A Multidisciplinary Allied Health Partnership Approach to Improving Chronic Disease Self-management in an Urban Indigenous Population: Let’s ‘Work it Out’!
Kyly Mills & Samara Dargan
Samara Dargan – Exercise Physiologist, Work It Out Program. Samara is a Kalkadoon woman from West Queensland. After completing her studies in Sport and Exercise Science and Clinical Exercise Physiology at James Cook University she then worked in the private sector in Townsville. In 2012, she moved to Brisbane to take on the role of Work It Out Manager with the Institute for Urban Indigenous Health. She is responsible for coordinating the chronic disease self-management program across South East Queensland.
Kyly Mills – Research Assistant, Work It Out Program. Kyly is a Kamilaroi woman whose family originates in Moree, New South Wales. She completed a Bachelor of Health Science in Public Health in 2012 at the Queensland University of Technology, and is currently studying a Masters of Applied Science by research degree. She works as a research assistant in the evaluation of the Work It Out Program.
Abstract – Chronic diseases disproportionately contribute to the burden of disease in Australia experienced by Aboriginal and Torres Strait Islander populations. Effective management of these conditions is elemental in closing the life expectancy gap between Indigenous and non-Indigenous Australians within a generation. Moreover, there is a need to design and implement programs which meet the unique needs of urban Aboriginal and Torres Strait Islander people.
The Work It Out (WIO) Program has been implemented by the Institute for Urban Indigenous health across five Indigenous Community Controlled Medical Services in urban South-east Queensland. This program adopts the holistic view of Indigenous health and utilises a multidisciplinary allied health partnership approach to aid in chronic disease self-management within an urban Indigenous population. Multiple weekly 45 minute education sessions are delivered by health professional from fields of exercise physiology, occupational therapy, nutrition, psychology, nursing or pharmacy. This is followed by a one hour individually tailored exercise program in a group setting. Independent of the group sessions, clients have the opportunity to meet one-on-one with allied health professionals to aid in self-management strategies which are unique to their chronic condition.
The WIO program is coordinated by an Aboriginal Exercise Physiologist, with ongoing research undertaken through partnership with an Aboriginal Research Assistant and a small research team. Additionally, clients in the program range from 21-84 years, with many recognised Elders in community participating. It is this direction from Indigenous staff combined with the diversity of clients in community that makes important steps for intergenerational change within this urban population.
Fostering a mixed-methodology approach, evaluation of the WIO program is ongoing. Recent analysis of blood pressure (BP) and blood glucose levels (BGL) show promising and statistically significant decreases on both measures. In addition, preliminary evaluation of the semi-structured qualitative interviews have shown encouraging results in increasing client knowledge of chronic conditions and motivation to empower self-management, as well as self-reported improvements in social and emotional well-being and general quality of life. This presentation will outline the project in detail and report on outcomes from preliminary evaluations.
Author Details: Ms. Kyly Mills, Research Assistant – Work It Out(WIO) program, The Institute for Urban Indigenous Health (IUIH); Ms. Chantal Roder, Research Assistant – WIO program, IUIH; Ms. Samara Dargan, Manager and Exercise Physiologist – WIO program, IUIH; Dr. Alison Nelson, Workforce Development Coordinator, IUIH; Ms. Katrina Rae, Exercise Physiologist – WIO program, IUIH; Mr. David Mclaughlin, Exercise Physiologist – WIO program, IUIH; Ms. Emma Campbell, Occupational Therapist – WIO program, IUIH; Ms. Tabinda Basit, Psychologist – WIO program, IUIH; Ms. Katherine Munce, Dietitian – WIO program, IUIH; Ms. Sian Truasheim, Music Therapist – WIO program, IUIH.
Building an eye-care program with Aboriginal communities in Victoria; a partnership approach
Presenter Biography: Genevieve Napper is Lead Optometrist Aboriginal Services at the Australian College of Optometry and has worked in the optometry service at VAHS and other Aboriginal Health Services around Victoria for the past 12 years. After completing her optometry degree, she completed a research PhD and a Master of Public Health. Genevieve’s clinical interests also include ocular disease and therapeutics, low vision and clinical education. She is a Senior Fellow with the Department of Optometry and Vision Sciences University of Melbourne and a Board Member of the Optometrists Association Australia Victorian Division. Genevieve has also contributed to eye care education in Vanuatu. She is also a founding member of the Public Health Optometry Group and a member of the Vision 2020 Australia Aboriginal and Torres Strait Islander committee and a Fellow of the Australian College of Optometry.
Abstract – The Australian College of Optometry (ACO) Aboriginal eye-care program operates in partnership with Department of Health Victoria, Victorian Aboriginal Community Controlled Health Organisation (VACCHO), Commonwealth Department of Health and Ageing, and Aboriginal communities around Victoria. An optometry clinic opened in 1998 at the Victorian Aboriginal Health Service in Fitzroy. The aim is to contribute to efforts to reduce avoidable blindness in Aboriginal and Torres Strait Islander communities.
The National Indigenous Eye Health Survey (2008) reported that blindness and vision impairment are 6.2 times and 2.8 times, respectively, more prevalent in the adult Aboriginal population than in the non-Aboriginal population, yet 94% of vision loss is preventable or treatable and 35% of adults have never had an eye exam.
The ACO pursues a government supported, community partnership approach to improve service availability and delivery. A team of 17 optometrists has been developed to work regularly with Aboriginal communities. The ACO Aboriginal Liaison Officer strengthens links with communities and clients. The VACCHO Statewide Eye Health co-ordinator facilitates new partnerships and initiatives to enhance services. In 2010 the Victorian Department of Health announced new eye care measures under the Closing the Health Gap program, including the Victorian Aboriginal Spectacle Subsidy Scheme that makes glasses available to Aboriginal community members for $10. The program is overseen by a subcommittee of the state Aboriginal health forum (VACKH) that comprises relevant stakeholders.
In 2012, over 1201 members of Aboriginal communities in Victoria received an eye examination with over 1500 pairs of glasses prescribed. In 2013 eye-care services are available at 18 Aboriginal community controlled sites and ACO facilitates access to eye care at 27 mainstream sites.
The ACO has demonstrated that by working in partnership with Aboriginal communities and reducing barriers to care, it is possible to dramatically increase utilization of eye-care services.
Author Details: Genevieve Napper, Jimi Peters, Mitchell Anjou, Tim Fricke, Kulan Barney, Cheryl Vickery, Jonathan Jackson.
COMHeLP – Best practice for Aboriginal and Torres Strait Islander Ear and Hearing Health
Dr Judith Boswell & Hayley Baldwin
Dr Judith Boswell is an audiologist with many years’ experience of clinical practice and research in the field of Aboriginal Audiology. She is currently a Director and practicing Audiologist with Adelaide Hearing Consultants.
Hayley Baldwin is an audiologist with vast experience of rural/remote and Indigenous Audiology. She currently works with ear and hearing health services in the Northern Territory through the Remote Area Health Corps (RAHC).
Abstract – The impacts of otitis media (glue ear, middle ear infection) and hearing loss in Aboriginal and Torres Strait Islander (A&TSI) peoples have been known for decades. Efforts to create and implement effective interventions and management strategies have suffered, especially in remote communities, from limited resources and poor understanding of discrepancies in cultural values and health knowledge.
Audiology as a profession has, over the past 10-15 years, attempted to improve services to Indigenous clients by increasing awareness of A&TSI ear health issues, by bringing cultural awareness and safety into mainstream audiological practice, and by highlighting tools and skills that support clinical practice with A&TSI people.
Chronic Otitis Media and Hearing Loss Practice (COMHeLP): A Manual for Audiological Practice with Aboriginal and Torres Strait Islander Australians (March 2012) presents the current understanding of audiological best practice with A&TSI people, highlighting aspects of particular relevance to this population, such as the need to address issues of health literacy, the screening versus surveillance debate, and interdisciplinary collaboration for outcomes. Cases illustrating relevant points will be used to discuss best practice for Indigenous people with ear disease and hearing loss.
Author Details: Dr Judith Boswell, Adelaide Hearing Consultants; Hayley Baldwin, Audiologist Amarjit Anand, NT Hearing Services; Kathy Currie, Hearing Health Program
Guide to Allied Health Professions in the Primary Care Setting in action
Elaine Dunn currently is the National Principal Adviser – Closing the Gap Workforce Support for Australian Medicare Local Alliance and is responsible for leading the AML Alliance Closing the Gap team in working with and supporting Medicare Locals in Aboriginal and Torres Strait Islander health, particularly with implementation of the Care Coordination and Supplementary Services program and Improving Indigenous Access to Mainstream Primary Care programs. Prior to this role, Elaine was the AML Alliance (AGPN) National Principal Adviser for a Mental Health program working with Divisions of General Practice whose communities were affected by drought. Elaine has worked in various industries from mental health, mining, property valuation, state and local government whilst continuing being a partner in farming business near Ballarat, Victoria.
Medicare Locals (MLs) are working towards providing high quality primary health and social care for our local community through tackling existing inequalities and introducing new opportunities to bring together all health professions (GPs, Nurses, Allied Health etc.). MLs have a responsibility to monitor the health workforce in their area and to align this to the population’s needs. A major challenge for MLs is how to fully understand the diversity in roles and services of the Allied Health professions. Collaboration with Peak bodies has been, and continues to be strengthened, as a critical factor to gain a deeper understanding of each profession. The Guide to Allied Health Professions is a key resource for MLs and the workforce they employ and/or fund.
A clear example of Medicare Locals addressing local population health needs and the critical role of allied health professionals are the Indigenous Chronic Disease Package funded Care Coordination and Supplementary Services (CCSS) program along with the Improving Indigenous Access to Mainstream Primary Care (IIAMPC) program.
The intent of the CCSS program is to contribute to improved health outcomes for Aboriginal and Torres Strait Islander people with chronic health conditions through better access to coordinated and multidisciplinary care.
The IIAMPC program funds Aboriginal and Torres Strait Islander Outreach Workers (Outreach Workers) within the Medicare Locals network who encourage and support Aboriginal and Torres Strait Islander people to access primary health care services and to ensure follow up treatment is accessed.
Indigenous Health Project Officer positions are also being funded to provide leadership in Aboriginal and Torres Strait Islander health issues within the Medicare Locals network, including increased awareness and understanding of the various Closing the Gap initiatives relevant to mainstream primary care.
Cases illustrating relevant points will be used to demonstrate the team approach of this workforce and how they are engaging, supporting and enabling Aboriginal and Torres Strait Islander patients to improve chronic disease self-management and the important role of Allied Health professionals.