Appendix 2. Developing conceptual frameworks and supporting evidence

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This Appendix outlines the process, conceptual frameworks and evidence used to develop this document.

Project committee

A project committee was established in June 2018 and continued to June 2019.

The committee oversighted the process for developing and drafting Understanding Brain Injury Specialist Rehabilitation in NSW and the associated Practice Checklist.

The committee worked on:

  • reviewing the work to date within the ACI more widely and the Brain Injury Rehabilitation Directorate in particular that was relevant to brain injury rehabilitation
  • developing conceptual frameworks for understanding brain injury specialist rehabilitation in NSW
  • identifying stakeholders for consultation
  • reviewing draft documents.

Committee members

  • Anita J. Barbara, Manager, New England Brain Injury Rehabilitation Service
    and Rural Spinal Cord Injury Service (Northern Region)
  • Marion Fisher, Outcomes Manager, ACI, Brain Injury Rehabilitation Directorate
  • Karen A. Height, Service Manager HNE Kids Rehab
  • Adeline Hodgkinson, Director Brain Injury Rehabilitation Unit, Liverpool Hospital
  • Nick Rushworth, Executive Officer, Brain Injury Australia
  • Barbara Strettles, ACI Network Manager, Brain Injury Rehabilitation Directorate.

Conceptual frameworks and evidence

The process for developing the conceptual frameworks and supporting evidence included:

  • reviewing existing NSW Health and ACI publications
  • developing initial conceptual frameworks
  • consultations with practitioners and iterative redevelopment of conceptual frameworks
  • an agreed conceptual framework
  • a literature search on aspects of the frameworks including specific issues such as values, principles, workforce, case management, challenging behaviours, paediatrics, family-centred care and TBI rehabilitation standards.

Sources and types of literature and evidence

The types of literature that were used in developing the conceptual frameworks and identifying relevant evidence.

  • Australian Professional bodies including The Australasian Faculty of Rehabilitation Medicine
  • Australian bodies that set some relevant guidelines or standards such as National Health and Medical Research Council
  • International professional bodies working on setting standards for brain injury rehabilitation, for settings similar to Australia e.g. Ontario Neurotrauma Foundation and the Institut national d’excellence en santé et en services sociaux (INESSS)
  • ACI studies undertaken to address specific issues such as the challenging behaviours projects 30,31
  • Other existing policy documents within NSW Health and health services, e.g. NSW Health (2017) NSW Health guide to the Role Delineation of Clinical Services 50
  • Other literature references including family centred care15
  • Information unique to NSW including the BIRD Network and adult and paediatric eligibility criteria.

Developing possible frameworks for documentation using core concepts

The initial conceptual framework for consultations was based on service planning and evaluation concepts including values, principles, service processes, pathways, standards and indicators and was additionally informed by conceptual frameworks being used in the ACI. The initial conceptual framework included the following.

Part A. Traumatic brain injury (TBI) and rehabilitation

Part B. Client pathways and brain injury rehabilitation

Part C. Brain injury rehabilitation: inputs to impacts consistent with values and principles

Part D. BIRP in NSW pathways, settings, processes and networking

Part E. Standards and indicators.

Consultations with practitioners and iterative redevelopment of conceptual frameworks

Drafts based on this initial framework were discussed face-to-face and in phone consultations with practitioners including:

  • project committee members
  • Royal Rehab
  • Northern Brain Injury Rehabilitation Service and Northern NSW Rural Spinal Cord Injury Service
  • Hunter Brain Injury Service
  • Brain Injury Rehabilitation Service, Westmead Hospital
  • South West Brain Injury Rehabilitation Service
  • BIRD directors and managers meeting.

Arriving at refined conceptual frameworks

Following these consultations an overarching conceptual framework was agreed for Understanding Brain Injury Specialist Rehabilitation in NSW and included the structure of the current document.

Part A: Brain injury and specialist rehabilitation

Part B: Brain injury specialist rehabilitation values, principles, pathways and core activities

Part C: NSW local health districts and speciality networks

Part D: Brain injury rehabilitation programs (BIRPs)

Part E: Settings and pathways: the continuum of care

Part F: Paying for and providing services in the community.

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