Key success factors in implementing allied health outreach services

Abstract

Clinicians who provide outreach services to remote communities often encounter barriers to engaging with local people.^{1, 2} Factors contributing to poor engagement include unwelcoming health settings, inflexible approaches to service delivery, a sense of alienation, poor understanding of services and referral pathways, long wait lists, inadequate care coordination and mistrust of mainstream health care.^1-3 However, there are effective ways of working with people in remote communities, which can build trust and authentic engagement.^4-6 This article provides a case study that highlights some key success factors that enabled engagement, and positive outcomes and experiences for people needing to access health and disability services in a remote community.

In 2023, our organisation was approached by Birrang Enterprise Development to provide Allied Health (Occupational Therapy [OT] and Speech Pathology [SP]) services in a remote rural community in NSW. Our approach to developing and delivering our clinical outreach services was drawn from the Wobbly Hub Rural and Remote Person-Centred Approach model.⁷ This model enables people in remote communities to access the health and disability services they want and need by first asking ‘What would make a good life?’⁸ In summary, our Allied Health clinicians used this model to take a flexible person-centred approach with each person seeking a service and sought to understand what existed locally, what the outreach service brings, what we travel for and what can be accessed online.^{7, 8}

Prior to implementing outreach services, our approach first focused on engaging at an organisational level with local service providers and leaders to clarify the local needs, budget available and agree on the scope of the outreach service to be delivered, through a codesign process.⁹ This was an important first step that established the scope and expectations of the Allied Health outreach service and enabled our clinicians to maximise the effectiveness of their work within the community using the principles of the Wobbly Hub model.

Our Allied Health clinicians travelled to the community across two phases. In Phase 1, outreach clinicians conducted two visits to the remote community. In these first two visits, the outreach clinicians met with the clients who were referred (children and adults, hereafter referred to as person we are working with, or person/people). The clinicians had conversations in which each person identified what they wanted to talk about. The clinicians aimed to build rapport and trust by listening and respecting the person and asking what they wanted or needed to do.^{7, 8} The outreach clinicians made a plan with each person for ‘What's next’. This was documented in a one-page easy English Assessment Summary document and provided to each person following the session (see example Assessment Summary in Appendix 1).

Between Phase 1 and Phase 2, local Birrang staff followed up with each person using the written Assessment Summary to ask how they were going with achieving the actions in ‘What's next’ and checked what had worked and what the person still wanted to work on. Local service providers compiled a summary of those who wished to see outreach clinicians in Phase 2.

In Phase 2, outreach clinicians visited a third time with the aim of helping each person towards their goals. For example, some people required outreach clinicians to provide formalised assessments (e.g. functional capacity assessments as evidence to support access to the National Disability Insurance Scheme [NDIS]), others required letters supporting engagement with doctors, and others required referrals to counsellors and other service providers. Outreach clinicians translated the information they gathered about what each person had identified as important to them into a format that enabled them to progress their goals.

Evaluation of this outreach service drew on key elements of the quintuple aim for health care improvement.¹⁰ Information regarding the outcomes achieved and the experiences of key stakeholders was collected by our outreach team. In brief, a key outcome was the strong engagement from local people and staff supporting them in the community. For example, in Phase 1, 32 people were seen in 57 appointments with the outreach OT and SP clinicians. In Phase 2, 23 people were seen in 31 appointments. Twelve people received specific support in relation to accessing NDIS services. This included formal OT and SP assessments to support eligibility for NDIS access or plan activation. Four people met access requirements following engagement with the outreach service. Others received information and support to enable NDIS plan activation, supporting letters to a paediatrician and information regarding access to Early Childhood Early Intervention (ECEI). Other outcomes included people receiving information and support to access specialist diagnostic assessments (e.g. Autism and Attention-Deficit Hyperactivity Disorder assessments), support to achieve daily routines including better sleep, and support to access employment pathways, adult literacy and community participation (e.g. painting class).

The experiences of local people who received the outreach services were generally positive. Local people provided feedback through the brief evaluation completed at the end of sessions with clinicians. Positive feedback was provided about the opportunity to meet the outreach clinicians, and the value of the Assessment Summary and follow-up process, (e.g. ‘I like this’ and ‘it's good to have this’). Birrang staff gave positive feedback about using the Assessment Summary to follow up with people. Local people and Birrang staff liked that the same outreach clinicians returned for follow-up visits.

The experiences of the outreach clinicians were also considered. Outreach clinicians liked spending time and having conversations with each person. Clinicians liked using the Assessment Summaries and reported satisfaction in the work completed while they were in the community and plans made for following up on progress in their next meeting with the person. Allied Health clinicians can provide health information and build health literacy, advise on referral pathways, translate clinical needs and goals for NDIS reports and other medical purposes. A key learning for us as an organisation providing allied health outreach services was the importance of clinicians being well-prepared to deliver person-centred services consistent with the Wobbly Hub model, listening, understanding and being flexible.

People living in rural and remote communities have difficulty accessing the services they need.^1-3 Health literacy and knowledge of referral pathways are often barriers.^{1, 2} Allied health staff bring a good understanding of clinical issues, and referral pathways that enable access to services. They can support the person to translate their goals and needs into language that the health and disability systems can understand and respond to. Allied health clinicians who use this approach can powerfully help people to identify their health and well-being goals and navigate the health and disability systems, with the support of their local network. This involves listening, starting with what is most important to the person (their goals), identifying and starting the first step with the person (the plan), working with the person to determine what's next (outcome measures), providing information in simple written form and following up on the person's progress.

Julie Cullenward: Conceptualization; methodology; writing – original draft. Lisa Hall: Writing – review and editing; methodology. Amanda Cook: Methodology; writing – review and editing. Donna Ambler: Validation; writing – review and editing; project administration. Brittany Cleary: Funding acquisition; writing – review and editing; validation. Tim Smith: Conceptualization; writing – review and editing. Matt Thomas: Conceptualization; writing – original draft; supervision.

The authors have no conflict(s) of interest to declare.

None.