JCPSLP Vol 19 No 2 2017

the authors to be a realistic possibility if suitable for both employer and employee. It was important to manage client expectations regarding the continuity of the clinic. It was difficult to book new clients into the clinic when other children were discharged. This was related in particular to the finite time period that the clinic would be provided, and unlikely to be an issue if offering a continuing service. If the clinic was an ongoing service delivery option, this issue would have been managed different and perhaps more successfully navigated. Scheduling appointments for children around other family commitments such as Saturday sport was difficult, with some families requiring times to be variable from week to week. Other families were not able to attend due to Saturday sport or other family commitments and expressed disappointment at this. Had the clinic run at a different time of year these clients would potentially have been able to attend on the Saturday. Attendance on the Saturday of the long weekend was poor, with four out of seven clients failing to attend. Although parents had been reminded the previous week that the clinic would continue, in retrospect a phone or text reminder could also have been provided the day before to remind families to attend. Reflection The Saturday clinic was an innovative model to trial for SLP in a community health setting, albeit not a new service delivery concept. Set up and implementation of the clinic was not deemed challenging for this program, but funding was, and is, an important consideration if the clinic were to become a permanent service offering. Anecdotal evidence indicated that therapy offered on a Saturday was perceived as beneficial by the children and families who participated, and children were often observed to be less tired than at after-school appointments. It also allowed children who were unable to attend appointments during the week to receive a service, and is considered a potentially viable alternative option, particularly for school-aged children. Parents were very appreciative of the flexibility of service arrangements with many indicating to staff they would have liked the Saturdays to continue. With adequate measures in place, there were no significant security or administrative difficulties. This article has discussed a number of considerations for implementing a Saturday service on a short-term basis, and there would be additional considerations if implementing this service on a longer term or permanent basis. Staff and parents were overall very positive about the experience, and children made positive gains towards their therapy goals. It is not the intention of this article to suggest that Saturday services should be a permanent addition to community health service provision. However, a Saturday clinic could be explored as an option to utilise vacant full time equivalent positions on a short-term basis, or explored as part of flexible working arrangements, particularly for clinicians returning from parental leave. References Brusco, N. K., Watts, J. J., Shields, N., & Taylor, N. F. (2014). Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up. BMC Medicine , 12 (1), 1–11. doi:10.1186/1741-7015-12-89 Commonwealth of Australia (2014). Senate Community Affairs References Committee: Prevalence of different types

Some parents of children who were offered a Saturday appointment but declined due to conflicting commitments, expressed disappointment that they were not able to take on the opportunity at the time it was available. The children participating in Saturday clinic made many positive speech and language gains. A number of children were discharged at the end of the Saturday clinic as they had achieved their goals. It is uncertain if goals were achieved more quickly compared to usual weekly therapy. However, it would be reasonable to expect that significant difference in client outcomes would not be noted, as flexibility of service models addresses a need and preference identified by parents; an outcome aligned more with service satisfaction rather than improved therapeutic outcomes. However, this is an important issue to consider and may warrant further evaluation. Some school-aged children who had previously been offered therapy, but had difficulty attending during the week, were offered six sessions and were then discharged. In regards to attendance, 13.6% of appointments were cancelled (either failed to attend or unable to attend). This compared to a weekday clinic rate of 25.1% cancelled appointments (any reason) for the same period, suggesting that families were motivated to attend on a weekend where their schedules and commitments had been accommodated. Important issues to consider Security and safety were considered prior to and during the implementation of the clinic. The area was within a hospital, and accessible by swipe card only. Staff required amendments to their swipe card access to enter the department on a Saturday. Security staff were notified of the clinic. All staff had personal duress alarms for additional security, due to isolation of clinic rooms and reduced staff presence on Saturday. There were also duress alarms in two out of three of the clinic rooms, and telephones in all rooms. There was no administration support on the Saturdays, although other groups such as ante-natal classes were using the department. The SLPs involved volunteered to work paid overtime. The Human Resource Department was consulted regarding the implementation of overtime. From the NSW State Award, the first two hours of overtime was paid at time- and-a-half, and time thereafter was paid at double time. It was agreed that overtime was suitable for a short and specific duration, but was not to be implemented on an ongoing basis. Staff reported increased efficiency on the Saturdays as there were no phone calls (except some cancellations), no emails, and minimal interruptions. Challenges Staff reported fatigue at the end of the clinic and agreed that it would not be possible to conduct the clinic indefinitely in its current form of overtime. The overtime was a reasonable service innovation for a short and specified duration; however, it would not be sustainable. Having Saturdays as a usual work day (for example, instead of Monday), or for part-time staff (for example, working Thursday, Friday and Saturday) was considered viable by all SLPs participating, but would have required greater adjustment of services than was available in this pilot evaluation. In an environment where work–life balance is a consideration for the employer, and returning part-time from maternity leave a common occurrence in the profession, working Saturdays as a usual work day is considered by

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology