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JCPSLP
Volume 16, Number 2 2014
Journal of Clinical Practice in Speech-Language Pathology
in inpatient rehabilitation for adults with spinal cord injury
(Brougham et al., 2011), and survey questions reflected key
areas of SLP service delivery from international SLP ABI/TBI
documents and guidelines (ASHA, 2004; RCSLT, 2006).
The survey was piloted and reviewed by 2 SLPs who were
clinical experts in the area of TBI/ABI rehabilitation. This
resulted in changes and clarification to the wording of two
questions in the survey.
Five areas were investigated via 42 questions; these
were: service data and demographics; SLP therapy/
intervention services; education, advocacy and liaison;
service delivery and “ideal state” of BIRU SLP services. The
survey took approximately 30 minutes to complete.
Service delivery and current practice of BIRU SLPs
(including service data, demographics and SLP intervention
services) are reported in Watter et al. (2014). The current
paper further explores the data from the survey, reporting
on the sections: (i) Consumer services: Advocacy, liaison
and education; Family education and (ii) Service gaps and
service enhancements in BIRU SLP services (“ideal state”
of services), totalling 18 questions.
Section (i) (14 questions) utilised a 3-point frequency
rating scale (as suggested by Rattray and Jones, 2007)
to rate the frequency of provision of advocacy, liaison
and education services, with free text areas available for
comments. The remaining four questions in section (ii)
utilised free text to maximise information from participants.
Data analysis
Responses were collated and entered into a Microsoft
Excel spreadsheet. Descriptive analysis of the collated
survey data identified frequency, percentages and means;
content analysis was utilised for data from open-ended
questions and involved the identification and count of key
themes. All results were reviewed by a second SLP to
ensure accuracy and agreement. The percentage
agreement initially between the two SLPs was 99.7%; after
discussion of the items, 100% agreement was reached.
Results
Consumer services: Advocacy, liaison
and patient education
The role of the BIRU SLP in advocacy, liaison and education
is summarised in Figure 1. Liaison with community or
transition services was identified by 75% (n = 6) of BIRU
SLPs as part of their regular service. Liaison with the adult
guardian (87.5%, n = 7), advocacy for patients with severe
communication impairment (62.5%, n = 5) and providing
education/support to other SLPs on brain injury and patient
management (75%, n = 6) were performed by the majority
of BIRU SLPs “if required”. Informal education was a
“regular service” delivered by SLPs to patients by 100% of
SLPs (n = 8).
Family education
All BIRU SLPs (100%, n = 8) reported educating families as
part of their service. This occurred formally and informally,
via written and verbal methods (including telephone), and
was provided by both teams and specific disciplines. SLPs
provided information to families on brain injury, behaviour,
cognition and communication via a range of education
activities, including progress updates of patients, family
forums and support groups; education of friends also
occurred. Informal education was the most widely used
method, delivered to families as a “regular service” (50% of
SLPs, n = 4) or “as required” (50% SLPs, n = 4).
aphasia (Brown, Worrall, Davidson & Howe, 2011); use of
alternative and communication devices in early intervention
(Iacono & Cameron, 2009); the perceived barriers to the
implementation of evidence based practice (O’Connor &
Pettigrew, 2009); and the perspectives of clinical educators
and students regarding SLP training and experience in
clinical placements (Hall, McFarlane & Mulholland, 2012).
However, SLP perceptions of current BIRU services and
future service needs have not been formally investigated. It
is possible that staff perceptions are well known at a local
level, and recorded and addressed via service-specific
activities (e.g., business planning, service development,
quality activities), but have not been investigated or
reported as a whole.
Identifying current practice in these areas will provide
a basis for future service development, and may lead to
further research in these areas. Identifying BIRU SLP needs
as a whole may provide a direction for whole-of-service
changes and assist in the provision of a unified approach
to rehabilitation and research; it may also help support
the development of SLPs working in other services which
also provide rehabilitation to adults with ABI/TBI (e.g., via
general or regional rehabilitation units).
This study aims to identify the practice of SLPs
within Australian BIRU services in regards to aspects of
consumer-focused service delivery and to explore the
perspectives of BIRU SLPs on the needs and future
development of their services.
Methods
This study has ethical clearance from the Queensland
Health Metro South Human Research Ethics Committee. It
is part of a larger study into SLP practice in sub-acute brain
injury rehabilitation. The methodology used in this paper
has been previously reported (Watter et al., 2014); a
summary is presented below.
Participants and procedure
SLPs working in Australian BIRUs were identified from
phone and email contacts, professional databases and
interest groups, and contacted via email and/or telephone
to participate in a survey of clinical practice. Ten centres
were identified across five states in Australia. These centres
consisted of nine BIRUs and one inpatient rehabilitation
centre that identified itself as providing significant state-
wide service to adults with brain injury, and included private
and publicly funded centres.
SLPs from all ten services agreed to participate in the
study and were sent an electronic survey. Reminder emails
were utilised to maximise the response rate. SLPs from
eight units (encompassing 15.1 full time equivalent SLPs)
returned completed surveys and consented to participate in
this research, with one response from each BIRU obtained.
Responses were completed by a member of the SLP BIRU
team (including clinicians and managers) and identified
the practice of the BIRU SLP team, not that of individual
clinicians. Surveys were completed and returned to the
investigator over a four-month period (October 2011 –
January 2012).
Survey instrument
The survey was developed to investigate the service
delivery and clinical practice of BIRU SLPs, and grew from
a BIRU SLP benchmarking project and quality activity.
Survey design was influenced by a study into SLP practice
