FIRST DRAFT - Telethon Kids_PATCHES

Transcription

1 Extension of the existing Telethon Kids-PATCHES Fetal Alcohol Spectrum Disorder (FASD) Project to the Kalgoorlie-Goldfields Area utilising seeding Funds provided by Rotary Clubs of Western Australia INTRODUCTION Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term for the physical, cognitive, behavioural and neurodevelopmental disabilities that result from exposure of the fetus to alcohol. As a guide, damage to the brain means individuals living with FASDs will typically experience some or all of the following characteristics: Memory problems Difficulty storing and retrieving information Inconsistent performance Impulsivity, distractibility, disorganization Ability to repeat instructions, but inability to put them into action Difficulty with abstract thinking mathematics, money, Time Cognitive processing deficits thinking which is slowed Slower auditory pace (may only pick up pieces of the information or instruction) Developmental development is younger than chronological age Inability to predict outcomes or understand consequences The effects of FASD on individuals, families and communities can be severe. FASD is entirely preventable if alcohol is not consumed during pregnancy. There are no national data on the prevalence of FASD or even FASD s most severe manifestation in Australia, but a number of smaller studies have found higher rates of FASD among the Indigenous population than the non-indigenous population 1. Early detection of FASD-related conditions in babies and young children is crucial to allow for early intervention to improve long-term outcomes. An Australian diagnostic instrument for FASD has been developed and is currently being clinically trialed in Western Australia. A review of 22 programs in the United States found that pre-natal health screening of all women to identify those who have alcohol-related issues, followed by brief, empathetic interventions by health professionals and motivational interviewing was effective in causing women to reduce or stop drinking alcohol during pregnancy. Research in the United States and Canada found that the following are effective in alleviating some of the effects of FASD: the parenting program Families Moving Forward ; training programs including neurocognitive habilitation therapy, sustained attention training and Children s Friendship Training; and medication. 1 Preliminary finding in Western Australia indicate FASD incidence levels amongst Fitzroy Valley Aboriginals to be 14 times higher than for the non-indigenous population. In the Northern Territory incidence rates of 9.5 to 23 times higher than the Non-indigenous population have been reported. 1

2 Strong Spirit Strong Future, is a Western Australian Indigenous-specific education campaign to increase awareness of alcohol abuse in Aboriginal communities, especially during pregnancy. It has been found to be a culturally appropriate and sensitive approach. However, the impact of the campaign on attitudes towards drinking and drinking behaviour has not yet been thoroughly evaluated 2. In Australia, programs and activities to address the effects of FASD have been implemented, but none has been evaluated. The Lililwan project in the Fitzroy Valley continues to show promise. Overseas studies confirm that targeting or shaming women for drinking alcohol while they are pregnant is not effective in causing them to reduce their alcohol intake. The United States of America has estimated the lifetime cost of care for a person with FAS in 2016 in the United States has been estimated to be $3 million. Why Rotary should contribute to this program? The current Western Australian FASD program has been developed by a not-for-profit partnership (i.e. the Telethon Kids Institute and PATCHES Pediatrics) to translate child health research quickly and directly into clinical practice. The current program has both a strong preventative approach combined with the delivery of evidence-based child development and intervention services for hard to reach populations and places. Currently, not-for profit funding is available for this holistic program to operate in the Kimberley, Pilbara and Perth communities. There is no funding to extend the program to the Kalgoorlie- Goldfields area, which has serious and growing needs for such a program. As FASD is a preventable disorder early action is essential to extend this program to the Kalgoorlie- Goldfields area to support this local regional community minimize the occurrence of FASD and the associated life-time costs of the condition. Hence, Rotary can make an important contribution to the Australian community (especially the Kalgoorlie-Goldfields community) by establishing this program in this area. Australian Governments have been slow in recognizing this disorder and developing the preventative and intervention strategies necessary. However, there is a growing recognition in Government bodies of the disorder and increasing funding is becoming available to provide child development and intervention services. Hence, Medicare and National Disability Insurance Scheme (NDIS) funds where available will be used to extend the program to the Kalgoorlie-Goldfields area. Funding for the preventative elements of the program tailored to the unique needs of Kalgoorlie- Goldfields population (including essential infra-structure) is not yet available from Government. PATCHES Pediatrics PATCHES Pediatrics has the capacity to extend their program to the Kalgoorlie-Goldfields area. However, they require an injection of $419,068 over a two year period to establish their program (See Telethon_PATCHES documents that accompany this submission). PATCHES Pediatrics understand that if Rotary contributes to this extension that they will have to undertake succession planning to fund the program on a continuing basis post the initial two-year establishment phase. 2 Recent preliminary findings indicate that 70% of Aboriginal women drank during pregnancy prior to intervention and that since the introduction of the Strong Spirit Strong Future program the proportion of pregnant Aboriginal women drinking has fallen to 20%. 2

3 PATCHES and Rotary would have to enter into an agreement for the establishment of the program in the Kalgoorlie-Goldfields area. At this stage, negotiations are occurring within Rotary Districts 9455 and 9456 and with potential sponsor Clubs to determine the appropriate structures to ensure the establishment of the program in the Kalgoorlie-Goldfields region through the effective use of Rotary funds. It is proposed that funding would be direct to PATCHES Pediatrics on their presentation of monthly invoices. This method of payment was selected because to pay through the Telethon Kids Institute would incur a 40% surcharge. Project Reporting PATCHES Pediatrics has agreed to provide a short six monthly report on progress and a comprehensive annual report on the project for each year. In addition to these reports they will provide 5 website reports per annum of progress. Western Australian Rotary Structures It is proposed that this be a collaborative project between the Rotary Clubs of Osborne Park, the two Kalgoorlie-Boulder Clubs and one other D9456 Perth Club. Funding could be managed by the Rotary Club of Osborne Park. A Rotary FASD Project Management Group should be established to manage funding and evaluate progress. This Group is entitled to seek additional information from PATCHES Pediatrics should this be required. The Rotary FASD Project Management Group could comprise Rotary Representatives from the sponsoring Clubs, the finance manager, and two Aboriginal Reference Group representatives. Rotary District Governors need to be approached regarding any recommendations they may have regarding the formation of this Project Management Group. Funding Funding will be through an application to the Rotary Australia Benevolent Society (RABS). Clubs may be required to assist with touting for donors. Evaluation The Telethon Kids Institute and PATCHES Pediatrics will be responsible for assessing the project outcomes. 3

4 1. Background The Telethon Kids Institute (TKI) and PATCHES Paediatrics have established a unique relationship (hereinafter referred to as the TKI/PATCHES Partnership ) in order to translate child health research quickly and directly into clinical practice. The TKI/PATCHES Partnership is effective because it brings a highly reputable not-for-profit child health organisation together with a paediatric services social enterprise. The enterprise aspect of this PARTNERSHIP is key, as this is what incentivises the participation and activity levels of medical doctors, allied health practitioners, and local Aboriginal therapy staff, for service delivery in remote and outer metropolitan settings. The TKI/PATCHES Partnership seeks to overcome disadvantage in early childhood by delivering evidencebased child development and intervention services in hard-to-reach populations and places. The ethos of the TKI/PATCHES Partnership is to Apply the Law of Love with Scientific Precision, as recommended by Mahatma Gandhi. Briefly, Telethon Kids Institute was established in 1990 by Professor Fiona Stanley, to improve the health and wellbeing of children through excellence in research. For more than 25 years its multidisciplinary researchers have contributed to significant breakthroughs in children s health and wellbeing. They have done this with chronic and severe diseases like cystic fibrosis, diabetes, leukaemia and brain tumours. Breakthroughs have also been made with respect to allergies, asthma, mental ill health, neurodevelopmental disorders, infectious diseases, and rare diseases. Importantly, Aboriginal child health has benefitted substantially from the work of the Institute s researchers. Within Western Australia, the Institute is the recognised, established link between scientific discovery and child health and is respected for its children come first leadership role in the community. PATCHES Paediatrics is a private social enterprise, developed along the principles of the Benefit Corporations (B-corporations). PATCHES as a legal entity is able to hold contracts with government agencies and provide clinical services. PATCHES employs clinicians to deliver multidisciplinary services as subcontractors. The capacity to hold contracts and access mainstream funding sources (Medicare, Disability Services funding, NDIS) means that the service model can grow despite Government funding restraints. Importantly, it allows incentives to increased service activity to be embedded in the model. The enterprise component of the model aims to enable service providers and individuals to operate independently of a welfare model of dependency on public grants and payments. Participating families do not pay to receive services in this model, however a fee for service model taps into mainstream funding mechanisms. The TKI/PATCHES Partnership aims to Overcome Disadvantage in Early Childhood by delivering world class Child Development and Early Intervention Services in hard to reach populations and places. 4

5 Our Vision: In hard to reach places and populations; children, young people and families will have access to high quality child development, disability and early intervention services. Improved access to these services will improve life outcomes for our clients, and their communities. Our Mission: To develop, implement and evaluate the effectiveness of services that reach disadvantaged populations including within the Justice system, rural, remote and outer/metropolitan communities in Australia. To deliver clinical services in a coordinated, team-based fashion so that the client journey is transparent, makes sense, and places the client/patient in a position of control. To produce appropriate diagnostic reports that trigger therapy/support funding, that are written in a language that can be understood by our clients. To deliver evidence-based, practical therapy and support programs, within a formal translational research and quality improvement framework. Our model: The TKI/PATCHES Partnership model has been developed in consultation and collaboration with communities and consumers, Aboriginal Community Controlled Health organisations, the WA Department of Health, Child Protection and Family Support, and Disability, Justice and Education sector stakeholders to provide: Service coordination and brokerage: For complex multidisciplinary diagnostic clinics, we act as a service coordinator and broker, so that a coordinated, team-based service model may be achieved. Depending on the client s needs, we bring a team of disciplines together that may include paediatrics, psychiatry, neuro/psychology, speech pathology, occupational therapy, physiotherapy, Aboriginal Therapists and social work. While we focus on child health, our teams may also provide assessments for adults where requested by local agencies. Diagnostic services: We aim to provide a regular, coordinated schedule of multidisciplinary child development and disability diagnostic clinics that are integrated with local primary health (general practice, allied health), and education (early childhood centres, schools) service models. We are committed to high quality and accurate diagnostic processes, to better understand children and family needs, and to trigger eligibility to health, disability and education funding. Translational research: therapy and support services: More than diagnosis, we are committed to delivering evidence-based therapy and support for children and young people with developmental or disability issues, working within a systems approach that values family, community and context. We believe that early diagnosis of developmental delay or disability, and early intervention and support, will help children and families to reach their true potential. Our model includes up-skilling local health staff, caseworkers, teachers and parents, and providing Telehealth support. In partnership with families, schools and other service providers, we deliver goal-oriented, evidence-based therapy and support programs, and evaluate these 5

6 through a formal research program at Telethon Kids Institute. All translational research is conducted under research ethics approvals and governance structures. Our success to date with this model is evident through: Disrupting current fragmented service models to remote Aboriginal communities by establishing a coordinated, team based approach to diagnostic services, within an early education environment. Unlocking mainstream Commonwealth funding sources (Medicare, NDIS) hitherto under-utilised in remote communities. Creating employment for local Aboriginal people, and providing training in child development and early intervention methods. 2. The Project Between the TKI/PATCHES Partnership endeavors to consolidate services and sites to the Kimberley (Fitzroy Crossing, Broome and Derby) and Pilbara (Port Hedland, Karratha and Roebourne) and will also continue to consolidate Perth outer/metropolitan services (Crawley, Midland, Armadale) to meet the need for assessment within the Justice system, Department of Child Protection and Family Support, family and children centers, and schools. With additional financial support from Rotary, TKI/PATCHES would be able to extend these services and support into the Kalgoorlie/Goldfields area. The TKI/PATCHES Partnership seeks support to enable the consolidation of service activity to deliver evidence based, practical therapy and support programs within a translational research framework, to address a service gap in Perth, the Kimberley, the Pilbara and potentially Kalgoorlie/ Goldfields, for diagnosis and intervention therapies for children with FASD. Results of our research will inform service planning and service delivery in other regions. We aim to deliver week-long child development clinics six times per year to the following four service sites: (within the Justice system and outer metro). With additional Rotary support, this clinic provision can be extended into the Kalgoorlie/Goldfields area. These sites do not otherwise have access to multidisciplinary child development services or early intervention services. Our clinics will diagnose complex conditions including Autism, Fetal Alcohol Spectrum Disorders, Intellectual Disability and Global Developmental Delay. These diagnoses trigger eligibility for school and home based funding including through Schools funding and State and Commonwealth disability schemes. We aim to provide diagnostic services to families per site per year, including upskilling and capacity building in families, teachers, and local health services that will impact an additional 200 children per site per year. The service activity comprises child health research and service delivery programs that deliver seismic benefit to Aboriginal and other socially disadvantaged communities through an efficient one stop shop for children and their families requiring complex developmental assessments. This process is integrated with early 6

7 childhood centers and schools. As such, the beneficiaries are not only the children and families but also the communities within each region who benefit from the ongoing service activity and resources. Sustainability: Service sustainability of this initiative means a change in the service landscape from poorly coordinated, poorly integrated clinical services; to a coordinated and streamlined screening, referral, diagnosis and therapy pipeline. State health services and Aboriginal Medical Services have requested ongoing TKI/PATCHES service delivery in the Fitzroy Valley, expansion of the Broome and Derby service models, and introduction of the Pilbara service model during Financial sustainability will be defined as the improved access to mainstream funding sources (MBS, NDIS) in areas that historically have been unable to access these programs. Our Kimberley services have recent success in accessing MBS funding for clinical services: Current Kimberley Medicare (MBS) Service Activity January 2015 May 2016 District Number of Appointments Broome 592 Derby 172 Fitzroy Crossing 52 Total 816 Funding challenges Funding for non-clinical staff: To enable our service model to run efficiently and reach as many sites as possible we employ coordinators and administrative staff members, who support our clinical teams. We also employ Aboriginal Therapists and Social workers who are key to providing ongoing therapy and support. General management, coordination, administration, Aboriginal therapy and Social work positions cannot be sustainably funded using mainstream programs. Therefore, the TKI/PATCHES Partnership requires funding partnerships with philanthropic, private sector and government entities. 3. Program logic/theory of change- Logic/theory of change matrix See Appendix A 4. Evaluation The outcomes and impact will be evaluated through key data which will include: Service activity (number of clinics delivered, number of children seen per clinic) Attendance rates (percentage of appointments attended) Number of MBS and Disability services funded episodes of care Number of diagnoses made that trigger health, education and disability services funding (e.g. Autism, CP, FASD, Global Developmental Delay) Behavioral and developmental improvement as a result of therapy/support provided, assessed using 7

8 standardised outcome measures Qualitative feedback from families on their experience of the model (Data currently being collected in the Fitzroy Valley by Aboriginal therapists using a structured questionnaire) Number of Aboriginal employees and trainees Activity reporting from our pilot in the Fitzroy Valley, Kimberley region Mar July 2015 The model was piloted in the Fitzroy Valley, WA Kimberley region, between and was deemed a valuable service by participating clinicians and service partners. Activity reporting: Extracting data from the minutes of the Multidisciplinary Team (MDT) meetings and clinic schedules/ attendance records, between March 2013 and June 2015 the following activity levels have been determined and are illustrated in Figure 1 (note 2015 data indicate only 6 months of activity to July 2015): 23 monthly MDT intake meetings facilitated and recorded, exceptions were two wet season months where meetings were cancelled, and two months in 2014 during which the TKI/PATCHES Clinical Coordinator was not employed. 13 combined WA Country Health Service (WACHS) Allied Health/TKI-PATCHES MDT clinics 40 TKI/PATCHES MDT clinics 401 episodes of MDT clinical care involving 114 individual child participants, including: o 104 new referrals to the MDT clinic o 204 complex case conferences and actions arising from conferences o 106 child assessments/reviews in the TKI/PATCHES MDT clinic (including 73 children seen with WACHS Allied Health colleagues) New Referrals WACHS/PATCHES MDT Clinics PATCHES Clinics Complex Case Conferences Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Figure 1. Fitzroy Valley MDT Clinical Activity March 2013 June 2015 (note 2015 data indicate only 6 months of activity). 8

9 Trends in clinic activity and new referrals are illustrated in Figure 2 (note 2015 data indicate only six months of activity): TKI/PATCHES Diagnostic Clinics: In 2013 only nine children were seen in one clinic conducted that year, in 2014 a total of 42 children were seen in four clinics for that year, and in the first six months of 2015 a total of 54 children have been seen in five clinics. This increase in activity is likely related to a delay in establishing clinical activity during due to a prolonged consultation and planning period. Combined WACHS/TKI-PATCHES MDT clinics: In children were seen in combined clinics, this increased to 25 in 2014, and 33 in the first half of The number of children seen in combined WACHS/TKI-PATCHES MDT clinics has increased since the TKI/PATCHES Clinical Coordinator position has been established. New referrals to MDT clinics: These have decreased from 66 in 2013, to 28 in 2014, and 10 in the first six months of It is likely that this represents high demand for MDT clinic reviews when the MDT model was first established in the Fitzroy Valley, and maintenance of manageable demand since service activity has been established Jan-June 10 0 PATCHES Clinics WACHS/PATCHES MDT Clinics New Referrals Figure 2. Trends in TKI/PATCHES Clinics, WACHS/TKI-PATCHES Clinics and new referrals to the MDT clinics over the three years of TKI/PATCHES activity (note 2015 data indicate only six months of activity to the time of reporting). Clinic attendance rates: To assess clinic attendance rates the TKI/PATCHES MDT clinic attendance has been compared with Fitzroy Valley General Paediatrics clinic (children being seen by the paediatrician alone). General Paediatrics clinics (WACHS): Data has been collected for 5 months since January In that time 362 appointments have been made (average of 72 per month) for 268 different children (average of 1.35 per child). The greatest number of appointments for one child was four. A total of 150 appointments were attended (average of 30 per month), giving an attendance rate for the non-tki/patches clinics of 41%. For those appointments where the patient did not attend (DNA) the majority (149) did not turn up with a minority being in a different identified location. 9

10 TKI/PATCHES MDT Clinics: In the first five months of 2015 the TKI/PATCHES MDT clinics were supported by a Clinic Coordinator and Aboriginal Therapist. This team is based locally, and conducts pre-engagement visits to families who are to be invited to the TKI/PATCHES MDT clinic. The attendance rates for the June, August and October 2015 PATCHES school based clinics was 88%. While TKI/PATCHES clinics have a pre-engagement process identifying families and supporting them to attend clinic is often times challenging, this difference is likely influenced by over-booking of General paediatric clinics, and expecting low turnout. Clinical conditions addressed: The range of complex conditions experienced by children attending the MDT clinics are represented in Figure 3: 1% 2% 3% 4% 5% 6% 2% FASD/PAE 12% Language Cogni on 10% 29% Motor/Sensory 8% Neurological 18% Au sm/ CP/ Down Syndrome Figure 3. The most common condition documented in the MDT process involves language/hearing problems (29%), followed by cognitive/behavioural concerns (18%), Fetal Alcohol Spectrum Disorder and prenatal alcohol exposure (FASD/PAE) (12%), Motor or sensory processing problems (8%), Autism/Cerebral Palsy or Down Syndrome (6%), and other neurological conditions (10%), other 1-5% (respiratory, heart, vision, skin, weight and nutrition). Clinicians represented at the MDT case conferences and Clinics include: Indigenous Therapy Assistant/Aboriginal Therapist Paediatrician Occupational Therapist Speech Pathologist Neuro/psychologist/school psychologist Physiotherapist Community Health Nurses 10

11 Clinical Coordination Fetal Alcohol Spectrum Disorders (FASD) Training Clinics In addition to service clinics, training clinics have been provided by the TKI/PATCHES Partnership throughout the Kimberley and Pilbara regions, and in Perth. The goals of these clinics are to increase the number of clinicians diagnosing FASD, to increase standardisation of the approach to diagnosis, and to develop a network of FASD Clinics in WA and nationally. FASD training and justice system referral process established in the Fitzroy Valley: TKI/PATCHES Paediatrics clinicians Dr James Fitzpatrick (paediatrician), Nikki Hulse (OT) and Dr Jonson Moyle (Neuropsychologist) met with Broome Magistrate Steve Sharratt, Haley Allan (Legal Aid WA) and members of the Kimberley Youth Justice team, Aboriginal Legal Service (Steven Carter). FASD training clinics conducted in Port Hedland: From April 30-May Wirrika Maya Aboriginal Medical Service and WA Country Health Services (South Hedland, Pilbara region) hosted a TKI/PATCHES Paediatrics team who delivered a FASD training clinic in Port Hedland. FASD training clinics in Fitzroy Valley With funding from Rural Health West for child development team outreach programs, PATCHES Paediatrics conducted FASD training clinics in the Fitzroy Valley (6-10 June, 2015) and Derby (22-26 June, 2015). This multidisciplinary process was supported by Nindilingarri Cultural Health Service, Derby Aboriginal Health Service, Marninwarntikura, Kimberley Regional Education Office, WA Country Health Service, and Kimberley Population Health Unit staff. The approach to multidisciplinary assessment and interagency integration aims to improve the patient journey and increase efficiency of assessing and managing children with complex neurodevelopmental conditions. 11

12 Qualitative and quantitative outcome data: Formal data collection relating to qualitative evaluation of clinic acceptability to participants using interview, and quantitative assessment of clinical outcomes using the Ages and Stages Questionnaire is in the early stages, and no data is available for reporting at this time. Ethics approval has been granted for this component of the study. The Qualitative evaluation questionnaire has been developed and translated into local languages, and data collection is ongoing. 12

13 BUDGET FOR EXTENSION TO KALGOORLIE-GOLDFIELDS (2 Years) Role Hourly rate Hours/week Monthly cost Annual cost Two year cost* Sustainability beyond 2018 Key Worker Goldfields (Kal) $40 16 $2,560 $25,600 $51,968 Medicare and NDIS funding Aboriginal Therapist Goldfields $30 16 $1,920 $19,200 $38,976 NDIS funding Clinical Services Manager (Perth) $50 8 $1,600 $19,200 $38,976 PATCHES core funding 2-3 day FASD clinics: 5 x 2016, 5 X 2017 ^ $100,000 $203,000 Rural Health West and MBS funding Vehicle lease/running (Landcruiser) $1,800 $21,600 $43,848 PATCHES to pay out residual value Office space lease# $10,000 $20,300 PATCHES core funding Child Development equipment/training** $12,000 One off costs Telehealth & communications equipment ^^ $10,000 One off costs Total cost if funded directly through PATCHES Paediatrics (preferred option) $195,600 $419,068 *Assuming CPI of 3%. Kalgoorlie based staff funded for 10 months per year; Perth based staff for 12 months ^ Multidisciplinary team two day clinic: Paediatrician, Speech Pathologist, Neuropsychologist, Occupational Therapist. All travel and accommodation # Based at local organisation AMS or WACHS in Kalgoorlie ** Griffiths and Bayleys Child Development Scales; Alert Program and Families Moving Forward training and therapy resources ^^ Mobile phone, data plan, laptop 13

14 APPENDIX A: PROGRAM LOGIC / THEORY OF CHANGE GOAL: Supporting FASD diagnosis and intervention therapies in Perth, the Pilbara and Kimberley Objectives Enable consolidation of service activity in Perth, the Kimberley and the Pilbara for diagnosis and intervention therapies for children with FASD and deliver seismic benefit to Aboriginal and other socially disadvantaged communities through evidence based, practical therapy and support programs. Disrupt current service models to remote Aboriginal communities by establishing a fully integrated, efficient, multidisciplinary team based one stop shop approach for children and their families to access diagnostic services. Unlock mainstream Commonwealth funding sources (Medicare, NDIS) hitherto underutilized in remote communities and create employment for local Aboriginal people, and training in child development and early intervention methods. INPUTS ACTIVITIES OUTPUTS OUTCOMES OUTCOME MEASURES IMPACT Clinical Staff Transportation General & project management Clinical service provision- facilitate local involvement Training & Support FASD Training Clinics Fitzroy Valley, Kimberly, Pilbara, Perth Justice system referral process Standardisation of the approach to diagnosis Develop a network of FASD Clinics in WA and nationally Formal data collection relating to qualitative evaluation of clinic acceptability Increased service activity and attendance rates Number of MBS and Disability services funded episodes of care Qualitative feedback Number of Aboriginal employees and trainees Create employment for local Aboriginal people and training in child development and early intervention methods that change the service landscape from poorly coordinated, poorly integrated clinical services; to a coordinated and streamlined screening, referral, diagnosis and therapy pipeline. WHAT YOU WILL DO WHAT YOU INTEND TO CHANGE OR ACHIEVE AS A RESULT OF YOUR INPUTS, ACTIVITIES AND OUTPUTS 14

15 . Job Description Job Title: PATCHES Clinical Service Manager Reports to: Director Location: Perth Casual hours per week Rate - $36-$50 per hour Salary equivalent. $70K- $80K/pa Key Accountabilities Key Activities Performance Indicators Staff Management Reports to PATCHES Director Direct line management of: o Clinic Administrator/Coordinator Perth&Justice o Clinic Administrator/Coordinator Kimberley&Pilbara o Key Worker Perth&Justice o Key Worker Broome&Fitzroy Valley o Key Worker Kununurra&Halls Creek o Key Worker Karratha&Hedland Management support to: o Clinical Contractors Responsibility for all aspects of onboarding and termination of staff and contractors as required o Onboarding and contract generation/renewal is managed through the Employment Hero system: Responsibility for initiatives that enhance and reward staff performance Provide updates on staffing status and emerging issues at fortnightly Management Group meetings Payroll and budget management Compile monthly payroll spreadsheet including: o o Manage receipt of monthly invoices from Clinical Contractors Generate monthly Medicare Benefits Scheme billing reports from Best Practice, calculate 60% payment to Clinical Contractors, and include in monthly payroll. MBS billing reports are managed through the Best Practice clinical records management system: o Perform check of monthly payroll spreadsheet with Clinic Administration/Coordinator Perth&Justice Maintain a clinic invoicing (sales) database to track Training/Therapy delivery; Multidisciplinary assessments, reports; and invoicing for these activities Management of team performance including: o o o o Maintaining current JDf for all staff Maintaining current and compliant contracts for all staff Work planning using GANNT chart system for all staff members Performance reviews using annual Growth, Particpiation, Support format Managing process of onboarding for all staff (Casual, Independent Contractors) Managing process of termination of all staff as required, in consultation with the Director Monthly payroll 100% accurate and complete MBS payments reported and disbursed monthly Invoices paid within 4 weeks of issue Clinician Service activity Reports submitted to Manager on final day of service delivery; Outreach service reports lodged within 2 days of completion of service delivery

16 Documentation, marketing and social media management Contracts and compliance management Work with the Director to ensure completeness of sales invoicing, and follow up on outstanding invoices to be paid within 4 weeks of issue o Invoicing is managed through Xero cloud based accounting software: Maintain reporting for Rural Health West-funded outreach services to remote sites (Broome, Derby, Fitzroy Crossing, Port Hedland) via collation of clinition Service Activity Reports, and online service reporting within 48 hours of completion of service. Outreach services are reported online through the Outreach Services portal: Maintaining the PATCHES Paediatrics Standard Operating Procedures manual, ensuring all staff are trained in relevant SOP components, and compliance with these Maintaining an update on clinic progress via monthly news updates including photographs on the PATCHES Paediatrics website: Maintaing the PATCHES Paediatrics Facebook page (pending) and Twitter account (PatchesPaeds Documenting the clinical clinic schedules through maintenance of the PATCHES Paediatrics service calendar: Completion of high quality service reports for funding bodies, as required Identify and organise opportunities for representing PATCHES Paediatrics at stakeholder meetings to report on progress and outcomes Maintaing a database and hard copy file of current and past contracts, MoUs, partnership agreements, liability and indemnity insurance policies, vehicle registration and insurance policies Maintaining a schedule of contract renewal dates and forecasting these to ensure ongoing compliance Assuring compliance of all PATCHES activities with current contracts, and reporting on activities as required by these contracts Quarterly review of SOP document, updating and dissemination/training for staff High quality monthly updates on PATCHES activity At least twice-weekly Twitter posts, including activity from PATCHES staff PATCHES Paediatrics calendar up to date at all times with current and future clinics in all sites All reports drafted 4 weeks ahead of due date, approved by the Director 2 weeks ahead of due date, and submitted on time Monthly presentation to relevant stakeholders/for a regarding the PATCHES service model and activites Electronic database always current and complete, matched to hard copy file Calendar of renewals current, and upcoming expiry/renewal/reporting discussed at fortnightly Management Group meeting Zero breaches of contracts or lapses of compliance 16

17 Qualifications Skills, Knowledge & Experience: A tertiary qualification in business management; OR significant experience in project management or organisational management Experience in the area of business/organizational management, community development High-level written and oral communication skills Demonstrated ability to set goals, develop priorities and meet deadlines Demonstrated capacity to work with communities (in particular Indigenous communities) in a respectful and appropriate manner Experience in working effectively as part of a multidisciplinary team Ability to be self-directed and visit remote communities Current drivers license including ability to drive a manual transmission vehicle Current Working With Children check, Clear national police record check 17

18 Job Description Job Title: Clinical Key Worker Reports to: Clinical Services Manager Location: Perth, Broome, Kununurra, Fitzroy Crossing, Karratha, Kalgoorlie Key Accountabilities Participating in neurodevelopmental diagnosis and therapy via: 1. Multidisciplinary diagnostic clinical assessment and report writing; and 2. Delivery and evaluation of evidence based therapy Note: Administrative activity and coordination will be the responsibility of the Clinical Administrator/Coordinator for the site/region. The Key Worker will focus on clinical assessment, interpretation and reporting of clkinical information, and providing clinical feedback/therapy for families. Casual 6-30 hours per week (depending on site and clinical activity) Key Activities 1. Diagnosis: Liaison with clinicians, families and schools in relation to multidisciplinary diagnostic clinics Reviewing the draft clinical reports and final clinical reports that are compiled by the Clinical Administrator/Coordinator Participating in multidisciplinary intake and case conference meetings Participate in or conduct clinical assessments of children at the multidisciplinary clinics, or individually as appropriate Contribution of clinical information to multidisciplinary reports for clinicians, families and schools, and maintain clinical notes in Best Practice 2. Evidence based therapy: Undertake training in specific therapy approaches: The Alert Program, Circle of Security (Connected Families), Families Moving Forward, Self Awareness Method Coordination of therapeutic goal setting in the home and school environment with individuals, families, or groups Delivery of therapeutic programs within a set timeframe (e.g. 4, 8, 12 week programs) Document therapy activity in best Practice Document clinical progress against predetermined therapy goals, using standardised assessments (e.g. goal-based, behavioural questionnaires or performance on tasks) Rate - $40-50 per hour Salary equivalent. $72K-$80K pa Outcomes Monthly multidisciplinary and general paediatric clinics successfully completed Streamlined and efficient processes of clinic intake, coordination, assessment, therapeutic goal setting and therapeutic program implementation Clinical assessments as part of a multidisciplinary team Production of multidisciplinary clinical reports Production of therapeutic goals Completion of therapeutic programs for children Documentation of progress against therapeutic goals (Goal Attainment Scaling) 18

19 Provide training in the areas of neurodevelopmental (FASD diagnosis and therapy, ASD diagnosis, GDD diagnosis and therapy, behaviour problems and management) Contribute to the development of PATCHES powerpoint presentations, training materials and training evaluation forms for training with stakeholder groups including schools, families/carers, child protection workers Deliver training sessions Document training through photographs and brief report forms Collect training evaluation material from participants Delivery of one training session per month Brief report including photographs prepared within 2 days of finishing training Collection of evaluation forms from at least 70% of training participants, return evaluation forms to clinical services manager Documentation Maintaining an update on clinical activity by contributing to the PATCHES facebook, twitter and website news content Contribution of content to reports required by funding and other agencies Representing PATCHES at community meetings to report on progress and outcomes Keeping clinical records up to date in Best Practice or other relevant health databases at host organisations Fortnightly content provided to the Clinical Services Manager, including photographs, brief written updates Timely completion of progress reports Participation at relevant meetings, conferences and seminars Clinical information logged in Communicare Continuous quality improvement and research Leadership and staff development Qualifications Feed back on successes and areas for improvement of the PATCHES model/your role at monthly Clinical Key Worker meetings Commiting to the implementation of evidence based clinical activity and practicing within a clinical research capacity Contribute to evaluation and research within the PATCHES model by conducting standardised assessments at baseline, and during/post-therapy As required, explain the research approach taken by PATCHES, and obtain signed consent for participation in clinical research Contribute to research study design and writing up of research (note, research participation is an opportunity offered to all Clinical Key Workers, and not an obligation) Supporting clinicians and Aboriginal Therapists during their visits to your site/region Provide supervision of students and trainees participating in clinical processes in your site/region A tertiary clinical qualification in social work, allied health, psychology or education; OR significant experience in child health or Aboriginal health (e.g. nursing, allied health, social work, mental health, education) Participate in monthly Clinical Key Worker meetings in person, via TC or VC. If not able to participate, send a brief typed update to Clinical Services Manager via Conduct diagnostic and therapy activity within a structured clinical research framework, using standardised assessments and therapy approaches Being available by phone or to visiting staff Being available to support students visiting your site/region 19

20 Skills, Knowledge & Experience: Clinical and/or academic experience in the area of child health and child development High-level written and oral communication skills Demonstrated ability to set goals, develop priorities and meet deadlines Demonstrated capacity to work with communities (in particular Indigenous communities) in a respectful and appropriate manner Experience in working effectively as part of a multidisciplinary team Ability to be self-directed and visit outre metropolitan, rural or remote communities if required Current drivers license and ability to drive a manual vehicle Current Working With Children check Clear national police record check 20

21 Job Description Job Title: Aboriginal Therapist Reports to: Director Location: Key Accountabilities Clinic Support Part Time / Casual? Key Activities Provide support to clinical coordinator Assist with clinic organisation and preparation Conduct Ages and Stages with clients before and during clinics Conduct clinic evaluation questionnaire with all clients at clinics Ensure all documentation is completed post clinic Outcomes Ages and Stages completed with all clients Clinic Evaluation completed with all clients Completion and accuracy of all documents Support provided to Clinical Coordinator Qualifications Skills, Knowledge & Experience: Qualification in Aboriginal health; OR significant experience 21

22 PATCHES ORGANISATIONAL STRUCTURE Director James Fitzpatrick GM- Operations Adam de Jong Clinical Services Manager Sophie Karangaroa Clinic Admin/Coord Perth&Justice Kate Campbell Key Worker Perth&Justice Bernie Safe Clinical Contractors Clinic Admin/Coord Kimberley&Pilbara Jada Carr Key Worker West Kiumberley Aimee Dawson Paediatrics, GP, Psychiatry Key Worker East Kimberley Emily Warmington Neuro/psychology Allied Health, Social Work, AHW 22