRU SLP services. The survey took approximately 30 minutes to complete. Service delivery and current practice of BIRU SLPs (including service data, demographics and SLP intervention services) are reported in Watter et al. (2014). The current paper further explores the data from the survey, reporting on the sections: (i) Consumer services: Advocacy, liaison and education; Family education and (ii) Service gaps and service enhancements in BIRU SLP services (“ideal state” of services), totalling 18 questions. Section (i) (14 questions) utilised a 3-point frequency rating scale (as suggested by Rattray and Jones, 2007) to rate the frequency of provision of advocacy, liaison and education services, with free text areas available for comments. The remaining four questions in section (ii) utilised free text to maximise information from participants. Data analysis Responses were collated and entered into a Microsoft Excel spreadsheet. Descriptive analysis of the collated survey data identified frequency, percentages and means; content analysis was utilised for data from open-ended questions and involved the identification and count of key themes. All results were reviewed by a second SLP to ensure accuracy and agreement. The percentage agreement initially between the two SLPs was 99.7%; after discussion of the items, 100% agreement was reached. Results Consumer services: Advocacy, liaison and patient education The role of the BIRU SLP in advocacy, liaison and education is summarised in Figure 1. Liaison with community or transition services was identified by 75% (n = 6) of BIRU SLPs as part of their regular service. Liaison with the adult guardian (87.5%, n = 7), advocacy for patients with severe communication impairment (62.5%, n = 5) and providing education/support to other SLPs on brain injury and patient management (75%, n = 6) were performed by the majority of BIRU SLPs “if required”. Informal education was a “regular service” delivered by SLPs to patients by 100% of SLPs (n = 8). Family education All BIRU SLPs (100%, n = 8) reported educating families as part of their service. This occurred formally and informally, via written and verbal methods (including telephone), and was provided by both teams and specific disciplines. SLPs provided information to families on brain injury, behaviour, cognition and communication via a range of education activities, including progress updates of patients, family forums and support groups; education of friends also occurred. Informal education was the most widely used method, delivered to families as a “regular service” (50% of SLPs, n = 4) or “as required” (50% SLPs, n = 4).

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JCPSLP Volume 16, Number 2 2014

Journal of Clinical Practice in Speech-Language Pathology