Speech Pathology Australia - Allied Health Assistant Feature

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From TalkHQ in Northern Queensland is Alex Hartley, speech pathologist and team leader, and Elise Teitzel AHA.

Working with allied health assistants (AHAs)

The use of allied health assistants (AHAs) to complement speech pathology practice is on the rise. In response, National Office staff have put together the following information to help you navigate an optimal working relationship with allied health assistants (AHAs), and we hear from members who share their experiences of developing and maintaining an AHA program at their workplace.

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EXAMPLES OF AHA TASKS

T he following information was developed to provide examples of tasks that an allied health assistant (AHA) can perform under the direction of a speech pathologist. The work of an allied health assistant is not limited to this set of examples. These activities can be undertaken following delegation by a qualified speech pathologist and with ongoing supervision. Speech pathologists delegating tasks to allied health assistants should be familiar with the key principles outlined in Speech Pathology Australia’s document Parameters of Practice (SPA, 2016 ). These examples are based on the table of competencies presented in Appendix B (p24-29) from this document and identifies activities which may be delegated to an allied health assistant (AHA), and the level of support required. Assessment Conduct specific screening tasks and record data (e.g., checklist) without interpreting the results Records observations of a client’s interactions with peers using a checklist. Monitor mealtimes (e.g. lunch) in home setting, using a mealtime observation checklist. Act as an ‘unfamiliar listener’ when assisting with intelligibility assessments. Record a language sample as directed by the speech pathologist.

Intervention Support development of specific skills

Work through a literacy program with a young person to support development of phonemic skills and reading. Support a young child with childhood apraxia of speech, whose parent/s have limited capacity to implement the programme at home, by doing ‘drills’ of speech sound production, practising production of sounds in core words and working through auditory bombardment activities. Support pre teaching of activities. For example, reads a chapter of a text/novel with the child that class teacher plans to work on as a whole class activity. Identifies new or unfamiliar vocabulary and discusses meaning of these words with child and uses them across range of activities, for example, explaining difference and similarities between two words; formulates sentences with words to demonstrate understanding of meaning of the word; defining words using key features. Practise semantic language tasks with an older person with aphasia as part of their individual therapy program designed by the speech pathologist. Provides additional sessions to increase the frequency of the intervention, to target specific speech and/or language structures using frameworks identified by the speech pathologist. Support a young person to improve their persistent difficulties with sequencing of activities following a traumatic brain injury from a recent car accident. Take photos of items in the home and daily activities which have been identified as priorities by that person. Create a low-tech communication aid using these photos according to the designated design of the speech pathologist. The AHA (and others) practises use of the aid, including help to prompt sequencing of daily tasks. Practise prescribed dysphagia exercises, e.g. chin tuck against resistance and prompted effortful swallow with a 46yr-old person who has had a stroke and has recently been discharged home. Assist a speech pathologist in preparing food/drinks/ equipment required for feeding therapy sessions as directed by the speech pathologist. Assists with transitioning the client, clearing up and setting up for the next session.

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Functional support in settings outside the clinic Provide regular and frequent coaching or modelling and/ or supports the use of strategies in a client’s everyday environment based on a session provided in the clinic by the speech pathologist. Spend time at the home of an 8-year-old child who has Autism to support them to interact with siblings, with a focus on communication development as directed by the speech pathologist, for example, developing the use of 3-4 word utterances and commenting. Attend the school setting to facilitate use of Key Word Signing for a 10-year-old child, including a focus on supporting their peers to interact more successfully with the child, and increasing the capacity of the class teacher to use Key Word Signing. Work with an older person with Down Syndrome to practice using apps for communication, with the goal of supporting more successful community access, and developing confidence with unfamiliar communication partners. Develop visual resources in consultation with the speech pathologist to act as a reminder for how and when apps could be used. Support communication interactions between clients who have had a stroke in a community aphasia group. Support client’s communication partners, such as friends, family, carers etc by modelling strategies to increase opportunities for communication in settings outside of the clinic. Support with technology and use of Augmentative and Alternative Communication Assistive Technology (AAC AT) Work with a family and a young person to identify individualised vocabulary needs within a particular context or setting, and then to find pictures or programe them on the young person’s electronic aided augmentative or alternative communication device. Support a young person with literacy difficulties to learn how to text message on their phone. Demonstrate the use of an about me book to care staff so they can understand preferences for personal care routines of an older person with dementia. Support a young person who is recovering from a traumatic brain injury by providing frequent and regular sessions to practice use of yes/no switches, including as part of partner assisted scanning of non-electronic aided AAC. Visit a client’s home to demonstrate the use of visuals for self-care skills as part of the morning routine for getting ready for school. Observe a child who is deaf or hard of hearing in their school environment, to identify communication opportunities and any barriers, for example, issues

related to missed interaction opportunities when the child did not hear their peer try to engage. Assist the speech pathologist to run a social skills group for people with a disability living in the community; model appropriate social communication skills; support any group members to use non electronic aided AAC (designed by the speech pathologist); provide extra opportunities for group members to practise skills. Support staff with the set up and modelling of an assistive listening device with older person in residential aged care. Planning, maintaining and delivering speech pathology services Assist with filing/uploading case notes and other client documentation in clinical records at the end of each session. Arrange home visit appointment days and times with client. Identify, collect and collate images for use in low tech communication boards, talking mats, communication books, etc. Create communication boards with personalised vocabulary for a client and using photographs from their specific environments. Program AAC AT devices. Create resources for a client as agreed with the speech pathologist. Support with setting up and delivering small intervention

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groups as agreed with the speech pathologist. Supports with food shopping for feeding therapy sessions as directed by the speech pathologist. Undertake audits (e.g. compliance with documentation policies, IDDSI Levels, COVID Safe Plan) Clean equipment and treatment areas between client appointments. Monitor supplies of stationery, assessment forms, and re-order as required.

Assist with administrative activities such as photocopying, shredding, laminating. Assist the speech pathologist with education sessions or promotion of the profession (e.g. stalls in the community, such as, Speech Pathology Week, training of hospital kitchen staff re making thickened fluids) Undertake pre contact screenings/checks (e.g. COVID screening checklist, home visit risk assessments) Support speech pathology delivery of telepractice consults by providing on-site support for technology set up and client positioning, as instructed by the speech pathologist. Support the speech pathologist during clinical sessions. For example, the speech pathologist completes a language assessment checklist with a parent/carer while the AHA performs early language stimulation with the child under the speech pathologist’s supervision.

Draft handouts, letter templates, as directed by the speech pathologist (who signs off on the final version).

Collect data for quality assurance projects.

Collect survey from clients as instructed by the speech pathologist for service review purposes.

Develop systems to assist with running the speech pathology practice/department as directed by the speech pathologist (e.g., spreadsheets, databases etc).

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Ethical issues WORKING TOGETHER

C hanges to funding models and increased in providing support to the work of a speech pathologist and for clients with communication and/or swallowing difficulties. Ethical issues when working as and with an AHA may arise when: An AHA is asked to work outside of their scope of practice An AHA is asked to carry out a task which is outside of their scope of practice for example to perform an assessment, make a clinical decision about a client’s goals or work independently with a client without regular contact from the supervising speech pathologist. An AHA does not have regular, timely and sufficient support from a speech and language pathologist A client’s quality and/or safety of care may be compromised if an AHA does not have access to regular, timely and sufficient contact with a speech and language pathologist to discuss and review the client’s intervention plan and progress towards goals. This may lead to an AHA having to make decisions without support, working outside of their scope of practice, or decisions regarding interventions provided being delayed, any of which can compromise the quality of service and care for clients. An AHA is asked to seek advice regarding a client’s care from multiple speech and language pathologists It is best-practice for the same speech pathologist to oversee and manage a client’s care. Ethical issues could arise if AHA’s are working independently demand and access to services have resulted in an increase in allied health assistant (AHA) positions and recruitment. AHA’s play a vital role

and seeking clinical advice and supervision from multiple speech pathologists who may have differing approaches, knowledge of the client and styles of working. The overall clinical management and responsibility lies with the speech pathologist and not with the AHA. A speech pathologist does not have a working relationship with a designated AHA It is best-practice for a speech pathologist to work with an AHA they have met and have a working relationship with. Each AHA will have a different set of knowledge and skills they bring to the role, will need differing amounts of support and be able to undertake different tasks. It is important that a speech pathologist is able to meet with the AHA on a regular basis so that they can make informed decisions on what tasks are appropriate for the AHA to carry out and they are aware of what support needs to be provided to the AHA within this role. A speech pathologist is requested to take on the supervision of a full time working AHA however a limited amount of time is allocated to provide this support It is best-practice for a speech pathologist to have regular meetings with an AHA to discuss client’s progress, care and clinical decision making. The amount of time required to provide appropriate supervision is dependent on a number of factors, such as; how many clients the AHA is able to work with, the complexity of the programs and the individual needs of the clients and AHA. It is important to remember that additional responsibilities sit alongside these discussions and it is important to have time for these in the working week. This may include; writing or countersigning clinical records for sessions provided by the AHA, having time to re-assess and/

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or review as the qualified professional, liaising with families/other professionals, providing support to the AHA to complete their tasks and being available to answer potential urgent questions from the AHA on an ongoing basis. When agreeing to work with an AHA it is important the speech pathologist discusses with their employer how much time they require to complete all of the tasks required in order to responsibly carry out their duties to the clients on their caseload. Case study 1 A speech pathologist and AHA work within a school and together provide assessment and therapy to a large caseload of young children. When directed by the speech pathologist, the AHA is confident to carry out set intervention plans provided by the speech pathologist within small therapy groups and individual therapy sessions. The speech pathologist receives a new job offer and submits their resignation from the post at the school. There are difficulties recruiting into the post within the notice period and there are a number of school children that will require end of year NDIS reports in a few months’ time. The speech pathologist is asked to provide intervention plans for the AHA to continue after their contract terminates until another speech pathologist is able to be recruited. They are also asked to provide future NDIS reports for children they know well, in case it takes longer than a couple of months to recruit a new speech pathologist. Discussion Ethical issues could arise if an AHA is working independently without a speech pathologist overseeing the intervention plan they are carrying out. During this time, client’s presentations may change, clinical questions could arise and clinical decisions may need to be made. It would be unethical for an AHA to be working without regular and sufficient access to a speech pathologist who is overseeing the client’s care. This could result in an AHA working outside of their scope of practice and reduced safety and quality of care for the client. Ethical issues can also arise if a speech pathologist is asked to prepare reports for in the future. During the time frame before the report due date there could be changes to the client’s presentation and it is unknown what progress they will make during this time. Speech pathologists are only able to provide reports based on known information that is current at the time of writing. Case study 2 A final year speech pathology student carries out voluntary work with a disability organisation and has regular contact with a client who accesses speech pathology services. The client’s family approach the student and offer them paid work as an AHA in order to help the client achieve their NDIS goals and work on their communication goals outside of sessions. The family believe the student would be well placed to provide the work as they already have a relationship with the client and are nearing the end of their

studies. The speech pathology student has shadowed some therapy sessions with the speech pathologist and feels confident enough to support the client with reaching their goals outside of sessions. Discussion Although the student has developed their knowledge and skills in the provision of speech pathology interventions as they progress through the course, the student is not yet a qualified speech and language pathologist and should not be undertaking tasks that are the responsibility of a qualified professional. By having a discussion with the speech and language pathologist working with the client, the student’s understanding of these ethical and professional obligations is developed. The student is then able to discuss with the family how they could work within a delegated framework, to still provide the input they are seeking in an appropriate way. Case study 3 A speech pathology student is employed by an organisation as an AHA. The role provides excellent opportunities for the student to develop their clinical the organisation to provide support to clients from a pre- prepared intervention plan written by an unknown speech pathologist. Regular supervision with a team of multiple speech pathologists is discussed and agreed between the student and the organisation however there are problems with the logistics and organisation of this. Discussion Ethical issues could arise if an AHA does not have a working relationship with the speech pathologist who has set and provided the intervention plan for a client. The knowledge and skill set of the AHA will be unknown by the speech pathologist providing the intervention program and there will be no opportunity for discussion and support for the AHA. Furthermore, ethical issues could arise if the AHA is requested to seek support from multiple speech pathologists regarding a client’s care or does not have access to regular, timely and sufficient time with the managing speech pathologist regarding clinical decision making and management. skills whilst in training and paid employment to fund their studies. The student is requested by

Trish Johnson Manager Ethics and Professional Issues

Kelly Williams Ethics Advisor Nadia Marussinszky Ethics Advisor

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EARLY CAREER SUPERVISORS OF AHAs

E arly career speech pathologists are sometimes asked to supervise allied health assistants (AHAs). As new professionals, this might be a daunting undertaking. SPA’s Position Statement: Working with Support Workers confirms that selecting appropriate tasks to be delegated and structuring the appropriate learning for support workers is a complex activity. It also states that this should be undertaken by those with experience and knowledge in supervision and delegation. However, this document affirms that new graduate speech pathologists have the skills and knowledge to supervise support staff as outlined by the Professional Standards . How can early career members who feel unsure about their skills in supervision and delegation appropriately supervise AHAs? Supervision in supervision The Association recommends that early career members include discussions regarding supervision of AHAs in their own supervision sessions. A supervisor can guide early career members in identifying which tasks are appropriate to be delegated, understanding how to support AHAs in the delivery of services, setting clear goals and expectations for AHA sessions, managing issues that may arise, monitoring client progress, and maintaining appropriate records. A supervisor may also be instrumental in helping the early career member to identify individual learning needs and appropriate resources to upskill where needed. Resources Although there are few courses or formal trainings to help early career members prepare to supervise AHAs, various resources may support the development of skills required for effective supervision. Speech Pathology Australia has created various documents to support members in working with AHAs. In addition, the Association’s Parameters of Practice document, appendix B, provides a detailed list of speech pathology tasks that may and may not be delegated to AHAs.

Various states have AHA frameworks, some of which include supervision guidelines and even online learning modules and instructive videos. These can be found through the NSW Ministry of Health, Queensland Health , and Health Victoria . Some of the skills that benefit clinical supervisors may also support the supervision of AHAs. These are listed in frameworks such as SPA’s Supervision Standards , and the Health Workforce Australia National Clinical Supervision Competency Resource . Using these frameworks to identify their own learning needs, early career members might then engage in relevant clinical supervision professional development . Although early career members sometimes find supervising AHAs a challenging new experience, accessing their own supervision and other resources can help them be successful. Nathan Cornish-Raley Professional Support Advisor

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STUDENTS WHO WORK AS AHAs

S tudents who are undertaking a course in speech pathology are sometimes employed as allied health assistants (AHAs). The Association supports the employment of speech pathology students as AHAs under the supervision and guidance of a speech pathologist, and acknowledges that the knowledge and experience that they bring may be helpful to that role. However, that knowledge and experience also require students and employers to make important considerations and to have a clear understanding of the student’s role. Context and role While working as an AHA, speech pathology students have the same responsibilities and scope of practice as other AHAs. Some tasks that may be appropriate for the student to complete in the course of clinical education would not be appropriate for them to undertake in their role as an AHA. These include administering or interpreting assessments, developing client goals or a therapy plan, engaging in clinical problem-solving, or altering the treatment plan created by the supervising speech pathologist. Speech Pathology Australia’s Parameters of Practice document, appendix B, offers a list of tasks that may and may not be appropriately delegated to AHAs, including speech pathology students working in that role.

Supervision Allied health assistants, including those who are speech pathology students, must follow a therapy program set by a qualified speech pathologist and receive regular supervision. This is the case across different employment arrangements, including where the AHA is contracted through a third party or directly by a client’s family. Supervision of AHAs serves a different purpose than clinical education. Students on placement will be familiar with guidance that fosters increasingly independent decision-making and critical self-reflection. The supervision required for the delivery of AHA services may have more directive elements as speech pathologists are responsible for determining the client’s needs, whether tasks can be delegated to an AHA, the AHA’s skill in delivering the service, what training and protocols the AHA requires, and the type and frequency of supervision. The Association’s document, Working with an allied health assistant to support clients, may help student AHAs and supervisors understand how supervision is undertaken in this context. In addition, the Working with allied health assistants webpage has helpful templates for supervising AHAs and Student AHAs and their employers should be aware that once an individual has received their qualification in speech pathology, they should no longer work as an allied health assistant. In this situation, employers would need to consider whether they will continue employment under a new contract as a qualified speech pathologist. SPA has created a document on speech pathology students working as AHAs , which provides detailed considerations for students working as AHAs. This includes information on scope of practice, finding work as an AHA, professional indemnity insurance, and a comparison of the work performed on a student placement and as an AHA. training/coaching for delegated tasks. Considerations and resources

Nathan Cornish-Raley Professional Support Advisor

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A s AHAs should only facilitate the delivery of speech pathology services when supervised by a speech pathologist then generally speaking your indemnity insurance will cover the work carried out by an AHA. It would be prudent to let your insurer know you are responsible for supervising an AHA. However, it is important to understand that under your insurance policy employees and contractors are treated slightly differently with respect to services performed for or on behalf of the business owner. If you own a business, you should be aware that employers have a direct liability for employees. If you engage an AHA as an employee, then you are responsible for the errors and omissions of that AHA even if their work is being supervised by another speech pathologist in your practice. You would need to confirm this with your insurer. Please note that Guild have advised the Association that a Guild PI insurance policy provides the business owner with coverage for that under the policy definitions. Employers, generally, do not have a direct liability for all independent contractors including AHAs. However, they can still be held vicariously liable for the actions of AHAs who are working in the business as contractors. *Guild Insurance have indicated their PI policy provides cover for this scenario under the policy’s Additional Benefits section. If you have PI insurance with another company, AHAs and professional indemnity insurance

you will need to confirm if a similar arrangement exists. AHAs working as contractors should also have their own PI policy as they may be sued in their own name and may incur legal costs in defending those claims. They may also need to fund any damages awarded against them. If an AHA signs an employment contract with a 3rd party company, then regardless of insurance or not, that company is vicariously liable for the actions of their employees and should have insurance in place to cover them for that liability exposure under a PI policy. However, like private practice owners, they are not directly liable for the actions of independent contractors in the same way that they are for their employees. If the AHA is engaged by a third party company on a contractor basis, then the AHA should maintain insurance in their own name as they are a separate entity to the company. If you are responsible for supervising and delegating to an AHA, it would be prudent for yourself and/or the business owner to have a conversation with an AHA about their insurance cover. Please see SPA's FAQ about Professional Indemnity Insurance and contact your insurer for for further information. Nichola Harris Manager Professional Practice

Employment considerations for engaging an AHA A llied health assistants (AHA) can provide assistance with the delivery and administration of speech pathology services. There are many potential benefits to engaging an AHA in your work under the direct supervision of a qualified speech pathologist. This supervision requirement generally does not meet the definition of an independent contractor. For more information on the difference between an

practice, including increasing your capacity to provide therapeutic services with the assistance and support of the AHA. Before engaging an AHA in your practice, you must ensure that you are meeting your employment obligations and taking the following factors into consideration: Working arrangement The nature of the employment relationship is a very important consideration. There are two main reasons why it is strongly advisable that AHAs are taken on as employees, not as independent contractors. AHAs who support speech pathology interventions must

independent contractor and an employee, refer to SPA's document Employees vs Contractors and Contractor or employee? AHA’s should be engaged as employees, so that they are covered by the employer’s insurance and can receive the appropriate entitlements per the Health Professionals and Support Services Award 2010 and the National Employment Standards . A casual employment arrangement is usually the most practical option for AHAs who are studying to become speech pathologists. Employment contracts and HR documentation Practice owners must ensure that their employment

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• clear guidance on when further advice or direction should be sought from a qualified allied health professional. Speech Pathology Australia has a range of documents for members to support this relationship, including a supervision template. Refer to Working with allied health assistants. Regular performance reviews are an important part of any supervisor/staff relationship. They include discussions around achievements areas for improvement and future objectives. From the beginning of your AHA’s employment, the supervising speech pathologist should set up regular meeting times to review, evaluate and log the AHA’s performance goals and progress. These are opportunities to give and receive feedback, and discuss any concerns. The information provided in the article is a brief summary of the employment obligations that practice owners need to be aware of when preparing to engage an AHA. If you have any questions or require more detailed or tailored information, it is advisable to seek professional workplace relations advice. All members receive special member benefits through WorkPlacePLUS for support with HR and IR issues. For more information, contact Anna on (03) 9492 0958 or visit www.WorkPlacePLUS.com.au. Anna Pannuzzo Director WorkPlacePLUS

contracts and position descriptions are up-to-date and clearly state all the necessary conditions of employment for an AHA. For example, they may need a Working with Children Check, an NDIS Worker Screening Check and/or a police check. The employment contract must clearly outline the employment relationship and obligations, and these should be reviewed annually. It is important to ensure that the AHA reads the contract, knows how they will be paid, and is given ample opportunity to ask questions about any employment matters they may not understand. Make sure the contract is signed! The position description should clearly outline the scope of the duties of an AHA in your practice, which may include details of the activities that have been identified as suitable to be delegated by a speech pathologist in your practice. You also need to ensure that your practice has workplace policies and procedures that cover all employees and contractors. These protocols include areas such as workplace conduct, infection control, privacy and confidentiality, performance management, complaints and grievances and others. Supervision and training AHAs must be provided with regular, formal supervision by a speech pathologist. It is the supervising speech pathologist’s role to determine what supports an AHA may be able to offer and what level of training and supervision they will need, to ensure they are offering assistance in a safe environment and achieving the desired outcomes. The speech pathologist must develop clear protocols and provide adequate training to guide the AHA. The supervising speech pathologist should provide: • clear instructions on the outcomes to be achieved • clear processes to be followed in undertaking the task • guidance on how to manage any perceived risks • alternative strategies to be utilised if modification is required

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Explore the SPA website for resources on finding an AHA or becoming an AHA.

In a recent episode of the Speak Up podcast, SPA’s Anneke Flinn spoke to Pitjantjatjara and Yankunytjatjara woman Lorraine Randall. Lorraine chatted about her journey to becoming an allied health assistant and her work in the speech pathology department at AHA podcast Lorraine Randall

the Royal Darwin Hospital. Listen to the podcast via the Association's Learning Hub.

WATCH - Ethics Collaborative discussion The ethical implications of a delegated care model

Click below to view the discussion about the various elements for consideration when hiring and working with AHAs.

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Member perspectives Working with AHAs

Members from a range of practice areas and states share their insights, experiences and tips on working with AHAs to ensure a mutally rewarding relationship.

J enna Mottin is Co-Founder and Director of TalkHQ Speech Pathology, a private practice with four physical clinic locations and various outreach circuits across North Queensland. TalkHQ was established in 2014 by Jenna and Julie Sexton, speech pathologists who grew up rurally and wanted to help children succeed without distance as a barrier. It is a solely paediatric practice and due to the rural locations, the speech pathologists are generalists. Jenna discusses some of the procedures and insights that has made working with an AHA a valuable experience for the TalkHQ team. Why did you choose to work with AHAs? We choose to work with AHA's due to an increase in our waiting list in our rural clinics. But also, the challenges we faced recruiting speech pathologists to our rural facilities. We also work with AHA’s to increase dosage requirements for some therapy approaches to achieve best evidence- based practice. How many AHAs do you work with and how were they recruited to your workplace/PP? We currently work with two allied health assistants, both of whom had a relationship with TalkHQ. Could you provide some examples of activities/ tasks you support and supervise AHAs to carry out/ complete? • Delivering structured activities to increase dosage for children with speech sound difficulties. Jenna Mottin Co-Founder TalkHQ Speech Pathology, QLD

From TalkHQ in Northern Queensland is Alex Hartley, speech pathologist and team leader, and Elise Teitzel AHA.

What CPD/supports would you recommend investigating for yourself before working with AHAs? (training in delegation etc.) • Reading all of SPA's documents on working with AHA's and support workers. • Collaborating with speech pathology colleagues around their processes. What do you and your AHA do (and avoid) in order to work well together? Scheduled meetings to touch-base around the therapy program for the clients are useful, as are scheduled meetings to touch-base around the business standard operating procedures that are not clinical in nature. What procedures do you have in place to support the work you do with an AHA? We have structured delegation templates in our practice management software where communications can be logged.

• Delivering structured language group therapy. • Creating resources (i.e., visual supports etc) for families.

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Can you talk about the schemes under which your AHAs work and how do you make engaging AHAs work financially? - NDIS and fee paying clients Knowing your business numbers inside out is very important in maintaining this service. Making sure you understand your breakeven figures and the minimum number of clients the AHA must support on their shift. What tips do you have for those speech pathologists thinking about working with an AHA? Allocate appropriate amounts of time to training Allied Health Assistants and dedicate time for structured and frequent check ins Consider rolling the model out as a trial with one clinician or one clinic location first and develop the majority of your policies and procedures prior to onboarding and don’t underestimate the time commitment in having an AHA.

We also have TalkHQ internal training modules, structured meetings and our AHA's undergo training in our 0-100 program for a supported start to working at TalkHQ. What additional benefits do you see for your practice in having an AHA? • Supporting in backfilling when we are faced with recruitment challenges rurally (i.e., block on block off for appropriate clients alternating between SP and AHA). • Allowing AHAs to have an idea of what it is like working in a private practice. • Clients who are requiring increased dosage and frequency of therapy can receive it. • Managing waiting lists.

Sam Gilmour Senior Speech Pathologist Chinchilla Hospital, Darling Downs NSW S am Gilmour is a rural generalist speech pathologist, at Chinchilla Hospital. Sam’s work includes outreach to the Western Downs region of NSW working as a clinician but also as a supervisor of clinicians and students. She is also the supervisor for the multidisciplinary AHA who works with Speech, OT, physio and dietetics teams at the hospital.

For Sam the key to having a successful working relationship with an AHA is about preparation and planning and clear delineation and understanding of the role. “Our AHA Mat, started with us just over two years ago. It was a brand-new position, so there was a bit of work in setting it up as a new position. “For our team it was a big draw card to have a multidisciplinary AHA. There already were examples of AHAs being used in the western cluster, which was working well, and we thought it would work well with our services. “Our AHA works full time and he’s based at Chinchilla Hospital. But like me, he goes and does outreach to the other smaller hospitals as well. “I would definitely recommend taking your time when planning a role for an AHA. You need to make sure you have all your processes and procedures set up before they arrive. “You need to set up all of the assessment and clinical tasks and non-clinical tasks that you want them to do, and what documentation and procedures need to be created and reviewed by everyone in your team and finalised before the AHA commences.

Sam’s team utilised information from Queensland Health to write procedures on how to introduce new clinical tasks and how to write up clinical task instructions for the AHA. “You want the AHA to feel like a valued member of the team. And for the AHA to be clear about their role. It does take time for an AHA to really settle into the role." How do you utilise your AHA in your everyday work? “Our AHA is able to help out clinically. We are quite busy and have a lot of different sites. In our case, though, we wouldn’t necessarily be able to give as much support so he’s able to take extra sessions, we wouldn’t be able to give as much time to the clients so that’s very helpful. “He is also really helpful in terms of general support. For example, the other day was hectic and busy clinical day. He was able to run around and grab printing in charts and helped me do what I needed to do. He does other tasks Senior Speech Pathologist Sam Gilmour working with AHA Mathew Skow at Chinchilla Hospital.

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"...having an AHA is about releasing the

such as setting up the food and fluids that I may need for a trial for someone on the ward for example. “It’s also been good having someone on the team who’s come from a different work background and life experience. AHAs are not always necessarily university trained like us (speech pathologists). Sometimes we get used to being around health professionals and having the AHA reminds us that not everyone has that same experience. It has helped us to step out of ‘our little world’. “Our AHA works on some of the repetition or practice sessions. For example, I may see a client for a couple of sessions and get the program set up and then our AHA will do the next few. “He has also been a great support on the end of telehealth sessions. I have an outreach site which is 2 1/2 hours away. It’s an overnight trip and being in a small town there isn’t a large case load to warrant me going there very often. “But that doesn’t mean that the people there don’t necessarily need the frequent care. Our solution was for our AHA and I to do the trip on alternating fortnights. The AHA on his trip might sit on the end of telehealth with the client to support my session. Or he might run a practice session and then the following fortnite I’d meet with the client in person. “He also does a lot of things like meal audits of the different modified textures that we have in speech pathology, such as working with the hospital’s food service and the kitchen around assessing that they’re up to standard and helping us to give education and training. “He will also do meal-time reviews. We may have a client in aged care or on the ward that we’ve prescribed a modified diet, and the AHA will follow up - sit with the client, have lunch with them and double check that everything is going ok. “There’s also some admin work such as screening phone calls. He might also develop a screening case history where he will call the client and get the information for us before we go into the assessment, which is very helpful." Tell us about the procedures you put in place to work with your AHA “We did develop comprehensive procedures around delegation and scope of practice and how to introduce

new clinical tasks. It’s an overarching procedure and we do task competency analysis for the lower risk clinical tasks that don’t need a huge procedure to go with them. “We’ve also created workplace instructions that are just for non-clinical tasks that just need a little bit of instruction on how to do things. I’ve just recently also created what we call a workplace guide for a AHAs which is designed to be for any AHA that might join us in the western cluster." What are some things other clinicians need to consider before taking on an AHA? “You do need to be mindful if you have an AHA who hasn’t done a speech pathology course, you will need to teach those skills. Taking on an AHA does need a lot of education work from the speech pathology team. It takes a lot of work to begin with, but it’s worth it in the long run. You need to be willing to put in that extra to train and teach an AHA. “There needs to be contingencies put in place before they start and you need to assess that they’re competent in tasks before they do them independently. You need to have these in place and keep in mind the level of experience or education that the AHA brings to the role. Distinguish them in your mind that they are not speech pathology students or a new speech pathology graduate. Since employing the AHA Sam says that the team has greater flexibility and opportunities to provide different services, particularly in a rural setting when there are large distances between clients. “There is a quote that I think about all the time that I heard in a meeting or training, that having an AHA ‘is about releasing the capacity of the clinician to work to the extent of their scope.” capacity of the clinician to work to the extent of their scope.”

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Megan Ingram Director of Peninsula Speech Plus

Megan Ingram is Director of Peninsula Speech Plus in Victoria, a private practice with clients right across the lifespan. The practice includes 20 speech pathologist, 10 occupational therapists, a teacher of the deaf and four AHA’s. The NDIS rollout has led

“AHAs are not for everyone. We’ve had a couple of false starts. As I said, it’s taken us a little bit of time to try things out and modify. “The practice offers three packages for AHAs and the packages are structured around frequency. We have a high frequency option which is twice a week, and we have a once-a-week option and a fortnightly option as well. “Initial meetings with the AHA, the family and the clinician are organised. There is a midpoint touch point and a final session. We’ve structured it to be term-based because that’s how most of our interventions work. “Once a family has been working with the clinician for a few sessions, and we know them well, we may work through whether an AHA might be an option. “We organise an initial meeting to set goals and write the plan. We do that collaboratively and then the AHA would carry out those sessions. The AHA has access to our practice management system so that the notes are there, and they can see everything. The clinician and AHA can track progress if there is ongoing intervention with the therapist as well. “Everybody involved, including the AHA is involved right from the beginning, right up to the point where the plan is sorted and worked out, and then the AHA is given a little bit of autonomy to execute the plan." How do you go about recruiting and managing AHAs? “We employ our AHAs in house and they are involved in all of our professional development. They participate in all our weekly meetings. They are part of the team. “Something we have definitely found is that what makes the program work well is having good templates and strong communication. “Education is definitely important as well. Education of AHAs can vary and be a little bit different depending on where the AHA is coming from. When we initially rolled the program out, we had third and fourth year allied health students. They stepped into the role easily, with prior knowledge they were able to get started with our families. But they graduate and move on, and we need to start again. What we do now is we have mixture of certificate three and four and under-graduate students as well. “Apart from the education in their coursework they also need to be educated around how we do things, so we have specific training around that. “Our AHAs work with individual clients, and also work within the clinic with us so they’re involved in our group program. This enables them to have ongoing education and support. “It is our intention to have an AHA lead in our practice. It’s not a position that is recruited for yet, but it is our intention.

to significant growth in the practice and the challenges of the pandemic meant that the practice has evolved to predominantly service NDIS participants. Megan shares her experiences with working with AHAs, highlighting communication and integrating AHAs as fully fledged team members as key to their program’s success. Tell us how you started working with AHAs and your overall experience “Our experience with AHAs began a few years ago where we started to host students during placements from Open college and our local TAFE. “Hosting students on placement was beneficial to the business as it was a way to test and review our policies and procedures, provide clients with extra sessions with the student AHA and develop new resources and projects. We have had a few false starts in establishing a consistent AHA presence within the team and it really has been through the NDIS and the available funding stream that got the program ‘up and running'. “What we really love about working with a AHAs is the move to a more social model of delivering services. We can focus closely on functional change. This is important. “AHAs have been a great complement to the therapy program because they can spend time with our clients out in the community. “That is how we have approached our AHA strategy. Assessing AHA sessions have meant that clients have been able to engage in more sessions, more meaningful practice. It’s also been great to provide families with different service delivery models. Some families attend intensive sessions (in holidays) with clinicians before working with an AHA during term time. We have other families who have reduced the frequency of clinician sessions and have increased AHA sessions. What we like is that we are providing options for families to tailor their support to suit their goals and situation." How do you incorporate AHAs into the client plan? “When people first come in, we break their family goals down into achievable steps and discuss how they want to achieve this goal. What they want it to look like and what’s going to suit them. It all begins with the client’s goal.

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The plan is that AHAs will have their own stream within our organisational structure." What kind of activities/tasks do your AHAs perform “The activities and tasks the AHAs perform are really quite different and will depend on the case. Sometimes it is purely practice, particularly with speech children, it’s really getting those high repetitions, and sometimes it’s more around generalisation- other times it is about communicating in a very functional environment. For example, for participants using AAC it’s actually about getting them out and about and using their device. “Sometimes for our older children it’s about taking them out and buying drinks and using their language. For example, we have some people whose goals are around using correct grammar. It’s hard working on those kind of things with a person at a table, so instead they might go to the park and talk about what they’re seeing." Can you give some advice or tips to anyone thinking about taking on an AHA? “I think for anyone looking at taking on AHAs, you need to think that they aren’t just an ‘optional extra’ they are a full team member. “In the past we employed AHAs as casuals, but as we’ve learned that wasn’t super profitable. It was a little bit hard to manage, so this time around we’ve employed them as permanent employees which is what I really love about it, it means that they’re part of the team. We have a combination of part-time and full-time AHAs. They come to all the meetings, they’re involved in our team development days, they’re just another member of our team. “I think we’re more comfortable with how it works now, I think because it has been a much more considered decision-making process. There is a lot more security and commitment to the roles. “We’ve recruited very strongly in this space, and we are rolling out lots of different programs this year with our AHAs. We’ve had 18 months of trial and error so there has been lots of learning. “It is a process to work out how it’s going to work best for your business, because ultimately that’s what it is about in the end. “Initially the team were a little reluctant because it did seem like (taking on AHAs) it was going to be more work for them, so you need to talk about and have discussions with your team about how they feel it would work. How they think it would work well for them and the practice. “You need to get your team on board. You need to allocate enough time for the planning and be realistic about the time that it does take to integrate an AHA. “You need to back that up with templates which make the process efficient. You’ve got to look at efficiency and your costings – for your participants, families, the community

that you’re working with, but also for your clinicians. “I also would highly recommend employing people directly. I think it’s just much easier from a private-practice point of view in regard to insurance, we don’t work with anybody externally. “Keep communication flowing and I would also say that you need to follow your recruitment process in the same way as you would recruit a therapist. Understand what your practice needs and then recruit for that. “Also understand the capacity that you have to supervise. The AHAs are going to be part of your team. They’re going to be representing your company, so you want the right people in the right roles, and you want them to stay and to also have a good experience." What have been the benefits of having AHAs in your practice? “I think for the clients it’s again around having access to different service deliveries so we can really deliver the service that really suits the client and is really meaningful and outcome based for the client. “For families that struggled to really make the goals work at home, it’s really provided them with a lot of support also. “It has broadened our team, brought in new ideas and different ways of thinking about things. It is also another big motivator for us and helped us to control the waitlist. “I guess the wait list is something that we are always trying to find ways where we can support people in timely ways. Clients working with an AHA and working with us, has meant that we can increase the supports that we can give and provide. “We’re also involving AHAs in some of our group programs that we run as well. So instead of having two clinicians in those programs, we sometimes have a clinician and AHA. So, we can run two group programs at the same time rather than just one, both really giving opportunities to expand the business."

Peninsula Speech Plus AHA Belinda, out and about with clients.

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