Catherine Turnbull - Academia.edu (original) (raw)

Papers by Catherine Turnbull

Internet Journal of Allied Health Sciences and Practice

The assessment of the palliative client and family caregivers by an interdisciplinary team compri... more The assessment of the palliative client and family caregivers by an interdisciplinary team comprising medical, nursing, and allied health allows for all aspects including the physical, social, and psychological and spiritual needs to be incorporated into care planning. This comprehensive level of planning for the care of the client and family caregivers can allow for a client to fulfil their own definition of a good death, or dying well. Whilst the provision of psychosocial support can be the seen as the role of the social worker in the team, all members of the palliative care team, especially in rural and remote areas with fewer members, will at times face a situation where they need to provide some psychosocial support. It is acknowledged by the authors that the social work professional identity, responsibilities, and skills are not easily understood, and this identity is further challenged with the prospect of interdisciplinary work. This paper describes and illustrates the psych...

Australian Health Review, 2009

There is no standard or agreed definition of "allied health" nationally or internationally. This ... more There is no standard or agreed definition of "allied health" nationally or internationally. This paper reviews existing definitions of allied health, and considers aspects of allied health services and service delivery in order to produce a new model of allied health that will be flexible in a changing health service delivery workforce. We propose a comprehensive model of allied, scientific and complementary (ASC) health professionals. This model recognises tasks, training, organisation, health sectors and professional regulation. It incorporates traditional and new services which are congruent with allied health foci, allegiances, responsibilities and directions. Use of this model will allow individual organisations to describe their ASC health workforce, and plan for recruitment,

The Lancet Public Health, Jun 1, 2018

Background High-quality mental health services for infants, children, adolescents, and their fami... more Background High-quality mental health services for infants, children, adolescents, and their families can improve outcomes for children exposed to early trauma. We sought to estimate the workforce needed to deliver tertiary-level community mental health care to all infants, children, adolescents, and their families in need using a generalisable model, applied to South Australia (SA). Methods Workforce estimates were determined using a workforce planning model. Clinical need was established using data from the Longitudinal Study of Australian Children and the Young Minds Matter survey. Care requirements were derived by workshopping clinical pathways with multiprofessional panels, testing derived estimates through an online survey of clinicians. Findings Prevalence of tertiary-level need, defined by severity and exposure to childhood adversities, was estimated at 5-8% across infancy and childhood, and 16% in mid-adolescence. The derived care pathway entailed reception, triage, and follow-up (mean 3 h per patient), core clinical management (mean 27 h per patient per year), psychiatric oversight (mean 4 h per patient per year), specialised clinical role (mean 12 h per patient per year), and socioeconomic support (mean 12 h per patient per year). The modelled clinical full-time equivalent was 947 people and budget was AU$126 million, more than five times the current service level. Interpretation Our novel needs-based workforce model produced actionable estimates of the community workforce needed to address tertiary-level mental health needs in infants, children, adolescents, and their families in SA. A considerable expansion in the skilled workforce is needed to support young people facing current distress and associated family-based adversities. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.

Background: It is often said that the only constant in health care is change. While change is ine... more Background: It is often said that the only constant in health care is change. While change is inevitable, implementing change in health care is complex, and health care stakeholders are often confronted by numerous barriers and challenges. Historically, students have been an integral part of the health system through aspects such as clinical placements, and hence, may play a role during times of change. Aim: The aim of this study is to provide strategies for using students as positive agents of change by discussing opportunities and highlighting challenges. Method: The tips proposed in this commentary are derived from the literature, identified using a systematic search, and from our experiences at the "coal face" of engaging students during times of change. Results: This article highlights specific challenges, targeted opportunities, and critical success factors of using students as agents of change. Students can play an important role in enhancing service provision, providing opportunities for staff recognition, and being enablers to drive, implement, and evaluate change in the health system and wider community. However, in order to achieve these positive impacts, it is imperative to recognize and address staff concerns early and build upon a number of critical success factors. These critical success factors such as intersectoral engagement, clarity, collaboration, support, training, resources, and ongoing evaluation can "make or break" students' involvement in a health service, and therefore, careful and regular consideration of these factors is recommended. Conclusion: We believe that these tips, synthesized from evidence from the literature and our first-hand experiences, will assist health care stakeholders in utilizing students as timely, effective, and practical agents of change.

The Lancet. Public health, 2018

High-quality mental health services for infants, children, adolescents, and their families can im... more High-quality mental health services for infants, children, adolescents, and their families can improve outcomes for children exposed to early trauma. We sought to estimate the workforce needed to deliver tertiary-level community mental health care to all infants, children, adolescents, and their families in need using a generalisable model, applied to South Australia (SA). Workforce estimates were determined using a workforce planning model. Clinical need was established using data from the Longitudinal Study of Australian Children and the Young Minds Matter survey. Care requirements were derived by workshopping clinical pathways with multiprofessional panels, testing derived estimates through an online survey of clinicians. Prevalence of tertiary-level need, defined by severity and exposure to childhood adversities, was estimated at 5-8% across infancy and childhood, and 16% in mid-adolescence. The derived care pathway entailed reception, triage, and follow-up (mean 3 h per patient...

Advances in medical education and practice, 2017

It is often said that the only constant in health care is change. While change is inevitable, imp... more It is often said that the only constant in health care is change. While change is inevitable, implementing change in health care is complex, and health care stakeholders are often confronted by numerous barriers and challenges. Historically, students have been an integral part of the health system through aspects such as clinical placements, and hence, may play a role during times of change. The aim of this study is to provide strategies for using students as positive agents of change by discussing opportunities and highlighting challenges. The tips proposed in this commentary are derived from the literature, identified using a systematic search, and from our experiences at the "coal face" of engaging students during times of change. This article highlights specific challenges, targeted opportunities, and critical success factors of using students as agents of change. Students can play an important role in enhancing service provision, providing opportunities for staff reco...

Diabetes Care, 2013

OBJECTIVEdBest-practice diabetes care can reduce the burden of diabetes and associated health car... more OBJECTIVEdBest-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations. RESEARCH DESIGN AND METHODSdCare protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region. RESULTSdA primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/;300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (;2,090 USD) (2012) per person with diabetes. CONCLUSIONSdA needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups.

BMC health services research, 2015

Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advanc... more Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in the policy dialogue and in service delivery, the prevention of mental illness remains a neglected area. There is accumulating evidence that mental illness is at least partially preventable, with increasing recognition that its antecedents are often found in infancy, childhood, adolescence and youth, creating multiple opportunities into young adulthood for prevention. Developing valid and reproducible methods for translating the evidence base in mental illness prevention into actionable policy recommendations is a crucial step in taking the prevention agenda forward. Building on an aetiological model of adult mental illness that emphasizes the importance of intervening during infancy, childhood, adolescence and youth, we ad...

BMC health services research, Jan 24, 2015

Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advanc... more Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in the policy dialogue and in service delivery, the prevention of mental illness remains a neglected area. There is accumulating evidence that mental illness is at least partially preventable, with increasing recognition that its antecedents are often found in infancy, childhood, adolescence and youth, creating multiple opportunities into young adulthood for prevention. Developing valid and reproducible methods for translating the evidence base in mental illness prevention into actionable policy recommendations is a crucial step in taking the prevention agenda forward. Building on an aetiological model of adult mental illness that emphasizes the importance of intervening during infancy, childhood, adolescence and youth, we ad...

Australian Health Review, 2015

Objective South Australia is taking an innovative step in transforming the way its healthcare is ... more Objective South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health. Methods A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature. Results Highly relevant across allied health ar...

Reviews, 1996

One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol... more One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol problem is with home visits. To determine the effects of home visits during pregnancy and/or after birth for pregnant women with a drug or alcohol problem. We searched the Cochrane Pregnancy and Childbirth Trials Register (30 April 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to April 2004), EMBASE (1980 to week 16, 2004), CINAHL (1982 to April 2004), PsycINFO (1974 to April 2004), citations from previous reviews and trials, and contacted expert informants. Studies using random or quasi-random allocation of pregnant or postpartum women with a drug or alcohol problem to home visits. Trials enrolling high-risk women of whom more than 50% were reported to use drugs or alcohol were also eligible. Assessments of trials were performed independently by all review authors. Statistical analyses were performed using fixed and random-effects models where appropriate. Six studies (709 women) compared home visits after birth with no home visits. None provided a significant antenatal component of home visits. The visitors included community health nurses, pediatric nurses, trained counsellors, paraprofessional advocates, midwives and lay African-American women. Most studies had methodological limitations, particularly large losses to follow up. There were no significant differences in continued illicit drug use (2 studies, 248 women; relative risk (RR) 0.95, 95% confidence interval (CI) 0.75 to 1.20), continued alcohol use (RR 1.08, 95% CI 0.83 to 1.41) failure to enrol in a drug treatment program (2 studies, 211 women; RR 0.45 95% CI 0.10 to 1.94). There was no significant difference in the Bayley MDI (3 studies, 199 infants; weighted mean difference 2.89, 95% CI -1.17 to 6.95) or Psychomotor Index (WMD 3.14, 95% CI -0.03 to 6.32). Other outcomes reported by one study only included breastfeeding at six months (RR 1.00, 95% CI 0.81 to 1.23), incomplete six-month infant vaccination schedule (RR 1.07, 95% CI 0.58 to 1.96), non-accidental injury and non-voluntary foster care (RR 0.16, 95% CI 0.02 to 1.23), failure to use postpartum contraception (RR 0.41, 95% CI 0.20 to 0.82), child behavioural problems (RR 0.46, 95% CI 0.21 to 1.01), and involvement with child protective services (RR 0.38, 95% CI 0.20 to 0.74). There is insufficient evidence to recommend the routine use of home visits for women with a drug or alcohol problem. Further large, high-quality trials are needed, and women's views on home visiting need to be assessed.

Diabetes Care, 2013

OBJECTIVEdBest-practice diabetes care can reduce the burden of diabetes and associated health car... more OBJECTIVEdBest-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations. RESEARCH DESIGN AND METHODSdCare protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region. RESULTSdA primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/;300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (;2,090 USD) (2012) per person with diabetes. CONCLUSIONSdA needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups.

Australian Health Review, 2009

There is no standard or agreed definition of ?allied health? nationally or internationally. This ... more There is no standard or agreed definition of ?allied health? nationally or internationally. This paper reviews existing definitions of allied health, and considers aspects of allied health services and service delivery in order to produce a new model of allied health that will be flexible in a changing health service delivery workforce. We propose a comprehensive model of allied, scientific and complementary (ASC) health professionals. This model recognises tasks, training, organisation, health sectors and professional regulation. It incorporates traditional and new services which are congruent with allied health foci, allegiances, responsibilities and directions. Use of this model will allow individual organisations to describe their ASC health workforce, and plan for recruitment, staff training and remuneration.

Australian health review: a publication of the Australian Hospital Association

Objective. South Australia is taking an innovative step in transforming the way its healthcare is... more Objective. South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health. Methods. A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature. Results. Highly relevant across allied health are the strategies of discontinuation of low value practices, targeting clinical interventions to those getting greatest benefit, active involvement of patients in shared decision making and self-management and advocating for integrated systems of care. Conclusions. Allied health professionals have been involved in the South Australian healthcare system for a prolonged period, but their services are poorly recognised, often overlooked and not greatly supported in existing traditional practices. The results of the present study highlight ways in which healthcare services can implement strategies not only to improve the quality of patient outcomes, but also to offer innovative solutions for future, sustainable healthcare. The findings call for concerted efforts to increase the utilisation of allied health services to ensure the 'maximum value for spend' of the increasingly scarce health dollar. What is known about the topic? In medicine, clinician-driven strategies have been proposed to minimise inappropriate and costly care and maximise highly appropriate and less expensive care. These strategies were developed based on clinical experiences and with supporting evidence from scientific studies.

Internet Journal of Allied Health Sciences and Practice

The assessment of the palliative client and family caregivers by an interdisciplinary team compri... more The assessment of the palliative client and family caregivers by an interdisciplinary team comprising medical, nursing, and allied health allows for all aspects including the physical, social, and psychological and spiritual needs to be incorporated into care planning. This comprehensive level of planning for the care of the client and family caregivers can allow for a client to fulfil their own definition of a good death, or dying well. Whilst the provision of psychosocial support can be the seen as the role of the social worker in the team, all members of the palliative care team, especially in rural and remote areas with fewer members, will at times face a situation where they need to provide some psychosocial support. It is acknowledged by the authors that the social work professional identity, responsibilities, and skills are not easily understood, and this identity is further challenged with the prospect of interdisciplinary work. This paper describes and illustrates the psych...

Australian Health Review, 2009

There is no standard or agreed definition of "allied health" nationally or internationally. This ... more There is no standard or agreed definition of "allied health" nationally or internationally. This paper reviews existing definitions of allied health, and considers aspects of allied health services and service delivery in order to produce a new model of allied health that will be flexible in a changing health service delivery workforce. We propose a comprehensive model of allied, scientific and complementary (ASC) health professionals. This model recognises tasks, training, organisation, health sectors and professional regulation. It incorporates traditional and new services which are congruent with allied health foci, allegiances, responsibilities and directions. Use of this model will allow individual organisations to describe their ASC health workforce, and plan for recruitment,

The Lancet Public Health, Jun 1, 2018

Background High-quality mental health services for infants, children, adolescents, and their fami... more Background High-quality mental health services for infants, children, adolescents, and their families can improve outcomes for children exposed to early trauma. We sought to estimate the workforce needed to deliver tertiary-level community mental health care to all infants, children, adolescents, and their families in need using a generalisable model, applied to South Australia (SA). Methods Workforce estimates were determined using a workforce planning model. Clinical need was established using data from the Longitudinal Study of Australian Children and the Young Minds Matter survey. Care requirements were derived by workshopping clinical pathways with multiprofessional panels, testing derived estimates through an online survey of clinicians. Findings Prevalence of tertiary-level need, defined by severity and exposure to childhood adversities, was estimated at 5-8% across infancy and childhood, and 16% in mid-adolescence. The derived care pathway entailed reception, triage, and follow-up (mean 3 h per patient), core clinical management (mean 27 h per patient per year), psychiatric oversight (mean 4 h per patient per year), specialised clinical role (mean 12 h per patient per year), and socioeconomic support (mean 12 h per patient per year). The modelled clinical full-time equivalent was 947 people and budget was AU$126 million, more than five times the current service level. Interpretation Our novel needs-based workforce model produced actionable estimates of the community workforce needed to address tertiary-level mental health needs in infants, children, adolescents, and their families in SA. A considerable expansion in the skilled workforce is needed to support young people facing current distress and associated family-based adversities. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits.

Background: It is often said that the only constant in health care is change. While change is ine... more Background: It is often said that the only constant in health care is change. While change is inevitable, implementing change in health care is complex, and health care stakeholders are often confronted by numerous barriers and challenges. Historically, students have been an integral part of the health system through aspects such as clinical placements, and hence, may play a role during times of change. Aim: The aim of this study is to provide strategies for using students as positive agents of change by discussing opportunities and highlighting challenges. Method: The tips proposed in this commentary are derived from the literature, identified using a systematic search, and from our experiences at the "coal face" of engaging students during times of change. Results: This article highlights specific challenges, targeted opportunities, and critical success factors of using students as agents of change. Students can play an important role in enhancing service provision, providing opportunities for staff recognition, and being enablers to drive, implement, and evaluate change in the health system and wider community. However, in order to achieve these positive impacts, it is imperative to recognize and address staff concerns early and build upon a number of critical success factors. These critical success factors such as intersectoral engagement, clarity, collaboration, support, training, resources, and ongoing evaluation can "make or break" students' involvement in a health service, and therefore, careful and regular consideration of these factors is recommended. Conclusion: We believe that these tips, synthesized from evidence from the literature and our first-hand experiences, will assist health care stakeholders in utilizing students as timely, effective, and practical agents of change.

The Lancet. Public health, 2018

High-quality mental health services for infants, children, adolescents, and their families can im... more High-quality mental health services for infants, children, adolescents, and their families can improve outcomes for children exposed to early trauma. We sought to estimate the workforce needed to deliver tertiary-level community mental health care to all infants, children, adolescents, and their families in need using a generalisable model, applied to South Australia (SA). Workforce estimates were determined using a workforce planning model. Clinical need was established using data from the Longitudinal Study of Australian Children and the Young Minds Matter survey. Care requirements were derived by workshopping clinical pathways with multiprofessional panels, testing derived estimates through an online survey of clinicians. Prevalence of tertiary-level need, defined by severity and exposure to childhood adversities, was estimated at 5-8% across infancy and childhood, and 16% in mid-adolescence. The derived care pathway entailed reception, triage, and follow-up (mean 3 h per patient...

Advances in medical education and practice, 2017

It is often said that the only constant in health care is change. While change is inevitable, imp... more It is often said that the only constant in health care is change. While change is inevitable, implementing change in health care is complex, and health care stakeholders are often confronted by numerous barriers and challenges. Historically, students have been an integral part of the health system through aspects such as clinical placements, and hence, may play a role during times of change. The aim of this study is to provide strategies for using students as positive agents of change by discussing opportunities and highlighting challenges. The tips proposed in this commentary are derived from the literature, identified using a systematic search, and from our experiences at the "coal face" of engaging students during times of change. This article highlights specific challenges, targeted opportunities, and critical success factors of using students as agents of change. Students can play an important role in enhancing service provision, providing opportunities for staff reco...

Diabetes Care, 2013

OBJECTIVEdBest-practice diabetes care can reduce the burden of diabetes and associated health car... more OBJECTIVEdBest-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations. RESEARCH DESIGN AND METHODSdCare protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region. RESULTSdA primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/;300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (;2,090 USD) (2012) per person with diabetes. CONCLUSIONSdA needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups.

BMC health services research, 2015

Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advanc... more Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in the policy dialogue and in service delivery, the prevention of mental illness remains a neglected area. There is accumulating evidence that mental illness is at least partially preventable, with increasing recognition that its antecedents are often found in infancy, childhood, adolescence and youth, creating multiple opportunities into young adulthood for prevention. Developing valid and reproducible methods for translating the evidence base in mental illness prevention into actionable policy recommendations is a crucial step in taking the prevention agenda forward. Building on an aetiological model of adult mental illness that emphasizes the importance of intervening during infancy, childhood, adolescence and youth, we ad...

BMC health services research, Jan 24, 2015

Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advanc... more Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in the policy dialogue and in service delivery, the prevention of mental illness remains a neglected area. There is accumulating evidence that mental illness is at least partially preventable, with increasing recognition that its antecedents are often found in infancy, childhood, adolescence and youth, creating multiple opportunities into young adulthood for prevention. Developing valid and reproducible methods for translating the evidence base in mental illness prevention into actionable policy recommendations is a crucial step in taking the prevention agenda forward. Building on an aetiological model of adult mental illness that emphasizes the importance of intervening during infancy, childhood, adolescence and youth, we ad...

Australian Health Review, 2015

Objective South Australia is taking an innovative step in transforming the way its healthcare is ... more Objective South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health. Methods A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature. Results Highly relevant across allied health ar...

Reviews, 1996

One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol... more One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol problem is with home visits. To determine the effects of home visits during pregnancy and/or after birth for pregnant women with a drug or alcohol problem. We searched the Cochrane Pregnancy and Childbirth Trials Register (30 April 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to April 2004), EMBASE (1980 to week 16, 2004), CINAHL (1982 to April 2004), PsycINFO (1974 to April 2004), citations from previous reviews and trials, and contacted expert informants. Studies using random or quasi-random allocation of pregnant or postpartum women with a drug or alcohol problem to home visits. Trials enrolling high-risk women of whom more than 50% were reported to use drugs or alcohol were also eligible. Assessments of trials were performed independently by all review authors. Statistical analyses were performed using fixed and random-effects models where appropriate. Six studies (709 women) compared home visits after birth with no home visits. None provided a significant antenatal component of home visits. The visitors included community health nurses, pediatric nurses, trained counsellors, paraprofessional advocates, midwives and lay African-American women. Most studies had methodological limitations, particularly large losses to follow up. There were no significant differences in continued illicit drug use (2 studies, 248 women; relative risk (RR) 0.95, 95% confidence interval (CI) 0.75 to 1.20), continued alcohol use (RR 1.08, 95% CI 0.83 to 1.41) failure to enrol in a drug treatment program (2 studies, 211 women; RR 0.45 95% CI 0.10 to 1.94). There was no significant difference in the Bayley MDI (3 studies, 199 infants; weighted mean difference 2.89, 95% CI -1.17 to 6.95) or Psychomotor Index (WMD 3.14, 95% CI -0.03 to 6.32). Other outcomes reported by one study only included breastfeeding at six months (RR 1.00, 95% CI 0.81 to 1.23), incomplete six-month infant vaccination schedule (RR 1.07, 95% CI 0.58 to 1.96), non-accidental injury and non-voluntary foster care (RR 0.16, 95% CI 0.02 to 1.23), failure to use postpartum contraception (RR 0.41, 95% CI 0.20 to 0.82), child behavioural problems (RR 0.46, 95% CI 0.21 to 1.01), and involvement with child protective services (RR 0.38, 95% CI 0.20 to 0.74). There is insufficient evidence to recommend the routine use of home visits for women with a drug or alcohol problem. Further large, high-quality trials are needed, and women's views on home visiting need to be assessed.

Diabetes Care, 2013

OBJECTIVEdBest-practice diabetes care can reduce the burden of diabetes and associated health car... more OBJECTIVEdBest-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations. RESEARCH DESIGN AND METHODSdCare protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region. RESULTSdA primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/;300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (;2,090 USD) (2012) per person with diabetes. CONCLUSIONSdA needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups.

Australian Health Review, 2009

There is no standard or agreed definition of ?allied health? nationally or internationally. This ... more There is no standard or agreed definition of ?allied health? nationally or internationally. This paper reviews existing definitions of allied health, and considers aspects of allied health services and service delivery in order to produce a new model of allied health that will be flexible in a changing health service delivery workforce. We propose a comprehensive model of allied, scientific and complementary (ASC) health professionals. This model recognises tasks, training, organisation, health sectors and professional regulation. It incorporates traditional and new services which are congruent with allied health foci, allegiances, responsibilities and directions. Use of this model will allow individual organisations to describe their ASC health workforce, and plan for recruitment, staff training and remuneration.

Australian health review: a publication of the Australian Hospital Association

Objective. South Australia is taking an innovative step in transforming the way its healthcare is... more Objective. South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health. Methods. A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature. Results. Highly relevant across allied health are the strategies of discontinuation of low value practices, targeting clinical interventions to those getting greatest benefit, active involvement of patients in shared decision making and self-management and advocating for integrated systems of care. Conclusions. Allied health professionals have been involved in the South Australian healthcare system for a prolonged period, but their services are poorly recognised, often overlooked and not greatly supported in existing traditional practices. The results of the present study highlight ways in which healthcare services can implement strategies not only to improve the quality of patient outcomes, but also to offer innovative solutions for future, sustainable healthcare. The findings call for concerted efforts to increase the utilisation of allied health services to ensure the 'maximum value for spend' of the increasingly scarce health dollar. What is known about the topic? In medicine, clinician-driven strategies have been proposed to minimise inappropriate and costly care and maximise highly appropriate and less expensive care. These strategies were developed based on clinical experiences and with supporting evidence from scientific studies.