FACULTY OF HEALTH SCIENCES Missing in Action: Allied Health Services in Far West NSW Michelle Lincoln and Kylie Gwynne

An example August 2013 Brewarrina ›Population 1,874 (ABS 2011) 2 DisciplineAgency Number of visits Based Occupational Therapy Dubbo Community Health Rural Primary Health service (RPHS) 4 x days per term Dubbo Community Health Speech Pathology Dubbo Community Health (RPHS) 5 visits per year Dubbo Community Health BothRoyal Far West ADHC Cerebral Palsy Alliance As neededManly, Dubbo, Mudgee

Walgett Population: 6,797 (ABS 2011) 3 DisciplineAgencyNumber of visitsBased Occupational Therapy Far West Medicare Local 1 x day/fortnight Lightning Ridge FWML Speech Pathology Walgett Aboriginal Medical Service POCHE 5 day/fortnight Lightning Ridge FWML BothRoyal Far West ADHC Cerebral Palsy Alliance As neededSydney, Manly, Mudgee, Dubbo

4 LGAPopulationDays of Service per year Brewarrina1,87421 Walgett6, Bourke2,8680

The Problem ›Access to allied health services for people living in rural and remote areas ›Small, unevenly distributed workforce ›Recruitment and retention issues ›‘Patchy’ engagement with Aboriginal people and communities 5

In Far West NSW A Patchwork of Services, not based on population needs or size ›Historical ›Opportunistic recruitment ›Outreach services from multiple government and nongovernment providers ›Lack of clarity about service delivery model and expected outcomes 6

This has resulted in … ›Overarching sense of instability and unreliability of allied health services ›Unidentified need ›Lack of awareness of the benefits ›Inequity of access ›Questionable effectiveness 7

Why is this a problem? › AHPs assist people to participate fully in their families, employment, and communities ›Their supply is critical to health, quality of life, and community participation, particularly for those with significant disabilities. ›Least services in areas of highest demand? 8

Aboriginal children and speech and language development ›The prevalence of speech and language delays and disorders is unknown ›Most likely due to a lack of culturally appropriate assessment tools and engagement strategies ›Otitis media occurs at much higher rates in Aboriginal and Torres Strait Islander populations than in in non-Aboriginal and Torres Strait Islander populations which can have a significant impact on speech and language development and educational outcomes 9

Speech, language and communication skills ›Oral language and literacy development ›Oral language and ability to access the whole school curriculum ›Communication skills and - social skills -ability to resolve conflict -employability, SES -incarceration rates 10

Fine motor, self care, self regulation and social skills ›Make friends and form relationships ›Grasp, write and manipulate objects ›Participate in classroom activities ›Participate in family and social activities 11

Poche Centre Model Poche Centre and Faculty of Health Sciences Allied health clinicians Allied health assistants 12 Students Postdoctoral Researcher

Resourcing ›Funding for 3 Allied Health Assistant scholarships ›Speech Pathologist and Occupational Therapist ›Postdoctoral researcher 13

Research The impact of the Poche Model on accessibility and effectiveness of allied health services in rural and remote areas ›Iterative cycle of health services research ›Mixed methods design ›Child outcome measures ›Stakeholder perspectives 14

References ›Davidson, B., Hill, A., & Nelson, A. (2013). Responding to the World Report on Disability in Australia: Lessons from collaboration in an urban Aboriginal and Torres Strait Islander school. International Journal of Speech- Language Pathology, 15, 1, ›Gould, J. (2008). Non-standard assessment practices in the evaluation of communication in Australian Aboriginal children. Clinical Linguistics and Phonetic., 22, 8, ›Morris, P., Leach, A., Silberberg, P., Mellon, G., Wilson, C., Hamilton, E. & Beissbarth, J. (2005). Otitis media in young Aboriginal children from remote communities in northern and central Australia. BMC Pediatrics, 5, 27. ›Pearce, W., & Williams, C. (2013). The cultural appropriateness and diagnostic usefulness of standardized language assessments for Indigenous Australian children. International Journal of Speech-Language Pathology, 15, 4, ›Toohill, B., McLeod, S., & McCormack, J. (2012). Effect of dialect on identification and severity of speech impairment in Indigenous Aboriginal children. Clinical Linguistics and Phonetics, 26, 2,

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