Room 208 – Day One – Part Two
LAURA GREEN:
Good afternoon ladies and gentlemen. Welcome to the plenary session for special interest. Our first
order of the day is could anybody raise their hand if they're and Auslan user and require the
interpreters. These guys are going to get their first break for the day so thank you for your hard
work. I don’t think they're staying for the dinner. They have been on the clock since this morning,
they must be tired.
Before we start, for anybody who might've been interested in attending the workforce session that
was held at 2:15 today, that session will be repeated at 1:30 tomorrow afternoon in Room 208.
Reminder, anyone who’s using a parking voucher about your complimentary parking, if you didn’t
pick up the instructions this morning you'll need to take your car park entry ticket to the parking
station before returning to your car. I believe you got a voucher when you registered, you need to
enter your complimentary parking code and that’ll allow to get you your free parking.
We also want to remind everyone that the sessions are being recorded, the reason for that is that
we’re going to publish everything to DisabilityCare Australia website so that other people can enjoy
what’s happened at the conference too. This is also the last session for the day, so we’ll run through
until 4:30, then we’ll break and see everyone again tomorrow. My name is Laura Green, I work for
DisabilityCare Australia national, member of the client and community engagement team. I’m here
to facilitate the session about paediatric rehabilitation and the rapid response unit presented by
Doctor Stephen de Graaff and Adam Scheinberg.
My opportunity this afternoon will be to keep questions to time, we really want to get talking about
DisabilityCare Australia. Where there are questions that are really specific for us, in government and
in DisabilityCare Australia as the agency I’m going to be taking them on notice and you're welcome
to find us during the break and otherwise we’ll open up the opportunity for people to talk about the
project they are able to undertake. I’ll hand over for presentation and come back to help during
question time.
STEPHEN DE GRAAFF:
Thank you Lauren. I’m Stephen de Graaff, I’m rehabilitation physician by training and I’m president
of the Australian faculty of rehabilitation medicine which is a faculty of the royal Australasian college
of physicians. My role today is to try and start the concept of … I’m sorry about having this in my
face the whole time.
Now we’ve got a title here, rapid response rehabilitation models for declining function. We could
stop now 'cause there aren’t any but that’s the whole point of today, we need to see what we can
do to help develop this process. It’s a novel and exciting concept and it needs to be developed to
assist disability care to be implemented and sustainable. Traditionally, people feel that rehab is
being done in hospitals but that’s now what we want, we want it in the community. We need to
develop these models which are disability management based, not medical model based. We’re not
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assessing for the scheme but identifying issues that arise before they deteriorate and require
medical intervention.
So we want to minimise our risk and help people move forward. Why multidisciplinary
rehabilitation? I’ll put these terms up and I’ll be more explicit shortly, but rehabilitation is a term
that’s thrown around and I can tell you that 50 percent of the population thinks rehabilitation is
about drug and alcohol rehabilitation, that’s not what we’re about.
We’re involved in disability prevention with community based models, so we’re trying to substitute
for in-patient, in-hospital care. We look at chronic disease management, transitional care and that’s
becoming a bigger focus as children become adults. We want to try and delay people being moved
out of their homes and into residential care if possible and getting people back to their former roles
is a really important process. So we’re looking at two levels of disability and handicap or function
and quality of life.
Why do we want to look at rehabilitation to prevent further function deterioration with timely
assessment and management of functional loss. This is my human version of the ostrich with its
head in the sand, I use this because a lot of people don’t understand what rehabilitation is about. It’s
not about medicine, it’s about function and quality of life. I still get called a geriatrician by my
colleagues, and I’m not, I’m a rehabilitation physician but there’s a lack of understanding even within
the medical field about what I do.
So what’s rehabilitation? This is a process that brings about the highest possible level of recovery
following a loss of function. Remembering that you can have a sudden or graduate loss of function,
so you need to be able to identify this. Usually, we develop physical compensatory mechanisms and
psychological adjustment for the situation that includes cognitive adjustment as well. Medical
rehabilitation is in a broader sense part of all patient care and all doctors should practice this,
because we’re looking at prevention, assessment and management.
Notice I don’t use the term treatment because that suggests we’re doing things to others,
management involves everyone being involved in the process. Rehabilitation medicine is part of
science and medicine involved in prevention and reduction of function loss, activity limitation and
participation restriction. So that’s the terms by we work by, what’s involved in the comprehensive
rehabilitation unit? We would love to have this, but we got to be realistic.
From a pragmatic perspective there are available units that can assist in this, unfortunately a lot of it
is hospital based but we’re pushing for more community based processes. This is not exclusive or
totally inclusive, I hope you know that the first part of the team is the patient family and carers.
Critical, rehabilitation is an active process, if the person doesn’t want to have (inaudible) we won't
get anywhere. Then we have the other components that are involved there. There should be
teachers and others in there as well … there’s a whole range of individuals involved and I’m not here
today to tell you what everybody does.
What you hope is there’s cross fertilisation so they understand what everyone else does as well. This
is a really important slide because some of us can remember the seventies, but then basically faith
was going to heal. If someone had a significant health issue things were managed (inaudible). In the
eighties we thought we’d do a few things in hospital and we started working at a very low level,
generally at personal care level and some light domestic level.
But now in 2000s and beyond it’s all about participation but we offer the structures for people to
move forward. It’s mostly done in the community, we try to avoid hospitalisation, we want
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individuals to have their own personality (inaudible). So it’s very much a different model, this is one
of the concerns we had in terms of the development of DisabilityCare Australia was that because we
were seen as a medical model we were an afterthought. We’re a difficult group to understand
because we do have a medical background but that’s not our focus, we want to be able to mould
and help assist in the middle so that we avoid the acute medical situations arising.
Remembering that rehabilitation has multiple factors, the key being the patient themselves, but
then you look at what you setup for them to do, the exercise can be physical, psychological,
cognitive. The therapists are very important and we do it in an enriched environment, generally at
home.
What is the rehabilitation process? It’s a selective process, we have to see what we’re targeting, look
at the implications at all levels of impairment, disability and handicap and we used inter-disciplinary
models which means that it’s not directive. It’s an encompassing process, it involves problem solving
but it’s also challenge management and it’s goal oriented. So you set out a goal to accomplish and
measure the outcome in the appropriate setting. No point trying to teach someone who’s struggling
to walk around their home, how to walk in a gym or elsewhere where they don’t have relevance to
where they are.
We try to use resources rationally so if you use the appropriate setting and processes you can be
much more rational in what you do. You may be trying to regain function in your problem solving, or
strengthen other body parts to compensate for that loss. One of the challenges is when you have
young, budding doctors and therapists being taught to manage acute situations and then someone
has a chronic disability who knows more about what they have than the young doctors and
therapists, trying to get that balance of understanding of what’s necessary for that person. This
compensation needs to be done on both sides.
The other thing is looking at the environment and how to minimise the risk and its impact on
disability. We have a buzz term these days, cognitive behavioural therapy but the construct there is
getting people feeling confident to being able to manage. I’m going to give you two models of care,
they're not rapid response but they do offer services to individuals in the community who have a
disability and they're a construct we can work from.
The first is the New South Wales spinal unit, this is an inter-disciplinary spinal unit. The medical
component is funded through health but then they have funding through state outreach services
and research funding. The spinal unit itself is Sydney based and they have four allied health
specialists, occupational therapist, physiotherapist, nurse and social … but they have access to other
services as well. They’ve also got four rural coordinators in local health divisions but they really
struggle, this isn’t a sufficient number.
They manage to do a rural outreach clinic every month, so they try and get a good assessment of a
person’s undertaking and how to manage it in the future. Within the rural outreach the spinal unit
will catch up and talk to the teams there. Most of their patients are 20 years post injury, so we've
got chronic disability and then there's the other aspects of life that impact upon their disability
including ageing.
One of the advantages the spinal unit has developed is treatment algorithms so they can assist the
treating teams in the community and a phone assessment tool. That allows them to do some rapid
response rather than being geographically aligned. Even within this attempt of keeping things in the
community at least 10 percent end up back in Sydney for some form of management, usually for a
medical complication. Part of the process is education, not only for therapists and treating
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practitioners, but also the spinal patients so they understand better so they can be active in their
management.
We have a second group, polio services Victoria, who work with individuals who sustained polio in
their younger years. It’s primarily an assessment model and it’s funded through the state
government. They have a manager who is also a physiotherapist, rehabilitation physician who’s part
time and allied health services, including occupational therapy, (inaudible) nurse and social worker.
Coordination is done at the (inaudible) face of PSV and they run rural outreach clinics as well. Their
patients are usually 20 to 40 post polio infection so these patients have learnt to adapt to their loss
but then things start to fail and things become harder. They have a whole range of assessment tools
and are developing a huge database and the number of polio survivors in the community is much
greater than we originally thought because people weren’t diagnosed at the time because they were
usually young.
Going to hand over to Adam now to talk about the Victorian paediatric model.
ADAM SCHEINBERG:
Hi everyone, I’m the state wide medical director for the Victorian paediatric rehabilitation service
and I’ve only got a couple of slides but it’ll fit in nicely to Steve’s talk. I think in paediatrics we’re
pretty lucky in terms of resources, certainly compared to adults, I some of the aspirations we’ve
developed, it’s not perfect, but we’ve gone a long way to developing those services in Victoria.
In paediatric rehabilitation, even more than in adult, we struggle to tell our medical colleagues what
rehabilitation is. I found this usually the easiest thing, the missing link between hospital and
community, I think that makes sense for my doctor colleagues. The Victorian paediatric
rehabilitation program, the VPRS, came out of a review of all Victorian paediatric services in 2002
and they found that there was no coordinated, comprehensive rehabilitation service in the state.
There was a little group of therapists maybe in Geelong, one or two medical specialists, but no
comprehensive service and particularly for patients coming in and out of hospitals, clients in the
community, no coordination.
A reference group was set up in 2004-5 and funding for state wide service started in 2005 with a
model of care development and a governance group that continues to this day. That’s got reps from
every health region in Victoria, consumers, the TAC and other groups. Services started at Monash,
Bowen, (inaudible), Ballarat, and we’re now going down to northern Tasmania as well. The model of
care that was developed I think meets the definition Steve mentioned of rehabilitation but a state
wide specialist service that caters for children and adolescents who as a result of injury, medical
surgical intervention or functional impairment, so I find that quite a negative description, will benefit
from a program of developmentally appropriate time limited, goal focused inter-disciplinary
rehabilitation.
I’m going to give a positive example soon. The regions that we have centres and we've got about 145
staff now across Victoria, out of them there’s about 6 doctors and the rest are all allied health, social
workers, psychologists, teachers, coordinators. In the metropolitan region, we’ve got the Royal
Children’s Hospital, Monash Children’s Hospital, and at Eastern Health. In the regions we’ve got you
can see the scattered regional centres and apart from the poor folk in Mildura or right out in the
east basically everyone is within an hour’s drive of one of the rehabilitation centres and that was an
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important part of this. That was very important, they are either within an hour’s drive of the
rehabilitation centres or our therapists are within an hour’s drive of going to the family home,
community and the school.
Because so much of the rehabilitation has been centred in the ivory tower teaching hospitals and it’s
not been able to go out to where it needs to go in the community. That was a key part of this model.
We’ve got a great in-patient unit for children, single rooms, adl kitchens and everything for the inpatients but then the one on the bottom right is the McKellar centre and that’s where rehabilitation
happens in the Geelong region.
It’s an adult and paediatric rehabilitation centre, it’s a fair distance from Geelong hospital, it’s got
hydro pools and a great gym and all sorts of sport and recreation groups. Transition going from
paediatric to adults is fantastic when you do it at that sort of centre whereas for some of the clients I
look after at the Royal Children’s hospital the transition to adulthood is more difficult. There was a
strong acknowledgment that even though we’re a big organisation we sit within a much bigger
health system and when you look at the NDIS a much bigger system than that.
This is a nice graphical representation of complexity needs going up to the top and the increasing
complexity of care partnerships. I’m not sure if the NDIS has a similar diagram to this, I guess it will,
and we really sit at the top three tiers. Children requiring intensive specialist rehabilitation, high
complexity rehabilitation needs, and rehabilitation needs able to be met within local community. We
start to share a lot with community organisations particularly in that middle bracket, that whole
layer of health support and disability support which will sit underneath that and my guess is that’s
where the NDIS is going to sit.
The few slides I have about ICF and Steve had a nice introduction to this in the seventies, I was
around in then but I don’t remember it, there was that idea that impairment led to disability led to
handicap and clearly we know that’s not the case. This is the current ICF framework but I’m going to
make it real. This is an email I got from a mother and it tells me that we’re probably doing something
right. This young girl Maddie is nine years old and she’s got cerebral palsy, she can walk
independently but she has a lot of difficulty with it and the email that was sent.
“Madison performed in the school sports last week, she completed all of her events. We had a
memorable moment when she finished the hurdles. During her last, that’s botchulin toxin therapy
sessions, Maddie wanted to learn how to hurdle. She was trained in the main room of the McKellar
centre, we had tears running down our faces as we watched her hurdle for the first time. Watching
her complete the hurdles for her school sports was an incredible feeling of achievement, gone are
the days of Maddie having limitations due to her CP, bring it on.”
I thought that was a fantastic email to get, but it’s actually been the basis for a lot of discussions
within the services. Why did we get that email? What did we do right? When you look at the ICF
model, this is the way we can conceptualise Maddie. She’s got cerebral palsy, if you look at the body
structure and function she has weakness, spasticity and contracture and that’s the area that health
services have traditionally concentrated, just on that bit. We thought, ok we’ll fix the spasticity, now
why isn’t the person less disabled and less handicapped. Clearly it doesn’t work like that. She’s not
able to run and jump, that’s partly related to the weakness and spasticity but not solely. She’s
unable to join the hurdles race at school, that was her goal, that’s why she came in, not because her
calf is stiff, not because she can't run. She wanted to do the hurdles.
She also had limited access to training at the hurdles and there was some school issues about the
way they were supporting her to do the activity, I think they just thought she couldn’t do it.
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Personally I think she also didn’t have confidence, she hadn’t been successful in a lot of things. The
translation for our rehabilitation service is this why you can't run a rehabilitation service with just a
doctor, you need all the other people in the team who are probably a lot more important than the
rehabilitation doctor. She did get some botchulin toxin that was my little bit, but she got casting,
strength training, running training at the McKellar centre but people actually went out with her to
the school and that was very important.
They looked at why can't you participate in this activity, let’s break it down, who do we need to talk
to at the school and how do we reframe your thinking to say look you can do this. All of that put
together as a team is what achieved the outcome we got. That is to me a rehabilitation team
because we’re all working on a single goal which is Maddie’s goal for the hurdles. I think this is my
last slide.
These are the things I feel have been very important in our rehabilitation program to get to this
stage. Team development, so doctors, physios, nurses, teachers, psychologists and I’m sure I’ve
forgotten a few groups, we all go to different universities, all do different training programs and at
the end we’re all meant to work perfectly as a team and there’s no training in those programs on
how to do that. To run a rehabilitation program there has to be a huge emphasis on how the team
works with the client. We get regular consumer feedback, what we’ve instituted is that every client
that comes to the VPRS get a phone call within a few days, how was the experience, what could we
improve. So it’s immediate feedback and we found that really beneficial.
Standardised training, that’s incredibly important, we didn’t want one of our clients to go to the
McKellar centre and get a different experience than what they did at the Royal Children’s Hospital,
'cause we know that’s a huge problem for families. They’ll travel to wherever they feel is the best
place and it’s no good if you live in Geelong but you feel the best place is the Royal Children’s
Hospital and you do that travel to get a treatment we think should be provided locally to where you
live. A lot of training about inter-disciplinary versus discipline specific skills, so that means that there
was a lot of training into how do you work through Maddie’s goal.
I’ve really simplified that, Maddie didn’t walk into the centre and say I want to do the hurdles. She
was probably referred by someone else saying she’s got cerebral palsy, can you treat her. That’s the
reality and there needs to be a process where you can have an interview, and we’ve got a few tools
if people are interested in question time I can talk about that, that actually generates the
conversation with the client about what are your goals. Don’t worry about what you're sent in for,
what are your goals.
We’ve got strong community links so one of the strengths of this model is that at each of the sites
there is a coordinator whose role is not only the flow of clients coming in and out of the service but
also going out into the community and strengthening links. I think they’ll link up with the local area
coordinators who we’ve also done research about. I think we’re presenting tomorrow at 10:30 if
you're interested.
Finally, what we’ve been able to do is provide a very strong research into practice. So we have
research sitting alongside and continually feeding back into our treatments to make sure that what
we’re doing is evidence based, and that’s a very important part of treatment. That’s our website if
you're interested, the model of care is on there, info about referral, and so forth. I think I’ll leave
that up there. That’s it from me, back to Steve.
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STEPHEN DE GRAAFF:
Just a few more slides and then we’ll have some questions. One of the things that struck me during
the evolution of the NDIS which is now DisabilityCare Australia came into place was, there is the
opportunity to identify individuals with disability who have been sub-optimally managed and it may
well be that the number of people that we can get involved in is much greater than first thought. We
won't know that for a while. This makes it very important to make sure we’ve got resources in place
to manage these people.
One of the challenges is that every state is different. DisabilityCare is a federal backed process, state
governments and federal governments don’t necessarily marry and I was in South Australia and the
funding in South Australia is totally different to Victoria in terms of managing rehabilitation. There is
a strong emphasis in Victoria for ambulatory services within outpatient services or the community.
In South Australia the emphasis is on in-patient model, so they have to rob that model to try and
support their ambulatory services. The patients spend a lot more time in a hospital setting rather
than a community setting which is against what we’re trying to achieve here.
So hopefully we may have so emphasis to change that thinking and get them out of the fifties.
There’s a general lack of community based rehabilitation in Australia and this is where we need to
head and it’s very important that this moves forward with the whole process. With that lack of
community based rehabilitation the function of the clients is generally not handled well, and we
need to get our thinking to not going to the doctor but going to a setting that’s going to help manage
the failing function. The other thing I need to emphasise is multi-disciplinary rehabilitation is not a
medical model, we certainly have doctors and we’re often the most minor part of the process.
It’s about function and quality of life. These are a few areas that we’re going to have to look at and
there are many more and one of the things that’s really important is that there are a lot of drivers
both for the acquired and general situations but there’s a transition from childhood to adulthood.
Adolescence is a major area that’s undermanaged and not necessarily understood so we need to be
aware of those things. We need to be inclusive, we want people to have buy in, clearly the first buy
in is the patient, their family and carers. We need the multi-disciplinary units to accept that they're
going to have a role in this and that’s a challenge for the faculty, to get our consultant physicians in
rehabilitation medicine prepared to drive their units in the direction where they can be more
community based and prepared to assist in that process.
I can tell you now that the faculty is committed to doing this. We need to get GPs and service
providers on side, it may well be that a person is functionally declining, they may be having some
part of a package but that’s not meeting the needs. That needs to be reassessed to see what’s
happening there. Support coordinators and local area coordinators, where their role is we have to
understand but local area coordinators are going to be important. One of the groups that we do
need to have involved are local councils 'cause they often provide the structure and facilities to
service these things.
We’ll keep banging our head and trying to get the state services on side too. So I haven’t given you
an answer 'cause there is no answer at the moment, but we need you to give us some ideas that we
can push forward with and the we is all of us. So if anyone has got any thoughts we’re open for
discussion now for the next 11 minutes, 13 okay.
So I’m going to grab a notepad and paper and open up the discussion.
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QUESTION FROM THE FLOOR:
Thanks Stephen. Your definition of rehabilitation really doesn’t suit people who’ve got progressive,
degenerative neurological conditions and part of the problem we have even motor neuron disease is
rehabilitation services say, oh no we can't do anything. Really the definition of rehabilitation needs
to be about helping people to regain or retain or extend their abilities because rehabilitation can do
much to help someone who is permanently lost a skill and has degenerated further down the skill
level to optimise their capacity at that point in time. I think part of the problem is that at the
moment rehabilitation thinks about, “we’re going to get you better and get it done in six weeks.” It’s
very short term.
Whereas often for degenerative conditions it’s about dipping in and out of rehab to help people
adjust to different levels of disability.
STEPHEN DE GRAAFF:
Ok, I understand what you're saying. I thought that the earlier slides before I put those definitions
addressed that but I totally agree with you. It’s about minimising impact, and that’s part of getting
back going forward again. It should be a forward going process, totally agree with you. So if I didn’t
make that clear I apologise but I certainly support that comment.
QUESTION FROM THE FLOOR:
Hi, I’m Jen …
STEPHEN DE GRAAFF:
One other comment. Just your comment about timeframes, funders, that’s the biggest problem in
terms of things are done in packages and we have to move beyond that. If models are done in
timeframes and then go away, a lot of us don’t try to do that but it is an issue and what I’m hoping is
that this whole concept of disability now that it’s in the media and being discussed – we do look at it
a different way. Because it was on the backshelf and now it’s not, and there’s a Federal election
coming which has put it up there. Sorry, go ahead.
QUESTION FROM THE FLOOR:
No problem. My name’s Janet Wagland, I’m from (inaudible) care group in Perth. We run a
community based rehab program for people with acquired brain injury, it’s very unique, it’s run by
not-for-profit organisation. It’s not attached to a hospital, it’s funded by the health department and
we’ve just negotiated a contract which isn’t based on length of stay but on process and it’s based on
outcomes we’re achieving with people.
I totally agree with so many of your comments, because we’ve battled for years to get people to
understand that rehab is very much community based, it’s about function, adding purpose to skills
and getting people back into living life. So often it’s attached to the medical system in the eyes of
the disability sector who see it as a medical model whereas it’s actually an answer for many people
who are struggling with the impact of their disability. That applies to people who have neurodegenerative disability, we also provide services for people with Huntington’s disease and work with
those people in the same sort of mindset.
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STEPHEN DE GRAAFF:
Adam’s term bridge is a very important term. Thank you for that.
QUESTION FROM THE FLOOR:
Hi my name’s Kate, I work for Nexus primary health. We’re a community health organisation, I’m a
disability case manager there. As part of working with one individual it was clear he had needs
related around his level function, we were running a pilot program with him within our organisation.
We’re running a therapy day, so he’ll come in one day a week and having the support of a support
worker, work through programs with occupational therapists, speech pathologists, exercise
physiologists, physiotherapist and accessing meaningful activities within the community to allow him
to increase upon those skills as he advances through the program.
Largely he’s been underserviced and so we’re very excited to being able to financially make this
happen through the current programs we have and to be able to provide that directly to him and it’s
becoming quite meaningful for him. This is a new model of support we’re approaching from our
agency’s perspective.
STEPHEN DE GRAAFF:
When he came to you, did he outline his goals?
QUESTION FROM THE FLOOR:
He came to us with an unmet need and because of that we were able to explore that more to find
out that rehab type services were required. He originally came from a metro area where a lot of
those services were easily gotten but once he moved to a rural area that was difficult. Any
development in his ability was lost when those services stopped. We’re revisiting that and going
back to a point where he can rebuild capacity again, which we’re excited about.
STEPHEN DE GRAAFF:
I think the question always needs to be asked, what does the person want to achieve, what is their
goal. The number of times I got referrals, can this person have hydrotherapy, and having the ability
to assess the person to what their needs and hydrotherapy was the least of their needs. It does take
a skill to understand what you're trying to achieve.
QUESTION FROM THE FLOOR:
Thank you, Penny Dogen from Bowen regen and disability care Australia. You were talking about
being able to access more education for practitioners that are working with rehabilitation models, is
there a clear area of addressing age and goal appropriate rehab that isn’t based on the medical
model for participants that want to advance in their goals. This is from a professional and personal
perspective, having come through the system.
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STEPHEN DE GRAAFF:
I think you’ll find that there’s not a great deal of info out there at this time, but there’s probably
models that can be modified to do that. But in terms of educating, I would suspect that there’s still,
within training in universities, there’s still very much that medical hands-on approach. Places like
Deacon university will be a little bit more all-encompassing.
ADAM SCHEINBERG:
I can only speak for paediatrics but two comments, one is that the conversation with the client about
what they want to achieve comes naturally for some health practitioners and not for others. In our
organisation we’re using a tool called the Canadian Occupational Performance Measure, it’s one of
several tools, we think it’s a good one particularly for paediatrics and it takes you through a
conversation with the client who has been referred in but you need to start a conversation. I
struggle to know what the medical model is, usually when people come in I think about 70 or 80
percent of the time they don’t see a doctor but I guess a medical model can be done by non-doctors.
Certainly, we’re focused on the client and their goals, something like the COPM takes you through a
conversation about daily activities, leisure activities, work or school activities and go from there and
the skill as a group is try and work out which bits might be able to help that client from our
organisation. You need a big organisation that has all those bits otherwise you’ll give what you’ve
got not what’s appropriate. In terms of training, what we do is run every three months an education
day which is both internal and we invite people from the local area to come along. The last one was
all about care planning, goal setting, using these different tools, so if your question is about some of
those tools and how they’re used, how goal planning is done, send me an email and I can let you
know when we’re running the next education program.
I don’t think it’s taught much at all in health, OTs generally tend to do it but doctors no.
QUESTION FROM THE FLOOR:
Hi, it’s Pat Dawsett from Grifith university, previously of the Queensland spinal cord injury service.
Just a comment, I have been convening up until a few months a masters in community rehab at
Grifith university, unfortunately Queensland government is shifting all its funds back into hospital
and the program might close down. The question is, my experience would suggest that people with
disability who had been through traditional medical models of rehab have sometimes had the expert
telling them what they need and as they age with disability are somewhat reluctant to re-engage
with the rehab services that are appropriate to address those needs.
STEPHEN DE GRAAFF:
Undeniably, it’s a real challenge. I think we need to consider two levels, the first level are those …
there’s the group with a newly acquired disability. Often it’s the individual with the disability who
knows more about what’s happening to them than the so called expert. We spend a lot of time
trying to teach our trainees not to tell patients how to do things but embrace them and allow them
to show how to do things. We should be seen as giving support and structure to allow the person to
move forward. It’s going to take some time to break down those barriers, my hope is for those
people who are afraid to re-engage in the hospital model is that if we can get it done in the
community we might break down some of those barriers that are there.
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There’s a lot of learnt processes there at both level that need to be adjusted.
LAURA GREEN:
Thank you very much. I had a great pleasure listening to that and we’ve got a lot to take back from
this. Certainly a lot of raised hands still so perhaps exchange contact details as possible. For people
who are going to the conference dinner this evening, it’s free seating, I don’t think that means it’s a
free dinner, I think that means you get to pick your seat. There are a few reserved tables, otherwise
you’re free to choose any table you like. Pre-dinner drinks commence at 6:30PM and dinner starts at
7:30PM in the Melbourne Room, which we were having the main sessions in today. It is the end of
today but I’d like to really thank Doctor de Graff and Doctor Scheinberg for their time.
(applause)
For an exceptional presentation and some really rich information for us all to take away and have a
good think about. Thank you to those coming back tomorrow, we look forward to seeing you in the
morning and have a good conference dinner.
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