Red Dirt RehabDelivering a cost effective and culturally appropriate

model to rehabilitation in rural / remote Northern Territory

Introductions

Angela Pilcher

Rehabilitation Counsellor (MASORC)

NT Manager / Rehabilitation Consultant

Vocational Management Services

M: 0419 947 479

E: angela@vmsrehab.com.au

Why do we Rehabilitate?

• Reduce financial and productivity costs

• Reduce social cost

• Maintain valuable work skills

• Encourage maximum medical recovery

• Prevent further or secondary injuries

• Limit employment impact

Welcome to the Northern Territory

• 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%

REFERENCE: NT Medicare Local Health Atlas 2014

Welcome to the Northern Territory

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.REFERENCE: NT Medicare Local Health Atlas 2014

Welcome to the Northern Territory

Darwin Alice Springs

Jabiru Katherine

Kings Canyon

Tennant Creek

Uluru

Darwin … 1482 251 314 1808 978 1923

Alice Springs

1482 … 1464 1168 326 504 441

Jabiru 251 1464 … 296 1790 960 1905

Katherine 314 1168 296 … 1494 664 1609

Kings Canyon

1808 326 1790 1494 … 830 318

Tennant Creek

978 504 960 664 830 … 945

Uluru 1923 441 1905 1609 318 945 …

Northern Territory Driving Distances (km’s)REFERENCE: Remote Area Health Corps; Darwin Profile 2014

Welcome to the Northern Territory

Clinician Number

GP 308

Hospital non-specialist

188

Specialist 192

Specialist in training

163

Other 44

Total 895

No. per 100,000 (NT Avg)

132

No. per 100,000 (Aust Avg)

353

Health Workforce Overview NT

REFERENCE: NT Medicare Health Atlas 2014

Welcome to the Northern Territory

Health Service District

Nurses GPs Total Pop.

Darwin Urban

2398 163 127,725

Darwin Rural

22 9 16,995

East Arnhem

158 18 16,956

Katherine 278 35 20,174

Barkly 97 15 6,677

Alice Springs Rural

290 22 14,243

Alice Springs Urban

767 61 29,092

Health Service District and Populations

REFERENCE: NT Medicare Health Atlas 2014

Understanding the Challenges

Locations and Travel

Understanding the ChallengesAccess 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

REFERENCE: NT Health Services Profile 2013, NTG Publication

Borroloola Remote Health Centre

Understanding the ChallengesLabour 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

REFERENCE: NT Government Labour Market Brief August 2014 incl Regional Profile.

Understanding the Challenges 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

REFERENCE: Remote Area Health Corps Darwin Profile 2014

Understanding the ChallengesCultural 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

REFERENCE: NT Medicare Local Health Atlas 2014

Understanding the ChallengesCultural 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

REFERENCE: Westerman; 2007; Indigenous Psychological Services

Impact on RTW Rates

Northern Territory Australia

Average claim cost $23,900 $13,126

Average loss time 15.1 week 8.7 weeks

Average $ spent on claimant services (gross)

$17.3M $197M

RTW Rates % 74% 80%

REFERENCE: Comparative Performance Monitoring Report, 16th Edition; Safe Work Aust.

Impact on RTW Rates

REFERENCE: Comparative Performance Monitoring Report, 16th Edition; Safe Work Aust

Delivering Red Dirt Rehab

.

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

RTW

1. Same Employer

Same Duties

Modified Duties

New Duties

2. Different Employer

Same Duties

Modified Duties

New DutiesREFERENCE: Safe Work Australia

Delivering Red Dirt RehabEngaging Stakeholders

• Injured workers• Employers• GP’s / nurses• Allied Health

Professionals• Community support

services

Tiwi Islands

Delivering Red Dirt Rehab

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 RehabCultural 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

REFERENCE: Westerman, 2007, Indigenous Psychological Services

Delivering Red Dirt Rehab

1. Location

2. Physical positioning

3. Acknowledge non-verbal cues

4. Cultural vouching

5. Identify and acknowledge cultural or gender differences

6. Confirm cultural boundaries

7. Negotiate limits to confidentiality

8. Discuss issues of possible blame

9. Assess what traditional treatments may have occurred

Culturally Appropriate Engagement

REFERENCE: Westerman, 2007, Indigenous Psychological Services

Benefits of Red Dirt Rehab

• 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

VMS Rehab NT Avg

Avg. cost per claim $

$5440 $23,900

RTW rate % 86% 74%

REFERENCE: VMS Statistics as at July 2014Comparative Performance Monitoring Report, 16th Edition, Safe Work Australia

Thank You