The brain injury specialist rehabilitation settings pathway goes from the point of injury to the client being back in the community. The pathway includes:
- acute hospital care and rehabilitation
- in-patient rehabilitation
- transitioning to community living
- living in the community.
This pathway is unique for each person and typically includes health and community services. The pathway is influenced by age at injury, age of client, life stage, e.g. younger – school return; older – work return.
The exact service pathway will vary from person to person and will vary from child to adult services.
This is a pathway through settings and services. The availability of services and settings also impacts on the particular pathway for the individual.
Figure 3: Settings and services pathway
Life before the injury
Getting immediate help
Ambulance, emergency department
Hospital intensive care unit
Hospital rehabilitation, transitional living
Brain injury or general rehabilitation unit
Assessments, care planning, funding management, case management
Back into the community
Living in community
Support services, case management
Continuing to re-learn
In the community with rehabilitation
Supported accommodation, outpatient services, case management, work continuing
Discharged from the community team
Living in the community
In community for life
Community services, case management, schools, workplaces, therapy services
For many people, case management is the process that weaves all the threads together through services and settings.
For children, a typical service pathway may also include transition from children’s to adult services. Children’s services also include rehabilitation for schooling and education.
In the community the person could be living independently in their own home, alternatively they could require supports to live in their home and access the community and community services.
A typical setting and services pathway for severe brain injury
- The injury event
- Emergency services, possibly including retrieval
- Hospital acute care, possibly including the intensive care unit and surgery
- Hospital rehabilitation
- Transitional care, possibly including the Transitional Living Programs
- Discharge planning and discharge to the community
- Living in the community, often with ongoing rehabilitation and out-patient services
- Vocational rehabilitation, where applicable.