Large, loud, learned: A proactive and integrative group to maximise independence and wellness in people with Parkinson’s Disease (PWPD)

Mrs  Natalie Grainger1, Mrs  Rachael Marlow1, Mrs Karen Thomas1

1NSLHD NSW Health , Ryde Hospital Eastwood , Australia

Maximising allied health resources to improve health outcomes for PWPD to live an independent and fulfilling life. This program is unique and innovative increasing value on available resources, collaborative practice and patient centred care.

Parkinson’s Disease (PD) is a common chronic neurodegenerative disease in the aged population. As the disease progresses the symptoms begin to amalgamate and the resulting complexities include freezing of gait, falls, micrographia, dysarthria, dysphagia, fatigue, continence, sleep and cognitive disorders. Exercise can minimise the progression through neuroplastic and neuroprotective changes. These symptoms and existing co-morbidities demonstrate the need for value based health care where the PWPD is empowered to be proactive in the management of their own disease.

Whilst LSVT LOUD and BIG programs are currently utilised and effective, they train targets in isolation. Long term gains from these interventions are usually decreased due to poor consumer motivation and maintenance of treatment effects as the disease progresses.

Neurological rehabilitation needs to be integrated so the health service can respond to growing numbers of chronic conditions in aged populations. The Large, Loud and Learned group will combine inter-disciplinary treatments and shared goal setting enabling an improved sense of wellness and re-enablement. High intensity of practical tasks will facilitate cortical drive and provide opportunity for social engagement and education.

The weekly group will run for 8 weeks with 9-12 consumers. Eligibility includes idiopathic PD, Hoehn & Yahr 1-2, commitment and no moderate-severe cognitive impairment. Exclusion criteria includes untreated depression and those house bound. Outcomes will be measured at 8-weeks for six months. Primary outcome measures include the UPDRS, Decibel readings, freezing of gait questionnaire and timed functional tasks. Secondary outcomes include carer burden, well-being, social participation and self-confidence. Carry over effects will be evaluated at 3 months post completion.

Currently there is limited research to determine the effectiveness of an inter-disciplinary group on functional gains in PWPD. The group will evaluate if combining treatments to replicate everyday tasks leads to greater functional change and well-being for PWPD living in the community.


Biography:

Rachael Marlow is a Senior Occupational Therapy with over 20 years’ experience in neurological and community rehabilitation. She is currently employed as the Acting Manager in the Community Aged care and Rehabilitation Service (CAReS) within the Northern Sydney Local Health District at Ryde Hospital. Rachael has worked in a variety of settings including Inpatient, Community, Day hospital and Out Patients and is passionate about patient centred care.

Karen Thomas is a Senior Physiotherapist with over 30 years experience in adult rehabilitation including orthopaedic, geriatric, aquatic physiotherapy, musculoskeletal caseloads. She is committed to health coaching and incorporating exercise prescription as an ongoing lifestyle intervention. Karen is currently employed within the Northern Sydney Local Health District as the fracture liaison coordinator, part of the Osteoporosis Refracture Prevention Service (ACI). Her second role is the senior physiotherapist within CAReS.

Natalie Grainger is a Speech Pathologist employed within the Northern Sydney Local health District at Ryde Hospital. Her experiences range between inpatient, outpatient and community services across geriatrics, neurology, respiratory, disability and palliative care. Natalie is dedicated to achieving patient objectives and enhancing community well-being for elderly patients and those living with chronic conditions.

As a team we are committed to enhancing the lives of PWPD living in the community by collaborating together and providing innovative, evidence based, patient centred care.

Obesity: Everybody’s problem, nobody’s responsibility

Ms Claire Pearce1,2,3, Professor Andrew Wilson2,3, Professor Lucie Rychetnik2,3

1Canberra Health Services, Canberra, Australia, 2The Australian Prevention Partnership Centre, Sydney, Australia, 3University of Sydney, Menzies Centre for Health Policy, Sydney, Australia

Introduction: Obesity continues to have a significant impact on health services with people with obesity tending to access healthcare services more often and having longer lengths of stay. The literature supports health care based obesity prevention in the form of screening for obesity followed by referral to appropriate intervention services. Health professionals do not typically adopt this practice. The key practical barriers are time, knowledge and resourcing. The delivery of services is also influenced by personal perceptions.

Objective: The aim of this study was to utilise systems thinking to examine how perceptions of obesity and prevention at a policy, management and clinical level may influence how prevention is integrated into healthcare delivery.

Method: A sample of ACT public health service policy, management and clinical staff were interviewed to ascertain their perceptions of obesity and the role that health services could play in obesity prevention. The data was analysed using grounded theory.

Results: Two major concepts were observed in the data. The first related to the notion of obesity as a disease which encompassed perceptions of stigma, individual responsibility and the effectiveness of prevention. The second main concept related to the differences in paradigms that influence the health service response to obesity. Staff responsible for policy expressed a negative view towards obesity and a sense of nihilism, that obesity prevention is too late by the time people present to health services. Managers were less judgmental of obesity but expressed a degree of futileness towards prevention, highlighting a need to focus on the practical issues of caring for obese people and the immediate priorities of providing treatment. Clinicians expressed empathy towards overweight people and regularly incorporate opportunistic prevention into treatment despite an absence of clear policy direction contributing to a sense of helplessness.

Discussion: The reality of working with individuals on a one-to-one basis in a healthcare setting provides a different perspective to the population health view of obesity. Consideration needs to be given to how different parts of the system can input into policy and service development in order to develop the role of health services in the prevention of obesity.


Biography:

Claire is an occupational therapist who works as a senior project officer with the Chronic Disease Management Unit based at Canberra Health Services. She has a Masters of Health Sciences from the University of London. Claire is undertaking her PhD at the University of Sydney supported by a scholarship from the Australian Prevention Partnership Centre. Her research is investigating the role of health services in the prevention of obesity.

INTRgr8: Integrating NGO partners with Totara House to promote Recovery

Richard  Grist1, Elisa Mcconnochie1, Eleanor Baggott1

1Totara House, Canterbury District Health Board, Christchurch, New Zealand

Background: Totara House, an Early Intervention in Psychosis Service (EIP), supports young adults experiencing first-episode psychosis. The project integrates support workers from two NGO organisations with the aim of improving social recovery and physical health outcomes. Physical health and social recovery are priority areas for EIP, given that poor outcomes here can lead to compromised physical health and poorer overall recovery rates. The project has involved key allied health professionals.

Method: In mid-2016 an NGO Employment Consultant began delivering a dedicated employment service to Totara clients. By mid-2017 this expanded to include two dedicated Community Support Workers and a Health Coach. This was achieved by NGO managers streamlining referral processes to allow for specific workers to be allocated to Totara. This enables NGO workers to hold dedicated Totara caseloads, attend team meetings, participate in shared-care planning and engage with clients easily. Prior to the project, allocations of NGO workers were inconsistent, and uptake was low, to the detriment of social recovery and physical health outcomes. The project was evaluated by a survey in mid-2018 which canvassed the views of clients, family members, NGO staff and Totara staff.

Results: 26 surveys were returned and provided very positive feedback on the project. This included: Increased engagement by service users with NGO staff, increased activity and improvements relating to social recovery and physical health; NGO staff reported feeling valued and supported by the Totara team; and Totara staff highlighted the improved access to NGO workers and more effective communication between the different aspects of a client’s overall care package.

Discussion: This project has demonstrated that optimised allocation of NGO resources and integration with State mental health care, can lead to improved outcomes for clients and more effective staff relationships, without additional resources.


Biography: To be confirmed

My goals, my guide

Dr Susan Waller1, Dr Alison  Beauchamp1, Mrs Nicole McFarlane2

1Monash University, Warragul, Australia, 2Latrobe Community Health Service, Morwell, Australia

Aim: This innovative model categorises clients according to ability to self-manage their condition. The categories provide a structured, multidisciplinary approach to care, within which clients participate in goal-setting. This project aimed to embed Guided Care into CDM service delivery and evaluate outcomes.

Methods: Study design: quasi-experimental. Setting: rural community health service. Participants: clients with diabetes and respiratory conditions enrolled in GCM. Process: care plans are completed for new clients to identify health goals. Baseline assessment includes scales from the Health Literacy Questionnaire (HLQ) and the health education impact Questionnaire (heiQ). Clients are categorised according to level of support needed to reach their goals; this determines multidisciplinary team input and follow-up frequency. Outcomes: changes in the HLQ/heiQ and goal attainment at 6-months. Clinicians were interviewed to identify factors influencing uptake of GCM.

Results: Baseline data from n=162 clients shows 20% required a high level, and 57% a moderate level of self-management support. At 6-month review (n=50) significant increases in all HLQ/heiQ scales were seen. 68% reported achieving their goals. Clinicians viewed GCM as a holistic, client-centred approach. Challenges and enablers to its implementation were also identified.

Significance for Allied Health: The GCM supports clients to build self-management capacity and offers AHPs a structured approach to planning intervention that meets the client’s need. AHPs are better able to support person centred management by actively partnering with the client to understand where they are in their chronic disease journey.


Biography:

Susan is a Senior Lecturer in Monash Rural Health, Monash University. Susan is responsible for nursing and allied student placement support in the MRH footprint, facilitating the interprofessional simulated student clinic at Latrobe Community Health Service and teaching on the Masters of Advanced Healthcare Practice.

A cultural journey: Papua New Guinea to a North Queensland tertiary hospital

Ms Julie Watson1, Ms Chris Fox, Ms Elisabeth McColl

1Townsville Hospital And Health Service, Townsville, Australia

Background:  Each year an increasing number of patients arrive at the Townsville Hospital Intensive Care Units (adult, paediatric and neonatal) via Queensland Health Retrieval Services from Papua New Guinea.   The social, emotional and cultural issues for these patients and their accompanying family member/s are significant.  Papua New Guinea is one of the most ethnically diverse and complex countries in the world. Patients arriving at The Townsville Hospital (TTH) are primarily from small coastal villages in some of the remotest areas of Papua New Guinea.

Allied Health teams managing these patients at TTH have developed a wealth of knowledge, networks and innovative solutions in helping patients through to recovery and eventually a safe return to their homelands.

Method:  A review of a cross section of these patients presenting to TTH over a four year period has established a range issues impacting the patient and family including language barriers, cultural concerns, border security issues and personal safety on home returns.

Results:  This paper will outline key areas of learning from the review, highlighting the training and education needs of staff working with Papua New Guinea patients and health system improvements to better support this client group.


Biography:

Julie Watson is Director of Social Work at The Townsville Hospital (TTH).   She is a James Cook University (JCU) graduate and has worked primarily in the areas of disability and health throughout her career.  She has interests in rural and remote health, workforce planning and professional development for Allied Health Professionals.

A multidisciplinary approach to support management of nutrition, swallowing and quality of life in patients with Motor Neurone Disease

Kirsty Niven1, Timothea Lau1,2, Rachael Hammond1, Dr Hans Bogaardt1,2, Dr Parvathi Menon1,4, Professor Steve Vucic1,4, Professor Victoria Flood1,2,3

1Westmead Hospital, Western Sydney Local Health District, , , 2Faculty of Health Sciences, University of Sydney, , , 3Charles Perkins Centre, University of Sydney, , , 4Westmead Clinical School, University of Sydney, ,

Background: Motor Neurone Disease (MND) is a complex disease with heterogeneous symptoms, and physical disabilities such as dysphagia contributing to poor nutrition and quality of life (QoL). MND is best managed through multidisciplinary care including medical, nursing and allied health professionals, however further research is required to investigate novel approaches to health care of this progressive disease. This pilot study has undertaken a multidisciplinary approach to investigate the feasibility and impact of conducting an intensive swallowing exercise program and diet regime. This combined the disciplines of neurology, speech pathology and dietetics to build a collaborative research approach.

Methods: Participants with MND were randomised into three groups: 1. Exercise only (lingual and laryngeal exercises) (Ex); 2. Diet only (diet); 3. Exercise and diet combination (Ex+Diet). Intervention occurred over four weeks and included weekly support from a dietitian on a diet regime of 20% energy from extra virgin olive oil; and bi-weekly intensive exercises with a speech pathologist with home visits available.  Baseline and follow-up assessments of swallowing, diet and QoL were investigated (included Swallowing QoL (Swal-QoL), and EQ-5D QoL), including paired t-tests and chi-squared tests, where appropriate.

Results: Preliminary data from the pilot study (n=14, mean age 66 years, 64% male), indicated good compliance with the diet, and moderate with the exercises. Participants in the Ex+Diet group reported less burden and fatigue with swallowing (Swal-QoL) (54.0 vs 68.2, p=0.017), better communication and fewer symptoms of swallowing difficulty, compared to those in the Ex or Diet only groups.  Participants overall also reported a decrease in anxiety/depression (EQ-5D) (42% with moderate, severe or extreme at baseline vs 0% post-intervention).

Discussion: MND patients who received combined diet and exercise intervention had improved dysphagia, communication and QoL. The study suggests there is scope to include new models of multidisciplinary integrated care among people with MND.


Biography:

Ms Kirsty Niven is an experienced speech pathologist and an emerging researcher at Westmead Hospital, Sydney. She completed her undergraduate degree in Speech Pathology at The University of Sydney in 2014. Kirsty’s career focuses on providing high quality assessment and intervention within multidisciplinary teams to adults in an acute tertiary setting. Kirsty is highly experienced in dysphagia rehabilitation for patients with neurodegenerative and respiratory conditions including the application of surface electromyography (sEMG) in patients with swallowing impairments.

She is passionate about providing quality speech pathology services and integrating innovative research to optimise patient care.

Optimising the integrated management of children and young people with persistent pain

Phil Nixon1

1Project ECHO®, Integrated Care, Children’s Health Queensland Hospital and Health Service, South Brisbane, Australia

Background:

Persistent pain in children and young people is common, with reported prevalence rates ranging from 11 to 38%.1 Persistent pain and associated disability is most effectively managed with a sociopsychobiomedical approach, ideally, in the patient’s local community. However, it can be challenging for regional and remote clinicians to manage these complex patients.

Project ECHO® is a model of inter-professional education delivered via videoconference, which seamlessly integrates advice from multiple disciplines in the support and mentoring of care providers.2 ECHO® improves access to services and enhances clinician capacity to deliver best-practice care to patients in their local communities.

Method:

Series one of Children’s Health Queensland Hospital and Health Service’s paediatric persistent pain ECHO® was completed in 2018. Descriptive data was collected including number of participants, their disciplines, and geographical locations. Qualitative data was collected using an on-line questionnaire including feedback on syllabus content, case-based discussions and recommendations, and on perceived knowledge and confidence before and after the series.

Results:

35 participants were registered for series one, from the following disciplines: General Paediatrics, Occupational Therapy, Physiotherapy, Psychology, Social Work, Music Therapy, and Nursing. Participants attended from a mix of community and hospital-based settings, across South-East and North Queensland. Questionnaire feedback indicated that participants valued the opportunity for networking and knowledge sharing.

Discussion:

Our ECHO® series is the first in the world dedicated to childhood persistent pain. Early feedback is promising. It is anticipated that engaging clinicians through ECHO® on a state-wide level will improve transfer of knowledge, and foster relationships between clinicians, with the ultimate aim of improving persistent pain services for children and young people in their local communities. A second series has been launched to a national and international audience, with the hope of promoting a consistent message of pain understanding and sociopsychobiomedical treatment approaches.

References:

1 King S et al. (2011). The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain 152 (12) 2729-2738.

2 University of New Mexico (2018). About Project ECHO®. Retrieved from the University of New Mexico website: https://echo.unm.edu/about-echo/model/


Biography:

Phil has a background in physiotherapy in the area of acute paediatrics. He has practiced clinically at both Mater Children’s and Queensland Children’s Hospitals, predominantly in the areas of orthopaedics and clinical education. Phil has a special interest in making quality health care accessible for families in under-resourced areas.

Phil’s current role in the Children’s Health Queensland Integrated Care team involves clinical engagement with Project ECHO® stakeholders, including participants, panel teams, and partners of the hub.

Integrated Place Based Hubs – The Yarrabilba Family and Community Place – a proof of concept hub utilizing cross-sector partnerships to enable a shared focus on improving health, development and wellbeing outcomes of children and families living in a specific geographical catchment

Mrs Joanne Allen-keeling1, Mr Andrew Resetti1

1Children’s Health Queensland, Brisbane, Australia

The Yarrabilba Family and Community Place (YFCP) is a purpose-built integrated community facility on the grounds of Yarrabilba State School. This innovative cross-agency initiative which opened in October 2018, is led by an allied health project team at CHQ HHS and focuses on the provision of inclusive and flexible health, education and social services in a safe and supportive environment that encourages community connectedness and improves outcomes for children, families and the broader community.

The hub utilises soft entry approaches to engage with the community and deliver a range of support services.  The Yarrabilba Family and Community place is an exciting and innovative initiative that showcases shared service delivery to improve outcomes for children and their families.  Supporting parents before conception, during pregnancy and in the early years of a child’s life has significant positive impacts on health and wellbeing. The literature reflects that early disadvantage can have lifelong effects – the first years of a child’s life provide the foundations for health and wellbeing. Children who have a poor start in life are more likely to develop problems with health, development, learning and behaviours, and these problems can have a cumulative effect over their lives. Many of the risk factors impacting on the long-term health outcomes of the child are family lifestyle risk factors (e.g. domestic violence, socio-economic disadvantage, smoking during pregnancy).

The Yarrabilba community sits within a region of increased risk but many of these risk factors are modifiable and preventable. Cross sector collaboration and an early investment in prevention is required to ensure that this emerging community does not progress down a path of disadvantage. The collaboration allows stakeholders to work together to address complex issues not easily addressed by working alone.


Biography:

Joanne Allen-Keeling is a Consultant Social Worker currently sitting in an Operations Management role with over 20 years’ experience in multiple health, child safety and community environments.  Since graduating with an honours degree in Social Work, and more recently an Executive MBA, Joanne has an extensive background in clinical, operational and strategic service management in government and non-government services.  She has a strong client-centred approach to her work, which is driven by principles built on humanity, compassion, integrity, empathy, respect.  Joanne currently has a leadership role within Children’s Health Queensland and has been involved in a range of consumer engagement and quality improvement activities to develop client- centred, community focused approaches to service development and delivery.   Joanne is passionate about improving the journey of people with complex needs by addressing social determinants that lead to inequities.

Andrew Resetti is a Senior Nutritionist with Children’s Health Queensland with a background in exercise science, nutrition and dietetics and health promotion. Over the last 17 years Andrew has had the opportunity to work across a range of practice areas from adult weight management, research, public health nutrition, remote retail stores, community nutrition, Pascifika health and most recently as a project officer establishing a family and community hub in a greenfield community. Andrew is passionate about supporting children and their families to have a great start in life. He uses an ecological model to guide his work taking a family centred approach.

Developing transition planning processes to deliver sub-acute care closer to home

Miss  Kerri-Anne Von Deest1 Mr Robert Farquhar2

1Queensland Health, Rockhampton, Australia  2Queensland Health, Emerald, Australia

Aim and Background:

The Transition to Sub Acute project involves a Collaborative of allied health professionals across the central and north-west belt of Queensland with the aim of improving a person’s sub-acute journey. The Collaborative was formed in response to a commitment from Queensland Health to provide equitable access to safe, quality healthcare for all consumers. It also supports a growing trend to transfer clients to smaller facilities in the sub-acute period, to minimise displacement from home communities and to support system efficiency in large regional and metropolitan hospitals.

A literature review confirmed the need for greater standardisation of early, supported criteria-led transition planning but was not able to identify a tool that was fit for purpose.

The project’s aim is to develop, embed and evaluate an early transition process to facilitate consistent, predictable and evidence-informed decisions regarding transition of the sub-acute client.

Method:

  1. The Transition Planning Tool (TPT) was developed, piloted and evaluated
  2. The transition planning process, using the TPT, was trialled and evaluated for four months in the central and north-west belt of Queensland.
  3. The TPT was evaluated through rural and regional clinician feedback obtained through formal surveys, focus groups and patient feedback

Results:

  1. Clinician feedback showed that the TPT enhanced communication between regional and rural teams and assisted discharge planning to the rural site.
  2. A series of case studies have demonstrated positive feedback from staff and clients including: “I felt like I was in control of what was going on with my discharge plan to home.”

Conclusion:

Early implementation of the TPT is proving that the process needs to be embedded and further that allied health can be the lead for the transition of sub-acute clients. Early transition planning and communication between regional and rural sites is critical to providing seamless and integrated sub-acute care that is closer to home.


Biography:

Kerri-Anne Von Deest is a Clinical Educator in Occupational Therapy at Queensland Health

The need for an integrated approach to rehabilitating individuals with a brain injury as the result of violence

Dr Annerley Bates1, Dr Lyndel Bates2, Mr Durc Fahrenhorst-Jones3

1Brain Injury Rehabilitation Service, Department of Social Work, Princess Alexandra Hospital, Queensland Health, , Australia, 2School of Criminology and Criminal Justice and Griffith Criminology Institute, Griffith University, , Australia, 3School of Criminology and Criminal Justice, Griffith University, , Australia

There is limited research regarding the effect of assault-related or violence related traumatic brain injuries (TBIs). This is despite violence-related TBIs being estimated to range from 6% to 26% as a proportion of all TBIs. This study involved the hospital records of 65 individuals with an assault-related TBI. They were seen by the Queensland Brain Injury Rehabilitation Service Social Work team between 2011 and 2015. In most cases, the person was the victim of the assault. The injured individuals had contact with a range of allied health professionals within the rehabilitation service including social work, occupational therapy, neuropsychology, speech therapy, physiotherapy and audiology. According to the hospital records, 36 participants also had contact with at least one agency within the criminal justice system regarding the violence that caused their injury. The results indicate that, those who did not have contact with a criminal justice agency, were more likely to use alcohol after their injury. Of those who did have contact with a criminal justice agency, they were more likely to report difficulty with planning, organisation and undertaking tasks and indicate that they were thinking more slowly and having difficulty with expression. For those people who are interacting with both the health care and criminal justice systems, it is important that they can communicate what occurred and the subsequent effects clearly. Given that there appears to be some difficulty with the skills required to do this, such as planning and thinking, multi-disciplinary healthcare teams may need to work together to ensure that individuals injured by violence are supported as they interact with the criminal justice system.


Biography:

Dr Annerley Bates is a Senior Social Worker with the Brain Injury Rehabilitation Service at the Princess Alexandra Hospital, Queensland. She commenced her research in the field of student learning when she completed her Honours year. She developed this further during her PhD when she investigated the transition of graduates into professional work as Statutory Child Protection Officers. In 2017 she completed her Post-doctoral work focussing on brain injury because of violence, the impact on families and carers and the significance of an inpatient peer support group.

12

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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