The rrala milaythina-ti (strong in Country) program was developed to showcase, what Aboriginal people have always known: when Aboriginal people are ‘On Country’ we are mentally, physically and spiritually stronger.
Aboriginal people’s health and mental wellbeing is improved when opportunities are provided for Aboriginal people to be together on country sharing culture, sharing knowledge, experiences and creating strong connections to each other.
However these opportunities are not easily afforded simply due to the modern contemporary pressures commonly suffered by Aboriginal people. Poor health, financial restraints, lack of access to camping equipment, access to transport all contain many Aboriginal people to the convenience of the suburban environment.
The problem with the convenience of the suburban environment is it promotes isolation, masking it with the label of independence. People have access to public transport and this will take you to the local health service or shopping centre but it will not take you to the edge of the river, to the mountains or to culturally significant places.
Aboriginal people are able to access health services to see doctors to obtain medicines to aid in the healing of physical ailments but when it comes to aiding the healing of the spirit and building strong connections to country this simply cannot be achieved through modern medication.
Through providing the opportunity for Aboriginal people to be together on country we are building individual capacity and community strength. Strengthening cultural confidence in families to break out of the suburban environment and get back on country as family groups and as community groups.
When we started the program we aimed to provide some guidance, camp equipment and transport in the hope to achieve getting people on country and if that was all, then it was worth the effort. However the program has provided much more and proven that time on country together has a far greater benefit then just helping Aboriginal people be on country.
The result of supporting Aboriginal people to be together on country has built strong intergenerational relationships, where younger generations have sat around the camp fire and learnt about family connections through elders, increasing family knowledge, and strong community connections for younger people and provided a sense of purpose for elders.
The struggle of daily life has been shared and a sense of acceptance replaces a sense of hopelessness, and encourages community solution-driven discussions. The learning of cultural knowledge has strengthened people’s cultural identities, leading to individuals having the confidence to participate in other Aboriginal community events.
The experience of being on country as created ongoing relationships between Aboriginal community members and improved health and wellbeing within the community. Proving that when we are together on country, we are better.
Melanie Reeves began her career in primary health by working with one of the top general practice accreditation companies in Australia. With a background in marketing, Melanie had never expected to find her niche in accreditation. From here Melanie went on to develop her skills in practice management and working within Medicare Locals and Primary Health Networks. Melanie has over eight years' practice management experience, and has an indepth knowledge of GP, multidisciplinary and specialist practice management both in urban and rural areas. With an interest in building practice capability and driving healthcare reforms, and having worked in Sydney for over five years, Melanie decided it was time to move again from the hustle and bustle of city life to be near her family in the country. Melanie has since been working with Murrumbidgee Primary Health Network as a portfolio manager for general practice initiatives for the last two years.
In 2016, 19% of people in Murrumbidgee PHN were over 65 years old and by 2036, this age group is projected to grow to 44% of the population regionally. Elderly people are at greater risk of avoidable falls, hospital admissions, and the need for institutionalised care. In the Murrumbidgee region, falls related hospitalisations are a significant component of hospital admissions; at a rate of 3,533 per 100,000 women and 2,587 per 100,000 men.
Recent randomised controlled trials provide strong evidence that the progression of frailty can be halted or reversed through multicomponent intervention programs. In response, MPHN commissioned the design and implementation of a frailty intervention for 500 people aged 65+ (55+ for Aboriginal and Torres Strait Island people) who score ≥ 6 on the Edmonton Frailty Scale (EFS).
The Vitality Passport Program was designed by a local physiotherapy provider, who then initiated the intervention in seven communities. The program uses a multi-component approach delivered in a case by case model via a range of allied health therapies including dietetics, occupational therapy, and physiotherapy. Participants have access to exercise coaching, advice on nutrition, social interaction and cognitive training. Eligible participants are referred to the program through general practice. The program components are delivered as face to face, group or webinar sessions.
The University of Notre Dame Australia has been engaged to evaluate the model. Outcome measures include: review of data from EFS at 0, 3, 6, and 12 months, focus groups of participants attending group education, collection of falls calendars, patient satisfaction survey and interviews with general practice staff, allied health staff implementing the program and GPs.
Thus far, both objective clinical data and patient report suggested that this program has been successful in reducing or arresting frailty. There was a significant reduction in frailty as measured using EFS score for patients with follow-up data. Practice staff reported that the program is useful and worthwhile and has the potential to make a considerable difference over time. Data from the falls diaries suggest a positive trend in falls reduction. In addition, the majority of participants who responded to the patient satisfaction survey thus far agreed or strongly agreed that they had improved quality of life (86.6%) and overall health (85.4%), better physical function (81.4%) and were less fearful of falling as a result of the program (76.9%). The funding for the program and has been extended until June 2019.
Carol Reid is part of the Rural Health Academic Network with the Department of Rural Health, University of Melbourne. Her embedded researcher position as Research Coordinator is located at Numurkah District Health Service. This is a jointly funded role between the University Department of Rural Health and the Numurkah Health Service. Carol's practice background is Social Work (Hons) and Masters in Evaluation. Her interests focus on place-based approaches to support rural communities.
Aim: This case study discusses an emerging interdisciplinary model for allied health student placement provision in small rural health services. The aim of developing this model is to move from student placement as an operational activity which is at times reactive, to a proactive approach incorporated within strategic planning.
Method: A partnership model emerged as a result of two recent appointments (research coordinator and allied health clinical educator) in a small Victorian rural health service. These roles have overlapping and reinforcing responsibilities to build workforce, evaluation and research capacity whilst, supporting evidence based practice and translation of research to practice. The partnership identified early the challenges for student placements in small rural health services.
Relevance: There are different needs involved with types of student placements; clinical or research/project based. In addition, many rural allied health positions are part-time and often staff are the sole clinician for their discipline due to funding allocation. This leads to lack of time and resourcing to support students, and adds burden to the clinician’s already busy role. The rural context has its own unique challenges; climatic events such as drought and flood, economic impacts of rural business collapse, and ongoing challenges with service access and availability. Rural communities turn to the local health service for support and solutions when challenges arise, highlighting the importance of strategic planning to meet community needs.
Results: Currently (August 2018) the allied health educator has increased placements to n=5 (previously 2016, n=1; 2017, n=1). Resources have been designed to promote placement learning opportunities. Networks have been strengthened, including a new partnership with the local area Department of Education. Processes and awareness is being developed for an interdisciplinary approach to supervision for better utilisation of the range of skills, knowledge and experience available at the service and in the community. The many benefits that students can contribute to the service and the community are also being explored and highlighted in the process of opening placement learning opportunities.
Conclusion: The interdisciplinary team of social worker (research coordinator) and occupational therapist (allied health educator), are working to promote rural student placement opportunities and explore ways to overcome barriers. The essential strategic element of this emerging model is understanding complex community needs and incorporating community engagement. Moving forward the team are now researching models which may be adapted and replicated at the health service.
Pam Renata is executive assistant to Phil Naden, CEO Bila Muuji Aboriginal Corporation Health Service, which comprises Aboriginal Community Controlled Medical Services from Brewarrina, Bourke, Coomealla, Coonamble, Dubbo, Forbes, Orange and Walgett. Bila Muuji actively address health inequality in each of their local communities. Bila Muuji’s approach is to 'provide health services addressing not just the physical well-being of the individual but also the social, emotional and cultural wellbeing of the whole community'. Pam coordinates, leads, and manages Bila Muuji research projects. With a background working in immigration, health and mental health, Pam has two First Nation Maori sons and as a result has a keen interest in first nation’s people’s health and wellbeing issues. As a research assistant on the National Career Pathways Project, Pam has travelled extensively through NSW assisting with the management of the project, working collaboratively with the NSW team, Associate Professor Ilse Blignault, Senior Lecturer Rural Health and Research, Jannine Bailey of Western Sydney University, and Bila Muuji CEO Phil Naden. Pam is an energetic community member taking a pro-active role in improving the health outcomes in her Central West community.
Expanding and strengthening the Aboriginal and Torres Strait Islander health professional workforce is recognised as crucial for improving the health and wellbeing of Aboriginal and Torres Strait Islander communities. A key challenge for Aboriginal and Torres Strait Islander health managers in both the mainstream and community-controlled health sectors is the recruitment, support, development and retention of a suitably skilled workforce to meet local community needs.
The Career Pathways Project is an Aboriginal-led national research project, funded by the Lowitja Institute, designed to provide insight and guidance to enhance the capacity of the health system to retain and support the development and careers of Aboriginal and Torres Strait Islander people in the health workforce. The mixed methods study has several components and many partners, including Bila Muuji Aboriginal Corporation Health Service, Maari Ma Health, Western NSW Local Health District, Western Sydney University, UNSW Sydney and AMSANT.
In western NSW, we conducted a series of yarning circles with Aboriginal health staff and their managers at community-controlled and mainstream health services to explore in depth the factors impacting on career trajectories whilst using a solutions-focus to generate a range of potential strategies for enhancing career pathways.
We learned how Aboriginal health staff make a unique contribution to health services, bringing valuable (and often under-valued) cultural expertise and community connections as well as an array of administrative, technical and professional skills and personal attributes. Holistic healthcare and a focus on the ‘we’ in wellness comes naturally for them in the ways they work for their communities. Aboriginal staff and their managers identified a number of key success factors for supporting career development. Central to these are teamwork and support. Participants described working together and growing together with their Aboriginal colleagues (peer support) as fostering a workplace environment that supports them to thrive. Managerial and organisational support, along with family and community support, are also critical. These networks of support help foster resilience to cope with the physical, emotional and spiritual demands of training and working in Aboriginal and Torres Strait Islander health.
In short, providing well-supported and varied opportunities to work together and grow together should be considered essential to enhancing career pathways of Aboriginal health professionals, which in turn will contribute to the health and wellbeing of Aboriginal communities. It truly is better together.
Tamara Reynish’s extensive counselling experience includes working with marginalised populations in the areas of torture; trauma; sexual assault; domestic, family, and intimate partner violence; discrimination; and exclusion. Through a PhD at the University of Tasmania, Tamara is exploring the impact of stigma, disadvantage, and a lack social and legislative human functioning capabilities on the mental health of sex workers and people with great diversity of sex, sexual, and gender identities in rural or remote Tasmania.
Poor mental health will be the leading cause of disability in the coming decades in Australia. This is particularly true in rural or remote regions, where issues surrounding isolation, discrimination, and access to services and treatment are more salient. The lack of mental health services in rural areas is well known; so too is the negative impact of this gap on mental health outcomes.
Tasmania, one of Australia’s poorest states, has among the highest state government per capita expenditure on mental health with 85% of current funding allocated to public services. Yet, despite this investment, mental health remains poor in rural areas. The Australian Health Care Reform Alliance has stated that government approaches to rural mental health care ‘fall short of the changes we need’.
These shortcomings affect marginalised people most profoundly. Marginalised people are those who live on the fringes of society, who have severely limited access to resources and opportunity, and who face a mix of economic, social, and health disadvantage. Research shows that the marginalised grouping of sexual and gender minorities and sex workers who live in rural or remote areas have extreme levels of general psychological distress and are more likely to attempt and complete suicide or self-harm than those living in metropolitan regions.
A service review of this practitioner’s counselling in rural Tasmania has demonstrated many compounding, negative health determinants and barriers to service that marginalised populations face: poor socioeconomic position, low educational attainment rates, social exclusion, limited social capital, high unemployment, and low-or-no access to mental health services. To offset these obstacles, this practitioner has developed a barrier-reduced counselling service that includes free/reduced-cost, afterhours, and remote service. Clients’ self-reported mental health outcomes have also improved through a focus on eradicating social exclusion and increasing social capital through strategies of inclusion, diversity, network building, support, and acceptance.
This on-the-ground service delivery model has been parlayed into a PhD. The research will involve methodical data collection, including lived experience of sexual and gender minorities and sex workers on mental health care and services, uptakes, barriers, enablers, and their impacts on these populations’ mental health.
An overview of the service review to counselling practice and the PhD research will be presented. This research will generate vital data that is currently lacking on these populations. It will also provide improvement opportunities for service providers and users alike through the development of health access standards.
Mara Richards has spent some 41 years in the health space. From public to private with a distinct emphasis on the rural and remote areas of Australia, she has seen and experienced a lot during her time. Mara commenced her career as a registered nurse in South Australia in the 70s and has worked in her home state as well as the Northern Territory, Western Australia and now Victoria where she is the CEO of a multi-purpose service, Robinvale District Health Services (RDHS). Of particular interest to Mara is the future sustainability of small rural health services and Aboriginal health. Primary health care is essential, she believes, to the future of any community, and looks at health from a generational/wellness perspective. If we can prevent chronic illness through innovative and engaging health programs by partnering with our community, this dream can be realised. Mara believes strongly in the foundation of investing in her staff as she firmly believes that supported staff provide good care and are a prime source of innovative thinking within the organisation. The focus of care is upon the individual who is accessing the service and who also belong within a larger community. Mara loves people and has a zest for life and believes in a positive mindset and that there is no such thing as ‘no can do’!
In 2016, RDHS launched a pilot project titled ‘The Ripple Effect of Ethnicities’ (TREE) that was designed to support multiculturalism in Robinvale. The TREE Project was founded to meet the gap in cultural tolerance and acceptance posed by the lack of community events for multicultural community members to engage in. Research indicates that people from diverse cultural backgrounds in rural settings are more vulnerable to social isolation in their community which in turn results in a high incidence of mental health markers amongst these groups. In addition, the lack of community engagement amongst the multicultural communities also resulted in limited representation of their voices in the health decision making process in the Robinvale community. To manage this, the TREE Project was developed as a soft entry approach to social inclusion and mental health to encourage community engagement of the multicultural communities in Robinvale. The main objective of the TREE project was to provide a meaningful platform for people from multicultural communities to engage in the Robinvale community with a clear vision towards improving their psychosocial health and wellbeing.
A 16-week cultural skills exchange program that was conducted with multicultural community members wherein participants nominated a skill inspired by their culture and taught it to the rest of the group. The skills exchange program consisted of 9 participants and 2 companions from different cultural groups. A range of different cultural skills were shared through this program, including Italian pasta making, Indian saree tying, Fijian basket weaving, Philippino spring roll making etc.
A multicultural festival was hosted by RDHS in Robinvale on 5 November 2016 that was attended by more than 700 people. The festival aimed to bring together people to celebrate the ethnic and cultural diversity of the community through the use of arts, crafts and food.
In 2017 RDHS received a High Commendation from the Victorian Multicultural Awards.
Another multicultural festival was conducted in 2017 and we are currently in the planning stage for the 2018 festival.
As part of the TREE Project our Manager People and Culture is conducting English conversation classes after hours two nights per week. The manager has donated his time to this activity, which has seen up to 20 participants enjoying the learning environment provided in our conference room. These classes are provided free of charge and the participants range from Thailand, Vietnam, Cambodia, Laos, China, Hong Kong, Taiwan and Afghanistan.
Dr David Ritchie has lived, worked and researched health services management in New Zealand, Australia and Britain. Having worked in administration in a large metropolitan teaching hospital, a small district rural hospital and a large rural referral hospital, he has been exposed to a range of managerial styles and experienced organisational change. As a health services management academic for almost 30 years, his interest has been on changing management education to focus more on management development. Management development can be facilitated when learner-identified performance concerns are improved through applying their learning in the workplace authentically. Learning should be an opportunity to acquire new knowledge, skills and experiences and given the multi-disciplinary involvement required to improve complexity health service delivery issues, that authentic learning should be increasingly collaborative . In recent years David has coordinated a year-long Advanced Management Practice capstone project, involving collaborative learning in conjunction with a Local Health District. For five years the focus has been on Aboriginal and Torres Strait Islander peoples’ access and experience of health services. David firmly believes that postgraduate students should have the opportunity to make a difference in closing the gap/chasm.
This paper is based on a milestone reached in a partnership in a five-year project to consider the access and experience of health services by members of the Aboriginal and Torres Strait Islander peoples in one community. It could have been presented as a case study, but without the permission of the Elders or participants, no details will be shared other than some of the process learning that might guide others who wish to make a difference themselves. Each community’s experience of researchers and others who wish to know more about them is different. The community of interest in our project acknowledged bad experiences previously and so building relationships based on respect and trust took time before any business could be discussed.
To understand how the partnership began, and what was entailed, the paper presents some background, before explaining further the significance of the title. Little progress has been made in the Federal Government’s Closing the Gap strategy, and so building partnerships with Aboriginal and Torres Strait Islander peoples locally does demonstrate a cultural awareness. The value of some of the cultural awareness or cultural competence training many health professionals are exposed to can be questioned for impact in changing behaviours as observed by members of the Aboriginal and Torres Strait Islander community. A degree of cultural competence is required before seeking to engage with any community, but the actual step of discovering who to speak with, when, where, and how often very much depends on both parties.
Changing how the community was consulted to improve access and experience of health services required conversation between the partners, negotiation and achieving consensus about the next step/s. Developing a mutual respect and a commitment to move forward takes knowledge, skill and experience and the paper and presentation address that further.
Russell Roberts is Associate Professor, Charles Sturt University and Adjunct Clinical Associate Professor, University of Sydney. Professor Roberts is the Editor in Chief of the Australian Journal of Rural Health, Chair of the National Alliance for Rural and Remote Mental Health and Chair of the Australian Rural and Remote Mental Health Symposium, and board member of the Australia and New Zealand Mental Health Association. He has served on the NSW Mental Health Commission Advisory Council and Director of Clinical Training at Griffith University in Queensland. He is the Co-Chair of the Australian Equally Well Implementation Committee tasked to oversee the national implementation of actions to improve the physical health of people living with mental illness. Russell brings together 15 years of experience as a clinician and 10 years as an academic with 12 years as director of services that provided 204,000 inpatient admissions and 1.3 million occasions of service. He has published 26 refereed journal articles, books and book chapters, over 50 conference presentations, 16 keynote speeches and been awarded $4.9 million in research grant funding.
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Meet the editors of The Australian Journal of Rural Health in a special session designed to clarify publishing procedures and improve your chances of being published in our journal and others.
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New and established authors are welcome!
Now in its 25th year of publication, AJRH provides research information, policy articles and reflections related to health care in rural and remote areas of Australia. Since its inception, AJRH has contributed significantly to the publication of research reports and expert opinion on rural and remote health.
Bronwyn Robinson has been the Education Manager at the Continence Foundation of Australia for the past 18 months. She has worked in diverse educational settings including nine years as the Learning and Teaching Advisor at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and seven years at RMIT University working as a Learning and Teaching Development Manager across both the higher education and TAFE sectors. Each work experience has provided engagement with diverse stakeholder groups, challenged and enhanced Bronwyn’s concepts of effective educational practice and informed her educational philosophy, which places the learner at the centre of the process while providing authentic learning and assessment experiences.
Background: With the current policy changes in the disability and aged care sectors and transitioning of funding streams and sources, organisations may need to source flexible alternatives for providing staff training. Staffing issues such as high staff turnover and casualisation of the aged care and disability support workforce also limit the time and cost-effectiveness of traditional face-to-face training and there may be an increased expectation for self-directed professional development. The challenge is to provide easily accessible information which will guide support workers in the delivery of best practice continence care.
Aims: The project aims to provide a web-based education tool (optimised for mobiles and tablet) which provides immediate Get Help information to allow disability support workers and personal care workers to provide appropriate continence care for the client in situ at the point of need. The tool also provides more detailed follow-up learning modules to encourage long-term knowledge development to underpin the Get Help topics.
Relevance: Extensive consultation conducted to inform this project, found that many support workers are currently managing a range of continence issues on a regular basis with limited or no specific training in the area. As many support workers work with clients in their homes, they often work remotely and unsupervised with limited or no support from managers or clinicians at the point of care. This is likely to increase given the changes to funding schemes and an increase in workers employed as independent contractors. Limited continence services in rural and remote areas means that specialist support for continence issues is often difficult to access.
This purpose written education tool, designed to give support workers the information needed to provide day-to-day continence support to their clients, includes practical demonstration videos and information about when to refer to a suitable health professional. All sections link to the National Continence Helpline where the workers or their client can speak in real time to a continence nurse.
Conclusion: With the increased focus on client choice and control, support workers are in greater demand and often provide care with limited support especially in rural and remote areas. With limited training in continence support in current training courses, this innovative tool is easily accessible for support workers to get practical information needed to provide quality care within their scope of practice. Currently, here is no other publicly available continence education tool designed for support workers in Australia.
Fae Robinson is an engaging, versatile and analytical thinker and facilitator who partners with organisations to bring out their best. She is skilled at identifying, gathering and sifting through complex information to inform decision making. She presents information clearly and concisely in plain English. Fae is experienced in engaging with communities, groups and individuals and facilitates conversations that map the future and produce results. She recognises the wisdom in the conversations, challenges and extends thinking to reveal more, and brings rigour to constructing the way forward. Fae earned her consultancy stripes with Impact Solutions International, gaining skills in leadership and values development, and PDF Management Services, a broad-based management consultancy. This experience underpins her extensive expertise as an independent, versatile consultant. Fae spent 17 years in the public sector working in strategic development, policy, planning and performance, and marketing; and had an extensive private sector career as a journalist, commissioning editor, communications specialist and national marketing manager. Among her other qualifications, Fae has a Master of Science (Strategic Foresight - Swinburne) and uses her expert knowledge and experience to orient organisations towards their desired future.
Deep understanding and empowerment of communities is the essential, and often overlooked, platform for driving long-term gains in health and wellbeing. Communities underpin the vital social connections needed to maintain good physical and mental health, provide unique and specific insights into the issues and relationships challenging local people, and have both intrinsic and extrinsic ‘power’ to make real change, particularly in rural settings. Giving voice to that power across Aboriginal people, descendent families, more recent arrivals, young and old—all the stories that together make the place unique—is an imperative for preventing ill-health and promoting good health and wellbeing in rural communities.
In an immersive project in rural Tasmania, the local Council permitted a deep dive into its diverse communities, using general public consultation, special interest group consultation and more than 60 one-on-one interviews across sectors—federal, state and local governments, business, not-for-profit, and local citizens from all walks of life and in varying states of physical or mental health. Surveys and written submissions also contributed to the community knowledge base.
In this extensive process of engagement, local histories threw light on the contemporary health and wellbeing status of diverse communities; long-held traditions and traditional knowledge supported equality; and pockets of innovation provided new ways to address wicked problems.
The result is a revelation—communities ready and able to connect with, and respond to, the health and wellbeing of their local populations. Their knowledge, ideas and expertise are a springboard for action; their deep commitment defines their sense of community and the real possibility of a sustainable, healthy future. Community provides the key ingredient to community wellness.
The insights and understanding gained from the engagement process, the key role of Council, and the role of consultant converge to provide a direction-setting health and wellbeing strategy that focuses on wellness, prevention, community and strengths, and demonstrates how to be better together. The presentation will provide insights into the engagement process, the defining moments, the foresight of Council, the wisdom of community and the role of trust in shaping the strategy. It will chart a socially determined, community driven pathway to wellness for a rural Tasmanian community.
Michelle Rothwell is the Allied Health Team Leader at Allied Health Education and Training at Cunningham Centre. She is passionate about the delivery of safe and equitable healthcare for rural and remote patients. She is an experienced clinical pharmacist and manager, currently working in the field of rural and remote allied health workforce development. Michelle studied at Aston University in the UK and completed her Research Masters with the Queens University, Belfast. Michelle has been instrumental in developing and implementing novel telepharmacy models of care resulting in equitable services for rural and remote patients. Michelle is currently the chair of the Society of Hospital Pharmacists of Australia (SHPA) leadership committee for rural and remote practice and a member of the Far North Queensland Human Research and Ethics Committee.
Background: Medication misadventure is a significant public health burden and patients are at particular risk when transitioning between healthcare settings. Home Medication Reviews (HMRs), initiated by general practitioners (GPs) are undertaken by community pharmacists (CPs) and they have been shown to reduce medication misadventure for patients transitioning between the hospital and community. The ageing population in the study setting reinforces the need for maximising and sustaining present community health services to minimise hospital readmissions in the long term. The minimal uptake of HMRs in these communities instigates further investigation.
Aim: To identify the enablers and barriers of HMRs in a cluster of rural communities, with the aim of improving HMR utilisation for patients when discharging from hospital.
Methods: This phenomenological qualitative study explored GP and CP awareness, experiences and perceptions of enablers and barriers to using HMRs. Semi-structured interviews were conducted with 9 GPs and 10 CPs identified by the hospital pharmacist through clinical and community networks. The rationale for inclusion of two participant groups was to derive variant perspectives of HMR utilisation. Transcribing and thematic data analysis were undertaken to recognise issues and possible improvement strategies. This research project was conducted as part of the Queensland Allied Health Rural Generalist Training Program (AHRGTP) initiative.
Results: Four themes were identified: Benefits and value of HMRs, barriers limiting uptake, strategies for improving HMR process and a hospital-initiated HMR referral pathway model. Perspectives were categorised into GP-related, Pharmacist-related and patient-related. All participants acknowledged the main beneficial roles of HMRs were medication rationalisation and patient education. The current HMR system itself was noted as a major barrier. Improvement strategies identified included having a simplified, streamlined referral process and better promotion of accredited pharmacists in the community.
Relevance: This research provides an opportunity for GPs and pharmacists to collaboratively review present practices. All participants supported the hospital-initiated pathway model developed from this study. The model would help resolve communication gaps, target relevant patient populations and assist GPs with recognising high-risk patients and completing HMR referrals in a timely manner.
Conclusion: Collaboration between GPs and both hospital and community pharmacists is imperative in order to utilise the HMR service more effectively. The identified enablers and barriers with the current HMR system gives better understanding into the issues that need addressing to improve HMR uptake.
Arts in health
Sam Routledge is a director, puppeteer and creator of contemporary puppetry with a strong record of innovation in the form. He has been the Artistic Director of Terrapin Puppet Theatre since November 2012 and has a BA in Communication (Major – Theatre and Media) from Charles Sturt University and a Post Graduate Diploma in Puppetry from the Victorian College of the Arts. His work has been presented by leading contemporary arts venues and festivals around the world, including Vancouver International Children’s Festival (Canada), Taipei Children's Art Festival (Taiwan), Soho Theatre (London), Festival De Betovering (The Netherlands), Sydney Festival, Performance Space, Perth International Arts Festival, Malthouse Theatre and Brisbane Powerhouse. As a puppeteer, he has performed and collaborated on 17 productions with leading Australian and international companies, including Societas Raffealo Sanzio (Italy), Gruppe 38 (Denmark) and LATT Childrens Theatre (Korea).
Before we walk, crawl, speak, read or write, we are puppeteers. As soon as we can hold objects, we bring them to life, making the impossible possible using just our hands. Inspired by a deep connection to the most imaginative and fantastic of art forms, an experience with Terrapin reminds us all that our ability to create something extraordinary is always with us, wherever we are.
Dr Erica Russ is a Lecturer, Field Education and Course Coordinator in Social Work at the University of New England, Australia. Erica has extensive industry experience in social work across child, youth and family services, with particular expertise in child protection, out-of-home care, and adoption. Erica has also worked as a hospital social worker and been a member and chair of multidisciplinary and multi-agency teams, and led significant projects in partnership with health services. During her career Erica has worked across direct practice, practice consultancy, program management, operational and strategic policy, and management, including holding practice advisor, research coordination, and senior management positions. In addition to teaching at a regional university, Erica’s interest in rural practice comes from many years working regional, rural and remote areas at both practitioner and management levels. Erica currently teaches in the area of rural social work practice and in the role of Field Education Coordinator arranges and supports student placements across Australia, including placements in rural and remote locations.
Children who are placed in out-of-home care have experienced abuse and/or neglect and as a result may have a history of trauma, attachment disorders, intellectual disability, poor physical, mental and dental health, self-harming behaviours and/or substance misuse. The philosophical approach to child protection practice gives preference to family reunification to either parents or kin for these children where possible. The significant shortage of foster carers, particularly the shortage of Indigenous foster carers for Indigenous children, combined with the need to prevent another Stolen Generation, has resulted in greater attempts to return these children to their kin. The increased recognition of Indigenous perspectives on health and well-being that involve not just physical health but connection to Country and the environment, connection to family and community, sense of Indigenous identity and culture is also necessitating more than just a medical focus on the needs of these children. However, reunification of Indigenous children often means they are being returned to their kin in rural and remote communities where there are scarce health services. This situation presents many difficulties for kin carers particularly those who are caring for children with a disability and those whose psychosocial adjustment has been detrimentally affected by cumulative harm as a result of further abuse while in care. Many of these children have been previously placed with carers in regional towns where there has been access to specialist health services. It these very services which sometimes object to children being moved to live with kin out of a concern about whether adequate medical follow care will be available. This paper will present two case studies which identify some of the complexities of meeting the health care needs of children returned to kin in rural and remote communities along with some suggestions for how these children’s wellbeing can be better monitored.
Peer-reviewed paper Top 20 abstracts
Deb Russell is a Senior Research Fellow at Flinders Northern Territory. Her research interests include rural and remote health services research (models of care, understanding and measuring access to health care) and rural and remote health workforce supply, distribution, recruitment and retention.
Background: Delivering effective primary care to where it’s needed most—specifically remote Aboriginal communities—is hampered by high turnover and low stability of health clinic staff. This research investigates changes over time in staff turnover and stability in remote communities in the Northern Territory.
Method: This study used descriptive statistics and multiple linear regression to analyse Department of Health payroll data, 2004-2015, for all staff based at 54 government-run remote NT clinics. Main outcome measures: annual turnover rates and 12-month stability rates in a specific remote community. Main outcomes were investigated by clinic, calendar year, professional discipline, employment level, age and geographical remoteness.
Results: Annual turnover rates for all staff averaged 118% (95%CI 113, 124), declining significantly over time (175% in 2004 to 92% in 2015; p<0.05). Turnover rates were significantly lower during the NT Emergency Response (66% lower, 95%CI 48, 85).
The most stable clinic had a mean 12-month stability rate for all staff that was 6 times higher than the least stable clinic (11%-66%, c2 35.6, p<0.01). There was a significant trend of increasing stability rates for all staff during the study period (increasing from 41% in 2004 to 51% in 2015; c212.5, p<0.01), averaging 49% overall (95%CI 46, 52).
Aboriginal Health Practitioners had significantly lower annual turnover rates (53%; 95%CI 46, 61), higher stability rates (71%; 95%CI 62, 78) and longer median employment survival (1.19 years; p<0.01) compared to other professional groups.
Nurses had significantly higher annual turnover rates (150%; 95%CI 141, 160) than administrative staff, though stability rates were no different. Median survival of nurses and administrative staff were 0.46 and 0.62 years respectively.
Discussion: Turnover rates for all staff almost halved between 2004 and 2015 and 12-month stability rates improved significantly. Turnover, averaging 92%, and 12-month stability at 49%, are both at unacceptable levels, thus compromising continuity of care. This is particularly problematic for effective management of complex and chronic conditions. These staffing patterns demand high and sustained resourcing, and constant effort to stabilise the remote health workforce. Increased recruitment and training of local Aboriginal people into clinical and non-clinical professions are key to improved access and culturally safe care in remote clinics. Job satisfaction and retention can also be improved by ensuring that all employees feel valued and supported, and their community knowledge and cultural skills are recognised and respected along with their clinical skills.
Maureen Ryan is a GP based in Cygnet, an hour south of Hobart. She is a Senior Medical Educator with General Practice Training Tasmania and has a passion for Aboriginal and Torres Strait Islander health.
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.
Paisley Rylance has travelled the world for over a decade interacting with people with acute and chronic mental illnesses. She’s been on the street level and worked with the elite. She’s seen mental health from a perspective that many health workers never get the chance to do. She has also cared for and interacted with hundreds of families and children, often those presenting with behavioural issues and trauma. Her life’s work is discovering how to break the cycle of child abuse, mental illness and suicide. She has founded a group for supporting children with ASD and anxiety to learn to self-regulate, and is currently developing the conscious parenting movement to bring deep, authentic parenting support to families who are willing to step up and break the cycle. She has years of real life experience and research and wants to share this and allow the creation of effective programs and education that will really work to support those who are most at risk, as well as those who are asking for support. She lives rural and enjoys being isolated from society.
I’ve spent fifteen years battling mental illness and working day-in, day-out to try and get better. I’ve tried everything the system has to offer. I’ve been homeless, I’ve been medicated, I’ve been institutionalised, I’ve been laughed at and judged by the very people that I’m always being told are “there to help” me. I’ve made so many attempts on my life that I have lost count and every day I see the scars that remind me that the battle was a long and lonely one. I never received the help everyone promised. I’ve been seeking support but the system continues to fail me, it’s not just failing me, it’s failing thousand of others too. Everyday I am hearing of more people loosing the battle, that they are not getting the help that they need; that they ask for help, that they reach out, but there is no one there. The phone line services are no longer empathetic, the doctors and nurses are abusive to patients, they mock patients while they’re coming down from overdoses, the psych nurses don’t do treatment plans and the psychiatrists won’t acknowledge diagnosis until patients are numbed out with the incorrect medication.
The current mental health system is not working. Over the years I have collected thousands of stories from across the country and the globe, which back up my feelings of utter helplessness, loneliness and belief that there is nothing left to do but give up asking for help.
It’s time that we do better for those in need, we can only do this together. We need you to listen, we need you, as health care professionals, to stop ticking boxes and to see us as real, raw, vulnerable humans who NEED YOUR HELP.
I want to come to you to share these stories, to share what the people in my position are really in need of, I want to open up the path to empathy and real, effective mental health support for those who are desperately in need of it.
I have lived remote and rural over the last decade because the healthcare wasn’t helping and I chose to be away from society to be safe. I have seen the depths of depression on the street in this country and around the world and there is far more to mental illness than will ever present to a clinic.