This project sought to influence the relationship between the roles of disability support workers and allied health professionals with the aim of strengthening outcomes of people’s therapy plans, particularly in a regional area.
Anglicare Tasmania provides disability services for people across Tasmania, including the Derwent Valley. New Norfolk is the main town in the Derwent Valley, with many smaller surrounding towns which depend on its services. Though only 35 km from Hobart, community members feel a greater sense of remoteness than experienced within similar distances of other capital cities. From 1827 until 2000, New Norfolk was home to the Royal Derwent Hospital, later Willow Court, which was an institution/asylum that housed people with disability and mental health conditions.
Anglicare Tasmania based this project in the Derwent Valley, as it was felt that the sense of remoteness and community knowledge of disability would provide a good understanding of the benefits generally associated with a hub-and-spoke model of allied health service provision. Additionally, support workers in the region are accustomed to working relatively independently and with remote supervision.
Clinical staff at Anglicare observed that some people accessing supports in regional areas were not experiencing the best possible outcomes in terms of the goals they identified in their individual plans.
Among the issues that the clinical staff identified was that the lack of allied health therapists based in New Norfolk and surrounding areas often required people to travel to Hobart for therapy services.
In addition, due to the community’s perception of remoteness, many of Anglicare’s clients were not engaged with therapists, or were engaging in therapy so infrequently that they weren’t maximising the benefits of therapy.
Finally, Anglicare recognised that they were having difficulty attracting and retaining support workers in this region. It was thought that this project could enhance the support worker role, thereby making it more attractive.
This project proposed the development and implementation of a hub-and-spoke model of allied health therapy. In this model, the therapist holds the appointment in the region where the person lives, and the support worker attends the appointment with the person. During the appointment the therapist trains the support worker. Between appointments, the support worker takes on some activities associated with the role of an allied health assistant as delegated by and under the supervision of the therapist. With some minor changes, the project was successful in doing this for people who wanted to use the model.
It was anticipated that people who chose to engage in the project would have a greater opportunity to achieve their goals. They said that it would be good to have everyone in their support team on the same page, and felt they would have better access to allied health services. Their therapists were hoping to observe strengthened clinical outcomes because of more consistency in therapy.
In addition, support workers would understand how they could better support the person’s achievement of their plan goals by supporting the person’s engagement with therapy as appropriate. They expected to feel a broader value in their role as they become more engaged in opportunities to strengthen clinical outcomes. This could also pave the way for them to further develop professional skills. It was also anticipated that shifts associated with the role of the support worker could become longer and perhaps more frequent. These outcomes would increase opportunity for Anglicare to attract and retain staff to this role.
This was the first time Anglicare Tasmania had trialled implementation of a hub-and-spoke model. The project began by speaking with people who access Anglicare’s services through their NDIS plans, and who Anglicare clinical staff felt might benefit from greater access to therapy. Based on these people’s interest in engaging in the project and their success in seeking the relevant funding through an NDIS plan review, relevant support workers and clinicians were also engaged. Despite good interest, only a small number of people successfully accessed the relevant funding in their NDIS plan.
Interested support workers attended a two-hour introductory workshop about allied health and the hub-and-spoke model. Those who worked with people with funded therapy supports in their plan also enrolled in accredited training to enhance their skills and knowledge in allied health. This comprised a skillset from Certificate IV Allied Health Assistance.
Most of the clinicians approached saw benefit to the model and were interested in participating.
By project end, there were three teams of three people trialling the model. That is, three people with funded clinical services, their therapist and their key support worker. The relationship between workers and therapists is guided by a supervision and delegation framework that Anglicare developed as part of the project.
The hub-and-spoke model involves at least three people: the person, their support worker and their therapist. Everyone needs to be committed to the model; that is there must be three-way buy-in.
Anglicare feels that the project’s success was challenged by people choosing not to engage with the model. In general, many people invited to participate in the trial didn’t feel confident to ask for clinical supports during their NDIS plan review, or didn’t see the benefit. Anglicare recognised there is a need for Easy English documents to support people to make decisions about whether therapy would be of benefit in their plan, and if so, how they can raise this during the review of their NDIS plan.
Anglicare, like most disability service providers, is going through a period of rapid change as participants transition to the NDIS. In projects of this nature where outcomes are established at the onset to a very high level, research and consultation is then required to develop low level objectives. This can prove difficult when one of the aspects of analysis is the thin demand and low resource availability in allied health professionals and support workers. This kind of pressure on the service delivery makes it challenging to have discussions around solutions to meet the project objectives.
The project team would recommend to other organisations that they actively ask for input from supervisors, rostering staff and support workers during the design of similar projects. Following the implementation plan outlined in this project will allow other organisations to bypass the concept stage and focus on assessing their level of demand for allied health assistants. They feel this will strengthen the buy-in to the project, and therefore make it easier to plan rosters around training, and coach support workers as they broaden the duties they undertake.