Red Dirt Rehab
Delivering 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: [email protected]
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
Katherin
e
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
Health Workforce
Overview NT
Clinician
Number
GP
308
Hospital nonspecialist
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
REFERENCE: NT Medicare Health Atlas 2014
Welcome to the Northern Territory
Health Service District and
Populations
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
REFERENCE: NT Medicare Health Atlas 2014
Understanding the Challenges
Locations and Travel
Understanding the Challenges
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
REFERENCE: NT Health Services Profile 2013, NTG Publication
Borroloola Remote Health Centre
Understanding the Challenges
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
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 Challenges
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
REFERENCE: NT Medicare Local Health Atlas 2014
Understanding the Challenges
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
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
Same
Duties
1. Same
Employer
Modified
Duties
New Duties
RTW
Same
Duties
2. Different
Employer
Modified
Duties
New Duties
REFERENCE: Safe Work Australia
Delivering Red Dirt Rehab
Engaging 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 Rehab
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
REFERENCE: Westerman, 2007, Indigenous Psychological Services
Delivering Red Dirt Rehab
Culturally Appropriate Engagement
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
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 2014
Comparative Performance Monitoring Report, 16th Edition, Safe Work Australia
Thank You