Project Plan Report Website - CRANAplus · 1.BSS!Workshops:!RHCE:!Project!Report ©CRANAplus!Inc Page6of11 Date!Created:!!02/11/2015! Aims: Theoverarchingaimoftheprojectwastocultivateresilienceintheremotehealth

1. BSS Workshops: RHCE: Project Report© CRANAplus Inc

Page 1 of 11 Date Created: 02/11/2015

CRANAplus Bush Support Services 02/11/2015

RHCE2 Funding Grant to Provide Workshops in Western Australia: ‘Through the Looking Glass: How to Thrive in the Remote Workplace by Cultivating Resilience’

“Funded by the Australian Government Department of Health through a Rural Health Continuing Education Stream Two grant administered by the National Rural Health Alliance”.



PROJECT PLAN FOR RHCE 2-‐FUNDED WORKSHOPS

WESTERN AUSTRALIA, 2015

DEVELOPED AND PRESENTED BY CRANAplus BUSH SUPPORT SERVICES Unit Name Brief Unit Description

Introduction Introduces participants to the principles of positive psychology and concept of resilience building.

Experience of Rural & Remote Encourages participants to share positive and negative experiences of remote practice. Highlights self-‐care challenges.

Claiming Your Space Art therapy unit introducing concept of taking responsibility for personal emotional safety.

Grounding Art therapy unit that focuses on activities of making changes, changing perspectives and language choices.

Mindfulness Introduces mindfulness as a way of life, way of work and a stress reduction technique.

Reflective Practice (Intro) Introduction to idea of exploring a experiences in the health workplace and examining individual’s thinking, feeling and doing role in the experience.

Creative Distraction Art therapy unit exploring creative options for building resilience.

Reflective Practice (Prac) Putting theory into practice.

Journal Making Art Therapy unit looking at the importance of memory making in emotional well-‐being.

Tips for Managing Stress A look at what current research is saying about self-‐care and resilience.

Self-‐Care Project A reflection on the workshop and how it can translate into daily work and personal life.

Through the Looking Glass: Resilience Building and Reflective Practice in the Bush

DAY 1

9:00 – 9:30am Welcome and Introduction -‐ Positive Psychology: Resilience & Creativity*

9:30 – 10:30am The Experience of Rural & Remote Practice*

Morning Tea (10:30 – 11:00am)

11:00 – 12:00pm Claiming Your Space

Lunch (12:00 – 1:15pm)

1:15 – 3:00pm Grounding, Take A New Leaf... Visit The Whole Ground... Language...

Afternoon Tea (3:00 – 3:15pm)

3:15 – 4:00pm Mindfulness

CRANAplus Bush Support Services Toll Free 1800 805 391 Support Line is a unique, confidential, free, 24-‐hour, nationwide telephone service for all rural and remote health service providers and

their families.


1. BSS Workshops: RHCE: Project Report © CRANAplus Inc


Through the Looking Glass: Resilience Building and Reflective Practice in the Bush

DAY 2

9:00 – 10:30am Reflective Practice (a)*

Morning Tea (10:30 – 10:45am)

10:45 – 12:00pm Creative Distractions (Play Stations)

12:00 – 12:45pm Reflective Practice (b)*

Lunch (12:45 – 1:30pm)

1:30 – 3:00pm Journal Making: Cutting & Folding & Putting It All Together

Afternoon Tea (3:00 – 3:15pm)

3:15 – 4:00pm Tips For Managing Stress & Self Care Project*

4:00pm Reflection

CRANAplus Bush Support Services Toll Free 1800 805 391 Support Line is a unique, confidential, free, 24-‐hour, nationwide telephone service for all rural and remote health service providers and

their families.

“Funded by the Ausytalian Government Department of Health through a Rural Health Continuing Education Stream Two grant administered by the National Rural Health Alliance”.

1. BSS Workshops: RHCE: Project Report © CRANAplus Inc




FINAL REPORT FOR RHCE2-‐FUNDED CRANAplus BUSH SUPPORT SERVICES WORKSHOPS

1. INTRODUCTION:

Background to Funding:

CRANAplus applied for funding to provide Resilience based workshops in remote locations in Western Australia in April 2015. The locations were chosen due to scarcity of training opportunities available in regional towns. Prospective participants feedback suggests that it is difficult to obtain leave to attend training/workshops due to extra days for travel and accommodation that is required if the workshop is held in the capital city several thousand kilometres away. CRANAplus Bush Support Services are ideally placed to provide training tailored to the remote context as they have a long-‐standing reputation for quality training delivered by experienced facilitators who have lived and worked remotely.

The format chosen for the workshops was ‘Through the Looking Glass -‐ How to thrive in the Remote Workplace by Cultivating Resilience -‐ A Two-‐day Experiential Workshop in Flexibility, Adaptability and Reflective Practice.’ The two-‐day workshop introduced participants to the principles of psychological flexibility, creativity, mindfulness, reflective practice and self-‐care.

Three successful workshops were conducted in the following locations:

• Exmouth, Western Australia -‐ July 9 & 10, 2015• Kalgoorlie, Western Australia -‐ July 29 & 30, 2015• Carnarvon, Western Australia -‐ October 14, 2015

The Exmouth & Kalgoorlie workshops were presented by:

Therese Forbes & Amanda Akers (Psychologists) and Jenni Francis (Art Therapist)

The Carnarvon workshop was presented by:

Therese Forbes (Psychologist) and Jenni Francis (Art Therapist)

The workshops introduced participants to the principals of reflective practice and built upon the strong foundation of self-‐care. The aim of the workshops was to provide opportunities to explore these concepts through best practice and experiential exercises including art therapy, mindfulness and positive psychology.



Aims:

The overarching aim of the project was to cultivate resilience in the remote health workforce. The stressors and challenges of remote work are well documented and current research is highlighting the individual resilience of the practitioner as being the factor that determines the long-‐term viability and satisfaction overall with remote work.

A secondary aim was to bring stakeholders in health together in their communities and to encourage the formation of strong bonds between practitioners, thereby improving the health outcomes of their clients.

Outcomes:

(a) Number of Workshops:

Three workshops were held in regional Western Australia. Locations were Kalgoorlie, Exmouth & Carnarvon.

There was a significant drop-‐out rate for those registered for the Exmouth workshop, however, the participants who attended included staff in management and senior roles who, during the course of the workshop, planned to take the workshop structure back to their staff and deliver it in the workplace for those participants who were unable to attend. Sufficient materials were provided to these participants to enable them to deliver these workshops.

Agencies Represented:

HACC, WA Country Health Services, ARAMFI, Anglicare, Community Corrections, Aboriginal Medical Services, Centrecare, WA Population Health, Department of Child Protection.

(b) Quantitative Outcomes:

Quantitative outcomes were measured by utilising the DASS 21, which was administered on the first day of the workshops, and at the completion of the workshops, held in Exmouth and Kalgoorlie. This outcome measure was chosen as a measure of stress, and for those scoring high in stress at baseline, as a measure of other symptoms, such as depression or anxiety, that may be complicating factors for the stress scores.

Depression, Anxiety, Stress Scale (DASS–21) (DASS: Psychology Foundation of Australia): The DASS-‐21 is a set of three self-‐report scales designed to screen for the negative emotional states of depression, anxiety and stress. The DASS-‐21 comprises a 21-‐item



questionnaire, which is a shorter version of the DASS-‐42, which can yield clinically significant emotional states such as depression, anxiety and stress. Its scores have been shown to have high internal consistency and to yield meaningful discriminations in a variety of settings. It is typically used as an outcome measure by obtaining a baseline score, then retesting following treatment, to check for improvement in mood states.

The essential function of the DASS is to assess the severity of the core symptoms of depression, and anxiety and stress over the past week, however, in this case the use of the DASS-‐21 on the second occasion of testing referred to the past day. The total potential score for each scale (depression, anxiety and stress) is 21. Scores become significant for depression when higher than 9; for anxiety when over 7; and for stress when over 14.

The following scores were obtained for the Exmouth and Kalgoorlie participants:

Table 1. Exmouth Workshop (N=5) Participant Depression

Baseline Anxiety Baseline

Stress Baseline

Depression Day 2

Anxiety Day 2

Stress Day 2

Average Score 2.4 3.6 10 0 2.8 1.6

Range 0-‐6 0-‐12 6-‐16 0 0-‐4 0-‐4

Table 2. Kalgoorlie Workshop (N=21) Participant Depression

Baseline Anxiety Baseline

Stress Baseline

Depression Day 2

Anxiety Day 2

Stress Day 2

Average Score 3.6 4.1 8.1 2.1 2.2 4.4

Range 0-‐20 0-‐24 0-‐24 0-‐26 0-‐20 0-‐24

Participants in the Exmouth workshop showed their highest scores in the stress subscales with scores ranging from 6 to 16. Two participants showed baseline scores in the clinically significant range (mild and moderate) for anxiety and stress. Following the workshop these scores had reduced to the non-‐significant range, showing no clinically significant scores for participants following the workshop. The average score for stress at baseline was 10 and after the workshop the average score for stress was 1.6. Despite the small numbers in this group there is a strong suggestion that the workshop reduced the stress of group participants. In addition, 6 participants showed reduction in anxiety to the non-‐clinically significant range following the workshop.



Participants in the Kalgoorlie group showed their highest scores in the stress subscales with scores ranging from 0 to 24. They showed scores in the clinically significant range (mild to extremely severe) across all 3 subscales (depression, anxiety and stress). There were 7 participants showing clinically significant scores at baseline. Following the workshop, 2 participants failed to submit their DASS21 assessment sheets, but of those who returned their DASS21 tests (N=19) only 2 participants showed clinically significant scores. The average score at baseline for the Kalgoorlie group was 8.1 and after the workshop the average score for stress was 4.4. In this larger group there was also a strong outcome of stress reduction.

Qualitative outcomes were obtained in evaluation questionnaires and are listed below.

(c) Evaluation:

Evaluation to be measured by use of feedback/evaluation forms inviting comment on whether expectations were met, skills learnt would be implemented, what people liked most and a Likert Scale of rating presenters and workshops overall from 1 -‐5.

Participant Feedback:

Participant feedback was very positive. 91% of participants stated that their expectations were met and that they would utilise the skills learnt. The components that people liked the most were: Mindfulness, Creativity & Reflective practice.

Ratings:

• Presenters: 70% Excellent, 25% Very Good, and 5% Good• Workshops Overall: 40% Excellent. 40% Very Good and 20% Good

Further Comments:

There were many positive comments from all the workshops: • The presenters were very knowledgeable and their abilities to get the group to open

up about experiences, good and bad, made the workshop more interactive andvaluable

• Presenters very approachable• Inclusive and informative• Very enjoyable -‐ made you look at yourself and understand why you feel certain ways• Good strategies offered• A timely intervention which will prevent further deterioration



• Interesting & Interactive• Loved the workshop• It feels good to trust and believe in yourself• Topics were great fun

2. BENEFITS: RHCE OBJECTIVES & LEARNING OUTCOMES:

(a) The first overarching RHCE objective was:

To help Aboriginal Health Practitioners/Workers, Allied Health Professional, Nurses, Midwives and GP’s in rural and remote areas to access cost effective and suitable CPD.

As can be seen from the outcome data presented above, participants felt better off in that they perceive they have learnt strategies of value and participated in activities which were creative, and have life-‐long benefits to both their home and work lives. They reported an improvement in their capacity to understand, identify, utilise and develop plans to incorporate the workshops’ learning’s into work and life in general.

(b) The second overarching RHCE objective was to:

Ensure follow-‐up provision of support through networking and enduring materials.

This was achieved by the workshops through the provision to all participants, materials and resources that enable them to review learning’s and also to share with their work colleagues. Many workplaces sought further assistance from the facilitators in regard to developing and delivering professional development (in service) around what they had learnt in the workshop. Furthermore, participants were invited to initiate a self-‐care group project in their own workplace with ongoing CRANAplus Bush Support Services support in place. A core element of the workshop was the introduction of reflective practice. This practice embodies the principles of networking and peer support.

All participants were made aware of the portfolio of services offered by CRANAplus Bush Support Services, including the 24/7 free and confidential telephone counselling service available through the 1800 805 391 line. Participants were introduced to the Positive Psychology model used by psychologists on the team. There is anecdotal information that EAP from participants is not as available or appropriate as previously, so the CRANAplus Bush Support Services line presents a real and immediate option for remote health workers looking for support.



(c) A number of learning outcomes were identified at the beginning of this project:

These were for participants to:• Experience creative ways of raising professional and personal awareness• Understand the impact of stress and to develop personal self-‐care strategies• Reflect on work and consider ways of tracking work performance• Explore ways of staying safe at work; and• Build resilience

Given the overwhelming positive response to the workshops and the positive participant feedback it would seem that these learning outcomes were reached.

3. RECOMMENDATIONS:

Some recommendations would be that greater lead in time be provided before the workshops are conducted, as long distance participants require additional leave to be authorised and allowed by management.

It is recommended that self-‐care be raised within organisations as an immediate priority. Pre-‐workshop quantitative measures suggest that remote health workers experience high and clinically levels of distress. Post workshop these levels had dropped significantly. Many potential participants reported that they were not supported by their organisations to attend the workshops. The outcomes indicated in this project suggest that self-‐care plays a key role in the ongoing wellbeing and sustainability for those working remotely and contributes to a safe and healthy workplace.

4. CONCLUSIONS:

The workshops were designed, developed, delivered and evaluated during 2015. The evaluation of these workshops, particularly feedback from the participants, indicates that the workshops met their needs for support and education. For rural and remote health workers the core workshop themes of self care (understanding stress, building resilience and practices and strategies to support them), understanding the experience of rural and remote practice, reflective practice and staying safe in the workplace appear central to building and maintaining a sustainable and resilient workforce.

Feedback from participants indicates that the cornerstone of the success of the workshops is the inclusion of mindfulness and creativity as a method of self-‐awareness, self-‐care and a practical extension of the “taught” concepts. The uptake of the workshop themes and skills



was enhanced because of these creative activities. For many, this is what made the workshop so valuable.

Another factor in the success of the workshops was the opportunity to build connectedness with other workers in their area. This reduces professional isolation, leads to a reduction in stress and builds opportunities for collaborative practice.

The overall objectives set for the project by RHCE and CRANAplus Bush Support Services were met, as were the identified and desired workshop outcomes.

For RHCE and CRANAplus Bush Support Services core business was achieved and recommendations for future work provided.

The overall project recommendation is for these workshops to continue to be funded.

Contributors to the project: Dr Annmaree Wilson (Senior Clinical Psychologist) Amanda Akers (Clinical Psychologist) Therese Forbes (Psychologist) Jenni Francis (Art Therapist) Joe Rusch (Administration Support)Steven Dangaard (Chief Finance Officer)

CRANAplus Bush Support Services would like to take this opportunity of extending thanks to RHCE2 for funding the above project and also for providing the opportunity to engage with members of the WA remote health workforce.

Colleen Niedermeyer Director of Support Services, CRANAplus Phone: 07 4047 6404 Mobile: 0448 011 956


Documents

Project Plan Report Website - CRANAplus · 1.BSS!Workshops:!RHCE:!Project!Report ©CRANAplus!Inc Page6of11 Date!Created:!!02/11/2015! Aims: Theoverarchingaimoftheprojectwastocultivateresilienceintheremotehealth