South Western Sydney Local Health District Research Articles

Implementing routine paediatric height/length and weight screening and weight management advice by clinicians: an evaluation

ObjectiveTo determine the views of health care professionals (HCPs) in South Western Sydney Local Health District (SWSLHD) about the effectiveness of implementation strategies used to increase routine height/length and weight screening, advice, and referral for children and adolescents. A secondary aim was to explore the prevalence of weight bias among HCPs.MethodsA questionnaire was sent to all HCPs who had undertaken online or face-to-face training between December 2018 and June 2020 in SWSLHD (n=840). The questionnaire collected data on their experience of routine height and weight screening and the effectiveness of strategies used in the implementation. It also included a weight bias assessment. Data were provided by the New South Wales (NSW) Ministry of Health on the performance of routine height/length and weight measures entered into the electronic medical records (eMR) in SWSLHD.ResultsOf the 840 questionnaires sent, 87 were undeliverable; of the remaining 753, 285 were returned (38% response rate). More than half (53%, 151/285) of the participants were nurses. Most HCPs agreed that there was a need for routine screening and reported that education, training, and access to resources were the most helpful implementation strategies. Most HCPs were confident in performing routine screening but were less confident in raising the issue of weight with children and their families. Barriers to implementation were lack of time, equipment, appropriate clinical setting, and HCPs’ perceptions and beliefs about obesity.ConclusionRoutine screening is the first step in identifying children and adolescents at risk of overweight and obesity, but many HCP found it challenging to incorporate into daily practice. Multifaceted strategies are effective in increasing routine screening across diverse healthcare settings so that children and adolescents receive timely and appropriate intervention.

Behavioural ‘nudging’ interventions to reduce low-value care for low back pain in the emergency department (NUDG-ED): protocol for a 2×2 factorial, before-after, cluster randomised trial

IntroductionOpioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and...

Outcomes for young people in out of home care accessing tiered mental health services in Sydney, Australia.

Young people in OOHC have complex mental health concerns, therefore the South Western Sydney Local Health District (SWSLHD) has trialled a tiered model of mental health care. Under this model the OOHC mental health team (OOHC-MHT) provides specialist tier four service delivery for those with the most severe, intense mental health needs. OOHC consumers with a reduced level of severity access services at a tier three centre-based iCAMHS. This study aims to understand the characteristics of young people in OOHC accessing different service provision options in Sydney, Australia. Sixty-six OOHC consumers 8-17years accessing mental health services across SWSLHD from January 2020-December 2021 participated in the study. Group differences in OOHC-MHT and iCAMHS outcome measures were compared. HoNOSCA scores were significantly worse for OOHC-MHT than iCAMHS, indicating more severe psychopathology for OOHC-MHT at baseline. In OOHC-MHT, HoNOSCA decreased significantly from admission to discharge and scores on the CGAS increased significantly, indicating significant improvements in psychopathology and functioning. In the iCAMHS group scores on the HoNOSCA significantly decreased indicating improved psychopathology over this period. These findings support a tiered model of service delivery for OOHC consumers, with this tailored level of care resulting in significantly improved outcomes across a range of complexity.

Management of acute appendicitis during the COVID-19 pandemic: a retrospective cohort study

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic profoundly impacted delivery of health care. South Western Sydney Local Health District (SWSLHD) experienced some of the highest cases, admissions and deaths during the Delta and Omicron waves in New South Wales. This study aims to determine the impact of the pandemic on emergency surgery services for adults presenting with acute appendicitis.MethodsA retrospective review of patient records was performed of adults presenting with acute appendicitis between 1st March 2021 and 31st March 2022, which was compared to a pre-COVID control period of the same dates in 2019–2020. Patients managed operatively or conservatively were included.Results1556 patients were included in the operative arm; 723 and 833 respectively in the study and control groups, which were comparable at baseline. 1.66% were COVID positive. During the pandemic, patients were significantly more likely to be investigated with computered tomography (CT) scan (p ≤ 0.001), present with complicated appendicitis (p = 0.03), and require caecectomy (p = 0.005). They had higher American Society of Anaesthesiology (ASA) scores (p = 0.001) and significantly lower negative appendectomy rates (p = 0.001). Fifty-two patients were included in the conservative arm; 29 and 23 respectively in the pandemic and control groups. Patients were comparable at baseline. There were two COVID positive patients. During the pandemic, there was a significant reduction in complications (p = 0.033), readmissions (0.044) and interval appendicectomy (p = 0.0044).ConclusionWe identified higher rates of complicated appendicitis, caecectomies and greater reliance on CT imaging preoperatively during the pandemic in SWSLHD.

Towards an effective collaboration between the South Western Sydney Local Health District and local councils: insights from a qualitative study

BackgroundPartnership between local government and local health districts is imperative, given their overlapping goals. However, the need for further evidence-informed actions to address health inequities remains. The effectiveness of such partnerships requires better insight into how local governments perceive partnerships with local health districts, and how well equipped and prepared they are to deal with the health equity opportunities and challenges. It was precisely for these reasons that a qualitative study was conducted by South Western Sydney Local Health District (SWSLHD) in 2016.ObjectiveThis study aims to better understand how to improve the effectiveness of collaboration between local governments and the public health sector.MethodsQualitative data were collected from 14 in-depth interviews with staff representing five of the local councils comprising SWSLHD. These data were then thematically analysed using inductive and deductive reasoning through the application of NVivo software.ResultsWhile councils recognize the potential value of consulting SWSLHD, limited communication and the absence of a clearly defined process for collaboration needs to be addressed. Moreover, councils perceive knowledge gaps in relation to basic issues, such as who provides what services to whom, and how to access local-government-level data from health experts.ConclusionsThe study confirms the importance of providing locally relevant public health data to help address issues of mutual concern that arise during the consultation process. Moreover, it suggests that proactive and ongoing consultation between SWSLHD and councils is critical if there is to be effective engagement, and coordinated and sustained action. The concerns raised in this study echo findings from studies from other local government settings of Victoria, South Australia and New South Wales. Thus, the study findings may be applied to other councils beyond the SWSLHD.

An exploratory study protocol examining if assertive integrated service delivery better meets the psychosocial and mental health needs of young people in out of home care

Young people in Out of Home Care (OoHC) have complex mental health and psychosocial needs due to a range of individual, systemic and intergenerational factors that may limit the effectiveness of usual clinic-based services. To address this, in 2017 an assertive-integrated service (AIS) model of care was adopted by the Child and Adolescent Mental Health Service (CAMHS) in South Western Sydney Local Health District (SWSLHD), Australia, through outreach to the young person in the community. This paper outlines the study protocol comparing AIS with clinic-based CAMHS usual care to meet the physical, mental health and wellbeing needs of young people in OoHC. Using routinely collected outcome data, the AIS model will be compared to clinic-based CAMHS treatment as usual care. Measures of overall functioning (e.g. Global Assessment Scale [CGAS]), psychological functioning (e.g. Strength and Difficulties Questionnaire [SDQ]), general health and social functioning (e.g. Health of the Nation Outcome Scales for Children and Adolescents [HoNOSCA]) and other relevant socio-demographic and clinical variables will be collected at intake and at 3-month intervals until discharge from the respective services. Semi-structured interviews will also be conducted with young people, their carers, and service providers, to examine qualitative themes about the suitability of service provision. It is expected that a better understanding of the key indicators of functioning for young people accessing AIS and clinic-based services will help inform what works for these young people so that they can receive targeted and tailored support from the start of service engagement.

Creutzfeldt-Jakob Disease in South West Sydney 2014–2020: An Unusually High Incidence of a Rare Disease

Introduction: Creutzfeldt-Jakob disease (CJD), a spongiform encephalopathy, caused by a transmissible misfolded cellular prion protein, is a rapidly progressive, debilitating neurodegenerative disorder with no effective treatment. The estimated global incidence is at 1/million inhabitants. This retrospective study examined the incidence of CJD in South Western Sydney Local Health District (SWSLHD) from 2014 to 2020. Background: SWSLHD had an estimated population of 1,038,534 in 2020, with CJD data being limited. Methods: The New South Wales (NSW) Health Information Exchange (HIE) database, for all admissions with CJD diagnoses in SWSLHD, between 2014 and 2020, was reviewed according to the WHO diagnostic criteria, consistent with the Australian national CJD registry. Only probable CJD cases were included. Incidence was calculated based on the projected SWSLHD population. Results: Thirty-five patients, diagnosed with CJD, were identified. Each was evaluated by 2 independent investigators, including clinical presentation, MRI, EEGs, 14-3-3, and RT-QuIC results, before assigning CJD-probable status. Four failed the CJD criteria and were excluded. Of the 31 CJD-probable cases, most (59%) were male and older (37%, range 61–70 years). The incidence rate peaked at 9/million in 2017 and was above 2/million, throughout the 7 years, with an average of 4.859/million/year. Conclusions: The incidence of CJD, in SWSLHD, exceeds the national average of 1/million. Cost-effective, adequate diagnostic and screening tools, implementable over a large population, will become increasingly essential.

Public Health Unit notifications of hepatitis C and their follow-up in South Western Sydney, Australia.

To determine hepatitis C virus (HCV) treatment rates among those newly diagnosed with the virus in the South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Cross-sectional study of patients newly diagnosed with HCV in SWSLHD, based on local Public Health Unit notification data from the second half of 2017. A total of 200 consecutive notifications were enrolled in the study. Either the ordering clinician was interviewed, and/or data linkage with local hospital records performed, to determine rates of antiviral treatment in this cohort. Outcomes measured included the proportion of patients: started on antiviral treatment; referred to specialists for consideration of treatment; HCV ribonucleic acid (RNA) negative; and lost to follow-up. Descriptive analysis of factors contributing to those lost to follow-up was performed where available. The follow-up outcome of 93% of patients was traced. General Practitioners (GPs) diagnosed a similar number (102) of new HCV cases to those diagnosed by specialists (94). After detecting a patient as HCV antibody positive and confirming active infection, GPs preferred to refer patients to specialists (53%), rather than further evaluate and treat patients themselves (5%). The remainder of cases from the GP-detected group were lost to follow-up (26%), or HCV RNA negative (16%). Among the speciliast-detected patients, 41% were treated, 18% were lost to follow-up, 20% were RNA negative and the remainder were not treated for reasons including a concurrent diagnosis of hepatocellular carcinoma, or death. The most common reason patients were not started on antiviral treatment was loss to follow-up. We found that less than half (47%) of people in South Western Sydney newly diagnosed with HCV, in whom treatment was indicated, received antiviral medication in the 12 months following diagnosis.This figure excludes the 25% cases referred from general practice to specialists, in whom the treatment status is unknown. Approximately one in five newly diagnosed patients (22%) were lost to follow-up and 18% were RNA negative, indicating they had no active HCV infection.

Contemporary Management of Coronary Stent Embolisation: Southwestern Sydney Local Health District Experience

Contemporary Management of Coronary Stent Embolisation: Southwestern Sydney Local Health District Experience

Characteristics and outcomes of patients receiving Hospital at Home Services in the South West of Sydney

BackgroundHospital at home (HaH) provides acute or subacute care in a patient’s home, that normally would require a hospital stay. HaH has consistently been shown to improve patient outcomes and reduce health care costs. The characteristics and outcomes of patients receiving HaH care across the South Western Sydney Local Health District (SWSLHD) has not been well described. This project aimed to describe the characteristics and outcomes of HaH services across the SWSLHD.MethodsThe characteristics of patients referred to HaH between January 2017 and December 2019, the indications for HaH, and representation rates to hospital emergency department (ED) will be presented.ResultsBetween January 2017 and December 2019 there was 7118 referrals to the local health district’s (LHD) HaH services, among 6083 patients (3094 females, 51%), median age 56 years (Interquartile range (IQR), 40–69). The majority of indications for HaH were for intravenous venous (IV) medications (78%, n = 5552), followed by post-operative drain management (11%, n = 789), rehab in the home (RiTH) (5%, n = 334), bridging anticoagulant therapy (4%, n = 261), and intraperitoneal medications (1%, n = 100). The requirement for presentation to an ED for care, while receiving HaH only occurred on 172 (2%) of occasions. The average length of HaH treatment was 7-days (IQR 4–16). Rates of presentation to ED for HaH patients have decreased since 2017, 3.4% (95% CI 2.7–4.2%), 2018 2.1% (95% CI 1.5–2.8%), and 2019 1.8% (95% CI 1.3–2.4%), p-value for trend < 0.001.ConclusionHospital at Home is well established, diverse, and safe clinical service to shorten, or avoid hospitalisation, for many patients. Importantly, avoidance of hospitalisation can avoid many risks that are associated with being cared for in the hospital setting.

Breast reconstruction in South Western Sydney.

The rates of breast reconstruction in Australian patients of culturally and linguistically diverse (CALD) backgrounds are currently unknown. This retrospective study determined the rate of breast reconstruction in women who had mastectomy as treatment for breast cancer at public hospitals in South Western Sydney Local Health District (SWSLHD) - a culturally diverse health district in New South Wales, Australia - and compared the rate of reconstruction in the CALD and non-CALD populations. The demographic and clinical data of all female patients who had mastectomy with or without reconstruction for treatment of breast cancer at the five public hospitals in SWSLHD between January 2006 and December 2015 were obtained from the clinical information department of each hospital and from electronic medical records. The average rate of reconstruction in SWSLHD was 9.4% for 2006-2015. Although the reconstruction rate was higher among English-speaking women (9.9%) compared to women from a CALD background (8.6%), the difference was not statistically significant (P = 0.57). The type (autologous versus implant) and timing (immediate versus delayed) of reconstruction did not differ between groups (P = 0.19 and P = 0.22, respectively). The Index of Relative Socio-Economic Disadvantage was not significantly associated with reconstruction (P = 0.74). However, younger patients were more likely to have reconstruction (P < 0.0001) and patients with adjuvant therapy were more likely to have a delayed reconstruction (P = 0.01). This study found a low breast reconstruction rate in public hospitals in SWSLHD. The reconstruction rate did not differ between CALD or English-speaking patients, or between patients from diverse socio-economic backgrounds.

Delirium in intensive care: A stepped-wedge cluster randomised controlled trial for a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the intensive care unit (protocol)

BackgroundDelirium is an acute disorder of attention and cognition with the highest rates among adults receiving intensive care. An acute episode of delirium is associated with morbidity and mortality, as well as a significant psychological sequela. Importantly, an increasing body of evidence supports the benefit of nonpharmacological, nurse-led interventions to reduce the incidence and duration of delirium among adults cared for in the intensive care unit (ICU). ObjectivesThis study will evaluate the impact of a nursing-led delirium prevention protocol that is aimed at reducing the incidence and duration of delirium among adults admitted to the ICU. The delirium prevention nursing protocol specifically targets risk factors for delirium. Study planA stepped-wedge cluster randomised controlled trial approach will be used to assess the effectiveness of the nurse-led intervention, in four adult ICUs across the South Western Sydney Local Health District (SWS-LHD), over a 12-month period. The primary outcomes of interest are (i) the incidence of delirium before and after the implementation of the nurse-led intervention and (ii) the number of delirium-free days during an ICU stay, before and after the implementation of the nurse-led intervention. Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): (ACTRN12618000411246p)

Community health alliances as social enterprises that digitally engage citizens and integrate services: A case study in Southwestern Sydney (protocol).

South Western Sydney (SWS) is one of the fastest growing regions in the state of New South Wales (Australia). Much of the population live in local government areas (LGAs) with levels of disadvantage higher than the state average, with a predominance of non-communicable and chronic diseases that are typically associated with age-related and behavioural factors. This necessitates the management of social determinants of health through the integrated provision of primary and social care. The SWS Local Health District and Primary Health Network is exploring the potential of community health alliances (CHAs) as an innovative approach to support the provision of integrated health services. CHAs are a population health approach for addressing health challenges faced by people who share a common area of residence, sociocultural characteristic or health need, and are characterised by a shared mission, shared resource needs and acquiring/developing necessary organisational knowledge and skills. We explore how CHAs operate as social enterprises that utilise digital health and citizen engagement to deliver integrated people-centred health services (IPCHS) by conducting two case studies of CHAs operating in SWS: in Wollondilly and Fairfield LGAs. Using this approach, we aim to unpack the conceptual convergence that enables social enterprises to utilise digital health interventions and citizen engagement strategies to co-produce IPCHS with a view to developing theory and a framework for engaging digital citizens in integrated primary health care via social enterprise.

033 Cluster of creuzfeldt-jakob disease in the south western sydney local health district population in the past 5 years

IntroductionNoting a perceived increased case-load of Creuzfeldt-Jakob disease (CJD) patients at Liverpool Hospital, in the South-Western Sydney Local Health District (SWSLHD), the authors questioned the accepted death from CJD incidence of 1 per million.MethodsWe reviewed the District Health-Information-Exchange (HIE) database for all admissions with CJD diagnoses in SWSLHD hospitals, over a 5-year period 2014–2018. The SWSLHD services a population of 1,001,437. The HIE identified cases were reviewed according to World Health Organization (WHO) diagnostic criteria as used by the Australian national CJD registry. Definite and probable CJD cases were included in the study. Incidence per year was calculated from the final case number across the 5-year SWSLHD population.Results26 patients coded with a diagnosis of CJD were identified from HIE database over the period. These cases were critically reviewed and 20 confirmed as definite (n=4) or probable CJD (n=16) cases. The diagnoses of excluded patients (n=6) were herpes simplex encephalitis, paraneoplastic encephalitis, delirium, and 2 with progressive multifocal leukoencephalopathy. Calculated incidence based on 5-year SWSLHD population was 4.16 cases per 1 million population/year.ConclusionsIn the 5-year period, we note an incidence of definite and probable CJD cases in the SWSLHD population, four times the national and worldwide reported rates. Cases from the last 2-months of 2018 are pending at the time of submission, which may alter these observations. These findings most likely represent a cluster of cases in the SWSLHD area but may alternatively reflect either better recognition or increased incidence of CJD.

Cross-sectional study protocol for the Arabic Healthy Weight Project promoting active living and healthy eating among Arabic-speaking communities in South Western Sydney

IntroductionThe South Western Sydney Local Health District (SWSLHD) is home to nearly 75 000 Arabic-speaking people. Of these, nearly three quarters are overweight or obese and suffer from a range...

Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers.

Clinical trials play a critical role in advancing cancer care, but international research shows that few cancer patients, particularly culturally and linguistically diverse (CALD) patients, participate in trials. This limits generalizability of trial results and increases health disparities. This study aimed to establish rates and correlates of trial participation among CALD patients in South Western Sydney Local Health District (SWSLHD), a highly culturally diverse area. Data from all cancer patients diagnosed and/or treated in SWSLHD from January 2006 to July 2016 were analyzed retrospectively. The primary outcome was trial enrolment among patients born in non-English speaking countries (CALD) versus English speaking countries (non-CALD). Multivariable logistic regression evaluated CALD status as a predictor of trial participation. Moderators of trial participation by the different CALD groups, namely those whose preferred language was English (CALD-PLE) or was not English (CALD-PLNE), were examined by testing interactions between CALD status and other demographic and clinical variables. A total of 19453 patients were analyzed (54.9% non-CALD, 16.5% CALD-PLE, 18.5% CALD-PLNE). Overall, 7.4% of patients were enrolled in a trial. Trial participation was significantly lower in CALD patients than non-CALD patients (5.7% vs 8.4%; odds ratio [OR]=0.80; 95% confidence interval [CI], 0.69-0.91; P=0.001). CALD-PLNE patients were less likely to participate in trials than non-CALD (OR=0.45; 95% CI, 0.36-0.56; P<0.0001) and CALD-PLE patients (OR=0.53; 95% CI, 0.67-0.41; P<0.0001). Limited English proficiency seems particularly unfavorable to trial participation. Development and evaluation of strategies to overcome language barriers (e.g. simplified and translated multimedia participant information materials) is needed.

Mixing it up: private, public, federal, state, seeking health outcomes in an integrated primary care centre – the Oran Park Family Health experience!

Oran Park Town is located within the Camden Local Government Area of greater south western Sydney. This greenfield development forms part of the first stages of the South Western Growth Centre (SWGC), which over the next 30 years will see over 100,000 additional houses and up to 300,000 additional residents. At present, its population is 3000 people. South Western Sydney Local Health District (SWSLHD) has publicly declared that the future health needs of this growth corridor will be best met through progressive investment in evidence-based primary and ambulatory care, not more hospital beds. The establishment of an Integrated Primary Care Centre network is a key deliverable for this vision. Oran Park Family Health (OPFH) is the first manifestation of this vision, aiming to provide multidisciplinary evidence-based care that is patient-centred and team-based, whilst respecting autonomy and choice. The model implemented in south western Sydney is unique to New South Wales, involving a long-term partnership between the SWSLHD, South Western Sydney Primary Health Network (SWSPHN), Western Sydney University, General Practice and the sole landholder for Oran Park Town, representing a fresh approach to the formation of a private/public partnership in the primary health care sector. It is a model that has been funded through the SWSLHD capital budget to ‘fit-out’ a medical centre in the town centre (shopping complex), purpose built by the developer in direct consultation with SWSLHD and SWSPHN. It is a model that has employed an outcomes-based commissioning framework to procure a General Practice Enterprise, soon to be complimented by commissioned pathology, medical imaging and allied health services, working in a shared space with an existing cluster of District funded primary and community health services. Operating in a federated environment, it is a model that is dependent on the effectiveness of cascading lease arrangements between all parties (landlord, tenant and subtenants), service agreements based on anticipated service utilisation and the good will of independent operators to function under a mandatory Centre Management Committee. The purpose of this presentation is to reflect on our success to date whilst also sharing our lessons learnt as we try to bring our diverse range of partners on our journey to create a truly integrated primary, secondary and tertiary care environment in a localised context where success is the only available incentive. The presentation will also consider our challenges in moving into the next manifestation (Phase 3) of a comprehensive and multidisciplinary health facility operating as a genuine alternative to hospital-centric care.

Integrated Health Care – a population health approach in South Western Sydney

Introduction: Wollondilly Shire is a heterogeneous rural community (population 45,000) in the South Western Sydney growth corridor. The Wollondilly Health Alliance (WHA), a partnership between South Western Sydney Local Health District (SWSLHD), South Western Sydney Medicare Local (SWSML) and Wollondilly Shire Council (WSC), was established in 2013 to address increasing needs for health services in the region. In addition, the WHA includes local primary care providers, Non Government Organisations (NGOs), local community groups and business representatives. The aims are to develop, implement and evaluate models of integrated care that enable enhanced connectivity between providers of primary and secondary care, embed a population health approach to preventative health care and self-management with the long term aim of more efficient use of health services, appropriate use of emergency departments and avoid unnecessary admissions. This paper describes the methodology and evaluation framework adopted for this project, and the progress to date. Methodology: The 3 partners in the WHA agreed to share equally in the costs of the initial planning phases of a health plan based on integrated care principles. The planning phase includes a comprehensive needs assessment, survey of local residents, desk top analysis of local health data including data extracted from local general practices, and extensive face to face consultations with over 100 local health services providers and staff of NGOs, government, and community organisations. The needs assessment information collected and analysed will guide a strategy and priority setting workshop with representation from the local health care providers and community. The workshop will address what integrated health will look like in Wollondilly, what strategies need to be employed, who will be responsible and the resources required. The evaluation framework will be both formative and summative, describing the context, structures and mechanisms established to implement and evaluate the model(s) of care established by the needs assessment and workshop, indicators of access to and impact on the actors in the delivery and use of primary and secondary care services, and patient outcomes. Outcomes to date/Discussion: The data collected so far by the Comprehensive Needs Assessment identified 17 local priorities (broken into 3 categories of population cohort issue, World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116683– http://www.ijic.org/ health issue and system issue) that need to be addressed to move towards an integrated care system. These priorities arose from more than 500 surveys completed by local residents, contributions received from over 35 different providers, and representatives from the 3 levels of government in this region. The priorities set in the workshop will be addressed in the presentation. Author: SWS Integrated Health Committee 5 August 2014

From an initial idea to dissemination: a case study of novice practitioner research in South Western Sydney

This paper describes the work of practitioner researchers in South Western Sydney Local Health District (SWSLHD), undertaking a project investigating a unique Augmentative and Alternative Communication (AAC) intervention. We outline the journey from an initial, practitioner-generated research idea through to research implementation and dissemination. The research journey is described in terms of research processes recommended in current practitioner research literature. This case study shows that with appropriate support and guidance, practitioner researchers can identify, develop, and implement clinically relevant research projects to generate evidence for clinical interventions. Keywords: practitioner research; capacity building; community health; allied health; AAC (Published: 17 June 2014) Citation: Journal of Assistive, Rehabilitative & Therapeutic Technologies 2014, 2 : 23207 - http://dx.doi.org/10.3402/jartt.v2.23207