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JCPSLP
Volume 16, Number 1 2014
Journal of Clinical Practice in Speech-Language Pathology
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%
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
