Conferences

2014

Conference: "Research to Action", Centre for Applied Disability Research Conference, Sydney.

Abstract Title: Evaluating a Rural and Remote Person-Centred Approach to improve transition to school outcomes for children with disability.

Abstract: The Wobbly Hub and Double Spokes project is a partnership between the Faculty of Health Sciences, University of Sydney and NSW Family and Community Services, Ageing, Disability and Home Care (ADHC), Western NSW. Based on data collected in earlier stages of the project, a Rural and Remote Person-Centred Approach (RRPCA) was developed that included four pathways: creative local solutions, innovative technologies, responsive outreach and centre-based support. This presentation will describe evaluations, developed in parallel with pilot projects using the RRPCA to support the inclusion of rural children identified with developmental concerns in the early childhood years to successfully transition to pre-school or school using a community capacity-building approach. How well does the RRPCA aid successful transition to pre-school and school for children with developmental concerns in rural and remote areas of western NSW? In 2013, ADHC provided 12 months funding to five NGOs in western NSW to pilot innovative therapy interventions based on the RRPCA. The Wobbly Hub team is evaluating these pilots using a formative evaluation model. Through a consultative, place-based process, each NGO, an allocated ADHC Senior Therapist, and the Wobbly Hub team together identified evaluation measures that considered: the process used in implementing the pilot (e.g., information, training and resources), the impact (i.e., changes for the individual child, their family, their community) and outcomes (i.e., sustainability over time). The five pilots started at different times throughout 2013 and so are at different stages in the evaluation cycle. We will report on preliminary data from the first two pilots to get underway. In these two pilots, the RRPCA is working well as it provides flexible options tailored to each environment. Nonetheless, barriers exist to implementing an approach that is very different from that traditionally used. We will present the successes and challenges. We will discuss some early implications for children, families and communities of using a RRPCA to pre-school and school transitions.


Conference: "Mind Matters", CRN Mental Health and Well-being Conference, Coffs Harbour.

Abstract Title: Well-being of rural carers: The role of local champions.

Abstract: The Wobbly Hub and Double Spokes project is a NHMRC-funded ‘Partnerships for Better Health’ grant between the Faculty of Health Sciences, University of Sydney and NSW Family and Community Services, Ageing Disability and Home Care, in western NSW. The aim of the project is to investigate therapy service provision for people with disability in rural and remote areas. As part of the data collection for the project, focus groups and interviews were conducted with 78 carers of people with disability in western NSW. The importance of ‘local champions’ was raised by carers. ‘Local champions’ contributed to carers’ sense of wellbeing by helping them to connect with supportive services, people and places and were described as providing a life-line post diagnosis or after moving to a rural area. ‘Local champions’ could be other parents of children with disability, local service providers or key community members. We will present qualitative data to describe the role and benefit of ‘local champions’ to the wellbeing of rural carers. We will discuss how rural characteristics of individuals and localities contribute to the development of ‘local champions’ and can be harnessed to reduce carers’ sense of isolation.


Conference: Implementation in Healthcare, Sydney Catalyst Translational Cancer Research, Sydney.

Abstract Title: Wobbly Hub and Double Spokes Project: accessible, simple and useful knowledge translation strategies.

Abstract: The Wobbly Hub and Double Spokes (WH&DS) project aims to develop, implement and evaluate evidence-based policies to support therapy service delivery to people with disability living in rural communities in western New South Wales (NSW). This NHMRC funded ‘Partnerships for Better Health’ project is in its fourth and final year. Throughout the project we have focussed on making sure that project findings are translated to a wide group of stakeholders including policy makers, service providers and service users. How can researchers translate the findings of their research in ways that are accessible, useful and meaningful for potential end users and have immediate impact? With the project focus on rural areas, it was important for us to think and act creatively to maximise the accessibility and timeliness of our research. We created a suite of complementary research outputs to reach rural and remote stakeholders and to attract other potential end users interested in our findings. Outputs include a quarterly newsletter; a website listing project activities, achievements and research developments; and a series of project briefs which give visually appealing, lay summaries of our research. To track and extend the reach and impact of these outputs we made use of available technology and infrastructure such as twitter, government information portals and the university e-repository. To extend our expertise in KT, we developed a collaboration with a Canadian KT expert. This presentation will describe the strategies we have employed to disseminate our research findings. Since the inception of our project our quarterly newsletter distribution list has grown from 200 to over 900 individuals and organisations. In addition to reporting our research findings, the newsletter regularly highlights people and topics of interest to the rural disability sector. By utilising available technology and infrastructure we have provided our research participants and end users with various channels to access our outputs. Using university supports such as branded documents and templates, and a website, has increased our searchability on Google and other search engines allowing us to potentially reach new audiences. Future work will evaluate the effectiveness of these strategies.


Conference: 7th Biennial Australian Academy of Cerebral Palsy and Developmental Medicine Conference, Hunter Valley.

Abstract Title: Therapy service delivery for people with CP in rural and remote Australia: is it as good as it’s going to get?

Abstract: We aim to understand the therapy service delivery experiences of carers of people with a disability, including cerebral palsy, who live in rural and remote areas, and the factors that influence the extent to which they receive person-centred services. As part of a larger study into the delivery of therapy services in rural NSW, focus groups and individual interviews were conducted with carers living in a rural NSW region (n = 78; female n = 70; age range 20-29y – 71+y; median age range 41-50y) who cared for a person with a disability (age 16mths – 60y; median age 9y). In total, 13 carers supported a person with cerebral palsy (age range 2-32y). Theoretical sampling strategies were employed to ensure participants represented a diverse range of experiences, based on gender, age, geographic location, type of disability, and living environment. Semi-structured question guides were used to direct focus groups and interviews, drawn from analysis of policy documents and literature. Participants described their experiences of accessing therapy services, including the extent to which they believed services were person-centred. Interviews and focus groups were digitally recorded, transcribed, and analysed separately using thematic analysis and constant comparison. Themes and patterns were compared and contrasted within and across interview transcripts and key variables such as disability type and age. : Although therapy services were highly valued by carers, participants described major barriers in accessing person-centred therapy services, including: a) travelling to access therapy, which entailed financial and personal costs; b) waiting times to get services, leading to sporadic, inconsistent and uncoordinated service delivery; and c) limited access to therapy past early childhood. Analysis of the subgroup of carers who supported a person with cerebral palsy suggested that major barriers existed in their access of timely, evidence based, person-centred interventions currently recommended as standard care within cerebral palsy literature. The shift to individual funding of therapy under DisabilityCare Australia has the potential to give people with cerebral palsy greater access to, and choice of therapy providers. However, the current results suggest that those living in rural areas have fewer service choices and do not have the same opportunities to access evidence based interventions as their counterparts living in metropolitan areas. Flexible and innovative service delivery models may hold the key to addressing the identified barriers and supporting the wellbeing of people with cerebral palsy living in rural areas.


Conference: Allied Health Professions Australia Conference, Brisbane.

Abstract Title: Wobbly Hub and Double Spokes Project: accessible, simple and useful knowledge translation strategies.

Abstract: Therapy service provision to people with disability living in rural areas is challenging due to a shortage of therapy workforce and unique geographic constraints resulting in a high level of unmet need. The introduction of the National Disability Insurance Scheme (NDIS) is likely to increase the demand for therapy services but not necessarily result in an increased rural therapy workforce. Previous work by the Wobbly Hub and Double Spokes project team highlighted the potential of rural private therapists to help meet the increased therapy demand. The Wobbly Hub team received Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) Practical Design Funds to develop a framework to enhance the capacity of rural private therapists to provide high quality, sustainable and accessible services to people with disability under the NDIS. Focus groups and telephone interviews were conducted with 28 private therapists working in western New South Wales. Data were analysed using thematic analysis and a draft framework was developed. The draft framework was refined through an online modified Delphi process and national consultations with key stakeholders. The resulting framework identifies the means by which a therapist and a person with disability work together within their community, drawing on existing networks, resources and processes to meet the needs and goals of the person. The framework identifies barriers, facilitators, drivers and potential solutions that limit or enhance the capacity of private therapists within rural communities to provide high quality services. The use of this framework to guide policy and service provision will result in high quality, sustainable and accessible therapy services for people with a disability in rural areas. Furthermore, the framework highlights the importance of drawing and building on the networks, resources and processes within rural communities to support the participation of people with disability.


2013

Conference: "Our Time" Australasian Society for Intellectual Disability, Sydney.

Abstract Title: A rural private therapy framework to support the delivery of high quality, sustainable and accessible services to rural people with disability.

Abstract: People with disability living in rural areas can have trouble getting therapy services. This can be because there are not enough therapists or because the person lives a long way from services. We found that private therapists might be able to provide some of these therapy services in rural areas. We got money from the Australian Government to look at how to help rural private therapists to give good services that people with disability want under the National Disability Insurance Scheme. We spoke to therapists who work in western New South Wales and came up with a framework. We asked experts across Australia, including people with disability and their carers, what they thought of the framework and what would make it better. Our framework describes the things that make it harder or easier for rural therapists to provide good services to people with disability.


Conference: "Our Time" Australasian Society for Intellectual Disability, Sydney.

Abstract Title: How many allied health professionals are employed in the disability sector in rural and remote NSW and how often do they leave the sector?


Abstract: The presentation will use different information sources to promote understanding of the allied health (AHPs) workforce in rural and remote areas of New South Wales (NSW) who work with people with disabilities. Findings from focus groups and interviews with 97 rural AHPs and service providers will be presented and compared to other data sources, such as: the Australian Health Practitioner Regulation Authority (AHPRA), National Census 2011 and other health reports. Reasons for differences between the data sources will be explored and future implications for workforce planning will be discussed. This presentation will show the discrepancies between the different data sources regarding the number of AHPs living and working in rural NSW and will recommend registration for all AHPs with modifications to current data collected by the organisations to capture the true rural workforce issues.


Conference: "Our Time" Australasian Society for Intellectual Disability, Sydney.

Abstract Title: Workforce preferences for therapist working in rural and remote areas of Australia.

Abstract: The number of rural therapists (physiotherapists, occupational therapist, speech pathologists and psychologists) is limited. Limited numbers of therapists makes it hard for people with disability to get therapy. In an online survey we asked 165 therapists working in rural NSW about what they liked and what would keep them working in their rural jobs. Therapists told us the things they liked best were being able to decide how they worked (autonomy), spending less nights away from home, having good opportunities for training, being supported by their managers and other therapists, and having flexible work choices. These are important factors in keeping therapists working in rural areas of NSW so they can provide people with a disability with therapy.


Conference: "Our Time" Australasian Society for Intellectual Disability, Sydney.

Abstract Title: Rural carers of people with a disability: Making choices to move or to stay.

Abstract: Carers of people with a disability who live in rural areas make choices about whether to stay living where they are or to move to a larger town to get therapy for the person they care for. We spoke to 78 carers of people with a disability in rural NSW. They told us that being close to therapy services is important but they also have to think about the help they get from family, friends and their local community. They may also be looking after other children or elderly parents and they have jobs. One of these carers will tell her story about the choices she made. We will tell about other carers’ choices. These stories show the personal, social and economic factors that lead to the choices carers make. We suggest a different way of making therapy easier to get for rural people with a disability and their carers.


Conference: DisabilityCare Australia National Conference, Melbourne.

Abstract Title: Enabling High Quality, Sustainable and Accessible Services: A Framework for Rural Private Therapists.

Abstract: There is less access to allied health professionals (therapists) in rural areas resulting in a high level of unmet need. Little is known about the capacity of the private therapy sector to meet the growing demand in a significantly changing disability sector. Funded by FaHCSIA, the aim of the Rural Private Therapy Project was to develop a framework to assist rural private therapists to provide ongoing, high quality and accessible therapy to rural disability service users.
After performing a literature review and conducting focus groups and interviews with 28 rural private therapists working in western NSW the first draft of the rural private therapy framework was developed. The draft framework was refined via two rounds of online feedback from participating rural private therapists, representatives of national peak allied health organisations, national peak disability organisations, and national rural Medicare Locals. Online and face-to-face consultations were then conducted with rural disability service users to further refine the framework. Feedback from all participants was combined to develop the final framework.
Therapists and service users who participated in the development of the framework indicated that the autonomy and workforce stability of private therapists means they have the potential to provide flexible, creative and responsive services in rural areas. Furthermore, they are often better positioned to develop long-term collaborative relationships with service users and their communities. Although there is clearly great potential for rural private therapists to provide valuable services, participants noted that they are often constrained by time limitations and inflexible funding and service systems.
The framework provides guidance for the development of policies, systems and models of practice that maximise the potential of rural private therapists to provide high quality, sustainable and accessible services. Implementation of the framework has the potential to create an environment that will encourage the growth of private therapy services through DisabilityCare Australia that are responsive to the diverse needs of rural disability service users. This document briefly describes the components of the framework.


Conference: Health Workforce Interest Group Meeting, Academy Health, Baltimore, United States of America.

Abstract Title: Using discrete choice experiments to explore workforce preferences for allied health professionals working in rural and remote areas of Australia.

Abstract: Rural shortages of health personnel are a major issue not just in Australia but globally. One of the biggest challenges facing health policy makers is motivating health workers to work in rural areas. Allied health professionals (AHPs) form a vital part of the health care infrastructure necessary to support ambulatory and primary care and to provide the full spectrum of basic health care. However only 23% of AHPs work in non-metropolitan areas. In recent years discrete choice experiments (DCEs) have been used to study health worker preferences and to provide insight into potential policy responses to the rural recruitment and retention problem.
This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapist, speech pathologists and psychologists) place on different work characteristics and the trade-offs they are willing to make between them using a best worst discrete choice experiment (BWSDCE).
A cross-sectional survey was conducted using an online questionnaire which was distributed to AHPs working within the field of disability in a rural region of Australia over a three-month period. Information was sought about various aspects of the therapists’ current job and their workforce preferences were explored using a BWSDCE. A conditional logistic regression model was used to determine the relative importance of six different job attributes.
199 therapists completed the survey; response rate was 51%. Of those 165 completed the BWSDCE task. Except for some job flexibility all other attributes had a statistical influence on AHPs job preference. High autonomy was the most important job attribute that would likely keep AHPs practising in a rural area. Travel one or less nights away per month, adequate professional development, readily available professional support, very flexible work practices were also significant. Remuneration (as a loading for leaving in a rural area) was the least important job attribute.
This study allowed the identification of factors that contribute to AHPs’ employment decisions such as staying and working in a rural area. This information can improve job conditions in rural and remote areas to increase retention An understanding of the relative importance of particular factors and/or combinations thereof, on AHPs’ choices. Evidence to support policy decisions about retention strategies that may be considered in rural and remote areas.


Conference: Carers NSW Biennial Conference 2013, Sydney.

Abstract Title: Rural carers of people with a disability: making choices to move or to stay.

Abstract: This presentation will explore the choices carers of people with a disability who live in rural areas of NSW face about whether to stay living in their local community or to move to a larger town where therapy may be more available.
The Wobbly Hub and Double Spokes project funded by the National Health and Medical Research Council is a partnership between the Faculty of Health Sciences, University of Sydney and NSW Family and Community Services, Ageing, Disability and Home Care, Western Region (ADHC WR) to develop, implement and evaluate new models of therapy service delivery in rural NSW.
During 2011 with the assistance of ADHC WR and non-government organisations, the research team recruited 78 carers of people with a disability living in western NSW. Carers were interviewed about access to therapy services. Interview transcripts were analysed using constant comparison and thematic analysis.
One of the themes that emerged from the interviews and focus groups addressed the choices that carers make about where they live. Access to specialist supports is a strong factor impacting on this choice. Balanced against the need for specialist support services was the availability of informal supports from family, friends and local community. Caring responsibilities for other children and ageing parents were also weighed up along with carer employment.
Drawing on the personal experience of one carer and using quotes from other carers along with literature, this presentation will explore the personal, social and economic factors informing rural carers’ decisions. We will present an alternative rural and remote person-centred approach that may provide greater access to therapy supports without the need for carers and the person they care for to move away from their rural communities.


2012

Conference: International Association for the Scientific Study of Intellectual Disability (IASSID), Halifax, Canada.

Abstract Title: Impact of individual funding on service access for people with a disability in rural and remote areas.

Abstract: Australian government policies have resulted in a move away from traditional service provider ‘block funding’, to individual funding models which should allow people with a disability greater service access flexibility and choice. However, people with a disability who live in rural areas have always had less choice and access to therapy services than their metropolitan counterparts. Little is known about how the introduction of individual funding has impacted on people in rural areas.
As part of a large four year study into the delivery of therapy services to people with a disability living in rural areas of western New South Wales, 78 carers and 10 adults with a disability were interviewed. Participants spoke about the difficulties they experienced in accessing services using recently introduced individual funding packages.
This presentation will use examples from participants to suggest strategies for place-based approaches that are tailored to local conditions to address the barriers to successful implementation of individual funding models for people living in rural areas. Internationally, careful planning is required to lessen the disadvantages to therapy service access experienced by people living in rural communities.


Conference: National Disability Services conference, Sydney.

Abstract Title: Individual funding and therapy service delivery in rural and remote NSW.

Abstract: The NSW disability service system has undergone significant expansion and reform under Stronger Together policy initiatives over the past 5 years. The recently affirmed commitment to the second phase of Stronger Together has ushered the disability sector into a further 5 years of expansion and reform, with a particular focus on individual funding models of service delivery, embracing a broader range of providers from both the government and non government sectors.
The delivery of disability services in rural and remote locations raises particular challenges and rewards, and the move to implementation of individualised funding models in rural and remote areas is no exception to this.
This paper presents initial findings from interviews and focus groups with carers and disability service providers, conducted as part of the Wobbly Hub & Double Spokes Project (WH&DS), a five year National Health & Medical Research Council (NH&MRC) funded partnership project with the Department of Family and Community Services, Ageing, Disability and Home Care, Western Region.
The capacity of rural and remote communities to rise to the challenge of individualised funding models is demonstrated by examples of localised solutions to the delivery of therapy services. The difficulties are also explored through the experience of the carers and service providers engaged in the project and a brief overview of the literature from other rural and remote jurisdictions.
The lessons for future disability therapy service system design and development in rural and remote locations is outlined, including issues of workforce collaboration, training, recruitment, retention and reform.


Conference: Allied Health Professionals Australia, Canberra.

Abstract Title: Building Capacity with Research Partnerships.

Abstract: Ageing, Disability and Home Care (ADHC) therapists working in Western Region (WR) articulated the need for a different approach to the delivery of therapy services to people with a disability living in the region than is used in urban regions. A ‘one size fits all’ approach was seen as inappropriate to adequately meet the therapy needs of people with a disability in the region.
A desire to address these issues resulted in a 4-year NHMRC ‘Partnership for Better Health’ grant bringing together ADHC WR and the University of Sydney. These partners seek to develop policy and service delivery models that are sustainable and regionally applicable given WR’s large geographic area and diverse population.
A number of mutual benefits have arisen from these beginnings. University project team members have delivered professional development, access to literature and data to inform best practice, opportunities to jointly present at conferences, and support to pursue individual research interests. Regional staff members have provided the University team with opportunities to understand the real-life complexities of delivering services in rural and remote locations, which in turn informs the preparation of future practitioners.
This collaborative approach builds capacity for both partners and leads to locally tailored service delivery models that will be sustainable into the future. This presentation outlines the development of partnership strategies that align the expertise and needs of WR therapists with the resources and skills of the University staff.


Conference: ASID NSW State Conference, Sydney.

Abstract Title: Recruiting and retaining therapists to work in disability services in regional areas.

Abstract: Allied health professionals including speech, occupational and physio therapists play an important role in maximising the community participation of people with a disability. The ‘hub and spoke model’ for delivering allied health services in rural and remote areas is an attempt to balance equitable allocation of scare resources to people with a disability, and to overcome workforce constraints. The challenges of recruiting and retaining therapists in rural areas are well documented. This 4 year NHMRC partnership project between the University of Sydney and Ageing, Disability and Home Care, Western Region (WR) aims to develop a sustainable, evidence-based model to support effective therapy delivery.
This presentation reports on a part of the larger project related to the recruitment and retention of therapists in disability services in regional, rural and remote areas taken from individual interviews and focus groups with 97 government and non-government service providers in the WR of NSW. Participants identified difficulties with recruiting and retaining therapists including: barriers to enticing therapists to non-metropolitan jobs, interagency competition, award disparities, lengthy recruitment times, and geographic and professional isolation.
There were a range of strategies utilised by organisations to address these issues including: undergraduate student scholarships, relocation packages, flexible job location, and professional supervision and mentoring programs. While effective, these strategies varied across organisations and across the region. This presentation will suggest a coordinated, multi-faceted approach to recruiting and retaining therapists to work in rural areas that may help to build and maintain the therapy workforce.


Conference: ASID NSW State Conference, Sydney.

Abstract Title: Recruiting and retaining therapists to work in disability services in regional areas.

Abstract: Allied health professionals including speech, occupational and physio therapists play an important role in maximising the community participation of people with a disability. The ‘hub and spoke model’ for delivering allied health services in rural and remote areas is an attempt to balance equitable allocation of scare resources to people with a disability, and to overcome workforce constraints. The challenges of recruiting and retaining therapists in rural areas are well documented. This 4 year NHMRC partnership project between the University of Sydney and Ageing, Disability and Home Care, Western Region (WR) aims to develop a sustainable, evidence-based model to support effective therapy delivery.
This presentation reports on a part of the larger project related to the recruitment and retention of therapists in disability services in regional, rural and remote areas taken from individual interviews and focus groups with 97 government and non-government service providers in the WR of NSW. Participants identified difficulties with recruiting and retaining therapists including: barriers to enticing therapists to non-metropolitan jobs, interagency competition, award disparities, lengthy recruitment times, and geographic and professional isolation.
There were a range of strategies utilised by organisations to address these issues including: undergraduate student scholarships, relocation packages, flexible job location, and professional supervision and mentoring programs. While effective, these strategies varied across organisations and across the region. This presentation will suggest a coordinated, multi-faceted approach to recruiting and retaining therapists to work in rural areas that may help to build and maintain the therapy workforce.


Conference: SPOT on DD, Sydney.

Abstract Title: Innovation in rural and remote therapy service delivery

Abstract: This presentation involves data from Stage 1 and 2 of a five year NH&MRC partnership grant between the Faculty of Health Sciences, University of Sydney and Ageing, Disability and Home Care Western Region. Known as Wobbly Hub and Double Spokes, this project is investigating the delivery of therapy services to people with a disability who live in regional, rural and remote areas of western NSW. The presentation will highlight current pratice and challenges in therapy service delivery in these areas and will present a framework for the future development of therapy services for people with a disability.
Stage 1 of the project involved content analysis of policy documents relating to the delivery of therapy services, and interviews with 50 senior staff in government and non-government organisations providing therapy services to people with a disability in western NSW. Stage 2 involved focus groups and interviews with 97 service providers, 78 carers and 10 adults with a disability in western NSW. Thematic analysis and constant comparison were used to extract themes from the transcripts of the interviews and focus groups. This presentation illustrates successes and challenges in providing therapy services in regional, rural and remote NSW from the perspectives of carers, people with a disability (service users) and service providers. Within the context of enhanced funding for therapy service provision through Stronger Together, we present participants’ experiences of providing and receiving therapy services in the context of local conditions related to vast geographic distances and dispersed populations resulting in workforce shortages, extensive travel, long waiting times, variable interagency collaboration, and difficulties accessing information and support.
Based on the initial analysis of the findings we developed a family-centred therapy model that represents the place of service users in relation to the current service sector in western NSW. This model influenced the development of a framework for implementation of a person-centred therapy service in rural and remote areas. In response to the barriers and challenges raised in the focus groups and interviews, the framework identifies potential pathways for building capacity utilising local place-based, outreach, centre-based, and telecommunication services. The framework suggests a mechanism for designing future therapy service delivery that is responsive and incorporates contemporary practice models and techniques. The model and framework will be presented and discussed.


Conference: Occupational Therapy Association, Sydney.

Abstract Title: An evidence based model to expand access to OT in rural NSW

Abstract: Occupational therapists are a key support for people with a disability and their families, promoting participation in valued and meaningful activities in a variety of contexts. Access to occupational therapy services in rural and remote areas can be compromised by, among other factors, geographic and workforce issues.
This presentation draws on data collected as part of a large-scale, four-year program of research in western NSW. The data presented here, collected in focus groups and interviews with 97 service providers, 78 carers and 10 individuals with a disability, reports on factors impacting on access to therapy services in rural and remote areas. Difficulty recruiting and retaining an adequate workforce to provide therapy services, including occupational therapy was reported widely. In addition, the therapists in rural areas faced significant challenges providing services to a geographically dispersed population, with those in remote locations having reduced service access.
A model for reviewing and planning therapy service delivery based on person-centered and place-based constructs has been developed in response to workforce and geographic factors. Four service delivery options: 1. Creative local solutions; 2. Responsive outreach; 3.Responsive centre-based, and 4. Innovative technology options were identified as parts of a system that will improve therapy service access. This model will be introduced using specific examples such as teletherapy, therapy assistants, fly-in-fly-out services and travelling to specialist support clinics which were identified from the interviews and focus groups. These examples highlight opportunities for improving access to occupational therapy services in rural and remote locations.


2011

Conference: Primary Health Care Research Conference, Brisbane.

Abstract Title: Integrating evidence into policy and sustainable service delivery: The ‘wobbly hub and double spokes’ model.

Abstract: Rationale: This multi-phase 4-year partnership project draws on the knowledge and experience of researchers, policy-makers, clinicians and consumers to generate evidence to confirm and develop evidence-based policies that enable a rural allied health workforce to more expeditiously respond to service need. It encompasses the full policy cycle - collect/review; develop; implement; evaluate.
This paper describes and discusses the importance of having input from policy-makers, researchers, clinicians and consumers at all stages of the project itself and the wider policy cycle.
Key issues:
1. Development of project plan and focus
2. Obtaining & maintaining stakeholder involvement
3. Data collection, analysis, intepretation & validation
4. Implementing findings & stakeholder input into policy
5. Developing and engendering stakeholder research capacity
Benefit to the community: The importance and relevance of stakeholder input in policy development is demonstrated by the broad interest in this study and commitment from stakeholders across the board. The process enables ready and timely input to policy and service development and implementation. It builds ownership and commitment. The outcomes enhance workforce recruitment, support and retention, and service delivery to consumers.


Conference: Rural Health Research Colloquium, Dubbo NSW

Abstract Title: Recruiting and retaining therapists to work in disability services in regional areas.

Abstract: Allied health professionals including speech, occupational and physio therapists play an important role in maximising the community participation of people with a disability. The ‘hub and spoke model’ for delivering allied health services in rural and remote areas is an attempt to balance equitable allocation of scare resources to people with a disability, and to overcome workforce constraints. The challenges of recruiting and retaining therapists in rural areas are well documented. This 4 year NHMRC partnership project between the University of Sydney and Ageing, Disability and Home Care, Western Region (WR) aims to develop a sustainable, evidence-based model to support effective therapy delivery.
Individual interviews and focus groups with a range of government and non-government specialist support staff including therapists and carers of people with a disability in the WR of NSW sought information about current models of service delivery. Formal and informal recruitment, retention and support strategies were used to increase and sustain therapists working in WR. Recruitment strategies included offering undergraduate therapy students scholarships to have placements in WR, advertising overseas to attract therapists, and payment of relocation expenses. Incentives to retain staff included offering flexibility to therapists in relation to the town in which they were based and offering part time work opportunities. Support strategies included appointment of senior therapists within each discipline to provide professional development, supervision and coordination to new graduate and experienced therapists, and opportunities for therapists to attend and present at conferences and workshops. While effective, these strategies varied across organisations and across the region.
This presentation draws on these preliminary findings to discuss these and other strategies in the light of growing demand for therapy services by people with a disability across all age groups.


Conference: Early Childhood Intervention Australia: NSW Chapter State Conference, Sydney.

Abstract Title: Therapy Assistants: Building capacity in rural and remote therapy services.

Abstract: The Wobbly Hub and Double Spokes project is a four year National Health & Medical Research Council (NH&MRC) partnership project with the University of Sydney, Faculty of Health Sciences and Ageing, Disability and Home Care (ADHC), Western Region. One element of this multi-phase project explores the delivery of physiotherapy, speech pathology and occupational therapy to people with a disability and their carers in rural and remote western NSW. This includes investigating policy, workforce and service design impacts.
The NSW Government has endorsed Stronger Together, A new direction for disability services in NSW: 2006-2016. The introduction of therapy assistants is one Stronger Together initiative designed to extend the reach of therapy services. That initiative has particular implications in rural and remote locations.
This paper (i) critically reviews the literature on the use of therapy assistants in rural and remote jurisdictions; and (ii) explores the policy settings and implementation of the current therapy assistant initiative in ADHC’s Western Region.
The literature indicates the importance of providing health professionals, services and clients with advance information about how new roles enhance and extend service delivery. The benefits that can accrue from successful integration of therapy assistants into existing services has the potential to increase access to timely and targeted therapy and support services in rural and remote locations in western NSW, leading to better outcomes for people with a disability and their carers in the region.


Conference: Australasian Society for Intellectual Disability (ASID), Adelaide SA.

Abstract Title: Collaborating to translate policy into practice: enhancing therapy services in Western NSW

Abstract: The Stronger Together initiative aims to enhance therapy services to people with a disability in NSW. A key consideration is recruiting and retaining sufficient numbers of therapists in rural and remote areas – something that has been historically difficult. Recognition that new approaches to addressing rural and remote therapist numbers are required resulted in a partnership between the Faculty of Health Sciences, University of Sydney and Ageing, Disability and Home Care, Western Region (WR). Funded through the inaugural NHMRC ‘Partnerships for Better Health’ scheme the project aim is to develop, implement and evaluate evidence-based policies which will promote timely and effective therapy service delivery to people with a disability living in WR.
This project demonstrates that a collaborative approach which promotes joint ownership, commitment to changing practice, and a willingness to try different models through the involvement of therapists, other specialist support staff, service users, management, policy makers and researchers, can engender realistic, appropriate and sustainable enhancements in workforce and service delivery. This paper, jointly presented by a researcher and a project partner, outlines a model for building a successful research partnership to translate policy into practice, enhancing the delivery of therapy services to people with a disability living in rural and remote areas.


Conference: The Health Services and Policy Research Conference, Adelaide.

Abstract Title: Integrating evidence into policy and sustainable service delivery: The 'wobbly hub and double spokes' project.

Abstract: Key issues included: the impact of geographic distribution of workforce and clients; workforce issues (recruitment, support, workloads, retention); equity and access issues for rural clients; and the important role of the NGO sector in rural service delivery and support. There are disconnects at every level between policy direction, policy development, policy implementation, and practice, thus information does not pass efficiently, or in 'language' that is meaningful between service levels. The greatest disconnect is between policy-makers and the population for whom they make policy. Senior managers have a better understanding of those who qualify for their particular service, although this doesn't mean people get service, or that managers understand the actual needs of potential clients. Clinicians understand what their individual clients want and need, but those clinicians do not have the wherewithal or appropriate 'language' to pass that information up to managers/policy-makers in ways that are meaningful to the latter.


Conference: World Report on Disability Symposium, Sydney.

Abstract Title: Addressing the barriers to people with a disability accessing mainstream and specific services in rural and remote areas.

Abstract: Vast distances and workforce shortages pose significant barriers to people with a disability accessing mainstream and specific services in rural and remote areas of Australia. The Faculty of Health Sciences, University of Sydney received an inaugural National Health & Medical Research Council (NHMRC) “Partnerships for Better Health” grant to work with the New South Wales (NSW) Department of Community Services, Ageing, Disability and Home Care (ADHC) Western Region (WR) to examine issues facing the delivery of therapy services in rural and remote NSW. The aim of the project is to develop, implement and evaluate new sustainable models of service delivery.
One year into the four year project, the project team have reviewed policy documents and spoken with 50 government and non-government senior managers, 97 direct service providers, 78 carers, and 10 adults with a disability. Senior managers reported difficulty in recruiting and retaining therapists to work in rural and remote communities; direct service providers reported challenges in implementing centrally developed policies including the ability to offer early intervention and ongoing support to people living in the least accessible areas; carers spoke about restrictive eligibility criteria, long waiting periods, and a lack of service options; and adults with a disability said they used to get therapy when they were younger but no longer could.
This presentation, which has relevance to countries providing services to rural and remote areas, will use case studies to present the multiple stakeholder perspectives and discuss preliminary options for overcoming the identified barriers including: flexible recruitment, retention and service delivery models which are tailored to local area-specific needs and promote cross-agency collaboration, expansion of the use of audio and visual technologies between therapists and between therapists and people with a disability and their carers, and training community-based therapy assistants to work remotely in order to implement programs.