Adult BIRPs provide services for clients fulfilling the following primary criteria.
- The client has suffered a brain injury appropriate for brain injury specialist rehabilitation.
- The client is aged 16-65 years.
- The client, or significant others, lives in the area covered by the BIRP or, particularly for adult inpatient services, the area of the state covered by each metropolitan BIRP.
Adult inpatient BIRPs provide consultation and support services when clients are in the acute care setting waiting for transfer, not yet ready for rehabilitation and not in need of specialist inpatient rehabilitation.
The core components in the continuum of services for the adult BIRP network of services are:
- acute admission
- inpatient rehabilitation
- transitional rehabilitation
- community-based rehabilitation including outpatient rehabilitation
- discharge.
There are many pathways through these core components. See Part E: Settings and pathways: the continuum of care.
Inpatient rehabilitation
Inpatient rehabilitation in a specialised brain injury rehabilitation unit involves dedicated inpatient wards for specialist rehabilitation for adults who are medically stable and require a high level of care, have had a severe or very severe brain injury and may still be in a state of confusion (post-traumatic amnesia). The units operate 24/7 with doctors, nurses, allied health and support staff in the team. The majority of admissions are received from trauma hospitals, however some trauma hospitals may refer to a non-BIRP rehabilitation service or to the local BIRP service. Each metropolitan BIRP unit may accept people living in other LHDs in need of this level of inpatient hospital-based specialist rehabilitation.
Transitional living programs
Transitional living programs (TLPs) provide contextually based rehabilitation with a community reintegration and social participation focus. TLPs emphasise a client-centred goal planning approach to rehabilitation within a supported therapeutic environment. Intervention is provided in individual and group sessions that incorporates functional skills, as well as more complex training in understanding the impact of brain injury, social communication, memory and even managing behaviour changes that affect performance in different situations. Involved staff provide formal and informal support and feedback about performance. The person is able to learn useful strategies to manage impairments arising from brain injury and apply these skills in home, education, employment and community settings. Family members and carers are engaged in the rehabilitation process to maximise opportunities to support clients to translate skills into daily living.
Most clients are admitted as a continuum of care (in the same BIRP or as a transfer of care from metropolitan to rural BIRP services) in response to changing needs for assessment and rehabilitation to support community participation goals. There are dedicated staff and most TLPs operate on a Monday to Friday basis thereby enabling the person to reconnect with their social network, practice and improve skills in everyday situations, identify barriers to participation and develop new and personally relevant goals.
Community-based rehabilitation
Community-based rehabilitation provides contextually based therapy and case management services. Outpatient medical and multi-disciplinary clinics are provided in metropolitan and some rural areas.
Case management
Case management is integral to the specialist rehabilitation team.
Where a rural BIRP has case management services only. They rely on consultation services to access medical and therapy services for outpatient clinics and the ability to refer clients to a range of other public and private medical and allied health staff, health and community services.