Day 1 Concurrent Sessions – 3.30pm – 5pm
Workforce Development Stream
3:30pm - Superannuation approaches to the Aboriginal Mental Health Workforce
Presenter Tom Brideson is a Kamilaroi/Gomeroi man from north-west NSW. Tom is the State-wide Coordinator for the NSW Aboriginal Mental Health Workforce Program. For more than 20 years Tom has been actively involved in Aboriginal mental health developments including: health policy; social and emotional wellbeing; clinical mental health care; suicide prevention; and education. Tom has published articles regarding the Aboriginal mental health workforce and advocates for the recognition of a specific degree based mental health workforce as an emerging profession across all health and human services. The most recent publication was a chapter in second edition of Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. Tom sits on a range of mental health leadership committees and projects to improve the mental health of Aboriginal and Torres Strait Islander people.
Abstract The contribution of the Aboriginal and Torres Strait Islander Health and Human Services Workforce across Australia is remarkable. The real value of this contribution may well be under estimated and under reported. According to the self-reported Census data 2011 there were 8456 Aboriginal and Torres Strait Islander people employed in selected health-related occupations. Allied Health Professionals reported at the same time was 724 (AHMAC 2015). To achieve basic equity of 3% across all allied health professions a number of things need to occur. Currently the overall Aboriginal and Torres Strait Islander health workforce is 1.6% and the distribution across professions is variable. The reference to Superannuation approaches becomes a useful metaphor which reflects a long term investment approach. Superannuation in this instance represents the workforce approaches needed to generate a more substantial benefit which are sustainable, innovative and builds for now and the future. While there are a range of definitions for superannuation there is no universal precise definition reported. An example explored is the NSW Aboriginal Mental Health Workforce Program. The Program has had 54 graduates successful completions since it began in 2007. A further 10 graduates are expected in December 2015. The Program model is successful and one model that has real potential to build a long term ‘workforce investment strategy’ or in real terms an Aboriginal Mental Health Workforce Superannuation Investment Strategy, especially given no universal precise definition exist. The investment is worthy in every sense. The superannuation objective resonates with philosophies that Aboriginal people have promoted over many years. Self-determination and self-sufficiency is promoted by consecutive Government’s superannuation objectives in respect to dependence reduction. Other valuable terminology includes regular contributions, accumulated annual milestones and progressive benefits. This investment needs to be on the backdrop of professional/service current responsibilities to Aboriginal and Torres Strait Islander people, which include among other things
- Alignment of curriculum to professional standards
- Setting Workforce Targets
A ‘workforce investment strategy’ viewed in parallel ways to superannuation could be meaningful and reduce burden. References 1.Australian Health Ministers’ Advisory Council, 2015, Aboriginal; and Torres Strait Islander Health Performance Framework 2014 Report, AHMAC, Canberra. Table 3.12-1 page 153 (Source: ABS and AIHW analysis of ABS data). 2.Steering Committee for the Review of Government Service Provision, Report on Government Services 2015, Indigenous Compendium
4:00pm - Anangu Ninti Tjuta- Lots of Intelligent Indigenous people
Kimberley Hunter – My name is Kimberley Hunter and I identify as a Nyikina woman. My people are from the Lower Fitzroy River, in the remote West Kimberley region of Western Australia however I have been born and raised in Adelaide with my mum and two brothers. I am currently in my fourth and final year of Occupational Therapy at the University of South Australia. On completion of my degree I would like to work rurally with Indigenous communities to help improve health outcomes of our peoples.
Tahnee Elliot – My name is Tahnee Elliot and I am a Yawarrawarrka woman. My family is from the top Northeast region of South Australia, along the Queensland boarder. I was raised in Roxby Downs before moving back to Port Augusta to complete my secondary schooling. In 2012, I moved to Adelaide to attend University and study Occupational Therapy. I am currently in my 4th year, and completing my final placement blocks before graduating at the end of this year. I am passionate about Indigenous culture, and aspire to work with Indigenous communities in rural Australia to work towards closing the current gap upon graduating.
Abstract Background – ‘Anangu Ninti Tjuta’ (Pitjantjatjara: Lots of Intelligent Indigenous people) was a community development project facilitated by Kimberley Hunter and Tahnee Elliot, two Indigenous fourth year occupational therapy (OT) students from the University of South Australia. The project took place at Wiltja Residential Program over nine weeks, commencing 10th February and finishing on 10th April 2015. The Wiltja program (Wiltja meaning “shelter” in Pitjantijatjara) was formed by a group of Ernabella women from the Anangu Pitjantjatjara Yankunytjatjara Lands in the 1970’s, who acknowledged the advantages of offering mainstream secondary schooling to their young people. The students come from a number of remote communities, most of which are located in the Central and Western areas of South Australia, Northern Territory and Western Australia. Wiltja provides Indigenous students the opportunity to self-determine their future by offering mainstream secondary schooling in a culturally safe and supportive boarding environment located in Adelaide. Project Aim – To build capacity of male students at Wiltja to take ownership of their health and wellbeing and confidently walk in two worlds. Project Need – Male Ninti students expressed a Felt need of ‘lack of student identity and ownership within the male students building’. Approach – A Community Empowerment Approach was used, one that ‘seeks to empower & support communities, individuals & groups to take greater control over issues that affect health. This includes notions of personal development, consciousness-raising and social action’ (Preston et al, 2010).
- Client: Male student’s demonstrated an enhanced capacity to collectively identify their needs, develop an action plan, mobilise resources and address problems impacting on their health and wellbeing.
- Agency: Wiltja Residential Staff supported male students to take ownership of their health and wellbeing.
- Advocacy: The wider community gained an increased awareness of how to support male students to confidently walk in two worlds.
- Project facilitators: experienced increased feelings of competency to walk in their own two worlds and a passion for community development and working with Indigenous youth and communities.
Conclusion The ‘Anangu Ninti Tjuta’ project supported Ninti students at Wiltja to demonstrate leadership, initiative and confidence to collaboratively produce art works that promoted their profile of identity and ownership within the male student’s building. The skills Ninti students learnt throughout the project will be transferable into other aspects of their lives, further supporting them to confidently ‘walk in two worlds’. The project unexpectedly had significant positive personal impacts for project facilitators Kimberley and Tahnee. Providing Indigenous students with an opportunity to undertake a university placement at an Indigenous organisation has enabled project facilitators to more deeply consider how application of health practice can be framed and implemented from an Indigenous view point, further supported project facilitators own ability to walk in two worlds and strengthened their passion for community development and working with Indigenous youth and communities.
4:30pm - Amsant Indigenous Leadership Program
Patrick Johnson is a Kaanju man from Far North Queensland and has 12 years in elite sport, and 20 years in Ambassador, mentoring and media roles. Patrick has had a previous 10 years career in the Department of Foreign Affairs and more than 20 years of advocacy work for equal rights for all Australia’s through health, education and wellbeing. In addition to working as the AMSANT Indigenous Leadership project officer, actively supports NTAthletics Remote Athletics program promoting a healthier lifestyle and wellbeing being through athletics and also works as a sports presenter for ABC Grandstand with Charlie King. Patrick is also on several committees like Co-Chair for Territories for Recognize Campaign and Ambassadorship roles such as Australian Sports Commission Indigenous Sporting program, Fred Hollows Ambassador, Queensland Libraries and Indigenous Literacy Foundation. Patrick took the Leadership position for AMSANT because of his belief in and passion for nurturing the development of current and future leaders within the community controlled health sector. His personal experience of having family members pass away due to chronic diseases such as asthma, diabetes, heart disease, and obesity, has strengthened his resolve to develop leaders in health.Erin Lew Fatt is an Aboriginal woman from Darwin and has been working in the Aboriginal community controlled health service (ACCHS) sector for over 15 years. Erin is the Program Manager at AMSANT, managing workforce policy, workforce support, leadership and accreditation for AMSANT and its members. Erin held previous roles with Danila Dilba Health Service (DDHS) and the Cooperative Research Centre for Aboriginal Health (CRCAH). Erin has also been on the board of Danila Dilba Health Service for over 6 years and is currently the Deputy Chair. Erin holds tertiary qualifications in Business, Project Management and is currently studying a Bachelor of Health Science. Aboriginal Medical Service Alliance Northern Territory (AMSANT) is the peak body to 25 Aboriginal community controlled health services in the NT. AMSANT, through its members, has made a long standing commitment to building leadership qualities amongst the Aboriginal community controlled health sector over the past 8 years. Strengthening leadership remains one of AMSANT’s top strategic objectives to “….work with our staff and member organizations to strengthen our leadership capacity to ensure our communities have a high level of health and wellbeing”. Abstract
The AMSANT Leadership program is building the capacity of tomorrows’ leaders today, through the development of skills, networking and confidence, and the promotion of cultural security in the workplace. The program is built on principles of respect, inclusiveness, diversity and ownership. The program promotes two-way learning, and seeks to empower participants to become leaders in the Aboriginal community controlled health sector. Since 2006, AMSANT have advocated for the need to provide opportunities to its staff and member services to build leadership specifically within our sector. In November 2006, AMSANT commenced its first Annual Leadership Workshop in Alice Springs and has since held six more annual workshops in Kakadu, Banatjarl, Ross River, South Alligator, Mount Bundy and Alice Springs. As well as the annual workshops, the leadership program has continued to provide ongoing support to leadership participants to build opportunities through networking, professional development and other potential opportunities. The Leadership Program addresses the need for a structured leadership development program to:
- identify and nurture emerging leaders within Northern Territory Aboriginal Community Controlled Health services
- strengthen leadership within the sector
- build the future capacity of primary health care services.
Specifically the program targets emerging leaders or future potential leaders from the amongst the staff and Board members of ACCHSs with the interest and capacity to further develop their leadership skills and capabilities. While there a limited number of Indigenous leadership programs across Australia, none specifically target the ACCHS sector. The AMSANT leadership program is contextualised to the Aboriginal health services sector and complements other professional development opportunities available to the Aboriginal health workforce in the Territory. In addition the program enables the sharing of valuable skills and knowledge between ACCHS across NT, which is not a feature of other more generic leadership programs. The Northern Territory labour market, and Aboriginal health in particular, has long struggled to meet employer demand for skilled and experienced workers. Building training and development pathways for existing workers has therefore been critical to address skill shortages. The leadership program meets this need, with a specific focus on creating pathways which build leadership capacity in the NT ACCHS sector, thereby creating a pool of talent to meet current and future demand.
Unique benefits of the AMSANT Indigenous Leadership program
- The development of a leadership program that is unique to the Aboriginal health sector and is driven by the leadership participants themselves.
- Promotion and recognition of local leaders that are heroes in the health sector who work tirelessly in closing the gap.
Interdisciplinary models and approaches
3:30pm - Allied Health Stepping into Action
Vicki Sheehan has been working with Wuchopperen Health Service for the last 2 years and has 30 years of overall clinical experience. Sue Charlesworth is an Accredited Practicing Dietitian. She has worked at Wuchopperen Health Service for the past 8 years, with 25 years overall clinical and community Dietetic experience.
Working as a Team to deliver care to the Aboriginal and Torres Strait Islander community in the Cairns and catchment region, the interdisciplinary, integrated care team as a model for the treatment of chronic illness is not a new concept. Its benefits have been supported in a variety of disorders. Adoption of this model is relatively new to diabetes, however, and requires a shift in how diabetes providers view their roles and relationships, both with patients and with professionals in other disciplines. Wuchopperen Health Service Limited is a community controlled organisation that delivers a suite of holistic primary health care services to Aboriginal and Torres Strait Islander communities across Far North Queensland. The organisation is governed by a 10 member Board of Directors that are elected annually by its members. The organisation has 622 members. The organisation employs approximately 180 staff of which 75% are Aboriginal and/or Torres Strait Islander. Wuchopperen delivers a range of local and regional programs that address the medical, social and emotional wellbeing of families and in addition provides child wellbeing services. Located in the beautiful city of Cairns, with a clinic in Atherton, Far North Queensland, the service area is quite large and extends from Gordonvale in the South, Croydon in the West and East to Yarrabah and North to Mossman with some of the regional programs extending well beyond these boundaries. Since 2012 Wuchopperen Health Service has been developing an environment in which we now have a Dietitian, Diabetes Educator, Optometrist, Podiatrist, Exercise Physiologist and Psychologist working together. While each health practitioner works autonomously they are committed to the concept of a team approach with common goals. This facilitates and efficient flow of clients between the allied health practitioners and doctors within the clinical environment. 2011 – 706 (prior to 2012 only a part-time Dietitian and part-time Diabetes Educator) 2012 – 3,989 occasions of service 2013 – 5,392 occasions of service 2014 – 6,623 occasions of service
How does it work?
- There is the team leader for any management issues, who is the Optometrist Assistant
- There is a collegial respect
- There is communication – email, chart, face to face, phone and team discussion
- Use of electronic charts – using Communicare (software), which allows for recalls to be set up
- Supportive management
- General Practitioners are responsive with referrals to Allied Health Staff
- Grouping of appointments to be all on the one day
- Flexibility and communication by AH staff regarding specific timing and order of appointments
- Encouragement of clients by practitioners, to see other AH staff
- Assistance for clients with transport to Wuchopperen Health Service
- Client centred service, with appointment bookings to suit client as much as possible
- Follow up and reviews booked at the completion of consult
This model of Interdisciplinary Allied Health Care has shown to be sustainable over time. With a team approach now into its 4th year, the staff believe their contribution is significant and that together they can make a difference for the individuals within the community.
4:00pm - The Outcomes from the Many Rivers Diabetes Prevention Project: an Aboriginal community governed program of research for rural children
Nicole is Kamilaroi woman and one of very few Aboriginal Nutritionist’s in Australia; she is currently managing the Go4fun healthy lifestyle program with Hunter New England health in NSW, her previous role for 10 years was health promotion Manager of the Many Rivers Diabetes Prevention program which includes collaborations with Durri Aboriginal Corporation Medical Service in Kempsey NSW, Biripi Aboriginal. Nicole also sits on National, State and regional boards, and she is involved with various NSW state advisory committees. Nicole won a major health award for her work in Aboriginal communities at the 2014 NSW Health awards She is very passionate about Aboriginal health, especially in “closing the gap” through good nutrition.
Dr Gwynn holds a conjoint appointment as post-doctoral research associate in Allied Health with St Vincent’s Hospital Network, Sydney and Faculty of Health Sciences, University of Sydney, co-located with the Charles Perkin’s Centre. Josephine has a background in Occupational Therapy (clinical and academic) and her research over the past 14 years has been conducted in partnership with Aboriginal communities focusing on: nutrition, physical activity, well-being and related determinants; Aboriginal community governance of research; models of Aboriginal community delivered health promotion; and the capacity building of Aboriginal researchers, project officers and community members. Josephine has been awarded awarded a large number of grants including a 5 year NHMRC project grant. She leads the Aboriginal Nutrition and Physical Activity ‘Node’ at the Charles Perkins Centre University of Sydney, and is currently an investigator on 6 programs of research with Aboriginal communities.
The Many Rivers Diabetes Prevention Project (MRDPP) commenced in 2001 at the request of the CEO of Durri Aboriginal Corporation Medical Services (ACMS) in Kempsey, on the mid north coast of NSW. He called for a program “to prevent children from growing up to get diabetes”, and requested that this program for Aboriginal children be inclusive of non-Indigenous children. This presentation will describe impact and outcomes of the third phase of the MRDPP, a program of research and health promotion for Aboriginal and non-Indigenous rural children conducted between 2007 and 2012. The MRDPP addressed the risk factors for type 2 diabetes of low physical activity participation, unhealthy food intake and overweight/obesity; was governed, delivered and supported by the 2 participating Aboriginal communities in partnership with the University of Newcastle; and adopted a ‘bottom-up,’ primarily school-based approach for the delivery of health promotion to all chil dren in the participating regions in school years 5 to 8. The MRDPP was the first Australian study at population level that examines the impact of program to promote healthy food intake and physical activity participation by Aboriginal children and one of a few to do so for rural children in general.
The MRDPP aimed to:
1. Maintain a research collaboration governed by an Aboriginal community.
2. Build the capacity of Aboriginal project officers, Aboriginal Medical Services and the community to deliver, engage in and govern research projects in their communities.
3. Describe the determinants of physical activity participation and healthy food intake for Aboriginal children.
4. Develop and deliver a school-based Aboriginal community governed health promotion program to Aboriginal and non-Indigenous children in school years 5 to 8 designed to improve: children’s knowledge about diabetes; their healthy food intake; and physical activity participation.
5. Evaluate the impact of the health promotion program on children’s: knowledge about diabetes; physical activity levels; fruit and vegetable intake; sugary drink intake; and body mass index.
The MRDPP was evaluated by a survey on diabetes knowledge, food intake and physical activity. Height, weight and waist circumference (anthropometric measures) were also measured. In the summer of 2007/8, 1620 (15% Aboriginal) children from school years 5-8 participated in Survey 1. Survey 2 was conducted in the summer of 2011/12 with 1035 (23% Aboriginal) children participating from school years 5-8.
The Aboriginal successful community governance structure for the research will be described, as will the extensive capacity building approach. Focus groups were conducted to identify the determinants of physical activity participation and healthy food intake for Aboriginal children, and key barriers and strategies to address these are reported. School and community based Nutrition and Physical Activity strategies were developed and delivered, Changes in: diabetes knowledge; food and drink intake; proportions meeting Australian guidelines for physical activity; body mass index will be described. Positive outcomes achieved will be discussed as will recommendations resulting from this research.
4:30pm - A pilot project using telehealth to provide Speech Pathology services with Aboriginal and Torres Strait Islander families
Jordana Stanford is a Gamilaraay woman from far north New South Wales and an Aboriginal Speech Pathologist currently working at The Institute for Urban Indigenous Health. In this role she has pioneered an outreach service to Aboriginal and Torres Strait Islander families in Central Queensland including the use of tele-health to support face-to-face service delivery. She is enrolled in a Master of Public Health (Indigenous Health) at the University of Queensland. Jordana has spent several years working in a mainstream tertiary hospital and outpatient community health setting in Sydney.
The involvement of allied health professionals in conjunction with children who are at risk or who have developmental delays and/or deviations is proven to show better long term outcomes in terms of educational attainment and health. These services have previously been difficult to access for Indigenous Community Controlled Health organisations. There is also a need to better integrate allied health services between the mainstream and community controlled sectors. In response to this the Institute of Urban Indigenous Health (IUIH) partnered with a Community Controlled Health Service in Rockhampton to develop an culturally responsive inter-professional Occupational Therapy and Speech Pathology service for Aboriginal and Torres Strait Islander families.
This service was delivered as part of a suite of services at the Rockhampton Child and Family Centre that works with Aboriginal and Torres Strait Islander families to assist with the access to early childhood education and care; child and maternal health as well as parent and family support. Its vision is to provide an open inclusive place where children and families connect to health, learning and culture. To supplement the fortnightly service a telehealth link-up service was piloted with the IUIH Speech Pathologist based in Brisbane linking up with the families in Rockhampton.
The aim of this paper is to describe the service delivery model used in piloting telehealth Speech Pathology services to support Aboriginal and Torres Strait Islander families with their communication needs. The Speech Pathologist worked towards providing an integrated face-to-face and tele-health service that allowed families to access a weekly therapy service.
To date this service has seen fifteen children and their families from this locally provided services. The number of families involved in telehealth is increasing with each visit. All children have made positive gains in their goals as ascertained using an outcome based five-point scale in a range of areas targeted by both Speech Pathology and Occupational Therapy. Qualitative data from the families which sought to gain the family’s perspective of the telehealth process will also be presented. Conclusion: A fortnightly visiting Speech Pathology and Occupational Therapy service to a Community Controlled Health Service in a regional/rural area can be effectively supplemented by telehealth with integration with an existing Community Controlled Child and Family Centre
Improving Access for Aboriginal and Torres Strait Islander peoples
3:30pm - Evaluation of foot health services for Indigenous community members of the Central Coast NSW
Dr Fiona Hawke is a Lecturer in Podiatry at the University of Newcastle and holds a PhD in Medicine from the University of Sydney. Fiona has received awards for Indigenous Engagement and Work Integrated Learning from the University of Newcastle and an award from The Australian College of Educators for ‘inspiring students’. Fiona also received the award for Best Paper at the 2014 International Foot and Ankle Biomechanics Congress in Busan, South Korea, and the Best New Investigator Award at the 2009 Australasian Podiatry Council Conference, Gold Coast, Australia.
Matthew West – I am currently completing the honours component of my Bachelor of Podiatry (a Bachelor of Health Sciences Honours). I have worked as a Clinical Podiatrist within the Central Coast Local Health District (CCLHD) for one year specialising in wound and diabetic lower limb care. This was an excellent experience and raised many questions about health care delivery. I am an Aboriginal man working in a health field; as such I’m very aware of the inequities that exist between Indigenous and non-Indigenous health outcomes. I am currently engaged in a broad range research to gain an accurate understanding of how these inequalities translate from a national statistic to health outcomes within my local community.
Chronic lower limb problems cause substantial morbidity and mortality in Indigenous Australians. Of Australians 25 to 49 years of age with diabetes, Indigenous Australians are 38 times more likely than non-Indigenous Australians to undergo a major amputation and 27 times more likely than non-IA to undergo a minor amputation. Prevention and early intervention through targeted lower limb health services are key to rectifying the disparity in health outcomes between Indigenous and non-Indigenous Australians.
The Close the Gap Progress and Priorities Report of 2015, prepared by the Close the Gap Campaign Steering Committee, identified that the nation is in a position to make ‘relatively large health and life expectancy gains in relatively short periods of time’ if there is ‘a much greater focus on access to appropriate primary health care services to detect, treat and manage [chronic] conditions’. The Central Coast Health District (CCLHD) services a population of 312,184 people. Of this population, 9,020 (2.89%) identify as Aboriginal and Torres Strait Islander (Australian Bureau of Statistics, 2014). The CCLHD has embedded data on access of foot health services by Indigenous community members but this data has never been retrieved or explored to ascertain the utility of the existing model for the recruitment and retention of Indigenous community members.
The project will explore the utilisation of Central Coast Local Health District lower limb health services by Indigenous people and compare patterns of utilisation between Indigenous and non-Indigenous people.
Data will be retrieved for a 5 year period (2009 to 2013 inclusive) for all occasions of service within the podiatry, diabetes and Nunyara (Aboriginal health) departments. Data for both Indigenous and non-Indigenous people will be retrieved and compared. Excel will be used to produce descriptive statistics to summarise the data.
Results will be presented for the first time at the Indigenous Allied Health Australia 2015 National Conference.
The results of this study will be used to identify gaps in foot health services for Indigenous community members on the Central Coast of NSW. Results may also inform the development of a new podiatry service within the Central Coast Yerin Aboriginal Health Service.
4:00pm - The impact of including an Aboriginal Psychologist and Social Worker within an established Indigenous health service
Michelle Combo grew up in the Gamilaroi area of North-West NSW, moving to Queensland to attend university at 18yrs old. After completing a Bachelor of Psychology (Hons), she began working for Qld Health via the National Indigenous Cadetship Program. Initially working in adult community mental health as a case manager, then obtaining a position with Inala Indigenous Health in 2012. Michelle is also the Chair for the Qld branch of the Australian Association for Cognitive and Behaviour Therapy.
Lesley-Ann Clements is a descendent of Quandamooka and Wakka Wakka peoples. She has had a long career in health, first as an enrolled nurse, then a community worker and hospital liaison officer. She studied social work in 1998 and joined Inala Indigenous Health in 2011. Lesley-Ann is also the Chair of the Board for Kummara Inc, which is a family support organisation.
Establishment of the Inala Indigenous Health Service commenced in 1995, primarily started by Dr Noel Hayman and later built on with Clinical Nurse Consultant Nola White. The clinic is now known as the Southern Queensland Centre of Excellence for Aboriginal and Torres Strait Islander Primary Health Care (CoE). The service was started when staff noted that despite the significant local Aboriginal and Torres Strait Islander population, few Indigenous people attended the Inala Community Health service. What they found was that the service was not culturally friendly or safe for Aboriginal and Torres Strait Islander patients. To fill this gap in service, they decided to work on establishing a special clinic which focused on creating a culturally safe environment for the clients. The changes were made with posters, art work, canvassing for Aboriginal and Torres Strait Islander staff such as Health Workers, and working with the community to build up the CoE. The addition of Allied Health services began in 1998 with a non-Indigenous Dietitian to assist with the Chronic Diseases that many of our clients experience. In 2011 an Aboriginal Social Worker was employed, followed by an Aboriginal Psychologist in 2012. Research was conducted in 2013 to assess the impact of employing the Psychologist and Social Worker in this clinic. Both clients and staff were very positive about the inclusion of a psychologist and a social worker in the primary health care team. The psychologist and social worker recorded 537 and 447 occasions of service respectively in their first year. Referrals to a psychologist, psychiatrist, mental health worker or counsellor increased from prior to the Social Worker & Psychologist working in the service.
The research concluded that increased access by Aboriginal and Torres Strait Islander people to social and emotional well-being and mental health care was improved by responsiveness to community needs; trusted relationships; and shared cultural background and understanding. This presentation will conclude with personal reflections from the Psychologist and Social Worker involved, regarding working as Aboriginal staff within an established primary health care service for Aboriginal and Torres Strait Islander clients.
4:30pm - Bridging the divide: A study of cross-cultural collaboration in the development and delivery of cancer services with and for Aboriginal people
Rick Shipp is the Aboriginal Health Team Leader, Southern NSW Local Health District
Victoria Jones was the project officer for the Aboriginal and Cancer Services Working Together project (2008-2013) and the Psycho-Oncology Service Development social worker (2006 – 2014) Southern NSW & Murrumbidgee Local Health Districts, NSW Health.
Joanna Zubrzycki is an Associate Professor of Social Work, ACU (Canberra Campus). Joanna was the research and training advisor with the Working Together project.
Cancer has become a significant health issue for Aboriginal people and their timely access to cancer services is critical to achieving optimum treatment outcomes. However a common response across cancer services is that Aboriginal people are not visible. Making sense of and responding to this paradox was a central focus of the Aboriginal Health and Cancer Services – Working Together project in Southern NSW and Murrumbidgee Local Health Districts, NSW Health (2008-2013).
The project produced important outcomes in the delivery of cancer services with a nd to Aboriginal people (Simpson et al, 2011). These included increased number of Aboriginal women attending breast screening, production of an Aboriginal men’s health promotional DVD “Early Screening Keeps you Dreaming” and cancer being “talked about” in the community. The development of collaborative working relationships between Aboriginal and non-Indigenous allied health workers was a central feature of the project. Through the sharing of knowledge and experiences new ways of working emerged. Identifying and documenting these collaborative relationships became the focus of a qualitative research inquiry.
The research data provides rich insights into what constitutes the critical foundations of successful cross-cultural collaboration in the planning and delivery of health services to Aboriginal people. A strength of this inquiry, is that the sample consisted of almost even numbers of Aboriginal (n=20) and non-Aboriginal health workers (n=21), thus providing an opportunity to discern potential cultural differences and similarities in how the workers experienced collaborative working relationships. An Aboriginal Reference Group provided cultural advice with the data analysis.
A key finding is that while both the Aboriginal and non-Indigenous health workers regarded this way of working as personally and professionally transformative, some cultural differences emerged in the meanings, processes and actions of collaboration. The conference presentation will focus on these research findings.
Simpson, L., Reid, I., Zubrzycki, J., Jones, V. (2011). A good way of doing business! Working Together to Achieve Improved Outcomes for Aboriginal People in NSW Cancer Services. Aboriginal and Islander Health Worker Journal. March/April, Vol. 35 (2), 12-15.
Culturally Responsive Approaches
3:30pm - “Their voice” through Photovoice: An evaluation of Health Promotion in Cape York Communities
PresentersFiona Millard is Gugu Badhun and Ngadjon-Jii Aboriginal woman from Far North Queensland. For the past five years Fiona has worked as a Health Promotion Officer at Apunipima Cape York Health Council in remote Aboriginal Cape York communities and prior to that at Mookai Rosie Bi-Bayan in Cairns. Fiona completed her Indigenous Health Promotion Post Graduate Diploma and in 2013 was shortlisted as a finalist for the Sister Alison Bush medal for Indigenous achievement from the University of Sydney. Her recent projects include “Photo voice” a qualitative review that empowers people through photography to document community health issues, their needs and other experiences. Photovoice was successfully delivered in the Pormpuraaw and Kowanyama communities with Women’s groups, school and playgroup children and their workers. Fiona lives in Cairns with her husband, Paul, and two sons, Jay and Ty.
“Their voice” through Photovoice: An evaluation of Health Promotion in Cape York Communities Photovoice is a strategy that uses photographs as a tool for social change. The Photovoice project is an opportunity to promote health education, create linkages to other health services and an approach that enhances the sharing of stories and ideas of life changes, culture, customs and traditions. Photovoice was initially identified, by the women’s group in the remote Indigenous community of Pormpuraaw as a way to provide an opportunity to engage, support and communicate their personal and community issues.
Consultation through community engagement workshops was a key process in identifying participation from all groups of women. The aim was to provide an empowering approach to positive and ongoing social changes in attitudes and awareness. The provision of skill development through educational workshops was a strength based approach to increase understanding and knowledge of good health, well-being and social issues that affected the women, their families and community. As a result, Photovoice gave the women the opportunity to:
• Take photographs and share their stories, ideas and concepts in their own way
• Engage, empower and increase women’s participation
• Demonstrate a change in attitudes, behaviour and awareness around decisions that affect health outcomes such as physical activity, nutrition and wellbeing
• Develop community resources
The Photovoice project has enabled strong relationships and encouraged engagement of the community women, elders and organisations. The evaluation process is captured through qualitative themes and changes in attitude and behaviour through reflective processes and methods. This project has also been implemented in the remote Indigenous community of Kowanyama.
4:00pm - Art Therapy
Marnie Weule – I am a recently qualified Art Therapist. Currently, facilitating a therapeutic arts based program for mothers and young children from The Early Years Family Hub in Gympie. Most of my career I have been a Montessori teacher with children and families from birth to 6yrs in many roles and varied environments. Art Therapy has given me tools to use towards allowing a gentle opening into a stronger understanding of myself and my identity, with many varied ways of that expression
What is art therapy? This presentation will provide a brief outline on art therapy and how it has been used historically innately, by people. Art is used culturally as a way to share stories and knowledge. All art making is therapeutic, however art therapy as a profession operates on a continuum of art as therapy toward using art in psychotherapy.
How does art therapy work?
Brief discussion on activating hemispheres of the brain during art making, relationship of art materials to emotional states. The art therapist develops a profound and intimate understanding of different art mediums and how they support an individual’s mental and emotional state. Human need for self and creative expression. As human beings, we all have a need to create ourselves and some aspect of our environment. This expression is vital in both building a person’s life and releasing individual and collective trauma.
Why is it beneficial for all people?
Art therapy give us a visual voice. It is self-empowering; for any age group; culturally appropriate; by using minimal dialoguing it breaks down language barriers and reduces a feeling of not being heard or understood; focuses on a holistic view of metal health and has diverse application, can be used in one to one practise, community group settings, schools, corporate productivity and development. Implications and potential for Indigenous mental health are immense, people are able to work through, trauma personal and vicarious, identify and establish new thought process and practise this new relational pattern in an emotionally safe space. Art therapy creates a more accepting environment for people working through mental health issues because it is client focussed and assessment based rather than diagnosis driven. An art therapist is able to collaborate and contribute in multi disciplinar ian teams bringing to those teams, not only a clinical awareness of mental health issues, but enriching them by diverse and creative thought and practise application.
4:30pm - Narrative Practice Across Discipline
Tileah Drahm-Butler is an Aboriginal Social Worker from Far North QLD. Originally from Brisbane, Tileah lives in Kuranda where she provides Narrative Therapy counselling to people experiencing hardship. Tileah also works at Cairns Hospital as an Emergency Department and Intensive Care Unit Social Worker. Tileah has recently graduated as a Master in Narrative Therapy and Community Work through the University of Melbourne in Collaboration with the Dulwich Centre Foundation. Tileah has worked with the Dulwich Centre Foundation for some time, delivering teaching Narrative Therapy ideas.
This presentation aims discuss the ways that Narrative Practice enables us to tell our stories in ways that make us stronger (Wingard, 2001) and to look at the ways that Narrative Practice principles and techniques can enable a particular way of yarning for Aboriginal and Torres Strait Islander Allied Health Professionals, across discipline. While Narrative ‘Therapy’ began as a way of providing counselling or therapy, many people from around the world have adapted its use within community work settings and outside of the therapy world. This presentation will explore the ways that these practices fit within our cultural way of being, and the ways that we can therefore see our work as political action. From a Social and Emotional Wellbeing framework we view problems, including health problems within a broad context and Narrative practices assist us to talk in particular ways that locate problems within this broad context.
The idea that ‘The problem is the problem, the person is not the problem’ (White, 2007) frees people from internalised understandings to be able to use their knowledge and skill to stand up to problems, including health problems. This presentation aims to look at some of the ways of yarning that might assist Allied Health professionals when talking to people about problems that take up a lot of space in people’s lives. This presentation aims to briefly discuss some key principles of Narrative therapy, then to briefly discuss three main techniques, namely, externalising, re-authoring and migration of identity. The presenter will then discuss pathways for further learning and exploration of the ideas.
Day 2 Concurrent Sessions – 11.30am – 12.30pm
Workforce Development Stream
11:00am - AIPEP – Psychology working to close the gap
Kristen Ella is a proud Aboriginal women from Yuin, South Coast of NSW, with strong family ties to La Perouse, Sydney. She has a Bachelor of Health (Mental Health) and works in the NSW Ministry of Health under MH-Children & Young People as the Aboriginal CAMHS Priority Advisor. She is currently in her second year of studying Graduate Diploma of Psychology at CSU and her aim is to help ‘blacken up the system’ and ‘create equality for our people’.
Kelly Hyde is a proud Wiradjuri women, living in the Bundjalung nation. She is a wife and a mother of three deadly children. She has a Bachelor of Health Science (Mental Health) and works at Lismore Community Mental Health as the Aboriginal Mental Health Clinician. She has also worked for the University Centre for Rural Health as the Aboriginal mentor, co-facilitator for the program ‘ R U Appy’ that focused on the Aboriginal app called Stay strong. She is currently in her second year of studying Graduate diploma of Psychology at CSU. Her aim in the workforce is to help the youth by showing them they can make healthy choices.
Jillene Harris is a Lecturer in the School of Psychology at Charles Sturt University (CSU), NSW where she teaches a first year foundational subject – Indigenous Australians and Psychology. She is the Indigenous Liaison Person for the School of Psychology and has experience in integrating support frameworks between community, education and health sectors. She was the Arts Faculty representative of the Indigenous Education Strategy Coordinating group which oversaw the implementation of this strategy across CSU.
The gap between Indigenous and non-Indigenous mental health and wellbeing is matter of national emergency. Among Aboriginal and Torres Strait Islander peoples psychological distress levels that can impact on mental health and suicide rates are at least twice that of other Australians. While the evidence to illustrate the problems and their causes gathers it is unarguable that two specific changes – increasing the number of Indigenous mental health professionals and increasing the competence of all mental health practitioners to work with Aboriginal and Torres Strait Islander peoples – can make a significant impact. Psychology, as a discipline and a profession, has a key role and responsibility to play in making this change. The Australian Indigenous Psychology Education Project (AIPEP) (www.psychology.org.au/aipep) is a collaborative project funded by the federal Office for Learning and Teaching, and led by Professor Pat Dudgeon of the University of Western Australia. AIPEP aims to address those two specific changes. AIPEP has undertaken extensive data collection with key stakeholder groups to explore the current state of affairs, good practice, and facilitators for change in increasing the inclusion of Indigenous knowledges in psychology education, and increasing the number of psychology students and graduates. This paper will provide an overview of key findings of the project and of the specific deliverables, especially a curriculum framework and strategy for recruiting and retaining Indigenous students. In this presentation we will discuss strategies for implementing and sustaining the changes needed in the education and training of Australian psychologists.
11:30am - Naanggabun Yarning, a cultural model for reflective peer practice and clinical SuperVision
Joanne Dwyer is an Aboriginal woman and mother of three who is traditionally from Gunditjmara country in the western part of Victoria. She was raised in inner city Melbourne and has completed a Bachelor of Arts/Drama, Certificate in Drug and Alcohol and a Diploma in Family Therapy. Joanne is the Team Leader of the Koori Kids and Adolescent Mental Health program at the Victorian Aboriginal Health Service, Family Counselling Program. She has been a Cultural Consultant for the Naanggabun Yarning project staff, has completed the five day Peer Reflection training and facilitated the Cultural Framework for clinical supervisors training. Joanne has previously worked in a range of areas including sexual health and drug and alcohol. Working with her community enables her to build the relationships that support people in their healing. Joanne is looking forward to bringing art into the healing process whether through writing, drama or visual art.
Katherine Bakos is a psychologist and consultant who has worked extensively in the area of Aboriginal mental health. Over the past ten years she has work in Victoria coordinating the development and providing culturally relevant training and resources for the Aboriginal workforce in the area of dual diagnosis. After much consultation with the workforce, research with senior Aboriginal staff and meeting with Cultural Consultants groups they have together produced “An Introduction to Dual Diagnosis for Aboriginal workers”; Our Healing Ways resources for supporting clients to heal and the Naanggabun Yarning model and framework for peer reflection and SuperVision. Katherine also has a private practice where she supports the wellbeing of Aboriginal clients with mental health and drug and alcohol issues and provides external SuperVision to a range of Aboriginal staff.
The aim of this presentation is to introduce people to Naanggabun (wise) Yarning, a culturally relevant model and framework for developing a reflective practice with peers and clinical SuperVision. We will also be providing evidence of the effectiveness of the framework through the evaluation of the Aboriginal Peer Reflection training. A Cultural model for clinical or practice SuperVision was initiated by the Social and Emotional Wellbeing Unit at the Victorian Aboriginal Community Controlled Health Organisation in 2012 after a needs assessment of the workforce identified SuperVision as a top priority for workers. The Naanggabun Yarning framework for peer reflection and SuperVision was developed through a process of consultation and research. Drafts were developed, language was explored, pilot groups were run and an action research approach was taken. This meant that the process of developing the training was an ongoing one. Coming to the waterhole is the metaphor for coming to peer reflection whether in a group or a one on one situation. Peer reflection is a place to stop, become grounded, reflect on the work, and for workers to grow in their role and take care of themselves so they continue to provide the best support for their clients. The waterhole is a metaphor for stopping, reflecting, calming the spirit, and for staff to nurture and refresh themselves. The Cultural model is at the centre of the Naanggabun Yarning framework and has four components; all the work is grounded in community and impacted by culture. It explores the positives of working with community and the challenges of community expectations and cultural obligations. Clients and their families are supported to do their best through workers looking after themselves and growing professionally in their roles whilst being valued by and accountable to their organisation. The Naanggabun Yarning framework acknowledges the importance of having a reflective practice that incorporates an action phase; that feedback is provided through observations and a strengths based approach; that peer reflection is based on equal relationships where everyone has something to contribute. Peer group reflection is structured to give everyone a go. Three training programs were developed during this project. These were; 1. Peer Group Reflection for Aboriginal staff 2. One on One Peer Reflection for senior Aboriginal staff 3. A Cultural Framework for clinical supervisors of Aboriginal staff Over 120 workers have completed the training programs. Participants connected with the Naanggabun Yarning model and framework. The Cultural model captured the complexity of their work yet presented a simple way of identifying and understanding it. The framework gave people processes that were culturally relevant and strengthening. As one participant said using the processes makes the work easier “Be effective, creative, work smarter not harder, use model to relate to each person’s needs”. It was also seen as “a wellbeing tool that should be in all Aboriginal organisations”. The goal of this training is for a healthy, strong and resilient workforce that continues to grow professionally and provide the best possible support for clients and community.
12:00pm - Stepping into action: Workforce development in an urban Indigenous health organisation
Presenter Alison Nelson is an occupational therapist and Director of Workforce development and Allied health at The institute for Urban Indigenous Health. Alison has been working and learning in Indigenous health for 20 years. This has included completing a PhD exploring the place and meaning of health and physical activity in the lives of urban Indigenous young people and establishing a range of inter-professional clinics within the urban Indigenous community-controlled health and education sectors.
Abstract Background – Developing an effective allied health workforce in Indigenous health requires an inter-disciplinary and integrated approach across schools, universities and workplaces. It also requires a multi-pronged approach of developing pathways for Indigenous students into allied health careers and developing the cultural responsiveness of both Indigenous and non-Indigenous allied health professionals as they move from university to work. The Institute for Urban Indigenous Health (IUIH) in South-East Queensland has been developing its allied health workforce over the past 5 years. This has been integrally linked to growth and reform in comprehensive primary healthcare within the Indigenous community-controlled health sector. IUIH’s workforce development program has aimed to:
- Increase the number of Indigenous students entering into careers in health
- Develop pathways for Indigenous students from high school to university and then employment
- Increase the number of allied health professionals working in the Indigenous community controlled health sector in South-East Queensland
- Increase the allied health workforce’s cultural responsivity in practice
- Develop inter-professional student and graduate opportunities
Aim – This presentation will outline IUIH’s workforce development initiatives and highlight key outcomes, including a research evaluation of student placement outcomes.
Results – IUIH’s workforce initiatives have resulted in growth from 1 allied health professional employed in 2010 to 35 employed in 2015 and 30 students placed in 2010 to 330 students placed in 2014. IUIH has also developed a school-based training program in allied health and fitness assisting which targets young people with significant barriers to academic success. This has resulted in an increase in university and employment opportunities. Several key learnings from this work will be presented including the importance of cultural mentors, pastoral care and graduate support, as well as key leadership from Indigenous allied health professionals.
Conclusion – The development of a culturally responsive workforce in Indigenous health and a growth in allied health positions within Indigenous health services can be achieved and maintained with strong partnerships across schools, universities and Indigenous workplaces when integration and Indigenous leadership are key drivers. IUIH has developed a workforce pipeline model to reflect this.
Interdisciplinary models and approaches
11:00am - Visual Impairment – Early Rehabilitation Intervention for Aboriginal and Torres Strait Islanders
Kathryn Martin is an Occupational Therapist working in Brisbane. She is of Aboriginal, Dutch and British decent. For the past two years she has worked at Vision Australia with adults and children who have low vision or who are blind to live the life they choose. She has been working with local Aboriginal-controlled health services in the greater Brisbane area using new models of service delivery formalised through Memorandums of Understanding. Recently she travelled to Far North Queensland to provide independence skills training to adults in a remote town. She lives in Ipswich and is married with four primary-school aged children.
The National Indigenous Eye Health Survey (2015) reported that vision loss is the third leading cause of the Gap in health – ahead of trauma, stroke and alcoholism but behind heart disease and diabetes. Alarmingly, 94% of vision loss is preventable or treatable and 35% of Aboriginal adults have never had an eye exam. Diabetes has a prevalence of 37% in the Aboriginal and Torres Strait adult population – and 13% of these already have vision loss, with many more at risk. When working with people with chronic illnesses, such as diabetes, health professionals immediately refer their patients to diabetes educators; exercise physiologists/physiotherapists, dieticians etc. but rehabilitation intervention for visual impairment is not immediately considered. Many health professionals are not aware that training for their patients in Adaptive Technology, Orientation and Mobility and Occupational Therapy is available. Therefore, referrals to visual rehabilitation organisations are not being completed and people with vision impairment do not receive the assistance they require. A Queensland Orthoptist recently commented that one of her staff members asked her “Now we’ve identified this person has low vision, what do we do with them?” Good question! Vision Australia is a leading national provider of blindness and low vision services in Australia. We work in partnership with Australians who are blind or have low vision to identify and achieve their goals and aspirations. Vision Australia would like to support more Aboriginal and Torres Strait Islander people and we are currently implementing innovative practices and programs to achieve this. For example:
- Our Aboriginal and Torres Strait Islander Community Engagement Worker (based in Queensland), has established Memorandums of Understandings (MOUs) with Indigenous health organisations in Brisbane and the Gold Coast. These MOUs state that Vision Australia staff will visit the health organisations regularly to have an informal ‘yarn’ with referred patients.
- Vision Australia is changing our eligibility criteria to include people who are not legally blind but who take off spectacles and cannot read/see clearly enough to complete everyday tasks.
Early intervention is important and we are striving to work with people who are in the initial stages of visual loss. Early intervention can significantly reduce stressors related with low vision such as anxiety, grief, depression and low self-esteem. Equipping a person with alternate strategies, for completing activities of daily living, increases their functionality and independence. The conference presentation will discuss the partnerships and programs currently being developed and give examples of positive outcomes via client’s stories.
11:30am - Stepping Into Action Towards Closing The Gap In Indigenous Health
Maisie James is an Aboriginal woman from Palm Island with connections to JIRRBAL and MAMU (Tully and Innisfail) and KUDJULA (Charters Towers). She started her career in health in 1998 as a Generalist Health Worker on Palm Island did various other roles as a Health Worker and is currently working as the Senior Health Worker with the Aboriginal and Torres Strait Islander Health Program (Townsville Community Health Service) based at the Kirwan Health Service Campus, Townsville. Maisie is passionate about helping her mob and has been imparting health education and information to the community in her role as health worker. She has conducted a number of group education sessions and provides some clinical services too. Achamma Joseph has been working for over 25 years with Indigenous peoples as a nutritionist, dietitian and diabetes educator. She is passionate about improving health outcomes for these people and has been running education sessions on healthy eating and lifestyle changes. She currently works at the Townsville Community Health Services and provides outreach services to Palm Island and Townsville Aboriginal and Islander Health Services in her role. She works closely with the Aboriginal & Torres Strait Islander health workers and is fascinated by their rich culture and heritage and is a strong advocate of preserving this richness. She considers it a privilege and honour to be able to walk the journey with the Aboriginal and Torres Strait Islander peoples of Australia.
Background -Queensland Health Nutritionists and Indigenous Nutrition Health Workers identified a gap in culturally specific weight loss programs for Aboriginal and Torres Strait Islander peoples. As as result an evidence based “Healthy Weight Program” was designed in 1997 which in 2007 was revised and renamed as “Living Strong Program” (LSP). LSP is a group based healthy lifestyle support program focusing on behaviour change to improve health and well being. Objective – To encourage behaviour change in Aboriginal and Torres Strait Islander adults in Townsville with regards to their eating and lifestyle
Methodology -LSP includes health screenings and 10 workshops, addressing various lifestyle issues, healthy eating, physical activity, self-esteem, behaviour, etc. It also incorporates practical sessions on cooking, shopping and budgeting. The Townsville Community Health Services, Aboriginal and Torres Strait Islander Health Program (ATSIHP) has been conducting the LSP in the community for various groups. The ATSIHP health workers run these sessions on a fortnightly basis of 11/2 hours duration at community centres. These interactive sessions have been conducted for women from the ages of 18 years and above. Participants are not only clients with health conditions but also their carers. Formal and informal evaluation are conducted after the sessions.
Outcomes – A maximum of 12 people attend these sessions at a time for the 10 workshops. 100% of participants have made some significant changes to their eating habits – reduced intake of fats and sugars, sugary drinks, etc; increased intake of fruit and veggies; increased intake of water. 25% of the participants having started walking every day, while others have included some activity 2-3 times per week. 75% of the participants have increased their incidental activity by parking cars away and walking, etc. One of the participants is on the quit smoking program. 100% of the participants have started attending health check-ups regularly and are taking a more active role in their health care. The flow on effect of the LSP has been that these participants have started to educate their families too. Most participants were the main family providers and therefore have been implementing changes for the whole family.
Conclusion – Townsville ATSIHP health workers have been stepping into action and making a concerted effort to improve health outcomes for their community members by offering the LSP. These changes will no doubt improve quality of life and help towards closing the gap for Aboriginal and Torres Strait Islander peoples in reducing the burden of chronic diseases.
12:00pm - Allied health services 'while you wait'
Elizabeth Watson is the Senior Speech Pathologist on the Child and Adolescent Community Health, Aboriginal Health Team in Perth, WA. She has been in the role since its creation in 2011, helping shape the delivery of accessible and culturally appropriate speech pathology services to Aboriginal children in the Perth metropolitan area. Elizabeth was born and raised in Perth, Whadjuk Noongar country. She completed a Bachelor of Science (Human Communication Science) at Curtin University and has worked as a Speech Pathologist for the Department of Health since 2008 in both rural and urban settings. She began her professional career working at Kalgoorlie Regional Hospital in WA’s Goldfields, where she developed a passion for working with Aboriginal children and their families. Moving back to Perth in 2010, Elizabeth worked at the Child and Adolescent Community Health, Child Development Service, before being approached to take up the role with the Aboriginal Health Team. Elizabeth is the WA representative on the Speech Pathology Paediatric Indigenous Network (SPPIN) steering committee, a national network for Speech Pathologists who work with Aboriginal and Torres Strait Islander children.
Casey Winton was born and raised in Perth, Western Australia. She studied Occupational Therapy at Curtin University, taking the opportunity to participate in practical placements in rural and remote towns in the north-west of Western Australia. It was here that her interest in Aboriginal Health began. Since graduating in 2006, Casey has enjoyed working in numerous country areas to further expand her occupational therapy and Aboriginal Health experience, knowledge and skills. To broaden her world experiences and follow her interest in exploring other cultures, Casey also worked in the UK for a year. Since 2012 she has been the sole Occupational Therapist on the Child and Adolescent Community Health, Aboriginal Health Team covering the Perth metropolitan area. Last year the Aboriginal Health Team was awarded the Rotary Allied Health Excellence Award for Excellence in Community and Primary Health Care. Casey is passionate about Aboriginal Health and working in partnership with Aboriginal families to assist their children to grow up healthy, happy and strong.
It is well recognised many Aboriginal families face barriers when accessing mainstream allied health services. In Perth, Western Australia, the Department of Health, Child Development Service provides allied health services to children with a wide range of developmental concerns. The Child Development Service acknowledged that they were not providing a service that was easily accessible or culturally appropriate for Aboriginal families. Aboriginal children were found to be under-represented in referral numbers and staff reported high rates of non-attendance at appointments. In 2011, positions for a Speech Pathologist and an Occupational Therapist were created in partnership with the Child and Adolescent Community Health, Aboriginal Health Team (AHT) to provide an alternative service for Aboriginal families. AHT supports Aboriginal families with children aged 0-5 years in the Perth metropolitan area to raise happy, healthy children.
Aboriginal Health Workers and Community Health Nurses work together to deliver the Enhanced Aboriginal Child Health Schedule, with 14 scheduled child health checks completed in the home or at the local clinic. AHT provides a range of other services for families including multidisciplinary clinics, immunisation, ear health clinics and Health Promotion programs.
Originally, the multidisciplinary clinics had a medical focus, with families attending the clinic to see a General Practitioner for child and maternal health concerns. Following consultation with the community, the Speech Pathologist and Occupational Therapist designed a culturally responsive, unique service delivery model, providing interdisciplinary, paediatric allied health services in the waiting room space at these clinics. The clinics are now a one-stop shop for families, allowing flexible access to both primary health and allied health services in the one location. Working in the waiting room space creates a relaxed, non-threatening atmosphere to build lasting relationships with children and their families. We provide fun, play activities with a focus on child development and school readiness. Engaging the children in play allows us to complete informal screening of all aspects of child development to assist in the early identification of delay. Yarning with the families while they wait to see the Doctor allows us to share information about child development in a conversational style.
We work in partnership with families to choose goals that build on the child’s strengths and model strategies that can easily be incorporated into the family’s day-to-day routine. This innovative, culturally responsive service delivery model has been well received by the local Aboriginal community and is successful in providing allied health services to families that may otherwise not have engaged in the mainstream Child Development Service. In 2014 we were awarded the Rotary Allied Health Excellence Award for Excellence in Community and Primary Health Care. We are excited to share with you our service delivery model, the benefits of this approach and the results of our recent Client Satisfaction Survey.
Culturally Responsive Approaches
11:00am - Partnering to develop culturally responsive practice in occupational therapy
Trevor Ritchie is a Kaurna man from Adelaide, South Australia. Growing up he spent much of his time alternating between the Yorke Peninsula and the west coast of South Austra lia, both in Aboriginal missions. Trevor’s family settled down in Adelaide so he and his siblings could have consistency and concentrate on their education. Trevor was 28 when he finished his Bachelor of Applied Science (Occupational Therapy) in 2013, and is the first Aboriginal person to graduate from the University of South Australia with this degree.
Alison Nelson is an occupational therapist and Director of Workforce development and Allied health at The institute for Urban Indigenous Health. Alison has been working and learning in Indigenous health for 20 years. This has included completing a PhD exploring the place and meaning of health and physical activity in the lives of urban Indigenous young people and establishing a range of inter-professional clinics within the urban Indigenous community-controlled health and education sectors.
Background – There is increasing recognition of the need for increased cultural responsiveness among allied health professionals. In 2013 a group of First Australian and Australian occupational therapists developed an approach to building the capacity of occupational therapists to provide best practice and culturally responsive services to First Australians.
Aim – The aim of this presentation is to describe the approach utilised by the facilitators to develop, deliver and evaluate the capacity building workshops.
Approach – Three workshops took place from 2013 – 2014 in South Australia, Victoria and Queensland. To date, nearly 60 occupational therapists have attended. Facilitators collaborated with key First Australian services and organisations (eg. Community controlled Aboriginal Medical Services and Indigenous Allied Health Australia) to support the workshops. The facilitators worked together to develop inclusive and interactive workshop content which encouraged reflective processes and used the strengths of each facilitator. These workshops were evaluated using the heads, hearts and hands methodology. Results – Eight main themes were identified from the evaluation. These were:
- Understanding First Australian perspectives
- Developing Strategies
- OT in Practice
- Motivation for Change/inspiration
- Deepening Knowledge/Experience
The action-oriented workshop format, which focussed on utilising evidence, stories and practice strategies, was an inclusive and supportive approach to build participants’ capacity to provide occupational therapy service to First Australians. Facilitators who were both First Australian and Australian occupational therapists from varied geographical and practice areas, enabled a rich learning experience for both facilitators and participants.
11:30am - Developing stroke community rehabilitation services in Cape York through a community based culturally appropriate stroke clinical service
Louisa Salee comes of an Indigenous Health Worker background, started with Torres and Northern Peninsula Area District and ventured out to Cairns and was soon exposed to working in the Cape York region. Being of Torres Strait Islander background has since then developed an interest in working for and within the Cape communities as the majority of the descendants are of Aboriginal inheritance and Louisa’s children are both of Torres Strait Island (mother’s side) and Aboriginal (father’s side) heritage. Louisa has worked in various management roles and have developed skills and knowledge in the fields of management. Louisa is currently the Manager Family Health Unit (Outreach) and is based in Weipa. Family Health Unit provides wide range of programs and projects with “Developing Stroke Community Rehabilitation Services” being one of the projects. Since the conception of Louisa’s first child in 1991, Louisa’s focus in life changed and wanted to contribute to helping fellow Indigenous people and started focusing on health after five long years Louisa finally had the opportunity and was employed as a trainee health worker at Umagico Primary Health Care Centre in 1996
Fiona Hall worked upon graduating as a psychologist as a counsellor in educational, community and hospital settings in rural, remote and metropolitan locations in Australia. Following this she worked as a clinical psychologist and researcher providing mental health services for more than a decade and completing post-graduate studies in clinical hypnotherapy and acute care in the community. The last seven years in the workforce have been committed to progressing the National allied health workforce and mental health reform agendas through the management of Statewide projects and programs, during which time she completed her Doctorate. Fiona lives with her family in Cairns, North Queensland and works for the Allied Health Professions Office of Queensland, Health Service and Clinical Innovation Division, where she manages statewide strategic workforce planning and policy development activities and provides strategic leadership to allied health professionals in the Cape York Hospital and Health Service of Queensland Health
Background – The rate of stroke for Aboriginal and Torres Strait Islander people is 1.7 times as high compared to other Australians, with stroke also recognised as the leading cause of disability. For the people of the Torres and Cape Hospital and Health Service, a higher prevalence of stroke risk factors, disease burden, death rates, and hospitalisation exists and is associated with socioeconomic disadvantage, remoteness and Indigenous status. Delivery of community based stroke services in remote areas has been difficult due to geographical isolation and lack of resources. People from the Cape York Communities who have had a stroke have been required to travel hundreds of kilometres to access stroke care. They remain away from their community from acute admission, through to discharge from rehabilitation with very few services available in their communities after discharge. A need for a change in the model of care to provide these services locally has been driven by consumers, community members, clinicians and allied health leaders.
Method – Provision of a community rehabilitation service to stroke survivors, in 5 remote Aboriginal communities across Cape York (Aurukun, Coen, Kowanyama, Lockhart River, Pormpuraaw), by a visiting physiotherapist and speech pathologist, with flexibility of visit duration and frequency, based on individual community needs. The focus of the community rehabilitation service is holistic, places emphasis on client goals to address individual needs, builds confidence and promotes independence and participation within home and community contexts. Consistent with the core principles of community rehabilitation, the service has aimed to work with, and strengthen, existing community support networks. Culturally appropriate resources have been developed to enhance delivery of follow-up stroke services in remote Cape York communities, including culturally appropriate assessment and intervention tools and resources for allied health professionals working with Aboriginal and Torres Strait Islander people living in Cape York. Culturally appropriate education and training has been provided to stroke survivors, carers, their families and health service staff in each community.
Results – Stroke survivors have reported high levels of satisfaction with the services provided including assessments and rehabilitation according to self determined meaningful goal. Working relationships with Cape York communities and local service providers has increased and health workers and family members have reported high levels of satisfaction with culturally appropriate stroke education.
Discussion – Key stakeholder consultation outcomes and feedback gained from stroke survivors and primary health care community staff has been used to generate recommendations for the sustainable delivery of multidisciplinary community rehabilitation services in Cape York. Recommendations from the initial trial suggested the communities surveyed (Lockhart River and Aurukun) required a generalist model of community based rehabilitation with a high demand for Physiotherapy services compared to Speech Pathology. The roll out of the service from February 2015 to the end of June 2015 to all five communities resulting in three visits to each community (excepting two for Coen) utilised a Physiotherapist only. Visits were mostly Monday to Thursday with half day required for travel to and from each community.
12:00pm - Culturally responsive methodology for the communication assessment of Australian Aboriginal children
Tara Lewis is an Iman woman from the Taroom Country of Western Queensland. She grew up in Brisbane and graduated with a Bachelor of Speech Pathology in 2002. Tara has been working in Aboriginal and Torres Strait Islander paediatrics for 13 years and has recently been awarded a research scholarship with the Lowitja Institute to complete her Masters of Philosophy at the University of Queensland. Tara currently works with the ‘Institute for urban Indigenous Health’ in Brisbane where she is the clinical lead in speech pathology, provides clinical speech pathology services for Aboriginal and Torres Strait Islander children and provides supervision to students on prac placements. Tara is also a guest lecturer at the University of Queensland. As a child she remembers following her older cousins around and listening to her Yarboo, brothers and cousins singing around an open fire. This gave Tara the inspiration to turn her childhood memories into an illustrative expressive and receptive language assessment that ensures Aboriginal children receive ethical assessments as well as appropriate language and literacy support.
Allied Health Practitioners are becoming increasingly aware of the importance of using culturally responsive assessments to inform diagnoses and intervention for Australian Aboriginal children. Although practitioners are aware of some of the issues surrounding the perceived efficacy of standardised assessments, their use continues in many situations, possibly due to the lack of appropriate informal or commercially available alternative assessments to inform their services or practice. This continued use has implications for the Aboriginal child being assessed as cultural differences; Aboriginal ways of communicating and Aboriginal English are not taken into consideration, which in turn may invalidate the results.
Current methodologies in the assessment of Australian Aboriginal children has been researched by and validated on non-Indigenous people. There is very little research regarding culturally responsive assessment methodologies that has been conducted by Aboriginal people and validated for Aboriginal people.
This presentation aims to discuss the Indigenist research being conducted by an Aboriginal speech pathologist that is studying the attitudes and beliefs Aboriginal people and speech pathologists have toward communication. The presentation will discuss the qualitative data collected and analysed through focus groups and surveys with Aboriginal people and speech pathologists and how this data will inform a culturally responsive assessment methodology for the communication assessment of Australian Aboriginal children. This research has current and future significance for health and education professionals working with Aboriginal children. There is currently no validated Indigenous Methodology for the assessment of the communication abilities of Australian Aboriginal children. The methodology that is developed through this research will inform speech pathologists and other allied health professionals as well as significant others, Aboriginal Health Workers, and Community Liaison Officers of a culturally responsive assessment methodology for Australian Aboriginal children. The findings of this study have the potential to be used more broadly to inform the assessment practices of other education and health professionals. An expansion on this research will be to incorporate this methodology into a communication assessment and validate its usefulness for the assessment of Australian Aboriginal children aged five years to eleven years.