country allied health outreach service (cahos) framework · project reference group / framework...

Framework for the Provision of Allied Health Outreach Services

Next Challenge Consultancy

Country Allied Health Outreach Service (CAHOS)

Framework:

A Framework for the Development and Provision of Allied Health Outreach

Services

Framework for the Provision of Allied Health Outreach Services

Next Challenge Consultancy 1

Country Allied Health Outreach Service (CAHOS) Framework

CONTENTS

SECTION ONE: INTRODUCTION

Acknowledgements 2 Executive Summary 4 Background 4 Project Objectives 7 Literature Review 10 Project Recommendations 15

SECTION TWO: FRAMEWORK EXPLANATION & EXAMPLE

Framework Overview 17 Framework Procedure 19 Framework Specifics 25

SECTION THREE: FRAMEWORK TOOL

Driver Analysis 38 Interaction Matrix 48 Builder Development 50 Summary Form 70

SECTION FOUR: SUPPORTING DOCUMENTS

Table of abbreviations 73 Interaction Matrix Rationale 74 Home Visit Precautions 83 Motor Vehicle Policy 84

Notification of staff involvement 92

SECTION FIVE: BIBLIOGRAPHY 93

APPENDIX

Project Implementation Plan 95

Framework for the Provision of Allied Health Outreach Services Section 1


SECTION ONE: INTRODUCTION

Acknowledgements This project was developed in consultation with Allied Health Professionals and Managers

of Allied Health Professionals working within a range of sectors across Western Australia.

The following people contributed to significantly to the outcome of this project and to the

manual with information, research, ideas, and feedback.

Project Reference Group / Framework Review Group

Suzanne Spitz Senior Project Officer, WA Country Health Service Paula Caffrey Senior Speech Pathologist, Derby Health Service Dianne Edmonds Physiotherapist, Division of GP, Kalgoorlie Elaine Ashworth Manager, North West Queensland Allied Health Service Aleks Markowski Speech Pathologist, Moora Erin Bond Manager, Primary Health Services, Esperance Kathryn Fitzgerald Speech Pathologist, Geraldton Maeva Hall Project Officer, Geraldton Trish Webb DSC CR &CT Sue Rowell Director, KE & PMH Stacey Longland Senior Occupational Therapist, Kalgoolie Helen Carter Community Health Manager, Albany Karen Beardsmore Dietitian, Wheatbelt. Debra Chambers Primary Health Manager, Carnarvon Consultation Groups MidWest and Murchison Health Service Maeva Hall Project Officer, Health Service Development, May Doncon Social Worker, Population Health Elly Trotti Social Worker, Population Health Kylee Cox Nutrition Coordinator, Population Health Karen Street Senior OT, Population Health Lee-anne Hewer Senior Speech Pathologist, Population Health Kathryn Fitzgerald A/Senior Speech Pathologist, Population Health Lisa Cameron Speech Pathologist, Population Health Bronwyn Baker Occupational Therapist, Population Health Esperance Health Service Erin Bond Manager, Primary Health Services Howard Reddyhough Senior Occupational Therapist Lauren Shelley Physiotherapist



Derby Health Service Paula Caffrey Senior Speech Pathologist Jane Thomas Senior Physiotherapist Kununnurra Health Service Lisa Farrell Senior Occupational Therapist Katherine Lamont A/Senior Physiotherapist Gemma Coumbe Senior Speech Pathologist Narrogin Health Service Simone Benson A/Senior Speech Pathologist Karratha Health Service Patrick Melberg Acting Operations Manager Michelle James Senior Speech Pathologist Danelle Crake Senior Occupational counsellor Amy Hollins Senior Occupational Therapist Gail Michels Senior Medical Imaging Technologist Bronwyn Bramwell Senior Physiotherapist Gascoyne Primary Health Service Debra Chambers Primary Health Manager Craig Suosaari Senior Speech Pathologist Luke Wilkinson Senior Speech Pathologist Terry Stone Senior Physiotherapist Katanning Health Service Jo Webb Manager Primary Health Services Jan Batchelor Senior Speech Pathologist Debbie Billing School Health Nurse Sarah Amesz Physiotherapist Wheatbelt Community Health Managers Kate Gatti Population Health Director Jeanette Young Jurien Community Health Sean Conlan Narrogin Community Health Chris King Avon Community Health Wendy Jardine Merredin Community Health Women and Children’s Health Service Sue Rowell Director Narelle Wynter HOD Speech Pathology Beth Martino HOD Nutrition and Dietetics Christina Anastas Head of Outpatients, Physiotherapy Sally Wojnar Horton HOD Occupational Therapy



Executive Summary Allied health professionals located in regional or district centre health services throughout

rural Western Australia, are responsible for the provision of services across large

geographical areas to a wide variety of rural and remote communities. Outreach service

delivery has become a major focus of country health services as they aim to provide

quality allied health services to all communities within their health service catchment.

Outreach services are defined as primary health care services delivered in sites where the

service is unavailable in the local community.

WA Country health Service, via National Health Development Funding, provided funding

to establish a framework to support the development and provision of outreach services

across a range of situations and contexts. Outreach services need to be flexible and

sustainable, giving appropriate consideration to the community the service is being

provided to, and the infrastructure in place to support the allied health provider and the

service itself. The framework establishes an understanding of the local context and

provides an indication of suggested elements for an outreach service being delivered in

that context. The framework has applications for new outreach services developments, for

review of current outreach services and for research and best practice establishment of

outreach models. The framework intends to establish guidelines and preliminary

strategies to support outreach service provision, and to provide a structure for the

systematic development of additional resources, policies and supporting documents.

Background This document is the outcome of a project that aimed to develop a sustainable and flexible

framework for the provision of outreach allied health services which is adaptable to local

contexts. The project was initiated in recognition of the growing use of outreach service

delivery models by allied health professionals in order to provide key services to

communities in rural and remote Western Australia. The project was funded by the WA

Country Health Service through the National Health Development Funding initiative.



The document details the framework developed, as well the process involved in

developing the framework. The application of the framework is demonstrated in a

hypothetical scenario. Support resources are also included.

Allied health professionals are generally located in regional or district centre health

services throughout regional and remote Western Australia. They are responsible for the

provision of services within the immediate “base” townsite that they are located within, as

well as to surrounding towns and communities which form part of the health service

catchment area. These surrounding communities can be anywhere from 30 kilometres to a

thousand kilometres distant, dependent on the rural region in question. There are also

some locations in rural Western Australia where there are no local allied health

professionals residing within a “base” rural townsite. This may be on a relatively

permanent basis due to lower service levels (i.e. Podiatry) or due to severe shortages of the

relevant professionals (i.e. Audiology). The lack of an allied health professional may also

be on a temporary basis due to staffing turnover and recruitment issues. This project has

focused on the concept of “outreach” service provision in the contexts of both a service

from a regional or district centre to the surrounds, and during a gap in professional

availability.

Outreach has become a major focus of country health services, with an increasing demand

for allied health services in a wide range of community contexts. Health services have

devised innovative and unique strategies to meet the demands of individuals and

communities in a variety of situations across regional and remote Western Australia. The

geographical size of Western Australia creates complexity for the delivery of outreach

services, with its mixture of larger town sites, and smaller often widely dispersed towns or

communities, all with varying levels of health standards and infrastructure development.

In addition the recruitment and retention issues for many allied health professions creates

added difficulty in establishing suitable services for such a large number and diversity of

community needs.

There have been several key documents that indicate the necessity for developing and

enhancing outreach models of allied health service provision. The first stems from the

report New Vision – Community Health Services for the Future (Marshall & Craft 2000),

with its brief to “articulate a vision for future community-based service and to provide a



strategy and framework to support practical, attainable health services at a community

level for Western Australia”. Further the New Vision report encourages the provision of

health services “as close as possible to where people live and or work without financial,

geographical, cultural and other barriers” (Marshall & Craft 2000). Outreach service

delivery methods can assist in bringing allied health services closer to the rural and remote

communities of Western Australia.

The Country Health Service Review (Department of Health 2003) endorsed a regional

network model for the development of country health services, with an expectation that

there will be a concentration of professionals in a regional or district centre with a

mandate to provide visiting services to the surrounding communities. Finally the Allied

Health Taskforce on Workforce Issues Report (AHTWI 2002) recommended the need for

allied health services to be flexible and to meet the needs of the local community. It

outlines the need for frameworks to be developed to assist in best practice service

provision and establishing resourcing requirements for different types of service delivery

models (AHTWI 2002). These recommendations emphasise the need to develop a degree

of consistency, further understanding and increasing innovative developments in the area

of allied health outreach service delivery.

This document describes the preliminary Country Allied Health Outreach Service

framework (CAHOS) to assist in the development, structuring and research of outreach

services. The CAHOS framework will support best practice in outreach provision by

ensuring that appropriate consideration is given to the context in which outreach is being

provided, and the unique needs of each community receiving outreach services. It is also

a tool supporting allied health professionals by maximising planning opportunities and

ensuring they have all the necessary preparation and engagement for providing outreach

services.

Health services within Western Australia are at variable stages of development of outreach

service provision and so individual health services and communities may use this

framework differently. Some health services or professions have yet to develop visiting

services, and consequently require support and guidelines in establishing such services.

Significant time is invested in developing policy and procedures relating to visiting

services at an individual and local level. The CAHOS framework will improve



consistency within these services and limit the re-creation of resources and

documentation. It is important to note that this is an initial working document, which is

not a definitive list of considerations or strategies. It is intended to generate sharing and

discussion of outreach services within a common framework.

The contextual issues, ideas and strategies outlined in this framework have been gathered

from the literature on outreach services and directly from a range of allied health

professional providing outreach services in the Western Australian environment. It is

intended that the framework will be added to and expanded in the future by ongoing

consultation and refinement by the allied health professionals providing outreach services

on a regular basis. There is considerable scope for ongoing development of the protocols

that support many of the suggestions made in this framework. Protocol development in

each of the areas may be shared by outreach providers to assist in ongoing standardisation

and consistency of service provision in similar contexts.

Project Objectives (Excerpt from Project Implementation Plan, Department of Health – see Appendix).

• The objective of this project is to develop a sustainable and flexible framework

for the provision of outreach allied health services, which is adaptable to the

local context.

• Develop a framework for the provision of outreach allied health service delivery

(fly-in fly-out or drive-in drive out).

• To identify strategies for optimising and integrating outreach services.

• Develop preliminary resources for outreach allied health services.

• To integrate outreach models into current service delivery frameworks (eg

Telehealth Allied Health Bureau Services, Therapy Assistants).



Methodology

(Excerpt from Project Implementation Plan, Department of Health – see Appendix).

Research phase

i) Provision of the final project plan and methodology.

ii) Conduct a literature search and critique on the utilisation of outreach services

for the provision of allied health services.

iii) Call for local and national documents.

iv) Collate pre reading and develop a standard analysis tool inclusive of

strength/weakness and requirement analysis for consultation process.

v) Establish and maintain regular contact with a steering committee consisting of

members selected by the DOH.

Consult/ liaison phase

i) Identify and liaise with key stakeholders in the development of the Country

Allied Health Outreach Service Delivery Framework.

ii) Call for involvement and information from rural allied health professionals and

other stakeholders/ outreach providers.

iii) Establish working groups.

i. 1 rural location (Midwest Health Service)

ii. videoconference with 10 sites

iv) Conduct workshops implementing a standard analysis format and conceptual

model development.

Audit and analysis phase

i) Audit & review current allied health usage (models and frequency) of outreach

services for clinical service provision in Western Australia.

ii) Collate and analyse findings.

iii) Document current status.

Model Development phase

i) Develop draft conceptual framework.



The framework may include:

• Model(s) of service provision.

• Identification of strengths, weaknesses, opportunities and threats of the

model.

• Strategies for optimising and integrating visiting services such as :

- video-conferencing

- therapy assistants.

- service methods and strategies.

ii) Seek feedback from participants.

iii) Finalise framework.

Resource Development

i) Collate all collected material and draft resource manual.

a. Resource requirements may include:

i. Safety considerations.

ii. Competencies and training.

iii. Cost assessment/formula.

iv. Client information.

v. Community information.

vi. Application of the model to local contexts.

ii) Feedback and alterations from participants.

iii) Finalise document.



Literature Review

What is an outreach service?

Outreach service is a broad term used to describe a range of methods of improving the

access of the local community to health and related services (Taylor 1995; Burns and Firn

2002). In general it implies removal of the health professional from their “resident”

situation to a nearby (or remote) location for short-term service provision. Service

provision in an outreach context can refer to

- client service provision

- speciality assessment and care services

- training and support services

- resourcing and locum services

A definition of outreach services was developed to guide the development of this project:

Primary health care services delivered in sites where the service

is unavailable in the local community.

This definition reflects the variety of sources and services that are referred to by the term

outreach in the literature. It also reflects the primary health care philosophy which has

contributed to the current focus of providing health services within a local context

(Department of Health 2003).

Sustainable outreach services

The sustainability of an outreach service has

been demonstrated as an important link to

the success of an outreach service in

achieving set goals (Battye and McTaggart; Wilson 2001; Gruen, Weeramanthri et al.

2002). Continuity of the service is considered a challenging and vital element of planning

an outreach service (Kuipers, Kendall et al. 2001). Therefore an outreach framework must

Sustainability is a global term that refers to program continuation. New Vision (Marshall & Kraft 2000)



acknowledge the need for adequate planning of the service. Recruitment and retention

issues are inherent to the challenge of sustainability. Appropriate recognition is required

of elements such as training requirements, providing a safe working environment and

appropriate remuneration for the level of skill and task complexity required (Battye and

McTaggart). Organisational restructure has been utilised to improve sustainability,

however the rapid change affecting the infrastructure can create additional challenges in

the maintenance of outreach services. (Taylor 1995). Sustainability of programs is most

likely if there is a focus on project design and implementation, the organisational setting

and the broader community environment (Marshall & Craft 2000). Funding, evaluation

and the use of multidisciplinary teams have also been linked to sustainability of services

(Gruen, Weeramanthri et al. 2002).

Flexible outreach services

The diversity of communities, health needs and health care services required across

Western Australia is widely acknowledged (AHTWI 2002). As demonstrated at the

Inaugural Western Australian Rural and Remote Allied Health Forum in 2002, many

innovative practices are continuously being developed in providing Allied Health Services

to meet this diverse need. The necessary flexibility in providing outreach services is

therefore a vital aspect of it’s success (Hodgson and Hornsby 1996). It is also important

to consider that there may be clients that are not suitable for specific models of outreach

when developing a flexible service (Burns and Firn 2002).

Adaptable outreach services

Primary Health Care philosophy provides the impetus for developing health services that

reflect the health needs of a community and are driven by the community context and

priorities (Marshall and Craft 2000). The demand for Allied Health Services has been

established in areas with limited access to these professionals, with identification of this

need continuing to improve (Allen 1996). This contributes to a situation where outreach

services are necessary, but where flexibility and creativity are required to meet local

community need.



The literature has suggested that the identification of community health needs must be

undertaken through a range of strategies including:

- Primary data collection (key informant or stakeholder interviews, focus groups or

community meetings)

- Secondary data collection (review of demographic and descriptive data, analysis of

morbidity and mortality data and health indicators) and review of past needs

assessments. A useful reference may be the Health Information Centre

(http://intranet.health.wa.gov.au/hic/index.html), which provides access to Western

Australian specific health epidemiological information.

Evidence regarding other community needs may be identified through a “Community

Resource Inventory” that provides a summary of activities and services provided by

organisations and agencies within the local community. This may include information

such as type of service, nature of service (visiting or community based), service

utilisation, service capacity, organisation/agencies functions and goals.

When community needs are recognised, the best means to accommodate these needs will

vary dependant on the context in which they will be delivered. Primary health care

philosophy encourages the planning of services that are tailored and supportive of the

uniqueness of the community rather than a one program fits all approach. This is

recognised in the literature with the wide range of approaches and programs that are

designed under the umbrella heading of “outreach” services (Taylor 1995; Hodgson 1997)

Services should be flexible and adaptable to the ever-changing requirements of the local

context are required (Marshall & Craft 2000).

Barriers & Strategies for Implementation

It is broadly acknowledged that there are significant challenges in providing services

within an outreach model. Many of the elements that are required for a successful

outreach service have developed in response to the barriers and difficulties in

implementing outreach services. The barriers are clearly identified in literature on

outreach services and are included in the following table.



Barriers Bibliography

Supervision

- Difficulty providing adequate supervision

- Lack of access to professional development

- Lack of same discipline supervision / support

- Lack of orientation

(Allen 1996; Marshall and

Craft 2000; AHTWI

2002)

Staffing

- Social and professional isolation

- Excessive workloads / large caseloads

- Limited locum relief/backfill support

- Inadequate staffing levels

- Accommodation requirements.

- Lack of career structure

- Lack of continuous and experienced staff

- Recruitment and retention

(Allen 1996; Marshall and

Craft 2000; Kuipers,

Kendall et al. 2001;

AHTWI 2002)

Community

- Geographical distance

- Cultural appropriateness of service

- Reality of population dispersion/density / low numbers of client

contact (critical mass)

- Rural populations generally less financially secure

- Transient populations

- Climatic and travel conditions

(Kuipers, Kendall et al.

2001; AHTWI 2002;

Gruen, Weeramanthri et

al. 2002)

Infrastructure

- Poor communication systems

- Cost effectiveness of service fulfilling equitable service

requirement

- Poor HR management

- Excessive travel requirements

(Battye and McTaggart;

Allen 1996; AHTWI

2002; Gruen,

Weeramanthri et al. 2002;

SARRAH 2002)

Specific strategies that have been suggested to include in the planning of outreach services

include:

Utilising existing infrastructure within local communities (Allen 1996)



Utilising different models of service delivery particularly local support workers

(Hill, Bone et al. 1996; Hodgson and Hornsby 1996; Kuipers, Kendall et al. 2001).

Training others in the local community (Marshall and Craft 2000; Gruen,

Weeramanthri et al. 2002).

Clearly establishing timeframes for clinical contact and service delivery (Battye

and McTaggart)

Establishing shared responsibility for the service (Gruen, Weeramanthri et al.

2002)

Strategies for coping with the travel component of outreach (Hodgson and

Hornsby 1996).

Utilising networks with other local services such as Home And Community Care

and General Practitioners (Allen 1996; Kuipers, Kendall et al. 2001)

Using alternative measures of service uptake and provision such as utilisation and

the number of follow up phone calls, (Allen 1996)

Effective workforce management to improve retention and therefore the cost-

efficiency of services (Marshall and Craft 2000; SARRAH 2002)

Management of allied health professional’s in outreach service provision should

have “experience with community cultural and social factors that may create

barriers to services” ((Marshall and Craft 2000))

A broader understanding of health care is required for community health work

including cultural and rural and remote specific (Battye and McTaggart; Marshall

and Craft 2000).

Service delivery models that are responsive to the needs of communities (Marshall

and Craft 2000; SARRAH 2002)

The capacity to measure the design and style of outreach services and the

subsequent outcomes of that. Services must consider how the cost and benefit of a

service can be clearly demonstrated and improved given the increasing focus on

evidence based service delivery (SARRAH 2002; Department of Health 2003).



Project Recommendations

1. Provide education and training to support Allied Health Professionals and

Managers of Allied Health Professionals in the planning and provision of locally

appropriate outreach allied health services

2. Investigate and research the effectiveness of the Allied Health Outreach

Framework in guiding outreach service development.

3. Ongoing development of policy, procedures and resources for the provision of

outreach allied health services.

4. Establish a formal system for the sharing of strategies, resources and

documentation. This will provide a mechanism for both increasing recognition of

quality and innovation of allied health services and increasing consistency in

planning and implementation of like resources across the state.

5. Future research into

a. The elements of planning an outreach service that have the most impact on

outcomes in differing community contexts.

b. Cost benefit analysis of different community contexts.

c. Minimum standards of service delivery for different levels of community

complexity.

6. Development of resources and information to assist in outreach contexts that are

currently considered high complexity for outreach services. This may include

community needs analysis, community resource inventory information, support to

develop infrastructure requirements and interagency collaboration at a strategic

level.



7. Further consultation with other stakeholders and service providers to continue to

develop the elements of establishing partnerships and engaging communities

within the framework to include this broader context.



SECTION TWO: FRAMEWORK EXPLANATION & EXAMPLE Framework Overview Allied Health Professionals and Managers of Allied Health Professionals may use the

Country Allied Health Outreach Services framework in a variety of ways. The following

process describes the suggested framework utilisation, which can be adopted for developing

an outreach service or when reviewing outreach services currently being provided in a

specific community. The process involves:

▪ Analysing (1) the community receiving the outreach service, and (2) the health service

providing the outreach service,

▪ Identifying elements of an outreach service that will have the most impact on the

provision of quality outreach services,

▪ Developing strategies to build a quality outreach service within the given context.

The Outreach Framework can be visualised as the following system:

Considering the local context first will ensure that the outreach service being developed is

adaptable, flexible and sustainable in the local context. Building that service with strategies

based on the local context will ensure the positive impact of the outreach service. These

strategies will be included in the description of the outreach service.

CONTEXT

Community and

infrastructure contexts in which the

outreach service is to be

provided.

ELEMENTS

Areas of development or

planning to support outreach service

provision appropriate to the context.

DRIVERS OF SERVICE

BUILDERS OF SERVICE

OUTREACH SERVICE Development and implementation of an outreach service appropriate to the local context and community needs. This may include:

- Contractual agreements

- Model development - Policy, procedures

resourcing requirements etc,

that support best practice provision of outreach service.



Current components or considerations in the framework are as follows (these are explained in

detail in the subsequent sections):

The final “model” or outreach service developed using the framework will be unique to the

context rather than a one-off prescriptive model.

CONTEXT Community - Demographics - Stakeholders/

Community Resources

- Capacity - Needs and

priorities Infrastructure - Staffing - Administration - Financial

Sources - Physical

Resources - Management

ELEMENTS

Resourcing Service Delivery

Method Timeframe

Competency – ClinicalCompetency – Outreach

Responsibility Training Others

Supports Safety

Measurement

DRIVERS OF SERVICE

BUILDERS OF SERVICE

OUTREACH SERVICE

Unique to needs of context



Framework Procedure The suggested process for implementing the framework involves four Steps shown in the

flow chart below.

For Step 1, 2 and 3 there are tools included within the framework to identify and record the

information specific to each community analysed. These tools are:

▪ Driver Analysis;

▪ Interaction Matrix/Frequency Table and;

▪ Builder Development/Summary Sheet.

A brief summary of each of the steps follows:

Step 4 Outreach Service

Description

Step 2 Interaction Matrix

and frequency table

Step 1 Driver Analysis

Optional Context Development

Step 3 Builder Development and Summary Sheet




An analysis of community and infrastructure factors ensures that a sustainable, adaptable and

flexible outreach service is developed that is ultimately successful at meeting the community

needs.

WHO WHAT WHEN Contracted Outreach Services The Allied Health Professionals and Managers of Allied Health Professionals responsible for contracting an external outreach service

Analyse the community and infrastructure of the local community for which services are being planned. (Refer to Driver Analysis Section Three)

Prior to contracting a service provider. or On review of a current contract.

OR OR Regionally Provided Outreach Services The Allied Health Professionals and Managers of Allied Health Professionals responsible for providing outreach services in their regional area

Establishment of new outreach services. or At a review/ planning point of current outreach service provision



Step 2 Interaction Matrix The interaction matrix links drivers to the most relevant builders (elements/strategies) that will

impact on the provision of outreach services in the given context. The interaction matrix

allows health services to identify builders that need most consideration based on the

complexity of drivers within a community.

WHO WHAT WHEN

Identify drivers rated as being of high complexity (refer to Interaction Matrix Section Three) Indicate the drivers that were of moderately high complexity. (refer to Interaction Matrix Section Three) Determine the most highlighted builders (Frequency table Section Three)

Allied Health Professionals and Managers of Allied Health Professionals

Identify which builders most need to be considered when developing the outreach service (most frequently occurring ).

At commencement of contract/ service or at review stage.



Step 3 Builder Development The Builder Development section details minimum elements that should be considered for

outreach services in all communities. High Complexity Context- Additional Elements

strategies are also provided that may be utilised in more complex contexts. The strategy list

is not exhaustive and should be used to generate planning and adaptable solutions to

individual requirements. The decisions or suggestions are recorded on the Summary Sheet.

WHO WHAT WHEN Allied Health Professionals and Managers of Allied Health Professionals

Analyse builders that need in depth consideration and identify specific changes/ developments required to support the community situation (Refer to Builder Development Section Three)

At commencement of contract/ service or at review stage.

Check all other BUILDERS to ensure minimum planning elements are considered. (Refer to Summary Sheet Section Three)



Step 4 Outreach Service Description

The final step involves the detailed description of strategies appropriate to the local context

and community needs that support best practice provision of outreach service. These may

then be considered and included within:

- Contractual agreements

- Model development

- Policy, procedures resourcing requirements etc,

Application of Step 4 is dependant on the type of outreach service planned, (i.e. contracting

of a service provider or planning of local service agreements between the regional or district

centre and surrounding communities) and is not detailed within this framework.. Options

include;

- Contract Development and service description to assist with service provider selection

or to strengthen current contractual arrangements.

- Development of relevant documentation of the analysis process undertaken including

justification of the model of outreach in place.

- Improvement of services using the identified strategies


Ensure all strategies required for the outreach service are planned & considered (contractual arrangements/ policy development plans etc.)

Establish timeframes for strategy implementation.



Optional: Context Development

This section is an optional component that supports the development of the local context,

which in the long term may improve the effectiveness of outreach services in that

environment. This may be pursued by the allied health team or health service as part of their

long-term community support role. This is considered independently from the contract /

service agreement developed for the outreach service and involves activities at many levels to

achieve long term, overarching health service objectives. For example, a visiting outreach

service may be implemented in a community without community support workers whilst

simultaneously resources may be put towards programs for identifying and training local

therapy assistants. In this way, valuable information from the context analysis that has been

performed is not lost, though not directly addressed through the development of an Outreach

Service Description.


Consider areas rated as highly complex drivers (Driver analysis). Identify possible health service strategies or goals that may impact on the complexity of the local community.

Annually



Framework Specifics This section details the specific application of the framework, including more detailed

information to be considered at each stage. To assist this, a hypothetical remote community,

“Serendipity” will be used to demonstrate each step in the procedure.


The first step of the framework examines the local context in detail. The context or drivers

have been divided in to characteristics of the community receiving services and the

infrastructure or characteristics of the service providers. These are:

Community Drivers

Demographics

The demographics of a community refer to the geographical situation of the community

and the general characteristics of the population within the community.

Key Stakeholders/ Community Resources

The people or agencies within the community who are considered to be supports or team

members in the delivery of allied health services to the community. Key stakeholders

include community leaders in appointed positions such as school principals or active

community members such as chairpersons of community development committees.

Needs, Perceptions and Priorities

The health needs of a community, how well the needs are established and the relative

health status of the community. Priorities will reflect the interaction of those health needs

with other community issues and needs.


Description Step 2

Interaction Matrix and frequency table



Step 3 Builder Development and

Summary Sheet



Community Capacity

The ability of the community to support allied health services and the level of

empowerment in the community to drive, plan and support service delivery.

Infrastructure Drivers

Staffing

The level of health service staffing available to support to the person or team providing

the outreach service. Health service staffing can refer to staff at the regional or district

centre or in the community receiving the service.

Physical Resources

Physical resources available to deliver an outreach services, ranging from workspace, to

the nature and quality of clinical equipment.

Administration Functions

Level of policy, procedure, administrative staff and systems in place to support the

provision of the outreach service.

Financial Sources

Financial sources available and that can be dedicated to outreach services.

Management

The management type, roles and responsibilities available to support the provision of

outreach services.

For each of these drivers there are four clusters of descriptors that make up the Driver Matrix.

The aim is to select one of these four clusters- A, B, C or D- that reflects the local context

being considered. In order to accurately describe the local context, select the cluster of

descriptors that is most like the community you are planning outreach service provision for or

providing them from. Note that not every characteristic in the list of descriptors may apply.

The descriptions provide a guide to characteristics only that may assist you in determining the

level of complexity for each driver.

The Clusters A-D are described in order of decreasing complexity for planning (A most

complex through to D least complex). You must decide whether the complexity of your

community or the infrastructure of your service is an A, B, C or D. Borderline selection,



between the clusters, can be selected if this is felt to most closely reflect the community

context.

A B C D

High Complexity

Context

Moderately High

Complexity Context

Moderately Low

Complexity Context

Low Complexity

Context

Begin by gathering any information or knowledge available regarding the community in

question.

An example is included on the following page that demonstrates the driver of Demographics

for the hypothetical community of “Serendipity”.



Example - Community Driver, Demographics Determine which characteristics apply to the community Serendipity

A B C D Small population Large population Large spread (distances) of small population

Large spread, large population Small spread, small population Small spread, large population

High ATSI community High levels of other ethnic groups/ cultures

Small variation in cultures Limited variation

Highly transient population

Some transient groups in community

High levels of permanency/ little movement in community

Isolated community requiring flight from major service

Isolated or remote site within driving distance of major health service

Within 1-2 hours of a major health service

Within 1 hour of a fully staffed health service Close to a major health service centre/site

High levels of low socio economic status groups

Moderate issues of poverty in some groups on the community

Mild levels of low socio economic groups in specific groups within the community

Medium to high socio economic status of majority of the population

No primary industry/ high levels of unemployment

Defined industry in the community. Moderate to low unemployment.

For this community, the Driver - Demographics - would rate as a high complexity context, even though there is a degree of spread in the descriptors for this community. WORKSHOP: Think about four different communities that you visit that are across a spectrum of difficulty. Map the communities on the matrix. It is also useful to compare communities.




The interaction matrix acknowledges the impact and relationship between drivers and

builders, local context and outreach service development. Within the matrix, each driver has

been linked to builders that it is proposed share an interactive relationship. Whilst each driver

could be assumed to affect every builder to a greater or lesser degree, the matrix directs focus

only on those that current research and practice suggest have most impact (See Supporting

Document- Interaction Matrix Rationale for more information). Use of this interaction matrix

supports time efficient planning of improvement in two to three specific areas that could be

considered to be the main factors potentially affecting the quality of the outreach service.

The utilisation of the Interaction Matrix is demonstrated in the below example for the

hypothetical community of Serendipity. The following levels of complexity were agreed

upon for each of the drivers in Step 1 (the first driver, Demographics, is considered on the

previous page as an example):

Example – Driver Analysis Results Community - Demographics A - Stakeholders/ Community

Resources D - Capacity C - Needs and priorities B

Infrastructure - Staffing D - Administration A - Financial Sources B - Physical Resources C - Management C


Description Step 2





Summary Sheet



Highlighted in yellow (and bold) are the drivers rated as being of high complexity for

Serendipity.

Highlighted in green (and italicised) are the drivers rated as moderate high complexity for

Serendipity.

The remaining drivers were rated as either a C or D (i.e. moderately low complexity or low

complexity). Where a community has only driver ratings of C or D, these should be entered

into the matrix as the highest and moderate levels of complexity respectively. The process is

intended to capture areas for possible improvement in outreach service delivery and this

information will still achieve that.

This rating of complexity is now transferred to the Interaction Matrix, to determine which

builders need more consideration for the community of Serendipity.



Example - Interaction Matrix The priority drivers identified for the hypothetical community of Serendipity have been highlighted. Each highlighted driver identifies

the most critical builder for developing outreach services to the community Serendipity.

DRIVERS BUILDERS

Demographics Resources Competency Clinical

Safety Measurement

Stakeholders/ Community Resources

Timeframes Responsibilities Training Supports

Needs, perceptions, priorities

Timeframes Competency clinical

Measurement

Community Capacity

Service Delivery Method

Competency outreach

Staffing Resources Responsibilities Competency clinical

Safety Support

Physical Resources

Resources Service delivery method

Competency outreach

Administration Competency outreach

Safety Measurement

Financial Sources


Timeframes Training

Management Responsibility Training Support Measurement



To establish the builders with the most relevance for this community, the most frequently

highlighted builders need to be listed. A frequency table (below) identifies the highest

priority builders for the community Serendipity.

Example – Frequency Table

Builder Frequency

Highest Moderate

Resourcing 1 1

Service Delivery models 1

Timeframes 2

Responsibility

Competency- Clinical 1 1

Competency- Outreach

Training Others 1

Safety 2

Support

Measurement 1 1

This table tells us that the builders that need the most development given the complexity of

the situation of Serendipity are SAFETY, followed by RESOURCING, MEASUREMENT

and COMPETENCY - CLINICAL.

Therefore, in the hypothetical community Serendipity, the framework suggests that these are

builders (requirements) of the service that through in depth consideration will assist in

appropriate outreach service development.

WORKSHOP- Repeat this task for one or two of the communities you previously identified

drivers for in Step 1. Enter this information into the Interaction Matrix and determine the

priority builders using a frequency table.



Step 3 Builder Development

Step 3 of the framework aims to suggest possible strategies for consideration when

developing outreach services. Suggestions for each builder are not exhaustive but seek to

provide possible solutions to issues arising.

The Builder Development tool (Section Three) contains suggested minimum elements to

be included in all contracts or models of outreach service provision development for each

builder. These minimum elements acknowledge that all builders can and should be

included in the final contract or outreach model not just those highlighted in the

interaction matrix.

However, for consideration of areas identified through the framework process that require

additional consideration, High Complexity Context- Additional Elements strategies are

included. Allocating planning and time to ensuring all necessary and feasible requirements

are in place for builders highlighted as being most necessary to consider from your

complex drivers, should improve the health gain or impact of the service being delivered

to the community.

The impact of high complexity situations on the builders is described in the table below.


Description Step 2





Summary Sheet



Builder Impact

Resourcing Increased resourcing will need to be considered to make an impact

on health needs

Service Delivery

Method

Innovation in service delivery methods will be required to impact

on health needs

Timeframes A need to limit the possible negative impacts of established

timeframes

Responsibilities A need to consider the spread of responsibilities across individuals

or agencies or to designate responsibility for a large number of

tasks.

Competency

Clinical

A high requirement of clinical competency needs to be considered.

Competency

Outreach

A high requirement of outreach competency needs to be considered

Training of Others A high level of planning for training of others needs to be

considered

Safety A high level of risk may exist and safety considerations need to be

specifically addressed

Supports Increased need to support systems to be developed or used to assist

the service provider.

Measurements More innovative methods of measuring the service benefits need to

be considered.

Step 3 Builder Development will be demonstrated using the hypothetical community of

Serendipity. From the Interaction Matrix, planning for outreach to the community of

Serendipity needs to consider in more detail the areas of Safety, Resourcing,

Measurement, and Competency – Clinical. Strategy development may include:

SAFETY

Implement a safety policy (For example, the Kimberley Health Region policies on home

visit safety and motor vehicle use included in Section 4: Supporting Documents),



RESOURCING

Commence discussions with other agencies such as the school, Disability Services

Commission to determine additional resources that could assist in making gains in the

main health needs of the community.

MEASUREMENT

Implement measurements that evaluate the amount of community capacity built by the

outreach service rather than a traditional measurement such as occasions of service,

COMPETENCY- CLINICAL

Secure a mentor(s) with experience in the clinical areas required by this particular

community to be accessible by phone or teleconference when the local allied health

professional is seeing more complex clients.

The final product of Step 3 is to record these additional strategies in the Outreach Services

Summary Sheet (Section Three) along with the minimum elements required for outreach

services. This summary sheet represents the product of the analysis of the framework

tools. At this point the service provider will individually and uniquely create the

development of the Outreach Service Description. The Outreach Service Summary Sheet

is intended to be the basis for outreach service development that is based on local context

of specific communities.

Example - Outreach Services Summary Sheet Resourcing • Establish agreement (including both onsite/ offsite costs/ levels) for either

o set price / volume contracts or o level of servicing agreements

• Establish agreement on the level of outreach services provided when availability of staff is reduced at the providing service.

• Include consideration of transport costs, staff time reimbursement policy, minimum equipment requirements for the service(s) being considered.

Additional Elements Required • Commence discussions with other agencies such as the school, Disability Services

Commission to determine additional resources that could assist in making gains in the main health needs of the community.



Service delivery method • Minimum Standards of Care and Duty of Care policies per profession • Documentation on the types of service delivery to be provided. • Documentation of minimum service level including client type, contact, etc. Additional Elements Required

Timeframes • Clearly stated and documented timeframes • Consultation with community regarding timeframe • Documented regular review dates to reconsider timeframes. Additional Elements Required Responsibility agreement • Document who is responsible for the tasks of

o Collecting and documenting referrals o Client Appointments o Travel Bookings

Additional Elements Required Competency/ skill development - Clinical • Multiskilled/generalist experiences. • Experienced health professional or support of a senior staff member • Understanding of PHC philosophy Additional Elements Required • Develop formal mentoring network for senior staff member with limited experience in th

clinical area Competency/ skill development – Outreach Specialist • Experienced professional. • Orientation – cultural awareness and understanding of the local community. Additional Elements Required Training Others • Mechanisms/ systems to record support workers details.



• Criteria of appropriate support workers for professions/ clients, inclusive of appropriate tasks/ duties.

• Job descriptions for employed and volunteer support workers. • Training guidelines including timeframes, supervision, follow up support. Additional Elements Required Safety • Policy

o Home visit process for informing others -informing pre/post travel o General departmental policy and procedures on safety/OSH/universal

precautions o Documentation –minimum documentation required to be covered for

workers compensation requirements • Current drivers license • Check car before driving/ prepare • Emergency Kit • Mobile phone or satellite phone • Essential contact numbers – police, regional or district centre, ambulance.

Additional Elements Required • Obtain and implement a copy of travel policy (see supporting documents for examples). Supports • Orientation to community, community agencies, and known key stakeholders

(including relevant contact names and numbers).

Additional Elements Required Measurement • A measurement system is identified for health care utilisation • Reporting requirements for funding are addressed Some steps towards PHC/establishing community needs and evaluating those is made Additional Elements Required • Implement measurements that evaluate the amount of community capacity built by the

outreach service.



SECTION 3: FRAMEWORK TOOLS Step 1 Driver Analysis Community Drivers Demographics The demographics of a community refer to the geographical situation of the community and the general characteristics of the population within the community.

A B C D Small population Large population Large spread (distances) of small population

Large spread, large population Small spread, small population Small spread, large population

Aboriginal or Torres Strait Islander community

High levels of other ethnic groups/ cultures

Small variation in cultures Limited variation

Highly transient population

Some transient groups in community

High levels of permanency/ little movement in community

Isolated community requiring flight from major service

Isolated or remote site within driving distance of major health service

Within 1-2 hours of a major health service

Within 1 hour of a fully staffed health service Close to a major health service centre/site

High levels of low socio economic status groups

Moderate issues of poverty in some groups on the community

Mild levels of low socio economic groups in specific groups within the community

Medium to high socio economic status of majority of the population

No primary industry/ high levels of unemployment

Defined industry in the community. Moderate to low unemployment.



Key Stakeholders/ Community Resources

The people or agencies within the community who are considered to be supports or team members in the delivery of allied health

services to the community. Key stakeholders include community leaders in appointed positions such as school principals or active

community members such as chairpersons of community development committees.

A B C D No identified key stakeholders Unsupportive key stakeholders Appointed by position Easily identified key

stakeholders Key stakeholders actively against service

Key stakeholders appointed but not following up

Open to listening to ideas – receptive

Key stakeholders with a broad agenda

Unstable leadership Vested self interest Critical interests in a few areas only.

Open to development

High levels of mistrust and resentment of key stakeholders in the community

Key stakeholders with some support from groups in the community

Key stakeholders with community support

Difficult to identify potential leaders Limited utilisation and capacity of community agencies.

Willing to participate but require training to be leaders Potential for coordination

Identifiable potential leaders - Avenues to find them requires more effort

Easily identified leaders Community agencies take lead role in coordinating visits.

Lack of any other regular community based agencies

Community services visiting regularly.

Some community agencies have skills and roles that assist service provision.

Wide range of skills and service programs (eg volunteer programs) in community.

Limited community resources Some community resources but in high demand/ frequently unavailable.

Community resources available.

Well developed and extensive resources



Needs, Perceptions and Priorities The health needs of a community, how well the needs are established and the relative health status of the community. Priorities will

reflect the interaction of those health needs with other community issues and needs.

A B C D No data/epidemiology Poor health status of population

Data applied from another area Below average health status of population

Limited data, some understanding of needs. Average health status of population

Needs are clearly identified with supporting documentation. Average to high health status of population

Ill-informed community/ isolated requests for services

Many preconceptions of health services/ lack of understanding of what services are available

Some knowledge of health services.

Well informed and aware community – understand most health services.

Random demands for services/ variable requests/ no coordination of types of services needed.

One group/ agency appears aware of a need/ requests support.

Have identified needs however little planning to work on needs.

Needs documented and action plans in place to work on them.

No voice or system to express need

Occasional/ random attempts to seek community opinion – one off questionnaires etc.

Systems for expressing need but not used.

System to express need and prioritise by community

Broad and ongoing community issues limiting ability to uptake health services eg drought.

Current/ short term issue compromising community prioritisation of health issues eg flood

Seasonal influences on community known/ communicated to health service.

Good understanding and consideration of local seasonal issues when planning.



Community Capacity

The ability of the community to support allied health services and the level of empowerment in the community to drive, plan and

support service delivery.

Community A Community B Community C Community D Fragmented community activity Bursts of activity – not

consistent Discrete or splinter groups of action eg school community only

Strong links to other similar communities/ community groups

Lack of networks – other community projects and resources

Not coordinated approach to networks

Effective community networks/ leadership for surrounding communities

No community projects evident.

Improvement ideas discussed but no outcomes delivered

Some community projects attempted/ started.

Strong community projects apparent.

High turnover of local community members.

Few members of community groups/ same people relied upon

Larger group of community members – relatively stagnant membership.

Breadth of community involvement eg not the same people participating all the time

Resistance to external ideas / involvement. Opportunity for coordination and support from other organisations/agencies

Community allows you to introduce new ideas/processes

Community occasional requests advice/ involvement from the health service

Health service members are regular participants/ partners in community planning activities

High levels of resistance or mistrust of outreach services.

Dissatisfied with past outreach services.

Preference for one to two types of outreach service that have had an impact in past.

Previous positive experience of outreach services



Infrastructure Drivers Staffing

The level of health service staffing available to support to the person or team providing the outreach service. Health service staffing

can refer to staff at the regional or district centre or in the community receiving the service.

A B C D

Sole discipline providing outreach

No established teams providing outreach

No team members of same profession

Well established teams, adequate Allied Health/peer support staff to provide service

No links/ communication to other health professionals in the health service

Extended vacancies of Allied Health professions.

Trouble filling vacant positions – occasional gaps in service

Little gap ins service/ back fill available for services.

Lack of staff in relevant positions

Unable to recruit experienced staff in all professions

Inequities in staffing (under or over staffing in some areas).

Staffing levels equitable across professional and supportive of whole team approach.

Unable to support student placements

Student placements but no planning time/ support for outreach service provision.

Systems to support students and encourage involvement in outreach.

Lack of mentorship/supervision in sole positions

Staff rely on personal networks to support their skill development.

Occasional team building activities/ peer attempt to support each others development

Supportive supervision/ same discipline support mechanisms in place.

Frequent staff burnout from unrealistic expectations

Poor culture/ acceptance of outreach service provision by staff.

Variable interest in providing services – some sites preferred over others.

Staff content and enjoy providing outreach services.



Physical Resources

Physical resources available to deliver an outreach services, ranging from workspace, to the nature and quality of clinical equipment.

A B C D No physical facility in the local community

Limited facilities Constantly changing venues/facilities Lack of confidentiality/shared room

Health centre building but not all specific for service provision

Facility always available / prepared for service provision. Purpose built/ easily used by multidisciplinary services

No access to videoconferencing facilities

Video-conferencing facilities available difficult for community to access.

Video-conferencing facilities available but not supported to use.

Appropriate video-conferencing facilities that are accessible to community with good support.

Outdated equipment IT equipment at regional or district centre but No IT access at remote site.

Limited access to IT equipment at the regional or district centre

Easy access to IT/equipment including communication equipment

Safety compromised by using available equipment Equipment ergonomically unsound

Incompatible equipment Staff need training to use equipment

Same equipment on each site.

Lack of transport/ appropriate accommodation etc

Transport difficult to arrange each time.

Appropriate accommodation Transport generally available / suitable.

Dedicated allied health car/ no reliance on personal car.



No equipment (especially new equipment)

Inappropriate equipment eg culturally inappropriate or not suitable for travel

Some basics kept locally but most brought

Core resources kept locally but monitored Appropriate car available (eg 4WD, station wagon etc)

Equipment not transportable/ often no appropriate equipment able to be used on visit.

Resources need to be adapted for outreach model

Resources exist (usually developed by clinicians) but not shared (poor networks)

Access to a range of appropriate outreach resources

No funding available for appropriate outreach resources

Able to purchase equipment on ad hoc basis.

Regular equipment budget/ planned team based purchasing



Administration Functions

Level of policy, procedure, administrative staff and systems available to support the provision of the outreach service.

A B C D

No policy/ procedures on outreach services.

Restrictive or incomplete Policies and Procedures

Developing documented Policies and Procedures

Complete Policies and Procedures, updated regularly.

No orientation to outreach/ health service.

Informal orientation dependant on staff availability to perform.

Informal orientation dedicated to one staff member to perform.

Effective/ documented orientation program

Different data collection/ recording systems for each site.

Some variation in data collection procedures.

One standard reporting system that allows across region comparison and reporting.

No administrative support at either the regional or district centre or the local site

Able to request administrative assistance occasionally.

Part time administrative/ coordinator assistance available.

Coordinator of outreach services.

Health professional responsible for client booking, travel, accommodation arrangements.

Health professional responsible for client bookings/ room bookings.

Support staff assist with most arrangements from the regional or district centre.

Local site support staff assist with all/ most arrangements.

High variation in support staff assisting in service arrangements.

Dedicated support staff



Financial Sources

Financial sources available and that can be dedicated to outreach services.

A B C D

No funding available. Some recurrent funding Non recurrent grant based funding

Limited recurrent funding Adequate recurrent funding

Management unaware/ not informed of additional funding requirements.

Time consuming procedures for business case development with little outcome.

Restricted but fair criteria for accessing funding for outreach services.

Easily completed evaluation with minimal documentation

Restricted funding utilisation. Occasion of service funding with funding for innovative projects

Dedicated and transparent budget in place for service, not reliant on occasions of service.

Excessively restricted criteria for funding

Flexibility in use of funding

Severe under resourcing of some allied health areas.

Some gaps in allied health service availability

Accessible and equitable distribution of funding

No further funding/ resources available in the community

Limited awareness of other funding sources.

Pockets of additional funding or resources

Interagency projects in place supporting allied health funding levels.



Management

The management type, roles and responsibilities in place to support the provision of outreach services.

A B C D

Manager not supportive of primary health approach

Generic manager only i.e. no access to clinical development options

Manager also works in primary health philosophy (support)

Health professional not responsible to local site manager.

No collocation and infrequent contact (not organised) with manager.

Manager not collocated but regular contact

Collocated and regular contact with manager.

No planning for professional development or service development Sole positions have no professional support in place

Intermittent access to PD/ support- not strategic

Some professions have same profession clinical support/ supervision.

All practitioners (or services) have access to same profession clinical support/ supervision

Limited health service support for outreach service provision/ negative belief about outreach

Outreach offered but not unsupported.

Outreach included as core business in JDF’s and reporting

Outreach included as core business and facilitated by all health service management.

Conflict in direction and management between regional or district centre and remote site.

Infrequent communication between regional or district centre and remote site

Collaboration undertaken between regional or district centre /local site – however person dependent (rather than process dependent).

Regional or district centre and local site management in close collaboration and have clear breakdown of responsibilities.




DRIVERS BUILDERS Demographics Resources Competency

Clinical Safety Measurement

Stakeholders/ Community Resources

Timeframes Responsibilities Training Others

Supports

Needs, perceptions, priorities

Timeframes Competency clinical

Measurement

Community Capacity

Service Delivery Method

Competency outreach

Staffing Resources Responsibilities Competency clinical

Safety Support

Physical Resources


Competency outreach

Administration Competency outreach

Safety Measurement

Financial Sources


Timeframes Training Others

Management Responsibility Training Others

Support Measurement



Frequency Table for Builders

Builder Frequency Highest Moderate Resourcing Service Delivery models Timeframes Responsibility Competency- Clinical Competency- Outreach Training Others Safety Support Measurement

High complexity drivers are indicative of: Resourcing Increased resourcing will need to be considered to make an impact on health needs Service Delivery Method Innovation in service delivery methods will be required to impact on health needs Timeframes A need to limit the possible negative impacts of established timeframes Responsibilities A need to consider the spread of responsibilities across individuals or agencies or to designate responsibility for a large

number of tasks. Competency Clinical A high requirement of clinical competency needs to be considered. Competency Outreach A high requirement of outreach competency needs to be considered Training Others A high level of planning for training of others needs to be considered Safety A high level of risk may exist and safety considerations need to be specifically addressed Supports Increased need to support systems to be developed or used to assist the service provider. Measurements More innovative methods of measuring the service benefits need to be considered.



Step 3 Builder Development Resourcing

This refers to the elements that can be built into the contract in terms of resources required or costs that may be incurred in providing the outreach service. If resourcing has been highlighted as a concern from your complex drivers, it is anticipated that the community has a high cost requirement to achieve appropriate health gains. Minimum Elements - Establish agreement (including both onsite/ offsite costs/ levels) for either


- Establish agreement on the level of outreach services provided when availability of staff is reduced at the providing service.

- Include consideration of transport costs, staff time reimbursement policy, minimum equipment requirements for the service(s) being considered.

High Complexity Context – Additional Elements Areas of Consideration

Possible Improvement Strategies/ Supports

Staffing Funding allocated to contract

Cost additional funding requirements.

Additional funds Determine alternative sources of funding (Division of GP, DOH, local community). Identify discrete supportive projects.

Service levels Consider alterations in service delivery levels for other sites, to increase levels at the site under consideration. Document policy on service levels per community to monitor and review equity.

Type of service delivery method offered

Consider alternative SDM options (see SDM)

Professional staff duties Reallocate tasks of planning, visit coordination, travel booking etc to clerical staff. Encourage local coordination of appointments where possible with clear lines communication. Increase team sharing of roles and



responsibilities – shared task allocation across professions.

Alternatives to increasing level of professional staffing

Seek funding for Therapy Assistants/ Aboriginal Health Workers to based at local site. Provide increased time and support staff for resource development (eg cultural adaptations of material) in early stage of the contract.

Integration with other activities/ tasks of therapist

Backfill / alter service delivery expectations at regional or district centre Establish policy on appropriate reimbursement for overtime/ excess hours for all outreach providers.

Equipment Need for duplicate equipment.

Seek funds to purchase multiples of necessary equipment. Seek community donations of equipment Rearrange workloads to decrease need for duplication Encourage suitable sharing and multiple purpose item purchases. Ensure suitable consumables and general purpose equipment is available on each site.

Access to portable substitutes Include time/ funds for adaptation of equipment and other tools for the community. Support grant applications to develop required equipment.

Transportation Collaborative planning with other services/ transport services. Clear guidelines on size and weight of equipment able to transported by different means.

Access to IT to increase task efficiency

Lap top / mobile computer systems to support on road documentation. Digital camera and video camera purchases for assessment and treatment/ educative purposes. Seek opportunity to share IT equipment with other agencies etc. Increase use of email access via mobile phones/ portable technology.

Opportunities for team/ agency sharing

Visit coordination/ timing – reduce inappropriate over lap reducing time



efficiency/ equipment access. Increase useful overlap.

Support Workspace options

Visit coordination Indicate suitable and non suitable clients for space available – or suitable SDMs. Provide portable equipment to adapt environments – mats/ screens. Support projects to improve workspace appropriacy (ie child friendliness for paediatrics).

Flights Document timeframes and other requirements for flight planning. Develop strategies to maximise time in locations relevant to flight schedule. Document contingency plans for failure of flight system to a community.

Cars Establish / maintain booking system Develop policy on car standards required for trips and road worthiness considerations.



Service Delivery Methods

The way in which services can be delivered in outreach contexts can be considered on the

continuum of traditional one to one or group assessment and care services, to consultative

approaches relying on non professional implementation of services, to educative personal

development approaches or manipulation of external health factors. Innovation and service

creativity may be required for those communities rated as highly complex in the relevant

drivers to ensure maximum health gain for the community.

Minimum Elements

- Minimum Standards of Care and Duty of Care policies per profession

- Documentation on the types of service delivery to be provided.

- Documentation of minimum service level including client type, contact, etc.

High Complexity Context – Additional Elements

Areas of Consideration


Assessment and care

Home visits Document methods and conditions for home visits.

Telehealth Support access to telehealth for follow up purposes after a visit. Document suitable and non-suitable clients for telehealth access.

Clinical pathways Focus on referral and early identification pathways to increase access.

Innovative therapy techniques – increased time efficient/ effectiveness

Literature reviews and communication with services in like communities.

Cultural adaptation and alteration of treatment methods

Documentation on appropriate and inappropriate techniques for use with communities.

Trandisciplinary approaches. Team planning of programs and implementation by one member of staff after suitable training and support.

Consultative Support worker use Increase opportunities to access support workers/ identify possible support workers. Establish regular communication



between service provider and local support worker. Offer opportunities for local support workers to attend services at providing site for extra liaison time/ training. Document training methods and programs for support workers.

Telehealth Document and develop consultative training packages specific to the medium.

Trandisciplinary approaches. Team planning of programs and implementation by one member of staff after suitable training and support.

Educative Telehealth Document and develop guidelines for administration of educative services using the medium.

Skills Establish training requirements in adult based learning. Acknowledge staff with strong skills in education delivery / local staff and develop guidelines for implementation of your material thorough others.

Enhance community capacity

Assign responsibility for community liaison and planning to one- two visiting members – focus skill development.

Community resources Seek community funding/ support of resource development. Policy on ownership of developed resources. Seek similar communities to collaborate on resource development.



Timeframes

Elements of timeframes are considered in terms of maximising or limiting the impact of

the planned service timeframe on the community and seeking ways to achieve health gain

irrespective of the timeframes able to be provided to the community. The frequency of

service provision may not be negotiable, but for communities with complex issues, the

endeavour of the outreach service is to implement improvements that are feasible in the

set timeframe services can be provided.

Minimum Elements

- Clearly stated and documented timeframes

- Consultation with community regarding timeframe

- Documented regular review dates to reconsider timeframes.



Service Appropriate services. Policy on feasible / non feasible clients Alter frequency of services. Determine options to increase

timeframes at suitable/ critical opportunities for development.

Alter service delivery method Clearly documented expected service delivery methods, alterations to existing methods. Support staff to alter way they provide service.

Clients Urgent referrals Develop and document strategy to manage/ support urgent requirements. Establish minimum agreements with health services likely to transition urgent cases back to local site.

Contingency plans for unavailability of one profession on visit

Establish minimum expectations of other team members. Establish “back up” staff/ plans.

Precluded services policy Document policy on non suitable clients and adequate rationale – review regularly – establish responsibilities for communication / complaints.

Local supports Access to support locally Reduce focus on assessment and care in initial stages and use visits to set up



support contacts. Establish an outreach provider responsible for a liaison role before other professions begin visits.

Access to remote support methods – emails, phone, fax.

Develop resources supporting community members to access other supports (i.e. local email access at health service).

Access to services at regional or district centre when families are able attend there

Policy on how and in what manner this occurs.



Responsibilities

Outreach services involve a range of tasks beyond the pure clinical service provision

responsibilities. Clear documentation on who is responsible for tasks is required in all

contracts. A community with complex drivers linked to responsibilities require an

increased list of responsibilities and/ or alteration of allocation of responsibilities to

support maximum outreach outcomes.

Minimum Elements:

- Document who is responsible for the tasks of

o Collecting and documenting referrals

o Client Appointments

o Travel Bookings



Services Keep community informed Establish contact with communities Identify communities members/ leaders Meet chairman of community Have regular joint planning days

Clients Identifying clients

Identify likely referees – keep informed of current and types of clients that are suitable. Establish referral policy and guidelines.

Planning Determine when to visit, what room will be available Determine method of SDM/ frequency

Appointments Fax, phone to arrange visits and lists Document strategies to assist finding clients in community

Evaluation Variable means - phone calls, telehealth, mail out. Plan method when no phones available Encourage to come in if ever in town

Administration Reporting Send information to finance manager



to sign off on Establish responsibility for cars and flight tenders

Travel Book car/flights Check roadworthy-ness Fill up with petrol Buzz plane over community to be picked up Wash car on return

Supports Therapy Assistants Clear JDF with responsibilities defined. Delegate and train in case management and client planning.

Training others to be supports in between visits

Use of telehealth, email, fax, phone contact with support person to keep progress occurring.

Management Service levels and requirements

Liaise with other managers Deal with complaints regarding Contracts/ service levels. Identify facilities/ standards that can or cannot be used

Review services Set regular review timeframes. Reporting

Provide regular feedback to funding sources



Competency - Clinical

A standard level of clinical competency is expected for any service provision, with

outreach services requiring specific clinical skills, experiences or knowledge. As the

complexity of the community increases, so to does the level or type of clinical

competency expected of the service provider. Plans to support the level of clinical

competency, especially with high complexity communities, are vital for maximum health

gain.

Minimum Elements

- Multiskilled/generalist experiences.

- Experienced health professional or support of a senior staff member

- Understanding of PHC philosophy




Experience Generalist skills

Ongoing PD and performance development relevant to past experiences

Gaps in past experience Identify skills necessary for community and seek to external development opportunities

Management Caseload management

Develop peer review and mentoring options. Professional support training in caseload management

Skills

Increase skills levels Seek opportunities for more than one of the same profession to make some visits.

Treatment methods/ ideas Access to PD and specialists and teaching hospitals Variation in PD access

Level of supervision Always accompanied on initial visits Policy that always accompanied by someone more senior if a new grad

Professional Interests

Seek opportunity to engage professional areas of interest for benefit of the community.

Clients Limit range of clients Restrict types of clients dependent on



level of experience/ skills. Limit SDM to particular

client groups. Restrict service delivery methods dependent on level of experience/ skills.

Develop speciality skills suitable to the community needs.

Telehealth support with complex clients/ arrange specialist visit.

Primary Health Care Philosophy

Target populations

Increase skills in 0-5 and preventative activities.

Needs analysis Skill development opportunities. Dedicated training role to assist need analysis.

Knowledge of community development models

Health promotion strategies and how to get people to attend



Competency – Outreach

Provision of outreach services as an allied health professional requires skill development

specific to the clinical competencies of the profession. Outreach Service provision is

seldom appropriate to be provided by a newly graduated therapist due to the level of

complexity and skill level required. Outreach services require considerable planning of

supports if a new graduate is the only available source of service provision in an outreach

context (see minimum elements). However as the complexity of the community being

serviced increases, then additional skills and qualities become essential, for the outreach

service to be effective. The suggested additional elements below endeavour to suggest

support mechanisms, training or staffing qualities that should be sought when planning

outreach services to more complex communities.

Minimum Elements

- Experienced professional.

- Orientation – cultural awareness and understanding of the local community.

In the scenario where a newly graduate therapist was employed for Outreach the following

considerations would be required:

- TIME- they would require more time to complete tasks, more time to come to terms

with workload and less expectation in terms of time. They should be gradually

introduced to Outreach concepts.

- LESS COMPLEX- would need to begin providing services in a more structured

environment such as within the regional or district centre hospital or communities

closer to town before they work in more complex scenarios.

- ALWAYS HAVE A SENIOR- they will require supervision, mentoring and

assistance from a senior preferably from within their own discipline.

- ORIENTATION- including cultural awareness and spending time with health

workers that they would be involved with. Be accompanied on all first time visits.

- SUPPORT – higher level of professional development





Personal

Travel Give clear information to prospective employees regarding the travel requirements. Include on JDF and all advertising.

Confidence/ comfort levels

Encourage independence and problem solving Enhance understanding of rural issues and innovativeness Identify interest in the rural lifestyles.

Team skills

Understanding of team roles.

Training in trandisciplinary assessment and treatment Experience working closely with other professionals Provide opportunity to learn from other Allied Health Professionals

Years of experience -in supervising staff -in completing admin -in rural communities

Adaptability/ Improvising

Able to develop program instantly and implement Non-reliability on equipment Capacity for quick assessment in unstructured environment

Skill development Excellent communication skills

Conflict resolution/negotiation

Training/ OSH issues First aid Driving Cultural awareness Safely transporting and carrying equipment

Facilitation and empowerment



Training of Others

Outreach services are known to rely on training support workers to assist in the

implementation of a range of service delivery methods. Support workers can be family

members, volunteers, paid assistants or staff working for other agencies or services.

Minimum elements exist for training of support workers in any context to ensure safety,

appropriate use, and effectiveness of service delivery. In more complex outreach

situations more strategies and consideration is required, in order to enhance the capacity

for training others in a manner which impacts on the health status of the community.

Minimum Elements

- Mechanisms/ systems to record support workers details.

- Criteria of appropriate support workers for professions/ clients, inclusive of

appropriate tasks/ duties.

- Job descriptions for employed and volunteer support workers.

- Training guidelines including timeframes, supervision, follow up support.




Skills of the Allied Health Professional

Planning training Identify possible support staff. Establish rapport with support staff.

Train the trainer skills Seek courses/ training opportunities to increase allied health professional abilities in adult training,

Evaluating training Skills of developing follow up post workshop with teachers and parents Innovative methods of measuring improvements.

Set topic of training Manual handling packages Recruitment Resources

Acknowledge part time workers difficult to overlap with professionals – plan to reimburse for training time. Ensure adequate to liaise with possible support sources.

Systems to capture Database to record support workers



availability details, areas of interest, additional hours if available. Have methods in place to encourage volunteering of time.

Appropriacy of support worker

Establish guidelines of - lifestyle factors –need to be a good role model -appropriate for clients (small country town) -wants to be trained - plan for annual turnover of staff (beginning school year)

Retaining Follow up

Suggested options include - Initially meet face to face - 6 monthly at least review face to face - term by term if school based - review if any changes to program - intermittent follow up via telephone

(structure for feedback) Resourcing Training packages Competencies to teach

-health promotion/prevention -should be competency or standard based Form a central point for training to occur (eg TAFE)

Offer appropriate and supported PD

Liaise directly with District Education offices to offer PD for teachers etc.



Safety

Outreach services have considerable safety risks, due to requirements for travel, isolation

and the variable workspace/ equipment parameters. For complex communities these

safety factors required increased consideration due to the high risk to the health

professional providing the outreach service. Safety elements need due consideration from

the perspective of the health service duty of care requirements and risks to the allied health

professional.

Minimum Elements

- Policy

o Home visit process for informing others -informing pre/post travel

o General departmental policy and procedures on safety/OSH/universal

precautions

o Documentation –minimum documentation required to be covered for

workers compensation requirements

o Current drivers license

- Check car before driving/ prepare

- Emergency Kit

- Mobile phone or satellite phone

- Essential contact numbers – police, regional or district centre , ambulance.




Travel Detailed Car Travel Safety policy requirements

Criteria where flight vs driving is required -wet season/distance Driving -not alone/not alone until done course -leave and arrive in daylight (flights also) -4WD maintenance and driver training Check car before driving/ prepare Documentation on car standards



-process of ensuring adequate car maintenance for car/transport at other end of flight

Requirements for tenders Check tender specifications - eg standards for flight charters

Contact -Outreach and home visit procedures and requirements

Sign in/out for outreach and home visit -written system for each site check in system each day outreach to regional or district centre Essential numbers-police, ambo, regional or district centre Home visit - no solo home visits - always Health Worker or other Allied Health Professional present

Booking system for contact equipment

Ensure access to mobile/ satellite phone and emergency kit as required.

Preparation for environment

Training -4WD training -Car maintenance -first aid training -cultural awareness

Therapy Assistant supervision

Minimum standard for safety

Cultural awareness

How to conduct services -liaison with local services re: safety, community violence

Special equipment requirements

Requirements for flying in/out -Equipment that can be carried/ needs support to carry Manual handling requirements

Accommodation requirements

Accommodation for overnight visits -lock in and other procedures



Supports

These are the supports that are available to the allied health professional to assist the

provision of quality outreach health services. This includes supports within the service or

base community from which the Allied Health Professional work and in the community

receiving the outreach service. The level of support available to health professionals can

influence the effectiveness of service provision on a number of levels. To impact on the

health of the more complex community, outreach services require increased support

structures and more innovative use of supports.

Minimum Elements

- Orientation to community, community agencies, and known key stakeholders

(including relevant contact names and numbers).




Community

Increase identification of key agency staff. -school, Principal, teachers, Education Support staff, Education Assistant -church services locally

Keep lay staff informed - initially through leader and then get him to nominate a liaison Anticipate turnover in staff – request to be informed when staff change.

Maximise opportunities to liaise

Be involved in common goal setting opportunities such as Individual Education Plan (IEP) Involve the community in service planning. Join morning tea sessions Arrange social catch up / attend social events when in town

Other health services

Interaction eg Aboriginal Health Service, HACC, Aged Care Services, Community Health Nurse

Encourage referrals/ promote areas. Know how to refer to their service Investigate historical links/ past links/ informal links.

Coordination Know which other similar services travel to the same communities and when

Family Ensure adequate time Regular contact



members -non-traditional -build links with other family members at all opportunities

available to liaison Keep some regularity in visits. Culturally appropriate contact Establish shared knowledge about services and events

Skill development of health professional

Target skills of demonstration of trust and respect Appropriate consideration of culture

Allied Health Team

Encourage adequate team development.

Formal - planning time - team meetings Informal - travel & accommodation opportunities.

Office/Administration and clerical support -community and regional or district centre

Maximise opportunities for support

Streamline supportive tasks through a key clerical staff member. Seek local community clerical supports.

Networking Support network opportunities Include attendance at network meetings in Job Description Form



Measurement

Measurement of outcomes of the service and utilisation of the service.

Minimum Elements

- A measurement system is identified for health care utilisation

- Reporting requirements for funding are addressed

- Some steps towards PHC/establishing community needs and evaluating those is made




Process Measure appropriate to context Time (organisation, travel, service provision) Occasions of service Number of referrals Attendance (including failure to attend)

Systems that measure data Shared client records Investigate other database systems

Outcome

Measurement Plan outcome measurements Number of health promotion events Change in individual client status Topics to evaluate -uptake -follow up in community

Data collection Alternative measures: Goal Attainment Scales, WeeFIM (Msall, Wilczenski et al. 1997; Tobbell and Burns 1997) Rating change in client on database system.

Impact Know current health status Health service need analysis results. Other organisations reviews Liase with other service providers eg Mercy Health, Aboriginal Health Service, etc

Measure change on community Early Development Index – Lower Great Southern initiative

Review benefit and costs Annual planning session to compare process, outcome, impact measures and costs of service.



Outreach Service Summary Sheet NOTES: Document elements requiring additional development specific context. Resourcing

Minimum elements • Establish agreement (including both onsite/ offsite costs/ levels) for either


• Establish agreement on the level of outreach services provided when availability of staff is reduced at the providing service.

• Include consideration of transport costs, staff time reimbursement policy, minimum equipment requirements for the service(s) being considered.

Additional elements required

Service delivery method

Minimum elements • Minimum Standards of Care and Duty of Care policies per profession • Documentation on the types of service delivery to be provided. • Documentation of minimum service level including client type, contact, etc.

Additional elements required Timeframes

Minimum elements • Clearly stated and documented timeframes • Consultation with community regarding timeframe • Documented regular review dates to reconsider timeframes. Additional elements required



Responsibility agreement

Minimum elements • Document who is responsible for the tasks of o Collecting and documenting referrals o Client Appointments o Travel Bookings

Additional elements required Competency/ skill development - Clinical

Minimum elements • Multiskilled/generalist experiences. • Experienced health professional or support of a senior staff member • Understanding of PHC philosophy Additional elements required Competency/ skill development – Outreach Specialist

Minimum elements required • Experienced professional. • Orientation – cultural awareness and understanding of the local community. Additional elements required Training Others

Minimum elements • Mechanisms/ systems to record support workers details. • Criteria of appropriate support workers for professions/ clients, inclusive of

appropriate tasks/ duties. • Job descriptions for employed and volunteer support workers.



• Training guidelines including timeframes, supervision, follow up support.

Additional elements required

Safety Minimum elements Policy • Home visit process for informing others -informing pre/post travel • General departmental policy and procedures on safety/OSH/universal precautions • Documentation –minimum documentation required to be covered for workers

compensation requirements • Current drivers license Check car before driving/ prepare Emergency Kit Mobile phone or satellite phone Essential contact numbers – police, regional or district centre , ambulance.

Additional elements required Supports

Minimum elements • Orientation to community, community agencies, and known key stakeholders

(including relevant contact names and numbers). Additional elements required Measurement (Process, Outcome, Impact)

Minimum elements d • A measurement system is identified for health care utilisation • Reporting requirements for funding are addressed • Some steps towards PHC/establishing community needs and evaluating those is made Additional elements required



SECTION 4: SUPPORTING DOCUMENTS Table of Abbreviations Key REGIONAL OR DISTRICT CENTRE - major health centre or site REMOTE/ LOCAL- community that outreach is being provided for Abbreviations 4WD Four wheel drive ATSI Aboriginal and Torres Straight Islander DOH Department of Health GP General Practitioner HACC Home And Community Care services IT Information Technology JDF Job Description Form OSH Occupational Safety and Health PD Professional Development SDM Service Delivery Model TA Therapy Assistant TAFE Technical and Advanced Future Education



Interaction Matrix Rationale For this part of the framework the premise was to incorporate a tool that acknowledges the

benefits of a link between local context and the elements included in an outreach service.

Further, to allow reasonable and feasible consideration of a limited number of factors, a

focus on those interactions that have the greatest impact was incorporated into the tool. In

this way the analysis of local context can be refined further to allow those developing

services to attach priority to the possible areas of development that exist.

In order to establish which of the interactions between drivers (context) and builders

(service) has greatest impact on outreach service delivery, evidence was sought from the

literature and clinicians experienced with outreach service delivery. Builders were ranked

for significance or importance to each driver. This ranking was used to determine which

builders (strategy) could be prioritised to address the impact of high complexity drivers

(or context). The interactions proposed in the Matrix are suggested to have a greater

impact in terms of strategies to address high complexity issues.

Further research into the impact of these interactions is required with continuing input and

support from those clinicians working in outreach services. This is the first trial of this

Interaction Matrix and there is a need for ongoing development and ranking of the driver/

builder interaction effects to assist in guiding progressive development of the outreach

service for an area.

Health service teams may wish to change the interaction matrix by placing different

builders against different drivers. The team will need to follow a similar rationalisation as

set out below, having a clear picture of what needs to be improved in the high complexity

driver and which builders “best” suit that need. Builders that are prioritised by using the

Interaction Matrix should have a flow on effect to other builders and may also impact on

the driver itself (i.e. decreasing the complexity of the local context). There are also

overlaps between some drivers, between the strategies in each builder and between most

builders and drivers. Monitoring and collating use of the framework will ensure the

continued development of these tools.



The Interaction Matrix in this report was developed using the rationale/ relationship

analysis explained below.

Relationship Analysis

The question posed when developing strategies based on the needs of the local context is:

Which builder can most significantly address the high complexity issues in X driver? COMMUNITY DRIVERS Demographics High complexity issue examples; • Geographical distance and spread • Transient population

Builder Priority

Impact Rationale

Resources Yes Creative use of equipment and networks will be required to ensure that a service can be offered to this community

Service Delivery Models

No Need should determine the chosen SDM rather than location

Timeframe No Altering frequency of visits should also reflect need rather than location

Responsibilities No Assigning tasks will not have a significant impact on improving services

Competency Clinical

Yes May need to be able to make rapid clinical decisions with little information/ limited follow up opportunities. Therefore will need rapid assessment and information provision skills.

Competency Outreach

No Partial as need general skills in communication and team work

Training Others No Partial as may need to be able to train local workers if it is an isolated community

Safety Yes High need for travel to the community with risks associated with travel, isolation factors and other risks may arise in these situations.

Supports No Partial as may need to use local supports (as in training of others)

Measurement Yes Innovative measurement needed to reflect that service performance will not be comparable to typical benchmarks (eg 9 hours of travel for 4 hours of therapy).



Key Stakeholders/ Community Resources High complexity issue examples; • No support/ working against service • Lack other agencies • No coordination/ planning of services

Builder Priority

Impact Rationale

Resources No Partial as increased creativity and development of resource use will flow on from increasing the key stakeholders, but may not necessarily support the development of them. This would be considered to be a secondary impact.


No The level of support or community resources should not be a primary reason for choosing the method of service delivery

Timeframes Yes Lack of supports in the local community may require additional visits/ capacity to visit more often to identify issues arising. No monitoring system available to tap into. More frequent visits can be spent talking with local stakeholders and harnessing their support.

Responsibilities Yes Clear designation of responsibilities will be imperative to avoid duplication or gaps in planning. Heightened awareness of who attends from other agencies and increased role of the manager in monitoring and supporting the service.

Competency Clinical

No Lack of community support for the outreach service will not significantly impact on the level of clinical decision-making required with clients/ situations that arise. (Partial – countering some negative community opinions may require higher clinical expertise to justify services)

Competency Outreach

No Partial as negotiating and liasing with offsite communities and attempting to coordinate service provision may benefit from strong outreach competency skills, but could be addressed under clear strategies for the builder responsibilities/ management taking higher responsibility.

Training Others Yes Strong plans/rapid capacity to train can increase community interest and base resources.

Safety No Not directly related to the presence or absence of supportive factors in the community. Possible implications but should already have emerged from other complex situations.

Supports Yes Strategies in this builder support identifying, collaborating and developing the local community to better support the service.

Measurement No Changing how you measure the outcomes of the service will not address the lack of community supports/ agencies. (Partial – may need to be innovative to measure time spent developing community resources)



Needs, perceptions, priorities High complexity issue examples; • No data • No clear picture of services needed • Considerable issues

Builder Priority

Impact Rationale

Resources No Applying resources appropriately will be an outcome of other strategies when needs are clearer or planned.


No There is a need for more information before SDM strategies will address this driver. Where there are a large number of needs clearly identified SDM decisions will be easier to make and therefore still not a priority for development.

Timeframe Yes Need to plan timeframes relative to determining needs/ health support required.

Responsibilities No Will need to clarify need or establish services with most need first rather than address this area.

Competency Clinical

Yes Proficiency in specific health need areas for that community, and to assist in gathering a clearer picture of the health issues.

Competency Outreach

No Could be supportive of building a clearer picture but not essential.

Training Others No Need clarity on needs prior to developing training approach.

Safety No No direct risks raised by this factors. Supports No Partial as relationship in collaborating with others to

identify and plan service provision. Measurement Yes Benefit from capturing current health status and planning

how to measure the impact of services. Community Capacity High complexity issue examples; • Fragmented community • Lack of community projects and direction • High turnover • Resistance

Builder Priority

Impact Rationale

Resources No Improved capacity may be a secondary impact of increasing services, but not necessarily a direct outcome of increasing funding.




Yes The community capacity to embrace certain methods of service provision may be restricted (high turnover – limits outcomes of SDM). Decisions about what is offered will need to take this into account.

Timeframes No Not primary determinant in the frequency of visits, flow on effect if more visits or visits are focused on addressing this driver.

Responsibilities No Outcome of other strategies building the capacity will support development of assigning responsibilities.

Competency Clinical

No Outreach competencies would be of more benefit that clinical skills in the early stages.

Competency Outreach

Yes Needing to engage the community requires strong interpersonal and experience skills or access to support to do this well.

Training Others No Training can be better addressed once this driver reduces in complexity.

Safety No No specific risk factors arise from this complexity. Supports No Partial impact as knowing and engaging supports may

assist in community capacity development. Measurement No Not an initial factor that will support the community or

promote the service delivery strategy. INFRASTRUCTURE DRIVERS Staffing High complexity issue examples; • Sole practitioner • Lack of staff • Lack of supervision

Builder Priority Impact

Rationale

Resources Yes Creative use of current staffing levels will assist in providing a service, eg using telehealth


No Need should determine the chosen SDM rather than staffing. (Partial- as you may limit the SDM you can offer)

Timeframe No Staffing levels should not drive the most appropriate timeframes. (Partial as you may alter timeframes of visit if staffing alters)

Responsibilities Yes Documenting the required tasks and assigning who will do these will assist in ensuring that all tasks are done and delegation occurs where possible

Competency Clinical

Yes Where there is no allied health team support or supervision then the AHP must be able to make



decisions rapid, independent clinical decisions. Competency Outreach

No The impact of clinical competency would be more significant for this driver.

Training Others No Ability to train others may be decreased, link to strategies addressed in Supports

Safety Yes Must be considered as other strategies may be required as can’t rely on team

Supports Yes Use of local agencies and other supports that you can access

Measurement No Complexity in this area is not related to measurement of costs or benefits

Physical Resources High complexity issue examples; • No facility • No access to equipment/accommodation/transport

Builder Priority

Impact Rationale

Resourcing Yes Creative use of resources may assist with this issue Service Delivery Models

Yes May need to modify choice of SDM to accommodate the physical resources situation, for example space to run groups

Timeframe No Visiting less or more often will not impact on the physical resources. (Partial by sharing space which is addressed in Resources strategies)

Responsibilities No Clearly allocating tasks will not change impact of not having enough cars to do the visit (Partial- for sharing and booking space)

Competency clinical

No The physical resources available are not the main driver of the clinical competency required. (Partial as need to be proficient enough to perform under varying circumstances)

Competency outreach

Yes Innovative approaches are required where there are not physical resources to provide services

Training others No This will not address a lack of physical resources. Safety No Partial as there are safety risks in confined space or

outdoor treatment areas. Support No This will not change the impact of having no space to

work (Partial- use others areas, home etc) Measurement No Not the most significant effect on recording the benefits

and costs of activities



Administration Functions High complexity issue examples; • No policy/procedures • No orientation • No clerical/admin support

Builder Priority

Impact Rationale

Resources No Partial as creative use of the resources that you have will not impact on policies but you may be able to improve clerical support


No Should not be the primary factor in planning SDM

Timeframe No Will not impact on planning frequency. Partial as may take longer to organise outreach services without clerical/admin support

Responsibilities No Partial as allocating tasks or delegating may assist and could be outlined in policy and procedures

Competency Clinical

No No relationship with clinical skill requirements.

Competency Outreach

Yes A good understanding of the duties is required, high level organisational skills as there is no clerical / administrative support

Training Others No Partial as you may need to train others in order to delegate tasks

Safety Yes If there are no policies and procedures or admin staff to monitor local conditions and AHP movements then considerations of this will be important to ensure that the service is offered safely

Supports No Partial as may access local supports to perform some of these tasks.

Measurement Yes Need for a system that is adaptable for travel/ lack of IT access offsite. Need measurement strategies that reflect the time taken on administrative tasks.

Financial Resources High complexity issue examples; • No funding • Not aware of other sources funding • Severe under resourcing

Builder Priority

Impact Rationale

Resources Yes Creative use of existing resources and exploring the awareness of what options are available




Yes May need to limit SDM that can be provided. In response to funding requirements this may be the primary reason that you have to modify service delivery model.

Timeframe Yes As above Responsibilities No Allocating tasks won’t alter the impact of funding issues.

Partial as someone may be given the task of negotiating contracts or applying for extra funding, covered under resources

Competency Clinical

No Financial Resources should not be a driver of the level of clinical competency required by a community

Competency Outreach

No As above

Training Others Yes Employing TA’s and training them may have a useful impact where resources are a problem, ie employing further AHP’s is difficult.

Safety No Partial but addressed by timeframe and SDM- if it is unsafe to go then will be addressed by timeframes/SDM

Supports No Need to use local engagement regardless of funding levels. Partial as we are training others

Measurement No Partial as need to demonstrate worth of service but will not have the most impact on delivering an outreach service where finance is a high complexity issue

Management High complexity issue examples; • Management not collocated • No professional development planning • Not supportive of primary health care or outreach

Builder Priority

Impact Rationale

Resources No Management regardless of resources available. Partial could allocate more resources to contact time with your manager if not collocated.


No Altering SDM’s won’t alter the impact of management. (It may influence the SDM chosen but strategies to alter this won’t work the other way around unless trying to demonstrate to management that they work)

Timeframe No As above Responsibilities Yes If there is no manager to help you then you need to

clearly assign tasks and contracts Competency Clinical

No Partial as you need to plan your own PD/PHC knowledge but overlap into training others

Competency No Partial as no supervision but not specific to outreach



Outreach Training Others Yes Planning your own professional development Safety No Partial as responsibility for safety will rest with the AHP

however covered in strategies for Responsibilities Supports Yes Need to liaise with local staff and liaise with the allied

health team for assistance Measurement Yes Need to be more innovative to demonstrate the worth of

outreach services where they are unsupported



POLICY EXAMPLE – SAFETY

Precautions to Observe When Visiting Clients/Carers at Home

For all home visits, the following safety precautions need to be taken, wherever practicable and possible, in order to ensure staff safety.

1 All visits to client homes are considered to have potential risk to personal safety.

2 If staff feel uncomfortable or unsafe, or assess the situation as potentially dangerous at any point on arrival, or during the visit, they should excuse themselves and leave immediately

3 Wherever possible staff should attend the visit with a second person, preferably a local person, whom is known to the family.

4 Visits should be arranged in advance, as far as is practicable, and the family informed that the staff member may not attend if there are intoxicated people present and there is considered to be some risk to staff

5 When arranging visits to clients’ homes, consider the timing of the visit. Therefore visits should be avoided on days when unemployment benefits have been paid and drinking alcohol is likely. Mornings would generally be considered to be a better time than afternoons when visiting homes.

6 Staff attending a client’s home for the purposes of a home visit must carry a mobile telephone. It is recommended this phone has local police numbers programmed and staff are ready to dial these in the event of an emergency.

7 Staff members should notify Pilbara Community & Aged Care Services of their whereabouts when home visiting.

8 Any identified or known potential risks in relation to homes, clients or families/carers should be documented in the client/carer files.

Thank you MANAGER PILBARA COMMUNITY & AGED CARE SERVICES 6th March 2002



POLICY EXAMPLE – SAFETY

MOTOR VEHICLE COMBINED POLICY

11.. PPOOLLIICCYY SSTTAATTEEMMEENNTT The Pilbara Gascoyne Health Region (PGHR) is committed to continuously improving the management and standards of Occupational Safety and Health. This commitment includes the health and well being of employees whilst using vehicles authorised for Health Region activities. These guidelines apply to average on-road vehicles and are intended to minimise incidents and accidents that may arise when using authorised vehicles This policy applies to all situations in which vehicles are used but may also be used in conjunction with more specific guidelines to address different circumstances such as off-road or remote driving duties and the use of specialised vehicles.

22.. DDEEFFIINNIITTIIOONNSS Responsible Officer The Regional Director is the ‘Responsible Officer’ as designated under the Occupational Safety and Health Act 1984. Accountable Officer An ‘Accountable Officer’ is a PGHR employee who has responsibility to others in the PGHR under the Occupational Safety and Health Act 1984 with the authority to approve the use of a PGHR vehicles i.e. Local Unit Managers and Departmental Heads. Attachment Attachment means any attachment that is not a standard part of the vehicle such as roof racks or trailers and which may necessitate a change in driving practices. Such changes may include a change in braking characteristics when towing a heavy load or taking into account wind conditions with loaded roof racks. Vehicle Vehicle means a motor vehicle that is supplied by the PGHR to an employee as part of their employment contract, a pool vehicle, vehicles hired from agencies external to the PGHR or private vehicles authorised for use for PGHR business. Average on-road vehicle means a vehicle that is used primarily on major or minor formed roads and includes sedans, wagons, utilities, vans and four wheel drives.

WA COUNTRY HEALTH SERVICE

PPIILLBBAARRAA--GGAASSCCOOYYNNEEHHEEAALLTTHH RREEGGIIOONN

WWEESSTT PPIILLBBAARRAA



Driver The driver of a PGHR vehicle is the person in charge of the vehicle who IS so authorised by their:

• Employment contractual conditions; or • Use for executing the official business of the PGHR; or • Use to undertake private activities with approval of their

Accountable Officer; and

• Is in possession of a motor vehicle driver’s licence that permits them to drive within the State of Western Australia as permitted under its Road Traffic Act 1974 provisions.

Employee Employees mean any person who undertakes work under a contract of employment with the PGHR or an apprentice or industrial trainee. Off Road Driving Off road driving means being in control of a vehicle, which is not being driven on a major

or minor formed road, or access way. Remote Driving Remote driving means being in control of a vehicle:

• More than 5 kilometres from a road or access, residence or other facility from which assistance can be summoned;

• At a location where traffic is infrequent or where topographic features would make summoning assistance difficult or unlikely.

33.. PPOOLLIICCYY IINNTTEERRPPRREETTAATTIIOONN

33..11 IINNDDIIVVIIDDUUAALL RREESSPPOONNSSIIBBIILLIITTIIEESS Responsible Officer

Provides suitable facilities and resources to ensure the effective implementation of this policy and associated guidelines.

Accountable Officer Ensures these procedures are implemented within their area of responsibility. Provides

information to employees regarding the driving of authorised vehicles. Driver Ensures that the journey has been adequately planned, resources required have been supplied i.e. first aid kit etc. They must also ensure that all aspects of the journey are within their capability and can be safely completed. It is also the driver’s responsibility if going off road or to remote locations, to ensure that appropriate authorities have been informed of the proposed itinerary



(e.g. their Accountable Officer, PGHR-WP Units, Nursing Posts, WA Police Service) of departures, arrivals and returns.

Background The safety and health of driver(s) and passenger(s) is paramount and takes precedence over all other considerations. Driver fatigue is a common cause of accidents as is collisions with wildlife and livestock, which can result in damage to motor vehicle and possible injury to staff. The planning of the journeys should ensure that pre-dawn, dusk and night driving is eliminated and only undertaken in emergency circumstances.

Safe Driving Responsibilities The following guidelines shall be followed at all times:

i No more than 10 hours in a 24 period shall be spent driving. The total time spent travelling, including breaks, shall not exceed 12 hours even when driving is shared.

ii A minimum 15-minute rest break should be taken after each two hours of driving. If the driving is shared drivers shall rotate every two hours as a minimum.

iii Ordinary duties combined with driving duties shall not exceed 12 hours in a 24-hour period.

iv Any employee who has been the sole driver of the vehicle for three (3) consecutive days should normally ensure that the fourth day is a non-driving day. Where work commitments include driving on consecutive day’s employees should attempt to restructure their workload so that each day includes non-driving activities.

v All legislative requirements such as speed limits, use of seat belt and/or child restraining devices, mobile phone and alcohol consumption associated with driving duties shall be observed.

vi The distance which can be reasonably travelled during one days driving will be governed by points 1 and 4 above as well as driver fatigue, climatic conditions, road conditions, vehicle and attachments (as described in “Definitions - Attachments”).

Accident/Incidents Drivers shall comply with all legal and insurance requirements if involved in an accident, including obtaining particulars of the other parties involved, and notifying the WA Police Service, their Accountable Officer and the Housing and Transport Officer. Drivers are NOT to make any admission of liability of the accident/incident. All accidents/incidents must be reported to the Housing and Transport Officer immediately. If the accident/incidents occurs after business hours it must be reported immediately on commencement of the following business day.

With a view to repairs being effected at the earliest possible opportunity drivers are to notify the Housing & Transport Officer within 48 hours of any theft or damage however slight.

A Motor Vehicle Accident Report (R/C) and Staff Accident/Incident Report must be completed and forwarded to the Housing and Transport Officer.



Traffic Infringements In the event of a driver of a PGHR vehicle committing a breach of the WA Road Traffic Act 1974 that results in a fine and/or loss of demerit points, the driver shall:

Supply to their Accountable Officer details of the infringement/s placed upon them, Be wholly responsible for the payment of any fine associated with any infringement/s

Off Road Driving All drivers required to travel off road or carry out remote work must complete a four-wheel drive course or similar accredited course with a recognised institution. Accountable Officers are to evaluate driver’s need to undertake training and organise and fund training requirements. Overnight Accommodation

The Accountable Officer of the driver must meet additional accommodation costs in the event of unscheduled and valid overnight stops Housing and Transport Officer

Housing and Transport Officer The Housing and Transport Officer is responsible for the following services relating to vehicles on behalf of the PHRH Housing and Transport (or similar) Committee:

• Coordination of vehicle allocation in consultation with the Committee and Accountable Officers.

• Coordination of vehicle maintenance service program, as specified by the vehicle manufacturer.

• Coordination of day-to-day usage of vehicles. • Additional duties described within the Job Description Form of

the position relating to vehicles. • Ensure vehicle allocated for long distance trips are road ready

(fuel, oil, tyres, coolant etc), roadworthy and safe to drive. . Further information Accountable Officers and drivers shall ensure that decisions made for conveyance of all passengers in PGHR vehicle shall be justifiable and defensible if subject to scrutiny against Public Sector ethical values and behaviours.

33..22 OOTTHHEERR FFAACCTTOORRSS

Private Motor Vehicles Approval for use of an employee’s private motor vehicle to undertake official business on behalf of the PGHR is not to be given unless exceptional circumstances exist and only with the approval of the Responsible Officer. Workers’ Compensation



All workers’ compensation claims submitted by PGHR employees who consider that they have suffered personal injury by accident arising out of or in the course of his/her employment shall be assessed individually. Accountable Officers should make drivers aware that:

• ‘Substantial interruption’ and/or ‘substantial deviation’ from the journey for any reason unconnected with his/her employment may affect their entitlements under Workers’ Compensation and Assistance Act 1981.

• ‘Substantial default’, the consumption of alcoholic liquor or of a drug of addiction, or both, to the extent that it impairs the driver’s proper functioning and contributes to the happening of the injury, can similarly affect entitlement.

Transport use for Patients Wherever possible written permission must be obtained from the Head of Department if using PGHR-WP leased vehicles to transport patients other than the use of the Hospital Orderlies vehicle. Where necessary, verbal consent will be sufficient, however this will need to be detailed and documented and signed off by the Head of Department as soon as practicable.

There must also be evidence that the client/patient has consented to this mode of transport.

All other exceptions to this must be documented and approved by the Housing and Transport Officer. The request for transport of a patient will be filed in the patient/clients Medical Record. Child Restraints “Child Restraints” means a device fitted to a motor vehicle and complies with the requirements of Australian Standard AS: 1754-1991 (Child restraint system for use in motor vehicles).

The compliance with these standards is the driver’s responsibility when securing baby capsules and other child restraints.

All users of leased PGHR-WP vehicles must be aware and understand the AS: 1754-1991. Pool Vehicles All leased PGHR-WP vehicles are considered to be “pool vehicles”. These vehicles may therefore be used during business hours by PGHR-WP staff to conduct PGHR-WP business. Medical Officers vehicles can also be used but this should be coordinated with medical officer’s needs. Leave



All leased PGHR-WP vehicles must be returned to the Housing and Transport Officer if the owner is away on leave from work. This includes medical officers. Staff must return their cars to the hospital on the day annual leave commences.

The West Pilbara Operations Manager may exercise their discretion in granting the use of government motor vehicles to medical officers while on leave. The only time the car may be exempt from return during annual leave is if the Medical Officer (and family) has no private vehicle him/herself. This would not generally extend to family members such as wives using it if the Dr was out of town when on leave, however if special circumstances exist, this may be negotiated with the Operations Manager. Drivers Licences Users of PGHR-WP vehicles must have a current drivers licence. The original and copy of the licence must be presented to the Housing and Transport Officer every year by 31 March. The copy of the driver’s licence will be kept on file in the Housing and Transport office. No vehicle will be lent or used by an employee unless there is evidence of their current driver’s licence.

In the case of disqualification of driver’s licence, the employee must notify the Housing and Transport Officer. Log Books and Maintenance The completion of log books relating to personal and private use, and required maintenance checks, must be adhered to in accordance with Operational Instructions. Every vehicle should have a log book and maintenance sticker on their windscreen. Motor Vehicle First Aid Kit Individual vehicles have been provided first aid kits and it is the responsibility of the allocated driver to maintain and stock the first aid kit. Additional supplies for first aid kits are available from Stores by completing an Internal Requisition.

Any supplies used during the course of that journey are to be replaced by the user department. The Housing and Transport Officer is not responsible for resupplying these kits. Copy of the contents of kits are located in each first aid kit and also the Housing & Transport office. 33..22 PPRRIIVVAATTEE UUSSEE OOFF GGOOVVEERRNNMMEENNTT VVEEHHIICCLLEESS Background LEASED PGHR-WP vehicles may be provided to designated positions or staff members

who have specified ‘home garaging’ or ‘limited private use’ privileges in their employment contract.

Home Garaging may also occur under the following circumstances, providing prior

approval has been obtained from the driver’s Accountable Officer:



• The vehicle is taken home at night in order to commence a trip early the following morning; or

• The vehicle cannot be returned to its normal location by close of business on the day of use.

• Approval is granted by the Operations Manager, for specified staff to take vehicles to their residence for security and/or work related issues.

Limited Private Use

In reference to “Limited Private Use”, leased PGHR-WP vehicles can only be driven within a 60km radius of the town centre. All driving must be on sealed roads and well-

maintained gazetted unsealed roads only.

Medical Officers • As an award condition Medical Officers and their spouses are

entitled to limited private usage. A “spouse” is defined as a wife or a defacto of twelve months standing.

• The West Pilbara Operations Manager may exercise their discretion in granting the use of government motor vehicles to medical officers to attend out-of-town conferences and/or visit surrounding communities within Western Australia. This will be subject to the availability of suitable backup vehicles for replacement locum medical staff. Such approval will be given on the understanding travel will be undertaken on sealed roads (when safe to do so) and at the medical officer’s own expense, including cost of fuel.

At all times medical staff are expected to comply fully with the Health Department of Western

Australia’s Departmental Vehicle Policy as deemed appropriate by the Director General of Health and in accordance with existing terms and conditions of their employment.

Other Position with Limited private use privileges

• Operations Manager • Directors of Nursing

Home Garaging Privileges Drivers with regular home garaging privileges are to be made aware of the following

conditions/requirements by their Accountable Officer: • As ALL vehicles are “pool vehicle” Accountable Officers shall ensure drivers

commencing an extended leave period, i.e. annual leave, shall return their vehicle to the Housing and Transport Officer within 24 hours of commencing leave.

• Home garaging may be subject to FBT and may have potential taxation implications.

• The driver shall take due care for the condition (see below) and security of the vehicle.



• PGHR vehicles are deemed a ‘workplaces’ under the Occupational Safety and Health Act 1984, when used for the execution of official business on behalf of the PGHR. As such employees with home garaging privileges are required to keep the vehicle clean and tidy, adequately fuelled and should conduct checks of oil/ coolant/tyre pressure levels regularly.

• Vehicles shall be periodically inspected for general upkeep. If the vehicle is found to be in an unclean and untidy state the designated driver will be liable for the cost of car detailing, refer (iv) above.

• Non-PGHR employees must not drive vehicles approved for home garaging Current Approved Positions for Home Garaging

• Finance and Administration Manager • On Call Staff - Vehicles may be allocated to “On Call” staff with approval of

DM • Locum Staff - The Housing & Transport Officer (subject to availability and

approval by DM) may supply a government motor vehicle with limited private use.

References Should further clarification on additional conditions not specified in this policy and guidelines be required reference can be made to:

• Employee’s Accountable Officer • PHRH Housing and Transport Committee • Housing and Transport Officer • Regional Coordinator Risk Management • HDWA Departmental Vehicle Policy • HDWA Motor Vehicle Usage Policy and Procedures

• Operational Instruction No. 1229/99

EENNDDOORRSSEEMMEENNTT OOFF PPOOLLIICCYY

This policy is effective following endorsement by the District Executive Committee and will be reviewed by the Regional Coordinator Risk Management on an annual basis.

On endorsement the policy supersedes all previous ‘general’ motor vehicle usage policies and requires the removal of all outdated policies from circulation.



FORM EXAMPLE - SAFETY

Notification of population health staff involvement in outdoor event Event

Gascoyne Games Denham Friday 16th May to Sunday 18th May 2003

Staff participating

Conditions of staff participation

Staff will be working, providing various services to participants and spectators at the Games, as well as competing in the Games as a corporate team. A work plan for the weekend has been submitted and approved. All time spent on Games activities is authorised as Population Health Unit work. All staff will submit TOIL or flexitime forms on their return.

Travel and accommodation

All staff working at the Games need to submit standard “Application for Travel Approval” forms to Manager via line managers, prior to the Games. Travel and accommodation arrangements will be made centrally by in conjunction with staff coordinating participation in the Games. Travel to and from the Games will be by Population Health vehicles and should comply with the standards set out in the Gascoyne Health Service Driver Training and Safety Policy August 2002.

Emergency Contact

Please contact one of the following in the event of an emergency: Manager as well as seeking appropriate available help e.g. Silver Chain Nursing Post.

Notified by:

A/Director Gascoyne Population Health Unit Pilbara Gascoyne Health Region

(Boyce 1996) (Taylor and Hodgson 1995; National Health and Medical Research Council 1996; Health Department of Western Australia 1998; Durand, Murchland et al. 2001; Humphreys 2002; Inaugural Western Australian Rural and Remote Allied Health Forum 2002; Lyle 2002; Starfield 2002)



SECTION 5 Bibliography AHTWI (2002). Western Australian Allied Health Taskforce on Workforce Issues Initial Report. Perth, Allied Health Taskforce on Workforce Issues (AHTWI). Allen, O. (1996). "Anthill and other injuries: a case for mobile allied health teams to remote Australia." Australian Journal of Rural Health 4(1): 33-42. Battye, K. and K. McTaggart Strategies for the development of a sustainable outreach allied health service in remote North West Queensland. National Rural Health Conference, http://www.ruralhealth.org.au. Boyce, R. (1996). Management and Organisation of Rural Allied Health Services. Brisbane, Graduate School of Management, University of Queensland. Burns, T. and M. Firn (2002). Assertive Outreach in mental health: a manual for practitioners. Oxford, Oxford University Press. Department of Health (2003). The Country Health Service Review- Vision, Goals, Directions. For developing WA Country health Services. Perth. Durand, S., S. Murchland, et al. (2001). Country outreach service evaluated. Motor and functional outcomes of children with physical and/or multiple disabilities living in rural and remote areas compared to their metropolitan counterparts: a pilot study. 4th National Paediatric Physiotherapy Conference, Melbourne. Gruen, R., T. Weeramanthri, et al. (2002). "Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability." Journal of Epidemiology and Community Health 56: 517-521. Health Department of Western Australia (1998). NORHEALTH 2020 The North West Health Service Plan. Position Paper. Hill, M., L. Bone, et al. (1996). "Enhancing the role of community-health workers in research." Image- the Journal of Nursing Scholarship 28(3): 221-226. Hodgson, L. (1997). Resourcing rural allied health. Implications of the evaluation of the allied health outreach support service. 4th National Rural Health Conference, Perth. Hodgson, L. and D. Hornsby (1996). Allied Health Service Delivery in the Bush. Inaugural Conference of the New Zealand Speech-Language Therapists Association and the Australian Association of Speech and Hearing, Auckland, New Zealand. Humphreys, J. (2002). Health Service Models in Rural and Remote Australia. The New Rural Health. D. Wilkinson and I. Blue. Melbourne, Oxford University Press.



Inaugural Western Australian Rural and Remote Allied Health Forum (2002). Promoting Rural Health- through innovations in service provision, networking, support and education. Kuipers, P., E. Kendall, et al. (2001). "Developing a rural community-based disability service: service framework and implementation strategy." Australian Journal of Rural Health 9(1): 22-28. Lyle, D. (2002). Infrastructure support for rural practitioners. The New Rural Health. D. Wilkinson and I. Blue. Melbourne, Oxford University Press. Marshall, J. and K. Craft (2000). New Vision for Community Health Services for the future report. Perth, Health Department of Western Australia. Msall, M., F. Wilczenski, et al. (1997). The Functional Independence Measure for Children (WeeFIM): UB Foundation Activities Inc. National Health and Medical Research Council (1996). Promoting the Health of Australians- A review of infrastructure support for national health advancement. Summary Report and Recommendations. Canberra. SARRAH (2002). A study of Allied Health Professionals in Rural and Remote Australia, Services for Australian Rural and Remote Allied Health (SARRAH). Starfield, B. (2002). "Equity in health." Journal of Epidemiology and Community Health 56: 483-484. Taylor, P. (1995). "Change without Pain - Organisation Change in a Rural Health Project." Australian Communication Quarterly Spring: 26-28. Taylor, P. and L. Hodgson (1995). Resourcing Rural Allied Health, Queensland Health- Darling Downs Region- Central Sector - Department of Allied Health. Tobbell, J. and J. Burns (1997). Goal Attainment Scaling (GAS) for people with learning disabilities. Bicester, Oxon, Winslow Press Ltd. Wilson, J. (2001). "Remote area aboriginal health service managers: key practice challenges." Australian Journal of Rural Health 9(3): 138-140.



Appendix PROJECT IMPLEMENTATION PLAN

Country Allied Health Outreach Service Delivery Framework Project

Project Title: Country Allied Health Outreach Service Delivery Framework Project

Year: 2003

Description: The development of a sustainable and flexible framework for the provision of outreach allied health services, which is adaptable to the local context.

Provider: Next Challenge Consultancy

WA Country Health Service

Contact Officer: Natalie Dewson, Next Challenge Consultancy

1.0 AIM

• The objective of this project is to develop a sustainable and flexible framework for the provision of outreach allied health services, which is adaptable to the local context.

• Develop a framework for the provision of outreach allied health service delivery (fly-in fly-out or drive-in drive out).

• To identify strategies for optimising and integrating outreach services.

• Develop preliminary resources for outreach allied health services.

• To integrate outreach models into current service delivery frameworks (eg Telehealth Allied Health Bureau Services, Therapy Assistants).

2.0 KEY STAKEHOLDERS • Rural and Remote Allied Health Reference Group • Allied health professionals. • Allied health managers. • Rural and metropolitan health services. • Country Services • Combined University Centre for Rural Health (CUCRH) • Health Consumers Council. • Services for Rural and Remote Allied Health (SARRAH)

3.0 PLANNED OUTCOMES 3.1 Review of outreach service provision and models currently utilised in rural Western Australia. 3.2 Guidelines and a framework for planning of outreach services.



3.3 Improved accessibility and efficiency of outreach service models used across health regions. 3.4 Promote best practice and innovation in outreach models of service delivery to rural and remote communities. 3.5 Integration of a framework for outreach services into existing initiatives such as the Telehealth Allied Health Bureau Service (TABS) and the Therapy Assistant Project. 4.0 OUTPUTS

4.1 Research phase

4.1.1 Provision of the final project plan and methodology. vii. Conduct a literature search and critique on the utilisation of outreach services

for the provision of allied health services. viii. Call for local and national documents.

ix. Collate pre reading and develop a standard analysis tool inclusive of strength/weakness and requirement analysis for consultation process.

x. Establish and maintain regular contact with a steering committee consisting of members selected by the DOH.

4.2 Consult/ liaison phase

xi. Identify and liaise with key stakeholders in the development of the Country Allied Health Outreach Service Delivery Framework.

xii. Call for involvement and information from rural allied health professionals and other stakeholders/ outreach providers.

xiii. Establish working groups. b. x 1 rural location (Mid-west proposed) (4 hours plus travel(3 hours flight return). c. x maximum of 5 videoconferences of up to 3 sites per conference (2 hours per conference). 4.2.4 Conduct workshops implementing a standard analysis format and conceptual

model development. 4.3 Audit and analysis phase

i. Audit & review current allied health usage (models and frequency) of outreach services for clinical service provision in Western Australia.

ii. Collate and analyse findings. iii. Document current status.

4.4 Model Development phase

iv. Develop draft conceptual framework. The framework may include:

- Model(s) of service provision. - Identification of strengths, weaknesses, opportunities and threats of the model. - Strategies for optimising and integrating visiting services such as : - video-conferencing - therapy assistants. - service methods and strategies.

v. Seek feedback from participants.

vi. Finalise framework.

d. Resource Development i. Collate all collected material and draft resource manual.

Resource requirements may include: - Safety considerations.

- Competencies and training.



- Cost assessment/formula. - Client information. - Community information. - Application of the model to local contexts.

ii. Feedback and alterations from participants. iii. Finalise document.

4.6 Reporting

4.6.1 Monthly reporting 5.0 STEERING COMMITTEE FUNCTIONS The Department of Health members of the Rural and Remote Allied Health Reference Group will act as the steering committee for this project. Functions include:

5.1 Agree and endorse project implementation plan. 5.2 Direction and liaison between stakeholders and project consultants. 5.3 Agree and endorse framework and developed resources.

6.0 QUALITY STANDARDS

The Provider agrees to:

• Comply with all appropriate legislative, statutory and health standards. • Ensure that relevant research standards are met in relation to all documentation

produced • Ensure that comprehensive feedback on all aspects of the project will be

undertaken and incorporated into changes within the project. • Ensure WA Country Services is aware of all policies and procedures developed by

the Provider in relation to the program.

7.0 REPORTING REQUIREMENTS 7.1 Monthly progress reports to the WA Country Health Services. 7.2 Final report and resource at the completion of the project. 8.0 PERFORMANCE INDICATORS 8.1 Undertake a literature search for relevant documents. 8.2 Consultation with key stakeholders across Western Australia. 8.3 Analysis of findings. 8.4 Development of a framework. 8.5 Development of source resources. 8.6 Production of a final report of the above. 9.0 RESOURCES Funding has been provided via the National Health Development Funding initiative. Next Challenge Consultancy has been awarded the tendered project following a formal tender process.