Jackie Kelly is the CEO of Moyne Health Services in Port Fairy. She has worked in rural health for several years and is passionate about making a difference in the health of rural populations. She is a member of a number of boards in the women’s health sector and supports prevention strategies across the South West. She lives on a small rural property next to the sea and looks after a variety of animals, including four donkeys. Jackie has a Masters in Nursing from the University of South Australia and her thesis included Prevention of Violence in Women’s and their Children and Men’s Behavioural Change Programs.
The South West of Victoria Hospital sector has a number of Regional and Rural Health Services which range in size and geographical spread.
Research tells us that one in three women are affected by domestic violence and this number rises in rural and remote Australia. The very nature of where we live in small communities raises the risk of domestic violence begin reported or of women seeking help.
With funding from the State Government to implement the SHRFV program the CEO’s of 11 Rural and Regional Hospitals in the South West came together and identified the Prevention of Domestic Violence as a shared priority across all the hospital’s. Moyne Health Services CEO is the lead for this initiative and although it is a Small Rural Health Service it has taken on this role with passion and become the driver for change across the sector.
As our work force across the 11 hospitals is over 90% female we identified that we needed to support and train our staff to firstly look after themselves and then develop the skills to look after their communities. By creating safe spaces, trained staff, support people and a knowledgeable and engaged Executive we have been able to help staff identify and seek support. Our policies now reflect domestic violence leave provisions , safe spaces for staff and flexible working conditions.
Staff have put up their hand to become Contact officers, trained DV specialist and support people for their peers. The Training involves asking the question of their consumers, identifying issues around Domestic Violence and having the knowledge of where to refer to if someone does disclose and need support. Staff are also able to contact Contact Officers from another hospital if they feel uncomfortable talking to someone they work with. This is a real issue particularity in Small Rural Health Services were everyone knows each other and privacy becomes an issue.
SHRFV initiative comes out of the findings of the Royal Commission into Domestic Violence. The inability of the Hospital sector to respond to women has been highlighted as a major Gap in services for Women across the Health Sector. The South West of Victoria has taken this issue seriously and has begun the journey of creating a safe space for women to disclose and be supported through our Hospital and Community Health Services.
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Dr Jenny Kelly is a registered nurse and midwife. In addition to her Bachelor of Nursing degree she has postgraduate qualifications and expertise in adult education (Graduate Diploma), women’s studies (Master of Arts), public health (MPH) and a PhD from Deakin University. Jenny has spent most of her professional life in northern Australia where she has worked as a remote area nurse, midwife and educator. Jenny holds an adjunct Senior Research Fellow appointment with James Cook University in Townsville where she remains an active researcher. Jenny was the initial CNC Project Officer for the state-wide Imminent Birth Education Program who developed the Imminent Birth Education Program.
Introduction: While the majority of births in Australia occur in hospitals with maternity services, it is inevitable that some women will present in established labour to health facilities without midwives or other appropriately qualified staff. These unexpected presentations pose challenges for the woman, her family and the health workforce. In 2016, 69 women gave birth in 32 Queensland Health facilities without maternity services; approximately 90% of these births occurred in rural and remote settings.
Methods: The development, implementation and evaluation of the Imminent Birth Education Program for non-midwives practising in rural and remote non-birthing facilities in Queensland employed a participatory action approach. A state-wide steering group was established and consulted on all stages of the project. The project consisted of three distinct phases:
- Development of an online, evidence based component of the education program.
- Pilot testing the online component and development and pilot testing of the face-to-face workshop and facilitator’s guide.
- Promotion, implementation, monitoring and evaluation of the Imminent Birth Education program throughout Queensland.
Results: The Imminent Birth Education Program for non-midwives practising in rural and remote non-birthing facilities in Queensland was developed, piloted and evaluated. The education package comprises an online component, 3.6-hour Imminent Birth workshop and a facilitator guide for a midwife to facilitate the course. By July 2018, 639 health professionals completed the online course, 54 health professionals were trained to facilitate the face-to-face workshop and 114 non-midwives completed an onsite workshop. The Imminent Birth Education Program was accessed by health professionals in all 16 Queensland Hospital and Health Services.
Conclusion: The education program resulted in improved knowledge of the non-midwifery workforce to assist and support women who present when birth is imminent. It has decreased levels of anxiety about providing clinical care to women who present at non-birthing facilities when birth is imminent and improved ability to provide women who present when birth is imminent with safe, evidence-based clinical care.
Elise (Lise) Kempler is a recent graduate from the University of Sydney and from the beginning of 2019 will be a Junior Medical Officer at Sydney’s Royal Prince Alfred Hospital. Lise spent her final year of medical school at the School of Rural Health in Dubbo, during which she developed a deeper understanding of what it means to be a clinician in the country. Having seen the inequalities in healthcare access that exist between city-based and rural-based Australians, she is passionate about doing her part to improve them. During her year in Dubbo, Lise also came to appreciate the need for culturally appropriate care for Aboriginal patients. Her presentation shares an example of how an approach to care can be modified to ensure cultural safety for patients who are the focus of a case report.
This paper describes the process of asking permission and gaining consent from two Aboriginal families to prepare a case report for submission to a medical journal. Obtaining consent varied from the usual process expected by the target journal.
Thalassaemia trait was recently identified in two young Aboriginal patients in a regional NSW hospital surprising some clinicians. Indeed, thalassaemia does occur in Aboriginal people and doctors should look for it when investigating mild anaemia. Thalassemia trait has been reported in Aboriginal people decades ago, yet it has been seemingly forgotten. This prompted us to consider writing a case report to propose that clinicians too readily narrow their differential diagnosis of anaemia to exclude thalassaemia.
On reading the recommended patient consent forms supplied by the journal, we considered how these might be perceived by the patient group of young Aboriginal people and their families. We were concerned that the language was formal and that this may result in alienation of the patient group. We realised that using the standard approach risked not getting permission and hence the opportunity to for us to advocate for better treatment of Aboriginal people with thalassaemia.
Informed by discussion with the NSW Aboriginal Health and Medical Research Council and using the journal-prescribed form as a template, we drafted a plain language version and included an information sheet. We then approached the Aboriginal Liaison Officers at the respective facilities, explained thalassemia and why we thought it was important to educate doctors to identify thalassemia in Aboriginal people better. The Aboriginal Liaison Officers voluntarily contacted the paediatric patients’ parents to explain what would be involved in a case report, its importance as well as how their consent was required to proceed. Both families agreed to have their contact details passed on to two members of the team who made phone or face-to-face contact (as preferred by the family) and again described what was involved and answered any questions before written consent was gained.
While time-consuming, this process yielded consent from both families and strengthened relationships and trust between health services and community members. We believe this justifies the variance from the usual approach.
To close the gap in health status experienced by Aboriginal compared to non-Aboriginal Australians, we need to question critically our clinical and administrative practices and change them to privilege a culturally-sensitive approach when possible.
Dr Jocelyn Kernot is a lecturer in the Occupational Therapy Program at the University of South Australia. Her research interests is in the promotion of physical and mental health and wellbeing for children and adults with a particular interest in rural health. Jocelyn's teaching involves coordinating and supervising Masters Entry Occupational Therapy Participatory Community Practice Projects. Jocelyn is keen to improve the mental wellbeing of men in rural areas and initiated two occupational therapy student project in Whyalla, South Australia, to explore the delivery of a mental wellbeing program through local football clubs.
Introduction/rationale: Suicide rates in rural Australia are 40 per cent higher than those of major cities with men being at greatest risk. A contributing factor is reduced access to appropriate mental health services, which is reflected in Medicare data. In 2013-2014 expenditure on mental health services in rural and remote areas was 17 per cent compared to 64 per cent in urban areas. Innovative primary health care approaches are required to address these issues.
Objectives: The objective of this paper is to describe two occupational therapy student led participatory community practice projects in Whyalla South Australia, exploring the delivery of a mental wellbeing program through local rural football clubs.
Approach: The projects were nine-weeks in duration with students working in partnership with South Whyalla Football Club and local community health and support services. The first project (2017), was a comprehensive needs analysis investigating the health issues experienced by men in the community and whether the delivery of a program through the football club would be acceptable and feasible. In 2018, the students worked in close collaboration with community services to plan two events. The first event was a family fun day held during one of the football games, where local services set up stalls to increase awareness of mental wellbeing supports. The second event was a social evening at the football club where two presenters discussed their lived experience with mental health issues.
Implications: As part of the project process students were asked to consider community driven sustainability strategies, with two projects planned for 2019: 1) a community wide project in partnership with a local Whyalla men’s mental health support group (INATT) who were key stakeholders in the 2018 project; 2) and a project working with another nearby rural football league (Port Lincoln) to develop and implement mental wellbeing strategies based on this communities unique needs.
Conclusion: The occupational therapy student led participatory community practice projects have demonstrated that local rural football clubs provide an important means of promoting men’s mental wellbeing, with communities expressing a desire to continue to build on the strategies implemented.
Professor Sue Kilpatrick is Professor of Education in the Faculty of Education, University of Tasmania, Australia. Until December 2015 she was Pro Vice-Chancellor (Students), University of Tasmania where her responsibilities included access and outreach programs, pathways to the University from schools and vocational education and training (VET), relationships with the VET sector, the Aboriginal support unit, Riawunna Centre, English Language Centre. She was formerly Pro Vice-Chancellor (Rural and Regional) at Deakin University, Australia, and Director of the University Department of Rural Health, Tasmania. Her previous positions at UTAS include seven years as Associate Director and Director of the Centre for Research and Learning in Regional Australia in the Faculty of Education. Sue holds a PhD in the Economics of Education and a Master of Economics in Labour Economics. She is a Graduate of the Australian Institute of Company Directors and Member of the Australian College of Education. Membership of community boards and committees in areas related to her research has complemented Sue's career, including school education, the early years, farmer education and training, economic development, rural health and community care. Sue is currently a Member of the Regional Development Australia (Tasmania) Committee.
This paper considers if, and how, social enterprises provide wellbeing for disadvantaged people in Australian regional towns.
Rural residents experience a range of place-based inequalities that are directly or indirectly related to health and wellbeing. There is less access to services, employment opportunities, educational experiences and social networks. Social enterprise, a model combining commercial orientation with social mission, is promoted as particularly appropriate for addressing place-based disadvantages. With the NDIS, social enterprises have become more prominent in providing work integration experiences alongside wellbeing-building activities. Social enterprises are depicted as affecting wellbeing, but there has been little analysis of how this occurs. Drawing from geography, health, community development and sociology, we provide findings from an ARC-funded Discovery project about how social enterprises realise wellbeing in Bendigo and Launceston.
We applied Fleuret & Atkinson’s ‘Spaces of Wellbeing Theory’, spatial data collection techniques and spatial analysis. We defined wellbeing as involving interconnected elements of: capability, social integration, ontological security and therapy. For four social enterprises, we conducted participant observation, walking interviews, face-to-face interviews and focus groups involving social enterprise employees, volunteers, staff and community informants. Data were entered into NVivo, themed, geo-coded and layered into a geographic information system. This provided rich data about wellbeing realisation in relation to places.
We found that realisation of capability, therapy, security and social integration varied in relation to the social enterprises’ mission, vision, practices and business sectors; and disadvantages experienced by employees. Here, we describe and show: the impacts on wellbeing of residents experiencing different types of disadvantage and how these came about; and how wellbeing experienced by employees related to the social enterprise’s engagement with regional communities.
We conclude that social enterprises are a valuable tool for wellbeing realisation for disadvantaged people in regional towns. They can mitigate for aspects that are relatively inaccessible in non-metropolitan places. They provide exposure to health-promoting experiences, including about healthy eating and self-care; support of mentors; education and experience-based learning that can lead to jobs or even establishing businesses; access to bridging networks that expose them to new people, places and knowledge; and considerable opportunities for social integration. Engaged social and civic town infrastructure enhance social enterprises’ ability to provide these. Regional towns and social enterprises do better when working together. From findings we suggest how social enterprises could boost rural wellbeing even further by undertaking activities pulled from ‘best practices’ observed across the social enterprises studied.
Erica Kneipp’s experience spans all levels of government, the private and not-for-profit health sectors in Australia and she is known for her passion for evidence based policy development and research praxis. She spent over a decade with the Western Australia Health Department establishing hospital casemix, purchaser- provider frameworks, first time public-private partnerships and managing health services in the Kimberley, remote north western Australia. She is known in Australia for her work on innovative renal dialysis service models and regional planning. From 2005 to 2009 she worked in the non-profit sector accelerating innovative aged care models and embedding new assistive technology in home care programs to support living boldly. During that time, Erica was also attached to the George Institute for Global Health leading collaborative researcher program and government policy agendas. Since joining Commonwealth Health in 2009, Erica has led a number of national portfolios spanning population health, hospital data and funding, primary care organisation transformations and reform and corporate services. She is currently responsible for the Office Health and Medical Research, which encompasses the $20 billion endowment Medical Research Future Fund (MRFF) and Biomedical Translation Fund, making Australia a preferred destination for clinical trials and delivering programs designed to translate and commercialise great Australian medical research. The MRFF is a new, additional and complementary fund that works alongside Australian’s premier research funding body, the National Health and Medical Research Council (NHMRC). The MRFF will effectively double Australia’s annual investment in health and medical research by the year 2021. Erica’s team supports the MRFF’s independent Australian Medical Advisory Board and is responsible for the recently announced $1.3 billion National Health and Medical Industry Growth Plan, inclusive of the $500 million 10 year Genomics Health Futures Mission funded under the MRFF.
Clinicians, researchers and community representatives are encouraged to attend this workshop and assist the Alliance to develop its rural research priorities and explore ways of ensuring effective translation of research outcomes from the MRFF have clear benefits for rural Australians.
The $20bn Medical Research Future Fund has been launched with $1.6bn expected to be spent in the first five years.
The program has some unique features that hold significant promise for transforming the health of rural and remote communities.
The key stated aim is through strategic investment to transform health and medical research and innovation to improve lives, build the economy and contribute to health system sustainability.
The underpinning principles are clearly geared to ensuring the fund is responsive to unmet health needs and promoting national focus and collaboration. Translation of the research for patient and community benefit is clearly a key requirement.
The opportunity exists to clarify the importance of effective engagement through MRFF and the research bodies to ensure the 7 million people living in rural Australia benefit.
In this process the role of the National Rural Health Alliance would seem pivotal.
The engagement needs to be able to:
- Provide a clear understanding of the major research questions and priorities for rural and remote communities. The Alliance is in a unique position to facilitate and describe these priorities to both the MRFF and participating Universities and Institutions.
- Articulate and potentially develop a pathway in both the design of the research and in the translation of the research into rural and remote health settings and practice.
- Ensure that all of the research undertaken through the MRFF includes a thread involving consideration of rural and remote health and communities.
The MRFF and the NRHA are already engaged through formal consultative processes and some part of these questions are already receiving a degree of attention.
Abraham Kuot is a Research Fellow at Flinders University Rural Health South Australia. He is a molecular biologist, geneticist and a public health researcher with 11 years of experience. He completed his PhD in Medical Research at the Department of Ophthalmology, Flinders University of South Australia in 2015. Currently, Kuot is the project manager for a national research study, funded by the Australian Department of Health and Ageing, called the ‘Harmony in the Bush: Co-design of a personalised model of care for dementia in rural residential aged care’. This study is undertaken to identify key drivers of personalised care intervention, and use co-design principles to implement and evaluate a personalised model of care, incorporating music, art and movement interventions for residents with dementia in five rural aged care homes in South Australia and Far North Queensland. Kuot’s research interests include healthy ageing and innovative care models for dementia in long-term residential aged care facilities, health services delivery, population health, and rural medical education.
Dementia is a major cause of overall disease burden for Australians aged over 65 years, and has no cure. In long-term aged care facilities, many residents with neurocognitive disorders experience behavioural and psychological symptoms of dementia (BPSD) such as agitation. BSPD are complex, stressful, costly aspects of care, and associated with diminished quality of life, and a high workload for care staff. Non-pharmacological interventions attract growing attention in caring for people with dementia, due to limited efficacy of the use of antipsychotic medications. However, these interventions are not widely implemented in Australian residential facilities, and have limited evidence suggesting their benefits. Progressively Lowered Stress Threshold model incorporating music interventions have not been previously tested in managing individual BPSD outcomes. Harmony in the Bush is an innovative project that aims to co-design and implement evidence based behavioural interventions with music in managing individual residents’ BPSD in five Australian rural aged care facilities. The project incorporates a longitudinal quasi-experimental design including behaviour measurements, interviews, and focus groups in the five facilities to evaluate the model’s effectiveness in different kinds of health services; small, large, public and private. This presentation aims to showcase the study design, ethically approved protocol and preliminary findings of this large multi-site study. The findings aim to result in long-term positive outcomes for people living with dementia, aged care staff and their workplaces, and dementia care in aged care facilities.