JCPSLP
Volume 16, Number 2 2014
55
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
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
