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within SLP ABI/TBI rehabilitation and BIRU service provision (AFRM, 2011; ASHA, 2004; RCSLT, 2006). Differences likely reflect the clinical practice of meeting local demands, individual services differences and availability of other services (e.g., following discharge). This was illustrated by one site which reported specific liaison services (regarding study and work) were “usually followed up by the community team”. Patient education Best practice guidelines (ASHA, 2004; RCSLT, 2006) advocate education as key component of ABI/TBI SLP services; however they do not specify the frequency, amount or type of education that should be provided. All BIRU SLPs (n = 8, 100%) reported educating patients as a “regular” service, with informal education the most popular method. While definitions of education methods (formal versus informal) were not provided to participants in the survey, a general clinical interpretation of this was anticipated by SLPs working within a specific health rehabilitation setting, and clarification was not sought by respondents. While we cannot guarantee uniform interpretation by SLPs, it appears that SLPs are broadly providing patient education services that address current best practice guidelines. Given the range of cognitive and communication difficulties patients can experience during this phase of their rehabilitation, including difficulties learning and retaining new information and changes to insight (Ponsford, 2012), providing “formalised” education at this point in time may not be as appropriate as providing patients with information and education that is informal and in a context of regular clinical interactions. Pegg and colleagues (2005) demonstrated that providing individualised education during TBI rehabilitation has a positive impact on rehabilitation; SLPs appear to be matching service provision to meet the needs of the consumer group. Family education Providing education to families of individuals with ABI/TBI is reported to be a key component of the SLP’s role in ABI/ TBI rehabilitation (ASHA, 2004; RCSLT, 2006; National Stroke Foundation, 2010). However, according to the results of the current study, it appears that services may not be meeting this aspect of best practice. While all SLPs provided education to families, differences were seen in frequency and types of education provided. Only 50% (n = 4) reported providing informal education as a “regular” service; formal education was provided “regularly” by 37.5% (n = 3). SLPs identified that formal family education programs regarding ABI/TBI occur within BIRUs; however these may not regularly involve SLPs. Further, when identifying service gaps and “ideal” BIRU SLP services, only 25% of SLPs surveyed (n = 2) identified improving services by involving families (including better access to families, providing increased education and better family involvement in therapy). There appears to be a discrepancy between best practice recommendations, service provision and service perception; however, the reasons are unknown. Potential reasons may reflect SLP survey responses that families are receiving education from other sources (e.g., via team processes); families may not be available regularly to SLPs or requesting education; families may have already received education in the acute setting.

Table 3. Other BIRU SLP services in an “Ideal setting”

Work practice

BIRU SLPs

Suggested activities

SLP therapy services

25% Computer use retraining

Formal vocational specific training Better family involvement in therapy

Team/clinic services

37.5% Increased community rehabilitation Increased transition services Concussion clinics Rapid multidisciplinary outpatient clinics Follow up reviews Formal vocational specific training Transition programs

Education

25% Education of friends

Increased family education Increased formal support groups for families/patients

Research

25% Not specified

Professional issues

12.5% Supporting regional clinicians Increased quality projects Increased taking students

Advocacy

12.5% Consultation re: decision-making ability Supporting patients in the legal system

Not applicable to service

12.5% Nil

services (50%) did not identify any gaps in their current service or identify ideas for enhancement of their current service; one service did not respond to the question (12.5%). Of the three sites that reported gaps or service enhancement ideas, four key areas for service improvement were identified (see Table 1): service delivery (n = 3), therapy services/interventions (n = 3), services to families (n = 2) and education/support (n = 2). BIRU SLPs were asked to comment on (a) how they would utilise additional SLP services (i.e., one full-time SLP), and (b) other services they thought BIRU SLPs should provide in an “ideal setting”. The majority of SLPs (87.5%, n = 7) responded to each of these questions, with one team reporting that (a) was not required and that (b) was not applicable. Responses are reported in Table 2 and Table 3. Discussion The present study investigated the clinical practice of BIRU SLPs in regards to providing specific aspects of consumer- focused services (including advocacy, liaison and education) and explored SLPs’ perspectives on the needs and future

development of their services. Advocacy and liaison

SLPs reported performing a variety of liaison and advocacy roles for consumers, including providing education and support to other professionals, liaising with external services and advocating for patients (with families, within teams and with other services). These services reflect core practice

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JCPSLP Volume 16, Number 2 2014

Journal of Clinical Practice in Speech-Language Pathology