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Barriers and solutions to providing consumer-focused services Reduced involvement of families with BIRU SLPs (e.g., in clinical interventions and in the provision of education) may result from a variety of factors. These include geographical considerations for family access, availability of working families to attend services within regular hours, the capacity of the service and service demands. Families have identified difficulties accessing allied health staff in BIRU during working hours (Fleming et al., 2012); the SLPs surveyed currently provide services only within regular working hours. For services with reduced staffing levels, providing education to families may be a lower clinical priority than providing therapy services to patients. This was demonstrated by one site which reported, “we offer limited services to families of patients as most of our resourcing is allocated to direct patient intervention”. Alternatively, it may be that SLPs are underestimating their service provision. In the survey, SLPs identified they provided education and liaison to families via regular team-based activities with families, including family meetings, information and planning meetings, family forums and via the phone. SLPs are likely providing education to families not as a stand-alone activity or via specific interventions, but as part of other regular service provision. To improve family access to SLP services, SLPs may need to consider the use of more creative, flexible service delivery models (e.g., extended hours of service, telehealth), and involve the broader allied health team. Teams need to employ consumer-centred approaches in order to provide best practice and achieve optimal client gains. Empowerment of consumers should drive the mode of intervention, and requires flexibility of practice and thinking, as well as use of emerging technologies such as telehealth to engage remotely located or otherwise unavailable families of clients. Service gaps and enhancements While only a small number of services identified “gaps” in their current service provision (37.5%, n = 3), 87.5% of services (n = 7) identified areas for service improvement via increased staffing and in providing “ideal services”. Most services (87.5%, n = 7) identified positive changes to patient services with increased staffing (e.g., increased therapy services, increased intensity), 50% of services (n = 4) identified changes to service delivery/team-based services with increased staffing. This is unsurprising, as many services had previously identified difficulties in providing intensive therapy services to certain patient groups, given reduced SLP staffing levels in BIRU (in Watter et al., 2014). Changes to current practice suggested by respondents to provide an “ideal” service involved team-based services, SLP-specific interventions/services, research activities and education. Many of these suggestions reflect variations in BIRU services and services available for patients following discharge (e.g., increased community/transition services, follow-up services). They also demonstrate the need for expanded brain injury services in growing fields (e.g., concussion clinics) and consumer-focused services (e.g., rapid response clinics). The range of responses outside of “traditional” SLP services demonstrates the holistic and team-focused nature of BIRU SLP rehabilitation. Differences between reported service delivery and staff perceptions may reflect personal perspectives of service

provision. While there seems to be a discrepancy between the perception of a service versus the reality of service provision, the impact of staff perception of providing a good service within the resources available needs to be considered. As one site reported, even though their staffing was below recommended levels (“we have about half staffing suggested by AFRM”), they were positive about the service they provided: “we do an amazing job”. Limitations Limitations of this study have previously been reported (Watter et al., 2014) and include small sample size, as there are only a small number of BIRU services within Australia; uncertainty regarding the level of collaboration for responses on the team-based survey; and service differences impacting service delivery and service needs, including changing staffing levels, cover for extended leave and changing models of care. Investigations into BIRU services in Australia will always be constrained by the small number of services; however, the response rate of 80% of services should ensure a comprehensive representation of existing services. The small number of services also prevents formal statistical analysis, impacting results and types of conclusions that can be drawn from the data. Conclusion This paper provides a preliminary investigation into the clinical practice of BIRU SLPs in providing specific aspects of consumer-focused services, as well as their perceptions of their service and future service needs. Similarities were found across BIRU services in many areas of consumer- focused service provision, including the use of informal education methods and liaison services; differences were seen in regularity of education provision and service perceptions of SLPs. Factors influencing consumer-focused service delivery included service differences, factors specific to BIRU state-wide services and SLP service perceptions. Differences in perceived service gaps and “ideal” services may be linked to different service delivery models and access to other brain injury services following discharge, as well as staff perceptions of their service. Given the findings, further investigation into SLP consumer-focused services and their perceptions of services are warranted; with future research directions including comparisons between SLP and consumer perspectives, investigations into “best practice” education provision for consumers in ABI/TBI (regarding frequency, types, amount), and whole-of-service development opportunities. Acknowledgements The authors would like to thank the BIRU SLPs from facilities across Australia for their participation in this study and for sharing their valuable time, and staff from the Speech Pathology Department, Princess Alexandra Hospital and Centre for Functioning and Health Research for their support with this project. References American Speech-Language-Hearing Association. (2004). Preferred practice patterns for the profession of speech- language pathology . Retrieved from http://www.asha.org/ docs/html/pp2004-00191.html American Speech-Language-Hearing Association. (n.d.a). Traumatic brain injury: Benefits of speech-language pathology services . Retrieved from http://www.asha.org/ public/speech/disorders/TBIslpBenefits.htm

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JCPSLP Volume 16, Number 2 2014

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