Enhancing participation outcomes for people with acquired brain injury, high and complex daily support needs and challenging behaviour: a qualitative study of Australian allied health practitioners

PURPOSE: To investigate how experienced allied health practitioners (AHPs) enhance participation outcomes for community-dwelling adults with high disability support needs and challenging behaviour following extremely severe acquired brain injury (ABI). MATERIALS AND METHODS: Participants were 23 AHPs experienced in adult ABI rehabilitation who participated in semi-structured interviews. Responses were illustrated with a single de-identified case example. Qualitative data analysis was conducted using NVivo and followed the six steps of Reflexive Thematic Analysis. RESULTS: Eight themes to enhance participation outcomes were identified: (1) "building a good relationship," (2) "it takes a team", (3) "I just need to find something he can do", (4) "behaviour, activity and participation are inseparable", (5) "behaviour is everybody's business", (6) "environments that match the person's needs", (7) "work with the disability support workers, team leader, and the person above them", and (8) "there's a direct correlation between behaviour and participation". CONCLUSIONS: This study supports a bidirectional relationship between behaviour and participation that can be harnessed to shape successful AHP interventions. Implications for future clinical research include the importance of integrating behaviour support plans into structured routines focused on meaningful activity and role participation following ABI, and concurrently measuring behaviour and participation outcomes.