Connections Winter 2023

Enhancing accessibility for health, independence and participation

Assessment and referral for assistance dogs

Cognitive assessment in the Northern Territory

Interpreting services for OTs

Student-led services: what do clients think?

We understand how crucial it is to have a bed that provides important mobility functions for safety and comfort while also complementing existing furniture in the home.

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President’s Report

Professor Carol McKinstry | OTA President

In reflecting on what has already taken place during 2023, there is a lot of action happening across a wide range of areas for OTA. Recently I had the pleasure of virtually attending the annual meetings of the divisional councils across the states and territories. The meetings were informative about what has occurred during the past year, while also highlighting common national issues such as workforce shortages, concern for clinicians (particularly those early in their careers working with increasing complexities) and ensuring quality professional placements for students.

The Board recently also had a National Forum with Divisional Chairs, who reported on their division’s risks and opportunities. These meetings are invaluable for the Board to ensure we are prioritising and allocating the needed resources to address the things we have some influence over. It also provides the OTA Board and staff with the opportunity to report to Divisional Chairs on current work and future plans. On behalf of the Board and OTA members, I would like to thank the Divisional Chairs and council members for the work they do as volunteers, which may go unseen but is absolutely crucial for our profession and OTA.

Workforce issues continue to feature strongly in OTA’s work across all teams. Our CPD activities and programs, such as the new Supervision and Leadership Programs, are designed to support and build capabilities both individually and as a profession. The upcoming National Conference will provide another opportunity to hear the latest developments in practice and research

relating to workforce, including emerging areas of practice and evidence to support core practice areas. The work done by the team advocating and lobbying for greater awareness and recognition of the contributions of occupational therapists is increasing. This work is often backed up and informed by the occupational therapists working within OTA and others working as clinicians and managers in specific speciality areas. Our Workforce Development Program has also commenced, and I would encourage OTA members to have input into this project.

I recently attended a rural workforce summit, facilitated to find real solutions to an increasing crisis in delivering rural health services to those who are both vulnerable and experience some of the worst health outcomes for our nation. What stood out over the two days of discussions was the need for professions to collaborate and not compete, thus parking turf protection, and the need to do things differently through finding local solutions and making systemic changes at a policy and funding level. The value of primary health was evident, particularly as we face workforce shortages in hospitals and growing waiting

times with the increasing impact of ageing populations and incidence of chronic disease. Occupational therapists have a major role to play in maintaining wellbeing, particularly in the primary health sector.

I am excited about the upcoming National Conference. It provides an opportunity to come together, network and reminds us why occupational therapy is the best profession. The keynote speakers will inspire us, while presenters of posters and oral papers will share innovative practices and discuss the latest in research findings and what this means for practice, the profession and, importantly, those who receive our services. It is also an opportunity to recognise award winners including the Sylvia Docker Lecturer, Professor Leeanne Carey. Board members and OTA staff will be at the OTA booth to talk with members about things that are top of mind for them – please drop by and say hello.

The Board is continuing to work on our new strategic plan, which had significant input from members, consumers and other stakeholders. Our partnership with Bundyi Girri has also informed this crucial work to develop and determine our future direction.

The work done by the team advocating and lobbying for greater awareness and recognition of the contributions of occupational therapists is increasing.

Recently, I was thrilled to join President Carol McKinstry and Dr Stephen Duns as we welcomed our inaugural OTA Leadership Program participants to the Yarra Valley. It was a jammed packed agenda where we started to explore the theory, models and concepts of leadership and how it applies to us across not only our work, but the wider lives we lead. The richness of the content was matched, if not surpassed, by the quality of the conversation and the almost immediate connection as we shared the common commitment to curiosity, authenticity and enquiry. It is such a diverse cohort of participants who have decided to invest considerable time in themselves over the 15-week program. I know that after the program has completed, each participant will have a wealth of knowledge and personal growth and a new group of peers to draw on as they navigate the future ahead. It is exciting to see programs like this come to life and I look forward to seeing more of our members flex their leadership skills for the benefit of the profession, for clients and for their communities. An important reflection from our first day was that we can all exercise leadership – it doesn’t come with your title, your position or your pay grade. It is within all of us, in decisions big and small and in how we influence and engage on issues of importance.

CEO’s Report

Samantha Hunter | OTA CEO

I am grateful for the members who embrace their leader within as they step into providing advice and feedback on a wide range of issues of importance to OTs in the current political climate. I know there is a great deal of unrest at some of the narrative around the NDIS. This concern is being felt across the entire sector that supports participants of the scheme, and indeed participants of the scheme itself. It is important at these times of media speculation and uncertainty that our advocacy is a true reflection of our profession – evidence based, rational and solutions focused.

While the NDIS steals much of the media spotlight, there are many other issues on which OTA is providing representation and advocacy. These are across all states, territories and federal schemes. The breadth and depth of work undertaken by our Government & Stakeholder Relations team continues to grow (and it can seem like whack-a-mole on some days!).

Advocacy is a fundamental activity of OTA in both promoting and defending the profession, and it is due to our members (and our members’ dues!) that we can conduct this important work. We are fierce advocates for ensuring the various schemes recognise and value the role of OT

as an integral profession in building and maintaining a robust health system, where equity and quality of care is available to all our community, and the best possible outcomes and optimal care is achieved for clients. Advocacy is a tightrope of both soft and hard skills if we are to negotiate optimal and sustainable outcomes for the profession. These relationships and representations are not always immediately visible to all, the art of advocacy and diplomacy is rarely front-page news. It may seem as if advocacy is always about fighting fires or defending our position; however, as one of the fastest growing allied health professions with a strengths-based mindset, there are a wealth of opportunities available to the profession should we choose to embrace them.

Our association is at its strongest when we are all united in stepping into leadership, either within our teams, our workplaces, our communities or through collaboration with colleagues or with OTA. We are at our strongest when we unite in our advocacy and speak as one, when we share, learn and support each other together.

I am humbled and grateful to our Board of Directors, our Divisional Council members, SIG convenors, National Reference Group, AOTJ Board, Conference Committees and to every member who volunteers their time and energy to enable us to continue to lead the association and the profession.

I look forward to seeing old faces and new in Cairns for the National Conference as we further ignite our passion for the profession.

We are at our strongest when we unite in our advocacy and speak as one, when we share, learn and support each other together.

Quarterly update – Member news

What we’ve been doing for members

It’s been a busy three months, with ongoing engagement around the NDIS Review, the launch of OTA’s Mental Health Endorsement Program pilot, and a renewed focus on compensable schemes.

Aged Care

Ongoing impact of AN-ACC

As flagged in the last edition of Connections, due to concerning data gathered through the Allied Health Professionals Australia (AHPA) survey of residential aged care allied health workers, OTA, AHPA and other allied health representatives met with representatives from the Department of Health and Aged Care. We raised concerns about the impacts of low levels of allied health service provision in residential aged care on older people and allied health professionals. We also discussed how data collected by the Department is not an accurate measure of levels of allied health service provision due to the quality of provider reporting. We will watch for the next iteration of data and will continue to engage with our members to understand the impacts and convey them to the Department and the Minister.

NACA update

OTA has been engaging with NACA members on the development of several papers for discussion at the next meeting (18 & 19 May in Melbourne) on topics including impacts of the introduction of AN-ACC, the impact of workforce pressures on the aged care sector,

and funding mechanisms and solutions to support sustainability in the aged care sector.

Support at home

OTA and other AHPA members attended a meeting with members of the Support at Home Reform Branch of the Department of Health and Aged Care to discuss the use of the IAT assessment tool in identifying allied health referrals and plans for short-term restorative therapeutic input. Testing of the proposed IAT tool will commence shortly and OTA will continue to liaise with the Department to inform the development of allied health pathways.

Cochrane Review research on falls prevention

OTA has been promoting the compelling findings in a recent Cochrane Review led by a prominent OT in falls prevention research, Emeritus Professor Lindy Clemson. The paper, titled Environmental interventions for preventing falls in older people living in the community, provides high-certainty evidence that interventions aimed at reducing fall hazards around the home can reduce the risk of falls for those at high risk by almost 40%. Findings also demonstrated that falls can be significantly reduced when interventions around home hazard reduction were delivered by an occupational therapist. Findings like these help underpin our messaging to key decision makers highlighting the value of occupational therapy intervention on the healthy ageing experience of older Australians.

Submissions

Following a meeting with the Independent Health and Aged Care Pricing Authority

(IHACPA), along with AHPA representatives, OTA endorsed AHPA’s submission to IHACPA. The submission commented on the draft IHACPA Work Program and Corporate Plan 2023–24 and highlighted concerns about the approach to costing allied health aged care being taken by the current Residential Aged Care Costing Study, and the need for better alignment between allied health pricing and funding and the care that is required.

In late February, OTA presented a submission in response to a paper released by the Department of Health and Aged Care on the proposed assistive technology and home modifications scheme for the future Support at Home program. As members, OTA also contributed to the responses submitted by the National Assistive Technology Alliance (NATA) and the Assistive Technology for All campaign.

OTA provided commentary to the Australian Standards on the adoption of two published international standards related to ageing with a particular focus on the proposed Framework for dementiainclusive communities (AS ISO 25552).

Mental Health

OTA Mental Health Strategy

Deakin University has been busy developing the first modules in our comprehensive suite of training developed by expert OTs specifically for OTs. The Mental Health Capability Framework has been used to drive the development of the eLearning modules. Through the development, OTA and Deakin University will be consulting with

consumers on the content. Keep an eye out for the first modules, available later this year.

OTA launched its Mental Health Endorsement Program pilot on 1 March 2023. The pilot is intended to test and support implementation of the OTA Better Access to Mental Health (BAMH) endorsement review. The program is expected to continue for around three months; however, duration will be based on the volume of applications and successful completion of pilot review activities.

The Mental Health Endorsement Program is built on the foundations of the OTA Mental Health Capability Framework, first drafted through the Thinking Ahead: Mental Health project, and further refined through the internal review of the BAMH endorsement. The MH Capability Framework proposes a series of capabilities that occupational therapists practising in mental health settings should seek to achieve at different career stages. The intention of the framework is not to create additional hurdles for practitioners—OTA recognises that mental health practice is within the scope of all registered occupational therapists. Instead, the framework is intended as an enabler for individual occupational therapists making decisions about where to focus their development activities, and managers and employers making decisions about the areas of capability development they should be providing for their staff.

Mental health services for injured workers

In line with our Mental Health Strategy, OTA has been working closely with schemes across the country to support more timely access to mental health services by injured workers. This has involved working collaboratively with the schemes to develop or review fee schedules to ensure OTs are appropriately accredited, recognised and remunerated for mental health services.

National Disability Insurance Scheme

NDIS Review

OTA was invited to attend two consultation workshops with Mental Health Australia (MHA) regarding the NDIS Review. The NDIS Review Panel Co-Chair, Professor Bruce Bonyhady AM, posed five questions to MHA, who reached out to its membership to gather an informed response. The questions focused on scheme eligibility, early intervention, Tier 2 supports, appropriate psychiatric and allied health support and shaping the NDIS to better meet the needs of people with psychosocial disability. OTA provided feedback on behalf of members, which will inform MHA’s submission to the review.

NDIS Pricing Review

In April, OTA made a submission to the NDIS Annual Pricing Review 2022-23. OTA’s submission called for an immediate increase to the maximum fee payable for

We eagerly anticipate the announcement of two new mental health fee schedules for occupational therapists this year in South Australia and Queensland.

Department of Veterans’ Affairs

OTA has been continuing to work with the Department of Veterans’ Affairs (DVA) on the Occupational Therapy Fee Schedule Redesign Project. We are waiting for the final outcome.

OTA wrote to The Hon Matt Keogh MP, Minister for Veterans’ Affairs in April expressing our concerns about the ongoing low fees offered to OTs through

the ‘therapy supports’ item code, due to the complexity that OTs experience in servicing NDIS clients (including self-managed clients and clients seeking service in the home), increased indexation and increased business costs. An outcome is expected in June, with any changes commencing on 1 July 2023.

Member forum with NDIA CEO

OTA was delighted to host the CEO of the NDIA, Rebecca Falkingham PSM, at a free OTA member forum on 28 March. Rebecca outlined her vision for NDIA and provided responses to several questions from members on topics including the hospital discharge processes, home modification approvals, and improvements for participants with psychosocial disability. OTA looks forward to updating you on our ongoing engagement with NDIA. Rebecca signalled her willingness to work more closely with stakeholders including OTA, and we look forward to a collaborative approach.

the DVA scheme and warned him of the impending shortfall of therapists willing to engage in the scheme.

OTA also made a submission to the Review of Veterans’ Compensation legislation, which was announced following the release of the interim report of the Royal Commission into Defence and Veteran Suicide. The aim of the legislation review is to simplify the various pieces of legislation covering current and former defence personnel. OTA’s submission has been drafted following input from our DVA National Reference Group and requests that the review ensures the current arrangements that enable veterans to access allied health services are not impacted.

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Quarterly update – Member news

Workforce

Workforce Development Project

OTA is embarking on a major Workforce Development Project and has engaged ManningCo as a consultant to support this work. Katharine Manning, Managing Director of ManningCo is an occupational therapist by background, and has extensive experience in consulting across the health system, working with clients across Commonwealth, State and Local Government, acute health, community health, primary care and the aged care sector. The project will deliver a robust workplan grounded in evidence for OTA in its approach to supporting the profession now and into the future. Workforce Strategy is expected to be developed and commence in the second half of 2023. Visit otaus.com. au/workforce for updates and to subscribe to be alerted to opportunities to be involved.

State/territory news

Since the last edition of Connections, the state election in NSW has seen the announcement of a new premier, Chris Minns, to lead a Labor government. In the lead up to the election, OTA wrote to the major parties advocating for commitments across the allied health workforce, mental health, disability, education and ongoing COVID-19 recovery. We have since congratulated the incoming government, which has committed to working with OTA to deliver improvements for the OT workforce in NSW.

OTA has met with Chief Allied Health Officers and key industry stakeholders and has contributed to several state/territory level workforce consultation opportunities. Some examples include Primary Health

Tasmania’s new Allied Health Engagement Strategy (in final draft at the time of writing), the Victorian Health Workforce Strategy and Victorian Eating Disorders Strategy, and the South Australian Social Development Committee’s petition on funding for children and students with additional learning needs in public schools and preschools.

Compensable schemes

We are pleased to welcome an additional policy officer to OTA, who will be focusing on compensable scheme issues. We are strengthening relationships with representatives from workplace injury and traffic accident injury compensation schemes in each state and territory and have contributed feedback to several consultation opportunities and fee schedule reviews. This includes collaborating with the South Australian (ReturnToWorkSA) and Queensland (WorkCover Queensland) workers’ compensation schemes on a proposed new fee schedule for mental health. We have also been engaged in discussions with WorkSafe Victoria, the Victorian workers’ compensation scheme, regarding the fee schedule for occupational therapists.

On 23 March, OTA’s CEO Samantha Hunter met with senior representatives of Victoria’s Traffic Accident Commission

(TAC) at their office in Geelong. The meeting was an opportunity to strengthen the relationship between OTA and the TAC, and discuss ongoing issues raised by OTA members. These issues relate to access to TAC’s ‘above rate service agreement’, payment processing, remuneration for travel and State Wide Equipment Program credentialling. TAC has agreed to continue to work with OTA to resolve these matters.

Hot Topic events

OTA’s Hot Topic program series is in full swing with several events held recently. Hot Topic events provide an invaluable opportunity for OTs to engage with other OTs, OTA and other key stakeholders to unpack issues impacting them, ask questions and expand their network. The events are intended to ignite conversation and provide information that is practical and relevant to OT clinical practice and/or business operating environments.

Hot Topics held so far this year have included Working with Allied Health Assistants; Restraint of Trade, Unfair Dismissal and Professional Indemnity Insurance; Person-Centred Emergency Preparedness; The Role of an OT as an Expert Witness and Building Optimal Energy and Resilience for Career Satisfaction.

OTA’s Workforce Development Project will deliver a robust workplan grounded in evidence for our approach to supporting the profession now and into the future.

Digital technology: Document and define to strengthen emerging practice

Carolyn Murray, Australian Occupational Therapy Journal

Digital technologies have been with Australians since the early 1990s and the term ‘digital divide’, which captures inequalities between those who use technology and those who do not, was first coined in 1995 (Dijk, 2019). Since then, there have been exponential advancements in digital technology, which have transformed both occupations and how they are performed (Liddle, 2023). For example, communicating and connecting with others can now occur through multiple methods, compared with the limited options pre-1990s. As such, there are also changes in occupational performance challenges, such as difficulty using a smartphone.

Dijk (2019) describes the ‘digital divide’ metaphor as simplistic; not fully representing the complexities of social, economic, and cultural inequalities related to digital technology. In a recent editorial in the Australian Occupational Therapy Journal (AOTJ), Liddle (2023) proposed that occupational therapists have a key role and responsibility in ensuring digital inclusion and the prevention of digital exclusion for the people and communities that we work with. This role is recognised through one of the behaviours in our Australian Occupational Therapy Competency Standards

(Occupational Therapy Board of Australia, 2018) being to “maintain knowledge of relevant resources and technologies and maintain digital literacy for practice” (p. 7).

Given our grounding in occupational performance, it is imperative that

occupational therapists are actively contributing to discourse related to motivation, physical access, skills, and usage of digital technology (Dijk, 2019). Given the complexities surrounding digital literacy, this discourse will be strengthened through collaboration with our information and communication technology and health and social policy colleagues already exploring this space (Dijk, 2019). A scan of papers related to digital technology over the last ten years within the AOTJ shows publications related to digital technology within three broad themes.

1. Digital literacy of occupational therapy students

There was agreement that occupational therapy students cannot be assumed to have the required digital literacy skills to study and practice (Hills et al., 2016), and there is a need for deliberately designed curriculum to address this core skill (McKinstry et al., 2020).

2. Use of technology to improve efficiency in or provide evidence for therapy outcomes

Research was published across practice areas of hand therapy (Cutler et al., 2018), stroke rehabilitation (Emmerson et al., 2018; Flynn et al., 2019; Hsu et al., 2019), and home assessment (Sim et al., 2015). Overall, technology was found to have benefits in therapy efficiency and outcomes (Cutler et al., 2018; Hsu et al., 2019), but there were concerns about resourcing, leadership and client suitability (Flynn et al., 2019). Furthermore, qualitative perceptions of benefits did not

always align with quantitative outcome measures (Emmerson et al., 2018).

3. A user-focused approach to technology for equality and advocacy (Liddle, 2023; Liddle et al., 2022)

Partnering with those people experiencing the occupational performance challenges will establish clarity around needs and ultimately lead to meaningful outcomes (Liddle et al., 2022). Awareness of the complexities of digital inclusion can be enhanced by greater co-design and community led approaches to addressing the digital divide (Liddle, 2023).

Occupational therapists have always been known for their capacity to adapt to different trends in society (Gilbert Hunt, 2017) and there is no doubt that Australian occupational therapists are confidently and adeptly addressing the growing digital needs among the communities in which they work. The next step is to document this practice through research of all designs (including co-design and partnership). Doing so will develop knowledge of how the digital divide manifests within the context of occupational performance. This will also enable us to consolidate our roles and responsibilities (Liddle, 2023) and define, control, and shape our practice with digital technology.

The scope of occupational therapy in assessment and referral for assistance dogs:

The responsibility of the profession in providing safe and ethical services

Dr Jessica Hill, Lecturer in Occupational Therapy, The University of Queensland

Claire Dickson, Occupational Therapist, Assistance Dogs Australia

Nat O’Neill, Occupational Therapist, Team Leader of Autism Assistance Dogs, Kites Therapy

Although assistance dogs have been around since the First World War, the introduction of the National Disability Insurance Scheme (NDIS) has resulted in a rapid increase of interest in, and demand for, assistance dogs to increase the independence and occupational performance of people with disability (Iong et al., 2021). Occupational therapists are increasingly being asked to complete assessments and funding applications for clients seeking assistance dogs. Minimal education on the occupational therapy role related to assistance dogs is currently provided at a tertiary level or offered in professional development courses or mentorship post-graduation (Hill et al., 2023). Occupational therapists consistently report that they lack confidence in clinical reasoning when supporting clients to obtain and care for assistance dogs (Chan et al., 2021; Hill et al., 2023; Iong et al., 2021).

The NDIS requires an assessment and report from a relevant allied health professional to confirm a client’s need for an assistance dog. It is imperative that occupational therapists have adequate education prior to assessing for and recommending an assistance dog to ensure they work within their scope to provide effective services to clients (Chan et al., 2021; Hill et al., 2023; Iong et al., 2021).

Definition of an assistance dog

Therapists must have a clear understanding of the difference between an assistance dog, therapy dog and companion dog. Under Australian Law, the rights of assistance dogs and handlers are protected under Section 9 of the Disability Discrimination Act 1992 that cites the legal definition of an assistance dog as a dog that: a) is accredited under a State or Territory law to assist a person with a disability to alleviate the effects of disability; or b) is accredited by an animal training organisation prescribed in the regulations; or c) is trained to assist a person with a disability to alleviate the effect of the disability and meets standards of hygiene and behaviour that are appropriate for an animal in a public space (Australian Human Rights Commission, n.d.). The National Disability Insurance Agency (NDIA), states that to be funded by the NDIS, an assistance dog must be “trained to perform at least three tasks or behaviours which mitigate the effects of a person’s disability.” (National Disability Insurance Agency, 2023).

In Australia, types of assistance dogs include guide, hearing, psychiatric, autism, physical, and medical alert. The NDIS website states they may fund guide and hearing dogs, as well as assistance dogs to support an individual with a physical

disability and some participants with post-traumatic stress (National Disability Insurance Agency, 2023). The NDIA states that as there is limited available research demonstrating that medical alert and autism assistance dogs are more effective than other forms of support, these applications are unlikely to be approved (National Disability Insurance Agency, 2023).

A therapy dog is trained to work with a health professional handler to support client motivation and engagement in sessions (Hill, 2020). Therapists who involve trained therapy dogs in their practice require additional training and continuing professional development. A therapy dog, by definition, cannot be placed with an individual client.

The terms companion and emotional support dog are used to describe a pet dog that provides emotional and informal support to their owner (Howell, 2019).

Although the NDIA recognises the benefits of pets, including companionship, increased social interaction, physical activity, wellbeing, and quality of life (Meredith et al., 2022), they will not be funded by the NDIA. Therapist understanding and correct use of terminology when providing information to clients and writing reports is essential.

Training and placement of assistance dogs

In Australia, assistance dogs can be ‘organisation trained’, for example Guide Dogs Queensland, or Assistance Dogs Australia, which means dogs are whelped, trained, assessed, and placed by an organisation. Or ‘owner trained’ which involves a person purchasing a dog and working directly with an assistance dog trainer, then completing a public access test externally (Hill et al., 2023). There are several considerations that must be made when working with clients to determine how to access an assistance dog.

If considering an owner trained assistance dog, the therapist must consider how to access an appropriately qualified/skilled dog trainer, the capacity of the client to train their dog, and the ability of the dog to perform the specific tasks required of the client (e.g., breed size, individual dog temperament, energy level, motivation). Organisation trained dogs may have long waitlists and high cost, whilst handlers working directly with an assistance dog trainer are typically charged per hour, with the additional fee for completing the public access test (Hill et al., 2023).

As the assistance dog organisation or trainer must provide the client with support for the life of their assistance dog, finding the right provider is essential. The Australian assistance dog training industry is unregulated, resulting in underqualified trainers placing clients at risk (Hill et al., 2023). Therapists must have enough knowledge of the industry to advocate for clients and ensure referral to appropriately qualified services (e.g., Guide, Hearing and Assistance Dogs Act, 2009). If a client decides to owner train, therapists must educate clients about the possibility that their dog may fail a public access test. This can be extremely disappointing for clients and therapists need to support clients to manage expectations and disappointment.

Assessing the suitability of a client for an assistance dog

The process of suitability assessment is complex, multifaceted and requires a thorough understanding of the person, their environments, and the daily occupations in which the assistance dog has been proposed to support (Hill et al., 2023). It is important that therapists seek education and guidance. Assistance dogs have public access rights as they support a person to access the community. If your client does not require support in the community then they may not need an assistance dog (Howell, 2019). An assistance dog should never be considered as the first form of support, nor should it be the only form of support. If considering an assistance dog for a client, therapists must first trial and/or implement evidence-based supports including therapy, equipment, or assistive technology (National Disability Insurance Agency, 2023).

Animal health and wellbeing is paramount. Therapists must consider a client’s capacity to care for an assistance dog including provision of a safe home environment, feeding, grooming, exercise, enrichment, on-going training, and cost of food, veterinary care, and equipment (Animal Therapies Ltd, 2021). Although the NDIS state they may provide funding for on-going maintenance costs, this is not guaranteed, and additional unexpected costs such as veterinarian bills must be considered (National Disability Insurance Agency, 2023).

A funding request report should be completed collaboratively with an appropriately qualified assistance dog trainer/provider and therapists must have understanding of the following: the specific tasks different types of assistance dogs perform and how the support provided by an assistance dog differs from the support provided by a pet, if and how an assistance dog can be trained to perform the identified support tasks and specific and realistic tasks the assistance dog will perform to mitigate the effects of the person’s disability (Hill et al., 2023).

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The scope of occupational therapy in assessment and referral for assistance dogs:

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About the authors Ongoing support required after the placement of an assistance dog

If a client has trialled all indicated evidencebased therapy, assistive technology and equipment and assistance dog placement is indicated, therapists must identify what ongoing support a client will require. Ongoing training will be required for the handler and assistance dog to maintain the assistance dog’s skills, and ensure they continue to work successfully as a team. The assistance dog and handler will be required to complete an annual reassessment to maintain their public access rights (Queensland Government, 2009). Clients may also require support from the occupational therapist regarding the occupational role of pet care (Hill et al., 2023).

Where to from here?

The process of completing an assessment and making a referral for an assistance dog is complex and requires sound clinical reasoning. Further support required to ensure occupational therapists are practicing safely and ethically includes, 1) foundational education specific to assistance dogs included in university occupational therapy programs, and 2) development of additional training and mentoring opportunities for therapists on how to assess, make appropriate recommendations, and support their client when making an application for an assistance dog.

OTA will be hosting a Hot Topic session on animal assisted therapy on Thursday 20 July. Scan the QR code below to visit the Hot Topic landing page for more information.

Dr Jess Hill is a Lecturer in Occupational Therapy at The University of Queensland and has eight years of experience working as an animal-assisted therapist with children and adolescents. Jess completed her PhD at The University of Queensland, exploring the efficacy of canine-assisted OT with autistic children. Jess has continued her research in the field of human-animal interaction including animal-assisted therapy, assistance animals and companion animals publishing in numerous peer reviewed journals, as well as contributing to several book chapters.

Claire Dickson is an occupational therapist at Assistance Dogs Australia in Waterfall, NSW with six years of experience in animal-assisted therapy. Claire has experience training assistance dogs and therapy dogs. Claire has co-authored research published in peer reviewed journals including a pilot research project with the University of Sydney exploring the benefits of OT with a trained dog involved for autistic children and youth. The same research team also completed a scoping review of the impact of assistance dogs on participation outcomes for people with disability.

Nat O’Neill is an occupational therapist at Kites Therapy in Western Australia. She provides animal assisted therapy services for children, as well as being the team leader for the Autism Assistance Dog program. Nat loves working in this field and enjoys volunteering with Story Dogs.

References can be viewed by scanning the QR code

Cognitive assessment with Aboriginal and Torres Strait Islander peoples in the Northern Territory.

Rebecca Leanne Smith, PhD Candidate, Charles Sturt University and occupational therapist, Learn and Thrive Therapy, Darwin

This article draws upon my experiences as an occupational therapist working in the Northern Territory for 11 years, and the doctoral research I am conducting through Charles Sturt University under the supervision of Associate Professor Melissa Nott, Dr. Judy Ranka and Dr. Robyn Williams.

In this article, I will describe some of my experiences in cognitive assessment with Aboriginal and Torres Strait Islander peoples and share the story of the research I am undertaking.

‘Aboriginal and Torres Strait Islander peoples’ will be used when referring collectively to the First Nations peoples of Australia. The author would like to acknowledge the Larrakia people on whose unceded lands this work was conducted on.

Cognitive assessment in the Northern Territory

I moved to the Northern Territory 11 years ago and my first role was the trauma occupational therapist at Royal Darwin Hospital. I worked with a team of health professionals seeing clients who had sustained traumatic and complex injuries at the only tertiary hospital in the Northern Territory. Assessing cognition following brain injury was a part of the role I initially found particularly challenging. Many Aboriginal and Torres Strait Islander clients were from remote communities, English was not the primary language spoken for the majority of clients and the concepts in the typical cognitive assessments we used were often irrelevant to the client. One cognitive assessment originally designed for use with Aboriginal and Torres Strait Islander peoples

in the Kimberly region of Western Australia is the Kimberly Indigenous Cognitive Assessment (KICA). The KICA is designed to screen for dementia and, while potentially useful for this purpose, in clinical practice the KICA is commonly used with Aboriginal and Torres Strait Islander peoples of all ages and diagnoses, well beyond its intended scope. In the absence of a more suitable assessment, my colleagues and I typically relied on adapting standardised assessments and using our observations of functional tasks to support the assessment process. I learnt that for occupational therapists, and other health professionals who work with Aboriginal and Torres Strait Islander peoples in the Northern Territory, cognitive assessment was widely acknowledged to be a challenging and complex area of clinical practice, and this was also Continued next page

Cognitive assessment with Aboriginal and Torres Strait Islander peoples in the Northern Territory.

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acknowledged in the literature (Dingwall & Cairney, 2009; Dingwall et al., 2014).

My experience using the PRPP Assessment

Following my initial experience, I went on to work in other roles as an occupational therapist in the Northern Territory including remote disability services, providing fly-in and out services to East Arnhem Land communities and rehabilitation at Royal Darwin Hospital. In 2014, I completed the five-day training course in the Perceive, Recall, Plan and Perform Assessment (PRPP Assessment). The PRPP Assessment is a standardised, person-centred, criterion-referenced, ecologically valid, strengths-oriented assessment of applied cognition – that is, how well cognitive strategies are used to perform everyday tasks and routines. It forms part of The PRPP System of Task Analysis: Assessment and Intervention. The PRPP Assessment is administered across two stages:

Stage One: Performance Mastery (PM) – measures how well a task or routine is performed.

Stage Two: Cognitive Strategy Application (CSA) – measures the use of cognitive strategies during task performance (Chapparo & Ranka, 1997; Chapparo & Ranka, 2023a; Chapparo & Ranka, 2023b).

Administering PRPP Assessment Stage One: Performance Mastery (PM)

Prior to assessing performance, the therapist determines through interview, observation, discussion, and clinical reasoning what the person is required to do and how they usually undertake the task. The methods typically used by the person are listed as ‘steps’ on Stage One of the PRPP Assessment and completion of these steps forms the criterion against which performance is measured.

Administering PRPP Assessment Stage Two: Cognitive Strategy Application (CSA)

The PRPP Assessment Stage Two determines reasons for reduced mastery, while also

identifying strengths in cognitive strategy use. An information processing model of cognition underpins this part of the PRPP Assessment Cognitive strategies assessed align with dimensions of attention, sensory perception, memory and recall, goaldirected planning, problem solving and self-evaluation, and output performance and monitoring (Chapparo et al., 2017).

Research exploring the PRPP Assessment

When using the PRPP Assessment, the flexibility in choosing the tasks assessed and the focus on how well people can use cognition to do what they needed or wanted to do seemed to fit well with what I needed to use in practice. So, following this training, I began to implement the PRPP Assessment and found this approach aligned well with the Aboriginal and Torres Strait Islander clients I worked with. I was able to acquire detailed and useful information about how cognitive function impacted occupational performance. I also had positive feedback

from clients who found the assessment process relevant and engaging and the explanations I gave afterwards were easily understood. From here, I commenced a PhD part-time to explore whether the PRPP Assessment is clinically useful, valid, and whether the approach is culturally safe to assess cognition with Aboriginal and Torres Strait Islander peoples. This research is being completed across four phases.

Case stories

I began my research by looking at two case stories to explore the clinical utility of the PRPP Assessment with Aboriginal Australian peoples who had experienced acquired brain injuries (Smith et al., 2023). The case stories detail PRPP Assessment findings at three observations over a sixmonth period and demonstrate how change in cognition is measured across time.

Validity of the PRPP Assessment

Following this, I completed a validity study exploring concurrent and construct validity of the PRPP Assessment with other commonly used assessments, including the KICA. These findings are in the process of being reported.

Occupational therapist perspectives of the PRPP Assessment

Next, I completed focus groups with occupational therapists who had experience working with Aboriginal and Torres Strait Islander peoples and had also undergone PRPP training. The participants compared their experiences of completing cognitive assessments with Aboriginal and Torres Strait Islander peoples before and after completing PRPP Assessment training. The occupational therapists interviewed worked across a range of clinical areas and these findings are in the process of being reported.

Cultural safety and the PRPP Assessment

For the final phase of the study, we wanted to find out more about how the PRPP Assessment process was perceived from the perspective of the client and their family. This requires consideration of elements of

cultural safety. Cultural safety uses a broad definition of culture that does not reduce it to ethnicity only. Instead, it includes a range of variables, such as age/generation, sexual orientation, socio-economic status, religious or spiritual beliefs, gender, and ability. Cultural safety considers peoples’ unique needs, and requires an ongoing process of practitioner self-reflection, cultural selfawareness, and an acknowledgement of how these factors impact on care (Williams et al., 2021). The cultural safety of health care services is typically determined by the person receiving the service but essentially begins with self-reflection by the clinician. I therefore sought ethics approval to investigate the perspectives of the client, a supportive person to the client and an occupational therapist. This proposed approach was deemed too high risk by the ethics committees reviewing the proposals and the time constraints of a PhD study required an alternative approach to be explored. Obtaining the perspectives of Aboriginal and Torres Strait Islander occupational therapists was also considered; however, the recruitment logistics and diversity in geographical areas people worked within presented a challenge as this research relates to experiences in the Northern Territory.

Perspectives of allied health professionals

The final approach selected and approved by the ethics committees was to interview allied health professionals who work with Aboriginal and Torres Strait Islander peoples in the Northern Territory. The purpose of these interviews was to explore the perspectives of allied health professionals on the key elements of cultural safety and possible tools or resources that may enhance the administration approach of the PRPP Assessment. To achieve this, simulated case scenarios were developed. An actor, (a Larrakia woman), was employed to play the part of a person with a brain injury being assessed by an occupational therapist using the PRPP Assessment. These videos were provided to the allied health professional research participants along with supplementary information to support their existing understanding of the PRPP Assessment approach. Qualitative interviews were conducted with this group where further insights into the clinical utility of the PRPP Assessment were sought. Importantly, allied health professionals were not asked to generalise their reflections but to consider how the PRPP Assessment may be used with clients they work with across a range of clinical areas. Analysis of these focus groups is currently underway.

What next?

Preliminary findings for the validity and clinical utility of the PRPP Assessment with Aboriginal and Torres Strait Islander peoples in the Northern Territory are promising. The PRPP Assessment offers a cognitive assessment approach that is strengths

based, occupation embedded, performance focused and can be administered regardless of age, diagnosis, cultural mores, or language spoken and does not require literacy or numeracy skills.

About the author

Rebecca Smith

Rebecca is a PhD candidate at Charles Sturt University investigating validity, utility, and cultural safety of The Perceive, Recall, Plan and Perform (PRPP) Assessment when used with Aboriginal and Torres Strait Islander peoples in the Northern Territory. Rebecca’s PhD is supervised by Associate Professor Melissa Nott and co-supervised by Dr Judy Ranka and Dr Robyn Williams. In addition to completing a PhD Rebecca runs her own business providing OT services to children and adults in Darwin.

I learnt that for OTs who work with Aboriginal and Torres Strait Islander peoples in the Northern Territory, cognitive assessment was widely acknowledged to be a challenging and complex area of clinical practice.

WFOT Update

Associate Professor Emma George, 1st Alternate Delegate

Occupational therapy in India

In April 2023, I had the opportunity to spend a month in India on a research fellowship, funded through the Australia India Institute. I was hosted by the Indian Institute of Public Health and a non-government organisation working with women in rural areas who are vulnerable to sexual exploitation. We worked closely with a wide range of stakeholders to discuss opportunities

for occupational therapy to support recovery, health and wellbeing from an occupational justice perspective. During this time, I was invited to speak with occupational therapy staff and students from five universities and spend a day with our colleagues in the All India Occupational Therapy Association (AIOTA). Occupational therapy in India is vibrant, passionate and growing. AIOTA is working to promote the best standards of occupational therapy as

an integral part of health care across rural and urban settings. AIOTA aims to improve accessibility of occupational therapy services in government hospitals, private hospitals, corporate sectors, industry, education and rehabilitation. For 50 years, Indian occupational therapy has been strategically focused on rehabilitation and research to improve the quality of life for people with disabilities. The work of AIOTA is founded on core

values of competence and commitment. These values were evident to me in the clinics I visited, the discussions I had about complex case studies, the critical and thought-provoking questions from staff and the excitement from students about future opportunities. For therapists interested in learning more about occupational therapy in India, the national conference hosted by AIOTA is held in February every year.

Asia Pacific Occupational Therapy Regional Group

The Asia Pacific Occupational Therapy Regional Group (APOTRG) was originally founded as the Asia Pacific OT Network

in 1995 in Malaysia. The first meeting was chaired by Professor Tsuyoshi Sato from Japan and initial members included Hong Kong, Indonesia, Japan, Korea, Malaysia, Philippines, Singapore and Japan. Inclusion was a key priority, and the region group grew to become officially recognised as a member of WFOT in 2006. The aim of the APOTRG is to enhance communication and networking and to promote occupational therapy across the region. Australia is a strong supporter of the APOTRG with Professor Lynette Mackenzie serving as the Vice President and Adam Lo serving as the Secretary. You can follow updates from the APOTRG on Facebook.

The APOTRG has been promoting the Sato Lectureship, an award created in honour of Professor Tsuyoshi Sato to stimulate interest in the development and advancement of occupational therapy in the region. The Sato Lectureship is a keynote address at the Asia Pacific Occupational Therapy Congress, to be held in Japan in November 2024. The awardee will be announced in September 2023.

Planning for the 8th Asia Pacific Occupational Therapy Congress is well underway. Convenors Ling-Hui Chang (President of the APOTRG) and Haruki Nakamura (President of the Japanese Association of Occupational Therapists) are collaborating to provide a regional congress that offers an opportunity to meet with international colleagues to share innovation, ideas and experiences and to discuss research, practice and education. The theme of the congress is Empowering Collaborative Community: Sustainable and Evidence-Based Occupational Therapy. The call for papers is now open and will close in November 2023. Please see the congress website for details: www.c-linkage.co.jp/apotc2024

WFOT Thelma Cardwell Foundation Award for Research

The Thelma Cardwell Foundation Award for Research provides pilot funding for a small-scale project to build or strengthen research capacity. Applications must align with the WFOT research priorities and applications are due by the 29 October 2023. Visit wfot.org/news and search for ‘Thelma Cardwell’ for more information.

Saveetha Medical College and Hospital College of Occupational Therapy

Clinic in Kochi hosted by the AIOTA

Meenakshi Academy of Higher Education & Research

Benefits of Belonging

peer-reviewed, evidence-based and covers a wide range of practice areas and career development stages.

OTA also offers a free Student Hub and Early Career Launchpad for new and emerging OTs.

the challenges you face are brought to the attention of government.

As an OTA member, you have opportunities to have your voice heard on issues that affect you and you are eligible for a variety of member-only awards, scholarships and grants.

our most valued member benefits.

If you’re not already a member of a SIG, we’re sure you’ll find the right group for your practice area with over 36 to choose from. Other member-only networking opportunities include our Divisional Councils and reference groups.

Connections, is published quarterly with the latest research and innovations, and you also have the opportunity to submit articles for publications.

Earlier this year, we hosted a free member forum with NDIA CEO, Rebecca Falkingham –keep an eye out for further member forums.

to contact OTA’s Professional Practice Advisors for general, in principle opinions on professional practice topics.

OTA has also partnered with a select range of providers to offer advice and product discounts, including discounted professional indemnity insurance through Aon, legal advice from Maurice Blackburn Lawyers and HR support from WorkPlacePLUS.

Free interpreting services for private practice occupational therapists

“If you talk to a man [sic] in a language he understands, that goes to his head.

If you talk to him in his language, that goes to his heart.” ~ Nelson Mandela

Nelson Mandela understood the power of connections made in a mother tongue.

Australians speak more than 350 languages. For new arrivals, and other people with low English proficiency, the use of language support is a significant determinant of the accessibility and effectiveness of health services.

Did you know that many communitybased occupational therapists have recently gained access to the Free Interpreting Service (FIS) so that we can serve clients in their mother tongue?

This national program supports 32 Local Government Areas across the nation and will be evaluated by June 2026.

Empathy with migration and settlement stories is enough to highlight that we need to use language support while someone is learning English; both to understand and to be understood.

Reflection on our practice and/or pathways into and through our service is enough to highlight that without language support, it’s impossible to enact competencies universally expected of occupational therapy practitioners.

To date, 50 privately practicing occupational therapists have registered with the FIS. The good news is that these 50 practitioners are now ready to seamlessly respond to a client who needs language support.

The bad news is that the 50 FIS registrations are not from Hobart, where we’re from. It’s the national figure for the profession to date.

Learning English as a new arrival

I met Somayeh while I was the lead for Settlement and Community Services in Tasmania’s Migrant Resource Centre.

She was a casual bicultural worker, new to Hobart and shares about her experience learning English:

“I came to Australia with my parents and younger brother as a refugee. I learned basic English first during my high school in Iran. When we moved to Australia, I attended TasTAFE and started my never-ending language journey there. I learned mostly through experiencing and overcoming day-to-day challenges.

I had the best English in my family, so I was in charge of dealing with different services, organisations and generally the outside world, which was in English.”

Humanitarian entrants from persecution and conflict areas in the world don’t often have Somayeh’s access to high school and English classes. Many start a very long journey of English language acquisition upon arrival to Australia.

Unfamiliar health systems and a new profession

Somayeh reflects on the significance of new systems, expectations, and ways of using services:

“For people from a refugee background, the whole Australian health system is new, let alone the language.”

Our youth worker mentioned that Somayeh was interested in studying occupational therapy, so I naturally brought in some texts and journals and had a chat. Somayeh reflects that:

“For almost all people from my community, occupational therapy is an unknown profession.”

Without an occupational therapy program yet in Tasmania, Somayeh would have to move away from family and community to study on the mainland; a decision with significant financial, social, and cultural dimensions. We’ve kept in touch over the years, and today she’s a fourth year Deakin occupational therapy student on placement.

Interpreter use

Somayeh continues to be a support for family and community members to access services while they have low English proficiency and says:

“It was always a relief for me when the services offered interpreter services. This meant less stress for me, as I was not needed anymore, and my family could go there independently.”

Clarissa Adriel, Clinical Lead of Richmond Fellowship Tasmania

Somayeh Kouhestani, 4th year occupational therapy student at Deakin University

When there’s no interpreter

Practitioners are often relieved that people have brought a community member or family member who has more English skills; however, at what cost? People like Somayeh compensating for service providers not using interpreters comes at the expense of engaging in other restorative, settlement, education or work occupations.

“Sometimes we would ask for an interpreter but the answer was not always a yes. Soon, we stopped asking for an interpreter and almost everything we did was in-person, with me being present everywhere with my family to interpret for them. I only had very basic English and for this reason at times I avoided asking questions or advocating for my family and I, simply because I didn’t know how to say it in English.”

Layered implications of language support

Service delivery without an interpreter results in a breach of rights and is an example of systemic racism where people’s service quality is dictated by where they are from.

How can a practitioner be assured that a family member has an adequate level of English comprehension, interpreting accuracy, confidentiality, or the impartiality expected of a professional interpreter?

Somayeh highlights another common hazard:

“Sometimes school aged children are asked to act as an interpreter for their parents when dealing with sensitive matters such as family violence or legal and financial matters. On top of its negative impact on a child’s mental health, this can create serious misunderstanding.”

Somayeh also reflected on how failing to use an interpreter to make a phone call can result in people not accessing services.

“I avoided phone calls altogether for many months as it was too complicated for me to understand people (speaking English) over the phone.”

Professional, ethical, legal, employer, public expectation – there are many layers of implications for failing to use an interpreter when needed.

(It’s a good student and clinical supervision exercise to brainstorm them!)

Tips for working with interpreters

Somayeh offers three simple tips to practitioners working with interpreters:

1. Take your time to explain your message (e.g. speak in ‘chunks’, unpack concepts and assumed knowledge)

2. Understand that key information can get lost even when using an interpreter (e.g. different assumed knowledge and different cultural frames of reference)

3. Check client understanding (e.g. the practitioner is responsible for the transmission of meaning, even with an interpreter providing the language support)

Why use an interpreter? Somayeh says it best: “It’s about making the client the centre of focus.”

Follow the QR code at the end of this article for a webpage with tips for what to do if:

• You’re not sure if you have an interpreter account

• You want to check if you’re eligible for FIS

• You just made a FIS account

Additionally, you’ll find resources for a short video, a webinar, national interpreter symbol and TIS National (Translating and Interpreting Service) promotional

materials so people know that they can have an interpreter in your service.

We trust this information is helpful, and we welcome contact to share tips or stories to help you. Or perhaps you could help the work of the Cultural Diversity ‘OTs in Action’ Social Justice group. Both authors can be found on LinkedIn.

About the authors

Clarissa Adriel is the Clinical Lead of Richmond Fellowship Tasmania, the state’s largest community mental health service provider. She participates in OTA’s Cultural Diversity ‘OTs in Action’ Social Justice group, drawing on extensive experience working with migrants and refugees.

Somayeh Kouhestani is a fourth year Deakin occupational therapy student and comes to the profession from Afghanistan. She has lived experience of language learning in the context of forced migration and providing language support to other new arrivals settling into Tasmania.

Did you know that many communitybased occupational therapists have recently gained access to the Free Interpreting Service (FIS)?

Occupational therapy student-led services in Australia:

Do we know what clients think?

Sijia Ding, Master of Occupational Therapy Student, University of Canberra

Dr Claire Pearce, Assistant Professor in Occupational Therapy, University of Canberra

Sijia is a second-year Master of Occupational Therapy student at the University of Canberra (UC) who recently completed an eight-week placement at a student-led clinic, which she found to be an enriching, fulfilling and rewarding learning experience. As part of her role at the University of Canberra, Claire helps facilitate placement experiences for students and had observed that student-led services provide a rich placement experience.

Professional practice education is central to development as an occupational therapist as it facilitates the integration of theory, knowledge, and professional reasoning within the clinical context to develop student competence (WFOT, 2016). Australian entry-level occupational therapy education programs meet the international benchmark set by the World Federation of Occupational Therapy (WFOT) of a minimum of 1,000 hours of clinical placements for entry to professional work practice (OTC, 2018; WFOT, 2016). However, ensuring sufficient quality placements for occupational therapy students is becoming increasingly challenging in Australia due to the rising number of occupational therapy education programs and the dramatic expansion of cohort sizes (Gustafsson et al., 2017). In addition, the range of practice contexts that occupational therapists are involved in has been growing, as reflected in the current Australian occupational

therapy competency standards (OTBA, 2018). To address the changing nature of practice education needs, many studies called for actions to push the boundaries and develop innovative and sustainable approaches to manage the quantity and quality of Australian occupational therapy placement places (Gustafsson et al., 2017; Hamiliton et al., 2015).

Student-led services (SLS) are one of the innovative approaches to meeting the growing demand (Hamilton et al., 2015). SLSs are dedicated settings where students are intrinsically engaged in service delivery under professional supervision in a single or multiple discipline clinical environment (Broman et al., 2022). These are generally in the form of university-run health clinics (Moore et al., 2018) or community-based clinics (Wilbur et al., 2017; Rens & Joosten, 2014) but can be designed in a range of ways such as the Student-Led Group Model (Patterson et al., 2021; Patterson et al., 2017; Patterson et al., 2019; Pigott et al., 2021; Pigott et al., 2022) or student-run free clinics which are prevalent in the United States (Dhans, et al., 2015; Zachry et al., 2016)

The literature relating to the effectiveness of these services tends to focus on clinical outcomes and student and/or supervisor perceptions. But what do the clients who access these services think?

To begin to answer this question, the authors undertook a review of the literature with the aim of providing an overview of client perceptions of occupational therapy discipline specific SLSs in the Australian context. We found a paucity of literature relating to this subject, but we hope by presenting a summary of what we did find, we will encourage further discussion and research on this subject.

Our review was undertaken in November 2022 and at that time, we found just six articles that answered our question ‘What are client perceptions of occupational therapy student-led services in Australia?’–five peer-reviewed publications and one blog. From these papers we derived the following four themes:

1. Overall clients are satisfied with student-led services

Positive health outcomes, changes in occupational performance and rehabilitation needs being met through reduced waiting time (Rodger et al., 2011a), more therapy, greater consistency, intensity in service provision and additional opportunities for clients to practice skills (Patterson et al., 2019) all contributed to clients overall being satisfied with SLSs. In rural areas, a SLS provided previously difficult to access services (Sedgwick, 2020).

2. Student-led services provide a mutual learning experience

Mutual learning relationships made clients feel more equal with students and clients valued the opportunity to be supporting the student learning needs while having their own health needs addressed (Patterson et al., 2021; Pigott et al., 2021; Rodger et al., 2011a)

3. Students’ personal traits influence client perceptions

Clients reported students demonstrated enthusiasm, patience, dedication, motivation, willingness to listen and learn, and were friendly and encouraging, and this contributed to the overall positive regard for the SLS (Patterson et al., 2021; Pigott et al., 2021; Rodger et al., 2011a; Sedgewick, 2020).

4. Clients expressed a desire for adequate supervisor input

Clients prefer to have a qualified occupational therapist present during student interactions, even if it was just for some of the time (Patterson et al., 2021; Carrigan et al., 2001; Pigott et al., 2021).

Implications for practice

It is apparent that from a client point of view, SLSs contribute to positive client health outcomes and address community needs for occupational therapy services. This finding is potentially helpful for universities and practice education providers as it further reinforces that student-led clinics can be an alternative and effective approach to meet the increasing demand for both placements and services.

From a student point of view, knowing that personal traits are held in high regard by clients could assist students to be less anxious and more confident while delivering services. Students aren’t expected to know everything, but appropriate therapeutic use of self can impact the occupational therapy process and outcomes. Another theme that may be of interest to students is that the client’s sense of supporting student professional development was identified as an external motivator for clients’ active participation in therapy – a unique feature of SLSs. Mutual learning is unique to SLSs and is considered to foster mutually beneficial, powerbalanced, and collaborative therapeutic relationships.

We know that clinical educators are facing challenges in meeting supervision needs due to staffing and physical resources shortages and high workloads (Thomas et al., 2007). In SLSs, clinical educators need to balance a range of different needs including students’ needs for timely and routine feedback (Rodger et al., 2011b); students’ needs for the ‘just right’ challenge to gradually foster autonomy and independence (Rodger et al., 2013), and clients’ desire for adequate supervisor input. There exists the possibility of tensions between a supervisor’s capacity and the demand for clinical supervision in SLS settings, with supervisors facing multi-layered challenges in leveraging the needs of different stakeholders and a potential lack of organisational support.

The findings of our review further reinforce that student-led clinics can be an alternative and effective approach to meet the increasing placement demand. Future research is indicated to be undertaken in a wider range of settings to explore in more detail the specific themes identified through this review, including addressing the balance of supervisor workload with client expectations, alternative settings for SLSs and harnessing the mutual learning experience to provide a greater range of both service delivery models and student learning experiences.

References can be viewed by scanning the QR code

Ensuring sufficient quality placements for OT students is becoming increasingly challenging in Australia due to the rising number of education programs and the expansion of cohort sizes.

Does my business need Professional Indemnity or Cyber Insurance?

If you own a business, you hold many different policy types, but sometimes distinguishing between the different policies, and understanding which events would be covered under each policy type can be confusing. As a starting point, it’s worth understanding the intention behind the various insurance types, and who may require them. Below, we break down two policy types – Professional Indemnity and Cyber Insurance and examine how they differ.

What is Professional Indemnity Insurance?

Professional Indemnity Insurance (PI) is designed specifically for businesses who provide professional services or advice. It is intended to help cover you and your business in the event a client alleges your professional negligence or breach of duty while you provided your professional service or advice caused them damage, injury, or a financial loss. PI may help cover the legal fees you incur in defending a claim or investigation costs of a claim that is covered by your PI policy, as well as compensation you might be required to pay. The policy may respond to allegations relating to your professional service or advice; however, it is important to keep in mind, a key requirement for potential cover to be provided under a PI policy is that the allegation must be an insured professional service stated on your policy schedule. For example, if your PI policy covers you for Occupational Therapy, but you add a service that is not within scope of practice for an Occupational Therapist, then it’s possible your policy may not respond to the claim.

Examples of claims which may arise under Professional Indemnity for health professionals include allegations of unprofessional conduct, service complaints, breach of confidentiality, and error or omission in the advice provided. Like most insurance policies, PI policies will

have some exclusions in place which may impact cover. Consultation with your broker can ensure you receive the most appropriate coverage for your business.

What is Cyber Insurance?

Cyber insurance is designed to help cover your business’ financial loss if it falls victim to cyber event. It can help cover a wide range of cyber related risks, and risks relating to information technology infrastructure. Cyber related risks may include, unauthorised system access, electronic attacks or privacy breaches, hacking and phishing attacks, malware infection (including spyware or Ransomware) and computer virus.

A claim under cyber insurance may cover several costs, liabilities and losses associated with the cyber incident in question. Firstly, if you suffer an attack, it’s likely you and your business will incur costs at your own expense because of the event, these may include costs to obtain advice and support; costs to identify the source and scope of the attack; restore your systems; recover your data and notify victims of privacy breaches. While these examples are not exhaustive these costs are known as ‘first party losses’.

If your business experiences a cyber-attack, it may also cause financial loss to the third parties you deal with, such as clients and/ or suppliers. For example, if you transmit a computer virus to a third party or disclose confidential information, that third party may suffer their own losses. Cyber Insurance may help cover your liability for these costs, this is called ‘third party liability’.

Following a cyber-attack, it can be tricky to work out what your next steps should be to minimise damage, so another important feature that may be included under Cyber Insurance is access to an incident response specialist. An incident response specialist role is to help coordinate the steps your business may need to take to

recover from the cyber incident. Examples of actions that can be taken are:

• a forensic investigation of your computer systems

• obtaining legal advice

• responding to regulators if needed (for example if there has been a privacy breach)

• public relations support to help minimise reputational damage

• costs to secure your computer systems against a future cyber attack

Is Professional Indemnity & Cyber Insurance required by all businesses?

Not all businesses require PI Insurance, for example, a business that is not involved in providing a professional advice or service is unlikely to require PI. Cyber Insurance on the other hand is likely to be applicable to all businesses that have a digital footprint, such as a website or if it stores personal data. Professional Indemnity Insurance is unlikely to cover cyber events.

Cyber insurance cover can vary between policies so when considering Cyber Insurance options, it’s important to carefully review the potential cyber risks that your business faces, along with the potential loss you could suffer following a cyber-attack when deciding which cover option to select.

If you have further questions on the intention of an insurance policy your considering, speaking with your Broker may assist to help clarify the intention of the policy coverage and if it’s a policy which your business should consider.

This information contained in this article is general in nature and should not be relied on as advice (personal or otherwise) because your personal needs, objectives and financial situation have not been considered. Before deciding whether a particular product is right for you, please consider your personal circumstances, as well as any applicable Product Disclosure Statement, Target Market Determination and full policy terms and conditions, available from Aon on request. All representations on this website in relation to the insurance products we arrange are subject to the full terms and conditions of the relevant policy.

Important changes to Awards: Temporary workplace shutdowns

WorkPlacePLUS

Effective 1 May 2023, private practice owners will need to change the way they implement temporary workplace shutdowns.

As part of the Commission’s four-yearly review of modern awards, the Fair Work Commission (FWC) has varied 78 modern awards by replacing existing shutdown clauses with a new model term, including the Health Professionals and Support Services Award 2020 (clause 26.5).

Shutdown clauses relate to an employer’s ability to direct employees to take a period of annual leave where the employer shuts down all or part of its enterprise. For example, some private practice owners will routinely close over the school holidays or the Christmas period.

The new model term varies and updates existing shutdown clauses in a number of ways. In summary, from 1 May 2023:

• Employers must now provide at least 28 days’ written notice of any temporary shutdown period. The written notice could be a shorter period as agreed between the parties, or a longer period if the term preserves an existing longer notice period.

• Employers may direct employees in writing to take a period of paid annual leave if the employee has an accrued annual leave entitlement, providing the direction is reasonable.

• Employees can no longer be directed to take leave without pay if they do not have sufficient annual leave or leave in advance to cover the whole period of the shutdown.

• Once an employee’s paid annual leave has been exhausted, by written agreement the employee may take unpaid leave or annual leave in advance during the temporary shutdown.

Key considerations for practice owners:

• Practice owners should review the Health Professionals and Support Services Award 2020 and any other applicable awards to apply the new temporary shutdown provisions.

• Practice owners should review their policies, processes, documentation, payroll systems and employee management systems regarding accessing annual leave entitlements, temporary workplace shutdowns and directing an employee to take leave.

• Practice owners may need to review their approval process for annual leave requests that fall before planned shutdown periods.

• Employees who do not have sufficient accrued annual leave to cover the shutdown period may in some circumstances be entitled to wages during the shutdown period if they do not agree to take pay without leave or leave in advance.

• When calculating the amount of paid annual leave accrued by an employee, practice owners must consider any leave taken in advance pursuant to the “annual leave in advance” clause.

• Practice owners should note that periods of annual leave taken for the purposes of a temporary shutdown do not apply for the purposes of the existing excessive leave provisions contained in modern awards.

• Practice owners should provide communications and training to HR and payroll managers and impacted employees regarding the changes to shutdown clauses in applicable awards. This includes accounting for the updated notice periods and requirements to take paid leave.

It is important for practice owners to keep up to date with changes to Australian workplace laws and regulations, including any changes to the awards that apply to their employees. Employers must ensure they are meeting their obligations under these instruments.

In particular, practice owners are required to provide notice and consultation to affected employees before implementing temporary workplace shutdowns. The specific requirements, which depend on the size of the practice and the number of employees affected, must also be included in the employment contract.

If you are unsure about how to correctly interpret and apply changes to the Health Professionals and Support Services Award 2020, you can contact the Fair Work Ombudsman or seek advice from an HR consultancy that works closely with the allied health sector such as WorkPlacePLUS.

As OTA’s HR/IR partner, WorkPlacePLUS provides support to OTA members on employment matters affecting your practice. For more information, contact Anna Pannuzzo on (03) 9492 0958 or visit www.WorkPlacePLUS.com.au.

2023-24 Federal Budget

On Tuesday 9 May the Federal Government released the 2023-24 Budget. There were measures to boost wages and skills, and it predicted a big fall in inflation to less than 3% by 1 July next year.

However, the growth forecast is predicted to fall to just 1.25% next year as global economies battle high inflation. Treasurer Jim Chalmers warned of the massive structural challenges facing the nation due to increased health, aged care, NDIS, defence and interest payments.

OTA attended post-budget briefings in the health, aged care and mental health portfolios and undertook an analysis of the budget papers to identify key spending and items relevant to OTs. Read on for a summary of some of the key areas.

Aged Care

Home Care reform

Commencement of the Support at Home Program will be postponed to 1 July 2025 to allow for further refinement of the final design. Grant arrangements for the Commonwealth Home Support Program will be extended for a further 12 months to 30 June 2025.

Additional funding of $338.7 million over four years from 2023–24 has been pledged to improve the in-home aged care system. This includes funding for:

• $166.8 million in 2023–24 to release an additional 9,500 home care packages.

• $15.7 million over two years from 2023–24 to establish a single aged care assessment system, including the establishment of a First Nations assessment workforce.

• $487 million pledged over four years from 2023–24 (and $133.6 million ongoing) to extend and make ongoing the Disability Support for Older Australians

Program, for those who were not eligible for the NDIS at the time of rollout.

Mental Health

$556 million (and $36 million ongoing) is allocated for improved mental health. This budget extends critical services, addresses urgent gaps and workforce shortages – laying the groundwork for future reform. OTA feels this does not go far enough to support the role of mental health OTs, despite OTA’s ongoing advocacy to government. Government investment includes:

• $260.2 million over two years invested for psychosocial support for more than 18,000 people with severe mental health illness who cannot access the NDIS.

• $17.8 million over five years to upskill the broader health workforce in mental health, to alleviate workforce shortages and deliver high quality mental health treatment and support across a range of settings. Undergraduate nurses, midwives and allied health students receive contemporary training in mental health treatment and support.

• Expanded supports for workplaces, children and young people, people with eating disorders, those bereaved by a suicide loss and individuals and communities impacted by natural disasters.

• Boosting mental health support for First Nations people in the lead up to, during and following the Voice referendum.

• Further protection for vulnerable members of the community, including refugees and migrants who have experienced torture and trauma, and culturally and linguistically diverse communities.

National Disability Insurance Scheme

OTA welcomes announcements to reform elements of the NDIS and increase

staffing and capability within the NDIA to make it easier for participants to access much needed supports. We are pleased that NDIA will extend participant plans beyond annual planning cycles and establish an expert advisory panel (in consultation with stakeholders) to identify evidence-based supports.

The Government signalled its intent to curb NDIS spending through an 8% growth target, which will be delivered through a range of measures to improve claims management and reduce fraud. We are pleased to see this is a target, not a cap, and that it will be supported through a major investment package to drive improvements within the scheme.

$732.9 million over four years from 2023-24 is being invested in initiatives developed in consultation with the NDIS Independent Review Co-Chairs.

Workforce

The budget saw some measures to support existing allied health workforce but fell short of funding a national allied health workforce strategy (which has been called for by OTA, AHPA and many stakeholders).

Workforce Incentive Program changes  Investment of $445.1 million over five years from will improve the quality and accessibility of multidisciplinary primary care and improve the financial sustainability of multidisciplinary general practice by immediately increasing all payments under the Workforce Incentive Program – Practice Stream. This funding will support practices to expand multidisciplinary teams and employ more nurses, allied health and other health professionals in practices.

Veterans

OTA was disappointed to see no meaningful investment in improving

the quality of health services accessible to Australian veterans, despite our calls for an increase in OT fees under DVA.

Claims processing

There is some investment in claims processing to reduce claims backlog including $64.1 million in 2023-24 to retain 500 DVA staff, and $254.1 million over four years to fix IT and payment systems.

Primary Health Care

Bulk billing

$3.5 billion over five years from 2022-23 in bulk billing incentives, which we hope will see more Australians be able to afford to visit their GP to receive important care including referrals for allied health services.

$99.1 million over five years will support establishment of a new MBS item for longer consultations over 60 minutes, which is expected to support an increasing number of patients with chronic conditions and complex needs.

Rural and First Nations Health

Better access to Allied health services for First Nations Australians  First Nations Australians with a chronic condition, or following a Health Assessment, will have streamlined access to the ten allied health services through MBS items 93000, 93013, and 81300–81360, 93048 and 93061, and 10950–10970. This includes occupational therapy, MBS item 10958.

All ten items will be accessible following either a GP Medical Plan/Team Care Arrangement or Health Assessment, rather than requiring both. This measure was due to be implemented on 1 March 2023, however, due to implementation challenges and the need for additional stakeholder consultation, it will now be implemented on 1 March 2024.

Scan the QR code to read our full budget analysis on the OTA website.

Thank you to our OTAUS2023 partners

We’d like to thank our premium sponsors and supporters of the 30th National Conference & Exhibition (OTAUS2023). Their partnership enables us to develop and promote programs and services for OTs and supports us to continue elevating the profile of occupational therapy.