JCPSLP Vol 19 No 1 March 2017

Communication and connection: Valuing Aboriginal and Torres Strait Islander perspectives

Development of student clinics in Indigenous contexts What works? Anne E. Hill, Alison Nelson, Jodie Copley, Teresa Quinlan, and Rebekah White

Previous research has indicated that interprofessional student clinics provide culturally responsive access to health care for Indigenous Australians. The aim of this study was to determine the factors and approaches which support student learning in Indigenous contexts and facilitate positive outcomes for clients. Students (n = 36) and their clinical educators (n = 4) in two clinical contexts were participants. All students completed a survey about their placement experience and all clinical educators and students in one context participated in semi-structured interviews. Survey data revealed that 94% of students in context 1 and 78.5% of students in context 2 felt they were more skilled in working with Indigenous people following their placement. Interview data was analysed qualitatively and four main themes emerged: 1) structures and processes supporting placements; 2) the importance of relationships; 3) client-centred practice; and 4) interprofessional leadership. These factors should be considered in development of student clinics in Indigenous contexts in order to maximise outcomes for clients and students. A chieving health and well-being equity for Indigenous Australians requires culturally responsive and accessible health care, and necessitates a workforce well equipped to partner with local services to improve health outcomes (Anderson, Ewen, & Knoche, 2009; Australian Department of Health and Ageing, 2013). Addressing this gap requires concerted action across multiple layers of health service provision, including government services, community controlled organisations, and universities (Thomson, 2005). Universities have a responsibility to ensure that their graduates acquire the necessary skills, knowledge and attitudes that will enable them to deliver culturally responsive care (Howells, Barton, & Westerveld, 2016). This includes providing experiences that support students to develop knowledge and practical skills to meet the needs of Indigenous Australians (Australian Department of Health

and Ageing, 2013; Indigenous Allied Health Australia [IAHA], 2015; Universities Australia, 2011). Clinical placements are an obvious vehicle for learning these skills and are an integral part of the undergraduate degree programs of most allied health professions (Howells et al., 2016). Interprofessional student clinics can improve client outcomes, foster teamwork, and improve understanding of health professional roles (Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013). Important features of interprofessional clinical experiences may include face-to-face meetings for therapy planning, joint goal-setting, and structured reflection on the interprofessional process (Copley et al., 2007). Interprofessional clinics have been identified as a culturally responsive way of providing services for Aboriginal and Torres Strait Islander peoples as service delivery is holistic and integrated, there is less burden on families to attend multiple appointments, and knowledge can be readily shared, resulting in a more contextualised approach to the family’s needs (Nelson, McLaren, Lewis, & Iwama, in press). Initial learnings from student interprofessional clinics in Indigenous contexts have included the importance of long-term partnerships and removing structural barriers to services, such as locating children’s therapy services in a school, which enables the development of effective partnerships with teachers and support staff (Davidson, Hill, & Nelson, 2013; Nelson, 2014). In order to further develop these clinical placement opportunities, there is a need to clearly identify the factors and approaches which support sustainable and culturally responsive service delivery for Indigenous Australians. Therefore, this study sought to answer the following question: What factors and approaches support student learning in Indigenous contexts and facilitate positive outcomes for clients? Method This study involved a mixed methods approach and took place in two contexts in which interprofessional student placement models were in place. In both contexts, students worked together in occupational therapy (OT) and speech- language pathology (SLP) teams of two or more students and were supervised by an interprofessional team of one OT and one SLP. Clinical contexts Context 1: Aboriginal and Torres Strait Islander Independent School (Murri School) The therapy service began in 1997 in response to a need identified by the principal and school board. The school is a

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS CULTURAL RESPONSIVE­ NESS INDIGENOUS INTER­ PROFESSIONAL STUDENT CLINICS

Anne E. Hill (top) and Alison Nelson

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JCPSLP Volume 19, Number 1 2017

Journal of Clinical Practice in Speech-Language Pathology