Cleft management in the Northern Territory: a review of the past 17 years (2000 – 2017)

Celina Lai1, Mr Mark  Moore1, Dr Gurmeet Singh1

1Royal Darwin Hospital, Darwin, Australia


About one infant in 700 live births is born with a cleft lip and/or palate (CL±P).  The prevalence of CL±P occurring in indigenous Australian population is reported to be higher when compared to the non-indigenous Australian population1.  The Northern Territory (NT) is the third largest state/territory in Australia and home to approximately 212 000 people of which 26.8% are Indigenous2.

In the “top end” of the NT, children born with CL±P are referred to the Royal Darwin Hospital (RDH) Cleft Lip and Palate Clinic for assessment, review and long term case management.  The RDH cleft clinic, made up of a multidisciplinary team of medical and allied health professionals, meet three times a year providing case management to children and young adults with a cleft condition.

Approximately 40% of active clients identify as Aboriginal or Torres Strait Islander.  Of this group, nearly 70% live in a remote or rural location (population <5000 to <100000).  For this group, the challenges to providing optimal cleft care are substantial, when you consider language and cultural barriers to understanding western health practices, cultural variations in processes for decision making, limited access to allied health services in remote NT and the tyranny of distance.

Cleft management is a long journey where children are followed up into their early adult years.  Continual review of the way services are delivered is imperative to ensure children with CL±P living in rural and remote NT, receive a service equitable to those living in metropolitan areas.


Coming Soon.

Development of a transdisciplinary diabetes model of care in a rural service

Ms Petrea Cronwell3, Ms Cristal Newman1, Ms Sonia Small3, Ms Elizabeth Ward2

1Community and Allied Health, Roma Hospital, Roma, Australia, 2Centre for Functioning and Health Research, Metro South HHS; and The University of Queensland, St Lucia, Australia, 3School of Allied Health Sciences, Griffith University, Gold Coast, Australia


Context And Aims
Provision of healthcare for clients with diabetes can be challenging, particularly in rural health services with limited resources. In South West Hospital and Health Service, an Accredited Practising Dietitian (APD) and a nurse Credentialed Diabetes Educator (CDE) traditionally provided care within a multidisciplinary service model. Existing service inefficiencies prompted exploration of a new transdisciplinary service model, aiming to improve service efficiency and patient care.
Diabetes assessment and intervention tasks completed within the scope of practice of a registered nurse, APD and/or CDE were identified and documented. The patient journey was mapped and parameters for inclusion in a shared initial assessment tool were identified. Referral criteria for patients requiring specialised assessment and intervention by either the nurse CDE, APD, Nurse Practitioner or Medical officer were developed. Acceptability of the model was tested with referral sources.

The results of mapping activities were used to develop a transdisciplinary diabetes service model. Opportunities for skill sharing, implementation of extended scope practices (including provision of advice on insulin dose adjustment and pathology requesting) and reducing service duplication were identified. A transdisciplinary diabetes model of care was produced including a comprehensive transdisciplinary initial assessment tool, defined referral criteria and skill share clinical task instructions for new tasks. The model demonstrated high levels of acceptability with key stakeholder groups.
Development of transdisciplinary healthcare models provide an opportunity to identify areas for skill sharing, reduced service duplication and improved patient care.


Coming soon

Providing a Kick Start to Rural Health through Student Led Services

Mr Alex Lalovic1, Dr Sandra Hamilton1, Mrs Kathryn Fitzgerald1

1WA Centre For Rural Health, Geraldton, Australia


Kick Start is an 8-week program for individuals 18-65 years of age residing in a rural setting and diagnosed with chronic or mental health conditions. It is an interprofessional student teaching clinic within a service-learning model, delivered by exercise physiology (EP) and physiotherapy students, and other disciplines as appropriate. Kick Start aims to improve clients’ quality of life and extend and improve students’ clinical skills and rural experience.
Students are responsible for undertaking a thorough case history, objective assessment, program design and delivery. A process and outcomes program evaluation is being undertaken. Outcome measures include student learning experience on rural placement and client measures including body composition analysis, 6-minute walk test, 30-second sit to stand test, waist-to-hip ratio and quality of life (SF12).
A process evaluation elicited several adaptions including change of the SF36 Health Survey to the SF12, use of the electronic medical record management system, Communicare with specific Kick Start clinical items, improvement of referral processes including extension of recruitment to retirement village residents, a Kick Start specific end of placement student survey, clarification of goal setting questions and inclusion of inter-professional disciplines other than of EP and Physiotherapy students when appropriate. Evaluation of outcome measures is ongoing.
Kick start provides rural clients with the opportunity to access and benefit from services and facilities they are otherwise unable to access and students a rich hands on supervised rural learning experience with a variety of complex cases.


Alex graduated Murdoch University with a Bachelor of Science (Exercise Physiology) and a First-Class Honours in 2013. After working in private practice for four years, he took the position of Associate Lecturer & Clinic Supervisor at the WA Centre for Rural Health with the University of Western Australia. His role includes the supervision of exercise physiology students on rural placement within a service-learning model.

His clinical exercise physiology interests include cardiac and metabolic rehabilitation, mental health and musculoskeletal rehabilitation.

Alex’s Honours research was in sports science, examining the link between visual anticipatory skill and timing of weight shift transfer to initiate bat swing between an expert batter (Major League Baseball experience) and near-expert batters (from the Australian Baseball League).

Alex’s other interests include marketing and business development as well as being active in sport, playing and coaching in soccer and futsal.

Using Simulated Patients to Enhance Basic Life Support Training for Allied Health Students

Mrs Jodi Ullrich1, Mrs Kathryn Fitzgerald1

1Wa Centre For Rural Health, Geraldton, Australia


The WA Centre for Rural Health (WACRH) offers rural clinical placements for Allied Health students. As part of orientation, students complete basic life support (BLS) certification.
Traditional BLS training includes assessment of theory followed by practice sessions on a half torso mannequins
While effective for teaching technical skills, the mannequins are unable to provide feedback such as prior to collapse such as body language or explanation of symptoms such as chest pain, inability to breathe and also verbal or painful response when assessing the response of the casualty- all aspects that are critical to the management of a life threatening event.
To create this feedback and add to the BLS program WACRH has incorporated scenarios using simulated patients. Simulated patients (SP) are individuals that are trained to portray a real person with the appropriate signs and symptoms of a deteriorating patient in a situation relevant to the students’ clinical practice. The student needs to respond not just to the patient’s condition but to the environment including the appropriate means of calling for help in the different settings health professional can work.

The SP adds an authenticity to the students’ learning as during the scenario they must interact, communicate and develop a relationship before reacting and recognising the need to apply the newly learnt skill of basic life support.

The feedback from the students regarding the addition of the SP is that it is more realistic as it enables them to see how to react in a real clinical situation.


Jodi Ullrich has in worked rural and remote areas as a Registered Nurse for 15 years. She has passion for working with children and providing health professional education mainly in the area of simulation based training programs. She currently works as the Simulation Educator for the WA Centre for Rural health based in the Midwest region of Western Australia

Developing a Student Speech Pathology Service with an Aboriginal Medical Service

Ms Belinda Goodale1

1WA Centre For Rural Health, Geraldton, Australia


Student speech pathologists worked with their clinical supervisor and the child health nurse at the Geraldton Regional Aboriginal Medical Service (GRAMS) to develop a new service for families. Prior to the student clinic, families could access speech pathology services with the public health services, but not at their local health service, GRAMS. The new service was developed to run alongside the child health service at GRAMS. It was developed through collaboration, and being mindful of working respectfully within the existing models of care for families at GRAMS. The students developed information resources for families and their initial services were focussed around waiting room play based interactions with families and children. This developed key relationships with families and trust in the student services that were also linked with the child health nurse clinic. After a few weeks individual referrals and regular client sessions began to grow and the important waiting room consultations also continues. This service has been in operation for a year and the presenter will share the collaborative process to develop this service, the impact on student learning outcomes and experiences, evaluation of this initial program and the plans for interprofessional expansion.


Belinda is a Speech Pathologist who has worked in rural and remote areas within the Midwest region of Western Australia and New Zealand for the past 18 years.  She is currently enjoying working as a lecturer and clinical educator for Speech Pathology students with WA Centre for Rural Health and is based in Geraldton.

Square peg into round hole: questioning the appropriateness of 24hour dietary recalls for Indigenous children.

Miss Sarah Ryan1,3, Dr Yasmine Probst1,2, Dr Anthony McKnight4, Dr Rebecca Stanley2,3,4

1School of Medicine and Health, University of Wollongong, , Wollongong, Australia, 2Illawarra Health and Medical Research Institute, Wollongong, Australia, 3Early Start, University of Wollongong, Wollongong, Australia , 4School of Education, University of Wollongong, Wollongong, Australia


Motivation/Aim: Research typically reports that Indigenous Australian children overconsume energy dense nutrient poor foods, with minimal evidence about the context surrounding nutritional intake. Current dietary assessment methodologies tend to only capture the physical rather than the spiritual, social and emotional aspects of food, which are important components of Indigenous Australian’s definition of health. The aim of this research was to explore the appropriateness of 24hour dietary recalls as standalone tools to capture dietary intake in Indigenous children. The 24hour recall dietary assessment is a validated tool though fails to capture the context surrounding consumption. Indigenous research methodologies require this context.

Approach/Methods: A pilot afterschool cultural program developed for Indigenous children (aged 7-12y) in the Shoalhaven region of New South Wales, used 24hour recalls to assess dietary intake. An analysis was conducted using FoodWorks 2009 software and AUSNUT 2011-13 food composition database. Participants also captured photographs and were interviewed about things connecting them to culture, including food.

Results: The uncontextualised dietary data (n=17) found high consumption of discretionary foods and low intakes of fruit and vegetables. Children photographed food and shared stories of how it made them feel connected to their culture. The context surrounding the food photographs unexpectedly highlighted the potential spiritual, emotional and social impacts of food on health.

Conclusion: Food has strong ties to culture. Incorporating mixed methods in Indigenous research may be more appropriate to provide contextual information to formulate a story and capture the holistic aspects of health. This approach aligns with recommended Indigenous research methodologies.


Sarah Ryan completed a Bachelor of Science (Nutrition) with Honours at the University of Wollongong while working with an Indigenous community on the south coast of NSW. She has worked alongside the local Aboriginal community and a team of researchers at the University of Wollongong for two years she has found her passion in working with children and community. Sarah hopes to explore further research in the area of cultural connectedness in the future.

Going Rural Health Program: changing student placements for the better

Ms Claire Salter1, Ms Keryn Bolte

1Going Rural Health – University Of Melbourne, Shepparton, Australia, 2Going Rural Health – University Of Melbourne, Shepparton, Australia


The Going Rural Health Program is part of the University Department of Rural Health under the auspices of the University of Melbourne. It is part of a federally funded project supporting nursing and allied health students to undertake placement experiences in rural settings. Our teams are based in Wangaratta, Shepparton and Ballarat and actively work with health services and education providers, along with students directly, to assist and improve the learning and experiences students gain during their clinical placement. This is all with the intent of promoting and addressing rural health workforce development and include traditional clinical opportunities as well as service learning placements. We have a strong focus on student support, which includes creative supervisions models, placement matching, accommodation, online and face to face training, social engagement, financial assistance and mentoring.

This presentation outlines the development of the program to date, some key learnings and how the Going Rural Health program has supported students, staff and communities to deliver outstanding health care with a community-minded focus within rural Victoria.


Claire joined the Going Rural Health team in Shepparton, Victoria in 2018 after two years working with an NGO in Cambodia. Claire has spent most of her professional career working in Northern Australia in Indigenous health and education spheres. Claire is a SARRAH board member and is passionate about providing students with innovative, exciting rural learning opportunities.

Preparing the next generation for the changing landscape: Physiotherapy students’ learning through community engagement programs

Ms Trishika Narula2, Ms Cassandra Small2, Mr Thomas Raeside2, Ms Rosannah Fizelle2, Mr James Bodycote2, Mr  James Dowton3, Dr Luke Wakely1, Mrs Kate Currie3

1University Of Newcastle Department Of Rural Health, Tamworth, Australia, 2University of Newcastle, Faculty of Health and Medicine, Discipline of Physiotherapy , Callaghan, Australia, 3University Of Newcastle Department Of Rural Health, Port Macquarie, Australia


Introduction:An innovative strategy to enhance work readiness of physiotherapy students at the University of Newcastle Department of Rural Health is to provide full-year immersion placements in a rural setting. A substantial component of this program is the facilitation of community engagement with the local rural community through a range of unique activities.

Method:This paper describes an innovative education method of improving the non-propositional knowledge and work readiness skills of physiotherapy students. This paper, about their experiences, will be presented by the students – the next generation.

Results:Physiotherapy students have the opportunity to study the entirety of their final academic year at the University of Newcastle Department of Rural Health. This includes a range of innovative community engagement activities. The activities aim to improve the health of the local rural community, but also to provide opportunity for students to engage with aspects of the community on a deeper, richer level. Students have the opportunity to interact with groups who they may interact with on placement but not engage with in a meaningful way, such as the local Aboriginal community, children and youth, and disability groups.

Conclusion/Outcome:Physiotherapy students find the community engagement programs to be a valuable adjunct to their education program. They perceive that the skills they develop will be beneficial in clinical practice.Take home Message
Students’ perceive that community engagement activities are an invaluable educational activity.
Community engagement through mutually beneficial activities improves the health of the community and enhances physiotherapy students’ work-readiness.


Trish Narula and Cassandra Small are both fourth-year physiotherapy students at the University of Newcastle. Both have nearing completion of their final year of study which they have undertaken as a rural immersion year at the University of Newcastle Department of Rural Health in Tamworth.

Changing inpatient rehabilitation ward to an enriched environment for rural patients

Mrs Bronwyn Connelly1

1Northeast Health Wangaratta, Wangaratta, Australia, 2Victoria Stroke Clinical Network, Melbourne, Australia


Central to the goal of stroke rehabilitation is the aim to reduce the level of impairment experienced by increasing participation in therapy and meaningful activities. Inpatient rehabilitation forms an integral step for patients to regain function following a stroke. Inpatient rehabilitation environments are often not conducive to maximising recovery despite recent innovations and increased knowledge. Research indicates stroke clients spend up to 50% of their day in their room alone and inactive.

Environment enrichment is an emerging concept within stroke rehabilitation that aims to provide a stimulating environment to maximise clients’ recovery but to date has tended to a metropolitan based service change. The enriched environment model was implemented in January 2017 to address reduced activity levels, and to maximise recovery and function within a rural inpatient rehabilitation setting. This innovative concept includes increasing levels of activity and increasing opportunities for stimulating, enjoyable activities for inpatient stroke patients seven days a week.

Underpinning the changes was the guiding principle of improvement in service delivery to offer a comprehensive, truly team based approach to maximise patient recovery and improve quality of life. This model created an approach to facilitate social interaction and stimulation by creating an environment to respond to individual needs and goals without increased funds or staffing.

This presentation will also outline how the model has been successfully sustained and extended for all rehabilitation patients.


Bronwyn Connelly is a senior occupational therapist at Northeast Health, where she specialises in the management of complex neurological clients. Bronwyn has a special interest in developing models of care which incorporate research into evidence based rural clinical practice.

Health Careers to Try – changing lives for the future

Mrs Susan Witt1, Mr Mantavya Patel2

1Flinders University, Tiwi, Australia, 2Top End Health Service, Tiwi, Australia


Introduction:Health workforce shortages in the Northern Territory are problematic for health services. Further most health courses are not available locally so students are required to move interstate to train, increasing the likelihood that they may not return to the NT after graduating.

Method:Our health service procured a Youth Week grant to fund a ‘Health Careers to Try’ day. As a health careers promotion event, interactive profession-specific 15 minute stations were designed where students could touch, ask questions and learn about the various disciplines. Additionally, local universities provided information about pathways to study the profession of choice.

Results:There have been four ‘Health Careers to Try’ to date. In 2018 a total of 108 students participated with many schools requesting additional places due to high interest from Year 10-12 students. All student groups were accompanied by school staff. Fifteen stations were included with most stations rostering staff and placement students to ensure minimal impact on clinical services. Following the event 98 students indicated an interest in pursuing a career in health with 43 students requesting follow-up information about specific courses.

Discussion: Feedback from health professionals, staff and students indicated the day was a great success with outcomes ranging from increased awareness of health careers, improved knowledge of career pathways and university access. It also provided an opportunity to showcase the diversity of the hospital services and built stronger relationships between University, local Schools and Health services.


Susan Witt completed Occupational Therapy training in 2000. She worked extensively across Australia and overseas before completing a Masters in 2015. She is currently employed as a Lymphoedema therapist at the Royal Darwin Hospital and Lecturer Nursing and Allied Health at Flinders University. She is also working towards a PHD in Lymphoedema.

Mantavya Patel is currently employed as Clinical Nurse Educator for the Graduate Nurse Program with the Top End Health Service, Northern Territory. He obtained a Bachelor of Science and then Post Graduate Certificate in Medical Laboratory Science before completing his nursing qualification in New Zealand. He continued to peruse a post graduate qualification in Health Science (Advance Nursing) and is currently undertaking a Masters of Clinical Education.

Mantavya is a highly motivated Clinical Nurse Educator with experience in various healthcare settings including major metropolitan hospitals as well as rural regional centres. Additionally, he has extensive knowledge and experience in simulation based learning. Mantavya has worked in clinical and educational roles in New Zealand, Western Australia, Northern Territory and Queensland.


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