Experts tell us that constraints are good for innovation. If this is true, all the constraints imposed on allied health providers during 2024 should trigger an earthquake of innovation in our sector.
Although painful, this could be a good thing for providers, participants, other clients, and families. But…
Innovation is such a terrible buzzword!
Even typing the word made me cringe, with flashbacks to my corporate law days. And innovation in healthcare is poorly understood. As John Glaser taught me many years ago:
- innovation doesn’t require us to invent stuff: Most allied health providers lack the time, money, and energy to create a pipeline of inventions. But that’s OK: there are plenty of other people’s inventions waiting for allied health providers to adapt them for our purposes;
- innovation doesn’t require radical changes: Continuous, incremental service tweaks make more sense in uncertain times like now. Over time, they can compound to deliver big improvements for participant care; and
- innovation isn’t a goal in itself. Innovation only makes sense if it contributes to our purpose.
So, how should we go about doing it in the real world?
Here’s a little case study to show you how we’re trying to do it in our practice:
1. Go back to the mission
Sometimes, as I pore over government press releases, consultation papers, expert reports, white papers, guides, and social media think pieces, I forget that navigating NDIS reforms isn’t actually my job.
I’m a speech pathologist running a single-site, independent clinic in Sydney. I started Banter Speech & Language more than 10 years ago to help children and adults with neurodevelopmental disorders and disabilities.
My special interest is helping people with significant communication challenges to speak, read, and write for themselves. My practice exists because I want to support clients to pursue their interests; and to participate fully at school, work, and out in the community – just like everyone else.
Six days a week, my wonderful team works hard to deliver quality, evidence-based support to clients in the clinic and by telehealth, including NDIS participants.
But we have a problem.
2. Identify something specific that’s getting in the way of the mission
Every workday, we field queries from all over Australia and overseas from families with children with disabilities who are struggling to access the help they need when they need it.
Many obstacles to access aren’t new. Mainstream education and health support for children with neurodevelopmental disorders and disability remains patchy. Too often, the NDIS is the only way for children to access help. In the real world, NDIS access and funding rules favour some children over others. (Different diagnoses, postcodes, and abilities to navigate “the system” mean that different children with similar functional needs get very different levels of support.) Because of disability, many children have health, education, and disability needs; but health, education and disability systems operate independently, with uneven levels of support depending on where they live. (This is one of the main problems underpinning the government’s decision to move forward on Foundational Supports.)
As a small provider, these systemic problems seem insurmountable, and far too abstract to do anything about. To avoid paralysis, we need to:
3. Get more specific until we find a concrete problem
Here’s an example. For privately-funded families, we deliver evidence-informed writing interventions for students with neurodevelopmental disorders, including autism, developmental speech sound disorders, developmental language disorder, specific learning disorders in reading and writing (better known as dyslexia and dysgraphia), and ADHD.
Writing instruction is considered a “mainstream educational service”, and thus outside the NDIS (including under the proposed transitional rules). But, for students with disabilities, an inability to write is also a health and disability issue that interacts with their primary speech, oral language and social communication difficulties to reduce participation.
Literacy improves work, health, and life outcomes. And writing is an essential part of literacy. Learning to write gives children a big boost at school, and later at work and in life. Writing helps children to remember things; to connect their day-to-day thoughts to their goals and plans; to communicate what’s going on to their friends, family, teachers and employers; to share and develop their ideas with others; and to think and advocate for themselves independently.
So, writing interventions create many challenges for our families and team. They are:
- in high demand by many families, including families of children with disability;
- unfunded by the NDIS, meaning many children across the country simply can’t access any help;
- time-consuming: most of our clients have lots of other challenges, too, including with their speech, oral language, and social communication skills;
- expensive to deliver: many clients with disability need lots of direct teaching, modelling, repetition, scaffolding and spaced practice to master foundational writing skills; and
- not carried out in the child’s “real-world”, e.g. at home or school.
To complicate matters, post-COVID, we started to be approached by lots of parents who were keen to help their reluctant writers overcome their writing challenges, including children in mainstream education settings; and children who were not in a mainstream school system (including home-schooled students). We wanted to help. But this spike in demand created havoc with our waiting lists.
But, despite all these challenges, we know that early writing interventions can make a big difference for short-term academic and social participation and longer-term work, health and life outcomes.
4. Be brave. Try and test new ideas
All these events and observations gave us the idea and motivation to launch Rally Writers.
It’s an online project to increase access to writing help for children. It’s for school-aged children – with and without disability – who need extra support with their writing for any reason. It’s self-paced, and can be worked through in natural settings like home or at school, one-to-one or in small groups, with or without an adult in the room.
Rally Writers is a labour of love that I work on during weekends and evenings. It’s designed to be affordable, not dependent on NDIS-funding, and suitable for children and teenagers.
To date, we’ve released three modules (or “Cups”): for simple, compound and complex sentence writing. (We see far too many children and teens who can’t write complete sentences.)
I’ve written five additional modules: for writing paragraphs, information reports, narratives, persuasive writing foundations, and advanced persuasive texts, which will be released progressively over the next year or so (when I find time to record them!).
For existing clients with disability, we can now spend our time in sessions on speech, oral language and social communication goals, and provide free access to our Rally Writers resources so they can work on writing at home.
If you are interested in the project, you can check it out here:
5. Stay open to feedback (including from other colleagues and other providers!)
Rally Writers is an example of a small, controlled experiment, adapting existing technologies to increase access and decrease costs in pursuit of our mission.
As part of the project, we’re actively seeking client and other feedback to make it better as we go. We expect it will undergo several iterations as we incorporate suggestions and get better at using technology.
If you have thoughts about Rally Writers, or this little case study, please get in touch!
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