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How can we scale up rehabilitation in Queensland?

The challenge

Rehabilitation 2030 is a call for action made by the World Health Organisation (WHO) in 2017 to scale up rehabilitation over the next decade.

The call for action encourages governments across the world to strengthen, extend and enhance rehabilitation as an important response to the significant and ever-increasing demand created by chronic disabling conditions.

There are a number of significant barriers that stand in the way of this objective. To strengthen and expand the availability of quality rehabilitation services, these barriers need to be addressed. Ten recommendations have been outlined by WHO that must be addressed to successfully scale up rehabilitation.

The Challenge

At The Hopkins Centre we want to identify the top three priorities over the next 5 years so we can do our part in addressing this call for action and solving this challenge. 

 

 

The Hopkins Centre: Research for Rehabilitation and Resilience is a collaboration between academics, practitioners, policy-makers and consumers in both government and non-government sectors. Our aim is to promote bold ideas and better solutions that foster better outcomes for people with acquired and developmental disabilities in future. By building interdisciplinary and cross-sectoral partnerships, and promoting research capacity, we are generating evidence that can immediately inform improvements in policy and practice.

 

Background to the Challenge

On 7th February, 2017, many of the world's leading rehabilitation experts gathered in Geneva and produced “Rehabilitation 2030”, a WHO call for action to all countries to address the significant and ever-increasing need for rehabilitation services.

The need for rehabilitation is fuelled by ageing populations and the global rise of non-communicable diseases, like cerebrovascular disease, cancer, as well as traumatic injuries, substance use and associated conditions. This increasing demand is combined with historically underdeveloped and poorly coordinated rehabilitation systems in most countries.

As a result of this trend, the growing need for rehabilitation currently remains unmet in most countries. The global rehabilitation workforce is one-tenth of its recommended size. Even in well-developed systems, utilisation of services and engagement in rehabilitation is less than desired. Even using the most conservative figures, it is estimated by WHO that 74% of years lived with disability in the world could be addressed through improved and timely rehabilitation services.

In terms of access to rehabilitation, there is a stark discrepancy between high and low income countries, but within our own country, the discrepancy between high and low income regions is also significant. Large investments are being made into avoidable re-admissions to hospital, self-management of chronic conditions and lifetime disability support systems. However, we are not yet using rehabilitation services as a systematic strategy to build resilience and health for tens of thousands of vulnerable people and contribute to health promotion for the entire population.  

 

Barriers to Scaling Up Rehabilitation

What barriers stand prevent us using rehabilitation effectively to address our rising tide of unmet need?

Rehabilitation 2030 identified a range of barriers that are relevant across the world - some are shown below. Most of these barriers are equally relevant in Queensland, Australia.  

  • Under-prioritisation of rehabilitation by governments amongst other competing priorities;
  • Absence of rehabilitation policies and planning at the national and state levels;
  • Lack of coordination between health and social sectors;
  • Artificial divisions between rehabilitation systems and disability services;
  • The lack of integration of rehabilitation into health, social and primary care systems;
  • Non-existent or inadequate funding for rehabilitation staff, facilities and equipment;
  • Poor insurance coverage for rehabilitation;
  • Insufficient evidence about rehabilitation, its effectiveness and the need for rehabilitation;
  • The misperception that rehabilitation is a luxury;
  • The lack of standardized referral pathways and seamless transitions;
  • The lack of comprehensive integrated models of rehabilitation;
  • Shortage of multi- and inter-disciplinary teams and disincentives to practice in innovative ways;
  • inadequate use of, access to and training in the use of assistive products and technology;
  • The lack of integration between acute specialist units, transitional/community rehabilitation and long-term community disability services.

 

To strengthen and expand the availability of quality rehabilitation services, these barriers will need to be addressed in Queensland, Australia. This year, we have a unique opportunity to respond to the WHO call for action with the introduction of the National Injury Insurance Scheme and the National Disability Insurance Scheme

 

Our Priorities for the Future

What will we need to focus on over the next 5 to 10 years to ensure that rehabilitation becomes an effective and integral service delivered to all Queenslanders who require assistance and could benefit from rehabilitation?

WHO identified ten priorities that must be addressed to successfully scale up rehabilitation. How do these priorities relate to Queensland?

  1. Creating strong leadership and political support for rehabilitation at local, state, national and global levels.
  2. Ensuring strong rehabilitation planning and implementation at national, state and local levels.
  3. Improving the integration of rehabilitation into the health and social sector to effectively and efficiently meet population needs.
  4. Ensuring that all people have access to rehabilitation services, of sufficient quality to be effective without causing financial hardship.
  5. Building comprehensive and equitable rehabilitation service delivery models to increase quality services.
  6. Developing a strong multidisciplinary rehabilitation workforce with ability to work in interdisciplinary ways and promoting rehabilitation concepts across the entire health workforce.
  7. Expanding financing for rehabilitation through appropriate mechanisms such as insurance and innovative budget resourcing.
  8. Enhancing health information systems to enable the collection and use of data relevant to rehabilitation outcomes rather than only prevalence and incidence data.
  9. Building research capacity and expanding the availability of robust evidence for rehabilitation.
  10. Establishing and strengthening networks and partnerships to support rehabilitation.

 

The Challenge for Hivers

What are the top THREE priorities for The Hopkins Centre over the next 5 years in scaling up rehabilitation in Queensland?

Why are these priorities are so important?

 

We are calling on Hivers around the world and locally to help us think through the best investment of our time and resources to achieve the WHO call for action. Can you provide information that could guide our work in addressing the recommended priorities, solving barriers and scaling up rehabilitation in Queensland:

  • Examples of successful strategies or activities from other places or locally;
  • Creative and innovative ideas that haven't yet been tried;
  • Reasons why some barriers are particularly challenging in Queensland;
  • Important steps that need to be taken to facilitate the recommended priorities;
  • Suggestions for how our research centre can contribute to the solution.

 

Challenge Opened: 12:11 AM, Tuesday 19 September 2017
Challenge Closes: 08:00 AM, Tuesday 30 January 2018
Time to go: Closed

 

Do you want to contribute to this challenge?

The context

Challenge Opened: 12:11 AM, Tuesday 19 September 2017
Challenge Closes: 08:00 AM, Tuesday 30 January 2018
Time to go: Closed

Do you want to contribute to this challenge?

Challenge Activity

Challenge Activity

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Bill Wyatte commented on the challenge How can we scale up rehabilitation in Queensland?

The medieval church was a source of knowledge and guidance for communities because its knowledge was written down, could be referred to and verbally provided to the illiterate congregation.  Education and communication advances diminished that central expert role.

If the providers of rehabilitation lack the capacity to fulfill demand, similarly making as much of their underpinning knowledge as publicly accessible as possible may engage the effort of individuals in new and unforeseen ways.

Nugget Coombs called this "devolution" in his landmark-and-still-relevant 1976 report into the review of Australian Government Administration.

 

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The Hopkins Centre commented on the challenge How can we scale up rehabilitation in Queensland?

Thank you for these comments Bill, you address a major challenge we face every day in rehabilitation. No-one fully understands the journey people take across systems. Each system dabbles in a person's life, sometimes with hidden and unexpected consequences on another aspect of life or another system. The frustration experienced by end-users when they have to repeat their story usually results in withdrawal. Many of those injured in motor vehicle accidents are lost from health systems into criminal justice systems or social welfare systems necessitated by homelessness and unemployment, but the extent of this challenge is not well documented. Cost shifting is possible and this hides real need. One of our core programs at Hopkins Centre involves a focus on integrating administrative data across systems to see if we can plot journeys and better understand the way in which people who are severely injured are using services. We will be applying this knowledge back into the clinical and community system, but achieving the type of integration you refer to seems to be incredibly difficult. One of our longer-term aims is to develop cross-sectoral teams that can begin addressing some of these challenges. Such partnerships have worked really well before to tackle some of the fragmentation created by the situation you highlight. 

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Bill Wyatte is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Bill Wyatte commented on the challenge How can we scale up rehabilitation in Queensland?

The global-national-state-local cascade nominated by the WHO stops before its logical end-point. 

A person.

Each of the human services programs with which a person may come in contact has unique insights into that person.  Unique, and limited to their narrow interest in the person.

Connecting those diverse insights will enable service providers to better understand a persons' circumstance and needs and better fulfil those needs. 

Lack of connection means missed opportunities, foregone leverage of existing effort and blockages to innovation-via-interdisciplinary sharing.  We may successfully resolve a bit of a person's situation via one program, but still not alleviate that person's major challenges.  Investment may not get the best possible results.

It is unrealistic to expect that rehab will drive such integration.  However, such integration will universally benefit all major streams of publicly-funded intervention, including rehabilitation.

Person-to-person manual sharing of insights is not a practical option.  People engaged in human services are too busy doing to be diverted to being transactional-level information whisperers and wranglers.  It must be electronic, automated, immediate and seamless.  "I need to know - I see it".

Services can become proactive rather than responsive.  Pennies of prevention.

Once the joined-up information is available to service providers, it is also there for policy analysts and decision-makers.

This knowledge integration will positively underpin most of the ten WHO priorities, while it is not clear that any of those priorities will be achieved in its absence.

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The Hopkins Centre commented on the challenge How can we scale up rehabilitation in Queensland?

Here are some themes emerging in the comments so far - things that seem to matter so far are listed below, but further comments are needed to broaden this view. 

Leadership and collaboration among consumers and professionals to promote awareness of rehabilitation and a united movement

Evidence of effectiveness through systematic reviews of both published and unpublished literature

Better understanding of need for rehabilitation

Interdisciplinary education and professional development opportunities

An economic task force to explore costs, benefits and funding models

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Michele Foster commented on the challenge How can we scale up rehabilitation in Queensland?

In the 1990s, there were at least three reviews of rehabilitation services conducted within Queensland Health with a view to achieving a comprehensive and integrated rehabilitation service system. I'm not sure what eventuated in terms of tangible outcomes from these reviews. However, the biggest and basic challenge then and now for scaling up rehabilitation in Queensland is the funding. This includes continuing to address the historical under-funding for public rehabilitation services but also the inadequate insurance coverage for the scope and duration of rehabilitation services that many people require. For effective lobbying of government, Courtney makes a very good point that we need a better picture of the true level of need, and this is consistent with the WHO's Call for Action agenda. In that respect there's real scope for collaboration between researchers and the recently established Statewide Rehabilitation Clinical Network. The Network has an important leadership role in scaling up rehabilitation since its brief is to provide direction and advice to government on the development of rehabilitation services. The funding solution also requires a stronger intersectoral approach, which includes public/private opportunities. 

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Pim Kuipers commented on the challenge How can we scale up rehabilitation in Queensland?

Maybe we need to harness and unify the many voices of people who have been through (and benefited from) rehabilitation, as advocates for rehabilitation.  I think it happens to some extent for specific groups (e.g people with Spinal Cord Injury, people who have been through cardiac rehab), but the natural tendency is to focus on the injury-relevant issues within that sub-group, not advocating for rehabilitation in general. 

Might fostering people power to draw attention to the importance of rehabilitation, and increase the social and economic base of rehab be possible? ... rather than competing within rehab???

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Pim Kuipers is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Delena Amsters is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Delena Amsters commented on the challenge How can we scale up rehabilitation in Queensland?

We need to work on changing the notion that rehabilitation is a poor cousin of acute and primary health interventions. Perhaps we have to think of it as a marketing exercise to internal and external stakeholders.

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Courtney Wright is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Stephanie Prout is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Catherine Cave is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Christine Randall is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Christine Randall commented on the challenge How can we scale up rehabilitation in Queensland?

Good points, Elizabeth. Your post also addresses priority number 6:  Developing a strong multidisciplinary rehabilitation workforce with ability to work in interdisciplinary ways and promoting rehabilitation concepts across the entire health workforce.

This is an area to consider in health professional education and professional development to change the culture in practice to a more interprofessional approach that both strengthens individual professional identity as well as understanding of the roles of other professions. Unfortunately, if we don't facilitate interprofessional learning in health professional education, we can't expect practitioners to find the time to develop interprofessional practice skills once they graduate.

There is a strong drive to improve this across all health professions now, but the silos within health professional education also need to be considered for this to happen. This is a challenge in curriculum that is already heavy with content, but a challenge some of us are taking up in various ways. 

These educational strategies also need to be underpinned by research and scholarship to inform effective strategies to promote learning and skill development, as well as accreditation processes that recognise the need for interprofessional learning and practice. 

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Elizabeth Kendall commented on the challenge How can we scale up rehabilitation in Queensland?

Well, I'll have a go at making the first comment - this is a very big challenge! I think I will start by commenting on just one thing that I see is a major obstacle to the advancement of rehabilitation in Queensland, namely artificial boundaries.

Despite a very common set of values and practices, the delivery of rehabilitation is spread across different populations (traumatic injury, serious illness such as stroke, osteoarthritis, cancer, and cardiac conditions, other chronic disabling conditions, mental illness, social/interpersonal trauma, natural disaster recovery, ageing, criminal rehabilitation, drug and alcohol).

In each population area, rehabilitation is similar, but seems to be a contained practice that is described and delivered in a very separate and discrete way. 

As a result, rehabilitation never gains the benefit of developing its reputation as a broader strategy that addresses multiple challenges and improves the lives of people following a range of different conditions and circumstances. Each "type" of rehabilitation develops in its own way with separate models, structures and pathways. 

To complicate this picture, rehabilitation covers a trajectory from acute treatment through to long-term disability support and maintenance of functioning in the community. These areas are also separated by artificial boundaries - inpatient/outpatient rehabilitation, medical rehabilitation, allied health therapies, vocational rehabilitation, workcover, CTP/NIIS, community services, leisure therapy, NDIS, disability services, sport rehabilitation. There are philosophical and practice gaps between these areas that are not as large as they may initially seem and could easily be described and understood along various continua to create a unified picture. 

Disciplines are a potential obstacle. Effective rehabilitation is interdisciplinary in that it draws on multiple skill sets at different times and in different ways. The minute that different aspects become "owned" by different groups, the person's experience of rehabilitation becomes fragmented. In Qld, we seem fairly good at crossing disciplinary boundaries, but it can be a challenge reporting to disciplines rather than to an overarching concept of rehabilitation. This needs very strong and responsive leadership in the disciplines.

The rehabilitation workforce also needs the capacity to accept, integrate and value new workers who are not bounded by disciplinary structures and/or may have personal experience of disability. They may also need to work with family and community members more successfully. 

One of the things that might be needed to make this shift is the development of a collective view of rehabilitation across these artificial boundaries and a mechanism for explaining how it all fits together. It may also require exchanges and transfers across boundaries so we can all experience different ways of working and better appreciate the skills brought by different groups. Those who can span boundaries become important assets in building a coherent understanding of rehabilitation and how it works across multiple areas. A mechanism for explaining how boundaries are crossed can be as simple as a diagram or a short position paper, but it might also be important to examine competencies and requirements across different areas. 

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Amy Nevin is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Sharon Mickan is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Michael Deen is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Kerrin Watter is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Elizabeth Kendall is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Sanjoti Parekh is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Macarla Kerr is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Julie Shaw is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Michele Foster is now contributing to this challenge How can we scale up rehabilitation in Queensland?

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Challenge Progress

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  • Online discussion, editing & synthesis
  • Panel Selected

Consultation Phase

  • Solution drafted
  • Crowd gathered
  • Context Published
  • Challenge published

Framing & Gathering Phase

Hiver

Macarla Kerr Research Support?Officer?
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Elizabeth Kendall
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Delena Amsters The Hopkins Centre
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Catherine Cave The Hopkins Centre
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Michael Deen The Hopkins Centre
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Michele Foster The Hopkins Centre
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Pim Kuipers The Hopkins Centre
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Sharon Mickan The Hopkins Centre
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Amy Nevin The Hopkins Centre
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Sanjoti Parekh The Hopkins Centre
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Stephanie Prout The Hopkins Centre
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Christine Randall The Hopkins Centre
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Julie Shaw The Hopkins Centre
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Kerrin Watter The Hopkins Centre
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Courtney Wright The Hopkins Centre
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Bill Wyatte Integrated Criminal Justice Governance and Program Manager
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Documents associated with this challenge

File name File type Date uploaded Size (KB)
WHO Rehabilitation in Health Systems
.pdf
9/19/2017 3,180
The need to scale up rehabilitation
.pdf
9/19/2017 112
Health information systems and rehabilitation
.pdf
9/19/2017 192
Concept note
.pdf
9/19/2017 47
Call for action
.pdf
9/19/2017 42
 

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