Inclusion, exclusion and prioritisation criteria

Essential criteria

• Has evidence of a brain injury
• Aged 16-65 years
• Client is able to engage in the rehabilitation process
• Functional, cognitive and psychosocial brain injury rehabilitation goals identified
• Resides within the geographical service region
• Complex needs can be addressed within a multidisciplinary team approach.

Inclusion criteria

* Refer to classification of injury severity for TBI

Exclusion criteria

• ABI from progressive and degenerative neurological disorders
• No evidence of TBI
• Single discipline referrals
• Age
  • Clients aged over 65 and still in the paid workforce will be considered on a case-by-case basis
  • Clients under 18 years of age may continue to be managed by the paediatric BIRPs while in school and then transition to adult services.

Mild traumatic brain injury

Mild TBI will be managed according to NSW Health policy document: PR2012_013 Closed Head Injury in Adults and the associated Institute of Trauma Injury Management guidelines Initial Management of Closed Head Injuries in Adults, edition 2.^42,49 In some LHDs clinics have been established to assess and respond to the needs of people with mild TBI with persisting symptoms.

Referrals not accepted

When referrals are not accepted, the referring person and the person who is the subject of the referral is informed of the decision. Suggestions as to other service providers will be provided whenever possible.

Co-morbidities note

Co-morbidities (mental health, drug and alcohol, medical issues) can impact on a client’s ability to engage in rehabilitation and identify goals. In situations where the co-morbidity is an overriding issue impacting on the ability of the client to engage in the specialised brain injury rehabilitation process, the client is assessed to not be able to engage (have ability to actively participate) and the referral will not be accepted. These referrals will be directed to more appropriate services.

A referral back to the BIRP can be initiated once the co-morbidity is managed and the client is able to engage in the rehabilitation process. Shared care may be an option for these clients.

Service access

Clients are eligible for BIRP service regardless of their living circumstances. People who reside in a residential aged care facility or disability accommodation services may be accepted into the program using the above guidelines, that is the ability to meet the essential criteria, and prioritised in accordance with the above guidelines. A consultative model of care may be offered according to factors such as the level of support available to the client to assist in the implementation of a program and the client’s access to other allied health services, resources and support to achieve goals identified by the client.

Transitional living programs

While these guidelines apply to the admission of clients to the Transitional living programs (TLP) setting of care, there will be additional considerations for level of support needs, risk and local organisational guidelines to assist in determining whether a client can be safely accommodated in a centre-based or home-based TLP.

Inclusion criteria

To access transitional living programs clients must meet all of the following inclusion criteria.

• The client has identified rehabilitation goals requiring intensive rehabilitation from two or more allied health disciplines per day for each resident.
• The client is medically stable to participate in a residential program as determined by a rehabilitation specialist or other medical practitioner.
• The client is continent or has the capacity to manage with appropriate intervention.
• The client is motivated to participate in an intensive rehabilitation program.
• The client is physically independent; the client must be independent or require minimal physical assistance for transfers, mobility and self-care tasks including feeding, grooming and hygiene (maximum support of one staff member only).
• If wheelchair bound, the client is able to transfer with the assistance of one staff member.
• Clients have manageable behaviour; clients must be able to be safely managed by a single staff member. They must not exhibit behaviour issues that are unable to be managed within the staffing profile.
• The client agrees to share house rules and understands consequences arising from rule breaking.
• The client abstains from drug and alcohol use throughout the duration of the rehabilitation program. Clients sign an alcohol and other drug agreement prior to TLU admission.
• Self-care equipment has been set-up and trialled by the referring rehabilitation hospital prior to admission. Arrangements have been made by the referrer for the client to access this equipment while on weekend leave and during their TLU admission.
• Access to weekend accommodation.
• Confirmed discharge destination.

Exclusion criteria

The following criteria excludes people from brain injury specialist rehabilitation services.

• Clients presenting with ABI from progressive neurological disorder.
• No evidence of a brain injury.
• If co-morbidities impact on a client’s ability to meet the essential criteria (i.e. patient does not have the capacity to engage in the rehab process or the client does not have identified goals), the referral will not be accepted. These referrals will be directed to more appropriate services.
• If a co-morbidity is an overriding issue, the referral will not be accepted.
• Care and support needs for the TLU program exceeds the ratio of one staff to four clients with the addition of this client.

Prioritisation

Additional criteria used in prioritising brain injury specialist rehabilitation clients include the following.

Client ability to engage: Client has the ability to actively engage in the rehabilitation process.

Length of time since injury: For example an injury is less than two years ago is a higher priority than an injury > five years ago.

Severity of injury: Severe is a higher priority than moderate.

Age: Age >65 years is a lower priority than age <65 years.

Length of stay: Based on the client’s participation in the program and continuing to achieve goals.

Inpatient brain injury rehabilitation

All children from birth to 18 years (still at school) in need of neurorehabilitation are considered.

Some children may be triaged to specialist disability specific rehabilitation services, such as dedicated services for cerebral palsy and acquired brain injury within a Level 6 paediatric hospital.

Children admitted for brain injury specialist rehabilitation services have options for receiving decentralised support services closer to home when ready for hospital discharge.

Eligibility criteria are described in in Table 4: Paediatric rehabilitation eligibility criteria.

Community BIRP

In several rural locations these services are co-located with the BIRP adult teams. Metropolitan paediatric BIRP teams initiate referrals internally (inpatient to community) and support transfer of care to rural paediatric BIRPs.

Ongoing outpatient medical and multidisciplinary clinics are provided in metropolitan and some rural areas.

Referral from metropolitan (level 6) paediatric hospitals to BIRP rural services is based on eligibility criteria at each BIRP location. Inclusion and exclusion criteria exist to manage client needs within resources.  These are provided in Table 4: Paediatric rehabilitation eligibility criteria.