JCPSLP Vol 16 Issue 1 2014

of their caseload. The length of individual therapy sessions ranged from 30 to 60 minutes, with two services providing 60 minute sessions, and six services providing sessions between 30 and 45 minutes. SLPs provided between 16 and 40 individual sessions per week (per therapist). Therapy assistants/allied health assistants were available to 62.5% (n = 5) of BIRU SLP services. Discussion This paper provides information regarding SLP practice within specialised inpatient BIRUs and services in Australia, including prioritisation and intervention schedules, therapy activities and service delivery. Even though the overall number (n) of participant sites is small, the data represents 80% of Australian BIRU services at the time of the survey, and the findings give direction for future research in this field. Demographics and capacity When comparing staffing levels across the services, there is a wide variation in staffing and clinician : patient ratios, which impacts upon the ability to provide all aspects of a service. Of the eight services in the study, only one met national minimum benchmarks for staffing levels of 1.5 FTE speech-language pathologists to 10 patients (AFRM, 2011). Differences in funding and health priorities at a state and district level impact the level of development of brain injury services, and are a leading contributor to variations in staffing. Differences between actual and minimum recommended SLP staffing levels within BIRUs ranged from –0.1 to 3.35 FTE speech-language pathologists. The mean difference between actual and recommended SLP staffing was 1.39 FTE ( SD = 1.21). In addition, staffing levels reflected overall FTEs, not the grade or level of SLP clinicians working within the BIRU. Given the different roles of SLPs at different levels and the increased non-clinical responsibilities of higher graded SLPs, the reported levels of staffing may not fully represent clinician : patient ratios. Service delivery and intensity Australian SLP BIRU services provided an average therapy “session” or intervention duration of between 30 and 60 minutes; however, intensity varied. While the average duration of interventions is comparable with findings from the TBIMS study (of 35 minutes per day, including direct and indirect intervention times; Cifu et al., 2003), frequency and intensity are not. The majority of patients (91.4%) in the TBIMS study received up to 1 hour (1–60 mins) of SLP intervention each day, whereas 0–40% of the BIRU SLP caseloads were seen daily. Only 50% of Australian BIRUs were able to offer daily SLP therapy services to identified patients. BIRU SLPs identified inadequate staffing as the factor that most impacted on the ability to provide such intensive therapy services, even when utilising other service delivery models in BIRU (e.g., groups, use of allied health/ therapy assistants). While guidelines suggest intensive daily therapy should be provided to patients with communication difficulties post stroke (National Stroke Foundation, 2010), few guidelines prescribe intervention frequencies for patients with communication disorders arising from ABI/TBI (e.g., severe

identified. Individual therapy sessions were the most frequent intervention performed by SLPs, with 75% (n = 6) of services providing this daily. Joint therapy sessions with members of the multidisciplinary team (MDT) were provided by 87.5% (n = 7) of SLPs; however, this only occurred “sometimes for specific patients”. Therapy interventions involving community or functional outings were provided as a regular service by only 50% (n = 4) of BIRU SLPs. Patient led computer based therapy (for independent patients) was also utilised by all SLPs; however, frequency varied. The frequency of clinical interventions provided by BIRU SLPs is shown in Table 2. Group-based interventions Across the eight sites, SLPs offered 23 group activities with 17 different types of groups identified. Groups could be categorised into two main types: impairment/skill-based groups (13 groups overall with 9 different types of groups) and those targeting function/participation (10 groups overall with 8 different types of groups). These groups are detailed in Table 3. The majority of groups (91%, n = 21) ran weekly and were offered as needed/when suitable clients were identified; one group ran daily and one ran monthly. Four groups (17%) ran for a set timeframe (between 6 and16 weeks), and 82% of groups (n = 19) were ongoing. Therapy intensity and prioritisation Intensity of therapy provision varied between the services. SLPs reported difficulties providing daily individual interventions secondary to staffing levels, caseloads and job share demands. One respondent commented “we provide patients with what they need, based also on what time we have available” (site F). Sites identified an “aim” to provide daily therapy services for selected clients, and difficulties delivering this (site G). Five sites (62.5%) identified a set frequency of service delivery for different patient groups, with treatment or intervention schedules dependent upon diagnosis and severity. Three sites (37.5%) reported no use of set treatment or intervention schedules, determining therapy frequency on factors including patient goals, patient needs and presentation, and ability to participate in rehabilitation. These services offered between two and five therapy sessions per week to patients. The “maximum” intensive individual therapy service able to be offered by BIRU SLPs was daily/five sessions per week (50% of sites; n = 4), four sessions per week (37.4% of sites, n = 3) and three sessions per week (23.5% of sites; n = 1). Patient groups identified by SLPs as receiving intensive therapy services included those with severe communication deficits, severe cognitive-communication deficits, aphasia, motor speech disorders and dysphagia. Patients with high level language, cognitive-language or cognitive-communication disorders were identified by 62.5% (n = 5) of SLPs as receiving lower intensity services, with individual therapy sessions provided between one and three times per week ( M = 2.6, SD = 0.65). Service delivery to this group also included group therapy and/or self- directed therapy tasks. BIRU SLPs reported up to 40% of their caseload received daily therapy (range = 0–40%). Two services provided daily therapy to 40% of their caseload, the remaining six services provided daily therapy for 0 to 25%

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JCPSLP Volume 16, Number 1 2014

Journal of Clinical Practice in Speech-Language Pathology