Paediatric Psychology Support, Training and Supervision Services
Many have been reflecting on this in recent months. I have been particularly interested in this topic as I opened the doors of Peninsula Paediatric Psychology in between 2 lockdowns in June 2021. Opening a clinic had been something I had debated for a few years, should I or should I not. As I opened the doors, I did not anticipate such a flow of referrals. Since then, we have grown the team, from just me, working alone in the cottage last year, to now, 10 clinicians and 4 admin and management staff.
We have steadily grown by simply meeting demands…
It has indeed been a crazy year!
It took me a few years to make the plunge after our relocation from the UK to Australia. There was always an intention to open a private practice but a number of barriers or contributing factors led to wait and wait…until last year. I asked myself so many times, will this be ok, am I making the right decision, what if…
I have been very surprised at the flow of demands since I opened and reflected on why there is such as demand and a shortage of psychologists at the moment. Clearly the pandemic has not helped but it is not that simply…
Increase of sessions on Better Access – 10 to 20
In covid, there was an acknowledgment by the government that the population would need additional mental health support so there was an increase of sessions rebatable on the Better Access Medicare program. This increase had been lobbied for a long time as needed for better client outcomes but had never been implemented until then. This created a significant increase in sessions clients accessed by a psychologist. It is unknown as to whether these 20 sessions will stay past the 31st December 2022.
Telehealth – offering alternative ways of working
In addition, Telehealth was implemented as a possible mode of service delivery. This mode had only been allowed in the past for rural/regional clients. This mode of delivery then increased accessibility for sessions and alternative ways to deliver services. This also allowed psychologists to review their ways of working to meet their family commitments. This mode of delivery has now been agreed to stay.
Skilled Migrants Stuck Overseas
For the 2 to 3 years, many skilled migrants whom applied for a visa to come to Australia could not come during the covid lockdowns/international arrival closures. Many bureaucratic challenges emerged as a result and delayed arrivals of skilled migrants when Australia has relied on this workforce for may years.
Retirement of the 4+2
Ahpra has announced the retirement of the training route 4+2 where last provisional psychologists were agreed onto this program in June 2022. This is the end to opportunity for psychology graduates to embark on a 2 years internship. This has been a decision made prior to the pandemic started but will have a significant impact on the workforce if no additional training places are funded in universities for the Masters in Professional Practice (MPP) and other Masters routes. Typically, graduates who chose the 4+2 route did because of the challenges related to finance internship and studies so unless significant funding is injected into training, it is possible we will see a big impact on graduates completing a psychologist training route.
During the 2-3 years, as the workforce is dominated by females, there have been some noticeable shifts of working patterns so that psychologists can combine a number of demands such as home learning, parenting, childcare, and supporting their own family needs.
Work-Life Balance and Choices
As a result, there may have been clear decisions made about work-life balance such as reducing workload, working on specific days, reducing hours, or branching out to different work to reduce the emotional load of session work. Telehealth and the online market booming allowed this to happen and for psychologists to explore other type of work.
Being sick and Recovering
Having covid and other illnesses have also increased absenteeism and rescheduling of sessions and assessment work. Isolation, sickness from children and families as well as clinicians has been particularly impactful since January 2022, with many being sick due to colds and flu in the last few months. The recovery time from these illnesses may have been impacted by time taken to recover after a few illnesses, as well as full households being sick.
Victoria Hit Hard
Victoria was clearly hit hard during the pandemic with so many days in lockdown, home learning with a clear impact of isolation and mental health challenges. Children keep talking about it in counselling sessions and the repercussions are still very real. Similarly, the impact on learning has been observed in assessments where children are clearly struggling to engage and participate at school, even now.
Families also tried to keep it together during these lockdowns and may now feeling like what happened, where have I been, and reevaluating life goals and future.
Has the paediatric allied health professionals been more particularly impacted by this shortage?
Although parents and children have engaged well with Telehealth, and have accepted it as being a good mode of service delivery, many also report that with a paediatric population, it can only be a short term solution as children engage so much better face to face. Many children and adolescents with socio-communication and language needs express not wanting to engage in this mode of psychological support, and prefer face to face sessions. Parents are engaging well with this type of support for initial consultations and parenting support, even preferring it due to busy lives and many commitments. However, it does not fully support the children and adolescents themselves.
Assessments can also not be done solely on Telehealth. Although there have a number of suggestions and changes to how we can use some psychometric tools, there is still an element of the work that would be not ethical and professional to do solely on Telehealth. This has therefore created a backlog of assessment work as many assessments had to be paused during lockdowns.
In between lockdowns and when clinics reopened, there was a significant flow of demands for assessments. These are time consuming and requiring lots of time and dedication, and cannot be done quickly and simply. Subsequent cancellations due to illnesses also delayed processes as many became sick with covid, flu, colds this winter.
We have heard so many parents talking about 12 to 24 months waitlist in the public sector and private settings to the point they were about to be giving up on support. We cannot let families give up on support when early intervention and preventative work is so important for children and adolescents.
A Tired Workforce
All of these contributing factors have led to a tired workforce, with many deciding to reduce hours and reviewing their work aspirations. It is not just one or 2 factors but a range of factors which have contributed to where we are now. We have seen so much sickness in recent months, after the lockdowns due to covid, many have had to recover from covid as well as the flu, colds, etc., not only the clinicians themselves but full families impacted by illness which have delayed recovery, getting back to work and getting on top of needs and demands.
All of this combined has created a tired workforce and there are no signs of relief in sight…Indeed, the APS and AAPPI
Here are additional readings from these organisations on the current situation:
Solutions that can be imminently implemented:
Support to internship in workplaces, offer pay packages and supervision support
Allow a rebate for provisional psychologist under Medicare
Increase in training places in range of psychology disciplines – also see https://3ppsychologies.com/2022/09/18/sunday-reflections-misinformation-risks-to-perpetuate-the-inequality-of-disciplines-in-psychology/
Increase skilled migrant places in psychology and simplify the process for highly skilled psychologists
Create stability in the workforce by giving reassurance about rebates, training places, and funding