Concurrent Speakers

This presentation will show a series of national case studies of creative arts engagements, where communities and artists have come together to support health and well-being. Regional arts Australia oversees the funding of hundreds of arts projects across the country each year through the management of the Regional Arts Fund. With this terrific overview, and with access to the latest research and development around the value of the arts for the health of regional individuals and communities, Simon will make the case for seeing creative activity as a key driver of personal and collective health and well-being. The examples will demonstrate how arts can successfully integrate with other sectors of society to provide opportunities for inclusive and meaningful engagement that fosters a strong sense of belonging and well-being. Regional arts projects can support communities self-confidence and connectedness, leaving strong long-lasting cross sector relationships. Community arts engagements have provided powerful opportunities for communities to rebuild and reconnect following personal and local trauma.

This presentation will present some case studies, point to recent research in Australia and internationally as well as hearing the voices of those engaged in projects to demonstrate the need to include ‘creative activity’ as a determinant for good health. Real community arts engagements where individuals feel connected and empowered supports the health of the individual, the local and the nation.

In 2018, discussions concerning the settlement of migrants and refugees in regional and rural locations is increasingly relevant to discussions of Australia’s migration program as well as broader considerations of regional infrastructure and development.

To be sustainable, regional settlement requires that migrants are adequately supported in their new homes, and that the receiving community is in the best possible position to meet the needs of vulnerable people arriving in their location.

With this in mind, settlement must be viewed through a place-based lens that empowers local communities to provide services and support wherever needed. To inform this approach, the Settlement Council has developed a set of National Settlement Services Outcomes Standards which provide key indicators for successful settlement services across nine priority areas. Health and Wellbeing of new arrivals is one of these nine priority areas, and requires that clients are engaged through effective and responsive primary prevention and early intervention initiatives that encourage health and wellbeing.

Access to appropriate, affordable and quality health services is crucial for new arrivals. These range from specific services dealing with torture, trauma and other conditions associated with the circumstances leading up to a migrant or refugee’s arrival in Australia, through to general medical assistance and intervention.

New arrivals must be supported to navigate the Australian health systems and understand their rights. Equally important, is the provision of information about maintaining health and wellbeing – both physical and mental, as migrants settle into life in Australia.

This presentation will analyse the key requirements for successful health care services in regional and rural locations that meet the National Settlement Services Outcomes Standards.

It is proposed that this could take the form of a general paper presentation, or alternatively, as a series of presentations as part of a concurrent session. If this were the preferred option, we would undertake to secure the involvement of potential presenters from the following possible sources:

• Refugee Health Networks
• Regional Australia Institute
• Migrant Resource Centres and/or Settlement Service Providers engaged in regional/rural settlement
• health care consumers with lived experience.

This paper will provide insights into the specific needs of a highly vulnerable population in Australia.

The health effects of climate change are evident today, with rural Australia particularly vulnerable owing to increasing extreme heat and bushfires, changed rainfall patterns and challenges to livelihoods. Future climate projections represent a major threat to public health in Australia and worldwide. However, tackling climate change offers significant opportunities for improvements in health (Watts et al, 2015). Rural health professionals are optimally placed to be at the forefront of this change.

Recognition of the social and environmental determinants of health is an essential foundation of healthcare. It is crucial that Australian health professionals are aware and empowered to integrate climate and health considerations into their professional practice. Health professionals’ respected position in the community empowers the profession to offer leadership in climate change mitigation by reducing carbon emissions, and to advocate for policies which safeguard and promote a healthy, sustainable Australia.

This workshop will offer health professionals an evidence-based overview of the health impacts of climate change with a focus on those relevant to rural communities in Australia and vulnerable populations including the elderly, children and those with chronic diseases. It will then lead into a discussion around the unique role of the health professional in advocacy, awareness and community engagement, and provide some tools and direction to further develop these skills. The workshop will cater for a range of knowledge bases, and is essential for those wishing to further their expertise and agency in tackling this public health issue.

This is the story of our journey embracing collaboration and working together to improve the health and well-being of the Gundjitmara people and those people living and working on Gundjitmara country in Southwest Victoria.

Our journey starts with understanding and respect and these themes underpin everything that we do.

The first part of the journey is understanding—it is vital for mainstream health organisations to take the time to listen and learn about the ways the traditional custodians of the land have managed their people’s health and wellbeing. The Gunditjmara peoples of Southwest Victoria have successfully thrived for many generations before colonisation and have many lessons learnt to share. Conversely opportunity the understand the mainstream health role provides insight into how organisations can effectively work together.

Over the last five years in the south-west of Victoria health care providers and traditional owners have joined forces to develop the Ka-ree-ta Ngoot-yoong Wat-nan-da strategy.

Simple initiatives include:

• monthly yarning sessions
• traditional names for initiatives and across organisations
• key events celebrated including Naidoc week with a calendar of events
• friendly and welcoming organisations

• all official flags flying at the building entrances
  • signage to acknowledge the Gunditjmara elders in organisations
  • local made gift bags for Aboriginal patients

• art competition—artwork symbolising the Ka-ree-ta Ngoot-yoong Wat-nan-da strategy, used on name badges, website and stationery
• orientation program with opportunities to go on country with traditional owners
• all babies born on Gunditjmara country receive a locally designed cot card and bib.

These simple initiatives have established a respectful framework to leverage off. The Ka-ree-ta Ngoot-yoong Wat-nan-da strategy with the guidance of our traditional owners is now starting to solve some of the more wicked problems with more complex initiatives

These include:

• Gunditjmara elder appointed to the Board of Management at Portland District Health (PDH) – PDH Aboriginal staff member on the Aboriginal Health Service (AMS) Board.
• PDH developing an Aboriginal and Torres Strait Islander (ATSI)employment plan has increased the % of ATSI employees from 0 to 2.5% of the total workforce.
• Established career pathway entry level positions for nursing and allied health careers
• Contract with local AMS to provide 24/7 support to ATSI patients in hospital. (fee for service arrangement)
• Aboriginal health workers part of the care team at PDH.

• Jointly appointed general practitioner between local AMS and PDH.

Since 2012 PDH has seen the numbers of Aboriginal and Torres Strait Islander patients seeking services increase by over 60% annually the organisation is no longer bypassed but is valued as a health care provider in the local Gunditjmara community.

The Ka-ree-ta Ngoot-yoong Wat-nan-da strategy is a deadly partnership initiative working effectively to improve the health and well-being of the local communities.

Background: There is an increasing focus on placing health students in sites outside of metropolitan areas to encourage the uptake of careers in rural and remote Australia. While there has been a significant and growing body of research on the impact of non-urban training for medical students, less is known about nursing and allied health students with very little research emerging from remote areas. This research project seeks specific information on the impact of placements in the Northern Territory in influencing a health professional’s work location in the 10 years post-graduation.

Allied health and nursing student placement numbers in the NT have been steadily growing with the increased focus and funding through the Rural Health Multidisciplinary Training Program (RHMTP). RHMTP supported placement in the NT have grown from 357 in 2016, 422 in 2017 to 506 in 2018. Students have come from 26 Australian Universities undertaking studies in nursing, midwifery and 14 allied health professions. Placements have occurred in hospitals, community health centres, schools and clinics; run by government, non- government and private agencies; located in Modified Monash Model (MMM) areas classified as outer regional (MMM5) remote (MMM6) or very remote (MMM7).

Aims: The aim of this study is to track nursing and allied health professionals who undertook one or more pre-registration placements in the Northern Territory. Understanding where these professionals then chose to practice may inform how placements are offered and supported, what types of students are best suited to experience the remote workforce and where effort should be concentrated to build the future workforce.

This research is a ten-year tracking study of the work practice locations of nursing and allied health students who complete a Northern Territory work integrated learning placement. The study will also investigate the factors that contribute to the work location decisions of the participants; and to determine if, and how, a Northern Territory placement influenced career decision-making.

Methodology: This research is a longitudinal cohort study with the primary objective to undertake a ten-year tracking study of the work practice locations of nursing and allied health graduates who completed a Northern Territory work integrated learning placement as a student. It will collect data at multiple points in time in order to investigate the factors that contribute to the work location decisions; and to determine if, and how, a Northern Territory placement influenced subsequent career decision-making.

The research will use a pragmatist theoretical framework which facilitates the researchers to select the best methods for answering the research question rather than being constrained by the limitations of a particular paradigm.

Over the ten-year period we will use two surveys tailored to two specific participant groups to collect the data to answer our research questions. The first is a student evaluation of NT placement survey which has been a routine part of the Flinders NT quality assurance program for many years. The survey is also used nationally by University Departments of Rural Health across Australia. This survey targets students who have undertaken NT placements. The second survey has been purpose-developed to track work location and the influences on work location decisions. This survey targets health professionals known to have undertaken NT placements as a student.

Conclusion: There are many factors which influence decisions on where to live and practice a health career. This research is seeking input from others in the field as to what are the most influential drivers in making these decisions. This will then inform the study design, seeking to gain information over 5-10 years on the impact of student placements and other factors on taking up a remote health career.

There is currently no consistent method of tracking students for 10 years post-graduation. Following nursing students in their careers can be done potentially using AHPRA data. Tracking the allied health professions will be more difficult with 10 professions not currently registered through AHPRA, so other methods will need to be employed. Input will be sought regarding methods of recruiting and tracking students over 10 years.

Understanding where these professionals chose to practice can inform how placements are offered and supported, what types of students are best suited to experience the remote workforce and where effort should be concentrated to build the future workforce.

Participation in this session will aim to garner ideas from those also in this field on appropriate methodologies as well as draw on experience of undertaking tracking studies over time.

It is predicted that osteoporosis or osteopenia will affect 6.2 million Australians aged over 50 years by 2022. However, osteoporosis often remains under-diagnosed even after a minimal trauma fracture (MTF). There is a ‘disconnect’ between the recognition of MTFs and their subsequent investigation resulting in a gap in osteoporosis care which continues to widen. This mixed method study looked at the attitudes and beliefs of general practitioners (GPs) and orthopaedic surgeons about the management of osteoporosis following MTF and the roles and responsibilities of health personnel.

Two questionnaires were developed and sent to 69 orthopaedic surgeons practising in rural and regional south-eastern Australia from the Royal Australian College of Surgeons website and 203 GPs working in a regional Local Health District. Three female and three male GPs, one female and five male orthopaedic surgeons were purposively selected for interviews. SPSS was used for descriptive statistics and NVivo10 was used for qualitative analysis. Interviews were analysed by two researchers independently and key themes were identified.

The overall response rate was 60.8% for orthopaedic surgeons and 35.5% for GPs. Almost all GPs and two-thirds of orthopaedic surgeons thought the most appropriate healthcare professional to initiate discussion about osteoporosis was the GP. Common reasons orthopaedic surgeons gave for not initiating osteoporosis treatment following MTF were that they did not have time and it was not their responsibility. The main barrier for GPs not initiating treatment was that they were not informed that the patient had sustained a MTF. The majority (70%) of both groups rated the quality of coordination of osteoporosis patient care between hospital and general practice as unsatisfactory or poor.

There was general agreement among the interviewees that the role of the orthopaedic surgeon was to fix the fracture and the role of the general practitioner was to manage osteoporosis as a disease. orthopaedic surgeons perceived their role was to ‘fix the fracture and send them home’ and ‘my role in the whole medical community is to operate and that takes up 100% of my time’. The difference in opinions centred on whether the orthopaedic surgeons had a responsibility to raise the issue of osteoporosis with a patient when they were in the acute stage of an MTF. GPs felt strongly that orthopaedic surgeons have a significant role in mentioning osteoporosis to the patient at the time of fracture and it should be a key element in the discharge summary.

The eye health of Aboriginal and Torres Strait Islander people is improving compared to other Australians—the gap for vision is demonstrably closing. The recent National Eye Health Survey (2016) reports Indigenous Australians having three times the rate of blindness and three times more vision loss compared to non-Indigenous Australians and in 2008 the blindness rate was six times greater. Over 90% of Indigenous vision loss—caused by refractive error, cataract, diabetic retinopathy and trachoma—is considered preventable or treatable, and the interventions required are affordable, effective and doable.

The Roadmap to Close the Gap for Vision (2012), proposes 42 sector-endorsed, evidence-based recommendations to address Indigenous eye health inequity through health systems reform, and require implementation at national, jurisdictional and regional levels and across the whole of Australia. The Roadmap describes the patient pathway of eye care as a ‘leaky pipe’ in which each ‘leak’ needs to be fixed, to ensure Indigenous people receive adequate eye care outcomes. Fixing one or two or even three leaks will not improve overall outcomes and it is only together, by eye care stakeholders working collaboratively, that the eye care pathway can flow successfully.

Regional implementation of the Roadmap requires a whole-of-system collaborative approach. Regional stakeholders groups are established, bringing together those involved along the patient eye care pathway, to discuss opportunities to reduce current gaps and barriers to access. To facilitate these discussions, patient pathways are mapped to identify ‘leaks’ or gaps existing within the eye care system. Priority areas are then self-determined by the region, who work together toward solutions to close the gap for vision. Currently, 48 regions across the country are operating in this way, covering over 75% of Australia’s Indigenous population.

In Tasmania, three Indigenous eye health regional groups (north, north-west and south) were formed in 2017. From these regional gatherings, stakeholders together identified barriers to access for eye care services and outcomes, which included, the identification of Aboriginal patients, costs of consultations and treatment and awareness of eye health pathways. Each regional group is now working together on solutions that address these barriers and improve Aboriginal eye health outcomes.

This presentation will discuss how collaborative approaches are being used to successfully tackle the ‘leaks’ of the eye care patient pathway for Aboriginal and Torres Strait Islander people in Tasmania and more broadly across Australia. These successes to close the gap for vision illustrate initiatives that are better together.

Relevance: The increase in demand for headspace services in Tasmania has identified a need to review, and potentially refine and improve demand and intake management processes. The need for a review was identified in discussions between Primary Health Tasmania and commissioned providers for headspace services in Tasmania: The Link Youth Health Services based in Hobart and Cornerstone Youth Services based in Launceston. As per the ASGC remoteness area classification, Launceston and Hobart classify as inner regional areas (RA2). Young people accessing headspace centres however also come from outer regional and remote regions. It was identified that increased service demand and comparatively small funding increases make service intake processes and waiting times difficult to manage. It was reported that staff at headspace centres are experiencing increased workloads and are frustrated with not being able to provide timely services when young people need them. Increasing demand for service and limited access to alternative mental health service providers, adds additional pressure on headspace services to continuously review their practices and develop innovative models of care that improve efficiency and client access.

Methods: In June 2018 Primary Health Tasmania commissioned Brockhurst Consulting to review intake and assessment processes, report on innovative intake and assessment models currently used in youth organisations in Australia and provide recommendations of improvements for consideration.

Results: Key findings that are going to be presented:

• summary and analysis of current intake and assessment systems and processes in youth organisations in Australia
• recommendations for improvement of intake and assessment processes taking into consideration the local context.
• recommendation of a draft implementation plan to assist service providers with the practical steps on how to implement recommendations, including the implications of any suggested changes on current policies, procedures, workforce requirements and systems.

Understanding how people engage with research and health promotion messages is important to inform the delivery of appropriate context based health care. Arts-based translational methods are effective modes for disseminating academic knowledge to non-academic audiences and creating public platforms for the discussion of health issues. The art-health lens provides a board paradigmatic framework (qualitative, visual/creative arts, social science) to explore and understand complex social phenomena that impact on both individual and communities health and wellbeing. Using these frameworks can offer an innovative multidisciplinary and collaborative approach to inform context based rural service models and create new public platforms for the discussion of sensitive public health issues.

We present an example of an innovative Arts and Health methodology used in our project ‘Broken Bodies’ that translated previously collected empirical research (127 Tasmanian mothers breastfeeding narratives) into visual art forms for a public exhibition. Based on qualitative interviews conducted with 20 gallery visitors and six artists involved in the generating of the work and exhibition, this paper provides evidence of a new approach for using art-health methods as a form of evidence translation and generation, public engagement and the impact it has on generating awareness and social discourse around sensitive health issues. We also highlight the use of artists’ skills in empirical research translation, in particular the role that empathy plays in generating awareness and social discourse around health. In keeping with the findings of the primary research and the conflicted, and often painful experiences of breastfeeding reported by mothers, this paper highlights the ethical importance of sustaining empathy throughout each stage of translation; from the artist’s response to the data and the conceptual development of their work, to the presentation of their work in a local gallery setting and gathering of the audience responses.

This methodology can be used to translate and generate data, return the research findings to the primary participants and local community, foster creative engagement across settings and disciplines whilst assessing the impact on community perception and understandings of public health promotional messages.