Principles for paediatric rehabilitation outreach

Published: December 2022

The following principles were derived from a number of sources, including a rapid evidence review by the ACI Evidence Generation and Dissemination Team, a series of consultations with existing paediatric outreach services in NSW and resources from the Australasian Faculty of Rehabilitation Medicine.1

Principle 1: Where possible, outreach should be provided in a face-to-face setting

Rehabilitation is a physical form of medicine, requiring hands-on examination of patients to determine care requirements.

Children requiring paediatric rehabilitation often require physical assessments and interventions, such as measurement of muscle strength, review fit of specialised equipment and injection of botulinum toxin.

While technology has huge potential to address issues of access to services in rural and regional communities, it is intended that ‘virtual care coexists as a complementary option for patients and communities in addition to face-to-face care. There will be situations where care and treatment require or benefits from face-to-face engagement’.2,3

It is further acknowledged that virtual care may pose cultural barriers for Aboriginal people. This is an important consideration when developing service models.4

NSW Health encourages equity of service delivery, particularly for those living in rural or regional areas.2

Principle 2: Outreach should be provided by a multidisciplinary team

Paediatric rehabilitation aims to enable the highest-level possible of physical, cognitive, psychological and social functioning.5 This is done through the provision of a multidisciplinary service, which includes medical, nursing and allied health professionals. Current PRS outpatient clinics operate in various multidisciplinary models.

People living in regional and rural areas of NSW have significantly poorer health outcomes and inferior access to services, as well as additional financial barriers to accessing services.6 To ensure equity and inclusion in service delivery and have meaningful impact on health outcomes, outreach clinics must provide the same level of service as current metropolitan clinics.

A higher level of service would potentially offset the current inequities of access for rural and regional families.

Therefore, outreach must provide access to the same multidisciplinary team offered to those attending regular clinics.

Principle 3: A consistent PRS care team should provide outreach at each location

The benefits for patients and families of having a consistent care team has been acknowledged for many years. When providing outreach clinics, continuity of care has added benefits for the local health services and teams.

Consistent teams visiting the same locations assists in the development of relationships and rapport with local services over time.7

This supports the achievement of minimum standard 3.2 – The PRS provide networked support, clinical advice and professional development support to level 4 and 5 paediatric medicine services.

Principle 4: Relevant documentation from outreach clinics should be provided to local clinicians

Providing clinic letters and other relevant documentation from outreach clinics to local care teams supports continuity of care and coordination between services. It helps to maintain strong communication links between all clinicians involved in the care of the child or young person, as well as supporting continuity for future clinics.

As per minimum standard 1.9 – PRS outpatient clinic letters are provided within two weeks of the appointment, with copies provided to the general practitioner and paediatric services at patient’s local level 4 or 5 paediatric medicine service. Copies of the clinic letter should also be provided to the child or young person’s general practitioner.

Principle 5: Outreach services should have a program coordinator or liaison officer who is responsible for the management and organisation of the clinics

Henry Review Recommendation 50 is focused on improved coordination of paediatric rehabilitation services across NSW. Care coordination is an essential part of this process. Documented models of care for outreach clinics have shown that the involvement of a program coordinator or liaison officer has benefits for both consumers and clinicians.7-9 This role would ensure integration between the services providing the outreach and those in the local location, as well as supporting strong communication between clinicians and consumers.9, 10-13

Principle 6: Consumers, including young people, should be involved in the development of outreach services

Co-design and the value of including those with a lived experience in the design of health services has been recognised across the world. Co-design provides the potential for treatment and care to be experience-focused, rather than protocol-driven, leading to better patient safety and outcomes.14 Development of outreach services should be no different. Evidence suggests that outreach services should be planned in genuine partnership and consultation with consumers, including children, young people and their families.7, 9-13, 15-19

Principle 7: All outreach clinics should include engagement with local care teams in the organisation and completion of the clinic

Engagement with local care teams is essential for provision of outreach clinics. This engagement should occur from the point of organisation through to the completion of the clinic and follow-up documentation. Outreach planning should include partnership and consultation with key stakeholders from regional and rural areas.7, 9, 11,12, 15-19 It is important to identify key local staff to act as champions for the model, who can support the process at a local level.18

LHD facilities are responsible for the provision of accessible treatment spaces to conduct outreach (Principle 9). This will need to be done in consultation with the PRS team or outreach coordinator. Local clinicians should be invited to attend relevant outreach clinic appointments of their patients.

This is described in minimum standard 2.2 – For all PRS outpatient appointments, it is recommended that families extend the invitation to their local care team. This attendance can be either face to face or via virtual care. Ensure the family is aware of any requirements related to NDIS therapist’s attendance, such as funding.

Engagement of local clinicians in outreach provides an opportunity for upskilling in specialist skills,which supports capacity building.12, 19, 20 This can be completed through a number of avenues outlined in Principle 8.

Principle 8: Educational opportunities for local health district clinicians should be provided in conjunction with the outreach clinics

Provision of outreach clinics provides an excellent opportunity to upskill local clinicians and build capacity within health services.

Options for education provision during outreach clinics may include face-to-face education during clinics, after-hours workshops, forums or in-services.

Compliance with this principle would also result in the achievement of minimum standard 3.2 – PRS provide networked support, clinical advice and professional development support to level 4 and 5 paediatric medicine services.

Principle 9: Local health districts should provide appropriate and accessible facilities for conducting outreach clinics

The importance of outreach being a shared partnership between PRS and LHD services is outlined in Principle 7. The provision of clinical treatment space for outreach is the responsibility of the LHD service involved. Ensuring outreach clinics are held in spaces which are accessible and acceptable to consumers is important.17, 21

It is essential that collaboration and communication occurs between teams to determine how visiting staff will be able to use shared spaces, equipment and information technology for both clinical and administrative purposes.7, 17

Considerations for service planning

The following is a non-exhaustive list of suggested items which the PRS may need to consider in planning outreach services.

  • Further interrogation of local data to determine cohort, potential locations for outreach clinics and frequency
  • Financial analysis of service provision, including staff transport and/or accommodation costs and long-term sustainability
  • Determination of clinic planning process and time points for liaison with local teams and services
  • Establishment of triage process to prioritise outreach appointments, as demand is likely to exceed capacity
  • Review of credentialling process for PRS staff to attend each identified outreach location
  • Coordination of clinic logistics such as scheduling, information technology access, transport and/or accommodation of staff
  • Process for tracking patient experience and outcomes and pathway for consumer engagement in design of outreach services.


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