54
JCPSLP
Volume 16, Number 2 2014
Journal of Clinical Practice in Speech-Language Pathology
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.
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
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
