Concurrent Speakers

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Rosanna Lacorcia
Connect to a better future with nbn
Biography

Rosanna Lacorcia is the National Stakeholder Relations Manager at nbn. In this role, Rosanna works closely with national stakeholders to provide updates on the nbn rollout and the opportunities and benefits that fast broadband will deliver for businesses, government, communities and individuals. Rosanna has been with nbn for over four years and prior to nbn worked in the telecommunications, finance and utility industries in communications and stakeholder engagement roles.

Abstract

The nbn™ network is Australia’s new, fast and reliable phone and internet network.

Its introduction means Australia will have internet speeds up there with the fastest in the world.

The powerful possibilities of the nbn™ network will change all our lives for the better in areas of health, education, business and lifestyle.

Join Rosanna Lacorica, nbn National Stakeholder Relations Manager as she takes us through how you can get onboard with the the nbn™ network and the opportunities it presents to be more productive, more creative & more efficient.

Karen Laing
From protests to plaudits: a small rural health service's community engagement journey
Biography

Karen Laing is the Director of Nursing, Quality and Community Engagement at Kyneton District Health. KDH is a small rural health service located in the Macedon Ranges in central Victoria, serving a population of ~45,000 people. Services provided by KDH include acute inpatient care, maternity, surgery, dialysis, palliative care, urgent care and community nursing services. Karen is committed to and has directed her career to rural health services management for the last 20 years. She has applied her knowledge and skills across the Victorian public and private sectors, initially in metropolitan and then in regional and small rural health services. Karen recognises that true partnership is an essential ingredient for success across a number of measures. Partnering with patients ensures patient-centred care; partnering with clinicians is imperative for cooperative and collaborative operational management and partnering with the community is vital in gaining engagement and support for the organisation.

Abstract

Kyneton District Health was experiencing difficulties engaging with its community. By 2013 community dissatisfaction was marked and a “Committee for a Better Functioning Hospital” presented 2400 signatures petitioning for change. Hundreds of disgruntled people bearing placards attended a rowdy AGM. Relationships with GPs were strained. Accreditation issues emerged. Our reputation was damaged and, naturally, staff morale and patient satisfaction were significantly affected.

In 2014, a new Board and CEO set re-engagement and re-building trust with the community as strategic priorities. We genuinely wanted input from the community into our planning and we actively sought their engagement to help build awareness, transparency and trust in the organisation.

The “Tea 4 Ten” community consultation project was a way to get grassroots feedback. Based on ‘Kitchen Table Conversations’ arising out of the USA; focused conversations were conducted amongst a group of people known to one another. We recruited hosts to lead a conversation over morning tea with 9-10 of their invited guests.

Based on extensive and frank feedback from these forums, our Strategic and Quality Plans were revised. New initiatives included recruitment of new consumer committee reps., revamping branding and publications and building traditional and social media profiles. Particularly successful have been activities where we invited the community into the organisation, such as a Garden Planting event and a ‘Check Out Our Insides’ Open Day.

Listening & responding to feedback from our medical community has also resulted in their renewed support for the hospital. Facilitated co-location of a local practice at the hospital has bolstered support for the Urgent Care Centre and reassured the community that medical staff and the hospital is working together for them.

The most important thing we learnt is the value of listening and responding. From a patient care point of view, not a lot has changed, but our openness and transparency have impacted significantly on community perception.

In just three years, we have restored community confidence, increased staff and patient satisfaction and improved quality and safety. Staff satisfaction has risen from 71% to 95% and patient satisfaction consistently out-performs our peers at 95% -100%. We recently gained full accreditation with no recommendations for improvement.

From protests at our AGM 3 years ago, this year the organisation was nominated by the community for the Business Excellence Award in the category of Professional Services. Not only did we win our category, we won the Macedon Ranges Business of the Year.

Slides | Paper
Sarah Larkins
International lessons in training a fit-for-purpose health workforce for health and growth
Biography

Sarah Larkins is an academic general practitioner, Professor in General Practice and Rural Medicine and Associate Dean, Research, College of Medicine and Dentistry, James Cook University.  She is also co-Director of the Anton Breinl Research Centre for Health Systems Strengthening; a centre of the Australian Institute of Tropical Health and Medicine, and a practising GP. Sarah has a passion for making health services more equitable, and to this end has more than 80 peer-reviewed publications and three current NHMRC grants.

Abstract

Aims: Access to health care is a prerequisite to achieving universal health coverage (UHC). This, in turn, depends on supply of health professionals with skills and commitment to provide responsive health care. Currently the achievement of UHC is limited by the geographic and vocational maldistribution of health professionals. Simply adding more qualified health workers into the mix without addressing issues of distribution will have little impact.

The Training for Health Equity Network (THEnet) is a global community of practice including 11 health professional schools from seven countries (five continents) who aim to address health system inequalities by training a workforce that is responsive to the priority health needs of underserved communities. THEnet member schools share a social accountability mandate: their core mission is to recruit students from, and produce health professionals for underserved communities.

This presentation aims to synthesise international policy evidence and findings from THEnet and Australian schools to understand what is required to produce and support a health workforce for rural Australia and our region.

Methods: The first collaborative piece of work done by THEnet was the development, pilot testing and broader implementation of an Evaluation Framework for Social Accountability in Health Professional Education. THEnet has now implemented an international graduate outcome study (GOS) to correlate student background characteristics, practice location and discipline. Findings from this international prospective cohort study are combined with evidence from Australia and the latest international policy documents to address our aims.

Relevance: The publication last week of the High Level Commission on Health Employment and Economic Growth (WHO and International Labour Organisation) drew on evidence submitted by THEnet and highlighted the effectiveness of investments in the health workforce in terms of health, social capital and economic growth.

Results: Currently the GOS contains data from more than 3200 medical students from eight THEnet schools across six countries, including two Australian schools (James Cook University and Flinders University). Results from the GOS to date will be integrated with international policy, in particular recommendations from the Commission on transforming the health workforce for Sustainable Development Goals.

Conclusions: Attention to training a fit-for-purpose health workforce is critical in attaining UHC and health for all, and provides a valuable return to communities in terms of economic growth and social capital. Lessons from these global initiatives for Australian rural health and policy will be discussed.

Slides
Therese Latjar
Responding to staff affected by domestic and family violence: rural health leads the way
Biography

Therese Lajtar has a lengthy background in mental health nursing and counselling roles spanning nigh on 40 years. She has worked in metropolitan, regional and rural locations in both the public and private sectors in New South Wales. Her experience includes inpatient and community-based settings and she has highly developed skills in adult, child and adolescent mental health and sexual assault counselling. Therese has specialised in trauma counselling for the past 20 years. In 2011, Therese was persuaded by management of the Mental Health Inpatient Services in Orange, to develop and implement guidelines for “Sexual Safety of Mental Health Consumers”, initially for Bloomfield Hospital and afterward, for the Local Health District. She has remained in the Acute Inpatient Services and is currently working as clinical nurse consultant, level 2. Therese is passionate about assisting those affected by trauma as well as building the capacity among her colleagues to be better skilled in responding. Her current project “Responding to Staff Affected by Family and Domestic Violence” was a logical progression. She has embraced the challenge with vigour to ensure the service has the structure and procedures in place to provide the best possible locally based support for affected staff.

Abstract

Western NSW Local Health District (LHD) encompasses 40 health facilities and employs 5833 staff with a large proportion of those staff being female. Domestic Violence affects 1 in 4 women in Australia with 75% of homicides of women perpetrated by an intimate partner. Given the statistics and the LHD staffing numbers it is estimated that 1000 female staff could be affected by Domestic and Family Violence at any given time.

Screening for Domestic Violence is mandatory for health staff when a woman enters into specific services within the NSW Health system. Staff however, can be experiencing Domestic Violence and may not know how to communicate to fellow workers or their manager the issues that may be arising for them. Often Domestic Violence affects their ability to attend work, work effectively and feel safe at work. The perpetrator may also attend the workplace and can harass and threaten other staff.

Western NSW LHD Mental Health Drug and Alcohol staff in Orange in partnership with the Orange Housing Plus Domestic Violence Project and the University of New South Wales (UNSW) Gendered Violence Research Network implemented a training and support project for senior managers in Mental Health, Drug and Alcohol Orange Campus, Human Resources and Employee Assistance Program to educate them on how to respond to staff experiencing Domestic Violence appropriately. A four hour training session was delivered by the Gendered Violence Research Network UNSW staff with the Housing Plus DV Project staff in attendance. The information included Domestic Violence, how the organisation can respond appropriately including referral to specialist services and assisting to make workplace adjustments to ensure a staff member’s safety at work.

A flowchart has been developed for all staff to follow a process of referral for staff experiencing Domestic Violence. Advertising was placed in all staff areas with information on support and referral options. Work continues with an ongoing training program for all first line managers at the site. It is proposed that eventually all managers in the LHD will be provided with education and information to better support staff experiencing Domestic Violence.

Acknowledging and supporting health staff experiencing Domestic Violence demonstrates Western NSW LHD’s commitment to the core values of NSW Health which are Collaboration, Openness, Empowerment and Respect whilst displaying good corporate citizenship in taking a stand against Domestic and Family Violence.

Slides | Paper
Lisa Lavey
Improving rural health: research activity can build capacity and make a difference
Biography

Lisa Lavey is the Research Administration Manager for the School of Rural Health at Monash University and was previously the Project Manager for the Centre of Research Excellence (CRE) in Rural and Remote Primary Health Care. Lisa has extensive administration experience working in universities, government departments and not-for-profit organisations and has managed whole-of-school research, teaching and other portfolio programs. She has extensive skills in office management, program presentation and marketing, human resources, finance and IT. During her appointment as Project Manager for the CRE, Lisa developed a database to capture the research activities and demonstrate research impact of the CRE over time. This database has been provided to many organisations, both nationally and internationally, under a license agreement with Monash University, free of charge. In collaboration with another CRE Project Manager, a document entitled “Establishment and Management of a Multi-Institutional Centre of Research Excellence—Tips for New Players” was produced and has been made available to assist new multi-institutional collaborations in establishing and managing their collaboration. A journal article has also recently been published in the Journal of Research Administration on Multi-Institution Research Centers: Planning and Management Challenges.

Abstract

Aim: Since 2007 a longitudinal evaluation of Elmore Primary Health Service (EPHS), as a single-entry point, comprehensive, multidisciplinary rural primary health care service, has been undertaken. The aim of this study was to assess whether the presence of this ongoing research activity has fostered a culture which contributes indirectly towards improved service performance, capacity building within its workforce, and improved patient satisfaction.

Method: This mixed-methods study included review and critical appraisal of documented quantitative data collected throughout the duration of the study, and analysis of recorded and transcribed qualitative data obtained through face-to-face interviews with EPHS staff.

Results: The process of conducting a comprehensive longitudinal study indirectly affected EPHS and the Elmore community. Initially research activities were sometimes perceived as intrusive and somewhat demanding because of the level of detail required. However, as the study progressed, data collection with analysis and feedback came to be accepted as a routine and necessary part of the annual cycle of activity within the service. The research process progressed from a stage of formal initiation and apprehension, through one of regular acceptance, to one of full-integration of a research culture as a necessary part of daily service activities.

Research findings indirectly benefited EPHS performance, as EPHS management increasingly valued the empirical evidence to inform accreditation and forward strategic planning, including grant and other funding applications. As clinical staff came to better understand what the statistics and quantitative data meant, they were able to modify individual practice. The research also helped inform the expansion of EPHS to becoming a ‘networked’ model, simultaneously improving service accessibility and increasing practice viability. Research was also a good selling point for recruiting new staff, especially doctors, who were referred to published evidence of EPHS excellence. As an indirect result, the service became sought after by registrars and medical students. Practitioners, in turn, gained greater confidence and professional satisfaction. Patients of EPHS and the broader community also experienced greater confidence in the quality of the services available, as research evidence was published in practice newsletters, available on the EPHS website and in the wider media when EPHS was shortlisted and subsequently successful in a range of awards.

Conclusion: This study suggests significant indirect associations between both research processes and research outcomes and the development of a research culture within EPHS which resulted in a number of organisational benefits relating to efficiencies in service delivery, staff recruitment, enhanced service viability and accessibility, and increased patient satisfaction.

Slides | Paper
Jess Law
Building community capacity and broadening student capabilities through community summer scholarships
Biography

Jess Law is a health promotion officer currently working with the Healthy Workers, Healthy Futures initiative as a Healthy Workers Advisor with the Civil Contractors Federation South Australia. Previously, Jess was the Project Officer with the University of South Australia Department of Rural Health. Passionate about 'win-win' situations, community development and empowering people to make positive changes to their lifestyle- Jess strives to work with communities using their strengths and knowledge to create sustainable change that is tailored to the local environment and people. Originally from the Riverland in South Australia, Jess has worked across both metro and rural locations in obesity prevention, workers health and with nursing and allied health students to improve health outcomes in communities of high need. Jess is keenly interested in most areas of health promotion, particularly SNAP factors (Smoking cessation, Nutrition, Alcohol and Physical Activity) and also enjoys playing most forms of sport,  travel, cooking, hosting parties and a good glass of wine.

Abstract

The University of South Australia Department of Rural Health (DRH) have created a unique pilot program to increase nursing and allied health students’ employability through improving and diversifying their skill set while assisting a range of local organisations to increase their capacity to deliver services in regional communities. This program may provide a solution in sparsely populated areas where organisations are often understaffed and underfunded. The scholarships allowed students to conduct and complete needed community development projects that will improve the capacity of staff and the wider community. The Community Summer Scholarship program was piloted across two sites in the summer of 2015/16. Local agencies from across social services, health, local government and education co-hosted scholarship recipients who spent 4 weeks working on projects identified as areas of need by the organisations. The students had the opportunity to improve their skills in areas such as communication, project management and stakeholder engagement and produced resources and training workshops for the workforce and wider community. The program faced a number of challenges in areas such as expectations and communication; these have been improved on for the second block of projects and will continue to be refined into the future. The Community Summer Scholarship program has demonstrated positive outcomes for students, organisations and broader community. Students reported a sense of accomplishment in the work they had achieved and felt that they would have an ‘edge’ in future employment opportunities. Organisations spoke highly of the quality of the work achieved and of how beneficial it had been for them. As a result of this pilot, the Community Summer Scholarships will be expanding to cover a greater area as a result of word of mouth regarding the program. This low-cost project has the potential to achieve positive community impact in many regional and remote communities both within Australia and around the world.

Slides | Paper
Amanda Lee
Diabetes telehealth for country Western Australia—partnership approach to chronic conditions
Biography

Amanda Lee completed her tertiary studies in nutrition and dietetics in 2010. Since graduating she has been practising as an accredited practicing dietitian and has always worked in the rural regional areas of WA. She completed her Graduate Certificate in Diabetes in 2013, and is currently working towards being credentialed. Amanda's work experience has included 4.5 years with the WA Country Health Service as a dietitian with a diverse range of patients, including those with CALD and Aboriginal and Torres Strait Islander backgrounds. She has worked in a range of settings including acute inpatients and community groups. She is conversant in Mandarin and has delivered diabetes education programs in Mandarin. Over the past 2.5 years, she has been providing clinical service with diabetes telehealth as a diabetes educator and diabetes dietitian, providing tailored diabetes service to people in rural and regional areas of WA via videoconference. She is also working with remote Aboriginal communities to enable access to diabetes service through this mode of education. Amanda is passionate about bridging the disparity in diabetes services in rural and regional areas of WA. She enjoys the complexity of the condition and the challenges it brings with a strong focus on empowering patients to self-manage their condition. Amanda is also an active member of the DAA WA Engagement and Development Committee and was the chair of the organising committee for last year’s WA symposium.

Abstract

Context: 2008-2012 ‘diabetes complications’ was the leading cause of potentially preventable hospitalisations for Wheatbelt and Great Southern adults (20%); with a non-Aboriginal rate significantly higher than the State rate.

Regional capacity for diabetes education is minimal, resulting in consumers travelling long distances to access metropolitan based services or worse still, not getting the care and support required, resulting in ongoing poor/deteriorating diabetes health and management.

Process: Service gap locations were identified through data analysis and regional consultation. Partnering with Diabetes WA, in March 2015 the Diabetes Telehealth for Country WA Service commenced. The telehealth diabetes education service integrates with WA Country Health Service and non-government organisation services across regional WA. The service is delivered via videoconference (or phone if required), and addresses gaps in diabetes education and clinical support for consumers and increases regional capacity through provision of professional development for Diabetes Educators, Aboriginal Health Workers and generalist health staff in the prevention, treatment and management of diabetes.

Delivering timely triage, assessment, individual education sessions, referral to other services and direct links to local diabetes educators, the service can be provided at home and outside of traditional business hours to support consumer needs. Professional development sessions are delivered in the workplace.

Trialled in the Wheatbelt and Great Southern the service has progressively expanded. With an ‘every door is the right door’ approach referrals range from self-referral through to allied health, nursing staff and GP referrals.

Analysis and lessons learned: Lessons learned have been applied to subsequent telehealth service development. Flexibility to support tailoring of the service to the specific and unique requirements of each region is integral. Working closely with health professionals and private practices to demonstrate the triage process with referral back to existing services on the ground, ensuring private business models are supported, has been key to service acceptance. Building trust and establishing shared care roles via a virtual multidisciplinary team has resulted in GP and health professional acceptance – with 56% of referrals coming from GPs.

Outcomes: The service is now available across all seven WACHS regions. Since commencement there have been over 741 occasions of service, with 54 referrals for Aboriginal people. Over 31 hours of health professional upskilling has been delivered. An external evaluation is being finalised. Initial indications are $120,000+ service delivery savings for WACHS whilst saving consumers over 113,000 travel kilometres, with over 90% of consumers saying that using telehealth saved them time and money.

Slides
Simone Lee
Epilepsy Connect: establishing a telephone-based peer support service in Tasmania
Biography

Simone Lee is a lecturer at the Centre for Rural Health, University of Tasmania, and has a background in health promotion, public health, nutrition, health literacy and chronic disease prevention and management. Simone completed a Master of Nutrition and Dietetics at the Flinders University of South Australia and went on to complete her PhD in medicine in 2005. Her passion for health equity lead to an 18-year career in public heath, working in the not-for-profit sector in both South Australia and Tasmania. As a result, she has developed expertise in the areas of cancer prevention, asthma management, workplace health and wellbeing, and epilepsy management. She has recently joined the University of Tasmania as an academic in rural health, and her current research interests include health literacy, bowel cancer screening participation, and access to health services and support for people living with or affected by epilepsy.

Abstract

Background: As many as 1 in every 100 Australians will have epilepsy at any given time, but the impact of epilepsy is much more than just the seizure itself. People with epilepsy report increased levels of anxiety, depression and poor self-esteem.  In Tasmania, high to very high levels of psychological distress have been observed in patients with epilepsy compared to the general population. Managing epilepsy can also prove challenging.

Peer-support has been shown to improve mental health, wellbeing and self-management for a range of conditions. Currently in Tasmania, peer support for epilepsy is available through face-to-face groups in Hobart and Launceston. For many, access to these groups is difficult, with 34% of Tasmanians living outside these regional centres.

To address these issues, the Centre for Rural Health in partnership with Epilepsy Tasmania developed Epilepsy Connect; a telephone-based peer support service for Tasmanians living with or affected by epilepsy. Generously funded by the Tasmanian Community Fund, the service is based on the successful and well-established Australian model for people affected by cancer.

Aim: The aim of Epilepsy Connect is to reduce the impact of epilepsy by providing equitable access to peer support for Tasmanians living with, or affected by the condition.

Methods: Seed funding was initially sought to establish the pilot program. A recruitment and training strategy was subsequently developed, with up to 10 volunteers trained to provide peer support over the phone. Ethics approval was also received to evaluate the project which was launched in September 2016.

Results: The process for establishing Epilepsy Connect as a new telephone-based peer support service resulted in some challenges around the recruitment of volunteers, evaluation design and community uptake. Good communication and strong commitment from all partners ensured these challenges were minimised.

Relevance: Epilepsy Connect is especially relevant for people who:

  • live in rural and remote Tasmania;
  • have limited access to support groups;
  • prefer to maintain a sense of anonymity; or
  • prefer one-on-one support over group support.

Conclusions: To our knowledge, there are currently no organisations nationally or internationally that provide a formal telephone-based peer support service for people living with or affected by epilepsy. A comprehensive evaluation of the service will ensure the community’s needs continue to be met and provide a foundation for the expansion of the program nationally.

Slides | Paper
Tanya Lehmann
Transforming rural health: equipping managers to be the change they want to see
Biography

Over the last 19 years, Tanya Lehmann has been motivated by a deep commitment to making a difference to the health and wellbeing of rural and remote communities, and the people who serve them.  A 'country girl' by birth and choice, Tanya started her career as a rural generalist dietitian, before progressing into community health management, and leadership and executive roles in allied health workforce and service redesign. Besides raising two kids, in her spare time Tanya advocates for national health system reform through volunteer roles in SARRAH (Services for Australian Rural and Remote Allied Health (SARRAH; on the Board for 7 years, President 2012 - 2016) and the National Rural Health Alliance (on Council since 2011, and Deputy Chair of the Board since 2015). For the most part of the last 18 months, Tanya has been acting Regional Director of a rural region in Country South Australia, and been part of a Project Team leading the implementation of a system-wide, integral approach to organisational development and performance improvement. There is a reason why the CEO of the Australian Rural Leadership Foundation, Matt Linnegar, described her as "having enough energy to power a small town".

Abstract

The rural health sector is facing unprecedented challenges in a time of rapid change. With an ageing population, escalating health care standards and costs, increasing consumer expectations, ageing infrastructure and game-changing shifts in state and national health policy and funding mechanisms, rural health care managers are increasingly being expected to do more with less.

The challenge is often misunderstood to be a need to better ‘cope with’ or ‘deal with’ continuous change and increasing complexity. But coping and dealing are insufficient for meeting today’s complex challenges.

Visionary strategic plans are often identified as being an important precursor to transformation of an organisation from one that is ‘coping’ to one that is flourishing in the context of volatility, uncertainty, complexity and ambiguity (VUCA)1. But often implementation is difficult. Performance management systems may be at odds with the strategic plan. They may preference measurable, objective factors such as financial performance and activity metrics, and fail to attend to subjective factors like staff motivations, mindsets, values and culture2.

So what do managers do if there is a gap between the things the organisation measures (in the performance framework) and the things the organisation says it values (in the strategic plan)? Managers are left to grapple with the dissonance between what the organisation espouses and their daily lived experience of role pressures, performance requirements and accountability expectations.

This presentation will showcase the efforts of a large rural health service, with a catchment population of half a million people dispersed across a geographic footprint of a million square kilometres, which is seeking to become ‘the best rural health service’ by adopting an integral approach to performance improvement.

The audience will learn how the organisation is building the capacity of managers to think differently about performance, and to act differently in response to complex organisational issues that defy simple solutions. An action research process3 is being used to gain a deeper, more integral understanding of the causes of wicked challenges, to open up new conversations, and to co-design of fit-for-context solutions. By applying integral tools and action learning, managers are achieving greater alignment with the strategic plan, and becoming the change they want to see in the world.

References: (1) Nick Petrie. Future Trends in Leadership Development, Center for Creative Leadership; (2) Dr Simon Divecha. (2014) A climate for change (PhD). The University of Adelaide, Adelaide; (3) Hilary Bradbury (Ed). (2015). The sage book of action research. Sage.

Slides
Ande Lemon
Use of arts for 0–12 year olds to lead change in local communities
Biography

Ande Lemon was Artistic Director of Melbourne’s Women’s Circus (2002-2003) for women who identify as survivors of sexual abuse or assault; Coordinator of the Royal Children’s Hospital Wyndham region Arts and Mental Health programme working with primary and special needs schools, community agencies and mental health professionals. She has written and directed over 50 community-based and professional scripts and productions.

Abstract

Kids Thrive is Melbourne’s leading arts and community development organisation committed to child-led community change. Kids Thrive co-designs and delivers programs partnering artists with specialists in children’s health, education, welfare and social justice. It uses the arts to tackle issues that children experience arising from trauma, disadvantage and cultural conflict, and to expand children’s creativity, communication and social skills.

Andrea Rieniets and Ande Lemon as Directors of Kids Thrive bring over 30 years’ experience as respected artists and community cultural development workers. Ande and Andrea’s work takes a long-term, heart-centred view of children as collaborators in, and creators of community.

Slides
Dallas Leon
A collaborative approach to enhance primary health care in north-west Queensland
Abstract

Aboriginal and Torres Strait Islander people living in the North West and Lower Gulf regions of Queensland experience a disproportionate level of illness, disease and exposure to health risk factors. These regions comprise some of the most disadvantaged communities in Australia.

Regional planning initiatives undertaken across the regions have repeatedly acknowledged the need to improve the cultural-appropriateness of mainstream health services to enhance accessibility and uptake of services. If there are to be any improvements in the health outcomes of our people, then it is imperative that all Aboriginal and Torres Strait Islander people across the region are provided with equitable access to culturally-appropriate, comprehensive Primary Health Care services, with a stronger focus on prevention, early-intervention services and the management of chronic disease.

A number of systemic issues have been identified within the existing model of care, which, if rectified, would support significantly improved health outcomes across the regions. These include:

  • acute-based health service system
  • lack of access to culturally appropriate health care services
  • critical need for Primary Health Care infrastructure
  • lack of a Regional Aboriginal and Torres Strait Islander Health Plan
  • fragmented service delivery system
  • lack of community participation
  • under-utilisation of the Medical Benefits Scheme and Pharmaceutical Benefits Scheme
  • a heavy reliance on an expensive fly-in/fly-out health workforce
  • limited access to health data and information.

In March 2016, Gidgee Healing submitted an application to the Australian Government for funding through the Indigenous Australians Health Program (IAHP), proposing a new way of delivering PHC services across the North West and Lower Gulf region.  This was submitted in a tripartite partnership with the Western Queensland Primary Health Network (WQPHN) and the North West Hospital and Health Service (NWHHS). Gidgee Healing has recently been advised of the success of this application, representing a critical acknowledgement of the evidence-base that supports the approach of Aboriginal Community-Controlled Health Services (ACCHS), and the Commonwealth's resolve to ensure these resources form part of the funding envelope available for ACCHS.

The opportunity to work collaboratively with the WQPHN and NWHHS represents a greater opportunity to develop a shared-vision and cohesion of strategy; improved coordination of care; and the capacity to leverage a greater value proposition for Aboriginal and Torres Strait Islander people in the North West and Lower Gulf regions. This partnership will also enable a shared accountability framework to be crafted through new models of care, along with an opportunity for a new unique conversation with Lower Gulf communities in the planning, co-design and delivery of services in their local communities. This level of collaboration across the peak organisations will enable a significantly greater capacity for innovation, and the ability to jointly evaluate and develop an evidence base to support a more comprehensive and integrated model of care across one of the most geographically remote and disadvantaged regions in Australia.

Slides
David Lindsay
Towards an Indigenous youth-led strategy: building research capacity in vulnerable youth
Biography

Assoc Prof David Lindsay is a registered nurse and an experienced nurse academic and researcher within the School of Nursing, Midwifery and Nutrition at James Cook University, Townsville. He has a long-standing interest and involvement in rural nursing and rural nurse education in Australia, and has been a past national President of the (then) Association for Australian Rural Nurses. His professional interests include nurse practitioner/advanced practice nursing roles in rural areas of Australia and across the western Pacific, the politics and practice of rural health and rural nursing, and the utilisation of evidence within nursing practice. Dr Lindsay is a Fellow of the Australian College of Nursing and a Friend of the National Rural Health Alliance.

Abstract

There is widespread concern about the health of youth and young adults in Indigenous communities in Australia. One such community Palm Island, identified the need to address the issues of young people’s health, their risk taking behaviors, relationships and health decision making. Anecdotal evidence suggests a culture of youth and young adults using drugs, alcohol and other substances which has given rise to community concerns on the social cost of this behavior to young people and their families.

This current study framework was developed through iterative community service meetings from 2013 to 2015 when services were tackling acute petrol sniffing in the community. A significant intervention secured through these meetings was the implementation of Low Aromatic Fuel (LAF) in May 2014 to the community as a strategic interruption to the sniffing activity, this was subsequently legislated in November 2015 under the Australian Government, Low Aromatic Fuel (Designated Area) (Great Palm Island) Instrument.

This study’s aim is to undertake a collaborative community survey towards a twofold outcome, (1) to develop a Palm Island baseline database of youth and young people’s health issues, (2) findings of the study would inform better service delivery by Palm Island organisations. Essential to this study are Palm Island young people and their close-knit peer groups, where verbal communication “Murri Talk’ is a highly functioning method of sharing information between peer groups in the community.

James Cook University recruited and provided research training to youth, employing them on a short term basis as research assistants who were involved in the survey tool design (based on the groundbreaking Indigenous Goanna Study model), data collection and analysis. This youth capacity building process is strategic towards future youth research projects on Palm Island.

The study is congruent with ongoing community strategic health plans, the practical outworking realised through committed cross-party support from the Palm Island Aboriginal Shire Council, the Townsville Aboriginal and Torres Strait Islander Corporation for Health Services who funded the study, Ferdy’s Haven Rehabilitation Aboriginal Corporation Palm Island and local Queensland Health Joyce Palmer Health Service.

A first of its kind this project is significant.  Undertaken on Palm Island by Palm Island people it is centered on the community’s very young population with 53.6 percent of total population under 24 years. The study is a component of a broader tri-stage comprehensive youth strategy for Palm Island, this is the second stage; the study findings bearing potential for change.

Slides | Paper
Robyn Linkhorn
Carer Gateway: providing support for country carers
Biography

Robyn Linkhorn is the Carer Gateway Manager for Healthdirect Australia. Robyn leads the Carer Gateway service, which includes a contact centre and website providing access to information and services for carers and their support networks across Australia. Robyn has extensive experience working with digital technologies in not-for-profit, public, private and education sectors including project implementation, management, facilitation, learning design, and developing products with a user-centric focus. Robyn believes in authentic online experiences that integrate emerging technologies, innovative design and business strategy. She uses her knowledge and experience to clearly transfer technical jargon into plain English and enjoys exploring the utilisation of technology to provide content through appropriate channels to end users.

Abstract

There are over 2.8 million carers in Australia, with 30% of these living in rural and remote areas. The estimated value of the unpaid care carers provide was estimated at $60.3 billion during 2015*, or more than $1 billion every week. This work is vital, especially in rural and remote parts of Australia where limited services place extreme pressure on the health system. Health professionals can play a critical support role by recognising carers and helping them overcome challenges, look after themselves, and empower them to provide the best support for the person they care for.

Carer Gateway was launched in December 2015 and is funded by the Federal Department of Social Services. Carer Gateway is a helpline and website designed to help carers navigate the health system to find the services and support they, and the people they care for, need. Prior to Carer Gateway, carers were accessing support across different industry sectors including aged care and disability services – Carer Gateway makes navigation simple by bringing access to appropriate services together.

This presentation will focus on the unique challenges faced by carers in rural and remote areas, who have different needs to carers in major cities. Services are limited, with geographic barriers to access and lack of transport making it critical carers know what is available to them in their local areas. Carers in these areas experience higher rates of disability or long-term health conditions than people in the same regions who are not carers. Rural and remote carers are often younger, with few of them over 65 years of age. The average age of Aboriginal and Torres Strait Islander carers is 37, compared to 49 for non-Indigenous carers, and inequalities in education and health literacy levels add to the challenges they face.

This presentation will demonstrate the practical ways Carer Gateway is making a difference to the lives of rural and remote carers, and how Carer Gateway can be used as a resource to educate and support carers throughout the care journey – from starting to care for someone while navigating complex legal and financial issues, through to respite care and coping when caring ends.

Through this presentation, delegates will gain a better understanding of what services are available to support rural and remote carers, how to use to connect carers and those they care for to these services, and when carers are most likely to need help during the caring journey.

* Source: Deloitte Access Economics (2015) The Economic value of informal care in Australia 2015

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Fiona Little
Rural community-based mental health placements: re-contextualising nursing and social work student learning
Biography

Fiona Little is a credentialed mental health nurse and an endorsed mental health nurse practitioner with 27 years’ experience working in regional and rural communities. She is currently employed in an academic role with the University of Newcastle Department of Rural health located in Tamworth. Her clinical experience includes working across both the public and primary health care sectors, with extensive experience dealing with people with acute mental illness as well as those requiring early intervention and prevention strategies. Throughout her career she has worked with people in crisis and specialises in assessment and risk management associated to suicide behaviours. Her current research interests include workforce development and student learning models and she has recently commenced her PhD.

Abstract

It is well documented that within rural and remote areas across Australia, the availability of a specialised mental health workforce is less prevalent than in metropolitan areas. Recent reviews into mental health services identify the focus of mental health care shifting from acute public healthcare to early intervention and out of hospital services (National Mental Health Commission, 2014). As a result, strategies are required to promote the detection, prevention and care for people living with mental illness in rural areas with access to a well-trained mental health workforce that has the capability to deliver care within upstream services.

One solution to do this is to offer undergraduate students placement within rural clinical settings where they have higher exposure to emerging undifferentiated mental health presentations and are required to develop their assessment skills at the earlier stages of care. Traditionally most rural mental health placements for nursing students occur within the public health sector, often with exposure to short acute episodes of care. For social work student’s the availability to experienced rural clinicians to provide supervision and limited infrastructure resources, place constraints on accessing rural mental health placements. To date there is limited information about rural mental health placements within community based settings and their impact on student learning and preparation for clinical practice into the rural mental health workforce.

To address the shortage and maldistribution of the mental health workforce and to meet ongoing demand for quality clinical placements, it is necessary to further investigate the capacity for expanded and new mental health educational settings. In July 2015 the project “Scoping novel rural mental health clinical placements for undergraduate nursing and social work students in Northern NSW” commenced with funding provided by the Hunter and Coast Interdisciplinary Clinical Training Network. This research explored the availability and perspectives of community-based rural organisations as suitable new mental health placement sites for nursing and social work students.

Qualitative interviews were conducted with 17 eligible organisations including Aboriginal health, rehabilitation and recovery, housing, employment, primary health and youth services. Findings from this research will be outlined demonstrating the substantial merit of these organisations as potential learning environments for nursing and social work students.

Reference: National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC

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Kathie Lowe
Regional collaboration in educating our present and future allied health workforce
Biography

Kathie Lowe’s career experience is across public, private and community health sectors during the last twenty three years. She has worked as a clinical physiotherapist in regional and metropolitan Victoria, Australia. Kathie has postgraduate qualifications in Sports Physiotherapy, however her ongoing clinical area of interest is Neurological Rehabilitation, particularly in the inter-professional care of clients in subacute rehabilitation. Kathie’s current role is Allied Health (Therapy) Education and Research Coordinator at Goulburn Valley Health, Shepparton, Victoria.  In this role, she coordinates student clinical placements, work experience placements and staff education for allied health professionals in acute, subacute and community programs. In this newly created role, which includes developing relationships with key internal and external stakeholders, Kathie has developed programs and processes to address the educational needs of local and regional allied health staff and students. This role also includes supporting allied health staff in clinical research and service evaluation.

Abstract

This presentation describes the establishment of an innovative, collaborative regional health education network in 2012, and the achievements, sustainability and future of the group. The Allied Health Education Group’s (AHEG) founding principles came from the State Government Health Priorities Framework 2012 – 2022: “Develop collaborative approaches that support health services to deliver the necessary professional education, training and support in partnership with others to reduce unnecessary duplication of effort”.1 The regional health area, one of five in the State, covers 40,000 square kilometres. The well-established regional Allied Health Leaders Council identified a duplication of effort and a lack of coordination of education activities for allied health staff across the region and, in May 2012, established a subcommittee to ‘discuss, develop and move forward with the development of an allied health education coordination group’.2 Health services in the region (4 large, 13 sub-regional and rural, and 3 stand-alone community services) nominated ‘skilled and interested staff members’ to join this sub-committee.2 State Government Department of Health and Human Services (DHHS) recognised the workforce development value of the group and provided secretariat support. The inaugural meeting was held in June 2012. Membership included representation from all levels of health services in the region, and seven allied health disciplines working in acute, subacute, community and mental health services. By the end of 2012, the group had: supported the first allied health clinical student placement planning day held in the State; established a collaborative, structured approach to regional education and research activities and resources; completed an Education and Training survey for allied health staff in the region; and gained Continuing Professional Development funding from DHHS to implement a Leadership Training Program in 2013. The group has continued to develop and become financially sustainable, achieving successful funding applications and education activity sponsorships. Since 2013, AHEG has successfully conducted: Leadership Programs (2013, 2014); Regional Allied Health Conferences (2013, 2015); repeat Education and Training survey (2014); Clinical Supervision training (2014, 2015); Patient-Centred Communication presentation (2015) and a region wide Allied Health Graduate Support Program (2015). AHEG has addressed issues of limited resources for allied health education and training through a strong collaborative approach to minimise duplication and share innovation, and developed partnerships with education fund holders in the region including the local Region Nursing and Midwifery Education Group. Planned ongoing opportunities include Advanced Leadership workshops (2016) and an innovative regional Allied Health, Nursing and Midwifery Conference (June 2017).

References: (1) Victorian Health Priorities Framework 2012-2022: Rural and Regional Health Plan, page 64; (2) Minutes, Regional Allied Health Leaders Council Friday 4 May 2012.

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Georgina Luscombe
The ARCHER study of health and wellbeing in young rural Australians
Biography

Dr Georgina Luscombe is Senior Lecturer in Medical Statistics at the School of Rural Health, University of Sydney. This position involves supporting the School's research agenda and actively undertaking research, providing advice and training others in statistics and research methods. This is a relatively new role and reflects the need to build research capacity in rural and regional areas. Georgina has a broad range of medical and allied health research skills, having conducted research in various academic medical departments in universities and hospitals over more than two decades. In addition she has consulted on statistical analyses and research methodologies in both public and private sectors, in settings as diverse as private surgical and dental clinics to national public health organisations. Her main areas of expertise are in research design and statistics, and main research interests are youth and rural health.

Abstract

Aims: To describe new evidence from the longitudinal ARCHER (Adolescent Rural Cohort Study of Hormones, Health, Education, Environments and Relationships) study of rural adolescent health.

Methods: The ARCHER Study is a three-year multidisciplinary longitudinal rural study of adolescents (recruited at 9 to 14 years) from two regional centres in the Central West of NSW. The ARCHER study includes an extensive yearly survey of adolescents and their parent(s)/guardian using questionnaires, anthropometry, blood and urine collection. Measures include universal aspects of adolescent health and wellbeing, such as education, health risk behaviours, mental and physical health. Data analysis was performed to explore trends over time and by age.

Results: 342 young people were recruited to ARCHER with 82% retention across four waves of data. At baseline, the mean age was 11 years, 45% were female and 11% were Aboriginal or Torres Strait Islander adolescents. Plasma testosterone and oestradiol levels confirmed that the majority of the adolescents were in early puberty. The young people came from diverse socioeconomic backgrounds, although participating families were generally more affluent and better educated than the broader regional population. Interesting patterns over time emerged for mental health, with between 10 and 18% experiencing significant depressive symptoms and rates increasing with age. According to adult reports, only approximately 1 in 10 young people met national guidelines for physical activity, and between 79 to 84% lived in a smoke free household. Prevalence of overweight and obesity ranged from 26 to 28% overall (females 29 to 32%; males 23 to 25%). Analyses have demonstrated associations between gender, mental and physical health and stage of puberty.

Relevance: Adolescence is a critical phase of life during which foundations for future health and wellbeing are established. Understanding and promoting rural adolescent health and wellbeing will contribute to addressing known rural health inequities.  

Conclusions: We have successfully recruited a cohort to answer novel research questions. Data generated will further our understanding of puberty and its effects as well as providing insight into the specific determinants of health for young people growing up in non-metropolitan NSW.

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David Lyle
The footprint of University Departments of Rural Health across Australia
Biography

David Lyle is Head of the Broken Hill University Department of Rural Health at the University of Sydney. David is a public health physician who moved to Broken Hill in 1995 to establish the first University Department of Rural Health. He holds a conjoint position between the Far West Local Health District and the University of Sydney. As an academic researcher David has contributed to the development, implementation and evaluation of health services in both metropolitan and rural NSW.

Abstract

Introduction: Twenty years ago, the Australian Government embarked on a unique venture in establishing regionally-based, multidisciplinary University Departments of Rural Health (UDRH) as one means of addressing health workforce needs in rural and remote regions. Today, the UDRH program supports a national Network of academic expertise in rural and remote communities which is acknowledged as having an important impact in non-metropolitan Australia. The UDRHs have recently had their funding doubled to support increased training activity and expand their footprint. There are also plans for the establishment of three additional academic centres from 2017.

Aim and method: This paper evaluates the education, training and research performance of the UDRH Network in 2013 and subsequently to provide a baseline to monitor the expansion of UDRH activity going forward. Mixed methods, combining administrative data from 2009-2013, ABS Census data 2011, and interviews with key UDRH staff, were used to collect the data.

Findings: The UDRH Network consists of 11 UDRHS, 6 located in rural regions and 5 in remote regions. In 2013, the Network covered an area of 3.152 million km2 - 40.9% of the Australian landmass, with a resident population of 2,207,426. An estimated 18% of annual enrolments from nine leading university trained health professions accessed UDRH supported clinical placements that year. In 2013, the UDRHs co-authored 220 peer-reviewed publications, 86% of which were applied research, and 47% of which either addressed a rural/remote specific question or included rural/remote findings. UDRHs also contributed to regional projects aimed at new models of care, improve access to services, support better trained health professionals, and to build capacity in rural/remote organisations and communities in other ways.

Conclusion: UDRHs have now become indispensable well-integrated entities, effectively embedded within their regional communities.

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