Policy and practice
50
JCPSLP
Volume 16, Number 2 2014
Journal of Clinical Practice in Speech-Language Pathology
KEYWORDS
BRAIN INJURY
CONSUMER
SERVICE
DELIVERY
SPEECH
PATHOLOGY
SUB-ACUTE
REHABILITATION
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
Kerrin Watter
(top) and
Paula Addis
Speech-Language-Hearing Association [ASHA], n.d.a;
Fleming, Sampson, Cornwell, Turner & Griffin, 2012;
MacDonald & Wiseman-Hakes, 2010; Royal College of
Physicians and British Society of Rehabilitation Medicine,
2003). Patients have identified that involving their families
and peers in rehabilitation, and providing them with
education and support is a key component of client-centred
rehabilitation (Cott, 2004).
Best practice recommendations for delivering consumer-
focused speech-language pathology (SLP) services in
acquired brain injury (ABI)/traumatic brain injury (TBI)
rehabilitation include working with families and carers, and
providing education and context-specific services (ASHA,
2004; ASHA, n.d.a; ASHA, n.d.b; Katz et al., 2002; Royal
College of Speech Language Therapists [RCSLT], 2006;
Ylvisaker, Hanks & Johnson-Greene, 2003). Consumer-
focused interventions include communication partner
training, skills training, empowering clients and families
(MacDonald & Wiseman-Hakes, 2010). Given the range of
communication impairments that can arise following ABI/
TBI and the resulting changes to activity and participation,
working with clients and their families aims to maximise
communication skills and resulting community integration
and participation for people with ABI/TBI.
It is unknown, however, how SLPs working in specialised
sub-acute ABI/TBI rehabilitation (i.e., a brain injury
rehabilitation unit [BIRU]) provide consumer-focused
services and what influences their practice.
Working with families
Fleming et al. (2012) investigated the experience of patients
and their caregivers/families within a metropolitan BIRU
prior to their discharge from the unit (i.e., in the final week of
inpatient rehabilitation) via semi-structured interviews. They
identified that families of patients in BIRU want increased
contact with therapists and increased involvement in
therapy activities. Kreutzer, Gervasio and Camplair (1994)
examined the psychological functioning of caregivers of
adults with TBI, recommending they should have an
increased role in rehabilitation, with increased support and
participation within the rehabilitation process.
A recent study investigating SLP service delivery in
Australian BIRUs found varying involvement of families
in SLP interventions (Watter, Addis, Copley & Finch,
2014). BIRU SLPs were asked to rate their intervention
frequency across a range of interventions, including “family
therapy sessions (active family involvement)”. A 5-point
descriptive rating scale of “never”, “rarely”, “sometimes –
The present study investigated the service
provision of speech-language pathologists
(SLPs) working in brain injury rehabilitation
units (BIRUs), including aspects of consumer-
focused service delivery. Currently, there is
little published research within SLP BIRU
services regarding consumer-focused service
delivery models (including client and family
education and services to families) and SLP
perceptions of services. These areas were
investigated via team-based surveys, with SLP
teams from eight Australian BIRUs participating.
Similarities were found across services in
liaison services and methods of education,
while differences were evident in regularity
of education provision and SLP service
perceptions. Consumer-focused service
delivery was influenced by service differences
(including staffing), the characteristics of BIRU
state-wide services and SLPs’ perceptions of
services. Barriers and potential solutions to
providing increased consumer-focused
services in BIRU are presented.
Introduction
The importance of the role of consumers (i.e., patients,
family and carers) in health care is increasingly recognised
in Australia. “Ideal” health care provides a people/family-
centred service and involves families and carers to assist
clients to achieve their maximum potential (National Health
and Hospitals Reform Commission, 2009). It also
maximises consumer involvement and is responsive to
meeting consumers’ needs (Australian Commission on
Safety and Quality in Health Care, 2011).
Consumer-centred care is recognised as a specific
aspect of quality health care, leading to improvements
in the quality and outcomes of care, with key principles
including dignity and respect, participation in decision-
making, communication and collaboration regarding
services (Australian Commission on Safety and Quality in
Health Care, 2013).
Involving families in the rehabilitation process is an
important aspect of brain injury rehabilitation (American
Consumer-focused practice
and service perceptions in
brain injury rehabilitation
units
Kerrin Watter, Paula Addis, Anna Copley and Emma Finch
