Bringing Student-led OT Services to Rural Queensland
A version of this article appeared in the Summer 2020 issue of Connections magazine.
The CQUniversity student-led Health Clinic first opened its doors to the Rockhampton community in July 2015. Initially the clinic offered community members student-led services (under the supervision of registered health professionals) in oral health, podiatry, and speech pathology. Shortly after, physiotherapy joined the services, and in January 2020 occupational therapy was welcomed into the fold. Preparation began to create a service that provided third and fourth-year CQUniversity occupational therapy students the opportunity to provide high quality support services to children and adolescents aged three to 18.
Due to the nature of the student-led service, we were presented with the opportunity to create a service that was affordable and accessible to clients of all abilities. We aimed at children who were often described as falling through the gaps as they were experiencing challenges to their participation yet did not meet the criteria for diagnosis, and therefore could not access NDIS funding or school support.
We also recognised our unique position as a central hub to rural and remote communities in the Central Queensland region, and knew we would have to ensure our service was built to support potential clients living in these communities. Planning how to make our service accessible to these communities was initially a challenge. However, a hidden blessing from the pandemic was that we had to familiarise ourselves with telehealth service delivery much quicker than expected.
We soon realised that delivering services via telehealth was not only manageable, it also offered a unique opportunity for students completing placement. Because of this, telehealth became a permanent feature of the CQUniversity Health Clinic, and we could begin offering our services to Rockhampton and the surrounding areas.
Image: Eilish Steinberg (left) and Alyssa Meyer (right) At Mount Murchison State School
Rockhampton has a limited number of local occupational therapy services and, consequently, large waiting lists to access necessary support. With this in mind, we kept advertising to a minimum, using the popular medium of Facebook and relying on word of mouth.
Word soon reached the regional town of Mackay just north of Rockhampton, where Colleen referred her 10-year-old son with a diagnosis of autism spectrum disorder. Before engaging with our services, Colleen said it had been difficult to access OT services in Mackay, where her son had been on waiting lists for two years, with most lists closed. She now says:
“Keeping my son focused over telehealth has been challenging. We have enjoyed being able to have any interaction with an OT and love the OT student’s enthusiasm. It has engaged him in recognising his different zones of regulation and working on his anxieties.”
Travelling two hours west of Rockhampton is Biloela, where Leanne resides with her husband and seven-year-old son who she referred to CQUniversity Health Clinic in June 2020 after seeing a Facebook flyer. While Leanne’s son does not have a formal diagnosis, she indicates that this can impact on how accessible services are:
“We have nothing, really, and if an OT does come to town, kids either have to have a referral with extensive evidence or they have to be ascertained. The fact that due to my location being remote and our town lacking any form of occupational therapy, my son is no longer at a disadvantage due to telehealth services. Now he can continue on his journey and receive the help he so badly needs.”
It has now been more than two years since Biloela has had a local occupational therapist, and with the support of the local Community Resource Centre (owned and operated by the Banana Shire Council, 2019) we liaised with the local schools to begin to educate and provide occupational therapy support to as many children as possible.
By liaising with schools, local organisations or through simple discussion with concerned parents, it is relatively easy to identify the needs. However, the main challenge we have faced so far is considering how to best deliver follow-up care.
This challenge was highlighted during our first outreach visit to Biloela and its surrounds in the second week of Term 4 2020. Two 3rd year occupational therapy students and I conducted a weeklong outreach visit where we attended three state primary schools and one state high school. It immediately became apparent that while the population of the rural communities may be smaller, the clinical presentations that we saw were just as, if not more, diverse in comparison to our in-clinic referrals. Despite this diversity, there were some consistent patterns across all referrals and our existing caseload; inability to attend to tasks, poor fine motor skills, and challenges with emotional regulation (specifically resilience). While no two clients are the same, being able to recognise this pattern did assist with information gathering processes and resource planning. This is notable as being adequately prepared is a key element of delivering service in a rural community due to the reduced access to general resources that we may use during a clinical session.
Adequate preparation is also essential to ensure that the stakeholders (in this instance school staff) were provided with as much education and information as possible to assist with follow-up care. A considerable highlight of delivering outreach services is the high level of appreciation received from the community members you interact with. Due to the limited access they generally have to services, particularly occupational therapy, their willingness to engage with our service and gain education on how they can best support their students is quite incredible.
In saying that, due to their remote location all the schools we visited experience frequent issues with stable internet connection, a sentiment shared by the parents. This is a contributing factor to their openness to the use of telehealth. While many of the individuals we spoke to were willing to trial telehealth, there was considerable reservations due to their lack of experience with it, their general internet connection and lack of access to an appropriate space to conduct it in. This led us to the consideration of how our support can be delivered in a consultancy role to school staff rather than reliance on 1:1 telehealth session. To further supplement telehealth, we are fortunate, due to the structure of the student block placements (four blocks of ten occurring in-line with school terms) we will be able to plan routine visits twice a school term to Biloela (and surrounds). These learnings are specific to an outreach service delivered in a school setting, and as our service continues to build and we work more closely with families, our experience and service delivery methods may change.
Not only does delivering an outreach service pose professional benefits as it challenges your exposure and ability to plan and adapt service delivery, it is also an opportunity to be reminded of how truly beneficial occupational therapy input can be.
About the Author
Robyn Sedgwick graduated from CQUniversity with a Bachelor of Occupational Therapy (Honours) in 2016. Since this time, she has practised as a paediatric occupational therapist with Child and Youth Mental Health Services, Head Start Children’s Therapy Services and the Department of Education. She now works as the occupational therapy clinical educator at the CQUniversity Health Clinic while studying a Masters of Mental Health through La Trobe University.