May 30, 2024 • 32 mins
An annual comprehensive health assessment improves the detection of health needs, enables active management of those needs, and significantly reduces health risks and poor health outcomes. So how can you support people living with an intellectual disability access one?
The CHAP tool is free and available to download from the Australia Government Department of Health and Aged Care at: Comprehensive Health Assessment Program (CHAP) – Annual Health Assessment for People with Intellectual Disability.
- www.health.gov.au/CHAP-adult (adult CHAP, 18 years +),
- www.health.gov.au/CHAP-YP (young person CHAP, 12 – 18 years).
If you’d like to learn more, check out the following NDS resources:
- Maximising use of the CHAP: A guide for the disability sector
- Government releases new CHAP for young people
This podcast was produced with the support of the Victorian Department of Health.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:11):
- Hello everybody.
My name is Lou Zamanilloand I'm a Senior Policy
and Project Officerworking at the National
Disability Services.
I want to welcome youall to today's podcast
where we're going to be talkingabout the comprehensive annual
Health Assessment Program,better known as the CHAP.
Firstly, I'd like to start byacknowledging the traditional
owners of the land in which we stand on.
In my case, that when wrong
(00:31):
and Wadawurrung people, I paymy respects to elders past,
present, and acknowledgethat land was never seeded.
So why are we here today?
We know from evidence that we need
to improve poor health outcomes for people
with a disability in Australia,the Australian Institute
of Health and Welfare, people
with a disability in Australia 2022 report
and the 2024 report identify adults
(00:53):
with a disability are six times as likely
as those without a disabilityto assess their health as fair
or poor with people living with a severe
or profound disability reportingpoor health almost nine
times higher and 13 timeshigher in 2024 than those
who do not have a disability.
Along with that, the NDIS Quality
and Safeguards Commissionhas identified completion
(01:14):
of a regular comprehensivehealth assessment
for people living with adisability to improve detection
of health needs, enable activemanagement of those needs,
and reduce health risksand poor health outcomes.
The commission also states
that disability providers are required
to monitor participanthealth, safety, and wellbeing
and supports participantsto maintain their health
and access appropriate health services.
(01:35):
In that sense, the CHAPtool supports this annual
requirement for people withan intellectual disability
with specific tools for adults
and a new release for youngpeople age 12 to 18 years old.
Today we're joined byProfessor Nick Lennox
and Paige Tehan to talk about the CHAP.
Nick Lennox is trained as a GP
and has worked for 28 yearsproviding medical services,
education and research about adults
(01:57):
with intellectual disability.
He's an honorary professor atthe University of Queensland
and a former directorof the Queensland Center
for Intellectual andDevelopmental Disability.
He conceived and led the work on the
development of the CHAP.
Paige brings over eight years
of experience in the disability sector
and is currently workingas a service manager
for Livability Care Australia.
Paige holds certificationsunder community services,
(02:20):
disability, travel and tourism,
and is currently completingher certificate in leadership
and management outside of work.
Paige is a strong advocate formental health, volunteering
for Beyond Blue to help thecommunity raise awareness.
I'd like to start with Nick.
Nick, can you please tellus a bit more about the CHAP
and maybe starting from startis what is the CHAP? The
- Chap is a process,actually it's a tool to try
(02:43):
to improve the health of
people with intellectual disability.
And it does this by decreasingthe many of the barriers
to good healthcare andI can talk about that.
So it, it is essentially abooklet that improves access
and gets people to see theirGP for not an acute problem,
but to come and reviewwhere they are in terms
of their health and ratherthan focusing on a particular
(03:04):
illness but gets peopleto think about, okay,
these are the things that we need
to think about going forwardand have we missed anything.
So it gives access to thatkind of review appointment,
which is quite different fromthe usual way that people go
and see their gp.
It also then gathers theessential part of healthcare,
which is gathering areally good health story.
(03:26):
See when you go and see your doctor
and indeed lots of other professionals,
we need a really good storyto understand what's happened
to you in the past andwhat's happening to you now.
And for people withintellectual disability,
this often is not easy to gatherand actually is often lost.
And so it tries to get a completepicture of what's going on
(03:49):
and has gone on for this personand present it to the GP and
or the practice nurse to review it
and ask supplementary questions.
So it actually changes, kind of supports
what we know is a gap in termsof that broader knowledge.
And it's really true
that if we don't have thiscomprehensive knowledge of
how the person is experiencing health
(04:09):
and what has happened to them in the past,
it makes it very difficult toactually one, make a diagnosis
of an underlying conditionor even to go forward
and do a really appropriate management.
So the first part of theCHAP gathers that story.
It also by its very nature,increases communication
and builds relationship
(04:30):
because you're going to bewith somebody for a period
of time and that buildsa better relationship.
And we know from the research we did,
in fact when people were beingdeinstitutionalized from an
institution and meeting anew GP for the first time,
it very much decreased theanxiety both for the gp,
the person with intellectual
disability and the support workers.
'cause they suddenly hadsome time to actually talk
(04:52):
to each other, understandeach other's needs and
and do their job the best
that they possibly could in that time.
The next thing that the, the CHAPter does,
it actually picks up unmet health needs.
And it does this througha couple of things.
It actually in the middleof it says these are things
that are commonly missed or poorly managed
and this is education for theperson with intellectuality
(05:14):
but also for their supporters,
whether they're familymembers or paid supporters
and also for the GP or the practice nurse
because they don'tnecessarily know this stuff.
And it's laid out inevery straightforward way.
That means that people couldjust look down this list
and say, I really should look at this.
For example, constipation maybe
there and I haven't picked it up.
(05:34):
And, and for peoplewith and their families
and supporters, it also says to them,
if you are worried about these things,
that's a really valid concern'cause here's a university
and expert saying thisis a common concern.
So it empowers them to do that.
So it's providing education
and then I like to think
of it in a supportiveway is it says to GPS
(05:54):
and practice nurses
and nurse practitioners actuallyin this particular area,
here's a little bit ofinformation you didn't know about.
One example is we usually expect people
to think about the cause
of somebody's intellectualdisability in childhood.
And that's kind of the end of it,
but it's not the end of it actually.
There's things you shoulddo if the cause is unknown
and most GPS and practice nurseswouldn't be aware of that.
(06:17):
So it provides some information about that
and in a supportive way
and an encouraging wayrather in a disempowering
or disrespectful way.
And it also provides somespecial information about
syndromes and associatedmedical condition with syndromes
and the classic example of thyroid disease
and down syndrome, whichis relatively common,
but there's a whole lot of other things.
For example, epilepsy goesto, its various people
(06:38):
that have a syndrome orcause of a disability
and it's important thatgps are aware of that.
And finally it tries to do thepiece that's really developed
and that is to say, okay,we've done this big review,
these are the things weneed to do going forward
and I as the GP thinkwe should be doing this.
And you as a support workeror a person with a disability
(06:59):
or a family, this is what you need to do
to make sure these things happen.
And in the simplest form itmay be, oh my god, I found
that you've got lots of wax,which is actually a very common
common finding and you knowyou need to take these drops
and we need to fix thatup in a more complex way.
Maybe you need to go andhave some blood tests
or some investigationsand come back and see me
because that joining together
(07:21):
and that shared mission iskind of set up going forward.
And that's a really important part
of getting really good healthcare,
but they're the kindof things that it does.
- Thank you so much for that Nick.
It definitely sounds likea really valuable tool,
especially considering
that oftentimes I thinkboth in the disability
and the health sectors, we canfall into silos And it sounds
(07:42):
like the CHAP in a way is a tool
to really improvecommunication between sectors
but also to clearly communicatewith the people living
with disability, theircarers or family members
and that everybody has kind
of this big picture about thehealth needs of the person,
not just at this point in time
but along the person's life,
which sounds like an an incredible tool.
Thank you so much for that.Nick Paige, I'd be interested
(08:04):
to know how did youfind out about the CHAP?
- I found out about the CHAPwhen I was working in Darwin in
the Northern Territory for anon-for-profit organization.
I was working as a supportedindependent living coordinator
and my quality
and practice manager at the time,
Justin Smedley actuallybrought it to our attention.
(08:25):
- Excellent. And I think it'dbe very interesting for us
to know from a disabilityservice provider perspective,
what was the reason behindyou starting using it
and deciding to to uptake it?
- When the CHAP was broughtto our attention, we did a lot
of research on it
and we found that usingthe CHAP was really great
for early stage detectionand also prevention.
(08:46):
Looking at the CHAP,
it also provides a really greatdetailed health assessment.
It's also individualized
and very person centered to each client
and it tailors reportsfor each client as well.
- So I'm thinking you foundthat very useful from a service
provider's perspective tohave that level of granularity
and insights in terms of thehealth needs of your clients.
(09:07):
- 100%. Especially when we've got
so many clients in differenthouses all across a certain
city or a certain state.
It's great to have such awell presented health tailored
program individualized for each client.
- Thank you so much for that Paige.
This CHAP sounds like a great tool.
There's no doubt thatthere's many benefits
to its application,
but I'm curious to know whatchallenges have you found exist
(09:29):
for the CHAPs implementation?
- One challenge I personallyfound is since talking
to team leaders
and service coordinators hereat livability care was the
lack of education
of doctor's awareness onthe CHAP was probably one
of the biggest things that we had.
- Yeah, yeah, no, I mean itit is quite difficult to get
(09:50):
that kind of awareness up.
That's true. And you know to, for many gps
they would see this is a very,
very small population eventhough we're talking about half a
million Australians actually.
And there's, you know, big sense
of them not necessarily identifying this
population in their practice.
So there's a a reality in
that the gps are more familiar actually
(10:11):
with geriatric health screening than
and indigenous health screening I
think than now with this group.
So it is, it is been an ongoing battle
to get that awareness up.
My suggestion is the thing
that actually made theresearch work was it was really
people with disabilitiesand their families
and supporters who didthe promotional work.
It needs to come from, you know,when you think about who's,
(10:33):
if you think of your ownhealth, who's most important,
who's most concerned about your own health
and that's you largely and
therefore if you want
to change things it's got to come often.
You know, you've got to drive it yourself.
And that was true to getthere, the studies done,
it was driven by people with
disabilities and their families.
So as much as governmentscan do as making it aware,
(10:54):
I think it's actually saying to your GP
and going, okay, we knowthis good Australian evidence
that this actually workswe know and look at.
So I think it relies on the services
and service providers topromote it very strongly.
And also families of courseand people with disabilities.
- One thing we also did as well,since we were getting a lot
of information back fromstaff, we would make contact
(11:17):
with the receptionist as well.
So after having a conversationwith them, we decided
to then send them an emailwith the PDF of the CHAP
so the doctor could actuallybe aware of what it's,
and they could have timeto read the information
before we also attended themeeting with the clients
as well, which I think alsomade a really big difference.
(11:39):
- That's really interesting Paige.
And did you find that yougot a good response from the
health services in terms ofbeing open to reading it
and reducing that pressure ofthe time constraints of having
to do everything at that15 minutes? You know?
- Yeah definitely.
We had some really great feedback as well
as when some doctors wouldread it, they would also do to
extend the appointment too.
(12:00):
And they did, some doctors hadsome gratitude board saying,
you know, thank you forsending this through,
this is really interesting.
And just really appreciated the fact
that we making them awareof what the appointment was
for prior as well.
- That's really interesting. Paige, Nick,
do you have any commentson like talking about time
constraints, we knowthat we're quite limited
(12:20):
by the current model thatonly lasts for 15 minutes.
Do you have any comments on that
or how to manage that inthe context of the CHAP?
- Yeah, look, I mean I thinkthat people have got to realize
that there's times in generalpractice that are really busy.
You never do this on a Monday or Friday or
before the doctor's about
to go on leave the lastweek in general practice
before we go on leave is a nightmare.
(12:41):
So I think negotiating with the practice,
like I was brilliant pageraised the receptionist,
the receptionist in my experienceis the key person often in
the practice that's not the gps
but there's also practice managers
and if there's practicemanagers, I'd be talking
to the practice managers
and saying to them,look, we want to do this.
(13:01):
How does it best work for you?
You know, we know everybody knows I
think, or if they don't they should know.
The biggest concern the GPS have is their
restraint around time.
It's the toughest job I've ever had.
You're often chasing your tail.
You know, when you have acoffee break you're usually
reviewing re results,you never break actually.
(13:22):
You just go on
and there's firstlynot a GP in the country
that wouldn't work later than they're
actually meant to work.
It's a very intense, so respectingthe constraints on which
they have and actually reachingout as service provider say,
how can we make this work best for you?
Tell me, you know, wewant to make this work best
because we know it's a, it's a tough thing
to do and hard to do. Well,
(13:43):
- Thank you Nick.
I think you raised some importantpoints in terms of, again,
going back to the main challengeabout GPS being quite time
poor and of course they have10 other priorities to look at.
And from what you weresaying at the beginning,
disability is probably not front
and center in their mindsor things like the CHAP.
So in that sense, I think youhave both raised importance
of advocacy and raising that awareness
(14:03):
with simple tools such aslike emailing it in advance,
you know, and scheduling theappointment at that time.
That's not like peak hour.
Would you add any otherstrategies for success?
I think if they, if thepractice has a practice nurse,
it's really crucial.
A lot of the CHAP can bedone by the practice nurse.
The second part of the CHAPwould be done by the check
and it can be set up.
(14:24):
I used to work in New Zealand
where every practice had a practice nurse
and so they could see theperson do the weights,
the height test, the visiona whole, a whole bunch
of things, blood pressure,et cetera, et cetera.
And then just line it up for the gp.
Say okay, you think about whatabout this, what about this?
And you can go through and often
and in a very good practice, you know,
you work really closelywith each other in that way.
(14:47):
And I mean it's often,in fact in the literature
around elderly healthassessments, patients prefer
to see the nurses thanthe GPS in that area.
And often they're, youknow, you can speculate
of all the different reasons for that
but you know, it can kind
of make it user friendly And I've found
with a practice nursethat they will often do
that linkage stuff very well
(15:07):
and provide extra support,have a bit more time,
you know, to do things.
So I think that's anotherreally, if it's a practice
that's got a practice thatI'd be definitely talking
to them as well.
- That's really useful Nick,thank you for raising that.
And it brings back theimportance of collaboration
and really playing to eachof the sector strengths.
Mm. And working together toimprove outcomes in that sense.
(15:30):
I'd be interested to know whatoutcomes you have seen Paige
from implementing theCHAP in your organization.
- Yeah, sorry, I just want totouch on about the collaboration
as well because I thinkthat's super important.
The CHAP is here tohelp and support clients
but at the same time thecollaboration of the staff,
the families, all thedifferent stakeholders
(15:50):
that were involved was just fantastic.
And I think that's something
that built everyone closertogether without even acknowledging
or realizing it as well.
So I think that's really super important
to touch on as well.
In regards with what I had seenfrom implementing the CHAP.
So currently LivabilityCare Australia have
(16:11):
around 55 clients whoSouth Australia, Victoria
and also Queensland.
We have done about, Iwould say 65% in our care
with intellectualdisabilities have finished
and finalized the CHAP.
So we still have around 30to 35% more to go ahead.
We have had absolutely fantasticreviews come back from our
(16:33):
team leaders, from our service managers,
service coordinators, familiesat the clients themselves,
which has been fantastic.
The feedback we havereceived in the reports,
which we're also going to bemaking sure that we utilize
and continue doing itin the following year.
So we can also use that asa module to look back on
(16:53):
and see how they're goinguse that as a report And
as within a tool, what I have found
and the information receivedwas clients not being up
to date with vaccinations.
That was a very large number of clients
that we had received, whichwas fantastic results for us
to be able to get them up to date
(17:14):
with their vaccinations as well.
We had a lot of referralsprovided for our clients.
Whether that is, for examplewe've, I had one client
that was referred to get an eye test
and they needed glasses.
So this whole timethey've been in our carer,
it was something that we were unaware of
that they needed to wear glasses.
We had a lot of bloodtests for clients done
(17:36):
and one client in particularwe had found out had diabetes
as well, which, which is probablyone of the biggest things
that we had found out through the CHAP.
This person does get regularblood tests every so often from
what is recommended from the doctor.
But when the CHAP wasreceived they thought okay,
like looking at the results,looking at some things
(17:57):
that the staff has alsowritten down in this report,
I think it's best that we goand get another blood test
and that's when we found outthat information as well.
So it just goes to showthat the CHAP is super,
super important
and without using this maybe
that's something wemight not have found out
and we found out further down the track.
- Yeah, absolutely. These arevery important health issues
(18:19):
that imagine if they goundiagnosed, you know,
they can have significant implications.
Nick, you also mentioned ear wax
as something coming up quite often.
- Yeah, earwax is actually,
the research was the mostcommon finding blocking up
people's ear and it kind
of sounds trivial like ifyou're kind of rating things,
but in fact people withintellectual disabilities have
problems learning by definition.
(18:40):
And we mainly learn byseeing and hearing actually,
and you very commonly find which they
can't see or hear properly.
And, and Paige has justmentioned exactly that situation
and then we have them in the context
of dis disability support organizations,
you often have peoplehave behaviors of concern
and how do you manage behaviors,concern, you learn stuff
(19:01):
and you and you need to beable to see and hear properly.
So what is seemingly a relativelytrivial thing can actually
be, has a major impact on people's lives.
I mean the other common ones
that we find is likeimmunizations are very common
and other health screens thatweren't done so has the person
now had was a pap smearin the research now,
(19:23):
but now it's a, can be aself-administered smear
to make sure they don't have cancer.
Breast examinations don't happen.Generally it's population.
And in my career I've beenon many mortality review
committees where breast canceris picked up very, very late
and the most appropriate person to check
that is actually the GP fora whole bunch of reasons.
Obviously if the person can'tcheck it for themselves.
(19:46):
The other things that we found in
over the years when I've talked about it,
we found reflux esophagitis.
I've also had GPS come tome saying they've done CHAP
and they've found lymphomapicked up epilepsies,
picked up melanomas and other things.
So it does do that kind ofbacks up the GP in terms
of picking up things that you may miss.
(20:06):
'cause it's very easy not to see things.
I mean the other thing we saw was scended
test were picked up.
Now this again, youthink is that important?
That's just really important.Increases your cancer risk if
you don't have your test ispicked up if they haven't gone
into the, actually gonedown into the scrotum.
So, you know, there's many stories.
I guess the other delightfulstory I have was a very
(20:27):
excellent GP who wasactually a father of a child,
adult child with intellectualdisability who said
to me once, Nick, I thoughtthis was a waste of time
until I started doing it.
And I kept picking up things
and I thought, yeah, that's right.
You know, even, even the very best.
And he was one of the very best, you know,
we can miss stuff and it's helpful.
I guess finally, I want toreiterate the point is actually
(20:51):
it's a wonderful way ofbonding the team together,
the health and thedisability team together.
And we know from the work wedid getting better respect
and understanding aboutwhat each other can provide.
And we found this in the studies,
we found much greater people wanting
to do this than you would've expected.
And I used to present thesestudies internationally
(21:12):
as a love in the time ofrandomized control trials
because it's not usual whenyou're doing this chart
of measurement research,
which randomized control trialsare that you get this love.
But in fact it connected people.
It made them really focuson the person they're really
concerned about and and doing a better job
and feeling more confident
and respectful of eachother, which is fascinating
(21:33):
and not necessarily easy
to measure, but it was definitely there.
Yeah. And hugely important.
Absolutely, hugely important. Yep.
- Nick, in saying that, I know
that we did have oneclient actually that needed
to get their ears checked
and their doctor actually hadto send them to a specialist
because they couldn't out themselves.
So yeah, that was also we hadfrom one of our clients too.
(21:54):
- Yeah, we also know fromsome of the stuff that we,
it generates our referralsto Allied Health for example.
A whole bunch of allied healthis increased as a consequence
and things are addressed
that previously wouldn't be addressed.
The other point I'd makeif you let me is, you know,
often obvious things can easily be missed.
You know, I've seen people with
(22:14):
fractures that have been missed.
I've seen people withepilepsy that have been missed
and you know, it soundslike terribly bad practice,
but these things happenand we know they happen.
So it can pick up, absolutelypick up those things
and drive people to dothings to, for clinicians
and staff to actually goa bit of a step further
and get better healthcare for the person.
(22:35):
- I also just wanted to point out as well,
I completely agree with that
and some people are nonverbal,
some people also have suchlarge pain tolerance as well
that we might not be awarethat anyone is even in pain,
someone that we're looking after.
So having a CHAP
and going to the doctorwhen someone is nonverbal
(22:55):
and not being able to express certain pain
that they're in can come out in a behavior
of concern as well.
So that's one thing I alwayssay, when there is a behavior
of concern that's taking place,
there's always a reason behind it.
So I would really recommendanybody that is unaware
of why a client is maybeacting out in a certain way,
(23:16):
maybe even go and utilize the CHAP as well
and go to the doctor.
There might be an underlying issue that
that can help find out.
- Yeah, I think that'sa really good point PA
and I'd say, you know,it's not so that so much
that often behaviors whenyou're doing in the field
of disability, they're oftendoing behavioral assessments,
got a behavioral assessmentprocess going on.
(23:37):
But in fact, rule number one
of doing a behavioral assessmentis make sure there's not an
underlying health condition.
And that's absolutelyembedded into all training
around behavioral staff and approaches.
I mean I, I'd say that it's not
that they've got a pain threshold,
but in fact that they've actually,
it's a communication threshold
that we can't interpret the communication,
which is the communication.
(23:58):
I'm in pain. I might beexpressing it in ways
that you don't recognize, but I'm in pain
and I've seen that too many times
unfortunately over the years.
- And it brings it back to the point
that you made early on today, Nick,
about the CHAP improvingcommunication by having that tool
that can prompt the conversation.
Yeah. And look at differentways of picking things up
that may not be necessarilyverbally communicated.
(24:19):
And with the wax issueI was thinking as well,
like it's a issue for learningbut also for communicating.
If they can't hear properly,
they may not understandnecessarily the question, you know,
and so yeah, very, very interesting.
Yep. Near our end, I would like
to know if you have any advice
for disability service providers
that are interested in usingthe CHAP in their organization.
How would they go about it and what tips
(24:40):
and tricks can you give thembased on your experience?
- I would 100% recommendit to any other provider.
I think that early intervention
and early stage detection
of any health issue isa huge priority for us.
I believe that the collaborationis absolutely huge.
(25:00):
As in saying before as well, the one tips
and tricks I would recommendwould be communicating
with the doctor's office,with the receptionist
as Nick also relayed beforewith the practice manager.
I think that was really, really great.
And as well, communicatingwith the families,
with the stakeholders,it's really fantastic,
especially when clientsare having behaviors
(25:22):
and concerns throughout the whole process
because the staff havesuch great understanding
of the clients too, whichwas really fantastic.
But with the reports that were received
and all of the clients
and what we had found out inregards with the vaccinations,
certain blood tests that were needed,
it was 100% relevant and required.
(25:42):
And we will be usingthis within the next year
and kind of using it
and incorporating it everyyear through the CHAP,
through our, throughlivability care is one thing
that we decided we're super,super happy with the progress
and with all of the informationthat we've received.
- Thank you. Paige, would you like
to add anything to that, Nick?
- Yeah, look, actually thething that struck me first was
(26:03):
actually the supportworkers on the ground in the
disability services.
My experience is theyreally want to do a good job
and this actually helps themdo a good job, you know,
and people embrace it
because it helps them actuallydo a really good job and, and,
and make the person's life better as well.
I guess the other thing from amore systems point of view is
what we've found over the years is
(26:25):
that the service providershave re-looked at some
of the things they do andevaluated their systems.
One of the ones that come to mind is one
of the organizations earlyon looked at, looked at what,
what happened and realizedthat one, they needed
to actually really be careful
and much more careful aboutproviding medications in the way
that what they were doing in medications.
And I mean, that's really crucial.
(26:47):
We know that the wrong, theinappropriate use of medications
or getting medications wrongis a disaster for people,
whether you're intellectuallydisabled or not actually.
So it's generated this systemchange within providers,
which I think has been really,really positive as well.
And I guess the, I mean theultimate thing is that there,
we now know, there's beena couple of circumstances
(27:08):
where the CHAP has been pointed to
because it hasn't been done
and there was actually aservice provider was held
to account, you know,eventually in the Supreme Court.
And one of the things the judgment pointed
to is if you'd done ahealth assessment to CHAP
and done a epilepsy management plan,
maybe this consequencewould not have happened.
And also there's been some dreadful deaths
(27:29):
where had they had a healthreview, maybe it would,
the outcomes would've been different.
So there's kind of thegovernance level responsibility
that disability serviceproviders, I think have in terms
of their duty of care.
- Yeah, absolutely. So itbecomes more of a question
that can you afford not
to do it essentially whenyou've got a duty of care.
Yeah. Yeah. That's very, very important.
(27:49):
Is there anything else thateither of you would like
to highlight that maybe we didn't cover
as part of today's conversation?
- Yeah, I, I've got, Imean people need to know
that the CHAP is now available
through the health department website
and there's the adultversion, which is 18 beyond,
which is the first work,but only recently we've just
released the young person CHAP,
which is from 12 to 18 year olds.
That's freely available.
(28:10):
This age group is a particular concern
because often what you find is children
with intellectual disability
and developmental disabilityare supported by pediatricians,
whether it's in the privatesystem or the public system.
And because they're seeinga pediatrician, they tend
to disengage to some degree
with their GP in the primary care setting.
(28:31):
And then of course thepediatricians are going,
or what do I do when they become adults?
And if people do a yearly annualhealth assessment using the
young person CHAP, it'llreconnect them back into the
primary care sector,
which will set them upwell going into adulthood.
And that the difficulty oftransitioning into adulthood,
but everybody faces,
but possibly more difficultfor people with disabilities.
(28:51):
So the young personCHAP is again available.
All you've got to do, andI've done it many times,
is put CHAP department of healthand you'll get the website
and be able to download it.
And then the other thing is
that we're also got a reallyexciting project within the
Commonwealth Governmentwho I'm working for
where digitalizing theGP part of the CHAP.
And this is, this soundssimple, but it's not,
(29:14):
and it's possibly a couple of years
before that will be readily available,
but it will be probably in a couple
of years time embedded intothe desktop computer system
of general practices so thatit'll make it even easier
for GPS to do it.
The first part of the CHAP,
which is the history gathering part
of it will remain in a hardcopy that can be a writeable PDF
(29:35):
and sent to the gps.
But the second part will be part
of all the software packagesthat are available to
through Australia, possiblyin, I think in 2026.
It's looking at the moment.The other advantage this is
that it actually can actually be even more
crafted for the individual.
So that if you're a doctrine,
you're seeing somebodyhas an unusual syndrome
that you've never heard of,say part of Willie syndrome,
(29:55):
it can prompt you
to look at particularthings for that syndrome.
If it's all done electronically,
- That's amazing and thathas huge potential in terms
of scalability as well.
And just ease of use for thegp, like it's all right there
and across practices.
That's incredible news, Nick,congratulations and good news.
Well, before we closeanything else, Paige?
Any last thoughts?
(30:17):
- I did have one morethought just in regards
with talking about whatI would probably say
to another provider.
It would just be in regardsof looking at the CHAP.
It is a large document,
but I don't want that toever scare anybody off
of looking at all these pages.
So I think one thing as well just
to be looking at is the fact
that our healthcare workers work so hard
(30:39):
and they're here in thefield because they want to help
and they want to support their clients.
I started off as a support worker myself,
and to be honest,
I probably spent more time atthe house doing sleepovers,
active nights than Iprobably spent at home
with my real family.
So they become family, theybecome people that you're
so important and close to
(31:00):
that this document can really help if not
save someone's life.
So anyone,
especially in this fieldshould be more than happy
to put their hand up to fillthis out and go to the doctor.
So I couldn't emphasize that enough.
- Thank you so much Paige. And I think
that does fall in linewith a lot of the findings
that we're seeing at NDSwithin the sector where one
(31:20):
of the key healthchallenges for people living
with a disability is accessingthe primary healthcare
and navigating it effectively.
So I definitely think
that using the CHAP could goa long way in improving the
health outcomes of thepeople that we're serving.
Well, without further ado,I'd like to thank you both
so much for joining ustoday in this podcast.
I also want to say to anyone listening,
if you're interested in usingthe CHAP in your organization,
(31:43):
we will make the linksavailable in the description
of the podcast as well sothat you can access them.
And if there's anything else,feel free to contact NDS.
We have contact details in the description
as well for your reference.
Thank you both so much forjoining us and see you next time.
(32:06):
- This podcast has beenproduced with the support
of the Victorian Department of Health.
- Hello everybody.
My name is Lou Zamanilloand I'm a Senior Policy
and Project Officerworking at the National
Disability Services.
I want to welcome youall to today's podcast
where we're going to be talkingabout the comprehensive annual
Health Assessment Program,better known as the CHAP.
Firstly, I'd like to start byacknowledging the traditional
owners of the land in which we stand on.
In my case, that when wrong
(00:31):
and Wadawurrung people, I paymy respects to elders past,
present, and acknowledgethat land was never seeded.
So why are we here today?
We know from evidence that we need
to improve poor health outcomes for people
with a disability in Australia,the Australian Institute
of Health and Welfare, people
with a disability in Australia 2022 report
and the 2024 report identify adults
(00:53):
with a disability are six times as likely
as those without a disabilityto assess their health as fair
or poor with people living with a severe
or profound disability reportingpoor health almost nine
times higher and 13 timeshigher in 2024 than those
who do not have a disability.
Along with that, the NDIS Quality
and Safeguards Commissionhas identified completion
(01:14):
of a regular comprehensivehealth assessment
for people living with adisability to improve detection
of health needs, enable activemanagement of those needs,
and reduce health risksand poor health outcomes.
The commission also states
that disability providers are required
to monitor participanthealth, safety, and wellbeing
and supports participantsto maintain their health
and access appropriate health services.
(01:35):
In that sense, the CHAPtool supports this annual
requirement for people withan intellectual disability
with specific tools for adults
and a new release for youngpeople age 12 to 18 years old.
Today we're joined byProfessor Nick Lennox
and Paige Tehan to talk about the CHAP.
Nick Lennox is trained as a GP
and has worked for 28 yearsproviding medical services,
education and research about adults
(01:57):
with intellectual disability.
He's an honorary professor atthe University of Queensland
and a former directorof the Queensland Center
for Intellectual andDevelopmental Disability.
He conceived and led the work on the
development of the CHAP.
Paige brings over eight years
of experience in the disability sector
and is currently workingas a service manager
for Livability Care Australia.
Paige holds certificationsunder community services,
(02:20):
disability, travel and tourism,
and is currently completingher certificate in leadership
and management outside of work.
Paige is a strong advocate formental health, volunteering
for Beyond Blue to help thecommunity raise awareness.
I'd like to start with Nick.
Nick, can you please tellus a bit more about the CHAP
and maybe starting from startis what is the CHAP? The
- Chap is a process,actually it's a tool to try
(02:43):
to improve the health of
people with intellectual disability.
And it does this by decreasingthe many of the barriers
to good healthcare andI can talk about that.
So it, it is essentially abooklet that improves access
and gets people to see theirGP for not an acute problem,
but to come and reviewwhere they are in terms
of their health and ratherthan focusing on a particular
(03:04):
illness but gets peopleto think about, okay,
these are the things that we need
to think about going forwardand have we missed anything.
So it gives access to thatkind of review appointment,
which is quite different fromthe usual way that people go
and see their gp.
It also then gathers theessential part of healthcare,
which is gathering areally good health story.
(03:26):
See when you go and see your doctor
and indeed lots of other professionals,
we need a really good storyto understand what's happened
to you in the past andwhat's happening to you now.
And for people withintellectual disability,
this often is not easy to gatherand actually is often lost.
And so it tries to get a completepicture of what's going on
(03:49):
and has gone on for this personand present it to the GP and
or the practice nurse to review it
and ask supplementary questions.
So it actually changes, kind of supports
what we know is a gap in termsof that broader knowledge.
And it's really true
that if we don't have thiscomprehensive knowledge of
how the person is experiencing health
(04:09):
and what has happened to them in the past,
it makes it very difficult toactually one, make a diagnosis
of an underlying conditionor even to go forward
and do a really appropriate management.
So the first part of theCHAP gathers that story.
It also by its very nature,increases communication
and builds relationship
(04:30):
because you're going to bewith somebody for a period
of time and that buildsa better relationship.
And we know from the research we did,
in fact when people were beingdeinstitutionalized from an
institution and meeting anew GP for the first time,
it very much decreased theanxiety both for the gp,
the person with intellectual
disability and the support workers.
'cause they suddenly hadsome time to actually talk
(04:52):
to each other, understandeach other's needs and
and do their job the best
that they possibly could in that time.
The next thing that the, the CHAPter does,
it actually picks up unmet health needs.
And it does this througha couple of things.
It actually in the middleof it says these are things
that are commonly missed or poorly managed
and this is education for theperson with intellectuality
(05:14):
but also for their supporters,
whether they're familymembers or paid supporters
and also for the GP or the practice nurse
because they don'tnecessarily know this stuff.
And it's laid out inevery straightforward way.
That means that people couldjust look down this list
and say, I really should look at this.
For example, constipation maybe
there and I haven't picked it up.
(05:34):
And, and for peoplewith and their families
and supporters, it also says to them,
if you are worried about these things,
that's a really valid concern'cause here's a university
and expert saying thisis a common concern.
So it empowers them to do that.
So it's providing education
and then I like to think
of it in a supportiveway is it says to GPS
(05:54):
and practice nurses
and nurse practitioners actuallyin this particular area,
here's a little bit ofinformation you didn't know about.
One example is we usually expect people
to think about the cause
of somebody's intellectualdisability in childhood.
And that's kind of the end of it,
but it's not the end of it actually.
There's things you shoulddo if the cause is unknown
and most GPS and practice nurseswouldn't be aware of that.
(06:17):
So it provides some information about that
and in a supportive way
and an encouraging wayrather in a disempowering
or disrespectful way.
And it also provides somespecial information about
syndromes and associatedmedical condition with syndromes
and the classic example of thyroid disease
and down syndrome, whichis relatively common,
but there's a whole lot of other things.
For example, epilepsy goesto, its various people
(06:38):
that have a syndrome orcause of a disability
and it's important thatgps are aware of that.
And finally it tries to do thepiece that's really developed
and that is to say, okay,we've done this big review,
these are the things weneed to do going forward
and I as the GP thinkwe should be doing this.
And you as a support workeror a person with a disability
(06:59):
or a family, this is what you need to do
to make sure these things happen.
And in the simplest form itmay be, oh my god, I found
that you've got lots of wax,which is actually a very common
common finding and you knowyou need to take these drops
and we need to fix thatup in a more complex way.
Maybe you need to go andhave some blood tests
or some investigationsand come back and see me
because that joining together
(07:21):
and that shared mission iskind of set up going forward.
And that's a really important part
of getting really good healthcare,
but they're the kindof things that it does.
- Thank you so much for that Nick.
It definitely sounds likea really valuable tool,
especially considering
that oftentimes I thinkboth in the disability
and the health sectors, we canfall into silos And it sounds
(07:42):
like the CHAP in a way is a tool
to really improvecommunication between sectors
but also to clearly communicatewith the people living
with disability, theircarers or family members
and that everybody has kind
of this big picture about thehealth needs of the person,
not just at this point in time
but along the person's life,
which sounds like an an incredible tool.
Thank you so much for that.Nick Paige, I'd be interested
(08:04):
to know how did youfind out about the CHAP?
- I found out about the CHAPwhen I was working in Darwin in
the Northern Territory for anon-for-profit organization.
I was working as a supportedindependent living coordinator
and my quality
and practice manager at the time,
Justin Smedley actuallybrought it to our attention.
(08:25):
- Excellent. And I think it'dbe very interesting for us
to know from a disabilityservice provider perspective,
what was the reason behindyou starting using it
and deciding to to uptake it?
- When the CHAP was broughtto our attention, we did a lot
of research on it
and we found that usingthe CHAP was really great
for early stage detectionand also prevention.
(08:46):
Looking at the CHAP,
it also provides a really greatdetailed health assessment.
It's also individualized
and very person centered to each client
and it tailors reportsfor each client as well.
- So I'm thinking you foundthat very useful from a service
provider's perspective tohave that level of granularity
and insights in terms of thehealth needs of your clients.
(09:07):
- 100%. Especially when we've got
so many clients in differenthouses all across a certain
city or a certain state.
It's great to have such awell presented health tailored
program individualized for each client.
- Thank you so much for that Paige.
This CHAP sounds like a great tool.
There's no doubt thatthere's many benefits
to its application,
but I'm curious to know whatchallenges have you found exist
(09:29):
for the CHAPs implementation?
- One challenge I personallyfound is since talking
to team leaders
and service coordinators hereat livability care was the
lack of education
of doctor's awareness onthe CHAP was probably one
of the biggest things that we had.
- Yeah, yeah, no, I mean itit is quite difficult to get
(09:50):
that kind of awareness up.
That's true. And you know to, for many gps
they would see this is a very,
very small population eventhough we're talking about half a
million Australians actually.
And there's, you know, big sense
of them not necessarily identifying this
population in their practice.
So there's a a reality in
that the gps are more familiar actually
(10:11):
with geriatric health screening than
and indigenous health screening I
think than now with this group.
So it is, it is been an ongoing battle
to get that awareness up.
My suggestion is the thing
that actually made theresearch work was it was really
people with disabilitiesand their families
and supporters who didthe promotional work.
It needs to come from, you know,when you think about who's,
(10:33):
if you think of your ownhealth, who's most important,
who's most concerned about your own health
and that's you largely and
therefore if you want
to change things it's got to come often.
You know, you've got to drive it yourself.
And that was true to getthere, the studies done,
it was driven by people with
disabilities and their families.
So as much as governmentscan do as making it aware,
(10:54):
I think it's actually saying to your GP
and going, okay, we knowthis good Australian evidence
that this actually workswe know and look at.
So I think it relies on the services
and service providers topromote it very strongly.
And also families of courseand people with disabilities.
- One thing we also did as well,since we were getting a lot
of information back fromstaff, we would make contact
(11:17):
with the receptionist as well.
So after having a conversationwith them, we decided
to then send them an emailwith the PDF of the CHAP
so the doctor could actuallybe aware of what it's,
and they could have timeto read the information
before we also attended themeeting with the clients
as well, which I think alsomade a really big difference.
(11:39):
- That's really interesting Paige.
And did you find that yougot a good response from the
health services in terms ofbeing open to reading it
and reducing that pressure ofthe time constraints of having
to do everything at that15 minutes? You know?
- Yeah definitely.
We had some really great feedback as well
as when some doctors wouldread it, they would also do to
extend the appointment too.
(12:00):
And they did, some doctors hadsome gratitude board saying,
you know, thank you forsending this through,
this is really interesting.
And just really appreciated the fact
that we making them awareof what the appointment was
for prior as well.
- That's really interesting. Paige, Nick,
do you have any commentson like talking about time
constraints, we knowthat we're quite limited
(12:20):
by the current model thatonly lasts for 15 minutes.
Do you have any comments on that
or how to manage that inthe context of the CHAP?
- Yeah, look, I mean I thinkthat people have got to realize
that there's times in generalpractice that are really busy.
You never do this on a Monday or Friday or
before the doctor's about
to go on leave the lastweek in general practice
before we go on leave is a nightmare.
(12:41):
So I think negotiating with the practice,
like I was brilliant pageraised the receptionist,
the receptionist in my experienceis the key person often in
the practice that's not the gps
but there's also practice managers
and if there's practicemanagers, I'd be talking
to the practice managers
and saying to them,look, we want to do this.
(13:01):
How does it best work for you?
You know, we know everybody knows I
think, or if they don't they should know.
The biggest concern the GPS have is their
restraint around time.
It's the toughest job I've ever had.
You're often chasing your tail.
You know, when you have acoffee break you're usually
reviewing re results,you never break actually.
(13:22):
You just go on
and there's firstlynot a GP in the country
that wouldn't work later than they're
actually meant to work.
It's a very intense, so respectingthe constraints on which
they have and actually reachingout as service provider say,
how can we make this work best for you?
Tell me, you know, wewant to make this work best
because we know it's a, it's a tough thing
to do and hard to do. Well,
(13:43):
- Thank you Nick.
I think you raised some importantpoints in terms of, again,
going back to the main challengeabout GPS being quite time
poor and of course they have10 other priorities to look at.
And from what you weresaying at the beginning,
disability is probably not front
and center in their mindsor things like the CHAP.
So in that sense, I think youhave both raised importance
of advocacy and raising that awareness
(14:03):
with simple tools such aslike emailing it in advance,
you know, and scheduling theappointment at that time.
That's not like peak hour.
Would you add any otherstrategies for success?
I think if they, if thepractice has a practice nurse,
it's really crucial.
A lot of the CHAP can bedone by the practice nurse.
The second part of the CHAPwould be done by the check
and it can be set up.
(14:24):
I used to work in New Zealand
where every practice had a practice nurse
and so they could see theperson do the weights,
the height test, the visiona whole, a whole bunch
of things, blood pressure,et cetera, et cetera.
And then just line it up for the gp.
Say okay, you think about whatabout this, what about this?
And you can go through and often
and in a very good practice, you know,
you work really closelywith each other in that way.
(14:47):
And I mean it's often,in fact in the literature
around elderly healthassessments, patients prefer
to see the nurses thanthe GPS in that area.
And often they're, youknow, you can speculate
of all the different reasons for that
but you know, it can kind
of make it user friendly And I've found
with a practice nursethat they will often do
that linkage stuff very well
(15:07):
and provide extra support,have a bit more time,
you know, to do things.
So I think that's anotherreally, if it's a practice
that's got a practice thatI'd be definitely talking
to them as well.
- That's really useful Nick,thank you for raising that.
And it brings back theimportance of collaboration
and really playing to eachof the sector strengths.
Mm. And working together toimprove outcomes in that sense.
(15:30):
I'd be interested to know whatoutcomes you have seen Paige
from implementing theCHAP in your organization.
- Yeah, sorry, I just want totouch on about the collaboration
as well because I thinkthat's super important.
The CHAP is here tohelp and support clients
but at the same time thecollaboration of the staff,
the families, all thedifferent stakeholders
(15:50):
that were involved was just fantastic.
And I think that's something
that built everyone closertogether without even acknowledging
or realizing it as well.
So I think that's really super important
to touch on as well.
In regards with what I had seenfrom implementing the CHAP.
So currently LivabilityCare Australia have
(16:11):
around 55 clients whoSouth Australia, Victoria
and also Queensland.
We have done about, Iwould say 65% in our care
with intellectualdisabilities have finished
and finalized the CHAP.
So we still have around 30to 35% more to go ahead.
We have had absolutely fantasticreviews come back from our
(16:33):
team leaders, from our service managers,
service coordinators, familiesat the clients themselves,
which has been fantastic.
The feedback we havereceived in the reports,
which we're also going to bemaking sure that we utilize
and continue doing itin the following year.
So we can also use that asa module to look back on
(16:53):
and see how they're goinguse that as a report And
as within a tool, what I have found
and the information receivedwas clients not being up
to date with vaccinations.
That was a very large number of clients
that we had received, whichwas fantastic results for us
to be able to get them up to date
(17:14):
with their vaccinations as well.
We had a lot of referralsprovided for our clients.
Whether that is, for examplewe've, I had one client
that was referred to get an eye test
and they needed glasses.
So this whole timethey've been in our carer,
it was something that we were unaware of
that they needed to wear glasses.
We had a lot of bloodtests for clients done
(17:36):
and one client in particularwe had found out had diabetes
as well, which, which is probablyone of the biggest things
that we had found out through the CHAP.
This person does get regularblood tests every so often from
what is recommended from the doctor.
But when the CHAP wasreceived they thought okay,
like looking at the results,looking at some things
(17:57):
that the staff has alsowritten down in this report,
I think it's best that we goand get another blood test
and that's when we found outthat information as well.
So it just goes to showthat the CHAP is super,
super important
and without using this maybe
that's something wemight not have found out
and we found out further down the track.
- Yeah, absolutely. These arevery important health issues
(18:19):
that imagine if they goundiagnosed, you know,
they can have significant implications.
Nick, you also mentioned ear wax
as something coming up quite often.
- Yeah, earwax is actually,
the research was the mostcommon finding blocking up
people's ear and it kind
of sounds trivial like ifyou're kind of rating things,
but in fact people withintellectual disabilities have
problems learning by definition.
(18:40):
And we mainly learn byseeing and hearing actually,
and you very commonly find which they
can't see or hear properly.
And, and Paige has justmentioned exactly that situation
and then we have them in the context
of dis disability support organizations,
you often have peoplehave behaviors of concern
and how do you manage behaviors,concern, you learn stuff
(19:01):
and you and you need to beable to see and hear properly.
So what is seemingly a relativelytrivial thing can actually
be, has a major impact on people's lives.
I mean the other common ones
that we find is likeimmunizations are very common
and other health screens thatweren't done so has the person
now had was a pap smearin the research now,
(19:23):
but now it's a, can be aself-administered smear
to make sure they don't have cancer.
Breast examinations don't happen.Generally it's population.
And in my career I've beenon many mortality review
committees where breast canceris picked up very, very late
and the most appropriate person to check
that is actually the GP fora whole bunch of reasons.
Obviously if the person can'tcheck it for themselves.
(19:46):
The other things that we found in
over the years when I've talked about it,
we found reflux esophagitis.
I've also had GPS come tome saying they've done CHAP
and they've found lymphomapicked up epilepsies,
picked up melanomas and other things.
So it does do that kind ofbacks up the GP in terms
of picking up things that you may miss.
(20:06):
'cause it's very easy not to see things.
I mean the other thing we saw was scended
test were picked up.
Now this again, youthink is that important?
That's just really important.Increases your cancer risk if
you don't have your test ispicked up if they haven't gone
into the, actually gonedown into the scrotum.
So, you know, there's many stories.
I guess the other delightfulstory I have was a very
(20:27):
excellent GP who wasactually a father of a child,
adult child with intellectualdisability who said
to me once, Nick, I thoughtthis was a waste of time
until I started doing it.
And I kept picking up things
and I thought, yeah, that's right.
You know, even, even the very best.
And he was one of the very best, you know,
we can miss stuff and it's helpful.
I guess finally, I want toreiterate the point is actually
(20:51):
it's a wonderful way ofbonding the team together,
the health and thedisability team together.
And we know from the work wedid getting better respect
and understanding aboutwhat each other can provide.
And we found this in the studies,
we found much greater people wanting
to do this than you would've expected.
And I used to present thesestudies internationally
(21:12):
as a love in the time ofrandomized control trials
because it's not usual whenyou're doing this chart
of measurement research,
which randomized control trialsare that you get this love.
But in fact it connected people.
It made them really focuson the person they're really
concerned about and and doing a better job
and feeling more confident
and respectful of eachother, which is fascinating
(21:33):
and not necessarily easy
to measure, but it was definitely there.
Yeah. And hugely important.
Absolutely, hugely important. Yep.
- Nick, in saying that, I know
that we did have oneclient actually that needed
to get their ears checked
and their doctor actually hadto send them to a specialist
because they couldn't out themselves.
So yeah, that was also we hadfrom one of our clients too.
(21:54):
- Yeah, we also know fromsome of the stuff that we,
it generates our referralsto Allied Health for example.
A whole bunch of allied healthis increased as a consequence
and things are addressed
that previously wouldn't be addressed.
The other point I'd makeif you let me is, you know,
often obvious things can easily be missed.
You know, I've seen people with
(22:14):
fractures that have been missed.
I've seen people withepilepsy that have been missed
and you know, it soundslike terribly bad practice,
but these things happenand we know they happen.
So it can pick up, absolutelypick up those things
and drive people to dothings to, for clinicians
and staff to actually goa bit of a step further
and get better healthcare for the person.
(22:35):
- I also just wanted to point out as well,
I completely agree with that
and some people are nonverbal,
some people also have suchlarge pain tolerance as well
that we might not be awarethat anyone is even in pain,
someone that we're looking after.
So having a CHAP
and going to the doctorwhen someone is nonverbal
(22:55):
and not being able to express certain pain
that they're in can come out in a behavior
of concern as well.
So that's one thing I alwayssay, when there is a behavior
of concern that's taking place,
there's always a reason behind it.
So I would really recommendanybody that is unaware
of why a client is maybeacting out in a certain way,
(23:16):
maybe even go and utilize the CHAP as well
and go to the doctor.
There might be an underlying issue that
that can help find out.
- Yeah, I think that'sa really good point PA
and I'd say, you know,it's not so that so much
that often behaviors whenyou're doing in the field
of disability, they're oftendoing behavioral assessments,
got a behavioral assessmentprocess going on.
(23:37):
But in fact, rule number one
of doing a behavioral assessmentis make sure there's not an
underlying health condition.
And that's absolutelyembedded into all training
around behavioral staff and approaches.
I mean I, I'd say that it's not
that they've got a pain threshold,
but in fact that they've actually,
it's a communication threshold
that we can't interpret the communication,
which is the communication.
(23:58):
I'm in pain. I might beexpressing it in ways
that you don't recognize, but I'm in pain
and I've seen that too many times
unfortunately over the years.
- And it brings it back to the point
that you made early on today, Nick,
about the CHAP improvingcommunication by having that tool
that can prompt the conversation.
Yeah. And look at differentways of picking things up
that may not be necessarilyverbally communicated.
(24:19):
And with the wax issueI was thinking as well,
like it's a issue for learningbut also for communicating.
If they can't hear properly,
they may not understandnecessarily the question, you know,
and so yeah, very, very interesting.
Yep. Near our end, I would like
to know if you have any advice
for disability service providers
that are interested in usingthe CHAP in their organization.
How would they go about it and what tips
(24:40):
and tricks can you give thembased on your experience?
- I would 100% recommendit to any other provider.
I think that early intervention
and early stage detection
of any health issue isa huge priority for us.
I believe that the collaborationis absolutely huge.
(25:00):
As in saying before as well, the one tips
and tricks I would recommendwould be communicating
with the doctor's office,with the receptionist
as Nick also relayed beforewith the practice manager.
I think that was really, really great.
And as well, communicatingwith the families,
with the stakeholders,it's really fantastic,
especially when clientsare having behaviors
(25:22):
and concerns throughout the whole process
because the staff havesuch great understanding
of the clients too, whichwas really fantastic.
But with the reports that were received
and all of the clients
and what we had found out inregards with the vaccinations,
certain blood tests that were needed,
it was 100% relevant and required.
(25:42):
And we will be usingthis within the next year
and kind of using it
and incorporating it everyyear through the CHAP,
through our, throughlivability care is one thing
that we decided we're super,super happy with the progress
and with all of the informationthat we've received.
- Thank you. Paige, would you like
to add anything to that, Nick?
- Yeah, look, actually thething that struck me first was
(26:03):
actually the supportworkers on the ground in the
disability services.
My experience is theyreally want to do a good job
and this actually helps themdo a good job, you know,
and people embrace it
because it helps them actuallydo a really good job and, and,
and make the person's life better as well.
I guess the other thing from amore systems point of view is
what we've found over the years is
(26:25):
that the service providershave re-looked at some
of the things they do andevaluated their systems.
One of the ones that come to mind is one
of the organizations earlyon looked at, looked at what,
what happened and realizedthat one, they needed
to actually really be careful
and much more careful aboutproviding medications in the way
that what they were doing in medications.
And I mean, that's really crucial.
(26:47):
We know that the wrong, theinappropriate use of medications
or getting medications wrongis a disaster for people,
whether you're intellectuallydisabled or not actually.
So it's generated this systemchange within providers,
which I think has been really,really positive as well.
And I guess the, I mean theultimate thing is that there,
we now know, there's beena couple of circumstances
(27:08):
where the CHAP has been pointed to
because it hasn't been done
and there was actually aservice provider was held
to account, you know,eventually in the Supreme Court.
And one of the things the judgment pointed
to is if you'd done ahealth assessment to CHAP
and done a epilepsy management plan,
maybe this consequencewould not have happened.
And also there's been some dreadful deaths
(27:29):
where had they had a healthreview, maybe it would,
the outcomes would've been different.
So there's kind of thegovernance level responsibility
that disability serviceproviders, I think have in terms
of their duty of care.
- Yeah, absolutely. So itbecomes more of a question
that can you afford not
to do it essentially whenyou've got a duty of care.
Yeah. Yeah. That's very, very important.
(27:49):
Is there anything else thateither of you would like
to highlight that maybe we didn't cover
as part of today's conversation?
- Yeah, I, I've got, Imean people need to know
that the CHAP is now available
through the health department website
and there's the adultversion, which is 18 beyond,
which is the first work,but only recently we've just
released the young person CHAP,
which is from 12 to 18 year olds.
That's freely available.
(28:10):
This age group is a particular concern
because often what you find is children
with intellectual disability
and developmental disabilityare supported by pediatricians,
whether it's in the privatesystem or the public system.
And because they're seeinga pediatrician, they tend
to disengage to some degree
with their GP in the primary care setting.
(28:31):
And then of course thepediatricians are going,
or what do I do when they become adults?
And if people do a yearly annualhealth assessment using the
young person CHAP, it'llreconnect them back into the
primary care sector,
which will set them upwell going into adulthood.
And that the difficulty oftransitioning into adulthood,
but everybody faces,
but possibly more difficultfor people with disabilities.
(28:51):
So the young personCHAP is again available.
All you've got to do, andI've done it many times,
is put CHAP department of healthand you'll get the website
and be able to download it.
And then the other thing is
that we're also got a reallyexciting project within the
Commonwealth Governmentwho I'm working for
where digitalizing theGP part of the CHAP.
And this is, this soundssimple, but it's not,
(29:14):
and it's possibly a couple of years
before that will be readily available,
but it will be probably in a couple
of years time embedded intothe desktop computer system
of general practices so thatit'll make it even easier
for GPS to do it.
The first part of the CHAP,
which is the history gathering part
of it will remain in a hardcopy that can be a writeable PDF
(29:35):
and sent to the gps.
But the second part will be part
of all the software packagesthat are available to
through Australia, possiblyin, I think in 2026.
It's looking at the moment.The other advantage this is
that it actually can actually be even more
crafted for the individual.
So that if you're a doctrine,
you're seeing somebodyhas an unusual syndrome
that you've never heard of,say part of Willie syndrome,
(29:55):
it can prompt you
to look at particularthings for that syndrome.
If it's all done electronically,
- That's amazing and thathas huge potential in terms
of scalability as well.
And just ease of use for thegp, like it's all right there
and across practices.
That's incredible news, Nick,congratulations and good news.
Well, before we closeanything else, Paige?
Any last thoughts?
(30:17):
- I did have one morethought just in regards
with talking about whatI would probably say
to another provider.
It would just be in regardsof looking at the CHAP.
It is a large document,
but I don't want that toever scare anybody off
of looking at all these pages.
So I think one thing as well just
to be looking at is the fact
that our healthcare workers work so hard
(30:39):
and they're here in thefield because they want to help
and they want to support their clients.
I started off as a support worker myself,
and to be honest,
I probably spent more time atthe house doing sleepovers,
active nights than Iprobably spent at home
with my real family.
So they become family, theybecome people that you're
so important and close to
(31:00):
that this document can really help if not
save someone's life.
So anyone,
especially in this fieldshould be more than happy
to put their hand up to fillthis out and go to the doctor.
So I couldn't emphasize that enough.
- Thank you so much Paige. And I think
that does fall in linewith a lot of the findings
that we're seeing at NDSwithin the sector where one
(31:20):
of the key healthchallenges for people living
with a disability is accessingthe primary healthcare
and navigating it effectively.
So I definitely think
that using the CHAP could goa long way in improving the
health outcomes of thepeople that we're serving.
Well, without further ado,I'd like to thank you both
so much for joining ustoday in this podcast.
I also want to say to anyone listening,
if you're interested in usingthe CHAP in your organization,
(31:43):
we will make the linksavailable in the description
of the podcast as well sothat you can access them.
And if there's anything else,feel free to contact NDS.
We have contact details in the description
as well for your reference.
Thank you both so much forjoining us and see you next time.
(32:06):
- This podcast has beenproduced with the support
of the Victorian Department of Health.
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