Principles are fundamental truths or propositions that serve as the foundation for a system of belief or behaviour, or for a chain of reasoning.
Principles outlined here are the foundational propositions for effective brain injury specialist rehabilitation.
There are other principles that also create the necessary foundations on which brain injury specialist rehabilitation can sit, for example evidence-based practice and quality improvement. These are embedded in the organisational and state network foundations.
Some of the principles apply to other services as well, e.g. person-centred care, engaging with families and carers, goal directed, however they are listed here because they are particularly relevant to brain injury specialist rehabilitation and have a direct connection to the nature of brain injury and brain injury specialist rehabilitation.
The 17 principles listed below are the propositions that combine to build effective brain injury specialist rehabilitation.
1. Equitable, timely and culturally appropriate access
Equitable, timely and culturally appropriate access to care, services and equipment that people require, as close to where they live as possible.
This principle is important because in NSW, brain injury specialist rehabilitation is a statewide program and not every part of what is required for rehabilitation is in each location. There is therefore a need to balance local decision-making with statewide network needs to achieve this principle. It is also important that local services have relevant collaborative relationships with other parts of the network to ensure the quality of the local services.
The person is at the centre of planning and delivery of services.
The outcomes, service delivery and funding pathways are matched with this unique person and their needs.
Services are flexible and respond to changing rehabilitation needs.
The intervention is not dependent on initial injury severity but rather on the nature and degree of disablement and the impact on the person.
This principle requires staff to be able to bring their own person into person-centred work with the client.
3. Facilitative and supportive environments
The environment must be appropriate to meet the cognitive, behavioural and physical needs of people and their learning and rehabilitation needs. This will require adapted hospital wards, transitional environments and real-life environments and situations.
4. Enabling life in and with community
The person is seen as part of a social network which may include family, friends, the neighbourhood and community.
5. Enabling self-management
Enabling self-management maximises the health and wellbeing of the person. 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.
6. Engaging with and supporting families and carers
Families are recognised as important members of the rehabilitation team and can influence rehabilitation and community outcomes when providing emotional, practical and social support.
Families are provided with education and support to maximise client outcomes and sustain positive family relationships.
7. Family-centred care when working with children with a brain injury 15
Family-centred care is critically important in providing healthcare to children with serious medical conditions.
In the family-centred care of children, the client and their family members are fully involved with healthcare providers to make informed decisions about the healthcare and support services the child and family receive.
8. Engaging and coordinating with the community
The rehabilitation process engages and coordinates across health, disability, education, community and other services.
9. Collaboratively goal directed (to maximise independence)
The rehabilitation process is goal directed. The goals are identified collaboratively with the person at the centre. During rehabilitation improvement is focussed to achieve new goals.
The focus while living in the community is to maintain goals (and prevent deterioration) while achieving new goals as life changes and transitions happen and new needs and goals emerge.
10. Working constructively with challenging behaviours 30,31
Many people with brain injury have challenging behaviours at some time during rehabilitation. The most common challenging behaviours are inappropriate social behaviour, verbal aggression and adynamia (lack of get up and go). Many people with severe brain injury display more than one type of challenging behaviour.
The team require positive behaviour support skills to work constructively with clients with behaviour changes following trauma.
There is access to specialised team members who manage challenging behaviours through social participation.
11. Manage life and service transitions well
It is important that hospital to community, hospital to school, inpatient to ambulatory and child to adult service transitions are well-planned and coordinated.
Life transitions including primary school to secondary school, not working to working, working to studying, single to married, parenting roles, etc. are managed well and allow the person to reconnect with rehabilitation services when necessary.
It is imperative that transitions from children's services to adult services are based on transition principles.
12. Case management 34
Case management is a principle because of the individual nature of each person’s rehabilitation process and the complexity of combining this with services and funding while engaging with the family and carers and dealing with all of the unique individual, family and social impacts.
The intensity of case management changes in response to what is happening in rehabilitation and within the context of the life of the person and their significant others.
Case management is provided in a flexible manner and the duration of intervention is based on continuing need rather than having a pre-determined time-limited program.
13. Individualised multidisciplinary rehabilitation
People and their families and carers receive individualised multidisciplinary rehabilitation that develops their skills and participation.
14. Therapeutic interventions promoting recovery, adaptation, compensation and prevention
Rehabilitation care is optimised when the full range of treatment approaches are considered for every client. This includes therapeutic interventions promoting recovery, adaptation, compensation and prevention.
15. People with brain injury, families and carers are engaged in the improvement of brain injury specialist rehabilitation services
It is particularly important to note the additional effort and skill that is required to ensure that this happens in a brain injury specialist rehabilitation setting.
16. Leadership in brain injury specialist rehabilitation
Leadership is displayed at all levels providing a strategic and operational direction, a sense of team and a commitment to the principles of brain injury specialist rehabilitation.
17. Advocacy for improvement and reform
Brain injury specialist rehabilitation services work with people in health and community settings. The rehabilitation process often involves other services and settings. Services also work within wider policy contexts.
Getting the best outcomes in brain injury specialist rehabilitation involves advocating both in relation to particular services and settings and also within a wider policy and services context.