I CAN! consists of 7 primary clinical care components each with a uniquely innovative model of care offering evidence-based alternatives to hospitalisation:
Learn more about our PATH program
1. The Inclusive Community Model
I CAN! is developing an inclusive community based on integrating the following three highly successful community models: (1) The Hogeweyk Model, (2) The York Retreat Model and (3) The Blue Zone Commmunity Model.
De Hogeweyk, is a gated model village in Weesp, Netherlands, designed specifically as a care facility for elderly people with dementia. It has been a tremendous success with the residents all being much more active and requiring less medication. Carers, doctors and nurses provide the 152 residents the necessary 24-hour care. The Hogewey complex is set out like a village with a town square, supermarket, hairdressing salon, theatre, pub, café-restaurant—as well as the twenty-three houses themselves. This model has been extended to a similar model for people with acquired brain injuries in the USA and is being replicated for people with dementia in many places including Tasmania at present. I CAN! will include a Hogeway Model village for people with cognitive impairment whether due to developmental disorders, acquired brain injury or neurodegenerative conditions.
The York Retreat was established by Quakers in 1796 in the UK as a community for people with mental health related and/or physical disabilities could live literally ‘unchained’ (in an era where such physical restrictive practices were the norm) in an environment where meaning and employment, connection to nature, healthy diet and exercise, and connection to the other members of the community were all integral in the inclusive environment.
The Blue Zones are five communities in Japan, Greece, Italy, the USA and Costa Rica where people have been found to live much longer, happier and healthier lives than in other parts of the world. This is related to their approaches to diet, exercise, connection with each other, meaning in life that is facilitated by the principles of living in these communities.
2. The PATH Model of Care
The Preferred Alternative To Hospitalisation (PATH) programme is an integral part of the Institute for the Clinical Advancement of Neuroplasticity (ICAN) and represents a well-researched clinically and cost-effective means of producing positive clinical outcomes as an established alternative to hospitalisation model of care. Randomised Controlled Trials (RCTs) have demonstrated that this model of care can produce equal or superior clinical outcomes in many neurological and psychiatric clinical populations at a greatly reduced cost over traditional inpatient hospital stays, with increased patient satisfaction (Hawthorne et al, 1999; Hawthorne et al, 2005; Chau et al, 2013; Lichtenberg, 2011; Wattum et al, 2013; Hengeggler et al, 1999; Lyttle, 2002; Pericas et al, 2013). This model differs greatly from the Australian Med-hotel model in that it involves active treatment onsite and offsite of individuals who would otherwise require acute hospitalisation, rather than serving as a ‘step-up’ or ‘step-down’ service without active treatment.
The PATH programmes offer a residential alternative to hospitalization for voluntary adults who are experiencing a severe neurological or mental health crisis that cannot be managed on an outpatient basis.
PATH encompasses the following services: (1) short-term diagnostic assessment and second opinion service, (2) polypharmacy and pharmacological restrictive practices review, (3) complex need medication review implementation and de-prescribing service, (4) comprehensive health services, 5) complex restrictive practice review, (6) activities of daily living (ADL) optimisation, and (7) neuroplasticity-based active capacity building and mobility training using robotics, virtual reality and artificial intelligence. Onsite EEG monitoring, neurophysiology and sleep studies will also be bulk billed to Medicare. Residents’ discharge plans begin prior to admission, with staff assisting with linkages to resources in the community.
3. Day Hospital
Day hospital programmes will be established as an alternative to hospitalisation providing individual and group therapies for the following:
1. Acquired Brain Injury
2. Post-Traumatic Stress Disorder
3. Epilepsies
4. Developmental Disorders
Patients and families may stay at nearby hotels or commute from home and receive the same quality of care as if they attended a hospital.
4. Subspecialty Services
Health, Disability and Quality of life assessment and support will all include:
– Clinical assessment and diagnosis
– Treatment formulation and recommendations
– Complex case reviews, including review of treatment-resistant cases and diagnostic dilemmas
– Second opinions
– Tertiary advice and consultation services – to other clinicians, professionals and disability workers, including GPs, specialists, allied health professionals and disability-workers employed in the government and non-government sector.
– Education of clinicians and professionals, families and carers
– Translational Research and clinical trials
Health Services will specifically include:
– Behavioural Interventions
– Diagnostic services – EEG, neuro-imaging, specialised laboratory services, genetic testing, metabolic testing, investigation of sleep disorders
– Homeless services and outreach
– Neurology
– Neuropsychiatry
– Primary Care
– Psychiatry
– Psychology
– Rare Disorders
Disability Services will specifically include:
• Accommodation support
• Adult and community support services
• Advocacy
• Community care services
• Community living initiative
• Community mental health
• Driving assessment and vehicle subsidy
• Family and early childhood services
• Intensive behaviour support
• Local area coordination
• Mobile attendant care
• Respite services
• Support for school leavers
• Supporting families services
Quality of life assessment and support Services will include:
• Activities of Daily Living (ADL) support
• Homeless services and community outreach
• Occupational therapies
• Paralympic and Special Olympics
• Physiotherapy services
• Recreational therapy
• Sports
• Advocacy
• Medicolegal Consultations
The Institute will not deliver acute services but will focus on the delivery of tertiary care and chronic health and disability services. It will offer inpatient, outpatient, off-site clinical outreach and telemedicine assessments and follow up.
5. Telehealth Outreach
The TeleHealth component of ICAN!, will be the first network of its kind in the world, delivering essential life-saving integrated healthcare to people with acquired and developmental brain disorders, epilepsy, dementia and other neurodisabilities. It will use cutting edge telehealth technologies including AI, VR, haptic, holographic, high and low bandwidth options, robotics and advanced diagnostic facilities to address inequities for Australia’s most disadvantaged healthcare consumers, providing within two years essential life-enhancing services to the 4 million Australians with neurodisability. The more than one million people with neurodisabilities living in regional and remote areas, and the homeless will particularly benefit, conservatively saving more than $1 billion to the Australian healthcare system through preventive measures. I CAN! is well established already in its use for telehealth to remote areas of Australia and has the scalability to expand its technologies as well as expand its reach internationally through its extensive relationships with overseas centres of excellence, the World Health Organisation and World Bank Institute.
The technology, business model and integration of disability and health services make I CAN!’s telehealth a unique and innovative programme. It is be the first of its kind in the world offering integration of health and disability services using this technology. It will be transformative in dramatically improving the quality of lives of people with neurological disabilities, saving lives, empowering people with disabilities, improving health and well-being and increasing life span irrespective of an individual health participant’s geography. It offers an innovative solution for the marked inequities for people in rural and remote areas with no access to care.
6. The Integrated Lifestyle Medicine Model of Care
ICAN! will centre on a model of care based on holistic rehabilitation (Wade, 2009). ‘Rehabilitation services are focussed on improving a person’s well-being (quality of life) and reducing any distress, discomfort and risk associated with their illness’ (Wade, 2011, p398). This model offers a more holistic approach to an individual’s care going beyond the current understanding of illness, the more linear biomedical model (Wade and Halligan, 2004).
Lifestyle Medicine refers to an approach to analysing illness and providing healthcare that acknowledges and responds to all factors relevant to the health (or illness) of a person. The term itself does not dictate what those factors are or how they are classified. This use of the lifestyle medicine and holistic rehabilitation model is compatible with the new National Safety and Quality Health Service Standards that place particular emphasis on consumer participation and engagement in service provision and design. A systematic holistic approach to illness and healthcare can help in the understanding and management of the problems faced by individual patients with complex neurological disability. This is because the main driver for care does not centre on a disease or illness itself, but places a greater emphasis on improving quality of life. This highlights the requirement for strong partnership within this process where the person’s experience acts as the main driver for rehabilitation goals that need to be relevant to the person’s context. This approach also requires approaches in rehabilitation utilising true interdisciplinary practices between health professions and services to affect seamless, timely and cost-effective outcomes (Körner, 2010).
7. In home and community outreach
This will encompass the same clinical components as available for subspecialty outpatients but extend to within the patient’s home in the community through a combination of onsite visits and telehealth services. It will include at-home monitoring of essential health parameters, and state-of-the-art clinical examination and laboratory monitoring including virtual reality, AI and haptic technologies. Interactive support through evidence based CBT and other behavioural programmes will be made available. It will also include online and phone support. This will include a platform for the use of disruptive technologies for integration of care as well as wellness boot camps offered onsite and online.
8. The Australasian College of Integrated Disability Health
This will be a first of its kind collaboration between carers, family, patients and professionals offering continuing professional development and education for Disability Medicine and Healthcare. It will offer certification in specific skills and professions essential for ensuring best practice care for people with neurodisabilities. At present there is no career pathway for disability care or health. This College will offer a clear career pathway as well as certification and disability continuing professional development.
9. Advocacy
People with cognitive impairment are often subject to a range of orders giving other people or government agencies power to make decisions on their behalf (substitute decision making). These orders are usually made by Queensland Civil and Administrative Tribunal, Mental Health Review Tribunal or Supreme Court of Queensland. Legal Aid provides no funding to support people or their families and friends to either negotiate options or provide representation at these Tribunals. A few agencies, such as Queensland Advocacy Incorporated, Queensland Aged and Disability Advocacy and Carers Queensland can provide limited representation in some circumstances.
Therefore most people are expected to represent themselves in respect of treatment, accommodation, health and financial decisions. As a result of limited advocacy, often people are subject to restrictive formal orders when there may be less restrictive alternatives, such as assistance from a family member or friend.
Mental Health and Disability Law is not well understood by either health or legal professionals, though there has been a growing and recent interest.
A Mental Health and Disability Advocacy Service (MHDAS) that provides student clinics or internships to medical, allied health and law students would provide advocacy, casework and alternative dispute resolution experiences to the clients of the institute and their families and friends, in order that they experience the least intrusion possible in combination with most appropriate care and treatment. We have extensive experience developing such a service winning the National Disability Advocacy Award.