Hunter Brain Injury Service is right in the heart of Newcastle, on Darby Street. With many Headstart consumers passing through it’s doors we recently met up with Sharon Lawrence, Service Manager.
What brought you to this role Sharon?
“I’ve worked for Hunter New England Health as a dietitian for 26 years. Most of my time I have worked in the community and aged care space. So this has been a huge learning curve working with people who have acquired a brain injury. I’ve now been in this role for 12 months managing the Hunter Brain Injury team to support clients.
So many of your staff have been here a long time?
Some of the clinicians have spent the majority of their career here at Hunter Brain Injury and their skill level and knowledge of brain injury is unbelievable! The allied health staff are classified as senior specialist clinicians due to their level of clinical skill and knowledge. They are always undertaking professional development, upskilling and sharing their knowledge with one another as well as other health staff outside of the service.
Can you tell us a little bit about the history and origins of the service?
Across New South Wales there are 15 specialized brain injury services, this being one of them. The funding across NSW originally came through the then Motor Accident Authority, supporting specialized brain injury services and in particular the rehabilitation units. Seven of them have a transitional living unit. Hunter New England has two units, one here and the other in Tamworth. This transitional living unit was opened 30 years ago.
Our catchment area is quite large. We support all of the Hunter Valley, the Central Coast, and the greater Taree area and because we have a transition living unit we often have clients that stay here from outside those area, such as Port Macquarie or Forbes.
So how do things work here?
There’s a couple of different pathways for clients who have experienced a brain injury. A client may start their journey at John Hunter Hospital, or one of the larger hospitals in Sydney, such as Royal Rehab in Ryde. Most of our referrals come from those hospitals or from the Rankin Park Rehabilitation Centre which is the public rehabilitation hospital located on the John Hunter Campus. Hunter Brain Injury Service is the next step in that rehab journey.
When we receive a referral the team review it to ensure the client meets the statewide criteria for brain injury services such evidence of a brain injury, age, do they live in the catchment area, capacity to participate in rehabilitation and what are the rehab goals for the client. After this, one of our allied health staff arrange an initial appointment to explore their needs a little bit more and to work out how our team can best support the client and their family or supports.
From there, a Case Manager is assigned who works with the client and their supports to identify which rehabilitation pathway is going to be best for them, that is either coming to stay in the transitional living unit for intense therapy support or going through our community stream where the client is living at home but they come in as an outpatient for therapy.
Really, everybody is different and it just depends on their individual needs and circumstances. So clients who come to the service are given an option and actively participate in the decisions about their rehabilitation, their goals and their therapy.
So you could say the service we provide is consumer or ‘client directed’.
Consumer or client direct care is where a client who has experienced a brain injury is given choice and control about the way their rehabilitation and care is delivered by the team. We are there to help and inform the client with their decisions and to provide the therapy they require to meet their rehabilitation goals. Our team just doesn’t focus on the brain injury. We also focus on the person, their strengths and the world around them, because we need them to go back to their community and life.
If a client comes to stay here in the transitional living unit they arrive Monday lunchtime and participate in scheduled appointments or therapy sessions during the whole week. This is where they live for the week and they go home on a Friday afternoon, returning the following Monday. It’s important they have family or somebody to stay with over the weekends to care for them and to help them practice the skills they have learnt during the week.
What therapies do people receive?
Clients have a minimum of five hours of scheduled therapy each day when they stay in the transitional living unit. The therapies offered could be across the whole team, including physiotherapy, occupational therapy, speech pathology, social work, dietetics, psychology and neuropsychology. Rehabilitation assistants are also available to help them too.
When a client is not in their therapy session, they have the opportunity to participate in other social or leisure activities such as art group, gardening, mindfulness, playing pool or the Wii and so on. During the stay, they also engage in planning and preparing their own meals, attending to their own personal needs such as doing their own laundry with the assistance of our team members and helping out with other common tasks such as attending to the vegetable garden or watering the plants, feeding the fish or taking out the garbage and compost.
We help our clients reintegrate back into everyday life. We try and make this place feel like a home so it’s easier to transition back to home, work or study.
They can have downtime and rest in their room or watch TV, listen to music or read a book. Families and visitors are welcome to come in from five to nine o’clock every afternoon. Clients can go out with their family or visitors and have a meal or go for a walk. We recognize it’s not just the client who has experienced the brain injury, it affects families, friends and colleagues who are known to the client. So we like to engage those who are important to the client as much as possible in the care we provide.
How many people do you help at any given time?
We have up to five clients staying here in the transition unit at any one time. But that doesn’t just limit our caseload to five because we also have just over 100 clients out in the community that we support as well. We support both compensable and non-compensable clients who have experienced a brain injury. We have strong links with iCare and NDIS as well as many other insurance agencies.
Our clinicians are also able to offer case management and some are endorsed by icare. It could be when a client finishes their therapy with us but they still require a health clinician to provide
case management, we can continue to support the client through their journey. We’ve got clients on our books that have been here for two to three years. So it just doesn’t stop once the leave our transitional living unit.
Do you have much of a waiting list?
Not at the moment and we can be flexible in how we deliver care. If our transitional living unit is full, for example, and there is somebody ready to come from Rankin Park or John Hunter, we can put some services in place to support a client at home until we have a bed available. It may be that we do some intense work in the community with them, and then bring them in when we have a bed available.
What sort of brain injuries do you see?
It’s a variety, from motor accidents - so car, bike, truck - to cycling accidents. We also see brain injuries associated with falls, assaults, self-inflicted, and those who have acquired a brain injury due to neurosurgery complications or brain hemorrhages.
Our our age group is from 16 to 65. Saying that, if a 16 year old was still in school, they would stay with the paediatric team. And if they’re - for example - 65 years old and they’re still actively engaged in work and are likely to return to that workspace, we will still accept them.
Our ultimate goal is returning a client back to their pre-injury work or study where possible, or working with them to seek suitable alternatives.
How often do you achieve that goal?
Our service has very strong outcomes when it comes to linking our clients with Disability Employment Services and / or returning them back to their usual work place. We are very proud of that as well as the physical, functional and psychosocial gains our client achieve.
How long do people spend here?
We’ve currently got two clients who are only here for two weeks, whereas we’ve got other clients who have been here for up to three months. It really just depends on what their individual needs are. So it’s variable. Our ultimate aim is to have that person back, living in their own home with their own family with their own supports. So we work very closely with care workers and care attendants and insurance companies to ensure this happens.
We also support public clients as well, for example those who’ve had a stroke, and may not be covered by any insurance. They still get exactly the same service it’s no different. We don’t treat people differently based on their compensable status.
Have you seen amazing recoveries?
Oh yes, I sure have! I’ve seen clients come through door with dysphasia - so trouble speaking - and deficits with their mobility. In some cases it’s been a really quick recovery, others have taken longer, but to see them leave and ring the bell, that’s on wall outside pulls on the heartstrings.
You can feel the sense of achievement for the client and even for our staff who can say “Hey, look where we’ve got them!” It may not be the complete pre-injury state, but we’ve still helped achieve the client’s goals. The feeling is overwhelming to be able to do that! If our clients are happy to, we also help them write their story to place on our storyboard wall. Other clients and visitors read these stories which can be really helpful for clients just beginning their recovery journey.
How do you work with the extended family of the clients?
The client’s family network is really important to us. Our care is not just for the client, but also for the healing of the family and other people important to the client. It’s traumatic to see changes in somebody - whether that’s behavioral, physical or functional changes. It’s like a grief and loss process that we need to support in the families, friends, and significant others, because they also need to learn and feel comfortable with managing new situation and feelings the person with a brain injury is experiencing and vice versa.
How do you work with other disability services, like Headstart?
Very early in the journey we start to understand what the client is wanting to achieve and what help and support they may need. It can be very daunting for a client or their family to know what’s out there. So we begin those conversations early, whether it’s with Headstart or another organisation. We might have a client who really just wants to get back to knitting, and so our staff search for those groups or connections for the client. We aim to introduce them whilst they are here with our service so that it’s easier when they leave. It’s a natural hand holding process and moving people through.
