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In reviewing its current practice and outcomes, the Brain Injury Rehabilitation Trust (BIRT) has identified a steady increase in the number of people being admitted with a brain injury who identify as homosexual, bisexual, gender fluid or transgender, and are in need of rehabilitation.

BIRT takes a person centred approach because every individual we support has their own personal narrative. In the case of sexuality and gender, in many instances the individual's journey has been highly emotional and accompanied by numerous challenges including, but not exclusive to, societal stigma.

The neurobehavioural approach, at the heart of BIRT services, involves assistant psychologists working with service users and their families. The wealth of information that has been gathered helps to bolster strategies in our rehabilitation and in this article we hope to highlight how this can be addressed further afield. An example of this was a transgender woman who, on admission, had little initiation or participation in her rehabilitation. The memories that she struggled to recall as a result of her brain injury were vital in building a therapeutic relationship, aiding the assessment of her brain injury and informing practice to increase her engagement.

In the case of this woman, the fragments of memory that seemed to endure in her fluctuating mental state were often traumatic due to the history involved. Additionally, her sense of bewilderment around events that led to her admission, understanding the physical symptoms and the challenges of making sense of the unfamiliar, meant that engagement in her rehabilitation programme was non-existent.

The assistant psychologist, who worked as part of the interdisciplinary team, relied on information from the service user's family about her transgender journey, her personality and personal interests. Gathering this data was a humbling experience. Dr Sue Copstick, Clinical Director of BIRT, said: "The prejudice that many members of these communities face is harrowing to hear; the information from this woman's family was used in one-to-one sessions and handled in a non-judgemental and gentle way. Her participation across the breadth of the rehabilitation programme has shown verifiable and positive outcomes."

BIRT hopes that this demonstrates the importance of listening to such narratives, without judgement or prejudice, with dignity being respected at all times. It also confirms the importance of supervision and support for our teams as we broaden BIRT's experience and expertise.