Demystifying the complex: The practical importance of telehealth to Australian Communities Kim Casburn, Manager Primary Care, Health and Wellbeing
Overview • The challenge • RFW – who we are and what we do • How did we get to where we are • Traditional telehealth • Breaking the complex into simple steps • Building capacity • What we have learnt • The future
The impact of distance Vulnerability - Children living in remote Australia are twice as likely to be developmentally • vulnerable compared to children living in major cities (AEDC, 2015) Indigenous Children • are twice as likely to be developmentally vulnerable in two or more domains compared to o non-Indigenous children (AEDC, 2015). high prevalence of Indigenous youth in Australian prisons which is strongly associated with o hearing loss, speech and language disorders ( Thomson, 2013) Workforce gap - the availability of Allied Health professionals ranges from 2.66 per 10,000 • people in capital cities to 0.60 per 10,000 in remote areas (NRHA) Isolated Practitioners in rural areas have a wide range of clients and clinical • presentations, lack management support incliuding orientation and mentoring (SARRAH) Percentage of children developmentally vulnerable in 2015 Geography Physical Social Emotional Language Communication Vulnerable 1 Vulnerable 2 Domain Domains Australia 9.7 9.9 8.4 6.5 8.5 22.0 11.1 QLD 12.4 12.4 10.1 8.0 10.5 26.1 14.0 NSW 8.5 9.2 6.8 4.8 8.1 20.2 9.6 Far West 15.8 14.2 8.3 12.7 11.5 33.7 17.4 Coonamble 26.8 28.6 19.6 16.1 8.9 41.1 33.9 Source: Australian Early Development Census (AEDC), 2015 Census
Royal Far West
The RFW way
Language is important RFW uses the term ‘telecare’ when describing its technology enabled services. This term is in preference to the more commonly used terms ‘telemedicine’ and ‘telehealth’ in order to reflect the unique nature of RFWs work across the health, education and community sectors. Impact: Helped us to better engage the education sector • Puts ‘care’ at the heart of what we do •
Our telecare story 2013: BUPA funded pilot (speech) with University of Sydney 2014: Expansion of speech program, delivering tele-OT & telepsychology, delivery into QLD 2015: Telepaediatrics & group programs introduced 2016: Launched Windmill (disability specific program), RFW telecare goes national! 2017: 20 unique telecare services across 7 different disciplines. We support over 1000 children annually, delivering over 10,000 Occasions of Service. We are in 60 schools each term and growing. https://www.youtube.com/watch?v=CvMRTbv98jY
Telecare locations: June 15-Dec 16 Speech Pathology Practitioner Dietetics Support RFW Telecare Services Paediatrics Psychiatry Occupational Psychology Therapy
Why telecare? • Therapy for children unable to access local services • Provides continuity where outreach and local services are unable to ‘Right time, right place, right clinician, right frequency’ • Reduce disruption to child’s routines • Capacity building of staff members within child’s school or preschool What parents told us: 57% of parents had previously tried to access services for their children and of these 77% could not receive service because: • The service was not available • They had to go on long waiting lists • The services were too far away • The cost of services was too much
Moving beyond traditional telehealth Traditional telehealth in our Paediatric setting: o ‘Child & Therapist’ consultation o Basic speech, language 1:1 approach Evolved to include: o Remote triage & stepped care o Interactive play therapy o Group therapy with children with similar needs o Capacity building (adults take on active therapy aide lead) o Real time feedback to teachers regarding individual and ‘whole of class’ strategies
Capacity Building It underpins all we do: o complement existing local services o leverage community capabilities o sustainable model “When I said to the teacher ‘he’s got significant language difficulties’…his teacher came and observed a session and then there’s that carry over now into the classroom. So she may, instead of giving him a set of three instructions in a row, she might be limiting them to just one instruction at a time’ Therapy aide working with RFW to deliver group therapy in a NSW school
Case study: Early intervention in regional QLD Design and implement a complementary and integrated sustainable Paediatric Early Intervention Allied Health service model delivered by telecare. “Our families have been Working with early educators to extremely happy with the identify and support children progress their children aged 4-5 so that they are school ready: are making due to being able to access allied health services while their Pathway 1: Screening children are in care. Lots Pathway 2: Specialised Assessment of positive feedback Pathway 3: Individual Therapy received from families and educators within the Pathway 4: Group Therapy service ” Pathway 5: Capacity Building Early educator
What we have learnt • Culture (clinicians and recipient of service) • Hype vs practical • Funding sustainability & Advocacy • Make the complex simple but don’t underestimate the time and commitment it takes to support people. • Technology runs ahead of people and systems • Co designing the solutions • EVIDENCE
Future Directions • National Centre for Child Health and Learning • Servicing all states in the country • Reaching most marginalized communities - strengths based approach • 12,000 kids reached annually by 2020 • Increase capacity building services = sustainability in community • Expansion of Disability services (NDIS) • Multi modal approaches
Telecare is changing lives “By helping these kids to receive the therapy they need, you are not only helping them to find their voice. You are helping them grow into more confident, happier kids. You are giving them an opportunity to learn new skills, build stronger relationships and hopefully achieve all their hopes and dreams!.” Teacher, QLD “At first I was a little sceptical about how the children participating in the program would be able to achieve their individual goals/learning outcomes but after supporting and guiding these groups I have seen significant growth in the overall development of each and every child.” Therapy aide working with RFW to deliver group therapy in a NSW school “When my anxious child says I don’t want to go to sleep. I used to say ‘Don’t worry go to sleep’. Now I ask; ‘Why are you feeling this way? What can we do? How can I make her feel like I understand’?” Parent , telepaediatrics program
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