Red Dirt Rehab Delivering a cost effective and culturally appropriate model to rehabilitation in rural / remote Northern Territory

Introductions Angela Pilcher Rehabilitation Counsellor (MASORC) NT Manager / Rehabilitation Consultant Vocational Management Services M: E:

Why do we Rehabilitate? Reduce financial and productivity costs Reduce social cost Maintain valuable work skills Encourage maximum medical recovery Prevent further or secondary injuries Limit employment impact

Welcome to the Northern Territory The NT covers one-sixth of Australia’s land mass with a land area of 1,364,000 square KMs It is the third largest state and has the largest proportion of ‘remote population’ then any other state / territory. NT has a population of 232,000 people, including 70,000 Indigenous persons (30%). 43% of the NT population is considered to reside in remote or very remote areas. The employment rate for rural / remote NT is 68% REFERENCE: NT Medicare Local Health Atlas 2014

Welcome to the Northern Territory The Index of Relative Social Disadvantage indicates that with the exception of urban centres, the rest of the NT is extremely disadvantaged across areas of education, occupation, employment, income, families and housing. REFERENCE: NT Medicare Local Health Atlas 2014

Welcome to the Northern Territory DarwinAlice Springs JabiruKatherin e Kings Canyon Tennant Creek Uluru Darwin… Alice Springs 1482… Jabiru … Katherine … Kings Canyon … Tennant Creek …945 Uluru … Northern Territory Driving Distances (km’s) REFERENCE: Remote Area Health Corps; Darwin Profile 2014

Welcome to the Northern Territory ClinicianNumber GP308 Hospital non- specialist 188 Specialist192 Specialist in training 163 Other44 Total895 No. per 100,000 (NT Avg) 132 No. per 100,000 (Aust Avg) 353 Health Workforce Overview NT REFERENCE: NT Medicare Health Atlas 2014

Welcome to the Northern Territory Health Service District NursesGPsTotal Pop. Darwin Urban ,725 Darwin Rural 22916,995 East Arnhem ,956 Katherine ,174 Barkly97156,677 Alice Springs Rural ,243 Alice Springs Urban ,092 Health Service District and Populations REFERENCE: NT Medicare Health Atlas 2014

Understanding the Challenges Locations and Travel

Understanding the Challenges Access to Health Services 54 NT Government run Remote Health Centres GP ratio =1:717 Psychologist ratio = 1:1588 Physiotherapist ratio = 1:1825 Occupational Therapist ratio = 1:2229 Specialist Outreach NT program Delays for appointments / treatment and equipment REFERENCE: NT Health Services Profile 2013, NTG Publication Borroloola Remote Health Centre

Understanding the Challenges Labour Market Challenges 14,525 registered businesses in the NT; only 2700 of these employ 5 or more people; Extremely limited rural, remote and community based employment; Limitations associated with education, experience and transferable skills Physical limitations Accommodation issues 201 positions for whole of Regional NT as at 15/10/2014 REFERENCE: NT Government Labour Market Brief August 2014 incl Regional Profile.

Understanding the Challenges Communication 28% of residents speak a language other than English 17% speak an Australian Indigenous Language Transient nature of employers / supervisors Regular rotation / transient nature of treating medical professionals Telephone / limitations REFERENCE: Remote Area Health Corps Darwin Profile 2014

Understanding the Challenges Cultural Considerations – Social Determinants of Health Poorer health status of Aboriginal people in the NT is influenced by additional social determinants Diminished self determination, connectedness to family, land, culture and identity present greater challenges. Social and economic disadvantage Geography, climate and accommodation Access / willingness to access services Appropriateness of services REFERENCE: NT Medicare Local Health Atlas 2014

Understanding the Challenges Cultural Considerations Understanding cultural competence; blindness & incompetence Individuals cultural identity Levels of acculturation; internal & external Appropriate engagement Assessment and interview techniques Community factors Level of worker / employer knowledge REFERENCE: Westerman; 2007; Indigenous Psychological Services

Impact on RTW Rates Northern TerritoryAustralia Average claim cost$23,900$13,126 Average loss time15.1 week8.7 weeks Average $ spent on claimant services (gross) $17.3M$197M RTW Rates %74%80% REFERENCE: Comparative Performance Monitoring Report, 16 th Edition; Safe Work Aust.

Impact on RTW Rates REFERENCE: Comparative Performance Monitoring Report, 16 th Edition; Safe Work Aust

Delivering Red Dirt Rehab. Early Intervention Immediate response Initial Rehab consultation – face to face Identify appropriate medical treatment and referrals Identification of RTW options / duties Cultural identity and appropriate techniques

Delivering Red Dirt Rehab RTW 1. Same Employer Same Duties Modified Duties New Duties 2. Different Employer Same Duties Modified Duties New Duties REFERENCE: Safe Work Australia

Delivering Red Dirt Rehab Engaging Stakeholders Injured workers Employers GP’s / nurses Allied Health Professionals Community support services Tiwi Islands

Delivering Red Dirt Rehab Treatment Considerations Community Health Services Northern Territory Medical Local programs E-Health / skype treatment Access to Specialist and IMEs Culturally appropriate considerations Travel

Delivering Red Dirt Rehab Cultural Considerations Understanding cultural disparity Appropriateness of introductions or vouching Impacts of gender differences Communication styles Use of culturally appropriate assessment / interview techniques Incorporating culturally appropriate treatment options REFERENCE: Westerman, 2007, Indigenous Psychological Services

Delivering Red Dirt Rehab 1.Location 2.Physical positioning 3.Acknowledge non-verbal cues 4.Cultural vouching 5.Identify and acknowledge cultural or gender differences 6.Confirm cultural boundaries 7.Negotiate limits to confidentiality 8.Discuss issues of possible blame 9.Assess what traditional treatments may have occurred Culturally Appropriate Engagement REFERENCE: Westerman, 2007, Indigenous Psychological Services

Benefits of Red Dirt Rehab Encourage whole of community relationship – reduce travel costs Early identification of barriers, appropriate medical treatment and RTW options Maintain and encourage worker / employer relationship Address RTW options in line with RTW hierarchy Greater understanding of location, labour market and limitations Reduce risk of further aggravation or secondary injuries Limit impact on employer and community through productivity loss Increase RTW outcome Reduce cost

Benefits of Red Dirt Rehab VMS RehabNT Avg Avg. cost per claim $ $5440$23,900 RTW rate %86%74% REFERENCE: VMS Statistics as at July 2014 Comparative Performance Monitoring Report, 16 th Edition, Safe Work Australia

Thank You