What do Allied Health professionals do?

Allied health professionals assist clients and their carers to function to the best of their ability at home and in the community.  The aim is to help clients to resume their normal activities, participate in their community and start enjoying life again.

Allied health professionals assist with identifying and overcoming barriers (physical, social, psychological or environmental) to independent living and slowing down the client’s rate of functional decline.  Access to allied health professionals can often reduce long term reliance on services, as the client and their carer become more independent.

Allied health disciplines specialise in different aspects of health, and practitioners often work as a team to meet the specific needs of the client.

 They also collaborate closely with their medical and nursing colleagues and other service providers, to ensure the best interests of the client and carer are met.

The availability of individual allied health disciplines varies from region to region in Queensland.  

All allied health professionals are university trained, have a unique body of knowledge, and conduct research into the effectiveness of their interventions. Their professional associations set standards for their work most of which are legislated under State Registration Boards.

Physiotherapists

Physiotherapists have expertise in the diagnosis, management and prevention of problems related to movement.  Physiotherapists in the community work with people who have mobility problems following surgery, stroke, accidents or diseases such as Parkinson’s, arthritis or osteoporosis, helping to build a person’s strength and assist with pain relief.  

Physiotherapists employ a combination of manual therapy and movement training to relieve pain, restore function and movement and prevent further problems.  Advice may be given on mobility and aids, and a personal exercise program is often prescribed, tailored to meet individual needs.  A physiotherapist considers all the client’s existing problems, and will prescribe and adapt a program to suit the client’s lifestyle.

The Australian Physiotherapy Association website offers more information about the role of the profession.  Information on arthritis and musculoskeletal conditions can be obtained through HealthInsite, an Australian Government initiative to improve the health of Australians by providing easy access to quality information about health.  HealthInsite includes links to resources that explain what arthritis and osteoporosis are, their causes, management, support services and statistics.

Occupational Therapy

Occupational therapists (OTs) help people to continue participating in activities of daily living.  Their clients include people born with disabilities, and those whose health suffers because of injury or illness.  Working closely with physiotherapists, they can teach patients to use particular movements (or compensate for a lack of movement) in day-to-day activities.  

An OT focuses on developing and maintaining people's skills to carry out their everyday tasks such as self care, meal preparation and leisure time activities, in a safe manner.  Services can include the provision of equipment and advice on home modifications (to prevent falls, for example);  advice on and modification of seating equipment, use of a wheelchair, commode or other adaptive seating options;  and training clients to use special equipment such as aids to enable them to shower independently.
Some core OT services include:

1. Retraining client and designing functional activities to assist people with cognitive decline or physical disability
2. Assessing the home environment to enhance safety
3. Adapting, designing and prescribing specialised equipment and seating
4. Task simplification
5. Stress management and relaxation
6. Independent living skills training
7. Driving skills assessment and retraining;  modification of vehicles

Contact Occupational Therapy Australia online or telephone their office in each state for more information.
Other useful links:
What is Occupational Therapy?
Occupational Therapy for Children and Older People

Psychology and Neuro-Psychology

Psychologists help people by teaching coping strategies for a range of conditions that seriously affect people's lives such as stress, illness, loss of function, depression and anxiety.
Unlike psychiatrists (doctors who specialise in treating mental illness), psychologists cannot prescribe medication, but in many cases their treatments have been shown to be as good as or better than drugs in treating anxiety and depression. Their treatments can also be valuable used together with medication.

Neuro-psychologists specialise in testing people to establish their level of cognitive decline.  This can help the person with a diagnosis of dementia or other condition, or their carer, to access services and establish routines that will assist the person in their day to day living.  The Australian Psychological Society provides an online and telephone referral service:  1800 333 497

Dietetics

Dietitians can give people easily understood, practical information about their nutritional needs at different stages of their life.  In the community setting, dietitians help the client meet their dietary goals, providing advice on better food choices for a balanced diet.  A dietitian will assess a person’s nutritional needs and base his or her counselling on the person’s usual diet, giving advice on how to prepare foods and store them safely.  In offering their professional advice, dietitians are very conscious of a client’s budget.
A dietitian may assist people who wish to lose or gain weight, or those with food allergies or intolerances, as well as conditions like diabetes, heart disease, cancer and digestive problems.  The Dietetics Association of Australia website:  www.daa.asn.au has further information.

Speech Pathology

Speech pathologists work with people who have communication and/or swallowing problems.  Clients can include people suffering degenerative diseases such as Motor Neurone or Parkinson’s disease; people who have sustained a head injury or had a stroke; people with dementia or those who have age related difficulties with swallowing.

A person who has had a stroke may have difficulty speaking or understanding other people when they speak, and a speech pathologist can work with the client to help them communicate better.  A person who coughs or chokes when they are eating or drinking can benefit from advice and/or therapy to make swallowing easier and safer.
Further information is available from:  www.speechpathologyaustralia.org.au

Podiatry

Podiatrists help improve the client’s mobility and enhance their independence by preventing and managing pathological foot problems. A Podiatrist can carry out an assessment and is able to diagnose foot pathology. They can then identify treatment options, assists clients with foot care, and provide advice on footwear, orthotics and foot health.  The podiatrist will refer the client to other disciplines if necessary, formulate a care plan, and provide the appropriate direct care as agreed to by the client.

Podiatrists establish collaborative relationships with other health care providers and provide information regarding foot care and appropriate support to other health professionals and carers.
To find other information about podiatry services visit www.findapodiatrist.org or www.apodc.com.au/Podiatry
Links and contacts for podiatrists can be found via the Australasian Podiatry Council.

Social Work

Social workers are focused on problem solving and helping to resolve a broad range of issues for individuals, groups and communities.   They focus on achieving equitable access to social, economic and political resources for their clients, and are also involved in community development.

Within a community setting, social workers provide a psychosocial assessment, intervention, referral and advocacy service to clients experiencing a wide range of health related psychosocial problems, such as: 

1. Disease specific (eg Alzheimer’s, dementia, stroke, Motor Neurone Disease, etc)
2. Alcohol/drug abuse
3. Domestic violence, elder abuse, sexual abuse
4. Future planning
5. Social isolation
6. Social aspects of cognitive impairment
7. Guardianship issues/Adult Guardian and Public Trustee
8. Mental health issues
9. Carer stress

           
Social workers use their professional skills to help each client realise their intellectual, physical and emotional potentials.  

A social worker can offer personal counselling and support in difficult times, when individuals and families are experiencing problems related to major life crises or changes such as deteriorating health.

For further information visit the Australian Association of Social Workers website:  www.aasw.asn.au

Case Studies for Allied Health

The following three case studies show how allied health professionals can assist HACC clients from a culturally and linguistically diverse background to manage a variety of medical and social issues and enjoy life again.

Please note that these are hypothetical situations and it cannot be assumed that all allied health professions will be culturally acceptable to all ethnic groups in all situations.  Nor can it be assumed that all the allied health professions will be available in a particular locality.

It is the aim of the HACC/Allied Health ‘Enjoy Life’ Project to encourage skilled case managers to train community workers to identify situations where allied health services could improve a client’s quality of life.  These workers will then have the knowledge and skills to ensure that the client is able to access the services of an allied health professional.

Case Study 1:  Mrs A

Mrs A reports to the care worker from your agency that she had a fall last night.  The care worker becomes concerned and asks a few questions because Mrs A has bruising on her upper arm and head and appears shaken.  She also appears to be limping.

Care Worker – Where is the worst pain, Mrs A?
Client – Yes, pain
Care Worker – Yes, but where are you feeling the most pain, in your hip, or shoulder or head?
Client – Yes, pain – over cat
Care Worker – Do you have a headache, or feel dizzy
Client – My head! Boom on my head, over cat last night

The care worker observes that Mrs A can speak a little English and is able to have a small conversation using learned statements like – ‘How are you?’, ‘How much?’ or ‘I come from…’ etc.  However, her ability to understand specific questions is very poor.  

The care worker also notices Mrs A is losing weight, her clothes are ill fitting, her footwear is loose and she requires support to move about the house.

Care worker – Mrs A, you are losing weight!  Are you eating well?
Client – Yes, eating
Care Worker – What did you eat for breakfast?
Client – Yes, eating … eating food
Care Worker – What did you eat today, Mrs A?
Client – Yes, eating. (Client becomes frustrated)

Mrs A understands that this conversation is about food, but is not able to grasp the specifics at all. 

From these two brief conversations, the care worker realizes that an interpreter is required to obtain more specific information.  The care worker sees that Mrs A is at great risk of another fall and needs the services of a physiotherapist, and that they will require an interpreter.  

The care worker is aware of the Falls Management and Prevention Program Referral Checklist Tool and intends to work closely with the physiotherapist to determine if other allied health disciplines are required.  The care worker has used the Functional Profile Referral Check List to identify the primary discipline to involve.

The Falls Management and Prevention Program Referral Checklist Tool is available from the Queensland Health Internet Site.

Case Study 2:  Mr B

Mr B has been looked after by his wife since returning home from hospital after a stroke.  He has become very short tempered.  Mr B was educated in China and has always been the family spokesperson, communicated with doctors, paid the bills etc.  Mrs B has very limited English and English understanding and has relied on her husband since their arrival in Australia.  Her son works interstate.
 
When the care worker from your agency visits, Mrs B is tearful and appears very concerned about her ability to care for her husband and herself. 
When trying to help her husband drink his tea, she becomes distressed because he coughs repeatedly when trying to drink.  Mrs B tells the care worker that Mr B is losing weight and becoming very disinterested in life.

The care worker sees that this client risks developing a serious if not life threatening lung infection because his swallow is not good, and tells Mrs B that it is most urgent to have Mr B’s swallowing problem assessed by a speech pathologist.  The care worker explains that a speech pathologist can tell her if it is safe for Mr B to continue drinking tea and other fluids and eating certain foods, and show her how to make her meals safe for Mr B to swallow.  Mrs B will require an interpreter and a care worker to help her tell the speech pathologist what the issues are. 

Mrs B worries that because she has always cooked foods in a certain way, Mr B only likes her cooking now.  In this situation, if it is seen as culturally appropriate, a dietitian could visit Mr and Mrs B with the speech pathologist.  The dietitian could help Mrs B prepare the foods that her husband prefers and present them so that they are safe for him to eat, now that he has swallowing difficulties.

Having attended to Mr B’s most urgent needs, the care worker at a later visit could suggest a psychologist who could help Mrs B adjust to living with someone who has had a stroke. The care worker is aware that people sometimes become sad after a stroke and, if Mr B seems depressed, it could be important to have him psychologically assessed.  (Cultural attitudes would determine whether such a referral would be acceptable).

During subsequent visits the care worker notices that Mr B is unable to move about safely in his home, posing a further risk to himself and to his wife.  An occupational therapist could assess the safety of the home and suggest ways to help Mr B regain independence with eating, moving about and bathing.  A physiotherapist could provide a program of activities that Mr B could enjoy participating in to regain muscular strength.  (These referrals could be part of the continuum of care.)

Case Study 3:  Mrs C

Mrs C has contacted her local support organisation to say that she is unable to attend her monthly social support outing: she has fractured ribs from coughing during a recent chest infection.  (She also has osteoporosis.)  This client, who cares for an intellectually disabled daughter, is well known to the organisation.  She is a refugee who arrived in Australia from Bosnia ten years ago, and speaks English well enough to manage basic needs like shopping and banking. 

Mrs C mentions on the phone that she is worried about her daughter’s long term care and often feels very sad when she thinks of the future, as she is concerned about her ongoing ability to care for herself and her daughter.  The pain from her fractured ribs has prevented her from shopping for food or obtaining a prescribed pain relief remedy.  The care worker offers a home visit.

During the visit the care worker finds out that Mrs C is unable to shop for food and has no one to ask for help.  She uses public transport, despite limited confidence, as she is unable to afford a taxi.  Since the terrorist bombings in London Mrs C has not felt confident to go out at night, as her headscarf makes her easily identified as a Muslim.  Pain has made movement even more difficult.

The care worker also notices Mrs C appears frail, her clothes are ill fitting, her footwear is loose and she uses support to move about the house.

Care worker – Mrs C, you look like you are losing weight!  Are you eating well?
Client – Yes ……….
Care Worker – What did you eat for breakfast?
Client – Toast
Care Worker – What did you eat yesterday, Mrs C?
Client – Yes, toast and tinned spaghetti.

The care worker realizes that this client urgently needs to have adequate food in the house.  The care worker’s organisation can assist with this; however Mrs C’s concern for her daughter also needs to be addressed. Mrs C also needs help to recover from her illness.  Mrs C may also benefit from further contact with a refugee support service.

The functional screen tool shows that a physiotherapist is needed as a priority to improve Mrs C’s ability to manage her cough and clear her airways, made painful because of her fractured ribcage. 

The care worker suggests that a social worker could help Mrs C find a service to assist with her daughter’s care.  The care worker also arranges for the local pharmacy to home deliver Mrs C’s medications.

An occupational therapist could also visit to advise Mrs C on how to conserve her energy in the home and to arrange home modifications if they are required.  A dietitian could also help Mrs C prepare cheap, nutritious, easy meals to help prevent further weight loss and promote health.

An interpreter may not necessarily be required;  however, the organisation might need to support Mrs C while she comes to understand the roles of the various health professionals and how they can assist her.

ONI Functional Profile Referral Checklist

The Ongoing Needs Identification (ONI) includes questions specifically related to the care recipient’s need for assistance.  The ONI Functional Profile comprises items that identify the person’s ability to perform selected activities of daily living.  It also includes two questions relating to memory and behavioural problems.

These questions include nine dependency items that assess the person’s ability to perform selected activities of daily living:

1. Housework
2. Travelling
3. Shopping
4. Taking medication
5. Handling money
6. Walking
7. Bathing

Once the ONI Functional Profile has been scored, the ONI Functional Profile Referral Checklist can assist with interpretation of the scores.  Health workers can then be guided to follow through with a referral to an appropriate allied health professional.

If a score of less than 2 is achieved for a particular question, then follow the Functional Profile Checklist guide to identify the initial allied health discipline to refer the client to.  Once an allied health professional has made their assessment they will liaise with the care worker and instigate referrals to additional allied health disciplines if necessary.

ONI Functional Profile Referral Checklist

Links

1. Carers Queensland:   provides carer support, and group/telephone counselling for carers.  Offices in Brisbane, Gold Coast, Toowoomba, Dalby, Maroochydore, Hervey Bay, Rockhampton, Mackay, Townsville and Cairns.

• Carer Information & Support Line and Carer Counselling Service:  Freecall 1800 242 636.   
• Website:   www.carersqld.asn.au

1. HACC Regional Service Directories:  HACC and Community Health allied health contacts state wide.

1. Commonwealth Carelink:  national database has information about allied health services, including day therapy centres). 
   
2. Multicultural Affairs Queensland (MAQ):  can refer clients with a migrant or refugee background to the appropriate professional physical and/or mental health or social support agencies that specialize in this area. 

Contact MAQ on:  07 3224 5690. 

1. Directory of Resources for Multicultural Health: