Hunter New England - Rural Occupational Therapists Working with Children
Aims and Objectives
- Improve rural children's access to generalist OT services;
- Enhance the capacity of rural Occupational Therapists conducting developmental assessments with children aged 0-5 years;
- Standardise the practice of rural OT's in conducting developmental assessments;
- Improve the knowledge, skills and competencies of generalist OT's who work with children.
Description of Project
The majority of Occupational Therapists working in the New England region provide a broad and generalist service in their community and incorporate both adults and children within their clinical case load. Whilst this ensures clinicians have wide and encompassing skills, it is difficult for them to maintain superior skills in working with children. The difficulties in maintaining a feeling of competence and confidence amongst generalist clinicians working with children was acknowledged in a recent report funded through the New England Families First Regional Officers Group .
An Occupational Therapist will be employed two days per week (0.4 FTE) to enhance the capacity of existing generalist OT's in their work with children. The project will commence by addressing the paediatric developmental assessment skills which includes assessments in: fine and gross motor skills; pre-writing skills; pre-academic skills; coordination; cognition and visual perception.
The process will require the Occupational Therapist to review the developmental assessments currently used by clinicians in the New England region. The Occupational Therapist will need to consider the assessments and processes used in the Hunter region and other Area Health Services in managing and prioritising child development assessments.
The Occupational Therapist will incorporate a mentoring role by jointly conducting developmental assessments with sole, generalist OT's and act as a resource to support their practice. The Occupational Therapist will convene additional training and education forums and encourage skill and competency development. This process also aims to standardise and enhance the practice amongst rural OT's and their work with children.
Expected Outcomes
- Generalist Occupational Therapists to feel more confident in their developmental assessments with children aged 0-5 years;
- An increase in the number of children accessing generalist Occupational Therapist services;
- Generalist OT's being adequately resourced with appropriate assessment tools and age appropriate resources;
- Standardised assessment practice amongst generalist OT's.
Performance Indicators
The following will be used to measure the success of this project:
- Base line audit regarding the number of children seen for developmental assessments by generalist OT’s, with an increase in the number of children when audited again just prior to completion of this project.
- Production, introduction, dissemination and use of standardised assessment tools and age appropriate resources by generalist OT’s. Tools will be provided with the final report.
- Survey of OT’s to show an increase in their knowledge and skills, conducted by June 2006.
Progress
A review of new assessments by paediatric and sole Occupational Therapists for the period 1/7/2005 – 30/6/2006 on children and adolescents aged 0-18 years was conducted. This identified that 353 New Assessments were undertaken by OT’s. This includes:
- Armidale: 33
- Emmaville: 2
- Glen Innes: 24
- Gunnedah: 16
- Inverell: 13
- Manilla: 4
- Narrabri: 2
- Quirindi: 54
- Tamworth: 200
- Tenterfield: 5
It is important to note that the Paediatric Occupational Therapist in Armidale uses a different data collection system and has not been incorporated in these results. It is also important to note that during the period 1/7/2005 – 30/6/2006 there were OT vacancies in Gunnedah, Narrabri and Inverell. The data also highlights the absence of a paediatric occupational therapy service provided in Moree.
A comprehensive service audit reviewing (amongst other things): paediatric client groups; prioritisation criteria; standardised and non-standardised assessments; models of intervention/treatment and resources was conducted. Additionally, discussions with southern sector colleagues (Maitland and Newcastle) regarding the use of standardised assessment tools and a literature review regarding the same was also conducted.
The review highlighted great diversity in practice and differences in the availability of assessment tools and resources in Community Health Centre. The review recommends:
- Guidelines for determining paediatric occupational therapy priorities
- Prioritisation criteria for Generalist OT’s (adult and child case load)
- All northern sector sites have access to:
- Hawaiian Early Learning Profile
- Movement assessment Battery for Children
- Beery-Buktenica Developmental Test of Visual Motor Integration (5 Ed)
- Test of Visual Perceptual Skills (3 Ed)
- Motor-free Visual Perceptual Test (3 Ed)
- Handwriting Speed Test
- Sensory Profile (3-10 years)
These assessment tools have been purchased and are being implemented with children by the OT’s. As there are a range of tools, the OT’s have booked a series of review meetings to discuss the implementation of the Tools.
The Paediatric Occupational Therapy working group will continue to share information regarding the appropriate use and implementation of the above mentioned Assessment tools.
The post implementation survey has not yet been completed however, clinicians have been very appreciative of the clinical tools and are constructing opportunities to monitor their use and implementation.
Discussion
The Rural Occupational Therapy Project aimed to employ a temporary part time (0.4FTE) Occupational Therapist for 12 months. The position was advertised on 2 occasions. On the first occasion, no application was received. On the second occasion, a decision was made by the panel not to interview the applicant. As the recruitment of a 0.4 FTE Occupational Therapist appeared unlikely, a variation regarding the process to implement this project was recommended.
The existing paediatric occupational therapy working groups were requested to take an active role in the development of this project. This was supported by Cluster General Managers. An Occupational Therapist (Grade 2) was also seconded to the project for a period of 6 weeks (Jan-Feb 2007) to facilitate the:
- Review of existing practice guidelines, resources and assessment tools used by Occupational Therapists within the northern sector.
- Liaison with southern sector Occupational Therapists (and Statewide services and networks as appropriate) regarding policies, assessments and standards of practice in paediatric Occupational Therapy service delivery.
- Defining the paediatric caseload in the context of generalist service delivery and determine the priorities for clinical intervention.
- Implement standardised evidence based paediatric assessment tools and resources for therapy intervention.
An HNE Health Paediatric Occupational Therapy Workshop was also convened on 24 and 25 May in Tamworth with approximately 25 Occupational Therapists attending. The workshop included components of clinical skills/education and discussions regarding the operating of individual services. This was the first occasion for HNE OT’s to meet and provided an excellent networking opportunity.
Newborn Services Workshops
In recognising the constraints in the delivery of this project (and in consultation with the NCHN Coordinator), additional multi-disciplinary education workshops for all clinicians working with neonates was convened in Muswellbrook and Tamworth (August and November 2007) with a third workshop scheduled for Taree (pdf 67K) in February 2008.
The workshops use a creative model of multidisciplinary education for nursing, medical and allied health staff using combined and separate group sessions. Training was provided by the multidisciplinary team from Kaleidoscope Newborn Services and included neonatologists, nursing and allied health staff. At each training forum an additional session was held in the evening to accommodate GP’s who were unable to attend the forums during the day. This session focused on neonatal resuscitation.
Participants could register for either one or both days. In Muswellbrook 31 participants attended the first day and 35 participants attended the second day. In Tamworth 90+ participants attended both days. At both workshops, participants included midwives, RN’s, Child and Family Health Nurses, social workers, speech pathologists, dietitians, occupational therapists, physiotherapists and Aboriginal Health workers.
Pre and post evaluations were conducted and a report for the Muswellbrook and Tamworth (pdf 674K) workshops has been completed (see attached). The evaluations indicate the workshops were very well received. Staff recognized the value of the education being conducted in rural communities and valued the multidisciplinary approach to training.
The pre and post evaluation demonstrated increased knowledge and understanding of:
- Identifying the risk factors for hip dysplagia;
- Performing hip checks and identifying abnormalities;
- Understanding coroners cases;
- Identifying signs of infant stress and avoidance behaviours;
- Identifying infants self regulatory or approach behaviours;
- Recognizing the clinical indicators of babies requiring specialized infant formula;
- Recognising the indicators for an increase in calories and nutrition for preterm infants;
- Knowledge of referrals for modified barium swallow;
- Confirming the placement of endotracheal tube; and
- Bereavement issues for parents with children in NICU.
The North Coast Area Health Service has requested Kaleidoscope Newborn Services to consider repeating this training program within their region.
This project is now complete.