Concurrent Speakers

Youth and mental health service: using music programs to bring about positive change in men's lives.

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.

Background: The Mount Isa Living with Lead Alliance runs a community awareness campaign aiming to reduce lead exposure in children living in Mount Isa. A broad range of informational and environmental strategies have been used to increase parental actions to reduce their children's exposure to environmental lead. The target audience of the health promotion efforts is community members, especially parents and carer of children less than seven years of age.

Aims: This study aimed to examine the extent to which Mount Isa residents report hearing the Lead Alliance's campaign message, their knowledge level regarding home remediation strategies, and the extent to which they self-report acting on the health messages.

Methods: A 32-item questionnaire was developed to assess parental and caregiver knowledge of reducing environmental lead exposure and evaluation of Lead Alliance’s campaign messages. In addition to online recruitment and data collection, i.e., by posting the survey link and study details on the community Facebook page, data were also collected through brief face to face survey. Survey responses were analysed by conducting basic descriptive statistical analysis including frequencies and percentage distribution.

Results:  A total of 272 surveys were completed involving participants from diverse socio-cultural backgrounds. Most participants had heard “wet wipe, wash and eat well” messages, but new families had significantly less awareness of lead contamination sources. Only 32% of participants were aware of a capillary blood test. It was also found that LEADSmart school program and newsletter from Lead Alliance had less penetration than other campaigns

Conclusion: Media campaigns and free blood lead test are well known in the community, but the Lead Alliance campaign messages need to focus on new entrants and promote availability of capillary blood testing in the community. It is expected that the findings of this study will assist the Lead Alliance in directing future promotional activities aiming to increase community awareness of living safely with lead in Mount Isa.

The NRHSN believes that Aboriginal and Torres Strait Islander health is a key issue and priority in Australian healthcare. We aim to support the development of health students who are passionate and competent in this aspect of healthcare, and who will advocate for accessible and quality healthcare throughout their studies and career. Through our programs, the NRHSN aims to facilitate the development of ongoing respectful and trusting relationships of our members with local Aboriginal and Torres Strait Islander health services, communities and patients.

The NRHSN works alongside Rural Health Clubs to support the development of Aboriginal and Torres Strait Islander Engagement Activities that improve the knowledge and skills of our members in the field of Aboriginal and Torres Strait Islander health. This Aboriginal and Torres Strait Islander Engagement Activity Guide was created to provide Rural Health Clubs across Australia with the guidance and resources needed to engage with Aboriginal and Torres Strait Islander health and communities through different engagement activities.

The aims of the Aboriginal and Torres Strait Islander engagement activities include:

• inspire rural Aboriginal and Torres Strait Islander students to pursue health careers
• develop health students’ knowledge of rural community health
• connect with local Aboriginal and Torres Strait Islander communities and health workers
• gain positive and rewarding rural experiences
• increase health students’ rural and Indigenous healthcare skills and training.

Aboriginal and Torres Strait Islander community engagement activities could include:

• working with Aboriginal and Torres Strait Islander students through youth clubs, Aboriginal Controlled Community Health Services or other organisations.
• Aboriginal and Torres Strait Islander Community Festivals.
• assisting schools with a predominantly Aboriginal and/or Torres Strait Islander student populations with a series of health workshops including healthy eating, skills based sessions and highlighting health careers as options for future study.

Being born on country is a significant part of the Aboriginal people of Mornington Island’s culture. Being born on country ties you to that place and affords you lifelong privileges as well as responsibilities for caring for country, both land and people. With colonisation came a whole series of impacts for Aboriginal people, most important of which was dispossession of our land. The establishment of a mission reserve on Mornington Island in 1914 marked the beginning of such impacts for my people and their subsequent subjugation under British rule. For Aboriginal women from Mornington Island such impacts have been none more personal than those on the birthing process. Today birthing on country is not supported by government health service policy or practice and as a consequence women must travel to a regional town at 36 weeks gestation to await the birth of their babies.

This PhD study, utilising Indigenous research methodologies and from an insider perspective, sought to discern, from our birthing experiences shared in yarning circles and key informant interviews, our ontological and epistemological position - our ways of knowing, being and doing. Our ontological and epistemological positioning was then compared and contrasted with those revealed through critical discourse analysis of interviews with health professionals providing maternity care to Aboriginal women from Mornington Island.

The findings of this study provide for a better understanding of the maternity services needs of Aboriginal women form Mornington Island and potentially better informed reform of maternity services policy and practice to meet our needs.

Aboriginal and Torres Strait Islander people residing in remote communities experience the highest rates of food insecurity in Australia at 31%, compared to all Indigenous people (22%) and non-Indigenous people (4%). This is likely to be an under-estimate of the true prevalence, and research suggests food insecurity could be as high as 62% in remote communities. Using a more extensive measure informed by a tool used in other countries, food insecurity prevalence has been reported to be higher in an urban Aboriginal and Torres Strait Islander population, than that reported for remote Aboriginal and Torres Strait Islander people nationally. Food insecurity leads to poor quality diet, which is a major contributor to malnutrition in all its forms, diet-related disease and inter-generational poverty. Food insecurity has multiple causes including socioeconomic factors such as employment, income, housing, food cost, access and availability, and other household costs. Addressing these determinants, and promoting food secure environments in remote Aboriginal and Torres Strait Islander communities therefore requires multiple solutions. Some solutions, such as the ability to purchase a healthy diet within and acceptable proportion of household income, are likely to apply broadly, and other potential solutions will be community specific, best informed by those experiencing food insecurity. This paper will focus on the gaps in evidence regarding affordability, relating to both income and food cost, of healthy diets, and potential mechanisms to support improved affordability of healthy diets. Any potential solution must be developed and tested in partnership with Aboriginal and Torres Strait Islander community residents, as part of a broader strategy to support community-led approaches to promoting food secure environments.

Context and aims: An innovative collaboration between public allied health services and primary healthcare service providers, including an Aboriginal Community Controlled Health Service, is implementing a project to provide an integrated sub-acute service across agencies and geographical boundaries in central and north-west Queensland. The project places the patient in the centre of the sub-acute journey, and aims to expedite the return to home communities, or as close as clinically feasible, for sub-acute care. The service model aspires to provide a seamless sub-acute service regardless of service provider and reduce duplication and gaps in existing models.

A series of tools have been developed to improve processes and build capability and capacity across rural and regional sub-acute services. A framework has been developed that builds on the allied health rural generalist service model, including better use of assistants, telehealth, skill sharing and partnerships. A criteria-led decision-support tool and companion discharge communication process have also been developed to facilitate a predictive, inclusive and consistent transition between regional and rural hospitals, and then to primary health care services.

Method: A two-year implementation phase commenced in 2018 that includes:

• Ongoing development and collective leadership from the multi-agency, multi -site collaborative
• Mapping current services and undertaking a gap analysis
• Introducing the decision-support tool and early discharge planning across sites
• Identification and development of education and training resources
• Application of the allied health rural and remote sub-acute framework

Results:

• The collaborative has established strong inter-agency and rural-urban partnerships that are changing the approach to sub-acute care in the region
• The criteria-led intake and step-down transition tool and early discharge communication processes are in use across health and primary health care services to transition patients between phases of care and services
• Rural allied health services are developing and implementing enhanced sub-acute service models

Conclusion: Co-design of sub-acute services across agencies, sectors and regional-rural teams presents opportunities to enhance service outcomes and the patient experience. This partnership can support service provided to fully capitalise on the scarce allied health resources in rural and remote communities.

First launched in 2016, the Heart Foundation’s Australian Heart Maps is an online interactive platform for comparing heart disease indicators across Australia. The Heart Maps can be used as a tool for service planning, policy making, advocacy and applications for funding. The Heart Maps have been shown to be an effective tool in helping to secure funding and shape services, particularly outreach services in rural and remote areas.

In November 2018, the Heart Maps were updated with new hospital admission data and for the first time, regional-level hospital admission rates for Aboriginal and Torres Strait Islander Peoples. The newly released Maps also feature a new local profile function, where users can see a summary of their local community’s heart health and social indicators (LGA-level).  We have known for many years about the cardiovascular inequities between Indigenous and non-Indigenous Australians, and the stark variation between rural/remote and metropolitan Australia, but the Australian Heart Maps now expose this at a local level.

This presentation will provide an overview of the Maps and will describe ways the Maps are already being used to address these inequities. In the spirit of ‘Better Together’, the Heart Foundation hopes to work with partners to build community-led responses and reduce the heart disease ‘gap’. The NRHA conference is a great opportunity to delve into the tool and start these conversations. For more information head to www.heartfoundation.org.au/heartmaps.

Background: Multipurpose Services (MPS) are co-located with acute care services and minimal staffing levels, with competing priorities, reinforce a medical task driven culture of aged care. Ageist attitudes, limited resources and lack of specialist knowledge impede true person-directed care based on wellbeing. Residents stated they felt helpless and bored, with little opportunity to exercise choice or engage in life outside their clinical needs within the existing culture of institutional care.

Aim: To enable and empower residents to live vibrant, involved and socially connected lives and eliminate institutional loneliness, helplessness and boredom

Method: A multifactorial approach was used to change the language and culture of care:

• partner with Agency for Clinical Innovation (ACI) for 2017 Living Well in MPS Collaborative
• revise staffing model to create a dedicated and specialist workforce to enable relationship-based person directed values and practices.
• introduce Healthshare My Food, My Choice Hostess Dining model
• trial Alzheimer’s Australia ‘Insights into the Hospital Dementia Experience’ program
• apply Eden Alternative cultural change philosophy to guide the co-design of a human community where plants, pets and people became the axis around which daily life revolves.
• Memories in Reflection Photography project; knowing a person’s life story builds meaningful relationships between residents and their care partners.

Results: ACI Living Well in MPS Collaborative survey results for Dorrigo MPS evidenced improvement across all 8 Principles of Care; with 129% improvement in dining experience and 81% in respecting the rights of the individual. Observations of care demonstrate flexible shower times, unscheduled spa treatments, spontaneous social activities/outings, regular continental breakfasts, impromptu resident/community afternoon teas, increased family/community visitation, inclusion of home-grown eggs & produce on the menu and residents making decisions about daily life.

Education, appreciative inquiry and monthly resident/family/staff gatherings engaged hearts and minds. 92% staff engagement improved patient care, increased productivity and reduced sick leave costs $65,000. Daily intentional rounding and safety huddles mitigate risk and community engagement increased financial donations and volunteers. ‘Highview’ achieved Eden Alternative registration in February 2018 as the first MPS in NSW and first in the public sector nationally.

Conclusions: Relationship based care, where care of the human spirit is as important as care of physical needs, changes mindsets and empowers residents to take control of their lives; make decisions, exercise choice, accept risk and create meaningful solutions within a wellbeing framework.

Background: Multipurpose Services (MPS) are co-located with acute care services and minimal staffing levels, with competing priorities, reinforce a medical task driven culture of aged care. Ageist attitudes, limited resources and lack of specialist knowledge impede true person-directed care based on wellbeing. Residents stated they felt helpless and bored, with little opportunity to exercise choice or engage in life outside their clinical needs within the existing culture of institutional care.

Aim: To enable and empower residents to live vibrant, involved and socially connected lives and eliminate institutional loneliness, helplessness and boredom

Method: A multifactorial approach was used to change the language and culture of care:

• partner with Agency for Clinical Innovation (ACI) for 2017 Living Well in MPS Collaborative
• revise staffing model to create a dedicated and specialist workforce to enable relationship-based person directed values and practices.
• introduce Healthshare My Food, My Choice Hostess Dining model
• trial Alzheimer’s Australia ‘Insights into the Hospital Dementia Experience’ program
• apply Eden Alternative cultural change philosophy to guide the co-design of a human community where plants, pets and people became the axis around which daily life revolves.
• Memories in Reflection Photography project; knowing a person’s life story builds meaningful relationships between residents and their care partners.

Results: ACI Living Well in MPS Collaborative survey results for Dorrigo MPS evidenced improvement across all 8 Principles of Care; with 129% improvement in dining experience and 81% in respecting the rights of the individual. Observations of care demonstrate flexible shower times, unscheduled spa treatments, spontaneous social activities/outings, regular continental breakfasts, impromptu resident/community afternoon teas, increased family/community visitation, inclusion of home-grown eggs & produce on the menu and residents making decisions about daily life.

Education, appreciative inquiry and monthly resident/family/staff gatherings engaged hearts and minds. 92% staff engagement improved patient care, increased productivity and reduced sick leave costs $65,000. Daily intentional rounding and safety huddles mitigate risk and community engagement increased financial donations and volunteers. ‘Highview’ achieved Eden Alternative registration in February 2018 as the first MPS in NSW and first in the public sector nationally.

Conclusions: Relationship based care, where care of the human spirit is as important as care of physical needs, changes mindsets and empowers residents to take control of their lives; make decisions, exercise choice, accept risk and create meaningful solutions within a wellbeing framework.

The Aboriginal cultural camp was an initiative that commenced in 2016 for Tasmanian registrars, GPs and members of the Tasmanian Aboriginal community. We wanted to go beyond the basic requirements of attendance at cultural training, to offer an immersion in to Aboriginal culture, on Aboriginal country, with mutual benefit for the Aboriginal and non-Aboriginal communities.

The camp is held annually at trawtha makuminya, Aboriginal-owned land in the Central Highlands of Tasmania, from a Friday afternoon until a Sunday afternoon. Registrars, General Practitioners, Practice Staff and General Practice Training Tasmania staff and family members attend, in addition to the TAC staff Camp Organisers and Caterers, Cultural and Land Educators, Elders and community members.

The weekend involves an official welcome speech, dance and music, yarning around the campfire, guided walks with discussion about Aboriginal history, the land and stone tools, kayaking, basket weaving, hand stencilling, clap stick making, and a session of “You Can’t Ask That”. There is a medical education session and participants hear from an Aboriginal Health Worker and Aboriginal Enrolled Nurse about the services offered by the Tasmanian Aboriginal Centre.

There is a lot of informal discussion about culture and life stories shared by both the adults and the children.

The feedback given to date, both informally and through the evaluation forms, is overwhelmingly positive. Participants value the beautiful location, the opportunity to spend time with community members outside the clinical setting, the obvious connection to country displayed by the Aboriginal community and the sharing of stories in a cultural exchange.

Cultural awareness training is widely used to address health inequities across multicultural populations. However, the literature on the effectiveness of this training in influencing health outcomes is inconclusive. Given the national priority for health equity across urban, rural and remote settings, deeper insight into the understandings, attitudes and beliefs of health practitioners regarding First Nations’ Peoples wellbeing is critical to closing health gaps.

This paper reports selected preliminary findings from an on-line survey disseminated to allied health, nursing and related discipline practitioners and students who had ever undertaken cultural awareness training during their careers or studies. Survey questions elicited demographic data, free text data on ‘Major Health Issues’ and ‘Health Systems Issues’, as well as self-reported degrees, respectively, of preparedness to engage with First Nations’ Peoples, willingness to advocate for health equity and readiness to actively promote health system change.

Thematic analysis of free text data fields suggested broad categories of ‘Diseases’ and ‘Social Determinants’ in the Major Health Issues field and ‘Culturally Safe Health Care’ in the Health Systems Issues field. The literature related to each of these broad categories was reviewed to develop appropriate reference frameworks based on evidence. Content analysis was then undertaken on free text survey data and results compared to respective reference framework evidence to assess the consonance of respondents’ reported perceptions.

Overall, respondents reported greater willingness to engage with First Nations’ clients and patients, having completed cultural awareness training. For the influence of professional or social connectedness with First Nations’ Peoples on practitioner preparedness to engage, the data strongly suggests that one or more connections can have significant impact.

Preliminary findings also suggest substantial incongruence in both nature and scale between practitioner perceptions of Major Health Issues and the Disease Burden / Social Determinants framework evidence, highlighting significant ‘blind spots’ in practitioner knowledge. For Health Systems Issues, survey respondent perceptions demonstrated similar incongruence with the reference framework evidence, with similar implications

These findings highlight the need for greater knowledge in the health practitioner workforce of the major issues impacting on Australian First Nations’ Peoples’ health and a greater appreciation of the systems factors limiting Australian First Nations’ Peoples’ engagement with government and private health services. The evidence of the positive effect of connectedness between Australian First Nations’ Peoples and health practitioners, the unexpected ‘power of one’, could be an important element of transformative change.

The National Rural Women’s Coalition facilitated two roundtable discussions in 2018 with a range of rural and remote stakeholders to examine issues around mental health and on the housing crisis how women often shoulder a disproportionate burden of the effects of natural disasters. As primary family carers and as community carers, women often play key roles in disasters or times of crisis—both before and after. Valuing gender is increasingly being recognised, yet during and after major events, women’s health and welfare is often impacted, and women continue to undertake unpaid and voluntary work which contributes to community recovery and general resilience.

This presentation will be addressed in two parts to examine measures from crisis management to resilience building that could improve gender responsiveness whilst addressing the mitigation of the social, economic and health impacts on women in approaches to future proofing the management of droughts, as well as the looming housing crisis specific to rural women. These two issues will be presented by addressing planning, relief and recovery, with additional focus on the part that rural women play.

Two presenters from NRWC will look at some key issues and offer measures that could improve gender responsiveness at a policy and local implementation level. The vulnerability of women will be examined, and solutions proposed that would assist in improving the physical and mental health of women, as well as their economic and housing circumstances. The affected are our women, the access to services is declining and the need to address the gendered impacts on women are numerous.

Anyone with an interest in drought preparedness, response and recovery or an interest in women’s health, housing and economic wellbeing will learn how a gendered approach can make a difference to individuals, families and rural and remote communities.