JCPSLP July 2014_Vol16_no2

in the literature (Eames et al., 2010; Leith et al., 2004; O’Callaghan et al., 2011). In O’Callaghan et al.’s study (2011), the majority of carers / family members reported positive satisfaction with education during inpatient rehabilitation, with 74.3% reporting receiving adequate general information, and 72.6% reporting receiving adequate information regarding the progress of their family member. In Leith et al.’s (2004) and Eames et al.’s (2010) studies, a range of similar themes was identified; however, there was diversity in the responses of consumers within each study. Identified themes included information provision and education regarding TBI/ABI (too much, not enough, use of jargon, too general); education on external services and availability (not enough); timing and presentation of information (too early, too late, overwhelming); client-centred factors (poor recall of information, poor comprehension of information). Other factors impacting the perspectives of consumers included the hospital environment, with issues identified including staffing and access (reduced staffing impacting availability for education, changes in staffing impacting education provision, difficulties accessing resources) (Leith et al., 2004; Eames et al., 2010). The variations in consumers’ perspectives regarding their education needs may reflect differences between specific services (e.g., in staffing, availability of resources, individual service provision of clinicians) as well as individual differences of consumers within the rehabilitation process. Additionally, difficulties are seen in the uptake and utilisation of educational information by families during this time (Paterson, Kieloch & Gmiterek, 2001). Gan, Gargaro, Brandy, Gerber and Boschen (2010) suggest that during inpatient rehabilitation, families are dealing with major life changes including the long-term challenge of having a family member with ABI, which may impact their ability to take in and utilise information. This may help explain the differences reported between the education provided by health professionals and families’ perceptions of that education/information (regarding content, type and amount of education provided) (Paterson et al., 2001). The frequency and types of education delivered by BIRU SLPs to consumers and how this compares with patient/family perceptions reported in the literature is currently unknown. SLPs’ service perceptions While research increasingly investigates the perspectives and experiences of consumers accessing ABI/TBI rehabilitation, there is minimal published information relating to allied health perceptions of service in sub-acute ABI/TBI rehabilitation. One general community-based study investigated consumer and allied health staff perspectives of health services in regional Victoria (Rowan, 1998). Both groups identified similar issues (including access, social issues, service delivery and local context issues). However, consumer perspectives focused mainly on outcomes and broader social issues, while staff perspectives emphasised a service delivery context. There has been no research to date examining whether staff perspectives and consumer perspectives of BIRU SLP services (e.g., in regards to education and involvement of families in rehabilitation) are consistent. Within the profession, researchers have investigated the perceptions of SLPs regarding clinical services across a range of disorders and service environments including knowledge of TBI in paediatric SLP services (Hux, Walker & Sanger, 1996); intervention practices for people with

patient dependent”, “often” and “everyday” was utilised. The majority of services (62.5%, n = 5) provided therapy interventions with “active involvement” of family members, “sometimes – patient dependent” with only 37.5% (n = 3) providing this “often”. No services reported working with families as an “everyday” clinical activity. SLP services reported that staffing impacted on overall service delivery, with SLP staffing levels below Australasian Faculty of Rehabilitation Medicine (AFRM) guidelines (2011) in 87.5% (n = 7) of services surveyed. Issues specific to the population and nature of BIRU services further impact upon family involvement with SLPs (e.g., for education or to participate in interventions), including families’ ability to attend the service and the availability of staff. BIRU services are based in metropolitan areas and cater to a large geographical region (e.g., a state- wide service). As the prevalence rate for ABI in Australia is higher for people living outside major cities (2.2%) than for those living in major cities (1.6%; O’Rance & Fortune, 2007), many patients attending BIRU are from a different geographical area, impacting the ability of families to attend the hospital throughout the rehabilitation period. In addition, given that the “typical” TBI population is young (under 30) and male (Katz, Zasler & Zafonte, 2007), their families and partners tend to be of working age / in the workforce and may have difficulties attending the hospital within working hours. Families have identified difficulties accessing allied health staff in BIRU during working hours as a barrier (Fleming et al., 2012). Education provision in inpatient ABI/TBI rehabilitation Uncertainty regarding the future is a key concern reported by people with TBI and their families (Lefebvre, Pelchat, Swaine, Gelinas & Levert, 2005). Overall, families of patients in BIRU want more education, particularly regarding injury, disability, realistic status, prognosis and treatment (Fleming et al., 2012; Lefebvre et al., 2005; Rotondi, Sinkule, Balzer, Harris & Moldovan, 2007), and knowledge on how to access information, education and other services (Leith, Phillips & Sample, 2004). Providing education during inpatient rehabilitation should also assist in addressing other needs reported by clients and families with ABI/TBI. It should empower patients and families, assist in adjustment to changes following injury, provide support during the rehabilitation process and help aid upcoming transitions home (Cott, 2004; Eames, Hoffmann, Worrall & Read, 2010; Fleming et al., 2012; Lefebvre et al., 2005; Rotondi et al., 2007). Education can also impact patient functioning and lead to better health outcomes. In a preliminary study investigating individualised patient education during TBI rehabilitation, positive changes were demonstrated in patient effort, cognitive function and patient satisfaction (Pegg, Auerback, Seel, Buenaver, Kiesler & Plybon, 2005). The perspectives of people with ABI/TBI and their family members/caregivers regarding their education and support needs during inpatient rehabilitation have been investigated, utilising a range of processes including semi-structured interviews (Eames et al., 2010; Rotondi et al., 2007), focus groups (Leith et al., 2004) and surveys (O’Callaghan, McAllister & Wilson, 2011). Consumers’ views regarding education and information provision by health professionals during sub-acute ABI/ TBI rehabilitation varies widely, with both high and low levels of satisfaction and education provision reported

Anna Copley (top) and Emma Finch

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JCPSLP Volume 16, Number 2 2014

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