|dc.description.abstract||Thesis Title: Community-Campus Partnerships and Service-Learning in Rural and Remote Australian Contexts: Moving from intervention to engagement with communities in their health service design and workforce development.
Providing children with the best possible start in life is critical if they are to achieve their optimal outcomes and be afforded the opportunity to become valued community members. The Australian Charter of Health Care Rights (Australian Commission on Safety and Quality in Health Care [ACSQHC] 2008) stated that health care access is a fundamental human right for all Australians. However, children residing in rural and remote Australian communities are more likely than their metropolitan counterparts to experience socio-economic, educational and health disadvantages that contribute to developmental vulnerabilities and delays. These same children are less likely to have access to essential allied health services, such as occupational therapy and speech pathology, to prevent, identify and intervene early to address these delays. For some families, this inequity of access to allied health services is an intergenerational experience. A failure to address developmental delays can result in: lifetime disadvantage; higher cost burdens for health sectors, individuals and communities through curative interventions and remediating social and educational strategies in later life; and continuing cycles of intergenerational poverty.
Even though rural and remote health has been the focus of Australian policy for a number of decades, these communities continue to be confronted with simultaneous and multiple health disadvantages. Contributing factors include: geographical isolation; lower socio-economic status of populations; resource allocations that fail to address existing health needs; a lack of focus and health expenditure on prevention, health promotion, early identification and intervention strategies; limited community engagement in their health care agendas; health workforce mal-distribution and shortages; and the development of poorly equipped health professionals for population health practice in these contexts. Strategies to address these challenges have typically been undertaken by health and higher education sectors in isolation from each other and the intended recipients of their health service and workforce strategies, the rural and remote communities themselves.
Health sector reforms are required. These reforms need to ensure health care alignment to community needs and priorities, the design of care that enhances service accessibility and acceptability across diverse rural and remote contexts, and care that is provided by responsive health professionals. This will necessitate the provision of ‘the right care, in the right place, at the right time’, provided by health professionals who have received the ‘right education’ and ‘right practice exposure’ to rural and remote Australian communities, their health care expectations and aspirations.
In seeking to achieve these outcomes, it is recognised that no single policy or government sector, has the capacity to overcome all of the challenges that contribute to developmental vulnerability and service inequities in rural and remote Australian locations. New approaches to health care design and workforce development are required. These approaches need to be informed by perspectives that consider issues in their entirety, drawing on collaborative partnerships with communities in determining their health needs, solutions identification, implementation and evaluation. It is imperative that communities are meaningfully engaged in their health care agendas. Civically engaged health care has the potential to enhance service accessibility, acceptability and sustainability, contributing to improved health outcomes for disadvantaged communities.
Several Australian University Departments of Rural Health—key stakeholders in rural and remote health service design and workforce development—are already engaging in the formation of community-campus partnerships, that include communities in the identification of their health issues , potential solutions and strategies for solutions implementation. Community-campus partnerships underpin the development of service-learning programs. Service-learning programs align health student placements with the provision of student-led services that address the identified unmet health needs of communities through emerging approaches to collaborative partnerships, service provision and the education of health students in Australia. These emerging partnerships and service approaches within the Australian context are heavily informed by international experiences and evidence. Despite the benefits associated with participation in community-campus partnerships and service-learning programs for universities, students and community agencies, limited evidence exists that describes who initiates these partnerships and for what purposes, how these partnerships are formed, and whether these partnerships and service models provide substantive gains for communities and quality learning outcomes for students, specifically evidence informed from community and rural and remote Australian perspectives. This thesis discusses community and campus participant perspectives and experiences of participation in the formation of a community-campus partnership and the development of an associated service-learning program. This partnership sought to address the unmet allied health needs of children residing in far west New South Wales, Australia, through the development of a service-learning program that aligned the delivery of student-led allied health services, occupational therapy and speech pathology to address the unmet developmental needs of these children.
In the latter half of 2008, primary school principals in far west New South Wales approached the University of Sydney’s Broken Hill University Department of Rural Health to express their concerns about the detrimental educational, social and health outcomes experienced by children with developmental delays who were unable to access allied health services, in the first instance, speech pathology services. The department facilitated the formation of a local partnership between health and school education sectors to explore the challenges faced by allied health service provision, past strategy failings and potential solutions. The department then drew on its organisational relationship with the University of Sydney to engage the Faculty of Health Sciences, which has carriage of allied health education, in contributing to solutions identification and implementation. The result was the formation of a community-campus partnership where community and campus participants worked collaboratively on the development of an allied health service-learning program, the Allied Health in Outback Schools Program. The program was operationalised in early 2009.
In the initial stages, the program aligned senior speech pathology student placements with the provision of speech and language services to Broken Hill primary school children. These services were delivered on school sites in Broken Hill to enhance service accessibility. The program was expanded in 2010 to include occupational therapy students, extending the type of allied health services available to children and providing students with the opportunity to participate in an inter-professional service-learning model. The geographical coverage of the program was expanded to include the remote outlying communities of Menindee and Wilcannia. Serial cohorts of speech pathology and occupational therapy students now participate in the program as inter-professional teams. Students undertake placement in the program across the four school terms contributing to service continuity and consistency. Under the supervision of qualified clinicians, students provide screening, assessment, services and referral activities in 12 primary school campuses across three regional communities. Approximately 150 school children access these student-led allied health services annually.
Although not explicit in the early stages of partnership formation and program development, a developmental evaluation approach was adopted. Local partners were aware of the challenges associated with developing and sustaining innovative approaches to addressing complex and protracted rural and remote health service inequities. External representatives from the Faculty of Health Sciences were cognisant of the additional challenges of ensuring quality educational experiences for their students within an emerging rural and remote Australian service-learning initiative.
However, the potential benefits of partnership and program participation were identified early. These benefits included: improved allied health service accessibility; enhanced developmental outcomes for children; growth in rural and remote placement capacity for allied health students; enhanced allied health student learning outcomes through ‘real-world’ practice experiences; and allied health student exposure to alternative health care practices such as population health in community-based settings. Despite these perceived benefits and internal program evaluations, no formal research had been undertaken to explore: the conditions that made the partnership necessary; the processes associated with partnership formation, service-learning program development and evolution; or the clinical, professional and civic impacts of partnership and program participation for community and campus participants.
In answering these questions, this doctoral study has been guided by three primary research goals: 1) to describe and understand the formation of the community-campus partnership; 2) to describe and understand the development and adaptation of the service-learning program (with  and  from the perspectives of community and campus participants); and 3) to develop a greater understanding of the impacts of participation in the partnership and program for community and campus participants. Four key questions were posed to inform the study design and approach. These questions focused on understanding:
1) What factors contributed to the initiation, formation and participation of community and campus partners in the community-campus partnership and associated service-learning program?
2) What were the impacts of participation in the partnership and program for community and campus participants and for the civic and higher education sectors in which they were located?
3) How did community and campus participants interact with each other to fulfil the shared purposes of enhancing allied health service accessibility and allied health student educational outcomes?
4) How did participation in the partnership and program impact on the clinical, professional and civic learning outcomes of allied health student participants?
In order to achieve these goals and answer these questions, this pragmatic qualitative study was designed and conducted. The study explored community (school principals and senior managers from local facilitating agencies) and campus (allied health students and academics) perspectives and experiences of partnership and program participation.
This doctoral research contains six papers: a descriptive paper and five papers that discuss findings from this research. The descriptive paper, Paper 1, contextually locates the study, describing the formation of the partnership, and the development and adaptation of the service-learning program between 2009 and 2015. This paper has been co-authored by executive representatives from partner organisations, school education, health and higher education sectors, and the University Department of Rural Health. Paper 2 presents community participant perspectives of the conditions and catalysts that influenced their participation in the partnership and program, as well as the civic impacts of participation, Paper 3 presents campus participant perspectives of the conditions and catalysts that influenced their participation in the partnership and program, as well as civic impacts of this participation. Paper 4 addresses campus perspectives on the participation impacts on allied health student acquisition of work-readiness attributes and their future employability. In Paper 5, campus perspectives on the impact of participation on students’ inter-professional skills, knowledge and practice are presented. Paper 6 describes the key features that contributed to community engagement in the partnership and program sustainability within this context.
This doctoral research extends our current understanding of community-campus partnerships and service-learning pedagogy as a community engagement strategy and educational approach. It provides deep insight into who initiated the partnership and for what purposes, how the service-learning program was developed and adapted, and the impacts of participation from the perspectives of community and campus participants, specifically within a rural and remote Australian context. A conceptual framework is presented in Chapter 4 and provides a comprehensive andmore nuanced approach to informing health and higher education sector approaches toward the engagement of rural and remote communities in health service design and the development of their health workforce. The framework has been informed by study findings and an exploration of existing theories and principles. Importantly, this framework has been informed by community perspectives and experiences of health care engagement.
As a complete thesis and series of papers, this research forms a body of evidence that can be drawn upon by health and health workforce policy makers, health and higher education sectors, and other rural and remote communities. The thesis and associated papers can contribute to informing health sector processes in the formation of community engaged community-campus partnerships and the development and adaptation of service-learning initiatives. In addition, this thesis describes the challenges and benefits of engaged approaches as they pertain to these contexts.
This thesis adds to the evidence base to support: the alignment of health care to rural and remote community needs and contexts; the need for new community engaged approaches to enhance health service accessibility, acceptability and sustainability; the imperative to align health workforce skills, knowledge and practice to rural and remote community contexts; with, the ultimate aim of improving the health outcomes of rural and remote Australian communities.||en_AU|