STUDENT HEALTH AND

WELFARE FORUM

HEALTHY CAMPUSES FOR STUDENT

HEALTH AND WELLBIENG

UNSW HEALTH SERVICE

DR BILL KEFALAS –DIRECTOR

JULY 29 TH 2013

UNSW HEALTH SERVICE – BACKGROUND

ESTABLISHED LATE 1962

CURRENT PREMISES FROM 1989

ORIGINALLY FOR FIRST AID AND

MEDICAL AND SURGICAL PROBLEMS

SUPPORT FROM PRINCE HENRY

HOSPTIAL

LONG TERM VISITNG PSYCHIATRISTS

AND ORTHOPAEDIC SPECIALIST

DENTAL CLINIC IN SAME AREA

EXPANDED GRADUALLY TO 8

CONSULTING ROOMS AND LARGE

TREATMENT ROOM

PATIENT VISITS STEADY 2003-11 AT

14,000 TO 17,00 PA

2012 – 25,900 VISITS

2013 – AIMING AT 34,000 VISITS

SIR PHILLIP BAXTER

VICE CHANCELLOR -1955-69

DR NAPTHALI – FIRST MEDICAL

DIRECTOR

Charles Shuttleworth (Jim) Smith

(1908 – 2001)- Caricatures

UNSW HEALTH SERVICE – THE SERVICE

DILEMNA

• CURRENT ENROLMENTS – 52,000 – STAFF 5,500

• CHINESE STUDENTS INBOUND – 6,000

• PEAK TEACHING DAYS –MONDAY TO THURSDAY – 60-

62,000 BOOKED FOR CLASSES

• CURRENT SPLIT OF TYPES OF VISITS TO HS – 40%

LOCAL STUDENTS – 40% O/SEAS STUDENTS -20% STAFF

• 2014 RESIDENT STUDENT POPULATION – 4400

• INCREASED EMPHASIS ON CAMPUS LIFE QUALITY –

RESIDENCES – SECURITY – RETAIL – CONVENIENCE –

HEALTH CARE

• UNSW WANTS TO MARKET HEALTH SERVICE AND 24

HOUR CARE + CHINESE MEDICINE CENTRE

• CURRENT SERVICES AT CAPACITY AND UNABLE TO

EXPAND

• PLANS TO MOVE TO NEW LARGER PREMISES WITHIN

UNI BUT WHEN???

• OPPORTUNITIES TO IMPROVE INTEGRATION AND LEVEL

OF SERVICES

MENTAL HEALTH – CURRENT PRACTICE

AND ISSUES

• APPROX 12-15% OF VISITS – DIFFICULT TO QUANTIFY DUE TO RECORDING ISSUES –

ROUGHLY 3 PATIENTS PER DOCTOR PER DAY

• MOSTLY DEPRESSION AND OR ANXIETY –MIXTURE OF LONG TERM AND ADJUSTMENT

DISORDERS

• ROLE OF HS VARIES BETWEEN PRIMARY PROVIDER, MEDICATION SUPPLIER TO ADMIN

TYPE ROLE FULFILLING MEDICARE CRITERIA AND CERTIFICATION

• PSYCHIATRISTS ATTEND 2 DAYS A WEEK – BOOKED UP 3-4 WEEKS IN ADVANCE

• NO MENTAL HEALTH NURSE NOW DUE TO BUDGET CONSIDERATIONS- EXAMPLE OF

BUREAUCRATIC ISSUES CONSTRAINING SERVICE

• NO ONSITE PSYCHOLOGISTS AS HAVE CAPS SERVICE UPSTAIRS FROM CLINIC AND UNI

PSYCHOLOGY DEPT STUDENT LED CLINIC

• INTERNATIONAL STUDENTS DISADVANTAGED FINANCIALLY AS MANY OUTSIDE

PROVIDERS DO NOT “ BULK BILL “ VIA PRIVATE INSURERS

• LANGUAGE AND CULTURAL BARRIERS- ISOLATION – STIGMA - POOR AWARENESS

INTEGRATION OF MENTAL HEALTH CARE

CAPS - UNSW – PART OF STUDENT LIFE AND LEARNING

(SLL) UNDER PVC STUDENTS ( DVC ACADEMIC)

SERVICE PRESSURES ++ FOR CAPS-

1998 – 8 COUNSELLORS – 25,000 STUDENTS

2012 --10.5 COUNSELLORS -- 52,000 STUDENTS

SLL RUN MENTAL HEALTH RESILIENCE PROGRAM –

STUDENTMINDS@UNSW

SAFETY AND WELLBEING TUTORIAL FOR NEW STUDENTS

EMPHASIZE PREVENTION AND THAT UNSW CANNOT BE THE

PRIMARY MENTAL HEALTH PROVIDER FOR STUDENTS

CROSS REFERRALS BETWEEN CAPS AND UNSW HS

NO COMMON ICT FRAMEWORK AND DIFFICULT TO SHARE

INFORMATION – PRIVACY AND PERMISSION PROBLEMS

SPORADIC MEETINGS BETWEEN COUNSELLORS AND DOCTORS

AND NO FORMAL CASE DISCUSSIONS AND MANAGEMENT

MENTAL HEALTH – POSSIBILITIES

• PROVIDE LOCAL SERVICES WITHIN UNI HS

• OWN PSYCHOLOGISTS AND MENTAL HEALTH NURSES

• ALLOWS EASIER ACCESS FOR LONG TERM THERAPY

• ALLOWS FOR DIRECT BILLING WITH OSHC INSURER -

• EXPAND CAPS TO INCLUDE LONGER TERM PSYCHOLOGICAL SERVICES PROVIDERS

UTILIZING MEDICARE AND INSURER INCOME TO SUPPLEMENT SERVICE COST’

• EXPAND ROLE OF MENTAL HEALTH NURSE – FUNDING OPPORTUNITIES VIA OSHC

INSURERS AND COMMISSION PAYMENTS

• REDUCE DEMAND – INCORPORATE RESLIANCE PROGRAMS MORE DEEPLY INTO

UNIVERSITY LIFE

• IMPROVE CARE COORDINATION ACROSS SERVICES IN DIFFERENT MANAGEMENT

ORGANIZATIONS – CASE CONFERENCING – COMMON ICT

• MINIMIZE THE DIFFERENCES IN FOCUS AND SERVICE DELIVERY BETWEEN AGENCIES

• GIVE A UNIFIED COHERENT MESSAGE TO STUDENTS

SEXUAL HEALTH-- CURRENT ISSUES

• OVERALL HIGH RATES REFLECT COMMUNITY PROBLEMS-

STEADY INCREASE OVER PAST DECADE – BOTH IN TESTING AND

INFECTION RATES

• BASIC MESSAGE FROM HS IS STILL – GET TESTED – WEAR

CONDOMS – TAKE CARE WHEN DRINKING

• ACCESSABILITY AND BARRIERS-

• SAME DAY SERVICE AND DROP IN SERVICE DIFFICULT TO MANAGE’

• PRIVACY WITHIN HS IN NURSE CLINIC (TREATMENT ROOM) AN ISSUE

• POOR KNOWLEDGE OF SOME O/SEAS STUDENTS WRT BASIC “SEX

EDUCATION ”

• CLINICAL SOFTWARE NOT ABLE TO ID GLBTI PATIENTS ACCURATELY

• MIXED MESSAGES TO O/SEAS STUDENTS’ PARENTS CONSIDERING

PLACEMENT OF THEIR CHILD

SEXUAL HEALTH – STRATEGIES

• CURRENTLY INVOLVED IN JOINT PROMOTION

WITH HUB (SLL) AND LOCAL HEALTH DISTRICT –

DARE TO SCORE CAMPAIGN

• INCREASE STUDENT DRIVEN HEALTH

PROMOTION WITHIN UNIVERSITY – ARC AND

WELLBEING AMBASSADORS

• POC TESTS – CHLAMYDIA AND HIV

• IMPROVE ACCESSABILITY – SEXUAL HEALTH

NURSES, MORE DROP IN APPTS

• IMPROVED PHYSICAL ENVIRONMENT

ALLOWING PRIVACY

PHYSICAL HEALTH– ISSUES

• WIDE VARIETY OF DEMANDS –

RESP ILLNESS –

SKIN PROBLEMS

GASTRO –H PYLORI – BLEEDING

MUSCULO-SK- POSTURE AND STUDY RELATED

INJURIES ,WOUNDS

UNUSUAL AND RARE ILLNESS COLLECT AT UNI –

RETURNED TRAVELLER – BBV- TROPICAL EXOTIC ILLNESS

VACCINATIONS AND TRAVEL MED

• DIFFERING CULTURAL PERSPECTIVES WRT BODY CONCEPTS AND BELIEFS

• HEALTH SYSTEM AND INSURANCE KNOWLEDGE OF O/SEAS STUDENTS

• INCREASED ANXIETY RE HEALTH AS OFTEN LONELY ISOLATED POOR SUPPORT AND

FEAR

HEALTH SERVICE CHALLENGES

FINANCIAL PRESSURE – BUDGET CUTS-

-- EXECUTIVE ATTITUDES

MEETING EXPECTATIONS OF STUDENTS AND STAFF

COORDINATING CARE

WITHIN-

PART TIME DOCS

SWAPPING PATIENTS

TEAMWORK ISSUES

WITHOUT –

OTHER SERVICES WITHIN AND OUT OF UNI

MEETING DEMANDS –

INCREASING ON CAMPUS POPULATION

INCREASING MENTAL HEALTH SERVICES

AFTER HOURS CARE

BEST PRACTICE FOR HEALTH SERVICES

VISIBILITY AND ACCESSIBILITY

CURRENTLY MID CAMPUS LOCATION (GOOD) BUT NOT EASILY SEEN

GETTING MESSAGE OUT TO DISPARATE GROUPS AND FACULTIES

INFORMATION DISTRIBUTION – OVERLOAD SITUATION FOR MANY

USE OF SOCIAL MEDIA – FACEBOOK, TWITTER, WEIBO, WEB RESOURCES

INTEGRATION WITH OTHER STUDENT SERVICES

CURRENT STRUCTURE IS WITHIN MANY SILOS

MORE MANAGEMENT LEVEL COMMUNICATION AND FORMALIZED CONTACT

PROCEDURES

CONSIDER BRINGING ALL HEALTH AND WELLBEING SERVICES UNDER ONE

ROOF

INTEGRATED CARE

ALL IN ONE BUILDING – ALL IN ONE SERVICES- SINGLE DESK

TRIAGING AND CASE COORDINATORS

INCREASING USE OF NURSING AND MEDICAL ASSISTANT STAFF TO OPTIMIZE DOCTORS

TIME

eHEALTH SYSTEM – PCEHR – APPLICATION TO STUDENT HEALTH

NATIONAL eHEALTH RECORD SYSTEM

• Personal health summary

• Personal health notes

(not available to

providers)

• Advance care directive

custodian

• Emergency contact

• Medicare services (MBS

& DVA)

• Prescription information

(PBS & RPBS)

• Immunisations (ACIR)

• Donor details (AODR)

• Shared health

summary

• Event summary

• Discharge

summary

• Specialist letter

• Referral

Healthcare professional or organisation

Medicare

Patient

• Child eHealth record

• National prescribed and

dispensed repository

(NPDR)

• Advance care directives

UC DAVIS STUDENT HEALTH AND COUNSELLING SERVICES

UNIVERSITY OF CENTRAL FLORIDA HEALTH SERVICES

STUDENT HEALTH SERVICES - STRUCTURES

COMMUNITY CONTROLLED ABORIGINAL HEALTHCARE MODEL

• CATER FOR DROP IN AND APPTS

• PATIENTS SEE “ CLINICIAN” – REMOTE RN- AHW – PRACTICE NURSE – DOCTOR

• USE OF STANDARDIZED TREATMENT PROTOCOLS –”CARPA MANUAL”

• DOCTORS USED FOR DIFFICULT CLINICAL CASES – SCRIPTS – PT PREFERENCE

• ALLOWS MORE FLEXIBILITY AND MORE EFFICIENT USE OF LIMITED MEDICAL

RESOURCES

• FUNDING MODEL PROBLEMATIC FOR STUDENT HEALTH APPLICATION

MEDICAL ASSISTANT MODEL AS USED IN USA.

• IN ITS INFANCY IN AUSTRALIA – INITIAL USE IN QUEENSLAND

• TRAINING OF EXISTING PRACTICE STAFF

• REDUCTION OF ADMIN TIME FOR DOCS- HIGHER THROUGHPUT

• BETTER SERVICE FOR O/SEAS STUDENTS WITH LANGUAGE/SYSTEM

KNOWLEDGE ISSUES –

THANK YOU

FOR YOUR

TIME