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Red Dirt Rehab

Red Dirt Rehab. Delivering a cost effective and culturally appropriate model to rehabilitation in rural / remote Northern Territory. Angela Pilcher Rehabilitation Counsellor (MASORC) NT Manager / Rehabilitation Consultant Vocational Management Services M: 0419 947 479

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Red Dirt Rehab

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  1. Red Dirt Rehab Delivering a cost effective and culturally appropriate model to rehabilitation in rural / remote Northern Territory

  2. Angela Pilcher Rehabilitation Counsellor (MASORC) NT Manager / Rehabilitation Consultant Vocational Management Services M: 0419 947 479 E: angela@vmsrehab.com.au Introductions

  3. Reduce financial and productivity costs • Reduce social cost • Maintain valuable work skills • Encourage maximum medical recovery • Prevent further or secondary injuries • Limit employment impact Why do we Rehabilitate?

  4. The NT covers one-sixth of Australia’s land mass with a land area of 1,364,000 square KMs • It is the third largest state and has the largest proportion of ‘remote population’ then any other state / territory. • NT has a population of 232,000 people, including 70,000 Indigenous persons (30%). • 43% of the NT population is considered to reside in remote or very remote areas. • The employment rate for rural / remote NT is 68% Welcome to the Northern Territory REFERENCE: NT Medicare Local Health Atlas 2014

  5. The Index of Relative Social Disadvantage indicates that with the exception of urban centres, the rest of the NT is extremely disadvantaged across areas of education, occupation, employment, income, families and housing. Welcome to the Northern Territory REFERENCE: NT Medicare Local Health Atlas 2014

  6. Welcome to the Northern Territory Northern Territory Driving Distances (km’s) REFERENCE: Remote Area Health Corps; Darwin Profile 2014

  7. Health Workforce Overview NT Welcome to the Northern Territory REFERENCE: NT Medicare Health Atlas 2014

  8. Health Service District and Populations Welcome to the Northern Territory REFERENCE: NT Medicare Health Atlas 2014

  9. Locations and Travel Understanding the Challenges

  10. Access to Health Services • 54 NT Government run Remote Health Centres • GP ratio =1:717 • Psychologist ratio = 1:1588 • Physiotherapist ratio = 1:1825 • Occupational Therapist ratio = 1:2229 • Specialist Outreach NT program • Delays for appointments / treatment and equipment Understanding the Challenges Borroloola Remote Health Centre REFERENCE: NT Health Services Profile 2013, NTG Publication

  11. Labour Market Challenges • 14,525 registered businesses in the NT; only 2700 of these employ 5 or more people; • Extremely limited rural, remote and community based employment; • Limitations associated with education, experience and transferable skills • Physical limitations • Accommodation issues • 201 positions for whole of Regional NT as at 15/10/2014 Understanding the Challenges REFERENCE: NT Government Labour Market Brief August 2014 incl Regional Profile.

  12. Communication • 28% of residents speak a language other than English • 17% speak an Australian Indigenous Language • Transient nature of employers / supervisors • Regular rotation / transient nature of treating medical professionals • Telephone / email limitations Understanding the Challenges REFERENCE: Remote Area Health Corps Darwin Profile 2014

  13. Cultural Considerations – Social Determinants of Health • Poorer health status of Aboriginal people in the NT is influenced by additional social determinants • Diminished self determination, connectedness to family, land, culture and identity present greater challenges. • Social and economic disadvantage • Geography, climate and accommodation • Access / willingness to access services • Appropriateness of services Understanding the Challenges REFERENCE: NT Medicare Local Health Atlas 2014

  14. Cultural Considerations • Understanding cultural competence; blindness & incompetence • Individuals cultural identity • Levels of acculturation; internal & external • Appropriate engagement • Assessment and interview techniques • Community factors • Level of worker / employer knowledge Understanding the Challenges REFERENCE: Westerman; 2007; Indigenous Psychological Services

  15. Impact on RTW Rates REFERENCE: Comparative Performance Monitoring Report, 16th Edition; Safe Work Aust.

  16. Impact on RTW Rates REFERENCE: Comparative Performance Monitoring Report, 16th Edition; Safe Work Aust

  17. Early Intervention • Immediate response • Initial Rehab consultation – face to face • Identify appropriate medical treatment and referrals • Identification of RTW options / duties • Cultural identity and appropriate techniques . Delivering Red Dirt Rehab

  18. Delivering Red Dirt Rehab REFERENCE: Safe Work Australia

  19. Engaging Stakeholders • Injured workers • Employers • GP’s / nurses • Allied Health Professionals • Community support services Delivering Red Dirt Rehab Tiwi Islands

  20. Treatment Considerations • Community Health Services • Northern Territory Medical Local programs • E-Health / skype treatment • Access to Specialist and IMEs • Culturally appropriate considerations • Travel Delivering Red Dirt Rehab

  21. Cultural Considerations • Understanding cultural disparity • Appropriateness of introductions or vouching • Impacts of gender differences • Communication styles • Use of culturally appropriate assessment / interview techniques • Incorporating culturally appropriate treatment options Delivering Red Dirt Rehab REFERENCE: Westerman, 2007, Indigenous Psychological Services

  22. Culturally Appropriate Engagement Location Physical positioning Acknowledge non-verbal cues Cultural vouching Identify and acknowledge cultural or gender differences Confirm cultural boundaries Negotiate limits to confidentiality Discuss issues of possible blame Assess what traditional treatments may have occurred Delivering Red Dirt Rehab REFERENCE: Westerman, 2007, Indigenous Psychological Services

  23. Encourage whole of community relationship – reduce travel costs • Early identification of barriers, appropriate medical treatment and RTW options • Maintain and encourage worker / employer relationship • Address RTW options in line with RTW hierarchy • Greater understanding of location, labour market and limitations • Reduce risk of further aggravation or secondary injuries • Limit impact on employer and community through productivity loss • Increase RTW outcome • Reduce cost Benefits of Red Dirt Rehab

  24. Benefits of Red Dirt Rehab REFERENCE: VMS Statistics as at July 2014 Comparative Performance Monitoring Report, 16th Edition, Safe Work Australia

  25. Thank You

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