If we want to best understand the challenges and opportunities associated with rural health care in particular communities, who best to ask than community members and local clinicians who know the context best? Over the past five years, Tresillian, the largest provider of specialist child and family health (CFH) services in Australia, has undertaken a journey of rural and regional service development. This commitment has seen Tresillian’s service move from being metropolitan based to being delivered across New South Wales, the Australian Capital Territory and north-east Victoria, including the establishment of a range of rural and regional services providing a referral pathway for primary health care providers, supporting parents experiencing a range of parenting and psychosocial difficulties in the critical early years of their child’s life.
The services are now available across eight family care centres delivering day services in rural and regional New South Wales in Wagga Wagga, Albury–Wodonga, Lismore, Queanbeyan, Coffs Harbour, Taree, Dubbo and a fly-in fly-out service in Broken Hill, with all services operating under partnership agreements with local health districts and health services. Tresillian has also established two innovative services in partnership with Mid North Coast Local Health District:
- a specialist CFH mobile service, the Tresillian2U Early Years Parenting Service, with a team including an Aboriginal Health Worker providing services from a purpose-designed T2U van which travels to communities across the mid-north coast
- the recently opened CFH residential unit, which is the first of its kind in regional Australia. The Tresillian Macksville Residential Unit, co-located with the Maternity Unit, provides four-night/five-day admissions for families experiencing persistent early parenting challenges requiring more intensive support and intervention through a multidisciplinary approach.
Tresillian’s commitment to building our understanding of what works best and adapting services for local communities has led to a number of research projects. This includes a recent study drawing on participatory action research (PAR) to explore the adaptation of metropolitan CFH service models for rural community contexts. A PAR cycle was undertaken by an eager group of local community members including clinicians, health managers and, importantly, local consumer (parent) representation. The PAR study forms part of doctoral research being undertaken by Deborah Stockton, Director of Clinical Service Integration, and a PhD candidate with the University of Technology Sydney Faculty of Health.
The PAR approach was used to explore the key challenges confronting families living in a particular regional local health district, identifying actions to improve access and outcomes for children and their families. The group used the reflective process of PAR to build their collective understanding of local community strengths, needs and opportunities to address identified priorities; improve the health and experience of parents and children; decrease the stigma often attached to help-seeking; and raise awareness and understanding of the services available at a primary and secondary level.
The PAR group developed an action plan which included recommendations forwarded to the service’s Joint Governance Committee and Executive, in addition to items for local implementation through a second PAR cycle.
Recommendations for action included modifications to the referral process to enable self-referral; increasing access to services via telehealth; and raising community awareness through a communication campaign. This has led to changes including the implementation of a self-referral pathway for families to decrease barriers to access and a scale-up of telehealth capability.
A second PAR cycle is now in progress, driven locally by a group with a similar composition including, importantly, consumer representation. The current PAR cycle focuses on the communication strategy, seeking input from consumers to improve the descriptions used of the primary and secondary CFH services, to ensure the words used are understood and resonate with families. The process has provided incredibly valuable opportunities for not only the learnings associated with the research, but for community capacity building and strengthening of community and health service network connections. This enables collaboration and pooling of workforce resources and expertise to address current and emerging rural health priorities.