ACAT and Remote Communities

1. ACAT and Remote Communities Bianca Broadwood Flinders and Far North ACAT Country South Australia May 2010

2. Flinders and Far North ACAT • The Team is made up of: • Social Worker’s (0.3 FTE) • Registered Nurse’s (0.6 FTE) • Occupational Therapist (0.3FTE) • Clerical Officer (0.5 FTE) • Coordinator (0.5 FTE) • Covers one of the largest geographical catchments for ACAT in South Australia

3. Flinders & Far NorthACAT Region

4. Flinders & Far NorthACAT Region

5. Service Provision to Remote Communities • Challenges include: • Language & cultural barriers • approximately 60% of Coober Pedy's population are from non- English speaking countries with more than 40 nationalities represented. • Lack of understanding about ACAT • ie the importance of attending or being present for ACAT • Transient Lifestyle • many of our clients lead a transient lifestyle and are difficult to physically locate • Remote Localities • minimum distance for travel – 80km round trip • many towns necessitating a fly-in / fly-out service provision • Limited facilities or service provision.

6. Service Provision to Remote Communities • Aboriginal Context for Flinders and Far North: • Large proportion (28%) of the Aboriginal population lives in the catchment area • 21% of the population lives in areas classed as remote • 24.4% in very remote areas (ABS 2001). • The ABS 2006 demographic profile for the Port Augusta Region suggest four main Aboriginal Language groups including, Adnymathanha, Antikarinya, Luritja and Pitjantjatjara. However, Port Augusta boasts approximately 29 Aboriginal languages, resulting in an amazing mix of cultures in one community (Looking Forward looking Blak, 2007) • Flight retrieval by the RFDS to the Port Augusta Hospital requires ACAT assessments conducted on clients from as far west as Ceduna, and as far north as Alice Springs. As such some of the aboriginal groups within our catchment area include Arabana, Arrente, Andymathnha, Pitjantjatjara, Yankjunytjatjara, Kokatha, Kaurna, Dieri, Ngarrindjeri, Nunkunu, Bungala. (Looking Forward looking Blak, 2007)

7. Methods to Address Complexity • Training & Employment Practices • Centre for Excellence for Aboriginal Health; • The Flinders and Far North ACAT team is fortunate enough to be located within the Port Augusta Hospital & Regional Health Service where good initiative in terms of best practice models of care are developed and implemented. • Cultural Awareness Training • Orientation • Staff employed at the Port Augusta hospital are given a brief insight into Aboriginal people and aboriginal health during orientation • Working within the Cultural Respect Framework • Cultural Awareness Training (All staff attend 1 day course), with refresher course under development. • Working closely with Aboriginal Liaison Officers and Aboriginal Health Workers, across all sites within the cluster.

8. Methods to Address Complexity • Orientation to Outreach Staff • Each site provides orientation to outreach staff on initial visit – including information on local staff, resources and population demographics. • Multidisciplinary teamwork • Viewed as one of the key processes, the team values the many skills and knowledge of individual assessors. • Understanding of others roles • To facilitate timely interventions, the team seeks to involve and understand not only one’s own role but also the role of other professionals working with clients requiring an ACAT. • Insight • Fresh thinking • Optimising the mix of skills and expertise • Flexibility

9. Methods to Address Complexity • Valuing Relationships • All are crucial to the completion of successful ACAT assessments & the maintenance of valued relationship with our service providers, facilities and community. • Regular Review • A review of current practices, policies and procedures was undertaken to improve information captured and disseminated as part of the ACAT process including; • Changes in the way referrals were received and allocated • Stringent adherence to priority categories; • Changes to the management of outreach clients;

10. Management of Outreach Clients • Review of the CHSA (Country Health SA) Draft Policy Directive on Outreach • Decided at a local level to adopt and trial this as a management process for outreach • Merit in the process – supportive of meeting proposed KPI’s • Consistent with ACAT Process • Support of outreach clients to receive assessments in timely efficient manner • After prioritising referrals from Outreach areas, the ACAT Coordinator ascertains if the referral can be assessed on the next scheduled Outreach visit.

11. Management of Outreach Clients • The Port Augusta Hospital & Regional Health Service sets an annual plan for scheduled outreach, either flying or driving • Each Outreach Health Unit is notified of the annual outreach schedule • Outreach services are assessed and reviewed for efficacy each 12 month cycle • If the timeframe for assessment falls outside of the priority time periods, a tele- or video- conference is scheduled for the assessment.

12. Suitability for Tele or Video Conference Assessment • The ACAT coordinator will: • Ensure that the client has needs that require immediate assessment and can not wait until the next scheduled Outreach visit • Ensure that the client meets criteria for tele- or video- conferencing: • Capacity to give consent • Sensory deficits do not impact on use of tele- or video- conferencing • Key outreach staff can be present to assist with assessment and interview process • Carers and/or family can assist with the assessment process • Basic functional information has been gathered

13. Outreach Site Workers • It is critical to work with staff on site to ensure the following is completed or arranged prior to assessment: • Book the tele or video- conferencing equipment at their site • Ensure equipment is working and trouble shoot any issues • Prepare and gather background information about the client and client’s situation for the ACAT staff • This needs to be forwarded to the ACAT at least 24 hours prior to scheduled tele- or video- conference • Support the client and family / carers through the process • If workers on site can be up-skilled / educated on the role of the ACAT, and their role in the process, this helps immensely.

14. Communicating with Outreach Sites • In preparation for the assessment, the Flinders and Far North ACAT have developed a standard letter that is forwarded to sites requesting copies of the results of any investigations or test, and case notes that are of significance. • Essentially the sites are asked to report any issues identified, including but not limited to: • social situation • continence • behaviour • sleep • transfers and mobility • significant assistance is needed • personal care • social support • meal preparation

15. Communicating with Outreach Sites • In order to prevent possible delays when conducting ACAT assessments, we work with the outreach sites to identify standard examinations that should be undertaken, completed and sent to the ACAT prior to assessment. • We always consider the appropriateness of each of these tools in relation to the person being assessed. • Assessments / Examinations include: • Mini Mental Status Exam - a brief, quantitative measure of cognitive status in adults • Kimberley Indigenous Cognitive Assessment (KICA) - used as a cognitive screening tool for older Indigenous Australians living in rural and remote areas. • Rowland University Dementia Scale (RUDAS) - a multicultural cognitive assessment scale • Geriatric Depression Scale - used to identify depression in older people • Barthel Index - assessing self-care and mobility activities of daily living

16. Expectations of Outreach Sites • The ACAT works with the Outreach sites to negotiate that they will: • Perform an assessment of the client by proxy under direction from the ACAT assessor • Ensure that a hard copy of the consent to assessment is on hand at the tele or video-conference • Be appropriately qualified and have reasonable knowledge of the client situation prior to participating in the tele- or video- conference. • Attend the tele- or video- conference with the client and family and/or carers. • Operate the tele- or video conferencing equipment. • Clients and/or their carers and/or family are invited toattend and participate in the tele- or video- conference.

17. Areas Requiring Development and Regular Review • Many clients still unable to have a face to face assessment. • Issues of staff turnover / absences, and rosters – in the ACAT and Outreach Sites • Original first page of ACCR is posted back to ACAT in timely manner.

18. Successes • Forging excellent relations with outreach sites both government and non-government organisations across all sectors • Gaining excellent knowledge of local resources and utilising more effectively • Sharing of resources and skills • Good recruitment of clients • Outreach clinics will schedule other assessments test in conjunction and arrange for clients to be present • Reduction in non attendance • Reduction in waiting timeframes • Stats to be added *********** • More comprehensive assessment conducted in a ‘safe’ and culturally appropriate environment.