Brain Injury Rehabilitation Principles

Principles

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 here are the foundational propositions for effective brain injury rehabilitation.

The 15 principles listed below are the propositions that taken together enable building brain injury rehabilitation.  They are numbered for ease of reference only.

Some of the principles apply to other services as well, e.g. person centred care, engaging with families/carers, goal directed, however they are listed here because they are particularly relevant to brain injury rehabilitation and have a direct connection to the nature of brain injury and brain injury rehabilitation.

1. Person centred

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 with 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 impact on the person.
This requires staff to be able to bring their own person into person centred work with the client.

2. Enabling life in and with community

The person is seen as part of a social network which may include family, friends, neighbourhood & community.

3. 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.

4. Engaging with and supporting families/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.

5. Engaging and coordinating with the community

The rehabilitation process engages and coordinates across health, disability, education, community and other services.

6. 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.
Living in the community  the focus is to maintain goals (and prevent deterioration) and to achieve new goals as life changes and transitions happen and new needs and goals emerge.

7. Working constructively with challenging behaviours

Many people with TBI 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 TBI display more than one type of challenging behaviour. 
The team require the skills for working constructively with clients with challenging behaviours.

8. Manage life and service transitions well

Hospital to community, hospital to school, inpatient to ambulatory, child to adult services transitions – are well planned and coordinated.
Life transitions - e.g. primary school to secondary school, not working to working, working to studying etc are managed well and allow the person to reconnect with rehabilitation services as need arise.

9. Case management as needed

Case management an needed is a principlebecause of the individual nature of each person’s rehabilitation process and the complexity of weaving together this with services and funding while engaging with the family/carers and dealing with all the unique individual, family and social impacts.
BIRP 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.

10. Individualised multidisciplinary rehabilitation

People and their families/carers receive individualised multidisciplinary rehabilitation that develops their skills and participation.

11. Therapeutic interventions promoting recovery, adaptation, compensation and prevention

Rehabilitation care is optimised when the full range of treatment approaches are considered for each and every patient. This includes therapeutic interventions promoting recovery, adaptation, compensation and prevention.

12. People with TBI/families/carers are engaged in the improvement of brain injury rehabilitation services.

This is consistent with NSW Health and ACI principles. It is particularly important to note the additional effort and skill that will be required to ensure that this happens in a brain injury rehabilitation setting.

13. Leadership in brain injury 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 rehabilitation care.

14. Equitable and timely access to the equipment, care and services people require, as close to where they live as possible.

This principles is important because Brain Injury Rehabilitation is a state wide specialist program. Not every part of what’s required is in each location.
There is therefore a need to balance local decision making with state wide network needs in order to achieve this principle.

15. Advocacy for improvement and reform

Brain injury rehabilitation services are working with people in health and community settings.  The rehabilitation processes often involves other services and settings.  Services also work within wider policy contexts.
Getting the best outcomes in brain injury rehabilitation involves advocating both in relation to particular services and settings and also with wider policy/services context.