Pathways
through the health system
A person with
a TBI can take a number of pathways through the health
system, depending on the severity of their injury.
The information
sources available will vary depending on the pathways through the
system.
Information sources
Information sources
you can use to assess a person's rehabilitation history include:
Agency
Reports: (obtain copies from family, hospitals, legal
representatives)
- Discharge
summariescan be obtained from acute hospitals or
rehabilitation services, Commonwealth Rehabilitation Service, private
rehabilitation providers.
- Neurophychological
reports Done by neuropsychologists or clinical psychologists
usually focus on changes to cognitive function. Some assessments include
I.Q. score, usually not that helpful.
- Rehabilitation/medical
reports Done by rehabilitation specialists,
physiotherapy, speech pathology, social work, rehabilitation
counsellors
- Other
therapist reports These include occupational therapy,
physiotherapy, speech pathology, social work, and rehabilitation
counsellors
reports.
Self
Report:
- Pre-morbid
functioning vs. current status It is important to get an idea of a person’s ability before
the injury and compare that with current functioning. Otherwise
it
is possible to make any number or erroneous conclusions about the
impact of the TBI.
- Verbal
vs functional ability Some people are verbally
articulate. But still have significant problems at a practical
level that may be
identified in an interview.
- Difficulties
with insight After a brain injury, some people have
reduced awareness about their needs, and may not fully understand
the level support being provided by key people in their lives
Family
Report:
- Impact
on the family Families are often a key support
for people with TBI. Information from families
can provide valuable
additional information in making an assessment.
- Under re-action vs over-reaction Family members sometimes minimize or over emphasize the disabilities
of their relative.
Others:
- Other people
may have valuable additional information. This may include agency
/ staff / friends/ employers,etc. The more sources of information
accessed, the better the quality of the assessment.
Pathways in NSW
Unique individuals mean that service pathways are unique.
At the same time staff need to be aware of:
- typical service pathways
- local barriers to pathways
- strategies for dealing with pathway barriers.
In 2008, an Interagency Agreement was signed between Ageing, Disability and Home Care (ADHC), NSW Health, Housing NSW and the Lifetime Care and Support Authority (LTCS). The purpose of the Interagency Agreement was to improve equity of access in the interface between health, housing and support services to meet the needs of people with ABI in the community.
A Pathways and Protocols Working Group comprising members from each of the inter-agency partners was convened to identify appropriate referral pathways and related issues for an adult with an ABI moving through health, disability and community services. This work has produced:
"Care and Support Pathways for People with an Acquired Brain Injury, 
Referral and Service Options in NSW". May 2011 (3.1 Meg)
This document includes 7 Example pathways and detailed information about all of the services mentioned in the example flow charts.
The seven pathway examples are:
1: Person with a recent ABI requiring housing and support
2: Person with a recent TBI requiring support up to 35 hours/week
3: Person with a previous TBI/ABI with drug/alcohol or mental health issues
4: Person with TBI/ABI with challenging behaviours
5: Person with previous TBI/ABI exiting prison system
6: Applicant or existing tenant of Housing NSW with a diagnosed or undiagnosed ABI/TBI
7: Person with TBI/ABI requiring formal support for more than 35 hours per week
People who sustain injuries in motor vehicle accidents (MVA) may have access to compensation (Workcover, LTSCA). This can increase service options and needs to be considered when planning service support.
Example 1: Person with a recent ABI requiring housing and support 
