Leading the rollout of the National Disability Insurance Scheme in Queensland: Realising our Value as Allied Health professionals in navigating a new system and achieving outcomes for patients in Townsville Health Service/Rehabilitation Unit

Mrs Richelle Carta1

1Queensland Health – Townsville Hospital and Health Service, Townsville, Australia

Australia’s National Disability Insurance Scheme (NDIS) has been described as the biggest social reform of a generation. Townsville and Hospital Health Service (THHS) has been at the forefront of the initial NDIS launch and rollout, for patients who have been admitted with new injuries resulting in permanent functional impairments. We have realised the value of Allied Health interventions and negotiation by ensuring that we provide continuum of care to eligible patients and seamless transition and discharge planning into the community.

Given the Scheme’s promise to ‘support a better life for hundreds of thousands of Australians with a significant and permanent disability and their families and carers’, it is important to examine the degree to which its objectives and principles are being achieved in practice from health professionals and from the perspectives of service users. Townsville’s experience, in leading the way, provides invaluable information to other Hospital and Health services regarding challenges which can be expected, and how they can be addressed.

As with any new reforms come trials and tribulations.  THHS Rehabilitation Unit will present our experiences thus far, on how we have navigated and implemented the new system to ensure our patients receive sufficient funding and optimum care on discharge, to live in their community as independently as possible. Case examples will be provided to illustrate these processes and how we as an acute health service have overcome some of the process hurdles.


Biography:

Richelle Carta, has been working as a Clinical Social Worker in the Health and Disability Sector for the past 19years. Richelle’s passion and clinical excellence in this field of disability and rehabilitation has enabled her to support people who have traumatic and complex injuries/illnesses to have a significant quality of life and positive outcomes.

Richelle has a vested interest in supporting people as she also lives with a high level spinal cord injury since the age of 13years.  Richelle strongly believes this has helped shape her to be the Advanced Clinical Social Worker she is today. Richelle more recently has seen her play a key role as one of the Townsville Hospitals NDIS Champion/representative where she has been instrumental in the roll out and launch of NDIS in Townsville since 2015.

Responding to the evolution of the NDIS – Implementation of a Clinical Improvement Framework for Allied Health Professionals in a Not for Profit organisation

Mrs Yolande Noble1, Ms Clare Besly1

1Montrose Therapy and Respite Services, Darra, Australia

Background: The disability sector is transforming in response to the rollout of the NDIS. Allied Health workforce development and commitment to growing and sustaining capability through investment in clinical supervision, training and mentoring, is vital to effectively adapt and be audited against the NDIS Practice Standards.

Method: An initial workforce survey at Montrose Therapy and Respite Services was completed to determine AHP supervision requirements and skill and experience levels. Once the results were analysed a tailored supervision programme was developed utilising a multi-method approach and enabled AHP’s to self-assess against a minimum set of core competencies. The framework was inclusive of mentoring and implementing discipline lead positions to facilitate best practice.

The self-assessment results were collected via survey monkey to analyse workforce data more broadly and develop an organisational response to gaps in knowledge and skills.

Results:

  • Some common themes from the initial survey included valuing supervision, and opportunities for reflective practice. Around 65% of AH staff employed in the last 12 months had 2 or less years of clinical experience, and a quarter of all AHP’s were graduates.
  • Currently 40% of the workforce have been graduated three years or less, and 60 % of AHP’s have been with Montrose less than 12 months, indicating a clear need for supervision.
  • The results of the self-assessments enabled development of learning goals for AHPs to enter into a formal supervision arrangement, as well as participation in targeted PD.

Discussion: The outcomes of this project will translate into quality assurance for customers and support to meet their goals by a competent and capable AH workforce. This work aligns with the NDIS Practice Standards core module of organisation and governance. The clinical improvement project will undergo further evaluation as the programme matures over the next 12 months, with a reporting system to provide accurate data and monitor service delivery.


Biography:

Yolande Noble is a clinical and continuous improvement manager with Montrose Therapy and Respite Services. She has over 25 years of experience working in paediatric physiotherapy across a variety of settings both in the UK and in Australia. Yolande has completed a post graduate diploma in professional studies as well as extensive post graduate training within the neurosciences field and management. Yolande has developed, run and presented at several courses and conferences. Yolande recently changed direction careerwise and now works for a not for profit organisation providing services in the disability sector. Her interests include clinical governance, leadership and learning more about the NDIS quality and safeguarding framework.

Ours or Yours- Health or Disability? Developing Guidelines to assist at the interface of Health and NDIS

Ms Helen Malcolm1, Ms Belinda Jones1

1Hunter New England Local Health District, Armidale, Australia

Background

Before the introduction of the National Disability Insurance Scheme (NDIS), Hunter New England Local Health District (HNELHD) received some funding to provide disability services. When HNELHD became an NDIS trial site in 2013, funding was transitioned, and HNELHD was no longer funded to provide disability services. With this change, the interface was proving to be difficult to negotiate for allied health staff.  In 2016, HNELHD developed a guideline, based on the Applied Principles and Tables of Support (APTOS), incorporating three Decision Support Tools which differentiated between health and disability interventions. It was identified that a practical interpretation of this guideline was needed, particularly for paediatrics.

Method

Three discipline – specific working groups were established, including metropolitan and rural paediatric clinicians, with co-ordination provided by the Allied Health Project Officer.   Typical scenarios, where the health/ disability delineation was less clear, were identified. Using teleconferencing and email, the group met and agreed on pathways. Flow-charts for each scenario were charted, based on the Decision Support Tools from the original guideline, together with Key Learnings that could be translated to other referrals. Later amendments included linkages to additional internal HNELHD tools to manage out of scope referrals.

Results

Three guidelines have now been developed for use by paediatric Allied Health staff (Occupational Therapists, Speech Pathologists and Physiotherapists) working within HNELHD. These guidelines provide staff with a framework to determine whether an intervention required by a child with a disability falls within the HNELHD scope of service or whether it is more appropriately provided by the Disability sector. This ensures consistency across the LHD and across the three professions.

Discussion

Therapist participation provided opportunities for education and joint problem-solving around the NDIS, based on real-life scenarios. Whilst the guidelines provide a useful framework, elements of the Health-NDIS interface remain challenging, and the HNELHD NDIS process for feedback, advice or escalation is utilised for these cases.

The collaborative input  into the development of these tools from a range of HNELHD allied health professionals  is acknowledged.


Biography:

Helen has extensive experience working as a speech pathologist in a rural health setting, and previously as a rural speech pathologist with a disability service. Since mid -2018, Helen has been working as a project officer with the Allied Health Directorate of Hunter New England Local Health District. One of her duties has been the completion of resources to support therapists, much of which was started by Belinda Jones, Performance Analyst, Rural and Regional Health Services, HNELHD.

The efficacy of a specialist NDIS social work role in a hospital setting : reducing waiting times and length of stay

Susie  Hines1

1The Canberra Hospital, Garran, Australia

Introduction:

The National Disability Insurance Scheme (NDIS) was introduced in 2014 to the ACT.  This presented challenges as negotiating NDIS was uncharted for all.  Canberra  Health Services (CHS) has significant numbers of long stay patients with high level care requirements who cannot be discharged due to difficulties obtaining NDIS plan and specialist accommodation. Discharge delays deleteriously impact a person’s quality of life as well as impose unnecessary costs to the health system. In line with research recommendations for the “positioning of NDIS champions in key health services”, Acute Support Social Work (AASW) commenced a five month pilot in February 2018 of a specialist NDIS social worker.

Objective:

The roll-out of the NDIS, necessitated establishing new processes for discharging patients (under age 65) with existing or newly acquired disabilities (sub-theme ‘Improving Services’). Consumers faced multiple challenges accessing NDIS. For patients with high level impairments, establishing supports and accommodation, resulted in extensive delays. For CHS, “delayed discharge or unnecessary retention in hospital is a major factor in increased costs”.

Method:

The positions’ function was to facilitate and coordinate discharge planning for patients with multi-faceted, complex care needs. Focus was on patients requiring NDIS services to meet complex housing and care needs. Further, it aimed to facilitate positive outcomes, through establishing pathways and collaborative partnerships within an emerging market and key government agencies.

Practical Implication:

AASW demonstrated a dedicated NDIS social worker displayed noteworthy achievements which contributed to reduced length of stay for twenty patients; a significant cost saving per bed day. Wait period for NDIS planning meeting was reduced by 170 bed days.

Conclusion:

The specialist NDIS Social Work pilot position resulted in developing a sustainable framework that facilitates timely and positive outcomes for NDIS patients in CHS through innovative solutions, decreasing length of stay and leading to improved quality of life for these patients.


Biography:

Susie Hines is a Senior Social Worker who has been employed at Canberra Health Services since 2013. Susie has developed expertise in the NDIS having worked with patients with complex disability needs to gain access to the NDIS and specialised disability accommodation and care support. In 2017, Susie was nominated for Allied Health Team Excellence Award: ‘Social Work and the NDIS’. In 2017, Susie published an opinion article in the Australian Association of Social Workers Focus Magazine; ‘Working with NDIS in the Health System’. Susie currently holds the position of the Canberra Health Services specialist Social Work NDIS Lead pilot position.

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