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STATE-WIDE CHILD HEALTH
NETWORKS ALLIED HEALTH
EDUCATION & CLINICAL
SUPPORT PROGRAM
FINAL REPORT JULY 2011 - JUNE 2013
2
GLOSSARY ACT AUSTRALIAN CAPITAL TERRITORY
AH ALLIED HEALTH
AHE ALLIED HEALTH EDUCATORS
AHP ALLIED HEALTH PROFESSIONAL(S)
AHS AREA HEALTH SERVICE
CHN CHILD HEALTH NETWORK
CHW CHILDREN‟S HOSPITAL WESTMEAD
EOI EXPRESSIONS OF INTEREST
FTE FULL TIME EQUIVALENT
GESCHN GREATER EASTERN AND SOUTHERN NSW CHILD HEALTH NETWORK
HETI HEALTH EDUCATION AND TRAINING INSTITUTE
LHD LOCAL HEALTH DISTRICT
NCHN NORTHERN CHILD HEALTH NETWORK
N&D NUTRITION AND DIETETICS
OT OCCUPATIONAL THERAPIST
PT PHYSIOTHERAPIST
Psyc PSYCHOLOGIST
SCH SYDNEY CHILDREN‟S HOSPITAL
SP SPEECH PATHOLOGIST
SW SOCIAL WORK
WCHN WESTERN CHILD HEALTH NETWORK
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TABLE OF CONTENTS STATE-WIDE CHILD HEALTH NETWORKS ALLIED HEALTH EDUCATION & CLINICAL SUPPORT
PROGRAM ............................................................................................................................................................... 1
FINAL REPORT JULY 2011 - JUNE 2013 ...................................................................................................... 1
GLOSSARY .............................................................................................................................................................. 2
TABLE OF CONTENTS .......................................................................................................................................... 3
EXECUTIVE SUMMARY ......................................................................................................................................... 5
BACKGROUND ............................................................................................................................................... 5
DISCUSSION .................................................................................................................................................. 6
RECOMMENDATION ...................................................................................................................................... 7
Recommendation 1: ............................................................................................................................................... 7
Recommendation 2: ............................................................................................................................................... 8
Recommendation 3: ............................................................................................................................................... 8
CONCLUSION ................................................................................................................................................ 8
FINAL REPORT ....................................................................................................................................................... 9
1. SUMMARY ............................................................................................................................................. 9
2. INTRODUCTION ..................................................................................................................................... 9
Literature ................................................................................................................................................................ 10
Health Education Infrastructure .......................................................................................................................... 10
Outcomes from Previous Projects ..................................................................................................................... 11
3. AIMS AND OBJECTIVES ...................................................................................................................... 12
4. PROGRAM INITIATIVES – METHODOLOGY, OUTCOMES AND DISCUSSION ....................................... 13
4.1. Telehealth ................................................................................................................................................ 13
4.2. Secondments .......................................................................................................................................... 14
4.3. Workshops .............................................................................................................................................. 15
4.4. Allied to Kids Newsletter ....................................................................................................................... 18
4.5. Referral/Discharge Processes – Clinical Handover .......................................................................... 18
4.6. HSNet Online Networking Groups ....................................................................................................... 19
4.7. Allied to Kids Website ............................................................................................................................ 20
4.8. Clinical Practice Guidelines .................................................................................................................. 20
4
4.9. Delivery of Education ............................................................................................................................. 22
4.10. E-Learning ............................................................................................................................................... 23
4.11. Allied Health Educator Forum .............................................................................................................. 24
5. CHALLENGES...................................................................................................................................... 24
Seamless Transition ............................................................................................................................................. 24
Engagement of Allied Health Departments ...................................................................................................... 25
6. DISCUSSION ....................................................................................................................................... 25
7. RECOMMENDATIONS .......................................................................................................................... 25
Recommendation 1: ............................................................................................................................................. 25
Recommendation 2: ............................................................................................................................................. 25
Recommendation 3: ............................................................................................................................................. 25
Estimated Investment .......................................................................................................................................... 26
8. CONCLUSION ...................................................................................................................................... 26
9. BUDGET: JULY 2011 – JUNE 2013 ................................................................................................... 26
REFERENCES ........................................................................................................................................................27
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EXECUTIVE SUMMARY Title of Project: State-wide Child Health Networks (CHN) Allied Health Education
and Clinical Support
Allied Health Educators: Carmel Blayden, Sonia Hughes, Jennifer Nicol, Susan Sims
Project Managers: Virginia Binns, Lyn Biviano, Jenny Martin
BACKGROUND The Allied Health Education and Clinical Support Program was funded by the Ministry of Health via biennial
Child Health Networks (CHN) funding July 2011 to June 2013. This program provided education and clinical
support to allied health professionals (AHP) working with children across NSW. The program developed AHP
skills, knowledge and confidence in the treatment of children with tertiary diagnoses and specifically skilled
AHP in tertiary and specialist areas allowing children to receive services as close to home as possible. The
intended outcomes of the project are listed below.
Continuation of activities currently coordinated by the AHE including:
i. 20 state-wide Telehealth sessions with joint responsibility across the three children‟s hospitals and
funding shared equally across the 3 Child Health Networks;
ii. 5 secondments per Child Health Networks with joint responsibility across the three children‟s
hospitals;
iii. 6 workshops/courses on priority areas with joint responsibility across the three children‟s hospitals;
iv. Development of 10 Allied to Kids newsletters;
v. Implementation of referral/discharge processes across the three children‟s hospitals.
vi. Oversee the management of Allied Health HSNet online networks.
vii. Develop and maintain the Allied to Kids website.
KPIs to expand Allied Health Education and Clinical Support:
1. Development of paediatric clinical practice guidelines (CPG) including
i. Completion of the paediatric feeding and cerebral palsy CPGs started in the previous project.
ii. Completion of an additional two CPGs for AHP and associated nursing and medical staff.
2. Develop guidelines to inform the best options for delivery of education, clinical support and learning
programs to AHP working with children in NSW including:
Telehealth
WebEx
Workshops
Online learning modules
Online seminar series
3. Establish an online e-learning program in specialty and tertiary care for allied health professionals
working with children. This would include:
i. Three e-learning packages available on line
4. Establish a forum for the Child Health Networks Allied Health Educators to work collaboratively with the
Allied Health Educators in the Local Health Districts (LHD) and the Health Education and Training
Institute (HETI).
6
Outcomes were evaluated against performance indicators using a range of process, impact, and outcome
evaluation tools.
DISCUSSION Key Performance Indicator
Outcomes
Options for Sustainability in the Absence of Allied Health Educators
20 state-wide Telehealth sessions with joint responsibility across the three children‟s hospitals and funding shared equally across the 3 Child Health Networks
Partially achieved – A total of 36 state-wide AH Telehealth sessions were presented between July 2011 – June 2013.
Without the structure of the AH Program supporting AH Telehealth, it will be up to individual clinicians/teams to present at venue specific Grand Rounds. This however will reduce access as it will not provide a statewide option.
5 secondments per Child Health Networks with joint responsibility across the three children‟s hospitals
Achieved – 47 secondments were accepted at the intake periods between October 2011 and February 2013.
The secondment program relies on co-ordination and funding from the AHE program and is unlikely to continue. Visits to Tertiary hospitals may be organised by AH departments on an ad hoc basis, with limited evaluation of outcomes and no funding support.
6 workshops/courses on priority areas with joint responsibility across the three children‟s hospitals
Achieved – 11 workshops were identified by clinicians and facilitated by the AHE program between July 2011 and June 2013.
Workshops may be identified and facilitated by individual AHPs but would no longer have the funding and support of the AHE program resulting in a lack of coordination of educational opportunities across NSW.
Development of 10 Allied to Kids newsletters
Achieved – 22 editions of Allied to Kids were produced and distributed between July 2011 and June 2013.
Production of the newsletter is unlikely as busy clinicians rarely have time available for such tasks.
Implementation of referral/ discharge processes across the three children‟s hospitals
Partially achieved – Statewide consultation with AHP regarding handover and referral processes completed. Development and implementation of strategies underway.
This will need to be lead by Tertiary facilities. Limited scope to consult with LHDs.
Oversee the management of Allied Health HSNet online networks
Achieved – 8 HSNet online networking groups for AHP were maintained with various rates of uptake.
Maintenance of the HSNet groups could be possible if appropriate clinicians can be identified to assume the role of group manager.
Develop and maintain the Allied to Kids website
Achieved – The Allied to Kids website was updated by the AHE with relevant information and clinical resources on an ongoing basis.
Production and maintenance of the Allied to Kids website is unlikely to occur.
Development of paediatric clinical practice guidelines including
i. Completion of the paediatric feeding and cerebral palsy CPGs started in the previous project.
ii. Completion of an additional two CPGs for AHP and associated
Partially achieved – Final drafts of the cerebral palsy, paediatric feeding and Congenital Talipes Equino Varus (CTEV) guidelines will be released for broader consultation prior to finalisation.
No resolution to date regarding a statewide process for the coordination of non-acute CPG .
As there is currently no identified Department, Directorate or Pillar responsible for the creation/review of state-wide non-acute CPG it is unlikely that further CPG will be developed. They may be investigated in the future by Pillars such as ACI or HETI.
7
nursing and medical staff.
Develop guidelines to inform the best options for delivery of education, clinical support and learning programs to AHP working with children in NSW including:
TeleHealth
WebEx
Workshops
Online learning modules
Online seminar series
Partially achieved - Literature review regarding the best educational modalities to provide education to rural and remote allied health professionals completed. Consistent evaluation strategies utilised across program initiatives to enable comparison of outcomes.
HETI may take on the role of further investigating this strategy in their quest “to pursue excellence in health education and training and workforce capability to improve the health of patients and the working lives of NSW Health staff”. Currently, HETI does not possess discipline specific clinical expertise in paediatrics.
Establish an online e-learning program in specialty and tertiary care for allied health professionals working with children. This would include:
i. Three e-learning packages available on line
Achieved –
a. Congenital Talipes Equino Varus (CTEV): a CTEV e-learning module created and used effectively as pre-learning for the CTEV workshop. It is housed on the Learn Paediatrics platform.
b. Plagiocephaly: The development of the plagiocephaly e-learning module in progress. Estimated to be available to clinicians by the end of 2013
c. Play Therapy: The development of the play therapy e-learning module is in progress. Estimated to be available to clinicians by the end of 2013.
HETI has been charged with the creation of mandatory education modules but to date has had a generic focus. Currently, HETI does not possess discipline specific clinical expertise in paediatrics that would assist with the creation of e-learning modules. Specific clinicians would need to be identified and approached to create modules.
Establish a forum for the Child Health Networks Allied Health Educators to work collaboratively with the Allied Health Educators in the Local Health Districts (LHD) and the Health Education and Training Institute (HETI).
Achieved – Links have been created with AHE in SCHN, SSWLHD and SNSWLHD. The AHE have created an HSNet online networking group for AHE and are members of the recently convened Allied Health Professional Educator Network (AHPEN).
HETI will be required to take on the lead role in maintaining AHPEN.
RECOMMENDATION The establishment of 3.0 FTE permanently funded Allied Health Educator positions is essential to coordinate,
facilitate and expand current and ongoing education and clinical support needs of allied health professionals
working with children across all of the NSW Local Health Districts. Following consideration of available
options for establishment of such positions and their governance, the following recommendations are
proposed.
RECOMMENDATION 1: The current Child Health Networks project funded Allied Health Educator positions be established as
permanently funded positions. This will enable the coordination, facilitation and expansion of current and
ongoing education and clinical support needs of allied health professionals working with children across all of
NSW.
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RECOMMENDATION 2: That the NSW Ministry of Health provides recurrent funding for 3.0 FTE permanent Allied Health Educator
positions based on Health Professional Educator, Level 5 (NSW Health Service Health Professionals State
Award, 2012).
RECOMMENDATION 3: The three Allied Health Educator positions will have governance through the three tertiary Children‟s
Hospitals, aligned with the Child Health Networks boundaries. This governance structure will optimise the
achievement of the positions‟ outcomes.
CONCLUSION The Child Health Networks Allied Health Education and Clinical Support project has achieved the majority of
identified outcomes and demonstrates the ongoing need for AHP to be supported in their professional and
clinical development. Permanently appointed CHN AHE will have the capacity to develop and implement a 3-
5 year strategic plan to ensure continued, high quality education and clinical support program for AHP
working with children, and minimise duplication of education initiatives across the state. It will also facilitate
the provision of allied health interventions for children with tertiary diagnoses to be undertaken as close to
home as possible.
9
FINAL REPORT Local Health Networks: All Local Health Networks across the state
Title of Project: State-wide Child Health Networks (CHN) Allied Health Education
and Clinical Support
Allied Health Educators: Carmel Blayden, Sonia Hughes, Jennifer Nicol, Susan Sims
Project Managers: Virginia Binns, Lyn Biviano, Jenny Martin
1. SUMMARY
The Allied Health Education and Clinical Support Program was funded by the Ministry of Health via biennial
Child Health Networks (CHN) funding July 2011 to June 2013. This program provided education and clinical
support to allied health professionals (AHP) working with children across NSW. The program developed AHP
skills, knowledge and confidence in the treatment of children with tertiary diagnoses and specifically skilled
AHP in tertiary and specialist areas allowing children to receive services as close to home as possible.
Such opportunities enhance knowledge and confidence in caring for children presenting with more serious or
complex clinical conditions than those encountered in their own practice, whilst fostering professional
relationships across the state.
2. INTRODUCTION
Allied health professionals (AHP) contribute significantly to the health and well-being of children across the
State of NSW. They are directly involved in the assessment and delivery of treatment to children across a
wide range of diagnoses, with the aim of maximising function and improving the quality of life of children and
their families.
In order for AHP to continue to improve the health outcomes of children in NSW, it is essential that
appropriate clinical support, training and education is available and accessible. The Final Report of the
Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals, Peter Garling SC (2008)
stated that:
“The provision of proper education and training to clinicians is vital to the functioning of
NSW public hospitals for, essentially, 4 reasons:
(a) to constantly achieve a high standard of patient care;
(b) to ensure the safety of patients;
(c) to ensure that … treatment is delivered in the most sensible and efficient
manner; and
(d) to attract and retain the workforce.”
In response to this, Garling‟s (2008) recommendations to support the education and training of AHP
highlighted the need for:
“Considering whether it would be appropriate and cost effective to create specific positions for the
provision of education to the particular allied health specialties” (Recommendation 35b)
10
L ITERATURE Allied health professionals are required to engage in lifelong learning to keep up to date with the changing
environment and current evidence to ensure delivery of quality and safe client care (NSW Department of
Health, 2005). Challenges of ensuring this occurs are discussed at length in the academic literature (Frenk et
al 2010).
There is substantial evidence that identifies lack of access to professional development and professional
isolation as challenges faced by rural practitioners contributing to the ongoing issues of adequate service
provision and retention of staff (Cornell 1991; World Health Organization 2010). Professional isolation and
lack of clinical support within disciplines is further magnified by those AHP working outside of metropolitan
areas (Battye & Taggart 2003; RHTD&U 2001; SARRAH 2000). Veitch (2012) identifies that there are limited
opportunities for personal and professional development for AHP in regional areas. Limited opportunities are
further exacerbated by an over representation of new graduates and those with limited experience and
limited access to professional education and support (Struber 2004). Currently 25% of the rural AH
workforce are under 25 years of age.
Recommendations by Services for Australian Rural and Remote Allied Health (SARRAH) identify that
accessible and appropriate professional development is required to ensure safe and effective delivery of
clinical and professional services in the remote and rural area. A study completed by SARRAH identified
that 81% of collated AHP identified clinical training as their priority for education and training needs. This
study also highlighted there is a higher proportion of allied health from smaller locations who undertake
distance education and videoconferencing, compared with larger centres.
Recommendations in the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals
accepted by the Health Action Plan for NSW, highlighted the need for enhancement of training and
education provided for the AHP, specifically “Considering whether it would be appropriate and cost effective
to create specific positions for the provision of education to the particular allied health specialties”.
HEALTH EDUCATION INFRASTRUCTURE Medical and nursing professionals have provisions for education and training built into their award and
associated education infrastructure permanently funded by NSW Health to support the completion of this
education. For example, in 2006 a network of 16.5 Area-based Clinical Nurse Consultants were
permanently funded under the auspices of the NSW CHN. The responsibilities of these positions included
the coordination of professional education strategies for paediatric nursing. Further examples include the
Hospital Skills Program, General Practice Procedural Training Program and NSW Rural Doctors Network
Program.
The Final Report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals, Peter
Garling SC (2008) highlighted the inequity in health education infrastructure between medicine, nursing and
allied health.
“Unlike doctors, who generally have a training allowance built into their award, so far as my
researches showed, there are no allowances for training in any of the awards that govern
allied health professionals. Nurses have had the benefit of the creation of dedicated
positions of clinical nurse educators and clinical nurse consultants. These have provided
sources of in-house knowledge and expertise that is relied upon by nurses as part of their
continuing education. There are no equivalent positions for allied health workers.”
Professional registration and accreditation criteria relating to education and training in allied health is an
increasingly important consideration. To date, permanent funding of education infrastructure for paediatric
allied health has not been granted. The revised NSW Health Service Health Professionals (State) Award
(2008) includes provision for a Health Professional Educator (Level 5). Appointment of the proposed Allied
11
Health Educator positions would commence the equitable alignment of allied health education infrastructure
with that of medicine and nursing.
The Allied Health Directorate of HETI has been established to provide a central point of leadership and
coordination in clinical education and training for the 23 AHP and allied health assistant workforce in the
NSW public health system (Allied Health Educators Consultation Forum, 2011). The role of the Directorate
is strategic, not operational with their focus set on building capacity, infrastructure and governance to support
education and training. The hands on facilitation of clinical training, education and support for AHP working
with clients are not within the brief of this Directorate.
OUTCOMES FROM PREVIOUS PROJECTS Since 2003, the three NSW Child Health Networks (CHN) have collaborated on a number of successful
projects to improve education and clinical support to AHP working with children in NSW. Outcomes of
projects undertaken from 2003 to present are outlined below.
IMPROVING EDUCATION AND CLINICAL SUPPORT TO ALLIED HEALTH
PROFESSIONALS W ORKING W ITH CHILDREN (2003-2004)
In 2003/04 Area Health Service (AHS) Chief Executive Officers (CEO) approved a collaborative project
between the three NSW CHN. The project aim was to identify the education and clinical support needs of
AHP working with children in NSW.
A state-wide survey was conducted in 2005, with Physiotherapists, Occupational Therapists, Speech
Pathologists, Dietitians, Psychologists, Social Workers, Play Therapists, Audiologists and Orthotists. As a
result of these findings, recommendations were made in the following areas to support AHP who work with
children:
clinical supervision
performance management
clinical caseloads
access to education and training
access to technology.
As a result of this project, the three CHN successfully obtained funding in 2006 from NSW Health to
undertake projects that implemented the project recommendations, to provide education and clinical support
for AHP working with children across NSW.
SUPPORTING ALLIED HEALTH PROFESSIONALS W ORKING W ITH CHILDREN (2006-2009)
The main aim of the project Supporting AHP Working with Children, was to develop a cost efficient model of
clinical support and education for AHP working with children. As a result of the project, useful models of
education and clinical support were identified. Allied health professionals requiring education and clinical
support participated in the Greater Eastern and Southern Child Health Network (GESCHN), Northern Child
Health Network (NCHN) and Western Child Health Network (WCHN) secondment programs and/or the
NCHN mentoring program. Additional opportunities were provided through the Telehealth education
program, as well as courses and workshops run through WCHN, GESCHN and NCHN. A static webpage for
the CHN was established and contains hyperlinks to each CHN webpage. Discipline specific listservs were
established and the newsletter Allied to Kids was established and distributed regularly throughout each of
the CHN.
The shared needs of AHP across CHN boundaries made it a cost effective and efficient strategy for project
officers to combine and work together to meet the overall aims of the project. This approach also ensured
that the final outcomes of the project had statewide applicability. A resurvey of AHP at the end of the project
12
highlighted improved communication with tertiary hospitals, attendance at Telehealth continuing to increase,
increasing uptake of secondments, improved congeniality with professional peers and increased awareness
of education opportunities including CDs, DVDs as publicised through Allied to Kids. Furthermore, the
confidence and competence of AHP in non-tertiary facilities in the management of children with disabilities or
complex medical conditions was reported to have increased.
CHILD HEALTH NETW ORKS ALLIED HEALTH EDUCATION AND CLINICAL SUPPORT
(2010-2011)
The successes outlined above were then followed by a further 18 month project. The overall aim of the AHE
was to collaboratively facilitate ongoing programs to support AHP who work with children across NSW. The
program primarily focused on the provision of support to six allied health disciplines namely Physiotherapy,
Speech Pathology, Occupational Therapy, Psychology, Nutrition and Dietetics and Social Work.
The outcomes achieved by this program, demonstrate the ability of the CHN AHE to fulfil the role of
supporting AHP working with children across NSW, through direct dialogue with clinicians and
implementation of effective education strategies.
CHILD HEALTH NETW ORKS ALLIED HEALTH EDUCATION AND CLINICAL SUPPORT
(2011-2013)
Following the success of these projects, funding was approved for a full-time Level 5, Allied Health Educator
(AHE) to be appointed in each CHN for a 24 month term. The three Educators were to be appointed from
July 2011 – June 2013. The overall aim of the AHE was to collaboratively facilitate ongoing programs to
support AHP who work with children across NSW. The program primarily focused on the provision of
support to six allied health disciplines namely Physiotherapy, Speech Pathology, Occupational Therapy,
Psychology, Nutrition and Dietetics and Social Work. The provision of support to additional disciplines was
to be determined on a case by case basis.
The State-wide Child Health Networks (CHN) Allied Health Education and Clinical Support program was an
initiative of the three CHN to enhance and facilitate opportunities for the education and clinical support of
AHP working with children and to address some recommendations of the Allied Health Services Report.
3. AIMS AND OBJECTIVES
The objectives of the program were to provide a range of education and clinical support to AHP working with
children across NSW and specifically up skill them in tertiary and specialist areas that would allow children to
receive services as close to home as possible. Such opportunities enhance knowledge and confidence in
caring for children presenting with more serious or complex clinical conditions than those encountered in
their own practice, whilst fostering professional relationships across the state. The overarching objective of
the project was to coordinate & facilitate the current and ongoing education and clinical support
needs/programs for AHP who work with children in all NSW Local Health Districts. The intended outcomes of
the project are listed below.
1. Continuation of activities currently coordinated by the AHE including:
i. 20 state-wide Telehealth sessions with joint responsibility across the three children‟s hospitals
and funding shared equally across the 3 Child Health Networks;
ii. 5 secondments per Child Health Networks with joint responsibility across the three children‟s
hospitals;
iii. 6 workshops/courses on priority areas with joint responsibility across the three children‟s
hospitals;
iv. Development of 10 Allied to Kids newsletters;
v. Implementation of referral/discharge processes across the three children‟s hospitals.
vi. Oversee the management of Allied Health HSNet online networks.
vii. Develop and maintain the Allied to Kids website
13
2. Development of paediatric clinical practice guidelines including
i. Completion of the paediatric feeding and cerebral palsy CPGs started in the previous project.
ii. Completion of an additional two CPGs for AHP and associated nursing and medical staff.
3. Develop guidelines to inform the best options for delivery of education, clinical support and learning
programs to AHP working with children in NSW including:
TeleHealth
WebEx
Workshops
Online learning modules
Online seminar series
4. Establish an online e-learning program in specialty and tertiary care for allied health professionals
working with children. This would include:
i. Three e-learning packages available on line
5. Establish a forum for the Child Health Networks Allied Health Educators to work collaboratively with the
Allied Health Educators in the Local Health Districts (LHD) and the Health Education and Training
Institute (HETI).
4. PROGRAM INITIATIVES – METHODOLOGY, OUTCOMES AND
DISCUSSION
The AHE from each CHN worked collaboratively throughout the program to ensure effective coordination and
facilitation of ongoing initiatives to support AHP across NSW and minimise potential duplication. The AHE
met weekly usually via teleconference. The program was overseen by a Steering Committee that comprised
the project managers, the three CHN Coordinators, the three CHN AHE, and a rural Allied Health
Director/manager from within each CHN. Due to the limited time of the program, the Steering Committee
met each month to ensure objectives were on target. The AHE also networked extensively with:
key personnel at NSW Health to ensure objectives of the program were meeting those of the
department;
the Resource Manager of the Northern Child Health Network (NCHN) to develop the Allied Health
website;
the Telehealth Coordinator at SCH to develop the Allied Health Telehealth program;
Heads of the Allied Health Departments in the tertiary Children‟s Hospitals; and
AHP across NSW to facilitate the development and implementation of program initiatives.
The following details discussion of the methodology and outcomes of the program‟s initiatives.
4.1. TELEHEALTH
METHODOLOGY
From June 2010, the GESCHN Allied Health Telehealth program became available state-wide for all AHP
working with children in NSW Health. The 2011 Allied Health Telehealth program was expanded to include
AHP speakers across NSW and a program schedule was developed using the prioritised topics listed in the
surveys collated after each Telehealth session, and the results of the education and clinical support survey
conducted by the AHE in 2010. The 2012/2013 Telehealth calendar aimed to continue the multidisciplinary
focus of the program and encourage local networking. AHP known to have extensive experience in a
particular clinical area were invited to present a Telehealth education session. However, all experienced
AHP working with children across NSW, were encouraged to present.
14
The Telehealth program was promoted by the AHE using email distribution lists, postings on HSNet, regular
inclusion in the Allied to Kids newsletter and on the Allied to Kids website. To provide greater detail
regarding the content of each session and to assist in the promotion of the program, an abstract was
requested from each presenter and distributed prior to each Telehealth session. The Telehealth Project
Officer managed the registrations, coordinated the bridging, hosted the sessions, and collected evaluation
results for each of the fortnightly Telehealth sessions.
OUTCOMES
The number of sites linking into the fortnightly Allied Health Telehealth Program are shown in Table 1. The
average number of sites attending in 2009 was 15, which increased to an average of 26 sites in 2010 when
the program became available state-wide, and to 48 in the first six months of 2011 when the multidisciplinary
program was introduced. On average, 63% of participating sites during 2011 were rural and 2 % remote
facilities.
TABLE 1: THE AVERAGE NUMBER OF SITES ATTENDING THE ALLIED HEALTH TELEHEALTH SESSIONS FROM 2009-2011
Year Number of AH
Telehealth sessions
Average No. of Sites per Session
July 2011 – June 2012 17 sessions 37 sites (range: 23-60)
July 2012 - June 2013 19 sessions 35 sites (range: 19-55)
Participants in the Telehealth program were requested to complete a post-session questionnaire. In addition
to this, at the end of 2011 and 2012 the AHE conducted a qualitative survey of the Telehealth program.
Overall feedback was positive with acknowledgement that the Allied Health Telehealth Program assists in
the facilitation of knowledge, capacity and confidence with respect to providing services to children with more
serious or complex clinical conditions.
Information technology (IT) challenges and lack of support at sites was evidently an area of ongoing
frustration. Some of the difficulties included missing visual links, not being linked in and late starting times
due to technical difficulties.
The sessions were recorded on DVD and also made available via webstreaming to increase accessibility for
clinicians. Unfortunately due to IT rules in a number of LHDs this was not accessible for all clinicians.
D ISCUSSION
The program partially achieved the key performance indicator of continuing the AH Telehealth program on
a state-wide basis to facilitate clinical best practice. Furthermore, the uptake of the AH Telehealth Program
continued to increase, in part due to the role of the AHE in the development of a clinically relevant program
targeting the identified needs of AHP and the ongoing promotion of the Telehealth sessions. It was noted
that 60% of AHP participating in the sessions were from rural and remote locations.
4.2. SECONDMENTS
METHODOLOGY
Secondments were coordinated at a state-wide level by the AHE with combined intake periods occurring in
July, November and February of each year. Expressions of Interest outlining specific learning objectives
were submitted by interested AHP. Negotiations were then undertaken by the AHE with the relevant Tertiary
facility or specialist clinic. Accommodation and travel expenses were met by the AH Education and Clinical
Support Program in order to reduce the burden on clinicians and Departments. Pre and post evaluation
occurred with each secondment to ensure that the placements were clinically relevant and that changes to
clinical practice were maintained.
15
OUTCOMES
A total of 58 expressions of interest to participate in the AH secondment program were received. Of these,
47 secondments (81%) were completed. Evaluation results indicated that clinician‟s knowledge and skills,
related to their indentified learning objectives, increased following participation in the secondment. This was
supported by follow-up data six months after the secondment, indicating the maintenance of levels of
knowledge and confidence as well as a positive impact on participant‟s clinical practice1.
D ISCUSSION
The program achieved and exceeded the key performance indicator of five secondments per Child Health
Networks with joint responsibility across the three children‟s hospitals.
Secondments continued to provide a popular and effective means of meeting the clinical education
requirements of AHP‟s across the state. A total number of 47 secondments were facilitated by the AHEs in
the period July 2011- June 2013, primarily with the cooperation of multiple allied health clinicians at the
tertiary children‟s hospitals: John Hunter, Children‟s Hospital Westmead and the Sydney Children‟s Hospital.
However, matching secondee‟s learning needs with the capacity of the sites to meet their objectives meant
that some secondments took place interstate in Adelaide, Brisbane and Melbourne, offering an opportunity
for networking with specialist centres outside of NSW. Feedback indicated that secondments offered an
opportunity for secondees to learn in a flexible, practical way enabling them to address specific learning
objectives in highly specialised areas of paediatric patient management. The information and practical skills
gained from these experiences was shared by the therapists on return to their workplaces through inservices
to colleagues, enabling other therapists within the secondees network to benefit from the educational
opportunity.
4.3. WORKSHOPS
METHODOLOGY
The objective was to provide workshops that had been identified by AH and fitted with the aims of the CHN
Allied Health Education and Clinical Support Program. The workshops identified by the AHE in conjunction
with clinicians across LHD included:
Paediatric Feeding
Congenital Talipes Equino Varus
Accredited Training Resilience Doughnut
Building Connections for Kids: a Place in Health for OOHC
Home Enteral Nutrition (HEN) Update Day
Functional Electrical Stimulation
Physiotherapy Reliability Sessions
Trauma, Abuse and Attachment
Allied Health Coaching
The AHE facilitated the development of workshops by networking with health professionals with expertise in
the key areas listed above. Consultation also took place with rural clinicians regarding location of the rural
workshops. The workshops were conducted between July 2011 and June 2013 and were offered as face to
face or via videoconference. Registration fees were charged for most workshops to cover associated costs.
These fees were generally kept to a minimum. However, due to the significant contribution of tertiary
clinicians to the development and presentation of the 2-day Paediatric Feeding workshop, some funds were
returned to the department to support the professional development of the contributing staff members.
1 Detailed evaluation results of the Secondment Program are available on request.
16
OUTCOMES
Workshop Attendance Key Outcomes2
By discipline
Location
21 & 22 May 2012
Paediatric Feeding
Sydney Children‟s Hospital
Participants
(n=62)
SP (38)
DN (14)
OT (4)
Psych (1)
Regional/Rural LHD (24)
Metro LHD (21)
98% of participants indicated that the workshop was an effective learning opportunity. Participants from both metropolitan and rural facilities reported an increase in their knowledge and skills, which would then be applied to their current caseload in the management of children with feeding difficulties.
22 August 2012
Accredited Training Resilience Doughnut
Participants
(n=12)
OT (2)
SW (2)
Psych (8)
Regional/Rural (7)
Metro (5)
11 attendees have completed their accreditation.
Workshops have been presented in 6 LHD by accredited trainers.
10 September 2012
Building Connections for Kids: a Place in Health for OOHC
Participants (n= 123)
SP (7)
OT (12)
SW (11)
PT(3)
Psych (3)
Attended at CHW (63)
Regional/Rural linked in by video conference
(60)
Evaluation of this workshop reflected a well presented and well received workshop.
The workshop was successful in improving participants‟ knowledge and understanding of managing the impact of trauma and abuse when working with children and young people.
The use of video conference increased access for rural clinicians despite some technical issues.
18th September 2012
Functional Electrical Stimulation
PT participants
(n=24)
SCH 100% of participants indicated that theoretical and practical components of the workshop would benefit clinical practice.
Understanding of the principles and application of electrical stimulation improved in all participants.
10 October 2012
CTEV Education Day
Tamworth Hospital
PT (13) Regional/Rural (13)
Workshop quality rated as excellent for: content (100%), relevance (92%), presentation (92%), organisation (75%), handouts (75%), overall (100%). 100% of participants indicated that the workshop was an effective learning opportunity.
9 November 2012
Paediatric Respiratory Physiotherapy Workshop
Participants (n=22)
PT (11)
Student PT (2)
Nurse (8)
PT Aid (1)
All participants reported a significant improvement in knowledge regarding oxygen delivery methods and suction techniques in babies and children, application of a cough assist machine and techniques for delivering a manually assisted cough.
Participants commented that the lecture content and presentation was excellent.
12 February 2013
Home Enteral Nutrition (HEN) Update Day
Participants (n= 119)
SP (22)
DN (45)
SW (1)
PT(1)
OT (1)
Attended at CHW (62)
Regional/Rural linked in by video conference
(57)
Workshop and resources were well received.
Significant technical issues impacted on feedback from rural clinicians.
21 February 2013 PT Regional/Rural 67% of participants indicated that the session
2 More detailed evaluation results of workshops are available on request.
17
Physiotherapy Reliability Sessions
participants
(n=14)
(n=8)
Metro (n=6)
provided new information or refreshed information relevant to clinical practice.
Feedback from this pilot session suggested appropriate alternate options to ensure access to high quality video transmission in future sessions.
15 April 2013 & 27 May 2013
Allied Health Coaching
Participants
(n=18)
PT (13)
SP (1)
OT (1)
DN (1)
Nursing (1)
Exec (1)
Bloomfield Campus
Orange Hospital
All participants reported increased confidence levels in delivering coaching/ clinical supervision post-workshop.
All participants indicated that knowledge and practical skills gained would benefit their current practice.
The ability to practice through role play contributed significantly to the effectiveness of the learning opportunity.
24 May 2013
Trauma, Abuse and Attachment
Participants
(n= 93)
Regional/Rural
(n=91)
All participants reported a significant improvement in knowledge regarding trauma, abuse and attachment.
Participants commented that the afternoon session would have been useful if more intervention strategies were discussed.
21 June 2013
CTEV Education Day
Children‟s Hospital at Westmead
Participants
PT (n=18)
Regional/Rural (n=5)
Workshop quality rated as excellent for: content (100%), relevance (81%), presentation (75%), organisation (675%), handouts (69%), overall (80%). 100% of participants indicated that the workshop was an effective learning opportunity.
Participation by regional/rural clinicians in workshops was facilitated by the provision of:
VPI Update Seminar for Speech Pathologists, 27 – 28th March 2012. Dissemination of information and
advocacy for rural clinicians resulted in videoconference sites provided in Ballina, Broken Hill, Maitland,
Port Macquarie, Orange, Queanbeyan, and Wagga Wagga.
A series of Advanced Workshops in Paediatric Feeding, Professor Joan Arvedson 13 – 16th October
2012. A number of positions were reserved for regional/rural Speech Pathologists. A total of 14
clinicians were selected through an EOI process to receive a full subsidy to attend workshop/s relevant
to their clinical caseload. Receipt of the subsidy was contingent upon the applicant‟s commitment to
taking a role in the dissemination of information and provision of support to clinicians in the LHD
regarding paediatric feeding. Teleconferences were conducted with participating Speech Pathologists
and their manager following attendance at the Advanced Workshops to determine the support strategies
to be implemented. These included development of resource folders, the provision of consultative
support and coordination of district-based paediatric feeding PD days.
D ISCUSSION
The Allied Health Education Program achieved the objective to conduct a range of workshops across NSW.
These comprised workshops and courses developed to address the identified education and clinical support
needs of AHP.
Long term funding will allow a more proactive and strategic approach to planning of future workshops and
courses. This will also enable the ongoing integration of workshops into blended learning models, in line with
educational best practice.
Some of the workshops were conducted using videoconferencing facilities with Hunter Bridging providing the
links. These workshops were also recorded. While this option minimised travel for many AHP, ongoing
technical issues continued to reduce effectiveness and increase frustration. NSW Health continues to look
for more cost-effective ways of delivering education and clinical support to those in rural and remote areas.
The use of existing and emerging technologies presents a potential solution to this question. However,
18
improved statewide infrastructure, access, and technical support is required to overcome the existing issues
limiting its uptake, reliability and effectiveness.
4.4. ALLIED TO K IDS NEWSLETTER
METHODOLOGY
The Allied to Kids newsletter was compiled and distributed by the AHE on a monthly basis (February through
to December). It was a newsletter for paediatric AHP by paediatric AHP and aimed to provide up to date
information that supports AHP in their work with children. The newsletter was distributed via email, posted to
the HSNet online networking groups and also the Allied to Kids website.
OUTCOMES
Twenty two editions of Allied to Kids were produced between July 201 and June 2013. Contributions for the
newsletter were received from AHP from across the state, with some coming from interstate AHP as well.
Anecdotal feedback indicated that the newsletter was very well received, meeting the needs of AHP working
with children. Some feedback received included:
“I just want to have it noted that it is such a great publication. I love reading about the PD
opportunities around the place to keep in touch with Allied Health.”
“I am on the mailing list for Allied to Kids and find it a very interesting and informative
newsletter.”
“Absolutely wonderful!”
D ISCUSSION
The key performance indicator relevant to this strategy reported that 10 Allied to Kids newsletters would be
produced. This indicator was achieved and exceeded, with 22 editions produced and distributed between
July 2011 and June 2013. The newsletter was well support with contributions coming from AHP from across
the state.
Alternative options of formatting the Allied to Kids newsletter will be considered to increase the efficiency of
newsletter publication.
4.5. REFERRAL/D ISCHARGE PROCESSES – CLINICAL HANDOVER
METHODOLOGY
The AH Education & Clinical Support Program aimed to develop a state-wide clinical handover process that
meets the needs of AHP and can be applied to the varying clinical settings of AH practice. AHP were invited
to participate in focus groups to discuss referrals and clinical handover between tertiary and non-tertiary
hospitals. The Allied Health Educators met with various departments, teams and individuals to discuss areas
essential for facilitating clinical handover in transition between local community facilities and tertiary facilities.
Interviews were conducted using a standard interview format with qualitative and quantitative questions
based on the format contained in Back to the Bush (WA Country Health Service, 2009).
OUTCOMES
All clinicians agreed on the importance of handover in client care. A number of issues were identified with
current handover systems across all sites.
Key issues identified by many clinicians included the importance of:
Communication and facilitating collaborative relationships.
Shared care between medical, AH and parents.
Common processes to ensure timely referral, structure to facilitate clinical handover and information
regarding points of referral including mapping of seniors for all areas.
Local processes to ensure timely and effective referrals and uptake of these referrals.
19
D ISCUSSION
The key performance indicator relating to this strategy referred to the implementation of referral/discharge
processes across the three children‟s hospitals. Therefore, this indicator was partially achieved.
The needs of different services obviously vary and no one solution would appear to address all needs
relating to clinical handover and referrals. Implementation of one uniform clinical handover process is not
supported. There were, however, several recommendations from the focus groups that will be developed in
the future including:
1. Mapping of key allied health services available for children within NSW Health.
2. Encourage effective and efficient utilisation of current systems.
3. Provide education/support to AHP regarding good models of practice, relating to:
Models of referral/intake.
Use of IIMS to report incidents/near misses related to referral processes.
Case coordination between health services.
Case conferencing/handover via teleconference/videoconference.
4. Develop tools to support the handover process by AHP, reflecting an allied health interpretation of the
ISBAR framework, including:
Modification of the ISBAR App, currently available through MOH, for use by AHP.
Sample referral form that can be adapted according to local service requirements.
Sample email referral template that can be adapted according to local service requirements.
5. Establish „referral/handover‟ page on the Allied to Kids website, including relevant resources for use by
AHP and services.
4.6. HSNET ONLINE NETWORKING GROUPS
METHODOLOGY
Online networking groups on HSNet were created for Nutrition and Dietetics, Occupational Therapy,
Physiotherapy, Play Therapy, Psychology, Social Work and Speech Pathology during the previous project.
An additional group for Allied Health Educators was created in February 2012. These groups were
maintained by the AHE. Membership to the groups was also moderated by the AHE.
OUTCOMES
Membership of the HSNet online networking groups included AHP from both Government and non-
Government organisations not only from within NSW but also interstate and internationally. The numbers of
AHE signed up to the respective groups as of July 2013 is listed in Table 1 below. The HSNet online
networking groups were regularly used by the AHE to distribute information to AHP.
Table 1: Number of AHP signed up to HSNet groups
Group Discipline Number Group Discipline Number
Allied Health Educators
Allied Health Educators
6 PaedPlay Play Therapy 7
PaedDiet Nutrition and Dietetics
32 PaedPsych Psychology 20
Paediatricots Occupational Therapy
597 PaedSocWk Social Work 27
20
PaedPt Physiotherapy 83 PaedSpeak Speech Pathology
106
D ISCUSSION
The key performance indicator relevant to this strategy stated that the AHE would oversee the management
of AH HSNet online networking groups. This indicator was achieved with the seven existing HSNet groups
continuing to be maintained and an extra group for Allied Health Educators being created and maintained.
There was a decrease in the number of registered members for each of the HSNet online networking groups
since the 2009 – 2011 report was compiled. This may have been the result of inactive members being
deleted from the system (this is a system that operates for all HSNet groups). Whilst membership was less
than previously under the Majordomo listserve system, the requirements of the Group Manager were far less
time consuming. The Occupational Therapy group (Paediatricots) continued to be the most active group.
4.7. ALLIED TO K IDS WEBSITE
METHODOLOGY
The maintenance of the CHN webpage remained the responsibility of the CHN and the MoH and updates
occurred during the period July 2011 to June 2013. The CHN webpage includes a link to the Allied to Kids
website and also to the Allied to Kids newsletters.
The Allied to Kids website is located on the NCHN website and contains links to each of the CHN websites.
The site is maintained regularly by the AHE.
OUTCOMES
The Allied to Kids website was originally launched in March of 2011. Since going live, it has been regularly
updated by the AHE and contains information about the Program, secondments, Telehealth, education and
training, clinical resources and also provides links to other relevant websites.
Statistically, between 1st July 2011 and 30th June 2013, there have been 11,377 visitors to the Allied to Kids website. The most visited pages were the home page (3,325), the news page (1,657), the clinical resources page (1,272), the Telehealth page (1,075), the education page (1,063) and the secondments page (736).
D ISCUSSION
The key performance indicator relevant to this strategy indicated that the AHE would develop and maintain
the Allied to Kids website. This indicator was achieved with the website being updated on a regular basis
following its launch in March 2011. As the website is housed on the NCHN website, the AHE were provided
with access to and training for CushyCMS (a content management system). This program enabled the AHE
to upload information to the website thus ensuring that it contained up to date information. Unfortunately,
changes to HNE LHD IT services resulted in haphazard access to CushyCMS. Early in 2013, Dreamweaver
CS6 software was purchased and the NCHN AHE was provided with training in this system. This resulted in
the website maintenance and updates being limited to NCHN AHE in the absence of consistent access to
CushyCMS. It is essential that other options are explored as the program moves forward towards
permanency.
4.8. CLINICAL PRACTICE GUIDELINES
METHODOLOGY
The development of two clinical practice guidelines was initiated during the previous project. These
guidelines focus on the clinical areas of Cerebral Palsy and Paediatric Feeding. The development of these
guidelines continued during this project. In addition, development of two new guidelines commenced,
focusing on Congenital Talipes Equino Varus and Burns Management.
The role of the AHE in the development of the clinical practice guidelines included:
21
chairing and providing secretarial support for working party meetings;
liaising with the working party members to facilitate the guideline development processes;
contributing to non-clinical components of the document;
clarifying processes regarding the coordination and endorsement non-acute clinical practice
guidelines.
CEREBR AL PALSY
The scope of the Cerebral Palsy Clinical Practice Guideline focuses on providing clinical pathways to support
allied health professionals in the assessment and management of children aged 2 – 6 years with a diagnosis
of Cerebral Palsy. The guideline aims to support individuals with Cerebral Palsy to achieve their goals and
to improve their participation in everyday activities and quality of life providing consumers with better
information about treatment options.
A working party was established consisting of Dietitians, Occupational Therapists, Orthotists,
Physiotherapists and Speech Pathologists from NSW Health as well as a rurally based private Speech
Pathologist. Negotiations were also undertaken with Cerebral Palsy Alliance (CPA) and ADHC to discuss
their engagement and clarify their role in the guideline development. Between May – June 2013, funding
was provided for an Occupational Therapist with clinical expertise in Cerebral Palsy to support the
completion of this guideline.
PAEDI ATRIC FEEDING
The scope of the Paediatric Feeding guideline focuses on supporting health professionals in providing
optimal, evidence based assessment and management of children with feeding difficulties from term at
assessment to 18 years of age, with reference to feeding skills and anthropometric measures.
A working party was established consisting of Dietitians, Speech Pathologists, Occupational Therapists and
a Clinical Psychologist from NSW Health as well as an Occupational Therapist from ADHC. Between April –
June 2013 funding was provided to backfill a Speech Pathologist with clinical expertise in paediatric feeding
to support the completion of the guideline. The final draft of the guideline will be distributed to relevant
stakeholders outside of the working party for review and consultation prior to its dissemination.
CONGENITAL T ALIPES EQUINO VARUS (CTEV)
The CTEV clinical practice guideline was developed in conjunction with the NSW CTEV Network Group,
which comprises physiotherapists from Sydney Children‟s Hospitals Network (Randwick and Westmead),
John Hunter Children‟s Hospital and Royal North Shore Hospital. The guideline was developed to ensure a
consistent, evidence based approach to the multidisciplinary management of infants and children born with
CTEV in NSW.
The final draft of the guideline was distributed to relevant stakeholders outside of the network group for
review and consultation prior to its dissemination.
BURNS M AN AGEM ENT
A process to develop a clinical practice guideline in the area of paediatric burns management was initiated to
assist AHP outside of the tertiary paediatric centres in the ongoing management of burns patients following
discharge from acute care. Key stakeholders from the Sydney Children‟s Hospitals Network and ACI were
identified and contacted to participate in the development of the guideline.
OUTCOMES
CEREBR AL PALSY
The Cerebral Palsy Clinical Practice Guideline will be released for comment shortly. The guideline will be
made available to clinicians online when a finalised document is obtained.
22
PAEDI ATRIC FEEDING
The final draft of Paediatric Feeding Clinical Practice Guideline is nearing completion. A process of review
and consultation with relevant stakeholders outside of the working party will be undertaken before the
guideline is made available to clinicians online in 2013.
CONGENITAL T ALIPES EQUINO VARUS (CTEV)
The final draft of CTEV Clinical Practice Guideline was completed. A process of review and consultation with
relevant stakeholders outside of the working party will be undertaken before the guideline is made available
to clinicians online in 2013.
BURNS M AN AGEMENT
The guideline development process was initiated but not progressed when it was identified that a similar
project addressing the needs of AHP managing patients with non-acute burns is already in progress at the
CHW Burns Unit.
D ISCUSSION
The key performance indicator for this strategy called for completion of the paediatric feeding and cerebral
palsy CPGs as well as completion of an additional two CPGs. Therefore, this indicator was partially
achieved.
It is anticipated that the Clinical Practice Guidelines will prove to be valuable resources in supporting the
clinical practice of AHP. Evaluation will be undertaken to determine their usage and effectiveness.
The development of the Clinical Practice Guidelines required a high level of involvement by contributing
expert clinicians, over a period of approximately two years. Barriers to maintaining this engagement included
heavy clinical workloads, participation in concurrent projects, levels of organisational/departmental support
and staff turnover. The role of the AHE in overseeing the guideline development process was critical. This
was supported by the short-term funding of an expert clinician to progress guideline completion.
Consideration of this model of guideline development is warranted for future projects.
As development of the CPG progressed, the AHE identified the need for a more coordinated process to
support and oversee the development and implementation of paediatric non-acute CPGs at a statewide
level. This process is required for guidelines developed through the Child Health Networks as well as other
groups within NSW Health. A key recommendation to achieve this is the establishment of a committee to
oversee the process. One of the roles of this committee may well be determining the appropriate
nomenclature for non-acute CPGs, as this continues to be a contentious issue. The AHE have been a
participating member of the Clinical Excellence Commission Paediatric CPG Steering Group. A letter was
also submitted to the Agency for Clinical Innovation (ACI). As of end June 2013, no resolution to this issue
was forthcoming.
4.9. DELIVERY OF EDUCATION
METHODOLOGY
Several education modalities were utilised in the delivery of education and clinical support, either in isolation
or using a blended learning model. Throughout the program, each educational modality implemented was
evaluated in relation to its effectiveness as a learning opportunity and impact on clinical knowledge and
skills. Consistent questions were included in the evaluation forms of all program initiatives to compare the
outcomes across educational modalities and results were compared.
OUTCOMES
A literature review regarding the best modalities to provide education to rural and remote allied health
professionals was completed. The literature review identified a range of educational modalities, many of
which may be transferable to the rural AH context. These include one or a combination of face-to-face
23
workshops, e-mentoring, work experience placements, web-based courses, simulation, asynchronous
computer conferencing, as well as videoconferenced seminars, journal clubs and peer review meetings.
Review of evaluation results across program initiatives did not indicate significant differences in the
outcomes or levels of participant satisfaction. Regardless of the educational modality, educational
opportunities which incorporated practical components that could be applied directly to their clinical practice
were rated highly. Opportunity for networking with other AHP was also highly valued.
D ISCUSSION
The key performance indicator relevant to this strategy referred to the development of guidelines to inform
the best options for delivery of education, clinical support and learning programs to AHP working with
children in NSW. Many of the educational modalities included in the educational literature were implemented
as part of the Allied Health Education & Clinical Support Program. Given the heterogeneous nature of the
rural AH workforce, it was not possible to conclusively determine the most effective model of providing
education for AHPs working in rural health facilities. Rather, this determination must be made following
assessment of the characteristics and learning needs of the target population, and application of the
appropriate educational model/s accordingly. Therefore, the indicator for this strategy was partially
achieved.
4.10. E-LEARNING
METHODOLOGY
The AHE participated in a CHN project to develop a Congenital Talipes Equinovarus (CTEV) e-learning
package. A project officer undertook the module development, with content provided by Physiotherapists
from the tertiary children‟s hospital. The AHE provided guidance and input regarding non-clinical
components of the module.
The success of this package indicated that e-learning is a mode of education well suited to support the
clinical practice of allied health professionals who work with children across NSW.
Allied health clinicians from across the state were asked to nominate clinical areas suitable for integration
into educational packages using e-learning technology. Both Plagiocephaly and Play Therapy were identified
as topics that would benefit from the development of currently existing resources into e-learning modules.
Endeavour Interactive is a developer of high-end customised eLearning products that maximise interactivity
using evidence-based design methodologies. This company was chosen to develop the modules based on
their successful collaboration on other e-learning projects within NSW Health (HETI). Endeavour‟s e-learning
designs have been researched and proven to add significant, measurable value to learning.
OUTCOMES
The CTEV e-learning module has been completed and is available on the Learn Paediatrics platform as a
pre-learning tool for physiotherapists attending CTEV workshops or secondments Access to the module is
moderated by the AHE to ensure that the theoretical content included is paired with a supported practical
experience. As of June 2013, 50 physiotherapists had completed the CTEV e-learning module. Evaluation
results indicated that it was an effective learning strategy to increase participant‟s knowledge regarding the
management of CTEV.
The Allied Health Educators are currently supporting and managing the process of combining clinical
knowledge gathered from content experts on both Plagiocephaly and Play Therapy, with the technical and
creative expertise of Endeavour Interactive. Both projects are in the design phase and have identified their
target audiences, developed learning objectives and are currently matching those objectives with the clinical
content supplied by the AHP and the interactive capabilities of the e-learning developer.
24
D ISCUSSION
The aim of the e-learning project was to establish three e-learning packages available on line to AHP. Part of
this aim was achieved with the CTEV e-learning package being complete and currently available on line via
the Learn Paediatrics platform. Plagiocephaly and Play Therapy e-learning modules are in the design phase
and will be available to AHP in the second half of 2013.
4.11. ALLIED HEALTH EDUCATOR FORUM
METHODOLOGY
The following strategies were implemented to establish networks and work collaboratively with other Allied
Health Educators:
an HSNet online networking group for AHE was established and used to disseminate relevant
information and resources.
meetings scheduled with the Allied Health division of HETI to discuss current initiatives and
opportunities for collaboration.
attendance at HETI Allied Health Professional Educator Network (AHPEN) Forum in May 2013.
a meeting occurred with each of the AHE from South Western Sydney LHD and Southern NSW
LHD. These AHE were also included as members of the GESCHN Allied Health Education Advisory
Group.
monthly meetings with SCH Allied Health Educator.
OUTCOMES
Outcomes achieved following implementation of the above strategies include:
Members of the recently convened Allied Health Professional Educator Network (AHPEN) were
invited to join the AHE online networking group (HSNet).
AHE have remained up to date with issues in HETI, SCHN and LHDs, relevant to program
implementation.
D ISCUSSION
The objective of establishing an Allied Health Educators forum was achieved, with support from HETI. In
addition to participation in the Allied Health Professional Educator Network (AHPEN), the AHE will continue
to implement a range of strategies to establish and maintain working relationships, and work collaboratively
with other educators.
5. CHALLENGES The Allied Health Education and Clinical Support program faced the following challenges to the achievement
of the program‟s objectives.
SEAMLESS TRANSITION
The uncertainty regarding continued funding and the temporary nature of the AHE positions resulted in
reduced momentum and limited ability to develop a unified, long term strategy. Recurrent funding of these
positions would enable medium and long term strategic planning to create a proactive plan for education and
clinical support needs of AHP. In addition, recurrent funding would result in efficient, uninterrupted
implementation of strategies and retention of staff within AHE roles.
25
ENGAGEMENT OF ALLIED HEALTH DEPARTMENTS
Ongoing communication between the AHE, Department Heads and relevant staff within the tertiary hospitals,
should keep the program in the minds of the AHP within these facilities and facilitate improved engagement.
6. DISCUSSION Since 2003, the three NSW Child Health Networks have successfully collaborated on a number of projects to
improve education and clinical support to allied health professionals working with children in NSW. The
extensive evidence demonstrated through the project outcomes supports the positive impact of the Allied
Health Educators in meeting the education and clinical support needs of clinicians, particularly those in rural
facilities. This success is well accepted across NSW as evidenced in 2008 when the NSW Health Children
and Young People's Health Priority Taskforce recognised the Child Health Networks Allied Health
professional development projects as an existing strategy to develop an “appropriately trained workforce”.
The funding for the current Allied Health Educators project roles will finish in 2013 and this creates an
opportunity for permanency of these positions to ensure sustainable achievements. There are currently no
other positions within NSW Health with the capacity to fulfil this role and achieve these outcomes.
A range of benefits are identified regarding the effectiveness of the proposed Allied Health Educator
positions in continuing to build on the outcomes achieved in the previous Child Health Networks projects.
Permanent establishment of the Allied Health Educator positions provides a cost effective model to
undertake the strategic planning and direct implementation of education initiatives to support allied health
professionals working with children; develop allied health education within NSW Health; increase access to
education for clinicians; and establish and maintain clinical networks across NSW. The permanently funded
Allied Health Educator positions will result in benefits for all key stakeholders, including children and families,
allied health professionals working with children, Local Health Districts/Specialty Networks and the NSW
Ministry of Health.
7. RECOMMENDATIONS The establishment of 3.0 FTE permanently funded Allied Health Educator positions is essential to coordinate,
facilitate and expand current and ongoing education and clinical support needs of allied health professionals
working with children across all of the NSW Local Health Districts. Following consideration of available
options for establishment of such positions and their governance, the following recommendations are
proposed.
RECOMMENDATION 1: The current Child Health Networks project funded Allied Health Educator positions be established as
permanently funded positions. This will enable the coordination, facilitation and expansion of current and
ongoing education and clinical support needs of allied health professionals working with children across all of
NSW.
RECOMMENDATION 2: That the NSW Ministry of Health provides recurrent funding for 3.0 FTE permanent Allied Health Educator
positions based on Health Professional Educator, Level 5 (NSW Health Service Health Professionals State
Award, 2012).
RECOMMENDATION 3: The three Allied Health Educator positions will have governance through the three tertiary Children‟s
Hospitals, aligned with the Child Health Networks boundaries. This governance structure will optimise the
achievement of the positions‟ outcomes.
26
ESTIMATED INVESTMENT Recurrent funding is requested from the NSW Ministry of Health to support 3.0 FTE permanent Health
Professional Educator, Level 5 (NSW Health Service Health Professionals State Award, 2012) positions with
governance through the tertiary Children‟s Hospitals, aligned to the Child Health Networks boundaries to
coordinate, facilitate and expand current and ongoing education and clinical support needs of allied health
professionals (AHP) working with children across all of the NSW Local Health Districts (LHD). The estimated
investment requested below will be utilised to meet the changing and dynamic needs of allied health
education and clinical support into the future. Funds requested will encompass the development and
delivery of education resources and modalities, as well as enable travel to rural and remote sites.
8. CONCLUSION The Child Health Networks Allied Health Education and Clinical Support project has achieved the majority of
identified outcomes and demonstrates the ongoing need for AHP to be supported in their professional and
clinical development. Permanently appointed CHN AHE will have the capacity to develop and implement a 3-
5 year strategic plan to ensure continued, high quality education and clinical support program for AHP
working with children, and minimise duplication of education initiatives across the state. It will also facilitate
the provision of allied health interventions for children with tertiary diagnoses to be undertaken as close to
home as possible.
Consumers have the right to expect that registered health professionals providing professional
services do so in a competent and contemporary manner. CPD can improve competence, and
result in better patient outcomes (Thomson et al 2004; Jamtvedt et al 2004). CPD is important
in the continued provision of safe and effective services by health professionals. (ACT Health,
2005).
9. BUDGET: JULY 2011 – JUNE 2013 Program Expenditure Original Budget $ Actual Expenditure $ Detailed explanation of expenditure
Salaries $716,085.00 $645,857.00 3 FTE
Goods & Services $347,968.00 $255,210.00 Travel Expenses
AHE Professional Development
Telehealth & other educational modalities.
E-learning resource development.
Secondments.
Administration including communications and stationery.
Mobile phone.
Administration fee (7.5%)
RMR $78,882.00 $4,663.00
Total $1,142,935.00 $905,730.00
27
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