John, our Community Programs Manager, has been working with country communities through the Healthy Kids Bus Stop program since its inception. Here, he tells us about why the program is so unique, and explains how the ingredients come together to create real change for children in the bush.
In 2014 an opportunity to partner with Ronald McDonald House Charity (RMHC) arose. They had commissioned a purpose built ‘mobile clinic’ and wanted to put it to the best possible use to benefit Australia’s kids. It was through this partnership that the Healthy Kids Bus Stop program was born. From the very start, the mission was to provide early intervention screening services to rural and remote communities where the need is just so large.
In the areas we visit, there’s often a multi-generational history of developmental issues within families and communities. Inherent speech and behavioural issues get passed down from generation to generation. It’s not necessarily a medical thing, it can be environmental. If a parent hasn’t received help for their own developmental challenges, how are they to know if their child is progressing in line with the usual developmental milestones?
In some of the most remote areas, the isolation is so great that we come across kids – maybe 15-20% – who haven’t interacted with the health system since they were a baby, and they’re now four, five, or even six years old. This gap makes it very difficult to pick up on developmental problems as they emerge in those early years.
That’s why access to screening to check on developmental milestones and the chance to sit and talk to clinicians about concerns, gives families a pathway to start accessing help. It relieves that sense of isolation. Over the years we’ve completed about 55 trips to rural towns and seen over 3,700 children. That’s a whole lot of kids who may not have otherwise ever been screened to receive help.
Before any visit, we liaise with as many local stakeholders as possible – Local Health Districts (LHDs), Education providers, Aboriginal Health Services, Social Services and so forth, to try get a clear picture of what it is the communities need, and what opportunities there are for local referrals.
Each child receives an appointment with six clinicians on the day, so over the years we’ve delivered over 16,000 individual screenings. These include health checks with child and family health nurses, speech pathologists, occupational therapists, oral health, audiometry and a dietitian. Sometimes we will also have vision screenings, social workers and a physiotherapist. We consistently refer around 80% of the children we see on to follow up care because one or more concerns have been flagged.
If they were to do each of these screenings individually, a parent may have had to drive two, three, sometimes four hours for each appointment, and that’s if they could get on the books in the first place. Demand for these services is so high, the books are often closed to new clients. It’s really important for us to give as many families as possible the opportunity to come through the Bus Stop, so we try to have one of our clinicians and one person from the local health district at each station.
Unfortunately, local clinicians are getting harder to find, so we often have to take the full team to make sure we can see as many kids as possible. This is not only costly, but logistically challenging. But at its heart, the program is a really integrated model and that’s one of its core strengths. Royal Far West, Ronald McDonald House, LHDs, Aboriginal health services, local community services, preschools, local clinicians and bmany others – all working together to support country kids.
When we can, we make the Bus Stop a real community event and have as many people join in as possible. It gives us much more opportunity to potentially find solutions for kids in all parts of the community, including some of the more disadvantaged and marginalised families.
After a visit, we send families a screening summary and then follow up with them at three, six and twelve-month intervals after the visit to make sure they were able to act on the referrals and see if they need any additional support. Wherever possible, we provide referrals to local services, but of course there are still barriers. That’s when we need to consider referrals internally to Telecare or the Paediatric Developmental Program. In these scenarios, so much responsibility falls on education providers to support the children as they are the ones with them for the majority of the week. Capacity building in the form of extra support and tools for these educators is vital and we put a lot of focus here.
At the end of the day, clinical services in rural and remote areas are getting thinner and thinner on the ground. It’s more important than ever for us to use every resource available to identify developmental challenges as early as possible to connect country children to the care they need to grow and thrive.
Take a look at what happens at a Healthy Kids Bus Stop!