Kelli Craig (Blackrobats) and Jenny Sader (Children’s Activity Groups Association, Circus Arts North), have an accumulation of 45 years of community circus. This has consisted of, from a grass-roots level, many hours of play, laughter, learning. With belief and determination to bring circus to children and youth. Circus activities allow freedom of expression, with a strong impact children, impacts them for life and this filters into community. Blackrobats, has recognition from renown circus troupes Circ du Solei, Circ du Monde, Circus Oz and National Institute of Circus Arts(NICA). Both Kelly and Jenny have completed Train the Trainer with Circ du Monde, using circus as a social medium. Kelly has a wealth of community engagement, strong connections with families, passion and cultural understanding. Jenny has used her knowledge and the value of the impact of social circus in developing programs to work in schools and community throughout north Queensland. She works as a youth and community worker and has been strongly involved in arts projects for young people. Both are working towards the continuation of Blackrobats to build upon the strengths of young people through circus, while helping them to acknowledge their strengths, and full potential in a safe, harmonious environment.
The many attributes of using circus/dance/theatre to nourish ourselves have been well documented and in the last ten years have seen a surge of uptake in a wide and varied capacity.
Many of us who were brought up with compulsory competitive sports understand the feeling of striving to WIN—be a WINNER—and flat out FAILING. Human nature is well endowed with a good dose of competitiveness within.
The notion that we are not good enough if we don’t win, drives us to share a medium where most can find a place or space to express themselves and feel self satisfaction. One of the mitigating factors alluded to overall health is self worth.
Inclusivity goes right back to our early development as a species. Without it our mobs survival was unlikely in the old world, both physically and socially. Though masked with an infinite number of individual issues, humanity is able to shine through when people feel connectivity. To connect we need to feel intrinsically included.
Benefits from social action circus, has a ripple effect. Not a cure but definitely an aid in addressing intergenerational trauma. While this is a human condition, in this instance it relates directly to the impact that colonialism has had on the First Nation peoples and the mixed families that have grown since then.
Blackrobats is a predominantly Indigenous community youth circus group, that has operating since 1996 with it’s roots in the outer regions of Kuranda, FNQ. With up to 40 youth at any given time, with over 200 young people being involved since the inception, Blackrobats program is used to support individuals and the communities they live in, using circus/dance/theatre as a tool for engaging youth in the arts
Social inclusion and recognition is essential to the health of our peoples, feeling connected creates a sense of well being. Blackrobats creates pathways that can affect future choices.
An accessible art form in that it exists purely within each human. Even when under resourced with material and equipment, we have always managed to work on the ground with the creativity of our bodies.
There has been unprecedented relationship and identity development with the broader, global social circus networks, ACAPTA, CIRCA, Cirque du Soleil, Circus Oz, NICA. These being the more renowned companies plus the many devoted individuals that have given their time and energy to the Blackrobats phenomena.
Jillibalu is one of the Blackrobats participants who has now become the first Indigenous person in Australia to graduate from NICA.
Dominic Sandilands has 15 years’ experience in tertiary and regional hospitals; remote primary and community healthcare centres and 9 years’ experience as a health service manager. He is currently Executive Manager Primary Healthcare and Human Resources, and before that was with North and West Remote Health 2011. With a clinical background in in podiatry, Dominic is passionate about fostering leadership pathways in regional, rural and remote areas and in 2015 was elected as a member of the Queensland Branch Council for the Australasian College of Health Service Managers and Secretary since 2016; Dominic is a Fellow of the ACHSM; an MBA Graduate and a Graduate with the Australian Institute of Company Directors.
Learning objectives and outcomes relevant to aims:
Evidence that the practice achieved its objectives: Increased staff satisfaction amid change and uncertainty; reduced turnover rate; Increased proportion of staff identifying as Aboriginal and/ or Torres Strait Islander 25% to 32% of total workforce in six months; and increased productivity and efficiency.
Practical implications: Rapid and frequent reform to health; aged care and disability services has led to increased contestability; short-termed funding agreements; and increased funding and job uncertainty. Organisations such as North and West Remote Health as a not for profit company limited by guarantee has responded by seeking to increase organisational capacity through a long-term in-house approach to increasing efficiency, cultural proficiency and workforce development in remote and Aboriginal primary health care.
Originality and innovation
Lessons learned: The fundamental lesson is the need to take a long-term approach through an in-house train-the-trainer model for organisational learning and sustained improvement in staff retention.
We have learned the practical importance of agile project management methodology and the importance of obtaining board and executive support and commitment.
Implementation is challenging and Implementation science as a new area of research has subsequently been identified as applicable to this project and will be considered in future stages.
Dr Emily Saurman is a full-time Research Fellow-Rural Health with the Centre for Remote Health Research in the Broken Hill University Department of Rural Health, University of Sydney. She has been a rural health researcher since 2008; trained in applied ethics, public health, and research methodologies.
National, state, and local policy objectives promote the provision of patient-centred high-quality palliative and end of life care for all rural and remote residents, either at home or as close to home as possible.
In the far west of NSW there is a specialist palliative care service, however not every dying person requires or will access specialist palliative care. The successful specialist Model of Care has been modified for implementation in generalist settings as a palliative approach to care. The Far West Palliative Approach aims to improve the quality of life and experience of dying for all patients and their families through early identification, assessment and treatment of pain and other physical, psychological, social, cultural, and spiritual needs, respecting their care preferences, and supporting their carers and family in bereavement. Providing a palliative approach to care has been shown to be cost effective and improve patient outcomes including effective pain management, fewer hospital admissions, and dying in the place of their choosing.
The Approach was originally implemented within three Residential Aged Care Facilities in Broken Hill. Operationally, it is focused on:
Earlier analyses have demonstrated a change in care for all of their residents including increased coordination of care, improved advance care planning, reduced unnecessary hospital admissions, increased number of residents dying in their ‘home’, more timely referrals to the specialist service, and greater confidence within the facilities to manage end of life care. This Approach will be progressively adapted for local fit and implementation into other health service sites and settings within the Far West and other rural Local Health Districts. An evaluation will report on the adaptation, implementation, and impact of the new approach.
David Schmidt is a PhD candidate at the School of Public Health, University of Sydney, studying the topic of research skill building in the rural health workplace. He also works for NSW Health in research education and training roles for the Health Education and Training Institute and Southern NSW Local Health District.
Aims: Research is the key to a world of discoveries in improving rural health. But where does research fit in the organisational priorities of a rural health organisation? This study aimed to understand where research fits within the strategic documents, position descriptions or elsewhere within the organisational structure of a large rural health organisation.
Methods: This qualitative study, underpinned by a critical realist perspective, used both publicly available documents from the organisation’s public internet pages along with internal documents made available by the organisation. Strategic, operational and other documents from the 2015 calendar year were collected, along with position descriptions from November 2015 to February 2016 from the NSW Health erecruit system and research governance approvals for all research projects approved or active in 2015.
Data was extracted into nVivo software for management and analysis. Content analysis was used to identify the term the terms ‘research’ and ‘evaluation’ within the documents and the context of the use of those terms. Secondary thematic analysis identified organizational factors influencing research activity.
Results: Strategic, operational and other documents from the 2015 calendar year were extracted from 1654 external and internal websites, 159 position descriptions and approvals for research projects active in 2015 (n= 53).
Only a third of research conducted in the organisation was locally instigated or involved local staff as researchers. There was limited matching between positional responsibility for research and research activity. Medical staff were more active in leading research, nursing staff had greater positional responsibility for research and allied health staff were lacking in both research responsibility and activity.
Research was a strategic goal for the organisation, however this was not well represented in operational documents with only one facility’s operational plan emphasising research. Collaboration was identified as a key driver of research activity. A need for research training was identified by several groups, notably allied health professionals.
Relevance: Research training is conducted within rural health organisations without a clear understanding of the role of research within the structure of the organisation itself, potentially limiting the effectiveness of that training.
Conclusions: A lack of research in operational documents devolves responsibility for research to individuals. Individuals with greater levels of individual agency were more likely to be engaged in research. This individual approach undermines the potential of research in rural settings. Collaboration, both internal and external, will be an essential strategy to open the world of research to rural health workers.
Dr David Schmitz is Professor and Chair in the Department of Family and Community Medicine of the University of North Dakota School of Medicine and Health Sciences. Dr Schmitz is also the current President of the National Rural Health Association. With a combined experience of nearly twenty years in rural practice and teaching residents and students, he recently relocated to North Dakota continuing work in the areas of medical education, rural health, and workforce research. He is active with both the American Academy of Family Physicians, serving on the Commission on Quality and Practice as well as with WONCA, the global association of family physicians, serving as the North American representative to the executive of the group on Rural Practice.
Relevance: Recruiting and retaining physicians in rural communities remains problematic internationally. One solution throughout rural United States (US) is the implementation of the Community Apgar Program (CAP). Just as an Apgar score quantifies resources and capabilities of newborns, the CAP strives to serve the same purpose. It quantifies important resources and capabilities of rural communities that impact physician recruitment and retention. The CAP enables healthcare providers to identify and appreciate individual community solutions, while providing explicit insights regarding health workforce planning.
The implementation of the CAP internationally was first achieved in the Hume region of rural Victoria in 2015-2016. This international collaboration provided an analysis of the strengths and challenges that certain communities encounter, while establishing the uniqueness of each community, including what each had to offer physician.
Aims and methods: The aim of this latest study was to undertake an international comparison of key resources and capabilities of rural communities that impact physician recruitment and retention, and to provide valuable insight into augmenting recruitment and retention approaches in Australia and the US. To achieve this, Victorian data was statistically analysed and compared with data from two US states. These two states were selected as they share a number of geographical and community similarities with rural Victoria.
Results and conclusions: The findings indicate there are international parallels that positively impact physician recruitment and retention. These factors include a good perception of quality – a community’s reputation for providing quality medical care; having adequate transfer arrangements due to limited sub-specialist availability; and having an adequate allied health staff workforce to undertake ancillary health care within rural communities. Other similarities were identified as challenges that impact recruitment and retention of physicians. These factors include spousal satisfaction, in terms of local community living, education and employment opportunities; and the adequacy or existence of electronic medical records in rural settings.
The CAP it has offered health services internationally the opportunity to develop strategic plans specifically tailored for their community, while confidentially sharing best practices, obstacle elimination, and facilitating greater networking opportunities with other services. In addition, the international comparison has also identified shared trends and themes that directly impact rural communities in both countries, and may highlight key factors that are experienced in other rural communities elsewhere. This process has developed a more robust evidence based platform for the advocacy of key issues at the community, state, national and international level.
Nick Schubert started in the role of Senior Research Fellow with Indigenous Eye Health (IEH), University of Melbourne in January 2016. Nick has a background of rural health workforce policy and program delivery across Australia at community, state and national levels. He is also currently undertaking a part-time PhD with James Cook University in rural health sciences, exploring global approaches to rural medical generalism. In his role with IEH, Nick is working with a number of regions and jurisdictions across Australia to support the implementation of the Roadmap to Close the Gap for Vision (2012), as well as working on a number of key underpinning projects in support of this work.
Aims: To develop culturally appropriate diabetes-related eye health promotion resources for Aboriginal and Torres Strait Islander people.
Methods: A national expert roundtable informed the development of the ‘Check Today, See Tomorrow’ resources that used a multi-community music and arts based approach. Three regions in three states were selected capturing remote, regional and urban communities. A three-stage iterative development process was undertaken in each region including i) community engagement and planning; ii) development of pilot resources through workshops; iii) ongoing participant and stakeholder feedback. Music and art workshops were held to explore key messages and develop culturally appropriate health promotion resources relevant to the local region. To support national rollout, resource acceptability was evaluated through an online survey sent to the 176 service providers who had ordered the Check Today, See Tomorrow resources (n=50 respondents, 28% response rate).
Relevance: Annual eye exams are recommended for Aboriginal and Torres Strait Islander people with diabetes, yet only 20% receive this care. Supporting health professionals in the delivery of diabetes-related eye health messages is vital to ensure that annual eye checks form part of routine diabetes care. Best practice approaches for Indigenous health promotion are well documented, yet there is little literature describing the application of such frameworks to national health promotion strategies that maintain a local and community-driven process.
Results: More than 100 community members and health professionals were engaged in the development of the ‘Check Today, See Tomorrow’ resources. Music clips and personal stories were developed as audio and video material from local community music and arts workshops. Digital material complemented a suite of hard copy and traditional health promotion material for broader social media and professional and/or community educational tools. Survey respondents were from all states and territories (excl ACT) and either Aboriginal health workers (29%) or nurses (36%), with only 29% respondents being ‘eye health’ professionals. Overall, the Check Today, See Tomorrow resources were rated as being easy to use (4.4+0.6) and an effective way of delivering eye health messages (4.4+0.6).
Conclusion: Adopting traditional local engagement and community-controlled approaches are critical to developing culturally appropriate and relevant health promotion resources supporting Aboriginal and Torres Strait Islander communities. The ‘Check Today, See Tomorrow’ resources demonstrate the feasibility of combining traditional approaches with persuasive communication mediums allowing the connection of local issues to a national contemplation scale up of diabetes-related eye health messages.
Lisa Searle grew up in rural Tasmania and completed medical school in 2006 at the University of Tasmania. She has always been interested in rural health and working in resource-poor communities. During her degree she did electives in remote Thailand and in the Philippines, and after graduation she became involved with the Peter Hewitt Care for Africa Foundation and did a couple of trips to work in a small remote hospital in Tanzania. In 2009, after many years of waiting and planning, she finally joined Médecins Sans Frontières (Doctors Without Borders). Lisa has so far completed three missions with Médecins Sans Frontières and is planning another one later this year. Lisa currently lives and works in rural Tasmania. She is working as a GP registrar but has just passed her final exams to gain her GP fellowship.
Madeleine Seeary is a final year medical student with Flinders University. In 2016 Madeleine completed a year-long placement at a medical practice in the rural town of Angaston, South Australia. During this time Madeleine was able to immerse herself in the community and fell in love with the rural way of life, confirming her passion to work rurally in the future. During second and third year of her medical course Madeleine worked as part of a research team headed by Dr Elena Rudnik to evaluate a Doctors on Campus (DOCs) program, which is the topic of her presentation.
Background: The mental health of young people in Australia is National health concern, with almost one in seven 4-17 year-olds assessed as having a mental disorder. Schools have an important role in the provision of services for emotional and behavioural problems as many students seek help from teachers and school counselors. The ‘Doctors on Campus’ (DOCs), implemented at Nuriootpa High School, rural South Australia in 2014, is a school-based mental-health service for students involving local GP’s and Psychologists who regularly attend the school to see students with mental health concerns.
Aims: The overall aim was to describe student experience as clients of DOCs. Lines of enquiry included access to the program, appropriateness of a school-based mental health service in regard to stigma and student satisfaction with the service.
Methods: Individual interviews were conducted with seven students who had participated in DOCs. Interviews were recorded, transcribed and then thematically analysed using Nvivo.
Relevance: The provision and accessibility of mental health services for adolescent students is an important issue. There are known barriers preventing young people accessing youth-friendly health services in rural communities. DOCs aims to address and reduce this barrier by bringing the health professionals, including two GPs and three psychologists, to the students at school.
Results: Students spoke about the ease and timeliness of access to mental health support through DOCs including convenience of location and no-cost. A previous lack of knowledge about mental health services and support available and a subsequent improvement in health literacy was discussed. The importance of promotion and awareness of DOCs amongst the students also became apparent, as students were previously unaware of the existence of the program until referred by the school counsellor. Responses also indicated that appointment organisation is imperative for student satisfaction. Students spoke positively about DOCs and expressed improvements in their mental health and wellbeing, as well as improvements in school attendance and work. The perceived presence of stigma towards mental health was expressed by many students.
Conclusions: The personal perspectives of students who have participated in DOCs provide valuable information on the effectiveness of the program. Initial results show that the provision of a school-based service improves access and enables earlier intervention for mental health issues. Currently services provided to students vary between schools. This research informs health and education policy and the potential for similar services in schools across Australia. Experience of students in other school-based services is planned.
Dr Ayman Shenouda has been the Chair of RACGP Rural since October 2014, prior to that he was the deputy chair for five years. Ayman is also a member of the RACGP NSW and ACT Board Executive and was on the RACGP National Standard Committee of Education for several years. Ayman is also the Chair of the Remote Vocational Training Scheme, former Director of Medical Education CCCT Riverina/Murrumbidgee, former Chair of Wagga Wagga GP After Hour Services, and former Director on the Board of the Riverina Division of General Practice and Primary Health. Ayman was awarded RACGP GP of the Year in 2009. His practice was awarded NSW and ACT General Practice of the Year in 2007 and three AGPAL awards in 2009 and 2010. Ayman migrated to Australia 22 years ago from Egypt. He commenced his medical career in Australia as a surgical registrar in Tasmania in 1995, and has been a rural GP in Wagga Wagga for the last 17 years, where he established Glenrock Country Practice. Ayman’s main interest is education and training and his passion is to develop quality frameworks and systematic management tools to enable and enhance the work of GPs.
Aim: General practice workforce shortages persist in many parts of rural Australia with International Medical Graduates (IMGs) remaining an integral part of our workforce. More recent policy by successive Governments has sought to balance an over-reliance on skilled migration through a marked increase, almost doubling, of our domestically trained medical practitioner workforce. However, it is clear that the local stream of medical graduates now coming through will not translate immediately into rural workforce gains and that there will be a continued reliance on IMGs for some time. It is therefore essential that the policy focus shifts toward IMG retention, beyond moratorium obligations.
Methods: A ‘soap-box’ style presentation will bring delegates across the key policy requirements toward longer-term retention outcomes of our rural IMG workforce.
Relevance: The Australian newspaper reported on 9 August 2016, in its front page article ‘Visa Plan to Stop Foreign Doctor Rush’, that the Department of Health is seeking to remove GPs from the skilled occupations list, one of 41 health roles floated to exit, as sourced from a document obtained under freedom of information.
Results: For a more sustainable solution, in addressing maldistribution, more policy attention around retention beyond moratorium obligations to encourage doctors to remain in their rural communities is required. Delegates will gain insights into the key requirements to ensure retention of our rural GP workforce which extend beyond current forced distribution strategies through moratorium.
A mix of recruitment and retention strategies without compulsion are required to address maldistribution which need to take into account system capacity. Rural areas which are almost entirely serviced by limited-registration IMGs also have limited training capacity. There is a shortage of experienced, senior GPs to undertake supervision and lack of financial model or adequate incentive to support the increased numbers (domestic) coming through. A balanced approach which can counter workforce attrition shock, an ageing workforce and need for experienced rural GP supervisors will be required to develop the next generation.
Conclusions: Future policy decisions pertaining to the SOL must take into account system capacity, both in training and workforce, and the need to accommodate and fully utilise the domestic supply coming through. This is particularly important given the potential shortage of vocational training places for Australian medical graduates and an expanding need for more rurally based specialty training positions.
Mark Sheppard is a Muluridgi-Mbarbarrum man hailing from Mareeba in the Atherton Tablelands. A graduate from the Western Australian Academy of Performing Arts, he has gone on to work with companies such as Yirra Yaakin Noongar Theatre Co. (Perth); Kooemba Jdarra (Brisbane); DeBase Productions (Brisbane); Circus Oz (Melbourne); JUTE Theatre Company (Cairns). It was during his time with DeBase Productions that he created his one-man show “Chasing the Lollyman”, which he toured extensively around Australia, including JUTE Theatre Company and Northern Queensland. Mark was also in the original cast of the JUTE Theatre Company show “Proppa Solid” and toured with the show extensively in 2016 and will tour with the show again in 2017. Mark is currently based in Cairns.
Mrs Lara Shur has an undergraduate Honours degree in Speech and Hearing Therapy, a Masters degree in Audiology and a Graduate Certificate in Business Management. She joined the Earbus Foundation of WA (EFWA) as Director, Clinical Services in 2013. She was previously Manager of the Audiology Department at Telethon Speech and Hearing Centre and worked for the Department of Health and Ageing’s Office of Hearing Services as Manager of the Clinical Support Section for WA and NT. Lara was responsible for the design brief and roll-out of the West Pilbara Earbus as well as the Perth South Metro Earbus. She also managed Perth East Metro and Bunbury Earbuses for three years prior to joining EFWA. Lara has extensive clinical experience in the field of paediatric audiology with clinical interests in the areas of Aboriginal children, diagnostic assessments for newborns and difficult to manage cases. Since 2013 she has spent over 70 weeks in Aboriginal communities providing audiology services and coordinating the transdisciplinary Earbus teams. This work has been in the East Pilbara, Goldfields and Kimberley regions of WA. In Perth Lara undertakes Infant Diagnostic Assessments and works in the Earbus Children’s Hearing Clinic.
Since 1988, the Starlight Children’s Foundation (Starlight) has been delivering programs, in partnership with health professionals, which support the total care of children, young people and their families who are living with a serious illness or a chronic health condition.
The Captain Starlight program was first launched in in 1991 and today there are 111 Captain Starlights across Australia. The program is delivered by professional performers from a wide range of backgrounds including actors, clowns and comedians. They engage with children and young people through activities such as art, music, story-telling, comedy and games to alleviate boredom and reduce anxiety. With a specific commitment to reaching regional and remote areas, the Captain Starlight program has been operating in the Northern Territory since 2006. In 2015 Captain Starlight undertook over 128 trips to 35 different Indigenous communities and reached over 400 children per month.
On the basis of this work, a partnership was formed with Earbus Foundation of Western Australia in early 2015. Earbus mobile ear health clinics offer full primary health care to Aboriginal children in schools, day-cares, kindergartens and playgroups. As well as providing comprehensive ear screening, the Earbus employs GPs, audiologists and ENTs in order to reduce the incidence of middle ear disease in Indigenous and at-risk children in Western Australia below the World Health Organization benchmark of 4%. The focus of Earbus’s work is Otitis media, which can affect every aspect of early childhood development, including the ability to learn and succeed in school and hence creating lifelong barriers that prevent children from achieving their full potential
This paper will explore the successful partnership between Starlight and Earbus and examine its role in reducing the incidence of Otitis media. Feedback from health professionals working with Starlight regularly has highlighted that Captain Starlight’s presence in the health clinics encourages attendance and reduced anxiety in children waiting for their health check. Earbus Foundation KPI data shows both the Pilbara and Godlfields regions of WA to be significantly improved across a range of important ear health measures.
The paper will provide practical insights into successful on-the-ground service delivery, draw out insights and highlight lessons learnt. Earbus and Starlight are currently planning to undertake further research in order to ensure the program is meeting the needs of rural and remote living Indigenous children in Australia.
Russell Simpson has 37 years' work experience across a broad range of sectors, including private, not-for-profits and non-government organisations and government. His current position held is Area Director, Aboriginal Health Strategy, WA Country Health Service in Western Australia, where he has been for two years. Russell has also committed to giving back to the wider community, accomplishing 16 accumulative years' of experience as a Director on Boards such as Child Australia, Midwest Traineeship Company, Meenangu Wajarri Aboriginal Corporation, Regional Development Australia, and Winja Wajarri Barna Limited. He also has extensive experience on regional government committees. Russell is keen to provide support and guidance to his people, the Wajarri People of the Murchison region in Western Australia, to achieve better life outcome for our families and communities.
The Your Footsteps, Our Future Aboriginal mentorship program (AMP) was developed by the Western Australia Country Health Service (WACHS), and began operating in 2014. The need for a mentorship program was identified by Aboriginal staff and key stakeholders.
AMP is a first for the WA health sector. It is aimed at providing new recruits and those looking to further their career with one-to-one guidance from someone who is already well established and respected within the workplace. This unique program is designed to enhance career opportunities for Aboriginal staff working in health in regional and remote areas, and increase the representation of Aboriginal people in the WACHS workforce.
Starting a new job can be exciting but also sometimes daunting, and systems in an organisation as complex as WACHS can be tricky to navigate. A successful mentor-mentee relationship can kick start a fledgling career, or change of career, by providing the mentee with the networks, support and advice to navigate the challenges of the workplace.
The AMP model was developed to be sustainable and cost efficient, and uses the train the trainer model. To date, 24 WACHS staff have been trained to deliver training to potential mentors, more than 70 WACHS staff from across the State have completed the training to become a mentor, and over 25 mentoring relationships have been established.
An evaluation of the AMP was undertaken after its first year of operation. The evaluation found a high level of satisfaction (two thirds) among trainers, mentors and mentees. The focus is now on promoting the program to existing Aboriginal staff, and managers and supervisors are now required to promote and use the program as a tool to assist them to build the capacity of their Aboriginal staff. The program is also offered to all new Aboriginal employees as a part of induction and orientation processes.
Mentoring is a critical strategy in developing and strengthening the Aboriginal workforce skill base and knowledge in a welcoming and supportive work environment. It can help break down cultural barriers through one-on-one interaction and coaching.
The AMP was highlighted as best practice by the Western Australian Public Service Commission, and was a finalist in the WA Health Excellence Awards.
Judy Sinclair-Newton was President of Isolated Children’s Parents’ Association Australia from 2011 to 2015 and is currently filling the role of Immediate Past President. She has spent most of her life living near Walgett in North Western NSW, running a mixed farming business and is passionate about rural Australia and people who live there. Accessing educating in remote Australia poses many challenges and it was through educating her three children that she became involved with ICPA. ICPA (Aust) is a voluntary parent body dedicated to ensuring all geographically isolated students have equity of access to a continuing and appropriate education. This encompasses the education of children from early childhood through to tertiary. The member families of the association reside and work in rural and remote Australia and all share a common goal of achieving access to education for their children and the provision of services required to achieve this. Many of our families live on isolated stations, great distances from their nearest community, with their only access to education, including early childhood education, being via distance education programs.
In our big beautiful country where the population is spread over vast and in places very remote areas, traditional educational services are not able to be provided to all students.
Since 1971 the Isolated Children’s Parents’ Association of Australia, ICPA (Aust), has represented families living in rural and remote regions of Australia. Our goal is to achieve equity of educational opportunity for all geographically isolated children and thus ensure they have access to a continuing and appropriate education determined by their aspirations and abilities rather than the location of their home. Due consideration must be given to factors which affect the delivery of and access to education by these children, factors which do not necessarily need to be considered within the context of metropolitan education.
Children may be educated in small rural schools, by distance education, attend boarding schools or school term hostels and sometimes have access to early childhood services. Tertiary students whose family home is in rural and remote Australia frequently must live away from home to access further education.
The financial cost to families educating children in these locations continues to rise and can be attributed to many leaving these areas. ICPA continues to provide government with evidence of the inequalities through thorough research and direct input from grassroots members.
For many of our member families the only access to education for their children is to study by distance education. A fascination to some, a chore to others, distance education schooling has long been the only option for education in rural and remote Australia. At the latest Federal Conference held in Perth, WA, ICPA launched the Distance Education Resource video showcasing the modern technology filled isolated classroom and this has received an overwhelming response from media and the public.
ICPA welcomes any opportunity to highlight the challenges geographically isolated children face and the latest developments as we continue to strive towards achieving the following:
Janie Dade Smith is the Professor of Innovations in Medical Education at Bond University, where she leads the development, transition and implementation of the Doctor of Medicine program; she also coordinates the Master of Clinical Education Program, and works heavily in the award winning Indigenous medical curriculum. Prior to Bond, Janie ran her own national consulting company—RhED Consulting Pty Ltd—where she undertook consultancies for health departments, universities, professional colleges, government and not-for-profit organisations. Janie is well published and is the author of the very successful text Australia’s Rural, Remote and Indigenous Health, the third edition of which was published by Elsevier in 2016.
Many health practitioners work in remote Indigenous communities in Australia, Canada and New Zealand, which makes it important that they understand the impact of the social determinants upon the health status of the people they serve.
Rather than recite the statistics that we echo daily this innovative filmic presentation will tell a fictional story about a day in the life of a young family who live in very remote Australia—Rob and Stella live in Nabvana.
Alongside the story are the health statistics that are suffered every day by remote Indigenous families. The story then describes what the future life trajectory would look like for their new son Arnold, if he was born today.
This is a different, powerful and innovative presentation, which fits in well with the nature of the conference. It is based on the latest statistics from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare and compares the health status of Indigenous peoples in the USA, Canada and New Zealand.
Tony Smith is a radiographer with over 35 years’ experience. He has worked in public hospitals, private practices and the tertiary education sector. Since 2003, he has been employed at the University of Newcastle Department of Rural Health, initially in Tamworth and since 2012 in Taree, on the mid-north coast of NSW. Tony is currently the Deputy Director of the Department, which supports students from various health professions on long-term and short-term rural placements. Tony’s research interests focus largely on rural health workforce issues, especially around the development of new models of interprofessional and collaborative practice, particularly in medical imaging. He has a long-term interest in the education and support of GPs and nurses who perform limited-licence radiography in rural and remote locations, where no radiographer is available.
Background: The impetus for introducing the Nurse Practitioner (NP) role in Australia some 16 years ago was to address gaps in rural and remote health services; yet, the growth in the NP workforce since has been modest, with the majority of NPs currently working in urban or inner regional areas. Given the consensus view that extended or expanded scopes of practice (ESoP) roles, such as NPs, have the potential to significantly enhance rural and remote workforce capacity, it is important to uncover professional and regulatory factors that facilitate or impede their uptake.
Method: Semi-structured, in-depth interviews were conducted with 15 NPs, as well as with 5 of their colleagues across 4 states and 1 territory. The NPs and their colleagues represented a range of specialities, and worked in a variety of rural or remote settings. Utilising institutional theory as the framework, data was analysed for common themes.
Results: A range of micro (practice), meso (institutional and community) and macro (legal and regulatory, education, economic and political) factors emerged that impact on the NP role. Prominent among these were:
The lack of NP jobs, as well as insufficient candidates available to fill vacated roles was also noted as a barrier by informants, with the lack of continued funding for NP roles being a contributory factor.
Conclusions: Policy advisers and health service managers need to be cognisant of how these factors can interact to hamper the sustainability of ESoP roles, especially in rural health. A lack of awareness and understanding by other clinicians, managers and community members means that extended scope practitioners can expend much effort in explaining, promoting and advocating for their role. Workforce innovations can engender tensions and intraprofessional and interprofessional territorialism when traditional scopes of practice are challenged. Moreover, limited funding and restrictive or contradictory regulations send clear signals to the health services and other clinicians about the relative value and long term sustainability of ESoP roles, even in rural areas where such roles are needed.
Melissa Smith graduated from James Cook University, Townsville, with a Bachelor of Physiotherapy in 2008. Since graduating, Melissa has worked with paediatric populations across multiple health settings and has worked at Child Development Service (CDS) Townsville since 2013. CDS Townsville is a community based early intervention service that provides family centred transdisciplinary care to children with chronic and complex developmental delays. CDS Townsville also provides outreach services to families living in rural and remote communities within the Townsville Hospital and Health Service. Melissa is currently employed as a senior physiotherapist and works across the developmental caseload and with the outreach team. Melissa is currently in the process of evaluating the new evidence-based model of care aimed at enhancing child development services provided to families in an outreach setting.
Child Development Service (CDS) Townsville has been providing outreach to children with chronic and complex developmental concerns living in outer regional, rural and remote localities across the Townsville Hospital and Health Service (THHS) in an ad-hoc way since the 1990’s. A review of this service indicated that the model was inefficient, ineffective, dislocated from local providers, and delivered in a way that was not evidence based or family focused.
The Australian Early Developmental Census (AEDC) is a population measure of children’s development upon school entry. The AEDC enables services to better understand the developmental capabilities of children from communities across Australia and compare communities in terms of the prevalence of developmental vulnerability. The AEDC confirms that geographical isolation increases a child’s risk of developmental vulnerability. The AEDC data indicates that CDS Townsville outreach communities demonstrate levels of developmental vulnerability significantly higher than the state and national averages, yet service access rates from these communities has historically been very low.
CDS Townsville has developed an evidence based model of care aimed at improving access to high quality, integrated, specialist child development services specific to the needs of children and families living in communities within THHS. The new model of care was informed by evidence gathered through a literature review, service mapping of local communities, analysis of needs and satisfaction feedback from consumers, clinicians and community stakeholders, and a three-month pilot of an interim service model. The new model is transdisciplinary, family-centred, culturally sensitive, partners with local community stakeholders, and utilises telehealth to support care provision.
Implementation of the new model of care commenced in July 2016 and an evaluation of the service will occur in January 2017. It is hypothesised that the new model will result in increased community engagement (demonstrated by an increase in referrals), earlier identification of children with development delay (demonstrated by a decrease in child’s age at referral) and an increase in family engagement (demonstrated by increased attendance rates). Qualitatively, it is hypothesised that the new model will result in improved consumer and community satisfaction and improved partnerships between Health, Education and other agencies.
The evaluation of this model will add evidence to support and improve the value of outreach services provided to children and families in outer THHS and provide transferrable learning points to agencies providing like services in varying contexts.
Teresa Smithson is the Manager Aged Care Services based in Darwin, at Carers NT. Teresa has worked for Carers NT for over three years. Teresa completed her enrolled nurse training in 1978 and went on to work in acute care settings. Over the past 20 years Teresa has worked in the aged care sector in a variety of settings, including residential facilities and community care. During this time working in aged care, Teresa discovered her passion for caring for our elderly and their families, with a special interest in dementia care. As the Manager of Aged Care Services, Teresa oversees the programs that are delivered through the Commonwealth Home Support Program, Carer Relationships and Carer Support sub-program. With many recent changes to the aged care sector, Carers NT has seen many challenges to the way services are delivered, especially in remote communities. Teresa ensures issues and challenges are fed back to the Department of Health. Teresa works closely with the local regional assessment team and Carers NT remote team, exploring options of streamlining the process of registering clients for services, particularly the remote camps and Urban Troopy program, to ensure no one is disadvantaged.
The organisation provides unique, flexible and culturally appropriate support options for indigenous Australians with a disability or who are frail aged and living in the Top End of the NT. Support is available in more than 33 remote communities. The Remote Respite Camp program, Troopy program, Wellbeing Troopy program and Urban Troopy program provide culturally respectful support on country.
Camps are delivered in communities on request during the dry season and are aimed at low care, frail aged indigenous females. A local person from the community is engaged to work as a support worker on camps, utilising a brokerage model; the aim being to contribute to strengthening community capacity, employment opportunities and skills development. The camp setup is self-sufficient with solar power, tents, sleeping equipment and all food supplied for the duration of the camp. Participants assist in camp duties and all staff focus on wellness, reablement and restorative approaches aiming at improving quality of life. Activities are planned in consultation with the participants, often with an after-dinner movie under the stars!
The Troopy program is delivered on request by, and in consultation with a community and is managed by local providers and their staff in the community. A Troopcarrier, fuel and a small budget for the outings is supplied. This provides the opportunity for carers and recipients in remote communities to access meaningful, on –country support, determined by them and delivered by familiar local people. Respite outings include fishing, hunting, gathering craft materials, funeral attendance, camping and visits to other communities to see family.
The recent Aged Care reform has posed some particular challenges in the change in approaches to providing support for remote clients. All referrals must be made through the Federal government “My Aged Care” portal, by service providers or by self-referral. When a service provider initiates the referral My Aged Care then attempts to make contact with the client. This can prove difficult in remote communities. If contact isn’t able to be made after 2 phone calls the referral is closed and then becomes the responsibility of the client to make contact to complete an assessment. Our experience on community tells us that phones are often lost, out of credit, people mightn’t answer an unfamiliar number or they may have given their phone to another and no longer have phone access.
The Earth has just recorded three years in a row of record temperatures. People living in rural and regional Australia are already dealing with the impacts of climate change and they will suffer disproportionally compared to cities and consequently the inequality will increase. There is a genuine concern what climate change is going to mean for them for health, food, security and economy in their communities.
There is the inevitable temptation to look to government to fix this issue directly, however government cannot fix all of Australia’s problems single-handedly. The Australian Government can support social enterprises working locally on issues providing them with an opportunity to fund the successes and not to throw money at lost causes.
There are many ways that the government can support social issues including social impact bonds where service providers are paid on the results they achieve, however in my opinion social enterprise is the best way forward. Social enterprises are businesses that aim to achieve financial and social or environmental outcomes through their work.
Two recent examples of this are:
In Australia’s geographically isolated indigenous communities, vegetables must be shipped thousands of kilometres with freight costs subsidized by the Government. The quality is inevitably compromised which reduces consumption of vegetables thereby creating costly health issues. Food Ladder’s social enterprises, which have the support of Federal Government, have created hundreds of employment outcomes and accredited certifications in horticulture, education programs for children, health benefits and significant savings on shipping food to remote areas.
The Loddon Campaspe Community Legal Centre (LCCLC), a program of ARC Justice, is a community legal centre (CLC) in Bendigo, Victoria. LCCLC provides social justice advocacy in the form of legal advice, casework and court based outreach to vulnerable and disadvantaged people in the Victorian Goldfields region. In order to extend our reach into vulnerable and disadvantaged communities we partnered with Bendigo Community Health Service (BCHS), who share our passion for social justice advocacy, to form a Health Justice Partnership (HJP).
One of our goals with the work of the Bendigo HJP is to provide our clients with a voice. Accordingly, as will be observed with our presentation, this is a non-traditional speaker biography because the speakers are primarily the clients who have been assisted via the Bendigo HJP. The Bendigo HJP has been independently evaluated and employed Dr Liz Curran’s 360-degree action research methodology to determine if the Bendigo HJP had a positive impact upon our client’s Social Determinants of Health. A summary of our observations will be presented by Dr Rob Southgate (Research Assistant to Dr Liz Curran). We will also detail the next exciting step in our collaboration with our community health partners.
The Bendigo Health Justice Partnership (HJP) is a partnership between the Loddon Campaspe Community Legal Centre (LCCLC) (a program of ARC Justice) and Bendigo Community Health Service (BCHS).
The Bendigo HJP aims to address the Social Determinants of Health capable of legal redress. It is based on the understanding that many vulnerable and disadvantaged clients only consult lawyers for about 16% of their legal problems favouring instead to make these disclosures to their trusted health professional. Clearly this makes health professionals a key access point for disadvantaged individuals when legal issues arise.1
By placing a lawyer along side heath professionals in the community health setting we wanted to extend our reach into the community to engage vulnerable and disadvantaged clients who might otherwise have a natural reticence to seek assistance for their legal issue. In essence we wanted to borrow the trust clients exhibit towards their health professional.
We have evaluated the Bendigo HJP via a 360 degree action research methodology (which places the client’s experience front-and-centre) (as pioneered by Dr Liz Curran of Australian National University). The learning’s over the duration of the project have been legion. We set out to have a positive impact upon Social Determinants of Health for our vulnerable and disadvantaged clients and we think we have achieved this.
However, the journey has proved to be of huge value to both partner organisations. It is fair to say it has instilled a sense of camaraderie in both organisations and has enriched the professional workers practice whether they be health worker or legal practitioner.
Here we report some of the client’s stories, their journey and the impact the HJP has had upon them. We discuss the impact upon the partner organisations and describe the immediate and longterm usefulness of co-localisation, legal advice and advocacy in the form of casework or secondary consultations. We provide ‘hints and tips’ for rural organisations contemplating their own HJP. Finally, we announce the next step in the Bendigo HJP, its novelty and what we hope to achieve in the immediate future.
Reference: Coumarelos, C., MacCourt, D., People, J. McDonald, H.M., Wei, Z., Iriana, R. & Ramsey, S. (2012) Access to Justice and Legal Needs: Legal Australia Wide Survey Legal Need in Australia’, (Sydney, Law and Justice Foundation of New South Wales). Available at: http://www.lawfoundation.net.au/ljf/site/templates /LAW_AUS/$file/LAW_Survey_Australia.pdf.
Rebecca Southurst is the Assistant Executive Officer and Population Health Planner at Lower Hume Primary Care Partnership. Rebecca is responsible for the chronic care portfolio and supports local health services to continuously improve processes that enable high-quality care for people living with chronic health conditions. She has completed a Bachelor of Health Science majoring in Public Health, as well as a Graduate Certificate in Health Services Management, which enables her to work with clinicians and managers to plan, implement and evaluate population health interventions. Rebecca is passionate about improving population health and ensuring that public health services are accessible to all.
Background: Lower Hume Primary Care Partnership (PCP) supports a working group of local health services across two Local Government Areas (LGAs) in regional Victoria to improve access, quality and coordination of local services to provide person centred diabetes care. Representation from Small Rural Health Services, Local Government, Aboriginal Health, Pharmacies and Murray PHN, demonstrate the commitment to local systems improvement.
Methods: The working group conducted consumer research to guide local systems improvements for diabetes care. A consumer survey and focus group explored local experiences of diabetes care to inform an integrated model of care. 70 survey responses were collected from October 2015 until April 2016, and 6 consumers provided input through the focus group.
Results: Over half of survey participants were over 65 years old, and 86% had type 2 diabetes. Results concluded a high prevalence of diabetes related complications, lack of knowledge of most recent HbA1c reading and emotional impacts of diabetes, despite high satisfaction with local health services. Analysis also highlighted that people living with diabetes rely on multiple health care professionals to support their ongoing management, and that age did not seem to be a barrier to wanting to try new technology. The focus group was able to pick up on the knowledge gaps from the survey results, and participants offered invaluable insight into strengths and weaknesses of the local rural health service system, including the need for food preparation education and health professionals to talk about depression in the early stages.
Conclusion: Understanding the experience of consumers was recognised as an essential starting point for systems improvement work across Lower Hume. A mixed method approach to collecting consumer input has provided insight into diabetes management in regional Victoria and identified opportunities for continuous local systems improvement to improve self-management.
Brooke Spaeth joined the International Centre for Point-of-Care Testing in February 2010 as a Research Assistant, after completing a Bachelor of Medical Science degree with Honours at Flinders University in 2009. As part of her degree Brooke completed the first university level topic offered on Point-of-Care Testing titled Application, Management and Effectiveness in 2008. Brooke’s honours project with the Centre evaluated the implementation and effectiveness of Point-of-Care Testing in remote health centres of Northern Territory, which has since resulted in several research publications. Brooke is now the Point-of-Care Coordinator for the Northern Territory Point-of-Care Testing Program and has also been the Device and Quality Coordinator for the national Quality Assurance in Aboriginal and Torres Strait Islander Medical Services (QAAMS) Program. In 2015, Brooke was successful in her first grant from the Emergency Medicine Foundation to evaluate the cost effectiveness of the Northern Territory Point-of-Care Testing Program. Results from the grant research were positive with the research indicating potential cost savings to the Northern Territory health system were in excess of $20 million per annum. Brooke’s other interests include Point-of-Care Testing for drugs of abuse in the workplace and also infectious disease; focusing on Point-of-Care tests for malaria in low resource settings and for reducing antibiotic prescription rates.
Introduction: The Northern Territory (NT) Point-of-Care Testing Program commenced in 2008 in over 30 selected remote health centres in the NT. Using the Abbott i-STAT point-of-care testing (POCT) device, pathology results are immediately available at the health centre enabling immediate diagnosis and treatment or monitoring of a wide-range of acute and chronic conditions.
Background: In 2015, under the direction of the NT Department of Health, the program was expanded to every remote health service providing equity of access to this diagnostic tool for all remote Territorians. The large scale rollout, doubling the program’s size to 72 remote health services, required careful planning and innovation.
Methods: The rollout was coordinated by a team of scientists, professional practice nurses and doctors who make up the NT POCT Program Management Committee. Strategies to rollout the program included: accessible training options including weekly teleconference training sessions; development of a website providing 24/7 Territory-wide access to training materials including videos; on-site visits to provide initial device set-up, training and coordination; and the development of an innovative method for monitoring the number and type of tests performed to assist with consumable ordering (a primary obstacle for remotely located health centres).
A cost effectiveness evaluation of the program was conducted, funded through a grant from the Emergency Medicine Foundation. Patient cases from 6 remote health centres where the availability of POCT ruled out the need for an emergency medical retrieval were reviewed to determine cost savings. Results were extrapolated using prevalence data for each condition to give an NT-wide estimate of cost savings. Clinical effectiveness of POCT was also examined.
Results: In the initial 6 months of the rollout, 158 new remote staff were trained as device operators with survey respondents expressing high satisfaction with the quality of training. The analytical quality of POCT results in this primary care setting remained stable during the rollout period and was of equivalent standard to a laboratory.
Improvements in outcomes for acutely ill remote patients were identified through POCT enabling more rapid diagnosis and treatment. Indicative cost savings through preventable medical evacuations using POCT are substantial (millions per annum), with final results to be released in October 2016.
Conclusion: This POCT program serving remote communities can be translated to other areas of remote Australia and internationally due to its significant cost savings through prevention of unnecessary medical retrievals and positive impact on patient outcomes and increased patient safety.
Erica Spry is a Bardi Jawi woman who has family ties throughout the Kimberley region. She has worked in legal, land management and health and is the northern coordinator for the ORCHID study, which is looking to find better ways to screen for diabetes in pregnancy. She also assists with other projects working on more positive health outcomes for her fellow Kimberley Aboriginal people.
Background: Screening recommendations for gestational diabetes mellitus (GDM) are for all pregnant women who are not known to have diabetes or GDM to have an oral glucose tolerance test (OGTT) at 24-28 weeks gestation. Anecdotally there are poor GDM screening rates in rural, remote and Aboriginal populations in Western Australia (WA). We aimed to determine the rate of screening for diabetes during pregnancy in rural WA after universal screening was introduced in 2012.
Methods: Antenatal records of 551 women aged 16 years or more without pre-existing diabetes and with singleton pregnancies delivered in 2013 were retrospectively audited (39.0% Australian Aboriginal; 8.3% other high risk ethnicities). GDM was primarily diagnosed using criteria at the time (OGTT: fasting glucose ≥ 5.5 mmol/L, or 2-hr glucose ≥ 8.0 mmol/L). Other tests included fasting and random blood glucose, HbA1c and glucose challenge test. The Modified Monash Model (MMM) was used to categorise health service remoteness. A linear regression model was created using a backwards step-wise approach to identify factors that were associated with OGTT screening.
Results: The health services of most Aboriginal women audited were located in MMM3 (rural towns; 42.3%), MMM6 (remote towns; 23.7%) and MMM7 (very remote towns / communities; 32.6%), while most non-Aboriginal women (92.2%) received their care in rural towns (MMM2 and MMM3). Only 276 (50.0%) women were screened with OGTT; 119 (21.6%) women had no record of being screened for GDM. There was a significant decrease in OGTT recorded (56.1% to 38.4%; P < 0.001 for trend) and concomitant increase in other tests recorded (16.4% to 47.9%; P = 0.001 for trend) as health service remoteness classification increased. In multivariate analysis women with a previous GDM diagnosis (OR 6.2; 95% CI 1.8-22.0; P = 0.004), high risk GDM ethnicity other than Aboriginal (OR 3.0; 95% CI 1.4-6.2; P = 0.004) and Aboriginal ethnicity were associated with being screened with OGTT (OR 0.47; 95% CI, 0.33-0.68; P < 0.001). Of those screened with OGTT there was a high rate of GDM diagnosed: 14.8% v WA average of 6.2%.
Conclusions: These results suggest that while women present for antenatal care at 24-28 weeks gestation there are specific problems with the OGTT as a screening test for GDM in rural WA. For screening to be effective it should be acceptable and available to all at risk. Further work is required into alternative screening strategies for GDM.
Marianne St Clair completed a BSc (majoring in biological sciences with a computer science minor) and Honours at Flinders University of SA (FUSA). She then taught and participated in research at the University of Adelaide (UoA) and FUSA for approximately nine years, specialising in whole organism biology, ecology (marine), animal behaviour (non-human primates), and biostatistics. Marianne then ran a consulting company specialising in environmental consulting, information system analysis, design and implementation. In 2002 she took up the position of Executive Officer for the Primary Industries Training Advisory Council, overseeing the national training package development, supporting industry development and training solutions for the primary industries. She was an active member of the Indigenous Mining and Enterprise Task Force. After leaving PITAC, Marianne worked with the cattle industry, Meat and Livestock Australia, Teas Bros and the camel industry to establish a large abattoir in the Top End. She has also worked with the forestry and forestry products industry to establish forestry-based enterprises in remote Indigenous communities, consulting work for Chinese companies and an animal care program in the Gili Islands, Indonesia. Marianne commenced a PhD project in management (part-time) in March 2015 at Curtin University. In 2015 she facilitated the development of Broadband for the Bush Alliance’s (B4BA) Strategic Plan with the Alliance’s partners. Since then she has continued to work with AMSANT, B4BA and a number of project partners to expand access to digital resources and telehealth. She is also the Executive Officer of B4BA (part-time).
The NT leads the country in the use of standards-based secure messaging for clinical information (eg specialist referrals, hospital discharge and pathology reports), shared health patient records and other internet connected diagnostic devices such as the iStat machine (blood analysis) and internet connected Electrocardiography (ECG). Benefits of telehealth have been demonstrated both internationally and through local assessments through reduced costs associated with patient travel, minimised time spent away from community and providing improved patient satisfaction eg use of remote diagnostic systems for identification of cardiac issues can improve patient care and save lives. For example, the Chinese government is looking to telehealth as a solution to service delivery issues.
Uptake of telehealth in the NT has been limited, for a variety of reasons including inadequate broadband access. Through collaboration between stakeholders, staged implementation has been developed at a number of test sites. Program partners (AMSAANT, NT DoE, Northern Institute, TelstraHealth) are keen to negotiate an incentivised remuneration system to assist increased uptake of telehealth in NA requiring engagement with hospitals and Aboriginal Community Controlled Health Organisations (ACCHOs). Additionally, initial discussions with colleagues from CDU working in remote China and Indonesia indicate there may be opportunities for collaborative work on extending telehealth services to remote areas in China and Indonesia.
NA context: Currently NT DoH is working to expand the number of acute, allied health and specialist services that provide telehealth solutions to remote patients. NT ACCHOs are developing change management strategies for telehealth usage that recognise existing work practices. They are also expanding the use of video conferencing within their organisations to support management, training, internal and external clinical support. Multiple organisations who currently interact to provide remote communities with primary health services and individuals who require access to specialist and acute/emergency clinical interventions will also be included in the digital solutions expansion.
The program will assist remote ACCHOs to establish telehealth and aid them in evaluating the cost/benefits of reliable internet and telehealth services as well as expanding digital inclusion. It will also promote telehealth enabled health outcomes into the future and has a significant research component:
This research will inform policy development to improve service delivery to remote communities and provide support to ACCHOs to expand telehealth and digital inclusion.
Mike Stephens is a consultant pharmacist and policy advisor at the National Aboriginal Community Controlled Health Organisation (NACCHO). Prior to this he has worked as practice pharmacist at Danila Dilba Health Service in the Northern Territory. Mike has recently convened a joint NACCHO–Pharmaceutical Society of Australia special interest network of pharmacists working in Aboriginal Community Controlled Health Organisations. He is also a member of the NACCHO Lead Clinicians Group. Mike has had experience in community and hospital pharmacies in Australia, the United Kingdom and Guatemala, and also worked in a range of health project management roles. Mike is in the final stages of a combined Master of Public Health and Business Administration with a focus on health economics.
Background: Government healthcare spending for Indigenous Australians is higher than for non-Indigenous Australians yet it does not appear to be impacting health outcomes equitably, especially in more remote areas. The defined region of Northern Australia is characterised by decentralised populations and has a high concentration of Indigenous people compared with southern Australia. Recent research has highlighted the need for investment in Northern Australia. The only Australian standard for economic evaluations of healthcare is the Pharmaceutical Benefits Advisory Committee (PBAC) guidelines, which recommend use of national data, such as Pharmaceutical Benefits Scheme (PBS) data. These data are more likely to be under-recorded and health services underutilised by Indigenous patients compared with non-Indigenous patients. Indigenous Australians also may have distinct health models that differ from mainstream Australian services. For these reasons, validated economic evaluation of healthcare is critical to deliver the best allocation of scarce resources for Indigenous communities in Northern Australia.
Aim: This study aimed to determine how health service use and costs are captured and quantified in economic evaluations for remote and regional Indigenous populations in Northern Australia.
Methods: A systematic review of health service economic evaluations involving Indigenous Australians within Northern Australia was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of records published from 2010 to 2016 was conducted from PubMed, Scopus, government and non-government databases. Thematic analysis was performed on evaluations that met inclusion criteria.
Results: Sixteen evaluations met the inclusion criteria from an initial 515 records identified. These studies used disparate evaluation methods. Most evaluations were performed from a state or territory perspective. Only seven evaluations captured patient data that extended outside of a state or territory source. There was no health service data capture using national data sources. Only two studies used a comprehensive societal perspective. Few studies considered Indigenous patients’ perspectives.
Conclusions: Despite the needs identified for robust economic evaluations for Indigenous peoples in Northern Australia, recent evaluations have not been conducted consistently or with sufficient consideration of federal, societal and Indigenous consumer perspectives. Uncoordinated evaluations from state and territory perspectives have led to the underutilisation of established guidelines. Barriers identified, such as unlinked patient PBS data, also limit the ability of governments and researchers to conduct comprehensive economic evaluations. Methodological consistency in economic evaluations of healthcare is recommended and will lead to improved, quantifiable comparisons of health services for Indigenous patients within, and outside the health sector.
Dr Ruth Stewart is President of the Australian College of Rural and Remote Medicine and is Associate Professor of Rural Medicine at James Cook University College of Medicine and Dentistry. She lives and works on Thursday Island in the Torres Strait where she is a Senior Medical Officer with surgical obstetric credentialing in the Thursday Island Hospital and runs the diabetes clinic. She worked for twenty-two years as a procedural GP in Camperdown, South West Victoria, Australia where she developed and implemented the Integrated Model of Medical Education in Rural Settings (Deakin IMMERSe) for Deakin University. Her PhD examined a rural maternity Managed Clinical Network. Ruth’s research interests are rural maternity care and policy, rural medicine and rural medical education.
Background: Rural and remote birthing services have been closing for several decades. The rationale behind these closures are often concerns about safety, economic resources, and professional indemnity. Many developed nations have experienced similar trends in closure of rural birthing services. These closures have considerable implications for patients, communities, clinical workforce and health services in rural areas. Many non-metropolitan community members continue to lobby for the reinstatement of local birthing care as they seek safe, equitable service access and high quality care. After many years of closures, the state of Queensland in Australia has seen increased interest and success in restarting remote birthing services.
There are significant challenges to be overcome for any birthing service to recommence, including: ensuring appropriately skilled workforce, consideration of community expectations, equipment availability, navigating health system requirements and the politics of the time.
Those wishing to reopen a rural birthing service would benefit from understanding the essential tasks and processes required to restart services and the enablers and barriers to achieving this. Analysing and collating this data from a number of services into a ‘toolkit’ may assist the direction of other remote health services seeking to reopen birthing care after a period of closure.
Aim: This paper outlines results from the first case study of a reopened birthing service in a remote northern Queensland health service.
Methods: A qualitative, case study approach was employed to investigate key enablers, barriers, tasks and processes associated with reopening a remote birthing service. Purposive sampling was used to identify key stakeholders and actors throughout the system including clinical and support staff, local service managers, community advocates and relevant district managers. These actors were invited to participate in individual semi-structured, in-depth interviews during which they discussed the experience of reopening the birthing service from their perspective; highlighting enablers, challenges, and important influences. Interviews were transcribed and analysed using an iterative, thematic technique.
Results: Qualitative analysis of the results found key enablers, barriers, tasks and processes can be categorised into thematic groups; the largest of which were associated with workforce, funding and safety. These will be discussed in light of the timeline for reopening: from initial groundwork required to start the process, service reopening and then ongoing concerns after the service recommences. The contextual factors surrounding the service recommencing are presented from community, staff and political perspectives.
Lindsey Stewart is a rural speech pathologist and team leader of a multidisciplinary allied health team servicing Aboriginal children aged birth to eight years in Dubbo, NSW. During her studies of a Bachelor of Applied Science Speech Pathology from the University of Sydney, Lindsey was fortunate to participate in rural health placements, including Dubbo, and participate in a research project for the university for Indigenous healthcare in urban areas. This piqued her keen interest in Aboriginal health and so, while initially commencing her career in early intervention, Lindsey recalibrated her career focus toward Aboriginal health when she commenced with Wellington Aboriginal Corporation Health Service in 2011. She has nine years’ experience as a speech pathologist in multidisciplinary teams and currently manages a diverse team, including Aboriginal health workers, therapy aides, speech pathologists, occupational therapists and a psychologist. She is passionate about improving health and education outcomes for Aboriginal children in her home community.
As a Commonwealth funded, paediatric, allied health team servicing the Aboriginal population in our community, we would like to share our service delivery models and workplace partnerships that make this multidisciplinary allied heath team a success.
We service birth to eight year old Aboriginal children for speech pathology, occupational therapy and psychology. Each discipline works in collaboration with our Aboriginal health workers (AHWs) to provide a comprehensive family centred and culturally relevant service.
A cohesive partnership between our AHWs and allied health clinicians has proved essential to our overall service delivery. This key philosophy contributes to successful client outcomes by assisting in client engagement, attendance at appointments, culturally relevant parent education and goal setting.
We have established key roles and responsibilities guiding this partnership through policy and position descriptions which builds the positive working relationship for joint assessments, home visits, therapy sessions, case planning meetings and outreach screening programs. All these tasks require on the job upskilling and sharing of information with your colleague.
AHWs share ideas on wider social and family issues and ideas on what will work best for the family. Clinicians share information on the specifics of their discipline to build the knowledge base of the AHWs in relation to allied health. This sharing of information and upskilling of each profession increases the knowledge of the whole team but most importantly benefits the child.
This case study demonstrates the successful working partnership;
Anna was referred to the program for all three services. The AHWs completed an initial screening on Anna and completed an intake with her mother. This included speech pathology and occupational therapy screening with a detailed parent interview. This step was crucial to engagement into the service. It was identified at the initial meeting that the mother had a hearing impairment and a signing translator via video link was organised for subsequent appointments. The AHWs also provided transport for the family and linked them in to services, including Mission Australia, to assist with other family goals. They organised a case conference with the school, and all allied health staff and external agencies involved. This team approach meant that the service could be coordinated and culturally engaging for Anna and her mother.
This case study and other clients accessing the program benefits from the cohesive partnership between the AHW’s and allied health clinicians.
Deborah Stockton has specialised in the field of child and family health nursing for over 20 years, with positions including Clinical Nurse Consultant, Director of Clinical Services (Karitane) and Community Services Manager in rural Victoria. Deborah holds a Masters in Adult Education and has held the position of Director Professional Development, Clinical Education and Research with Albury Wodonga Health. These positions have enabled Deborah to develop innovative initiatives in partnership with other organisations, promote interprofessional practice and develop organisational research capacity building. In her current duel role as Operational Nurse Manager Rural Services with Tresillian Family Care Centres, Deborah has operational management responsibilities for Tresillian’s rural services and coordinates the organisations rural service development. Tresillian’s commitment to increasing access to services for rural families experiencing difficulties in the early parenting period has resulted in the commissioning of specialist child and family health services in rural and regional NSW and Victoria, with an emphasis on capacity building and interagency collaboration. Deborah is a PhD candidate at University of Technology Sydney, with her area of research focusing on rural service development.
The early parenting period is vital to the health outcomes of individuals, their families and communities, with research demonstrating ‘that intervening early in the life course to either prevent events that increase risk or address issues early is effective in preventing or reducing later health issues’ (Australian Health Ministers’ Advisory Council 2015a, p.9). Specialist child and family health services play an integral role in the identification, support and response for children and families with increasingly complex physical, developmental, psychosocial and behavioural health needs. The ‘National Framework for Child and Family Health Services – secondary and tertiary services’ identifies children living in rural, regional or remote areas as at risk of particular vulnerabilities.
Tresillian is the largest early parenting organisation in Australia, providing specialist secondary and tertiary level child and family health services in NSW since 1918. The organisation has sought to be responsive to the changing needs of families, particularly those experiencing challenges in the crucial early years of their child’s development to address the social determinants of health. The Tresillian Strategic Plan reflects the organisation’s commitment to provide greater access to families in rural and regional areas, with key goals including: extend our reach, partner with other agencies and build capacity for health professionals.
Tresillian embarked upon a journey to create a path for rural service development which would provide specialist services to address issues of access and inequity for rural families, including those experiencing vulnerabilities impacting on parenting capacity. The strategy was informed by service development modelling utilising a combination of data driven needs analysis and multi-level, multi-agency local consultation across a range of NSW rural health districts.
This presentation will describe the data-driven framework to inform service development developed by Tresillian in conjunction with a multidisciplinary team of UNSW students through 180 Degrees Consulting. The framework drew upon existing data sources across 4 domains: population, health outcomes, social outcomes, and existing coverage. The framework applied a system of weighting for outcomes aligned with Tresillian service aims, to provide rankings which were utilised to inform and triangulated against consultation with a broad range of stakeholders including senior management and direct service providers from health, community services and non-government agencies. Building relationships through this process led to collaboration and partnerships to enable the implementation of new services to support families experiencing early parenting difficulties in rural areas.
Kylie Stothers is a mother of two children and a Jawoyn woman who was born and raised in Katherine, NT. Kylie comes from a large extended family with strong ties in Katherine and surrounding communities. Kylie is the Workforce Development Officer at Indigenous Allied Health Australia and is a social worker who has worked throughout the Northern Territory for over 18 years. She previously worked for the Centre for Remote Health at the Katherine site and her interest areas are in child and maternal health, working with families, health promotion, child protection and health workforce issues. Kylie is passionate about education and issues that relate to remote and rural Australia and coordinates a local social work network group, K-Town Social Workers, whose main aim is to keep Katherine region social workers connected and supported whilst practising in remote NT.
Utilising strengths based approaches that build on Aboriginal and Torres Strait Islander knowledges and perspectives, our national Indigenous allied health organisation and our partners are collaborating to develop models of health workforce development that are flexible, community driven and aim to provide local solutions to local health workforce problems in remote/rural Australia.
One such model under development through a collaborative effort between partners across sectors and disciplines, is a school based traineeship program in the Northern Territory (NT) that will enable, encourage and support local NT Aboriginal and Torres Strait Islander students to pursue a career in health.
With the first cohort planned for 2018, the program currently known as ‘The NT Health Academy’, is a model of health workforce pathway development that aims to engage Aboriginal and Torres Strait Islander students to stay in the school system and graduate with Year 12 qualifications, whilst also completing a Certificate III in Allied Health Assistance and gaining job ready skills.
It is not our role to determine health workforce solutions for local communities, it is rather our role to facilitate conversations, opportunities, strategies and solutions at a local level to meet the needs of those who require equitable access to culturally responsive healthcare.
Therefore the process involved in progressing this workforce development model is equally as important as its potential outcomes. We actively engage in ways of knowing, being and doing that demonstrate Respect for Centrality of Culture, Self-Awareness, Proactivity, Inclusive Engagement, Leadership, and Responsibility and Accountability. Central to the success of this model is engagement with local Aboriginal and Torres Strait Islander individuals, families and communities to drive and sustain it over time.
This project, whilst important, is just one solution that has been developed through inclusive community engagement to meet local health workforce needs. There is no one-size-fits-all approach to workforce development, and targeted investment is required nationally to enable further cross sectoral collaboration and authentic community engagement to develop health workforce solutions in other remote and rural areas.
Flexible career development pathways, with multiple entry and exit points dependent on the needs of communities and aspirations of individuals, will be required. Providing ongoing support, opportunities and choices to local Aboriginal and Torres Strait Islander peoples in remote and rural Australia to pursue careers in health, across a diverse range of disciplines, will be essential in order to build a sustainable health workforce for the future.
Deb Suckling has been an artist and arts-worker for almost two decades. She released a number of albums before forming her record label Sugarrush Music with partner Craig Spann. Over the past 10 years, Deb has become highly passionate about community music projects, specifically in regional communities, and using songs to tell the stories of our country. “When I started songwriting, it was like a revelation for me. All the sadness I had in my life up until then had an outlet. I see songwriting and music as having enormous health benefits to the wider community and with the help of songwriters—everyone can turn their story in a song.”
In years gone past, songs were the form of documenting our stories—telling the stories of those who had gone before, our histories, our tragedies and our hopes. And music accompanied, being the one thing that could transverse those feelings that could sometimes not be voiced. This is at the very heart of The Soldier’s Wife.
The past 30 months has seen a small group of Queensland songwriters go on a truly remarkable songwriting journey—to tell the stories of women whose partners have served in conflict over the past 60 years. To tell the stories of soldiers’ wives and their families and of their personal sacrifice.
The songwriters have talked to almost 100 women—aged from 25 to 104 years old. From varying backgrounds and conflicts, from remote and regional areas to inner cities, their personal journeys all have similar themes of love, of loss, of existence and most of all of resilience.
The artists use their voices and their muse to hold legacy to these stories and to share them on stage. These are not just stories of incredible women—they are stories of our history and of the new generation.