“Negative trends in child and youth wellbeing are costing Australia $22 billion per annum.”So what does it take to change this negative trend and truly make a difference to the wellbeing of our children, families and communities?That is what we.... a group of educators, practitioners and government agency workers have been trying to figure out ….How do we respond, in effective & sustainable ways to the complex interplay between Prevalence of communication impairments in our society;the social and geographic determinants of healthThe introduction of the International Classification of Functioning as the overarching framework for SP practice in Australia and;The need to strengthen the rural and remote workforce?Like all good journeys – we have gone to places we didn’t expect, changed directions a few times....and learnt some important lessons in going the distance– not least of which is how much we have all been enriched, both personally and professionally by trying to stretch ourselves to find ways to really build the capacity for effective and SUSTAINABLE services for rural and remote community wellbeing.We think our story has relevance to others – so we’d like to share it with you today. This presentation is a collaboration, because the truth is that we need engagement of all levels of ‘community’ to build sustainable solutions to a significant national challenge – the communication and learning potential of all of our children.- especially those in rural and remote areas.
To sustain the wellbeing of Australia, it is well known that we need to invest in the children who will become the future families and communities of our country. Having the skills and resources to fully participate throughout life is the result of starting well in early childhood. Supporting children in their early development has long-term benefits to them and the community. However, there are three factors that indicate we still have a distance to go to make real improvements in better life outcomes for our children….Firstly, according to the Australian Early Development Index (AEDI) there are still three groups of children who are developmentally ‘vulnerable’ or ‘at risk’ including those living in rural and remote locations, those with lower socio-economic status and indigenous children. Not only are there more children from these groups who are not ‘on track,’ there are also more children who score poorly in more than one developmental domain, suggesting more complex issues are faced by these groups. Secondly, there are still significant challenges of providing a sustainable workforce suitable to the needs of rural Australia. Health Workforce Australia has stated “There is a serious problem of maldistribution of the health workforce nationally, which significantly disadvantages regional, rural and remote communities, particularly in accessing some specialists and dental and allied health services”Considering these first two issues it becomes apparent that we need to look for where we can build capacity, and schools are an obvious place to do this. However a NSW upper house enquiry (2010) has found that teachers too, are struggling to educate students with additional needs and need assistance to develop new skills and techniques to address this.
Our opening statement about the financial cost of declining wellbeing is based not only on the costs from reduced skill levels, sub-optimal workforce participation and productivity and increased welfare dependency, but also on the need to spend on crisis interventions when investments in prevention are both effective and cost effective. Considering the value of investing in prevention and the fact that there will never be enough specialist services in rural and remote communities, it becomes imperative that we find new ways for rural communities to engage with specialist services; that there is a redefinition of specialist services’ scope of practice (particularly emphasising the need to engage with communities); and that we appropriately prepare the future rural workforce and reskill the current workforce.
The challenge of course, is how to put the principles of the ICF into action… and this presentation describes an example of how a good student idea about working with schools has evolved into a much broader community engagement framework. CLICKThe initial good idea of using speech pathology students to work in schools at a non-impairment level became the Schools Project.CLICKA significant bank of resources and knowledge about working effectively with schools, has been accrued over the years of the Schools Project. In an attempt to share this knowledge a website, Speech SPACE, was developed and trialled with educators and community groups in 3 central western NSW Communities. The website project was part of a multifaceted investment in speech pathology in these communities. As the name suggests, the website was built around exchanging information between speech pathologists and classroom educators. CLICKEmerging from the Speech SPACE activities in rural communities were a number of strong relationships, ‘champion’ teachers and enthusiasm to take the website and Schools Project a bit further. So the idea of delivering Schools Project activities simultaneously to multiple classrooms, in different locations, using video conferencing was trialled. The NSW DEC have a video conferencing and interactive whiteboard initiative called ‘Connected Classrooms’. The use of this technology to deliver speech pathology content, enabled the participation of users, including the children, in the development of knowledge and provided the opportunity to learn in both a social as well as cognitive manner.
The Schools Project has been running in the Riverina, southern NSW, for the past 8 years. It is a partnership between Charles Sturt University, Albury Community Health Centre and the NSW Department of Education and Communities. Twice a year, four teams of CSU speech pathology students, supported by a Senior Speech Pathologist (Community Health) and Learning Support Specialist (DEC) develop projects with schools around their identified speech and language needs. The CSU student teams develop resources and lesson plans and deliver these in schools for 16 days over an 8 week period. The translation of speech pathology approaches and terminology into school friendly formats enables the communication projects to be embedded into classroom curriculum and the school ethos. The Schools Project operates around the idea of collaborative engagement between agencies. The project teams develop strengths-based and preventative strategies rather than targeting children’s impairments. Projects are tailored to meet the needs of the particular school and build on what is already working well. The Schools Project provides speech pathologists and teachers the chance to better understand and learn about each others’ roles and the opportunities that can maximise the reach of their endeavours. It has also demonstrated that practical and engaging activities facilitate the involvement of parents and the broader community in the educational process.There is clear evidence of the educational effectiveness of students learning in an engaged, real-life manner, and while the Schools Project poses many challenges to speech pathology students’ conceptions of ‘legitimate practice,’ the key motivator for promoting this fieldwork experience has been maximising the opportunity to broaden the students’ professional identities in an effort to develop skills more appropriate to rural contexts.
CLICKA very clear lesson from the schools project, and particularly the Speech SPACE website development, is that relationships are everything. It is relatively unimportant how fabulous your resources are if you don’t make personal contact with your potential audience and follow up this contact at regular (but not necessarily frequent) intervals. Building trust through face-to-face encounters and having positive experiences from practical activities between professionals and families, are some of the key factors in successfully developing a level of social capital across a community and supporting genuine community engagement. CLICKWe have all heard the term ‘silo’ used in reference to the inadequate outcomes of services provided in an isolated, narrow and disjointed way. While the schools project poses many challenges the significant productivity achieved in the 16 days of the projects is testament to what can be achieved by working in an integrated and collaborative manner in order to achieve a common goal.CLICKThe ongoing success of the Schools Projects model for speech pathology indicates that the next step is to broaden the concept to incorporate ‘specialist’ services into the model. Specialist services refers to all professional disciplines that can contribute to child development and wellbeing including speech pathologists, occupational therapists, physiotherapists, teachers, oral health practitioners, podiatrists, psychologists … and more. CLICKWe are forced to acknowledge that there are just not enough services to go around. We have to start investing in building capacity at a community level if we are serious about improving child wellbeing outcomes. Solutions come best from within communities and facilitating the ability of these communities to identify, define, act on and sustain positive change is achievable and worthwhile.So….the Schools Project lessons bring us to a new model ….the Specialist Integrated Community Engagement Model….. SpICE
The SpICE model illustrates how to enhance family and community wellbeing, and is built upon the notion of building capacity and social capital in a community, by genuinely engaging all key stakeholders, fostering cross-sector initiatives and embedding sustainable approaches while a ‘community of learners’ evolves. Family and Community Wellbeing are essential to achieving a vibrant and prosperous society. Wellbeing is considered to encompass physical and emotional health and safety, social connectedness, autonomy, meaningful participation and economic security. The SpICE model recognises that supporting child development and health has a significant impact on family and community wellbeing. Addressing the issue of child wellbeing is the main driver behind the SpICE model.Capacity Building and Social Capital Given that ‘need’ for specialist services will always exceed the level of service that will be provided in a particular community, the intention of SpICE is to build the capacity and social capital of a broad base of key community stakeholders. By creating an increased level of specialist knowledge in a community (knowledge economy) all stakeholders will be able to change behaviours in order to break the cycles that perpetuate disadvantage. The Community of Learnersrefers to the SpICE concept of all stakeholders involved in a program, project or service (including service recipients) being learners as well as imparters of knowledge and service expertise. Information and experience is exchanged and a knowledge economy created as well as social and cultural capital. The community of learners will ebb and change over time with different stakeholders coming and going at particular points. It is not a defined group of representatives, rather a description of the ‘champions’ who make the ‘cultural shift’ that embeds sustainable change to address family and community wellbeing.Six Key Processes of the Community of LearnersThe community of learners is guided by six key processes of: Engagement; Participation; Investigation; Coordination; Implementation and Evaluation. These processes are not mutually exclusive, but rather operate in complementarity and should be seen as collectively ‘guiding’ the community of learners rather than demanding rigid adherence as a linear process might. At the outset, it is the ‘families’ and ‘communities’ particular self-identified need that shapes the community of learners and provides the focal point, rather than a specialist identification of impairment alone. Stakeholders move in and out of the community of learners relationship focussed and as equal entities in their mutual exchange of knowledge and expertise.
Unfortunately there is not enough time to properly describe the potential and nuances of the SpICE model. So some examples of how a pilot of SpICE has addressed the issues of rural specialist service provision are briefly presented here in relation to:Poor childhood development outcomes that impact on family and community wellbeing; Rural community disadvantage; and Rural workforce challenges.CLICKPoor childhood development outcomes that impact on family and community wellbeing.In the Central West pilot project, over half a million dollars’ worth of therapy was delivered for twenty-thousand dollars. A joint investment resulted in: Assessment of 195 pre‐school and school‐aged children; 18 lower primary school students were seen for a two‐week intensive therapy program; 76 lower primary school children received an intensive four‐week therapy program, in three communities; Forty-two per cent of those who were screened, assessed and received therapy were of Aboriginal and Torres Strait Islander descent.CLICKRural community disadvantageA positive consequence of the pilot project working with the community, in workshops, was the increased interest shown by participants in pursuing ‘formal’ training that could lead to work opportunities. With funding provided by Families and Community Services, Central West Family Support were able to support both Aboriginal staff and parents in undertaking training modules with TAFE that could contribute to participants attaining a Certificate III in Child Studies and/or Teachers’ Aide.CLICKRural workforce challenges. To increase the proportion of specialist services an integrated, ‘multifaceted’ approach is needed, initially to address the backlog of demand (and as part of learning about the need), but also to value-add to existing services and increase their capacity/potential and to introduce ‘new’ ways of working with specialists. The SpICE Model advocates establishing informal partnerships between key locally delivered government services, outreached government services, the non-government sector and the university sector. These partnerships will enable the use of a short-term, supervised, university student workforce to assess and provide intensive therapy to children as well as building the capacity within the Community of Learners.
The wellbeing of our communities is underpinned by the wellbeing of families and of particular interest to this paper, the wellbeing of the children of those families. Promoting wellbeing in children - their ability to develop, learn, maintain health and participate in society, is a complex issue. This complexity requires that the key messages in the SpICE Model – Specialist support services need to be Integrated through genuine Community Engagement - start to inform our actions to reduce the unnecessary and unfair disadvantage faced by some communities. This principle must underpin our decisions in relation to identifying the opportunities that we can turn into achievements.
Spa going the distance-final
Going the Distance: Providing speech pathology services to schools in rural NSW Marijke Denton2, Kendall Clarke3, Libby Clark1, Jane McCormack1, 1Charles Sturt University 2Albury Community Health Centre3Department of Families, Housing, Community Services and Indigenous Affairs Speech Pathology Australia National Conference, June 2012, Hobart SCHOOL OF COMMUNITY HEALTH
Issue Supporting children in their early development has long-term benefits to them and the community. However….• There are three distinct groups that have significantly poorer results in childhood development including geographic location (more remote the poorer the result), socio-economic status and being indigenous.• The “…maldistribution of the health workforce nationally,…significantly disadvantages regional, rural and remote communities, particularly in accessing … allied health services”• 1:10 students in public schools are disabled or have special learning needs and teachers are struggling to educate these students. SCHOOL OF COMMUNITY HEALTH
Impact of the problem “Negative trends in child and youth wellbeing are costing Australia $22 billion per annum.” Community SP practice Workforce• Social • Waiting lists • Placements disadvantage • Staff • Current and• Engagement retention future rural• Cost • Service workforce• Distance delivery • Local models workforce. SCHOOL OF COMMUNITY HEALTH
Communication impairment and the ICF-CY SCHOOL OF COMMUNITY HEALTH
Riverina Schools Project Evolution Riverina Schools ProjectSpeech SPACE - Speech Pathology and Classroom Exchange http://csusap.csu.edu.au/~mdenton/pages Connected Classrooms (Video Conferencing) TrialsSpecialist Integrated Community Engagement Model SpICE SCHOOL OF COMMUNITY HEALTH
Building on the Schools Project LessonsSpeech pathology g Specialist servicesIntegrated: cross sector / discipline servicesand student placements co-ordinated andtimely.Community - Building capacityEngagement - Building social capital SCHOOL OF COMMUNITY HEALTH
Specialist Integrated Community Engagement SpICE Model Specialist Integrated Community Engagement ENGAGE – Growing the Community of Learners city Community of PARTICIPATE – “What is the ‘relevance’ to C apa Learners Bu Refers to the concept of me?” nts & Uni Stude ild Ed all stakeholders involved rvisors In uca in Supe (including service g sti ti Community tu on recipients) being learners tio al Wellbeing WellbeingINVESTIGATE – Learn ns as well as imparters of Family Servic ent about Need knowledge and service es expertise. rnm COMMUNITY OF Gove Information and LEARNERS ices INSTIGATE & experience are exchanged Serv IMPLEMENT – and a knowledge ‘sustainable’ Ph economy created as well ila NGO opportunities nt as social and cultural hr op capital. Carers ies Parents / l ta ity COORDINATE – & Commun pi This will have a direct Ca Nurturing the ‘cultural’ So impact in increasing shift cia l family and community wellbeing EVALUATE – Describing Outcomes; building on success SCHOOL OF COMMUNITY HEALTH
Challenges that SpICE addressesPoor childhood development outcomes that impact on family andcommunity wellbeing.In a pilot project, over half a million dollars‟ worth of therapy wasdelivered for twenty-thousand dollars.Rural community disadvantageThere was an increased interest shown by parent members of theCommunity of Learners in pursuing „formal‟ training that could lead towork opportunities like Cert III in child studies or Allied HealthAssistanceRural workforce challenges.An integrated, „multifaceted‟ approach is needed, initially to address thebacklog of demand but also to value-add to existing services andincrease their capacity/potential and to introduce „new‟ ways of workingwith specialists. SCHOOL OF COMMUNITY HEALTH
Summary Go the distance by… Community SP practice Workforce• Finding solutions to • Providing placements complex problems from • Building relationships that enable within communities and with communities and collaborative by communities. partners. engagement to build• Building capacity in the • Persevering in seeking capacity and generalist community to ways to engage, listen skills participate in strategies and follow-up. • Increasing capacity of for change that result in • Working in an rural supervisors sustainable integrated and timely through shared achievements. way … if you can do it placements and using• Building on what works you should…. despite technology. well. service and geographic • Up-skilling the local• Forming partnerships to boundaries. community to enhance maximise the use of the delivery of resources. specialist services. SCHOOL OF COMMUNITY HEALTH
AcknowledgmentWe’d like to acknowledge everyone involved in making this journey happen:- Our respective departments/institutions: FaHCSIA, MLHN, NSW DEC and CSU- The students ….from Kim & Cara-Jane through to the students preparing for placement in Spring;- The teachers, and the pupils of Albury, the Riverina and the Central West- The parents in Condo, Lake, Murrin Bridge and beyond- The fabulous folk at NSW DEC- To Ruth, Helen, Marion, Andrew, Carl, Eva and Julia – you know how you contributed!…and the dynamic Kendall Clarke, for helping us to see that we need to think ‘big’ & ‘local’ at the same time! These relationships really are the heart of it all. SCHOOL OF COMMUNITY HEALTH
Going the Distance:Providing speech pathology servicesto schools in rural NSWKendall Clarke Libby Clarkkendall.firstname.lastname@example.org email@example.com+61 8 8975 0628 +61 2 6051 9205Marijke Denton Jane McCormackmarijke.firstname.lastname@example.org email@example.com+61 2 6058 1800 +61 2 6051 9224 SCHOOL OF COMMUNITY HEALTH