Engaging with people in rural, regional and remote locations

Heather Lambert, Clinical Lead – Positive Behaviour Support
(Marathon Health; Albury, New South Wales)

Communities in rural and remote areas are tight knit and people know each other. People know of this service and of that service. And when you're actually there on the ground with them taking a walk up the street saying ‘hi’ to different people and know what life is like there, that's so important because then you're speaking their language and you're talking about the community as it is.

Sarah Bingley, Core Positive Behaviour Support Practitioner
(Marathon Health; Albury, New South Wales)

People who live in rural and remote communities have a very different outlook and perspective of life than people who live in urban and cityscapes.

Doug Payne, Senior Clinical Consultant, Behaviour Support Practitioner
(SAL Consulting – Darwin, Northern Territory)

Up here in the Northern Territory, a township I go to is Maningrida, which is out in Arnhem Land. Been going there maybe 4, on 5 years.

Danielle Quinlan, Clinical Consultant, Speech Pathologist
(SAL Consulting; Darwin, Northern Territory)

I've got a lot of work out in Maningrida. We head out on a 4-week basis for a week, so it's quite a nice time out there.

It's obviously very different being in remote contexts. It's a different life, it's a different lifestyle.

The way that schools are working and aged cares are working are quite different to here [Darwin]. And the issues that we're seeing people are facing are a lot more complex.

Doug Payne

Maningrida has many people with disabilities out there. Whether it's the fellas I work with who have got a psychosocial disability, people with physical disabilities from car accidents.

Kids are born and have autism and chromosomal disorders. So it's, you know, the full gamut of potential disability.

Danielle Quinlan

We've also got gaps in health literacy as well, I think that's a big thing and a lot of our job when we're out there is providing health literacy to the families we're working with about our roles and what we can offer and what we can help with. And that's always the foundation before any sort of therapeutic practice is going to be commencing.

Heather Lambert

So for participants in regional and remote areas, access to the professional supports – those formal supports – is incredibly difficult.

Nandita Patel, Team Lead – Positive Behaviour Support
(Marathon Health; Albury, New South Wales)

They appreciate that you're being there for them, that tells you so much about the limited resources, the limited services that they have.

Sarah Bingley

Even here in Albury, we are one of the bigger towns in this area, we have a lack of speech pathologists and occupational therapists.

Heather Lambert

There's again, a long wait time as well as a lot of stress for them as they try to find a person who actually understands them but is halfway across the country trying to do that. It also uses funding.

Sarah Bingley

Some of their NDIS package will be spent on their practitioners travelling to them.

Cherry Reynolds, Director / Senior Clinician
(Woollybutt Specialist Services; Darwin, Northern Territory)

We support a family in a remote community of Lajamanu. It's like almost as far west as you can go and as far south as you can go before you hit Alice Springs kind of region. And to fly there costs $20,000. It's a 10-hour drive if you drive.

So from a funding finance-management perspective, it's very hard to go there. So you need to be able to go in and hit the ground running in terms of who do I need to talk to, who do I need to get information from, so that I can do work remotely, because we do do a lot via telehealth.

Heather Lambert

A lot of times it is by nature of location having to be telehealth. That's not ideal.

Cherry Reynolds

Telehealth or TelePBS [Tele-positive-behaviour-support] is challenging in that you don't get a big feel for who the person is, their environment.

Nandita Patel

How am I going to engage with a 10-year-old who has ADHD? Hardly can sit at their spot for 2 minutes?

I cannot do any activities with them on telehealth to make them engage. If I'm face to face, okay what you would like to do, let's just do this, let's go for a walk.

Face to face when you go there, you feel engaged with them.

You get so much information.

Stuart Martin, Core Positive Behaviour Support Practitioner
(Marathon Health; Albury, New South Wales)

Nothing beats that sort of personal interaction and I feel you can be, not only a lot more effective, you're a lot more efficient with your time when you're meeting face to face with a person rather than over a screen.

Cherry Reynolds

We often will try and do it once we've met a person first, particularly on remote communities, you may not be able to get back to somewhere for 4, 6 weeks, sometimes 3 months, because of the distance and the remoteness.

Heather Lambert, Clinical Lead – Positive Behaviour Support (Marathon Health; Albury, New South Wales)

So as a practitioner, there's a lot of adaptation that needs to happen when providing services with individuals who live in rural and remote areas.

That's got a lot to do with how you connect with different people.

Doug Payne

Those activities like fishing or going to Men’s Shed or sitting around a campfire and chatting.

They are the tools of engaging and their recovery.

Cherry Reynolds

Sometimes it's just sitting with them and spending time and getting a feel for who they are, what's important to them and their families.

And you don't get that by asking a million and one questions in a remote community. You get that by sitting being present and being a part of that person's community.

Doug Payne

Formal assessment? Nup. Sitting and chatting? Yep. Do I take a piece of paper out with me? No. Important stuff gets committed to memory.

I go and chat with people, but it's often sitting at their pace. I could rush it, I need to be patient. A behaviour support practitioner’s job is about being very, very patient.

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How will you use these ideas to improve engagement in your behaviour support practice?