Concurrent Speakers

In common with rural communities throughout Australia, those in western Victoria are characterised by an ageing population with concomitant issues such as cognitive decline. Up to 40% of patients aged over 65 in hospital have some form of memory or thinking difficulties which may be exacerbated by hospitalisation and surgery.

Organisations will be assessed against the new National Safety and Quality Health Service (NSQHS) Standards from January 2019. Compliance with the Comprehensive Care Standard will require cognitive screening of at-risk populations. This paper investigates the consistency and efficacy of cognitive decline testing in a rural Victorian hospital with an ageing surgical cohort.

To more fully understand the extent and impact of cognitive decline and hospitalisation in a rural community, investigators at the Western District Health Service (WDHS) undertook an initial retrospective data collection focussing on surgical admissions for patients aged 65 and over (ATSI > 45), undergoing a general anaesthetic with at least a 48hr admission.  According to WDHS policy, every person meeting these criteria should have been screening using the AMT 10 tool.

Initial findings demonstrated that compliance with the existing policy was low and that less than 65% of patients in this at-risk group had received a cognitive screen.  An informal qualitative and human factors approach indicated a lack of faith in the efficacy of the test amongst staff. Results from a voluntary survey supported the contention that staff perceived the AMT 10 as ineffective. Results also indicated a lack of understanding of the implications of cognitive decline for patient recovery and on-going quality of life in this surgical cohort.

In response it was decided to replace the AMT 10 with a combination of the AMT4 and the Clock Drawing Test and to provide additional staff training around screening using these tools. An evaluation of this intervention will be completed in late 2018/early 2019. Quantitative data collection will focus on screening rates while qualitative data collection will investigate any concomitant attitudinal shifts or other factors that may be affecting usage of the screening tools.

It is clear that we can do better in screening for cognitive decline in rural hospital patients. The new NQSHC Comprehensive Care Standard will highlight the need for better screening and more responsive systematised responses to cognitive decline and delirium in health services. This project identifies both blockers and enablers for systems improvements in cognitive screening.

Songwriting is a creative process that has several social and health benefits, including enhanced mental wellbeing and social connectedness (Baker, Jeanneret & Watt 2017). However, the creative process can also be fraught with tensions and difficulties. This paper outlines a songwriting workshop undertaken early in 2018 in a small rural town. While the women who participated experienced many of the benefits suggested in the literature, this paper will instead focus on some of the challenges associated with implementing, managing and evaluating a songwriting workshop in a rural context. We focus our argument on ‘ins and outs’ to highlight the behind-the-scenes workings of such a workshop, but also to highlight the inclusiveness/exclusiveness realities of small communities and how these can play out through the creative process. Specifically, this paper will explore three logistical and ethical issues: 1) getting buy-in from the media and community; 2) managing personalities within small towns (who is in and who is out); and 3) the expectations around an external facilitator when an internal champion is needed for sustainability.

The paper draws on qualitative evaluation data collected by the presenting author. In particular, interviews with the workshop facilitator and project manager provide the primary data source. However, interviews and journal entries from some of the women who participated are also used to more fully understand the issues and circumstances from a variety of perspectives. The evaluation was framed within narrative inquiry that privileges the stories of the women involved, both those who ran the workshop as well as those who participated. To protect the identities of those involved, the names of the women and the place names have been changed.

By examining the logistic and ethical issues associated with this workshop, we contribute to better understanding how creative and arts-based workshops can optimise the health and wellbeing outcomes for rural people who attend while minimising some of the potential risks.

This paper presents the results of an evaluation of a regional Queensland community-based Indigenous health and wellbeing program that works with families in a holistic way, including helping them reconnect with their cultural and spiritual wellbeing, their housing environments, their kinship groups, as well as their emotional and physical bodies. Many of the families the program works with have experienced significant cultural disruption and dislocation. The program is founded in a model of health that emphasises cultural and spiritual reconnection. From this base, families are encouraged to make changes to their lifestyle behaviours including transforming their houses into homes that support healthier practices such as vegetable gardening and home-made meals.

A participatory mixed methods approach was used for the evaluation, including statistical analysis of changes in lifestyle behaviours and emotional measures over time, photovoice-inspired journals, and interviews. This paper focuses on the qualitative aspects of the evaluation. The decision-making regarding the evaluation data collection, analysis and interpretation was undertaken in partnership with the program team, funding body and academic researchers. The stories that emerge through the photovoice journals and interviews provide evidence of transformed lives: culturally, emotionally as well as physically. While this is an ongoing process, the photographs of the changes made to family homes provide clear indications of deeper personal changes that support health and wellbeing for parents, children and the broader kinship group. The testimonies of those who have completed the program verify the photographic evidence.

The model underpinning this program places culture at the centre of all its work in order to help heal some of the deep intergenerational wounds carried by many Australian Indigenous people that contribute to them not seeking out healthcare services. By looking beyond their lifestyles to the cause of their disconnect, this program is contributing to a more resilient Indigenous community through developing more sustainable health practices.

The premise

1. People with a range of mental conditions are often isolated by the inability to communicate socially or formally. 
2. Health professionals without experience in rural communities may need to develop their communication skills to suit these varied conditions.

The structured and supportive process of a Toastmasters meeting provides an effective process to build these skills.

The evidence: Over the past three years, the SunUp Speakers Club in Tamworth has worked with a small number of people, including candidates for the Country Music Queen competition, to improve their communication skills.

Example N1: Female high school certificate graduate within ‘the spectrum’. Highly intelligent, extremely well read and well supported within family.  Unable to find employment due to lack of social communication skills. Within twelve months has gained the personal confidence to travel and socialise beyond the family structure.

Example N2: Health professional with English as second language had difficulty communicating with concepts and phrases consistent with local population. This process limited professional registration, job and career options. Within six months had developed the new and appropriate skills.

The goals

1. To identify people in the community whom have withdrawn from society due to communication skills and to provide non-discriminatory training options and support.
2. Utilise the formal “Pathway” accreditation model to provide individuals with recognised certificates of achievement.

The pitch

• To establish a trial in Tamworth to develop a selection metric for health professionals which will identify candidates who could benefit with enhanced social communicating skills.

and

• To fund a project which would enable access for these candidates.  To provide the trainers and observers to monitor and measure the benefits of this training.

When patients receive a change in medication, or a new medication, it is vital that education is provided to the patient by the pharmacist responsible for the dispensing. Apart from in remote Australia, patients access this service via their community pharmacist. It is an expected and valued service to patients to ensure successful health outcomes are achieved from the medications prescribed.

Due to the remote location of patients in the Kimberley, this medication education is provided primarily by GPs at the time of the medication change. Often thought, this new medication is not commenced for some weeks and by then, patients may be unsure of why the medicine was changed. Nursing staff and Aboriginal Health Workers are then required to explain the medications to the patient. This process can reduce the patients trust that the medications they are being given are what the GP prescribed.

Information, and the opportunity to ask questions of the pharmacist dispensing the medication, has not been possible in the standard manner most Australians are accustomed to. Pharmacist visits to remote clinics are limited therefore restricting the opportunity for direct pharmacist patient consultation.

This tele-pharmacy service aims to bridge this gap to ensure that all patients receiving a new medication, or a medication change, have access to medication and health education by the pharmacist who has supplied their medications.

This remote consultation builds on existing ehealth infrastructure, utilising existing systems and software, and provides support to patients and clinicians in remote areas.

Service goals

• Improving patient’s knowledge of medications through direct pharmacist patient consultation. This discussion is to include all medications, not just new and changed ones to improve overall medication knowledge.
• Improving patient compliance with prescribed therapy
• Improving patients understanding of chronic disease
• Assisting clinic staff in improving knowledge around medications for Aboriginal Medication Assistants and Aboriginal Health Workers
• Builds trust for patients that any change in their medications will be explained and they will have the opportunity to ask questions
• Improve adherence though knowledge-based empowerment
• Improve health outcomes as medications are taken as prescribed

Rationale: Cervical cancer is largely preventable, if women regularly participate in screening programs. The renewed National Cervical Screening Program, incorporating clinician-led HPV testing with HPV self-sampling for under-screened women, has potential to improve screening rates. It is unknown, however, how to effectively access women that do not routinely engage in existing health services.

Aim: This study assessed the effectiveness of a community-based HPV self-sampling program for Aboriginal women in rural and remote NSW; developed a best-practice service model; and provided recommendations on how to best access this under-screened and hard-to-reach population to increase cervical screening rates.

Methods: Marathon Health (a regional Primary Health Care Organisation) implemented the Pilot Program, working with numerous stakeholders to ensure those ‘best-placed’ to provide clinical advice and deliver components of the Program were involved. The Pilot Program was trialled in eight communities in Western NSW.

With the assistance of an Aboriginal Community Engagement Worker (CEW), women completed an eligibility survey, the self-sample kit (pathology by the Victorian Cytology Service) and a follow-up evaluation survey. Primary Health Care Nurses engaged with women around their results and appropriate follow-up care. A focus group with Marathon Health staff explored the key components of a best-practice service model. Focus groups with CEWs are currently underway.

Results/Discussion: The Program effectively recruited 215 women (81% of target 266 sample size), of which 53%-79% had not been screened in the previous 4 years (or were never-screened). HPV positive rates were 4% (9) for HPV 16/18 and 14% (30) for HPV other; 56% of women attended their follow-up appointment and a further 18% had booked appointments by July 2018.

The Pilot Program was highly feasible and showed a high level of acceptability amongst Aboriginal women. Key elements to the success include: clarity of roles and responsibilities of individuals/organisations involved, flexibility within the service model to be responsive to community need; community support, endorsed by the Local Lands Council; professional, personalised care by the Primary Health Care Nurses and Community Engagement Workers, and the consistency they provided from kit distribution to supporting pathways of care. Future research and evaluation is needed to explore translation of the best practice service model developed in this study into other regional locations.

This pilot provided an opportunity to work ‘Better together’, to walk on Aboriginal land, alongside Aboriginal women, achieve research ‘with them’ rather than ‘on them’, while supporting empowerment and women-centred decision making in Aboriginal ‘women’s business’.

This paper presents findings from recent participatory, qualitative research which illuminates a rural context for Health Promoting Palliative Care from the perspectives of bereaved carers from a small community in rural Australia. Eligible participants had cared for someone until their death within a three-year period prior. Results indicate that rural residents face particular challenges at the end of life, but also have positive experiences which include expert and flexible formal and informal palliative care, and the space for personalised expressions of compassion, bereavement and grief. This research adds new insights to understandings of rural compassion as a complex intersection of supererogation, innovation and place-based care.

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

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

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

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

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

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

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

The Nayri Niara Centre is a sanctuary for people to experience transformational activities aligned with Indigenous traditions of healing. Nayri Niara encourages people to explore a more harmonious relationship with ourselves, our family, communities and the earth which sustains us.

Background: Whilst the value of rural clinical exposure in attracting health students to long term rural locations is now proven, a key element which needs to be explored are the economic benefits of health education training in rural communities.

In a discrete geographic area in remote Canada the economic value of health education training was explored and found that there was significant direct and indirect multiplier effects of funding within small northern communities (1).Prior looked at remote communities in Australia and Canada and identified institutional and individual gains using economic, social and human dimensions(2).This paper reviews two Australian rural sites and considers the direct and indirect financial impacts of the Rural Health Multidisciplinary Training program (RHMT) being delivered in these sites.

Objectives: This is the first Australian exploration of the financial benefits to be gained from health professional student training and potentially raises the question of other measurable benefits that programmes of training may bring.

The building of social capital within communities, the contribution to community ‘life’ and the establishment of critical mass of health workforce should all be measurable outputs from such an exploration.

Results: The direct financial multiplier effect was calculated on the goods and services directly purchased though the grant in the postcode area of the training sites. Using the REMPLAN Economic Access program and publicly available council data, an estimation was made of the indirect multiplier effect that this would then have on employment and local business. Sector agreed benchmarks were used to calculate the multiplier effect of student spending.

Discussion: Consistent with overseas experience the economic impacts of salaries and purchase of goods and services had major direct and indirect employment and economic benefits for the two Modified Monash (MM3) locations studied. Student spending also provided a major economic stimulus.

The impact of an increasing critical mass of health clinicians and expansions in health services were also noted as major attractants for new residents to both locations. Measuring the financial impact of these indirect benefits was recognised as challenging and will be included in the next phase of this study.

Conclusion: Rural communities require ongoing economic stimulus and turnover in order to prosper. The contribution of health training and health services to economic wellbeing cannot be underestimated. Benchmarking this value is proving useful in engaging the community with health training and supporting genuine reciprocity and the welcoming of health students.

The Government is committed to ensuring Australia has a world class health system, supported by a highly trained and well distributed workforce. To support this the Stronger Rural Health Strategy was announced as part of the 2018-19 Budget and includes a comprehensive package of initiatives that aims to build a sustainable, high quality health workforce that is distributed across the country according to community need.

Through a range of mechanisms—including rurally based medical training, Australia’s skilled migration program, Medicare, streamlined GP qualification arrangements, and expanded incentives for health professionals to work outside the major cities—the Strategy will improve the capacity, quality, distribution and mix of our primary care workforce particularly in rural and remote communities, and other areas that have difficulty attracting doctors.

It will also enable a stronger role for nurses and allied health professionals in the delivery of more multidisciplinary, team based models of primary health care and will provide opportunities for Australian trained doctors, and overseas trained doctors entering Australia to be directed to work in areas where they are most needed.

There will be extra dental, mental health and aeromedical services delivered by the Royal Flying Doctor Service in remote areas, as well as targeted support for the Aboriginal and Torres Strait Islander health workforce.

Underpinning the Strategy, a new planning Tool will provide a single, integrated quality source of health workforce and services data to inform future workforce distribution planning and analysis for government and health workforce planners.

These initiatives will strengthen the health workforce and ensure that all Australians across the country can access the right mix of qualified health professionals and services.

Although Australia has plenty of doctors, they are not well distributed according to local need. There is currently limited ability to measure and analyse the health service needs of a community, and apply the right resources to improve workforce distribution.

Under the Australian Government’s Stronger Rural Health Strategy, the new Health Demand and Supply Utilisation Patterns Planning (HeaDS UPP) Tool will, for the first time, bring together data on how the community uses health services and the health workforce.

The HeaDS UPP Tool will provide a single, integrated quality source of health workforce and services data to inform workforce planning and analysis for government and key health workforce planning stakeholders.

The Tool will map health workforce and services data according to 829 newly created General Practice (GP) Catchment areas based on factors such as patient flows, health workforce, rurality, topography, and accessibility.

It will reflect where people live, where they access health services, and where health practitioners are providing those services. This will make it easier to measure and analyse the health services needs of a community, the workforce required to meet that need, and identify the gaps in the current health workforce.

The tool will initially map the primary care workforce, with a specific focus on the GP workforce. Information on nurses and allied health in primary care settings will be included in early versions of the tool, with more detailed information added as the tool expands to become a whole of health workforce planning tool.

The Tool will be available for use by approved local, regional, state, territory, and national workforce planners to inform policy development and program decisions around where workforce and services are needed.

Health workforce planners will be consulted during the development of the Tool to ensure it is relevant to their requirements.

Once launched the Tool will encourage collaboration across parts of the health system. Health workforce planners, once approved to use the Tool, will be able to focus visually on a mapped geographical region to view health workforce and service usage information about that area.

This will result in an increased capability to measure and analyse the health service needs of a community to develop evidence based health workforce planning policies and programs.

Improving the equitable distribution of doctors, nurses and allied health professionals will result in improved access to services for patients, especially in areas of need, such as rural and regional locations.

A beta version of the tool is currently being made available to a targeted internal and external audience (Rural Workforce Agencies), with the ‘Live’ version expected to be released in later in the year.

A child’s future is decided in its first 1000 days of existence—from the mother’s pregnancy to the child’s second birthday. During this time appropriate nutrition is pivotal, with international research finding children with a healthy diet are up to ten times more likely to overcome life-threatening childhood diseases, go on to earn 21% more in wages (Hoddinott et al 2013), complete 4.6 more grades of school and are more likely as adults to have healthier families (Save the Children 2012).

It is undeniable that malnutrition stunts a nation’s economic growth, due to higher healthcare costs, earlier mortality and a lack of concentration - therefore advancement - at school. This is occurring in Australia, most evidently in remote Indigenous communities, where 30.8% of Aboriginal and Torres Strait Islander people are unable to buy food due to lack of funds and produce availability (Aboriginal and Torres Strait Islander Health Survey 2015).

Radical change is required across the entire food supply chain; to shift communities away from freighted, expensive and at times rotten produce, to locally grown, affordable and fresh alternatives. However, due to the remote, arid landscape of rural Australia, many communities cannot rely on agriculture as a primary industry. In answer to this, Australian not-for-profit organisation Food Ladder has pioneered a cutting edge, hydroponic food growing system, which is five times more productive than traditional farming methods.

Implemented in the Northern Territory towns of Katherine and Ramingining, each Food Ladder system is governed and run by the community, creating a locally-owned, viable social enterprise. In Ramingining, nutritionists recorded a 5% increase in the sale and consumption of fruit and vegetables in the first six months of the Food Ladder system being in operation, an increase never before seen in the community.

Food Ladder systems not only provide food, but create employment and education opportunities; engage individuals in the growing of produce; increase community pride; and teach children about nutrition through a STEM-aligned curriculum. Since its inception, Food Ladder has employed over 600 disadvantaged people, as well as provided meaningful work for Community Development Program participants.

By implementing a Food Ladder system communities can restructure their food supply chain, shifting from towns that are geographically vulnerable and food insecure, to self-sufficient neighbourhoods with food sovereignty; a process which can be replicated all across rural Australia.

Aims: This project engaged ‘at risk’ client groups taking a 6-month course of tuberculosis (TB) treatment via DOTS. Triggers included psycho-social impacts of treatment on individuals and their families. Overcoming treatment non-compliance and medication side effects underpins improved health outcomes. We proposed to achieve this by building trust, facilitating access, and creating innovative service delivery options to better connect with our indigenous, refugee and migrant communities, a cohort familiar and competent at using internet-based video call services due to rurality and isolation.

Methods: We investigated accessible, low cost, and user-friendly video call facilities, selecting a secure web-based real-time video conferencing solution. Staff were trained to use the technology and manage equipment set-up, Google Chrome™ installation and video call activation. Staff were provided access to the secure Telehealth platform. DOTS clients across two NSW local health districts were offered the video conferencing solution.

Relevance: TB treatment supervision (i.e. DOTS) is expensive for clients and providers. Staff may view it as non-productive time as the impacts of non-compliance and treatment side effects aren’t immediately apparent. DOTS clients fear adverse consequences if absent from work or domestic responsibilities. VDOTS reduces anxiety and frees up time for clients. Service providers no longer have to make home visits for clients unable to travel to services.

Results: Over a period of 12 months, 9 of 13 clients participated in the VDOTS trial. Four of 13 self-excluded citing inadequate equipment, poor IT literacy or personal preference.

Surveys indicated high levels of satisfaction with this patient-centred care model. All clients either 'agreed' or 'strongly agreed' VDOTS was convenient, reduced travel costs, and staff were supportive. Clients reported significant saving of personal and travel time (mean 73 min x 182 days, range 30–210 min/day) and cost for fuel or public transport.

Savings to providers are demonstrated in reduced length of service encounter, the mean duration of calls was 6 min 49 sec (range 28 sec-31min, 23 sec).

All (n=10) VDOTS clients ‘strongly agreed’ or ‘agreed’ they’d use this modality again. This model of care is available to clients anywhere in the world with internet access.

Conclusions: Use of this technology benefits clients choosing when and where treatment occurs whilst maintaining privacy and work-life balance. Service providers benefit from reduced service costs, increased productivity, reduced travel-associated risk, and increased staff satisfaction. This modality works anywhere, most of the time, and is transferable across health services.

Aboriginal Australians view life and death differently than non-Aboriginal Australians. Observations by the DON/Facility Manager at the Goondiwindi emergency department foyer showed young and older Indigenous people interacting with technology. There was no easy to understand, ‘culturally specific’ End of Life (EOL) care resources for the Indigenous population.

The APP aims to provide a culturally sensitive way to engage with Aboriginal people to gather their information about family, health care wishes. Yarning with the Indigenous reference group assisted with the APP illustrative framework of fishing by the river in their bush setting.

This APP will be trialed with the Indigenous community in Goondiwindi Hospital.

This project was a need and fits within the Minister for Health endorsed Queensland Health’s first Statewide strategy for end-of-life care 2015 and the Department of Health endorsed associated Care at the End of Life Implementation Plan 2015-2025.

The first years of life are vital to the positive trajectory of the life course and health outcomes of individuals, their families and communities. However, families in rural and regional New South Wales face challenges to accessing support during those crucial early years. The NSW Rural Health Plan (2014) emphasises the need for service development in rural and regional areas in light of poor health outcomes for families in Rural NSW impacted by geographic isolation, socio-economic disadvantage and drought/climate change.

Tresillian is Australia’s largest specialist child and family health organisation, providing support to families experiencing difficulties in the early parenting period in NSW since 1918. The organisation has evolved as it has responded to current community needs, while maintaining a focus on child wellbeing and building resilient families and communities. This has been achieved through a service model which addresses the social determinants of health, engaging with families in the critical early years and working collaboratively with parents to build confident, resilient families and communities.

The Tresillian Family Care Centres model provides a base from which a range of services are provided including comprehensive assessment and consultation for the management of a range of early parenting challenges, home-based services, evidence-based group programs, perinatal mental health services and an early intervention home visiting program for families experiencing complex vulnerabilities impacting on parenting capacity. Telehealth consultation services and satellite services to surrounding communities further extend the reach to geographically isolated communities.

Core to the service model is the provision of professional development and clinical support to enhance the capacity of primary-level clinicians working with families in the local area. The foundation of the model are the partnerships with the Local Health Districts, enabling the effective delivery of integrated care for families.

This presentation will describe Tresillian’s journey and learnings from the commissioning of two pilot rural services in Northern and Southern NSW to the scale-up of Level 2 specialist services across 8 locations with broad reach throughout rural and regional NSW in partnership with Local Health Districts from the coast to the far west of the state. Partnerships and integration into local service system networks has been integral to the model achieving a seamless service response for families in the early parenting period, appropriate to the level of need and complexity.

A very remote Hospital Pharmacy Department undertook a six month trial of an additional full time clinical pharmacist. The Pharmacy Department, historically staffed by a sole pharmacist and pharmacy technician, provides clinical pharmacy, stock distribution, and medication management services to a 32 bed hospital and 23 community health care providers. This trial aimed to demonstrate improvements aligned with the strategic and business priorities of the health service, and National Safety and Quality Health Service Standards.

Clinical pharmacy interventions were recorded for a 4 week period and graded using a national risk classification tool. Antimicrobial Stewardship (AMS) interventions were recorded for 3 months and assessed against National Guidelines. The percentage of patients for whom a pharmacist generated a discharge medication information summary was recorded over a 4 week period, and retrospectively calculated for the same 4 week period in the previous year for comparison.

The expanded Pharmacy team contributed to safety and quality initiatives including: providing education for medical and nursing staff, reviewing all reported medication incidents, participating in an organisation wide review of adverse drug reaction and allergy recording, redesigning freight arrangements, and driving a comprehensive review of medications on Emergency Response trolleys.

A total of 83 clinical pharmacy interventions were recorded, including 9 rated as extreme. There were 93 recorded AMS interventions and antibiotic usage in the hospital was decreased.

Communication at transitions of care improved, with 52% of discharged patients having a pharmacist-generated discharge medication information summary sent to their community health care provider during the trial compared to 13% in the sole pharmacist period.

Financial sustainability was demonstrated by decreased freight costs, improved stock management, and decreased reliance on locums for leave cover and associated costs.

Feedback from staff and management about the increase in Pharmacy services across the hospital and region was positive.

The clinical pharmacist quickly became an integral part of the very remote hospital multidisciplinary team. Increased contributions by the expanded Pharmacy team were noticed across the health service, in areas including inpatient clinical care, governance, quality improvement, AMS, medication safety, and collaboration with community health care providers.

The results of the trial were presented to senior management and the position has been made permanent. The isolation of the sole hospital pharmacist in this very remote part of Australia has ended, and the possibilities for collaborative health care have grown.

Since the Closing the Health Gap initiative began in 2008, the health and wellbeing of Aboriginal Victorians has not significantly improved. This has been associated with a lack of access to culturally appropriate health and community care for Aboriginal people. Unless mainstream rural health services become culturally competent, access to culturally appropriate care will remain difficult. The Aboriginal Health Cultural Competency Audit Project was implemented in 2017 to assist mainstream health and community service organisations in the Goulburn and Ovens Murray Areas of Victoria to improve their cultural competency and therefore improve the access to these services for Aboriginal and Torres Strait Islander people.

The present review investigated, from an organisational perspective, what the experience of undertaking the project was like; what was useful from the implementation of the audit process, and what changes had been made as a result of implementing the AHCC Action plan and framework. The research was undertaken in three Phases: Phase 1 consisted of 20 semi-structured interviews with key individuals across 20 organisations in the region. Phase 2 investigated six case study organisations involving a review of over 50 documents and an additional ten interviews across the six sites. Phase 3 presented a draft reports of the findings to a reference group of experts in the area of cultural competency in rural health services.  Input from the group assisted with interpretation of the findings.  The analysis identified that institutional racism persists in mainstream health and community services across the region, manifested as ‘difficulty’ in prioritising cultural inclusion within their organisations and a demonstrated lack of relationships with local Aboriginal communities. As a result, there remains a persistent ‘invisibility’ of Aboriginal populations in mainstream organisations. The current lack of accountability was identified as further de-valuing cultural competency by allowing services to not fully invest in the KBCC Audit project’s aims.

In order to effectively overcome these barriers, cultural competency needs to be resourced appropriately and for the long term. It requires identified Aboriginal project worker positions to be recruited from within the local communities in which the health and community services operate. Cultural awareness training needs to become a mandatory requirement of non-Aboriginal staff development and all health and community services must be held accountable for the implementation of cultural competency across their organisation regardless of size or funding stream.

tagari lia Child and Family Centre is an early years community hub for expectant parents, children from birth to five years, their families and carers. Situated in southern lutruwita/Tasmania and operating for six years within The Tasmanian Department of Education, tagari lia is adjacent to five local primary schools with the highest percentage of children in lutruwita/Tasmania who identify with an Aboriginal background. Other family dyads who access the centre include children within the child safety system; children of CALD parent backgrounds, including new arrivals, refugees and migrants; and children with profound and multiple disabilities. Many of the children are amongst the most vulnerable children in lutruwita/Tasmania.

tagari lia staff work collaboratively with families alongside health professionals and service providers to support relationship building between the children and their parents, families, carers and others in the communities who support them. We address many social determinants of health: poverty, literacy, teen pregnancy, intergenerational trauma, relationships, attachment, grief, loss and bereavement, family violence, substance abuse, mental health and wellbeing. We use innovative and creative approaches to engage children and draw out their creativity and big ideas. We learn from our Aboriginal communities and maintain country, culture and mindfulness at the heart of our work. In trowunna giblee, our lutruwita/Tasmanian Bush Food to Plate project, we are developing deeper understandings around non-linear learning, country and culture links to inform western pedagogy, yunkaporta.

In 2018, tagari lia Child and Family Centre, secured three-year funding from the Australian Department of Education and Training to be the Backbone agency and employ additional staff to establish Connected Beginnings: a collective impact framework in lutruwita/Tasmania. Connected Beginnings supports the integration of early childhood, maternal, child health and family support services to work together and better prepare Aboriginal and Torres Strait Islander children for school transition. The Australian Government Health Department joined the collaboration and funded the katalayna Tasmanian Aboriginal Centre as an equal partner, enabling TAC staff to co-locate at tagari lia and provide health services.

This presentation shares our tagari lia stories. Hear the voices of the children and their families, collected through musicking, storytelling, movement, improvising, songwriting, art and trowunna giblee.

Please join us to hear how we identified challenges, listened deeply, and worked better together across silos of health, arts, education and justice to make change happen.

Elder abuse is a silent yet pervasive tragedy occurring daily within our communities, a grim topic enmeshed in a rich context of culture, family and financial familial law. Elder abuse has a prominence within our communities with 5-10% of older Australians (180,000- 360,000) experiencing abuse, often at the hand of a person they trust. 28% of those reporting abuse live with their adult child. An imbalance of power and infringement of the basic human rights, elder abuse involves neglect, violation and deprivation.

The national agenda for elder abuse has recently quickened its much needed pace in order to; create a definitive definition of elder abuse, the formation of a new national body, Elder Abuse Action Australia EAAA and governmental funding for the National Research Project. This project will provide rigorous research data on the approaches and rights frameworks for elder abuse and to improve awareness, support and the understanding of issues that affect our older Australians.

An essential component of understanding, planning, defining and generating rights frameworks and law reforms for elder abuse is to inaugurate the crucial work of undertaking the complex conversations with all Australians concerning elder abuse, providing the platform and opportunity to bring the issue out of the shadows.

It is in telling these stories that will allow our communities to understand and address the issues that face older Australians. Under pinning a sociocultural change in that Better Together will provide awareness, support and prevention of elder abuse in all of our communities.

The community empowerment by Innovation project is specifically aimed at generating discussions on elder abuse in our communities and is a direct action outcome of the Elder Abuse Action Australia agenda July 2018. The project aims to provide via the utilsation of interviews with key peak bodies and stakeholders and relevant resource papers on elder abuse a platform for discussion and dissemination of ideas with community leaders such as and not limited to, Probus, Rotary and Lion’s groups, Men’s Shed, Country Women’s Association, local councils, LBGTI, Indigenous and Diverse Communities across regional and remote New South Wales.

The project and resources are designed to bring the conversation of a unique perspective of elder abuse to the floor, allowing the topic and insight of the interviewer initiate the intended ‘spotlight’ on acknowledging understanding, and stopping the mistreatment of older people now, together within a rural and remote community.

The hope is together we empower communities to have their own conversations about the abuse of our older people, and to share skills among community members to lead and facilitate community discussions and ensure referral pathways to existing services are understood, that communities share a strong voice and demonstrate the way forward into the prevention of elder abuse.

Through the early identification of autism spectrum disorder (ASD), access to early intervention services is possible and better outcomes achieved. This study investigated the implementation of the Social Attention and Communication Surveillance-Revised (SACS-R) by the Child Health and Parenting Service (CHaPS) nurses to identify children at ‘high likelihood’ for ASD. The SACS-R is a developmental surveillance tool that has been used by the CHaPS in rural and urban areas of Tasmania since 2016 as part of children’s routine health checks. Over 100 nurses were trained and undertook surveillance with ~6000 children, aged 12-24 months.

This practice change was evaluated with the parent and their child at the centre of the process through the use of an innovative methodology, design thinking (DT). DT utilises a collaborative approach to aid understanding, development and evaluation of the needs of the stakeholders and their responses regarding the implementation of the SACS-R project. Parents, nurses, service managers, assessment teams, support agencies, allied health professionals and representatives from health and educational associations were recruited to participate in this research. A mixed-method approach was selected to investigate these key stakeholders’ experiences of the implementation of the SACS-R, including questionnaires administered through surveys and follow up in-depth interviews. This paper reports on the research methodology and procedures. It was anticipated that DT would enable greater understanding of the implementation of the SACS-R. I conclude that DT is a robust and effective approach that supports the investigation of unique perspectives. A DT framework captured stakeholder experiences of the implementation process of the SACS-R and therefore can inform the roll out across other Australian jurisdictions and health service settings.

In March/April 2017, Severe Tropical Cyclone Debbie, a category 4 system, wreaked havoc across regional and rural Queensland. There was more than $1 billion of damage with 36 communities activated for Natural Disaster Relief and Recovery Arrangements and 118,000 people provided with assistance through the Personal Hardship Assistance Scheme. The agricultural industry was severely affected at an estimated $1 billion loss to crops. Coal exports and the tourism industry in the regional and rural areas were also heavily impacted and sustained severe losses. Queensland Health managed the response phase well in the areas of medical services, mental health and public health.

To assist communities in the transition to recovery and a new normal, Queensland Health in collaboration with the Department of Communities and the Queensland Reconstruction Authority developed a mental health recovery program. 50:50 funding from State and Federal governments was provided to employ approximately 23 mental health clinicians in Queensland. Clinical mental health services are currently being provided in the RA 2-3 areas of the Mackay, Central Queensland and Metro South Hospital Health Services (HHSs) till June 2019.

This presentation will focus on the regional and rural mental health recovery program, which includes clinical mental health service provision, community engagement and resilience building, and also the lessons learnt over the last 15 months.

A key feature of the mental health recovery program is effective, appropriate and safe delivery of services within an ever-changing disaster context. The complexities of a disaster and the differences in each community means the program relies on models of care, program infrastructure and service delivery which is:

• flexible and agile during the response phase
• evolves in structure through the phases of response/recovery, and
• adapts to the needs and wants of community members, culture and geography.

Recovery programs need to be directed by the community and incorporate their self-identified needs.

Overall operational lessons learnt from the STC Debbie response/recovery program have already led to the development of the following:

• a data collection platform for clinicians during the response phase,
• a state-wide training framework,
• the implementation of state-wide Mental Health Disaster Coordinators,
• a state-wide register of ready to be deployed trained clinicians.

The current recovery phase of STC Debbie in Central and North Queensland provides a dynamic example of how policy, evidence based clinical practice and characteristics of the impacted communities are creating innovative and responsive additions to practice frameworks.

Objectives: To evaluate three examples of Aboriginal, community-based drug and alcohol programs to better understand the mechanisms of partnerships between academics and Aboriginal communities. Study 1 examined the impact of a drug and alcohol radio advertising campaign in a remote setting. Study 2 evaluated community-led programs implemented across four rural Aboriginal communities from 2012-2015. Study 3 was a three-year community-based participatory research (CBPR) project with a remote Aboriginal drug and alcohol residential rehabilitation service.

Methods: Study 1 used survey design; Study 2 adopted a multiple baseline design (MBD) analysis of routinely-collected crime data; Study 3 triangulated 5 years of service data and staff and clients interviews to develop a Healing Model of Care.

Results: Study 1: The radio advertising campaign increased community awareness but had a limited impact on formal help-seeking. Study 2: The trends indicated that the programs did not consistently reduce alcohol-related crimes; however, the MBD methodology was identified to be a rigorous approach for future Aboriginal community research. Study 3: Residential rehabilitation clients tended to be older, Aboriginal, criminal justice-referred and have a mental health problem. Interviews identified culture was highly valued, with the location, or “country,” fundamental to the daily practice of, and access to, culture. The Healing Model of Care will help to strengthen future service-delivery in Australia and internationally.

Conclusions: CBPR offers a culturally-acceptable model in which academics can work in partnership with, not for, Aboriginal communities, to strengthen the quality of the research and, importantly, improve health outcomes for Aboriginal Australians.