Kathryn Naden is a strong Arabunna woman of South Australia and has gained a variety of experiences whilst working within education, non-government organisations and health. Kathryn is passionate about building aspirations for youth, and access to appropriate services for Aboriginal populations, especially within rural and remote locations. Kathryn has completed a Bachelor of Community Management at Macquarie University, Sydney, NSW and a Cert IV in Aboriginal and/or Torres Strait Islander Primary Health Care (Practice), Western Institute TAFE, NSW. Kathryn’s current role is as an Aboriginal Community Development and Health Education Officer, Broken Hill Department of Rural Health, The University of Sydney, New South Wales.
Rural health workforce shortages impact the health and wellbeing of our communities. Evidence suggests that rural origin students are more likely to return and practice rurally upon graduation. However, limited career exposure along with financial, social, cultural, and educational barriers must be overcome. The seed and grow approach, such as promoting health professions to rural secondary students, is one strategy to address health workforce shortages.
The Health Career Academy Program (HCAP), established in 2007, sought to; 1) introduce secondary school students to the diversity of health careers, 2) encourage students to consider tertiary education and health professional attainment, 3) provide guidance on multiple pathways to health careers, and 4) strengthen partnerships across health, education, industry and communities. Strategies of the HCAP include providing earlier exposure to health careers, relevant information on health career pathways, and culturally respectful career promotion for Aboriginal students as well as the integration of local health professionals into career activities and enhanced partnerships across health, school and tertiary sectors.
The HCAP targets Year 7 to 12 students and enables student exposure to a diverse range of health professions. Students can attend 1-2 full day academies based on professions of interest. Local allied health, medical and nursing professionals, and pre-registration health students undertaking their placement in the region, provide career pathway information and practice exposure through structured and age appropriate clinical skills sessions, and health information on chronic diseases prevalent within the region. The program partners with local health services: the Royal Flying Doctor Service, Aboriginal Health Service, and community services, to support exposure through site visits.
On average 132 secondary school students, from 4 far west NSW communities, participate in the program annually; 25% self-identify as Aboriginal. Key catalysts for participation include the presence of health role models in immediate/extended family, personal experience of illness, and existing carer roles. Each year the number of students participating increases and there is interest from other communities for program delivery.
Aboriginal Staff Alliance members, from across the University Departments of Rural Health, intend to collaborate in applying this program as a key strategy to promote health career pathways for rural secondary students, with a specific focus on Aboriginal student participation. The Health Career Academy Program Manual was written to guide localised ‘seed and grow’ program development, adaptation, implementation and evaluation elsewhere.
Councillor Nai is committed to “engaging with community on the key roles and responsibilities of local government and the challenges we face … There are opportunities for us to take up.” Ensuring our essential services are running efficiently and effectively is also a priority. Councillor Nai worked in retail, tiling and as a Healthy Lifestyle Officer. He is currently serving as a Board Member of the Torres and Cape Hospital and Health Service. He sees the importance of building stronger stakeholder relationships regionally through appreciation and understanding of each other’s roles. His biggest goal for the region is to change negative paradigms into positive, healthy ones—that will be the catalyst for real change. Councillor Nai hopes to improve the regional understanding of where Council is and the challenges and opportunities that are presenting itself to our region, where we’re going is our foundation/building block. Effective communication underpins all of this—it is important that everyone really understands the role and capacity of Council. “It’s a privilege and honour to serve my family on Masig and Torres Strait. Let’s dream big for our people together. Building a better you is the first step to building a better Torres Strait. I will finish with the quote: ‘Our children are our only hope for the future, but we are their only hope for their present and their future.’ Let’s do this together - let’s dream as one.”
Aim: Our project “Lessons from the Best to Better the Rest” looked at high continuously improving services to find factors that might be associated with high continuous improvement. We found that ‘communities driving health’ was one of them. The aim of this paper is to understand the way in which one Torres Strait Islander community drove healthcare resulting in high levels of continuous improvement.
Methods: A case study design, in partnership with the services, was used. The services were selected through standard continuously quality improving (CQI) audits. We visited services and interviewed service providers, clients, community members, and managers at the local and regional levels (n=134). We then looked at themes within each service and compared themes across the services at the macro (external system), meso (local system) and the micro health system (client – health provider interaction). Feedback visits and collaborative meetings with all services were conducted.
Relevance: Community participation in health care is continually promoted. How this plays out in different services varies. The benefits of community participation are seen to be a level of community ownership and more relevant and accessible health services.
Results: In this health service, located in the Torres Strait, we have an important example of a community driving health care, using a holistic model of health, and working in partnership with trusted health professionals. Community history and culture influenced all aspects of health so that a unique local way of doing things prevailed. ‘Our culture is our way of life’. This resulted in a highly continuously improving accessible service with trusting and valued relationships between community members and dedicated health providers. The usual clear distinction between ‘patient’ and ‘provider’ was absent. “Whole of community” means health promotion and treatment is for all. One crucial element is the Gudhmud Aboriginal and Torres Strait Islander Health Corporation Health Committee bringing together community and health leaders, and other agency staff about issues to do with the overall health of the whole community.
Conclusions: This is a clear example of what is often talked about as the ‘gold standard’ in community participation. “Our culture is our way of life’ and ‘serving our people’ underlie all aspects of service and result in a high continuously improving health service. The community is in control of operationalising their health care and working in highly valued partnerships with their dedicated health professionals.
Carcia Nallajar is a member of the Bwgcolman people of her home Palm Island and a descendant of the Mirraway, Karrawa and Kuku Yalanji nations of North Queensland. Carcia is the Program Manager of Ferdy’s Haven Alcohol Rehabilitation Aboriginal Corporation on Palm Island, a sixteen-bed Aboriginal community controlled health residential facility for adult men and women. As Program Manager, Carcia manages a committed team of local Palm Island staff. Almost every person that presents to Ferdy’s Haven for support and care are known to the team, which enables Ferdy’s Haven to provide culturally safe care. Carcia is a dedicated manager with a passion to provide the best outcomes for her Bwgcolman people. Her role also involves participation in community engagement at stakeholder meetings and community events. Carcia holds a Certificate IV in Mental Health (AOD) and a Diploma in Management and has also worked for State and Commonwealth Departments in Queensland and the ACT, private companies and non-profit organisations.
Working in a remote Indigenous community has many challenges in delivering an effective drug and alcohol harm minimisation and treatment program. We live and work in the community and have firsthand experience of the cost of drug and alcohol misuse, this behaviour now normalised is not consistent with Aboriginal culture.
Ferdy’s Haven is an Aboriginal Community Controlled Health Organisation which provides a residential recovery program for people who self-identify as having a substance misuse problem and self-refer on Palm Island. Services were initially established in early 1980 on the Alcoholics Anonymous (AA) program. However, the AA program does not meet everybody’s needs and is not consistent with the harm minimisation strategies within the current Australian National Drug Strategy.
Now, times have changed since the early 1980s, and community social issues have evolved and escalated with the introduction of other forms of drugs and substances resulting in high levels of drug and alcohol consumption that is now affecting young people and their families in the community. Tackling the issues has meant that we need to evaluate how we provide our service and we recognise that our programs need to change to meet the needs of the community today.
The Australian National Drug Strategy is developed on evidence based research and we realised that this was needed at Ferdy’s Haven and became research partners with James Cook University though the Townsville Aboriginal and Islander Health Service in 2015.
This is the first time that Ferdy’s Haven has been involved with a formal research process in the last decade. This is an important process which included Ferdy’s from the beginning, the youth workers were trained as research assistants and were involved in developing the survey tool through to data analysis in the project.
Young people doing research with young people and finding out the issues is really important for our service delivery and building Ferdy’s to meet the community’s need. Our experience has been positive, the interim findings of the research has provided more insight into the lives of the young people and their needs for us. The research process has been a steep learning curb for Ferdy’s but we see this as having potential to building a better service for our remote community. We would like to share our story with you.
Genevieve Napper is the Lead Optometrist Aboriginal Services at the Australian College of Optometry, a non-government organisation providing accessible eye care services for people experiencing disadvantage. In this role she works with Aboriginal community controlled health services to coordinate optometry services across urban and rural Victoria, and coordinates access sites for the Victorian Aboriginal Spectacles Subsidy scheme that provides glasses for $10 for Aboriginal and Torres Strait Islander Victorians. Genevieve has worked in a range of roles developing new models of eye care and strengthening eye care pathways and eye care outcomes. She contributes to national policy development and systems improvements through membership of the Optometry Australia Aboriginal and Torres Strait Islander Eye Health and Vision Care Committee and the Vision 2020 Australia national Aboriginal and Torres Strait Islander committee. She also serves as a Board member of Optometry Victoria and is an honorary Senior Fellow with the Department of Optometry and Vision Sciences at the University of Melbourne.
Background/aim: The Victorian Aboriginal Spectacles Subsidy Scheme (VASSS) commenced in 2010 providing additional subsidy to the long-established Victorian Eyecare Service (VES) operating through the Australian College of Optometry. The VASSS aims to improve access to affordable spectacles and encourage uptake of eye examinations for Indigenous Victorians. The VASSS receives regular input from a committee convened by the Victorian Government Department of Health and Human Services and includes eye health stakeholders from the Aboriginal community, government, not-for-profit, and university sectors.
Uncorrected refractive error accounts for over 50% of Indigenous vision loss and can be effectively addressed by eye examinations and affordable glasses supply. The cost of spectacles is one of the known barriers to utilising the eye care system and some 35% of Indigenous adults have never had their eyes tested. Good vision is important for education, employment, self-management of health issues, community participation and leadership.
Methods: Key features of the VASSS include: cost certainty ($10 fixed client contribution); extensive and community approved frame range; broad eligibility; and ongoing community participation in approaches to service delivery.
The VASSS is available at 21 Aboriginal Health Services (AHS) across Victoria and over 45 mainstream sites (including community health services and a network of private optometry partners working closely with visiting services in AHS) in both urban and rural areas. In 2015, 2,387 glasses were provided under the VASSS across Victoria with 2,200 eye examinations. Demand continues to increase and sustainable funding support for the program is under consideration.
Community and stakeholder monitoring through the program has been an important strategy in the ongoing development of the VASSS. Quarterly reports are provided to the statewide stakeholder group with spectacle provision mapped against population-projected needs developed by Indigenous Eye Health, The University of Melbourne. This process has enabled community, government, service providers and other stakeholders to work together to continue improving outcomes. Evaluations of the VASSS were undertaken in 2012 and 2016 with results supported by community consultation through the Victorian Aboriginal Community Controlled Health Organisation (VACCHO).
Conclusions and recommendations: The VASSS is an example of a successful and ongoing program providing improved health outcomes for Victorian Aboriginal and Torres Strait Islander communities. It is aligned with nationally consistent principles developed by Optometry Australia and adopted by Vision 2020 Australia and with the government and sector-endorsed Roadmap to Close the Gap for Vision. Successes of the VASSS are potentially transferable to other jurisdictions.
Dr Bushra Nasir us a Research Fellow at the Faculty of Medicine, the University of Queensland. She is implementing the successful initiation and completion of a range of exciting epidemiological and clinical research projects designed to improve the health of Indigenous and rural Australians. She is currently part of a team funded by the NHMRC to develop an Indigenous-specific suicide prevention training program - INSIST.
Background: The overall Australian suicide rate has reached a 10-year high, with 3027 deaths reported last year alone. In Queensland, 109 children under the age of 18 took their lives in just the past four years; of these 31 were only between 5 and 14 years of age. Indigenous people are also twice as likely to die by suicide, with 152 deaths reported in the past year. Despite this, it is still unclear how effective existing suicide intervention pathways are in providing appropriate management of Indigenous people at risk of suicide. The aim of this study was to explore current pathways for Indigenous suicide prevention, identify gaps, and explore alternate models that are appropriate for Indigenous communities.
Methods: Semi-structured, face-to-face, community consultations with 29 individuals, and 19 service providers or community organisations, were conducted across five rural and regional towns of Queensland. The consultation sessions discussed existing pathways for suicide prevention, and attributed of models of effective pathways. Thematic analysis was performed to identify and analyse patterns and consistent themes.
Results: Community consultations identified that current pathways were not effective or culturally appropriate for Indigenous people at risk; and not sustainable for rural and remote Indigenous communities. Suggestions focused on implementing social, emotional, cultural, and spiritual underpinnings of community wellbeing. Identifying ‘roles’ within the local community and having each individual playing their own role, may lead to a sustainable suicide prevention model. Training is necessary for Indigenous communities, so they can identify people at risk, provide appropriate interventions, and prevent future risk of suicide. Indigenous appropriate suicide intervention training is also necessary for front-line service providers, so that those at risk are provided appropriate intervention, and support.
Conclusions: Evaluations of current pathways indicate that an Indigenous community-led approach is essential to encourage connectedness, and prevent suicide. Providing culturally appropriate training is more likely to provide effective solutions for Indigenous communities.
With a career in disability that spans three decades, Roland Naufal is one of Australia’s most knowledgeable disability professionals and his blog posts now attract a readership in the thousands. He was winner of the 2002 Harvard Club Disability Fellowship and consulted on NDIS design for the National Disability and Carer Alliance. Roland has held leadership roles in some of Australia’s most successful disability organisations, including CEO Villa Maria, General Manager Yooralla, State Manager Vision Australia and CEO Association for Children with a Disability. He worked extensively on disability deinstitutionalisation and lectured on the politics and history of disability. Roland has degrees in Economics and Social Work and an MBA from Melbourne Business School.
This statement has two famous and very different endings. Applied to the NDIS, which would you choose?
and it works. Lincoln Steffans 1936
brother: it is murder. Leonard Cohen 1992
The NDIS is now live and national, and when we look into that future we do see quite a bit of mayhem. And then again, we see a future that works better for many NDIS participants and hands on staff.
Although we see a lot of client stickiness in these early days of the NDIS, in the future people will vote with their individualised funded feet. Many people with disability in the major urban centres will have real choice and control; those in rural and remote areas, CALD groups and Indigenous communities will still be struggling to find quality services.
The biggest worry in the NDIS future is the many people with disability at the margins, those not eligible to become participants (the estimate is up to 900,000 people). What is going to happen to people who only need a little support to carry on or vital programs where funding cannot be individualised?
Another very significant shortcoming is the area of mental health in the NDIS. This can only be described as a mess: the assessment criteria and process fit so poorly for people with mental health challenges, and we have real concerns about the adequacy of the NDIS to adapt quickly enough to ensure quality of outcomes.
Some of the changes we are seeing in organisations is that teams are operating at the neighbourhood level; employing people with lived experience and highly qualified staff. They are paying higher wages with extremely low management ratios and delivering better outcomes.
People are also going to master the office-less organisation by using great software and diverting the building cost savings into processes for building great teams. In the future we will have identified lots of infrastructure in the community that we can all use better. We will find and use lots of places and other resources like the massively underutilised disability mini bus fleets.
Too many organisations are doing too little, too late, to survive in the NDIS. We have seen the future, and like always, there are winners and losers but it looks like some of the winners might be the underdogs, people with disability (but mostly those that are urban dwelling NDIS participants) and the great hands on staff that work with them.
Ilsa Nielsen is Principal Workforce Officer in the Allied Health Professions’ Office of Queensland, Department of Health. This role is based in Cairns and supports workforce policy, planning and development for rural and remote allied health services in Queensland Health. Ilsa has postgraduate qualifications in public health, education, and health economics and policy. Her former appointments include academic and clinical physiotherapy positions in metropolitan and regional Queensland.
Introduction: The merits of rural generalism as the basis for training, workforce and service models have been demonstrated in medicine and other professions. Implementing structured and supported rural generalist training pathways for the allied health professions is anticipated to provide similar benefits in terms of improved recruitment and retention, enhanced service capacity through use of professionals’ broad full scope and into extended scope of practice, and greater access for rural and remote consumers to high quality multi-disciplinary healthcare.
Methods: The development of rural generalist workforce and service models for seven allied health professions commenced in 2013 and has progressed through six stages:
The work has been lead and supported by a collaborative of health sector providers across Northern Australia with the addition of education sector partners in 2016.
Outcomes: Comprehensive profession-specific and skills shared clinical tasks for rural and remote practitioners in six professions have been published online.
Queensland Health has successfully trialled designated rural generalist training positions in six professions finding:
Education frameworks demonstrate significant consistency between non-clinical requirements of a range of disparate allied health professions including pharmacy, physiotherapy, podiatry, speech pathology, occupational therapy, medical imaging and dietetics. Combined with profession-specific clinical capabilities, the frameworks provide the basis of a formal training program.
Conclusion and the next steps: Collaboration between jurisdictions and health services is necessary to deliver sector-level implementation of an allied health rural generalist pathway. The addition of education partners in 2016 as the project enters its sixth stage is anticipated to produce the formal training program required to embed rural generalist practice models and improve the sustainability of the rural and remote allied health workforce.
A passionate and enthusiastic junior doctor, Shannon Nott is currently a rural generalist trainee based in Dubbo NSW. As a strong advocate for rural and remote health, Shannon has filled various roles during his relatively short career, including Co-Chair of the National Rural Health Students’ Network, NSW Representative for AMA’s Council of Rural Doctors, Founding Chair of Health Workforce Australia’s Future Health Leaders and National Rural and Indigenous Officer for the Australian medical Students’ Association. Shannon’s passion for creating an improved and sustainable health system, particularly in the field of rural and remote health has seen him win numerous prestigious awards including Australian Medical Student of the Year, NSW Finalist for Young Australian of the Year, and recently runner-up for AMA’s Junior Doctor of the Year. Shannon has also completed a Churchill Fellowship to research the role of telehealth in delivering care to rural and remote communities. His work in this area has been to look for new, innovative ways of delivering quality healthcare closer to home for rural communities across Australia. Shannon currently sits on the NSW Health Telehealth Strategic Advisory Group and the eHealth NSW Conference and Collaboration Working Group looking to help improve digital models of care across NSW.
Background: Clinical variance is a phenomenon where different clinicians have significantly different modalities and methods of treating patients despite what may be considered best practice or evidence based. There are multiple disease processes where there are no universally accepted best practice treatment regimens in which case clinical variance is understandably accepted. There are others, such as management of sepsis, whereby there is a multitude of literature to suggest how to improve patient outcomes yet clinical variance still creeps in. In rural and remote Australia, where there is limited support from peers, often limited opportunities for continuing professional development and a continued reliance on overseas trained doctors of whom some have limited critical care experience; there has been few programs to help support clinicians in treating patients through best practice guidelines and minimise harmful effects of clinical variance.
Objectives: This report will use case studies from Western NSW Local Health District whereby a medical model through its Patient Flow Unit has been devised to provide patient support and clinical advice to rural and remote communities. This medical model utilises telehealth cameras throughout almost 40 hospitals in western NSW to allow critical care registrars and consultants to provide timely support and advice. This model adds a second set of eyes and ears in managing patients to ensure that rural and remote patients, regardless of where they are treated receive the same high quality of care and outcomes as though they presented to a major tertiary hospital.
Conclusion: The Western NSW Local Health District’s medical model for advice and support through its Patient Flow and Transport Unit has shown to improve outcomes for patients across the LHD. This model can be expanded to other regions in Australia to help address clinical variance and avoid adverse outcomes for patients in rural and remote Australia.