OTA Connections Summer 2020 by Occupational Therapy Australia

Supporting all people to engage in activities they find meaningful

SUMMER 2020 | VOL 17 ISSUE 4

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Print Post Approved PP340742/00147 ISSN 1832-7605

Regional , Rural & Remote Bunbury Garden Labyrinth: A Place for Hope, Harmony and Community Bringing Student-led Services to Rural Queensland Learning from Disaster: Teaching and Learning through the North Coast Bushfires

O T W E E K 2 0 2 0 C E L E B R AT I O N S A N D P H O TO H I G H L I G H T S

Bringing Australiaâ&#x20AC;&#x2122;s Major Scientific Conference for Occupational Therapists to Cairns

23-25 JUNE 2021

www.otaus2021.com.au

Virtual and in-person CAIRNS CONVENTION CENTRE QUEENSLAND

#otaus2021

29TH NATIONAL CONFERENCE AND EXHIBITION 2021

INTRODUCING OUR

KEYNOTE SPEAKERS

NOWID R HYB

The Hon Michael Kirby AC CMG

Sylvia Docker Lecturer Professor Lindy Clemson

Dr Karen Whalley Hammell

The Hon Michael Kirby is an international jurist, educator and former judge. He served as a Deputy President of the Australian Conciliation and Arbitration Commission (1975-83); Chairman of the Australian Law Reform Commission (1975-84); Judge of the Federal Court of Australia (1983-4); President of the New South Wales Court of Appeal (1984-96); President of the Court of Appeal of Solomon Islands (1995-96) and Justice of the High Court of Australia (1996-2009).

Professor Lindy Clemson is a recognised international leader in enablement and environmental approaches to falls prevention, and more recently has conducted research in restorative programs for people living with dementia. She has led the development of three novels and successful fall prevention programs, all implemented world-wide. Her research expertise includes multi-methodology inquiries, intervention trials and implementation science.

Dr Karen Whalley Hammell is Honorary Professor in the Department of Occupational Science and Occupational Therapy at the University of British Columbia, Vancouver, Canada. She is an internationally renowned author of books, chapters and numerous papers concerning disability, spinal cord injury, and occupational therapy theories, research and client-centred practices.

SPONSORSHIP AND EXHIBITION OPPORTUNITIES

To discuss how you can be involved, please contact Emelia Hinge, Industry Engagement via emelia.hinge@otaus.com.au or phone 0451 807 647.

NOW AVAILABLE: Onsite and Virtual Opportunities

FURTHER INFORMATION Ph: 1300 682 878 Email: conference2021@otaus.com.au www.otaus2021.com.au #otaus2021

CONTENTS

ABOUT CONNECTIONS

Connections is a publication of Occupational Therapy Australia (OTA), the peak body representing occupational therapy in Australia. CONTACT US

Occupational Therapy Australia ARBN 007 510 287 ABN 27 025 075 008 5/340 Gore St, Fitzroy, VIC 3065 T: 1300 682 878 E: info@otaus.com.au W: www.otaus.com.au

How You Celebrated OT Week 2020

CONTRIBUTIONS AND ADVERTISING

Would you like to contribute to Connections, or do you have a product that is attractive to occupational therapists and would like to advertise your product? For advertising enquiries, please email advertising@otaus.com.au Editorial material including letters to the editor, upcoming events, research material, and important information for inclusion in Connections should be sent by email to digitalcomms@otaus.com.au. The editor reserves the right to edit material for space and clarity and to withhold material from publication. DEADLINES FOR SUBMISSIONS

Autumn 2021 15 January 2021 Winter 2021 9 April 2021 Spring 2021 9 July 2021 Summer 2021 8 October 2021 Please email digitalcomms@ otaus.com.au to enquire about submitting an article.

NEWS 04

President’s Report

CEO’s Report

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DISCLAIMER

This newsletter is published as an information service and without assuming a duty of care. It contains general information only and, as such, it is recommended that detailed advice be sought before acting in any particular matter. The materials included in this newsletter by third parties are not attributable to Occupational Therapy Australia, and are not an expression of Occupational Therapy Australia’s views. Occupational Therapy Australia is not responsible for any printed expressions or views in any third parties’ inclusions. Any enquiries regarding inserts, advertisements or articles placed by these third parties should be directed to them.

Learning from Disaster: Teaching and Learning through the North Coast Bushfires

Policy, Lobbying & Advocacy Update

Professional Practice & Standards Update

Bringing Student-led Services to Rural Queensland

Working in Rural and Remote NSW: Challenges and Innovative Solutions

Going Rural, Regional and Virtually Beyond Borders

Exchanging Ideas, Knowledge and Support

Rural Health Commissioner Report: Improvement of Access, Quality and Distribution of Allied Health Services in Regional, Rural and Remote Australia

Bunbury Garden Labyrinth: A Place for Hope, Harmony and Community

Tips for Managing a Remote Workforce

Wrong Set of Wheels: An Occupational Therapy Claim Example

WFOT Update

Celebrating Rural Health Research in the Australian Occupational Therapy Journal

DESIGN

Perry Watson Design

FEATURES

How You Celebrated OT Week 2020

CPD Updates

Bringing Studentled Services to Rural Queensland

CONNECTIONS SUMMER 2020 3

PRESIDENT’S REPORT

President’s Report Associate Professor Carol McKinstry | OTA President

he theme of this issue ‘Regional, Rural and Remote’ has special relevance to me. I have spent most of my life in regional Victoria. I grew up on my family’s farm on the Campaspe River at Barnadown, attended the small local primary school at Goornong with three other pupils in my grade, and then attended secondary school and later worked in Bendigo after I graduated. As a clinician, I worked with people living in Bendigo and up to 150km away—helping establish regional rehabilitation services so people did not have to travel to Melbourne. Later, as an academic, I established an occupational therapy course in Bendigo to provide tertiary educational opportunities for regional and rural students and workers. I am passionate about improving the health inequities of those living in regional, rural and remote areas—having seen firsthand the impact that a lack of access to services can have. It is well-documented that there are higher incidences of chronic

disease, cardiovascular conditions, cancer, mental illness, and suicide in rural areas. While country living has many advantages, it also has health concerns. The number of health professionals, including occupational therapists, per 100,000 people is much less the further you move away from metropolitan cities. While the lack of medicos in the bush attracts a lot of attention, the need for allied health professionals can often be overshadowed. A Rural Health Commissioner report released earlier this year highlighted issues associated with a maldistribution of the Australian allied health workforce. University Departments of Rural Health (UDRHs)—initially established to attract more metropolitan medical students to rural placements and communities—much later included allied health and nursing students. However, many still focus on converting metropolitan students to rural practice, when all the research shows that students from a rural upbringing are a much better bet.

I am passionate about improving the health inequities of those living in regional, rural and remote areas— having seen firsthand the impact that a lack of access to services can have.

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One challenge in building a rural occupational therapy workforce is attracting enough students with the academic requirements to undertake our courses. Aspiration is a huge issue in rural schools. I frequently tell the story of a debutante ball in a rural community in which I am on the local health service board. As board chair, I was invited to be in the official party to which each of the nineteen pairs of debutantes were presented—along with a small description of their interests and life goals. No boys, and only a handful of girls, had any aspirations to attend university. This community is only 60km from Bendigo and 200km from Melbourne. Lifting aspiration for country students was also highlighted in the Napthine Report’s National Regional, Rural and Remote Education Strategy (2019). Tertiary participation rates of regional, rural and remote students are way too low for a country like Australia. While doing my occupational therapy course in Melbourne, people were amazed that I had been admitted—firstly because I was from the country, and secondly because I had attended a public high school. Admittedly, that was some time ago. Now as an educator, I love teaching rural students, and they make great occupational therapists. They are very resilient and take things in their stride. Undertaking placements in regional and rural areas gives them a solid base for future practice,

PRESIDENT’S REPORT

as they gain broad experience working with a whole range of people with different needs. They also realise they can make a substantial difference to rural communities. Retaining rural occupational therapists can be a challenge with inadequate support. Accessing supervision and continuing professional development can be difficult for both recent graduates and experienced occupational therapists. Lack of career pathways is another frequently reported issue. Managing the dual relationship of living and working in a rural community can also be a challenge. My husband, originally from Melbourne, does the supermarket shopping early Saturday morning to avoid bumping into one of his patients. For those raised in rural areas, this is not so much an issue. I have played in sporting teams with people who later become my students, and frequently buy coffee from my students working in a local café. Yet more importantly, networks and community connections are much easier to establish in rural and regional settings. Reflecting on a very challenging year, there has nonetheless been positive outcomes for rural people. The massive uptake of telehealth has seen clinicians, including occupational therapists, increase access to health services while also reducing the need for travel. Rural occupational therapists have also benefited from better access to continuing professional development.

I have played in sporting teams with people who later become my students, and frequently buy coffee from my students working in a local café.

Earlier in the year, the OTA divisional annual meetings were held via teleconference—and it was amazing to hear from occupational therapists who had been unable to attend in the past. Hopefully we will retain some of the positive changes that will increase participation opportunities for regional, rural and remote occupational therapists within OTA. I would also like to acknowledge the difficulties that everyone has faced due to COVID-19. Challenges associated with a worldwide pandemic include upskilling in technology to deliver services, wearing PPE, adopting extra infection control practices, working from home, and juggling other responsibilities such as distance education and impacts on private practice revenue. Students have had a tough time, too, particularly those in their final year, with the uncertainty of being able to finish their courses. This has been very

evident in Victoria. Academics from the following universities that source placements in Victoria would like to thank clinicians and service managers for their flexibility, generosity, and willingness to provide placement opportunities during these trying times: Australian Catholic University, Charles Sturt University, Deakin University, Federation University, La Trobe University, Monash University, and Swinburne University. Preference has been given to final-year students, and the vast majority will be able to graduate. Thank you to everyone throughout Australia who has provided placements and learning opportunities for students, and supported them in a different way of learning. Finally, I would like to acknowledge OTA staff, the Board and other volunteers such as special interest group convenors for their work during these different times. Hopefully we look forward to a bigger, better and brighter 2021 when we can network online as well as face to face.

CONNECTIONS SUMMER 2020 5

CEO’S REPORT

CEO’s Report Samantha Hunter | OTA CEO

s this strange year draws to a close and we slowly become accustomed to the ‘new normal’, I have been reflecting on how this year has affected each of us so differently. Members have experienced the fallout, disruption, and sometimes opportunities that 2020 has brought. The staff of OTA have seen these changes firsthand as they juggled and responded to the needs of members while navigating a new course through practice, embracing technology, and entwining their professional into their personal lives on a scale not previously imagined. It seems a lifetime ago when many of our members were confronted by a long summer of raging bushfires that devastated communities across New South Wales and Victoria, followed by soaking rain and floods across Queensland, and again in New South Wales—all while breaking a lengthy drought in some regions yet heartbreakingly skipping still drought-ravaged tracts of outback. Occupational therapists’ need for information and guidance has varied depending on their practices, their state or region, their employment status and their family circumstances, with many juggling work and home schooling for extended periods. Despite the adversity the pandemic thrust upon us, members have displayed resilience in adapting to rapid and constant change, and in supporting their clients through an incredibly challenging year.

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Despite the adversity the pandemic thrust upon us, members have displayed resilience in adapting to rapid and constant change, and in supporting their clients through an incredibly challenging year.

Some small silver linings have emerged, too. The rapid requirement to adapt to video conferencing has led us to connect more often, with more members, across a range of ideas and issues. This has created greater equity and engagement for members right across Australia, particularly those working in rural, remote and regional areas where travelling to face-to-face meetings, CPD or other events can be costly and time consuming. Re-invigorating our SIGs on to an online platform has led to greater participation. The OT Exchange and Mental Health Forum were delivered as virtual conferences, allowing occupational therapists Australia-wide to join online (with the additional benefit of being able to review the entire conference program post-event). Divisional Councils meeting online enabled a greater uptake of regional representation, adding a new depth and dimension when considering local issues. A digital transformation is upon us with

the capacity to enhance the way we work, connect and collaborate. Adaptability to new platforms and technologies will create incredible opportunities for occupational therapists and their clients. This year we celebrated OT Week with the theme Rebuild, Recover, Reengage, which was so appropriate for the turbulent year Australians have endured together. Whether your community has been impacted by natural disaster or the pandemic has seriously affected your life or livelihood, we have all faced challenging times. As the year draws to a close, I hope you will have the opportunity to slow down and reflect on the year that has passed. Has your resilience and resolve been tried? How have you re-assessed your priorities, professionally and personally? I hope you will have the opportunity to rest, recharge, and refill your cup for a brighter 2021.

P O L I C Y, L O B B Y I N G & A D V O C A C Y U P D A T E

Healthcare Access in Regional, Rural and Remote Australia Michael Barrett, OTA National Manager, Government and Stakeholder Relations

nsuring access to healthcare in regional, rural and remote areas of the country is a perennial challenge for all Australian governments and, as such, is a high priority for OTA’s policy and advocacy team.

And we stated:

In our most recent pre-budget submission to the federal treasury, OTA wrote:

It was heartening that the 2020-21 federal budget, delivered on 6 October—five months late, owing to the economic turmoil caused by COVID-19—included several initiatives in line with OTA’s recommendations.

• Funding five projects to enhance aged care training

The Morrison government announced that it would implement a $550 million Stronger Rural Health Strategy. This aims to give doctors more opportunities to train and practise in rural and remote Australia, and gives nurses and allied health professionals a greater role in the delivery of multidisciplinary, team-based primary care.

The budget also funds trials of a new way to provide health services to smaller, connected rural communities across western and southern New South Wales, focusing on models to create efficient, coordinated networks of general practitioners, nurses and other health providers. The selection of new primary care models was based on their readiness for implementation, and was the product of collaboration between local primary health networks, state government health districts, and local medical leaders. The government has indicated that outcomes of these trials will inform wider primary care reform in rural Australia.

‘In a land as vast as Australia, and with a population as urbanised as Australia’s, it is unsurprising that our health, aged care and disability workforce is stretched so thinly between our major cities. But while the problem comes as no surprise, it nonetheless remains a problem … The federal government should work to address this maldistribution as a matter of urgency, ensuring those Australians living outside our major cities and regional centres enjoy reasonable access to health services befitting one of the world’s most advanced countries. The stated determination of all governments to ‘close the gap’ of Indigenous disadvantage is another compelling reason to ensure such access.’ We went on to note that education must play a key role in any long-term solution to this problem. Regular and meaningful rotations through regional and remote locations during the training of medical and allied health professionals heighten the possibility that students will eventually settle and practice in such locations.

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‘We also join with other organisations in calling for the development and implementation of a comprehensive rural and remote health strategy.’

Funding of $50.3 million over four years will expand the Rural Health Multidisciplinary Training (RHMT) program, which has been in place for more than 20 years. Incorporating 16 University Departments of Rural Health (UDRH), the program provides training to students across a range of health disciplines, including nursing and allied health, in such fields as aged care, disability and rehabilitation, childcare, education, community facilities, and Aboriginal Community Controlled Health Organisation settings. According to the government’s budget statement, the expansion of the RHMT

will deliver four key elements: • Funding a new UDRH • Increasing training in five remote communities through existing UDRHs (including student accommodation)

• A feasibility study to identify best approaches to increase dental training in regional locations

The government also committed to expanding the National Rural Health Commissioner’s function, indicating the office would take a system-wide view of rural health, ensuring initiatives were integrated and address gaps. These announcements largely align with recommendations made by OTA in recent years, and are welcome.

P O L I C Y, L O B B Y I N G & A D V O C A C Y U P D A T E

But amid the good news were inevitable disappointments. Occupational therapists working with veterans have been disappointed yet again, with the Morrison government failing to lift the rates paid to occupational therapists by the Department of Veterans’ Affairs (DVA). This is despite the fact that the number of occupational therapists able to sustain DVA work has fallen sharply in Far North Queensland, which is home to a large number of veterans. Like their counterparts in the Northern Territory, these veterans must now seek occupational therapy at their nearest public hospital. They deserve better. It should be a source of national shame that occupational therapists with longstanding clinical relationships with wounded, disabled and ageing veterans are having to cut these ties because DVA is unable or unwilling to pay them a living wage. OTA will continue to advocate in this space and has recently been in touch with two government backbenchers on the issue. These backbenchers are rurally based, reflecting the fact that this problem is much more pronounced outside our capital cities. Another budget measure was funding of an additional $92.9 million over the next four years to ensure the NDIS Quality and Safeguards Commission has the resources required to carry out its role in regulating NDIS providers. OTA reiterates its strong belief that those NDIS providers registered by one arm of the Federal Government—the Australian Health Practitioner Regulation Agency (AHPRA)—should not be subjected to the trouble and expense of being registered by another arm of the Federal Government, the NDIS Quality and Safeguards Commission. Moreover, by supporting the commission’s existing role and arrangements, the Morrison government contradicts its stated objective of supporting access to health services in rural and remote Australia. In our recent submission to the Australian parliament’s inquiry into the NDIS Quality

While large city-based businesses should be able to provide telehealth services to rural and remote clients, these should supplement, rather than supplant, the great work of locally based occupational therapists and Safeguards Commission, OTA addressed the inordinate trouble and expense involved in undergoing certification by the commission, in particular the cost of the associated audit. We wrote: ‘… the fact remains that the audit is unnecessarily expensive, a fact attributable in part to the limited number of approved auditors. Despite repeated assurances by the commission, the number of approved auditors has not increased over the past 18 months; in fact, it seems to have been cut from 16 to 15. While these firms claim to provide services across all of Australia, they are all metropolitan-based, meaning that NDIS providers based in regional and rural parts of the country must bear the additional cost of the visiting auditors’ travel and accommodation. If OTA is incorrect about this, and measures have been taken to address this injustice, we would be delighted to hear it. We urge the Joint Standing Committee to inquire into this particular matter, given that thin provider markets in regional and rural Australia will never be meaningfully addressed if there are institutionalised disincentives to practising in these areas.’ Finally, no discussion of regional, rural and remote healthcare is complete without reference to the phenomenal, if enforced, take up of telehealth in 2020. Almost overnight, scores of thousands of health professionals, including thousands of occupational therapists, began delivering care by means of a variety of telehealth platforms. Surveys conducted by several allied health peak bodies, including OTA,

alongside significant anecdotal evidence, indicate that telehealth is an efficient and effective means of delivering care. Ideally, occupational therapists would adopt a hybrid model, seeing clients face to face whenever necessary but opting for telehealth when appropriate. Significantly, many occupational therapists report that the time saved by not having to travel to see clients means more clients can be seen in a day, an important consideration given the shortage of occupational therapists across many parts of Australia, particularly rural and remote areas. OTA is currently involved in a universityled study of the clinical effectiveness of telehealth, the findings of which will inform our advocacy going forward. Occupational therapists were understandably pleased when in September the Federal Government announced the extension of MBS subsidised telehealth services to 31 March 2021. DVA announced the same extension to its telehealth services the following week. We are conscious of the fact, however, that telehealth may not be an unalloyed blessing. While it ensured vulnerable Australians had access to much necessary allied healthcare in 2020, and thereby enabled many small allied health businesses to remain afloat, it must not be allowed to mark the beginning of the end for rural and remote practices. While large city-based businesses should be able to provide telehealth services to rural and remote clients, these should supplement, rather than supplant, the great work of locally based occupational therapists, people who every day make emotional and economic investments in their communities.

CONNECTIONS SUMMER 2020 9

P R O F E SS I O N A L P R A CT I C E & STA N D A R D S U P D AT E

OT Experiences in Regional, Rural and Remote Practice Carol Jewell, OTA Acting National Manager, Professional Practice and Development

ccupational therapists working in regional, rural and remote Australia have a uniquely challenging and rewarding role supporting their communities (Boshoff and Hartshorne, 2008, Pidgeon, 2015). Typically, these communities have higher rates of hospitalisations, mortality, injury and poorer access to, and use of, primary health care services compared with those in metropolitan areas (AIHW, n.d.).

Many of these communities have also experienced the devastating and lasting impacts of extreme weather—events that test the core of communities and the health and wellbeing of locals. What is it like working in regional rural and remote Australia as an occupational therapist? What are the opportunities, what are the challenges, and what is a typical day like?

I invited Kathy Luke and Katrina Pacey to share their thoughts, insights and experiences of regional, rural and remote practice. Ms Luke and Ms Pacey are codirectors of RAR Therapy and long-time friends. They have more than 20 years of experience working as occupational therapists, and have a passion for reaching out to people living in regional, rural and remote (RRR) Queensland. Here’s what they have to say.

Reflections and Insights from the Heart of Australia Kathy Luke and Katrina Pacey, Co-Directors RAR Therapy Thankful for Qantas Link still operating amidst COVID-19 restrictions to reach our rural, regional and remote communities

n 2013, Rural and Regional Therapy Services formally began in the small country town of Ayr, one hour south of Townsville.

Our dream to reach out to people of all ages living in RRR areas began more than 20 years ago as occupational therapy students sitting on the bank of the Brisbane River after a day of university lectures. We were talking about our RRR student placement experiences and noted the need for better support for occupational 10 otaus.com.au

therapists living and working in RRR areas. This was a time when computers were relatively new, and the best form of contact with other therapists was by calling on a landline (as mobile phones were rare, expensive brick-like packs). This was also a time when there was no NDIS funding, and people with disabilities were being moved from larger institutions into much smaller, supported and funded group homes in the community.

Since the more recent introduction of the NDIS scheme, we have been excited at the increase in the opportunities for occupational therapists to reach people living in RRR areas. As occupational therapists, we are often at the front line, seeing people with significant challenges for the very first time—people who have been getting by and struggling with minimal or no funding, supports or equipment their whole lives. Commonly, living in old, raised homes built on stumps (to avoid floods and snakes).

P R O F E SS I O N A L P R A CT I C E & STA N D A R D S U P D AT E

In these areas, home modifications have often been made by nonbuilder family/friends, of the kind that make occupational therapists cringe at how unsafe it may be (but at the same time have been working for the person). One example was a husband who was so proud to show us the wooden ramp he had just handmade so his wheelchairbound wife could get in and out of their house. With a doorway set one metre off the ground, the ramp was steep (under 1:5 gradient), narrow, with no sides, and “gets a bit slippery when it rains”. Having a clear understanding of the nature and challenges of rural, regional and remote practice goes a long way to increasing the resilience of occupational therapists who choose this career path. The broad nature of our role provides exciting opportunities to see and experience variety unparalleled in urban centres. Being immersed in a close-knit community, and working with vibrant personalities who run the local businesses and tough it out on the farms that feed our nation, also brings rich flavour to the hard work and steep learning curve of an occupational therapist. Isolation, lack of ready support, scarce opportunities to attend

training events, and expectations of service beyond knowledge and skill are some of the drawbacks to choosing rural practice. Being prepared to take action to reduce the impacts of the challenges can set up a rural therapist to thrive and develop skills beyond what they could in a city hospital or a busy paediatric clinic. To succeed in rural practice, therapists need to be ready to: • Reach out to other therapists either digitally or in a nearby hospital or community health centre to set up networks • Join OTA’s MentorLink program • Reconnect with colleagues from university or previous experience • Plan ahead to organise PD opportunities • Find a supervisor to guide your development • Regularly review articles and keep a journal of how this changes your practice • Maintain a weekly reflection to keep track of what changes you can make With the right support and a passion for learning, rural practice brings fast learning and expedited development of both experience and skill. It is a challenge worth pursuing! References Australian Institute of Health and Welfare (AIHW) (n.d.) Rural and Remote Health Web Report 22 October 2019, retrieved from www.aihw.gov.au/reports/rural-remoteaustralians/rural-remote-health/contents/summary Boshoff, K., and Hartshorne, S. (2008), Profile of Occupational Therapy Practice in Rural and Remote South Australia, Australian Journal of Rural Health, 16(5), 255-261 Pidgeon F. (2015), Occupational Therapy: What Does this Look Like Practised in Very Remote Indigenous Areas?, Rural and Remote Health 2015, 15:3002, available from www.rrh.org.au/journal/article/3002

Liz Haberley and Kathy Luke: Long road trips made more fun when shared with fellow therapists

North Queensland cane fire at sunset

Madeleine White, Kathy Luke, Andrew Evetts (community member), Katrina Pacey, Jessica Fowler: Making connections with the local community CONNECTIONS SUMMER 2020 11

W F OT U P D AT E

WFOT Update Adam Lo, WFOT 1st Alternate Delegate

WFOT Bulletin Articles on COVID-19 Occupational therapists around the world are continuing to work with distinction across various settings in response to the pandemic. If you would like to learn about some of the work and research that our international counterparts are doing, here are some examples of case reports and articles from the WFOT Bulletin: • A New Experience of Online Education under the COVID-19 Pandemic for Occupational Therapy Students in Palestine (Maher Assaf) • The Promotion of Positive Mental Health for New Mothers during Covid-19 (Kate Barlow and Aviril Sepulveda) • Covid-19 Pandemic: The All India Occupational Therapists’ Association’s Response to the Challenges (Anil K. Srivastava, Neeraj Mishra and Lakshmanan Sethuraman)

World Occupational Therapy Day 2020

World Occupational Therapy Day on 27 October 2020 was the annual opportunity to heighten visibility of the work of occupational therapy across the globe. With a theme of ‘Reimagine Doing’, the occasion celebrated the expertise of occupational therapy for reimagining participation in occupations that provide value and meaning to everyday life. 12 otaus.com.au

• Embracing telehealth: Supporting Young Children and Families through Occupational Therapy in Singapore during COVID-19 (Hepsi Priyadharsini and Jing Jing Chiang) • Disruption of Academic Occupations during COVID-19: Impact on Mental Health and the Role of Occupational Therapy in Tertiary Education (Karen M. Keptner and Karen McCarthy) To access the articles, please go to the WFOT Bulletin’s webpage: www. tandfonline.com/toc/yotb20/current

WFOT Occupational Therapy International Practice Guide 2020 For occupational therapists looking at practising occupational therapy in a different country or territory, the WFOT Occupational Therapy International Practice Guide 2020 provides essential information relating to entry-level requirements for language and practice in WFOT member organisations around the world. Additional sections of the guide also provide information to assist with exploring job opportunities, experiencing a new culture and developing a professional community. MORE INFORMATION

MORE INFORMATION

For more information about the bulletin and submission guidelines, visit: www.wfot.org/bulletin

The guide can be downloaded from the WFOT website at: www.wfot. org/resources/wfot-occupationaltherapy-international-practice-guide

Conferences and Events Reminder The following is a reminder of some of the occupational therapy conferences and events that are coming up around the world, providing opportunities to connect with one another across the globe. They include: American Occupational Therapy Association (AOTA) Children and Youth Specialty Conference 2020 This virtual conference is to be held 2-4 December 2020. Register by 29 November 2020 to participate in the live conference. For more information, visit: www.aota.org/ Conference-Events/Children-Youth.aspx WFOT Congress 2022 The 18th WFOT Congress will be held in Paris, France, 27-30 March, 2022. The

official Congress 2022 Facebook page is at www.facebook.com/wfot2022. More updated information will soon be provided at www.wfot.org/Congress Malaysian Occupational Therapist National Conference (MOTNC) 2021 A two-and-a-half-day conference for occupational therapists and other professionals, empowering networking, services and exploring applied knowledge. The event will be held 8-10 April 2021 at Rainbow Paradise Beach Resort, Penang, Malaysia. For more information, go to: www. eventbrite.com/e/malaysian-occupationaltherapists-national-conference-motnc2021-registration-66150394611

A O TJ R E P O R T

Celebrating Rural Health Research in the Australian Occupational Therapy Journal Dr Nerida Hyett, Australian Occupational Therapy Journal Editorial Board Member Robyn Soulsby, Neurological Stream Leader, Outpatient Rehabilitation Services, Bendigo Health Siobhan Branagan, Occupational Therapist, Outpatient Rehabilitation Services, Bendigo Health Fay Wallis, Occupational Therapist, Senior Clinician, Community Allied Health Services, Bendigo Health

o celebrate the theme of ‘Regional, Rural and Remote’ we discussed an article from the Australian Occupational Therapy Journal to highlight the value of rural health research for occupational therapists. The article was selected from the journal’s Virtual Issue for the Virtual OT Exchange 2020 hosted by Occupational Therapy Australia. The Virtual Issue is a new initiative for events held in alternate years to the biennial national conference. The article by Pighills, Tynan, Furness, and Rawle (2019) was titled ‘Occupational therapist-led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service’. I, Nerida, met with three occupational therapists from Bendigo Health who have experience in Environmental Assessment and Modifications (EAM) for falls prevention

to discuss how this research can inform practice. The following is a summary of our discussion highlighting their perspectives. Siobhan: I work across both the falls specialist assessment and generic rehabilitation clinics, which have different approaches to occupational therapist-led EAM. I read the article from this clinical perspective and reflected on my experience with a Knowledge Translation (KT) project with the Falls and Balance Assessment Clinic. Robyn: I read the article with two hats—as an occupational therapist and operational manager—and considered applications to practice from both perspectives. Fay: I read the article from the perspective of a senior clinician working in a multidisciplinary Community Allied Health Services team. We provide services under the Commonwealth Home Support Programme and our core business is to support people to remain living at home and prevent admission to residential care. Siobhan and Robyn: The article prompted us to reflect on the range of factors that support and hinder the conduct of evidence-based falls assessment across the continuum of care. In outpatient and community settings we have greater capacity to conduct home falls assessment (more time and fewer resource constraints). However, as highlighted in this research, there is variability in knowledge of EAM and falls prevention interventions. Evidencebased EAM was rarely reported in the study

setting and we reflected on the importance of therapists having a good understanding of falls assessment and prevention irrespective of setting in the continuum of care. This research made us reflect on how evidence-based EAM is supported at Bendigo Health through clinical supervision, professional development, a falls specific learning program for new staff in specialised roles, and ongoing quality improvement via KT and consumer engagement. Fay: Our service is more generalist, and while we are not a falls prevention service, the evidence is clear that falls prevention enables people to remain at home. Reading this article prompted me to reflect on how we conduct orientation and clinical supervision, and I reflected on how EAM fits within the occupational therapy practice process. The researchers discuss the role of the rural generalist occupational therapist which resonated with us. We discussed the differences between roles that require specialist falls knowledge in comparison with roles that require more generalist knowledge. Fay: At Bendigo Health, occupational therapists in outpatient and community settings often have more generalist roles, and falls prevention is part of the scope of practice, compared with our specialist Falls and Balance Assessment Clinic. Siobhan: For example, there is a difference between an occupational therapist’s EAM scope of practice working in a specialist falls assessment clinic compared to an orthopaedic rehabilitation clinic. CONNECTIONS SUMMER 2020 13

A O TJ R E P O R T

Robyn: Specialist knowledge of falls assessment and prevention also requires greater knowledge of factors that contribute to falls, such as medical comorbidities, medications, cognition, and vision. A more generic focus is common in rehabilitation clinics, which is where we could continue to build clinician knowledge of evidence and advocate for use of standardised assessment tools. We discussed the importance of KT for EAM and reflected on experiences of KT at Bendigo Health. Robyn: Following a KT process was really helpful in reviewing how our Falls and Balance Assessment Clinic is delivered. This helped us to understand how to apply the evidence in the local context and address context-specific and service-level barriers (e.g. staff grade and experience, and client geographical considerations). We used a KT process to effectively advocate for resources and to deliver evidencebased assessment (e.g. integrating a standardised home safety assessment). Siobhan: Our KT process has resulted in the geriatrician and physiotherapist being able to flag concerns early in preparation for home assessment, which gives clients more time to consider recommendations and increases acceptance. Robyn: Utilising a KT process was useful and positive for applying evidence to our local context with consideration of clinician knowledge and experience. We agreed with the researchers’ recommendations for peer support from experienced occupational therapists, and reflected on clinical supervision as a structure to support occupational therapists’ practice. Fay: Clinical supervision provides the supervisee the opportunity for reflection on practice and discussion, to explore learning needs, and opportunities to address them. This provides a framework for exploring clinical reasoning through a variety of

14 otaus.com.au

Clinical supervision provides the supervisee the opportunity for reflection on practice and discussion, to explore learning needs, and opportunities to address them. – Fay Wallis approaches (e.g. case and documentation reviews, and joint home visits). Bendigo Health therapists are supported by an organisation-wide Clinical Supervision Protocol for Allied Health and the Victorian Allied Health Clinical Supervision Framework to promote a consistent approach. Access to clinical supervision might address some of the issues identified in this research. Robyn: Clinical discussion with peers, alongside clinical supervision, is important for occupational therapists experienced in EAM because there are ongoing developments in options and equipment, and approaches to client communication. Fay and Siobhan: Communication skills and how recommendations are introduced to clients is strongly linked to acceptance and behaviour change, which is the key focus of this research: successful and sustained change. Orientation and training in the use of standardised home assessments is also important. A key issue identified by the researchers was a lack of documentation regarding occupational therapists EAM. Fay: My initial thoughts were that if it is not written down it didn’t happen. Communication of the occupational therapy process, including clear clinical reasoning, is also a valuable tool for promoting understanding of our role. At Bendigo Health we have overarching documentation guidelines with program specific examples. There are guidelines for the completion of initial and home assessment. This provides clear expectations for documentation,

a reference point for new staff, tools for reflection for existing staff, and promotes consistency across program areas. We reflected on the application of this research in our local rural/regional context. Siobhan and Robyn: We address the barrier of geographical distance in the Falls and Balance Assessment Clinic through administering the Westmead as part of occupational therapist assessment via telehealth for clients who reside greater than 45 minutes away. The use of a standardised home assessment tool helps to identify factors contributing to falls risk that might not have otherwise been identified through a generalist occupational therapist assessment. Robyn: Using telehealth for clients who live further away creates collaborative opportunities between our specialist clinic and local generalist services. Fay: Our program can provide face to face service to clients up to two hours away. Overall, we found it useful to reflect and discuss this research as a collective of clinicians across settings. This allowed us to consider how we align with the evidence base, areas for further practice review, and opportunities for further learning. Reference Pighills, A., Tynan, A., Furness, L. and Rawle, M. (2019) Occupational therapist led environmental assessment and modification to prevent falls: Review of current practice in an Australian rural health service. Australian Occupational Therapy Journal, 66, 347-361. doi:10.1111/1440-1630.12560

OT WEEK 2020

How You Celebrated OT Week 2020 Last year we reflected on and highlighted how occupational therapists work to support all people to engage in activities they find meaningful. Through the hashtag #ThisIsOT, people shared stories from their occupational therapy journey, learnings to offer, team photos, information on their practice area, and why they love OT. In 2020, given the onset of droughts, bushfires, and the global pandemic, our OT Week theme was: Resilience: Supporting our communities to rebuild, recover, and reengage. In supporting people to participate in activities they find meaningful, occupational therapists are vital in helping our communities through disaster recovery. This year the event not only shined a spotlight on the value of occupational therapy in our communities, but also served as a call to arms to support those hardest hit.

The Early Links OT team having fun at their OT Week event

OT Week event in West Moreton, Ipswich, Queensland

Pam Samra and Hannah Terry on the sunny Gold Coast, representing Mental Health OT

The University of Newcastle, Department of Rural Health, held its first face to face catch up to celebrate OT Week

OT staff at Osborne Park Hospital, Perth. Anne Pressley led a presentation on ‘OT in a COVID-19 World’, followed by an accessible gingerbread house building competition CONNECTIONS SUMMER 2020 15

OT WEEK 2020

Celebrations Across Australia In the midst of a challenging year, it was pleasing to still see such a diverse range of events (both in-person and online) held by our OT community across Australia. Here’s a look at how you and your peers celebrated the value of occupational therapy during OT Week 2020.

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WORLD OCCUPATIONAL

Life changing help from OT

WHEN Belinda Abel started losing her vision as a result of Autosomal Dominant Optic Atrophy, she was 1300 kms from family support, living in Orange with her husband and two children, aged ten and six. "Autosomal Dominant Optic Atrophy (ADOA) is where the optic nerve dies," Belinda said. "I thought I just needed stronger glasses but when the optometrist scanned the back of my eyes, it showed a bigger problem. I couldn't see well enough to drive at night or read with my children. Eventually, I had to tell my son's teacher I couldn't help out BETTER LIFE: With better lighting, colour with reading in the classcontrast and special magnifiers, Belinda room anymore. no longer got headaches and her kids started asking her for help. Photo: Supplied. I didn't know what was happening, I wasn't coping ing occupational therapy. well and had lost all self-contalking scales, a liquid level "That's when my life fidence." sensor to pour hot liquids changed. I knew the condiA move to Bendigo brought and had clear ideas for ortion was untreatable, glasses a clear diagnosis of ADOA ganising the pantry." for couldn't fix it so I didn't think Belinda. At the Eye and Belinda then got involved Ear I could be helped, but with Hospital in Melbourne she Vision Australia, everything in the community, including was given information about with Vision Australia as fell into place," Belinda said. a Vision Australia's specialist volunteer, supporting others "I could control the temsupport in Bendigo, includwith vision loss and her kids perature of the oven, use are asking her for help again.

Saturday October 24, 2020

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EVERY WALK OF LIFE: When crisis hits we are reminded how important occupational therapists the skills of are to our wellbeing. Photo: Shutterstock.

Occupational therapy more vital

OCCUPATIONAL therapy that we should acknowledg enables people to particie rebuild and re-engage. And the importance of the profespate in activities they once again life can be a posifind sion given the devastation of tive journey. meaningful. These activities bushfires and COVID-19. include taking care of oneself "Since my graduation, "It is also relevant for any(and others), working, I have seen enormous vol- one who has to face a major changes in the unteering, and participatin profession. g challenge in their lives," Ms Occupational therapy in hobbies, interests and so- Cooper said. has cial events. When life changexpanded to become a vital From acute illness to es suddenly due to accident component in the field of chronic disability or a trauor illness, it is often the skills health sciences. The Bendigo matic event forces us to conof an occupational therapist Regional Occupational Thersider how we can manage that brings some normality apy award, given through into the future. back to our lives. Latrobe University Bendigo "Daily occupations we Lynne Cooper, occupacampus, gives me a way of may have taken for granted tional therapist at Bendigo contributing back to my could become difficult. An profession and encouragin Regional Occupational Theroccupational therapist g will some of our future apy said it was appropriate leaders." help the person to recover,

Pivotal Occupational Therapy provides occupational therapy services to older adults and people living with a disability residing in the Loddon Mallee Region of Victoria. Pivotal Occupational Therapy is a registered provider of services for NDIS, TAC & DVA. Services are also provided to home care package providers and their clients. “The greatest feeling in the world is being a contribution to others and enabling their independence and engagement in everyday tasks that are pivotal to them”

Debra, Vision Australia client

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Lynne Cooper

• Advice on living safely and independently • Adaptive equipment and assistive technology • Maximise your NDIS and My Aged Care funding

• Home assessments for falls prevention • Special equipment at home to assist independence • Wheelchair and scooter assessments • Seating and special chairs • Personal alarm applications • Pressure care assessments • Palliative care - support to stay at home • Carer Support • Advisory service by phone

Speak with a local Occupa tional Therapist who can provide the support you need. Teal Annett McClellan - Winner of Bendigo Occupational Therapy Award for a Latrobe University OT student in 2020

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OT Week feature in the Bendigo Advertiser, prepared by Lynne Cooper

Monash University OT Department marked World OT Day with over 90 staff, fieldwork partners, collaborators and friends

Baked Goods at OT Week Inter Hospital Department Fremantle Hospital Bake Off (Freemantle)

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OT WEEK 2020

OT Week social BBQ and lawn games event in Whyalla, South Australia

Laura Fletcher and Miriam Hobson celebrating OT Week with the Northern Adelaide Local Health Network team at Lyell McEwin Hospita

OT Week Inter Hospital Department Hospital Bake Off (Fiona Stanley Hospital) with team winner Mel Grant

CONNECTIONS SUMMER 2020â&#x20AC;&#x201A; 17

OT WEEK 2020

Online Panel and Discussion Event On 27 October (World OT Day) OTA hosted an interactive online event, featuring a selection of thought leaders (Professor Lisa Gibbs, Dr Leanne Beagley and Dr Samantha Ashby) to discuss and promote resilience in our communities. The panel was then followed by breakout discussion sessions where attendees connected and discussed the concepts raised in the panel with other occupational therapists. Thank you to everyone (over 100 OTs!) who participated in the morning and afternoon live discussion sessions. The earlier panel discussion is now available as a recorded webinar here: www.otaus.com.au/cpds/ot-week-2020-panel-discussion

Social connections are the things that make the difference. Building those social connections when times are good will make the difference when we run into strife. Professor Lisa Gibbs

“ What strategies or resources have you or your team used this year to build or maintain resilience? ”

“ Have you experienced

any key changes in the way your clients or communities have wanted to engage during this time? ”

“ What interventions have you found successful to use with your clients to build resilience? ”

“ How have you balanced maintaining your own resilience in the last year when also trying to support others to reengage? ”

Encouraging people to talk about and share their narrative and their experience of what’s happened will be part of moving forward ... Speak up, talk and share. Dr Leanne Beagley

[As OTs], we can be strengths-based about what we can provide. Valuing the ordinary and also the importance of place--making sure that people have secure places wherever they choose to be. Dr Samantha Ashby

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F E AT U R E

Learning from Disaster: Teaching and Learning through the North Coast Bushfires Karen Hayes, Lecturer in Occupational Therapy, Charles Sturt University, Port Macquarie Campus

he choppers overhead drowned out the first-year students presenting their final oral viva one October day last year. The air was full of smoke, but smoke had been draped over Charles Sturt University in Port Macquarie like an oppressive blanket since July, so we were accustomed to it. Most of us had stopped talking about the irony of the peat swamp outside town being on fire in winter, and just woke up each day and looked outside to see how bad the smoke was. We coughed through classes, kept doors closed, and learning continued. But part way through that October day, the phone started pinging with panicked students: I will be late. I won’t make it. Roads are closed. Evacuation orders. Fire engines. Smoke. Planes. Helicopters. What do I do? Will I fail my viva? Uni can wait. Are you safe? Have you somewhere to go? Can you get there safely? What did the Rural Fire Service (RFS) say? Let me know where you will be. The telecommunications cable to the university burns through. Exams are over. Vivas are caught up. Mark them at home. The fires continue. The smoke remains. Maps of destruction predicted. Campus is closed. The smoke thickens and the skies go red. Sirens. Helicopters. The school is closed. Get the children! Implement bushfire plan. Wait and watch. ABC radio updates. Catastrophic.

Charles Sturt University, Port Macquarie Campus, October 2019.

Prepare to leave. Wait and watch. Fire engines in the street. Sirens. Choppers. Aeroplanes. Neighbours congregate to watch fire retardant fall from the sky. Under control. The danger passes for us—but not the town, and not the coast. A new role emerges for the campus as the student residence fills with orange jumpsuits and fire engines. Brave, resilient men and women who came to protect us fill halls and common areas usually reserved for students, with dusty boots and the sweet, sticky smell of burnt eucalyptus. Fire engines and teams stream in from Queensland, Victoria, the South Coast, and New Zealand. They need food, drinks, and warm, safe, clean beds. A grateful community steps forward. Academics, administration staff,

students, friends, and family take shifts cleaning, cooking, stacking drinks. My heart bursts with pride as I read in the Port News that the Charles Sturt Port Macquarie Occupational Therapy Club (OT Club) leads the way in stepping up to support the RFS volunteers. Occupational therapy students using occupation to support weary volunteers and to support themselves through this crisis. Don’t sit and watch—get up and do! Make a difference, fight the fear, and build resilience. The students in the OT Club worked tirelessly in shifts from October 2019 to January 2020 to feed the hundreds of firefighters who stayed on residence at Charles Sturt University when not out battling the fires that burned through the NSW north coast. CONNECTIONS SUMMER 2020 19

F E AT U R E

Their new lecturers arrived in the midst of a catastrophe and met the students while they were packing nuts into lunch boxes, stacking shelves, and cooking barbecues. They handed them gloves, boxes, and a packet of trail mix, and kept going. Welcome to Charles Sturt University. We are part of the Port community—so now you are, too. Please pack some nuts. These students are the future of regional and rural occupational therapy practice: practical, resilient leaders. I am privileged to teach them and grateful for what they are teaching me. No matter what they throw at us, we will keep growing together.

Top: Packing nuts for the firefighters. From left: Hannah Lewis (student), Danielle Morante (lecturer), Jaimie Prendergast (student), Laura Thomas (student) and Vagner Dos Santos (lecturer).

Hannah Lewis, Third Year Occupational Therapy Student, President Occupational Therapy Club, Charles Sturt University, Port Macquarie Campus It started with a simple text from our OT Club secretary: “We are cooking breakfast for the firefighters in the morning. Would you like to help out?” And as simply as that, only days after finishing our last exams, we had a small team on board. We arrived bright and early the next morning at the residential hub. The oncebusy room usually filled with students was bursting with tired firefighters and CSU staff and students. Tables lined with food, water, soap, first-aid supplies— everything you could imagine to be needed was there, mostly donated by community businesses and families. We grabbed our aprons and gloves and were put to work. Some of us cooked barbecue breakfast and lunch each day, others filled snack bags ready to be taken out on the job, others drove around town collecting supplies, and some helped clean the residence rooms. Whatever the job, big or small, there was always someone ready to put up their hand and help. What began with a call to help cook breakfast one Monday morning, soon turned into OT Club members turning up to help every day. We soon became known as the ‘BBQ Queens’.

Laura Thomas, Third Year Occupational Therapy Student, Secretary Occupational Therapy Club, Charles Sturt University, Port Macquarie Campus

Charles Sturt University, Port Macquarie Campus car park had very different vehicles in November 2019. Photograph by Bradd Payne 20 otaus.com.au

The OT Club’s involvement with supporting the care and housing of the firefighters in November 2019 gave

I remember one day vividly. I had work, so I turned up at the hub at 7am to cook breakfast, quickly got changed, headed for my job at 10am, finished work at 6pm, headed back to the hub to cook dinner and clean, and left about 11:30pm. As I was leaving, I felt a hand on my shoulder. I turned around. It was a firefighter. With one hand on my shoulder, he looked me in the eyes and said: Thank you! Thank you for everything you have done for us. It almost felt wrong to be the one being thanked when they were the real heroes. However, he went on to say that although they were the ones on the front line fighting the fires, it took an army of people behind the scenes to get them back to where they needed to be, day after day. It makes me extremely proud as the president of the Port Macquarie Occupational Therapy Club to say that our small club had such an enormous and positive impact on our community when it needed it most. As a result of this experience, I have never been more proud to be a student of Charles Sturt University. As a result of club events throughout the 2019 university year, we as a club were able to use some of our money to donate a supply of sunscreen to the firefighters staying at our campus. This was a much-needed supply given the heat and hours spent in the hot summer sun day in and day out.

me a sense of community and a space to feel valued in such a scary time. By giving back to those who selflessly protected the local community, I was able to truly appreciate the efforts they contributed. I felt extremely proud of the university I chose to be a part of, and how everyone stepped up and offered what they could.

C P D U P D AT E

CPD Updates For the latest courses and dates, please visit: otaus.com.au/cpd CPD ELEARNING SPECIAL: 20% OFF Throughout December 2020 and January 2021, members and non-members receive 20% off all CPD eLearning (Recorded CPD Library). Take advantage of this great saving to support your learning over summer: otaus.com.au/cpd

NEW GRAD? EXPLORE OUR NEW GRAD HUB While your transition into practice will be rewarding, we know the first few years can at times be challenging. These resources—consisting of five comprehensive modules—have been developed to help you on your way: otaus.com.au/ member-resources/new-grad-hub

WORKSHOPS, WEBINARS AND ELEARNING To support clinical decision making, continued learning and professional engagement, OTA offers a range of evidence-based CPD webinars, workshops and online resources. To browse and register, visit: otaus.com.au/cpd

NDIS LEARNING Are you interested in learning more about the NDIS? Check out the new content now available in the CPD Library. Simply filter by ‘Domain of Practice’ to view the range of learning opportunities.

INTERESTED IN PRESENTING CPD FOR OTA? OTA is now accepting Expressions of Interest (EOIs) for those wishing to contribute to the continuing professional development program. For more information and to submit, visit: otaus.com.au/cpd

WHAT DO YOU WANT TO SEE IN 2021? How can we further support your learning and development? What new areas would you like to see added to our CPD program? Please email info@otaus.com.au with your feedback and suggestions.

CPD BULLETIN Be sure to check your email for our monthly CPD Bulletin as we announce new workshops and webinars throughout 2021.

Thank you for supporting our 2020 CPD program through challenging circumstances. We have a variety of new content, presenters and learning opportunities for next year’s CPD program. We look forward to seeing you online or in person in 2021! CONNECTIONS SUMMER 2020 21

F E AT U R E

Bringing Student-led Services to Rural Queensland Robyn Sedgwick, Occupational Therapy Clinical Educator

he CQUniversity student-led Health Clinic first opened its doors to the Rockhampton community in July 2015. Initially the clinic offered community members student-led services (under the supervision of registered health professionals) in oral health, podiatry, and speech pathology. Shortly after, physiotherapy joined the services, and in January 2020 occupational therapy was welcomed into the fold. Preparation began to create a service that provided third and fourth-year CQUniversity occupational therapy students the opportunity to provide high quality support services to children and adolescents aged three to 18. Due to the nature of the student-led service, we were presented with the opportunity to create a service that was affordable and accessible to clients of all abilities. We aimed at children who were often described as falling through the gaps as they were experiencing challenges to their participation yet did not meet the criteria for diagnosis, and therefore could not access NDIS funding or school support. We also recognised our unique position as a central hub to rural and remote communities in the Central Queensland region, and knew we would have to ensure our service was built to support potential clients living in these communities. Planning how to make our service accessible to these communities was initially a challenge. However, a hidden blessing from the pandemic was that we had to familiarise ourselves with telehealth 22 otaus.com.au

Eilish Steinberg (left) and Alyssa Meyer (right) at Mount Murchison State School

service delivery much quicker than expected. We soon realised that delivering services via telehealth was not only manageable, it also offered a unique opportunity for students completing placement. Because of this, telehealth became a permanent feature of the CQUniversity Health Clinic, and we could begin offering our services to Rockhampton and the surrounding areas. Rockhampton has a limited number of local occupational therapy services and, consequently, large waiting lists to access necessary support. With this in mind, we kept advertising to a minimum, using the popular medium of Facebook and relying on word of mouth.

Word soon reached the regional town of Mackay just north of Rockhampton, where Colleen referred her 10-year-old son with a diagnosis of autism spectrum disorder. Before engaging with our services, Colleen said it had been difficult to access OT services in Mackay, where her son had been on waiting lists for two years, with most lists closed. She now says: “Keeping my son focused over telehealth has been challenging. We have enjoyed being able to have any interaction with an OT and love the OT student’s enthusiasm. It has engaged him in recognising his different zones of regulation and working on his anxieties.”

F E AT U R E

Travelling two hours west of Rockhampton is Biloela, where Leanne resides with her husband and seven-year-old son who she referred to CQUniversity Health Clinic in June 2020 after seeing a Facebook flyer. While Leanne’s son does not have a formal diagnosis, she indicates that this can impact on how accessible services are:

caseload; inability to attend to tasks, poor fine motor skills, and challenges with emotional regulation (specifically resilience). While no two clients are the same, being able to recognise this pattern did assist with information gathering processes and resource planning. This is notable as being adequately prepared is a key element of delivering service in a rural community due to the reduced access to general resources that we may use during a clinical session.

“We have nothing, really, and if an OT does come to town, kids either have to have a referral with extensive evidence or they have to be ascertained. The fact that due to my location being remote and our town lacking any form of occupational therapy, my son is no longer at a disadvantage due to telehealth services. Now he can continue on his journey and receive the help he so badly needs.”

Adequate preparation is also essential to ensure that the stakeholders (in this instance school staff) were provided with as much education and information as possible to assist with follow-up care. A considerable highlight of delivering outreach services is the high level of appreciation received from the community members you interact with. Due to the limited access they generally have to services, particularly occupational therapy, their willingness to engage with our service and gain education on how they can best support their students is quite incredible.

It has now been more than two years since Biloela has had a local occupational therapist, and with the support of the local Community Resource Centre (owned and operated by the Banana Shire Council, 2019) we liaised with the local schools to begin to educate and provide occupational therapy support to as many children as possible.

In saying that, due to their remote location all the schools we visited experience frequent issues with stable internet connection, a sentiment shared by the parents. This is a contributing factor to their openness to the use of telehealth. While many of the individuals we spoke to were willing to trial telehealth, there was considerable reservations due to their lack of experience with it, their general internet connection and lack of access to an appropriate space to conduct it in. This led us to the consideration of how our support can be delivered in a consultancy role to school staff rather than reliance on 1:1 telehealth session. To further supplement telehealth, we are fortunate, due to the structure of the student block placements (four blocks of ten occurring in-line with school terms) we will be able to plan routine visits twice a school term to Biloela (and surrounds). These learnings are specific to an outreach service delivered in a school setting, and as our service continues to build and we work more closely with families, our experience and service delivery methods may change.

By liaising with schools, local organisations or through simple discussion with concerned parents, it is relatively easy to identify the needs. However, the main challenge we have faced so far is considering how to best deliver follow-up care. This challenge was highlighted during our first outreach visit to Biloela and its surrounds in the second week of Term 4 2020. Two 3rd year occupational therapy students and I conducted a weeklong outreach visit where we attended three state primary schools and one state high school. It immediately became apparent that while the population of the rural communities may be smaller, the clinical presentations that we saw were just as, if not more, diverse in comparison to our in-clinic referrals. Despite this diversity, there were some consistent patterns across all referrals and our existing

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Not only does delivering an outreach service pose professional benefits as it challenges your exposure and ability to plan and adapt service delivery, it is also an opportunity to be reminded of how truly beneficial occupational therapy input can be.

Robyn Sedgwick graduated from CQUniversity with a Bachelor of Occupational Therapy (Honours) in 2016. Since this time, she has practised as a paediatric occupational therapist with Child and Youth Mental Health Services, Head Start Children’s Therapy Services and the Department of Education. She now works as the occupational therapy clinical educator at the CQUniversity Health Clinic while studying a Masters of Mental Health through La Trobe University.

CONNECTIONS SUMMER 2020 23

F E AT U R E

Working in Rural and Remote NSW: Challenges and Innovative Solutions Julie Cullenward, Occupational Therapist, Practice Lead at Marathon Health Mandy Colless, New Graduate Occupational Therapist at Marathon Health

ccessing therapy services has traditionally been difficult for people living in rural and remote regions. For people with complex disabilities, access can be even more challenging. This article will explore some of the factors that contribute to these challenges, and discuss innovative solutions to provide occupational therapy services developed by our rural NSW organisation. Some of the challenges have been: • Recruitment and retention in an environment where occupational therapists with the skills and experience working with people with complex disabilities are in high demand

• Tele-practice supports, such as having the required technology, having someone local to support the person with a complex disability in their environment if required, and ongoing education for staff and the person they are working with as new technology and interventions are developed • Ongoing access to key support people in the community who can assist with ensuring coordination and the continuation of services • Changing funding pathways and programs that can be complex and variable (such as the roll-out of the NDIS)

• Travel. The further inland, the more remote, and travel becomes a major consideration. An outreach service delivery model is required. This requires planning and organisation which takes time

• Complex equipment prescription. This includes how to provide a comprehensive assessment in a person’s environment, trial in the same environment, provide education and monitor and review the outcome for someone who lives five hours or more away from your base

• Long waitlists for services. Managing expectations and staying in scope in an environment of high clinical need and few other service options

• Providing services in a lockdown. How do you provide home modifications and prescribe a wheelchair in a COVID environment?

• Technological considerations, including access to hardware, data, platforms, and connectivity. You can expect and plan for unreliable connection (aim to have back-up plans A, B and C)

• Having unique conversations to support people to know what is possible. Breaking down barriers and perceptions about what a service can provide (e.g. not only a ramp, but perhaps a modified kitchen as well)

24 otaus.com.au

Occupational therapists Dimity, Grace and Hayley, who provide long-arm clinical supervision.

• Staying connected with staff and participants in rural communities In order to overcome some of these challenges, we have developed the following strategies.

Building a Multidisciplinary Team to Work with People with Complex Disabilities Recruitment practices were reviewed and a structured approach to recruitment was developed. We set out to develop a multidisciplinary team that could develop the skills to deliver services to people with complex disabilities living in rural and remote NSW.

F E AT U R E

This involved using multiple advertising mediums, initiating a student program (we have welcomed more than 20 occupational therapy students from five different universities), starting a new graduate program, and employing people from different disciplines to build a multidisciplinary team. Starting with two occupational therapists and one speech pathologist providing services to people with complex disabilities, we now have 15 occupational therapists and eight speech pathologists in the team. Retention is a key focus. The research from the Wobbly Hub project (ses.library.usyd. edu.au/handle/2123/9234) has assisted in this approach, including embedding the attributes it identified that may influence allied health professionals working with people with disabilities in rural areas to continue to do so (Gallego, et al. 2015). Initiatives to support retention include:

• Flexible travel arrangements. For example, incorporating flying into outreach models to reduce travel for those staff who are unable to spend a number of nights away from home and extend service delivery options • Work flexibility • Professional support. This includes clinical supervision, peer supervision, coaching, and mentoring with a focus on individualised arrangements to support the therapist. • Professional development. Staff are encouraged to identify PD related to their case load and interest area to build skills to extend options for service delivery. For example, two staff recently completed driver training assessments using this approach. The support of the scholarship program from the Rural Doctors network (RDN) is invaluable www.nswrdn.com.au/ site/hwsp. Staff are supported to participate in the Allied Health Rural Generalist Pathway Program (AHRGP) sarrah.org. au/ahrgp. Six staff are participating in this program, gaining valuable skills for working in rural and remote areas

Psychologist Kristie, occupational therapist Hayley and psychologist and pilot Matt.

• Renumeration. In attracting skilled senior clinicians and retaining new staff as they develop skills, appropriate renumeration is needed • Autonomy of practice. This is highly valued as a retention strategy as therapists value the ability to be flexible in managing their caseloads and contributing to practices

Collaborative Organisational Practices It’s important to incorporate organisational practices that facilitate communication and foster opportunities for people to be heard, valued, and contribute to shared values. We have a weekly communique, clinical support through practice leadership, successful outcomes are celebrated, and there are leadership opportunities to engage in. For example, all staff are encouraged to identify passion projects, with opportunities for these projects to be supported by management, and staff members having the responsibility to run the projects.

Working in a COVID Environment Moving to a working-from-home, virtual model of service delivery quickly was an experience.

“It was challenging and forced us to think outside the square,” one occupational therapist said. Some of the initiatives developed during this time were offering six virtual student occupational therapy placements, trialling tele-practice models using different platforms including Microsoft Teams and Healthdirect to deliver interactive therapy sessions, and developing practice guides for telehealth.

Service Delivery Models • Outreach. Outreach is a highly valued service delivery model and we continue to develop approaches to provide an efficient, flexible, consistent and timely service. Before COVID, we trialled a flying model (see photo). We have learned that planning is essential and no detail should be overlooked. One thing to be aware of, and to plan for, is organising a car at the other end when public transport and taxi services are unavailable • Allied Health Assistants. Working with allied health assistants/therapy facilitators in more remote areas provides a valuable link to the communities, and assists therapists located in bigger regional centres to connect to the people who have

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identified that they want an occupational therapy service delivered in their home community. We are trialling employing allied health assistants, and have a final year occupational therapy student employed as one of the trial options • Tele-practice. Providing tele-practice in all its forms is a growing model of service delivery, as we and the people we are working with learn the many options and try to keep current with new developments. Hardware and data options have been sourced to support people in more remote areas that do not have access (such as iPads with data, with the camera and video assisting with work in home modification assessments and equipment prescription)

Staying Connected We have initiated an OTA Regional Interest Group (RIG) and support occupational

therapists to join communities of practice to stay connected and interact with their profession.

Marathon Health, a not-for-profit, registered charity located in rural NSW and the ACT.

Working in rural and remote communities is rewarding and challenging. No two days are the same. We continue to focus on building a sustainable and quality occupational therapy service. MORE INFORMATION

Mandy Colless is an occupational therapist who graduated with a Bachelor’s degree in 2018 and started with Marathon Health in 2019. Mandy has a keen interest in rural and remote health. Mandy travels to rural communities to provide an outreach service to participants under the NDIS. References

To learn more and get involved, visit: www.otaus.com.au/member-resources/ interest-groups/regional-groups. About the Authors Julie Cullenward is an occupational therapist with extensive experience working with people with complex disabilities in rural areas. She is employed in a Practice Lead role with

Gallego, G., Dew, A., Lincoln, M., Bundy, A., Bulkeley, K., Brentnall, J. and Veitch, C. 2018, Carer's Preferences for the Delivery of Therapy Services for People with a Disability in Rural Australia: Evidence from a Discrete Choice Experiment, Intellectual Disability Research (62) 5 371-381 Gallego, G., Dew, A., Lincoln, M., Bundy, A., Chedid, R., Bulkeley, K., Brentnall, J. and Veitch, C, 2015, Should I Stay or Should I Go? Exploring the Job Preferences of Allied Health Professionals Working with People with Disability in Rural Australia, Human Resources for Health, 18-53

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Going Rural, Regional and Virtually Beyond Borders Nick Warren, Manager of Marketing and Community Relations at Solve Disability Solutions

elehealth may seem like a new concept developed on the back of the global pandemic, but health services have been delivered outside the traditional face-to-face model in Australia since 2007. First known as the National Health Call Centre Network (NHCCN), the 24-hour, seven-day government-funded service was later renamed Healthdirect Australia, providing health advice and information via telephone and a range of digital channels. Fast forward to April this year when federal Health Minister Greg Hunt reported that more than 4.3 million health and medical services had been delivered to more than three million people through the telehealth items introduced by the Australian Government in response to COVID-19. An extra 28 telehealth items for specialists and allied health professionals were then added to the Medicare Benefits Schedule, allowing more people to receive care by video or telephone during the pandemic. Once reserved for rural and remote areas, telehealth’s services, tools and resources have now been universally adopted. This is an extraordinary digital transformation for Australian healthcare, linking the breakthrough innovations of wi-fi and the world’s first national disability health reform. Research shows that telehealth can enhance quality of care by managing chronic disease better, applying best practices, developing the knowledge and skills of providers, and improving care coordination.

But is it really as good as the research says? Telehealth continues to improve timeliness and outcomes. It has also been the catalyst for numerous changes that result in better quality of care. Melbourne-based occupational therapist Liz Doyle provides telehealth services to regional Queensland. “While telehealth was originally started to support people in rural and regional areas—where access to good quality services and health professionals is limited, and staff turnover is frequent— modern telecommunications fill the gap by enabling occupational therapists to stay with their client regardless of where they live.” – occupational therapist Liz Doyle Delivering channels for better choice and control, telehealth allows people to choose how and when they access health services and providers. “I support a person in Queensland whose dietician is in Tasmania, and their psychologist is in Brisbane. It’s pretty amazing,” Ms Doyle said. According to Healthdirect, it has many advantages. Benefits for clinicians: • Efficiency: Video consultations can be an extension of day-to-day clinical practice • Flexibility: Work from anywhere that has a good internet connection, including from home after hours

• Cost: Save on the costs of travel, rooms and clinic space when working remotely • Coverage: Ability to offer services to a wider network of patients Benefits for clients: • Access: Provides quality health care to everyone regardless of where they live • Continuity of care: Outpatient followup appointments can be maintained with more consistency due to simple, convenient access to clinicians • Holistic health: Local health professionals such as nurses, Aboriginal health workers or general practitioners can be on call to check blood pressure, interpret test results, or answer specialist questions • Confidence: Reliable and secure system Like all technology, it’s great when it works. While telehealth does not replace all clinical interventions, with more than four million services delivered this year alone it has proven highly effective in enabling continuity of care and safely delivering essential services to metropolitan and regional communities.

Rolling into Regions Offline and on the front lines, health services continue to be delivered across the country in a COVID-safe way, especially in regional areas where there are lighter restrictions and fewer community transmissions. With continued emphasis on the importance of exercise during the

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Building up Ballarat In 2016, Ballarat had one of the highest regional populations needing daily help due to disabilities. At 6.2 per cent of the general population, it was a significant number for a city with just over 100,000 people and less than 50 NDIS providers (NDIS Provider Guide, 2020). Due to growing demand and trouble accessing assistive technologies in regional areas, metropolitan-based providers have expanded their specialised services. Melbourne-based Solve Disability Solutions has partnered with TOM: Melbourne to drive innovation in the Ballarat community. Together, these dynamic teams design and build products that solve complex problems and meet the needs of people living with disabilities. One key focus is increasing access to supports and services to enable greater participation in sport, recreation and leisure activities.

Freedom Wheels enables riders of all ages and abilities to learn to safely ride a bike

pandemic, communities across Australia have been seeking safe ways to engage in physical activity. In particular, there has been growing interest in bicycles, tricycles, e-bikes and exercise bikes. In Port Macquarie, physiotherapist Laura Burke works with people of all ages who live with disabilities. Having poor access to equipment, they eagerly await visits from metropolitan providers. “Until recently, there wasn’t really anything available for my clients who wanted to ride a bike. But we’re changing that now,” Ms Burke said.

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Unsatisfied with the limited local offering and fly-in-fly-out services, Ms Burke has teamed up with Sydney-based assistive technology specialist TAD to make the Freedom Wheels customised bike service available on an ongoing basis. “Freedom Wheels has been taking off and it’s been really great getting more people in Port Macquarie on bikes to enjoy riding with family and friends.” – occupational therapist Laura Burke Port Macquarie is one of three regional areas into which Freedom Wheels has expanded this year, following the launch into the Hunter region. Up next will be Ballarat.

In November 2019, Ballarat came alive with the TOM: Ballarat Makeathon. The event— the first of its kind in regional Victoria—brought together experts (Makers) and people with disabilities (Need Knowers) to address challenges. TOM: Melbourne hosted the two-day event in partnership with the Victorian Government, philanthropist Debbie Dadon (AM) and Ballarat Tech School to allow allied health professionals, engineers and people with disabilities to co-design innovative solutions (see case study). “The Makeathon is a life-changing experience for both people living with disabilities and Makers.” – Debbie Dadon (AM), TOM: Melbourne The event combined a talented cohort of 36 individuals from regional and metropolitan Victoria working on three unique Need Knower challenges. Held at the Ballarat Tech School at Federation University, the facility’s unique and innovative learning environment delivered everything from 3D printers to laser cutters, modern electronics, and a metal and wood workshop.

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“TOM: Ballarat was such an amazing experience which enabled us to help, learn and laugh.” – industrial designer Brigitte Montalan With regional and rural areas across Australia receiving growing attention and resources, occupational therapists have exciting opportunities to tap into, and be part of, assistive technology. Therapists in hospitals, private practice, specialist schools and rehabilitation facilities are partnering with providers to maintain local access to essential assistive technologies. “Where is the choice and control if the only options for people with disability in regional areas are to either go without, wait for months, or travel hours to trial a piece of equipment? We can do better. We are doing better.” – Nick Warren, Solve Disability Solutions By partnering with an assistive technology provider, occupational therapists can gain better and ongoing local access to disabilityspecific programs, services and equipment. MORE INFORMATION

To find out more about local assistive technology providers and partnership opportunities in your state or territory, visit www.tadaustralia.org.au. About the Author Nick Warren is a marketing and communications professional based in Melbourne. He is the Manager of Marketing and Community Relations at Solve Disability Solutions, and is on the Board of Directors of Accessible Beaches Australia.

TOM: Ballarat Makethon: Team Joanne created a device that enables Joanne to independently put on her shoes

CASE STUDY: TOM: Ballarat Makethon (2019) Challenge Joanne, 47, has a neurological degenerative muscular disease that limits mobility in her arms and legs. She has trouble using her hands due to her flexed wrists and poor skin quality, making simple tasks incredibly difficult. Joanne would like a device that helps to hold her shoes open so she can independently slide her feet in.

Solution Team Joanne (blue) has created a device that enables her to put her shoes on. The device has two hardwood panels, one supported by a pneumatic actuator that can adjust the pitch and angle of the platform. The platform contains a lip to secure either the left or right foot and a magnetic hook mechanism to hold the tongue of the shoe open.

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Exchanging Ideas, Knowledge and Support ARATA and OTA Collaborate to Run Assistive Technology Group Mentoring Dr Natasha Layton, PhD, Occupational Therapist, ARATA International Lead Betty Kuok, Occupational Therapist, TAD

he OTA MentorLink program is a wellestablished and successful resource connecting occupational therapists with mentors across wide ranges of practice. More information can be found on the OTA website otaus.com.au/membership/ ota-member-programs/mentorlink. However, mentors in the assistive technology (AT) field are difficult to recruit, so alternative models—drawing on a longstanding established AT community of practice—were sought to meet the needs of recent graduates interested in the area. The Australian Rehabilitation and Assistive Technology Association (ARATA), as peak body for AT in Australia, partnered with OTA on this initiative. Through a pilot project, the associations collaborated to offer AT mentoring for OTA members by ARATA members who are practitioners from a range of disciplines, across a range of AT practice areas.

About the Project Mentee/mentor dyad Dr Natasha Layton and Betty Kuok planned the pilot group mentoring series. Mentors were sourced from the OTA MentorLink program pool, having a minimum of five years of clinical experience and being members of OTA and

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ARATA. Mentees were sourced from the MentorLink program and chosen according to interest and need. The pilot ran as the AT Group Mentoring Series in winter 2020. AT resources were drawn from the literature and occupational therapy teaching contexts by Dr Layton, and were appraised and organised by Ms Kuok for discussion during sessions, provided to participants in a PowerPoint resource pack. The content was created to focus on mentoring, not clinical supervision. This included models of practice, frameworks, evidence-based approaches, clinical reasoning, and tools and resources. Three 75-minute Zoom meetings, hosted by OTA and chaired by ARATA, were held monthly from May to July. Four mentors and four mentees, plus Dr Layton as chair, volunteered to participate. A pre- and post-survey was conducted to review the utility and benefit offered by the group mentoring model, and gather recommendations for future directions. Four mentors attended the sessions, with one absence during a session, and three mentees participated in each session.

Session Outline Each session included sharing of backgrounds, motivations, current

Figure 1: Participants’ responses to group mentoring surveys – Key Word Depiction

work situations, and examples from occupational therapists practising in AT. Discussions were guided by topics that enabled questions and answers, taking turns in conversation and storytelling. • First Session: Included models of practice and each person’s favourite frameworks for assessment and intervention, as well as pros and cons of each approach. For example, the IMPACT 2 model outlines the range of interventions an occupational therapist has at their disposal. Sometimes workplaces enable a wide range of interventions or a broad set of funded options, and sometimes they do not. • Second Session: Focused on pragmatic constraints to practising to our best ability, and strategies to manage these.

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This included discussion about how the broader context of workplaces and areas can impact on practice—such as funding models or differing scope of practice within each role, and included dialogue about the need for holistic bodies, advocacy, and policy change in the greater context. How can we work a ‘political practice’1 of occupational therapy? By connecting consumers into systemic advocacy actions, monitoring work completed by peak bodies which can support our practice, including argumentation in our reports to support policy makers and funders to see the value of expenditure, and sharing current evidence with our workplaces. • Third Session: Involved sharing of case examples that held meaningful practice principles that mentors learned through experience, and utilising those values in practice. Themes included supporting participation, family and culturally informed practice to support engagement, and working in group homes, telehealth settings, and low and middle-income settings.

Outcomes Pre- and post-surveys incorporated openended questions about participants’ experiences. A Likert rating scale of abilities in different components of practice included professional skills, confidence with practice, support and networking within the profession, job satisfaction, and personal and professional growth within the career. The concepts chosen to be rated were drawn from literature about the benefits2 ,3,4 of one-on-one mentoring to determine if the same benefits could be achieved through a group mentoring style. Results showed that, as a group, improvements in almost all components were recorded with the greatest increases being in professional networking, interest in work, connectedness to the profession and job satisfaction (see Table 1). Mentees and mentors had sought participation in the program for growth and to become

more active in the profession. Mentors aimed to pursue formal mentoring experience and further their engagement and development with this role.

The last month has involved

Positive feedback focused on the social aspects in the program such as networking and connecting with other occupational therapists. Feedback also included development in thinking critically as an occupational therapist working in AT, while mentors noted accomplishment with a formal mentoring role.

practice. There have been

Group mentoring provided an enjoyable opportunity to meet and talk with colleagues. There was a sense of trajectory across the three sessions. Conversations about experience in practice validated existing concerns from mentees in work, and provided insight to potential challenges that could arise. Mentors enjoyed hearing about current jobs and contemporary practice challenges, some of which were the same as when mentors were new graduates, and some very different. Mentees had current knowledge of models of practice, and mentors had

increased flexibility and growth in my professional moments of isolation, but at the same time increased connectivity with others. It has been both a challenging and rewarding time. – Mentor old favourites. We all learned something about what models have in common, where they can help, and what happens. “Always helpful to reflect on practice with critical friends, this process enabled this to occur. Particularly useful to reflect on a career of practice, through the eyes of newer graduates, as this provides insights about ways of thinking, contemporary models, etc.” – Mentor

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While being mindful of trying to meet the learning needs of our mentees, each of us experiences clinical dilemmas and practice constraints. As a result, lots of ideas and strategies based on pastpractice knowledge were shared. Mentees said it was beneficial to hear mentors discuss their practice issues—current and past—and hear the perspectives that a group of ‘critical friends’ could offer. Several mentors offered to continue mentorship arrangements individually.

Lessons Mentors and mentees valued this program. We learnt that three sessions were useful, but monthly sessions were too far apart. A three-weekly series was recommended. A 6pm timeslot worked across time zones, though some participants were commuting home from work during this period. We wondered if a group format would be a challenge for mentees to share their concerns and dilemmas and seek individualised discussions. We feel the time-limited cycle of engagement with colleagues did provide a starting point for building a community of practice support for our mentees. We also observed and experienced that the overall content of sessions could be translated through different work contexts. Additionally, the social aspect was reported to be a rewarding component of this program.

Table 1 Rating Key (1: very poor, 2: poor, 3: fair, 4: good, 5: excellent)

on AT, or in collaborating on group models as described above, please get in touch with ARATA via www.arata.org.au If readers would like more information on the MentorLink program or wish to apply as a mentor or mentee, please contact Lissa Selga, National MentorLink Coordinator, via mentorlink@otaus.com.au MORE INFORMATION

Members may also be interested in joining the new OTA Assistive Technology Special Interest Group. For more details, see www.otaus. com.au/member-resources/interestgroups/assistive-technology.

What Next?

About the Authors

This article describes our AT group mentoring program pilot and presents a brief snapshot of the review conducted to establish benefits and areas of improvement. Three out of four mentors have signed up to provide individual mentoring. This pilot demonstrated significant potential to connect people interested in AT and may be a useful addition to the individual mentoring program as it runs.

Natasha Layton is a Melbourne-based occupational therapist practising, researching and teaching in the areas of AT, disability, and outcomes. She is a Senior Research Fellow with Rehabilitation, Ageing and Independent Living (RAIL) Research Centre at Monash University, an Industry Adjunct with Swinburne University of Technology, and consultant to the World Health Organisation. Natasha is past president and currently the international lead of ARATA, the peak body for AT in Australia (www.arata.org.au).

Group mentoring is, we feel, a viable model and has enormous potential for expanding mentoring options for members. If readers are interested in further exploring mentoring 32 otaus.com.au

Betty Kuok is based in Sydney and is an occupational therapist at TAD. She has

an interest in assistive technology design and accessibility to help people achieve their goals, and investigating qualitative research methods to better understand and improve service provision. The authors would like to thank ARATA and OTA for their support of this project, including Lissa Selga, Libby Callaway and Carol Jewell, and the mentors who shared their time and experiences: Liz Doyle, Rachael Schmidt, Rachelle Baldock, and Robyn Guthrie. References 1. Pollard, N., Sakellariou, D., and Kronenberg, F. (Eds.), (2008), A Political Practice of Occupational Therapy, Philadelphia: Churchill Livingstone Elsevier 2. Doyle, N. W., Lachter, L.G., and Jacobs, K. (2019), Scoping Review of Mentoring Research in Occupational Therapy Literature, 2002-2018, Australian Occupational Therapy Journal, 66(5). doi: 10.1111/1440-1630.12579 3. Smith, L. S., McAllister, L. E., and Snype Crawford, C. (2001), Mentoring Benefits and Issues for Public Health Nurses, Public Health Nursing, 18(2), 101-107 4. Wilding, C., Marais-Strydom, E., and Teo, N. (2003), Mentorlink: Empowering Occupational Therapists through Mentoring, Australian Occupational Therapy Journal, 50(4). doi: 10.1046/j.1440-1630.2003.00378 MentorLink (2013), Health Professionals Supporting each Other: Education Workbook, Victoria, Australia: Occupational Therapy Australia Wilding, C., and Marais-Strydom, E. (2002), Mentorlink: An Australian Example of Continuing Professional Development through Mentoring, British Journal of Occupational Therapy, 65(5), 224-226. doi: 10.1177/030802260206500507

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Rural Health Commissioner Report: Improvement of Access, Quality and Distribution of Allied Health Services in Regional, Rural and Remote Australia Alison Dymmott, Lecturer and PhD Candidate at Flinders University Caring Futures Institute A/Professor Stacey George, Academic and Research Lead for Occupational Therapy, Flinders University Caring Futures Institute

ith the wide-ranging challenges that regional, rural and remote occupational therapists face meeting the needs of their communities while maintaining their own worklife balance, outgoing Rural Health Commissioner Professor Paul Worley’s recent report articulates opportunities for change. The report outlines four recommendations for improving the access, quality and distribution of allied health services in regional, rural and remote Australia: 1. The service and learning consortia program involves local services including government and nongovernment agencies, networks and training organisations being brought together to develop collaborative service models that are co-designed by local communities and service providers 2. Investing in a culturally safe and culturally responsive workforce explores possibilities for expanding the number of Aboriginal and Torres Strait Islander students training to become allied health professionals and the strengthening of culturally safe and responsive workplaces 3. Investing in allied health data and infrastructure outlines the need for investment in allied health data and infrastructure in order to demonstrate gaps in the distribution of allied health, and more robustly advocate for change

Stacey George and Alison Dymmott

4. Investing in national leadership was enacted shortly after the release of the report, with the appointment of Dr Anne-Marie Boxall as the inaugural Chief Allied Health Officer. This role has been advocated for extensively and will see allied health representation and input into federal government policy By bringing services together into a learning consortium, they will be better positioned to expand and attract new funding, as well as improve supporting and training staff. The report acknowledges that this would require ‘back-of-house’ support to be sustainable, reducing the administrative burden on clinicians, however, it is unclear how this would be funded. There were suggestions of the reprioritisation of funding or the application for catalytic Commonwealth funding, but as we work through COVID-19 with billions of dollars being spent on health and the

economy, it is challenging to envisage how this will be available in the near future. The report outlines a range of benefits of these consortia, including having a positive influence on how allied health professionals are trained for rural practice at university. Having access to rural and remote placements—with opportunities for students to spend considerable time in rural and remote areas during their training—was proposed as a strategy for improving access to health education for rurally raised students. Having locally available occupational therapy supervisors is a challenge in rural areas with high numbers of vacancies and workload pressures. In our experience at Flinders University, rural and remote occupational therapists go over and above the call of duty to support students wherever possible. However, the idea of having longer placements, as also suggested, may be challenging.

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2020 has demonstrated to universities that remote learning is possible to some extent for occupational therapy courses, as a range of students spent most of first semester in their regional, rural or remote home towns. This posed a range of challenges for universities, drawing focus further onto adaptive approaches to work-integrated learning. One of the challenges that Worley discussed was the lack of rurally based academics to help students bridge the gap between online curriculum and practical skills. As a result, students sometimes needed to travel to university for practical learning. The idea of the learning consortia raises interesting ideas for local regions to come together to support local students—further strengthening the innovative work that they are already doing—however, a range of barriers needs to be addressed. These include adequate numbers of rurally based students to fund courses locally, placement and supervisor availability, options for face-toface practical teaching, accessible pathways for university study, local facilities to enable students to study together, accommodating the varying health and wellbeing needs of regional, rural and remote communities in curriculum, and accommodating accreditation requirements of allied health courses. All of these barriers could be accommodated with adequate resourcing and flexibility in accreditation requirements. The commissioner discussed the need to support early career allied health professionals to develop their skills and careers without having to move to a metropolitan area. He acknowledged the early success of the Allied Health Rural Generalist Pathway and recommended that this continue to be rolled out across Australia. For occupational therapists, the generalist pathway appears to have a range of benefits, with Flinders University researching the impact of the pathway in South Australia (Dymmott, Brebner, George and Campbell ,2019) and early results indicating positive outcomes and experiences for occupational therapists. These preliminary results indicate that funding for more occupational therapists 34 otaus.com.au

to undertake postgraduate study relevant to rural practice would be beneficial. The development of the learning consortia would enable the second recommendation, with avenues to reduce barriers to regional, rural and remote people undertaking allied health courses. It will be imperative that these consortia work collaboratively with local Aboriginal Community Controlled Health Services and associated services to ensure new initiatives are safe for Aboriginal and Torres Strait Islander people to engage with. Again, this requires significant local resourcing and expertise—but more importantly it requires relationships and trust with local people, and adaptive approaches to work-integrated learning. Occupational therapy programs around the country are working to further embed culturally responsive content into their curriculum, however there is a long way to go. Having access to Aboriginal and Torres Strait Islander people who are willing and able to teach occupational therapists and students is challenging without overburdening those who are willing to help. We need to continue to build reciprocal and meaningful relationships with local elders and Indigenous health professionals in rural and remote areas who can help us deliver the most culturally appropriate curriculum, and it will be great if the service and learning consortia are able to support this. The third recommendation has broad implications for allied health funding, as currently there is no single repository for data demonstrating the impact of allied health services. Data linking allied health activity to health outcomes and inequities in rural and remote areas would support data-driven solutions. This should be a priority for the chief allied health officer to initiate. It will be imperative that the collection process is not a burden for local services, and that they have access to aggregated data in order for it to be useful. A range of long-term and multilayered challenges and opportunities exists in enacting these recommendations—especially

in establishing learning consortia with an expectation that a wide range of public, private and non-government agencies will work together. These challenges must be addressed and will be unique to each rural and remote location. Retention of occupational therapists is a major barrier to both relationship building and continuum of care, and any strategies that can make a difference are worthwhile. In our research in South Australia, we find that occupational therapists intend to stay in rural areas for a range of personal, clinical and organisational reasons—some of which could be easily influenced, and others being more challenging (such as location of family or partner, and lifestyle). These findings support the Commonwealth Government investing in the commissioner’s recommendations with a collaborative consortium-led approach, so we can start to see locally driven change to improve health outcomes for all people in regional, rural and remote Australia. About the Authors Alison Dymmott is an experienced occupational therapy rural practitioner, Lecturer and PhD candidate at Flinders University Caring Futures Institute. A/Professor Stacey George is Academic and Research Lead for Occupational Therapy, Flinders University Caring Futures Institute, and an Associate supervisor along with Professor Chris Brebner and A/Professor Narelle Campbell of the Allied Health Rural Generalist Pathway: A workforce strategy project. The project is funded through the Rural Health Workforce Strategy (Government of South Australia). References National Rural Health Commissioner (2020), Report for the Minister for Regional Health, Regional Communications and Local Government on the Improvement of Access, Quality and Distribution of Allied Health Services in Regional, Rural and Remote Australia, accessed online https://www1.health.gov.au/internet/main/publishing.nsf/ Content/2922D6D8BBCE122FCA2581D30076D09A/$File/ National%20Rural%20Health%20Commissioner’s%20 Allied%20Health%20Report%20to%20the%20Minister%20 June%202020.pdf Dymmott, A., Brebner, C., George, S. and Campbell, N. (2019), South Australian Allied Health Rural Generalist Pathway Evaluation: Phase 1 report December 2019, Flinders University, South Australia, accessed online https://www.sahealth.sa.gov.au/wps/wcm/ connect/89c9c150-285d-44e0-8ae2-8fbaa4d96670/

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Bunbury Garden Labyrinth: A Place for Hope, Harmony and Community Linda Blyth, Occupational Therapist at Key Assets “This is a place for hope, contemplation, and re-creation. Seeds have been sown, activation has begun, and we now hand this labyrinth over to you, the village, for your use, to live in, move through, step by step and onwards.” – Linda Blyth at Bunbury Garden Labyrinth opening on 19 September 2020. In 2015, a small group of mental health professionals and friends gathered in Bunbury, Western Australia, to share conversations about family, life and loss, and how we grow ourselves and our communities through the difficult places we find ourselves in. They said, “Let’s build a place for hope in the heart of Bunbury—a garden labyrinth.” A labyrinth is an ancient cross-cultural, non-denominational sacred space. It invites quiet contemplation. It is a path we can walk alone while being alongside others. Nari Jones, occupational therapist and secretary of Projects of Heart and Soul, put it this way: “As we walk the inevitable twists and turns, we are ultimately brought to the centre, to our own centre. Our breath slows and the relaxation response means we are able to be present with ourselves and our surroundings. Moving quietly, step by step, as we make our way back out along the very same path we came in on, allows space to pause, remember and authentically respond to what is going on in our lives, rather than simply react in stress. It invites a way through the chaos and complexity.” As a first step, the group formed the not-for-profit Projects of Heart and Soul with a committee of management led by occupational therapists Carolyn Ngan

Labyrinth, Moongate and Welcome Disc. (Photo: Linda Blyth)

(chairperson) and Nari Jones (secretary). It collated evidence-based research on health outcomes, green spaces and mindfulness practices, then formed sub-committees to drive the various aspects of the project, from design and fundraising to implementation and community engagement. Colleagues from health and business backgrounds joined the committee including occupational therapists Di Panorios, Heather Reid, Mel Birrell and myself (current chair). Wider conversations were facilitated with the executive and elected members of City of Bunbury and the Bunbury Rotary Club and their extensive networks and community groups, sponsors, suppliers and tradespeople. Bunbury Garden Labyrinth opened on Saturday, 19 September in the presence

of Mayor Gary Brennan, Member for Bunbury Don Punch, the chief executive and councillors of the City of Bunbury, designers Nic and Alex Mickle from Safehaven Studios, our eight major sponsors and other contributors and supporters. A local Noongar elder, a singer and dancer from Wardandi Miya-k Kaadadjiny, provided a Welcome to Country as the labyrinth was formally handed to the City of Bunbury. It joins a national and international network of labyrinths, acting practically to bring peace and contemplation to individuals, to the wider communities, and to the many tourists and pilgrims who visit such sites. In every culture, on every continent, for thousands of years, labyrinths have been created to bring together communities. In the CONNECTIONS SUMMER 2020 35

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• A neighbour comes regularly to give extra care and water the plants • A person using a wheelchair moves through the circular path, gaining a sense of the turns and cycles of the winding path • A worker walks the circular path on their way to and from the CBD for work • Someone uses the labyrinth as a structured path for exercise as part of their physical rehabilitation or as walking mindfulness for mental health and wellness Committee of management in front of Labyrinth and Moongate: John Sherwood (retired teacher), Linda Blyth (OT, Chairperson), Michele Schoder (Treasurer), Di Panorios (OT). (Photo: Nicolette Barbas, South Western Times)

• Three friends meet to sit, talk, walk and reflect

modern context, labyrinths are used for many purposes including mindfulness, recreation, education, rehabilitation, spiritual healing and personal wellbeing. Evidence of health outcomes via the use of labyrinths occurs within green spaces and mindfulness research.

• A family walks the circular path as one point along their circuit around the inlet

As part of OT Week celebrations in October, the South West Occupational Therapists Professional Development Group organised for Di Panorios and myself to facilitate a professional development session with colleagues on Labyrinth Walking as Mindfulness, supporting use of the labyrinth for reflexive practice, goal setting and self-care.

Reflecting on the Garden

• Generosity of spirit, curiosity and openness to new ideas and ventures • Quality of craftsmanship and leadership in big and small details of this design and building process People are now being invited to form a Friends of Bunbury Garden Labyrinth group, helping to facilitate ongoing activation and enlivenment of the space. Each in our own capacity enters the labyrinth in our own way, with a different experience each time: • A child runs in and playfully follow the curves around and out again with delight

• People practise the flowing movements of qigong in the morning sunlight About the Author Linda Blyth is an occupational therapist at Key Assets in Bunbury, Western Australia, having worked in various settings in the southwest of WA for 34 years. She has been a member of the committee of management of Projects of Heart and Soul WA for three years including 12 months as chairperson and is leading the formation of Friends of Bunbury Garden Labyrinth.

As a community development building project with many twists and turns, Bunbury Garden Labyrinth was completed over five years within a restricted budget. It was made possible through people’s vision, fundraising initiatives, and donations of materials, skills and labour. Through all this, the committee comprising several occupational therapists noticed that not only had they been building a garden and public meeting space, but also harmony and community. They witnessed surprising gifts and capacities arising in this process: • Relationships, connections and teamwork between people from all walks of life • Understanding of different skills, strengths and industries contributing to a common goal 36 otaus.com.au

Gathering of occupational therapists following the opening ceremony: Linda Blyth (committee chair), Nari Jones (secretary), Bess Fowler, Carolyn Ngan (founding chair), Heather Reid (previous committee member), Di Panorios (committee); Deb Wraight. (Photo: Carolyn Ngan)

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Tips for Managing a Remote Workforce Anna Pannuzzo, Director at WorkPlacePLUS

ver the past several years, a growing trend in the disability and aged care system has been the number of people wishing to receive care in their own homes. This has created a greater demand for allied health home visits and other home care options. 2020 took working remotely to a new level, with people across all industries working from home wherever possible to slow the spread of COVID-19. Telehealth has surged in Australia as the safest option for providing health care where practical. Managing a remote workforce presents a range of leadership challenges and considerations.

Monitoring Staff Performance With practitioners and staff working remotely, it can be more difficult for supervisors to ensure the work is performed to the agreed standard. Supervisors need to be able to track and measure staff performance, both during the probation period and throughout employment, including: • Agreeing on performance goals, expectations and KPIs • Giving and receiving feedback with staff • Giving and receiving feedback with clients • Measuring outcomes and feedback Management Tips • Review your organisational policies, processes and expectations for performance management, ongoing supervision, communications, and working from home

• Set up regular one-on-one checkins via phone or video conferencing (daily or weekly depending on your requirements, their level of experience, and the working arrangements) • Take notes, follow up on agreed goals/actions, and review how the process is working • Ask staff how they are going and listen to their issues • When measuring client feedback, take the client’s mood and personality into consideration Top Tip: Get to know your staff over video conferencing, particularly their communication nuances. Video conferencing has enabled business to continue through COVID-19. However, this mode of communication can be fraught with issues, both technologically and regarding communication patterns. Supervisors and staff will need to be clearer and more explicit in communicating expectations and feedback.

Addressing Workplace Conflict Serious complaints and grievances, such as bullying, harassment or discrimination, should take urgent priority for a supervisor. In the current climate with more staff working from home, these serious workplace issues can and still do occur.

Additional challenges when investigating workplace conflict remotely include: • Mitigating technical issues with videoconferencing, electronic signatures, and transferring files • Ensuring the interviewee is in a private setting without unauthorised people or recording devices • Obtaining and maintaining detailed records • Gathering and safeguarding physical evidence and confidential documentation • Assessing and monitoring the remote workplace culture Management Tips • Review your code of conduct and your organisational policies and processes for complaints and grievances, bullying and harassment, and equal employment opportunity • Respond and deal with issues in a timely, fair and systematic manner • The rules of procedural fairness and evidence apply when addressing workplace issues—in some cases, engaging an independent workplace investigator is the best option Top Tip: Facilitating conflict resolution or conducting a workplace investigation remotely may take additional time and planning. Plan ahead to ensure that documentation has been securely transferred, you are using a secure meeting platform, and all parties have a working microphone, camera and internet connection.

CONNECTIONS SUMMER 2020 37

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Protecting Employee Mental Health Employers have a duty to protect the health and safety of their employees, so it is important to note that remote and isolated work is recognised by SafeWork Australia as a mental health hazard in the workplace. People working remotely may not have easy access to resources, communication or support. The risk to mental health is made worse when: • No policies and procedures are in place for working alone, remotely or in isolation • Employees lack the appropriate equipment or technology for communication (important for safety and social connection)

Management Tips • Review your organisational policies and processes for work health and safety, and mental health • Ensure you are providing flexible and healthy workloads, allowing for rest and recovery • Keep staff informed on significant workplace changes or issues, including what this means for them and their jobs • Regularly check on each employee’s wellbeing through good communication— be accessible and demonstrate that it’s OK to talk about mental health • Look out for behavioural changes and learn how to respond to an employee who is struggling • Provide support resources, such as an Employee Assistance Program

• The workplace doesn’t offer flexibility • The workplace doesn’t offer an employee assistance program or wellness support program • There is a community crisis such as a bushfire or pandemic, which may cause grief, fear, fatigue, heavier workloads, financial distress, and/ or extra pressures at home 38 otaus.com.au

Top Tip: If staff are working remotely due to a crisis such as COVID-19, they may feel increased isolation and uncertainty. Supervisors will need to be more empathetic and flexible regarding what staff are dealing with at home, and more available for regular check-ins to help keep staff on track and ensure they are coping.

The two common threads throughout these management tips are the importance of knowing the organisational policies and processes, and the importance of regular, transparent, one-on-one communication between supervisors and staff. Even when, ideally, a remote employee demonstrates autonomy and confidence in their own abilities, a supervisor should remain consistent in following the organisational protocols and connecting regularly with each person on their team. About the Author Anna Pannuzzo is the Director of WorkPlacePLUS, OTA’s preferred HR provider. OTA members can receive professional support for addressing complex HR issues such as restructuring, bullying and harassment claims, industrial audits, employment agreements, and more. MORE INFORMATION

Learn more at www.workplaceplus. com.au or by calling (03) 9492 0958.

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Wrong Set of Wheels: An Occupational Therapy Claim Example Aon This story is based on a real-life claim experienced by an occupational therapist with insurance arranged by Aon.

n accident causing permanent injury is something many people could not even begin to imagine, yet occupational therapists deal with it every day. Sarah* was one such occupational therapist. She had been practising for more than 20 years, was passionate about helping people, and took great pride in her treatment of clients. She’d seen it all, but her passion and experience were not enough to save her from an unhappy client taking legal action against her. Margaret* had suffered an accident that left her needing a wheelchair, and was referred to Sarah to assess her treatment requirements. After a thorough examination, Sarah researched and assessed a number of wheelchair options that would enable Margaret to go about daily life and stay mobile with minimal fuss. She knew Margaret had physical limitations to manoeuvring a wheelchair on her own, so it was clear that an attendant-driven electric wheelchair would be the best option—which Margaret and her partner agreed to. After recommending and prescribing a specific model based on her research, all due checks and trials were carried out, covering transfers, seating and positioning. Further recommendations were made following the initial trial, aiming to enhance Margaret’s comfort in wheelchair and her partner’s confidence in steering it. Sarah

explained to Margaret and her partner that driving a wheelchair was similar to driving a vehicle—many of the same hazards applied, and all necessary precautions should be taken. She also recommended seat belts be fitted, which was done. A few years later, Sarah received possibly the most surprising letter of her career—from Margaret’s solicitors claiming financial compensation of $150,000, based on allegations that Sarah’s negligence in her treatment had caused Margaret an injury. Margaret’s foot had slipped off the footplate of the wheelchair while operating it and got trapped in an adjacent wheel, causing an injury that required stitches and led to ongoing issues. Sarah was shocked at the allegations, as she felt she had taken all reasonable care and done due diligence with this client. Among other things, it was alleged that she failed to provide advice and treatment and recommend appropriate equipment in a ‘careful, properly skilful and competent manner’. Anyone would be shocked to receive this kind of notice, and Sarah was no different. What happened? Fortunately, Sarah’s solicitors were able to handle the matter, and it was agreed there was no evidence to suggest the recommended wheelchair was inappropriate. This was possible because Sarah had kept detailed records of her interactions. Although Sarah did not

have to pay the $150,000 in compensation, she did have to raise a defence against the allegations. Fortunately, she had a professional indemnity insurance policy arranged through Aon, which not only covered the cost of the legal defence, but also provided access to a defence team familiar with these types of allegations and able to negotiate this claim to a successful conclusion. * Names in this article have been changed for privacy reasons. © 2020 Aon Risk Services Australia Limited ABN 17 000 434 720 AFSL 241141 (Aon) This information is intended to provide general insurance related information only. It is not intended to be comprehensive, nor does it, or should it (under any circumstances) be construed as constituting legal advice. You should seek independent legal or other professional advice before acting or relying on any of the content of this information. Before deciding whether a particular product is right for you, please consider the relevant Product Disclosure Statement (if applicable) and full policy terms and conditions available from Aon on request or contact us to speak to an adviser. Aon will not be responsible for any loss, damage, cost or expense you or anyone else incurs in reliance on, or use of, any information contained in this article.

MORE INFORMATION

If you would like to discuss claims, risk mitigation, or your insurance cover, call the friendly Aon team on 1800 805 191, email au.ot@aon.com or visit aon.com.au/ota

CONNECTIONS SUMMER 2020 39

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OTA Connections Summer 2020

Articles inside

How You Celebrated OT Week 2020

Policy, Lobbying & Advocacy Update

Celebrating Rural Health Research in the Australian Occupational Therapy Journal

Professional Practice & Standards Update

CEO’s Report

President’s Report