1. PROBLEMS, PATHWAYS AND PROCESSES IN THE DEVELOPMENT OF A CHILDHOOD BRAIN INJURY SERVICE (NIHR CLAHRC-CP Fellowship project, Fergus Gracey) UK prevalence of severe TBI in children: 5.6 per 100,000 per year require admission to Paediatric Intensive Care Unit (Parslow et al, 2005) Vulnerable to a wide range of problems – CCPNR set up to provide neuropsychological rehabilitation for children with ABI within EoE region Data collected and represented to illustrate nature and complexity of CCPNR referrals

2. NSF ‘ABI Exemplar’ – but service use post discharge described like a “pinball” Psychiatric morbidity and TBI interactions (Dasarathi et al, 2010) Complex patterns of service use difficult to understand and measure Swim-lane activity diagram used to illustrate pathways to CCPNR CCPNR Educational Assistance Private Therapy Community Therapy Tadworth Carer Private Psychologist Case Manager Social Worker Local TBI Team CAMHS Hospital Follow Up Therapy Neuropsycholog y Behavioural Support Assistant Music Therapy L R K C J M C D H H C J A

3. simulation modelling of CCPNR Referrals Screening Funding IA DA Funding DA Funding Bundle IA Funding FP FP Exit service Rejected @ Screening Rejected @ Funding IA Rejected @ Funding DA Discharged @ DA Rejected @ Funding FP Rejected @ Funding Bun. FPs @ T= 0 DAs @ T= 0 Funding DAs @ T= 0 I As @ T= 0 I As @ T= 0 General flow Sources of clients Client exit points Processes Decision points Summing points Cambs clients flow T = Simulation time 1 2 3 4 5 6 0 A Komashie, Engineering Design Centre, Cambridge University