JCPSLP Vol 19 No 2 2017

Shaping innovative services: Reflecting on current and future practice

Saturday paediatric speech-language pathology service Emily Davis, Jessica Bauer and Katrina Rohr

Paediatric speech language pathology (SLP) in the community health setting is historically provided Monday to Friday during usual business hours. While weekend acute services have previously been implemented for speech-language pathology at various hospitals, there is no evidence in the literature regarding weekend paediatric community health services. A Saturday service for community health SLP was implemented for two months, and was made possible as a result of additional funding provided by Western Medicare Local, NSW. Outcomes were measured by parental survey, occasions of service, number of discharges and staff report. This article presents a detailed overview of the service delivery model, considerations for implementation, and reflections on the benefits and challenges of providing a paediatric Saturday service. T he recent Senate Inquiry into Speech Pathology (Commonwealth of Australia, 2014) highlighted a number of issues affecting the availability and uptake of speech-language pathology services. These factors included the increasing demand for speech- language pathology services, lengthy waiting lists, restricted service delivery models, large caseloads, lack of time and resources, and geographical diversity. Although these issues are well recognised by speech-language pathologists, solutions are not necessarily apparent, nor able to be implemented without access to additional resources. Ruggero, McCabe, Ballard, and Munro (2014) conducted a survey of 154 parents from across Australia. They established that parental satisfaction with a service was impacted by the length of time they waited for a service, the frequency of access to that service, the type of service provided, and the perceived support or follow-up received during “down” times. A significant majority of the participants (89%) in Ruggero et al’s. (2014) study, rated availability of local services as “unavailable” or “insufficient”,

and identified the needs for more services, shorter waiting times, greater affordability and more flexibility in service delivery, as desired solutions for this issue. Interestingly, the service delivery models discussed in the Ruggero et al. (2014) article included varied appointment frequency (e.g., weekly, monthly, yearly), and individual/group therapy, but not services outside of usual business hours. McAllister, McCormack, McLeod, and Harrison (2011) further emphasised the importance of listening to and responding to client and family preferences, finding that in order for families to feel able to access speech pathology services regularly and consistently, the service must be offered at a time that is appropriate for the family to attend. Appointments need to be scheduled with consideration of parent/caregiver commitments (including work) and children’s commitments including school and extra-curricular activities. This reflection arose from the observation that after work/school appointments were extremely popular with the clients of the SLP service showcased, and were often booked out weeks in advance. In light of these findings, and cognisant of the paucity of published literature about non-traditional paediatric speech- language pathology service delivery, a literature review was conducted to establish if other services or disciplines had published information regarding weekend services, and the impact these services had on client outcomes. The literature was primarily accessed through CIAP, with search terms including “Saturday”, “weekend”, “after hours”, “allied health”, and “service delivery”. The review yielded several articles that discussed Saturday services in the inpatient/ rehabilitation setting, with particular reference to physiotherapy and occupational therapy (Brusco, Watts, Shields, & Taylor, 2014; Hakkennes, Linder & Reid, 2015; Peiris, Taylor, & Shields, 2012; Taylor et al., 2010). These articles discussed the benefits of a Saturday service, including reduced length of stay and improved client outcomes for therapy given in addition to weekday rehabilitation. However, the literature search did not reveal any published data for any allied health services specifically pertaining to community health or paediatric allied health clinics running on a Saturday. Currently, SLP services are offered on Saturdays in some major hospitals. Other services do not offer a regular Saturday inpatient service, but may offer inpatient SLP cover for a long weekend (e.g., four hours on the third day). This service provision is for acute care and in particular clients with stroke and dysphagia. Models of service delivery in the private sector were not discussed

KEYWORDS FUNDING PAEDIATRIC SATURDAY SERVICE

THIS ARTICLE HAS BEEN PEER- REVIEWED

Emily Davis (top), Jessica Bauer

(centre) and Katrina Rohr

72

JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology