Concurrent Speakers

In 2017, the Centre for Rural and Remote Mental Health produced a position paper on rural suicide prevention, which recommended five focus areas to reduce rural suicide. The first two strategies were for immediate action to prevent suicide deaths, they were: (1) Prevent people who experience suicidality from taking their own lives and (2) Help those who are affected by suicide. The other three focus areas were strategies for medium to long term reduction in deaths and rates. Specifically they were, (3) Provide support to vulnerable groups and (4) Build protective factors in children and young people. The fifth (5) area focuses on building healthy and resilient people and communities. We suggest this area should be focussed on promoting positive mental wellbeing in addition to working towards the reduction of mental illness.

Community mental health and wellbeing is complex and multifactorial. We suggest that a collaborative approach can bring the necessary networks, skills and experience to address community wellbeing. We have conducted a literature review on community wellbeing collaboratives to elucidate the factors that make them successful. From this information, we developed a guide for community wellbeing collaboratives, which separates action into four iterative stages. These are to establish purpose and rationale, plan with partners, implement and engage, and embed and evaluate. We are currently consulting with several communities who are in the various stages of development of community wellbeing collaboratives to establish whether the guide is reflective of the work they have done. These collaboratives include Our Healthy Clarence, on the northern coast of NSW, Muswellbrook Healthy & Well, in the Hunter Valley, and the Lithgow Mental Health Taskforce, in the Central Tablelands of NSW.

In the remit of each of these community collaboratives is a commitment to improve the quality of life for the local people, through action and advocacy. This means that these communities are striving to build on what already makes people mentally healthy, and are working to decrease the impact of the conditions that erode mental health.

Aim: To deliver health education events for women in the Grampians and Barwon South West regions of Victoria that:

• address poorer health outcomes and promote healthy lifestyles
• highlight a preventative approach
• work within a multi-sectoral and partnership model
• reach widely into communities through a social inclusion and accessibility framework
• strengthen community resilience and social connection
• improve awareness of local health services and programs.

Method: A program for delivering health information that responded to local needs and reached priority groups was delivered using a mix of health promotion, stakeholder engagement, capacity building and community strengthening strategies. Delivered in targeted regions by a national women’s health organisation at no cost to attendees, the model highlights how ‘better together’ is achieved with contributions from philanthropic, health, community, business, government and private sectors.

Results: Women’s Stuff: a night of fun, facts and the latest in women’s health is a successful model for a community-wide women’s health seminar. Registrations at both event locations surpassed estimates. Venue and event changes were required to accommodate high demand, including integrating livestream and digital access to extend access. In total there were 1419 registrations with 1020 attendees, 9 formal partnerships, 16 exhibitors, with 424 evaluations received, including 1,257 comments. Overall the feedback was incredibly positive, highlighting the appetite of women in these regions for reliable face-to-face health education in this format.

Insights: In reflecting on the success of these events, the following insights are offered:

• Early engagement and consultation with local health service providers and stakeholders helped inform program development and event delivery ensuring strong collaboration and on-the-ground support.
• Understanding women’s motivations to attend a three-hour educational event (in the middle of winter) is critical to ensure needs are catered for across the various project elements.
• The opportunity to connect to others, feel inspired and empowered and take away useful health information was greatly valued by the attendees
• Offering the event at no cost assisted women from lower socio-economic backgrounds and/or marginalised groups to attend
• Leveraging the event to a wider national audience via live streaming and social media platforms highlighted the regions’ health promotion work and offered the opportunity for other rural and regional women to connect.

Discussion: The model effectively incorporates several key elements and combines on-the-ground and digital education platforms, offering rural and regional health services a blueprint to consider adapting to suit local contexts.

People in rural, regional and remote Australia access medical services at half the rate; medical specialists at a third of the rate; and mental health and allied health professionals at a quarter the rate of those in metropolitan Australia.

In 1912 Rev Dr John Flynn founded Frontier Services to ensure those living in rural and regional Australia had the same access to services as their city peers.

Over106 years later, the disconnect between those living in remote and regional Australia is greater than ever.

As Australia’s oldest bush charity, Frontier Services is still championing that vision. Our Bush Chaplains are on-the-ground in remote and regional areas, providing assistance from a mental health, counselling perspective, playing a key role in identifying those in distress to activate additional support services and volunteer support.

No-one likes the term charity, so we have a constant challenge ‘don’t worry about me, check my neighbour “Bob” he really needs help’. Bush Chaplains walk a sensitive line to ensure those in need don’t feel like they are being singled out.

A ‘drop and go’ mentality for charities is not an effective way to service those in critical need. As more services leave remote areas and more, especially in mental health, go online, face-to-face contact becomes more essential.

Bush Chaplains play an important role within small communities providing support for local schools, hospitals, retirement villages, prisons and in times of crisis the police, usually as the local police chaplain, army chaplain or school chaplain.

When an incident, particularly a death occurs in a small town, it effects the whole community. Our Bush Chaplains are on hand, known and trusted. They provide mental health support whether it is in the local town hall or the local pub or one-to-one support.

Outback Links program is a network of skilled volunteers who assist remote and rural families and communities in times of need, giving a practical hand up not a hand out. Practical on-the-ground support can be the best type of assistance for those that are broken down by the conditions like the drought.

The benefits of programs such as these on small, far-flung communities can be life changing.

People in rural communities are more likely to consume alcohol at high risk levels. They also experience disproportionate harm from alcohol compared with urban areas, including higher rates of alcohol-related disease, alcohol-related hospitalisations, fatal alcohol-related traffic accidents, and fatal alcohol-related drownings.

The burden of disease and injury from alcohol use is 2.4 times higher in very remote areas compared with major cities. There is also a clear pattern of burden increasing as remoteness increases.

When combined with the stretched and under-resourced medical services in much of rural and remote Australia, there is a confounding effect whereby people in rural communities have poorer health outcomes.

This is not a problem without solutions. The World Health Organization outlines clear evidence-based, cost-effective interventions to reduce alcohol harm. This presentation will explore what the central pillars of alcohol prevention—affordability, advertising and availability—might look like when translated into rural Australia.

Price is very closely linked to consumption. Evidence shows that young people in rural areas are more motivated by price reductions on alcohol than young people in the city. The Northern Territory has moved to harness this through the introduction of a floor price, and similar proposals are gathering strength in other jurisdictions.

Alcohol consumption is a highly socialised behaviour and often our community structures and organisations encourage drinking rather than supporting health. Sport, including community sport, is routinely targeted by alcohol companies, who use sport as a way to normalise alcohol consumption and groom their consumers of the future. Pulling apart the strands of alcohol, sponsorship and boozy culture is one key way to curb unhealthy influences in regional Australia.

Takeaway liquor is responsible for a large proportion of alcohol harm in Australia, due to its low cost and wide availability. This is no different in rural areas—evidence shows that almost two thirds of alcohol-related attendances at rural emergency departments are fuelled by takeaway liquor, yet media discussions on alcohol availability concentrate on inner city hot spots and disadvantaged suburbs. What measures to curb availability would work outside of the urban environment?

More alcohol equals more harm, more profit for the alcohol industry and more damage to regional and remote Australia. This situation must improve, and to do this we need real solutions for rural Australia.

An outbreak of infectious syphilis began in northern Queensland in January 2011, extending to the Northern Territory in July 2013, the Kimberley in Western Australia in June 2014 and since November 2016 the Western, Eyre and Far North regions of South Australia. Since the commencement of the syphilis outbreak in 2011 to 31 July 2018, there have been 2,228 cases of infectious syphilis and 14 congenital syphilis cases associated with the outbreak regions of northern and central Australia.

In December 2017, the Australian Health Ministers Advisory Council (AHMAC) endorsed a National Strategic Approach and Action Plan to address the disproportionately high rates of syphilis and other blood-borne viruses and sexually transmissible infections in regional and remote Indigenous communities. The Action Plan was developed in consultation with affected jurisdictions, NACCHO and key stakeholders.

The Australian Government has committed $8.8 million in funding over three years (2017-18 to 2019-20) to be delivered through Aboriginal community-controlled health services (ACCHS) in the outbreak regions. The types of projects funded include:

• workforce supplementation and implementation costs for the roll out of the ‘Test and Treat’ model, including point-of-care test and treatment medication, negotiated on a case by case basis with each ACCHS in the outbreak region
• development and roll out of a ‘train the trainer’ model to upskill the existing and the supplemented workforce in both the ‘Test and Treat’ model and sexual health in general
• culturally appropriate health, communication and education materials.

The Department of Health established an Enhanced Response Unit to coordinate the Australian Government’s contribution to the Action Plan. The Unit worked closely with NACCHO, state and territory public health authorities, and ACCHS across the affected areas to develop locally-relevant models to rollout a phased approach to the response. Close collaboration between Health and the ACCHS sector, led by NACCHO, was fundamental for the design of this response.

Every aspect of this activity followed a bottom-up design methodology, in which the selection of sites, development of specific on-the-ground workforce models, and organisation of regional coordination happened in partnership between the services and Commonwealth and state and territory governments. Extensive consultation, including workshops in four states and territories was fundamental for the planning of the staged rollout.

In this presentation we will outline the specifics of this innovative co-design model, and the strengths of meaningful partnership between government departments and the Aboriginal community-controlled health sector.

Whilst there are a large number of people and organisations involved in bereavement care across Tasmania, there is limited knowledge about the types of services available and little connection between services. This can resulted in fragmented service provision and reduced access for those in need, especially those living in more rural and remote communities where low population densities mean that establishing bereavement services can be very difficult.

This project addressed this problem though the establishment of a ‘network’. The Tasmanian Bereavement Care Network (BCN) aims to link and improve support for people working in bereavement care across Tasmania. This project was initially funded as part of the Australian Government Better Access to Palliative Care (BAPC) program through the Tasmanian Government Department of Health. More recently, it has received support from the Tasmanian Community Fund through Palliative Care Tasmania.

The impetus to establish a BCN in Tasmania stemmed from previous consultation, research and policy development in palliative care. Bereavement care is integral to palliative care and involves both formal and informal bereavement care and support services.

Development of the BCN was underpinned by Asset Based Community Development principles by which individuals, community groups and local service providers worked collaboratively to identify strengths and weaknesses and build connections between each other.

A multidisciplinary team of health professionals worked together and consulted with a large number of individuals, key service providers and organisations with direct and indirect involvement in bereavement care. This included volunteer groups, NGOs, health service providers and policy makers. Workshops and regional forums were held to inform the formation and development of the network and to articulate the values and principles that should underpin the provision of high quality bereavement care by both formal and informal service providers in Tasmania.

The Tasmanian BCN is now comprised of regional groups that meet regularly in the South and the North/North-West. A Management Group has been established, comprised of key individuals working across the bereavement sector. This group takes responsibility for the ongoing development, administration and sustainability of the network.

The project commenced in late 2016 and work has been ongoing. In this presentation, we outline the processes used to establish the network, progress to date, some of the challenges experienced and explore the future directions for the network in Tasmania. These learnings may have application to other rural areas of Australia where access to bereavement care and support may be limited.

Sustainability of rural midwifery services has been a hot topic in New Zealand for a number of years. Added to this problem is the challenge of providing equitable and appropriate care for Maori and Pasifika women and babies which enables positive, measurable outcomes.

The Waikato DHB’s Southern Rural Maternity Project was given Board mandate in 2017 to address these issues within the context of a disinvestment – re-investment model including the community co-design and development of Rural Maternity Resource Centres.

In this paper the project team will explain the purpose, goals and process of setting up a new model of care and the role of co-design and community leadership in achieving increased access and change to the delivery of services to women and babies. The paper will also identify some of the tools and approaches used to enable change and the role of the funder in engaging with the project at a governance level.

Levels of engagement and outcome data will be discussed.

The project incorporates the principles of the first 1000 days, sustainable midwifery services, cultural appropriateness, community leadership, co-design equity and sustainability.

Recent trials have demonstrated that selected stroke patients benefit dramatically from endovascular thrombectomy (EVT) up to 24 hours’ post-onset. Consequently, all Australians living in rural areas experiencing acute stroke are potential candidates for this cost effective treatment. South Australia has 61 public country hospitals, 12 have neuroimaging capacity with vast distances between a majority of the larger centres and from Adelaide.

We sought to design and evaluate a whole-of-state telestroke service integrated simultaneously with 24/7 expansion of three country stroke services, and the introduction of tenecteplase for thrombolysis eligible patients with proven or suspected large vessel occlusion.

From June 2018 additional neurologist support in Adelaide assisted clinicians at country hospitals to determine the best care pathway for each patient, administer treatment locally and/or initiate timely transfer of the patient to an appropriate hospital.

All rural stroke patients potentially eligible for reperfusion therapies were assessed remotely by a metropolitan stroke neurologist, using the Digital Telehealth Network and remote access to neuroimaging (where available). The results of the consultation and treatment recommendations were recorded and supplied to the treating rural clinician.

In the first two months of operation 36 consults occurred for 35 patients (18 per month). Stroke mimics comprised nearly a third (11 consults). Of the 25 consults for 24 stroke patients 25% (6) underwent endovascular thrombectomy, and 21% (5) were given thrombolysis.

Following the 36 consults, 1 patient (3%) required a metropolitan transfer that otherwise might not have occurred and 12 underwent expedited transfer (33%). These transfers were offset by another 12 patients (33%) for whom transfer was avoided, and 1 patient who was transferred to a more appropriate service (a non-endovascular centre, with pathways to country rehabilitation).

The whole of state telestroke service has led to a substantial percentage of people from country SA presenting with stroke being treated with acute reperfusion treatments. This did not appear to increase transfer rates to Adelaide, although some extra expedited transfers occurred. It is likely that additional retrieval and metropolitan hospital costs are more than offset by avoiding transfers through provision of a non-stroke diagnosis.

The statewide approach to acute stroke management has enabled all South Australian stroke patients, no matter where they live, to be assessed and treated, improving efficiency and more significantly, patient outcomes. This enhanced stroke service allows appropriate patients to be selected for retrieval to Adelaide while allowing others to access specialised stroke care closer to home.

Sustainability of rural midwifery services has been a hot topic in New Zealand for a number of years. Added to this problem is the challenge of providing equitable and appropriate care for Maori and Pasifika women and babies which enables positive, measurable outcomes.

The Waikato DHB’s Southern Rural Maternity Project was given Board mandate in 2017 to address these issues within the context of a disinvestment – re-investment model including the community co-design and development of Rural Maternity Resource Centres.

In this paper the project team will explain the purpose, goals and process of setting up a new model of care and the role of co-design and community leadership in achieving increased access and change to the delivery of services to women and babies. The paper will also identify some of the tools and approaches used to enable change and the role of the funder in engaging with the project at a governance level.

Levels of engagement and outcome data will be discussed.

The project incorporates the principles of the first 1000 days, sustainable midwifery services, cultural appropriateness, community leadership, co-design equity and sustainability.

Fulton Trotter Architects design aged care across the country. Utilising case studies of Clermont MPHS Aged Care and Richmond Lodge, Casino, we will discuss the different processes and requirements that we see in rural areas and how we deliver better facilities and create opportunities for joy, by taking these into account. We will examine the following.

Community

• In rural areas consultation matters more because residents are more connected to and invested in their services.
• Users are not part of the faceless mass; they are neighbours, netball coaches and uncles.
  • In Clermont, consultation changed the scope of the project to reflect more accurately the requirements of the community – larger rooms, better access to the community.
  • In Casino the scheme aims to turn an inwardly facing facility into one that engages with and invites the public in.

Providers

• Smaller resident numbers drive the financial viability of facilities.
• Often the government is the only provider and co-location of aged care on hospital campus is common.
• Aged care co-located with hospital faces the challenge of delivering a home not a hospital.
  • At Clermont the co-location with hospital was offset by providing a distinct location, entry and feeling to the aged care.
  • The Clermont project involved the constant reminder to clinical staff that the project was aged care not hospital.
  • Changing attitudes and expectations are helping to deliver more resident centred facilities.

Expectations

• Providers aim to meet the market, generally lower socio-economic standards in rural areas than the city.
• Limited availability of choice lowers expectations; “you take what you can get”.
• People want to age where they live, not move
• Priorities are different.
  • Inviting clients and residents to visit other facilities is raising the expectations and results in better built outcomes
  • Understanding the priorities of a community helps deliver better outcomes, in Clermont a spot to view the goings on was important, so funding was focused on delivering a wonderful deck to view from.

Aged care in the bush may never offer the choice that the city does, but it should offer quality, respond to the priorities of its community and connect to community. Ultimately aged care in the bush needs to offer joy to those who live in there.

Acute post infectious glomerulonephritis (APIGN) is predominantly a disease of poverty and disadvantage, complicating prior infection with Group A streptococcus. The highest documented global rate of this disease is seen in Indigenous Central Australians (98 cases per 100,000 people).

Alice Springs Hospital services an area of Central Australia covering 900,000 km² and a population of 48,000 people, of whom 44% identify as Aboriginal or Torres Strait Islander. As the referral centre for Central Australia, Alice Springs Hospital sees a large number of children presenting with symptomatic Acute Post infectious Glomerulonephritis (APIGN). This study presents 5 years of admissions data to better understand the clinical course and burden of paediatric APIGN in Central Australia.

Methods: This retrospective observational descriptive study presents all cases of APIGN diagnosed in children under 14 between 2010 until 2015. Cases of APIGN were confirmed using the Northern Territory Centre of Disease Control case definition guidelines. Case notes and electronic medical data were reviewed and data relating to clinical presentation, management and outcomes were collected.

Results: 69 cases APIGN were diagnosed over the study period. All cases were in Indigenous children aged 1 to 12years. Preceding skin infection was identified in 65.2% of cases. Common complications included moderate hyperkalaemia (K³6) (15.9%), renal impairment (81.2%), oedema (60.9%) and hypertension (72.5%).

Diuretic and antihypertensive therapy were used in 75.4% and 53.6% of patients respectively. Fluid restriction occurred in 65.2% of patients for a mean of 8.9 days. Long acting benzathine penicillin was given in only 34.8% of cases.

Co-occurring infections were common, including scabies/headlice (47.8%), urinary tract infection (18.8%) and pneumonia (18.8%).

Mean hospital stay was 10.46 days (2-37), 2 cases required transfer to a tertiary centre.

Repeat complement levels were performed in 42 cases (60.9%) at a mean of 297days. There was no evidence of ongoing renal impairment in cases (mean follow up 1621 days following diagnosis).

Conclusion: APIGN is a common presentation in Aboriginal children in Central Australia, and often requires prolonged hospital admission. Children admitted to hospital require close monitoring due to the frequency of renal impairment and associated complications. Skin infection is the major exposure to Group A streptococcus and community and public health measures to limit Group A streptococcal exposure continues to be a priority in Aboriginal Health. These data have been used to develop guidelines to assist with the management and follow up of paediatric patients in Central Australian with APIGN.

How do community theatre develop links in community which strengthen people and social capital, promote wellbeing and challenge social determiners?

By creating linkages between individual participants and wider organisational partnerships to make collective, collaborative theatre work. Community theatre necessitates a strength-based approach. People dancing, painting, reading, designing, playing together.

Tropical Arts makes innovative theatre by developing and working with inclusion practices. We are better together because diversity is our aesthetic and our lived experience. Tropical Arts strives to find new ways to include participants. We partner with service organisations to bring more people and resources to the production.

The Real Inclusion Project evaluated the Tropical Arts’ ‘Twelfth Night’, the 10th annual Shakespeare at the Tanks production in October 2018. The findings of this evaluation have a particular focus on our continuing work with Inclusion.

This abstract presents the approaches Tropical Arts takes to Inclusion. The presentation documents mages of the production and behind the scenes. Our presentation will deconstruct the who, what, why and how of inclusion practices, in a playful and practical way.

Inclusion as a process

The evaluation address many subjects relevant to inclusion processes, such as:

• Can everybody be included and contribute creatively?
• What barriers are there to inclusion and how do we overcome them?
• What are the benefits for participants, wellbeing in a regional community?
• How does the vision grow as the play evolves?
• How does the theatre making process create, develop and sustain linkages?
• Why is language and culture important?
• Why theatre and Shakespeare?

Loneliness

‘Loneliness has been associated with a range of poor mental, physical and socio‑economic outcomes, including low self-esteem, suicide, depression, heart disease and poor physical health.’

Tropical Arts Vision is to include as many people as possible under the umbrella of Theatre. A particular feature of our work is with the Deaf Community of Cairns and our theatre productions are unique in their diversity:

• 60+ actors and associated families and networks.
• 10 actors Deaf Community
• 10 actors with a disabilty
• 10 actors over 50
• 10 child/youth actors
• 8 paid theatre maker professionals
• 30+ volunteers
• 5 international actors or assistants
• 5+ language groups
• 15 Indigenous or CALD participants
• 1400 audience capacity + roving performance to a possible 4000 crowd.

This presentation is especially relevant for people interested in inclusion and how to do it.