Project activities

Rural landscape with a rusty shed under a large tree


Ute on a Stick


Mudgee Market St

Evaluating new models of rural and remote therapy service delivery

Aim: To test and evaluate new models of rural and remote therapy service delivery for children aged 0-8 years

Team: Anita Bundy, Angela Dew, Kim Bulkeley, Rachel Mayes and Gabrielle Hindmarsh

Approach: Using a formative evaluation approach we are currently working in partnership with ADHC Western Region to evaluate 5 pilots of different models of rural and remote therapy service delivery for children aged 0-8 years. Each project is individually tailored to meet the needs of the local community and the evaluation strategies and outcomes are similarly tailored.

Outcomes: Information will be gathered about the effectiveness of a range of different approaches which incorporate trained local support workers liaising with therapists using technology to deliver place-based therapy supports to children who have a disability.

Full Moon Broken Hill Sculpture Park


Dubbo Courthouse

MacKillop Rural Services Therapy Pilot Project - Evaluation

Aim: To evaluate the MacKillop Rural Services therapy pilot project. Under the Strengthening Children 0-8 Years Strategy, NSW Family and Community Services: Ageing, Disability and Home Care (ADHC) Far West District funded MacKillop Rural Services to conduct a 12 month therapy pilot project. The aim was to assist children aged 0-8 years who were identified as having a developmental concern to improve their physical, social and emotional well-being and facilitate their transition to preschool or school. The pilot was based on the Rural and Remote Person-Centred Approach developed by the Wobbly Hub team, and the Wobbly Hub team evaluated the pilot.

Team: Angela Dew, Rachel Mayes, Anita Bundy, Kim Bulkeley, Alexandra Iljadica, Rebecca Chedid

Approach: Using creative local solutions, MacKillop employed four women from each of four remote communities in North West NSW to work as part time Therapy Support Workers (TSW). The TSWs connected with outreach therapists to provide therapy support to the children within mainstream services such as playgroups, child care settings, preschools and schools. Priority was given to Aboriginal children and their families and all children/families were existing clients of MacKillop Rural Services.

The Wobbly Hub team used a Formative Evaluation approach involving quantitative and qualitative data collection methods across multiple stakeholders over 15 months. Quantitative data were collected based on the hours TSWs spent with each child and their family and on the achievement of individual child goals. Access to outreach therapists was mapped three times across the 12 months. Qualitative data was collected via individual telephone interviews with TSWs, MacKillop management, outreach therapists, preschool and school teachers and families.

Outcomes: Over the 12 month period, 56 children participated in the therapy pilot project across the four towns. Individual children made good progress against their goals. The pilot project was successful in building capacity in children and families and in preparing them to transition to preschool and school. Ongoing work is required with outreach therapists and educational settings to embed the TSW model with existing services to ensure the best outcomes for children with developmental concerns accessing mainstream settings in remote communities. The local and culturally appropriate attributes of the TSWs were seen by all stakeholders as key to the pilot’s success and ongoing funding.

Aboriginal Fish Traps

Literature Review: Strengthening Supports for Children and Families 0-8 Years Strategy

Aim: Review the literature related to The Strengthening Supports for Children and Families 0-8 Years Strategy. The review was commissioned by the New South Wales Department of Family and Community Services (FACS): Ageing, Disability and Home Care (ADHC). Consistent with the international, national and state policy context and discourse, ADHC’s strategy encourages the inclusion of young children with disabilities and their families in mainstream settings.

Team: Angela Dew, Tania de Bortoli, Jennie Brentnall, Anita Bundy

Approach: A systematic review of the literature on interventions provided in mainstream settings for children with disabilities aged 0 to 8 years and their families. The focus of the review was on inclusion-based approaches to delivering services in mainstream settings.

The systematic review of six major data bases resulted in the inclusion of 77 ‘core’ papers reporting on inclusion-based approaches and published in the past ten years. A further 49 titles reporting on interventions in mainstream settings that were not inclusion-based were added as ‘contrast’ papers.

Outcomes: There is a paucity of research reporting on/evaluating the effectiveness of inclusion-based approaches. Research is further limited in terms of quality and depth in any given area.

The existing evidence supports the potential for these practices to improve outcomes for children and families. Inclusion-based interventions have resulted in children making progress towards goals across functional skill areas, improving peer acceptance and interaction and participation in educational settings. These interventions have also been associated with benefits for families, typically developing peers, siblings and educators. Home-based interventions in which family-centred practices are implemented seem to improve access to, and satisfaction with, services.

On the basis of the findings of the current review, more research is required documenting details about the implementation of inclusion-based interventions, in particular multidisciplinary and family-centred practices, and evaluating the impacts of these interventions on the inclusion and participation of children with disabilities.

Publications: Dew, A., de Bortoli, T., Brentnall, J., Bundy, A. (2014) Strengthening Supports for Children 0-8 and their Families: A Literature Review. New South Wales Department of Family and Community Services: Ageing, Disability and Home Care. Sydney, Australia.

Find out more about this research by visiting the NSW Department of Family and Community Services website.

Knowledge Translation – a collaboration between the Wobbly Hub project team and Professor Katherine Boydell, SickKids Hospital and University of Toronto, Canada

The collaboration was supported by two University of Sydney International grantsInternational Program Development Fund and an International Research Collaboration Award.

Aim: To build the capacity of the Wobbly Hub team and the University community to pioneer the use of knowledge translation strategies and to maximise the impact and dissemination of Wobbly Hub research findings.

Team: Katherine Boydell, Angela Dew, Alexandra Iljadica, Michelle Lincoln, Anita Bundy, Gisselle Gallego, Jennie Brentnall, Jo Ragen, Kim Bulkeley, Susan Cox (University of British Columbia), Shannon Scott (University of Alberta)

Approach: We know that the transfer of research findings into policy and practice is often a slow and haphazard process. The newly emerging science of knowledge translation (KT) shows evidence of the success of a number of KT strategies to enhance research uptake. Our collaboration with Professor Katherine Boydell involved lectures, skills building workshops and forums.

Outcomes: Katherine has worked with the Wobbly Hub team to refine and develop our KT strategy including guidance on developing accessible and useful research outputs such as project briefs, and applying arts-based research techniques. In February 2014 Dr Angela Dew visited Canada to complete the prestigious KT Professional Certificate at the University of Toronto and to give a number of guest lectures on the Wobbly Hub project. Professor Boydell then visited Sydney from March to June 2014. During her time in Sydney we jointly conducted a number of KT activities:

  • Two forums with policy makers within NSW Government and non-government organisations to identify how policy makers use research and together brainstorm strategies for overcoming the Policy-Research Gap. The data from these forums is currently being analysed by a Bachelor of Health Sciences Honours student, Akshay Rai based with the Wobbly Hub team;
  • Two university lectures open to staff and students on 1: Examining the impact of arts-based KT strategies and 2: KT and Implementation Science – the state of the field [wmv 408MB]
  • Three KT skills-building workshops open to university staff, students and members of the public. Workshop 1: Components of a KT Plan; Workshop 2: Strategies for Researchers and Policy Makers; Workshop 3: Creative Strategies for Developing and Sharing Research
  • Individual consultations with staff and students interested in KT.

Teletherapy at Royal Far West - speech therapy for children in rural NSW

Aim: To evaluate the feasibility, acceptability and preliminary effectiveness of a comprehensive speech pathology teletherapy program implemented by clinicians at Royal Far West for children who attended schools in rural New South Wales.

Team: Michelle Lincoln, Monique Hines, Craig Fairweather, Robyn Ramsden, Julia Martinovich

Approach: We used a multimethod evaluation framework to capture measures of preliminary effectiveness, feasibility, and acceptability, including children’s pre and post intervention Goal Attainment Scale scores, teletherapy process data, and interviews with parents, school principals, and therapy facilitators.

Outcomes: Results indicated that the teletherapy program was feasible and highly acceptable to stakeholders, with the majority of children achieving speech and language goals over the course of the program. The findings have provided insights into factors that support the feasibility and acceptability of teletherapy delivery of a comprehensive, generalist speech pathology service, and will inform future design of teletherapy services to support people living in rural and remote areas.

A rural private therapist framework under DisabilityCare Australia

Aim: This project will develop a quality framework to assist rural private therapists (occupational and physiotherapists, speech pathologists and psychologists) to provide ongoing, high quality, sustainable and accessible support to people with a disability.

Team: Angela Dew, Rebecca Barton, Jo Ragen

Approach: This project was independently managed by researchers at the University of Sydney and funded by a Practical Design Fund (PDF) grant from the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs. The PDF is part of the Australian Government’s commitment to introduce the National Disability Insurance Scheme (NDIS). Funded projects will develop practical ways for people with disability, their families and carers, and the disability sector and workforce to prepare for the transition to the NDIS.
As there is less access to therapy in rural and remote areas, this results in a high level of unmet need. In the context of a NDIS the private therapy workforce will have an increasingly important role in providing individualised support. Little is known about how private therapists will meet the growing demand in a significantly changing disability sector.

Outcomes: The WH&DS project sought to fill that gap by building on the information gathered from an online retention survey completed in mid 2012 by 62 private AHPs from the western area of NSW. Focus groups, interviews and online expert panels provided information to develop a quality framework that will be used to inform how rural private therapists provide ongoing, high quality, sustainable and accessible support to people with a disability.

Publications: Dew, A., Barton, R., & Ragen, J. (2013) Enabling high quality, sustainable and accessible services: A framework for rural private therapists. Wobbly Hub Project Brief. The University of Sydney, Australia.

Carers Survey – access to and preferences for therapy services

Aim: The aim of the carers’ survey was to explore the current access to and preferences for therapy services for people with a disability or developmental delay living in western NSW as reported by their primary carers. Survey questions are based on the data collected from carers via focus groups and interviews.

Team: Gisselle Gallego, Craig Veitch, Michelle Lincoln, Anita Bundy, Kim Bulkeley, Angela Dew, Jennie Brentnall, Rebecca Chedid

Approach: The research team is interested in the experiences of primary carers of people with a disability or developmental delay. This is the person who has substantial responsibility for providing unpaid care or support to a person who has a disability or developmental delay regardless of whether he or she lives with the carer or not. To find out about these experiences the team developed a survey which was available both online and in hard copy.

Outcomes: The survey will help the research team to understand the experiences and preferences of rural carers of people who have used therapy services. These valuable insights will assist with future planning and design of therapy services so to meet the needs of people in rural and remote areas.
The survey was completed by 166 carers in western NSW, 70 online and 93 using paper. Some preliminary findings include:

  • 56% of respondents were female and 44% male
  • 84% were caring for a son/daughter with a disability or developmental delay. The others were caring for a sibling (4%); grandchild (3%); foster child (3%); other relative or friend (6%)
  • Approximately 14% of respondents were caring for two or more people with a disability or developmental delay.
  • 74% of the people being cared for had received therapy services in the past two years.

Outcomes: Dew, A., Iljadica, A., Chedid, R., & Gallego, G. (2014) Carers' Therapy Access Survey, Wobbly Hub Project Brief. The University of Sydney Australia.

Therapist Survey – workforce retention issues

Aim: The aim of the therapist survey was to explore retention of therapists working with people with a disability in western NSW.

Team: Gisselle Gallego, Craig Veitch, Michelle Lincoln, Anita Bundy, Kim Bulkeley, Angela Dew, Jennie Brentnall, Rebecca Chedid

Approach: The survey was designed to understand disability therapy workforce retention issues and preferences in western NSW. The survey was based on data collected from focus groups and interviews with service providers.

Outcomes: The online survey was completed by 226 therapists with 199 responses being included in the final analysis (those not included either did not meet the inclusion criteria, opted out, or had incomplete information). Some findings of the survey include:

  • 93.5% of the respondents were female;
  • Median age of respondents was 38, with an average of 12 years post qualification; Respondents came from all sectors including private practice, government and non government;
  • Slightly over half of respondents were employed in full time work, with a similar figure also having dependent children;
  • The majority (87%) of the respondents were satisfied with their current job, with the highest satisfaction observed for those in private practice;
  • Respondents reported spending on average 41% of their time in direct client/carer contact, 23% indirect contact, 10% on administration, 4% on educational activities and 2.5% travelling for work related activities.

A presentation of the key finding of the survey was put together and shared in real time with participants using Adobe Connect. This presentation was followed by a question and answer session. For those who could not attend online at the time of the presentation, it was made available on Vimeo.

Focus Groups & Key Informant Interviews

Aim: Stage 2a of the project aimed to understand the current situation for therapists, carers, providers and people with a disability in Western NSW.

Team: Angela Dew, Kim Bulkeley, Craig Veitch, Michelle Lincoln, Anita Bundy, Gisselle Gallego, Jennie Brentnall.

Approach: In 2011, focus groups and individual interviews were held with 97 direct government and non-government service providers, 78 carers and 10 adults with a disability in western NSW.

Outcomes: The data collected gave the research team a real understanding of the lived experience of people with a disability, their family members and service providers living and working in western NSW. These multiple perspectives allowed the team to place a truly local lens to understanding the data which in turn informed the development of the pilot projects.
Based on the analysis of these focus groups and interviews, and combined with the findings from the policy document analysis the research team developed a model of person and family-centred therapy.
In developing this model the research team drew on the principles underlying policy and service provision by putting the person and their family at the centre surrounded by extended family and situated within their local community with government as a backdrop.


Policy Document Analysis

Aim: The purpose of the review was to gain insight into the issues currently influencing disability policy development and implementation. Additionally, gaps in key policy-related evidence were identified.

Team: Angela Dew, Kim Bulkeley, Craig Veitch, Michelle Lincoln, Anita Bundy, Gisselle Gallego, Jennie Brentnall.

Approach: Twenty seven policy documents were read and a summary of the key policy content made. This initial summary was used to assign documents into three tiers. Tier 1: overarching NSW Government policy documents including major disability-specific and general population related documents. Tier 2: ADHC specific policies, sub-divided according to whether they were client-focussed or workforce-focussed. Tier 3: ADHC operational guidelines also sub-divided into client-focussed and workforce focussed. The collation and qualitative content analysis of these documents generated themes further explored in focus groups and individual interviews.

Outcomes: In reviewing the documents taking knowledge from the literature, there were some strong drivers of future directions in the disability sector that influenced the teams thinking. Twenty seven policy documents were reviewed and based on analysis, categorized into tier 1 (higher level strategic policies) and tier 2 (specific operational policies). Tier 1 policy documents provided consistent messages about the need to develop strategies and service delivery options to address geographic, cultural and age-related barriers facing all people in New South Wales including those who have a disability. Tier 2 documents revealed a lack of attention to the practical differences between implementing the policy principles in metropolitan compared to rural areas.
Study findings identify that the implementation of metropolitan-formulated policy does not always encompass the unique challenges experienced by therapists providing services to rural people with a disability and their carers. This study highlights the importance of “rural proofing” policy to consider people who live and work in rural areas.


Consultations with senior managers in government and non-government organisations

Aim: To obtain the perspectives of policy makers, managers and senior therapists about the issues affecting the therapist workforce and service delivery in the disability sector in rural and remote New South Wales.

Team: Angela Dew, Kim Bulkeley, Craig Veitch, Michelle Lincoln, Anita Bundy, Gisselle Gallego, Jennie Brentnall

Approach: Information was gathered via semi-structured interviews with individuals and small groups. Head office and regional office policy-makers, along with managers and senior therapists in western NSW were invited to participate. Participants included 12 policy-makers, 28 managers and 10 senior therapists from NSW government agencies and non-government organisations (NGO’s) involved in providing services and support to people with disabilities in the region. Information was synthesised prior to using constant comparative analysis within and across data sets to identify issues.

Outcomes: Five broad themes resonated across participants’ roles, locations and service settings:

  1. Challenges to implementing policy in rural and remote NSW;
  2. The impact of geographic distrubition of workforce and clients
  3. Workforce issues – recruitment, support, workloads, retention
  4. Equity and access issues for rural clients
  5. The important role of the NGO sector in rural service delivery and support

Although commitment to providing best practice services was universal, policy-related information transfer between organistaion and employees was inconsistent. Relative recent innovations such as therapy assistants, information technology and trans-disciplinary approaches, were raised as important service delivery considerations within the region. These and other innovations are intended to extend the coverage provided by therapists. NGOs played a significant role in service delivery and support in the region, and there is also a need for therapists working for different organisation, in rural areas, to collaborate both in terms of peer support and service delivery to clients.