Table 4 Case Study Exemplar of Model In-Situ.

LilaCARE* is a not-for-profit community organisation who provides comprehensive services to adults following brain injury. The shift to consumer-directed funding, via the NDIS, most significantly impacted their Community Rehabilitation and Transition* (CRT) program. The CRT supported adults with brain injury to transition back to the community following a period of subacute inpatient rehabilitation. Multiple AHP disciplines were involved to enact these transitions, and prior to the enactment of the policy change, LilaCARE had regularly hosted AHP students on placements.

The CRT was identified to be unsuitable as a service provision model in the NDIS landscape due to funding and administrative constraints. Funding for CRT clients had previously been received in 3 year blocks, which was not compatible with the annual funding cycle delivered through the NDIS. Further, it was unclear how the program could be administered using market logic, as service demand was unpredictable and holding recipients on waiting lists would delay client transition into the community.

LiliCARE also had several questions about the compliance of supervision activities. For example, it was unclear if practitioners needed to be ‘in the room’ in order to bill for a service activity. Previous centrally-controlled funding was administered at the service provider level, so the provider themselves governed whether students were appropriately skilled and able to provide this service. The status of student-led service activities in relation to billability was not transparent in policy or procedural information that related to the NDIS.

Placement facilitators used the model with LilaCARE staff to identify new opportunities for AHP student placement that aligned to the client and service provision needs, and market environment. They explored the dimensions of student placements, to elucidate detail of how student placements did or could function within LilaCARE’s service offerings. Examples related to timing (services were completed in half day sessions that were incompatible with traditional student placement hours; students arrive in placement blocks), setting (LilaCARE has close partnership with health sector and CRT Program involves multidisciplinary work, both of which had to develop new pathways following marketisation), supervision (remote, shared and cross-disciplinary supervision was considered to facilitate students to be placed in more environments) and university (support and communication from university staff to facilitate new supervision models).

A consideration of existing/potential placement dimensions were brainstormed to account for novel ways in which LilaCARE could offer student placements. The underpinning principles provided a contextual framework for whether the emerging possibilities/ideas for student placements would be fit-for-purpose for the needs of the service provider, and within the NDIS service landscape.

This collaborative process facilitated the implementation and trial of new methods for clinical supervision for placement students as outputs (i.e. peer and mentor learning, type of supervision levels, cross-disciplinary supervision). Further, a framework was developed that enabled students to lead group sessions, that were a service activity considered less financially viable in the individualised funding environment.

To enact these changes, LilaCARE supervised more students who were also from different disciplines. To realise this, novel communication and support structures were developed with universities. During the trial of new supervision processes, the placement facilitators worked responsively in partnership with service providers to overcome challenges as these arose – for example, how to navigate constraints on physical space when multiple staff and students were present at the service.

The conceptual model was then used as a tool for evaluation with stakeholders. Staff from LilaCARE were interviewed, and asked to use the model to reflect whether/how the adaptations to student placements achieved the purpose – quality placements with NDIS service providers – and the underpinning principles. LilaCARE reported that the innovations posed financially viable and pedagogically sound placement opportunities. During evaluation, LilaCARE staff identified a gap in students’ placement preparation, and university changes were enacted to ensure students understood how person-centred practice is enacted for NDIS recipients.

*names have been changed to preserve the confidentiality of the organisation who participated