Family-based treatment (FBT) is an efficacious outpatient intervention for young people diagnosed with anorexia nervosa (AN). To date, treatment to protocol has relied on standard face-to-face delivery. Face-to-face therapy is subject to geographic (a lack of services), temporal (long distances to services) and human factors, rendering it particularly susceptible to inequities and disruption, resulting in poor service provision for rural and regional families. Rural areas have been affected by recent significant challenges, such as during the Australian and Californian bushfires and COVID-19 global pandemic, which have created an unprecedented demand for telemedicine to facilitate the continuity of care, rendering the evaluation and optimisation of providing evidence-based therapies via this modality critically important. The primary aim of the current study was to examine whether a traditional, unspecialised, face-to-face workforce and service model can be safely and effectively translated and transformed to digitally deliver FBT for AN to address these access issues. Forty young people aged 12 to 18 years who meet DSM-5 diagnostic criteria for AN/Atypical AN and live in a rural or regional setting, along with their family, are being recruited to the study. Therapists will provide 18 sessions of FBT over nine months via telemedicine, directly into the home of the young person and their family. The analysis will examine treatment effectiveness: change in per cent median body mass index (BMI) and global eating disorder examination scores (EDE; proxy for ED symptomatology), treatment and service feasibility, acceptability and cost-effectiveness. Initial quantitative (%m BMI and EDE) and qualitative (acceptability and feasibility) findings from the first wave of families will be presented. The study addresses the needs of health services by increasing workforce capacity to deliver specialised, evidence-based treatments as well as address the treatment needs of families not able to attend face-to-face clinical services. If delivering treatment in this modality is clinically effective and economically feasible, and health services and workforce can adapt to this alternative model of taking potentially lifesaving, evidence-based treatments directly to the patient, currently existing access and treatment inequalities will be significantly minimised, and the healthcare system can be better positioned in the face of future service disruptions, as has been seen in 2020.

The past twenty years has seen a dramatic increase in research into the effects of arts and cultural engagement on the health and wellbeing of individuals and communities (Fancourt and Finn 2019: vii). The Creative Health Inquiry Report (APPGAHW 2017) and the ArtPlace America white paper Creating Healthy Communities (Sonke et al 2019) represent two significant recent efforts to assert the role of the arts in advancing health and wellbeing. Both reports advocate community-based and societal approaches to improving wellbeing through the arts, as opposed to individualised approaches.

In Australian communities, our research shows the value of arts and cultural engagement is in social bonding and bridging that allows individuals and communities to develop a ‘sense of connectedness, self-understanding and identity construction, as well as a sense of belonging with, or pride in, one’s community, defined by geography or people’ (Brown and Novak 2007 and 2013). Using outcomes from an Australian Council Research Project (2019–22) investigating the impact of arts and cultural engagement in regional Australian communities, this paper examines the connection between wellbeing and social inclusion through an arts lens.

Locating the examination of wellbeing and social inclusion in community-initiated projects in central-west Queensland, The Lost Art, and north-west Tasmania, Shorewell Presents … Dear Friend, the paper illustrates through these projects how creative and cultural activities maintain social connection and avoid potential social fragmentation. Additionally, the paper will discuss project responses to COVID-19 using both physical and virtual creative art-based engagement strategies in a crisis to entice continued participation and support wellbeing.

The HEAD YAKKA (HY) initiative was developed following three years of community engagement by Outback Futures, around mental health, in the Barcaldine Region. In late 2018, a community-initiated collaboration between Outback Futures, Barcaldine Regional Council (BRC) and the University of Southern Queensland’s Institute of Resilient Regions (USQ) launched this whole-of-community approach to ensure the development of a resilient and robust region.

HY is a long-term, place-based suicide prevention/mental health and wellbeing initiative that has been genuinely co-designed to ensure an educated, empowered and equipped region owning its own mental health and wellbeing future. With Outback Futures facilitating initial phases and providing clinical backing, BRC providing community leadership, and USQ offering evaluation and research support, this initiative is having a powerful impact and is being adopted and shaped by all central-west Queensland regions and beyond.

In Barcaldine Region’s first 12 months of HEAD YAKKA, 76 community leaders participated in roundtables and community forums; 150+ people engaged with community mental health and wellbeing events and there was a 21 per cent increase in engagement with Outback Futures mental health service provision. Eighty-two percent of people recorded an increase in personal wellbeing, 98 per cent were keen to engage a friend with the initiative and 80 per cent reported an increased sense of safety in discussing mental health.

Additionally, a social and personal wellbeing survey is being used to measure community change across ten years. The ‘Look Out; Check In; Speak Up’ HY school and community education program is ensuring that the impact is genuinely intergenerational and that there is consistent messaging at all levels. HY is not a service provider but engages with all people, agencies, businesses and services in a community to ensure clear and common purpose, conversations, activities and pathways. The HY process is replicable, allowing each new region to shape its design to suit their unique story and needs.

Despite creative incentive schemes, policy and strategy changes, and continuous debate and dialogue at the training and employment levels, workforce issues remain one of the most compelling challenges and arguably significant inhibitors of long-term change in rural health outcomes. Understanding around the power of place-based and locally owned services is solid, however the reality of up to 80 per cent annual turnover figures in remote contexts is real. So the question of how to better incentivise workers to ensure longevity and quality is the wrong question to be asking.

Data from Western Queensland Primary Health Network’s 2019–2022 Needs Assessment indicates ongoing workforce issues in rural and remote areas, including high vacancy rates, curtailment or ceasing of service when there is turnover in individual employment positions, and low rates of psychologists per 100,000 people. It could be argued the inherent characteristics of rural and remote life potentially create a situation that is intrinsically bound to struggle or at least be significantly less than optimal for client and practitioner, especially in the mental health arena.

Outback Futures’ Community Facilitation Model was developed in the bush, with the bush, and is achieving significant traction in staff retention resulting in positive long-term service delivery outcomes in remote Queensland. For the three years between 2018 and 2020, Outback Futures’ average staff turnover was 10.8 per cent per annum, ensuring consistent client engagement, which in turn is contributing to reduced stigma and increased help seeking in communities.

A workforce model of recruiting to a region, and utilising an ‘extended FIFO’ approach based on genuine community engagement, is resulting in staff longevity and retention of senior experienced staff. In combination with a hybrid, multidisciplinary face-to-face/telehealth approach, the emphasis on community ownership and self efficacy in the mental health and wellbeing space is creating confidence, consistency and long-term change for these remote communities.

Ensuring we are asking the right questions as service providers and an industry is key to addressing these entrenched issues for our rural and remote communities. Continuing to ask the same questions and simply working harder at the same approach is not the answer to creating real change.

Kultchafi delivers cultural responsiveness and healing education, and training based on a reconciliatory framework and set within Aboriginal terms of reference.

Our services provide cultural healing training with integrity and honesty, from the Voices of First Nations peoples. We bring together all peoples in an environment of sharing and learning from the beliefs and wisdoms of the ancient culture of First Nation Australians, for the highest good of our communities.

Kultchafi services have been developed over many years in consultation with Elders and Traditional Owners from across Australia, to ensure the ongoing integrity and focus of our healing.

Kultchafi Healing Circle Work (HCW) is not a therapy, but therapeutic outcomes are experienced. It is a healing process based on an ancient Aboriginal and Torres Strait Islander methodology.

Participants learn to live life in the moment, recognising and understanding their own spirituality and gaining the ability to enter the moment to reaffirm themselves.

Participants in a healing circle learn to appreciate and be accountable for their highest good, and the highest good of others around them. HCW is provided in group sessions and it is suitable for both Indigenous and non-Indigenous participants over 18 years of age.

Delivery of HCW is suitable for addressing:

• Stolen Generation trauma
• displacement
• abuse
• isolation
• alcohol and other substance abuse and addiction
• domestic and family violence
• gender issues.

By taking part in the seven steps of HCW, participants can learn to experience a restorative and health-giving sense of wellbeing for themselves and others.

HCW has been delivered by the Indigenous Wellbeing Centre in Bundaberg for several years and 430 participants have completed it. The majority have been Aboriginal, but non-Indigenous people have also completed it. There has been an 85 per cent success rate in improving participants’ wellbeing and their life issues.

Kultchafi has successfully implemented Facilitator training so the methodology can be shared across communities.

Background and aims: The challenges of chronic disease self-management in multimorbidity are well-known. Resource (capacity) and treatment workload (burden) factors are known to predict engagement and adherence, but healthcare providers are reported to have a limited understanding of these concepts. We wished to explore the views of rurally-based nurses and allied health clinicians who worked directly in chronic disease self-management support. Our aim was to discover whether health providers in regional community health settings could recognise and address burden and capacity factors, and the barriers they encountered.

Methods: Our study was qualitative. We interviewed 12 health professionals who provided chronic disease self-management support across two regional community health centres in Victoria. Using vignettes constructed from interviews with multimorbid patients at the same health centres, we explored the clinicians’ understanding of burden and capacity. Our interview structure was informed by the Cumulative Complexity Model, which describes complexity as arising from an imbalance between the individual patients’ capacity and required workload. Interviews were recorded and transcribed verbatim. Analysis was by the framework method, using Normalisation Process Theory to explore burden and the Theory of Patient Capacity to explore capacity.

Results: The framework analysis categories fitted the data well. All participants clearly understood capacity and were highly conscious of social (for example, income, family demands, isolation) and psychological (for example, cognitive, mental health) influences on healthcare engagement and access. Although the term ‘treatment burden’ was unfamiliar to some, all participants understood the concept, relating it both to specific treatment demands and to healthcare system deficiencies. Participants used a range of strategies to increase capacity and decrease burden, but health system and access barriers (leading to increased burden) were perceived to be insurmountable at times.

Relevance: Participants in this study displayed an understanding of capacity and burden that was comparable to the patient literature. However, despite their awareness, health providers continued to operate in ways that were likely to increase burden. The lack of overall care coordination was frequently discussed in the context of a rural environment where GPs were often transient or absent. Given long-term GP workforce shortages, this may be best addressed by expanding the roles of health providers currently working in chronic disease management. We intend to explore this further in 2022 by conducting a pilot study of care coordination focused on reducing burden and supporting capacity in rural community health settings.

Introduction: Allied health plays a vital role in optimising the quality of client care across the continuum. The workforce provides care in a diverse range of settings and contexts which increases the complexity of workforce planning and development.

Challenges with the recruitment and retention of allied health in rural and regional settings, including the Loddon Mallee region, are well-documented. Factors contributing to this include: limited opportunities for clinical training of students; limited support for graduates; professional isolation associated with poor access to clinical supervision and peer support; and lack of access to continuing professional development (CPD).

Presentation: The Murray Health Partnership (MHP) established an Allied Health Education and Support Scoping Project (AHESSP) in August 2019. The project involved a detailed scoping of the allied health workforce in the region and associated challenges relating to allied heath workforce recruitment and retention of the seven organisations in this sub-region. Proceeding the scoping phase, an Allied Health Education and Support Project Officer has been recruited to deliver a three-year strategy, and implemented a number of collaborative workforce strategies. These initiatives support the growth, training, professional development and retention of a rural and regional allied health workforce, with the overall aim of enhancing the quality and safety of consumer care.

Outcomes: Six core project goals were identified as follows:

1. Implement the Victorian Allied Health Clinical Supervision Framework (VAHCSF) across all MHP organisations.
2. Establish peer-support strategies for MHP allied health professionals.
3. Establish a MHP allied health CPD plan.
4. Commence a collaborative MHP allied health new graduate program.
5. Build capacity for allied health undergraduate clinical placements in the MHP.
6. Develop a standardised mandatory training framework for allied health staff working within the MHP.

The project goals were very much interwoven throughout the project; a wide array of deliverables were implemented, each falling under one or more of the project goals listed above.

Each project goal will be discussed in detail, with respect to the associated background, methodology, deliverables and project recommendations.

We know that rural Australia faces serious general practitioner (GP) workforce shortages.

At the same time, there are GPs who would like to support rural locations more – be it through regular rural placements or telehealth support – but do not feel they have the connections or confidence to do so.

To help bridge this gap, the Royal Australian College of General Practitioners launched an innovative pilot program with the aim to connect practices and GPs in diverse geographical areas to help grow locum pools, increase peer support, enhance professional development and provide a greater service offering for patients.

In doing so, the Practice to Practice pilot program helps improve access and quality of care for patients, particularly those in rural and remote communities.

Urban and regional practices and GPs will match with their counterparts in rural and remote Australia to share skills and support, and maximise quality services for patients across the country.

The Practice to Practice pilot program also exposes GPs to the challenges and benefits of living in a different area. This is significant because the research has shown that GPs who gain exposure to work and life in a rural community are more likely to choose to go rural permanently.

This session will provide an overview of the pilot and share case studies on how practices and individuals across Australia are sharing skills and support and maximising quality services for patients.

Learning outcomes:

1. Describe the Practice to Practice pilot program and its purpose.
2. Identify situations for general practices or GPs to get involved and highlight the benefits.
3. Explain how the program can help improve access to high-quality general practice care nationwide.

With 11 million Australians currently living with a chronic disease, cause and correlation is a priority research area to help close the gap between symptom management and disease remission.

Supported by the Australian Patients Association, PANDIS is an environmental health and medical research and data platform investigating pathogenic microbes in chronic disease causation, correlation, cascades and clusters.

Important research is currently underway to study Australian pathogenic ecologies and ‘super spreader’ reservoir sites in rural and regional areas to identify, map and research environmental disruptors in human health. If bitten by a vector, pathogens may be transmitted to humans, including viruses, fungus, bacteria and parasites. Other pathogenic environmental disruptors are biotoxins including mould and blue-green algae.

People who work outdoors or spend time outdoors have a higher risk of exposure to an infectious or zoonotic agent which, if left untreated, may lead to a chronic disease.

Zoonotic infections impacting human health in Australia include Ross River Fever, Q Fever, and the genus of Bartonella, Babesia, Borrelia and Rickettsia. Rural communities are also at risk of other pathogenic microbes including blue-green algae outbreaks in water and mould.

Vectors such as a mosquito, mite, lice or ticks are vulnerable to climatic events such as bushfires, floods and rain. Changes to their habitats may increase the risk of passing on infections from intermediatory hosts such as rats, mice, migrating birds, livestock, domestic pets and wildlife.

PANDIS comprises 26 researchers in collaboration with clinicians and patients and uses innovative technologies and protocols to conduct research projects spanning COVID-19, cancer, arthritis, mental health, multiple sclerosis, motor neurone disease, chronic fatigue syndrome and dementia.

Through the latest evidence-based research and community-operated data mapping apps developed by PANDIS, rural Australians can learn about pathogenic environmental harm and participate in data research to help keep communities safe, and reduce the burden of disease in rural and regional communities.

Background: The Bachelor of Dental Surgery (BDS) at James Cook University (JCU) is a socially accountable program designed to address the population health needs and current workforce shortages of regional, rural and remote communities, with a particular focus on underserved communities in tropical Australia. As one of only three dental schools in Australia located outside a capital city and the only dental school in northern Australia, a rural, remote and Indigenous health focus is embedded across the curriculum. The JCU program is designed to grow fit-for-purpose graduates who can meet the needs of these communities and contribute to addressing the maldistribution of the dental workforce, including into public over private practice.

Analysis of BDS exit surveys from 2013 to 2021 shows 70 per cent of JCU dental graduates intend to practise rurally. This study quantitatively investigates trends in graduates’ employment (rurality of practice, choice of public or private practice) since graduation, and qualitatively explores key enablers and barriers to rural and public health system careers.

Methods: An explanatory mixed-methods study undertaken by a team of three BDS faculty and six fourth-year students. The study involves an initial survey of JCU BDS graduates (2013 to 2020), followed by qualitative interviews with a sample of graduates who consented to share further information about their career choices in the survey. The survey will investigate changes in practice rurality and private versus public practice since graduation. Rurality of practice will be defined according to the Modified Monash Model.

Semi-structured interviews were conducted using a purposive sample of graduates who agreed to participate in further studies. Significant trends in the survey will guide the purposive sampling. The interviews will enrich the survey data by exploring the factors influencing graduates’ career choices and changes, with a focus on identifying enablers and barriers to rural and public health system practice. Interviews will be digitally recorded, manually transcribed and analysed thematically following a flexible, interpretive approach based on Braun and Clarke’s six-step process.

Results: The graduate survey was conducted in December 2021, with 110 graduates out of a possible 395 (response rate = 28 per cent) providing the location, type (public or private) and duration of all employments since time of graduation. Preliminary findings indicate 59 per cent of JCU dental graduates are currently practising outside of metropolitan areas, with more detailed analysis of their career employment choices with respect to rurality of practice and private versus public practice currently being in progress. Qualitative investigation of the personal enablers and barriers to rural practice and public system practice will be undertaken in the coming months.

Conclusion/recommendations: This poster reports early evidence on the career choices and outcomes of the first eight cohorts of JCU BDS graduates since graduation. Preliminary findings suggest that the early career outcomes and choices of JCU dental graduates are aligned with the workforce needs of the region. These findings have the potential to inform strategies to address the maldistribution of dentists towards metropolitan and private practice through curriculum redesign and greater retention of graduate dentists in rural and public practice.

In rural and remote locations across all Australian states non-radiographer X-ray operators (XOs) who have no formal radiography qualification, can be licenced under State Radiation Control legislation to perform a limited range of plain radiography examinations. The licencing of XOs provides rural and remote patients with access to medical imaging services that would otherwise be unavailable without travelling long distances, often at substantial cost. The benefit of improved service access, however, should not come at the cost of lesser-quality radiographic services for patients. It follows that the education and ongoing support of XOs should be of a high standard.

In seeking to provide high-quality training to XOs across Queensland, the Cunningham Centre began a collaboration with the University of Newcastle’s Department of Rural Health in 2017, sharing online educational resources for the introductory XO course. This training is supplemented by face-to-face workshops at the completion of the online component. Despite the challenges of differing licence conditions and target course participants, the collaboration has been highly successful, demonstrating a willingness to overcome local legislative and professional practice variations.

Even with improved online educational resources, XOs were still concerned about a perceived lack of support. XOs felt alone. At the same time, financial and staffing resources at the Cunningham Centre were stretched and COVID-19 meant that travel was, at times, impossible. It was important to find a more sustainable way to provide ongoing support and guidance.

With only a small team based at the Cunningham Centre, courses rely on the statewide network of local radiographers to provide ongoing support and guidance to XOs within their own community. As such, the Cunningham Centre has sought to actively foster these relationships through the introductory course, various communication platforms and in-services, and plans to provide further support and training to radiographers to ensure that XOs remain well-supported.

Videoconferencing tools have also been utilised to conduct the annual training and assessment workshops remotely, which has allowed the Cunningham Centre to continue to provide support and training using minimal resources and without the need to travel. This training has been well-received.

The Cunningham Centre and XOs in Queensland have already benefited greatly from embracing collaboration and change, perhaps especially in challenging circumstances. This serves to promote ongoing collaboration and innovation and raises prospects of a national curriculum and standard for XO education.

The Allied Health Rural Generalist Workforce and Education Scheme (AHRGWES) is a pilot project that seeks to engage the NGO and private sectors in the allied health rural generalist  (AHRG) pathway. The pathway is part of a national strategy that aims to increase the recruitment, retention and development of allied health professionals (AHPs) in rural and remote Australia. The pilot provided workplace training grants and education support for up to 40 AHRG trainees. At project closure we had 34 trainees who had completed or were completing the pathway across eight allied health professions and five states and territories. Organisations involved in the pilot included NGOs, Aboriginal Community Controlled Health Organisations and private organisations working across health, disability and private sectors. Organisations varied in size from two to 250 employees.

Learnings throughout the project included a reframing of the supports required by trainees, their supervisors and managers, and organisations to successfully implement the pathway. This included providing specific interpersonal, professional and peer-networking support which allowed for trainees to discuss their experiences, challenges and success on the pathway. We found that creating a network of innovation and collaboration opportunities among rural AHPs increased trainee engagement within the pathway.

Additionally, we identified that supervisors and managers of trainees may benefit from additional support with supervision and service development aspects of the pathway. We created a professional development series aimed at supervisors and managers so that they were better equipped to support the trainees on the pathway.

All trainees were required to put into practice their university and workplace learnings by participating in a service improvement project, creating innovative solutions to service delivery challenges for their workplace. Examples of projects have included new telehealth training resources, allied health assistant programs, rehabilitation groups amongst at-risk populations and development of new services such as paediatric feeding programs and diabetes education.

This pilot and its unexpected outputs will continue to inform rural and remote allied health workforce development.

The healthcare and social assistance sector plays important roles in supporting the health, economy and liveability of regional Australia. It is both a provider of jobs and essential services, and a determinant of the liveability of a place. The sector is forecast to see the biggest increase in jobs of any industry in the coming years in regional Australia, and has persistent job and skills shortages.

This research identifies places with a specialisation in the healthcare and social assistance sector, with a high rate of growth of businesses in this sector, a mix of private and public jobs and a high share of jobs in this sector. The resulting maps demonstrate the diversity of this sector in the role that it plays in regional economies. For example, remote and very small town Australia operates in a very different context than other places in Australia and is highly reliant on indirect public provision by NGOs. Meanwhile, there are places in regional Australia with ageing and relatively wealthy populations where the private healthcare sector is providing significant employment.

Our analysis found 36 regional Australian healthcare hotspots – each different from the other. We chose five of these hotspots that had built a health precinct. We then profiled these places to further understand how local health sectors are built collaboratively with multiple stakeholders.

The five precinct profiles are in places of very different sizes and locations. While Lismore and Ballarat incorporate a university and hospital presence, for example, Coleraine in the Southern Grampians has established a small town precinct model by engaging with community support to relocate services for increased efficiency and delivery. Defining what a precinct includes and what it looks like depends on the specific needs and contexts of the community.

While each of these precincts demonstrate the importance of place-based approaches to building a high-capability healthcare and social assistance sector, they also share some key elements. All of the examples included cooperation and collaboration – between service providers, with council and a recognition of the importance of this sector for economic and community development. This cross-sectoral collaboration meant that education and training, zoning, accommodation, and rethinking resource allocation and responsibility delineation became possible.

Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation is the official name for what is now more commonly known as the Purple House. The Purple House is a non-profit Indigenous health organisation dedicated to assisting First Nations people from remote communities to be home on Country through the delivery of dialysis services. Its conception, design and delivery are based firmly in the values of Yanangu. It remains entirely Indigenous run and owned, with an all Yanangu Board of Directors who are elected by its members.

A translation of the Purple House’s official title means ‘making all our families well’. This is also the vision statement of the organisation. Since its beginnings in 2000, Purple House has worked to address the epidemic of kidney disease inflicting remote First Nations communities as well as the layered impacts of people being forced off Country to access critical health services. This it has done effectively and successfully, vastly improving the quality of life and life expectancy of renal patients. It is now possible to say that, in this space, the Purple House has not only Closed the Gap but has opened a gap upon the national average. The Purple House currently operates nineteen permanent remote dialysis clinics, with more in the planning, and two mobile units called the Purple Truck. The success of the model has led to a natural holistic expansion of Purple House services. These now include aged care, disability, primary health and social support services and a bush medicine social enterprise. However, achieving the vision of Yanangu remains a continuing challenge.

The Purple House Strategic Plan (2019–2022) outlines the core values underlying the philosophy and practice of the organisation. These values are listed as Walytja, Tjukurrpa, Ngurra and Kuunyi. This current plan provides a simple explanation of these terms as family, dreaming, country and compassion respectively. However, what it is unable to articulate is the complexity, interrelatedness and profundity of these values in the lives of Yanangu. These values carry a depth of knowledge which not only ascribes what it means to be Yanangu, but also defines and determines the health and wellbeing of Yanangu.

Yanangu knowledge is encased within symbolic texts. In this workshop we would like the audience, led by Yanangu leaders, to undertake a Yanangu knowledge journey through a personalised reading of texts forming the knowledge base of the Purple House. In so doing, it is hoped that participants to this workshop will come to a deeper understanding of the drivers of Yanangu wellbeing and what is required in ‘making all our families well’. Moreover, due to textual symmetry, this workshop will demonstrate how this Yanangu vision also aligns with a vision of this nation; so the achievement of one is also achievement of the other.