The Clinical Practice of a Community Rehabilitation Team for People with Acquired Brain Injury

Abstract

The aim of this study was to examine the clinical practice of a community team that is one component of the statewide, government-funded, specialist Brain Injury Rehabilitation Program for New South Wales, Australia. The 467 clients served by the community team of the Brain Injury Rehabilitation Service at Liverpool Hospital, Sydney during the calendar year 2000 were identified and their use of clinical services described. A random sample of 50 clients from this group was studied in further detail, with specific reference to the type of therapy interventions they received. This was compared with the therapy interventions received 2 years later, in 2002. A total of 8046 occasions of service (OoS) were recorded for the 467 clients during 2000, with a median number of 8 OoS per client. All disciplines contributed to this number, with case managers providing the largest number of OoS (n = 2734). Between 65–75% of clients attended medical clinics and received services from case managers, with between 15–30% of clients receiving services from allied health disciplines. The random sample received a median of 9 OoS during 2000, and a median of 3 therapy interventions per client. Therapy interventions pertaining to living skills were addressed in 66% of the group, interpersonal relationships in 54%, and occupational activity in 44%. Although the community team continued to provide a comparable number of OoS in 2000 and 2002, 56% of the random sample had been discharged by 2002. There were significant group differences between those who were discharged and those who remained in the service. Additionally, for those who remained in the service, there was a significant reduction of OoS and therapy interventions between 2000 and 2002. The data were used to draw together a model of clinical practice of the community team.