Alison Fairleigh is well-known for her efforts to raise the profile of mental health issues, particularly in rural and remote Queensland. She believes in the power of digital technology to connect people, especially those ‘doing it tough’, helping them to share their stories and get the support they need. As an Advance Queensland Community Digital Champion, Alison has used her role to empower Queenslanders through delivering social media workshops in regional areas. She is particularly passionate about increasing the digital literacy of people in remote locations, so they can access online mental health resources and support. Alison is currently Area Manager at the Mental Illness Fellowship NQ, a busy, community mental health organisation with its headquarters in Townsville; and is Chair of the Townsville Suicide Prevention Network. She is a Board Member of the Queensland Alliance for Mental Health, the peak body for the community mental health sector; and Alison also sits on several advisory committees and steering groups related to social inclusion, rural health and suicide prevention.
Suicide prevention is everyone’s business and it takes a whole community, united in purpose and vision, to effect change. Next month, the Townsville Suicide Prevention Network (TSPN) will be launching a Community Action Plan for suicide prevention in Townsville—a game-changer for the regional city. In this session, we will learn how the TSPN worked quietly in the background for two years to listen to the voice of lived experience, consult widely throughout the community, map services, find gaps and gain insights into the data, and in the process draw every major player in the community to the table.
Lucy Falcocchio is the Health Systems Development Manager for Kimberley Aboriginal Medical Service where she has worked collaboratively for the past six years, bringing clinicians and software engineers together, ensuring the continued clinician led development of electronic patient systems to promote better health outcomes for Aboriginal people living in the Kimberley. Lucy commenced her interest in providing better health outcomes during her 11 year career with the Department of Corrective Services NSW. Her initiation into the world of health promotion occurred during the early days of HIV/AIDS and its impact on the NSW Corrections environment. This resulted in further contributions towards policy and procedural change, including the introduction of condoms into NSW Correctional facilities in 1997 for which she was awarded a Public Sector Award for Service Delivery Improvement. Soon after, Lucy’s work expanded into promoting policy and procedural change, ensuring adequate education and resource provision for both staff and inmates in relation to other communicable diseases. Lucy has continued to actively work with marginalised populations, either through systems development, training and support initiatives, workflow structures or health informatics initiatives, in her commitment to continue contributing to the promotion of better health outcomes.
A remote, multi-site Aboriginal Medical Service in Western Australia has been using an electronic medical record as their primary health care clinical record for seven years. During this time a number of innovations have been developed which have improved the care delivery to patients in an incredibly remote part of Australia.
In this presentation, a representative of the Aboriginal Medical Service will outline how the customer, together with the Vendor developed a software feature that has enhanced emergency patient care in this remote region. Due to the transient nature of the patient demographic, high rates of chronic disease/comorbidities and English being a second and sometimes third language among many of their patients, the customer needed something to assist in ensuring the continuity of care, for the many patients who end up at an acute care facility around the region.
The software enhancement allows a pre-approved organisation, in this case, 6 remote hospitals, to be able to search for and access the patient’s primary health record if they present to the hospital requiring treatment.
When the patient presents, the hospital searches for the patient in the organisations’ patient lists. They select the correct patient and after recording patient consent or inability to provide consent, the record is made visible to the hospital for a period of 24 hours.
A secure and encrypted message is sent to clinical leaders at the AMS, advising them that the patient has presented to the hospital and that the patient clinical record has been accessed.
Staff at the primary health care site are aware of the patient’s presentation, and are able to provide appropriate follow up that they otherwise would not if they did not know of the presentation. Since training was completed, there has been an average of 173 ED Access episodes per month. Following the patient encounter, staff at the hospital, record a progress note, advising the reason for presentation, findings, management and importantly whether the patient was admitted of discharged.
The customer will talk about governance and training models implemented, and outline the impact that the ability to share the patient primary clinical record has had on the lives of those who live in this remote outback area, and how she monitors the program to ensure protocols are respected.
The vendor will outline some of the technical challenges of developing this feature and how organisations using this feature address privacy concerns and will provide a live demonstration of the feature.
Sally Fisher has twenty years of experience as a community dietitian, health promotion worker and educator in government, university, small business and NGOs located in rural Victoria, New South Wales and across South Australia. Her farming heritage has resulted in her being attracted to roles that have close connections to producers and that ensure high-quality food and health services are available to all. Her passion for sustainable food systems led to her writing a topic for the Flinders University SA Nutrition and Dietetics Department called “Ecological Issues in Food and Health”. She was a founder of Food Connect Adelaide, a social enterprise based on the principles of community supported agriculture. More recently Sally has focused upon farmer health and wellbeing as part of the Federal Government’s Healthy Workers, Healthy Futures initiative, which later became SA Health’s Men’s Health initiative. She also worked across southern SA to deliver the Community Foodies program, a peer nutrition education program. She is now located in Geelong, Victoria. Twitter @SalFisher19
Fat Farmers was founded in 2011 by a group of grains producers who, recognising their growing waistlines and declining health, gathered in their local gym in Yorke Peninsula, SA to become fitter and to participate in fun runs and cycling. Industrialised farming has led to many farmers experiencing high levels of sedentary work, just as urbanised populations do. With leadership from several of the members and support from the Healthy Farmers Adviser based at Primary Producers SA, the group has now spread to six further locations in SA. It’s politically incorrect name and bottom-up approach “cuts through” in a nation that has become blasé about obesity and its impact on health and wellbeing. This presentation will explore the growth and development of the initiative, the strengths of its champions and the group, partnerships it has formed, the challenges it faces and its strategies for sustainability in the medium to long term. As health promotion has now been largely removed from the health budget, the presentation will explore an innovative funding strategy with agribusinesses in the “brave new world” for preventative health in South Australia. For further information, see www.fatfarmers.com
Steve Fisher is the Director of Community Works, a small company that provides management consultancy and project management services to organisations in Australia and overseas. Community Works is a long-term partner of Ninti One Ltd and Steve contributes to a range of the company’s work, including the Cooperative Research Centre for Remote Economic Participation, Stronger Communities for Children and work on improving health and disability services. For many years, a large part of his work has involved designing and using monitoring and evaluation methods for remote communities in many places across Australia. He has also worked extensively on mental health programs internationally, most recently for the World Psychiatric Association, BasicNeeds and mhNOW.
Aboriginal and Torres Strait Islander people face complex challenges in gaining consistent access to the range of services required to live successfully in remote Australia. Geographical distance from urban centres, environmental extremes, high costs and cross-cultural considerations are factors in people being able to choose and use services that best meet their needs. For people with disabilities, accompanying ill-health, limited transport and low levels of community understanding of their situation are additional obstacles.
The purpose of this paper is to share the findings of research on ways to improve the positive impact of services on the lives of Aboriginal and Torres Strait Islander people with disabilities in remote Australia. It presents six key insights that have emerged from the activities of our organisation over the last decade, with special reference to our research with Aboriginal people with disabilities in four communities in the Northern Territory and South Australia in 2015-16.
Notable observations arising from the research are that people tend to be passive in their responses to service providers, that community knowledge and education levels on disability are very low, benchmarks and standards relevant to remote communities are applied unevenly and that competencies to work cross-culturally are under-developed among service providers. We find that groups that support empowerment and advocacy for people with disabilities are largely absent from remote communities. A significant theme is that the design of services for Aboriginal people with disabilities in remote locations tends to be transactional in character rather than transformative, a point developed further in the paper.
Through case studies and examples, we offer greater depth and human insight to the subject, as well as bringing out the voices and perspectives of people with disabilities. The paper proceeds to make recommendations orientated towards improving services, an aim best accomplished by integrating what has been learned from research into augmented national strategies, standards and approaches. We argue that for disability in remote communities to be better understood, greater knowledge should be generated in ways that empower people with disabilities themselves.
The fundamental challenge for people with disabilities in remote Australia is how best to gain access to care and support services within a community environment that encourages social and economic inclusion. We recommend that further strategic, design and operational work is conducted to tackle the challenges and problems we describe in the paper.
Dr Emily Fitzpatrick BMedSci(Hons), MBBS, DCH started this research journey while working as a Junior Medical Officer for the Children’s Hospital at Westmead. She was taking a lunch break while attending a Grand Rounds lecture where she heard about The Lililwan Project. This fetal alcohol spectrum disorder (FASD) prevalence study was conducted in collaboration with Aboriginal communities and visiting researchers. FASD was thought to be affecting the next generation of Aboriginal children, who were having trouble remembering their dreamtime stories. Dr Fitzpatrick volunteered a year of her time as a doctor and a researcher in supporting this community-based project. Following this, Aboriginal leaders invited Dr Fitzpatrick to lead The Picture Talk Project to review the positive community engagement and consent process and explore what makes research culturally respectful. This is part of her doctorate with the University of Sydney was supervised by Prof Elliott, Assoc/Prof Martiniuk, Ms D’Antoine and Dr Macdonald. She also receives cultural supervision from Ms June Oscar, Ms Maureen Carter and Mr Tom Lawford, Aboriginal leaders of the Kimberley. In addition, Dr Fitzpatrick is training to be a General Paediatrician with an interest in Aboriginal health and continues to work for the Children’s Hospital at Westmead in Sydney.
Introduction: An international systematic literature review found that few publications evaluate preference or understanding when seeking consent for research with Indigenous communities. Research with Indigenous communities has not always been done well or addressed community priorities. The Lililwan Project is an example of a study that was well received by the Aboriginal communities of Fitzroy Crossing with a 95% participation rate. In reflection, The Picture Talk Project, was invited to examine the community engagement and consent process.
Methods: Invited by Aboriginal leaders of the Fitzroy Valley, researchers with The Picture Talk Project interviewed Aboriginal community leaders and held focus group discussions with Aboriginal community members about research experiences and the consent process including the methodology used by the Lililwan Project. These are analysed using NVivo10 software with an integrated method of inductive and deductive coding and grounded theory. Local Aboriginal research team members, employed as Community Navigators to interpret language and provide cultural guidance also validated the coding of data. Themes were synthesised and supporting quotes from participants were identified.
Results: Interviews with Aboriginal leaders (n=20) and focus groups (n=6) with Aboriginal community members (with 3 to 10 participants) where conducted in the presence of a local Aboriginal Community Navigator to interpret language and provide cultural guidance. Participants were from different age groups, both males and females and from all major local language groups of the Fitzroy Valley. Themes such as Research – finding knowledge; Showing respect for Aboriginal people, working on country and being flexible with time; Working together with good communication; Reciprocity – learning two ways; and Reaching consent emerged from these discussions. Rich quotes from individuals exemplify these themes.
Conclusion: We need to change the way we approach and engage with Aboriginal communities for research. Respect for cultural differences needs to be embedded in every step of our research process. Aboriginal research partners need to be engaged from the start to the end of a project which should benefit their community.
Cristen Fleming is one of the Quit for New Life Coordinators for Western NSW Local Health District (WNSWLHD). After completing her Bachelor of Pharmacy she had worked in rural hospital pharmacy for five years, including as Senior Pharmacist for Education and Training for WNSWLHD before beginning a Masters in Public Health and Masters of Health Management through the University of NSW. In 2014 Cristen participated in a research trip to rural and remote indigenous communities in Canada, Alaska and Brazil where her passion for rural public health was sparked. This was further reinforced during a 2015 around Australia trip when she worked and studied in rural and remote Western Australia, Northern Territory and Queensland. In 2016 Cristen returned to Western NSW taking up a position of Senior Health Promotion Officer. Her current work focuses on Aboriginal maternal and family health with focus on smoking cessation.
Aim: To re-develop a model of care to provide smoking cessation support to pregnant Aboriginal women, and women having Aboriginal babies in Western NSW.
Description: Each year in Western NSW around 850 Aboriginal babies are born, with half born to mothers who smoked during pregnancy. The health impacts of smoking during pregnancy are well known; there is strong evidence linking successful smoking cessation interventions and reductions in babies born with low birth weights and preterm. Midwives and Aboriginal Health Workers are key health professionals for Indigenous women during pregnancy, and antenatal care provides an ideal opportunity to address smoking cessation for women and their families. Western NSW Local Health District (WNSWLHD) has pursued development of a sustainable and effective model of the Quit for New Life (QFNL) program to build capacity of Aboriginal Maternal and Infant Health Service (AMIHS) and Child and Family Health Nurse (CFHN) professionals providing smoking cessation advice to clients. The original WNSWLHD QFNL model of care has been to provide skills in smoking cessation brief intervention to staff via workshops, who would then refer on to more specialised smoking cessation service providers for extended follow up, NRT provision and CO (Smokerlyzer) monitoring. After 18 months it was evident the original model was not achieving expected level of engagement and a program review was instigated.
A mixed methods process evaluation design has been used to gather feedback from AMIHS staff, CFHN staff and Smoking cessation providers in WNSWLHD, with support from data on QFNL program referrals, provision of NRT and referrals to Quitline. The new QFNL model is designed to better meet the needs of this area, enhance capabilities of staff to provide frontline smoking cessation care, and improve the success of clients quitting during pregnancy.
This presentation will outline lessons learnt about tailoring delivery of the QFNL program to a rural location facing challenges in terms of geography, population distribution, and resourcing. A detailed description of the model redesign process will be presented, focussing on capacity building model for staff delivering smoking cessation. The successes and challenges of addressing smoking cessation among women having Aboriginal babies in Western NSW will be covered, including insight from Aboriginal Health Workers on program accomplishments in their communities.
Jennifer Floyd is the Director Oral Health Services in Western NSW Local Health District, with responsibility for public oral health services in an area that covers around one-third of NSW and incorporates inner regional through to remote areas of the state. Jenni is based in Dubbo. Jenni began her career as a Dental Therapist. She worked as a clinician in country NSW for 14 years before moving into oral health management roles. In 2006 Jenni completed a Masters in Health Services Management. She is a long-standing member of the NSW State Oral Health Executive and holds an adjunct appointment with Charles Sturt University. Jenni is passionate about ensuring that the needs of rural and regional communities are made a priority and that these communities have access to high-quality dental services. Her focus has been improving access, developing infrastructure and building strong partnerships based on the needs of the population and in particular the needs of Aboriginal communities.
The Mobile Oral Health Centre is an innovative two chair mobile dental service established in 2014 to provide dental treatment close to home for both adults and children in small rural communities. The primary aim was to improve access for Aboriginal clients, whilst still providing a much needed mainstream service in each community.
With a focus on local community engagement, the clinic has successfully reached Aboriginal populations with 451 appointments utilised by Aboriginal clients. This represents 40% of total appointments and is almost twice the proportion of Aboriginal people residing in the rural communities visited (22%).
This service is achieving positive patient experiences for Aboriginal clients demonstrated through structured patient feedback. All Aboriginal clients who provided feedback said they would recommend the service to others. Utilisation has also increased at return visits with total unique clients increasing 37% and total appointments increasing 48%. This further illustrates acceptance of the service by both Aboriginal and non-Aboriginal people residing in each rural community.
The Mobile Oral Health Centre is a semi-trailer which is highly visible due to its size and signwriting, which brings together Indigenous art and health service branding. Prior to and during each visit staff engage with local Aboriginal organisations including Aboriginal Lands Councils, Aboriginal Medical Services and Aboriginal Health Workers. This local community engagement has been significant in the success of this service, building trust between the community and dental staff and increasing local knowledge of the service.
The Mobile Oral Health Centre provides dental care to both adults (56%) and children (44%) and is accessible with wheelchair lifter. Staff deliver oral health promotion in schools and residential aged care facilities in conjunction with the clinical service.
The Mobile Oral Health Centre is a working example of a mainstream service which is improving access for Aboriginal people through community engagement and by providing a culturally appropriate and highly visible service close to home. Importantly fragmentation and duplication is being avoided by providing a single service meeting the needs of both Aboriginal and non-Aboriginal clients in the small rural communities visited. It is through the strategies of engagement that Aboriginal participation is proportionately greater, and this is essential toward closing the gap.
Melissa Fox is a Brisbane health consumer and mother of two daughters, aged 9 and 12. Having worked in documentary and reality television, Melissa now works to improve the safety, quality and consumer-centredness of health services through her positions as Chief Executive Officer of Queensland’s peak health consumer organisation Health Consumers Queensland (HCQ), as a Board Member of the national peak health consumer organisation Consumers Health Forum (CHF), Independent Chair of Logan Together’s Community Maternity Hubs Governance Group and as a consumer representative on the Queensland Clinical Senate, Children’s Health Queensland’s Neurodevelopmental Disorders Steering Committee and the ACHS Qld/NT State Advisory Committee.
This workshop will focus on practical health consumer engagement based on real experiences in rural and remote Australia. It will consider different methods of consumer engagement, and the issues and considerations with each method. The workshop will consider how we take consumer engagement to the next level – beyond the provision of information to consumers, to meaningful consultation and, ideally, on to genuine consumer involvement – and the particular issues that arise in a rural and remote context.
The workshop will comprise a full 1.5 hour concurrent session, with the presenters selected and coordinated by CHF. Possible presenters could include a rural and remote Primary Health Network reflecting on their experiences with community and consumer engagement; a state/territory health consumer organisation with rural and remote experience; and someone working in Aboriginal and Torres Strait Islander health. In relation to the format of the workshop, it is expected that each presenter would make a short initial presentation, then participate in an interactive Q&A panel discussion.
Thinking about publishing research on rural and remote health?
Want to know more about peer review and the pathway to academic publication?
Interested in becoming involved with the journal as a reviewer or in some other capacity?
Meet the editors of The Australian Journal of Rural Health in a special session designed to clarify publishing procedures and improve your chances of being published in our journal and others.
Editor in Chief Russell Roberts and Associate Editor Jeff Fuller will be available to discuss the editorial policies and priorities of AJRH and answer your publishing questions.
New and established authors are welcome!
Now in its 25th year of publication, AJRH provides research information, policy articles and reflections related to health care in rural and remote areas of Australia. Since its inception, AJRH has contributed significantly to the publication of research reports and expert opinion on rural and remote health.
Linda Furness graduated as an occupational therapist in 1989, and since that time has worked in rural and regional service delivery. She has worked in a number of clinical, case management, management and education roles. Linda is currently employed as a Clinical Education Support Officer within the Occupational Therapy Clinical Education Program (OTCEP), a program aimed at supporting the clinical education of pre-entry occupational therapy students and new graduates in Queensland Health Hospital and Health Service facilities. She is also involved in a number of research projects aimed at enhancing rural and regional occupational therapy service delivery.
Introduction: One older person dies every five hours following a fall in the home and falls are the leading cause of injury induced mortality in people aged 75 years and over. Research findings indicate that Environmental Assessment and Modification (EAM) is an effective approach to reducing falls and that EAM for falls prevention should be of high intensity, provided by occupational therapists and targeted to high risk populations. The aim of this study is to identify factors that support the local adoption of best practice in EAM in falls prevention within a regional and rural health service.
Method: This research will employ mixed methods and Promoting Action of research Implementation in Health Services (PARHIS) will be used to guide the process of best practice implementation. Baseline data collection to establish baseline OT practice in falls prevention and define local barriers and enablers to uptake of best practice EAM will include – chart audit, self-report survey of current OT practice and semi-structured focus group discussions with OTS and key operational managers.
Results: This presentation will report on data gathered in the baseline collection phase.
Conclusion: This study will provide insights into current barriers and enablers for OTS implementing best practice EAM in a regional health service. Findings will be used to develop strategies to guide implementation of best practice EAM and will provide insight into how this approach could be adopted across similar settings.