1. Person-centred care and a goal directed synergistic team

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  • Person-centred care, engagement with family and enabling self-management
  • Goal directed synergistic teamwork where the team includes the person, family and carers, rehabilitation specialists, clinicians and other services.

While person-centred care is a principle in all good practice healthcare and community services, it is especially important in brain injury specialist rehabilitation as it is carries the added significance that the injury, impairments and impacts are unique to the person and their rehabilitation pathway will also be unique.

Assessment incorporates the discovery of what is important to the person (their values – valued activities, people, places and beliefs) along with the biological, psychological and social aspects of the person. Brain injury specialist rehabilitation must be informed by the person’s values when addressing the biopsychosocial aspects of care. Brain injury specialist rehabilitation is optimised when all of these aspects are addressed within a teaching and learning framework. Services and information provided must be culturally appropriate (including for Aboriginal clients and their extended families).

Families and carers are recognised as important members of the rehabilitation team and can influence rehabilitation and community outcomes when providing emotional, practical and social support.

The rehabilitation team’s teamwork draws on the strengths, skills and expertise of all members of the rehabilitation team by engaging in respectful relationships to maximise the outcomes valued by the person. By working synergistically in this way the team produces something greater than the sum of its parts. The rehabilitation team includes but is not limited to the client, their family and carers and clinicians.

Self-management is enabled through a range of mechanisms which may include the provision of education and information, peer support, the development of problem-solving skills, cognitive approaches and coaching.

Intervention is not dependent on initial injury severity, but rather on the nature and degree of disablement and impact on the person.

Person-centred care requires staff to be able to bring their own person into person-centred work with the client.

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