MP4 Allied Health Paediatric Capacity Mapping Combined Report Date: June 2017 Background The capacity of allied health professions who work in hospitals to provide appropriate services to children and their families is dependent on a skilled workforce and service demand. The ability of these disciplines and the individual clinicians to adequately meet the demands of this service provision may be impacted by staffing establishment; allocation of hours dedicated to paediatric service provision; changes in the casemix of paediatric services; knowledge, skills and confidence of clinicians in providing services to children and their families; and professional networks within the facility and with other facilities, including the tertiary children s hospitals. The impact of these factors on the capacity of allied health disciplines is currently unknown. The Children s Healthcare Network Allied Health Educators (AHE) aimed to obtain information regarding the capacity of allied health disciplines in metropolitan level 4 (MP4) facilities. MP4 facilities are hospitals with designated paediatric wards. The purpose of this mapping was to: Identify allied health professionals working with children and families in MP4 facilities Establish a baseline of current allied health service provision for children and corresponding workforce allocation Identify areas of need requiring service development/capacity building Identify key areas of paediatric clinical practice requiring education and clinical support. Information was collected from allied health departments as follows: The AHE emailed information regarding the MP4 Capacity Mapping initiative to all the relevant Directors of Allied Health regarding the intent and process of information collection Contact was made with individuals or groups of allied health profession managers at the MP4 facilities either online or face to face, to further discuss and clarify relevant issues Allied health profession manager/s were provided with an online questionnaire for completion. Educators and cannot be reproduced in any form without their express permission. 1
Results A total of 75 responses were received from allied health departments at the following facilities: Blacktown Mt Druitt Hospital Bankstown Hospital Campbelltown Hospital Canterbury Hospital Gosford Hospital Hornsby Ku-ring-gai Hospital Liverpool Hospital Manly/Mona Vale Hospital Nepean Hospital Royal North Shore Hospital Royal Prince Alfred Hospital St George Hospital & Integrated Community Health Sutherland Hospital Sydney LHD, Child & Family Health Service Wollongong Hospital Data was provided by a range of allied health professional groups as illustrated in Figure 1. Allied health professionals are not an homogenous group and provide a varied range of therapeutic and diagnostic services in the MP4 facilities. Figure 1: Allied Health Professions Responses were submitted via an online questionnaire between April - October 2016. The results reported below are a summary of the combined information collected from the allied health departments who responded across participating facilities. Unless otherwise noted, combined results are listed in descending order of number of responses. Educators and cannot be reproduced in any form without their express permission. 2
Current services for children and young people Inpatient services Allied health departments currently accepting inpatient referrals accounted for 77% of the responses received. The different facilities, and professions within these facilities, identified varied referral categories and criteria reflecting differing roles and capabilities. Across the responding departments, inpatient referrals were most commonly accepted for the following clinical areas: General paediatrics Newborns and neonates Musculoskeletal and connective disorders Digestive system disorders Nervous system disorders. Inpatient referrals are generally accepted for children aged from 0-16 years or 0-18 years for the majority of departments. Departments indicated different referral criteria due to the variety of clinical caseloads covered. Those allied health departments accepting inpatient referrals accept them primarily from medical, nursing and other allied health professionals. Inpatient services provided by allied health departments were most commonly reported to include: Assessment Intervention and treatment Case discussion and planning Referral Ward rounds. Outpatient services Allied health departments currently accepting outpatient referrals accounted for 76% of the responses received. The different facilities, and professions within these facilities, identified varied referral categories and criteria reflecting different professional roles and capabilities. Across the responding departments, outpatient referrals were most commonly accepted for the following clinical areas: General paediatrics Digestive system disorders Musculoskeletal and connective tissue disorders Nervous system disorders Newborns and neonates. Outpatient referrals are generally accepted for children aged from 0-17 years although some departments reported stricter age guidelines. Those departments accepting outpatient referrals accept them from parents/carers, tertiary hospitals, community services, schools, allied health, medical and nursing professionals. Educators and cannot be reproduced in any form without their express permission. 3
Outpatient services provided by allied health departments were most commonly reported to include: Assessment Intervention and treatment Referral Multidisciplinary team clinics Case discussion and planning. Community services Only 53% of allied health departments providing data currently accept referrals for services provided in the community. This low response is in part due to the existence of separate Community Health facilities in some areas. The referrals accepted vary significantly according to facility and profession. Referrals for services provided in the community are accepted for children aged from 0-17 years although some departments have stricter age guidelines and focus on early intervention. Service provided by allied health departments in the community were most commonly reported to include assessment, intervention, treatment, case discussion and planning, and referral. In addition, service provision available in the community further builds on: Multidisciplinary team intervention Community visits Consultation/liaison Provision of education and information Home/school programming. Changes to service provision 55% of responding allied health departments reported that services provided for children and young people had changed over the past two years. Departments reported that these changes were the result of: Establishment of new services/clinics Impact of the introduction of the National Disability Insurance Scheme (NDIS) Increase in referral numbers and acuity Policy changes. The following priority clinical areas relating to children and young people that require further service development were identified (listed alphabetically): Adolescent youth health Anxiety Autism Spectrum Disorder Behavioural issues Brain injury Educators and cannot be reproduced in any form without their express permission. 4
Early intervention Mental health Orthopaedics Pain Palliative care Post-acute care Rehabilitation Special care nursery/ neonatal intensive care nursery Transition to school. Respondents also identified the following priority areas that were not clinical (listed alphabetically): Discharge/transition of inpatients Education for community/schools/preschools General service development within the hospital, community and schools Impact of NDIS Insufficient capacity Lack of dedicated paediatric staff. Workforce/staffing Allied health departments with allocated staffing for service provision to children and young people totalled only 72% of respondents. Most professions and departments reflected on a complex blend of part funding or quarantining of positions. The most common clinical areas for which departments reported having allocated staffing for service provision to children and young people were: Outpatients Paediatric ward Community health Neonatal intensive care unit/high dependency unit Special care nursery. The data collected did not allow for the accurate calculation of the percentage of total full time equivalent (FTE) allocated to service provision for children and young people for inpatient, outpatient and community services. Despite changes in population, complexity of referrals and service redesign, 75% of allied health departments reported no change to FTE allocated to service provision for children and young people over the past two years. Governance Data pertaining to the governance structures for allied health departments as it relates to service provision for children and young people was not suitable for analysis. There was significant variation in the interpretation of the term governance Educators and cannot be reproduced in any form without their express permission. 5
as it included management and reporting structures, but also the systems in place to maintain and improve the quality of patient care within the hospital system. Overwhelmingly it was clear that the following factors were identified as important: Clinical supervision Line to service management Paediatric clinical stream Paediatric senior positions. Education and clinical support The following professional networks are currently in place for allied health clinicians to support service provision to children and young people: Within professions Allied to Kids (A2K) initiatives, clinical networks, clinical supervision, interagency meetings, links with other departments or senior clinicians, multidisciplinary meetings, peer support, professional associations, professional development groups, team/department meetings, tertiary hospitals. Within clinical streams - A2K initiatives, clinical networks, clinical streams, links with other departments or senior clinicians, peer support, professional development groups, tertiary hospitals. Within facilities - links with other departments or senior clinicians, multidisciplinary meetings/networks, peer support, professional association, professional development groups, team/department meetings. Within local health districts clinical networks, interagency meetings, professional and team meetings. With tertiary children s hospitals - most respondents could not identify formal networks with the tertiary children s hospitals. Some respondents reported that there were ad hoc networks created based on the needs of particular children and/or families. With other facilities community health services, community services, nongovernment agencies and A2K initiatives. A wide range of priority clinical areas relating to children and young people that require further education and clinical support for allied health clinicians were identified across the professions. The most frequently identified areas were (listed alphabetically): Adolescent health Autism Spectrum Disorder Cardiorespiratory conditions Child protection Chronic and complex care Developmental delay Disability and transition to NDIS Educators and cannot be reproduced in any form without their express permission. 6
Early childhood development Eating disorders Enteral feeding Language delay/disorder Mental health Overweight and obesity Paediatric feeding difficulties Sensory processing Special care nursery/neonatal intensive care unit Speech sound disorders/phonology Trauma. A range of service related issues were also identified as priority areas, most significantly, the implementation of the NDIS and its subsequent impact. Respondents indicated that their education and clinical support needs could best be provided via a range of methods, including (listed alphabetically): Clinical competencies Clinical guidelines based on best practice models Interprofessional learning Educational secondments Linking with specialist positions Management/financial support of education Online learning Support networks Workshops/conferences Web/Videoconferences. Other comments Allied health departments were invited to provide general comments regarding their capacity to provide services to children and young people. Overwhelmingly, these comments related to the impact of inadequate staffing allocation and resources to services to children and young people, as well as the increase in the number and complexity of referrals. Below are examples of comments provided: Department has been set-up to address the needs of the adult population. We currently do not have the resources (FTE, skills and equipment) to address any detailed needs of a paediatric/ young person population. Demand far outweighs capacity. We are constantly evaluating our service and adapting our services in response to this, but have found no solution that work wells from therapeutic outcomes perspective. We will never be able to offer the Educators and cannot be reproduced in any form without their express permission. 7
amount of service the research suggests is needed for there to be a therapy outcome with our current FTE. Our service provides quality care to the children and young people but due to the development of new services within the medical area, e.g. specialist clinics and Paediatric Review Clinics that have been established without allied health support, as well as an increase in referrals of more complex conditions, the length of time children wait to be seen is not appropriate there is a need to re-evaluate this service and establish services in a more coordinated way with appropriate staffing. It would be helpful if advocacy could be provided to LHD CEs regarding the need for acute facilities to staff wards caring for children and young people with specialist paediatric AH clinicians. Conclusion The information contained in this report should be interpreted with caution due to the relatively low response rate as well as the inconsistent interpretation and response to specific questions. It is important to note that the collective term allied health actually refers to a heterogeneous group of 23 professions who provide a wide range of therapeutic and diagnostic services to children and their families in the MP4 facilities. The data received indicated that all allied health professions who completed the survey offer some inpatient, outpatient and community services to children and families within their facilities. It is difficult to establish a baseline of current allied health service provision for children and young people. There are significant differences between professions, reporting of workforce allocation and a lack of quarantined funding for this service provision. All respondents identified an increase in the number and complexity of referrals A number of key areas of paediatric clinical practice requiring education and clinical support were identified and these will be further investigated by the AHE. These areas may be addressed via a range of educational and clinical support options. Educators and cannot be reproduced in any form without their express permission. 8