Quality of care collaborative Australia: delivering education in paediatric palliative careAuthor/s
Julie is currently the paediatric palliative care educator for Quality of Care Collaborative Australia Delivering Education for Palliative Care, South Australia. With a background in paediatric haematology / oncology nursing, adult palliative care nursing, and community nursing she commenced work as Clinical Practice Consultant in the Paediatric Palliative Care Service (PPCS), Adelaide SA in 2007. Julie has a Graduate Diploma in Palliative Care, and in 2012 co-authored the bereavement audit, Saying Goodbye, which investigated bereavement support services across the Women’s and Children’s Hospital. In 2015 Julie edited and coordinated the launch of the website Grief support following the death of a child in response to the report recommendations, on behalf of the PPCS <www.wch.sa.gov.au/griefsupport>.
‘If you have seen one country town, you have only seen one country town’ Larson 2009.
Caring for children with a life limiting or life threatening illness is a rare and imposing privilege. Health care professionals will seek evidence based resources and expert support to ensure they provide the best care for kids facing serious illness.
Quality of Care Collaborative Australia (QuoCCA) is a new project that aims to build community capacity in paediatric palliative care knowledge, skills and confidence, by delivering specialist education and support at the site of care.
This federally funded two year project is coordinated through the Paediatric Palliative Care Service (PPCS) Children’s Hospital Queensland, and will be rolled out across Australia by state paediatric palliative care services.
The project began earlier this year in South Australia with a Pop-up to Kadina and scheduled session in Mt Gambier. The outcomes, learning and feedback for the project will be discussed with an invitation to health care professionals in the Northern Territory to access free specialist education that is meaningful to their local services.
Keeping it local: using elearning and simulation to teach RMDP for paediatricsAuthor/s
Louise Dodson a Nurse Educator with Simulation Training on Resuscitation for Kids team (SToRK) and a background in paediatric emergency nursing.
I have an interest in simulation training as a catalyst for behavioural change through reflection with the goal of improving outcomes for sick children under our care.
Over the past 2 years I have had the pleasure in meeting and working with likeminded clinicians and educationalists across the state of Queensland. In working with these clinicians, I have gained a huge respect for the highly skilled clinicians who work in rural and isolated locations and a humble appreciation for the challenges they face.
The ability to recognise deterioration, escalate concerns and implement resuscitation procedures is crucial for positive outcomes for the sick child. Paediatric resuscitation is a rare event in most regional, rural and remote clinicians’ practice and therefore the opportunity to develop skills is limited.
RMDPP is a time efficient, low cost, paediatric life support course for all healthcare workers caring for sick children. The design is flipped classroom style with interactive e-learning modules and a four hour face to face program. As well as standard basic paediatric life support the course covers paediatric assessment, use of an early warning tool, airway management, vascular access, defibrillation, the principles of clinical handover and human factors training using simulation.
The train-the-trainer model increases the capability of local educators to deliver the course within their healthcare service. This includes a learning needs analysis, site and equipment assessment, course delivery, follow-up mentorship and evaluation.
Implementation state-wide commenced in March 2014. As of August 2015, 1731 clinical staff have completed the RMDPP course, and an additional 321 staff have been trained as trainers to deliver the course. 9141 people have completed the e-learning modules.
Participants have described an increase in their knowledge, confidence and ability to recognise and respond to the deteriorating child. Anecdotally there are reports of the principles being applied in practice and affecting outcomes in real children.
BRAVE kids in the country: outcomes for young people accessing BRAVE self-helpAuthor/s
Dr Caroline Donovan is Senior Lecturer at Griffith University in Brisbane, Australia. Her research focuses largely on the treatment of psychopathology in youth and spans numerous disorders including anxiety, depression, body dysmorphia, eating disorders, autistic spectrum disorders and obesity.
Central to her research is the use of technology in the treatment of youth mental health issues. She is a co-developer of the BRAVE-ONLINE programs that have been rolled out nationally through beyondblue and which have now had over 10,000 registrations.
Dr Donovan has received over $1.2 million of funding throughout her career, and has published 9 book chapters and 31 refereed journal articles. She is on the Editorial Board for Child Psychiatry and Human Development and Australian Psychologist. Dr Donovan regularly presents papers at national and international conferences, the most recent of which was in Montreal, Canada. She is also a clinical psychologist and maintains a small private practice working out of the Griffith University Psychology Clinic.
Up to 80% of children and teenagers who have anxiety don’t have anyone helping them with their concerns, despite the considerable impact of anxiety on young people’s social, emotional and academic functioning, and its propensity to persist into adulthood. Unfortunately, this problem is exacerbated for young people in non-metropolitan communities, where access to specialized psychological services can be limited. BRAVE Self-Help empowers young Australians to overcome their anxiety using an online, Cognitive Behavioural Therapy (CBT) program. Supported by beyondblue, the BRAVE Self-Help Program is freely available, and can be accessed from anywhere, at any time by both young people and caregivers. In its first 17 months, over 9400 people have registered for the program, with 40% logging on from regional, rural and remote areas. Results indicate that young people with anxiety who engage in the program show significant improvements, even without the support of a therapist. This presentation will provide a summary of outcomes of the program to date, with a specific examination of regional participants. It will discuss ways that school-based professionals in rural and regional areas are effectively using the program to suit the needs of the young people and families they work with.
Connecting the family with care: integrated care models for rural childrenAuthor/s
Lisa Altman is the Integrated Care Manager for the Sydney Children’s Hospitals Network, supporting children with chronic and complex conditions to reduce the impact of the condition on the child and their family. Lisa is managing 6 project streams in partnership with local health districts and primary health networks in Murrumbidgee, Western Sydney and South Eastern Sydney, and consumer support organisations, to develop individual models of care for these children. Over the last five years she has worked exclusively on Health programs, from leading a project team of 60 in securing the Fiona Stanley Hospital Systems Integration and Communications Technologies contract to her last role as the Director of Health for British Telecom (BT) in Australasia. As founder and inaugural chair of the One in Four Lives industry campaign to promote Telehealth as a sustainable business model in Australia, Lisa co-authored the One in Four Lives: The Future of Telehealth in Australia White Paper which was launched in 2014. Lisa was previously Head of Major Deals for BT in South East Asia, based in Singapore.
Background: The challenges of navigating the health system for families who are managing their child’s chronic and complex condition are exacerbated in a rural setting. Local expertise in complex paediatric conditions is limited, requiring families to frequently travel long distances to access care for their child, often at their own expense.
Approach: The partners representing tertiary, secondary and primary care organisations, are developing an integrated care model for children requiring complex ongoing healthcare. This model will incorporate remote access to specialist advice for local care providers, collaboratively developed pathways to support ‘point of care’ decisions and accessible patient-held care plans to enable communication.
Outcomes/results: Outcome measures include a reduction in unnecessary presentations to the secondary and tertiary facilities and a reduction in the travel and/or accommodation costs to the family.
Take home message: An Integrated Care model will support both the family and the local clinicians providing care for a child with a complex and chronic condition. The challenge of remote and scarce resources can be overcome with an Integrated Care model that provides a ‘health service’ approach, instead of the current silos of healthcare delivery across primary, secondary and tertiary care.
Improving the management of the febrile child with cancer in regional QueenslandAuthor/s
Rachel Edwards is a registered nurse with 21 years' experience providing care to patients with haematology and oncology conditions. Rachel currently works as a Nurse Educator for the Queensland Paediatric Palliative Care, Haematology and Oncology Network, and the tertiary Oncology Services at the Lady Cilento Children’s Hospital, Children’s Health Queensland, Hospital and Health Services (CHQHHS). In this role Rachel provides educational leadership, develops curriculum, and facilitates training programs for staff employed in the CHQHHS and across the State in the Regional Paediatric Shared Care Units. Rachel is the current Chair of the Nursing Sub-Group of the Australian and New Zealand Children’s Haematology and Oncology Group (ANZCHOG) and is providing nursing leadership to the group as they develop a nursing research agenda and embark on nursing research activities.
Neutropenic fevers are the most common emergency presentation in children with cancer, with a risk for rapid progression to septic shock. Optimal care requires the child to be assessed and have intravenous (IV) antibiotics commenced within one hour of presentation. A retrospective audit of fever management in Queensland oncology children identified several challenges in meeting this target and managing this cohort of patients in the regional setting. A clinical pathway for suspected neutropenic sepsis was developed and implemented across the regional paediatric oncology share care units in Queensland to improve time-to-antibiotics (TTA) for this patient cohort.
A prospective observational cohort study is underway to assess all children 0 -18 years with cancer who present to both regional and metropolitan hospital facilities with a fever and suspected neutropenia (neutrophil count < 1.0 X 10^9/L). Data is prospectively collected for all presentations including the time and place of presentation, time of initial assessment, immediate actions taken, time to commencement of IV antibiotics, type of IV access and associated issues, and clinical pathway usage. Caregivers participate in a telephone survey that captures data including time of fever onset, time taken to access health care, and factors that delay treatment. Clinicians are also invited to participate in surveys/ interviews which evaluate the impact, usage and /or barriers to usage of current fever management guidelines.
Data from this study reports on the incidence and TTA of suspected neutropenic presentations in children across Queensland. Preliminary data suggests that the intervention of the suspected neutropenic sepsis clinical pathway has improved TTA in this cohort of patients. Factors that have already been identified to contribute to delays in treatment include regional models of care, appropriate triaging, central venous access devices, and emergency department use of the clinical pathway. These factors may impact optimal clinical outcomes and warrant further scrutiny for improvement and potential targeted intervention.
Optimal management of fever in children with cancer is crucial to prevent progression to sepsis. The development and implementation of the clinical pathway for the management of suspected febrile neutropenia appears to have improved fever management. However, further evaluation is necessary to identify other barriers to the provision of safe and reliable care in regional Queensland.
Perinatal and infant mental health telehealth pilotAuthor/s
Dr Andrea Baldwin is a Service Development Leader at the Queensland Centre for Perinatal and Infant Mental Health (QCPIMH). In this role she works to promote the importance of mental health and wellbeing in the perinatal period (for parents) and infancy (for children). QCPIMH fosters mental health promotion, service development, research and evaluation, to improve the mental health and social emotional wellbeing of parents, infants and families across the state. Andrea has worked clinically as a Psychologist in child and youth mental health, and in a number of managerial, research and education management positions. Andrea grew up in rural and remote communities, principally Murgon in Queensland’s South Burnett. She has a keen interest in rural and remote service development, including workforce development and the fostering of collaborative relationships across sectors, services and disciplines, to deliver better outcomes for country kids and families.
Naomi Kikkawa is the Rural and Remote Project Coordinator for the Queensland Centre for Perinatal and Infant Mental Health (QCPIMH) based in Brisbane. Naomi has an Arts degree, majoring in Psychology, and a Bachelor of Social Work (Hons). In 2008, Naomi completed the intensive Circle of Security (COS) Training and has continued to use the COS model and approach throughout her work. In the last ten years, Naomi has worked in the mental health sector, particularly multicultural mental health and child and youth mental health. More recently Naomi was the Team Coordinator of the Children and Youth Team for the Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT), coordinating projects, youth workers and counsellors. Naomi has a particular interest in community development and building workforce capacity of rural and remote communities.
The Queensland Centre for Perinatal and Infant Mental Health (QCPIMH) was established in 2008 as a state-wide hub of expertise in perinatal and infant mental health, to provide consultation, liaison and support to public mental health services and the broader community sector, using whole-of-government and cross-sectoral clinical and community partnerships and networks. Perinatal and infant mental health (PIMH) can be described as the emotional and psychological wellbeing of mothers, fathers, infants and families, including the parent-infant relationship, from preconception through pregnancy and up to 3 years post-birth.
Over recent decades a strong evidence base has emerged, which highlights:
- The importance of the early years of a child’s life, including the establishment of secure attachment relationships
- The impact of parental mental health issues, including trauma history, on a child’s wellbeing and development
- The effectiveness of interventions designed to minimise risk and increase protective factors for parents, infants and families
- The need for an integrated approach to the provision of services for high-risk parents, infants and families
Recognising high levels of need, QCPIMH aims to develop a strategy to improve supports for the mental health and emotional wellbeing of expectant and new parents and their infants in rural and remote communities in Queensland. The project is taking a cross-sectoral, collaborative approach, building relationships with public, private and non-government providers of health and education services, including Indigenous organisations. Part of the project is a trial, in a limited number of sites, of innovative ways to build the capacity of existing services to respond to the mental health needs of parents and young children in a timely, relevant manner.
The Perinatal and Infant Mental Health Telehealth Project aims to support the existing workforce – workers who already provide services in communities – through training and education, to detect mental health issues earlier and respond effectively. Limited support can be provided via phone consultation, with assistance to refer on to appropriate services, thereby building local knowledge of different referral options and reducing the sense of isolation that service providers often experience. It is hoped that with additional resources, the model can be expanded to include clinical consultation and liaison via video conferencing, to support smooth transition from primary and secondary levels of support to tertiary levels and back again.
The Royal Flying Doctor Service: delivering oral health care to country kidsAuthor/s
Dr Lara Bishop is the Research and Policy Manager for the Royal Flying Doctor Service. She recently completed a research paper that explored the disparities in oral health between remote and rural Australian adults and children, and those living in major cities.
She is currently conducting research around the disparities in health outcomes for remote and rural Australians across a range of illnesses and injuries, including unintentional and intentional injuries, diabetes, and cardiovascular disease. Lara is also a visiting fellow at Murdoch Children’s Research Institute, where she is involved in research investigating the health literacy of parents of 0-2 year olds, as part of the right@home randomised controlled trial of sustained nurse home visiting, being conducted in Victoria and Tasmania.
Background: Oral Health is fundamental to overall health, wellbeing and quality of life. Good oral health contributes positively to physical, mental and social wellbeing and enables people to speak, eat and socialise unhindered by active disease, pain, discomfort or embarrassment. Conversely, poor oral health can have negative impacts on speech, sleep, productivity, self-esteem, psychological and social wellbeing, relationships and general quality of life.
Unfortunately, remote and rural Australian children (country kids) experience poorer oral health than children living in Australia’s major cities, including: more dental decay (1.5 times higher for country kids); more filled teeth (more than 2 times higher for country kids); more potentially preventable hospitalisations from oral disease; lower rates of favourable dental visiting patterns; and higher rates of unfavourable dental visiting patterns.
Generally, oral health status declines with increasing remoteness, meaning that kids who live in the most remote areas of Australia have the worst oral health of all Australian kids.
Services: The Royal Flying Doctor Service (RFDS) recently released an oral health discussion paper - Filling the Gap – that addressed the poor oral health of Australians living in remote and rural locations. It described the significant role the RFDS plays in providing oral health services through fly-in fly-out, mobile and outreach services, to country kids and adults. Often, the RFDS is the only organisation providing oral health services in remote and rural communities.
Outcomes: All RFDS oral health programs provide dental care to country kids. In 2014, the RFDS provided services to kids through 11 different oral health programs. More than 11,000 remote and rural Australians accessed the services.
RFDS programs will be described, along with outcome data from a selection of 2013/2014 programs. The role of Commonwealth programs, such as the Child Dental Benefit Scheme, in supporting oral health services for country kids, will be discussed. Evidence-based strategies to reduce inequalities in oral health outcomes for country kids, comprising upstream measures (e.g. water fluoridation, strategies to reduce the cost of healthy food in remote areas, reduction of taxes on oral hygiene products etc.) and individual measures (e.g. eating healthy food, maintaining good oral hygiene etc.), will be presented.
Take home message: Delivery of oral health services through RFDS fly-in fly-out, mobile and outreach models is an effective way to provide comprehensive oral health care to country kids. Implementation of upstream and individual measures can improve the oral health of country kids.
A population perspective on FASD diagnosis, treatment and preventionAuthor/s
Dr John Boffa graduated from medicine from Monash University in 1985 with first class honours. He has been working in Aboriginal community controlled health services since 1988 in Central Australia and is currently the Chief Medical Officer Public Health at the Central Australian Aboriginal Congress.
John has played a role in significant Aboriginal health policy developments including the transfer of administrative responsibility for Aboriginal health from ATSIC to the Commonwealth DoH in 1994. In addition to working on health system improvements he has worked on alcohol policy especially alcohol supply reduction measures as well as the development of early childhood programs and services. He is probably best known as the spokesperson for the Peoples Alcohol Action Coalition (PAAC) and this role primarily led to recognition as the 2012 NT Australian of the year.
The current concern about FASD is a very welcome addition to the long standing concern that Aboriginal community controlled health services and others have had about the harms caused by alcohol over many years, especially the harms caused to women and children. FASD is a critical harm but as with other harms from alcohol, including Domestic Violence, it is best approached from a population perspective. It is not necessary to wait until we are able to diagnosis each individual child before we can quantify the problem that alcohol is causing for the development of children at a population level and before we can implement the necessary policies to prevent and treat the problem. In this paper I will argue that the AEDC scores make evident a ‘population diagnosis’ of FASD as it is very clear that the level of developmental vulnerability present in many children at age 5 is significantly caused by alcohol related harms both direct and indirect. Heavy alcohol consumption amongst both parents can cause harm at many different points in the early life course of a young child from pre-conception, conception, pregnancy and then in the impact that alcohol has on the capacity and capability of parents to provide responsive care and stimulation at critical points from birth to age 3. It is not necessary to know exactly at what point in the early life course the harm from alcohol occurred in order to implement the policies, programs and services that are going to both prevent and treat FASD. Policies that reduce population level alcohol consumption are critical as the consumption of all men and women who are sexually active and could conceive needs to be reduced if FASD is going to be effectively prevented as most pregnancies are unplanned and most of the congenital harm occurs prior to any knowledge of being pregnant. In addition, providing evidence based early childhood programs that support all parents and reach all disadvantaged children in a population is the best way to reach children who have been affected by their parents alcohol consumption at any stage in their early lifecourse. Implementing the recommendations of the House of Reps Standing Committee on alcohol will be key to reducing the prevalence of FASD in Australia, especially amongst the most disadvantaged families. The concern around FASD and domestic violence needs to be harnessed to properly address alcohol at a population level.
History inscribed on the body: growth stunting as loss of human capitalAuthor/s
John Boulton worked in the remote Kimberley region of north-western Western Australia from his retirement from the University of Newcastle in 2005 until Jan 2015. In the Kimberley he advocated the need to inform medical practice with an engagement in its unique history and artistic tradition, and from anthropological and demographic perspectives. He is privileged to have friendships with Aboriginal people whose own lives have been lived so differently but who share many of the same life values.
In March 2015 he was given the Rural Health West award for the most outstanding contribution to rural and remote health services in Western Australia.
His forthcoming book ‘Aboriginal Children, Health and History: Beyond Social Determinants’ (Routledge 2016) uses endemic growth faltering from nutritional neglect as the focus for the analysis of the deep origins of the low health status of children in remote Aboriginal Australia.
He is an Emeritus Professor at the University of Newcastle, NSW; and has honorary academic affiliations with the Telethon Kids Institute, Perth; the Centre for Values, Ethics and Law in Medicine at the University of Sydney; and with the Broome campus of Notre Dame University, Western Australia.
Childhood emerged with archaic H. sapiens as the unique developmental phase of nutritional dependence after weaning. This became inserted between the Infant and Juvenile phases, as defined in physical anthropology, and was achieved by a slowing of somatic development. It represents a phase of adaptive plasticity in response to a stochastic nutritional environment, with the transition from the Infancy to the Childhood (ICT) phase of growth (in Karlberg’s Infancy-Childhood-Puberty model) being a critical period for choice of phenotypic trait. Growth faltering is the result of a delay in ICT; an echo of evolutionary adaptation to nutritional constraint at the cost of the trade-off of survival in childhood against diminished future reproductive fitness.
Contact between Australian and British led to a devastating loss of food security at every locality through to the twentieth century. This caused the widespread starvation and consequent loss of fertility amongst Aboriginal families noted by every observer. This contributed to the collapse of the population to a nadir in northern Australia from the 1930s to 1950s. Not until the mid-twentieth century was the extent of malnutrition formally documented.
In remote Aboriginal Australia intergenerational malnutrition has created a nutritional ghetto (as in India). This caused a phenotypic shift towards short stature, central adiposity with metabolic syndrome, and increased risk of early death from cardiovascular disease and diabetes.
As stature is a measure of human capital, reflecting intergenerational investment in childhood nutrition within a population, then adult stunting and central adiposity amongst Aboriginal people can be understood as an under-investment in human capital, with the history of oppression and want of food inscribed on their bodies.
The prevalence of low birth weight remains unchanged over five decades; likewise the rate of endemic growth faltering remains unchanged amongst Aboriginal children on remote communities. Since growth faltering is due to a delayed ICT from insufficient food energy from 6 months of age, doubtless worsened by the burden of immunologic stress from chronic infections, this is the herald sign for future adverse adult health from metabolic syndrome.
This revisionary approach to the causality of growth faltering, grounded in the life history theory of evolutionary biology, informed by political history, and interpreted through the lens of Farmer’s ‘structural violence’, leads to the conclusion that only an ecological approach, not a therapeutic medical one, can reverse this fundamental cause of the gap.
Queensland’s response to otitis media and hearing loss in Indigenous childrenAuthor/s
Matthew Brown became the inaugural Director of Queensland Health’s Deadly Ears Program in 2008. A population scientist by training, he initially worked as a microbiologist in health care before relocating to live in the Northern Territory. Since then he has worked with remote Aboriginal and Torres Strait Islander communities in all states except Western Australia. He proudly leads the talented and multiple-award winning Deadly Ears team, which has seen significant reductions in the rates of middle ear disease and hearing loss amongst Indigenous children in its partner communities. The Program is also leading a range of changes to procedures and policies across health, early childhood development and education to reduce the impact of this problem and enable these children to reach their full potential.
Background: The unacceptably high rates of otitis media and conductive hearing loss in Aboriginal and Torres Strait Islander children are well documented.
In Queensland, a novel approach is delivering significant results. The Deadly Ears Program has led a multi-agency response across the State. It has ensured coordinated services within communities, and changed systems and procedures which guide training and practice across the state.
Methodology: Recently, the Queensland Government signed off on a new ten-year framework to continue this work. This presentation explains how Queensland tackles otitis media and associated hearing loss in a coordinated state-wide response, and the significant outcomes which have resulted. Fundamental to this is the partnership between the Departments of Health and Education, and their collaboration with a host of other critical service providers.
Results: In one example, presentations of children with chronic suppurative otitis media at Deadly Ears clinics have dropped dramatically. In the critical 0-4 age group, from 2010 to 2014, it has reduced by two-thirds (from 18.6 to 5.9%).
The Deadly Ears Program is now exiting or reducing services to a number of communities because of low rates of otitis media.
A significant contributor to this is ‘systems change’, via a state-wide approach to changing policies and protocols, training of health providers and educators, and the development of a cutting edge statewide data system.
Conclusions: Coordination, commitment and consistency in Queensland ‘closes the gap’.
Kaltukatjara children: child rearing practices in a remote Central Australian Aboriginal communityAuthor/s
Lyn Byers is a Nurse Practitioner in the speciality of remote area nursing, a Midwife and a Mental Health Nurse. Lyn has worked in Central Australia since 2001 as the resident Remote Area Nurse and Midwife in remote communities. She has also worked as the manager of an outreach mental health team in Central Australia.
Before coming to Central Australia Lyn worked in small country hospitals and bush clinics in country Victoria. In 2010 she worked with families at Kaltukatjara on a qualitative research project looking at aspects of child rearing in the remote Aboriginal community context. As well as her clinical work Lyn also sits on the Board of CRANAplus and the Australian College of Nurse Practitioners. She is a graduate of the Australian Institute of Company Directors and passionate about delivering high quality health care in remote areas. This passion has resulted in her being an active member of the Editorial Committee for the Remote Primary Health Care Manuals, which guide and support remote practitioners in their day to day clinical work.
Aboriginal women in a remote central Australian community felt there was a lack of understanding of their child rearing practices by non-Aboriginal service providers. They wanted to share what they felt was important for non-Aboriginal people to know about their parenting methods to promote better understanding.
A descriptive study was carried out by Aboriginal and non-Aboriginal researchers, who used a grounded theory framework and ethnographic techniques. Data was collected in the community through participant observation, informal conversational interviews and narratives over a six month period. Three main themes were identified; ‘fitting in’ which refers to the integration of children into adult community life, ‘growing up’ referring to the development of individual autonomy and ‘staying strong’ which pertains to the importance of both collaboration and autonomy in raising children.
The child rearing practices described encourage the development of independence and self reliance within a closely nurturing environment. Children are taught their responsibilities and obligations through interaction in the adult life of the community from birth. The importance of food in child rearing and its relationship to children’s development of both autonomy and collaboration also emerged as a central aspect of child rearing in this community.
This was primarily a descriptive study providing opportunity for Aboriginal people to share their perspectives about child rearing. Implications for practice include the need for greater understanding of different practices of child rearing in order to work more effectively with Aboriginal families and to challenge negative stereotypes. This study provides some insights into positive child rearing practices of another culture.
First Bites: timely introduction of tucker to reduce growth faltering and anaemiaAuthor/s
Clare Callaghan is currently employed with the NT Primary Health Branch as a Child Health Nurse in Wadeye community, and is one of two nurses responsible for the Healthy Under 5’s Kids program.
As a Registered Nurse, Clare has worked for 12 years in the health sector, including clinical and program work, primarily with Indigenous people and youth. She has lived in the Northern Territory since 2008, working as both a RN and a Remote Area Nurse; and the last three years has seen her work solely for the Under Fives Program in Wadeye in partnership with Indigenous families and young children to improve broader health outcomes for remote children.
Clare has Bachelor of Nursing from QUT (2003) and has recently obtained her Post Graduate Diploma in Child and Family Health from Charles Darwin University (2015).
Bronwyn Nankervis is a Child Health Nurse for the Northern Territory Primary Health Care Branch, and is one of two dedicated Child Health Nurses delivering the Healthy Under 5’s Kids Program in the Wadeye Community. Her focus is on working in partnership with families to improve health outcomes for Indigenous children, through the provision of health care and education, targeted at supporting the broader social context, offering families soft entry points, and reorienting the focus toward healthy development. Throughout her career in the Northern Territory she has worked in the public sector and in clinical research for the Menzies School of Health Research. Bronwyn has a Bachelor of Nursing from Latrobe University, and a Master in Public Health and Tropical Medicine from James Cook University. She is currently completing her Graduate Diploma in Child and Family Health with Charles Darwin University.
Optimal nutrition, including an enhanced iron intake, supports optimal brain and physical development, which in turn reduces the prevalence of growth faltering and anaemia. Despite this understanding, anaemia and growth faltering rates are significantly high for children aged 6 to 24 months across the Northern Territory. The delayed introduction of solids and complimentary foods in Remote Indigenous Communities has been identified as a key factor for the high rates of growth faltering and anaemia. This delay can be contributed to food security issues, traditional beliefs and cultural approaches to parenting, poverty and overcrowding. The First Bites Program seeks to address these issues through the provision of care targeted at supporting the broader social context, offering our vulnerable families soft entry points, and reorienting the focus toward healthy development.
The program aims to improve the health and wellbeing of infants aged from 0 to 2 years of age, by reducing the incidence of anaemia, growth faltering and skin disease. This is achieved by; building on community understanding of the importance of the timely introduction of iron rich solids to infants, through the provision of a safe and supportive environment for families to engage in experimental learning; the dissemination of key feeding messages in local language; the promotion of hygiene and healthy skin messages; and the opportunity for social and emotional development of infants via engagement, bonding, and attachment play therapy.
The program works in partnership with multiple community groups, and is delivered by local Strong Women Workers and Child Health Nurses. Its design and objectives have been tailored to meet the needs raised by local woman, with the aim of empowering families and local community members to take ownership of the program, ensuing community support and program sustainability. Through the evaluation of the program, it is hoped it has the capacity for broader application to other remote Indigenous Communities where anaemia and growth faltering are also common.
Online speech and occupational therapy: anywhere, anytimeAuthor/s
Sue Cameron is a Certified Practising Speech Pathologist with more than 30 years’ experience working in health and education. For most of her career she has worked in a country hospital in Victoria with a varied caseload.
Her passion for ensuring that country people have equitable access to high quality services has led to her interest in telepractice. In her role as a senior speech pathologist at Western District Health Service in Hamilton, Sue instigated the development of a telehealth service delivery model for speech pathology clients who had difficulty travelling to the clinic. Sue has more recently established a private online therapy practice with Simone Dudley an occupational therapist from Deniliquin, NSW. Together they provide online therapy services to families and children experiencing developmental difficulties. Their clients come from rural and remote areas of Australia and from expatriate communities in the Asia-Pacific.
Sue and her colleagues are passionate about giving families increased access to therapy services at the time when they are most needed. They aim to provide well-coordinated multidisciplinary services which are equal to or better than traditional face-to-face services.
Simone is a registered occupational therapist, having completed her degree from University of Sydney in 1992. Simone has worked in a range of settings including both paediatric and Early Intervention Services in the public and private sectors.
Simone has completed a Bachelor of Primary Education through Charles Sturt University and a Post Graduate Certificate in Health Sciences in paediatric learning difficulties through University of Sydney. Simone has 9 years teaching experience across specialist itinerant roles in disability, behaviour and learning difficulties, with both children and adults through the Education and TAFE system.
Simone is co-director of Therapy Connect, a unique online private therapy service able to provide speech an occupational therapy services to children who live “anywhere at anytime”. Simone has a special interest in working online with families and children by providing goal based information, strategies and coaching interventions. Simone is based in rural & remote Australia and committed to contributing to the evidence to support teletherapy as an acceptable & effective service delivery method to support families unable to easily access face to face therapy.
Our organisation provides online speech and occupational therapy to families who have difficulty accessing traditional face-to-face therapy because of geographical isolation or lack of mobility. It is one of only a handful of private practices in Australia which offers this unique service delivery model to rural and remote Australians and families in Asia Pacific countries.
Government programs including Helping Children With Autism, Better Start and the National Disability Insurance Scheme, provide individualised funding that places the person with the disability at the centre of care and provides freedom to choose the services they use. However, children with disability in rural and remote Australia face barriers to receiving the Early Childhood Intervention Supports that are available to their metropolitan peers.
Private therapists are concentrated in Australian cities with few if any options available to rural and remote families. Families are faced with travelling very long distances to services or using large amounts of their funding for a therapy team to travel to them. Therapists fly in or drive to rural and remote areas on a schedule that is often not frequent enough to meet best practice guidelines for Early Childhood Intervention.
This paper will illustrate how online therapy can offer a significant part of the solution to families of children with disabilities in rural and remote Australia. We will describe how we have implemented online strategies for assessment and therapy by using case studies of families from Australia and the Asia Pacific. The paper will include information about the technology required, the accommodations needed to provide therapy online, the role taken by therapists to coach parents and carers to become agents for therapy and the ways we have achieved coordinated, multidisciplinary care for our clients. We will talk about a trial of telepractice service delivery for disability service provision which we are partnering in with a major University. We will share the successes and challenges of our telepractice experience to date and talk about our vision for the future of online therapy.
Adopting a child’s eye view for promoting mental health in schoolsAuthor/s
Professor Timothy A Carey is the Director of the Centre for Remote Health in Alice Springs. He is a psychologist specialising in clinical psychology with a background in teaching. Professor Carey initially trained in early childhood education and worked as a preschool teacher in rural Queensland. He then studied for a Graduate Diploma in Special Education for the Severely to Profoundly Multiply Handicapped and, once again, taught in special schools in rural Queensland.
From Special Education Professor Carey worked as a behaviour management specialist in both primary schools and secondary schools. His PhD explored the prevalence of counter control in rural and metropolitan primary schools and he has continued to investigate the importance of control to psychological wellbeing across a range of contexts. After completing his PhD he worked for five years as a clinical psychologist in the adult primary care service of the National Health Service in Scotland before returning to Australia to continue exploring the importance of control in different contexts with different people. He has published a book called ‘Control in the Classroom: An adventure in learning and achievement’ which emphasises the importance of control to student learning, achievement, and overall wellbeing.
While the rates of youth mental health problems are similar regardless of geography, children in rural and remote locations are burdened by impaired access to services. Having limited local services can delay treatment and compound problems. Schools represent ideal places to assist children in developing robust and resilient mindsets. In fact, the various missions, visions, aims, values, and mottos of schools indicate that they already recognise the importance of attending to the mental health of children. Currently, however, it appears that there may be a disconnect between the aims and values that schools profess and the actual practices that unfold on a daily basis. It is rare to find, for example, statements about obedience and compliance in the statements expressing what is important to a school yet obedience and compliance are often regarded as essential for the effective classroom functioning. Emphasising the importance of obedience and compliance to school children, both implicitly and explicitly, may not be the most helpful way of developing the necessary attitudes and abilities required to thrive in rural and remote contexts. In this presentation the issue of developing robust states of mind will be addressed. A sample of school statements will be reviewed and an explanation of behaviour will be presented. The implications of this behavioural approach will be explored for developing simple and unobtrusive means of nurturing the mental health of rural and remote school children on a regular and ongoing basis. Importantly, the explanation that is offered describes behaviour from the perspective of the behaving person, not the perspective of an external observer. Thus, we can approach the teaching of skills like cooperation by organising activities that provide an experience of cooperation for the child. Considering the behaviour of the child from the child’s perspective, rather than from the perspective of a parent or teacher, will allow the development and implementation of practices and interventions to assist in enhanced social and academic functioning.
Improving children’s oral health in rural Queensland and Victoria through participatory planningAuthor/s
Dr Karen Carlisle holds an adjunct senior research fellow position at the College of Medicine and Dentistry at James Cook University and is a research co-ordinator and population health advisor at Northern Australia Primary Health Ltd. With over 18 years of research experience in the UK and Australia Karen has worked within population health, oral health, education and psychology settings. She has a particular interest and has published in the areas of collaboration to improve health access and outcomes for the underserved and at risk. Karen’s current role is managing the Rural Engaging Communities in Oral Health (Rural ECOH) project. Funded by the National Health and Medical Research Council (NHMRC) this is a multi-institution project, partnering with James Cook University, La Trobe University, Royal Flying Doctor Service, Dental Health Services Victoria and Murray Primary Health Network.
Aims: Dental cavities (tooth decay) is one of Australia’s most common health problems. The prevalence of tooth loss and untreated tooth decay is higher in rural areas. Rural children have more tooth decay than children from urban areas. The aim of this presentation is to explore the role of community participation in oral health service planning, with a focus on implemented strategies to improve the oral health of rural children.
Methods: Rural ECOH (engaging communities in oral health) is a three-year NH&MRC funded study in six rural communities in Victoria and Queensland. Local people were invited to discuss their oral health needs and priorities, and develop strategies to improve oral health. Strategies were implemented, with community members monitoring the implementation. Data collection comprised of evidence generated from the workshop series, interviews with community members and completed oral health plans.
Relevance: The findings from this project contribute to keeping rural and remote kids healthy, and building the capacity of the rural and remote workforce to care for children locally.
Results: When community members and health service providers design oral health service plans together, strategies to improve the oral health of children and young people are important. The communities recognised the need for education and early intervention to achieve good oral health. Oral health plans included the introduction of toothbrushing programs in schools, oral health screening and education as part of immunization, and healthy child programs and lift the lip training for non-oral health professionals.
Conclusions: When rural communities were involved in oral health service planning they identified oral health of children and young people as a priority area. They focused on low-cost, sustainable activities which were reflective of their rural context and available workforce.
Koorliny Moort (‘Walking with Families’): ambulatory care coordination for Aboriginal children in Western AustraliaAuthor/s
Karen Clarke graduated as a Registered Nurse in 1998. She has spent the majority of her nursing career in Paediatric Nursing, including completing a Postgraduate of Paediatric Nursing in 2000. Karen has also worked in Rural/Remote areas throughout Australia. In 2010 Karen piloted and evaluated a program at Princess Margaret Hospital that applied a model of care coordination to children living in Rural/Remote regions of WA who had been referred to PMH for treatment, with the aim of decreasing unnecessary trips to PMH and preventing non-attendance thus improving health outcomes of the children referred. She is now working as the Clinical Nurse Specialist for the Koorliny Moort (‘walking with families’) Ambulatory Care program, which is based on the program that was piloted in 2010.
Aboriginal children in Western Australia continue to have increased morbidity and mortality compared to non-Aboriginal children. Primary health care providers in Western Australia identified a need for services for high risk Aboriginal children including preterm infants and children with chronic medical problems. In July 2012 Princess Margaret Hospital for Children (PMH) obtained funding from the COAG Closing the Gap initiative to improve ambulatory (out of hospital) care for Aboriginal children. Initially the funding was to run the program in three sites (Perth metropolitan, Kimberley and Pilbara), however in July 2015 the funding changed to WA Footprints to Better Health and the program was rolled out State wide.
Our program improves access to services by providing:
- discharge planning and coordination of follow up
- care and investigations closer to home through outreach clinics
- coordination of outpatient appointments
- timely communication between primary health care providers and PMH
- telehealth consults
- education programs.
Our program has the unique ability to combine primary, secondary and tertiary prevention strategies as part of our core business. Our team comprises an Aboriginal program manager, senior Aboriginal social worker, paediatric nurses, paediatricians and administrative staff.
1301 children have been enrolled into the program from August 2012 to February 2015 - 54.7% from Perth Metro, 23.7% from the Kimberley, 14.0% from the Pilbara and 7.6% from other regions. We conduct yearly evaluations of the program and our measurable outcomes show improvement in attendance rates, reduced emergency department presentations and hospital admissions and reduced length of stay. We are in the middle of a qualitative study asking families and service providers what they think about our service; what we are doing well and what we are doing not so well.
Our findings suggest that is it possible to improve health seeking behaviour and health outcomes for Aboriginal children by engaging Aboriginal families in their health care, providing effective communication between health service providers and delivery of a coordinated program of Aboriginal service provider led care.
The Royal Far West Healthy Kids Bus Stop ProgramAuthor/s
Children in rural and remote communities have a profound disadvantage to their urban counterparts before entering school. They are shown to have higher rates of developmental vulnerabilities, which impacts education outcomes. Developmental vulnerabilities are exacerbated in remote locations by geographic isolation, access to health services, and health service workforce shortages. It is critical for these children that they have access to specific health programs targeted to combat these barriers.
The Healthy Kids Bus Stop is a whole-of-child, one-stop-shop health screening, assessment and pathway to care program for children aged 3-5 years old. The program focusses on early detection and coordination of an integrated effective pathway to care for children living in rural and remote Australia. The health assessments are undertaken by a multidisciplinary team comprising of nursing and allied health staff, including local service providers. These assessments cover child health, hearing, oral health, nutrition, speech, and fine and gross motor skills. Stakeholders including Medicare Locals, Community Health Nurses, Teachers, Royal Far West staff, parents and Aboriginal community members were asked for their feedback on aspects of the program including its effectiveness and appropriateness.
More than 750 children were screened from 27 remote communities throughout New South Wales from 2014 to 2015, with 30% of these children identifying as Aboriginal and/or Torres Strait Islander. The program found that 80% of children from these communities required referral onto specialist services. Evaluation of the program was conducted by examining initial referral rates for each discipline, parental and staff evaluation details, children’s Ages and Stages data, and a 6 monthly referral uptake report.
Strong community partnerships were not only key to running the screening process smoothly, but to ensuring children were following through with their referrals. The most successful outcomes came from the communities that had the most engaged local service providers. By incorporating local community services in the program process, service providers gained insight into the gaps within their local community. This often spurred on the community as a whole to broaden their referral pathways, and increased communication with local families.
Our review will focus on the implementation of the program and how well it was received, the identification of health issues by specialty and whether this corresponded to parental concerns, successful creation of referral pathways for continued community support, and the strengths of having working community partnerships for such a complex screening program.
Hip dysplasia screening in a rural health districtAuthor/s
Introduction: Screening processes for Developmental Dysplasia of the hip (DDH) are guided by tertiary hospital practice guidelines and prompts in the Personal Health Record (PHR). Infants in rural locations could be at increased risk of late presentation of DDH compared to their urban counterparts but the reasons for this have not been extensively studied. The patterns of DDH screening in a rural area are not known.
Aim: To describe hip dysplasia screening practices in a local rural health district.
Method: This cross-sectional study of DDH screening patterns and behaviours was conducted in rural NSW. Data was gained from the following four sources:
- Hospital Medical Record. Examined consecutive birth records for a three month time period to assess DDH birth screening rates.
- Community Health Record. Examined the number of infants who received a universal home visit (UHV), six-eight week, six month and 12 month check in an early childhood setting.
- Clinician survey to identify the DDH screening practices of clinicians within the local health district.
- Physiotherapy records were accessed to identify clients who presented for management of DDH (late or early).
Results: At birth the majority of babies (91%, 179/196) had documented hip screening. Community health records show this dropped to 75% (587/788) at one-four weeks and 29% (227/588) at six-eight weeks. A survey of local clinicians (54% response rate; 49/91) revealed most (78%) screen for DDH and less than half (43%) use guidelines. Almost all (97%) clinicians reported screening for DDH at 6-8 weeks of age. Only 51% of clinicians reported having training for DDH screening and 80% would like further training. The rate of late DDH requiring management in 2012 was 0.87% (7/806) and the rate of late DDH requiring surgery was 0.25% (2/806).
Conclusion: DDH screening practices are well established at birth in the rural area under study. There is a decline in attendance at CFN clinics after the UHV and reported variability in DDH screening practices beyond 8 weeks of age, which coincides with a lack of prompts in the PHR. Further training in DDH screening and hip screening prompts added to the PHR may improve rates of DDH screening beyond 8 weeks of age.
Innovation providing dental care for children in small rural communitiesAuthor/s
Jenni Floyd is the Director Oral Health Services in Western NSW Local Health District, with responsibility for public oral health services in an area which covers around one third of NSW and incorporates inner regional through to remote areas of the state. Jenni is based in Dubbo.
Jenni began her career as a Dental Therapist. She worked as a clinician treating children in country NSW for 14 years before moving into Oral Health management roles. In 2006 Jenni completed a Masters in Health Services Management. She is a long standing member of the NSW State Oral Health Executive and holds an adjunct appointment with Charles Sturt University.
Jenni is passionate about ensuring that the needs of country NSW are not forgotten and that the community has access to high quality dental services. Her focus has been improving access, developing infrastructure and building strong partnerships based on the needs of the population and in particular the needs of Aboriginal communities.
The multi-purpose dental room is a contemporary approach to the delivery of outreach child dental services in small rural communities. It achieves better value for money and brings benefits to both patients and the local community.
Historically dental caravans were towed from town to town but have largely been eliminated because they do not meet work health and safety and infection control standards. In many smaller communities the establishment of a traditional dental clinic cannot be justified based on patient numbers, yet there is a clear need for access to local services.
A mix of permanent and semi-portable dental equipment has been used in an innovative and cost effective way to create clinical rooms in small towns to enable regular visiting dental services for children. Unlike traditional dental surgeries, the model requires no plumbing or expensive fit-out and delivers both a practical solution and better value for money. The model uses existing space in a health facility and is designed to promote resource sharing; ensuring the space can also be utilised by non-dental health professionals when dental staff are not present.
Through this model, communities receive regular visiting services on a fortnightly or monthly basis, rather than irregular blocks of service. Based on its success we have now established six clinics of this type across Western NSW.
The first clinic was established in a doctor’s consultation room in a medical centre in Warren in 2013 in a partnership with local government and private practice. A second clinic was established in Coonabarabran later that year. Throughout 2014 these two clinics provided 381 clinical appointments for children, saving families an estimated 108,492km and 1240 hours in travel time compared to travelling to the regional dental clinic in Dubbo. Staff feedback and parent reported experience surveys found that the equipment and room set up was both appropriate and accepted. More families accessed care for their children because the service was available within their local community.
In 2014 a third room was established in Gulgong, with three further locations completed in 2015 (Peak Hill, Grenfell and Blayney). Each location is now providing clinical dental treatment for up to 22 children each month. Across our large geographical area we can now provide local dental care to children in almost every town with a population of 2000, and also to a number of smaller towns.
The model has been used within existing rooms of varying shape and size, and in the case of Peak Hill, the room was purpose designed as part of a new multi-purpose health service. Peak Hill is a small town of 755 people in Central NSW. The purpose designed room at Peak Hill is a prototype consistent with triple aim principles that can be used when planning new rural health service facilities.
Services are provided by Dental and Oral Health Therapists who report satisfaction participating in the outreach clinics. Dental instruments are reprocessed at the base clinic where the clinician is based, and most dental specific consumables are transported in kits each visit.
This cost effective infrastructure model supporting an outreach service can readily be adapted to a range of settings, providing the clinical equipment required to establish and maintain regular day or two-day clinics for children. Whilst applicable to small rural communities, it could also be used in any location where a traditional dental clinic is not feasible. The equipment can be relocated to a new room or community at any time if future needs or priorities change.
The crossroads of health, disability and education policy for country kidsAuthor/s
Speech Pathology Australia is the peak professional body representing over 6700 speech pathologists in Australia. Speech Pathology Australia has members who work within the health, disability (including state funded early intervention and the NDIS) and education sectors (including government, catholic and independent) across Australia. Speech Pathology Australia is represented at the Conference by our Northern Territory branch member Michelle Foley. Michelle is an experienced paediatric and adult speech pathologist based in the Northern Territory. She has seen first hand the intersection of education, health and disability policies on country children with speech, language, communication and swallowing problems. Among her varied professional and clinical roles, Michelle has previously been a Board Director of Speech Pathology Australia.
Communication difficulties can arise from a range of conditions that may be present from birth (Down Syndrome, Autism Spectrum Disorder or Cerebral Palsy), may emerge during childhood (e.g stuttering, severe speech sound disorder), or may occur as a result of an injury, disease or disorder (e.g traumatic brain injury, hearing loss, stroke or head/neck cancers). Speech pathologists are the allied health practitioners who specialise in treating communication disorders and swallowing difficulties (dysphagia) and are key members of the multidisciplinary team needed to provide early intervention and ongoing treatment for country children with communication and/or swallowing problems. Like most health professions, there is significant workforce maldistribution in rural and remote regions of Australia. Paediatric speech pathologists are employed in public hospitals (including in child and adolescent mental health services) and in early intervention services (often state funded), in private practices (often funded through fee for service or private health insurance or minimally, through Commonwealth MBS rebates), in disability services (soon to transition to NDIS funding) and in schools in some states of Australia (employed by Departments of Education or employed directly by schools). The diversity of funding and policy programs aimed to provide speech pathology services for children with communication disorders belies the fact that there are significant problems in access to services – with access issues compounded for rural and remote children. These access problems are so significant that the federal Senate held an inquiry into the prevalence of communication disorders and speech pathology services in 2014. The inquiry recognised the intersection of policies within the disability, health and education sectors across all jurisdictions and that national coordination and leadership through the Australian Government Department of Health is required. Within this challenging policy and funding context, models of speech pathology services have evolved to attempt to ‘fill the gap’ in access to services for country children. Many of these models of service capitalise on the involvement of the health, disability and education sectors involvement in these children’s lives. Some of these models of service delivery might be usefully extended to other allied health, and health services in rural and remote areas.
Mind the Gap! The tube journey between city and countryAuthor/s
Alison Forrest completed her Registered Nurse training at the Adelaide Children’s Hospital in 1987, and has since been working in the field of paediatrics in a variety of areas. She has completed Paediatric Nursing Studies and more recently a Graduate Diploma in Child and Adolescent Family Health. Alison has been a member of the Home Enteral Nutrition Service at the Women’s and Children’s hospital since 2000, initially in the position of Clinical Nurse and now in the role of Clinical Practice Consultant. The service cares for children aged from birth to 18 years who require enteral feeding for a variety of underlying reasons. Patients supported by this service are from metropolitan and rural South Australia, as well as some children who live in the Northern Territory and western parts of the eastern states. As a member of this state-wide service she supports children and their families to manage all aspects of tube feeding, educates staff and of ensures high standard of care are in all areas enteral nutrition. Her interests lie in the care of children with complex and chronic medical conditions, in particular working alongside families who care for these children to optimise the child’s quality of life.
Background: The Home Enteral Nutrition Service (HENS) at the Women’s and Children’s Hospital (WCH) within the Women’s and Children’s Health Network (WCHN) in South Australia provides an integrated support service for all aspects of maintaining healthy nutrition for tube-fed children from birth to 18 years of age. The service manages approximately 300 children, with around 20 percent living in rural and remote areas including NSW, Victoria and the Northern Territory. The service consists of gastroenterologists, registered nurses, dietitians and speech pathologists who work with the child’s primary medical or surgical team.
Service model: The service provides education and support on all aspects of enteral feeding including tube insertion, education and management of equipment with ongoing follow-up and support in the community. An integral part of this service is to ensure the comprehensive care provided to metropolitan children is translated to rural and remote areas as a seamless service expansion. Families are recognised as the ‘experts’ for their child and are at the centre of all care provided. When children return home to rural and remote areas they may not have access to health professionals experienced in managing tube feeding and the HENS support is crucial to both the family and local health professionals to ensure open and accessible communication is available.
Bridging the Gap: The HENS team has identified gaps for rural and remote families which is primarily a lack of local expertise in the insertion and management of gastrostomy and naso-gastric tubes. An updated handbook has recently been developed to support families who are tube feeding their child at home. The next step to bridging this gap is the development of two E-learning Packages for local health care professionals. The use of e-mail and mobile phone to troubleshoot tube feeding issues or provide advice on the use of equipment is well established to support families and local health professionals in rural and remote areas. HENS aims to further explore how they can provide comprehensive education and knowledge to empower families to care competently for their children and for these families to be well supported by local staff with greater access to learning resources.
Young Carers: a national program with a rural approachAuthor/s
Originally from Country Victoria, Kate Francis has resided in Darwin for 11 years. Before commencing employment with Carers NT, she worked in a variety of jobs stemming from Crocodile feeding to managing a café for a not-for-profit organisation while teaching skills in hospitality to individuals living with mental ill health. Kate is currently employed as the Senior Young Carer Advisor at Carers NT and has worked with hundreds of young people aged from 5-25 who provide care and support to a loved one who lives with some type of physical or mental disability or chronic illness: Through this role she endeavours to empower these young people so they can stay healthy and strong within their caring role while working through the challenges associated with growing up and developing as an individual. Kate lives with her husband in Coconut Grove with her pink car and cat named Deloras.
BethanyO’Shea is the primary carer to her mum who lives with PTSD, anxiety and depression as well as offering support to her younger sister who was last year diagnosed with diabetes.
Due to the episodic nature of her mum’s illness, there can be times that Bethany will need to provide all elements of personal and practical care required by an individual while insuring that all day-to-day tasks are managed to ensure stability in the family home. While her commitment to her family is foremost, Bethany also contributes to her local community: Last year, Bethany was nominated to represent the NT on the Australian National Young carer Action Team (ANYCAT). She attended Parliament house and shared her personal story to a number of Federal Ministers. She was also awarded the 2016 LWB NT division of the National Young Carer Award. Bethany is passionate about creating young carers awareness. She participated in the production of a Young Carer short film and has spoken in public about her role as a carer as well as the supports that have been available for her. Bethany also volunteers her time assisting in activities for young carers aged 5-12.
Jauhari Wright is at Charles Darwin University completing a five year double degree.
He is also a young carer to his father who has a neurological degenerative disease, Huntington Chorea, as well as providing care to his mother who was injured in a work related incident and requires emotional and financial support.
Jauhari has been actively involved with CarersNT and their Young Carer program as a volunteer and until recently sat on the Organisations Board. Jauhari joined the Australian National Young Carer Action Team (ANYCAT) in 2012 and has created awareness and helped implement national policy schemes such as an educational bursary tailored specifically for young carers. He has been involved in Pollie Pedal, a federal fundraising event headed by our former Prime Minister Tony Abbott. Furthermore, he has been involved in awareness raising with federal ministers around the topic of unpaid caring and disability services. Jauhari has devoted time to advocacy on national and local media outlets; and has received training in relation to communication with media groups.
The Young Carer Program is a National, Government funded Program that provides information to young people aged 5-25 who are caring for a family member or loved one who has a disability, is frail aged, has a chronic illness, a mental health issue or suffers from a drug or alcohol problem. Utilising current Commonwealth funding through Carers Australia, Commonwealth Young Carer Respite funding, as well as State Government, Carers NT Young Carer program is also able to assist this exceptional client group through advocacy, as well as emotional, social and care provision.
At least one in ten children in Australia has some level of responsibility as an unpaid family carer in their home which equates to 2 to 3 young carers in each Australian classroom
It is a highly conservative estimate that there are over 4000 young carers providing support to a loved one within the Northern Territory.
While many young carers emphasise that ‘caring is a positive experience’’, research suggests that when inadequately supported, a young carer’s physical and mental wellbeing can be seriously impacted in a negative way. So how can this support be applied in this unique and vast Territory known as the NT, with the sparsest population of any state or territory in Australia?
Within the NT, 30% of the population is Indigenous and 15% are born overseas: Darwin alone is home to people from more than 60 different nationalities. One poses the question: How can this program benefit the needs of the NT’s rural and remote children and young people, while taking into consideration the wide diversity of family systems.
Over the last 12 years, the Carers NT Young Carer program has provided practical support to this unique client group through individualised and flexible social activities, workshops and age appropriate respite opportunities which encourage invaluable peer support while building trusting relationships between the carer and the young carer worker:
This conversation will share some of these practical applications while highlighting the benefits of relationships formed, all through the personal experience of the expert: the Carer. The stories shared will reinforce the helpfulness of ‘everyday application’.
It will also negotiate through some of the concerns associated with changes in funding and possible impacts on the move of focus for these funds being about the Young Carer to being about the Participant under NDIS.
Development of a visual oral health literacy tool for Indigenous Australian youthAuthor/s
Dr Donna Furler is a Dentistry honours candidate at James Cook University who is researching oral health literacy of Indigenous Australian youth. She practices as a general dentist in private and public practice in rural South Australia.
Donna previously completed a Bachelor of Oral Health at the University of Adelaide in 2005, postgraduate studies through Flinders University in primary health care in developing countries in 2011, a Bachelor of Dental Surgery at James Cook University in 2015.
Her current research is based in North Queensland and focuses on Indigenous Australian youth who suffer a greater burden of oral disease compared to non-Indigenous Australian youth. Recent evidence suggests that oral health literacy is related to oral health outcomes and linked to overall general health. Donna has developed a visual tool to measure oral health literacy of this young population so as to enable appropriate oral health interventions.
Donna has experience working with children from diverse rural areas of Australia, and internationally in Timor Leste, where she completed a two-year volunteer dental program in the remote area of Eraulo. Donna has identified similarities in oral health of children in rural Australia and the developing nation of Timor Leste.
Aims: To develop and explore a visual oral health literacy (OHL) tool for urban, rural and remote Aboriginal and Torres Strait Islander youth aged 12 to 16 years.
1. To develop a visual OHL tool
2. Explore the appropriateness of the OHL measures among Aboriginal and Torres Strait Islander youth aged 12 to 16 years.
Methods: The project is based at Shalom Christian College, an Indigenous boarding school in Townsville. Students originate from a diverse range of urban, rural and remote communities throughout northern, western and central Australia. A visual OHL tool was developed specifically for a diverse Aboriginal and Torres Strait Islander youth aged 12 to 16 years in consultation with an expert panel. Cognitive interviews involving a purposive sample of 15 students from Shalom Christian College identified the appropriateness of the visual OHL measures.
Relevance: Poor OHL among Aboriginal and Torres Strait Islander peoples is a significant factor associated with the higher disease burden and poor oral health outcomes amongst this population. The OHL of Aboriginal and Torres Strait Islander youth remains largely unexplored, with no tool available that is appropriate for this population. The pressure to assess the OHL of this young population is increasing due to the widening oral health inequalities and disparities present today.
Results: Cognitive interviews of 15 participants provided valuable information regarding the appropriateness of the OHL measures. The results have guided further development of the visual OHL tool with pilot testing planned in the near future to test for reliability and validity.
Conclusions: The ability to measure and assess the OHL of Indigenous Australian youth is important in order to improve the oral health outcomes among this group. Understanding the OHL of Indigenous Australian youth, will enable the development of effective and appropriate oral health interventions. These oral health interventions have the potential to improve oral health across the lifespan, not limited to adolescence.
No more pain is our gainAuthor/s
Ms Mulu Gebremariam- Clinical Nurse Specialist/Infection Control link nurse at Alice Springs Hospital
Ms. Mulu Gebremariam is a clinical nurse specialist in Paediatric Ward Alice Springs Hospital. She has been a registered nurse for almost 12 years in different domains of care, of which the last six years were in Paediatric ward, Alice Springs Hospital. Mulu has completed Post Graduate studies in Paediatric nursing and has a special interest in Paediatric Pain Management.
Over the last five years, she has also been working as an Infection Control Link Nurse for the ward.
Sukoluhle Moyo is a Registered Nurse at Alice Springs Hospital, with 15 years of nursing experience that spans across a variety of paediatric specialties both in Australia and overseas. She has also been employed as a Research nurse by Menzies School of Health Research and overseas. Sukoluhle has a keen interest in contemporary paediatric nursing and is involved in the children’s ward initiatives for translation of evidence into effective clinical practice, through writing and implementation of evidence based clinical guidelines. Sukoluhle has completed a Postgraduate diploma in Health Sciences (child stream) at the University of Auckland in 2012 (New Zealand) and a Masters in Child Health Practice with Auckland University of Technology in 2014. She is currently enrolled in a PhD program with Charles Darwin University/Menzies School of Health Research to investigate the role of health workers in provision of targeted smoking cessation in reducing tobacco related childhood illnesses in Central Australia.
Aim: To assess the effectiveness of the (Alice Springs Hospital) ASH paediatric pain management quality initiative implemented as part of evidence based family centred care.
Background: This paper reports progress on a recent initiative to improve quality in pain management among paediatric patients in central Australia. Pain management in children is a very dynamic process that requires constant review and update of practice. The role of health professionals in pain management has evolved from being mere completion of tasks to extended roles that include advocacy, conventional rights of a child and family centred care, all within a culturally sensitive paradigm.
On the children’s ward at ASH, children and families of Indigenous descent represent the highest proportion of our patient demographics. Our highest Diagnosis-related groups (DRGs) include skin sores, abscesses, and injuries. This ultimately results in a large number of children requiring surgical intervention followed by wound reviews and intravenous cannulation for antibiotics. Pre review medications are often administered at 0600hours by night shift staff and often wound reviews will not happen until close to midday. This practice raises clinical queries of the ineffectiveness of the procedural pain management pathway.
Methods: Identification of gaps in practice, in 2014, led to the ASH paediatric ward committing to a nursing led paediatric service quality improvement through collaboration with Westmead children’s Hospital (Sydney).This resulted in the implementation of standardised, collaborative interdisciplinary pain management pathways. The assessment of this quality improvement involved quantitative comparison of post-operative patient’s medical records, pre and post implementation to assess the type of pain modalities that are prescribed in the children’s ward and the consistency in administration of analgesics.
Results: Medical records were audited pre and post implementation. The data indicates a noticeable improvement in appropriate use of pain assessment tools (Flacc faces on CEWT charts), an increase in the number of prescribed pain modalities, and appropriate use of analgesic modalities following the stepwise (World Health Organization) WHO pain management ladder as an escalation framework.
Conclusion: Since the introduction of the initiative, there have been many paediatric pain management awareness programs that include patient advocacy, family centred care and cultural safety. There is also a close follow up on type and strength of prescribed pain management medications. Our quality improvement has broken down restrictive interdisciplinary silos and created multidisciplinary cohesion which ultimately improves advocacy for the Indigenous children.
The Royal Children’s Hospital Complex Care Service: potential benefits for rural and remote kidsAuthor/s
Dr Susie Gibb is a general paediatrician who trained at RCH, Melbourne and in Sheffield Children’s Hospital, UK. She has worked in a number of different settings in public and private community practice: in metropolitan, outer suburban and regional areas and in tertiary hospitals. She currently works as part of a number of different interdisciplinary teams at RCH Melbourne providing care in a shared care model for children with less common conditions who live across the state and in Southern NSW and Tasmania.
Her current research interests include paediatric incontinence and cleft and craniofacial conditions.
She currently works across the departments of General and Developmental Medicine at RCH where she is now the medical lead for the newly developed and evolving Complex Care service. This program aims to improve the coordination for care for medically fragile children with multiple speciality health care needs. The program is designed with the primary aim of improving the experience of care for the child and family and it is hoped will also improve the efficiency of their health care provision.
Background: Changing medical care has resulted in an increase in the number of children with complex medical needs. At The Royal Children’s Hospital (RCH) a small number of patients with complex medical needs use a disproportionately large number of bed days, impacting on access to services for other patients. Complex patients have multiple teams involved in their care, often with no clear clinical lead co-ordinating care resulting in fragmented, crisis-driven care. This complexity is further amplified for families living distant from our tertiary centre.
There is growing evidence suggesting that improving the care for this population of children results in improved efficiency of utilisation of healthcare resources. We describe a pilot study undertaken at RCH that informed the design of a complex care model, and present two case studies of families from regional Victoria who have participated in our Complex Care Service.
Pilot Complex Care Project: The pilot trialed an integrated approach to the care of children with complex medical needs. 20 patients were enrolled between March and June 2014, and of these, two resided in rural or regional Victoria. Families were supported by a Clinical Nurse Consultant (CNC) and a consultant paediatrician as Medical Case Manager (MCM). The service focused on care coordination, timely access to advice and support, and family partnership.
The pilot delivered a significant reduction in bed days and emergency department presentations (about 50%). Parents reported an increase in their overall satisfaction, from 47% to 77%.
Complex Care Service: These results informed development of the RCH Complex Care Service (CCS). Currently the team consists of two CNCs (full-time), MCM (.5), Administration Co-ordinator (full-time) and Social Worker (.5). In the first year 80 patients will be enrolled and we aim to embed the CCS in the Medical Departments and integrate care with existing home based services. The second year will see further staff employed and a further 100 patients enrolled. Strengthening systems and fostering partnerships with community and regional providers will be the ongoing focus.
A pre- and post- evaluation is planned, exploring outcomes for children, parental quality of life, and parental and practitioner satisfaction with care, at 12 months. Ultimately, our objective is to implement a sustainable model of complex care that improves the quality of care provided to children with complex medical needs requiring tertiary care, wherever they live within our catchment area.
Keeping country kids mentally healthyAuthor/s
Nicole is committed to making a positive difference in the lives of young people. After overcoming mental health challenges as a young person, in particular anorexia nervosa, Nicole is channelling her energy into motivating other young people to be the best they can be. In 2011, Nicole established The Rogue & Rouge Foundation to reverse the stigmatisation of mental health, body image and self-esteem issues in Australia’s young people.
As the Foundation’s Chief Executive Officer, Nicole dreams that every teenager can look in the mirror and smile. Nicole is tackling the epidemic of low self-esteem by creating community outreach programs and working directly with schools, service providers and education departments in both central and remote parts of Australia. Nicole has recently completed her national youth motivation tour, ‘Champions for Change’, which has since seen her facilitate workshops at 300 schools with 50 000 young people across Australia to encourage young people to champion change in their communities through the development of innovative solutions.
Ms Gibson was a finalist for Young Australian of the Year 2014, named as one of Australia’s 2012 Young Social Pioneers and is a current finalist for The Pride of Australia Medal.
Aims: Kids in regional, rural and remote areas experience mental health problems at about the same rate as those in cities but they face greater challenges. Social isolation can have a big effect on country youth, who may struggle to find meaningful work and activities with higher unemployment and longer travel distances. The lower availability of services may mean difficulty in accessing the support needed. Added to this is the greater visibility of mental illness in a smaller community, which may lead to stigma and the fear (or reality) of discrimination. We need to plan and provide mental health services in ways that improve access to an integrated, coordinated and responsive approach that meets the needs of individuals, their families, and local populations.
Contents: Central to keeping kids mentally healthy is a person-centred approach to mental health care. This means the development of integrated care pathways to improve outcomes for children experiencing mental ill health and their families. The Commission’s report Contributing Lives, Thriving Communities - National Review of Mental Health Programmes and Services recommended:
1. Planning and delivering services on a regional basis
2. Ensuring a strong focus on prevention, early intervention and primary health care as fundamental to mentally healthy individuals, and to supporting a recovery oriented approach
3. Integration of mental and physical health at the primary health care level.
E-mental health also has a particular role in overcoming distance for our country kids. We need to develop and promote e-mental health solutions that build on self-help, link to biometric monitoring and provide clinical support strategies. This provides options for kids who may have difficulty accessing direct services, for help between sessions, and for those who are able to manage their own mental health.
Conclusions: The newly established Primary Health Networks provide a mechanism for regional and local approaches to planning and providing services. The Networks have six key priorities for targeted work, including mental health, with the aim of providing localised health care services. It is essential that these services include those that are mental health-specific, delivered through health and non-health portfolios, e-mental health and other phone and online services, as well as broader services which contribute to physical health. Regional mental health and suicide prevention strategies need to be developed. The Review found high levels of unmet mental health need in rural and regional communities and this requires immediate attention.
National Disability Insurance SchemeAuthor/s
Lizzie recently joined the National Disability Insurance Agency (NDIA) as the Regional Manager for the Northern Territory. She is based in Darwin.
Lizzie brings significant public sector experience to the NDIA, particularly in the area of remote service delivery in the NT. Prior to commencing her new role with the NDIA, Lizzie worked for the Northern Territory Government in the areas of child protection, foster care and adoptions. She went on to work for the Department of Human Services (DHS) for 17 years based in Alice Springs, Katherine and Darwin. As a Centrelink social worker based in Alice Springs for eight years she delivered services to a vast region - one million square kilometres - up to Elliott in the north, the remote communities in the region, the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia and the Ngaanyatjarra (NG) Lands in Western Australia.
Lizzie went on to become the Region Manager for the Top End in 2012-2014. This region included a number of remote service centres in Indigenous communities: Wadeye, Tiwi Islands, Galiwinku, Maningrida, Groote Eylandt, and Nhulunbuy. During this time, Lizzie developed a strong commitment to local Indigenous employment.
Lizzie maintains a strong interest in Indigenous affairs and social policy particularly where it relates to remote service delivery.
The National Disability Insurance Scheme (NDIS) is a revolutionary way of providing supports for people with disability which commenced in 2013 with four trial sites. By 2016, there will be trial sites and early transition site locations in all Australian states and territories. More than 460,000 people with disability are expected to be eligible for financial support from the NDIS when it is fully rolled out as a national Scheme.
This presentation will provide an update on the rollout of the NDIS in rural, regional and remote areas, with a focus on children, their families and carers. The National Disability Insurance Agency (NDIA) is responsible for delivering the NDIS as a scheme for all Australians and to:
- build community awareness of disability,
- ensure financial sustainability of the NDIS, and to
- develop and enhance the disability sector.
The Agency role is to facilitate innovation and to address the challenges and opportunities to build a sustainable scheme that exists in community based contexts. Experience in trial site locations is leading to growing knowledge of participant experiences, approaches to support management, and factors that lead to a viable supply of providers.
Early childhood intervention is a key area for the NDIS. Engagement with stakeholders and in-depth consideration of national and international research are important strategies for development of guidelines that will be responsive to participant and family needs.
The Agency adopted a wide-ranging consultation process in developing a Rural and Remote Strategy and is also informed by work of the Independent Advisory Committee. As part of its commitment to a co-design approach, the Agency has established relevant reference groups to guide projects and to inform the ongoing development of processes.
A focus on rural, regional and remote communities highlights the need for Innovation, flexible delivery of services, sector development, assistive technology options and community awareness and capacity building as important features of NDIS planning and implementation.
Health and wellbeing are also key elements of the NDIS. Managing the interface with mainstream services, building capacity of local teams and ensuring quality of service are part of ongoing work essential to ensure effective rollout of the NDIS.
Baby steps: Fetal Alcohol Spectrum Disease (FASD) policy in AustraliaAuthor/s
Caterina Giorgi is the Director of Policy and Research at the Foundation for Alcohol Research and Education (FARE), a not-for-profit organisation working to stop the harm caused by alcohol. Caterina has worked in a range of policy, advocacy and research roles in the government, research and not-for-profit sectors. Caterina was a finalist in the 2015 ACT Young Women of the Year Awards and is a member of the ACT Government’s Liquor Advisory Board. Caterina was an editor and author of Stemming the tide of alcohol: Liquor licensing and the public interest, a book for policy makers, liquor regulators, governments, advocates, researchers and the community about alcohol regulation and harms in Australia. Caterina has taught advocacy at the University of Canberra and has delivered policy, advocacy, social change and government relations workshops to not-for-profit professionals across Australia.
Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term for a range of disabilities resulting from prenatal alcohol exposure. FASD are the leading preventable cause of non-genetic, developmental disability in Australia and people born with FASD have the condition for life.
The National Health and Medical Research Council recommends that ‘for women who are pregnant or planning a pregnancy, not drinking is the safest option’. Despite this, the 2013 Australian Institute of Health and Welfare National Drug Strategy Household Survey found that more than half (56%) of women consume alcohol during pregnancy and more than one quarter (26%) continue to do so after knowledge of pregnancy.
Over the last decade, there has been increasing advocacy for the prevention, diagnosis and management of FASD in Australia. This advocacy culminated in a House of Representatives Inquiry into Fetal Alcohol Spectrum Disorders in November 2011.
The Foundation for Alcohol Research and Education (FARE) worked closely with people affected by FASD, health professionals and researchers to collaboratively advocate for a funded National Plan through this process. FARE developed and released a fully costed FASD Plan to guide this advocacy.
The Australian Government responded to the FASD Inquiry in 2014, announcing the Commonwealth Action Plan to reduce the Impact of Fetal Alcohol Spectrum Disorders (FASD) 2013-14 to 2016-17 (The Plan), committing $9.2 million. The Plan focused predominantly on improving diagnosis and supporting Aboriginal and Torres Strait Islander peoples with FASD.
In recent years, some State and Territory Governments across Australia have also taken action on FASD. New South Wales, Queensland and Western Australia all support diagnostic programs in varying capacities. The Australian Capital Territory has also provided funding for prevention campaigns.
While some action has been taken to develop and implement FASD policies and programs in Australia, the progress and implementation has been slow. There are also inconsistencies in the approach to FASD by the Australian Government. For example, while The Plan was funded, the peak organisation for FASD; NOFASD does not have ongoing funding. Similarly, Australian Governments did not support a recommendation by Labelling Logic, the 2011 final report from the national food labelling review, to mandate alcohol pregnancy warning labels.
A further criticism of the actions taken by Australian Governments is that they do not provide the immediate and comprehensive support needed for people currently living with FASD, their parents and carers.
Moving forward, further advocacy is required to ensure the Australian Government implements The Plan in full. Greater coordination and funding is also needed to ensure that diagnosis occurs across the country, that diagnosis is undertaken in a standardised manner and that data on prevalence of FASD is collected and consistently recorded. FARE is currently advocating for a National FASD Clinic Network to facilitate this.
This presentation will provide an overview of the current FASD policy landscape in Australia, and discuss the progress to date and further action needed.
Getting back to the kurturtu (heart) of good practiceAuthor/s
Russell Gregory is a descendant of the Bardi, Ngul Ngul and Kidja people from the West and East Kimberley Region of Western Australia.
Russell comes from a family of eleven children, and accredits his cultural identity, pride, and personal confidence, to the loving, secure and nurturing family environment, provided by his parents.
His professional experience includes service in the Australian Army, employment in the Australian Electoral Commission, Department of Education, Disability Services Commission, Department of Corrective Services, and Department for Child Protection and Family Support, Western Australia.
He has lived and worked, predominantly in regional and remote areas of Western Australia, and has extensive knowledge of the issues facing Aboriginal communities and families, particularly those affecting children and young people. He has been an advocate for the rights and interests of vulnerable children, though his work in juvenile justice, education, disability services, and child protection.
He has participated in football and athletics at a regional, state and national level, and now enjoys coaching young Aboriginal people, in sport such as football, basketball, cricket and athletics. Previously he was a board member of the Geraldton Aboriginal Sporting Association.
He is currently the Aboriginal Practice Leader at the Department for Child Protection and Family Support, Western Australia. In this role he provides mentoring to Aboriginal staff and cultural practice consultations, to all staff working in child protection, across the Goldfields District of Western Australia. In addition, he provides advice to local government and community organizations, community development agencies, healthcare providers, and Aboriginal controlled organizations.
He is a graduate member of the Australian Indigenous Leadership Centre, (2006), and the Australian Rural Leadership Foundation, (2008). In 2011 he graduated from the Curtain University of Technology, with a Bachelor of Applied Science (Indigenous Community Management and Development).
This presentation focusses on cutting edge practice in the Goldfields district of Western Australia in the Department for Child Protection and Family Support (CPFS). The use of the Signs of Safety framework in Western Australian child protection practice work, among remote Aboriginal communities, their children and families, through establishing interactive outcomes, real community engagement and sincere collaboration. It is about ensuring the delivery of good cultural outcomes for children, families and communities where children remain in their community and are safe.
This presentation will highlight the use of Words & Pictures and Safety Planning using a few case examples to demonstrate the innovative work being done in one of Western Australia’s most remote communities - Tjuntjuntjarra. Over the last 18 months the Goldfields districts leadership group have been integral in making changes to the way CPFS is working alongside Aboriginal families.
The SofS framework practice in the Goldfields provides workers with a unique opportunity to get back to the kurturtu (heart) to why they do this work in the first place. The SofS framework used in child protection casework, was developed throughout the 1990,s in Western Australia, by Andrew Turnell and Steve Edwards, in collaboration with over 150 West Australian Child Protection Workers (CPW). The SofS framework is now being utilised in jurisdictions of the USA, Canada, the UK, Sweden, Denmark, Finland, The Netherlands, New Zealand, Australia and Japan.
Using the SofS framework the CPW are asked to consider ‘How can the worker actually build partnerships with parents, children and communities in situations of suspected or substantiated child abuse and still deal rigorously with the maltreatment issues?’. This strengths-based and safety-organised approach to child protection work is grounded in partnership and collaboration, because it expands the investigation of risk to encompass strengths and SofS framework, that can be built upon to stabilise and strengthen the child’s and family’s situation. The SofS is a core practice framework for CPFS in Western Australia.
Using family-centred creative methods to connect families of deaf and hard of hearing children living in rural and remote Queensland with health and other servicesAuthor/s
Suzanne Harris is the Team Leader for the Queensland Hearing Loss Family Support Service, an award-winning state-wide Queensland Health program providing direct services to families of children 0-6 years who have been diagnosed with a permanent hearing loss. Suzanne is a Senior Social Worker with over 30 years’ experience across three mainland states, at both state and Commonwealth level, and in the non-government sector. Suzanne is a keen advocate for the rights of consumers and has previously been involved in service development through consumer engagement across a number of sectors including adoption information, mental health and family services, and has presented internationally at conferences on Family Centred Care and service delivery. She is passionate about providing opportunities for parents to make informed decisions about their children’s care.
Suzanne’s leadership of the QHLFSS supports the Newborn Hearing Screening Program in Queensland which recognises the critical early identification of hearing loss and that early intervention must occur within the first six months of life in order for the majority of children with congenital hearing loss to maintain language development commensurate with their normal hearing peers. This includes innovative research and project implementation, especially in regional and remote areas across Queensland to support families to make the best decisions regarding communication options for their children.
The Queensland Hearing Loss Family Support Service provides family-centred information and support to families of children 0-6 who are diagnosed as deaf or hard of hearing. QHLFSS is a state-wide service and has implemented a number of initiatives to facilitate access across the state. This aligns with the specific objective of Children’s Health Queensland to drive improvements in the delivery of quality health care to children and young people across the state, including increased access to and integration of paediatric services state-wide.
QHLFSS initiatives include:
- A Telehealth project for rural and remote families enabling QHLFSS to provide services to families using Movi on loaned iPads which has partly addressed the need for families or facilitators to avoid having to travel to enable families to access services.
- In late 2015 the Telehealth project was expanded to develop an assessment and triage tool to increase the use of Telehealth in the home to other hearing health services.
- QHLFSS has also recently developed the EARS for Kids App which has highlighted further opportunities for reaching our clients in a digital space.
- A culturally appropriate Indigenous Pathways Resource for Aboriginal and Torres Strait Island families is also under development which will utilise digital access for families and health workers.
Advantages of these digital approaches include:
- allowing parents to decide when and where they want to consume the materials offered;
- increased engagement for families who are rural and remote, unable to travel or working full time;
- increased participation of fathers and young parents;
- provision of the ability to engage with other parents regardless of their location
This presentation will showcase these projects using PowerPoint and practical demonstrations and present the results of the family surveys providing evidence of the family centred values that underpin the service.
Cerebral palsy hip surveillance: a virtual clinic modelAuthor/s
Karen Height is the Service Manager with the Kaleidoscope Paediatric Rehabilitation Service (KPRS) based in Newcastle, NSW. KPRS supports the rehabilitation needs of over 1000 children residing within the Hunter New England Local Health District and broader Northern Child Health Network in NSW. Over the past three years, Ms Height has supported and directed the development of a coordinated Cerebral Palsy Hip Surveillance (CPHS) program for children and young people living within the NCHN. The innovative virtual clinic model, allows for x-ray service provision in the child’s local community, with the results accessible online meaning that children attend clinic only if an issue is highlighted thus providing the right care, in the right place, at the right time. The CPHS program has recently been recognised as a 2015 C.A.R.E. Winner by the Hunter Children’s Research Foundation for Achievement in Quality Improvement and was a finalist in the 2015 HNELHD Excellence, Quality and Achievement Awards. Ms Height would like to acknowledge the work undertaken by Ms Erin Ralph and Ms Elisabeth Bowes (Physiotherapists, KPRS) and Dr Caroline Hodge and Dr Chanka Nanayakkara (Paediatric Rehabilitation Specialists, KPRS) in conducting the initial project work and subsequent ongoing service delivery with the CPHS program.
Aim: To establish a comprehensive hip surveillance service for children with Cerebral Palsy (CP) residing in the Northern Child Health Network (NCHN)
Method: Within NCHN there are 500-550 children with CP who require access to hip surveillance. Insufficient clinic appointments are available within paediatric rehabilitation and orthopaedic services to meet this need. The CP Hip Surveillance (CPHS) Service was therefore established within the Kaleidoscope Paediatric Rehabilitation Service (KPRS) using an innovative virtual clinic model to capture maximum numbers of children with CP across NCHN.
This unique virtual clinic model allows for x-ray service provision in the child’s local community, with the results accessible online. The CPHS service monitors need, requests x-rays, measures hip migration and provides recommendations according to the Australian Standards of Care (ASC) (2008). Children are required to attend clinic only if an issue is highlighted.
Relevance: This virtual model of hip surveillance provides children with CP and their families the right care, in the right place, at the right time. Travel, family disruption, time and financial costs are kept to a minimum by eliminating unnecessary face-to-face appointments. Pathways for referral for an orthopaedic review are in place for when tertiary care is required.
The CPHS service works in partnership with the child and family, the child’s local health workforce team, private and public radiology services and orthopaedic services. The service is readily sustainable due to low staffing and resource requirements; simple non-invasive diagnostic examination; clear referral pathway to CPHS and clear clinical pathways between services.
Results: A total of 227 referrals have now been received from across NCHN with approximately 50% of these children living in regional and rural areas. All children identified as being at risk of subluxation/dislocation have been referred for orthopaedic review (n=42) and intervention.
Patient outcomes have been enhanced via: increased access to hip surveillance; early intervention to prevent joint deformity, further disability and pain; greater coordination of care between specialist services, families, and local service providers; and reduced need for travel.
Conclusion: The establishment of the KPRS CPHS Service and virtual clinic model has enabled significantly more children with Cerebral Palsy living within the NCHN in NSW to access hip surveillance and subsequent early intervention when indicated.
Huge potential exists for the KPRS CPHS model to be replicated in other CPHS services throughout Australia as all clinical and administrative processes are readily transferable.
Victorian Paediatric Rehabilitation Service: a case study in Victoria’s coordinated approach to service deliveryAuthor/s
Janet is a senior physiotherapist who has been working in paediatrics for almost 30 years. After working in acute teriatiary paediatrics, then community /education and private sectors, her current roles include working in the Victorian Paediatric Rehabilitation Service and the physiotherapist led paediatric Orthopaedic clinics at Monash Children’s Hospital. These roles involve working with children with cerebral palsy, and simple orthopaedic conditions seen in childhood (mainly DDH, CTEV management, and postural variations). Janet has been an integral part of the team of experienced paediatric physiotherapist who have written, and now teach, on the 4 post graduate online learning modules for physiotherapist to gain skills in paediatric physiotherapy through Monash University. These modules cover the following areas; an introduction to physiotherapy in paediatrics (respiratory, CP, red flags, complex), newborn and infants, cerebral palsy (across the ages – infancy, preschool, primary, transition), chronic and complex (ABI, chronic fatigue, neuromuscular conditions, and burns).
Joannah Tozer trained as an Occupational Therapist and has a Master’s of Business Administration and has worked in health and disability for over 20 years in a wide range of roles across acute, community and primary health care.
She has been the statewide manager of the VPRS for the past 7 years which sees her having the strategic management and oversight of 8 VPRS sites. Over this time she has worked closely with the Department of Health and Human Services (DHHS) in Victoria and Tasmania to improve paediatric acute and subacute services over both states.
She is deeply committed to working in health and disability and improving the client and their family’s experience through the health system. She has successfully implemented a number of projects that have improved the client journey, and their health outcomes. She is also passionate about improving access to specialized clinical skill close to the home of clients and moving services away from tertiary sites and into local communities. This has led to her and the VPRS team to develop an education and competency framework for paediatric staff which includes expectations of different grade levels, competencies with common health conditions and best practice evidence.
As a statewide service the Victorian Paediatric Rehabilitation Service has 8 sites with specialist trained paediatric rehabilitation specialists and allied health staff. The VPRS provides a unique approach to the management of children who require long term specialist care from multiple specialists. Children with complex disability live and play within a multi-layer service system, and coordination between these services is paramount to the success of any intervention given.
This is a case study of SW a nine year old girl from Bendigo with a diagnosis of Cerebral palsy with predominance of multilevel spasticity in her lower limbs. From the time she was diagnosed with Cerebral palsy at 19 months, she was managed by her local paediatrician and a visiting rehabilitation consultant from VPRS.
Her goals have always been around her mobility from walking around home, to school to more specific areas such as school sport. As part of her rehab program she required Botulinum toxin injections for spasticity management in her legs. In her early years her only options for this was to travel to RCH, but in 2013 VPRS – Bendigo set up an injecting clinic in the hospital and her rehabilitation consultant travelled there to do the injecting. As she grew, the spasticity of her lower limb became less responsive to BTX-A and she was considered for Selective Dorsal Rhizotomy.
In 2014 she was evaluated by the RCH Complex Movement Disorder forum (CMD) comprising her rehabilitation, paediatrician, neurosurgeon, orthopaedic. As part of her evaluation a gait laboratory evaluation, orthopaedics long term planning and a battery of SDR assessments were required to assist with the decision making of her surgery and long term medical plan.
She received her SDR in 2015 where she had in-patient rehabilitation for 6 weeks before being transitioned back to Bendigo with a combination of specialist rehab provided by VPRS-Bendigo and community/school allied health therapy programme.
Ensuring that everyone is working on achieving the client goals and having a clear plan and communication strategy with from the neurosurgeon and orthopaedic surgeon to her VPRS team at both Bendigo and RCH and her school understand the family’s goals and the issues associated with achieving them is the main challenge in delivery care across the spectrum. It relies heavily on creative delivery of therapy suited for the individual child and clear communication and transition between all teams.
Building workforce capacity through an innovative model of online paediatric physiotherapy educationAuthor/s
Janet is a senior physiotherapist who has been working in paediatrics for almost 30 years. After working in acute tertiary paediatrics, then community /education and private sectors, her current roles include working in the Victorian Paediatric Rehabilitation Service and the physiotherapist led paediatric Orthopaedic clinics at Monash Children’s Hospital. These roles involve working with children with cerebral palsy, and simple orthopaedic conditions seen in childhood (mainly DDH, CTEV management, and postural variations). Janet has been an integral part of the team of experienced paediatric physiotherapist who have written, and now teach, on the 4 post graduate online learning modules for physiotherapist to gain skills in paediatric physiotherapy through Monash University. These modules cover the following areas; an introduction to physiotherapy in paediatrics (respiratory, CP, red flags, complex), newborn and infants, cerebral palsy (across the ages – infancy, preschool, primary, transition), chronic and complex (ABI, chronic fatigue, neuromuscular conditions, and burns).
Background: Current undergraduate training in paediatric physiotherapy is limited. Many physiotherapists find themselves relatively unskilled in managing paediatric conditions. This is compounded outside tertiary hospitals where senior staff support and professional mentoring is limited. Physiotherapists working in the community, or in rural or remote areas are often required to work in isolation and practise in paediatric physiotherapy beyond the level of their expertise. Currently the only way physiotherapists can improve their skills in paediatrics is to attend face to face professional development courses (typically run in metropolitan areas), or enrol in formal post graduate training (involving considerable time and cost).
Method: Best practice in online education was identified, and knowledge deficits in paediatric physiotherapists described. Each of the 4 training packages (modules) incorporated four weeks of online interactive content depicting problem based learning, facilitated clinical reasoning (with ‘vodcast’ case scenarios) and consolidation of theoretical framework underpinning paediatric clinical practice. Participants ‘attended’ via the online learning website for up to 8 hours per week (at participant’s convenience) and completed assessment and learning tasks. A team of remote tutors were assembled to provide online feedback to participants and assist in delivering learning outcomes. The modules also provided a final face to face day (substituted with online video viewing of content) to enable practical skill development in elements addressed within the online components. The suitability of this style of professional development for what would traditionally be provided via clinically based teaching was up until now, relatively untested.
Results: Four online courses were developed over the period 2011-2015: Introductory, Neonates and infants, Cerebral palsy, and Chronic and complex conditions. Each course was initially piloted and refined following participant feedback. The response to engagement with content was positive with qualitative and quantitative data gathered. Participants were asked about their perception of the efficacy of the courses. All agreed or strongly agreed that the courses were intellectually stimulating; achieved learning objectives; supported their studies and provided good feedback. Enrolment in the paediatric online courses came from all states in Australia as well as overseas, and the evidence of uptake by those working in remote and rural areas was demonstrated. The successful implementation of the online education model has facilitated the development of an online short course in Paediatric Nutrition, and a Masters of Advanced Paediatric Physiotherapy Practice at Monash University using the same methodology.
Conclusion: An effective sustainable model of online professional development in paediatric physiotherapy, accessible to those living in rural/remote areas has now been established, achieving the goal of building paediatric physiotherapy workforce capacity. Demonstrating success with this model has enabled the development of similar educational opportunities for other paediatric health care providers.
An early childhood program to respond to otitis media: feedback from familiesAuthor/s
Associate Professor Caroline Jones (PhD) is an Australian Research Council Future Fellow at MARCS Institute for Brain, Behaviour & Development, at Western Sydney University. Her current research focuses on normal language use in north Australian Kriol and varieties of Australian English, and typical paths in speech and language development for children in these language varieties, including for children with hearing loss. Since part of the picture for many children is participation in early childhood programs, the effectiveness of such programs for children from diverse cultures and/or with hearing loss is an important focus.
Chronic otitis media (OM) remains difficult to treat successfully, especially for Aboriginal children in remote communities in northern Australia. In recognition of this, an early childhood program ran for several years until 2014 through Sunrise Health Service, an Aboriginal-controlled primary health service in the Katherine NT region. The LiTTLe Program (Learning to Talk, Talking to Learn) was a parent-implemented early childhood language and school readiness program. Parents of children aged 0-3 years, regardless of the children’s OM status, were modelled intensive talk with their children, to boost oral language development as a buffer against the impacts of chronic otitis media. Parents attended group sessions in a school-based facility for four hours a day, five days a week during school terms. Families were also connected with clinic services and ENT/audiology, and with other programs e.g. nutrition, and maternal health. The program was staffed by local Aboriginal community members undertaking childcare qualifications, supported by a visiting program manager.
In this paper we report on the results of in-depth interviews with family members who with their child participated in the LiTTLe Program. We interviewed 7 Aboriginal mothers in their early to mid twenties, and one grandmother, from a remote Aboriginal community in the Northern Territory where several of our presentation team live. We invited the parents to respond to open-ended questions in conversational format, encompassing: (i) their general opinions about the program, (ii) their experience of the program’s implementation, (iii) their conceptions and prioritisation of ear health in relation to other child health problems, (iv) their perception of the program’s utility in promoting school readiness, (v) issues relating to program engagement and attendance, and (vi) their suggestions for improvement.
While each parent’s feedback reflected their personal situation, a number of themes emerged during interviews. Parents were generally positive about the program overall, as a stimulating and social activity for themselves and their children. Parents varied in how much language modelling and ear health support they experienced or perceived as occurring in the program, but strongly thought that the program promoted school readiness in their children. Parents provided insights into the extent to which good hearing was viewed as necessary in their community, and raised cultural alternatives to oral language such as sign language as alternative strategies for communication in the context of otitis media. Finally parents provided clarifications of reasons for non-attendance and several suggestions for improvement including in terms of program location.
Telehealth access to sub-specialist services for country kidsAuthor/s
Susan is an NZ and US Registered Nurse, with a Master of Public Health degree and Graduate Certificate in eHealthcare. She has worked in New Zealand, Hong Kong, China and Australia.
In 2012, with clinical lead and Director of Neurology Prof Andrew Kornberg, she established video consulting at the Royal Children’s Hospital in Melbourne. The underlying philosophy was to embed telehealth within existing processes for clinical and administrative staff—‘business as usual’. Telehealth is now available across all clinical services and offered regularly by most.
Susan has also delivered a range of private consultancy telehealth advisory services and educational packages including for APNA (Australian Practice Nurse Association)/ ANMF (Australian Nursing & Midwifery Federation) and regional health services. She presents regularly, has had a few papers published and is a member of the Australasian Telehealth Society Scientific Committee and the National Telehealth Working Group, providing recommendations to the National Health CIO Forum on telehealth strategy.
In 2011 the Royal Children’s Hospital in Melbourne began offering web-based telehealth video-consultation using existing infrastructure—computers, webcams and internet. The aim was to integrate telehealth in to usual service delivery and enable access for rural, regional or interstate children and their families from their home, school or with their local paediatrician or GP. Telehealth was introduced in response to the introduction of new Medicare telehealth Item numbers and also has an aim to be financially sustainable.
Telehealth is now available across most sub-specialties and is increasingly integrated in to organisational systems and processes.
Additionally, in July 2015 the hospital undertook a generalised communication survey of all their referring community paediatricians, including a section on telehealth. There were 76 respondents, including 38 rural or regional paediatricians. Paediatricians were asked about their perceived benefits of telehealth, barriers to using it more, areas of highest need, recommendations for improvement and more.
The aim of this presentation is to provide some insights for integrating accessible, financially sustainable, web-based telehealth—from the perspectives of regional paediatricians and the tertiary hospital. It will include a brief overview of the introduction of web-based telehealth; explore challenges in achieving financial sustainability through Medicare funding and present findings from the survey of rural and regional paediatricians.
Increasing the confidence of nurses caring for country kids using continuing educationAuthor/s
Tracy has a 25+ years background in emergency and critical care nursing in both metropolitan and regional settings. She has been a clinical educator for the last 16 years in both the hospital and tertiary setting. She has completed a masters of nursing science with a focus on clinical nursing education, particularly in rural and remote settings. She currently coordinates the Continuing Nursing and Midwifery Education Program for the Loddon Mallee Region in Victoria, she is an Advanced Life Support educator for the same region and also coordinates the certificate in Gerontological Nursing course at Bendigo Health. Tracy also sits as the Australian College of Nursing representative on the National Australian Resuscitation Council. She endeavours to make learning interactive and seeks to positively impact clinical practice through continuing nursing education.
Aims: To enhance nurse confidence and paediatric clinical care in rural and remote health services.
Methods: The Loddon Mallee Continuing Nursing and Midwifery Education (CNME) program provides education for nurses and midwives across 30% of Victoria and includes a study day called ‘Management of the acutely unwell child’. This study day aims to provide nurses with the background knowledge and skills to more confidently care for the acutely unwell/injured child. Educational material is based on national standards, evidence based and relevant peak body recommendations. Transformative learning theory has been applied to both content and evaluation. Content includes a mixture of didactic teaching, group work, case study work and practical sessions. It is presented by a Paediatric nurse.
Relevance: While presentations of acutely unwell children to rural, regional and remote Australian hospitals are not as common as those in metropolitan settings, nurses still need to be prepared to receive and care for the acutely unwell/injured child in this setting. Complicating this need is the geographical isolation of the health services that do not have medical officers on site at all times and limited access to a paediatric specialists. This means these essentially ‘nurse led’ services require that the nurses in that service maintain a high level of skills and knowledge in all areas, including caring for the acutely unwell child. Studies describe, however, nurses are unprepared to care for the acutely unwell paediatric presentation citing lack of exposure and rusting of knowledge gained in training as one of the challenges faced by nurses working in these health services.
Results and conclusions: Evaluation data shows that this program is enhancing nurse confidence and paediatric clinical care and shows education that is provided with careful attention to addressing the theory-practice gap and contextual education needs, can positively impact nursing confidence, clinical care and ultimately workplace satisfaction.
An insight into telepaediatrics: Royal Far West pilot programAuthor/s
Dr John Kramer has been a general practitioner in Woolgoolga since 1981. He works at
Beach Street Family Practice. Woolgoolga has DWS status, currently recruiting for my new surgery opening in July 2016. Dr Kramer attends case conferences at local schools, usually one each term (Sandy Beach PS, and St John Paul College in Coffs Harbour). His major clinical interests are developmental paediatrics, Indigenous health, medical education, palliative care and refugee health. He has been involved in Royal Far West Telepaediatrics with Dr Marcel Zimmet from early 2015. He holds VMO positions at Coffs Harbour Base Hospital and Baringa Private Hospital, Coffs Harbour, is a part-time senior lecturer at UNSW Rural Medical School in Coffs Harbour, is a Board Member of NSW Rural Doctors Network (RACGP Nominee), Provost RACGP Rural.
Dr Marcel Zimmet is a paediatrician specialising in developmental and behavioural disorders.
Marcel works at Royal Far West in Manly where he has developed a Telecare program providing on-line developmental-behavioural paediatric care and parent therapy to children in rural and remote New South Wales, as well as face-to-face consultations.
Marcel also works at the at the Sydney Children’s Hospital Network (Westmead) in the Fetal Alcohol Spectrum Disorder (FASD) Clinic. This is part of the CICADA (Care and Intervention for Children and Adolescents affected by Drugs and Alcohol) Centre NSW.
Marcel has been awarded a Fulbright professional scholarship to study best practice models in FASD clinical care, research, teaching and advocacy in the USA. He is a member of the Expert Panel developing the Australian FASD Diagnostic Instrument, including national diagnostic guidelines and online training modules. He is a chief investigator for national FASD case surveillance through the Australian Paediatric Surveillance Unit, and for research into the impact of FASD on children and families.
Marcel’s paediatric training began at the Royal Children’s Hospital in Melbourne, and continued in Alice Springs and then Darwin, where he became a consultant paediatrician and established a private practice.
Background: Lack of access to mental health services, resources and support can be a major difficulty for Australians living in rural and remote areas of the country. This is particularly relevant for children with developmental-behavioural problems and their families who often have limited access to specialised paediatric services. Royal Far West undertook a pilot program to deliver an innovative developmental-behavioural telepaediatric service to rural and remote NSW in order to bridge the gap in the delivery of specialised care and to help support local GP’s and Paediatricians.
Objectives: telepaediatrics is a relatively new endeavour, with the Royal Far West pilot program being the first developmental-behavioural telepaediatric service of its kind being delivered to rural and remote NSW. This presentation aims to provide an insight into the unique nature of the telepaediatric consultation process and give a first-hand account of the successes and challenges associated. It will also look at the way in which therapeutic relationships can be developed over the Internet and showcase the use of the ‘Royal Far West Telecare Toolkit’. Through the exploration of individual case studies from the program this presentation will provide insights into the implementation of a telepaediatrics program for children in rural and remote NSW.
- A description of the telepaediatrics pilot program at Royal Far West and the outcomes and results achieved
- An insight into the unique nature of a telepaediatrics consult
- A tour of the ‘Royal Far West Telecare Toolkit’ and its utilisation during the consultation process
- How the successes and challenges associated with this unique form of specialised care delivery for children with developmental-behavioural issues can inform practice.
- Provide case studies as first hand examples of the way in which the service delivery model was implemented and discuss the key success factors involved.
Conclusion: With the growing demand for specialised paediatric services in remote and rural Australia, there is a need for innovative models of service delivery to support children and their families. This presentation provides an opportunity for a unique insight into the world of telepaediatrics and the potential that exists for providing specialised developmental-behavioural care.
An old but cutting-edge clinic: maintaining relevance and moving with the timesAuthor/s
Ruth Kreamer initially trained as a registered nurse then changed careers to Social Work. Since1995 Ruth has been working within the Tamworth community where she grew up, in a variety of roles for Health and Centrelink.
Ruth also worked on the Aboriginal Children and Family’s Journey project. This project has had lasting impacts including approval for aboriginal children to have two escorts covered by IPTAAS in HNE Local Health District, an aboriginal flag flying at the entrance to John Hunter Hospital, and collaborative meetings run regularly to provide an avenue for Aboriginal Staff to meet and raise issues with hospital and community health management.
Ruth is a currently working with the Child Development Service at Tamworth Community Health Centre, the Tamworth Diabetes Centre and provides in-reach to children’s ward, special care nursery and maternity at Tamworth Rural Referral Hospital.
Early intervention for children and parents is a passion of Ruth’s so working in the Child Development Service, an interdisciplinary allied health team providing family-centred developmental follow up for children, provides great job satisfaction.
In line with her dedication to the principles of early intervention Ruth also facilitates Circle of Security Parenting® programs and Reparative Parenting Program courses for foster carers.
Aims: The Child Development Service (CDS) has been developing as a service since 1997 and continues to provide family-centred interdisciplinary developmental follow-up for children up to 3 years at risk of delay in 2+ areas (e.g. prematurity). This specialised review clinic aims to deepen understanding of a child’s strengths and abilities to help structure a caring, stimulating environment for a child’s developmental potential.
Methods: An interdisciplinary clinic, CDS assesses children at specific ages, utilising a range of allied health professionals depending on the age or needs of the child. CDS provides recommendations and reports to families and referral for additional follow-up and support. The model aims to be efficient and flexible to cater for individual families while responding to challenges such as staffing, external influences, service demands and evaluation outcomes. This requires innovation and the unique ‘one stop shop’ CDS model of service incorporating such a variety of professionals in a coordinated community clinic approach is not available elsewhere in our local health district.
Relevance: Regular and thorough service reviews occur to ensure CDS remains relevant. With improvements in medicine and neonatal care the need for clinics like CDS is increasing with premature babies surviving at earlier gestational ages. Prematurity has long term developmental, social, and learning concerns which can impact well into school age meaning local developmental follow-up is important. As our rural city has a higher-than-national-average of vulnerable children, early identification is crucial for maximised intervention and outcomes.
Results: The longevity of CDS indicates the service is useful, necessary and valued by our local community. Client satisfaction surveys and family comments reflect involvement with the service as beneficial. Rates of referrals and occasions of service indicate demand for the service is consistently high, including a high percentage of referrals for Aboriginal and Torres Strait Islander children. This is an ongoing focus area and CDS has attempted to provide a range of options to better meet the needs of Aboriginal families including outreach clinics to local Aboriginal organisations and strengthening links with Aboriginal services both within and external to health, including ‘getting our faces out there’ at local Aboriginal events. As a result of the flexibility and longevity of CDS, continuity of collaboration and partnerships with other services and agencies has been well maintained.
Conclusion: The current CDS model of service delivery utilises interdisciplinary approaches to provide holistic, flexible, timely, efficient, client-centred care. This is a uniquely rural service with most follow up in our state occurring through metropolitan centres or costly metropolitan outreach. CDS is free and accessible for eligible families within our Local Government Area. There is scope for improved engagement of Aboriginal families and service improvement for children older than 3 years, with research indicating the impacts of prematurity and high-risk diagnoses last well into school-age. Current service restrictions and boundaries leave many families needing to travel to metropolitan hospitals for developmental follow up when this could occur in a less confronting rural location.
Preventing dental disease in remote Indigenous children: importance; methods and challengesAuthor/s
I am an Associate Professor, Teaching and Research, in the School of Dentistry, University of Queensland. I am an NHMRC Chief Investigator B and hold an academic title of Professor in the School of Dentistry and Oral Health, Griffith University. I am an Adjunct Associate Professor in the Australian Research Centre for Population Oral Health (ARCPOH), University of Adelaide.
After almost 20 years as a dental academic in South Africa and I took up the position of Colgate Chair & Professor: Rural, Remote and Indigenous Oral Health, in the School of Dentistry & Oral Health, Griffith University, for 5-years from January 2009. I was then a Senior Research Fellow at ARCPOH for a year. More recently I was an Associate Professor, on a short contract position, in the Faculty of Dentistry, University of Sydney.
I have been involved in the training of under- and post-graduate dental students, dental public health related research and various management roles. I am a dental public specialist, with an undergraduate degree in dentistry (1986), honours degree in Epidemiology (1992), Masters degree in Community Dentistry (1994) and PhD in Dental Public Health, University College London (2002). I have published widely and my main research interests vary across many dental public health issues including evidence-based dentistry, oral health-related quality of life and health inequalities.
Background: Fluoridation of public water supplies is the single most effective method of minimising dental caries [tooth decay] in children, and one of the most cost-effective measures in public health. Optimal levels of fluoride need to be present in water throughout the lifetime of residents to be of continued benefit, as the mechanism is primarily topical: F ions inhibiting demineralisation of tooth enamel and promoting remineralisation. In the Northern Peninsula Area of Far North Queensland, reticulated water was fluoridated between 2006 and 2011 when the plant failed and is unlikely to be reintroduced. We are researching the cost-benefit of an alternative approach.
Methods: An epidemiological survey of preschool, primary and secondary school children was conducted in 2004. We repeated this in 2012 and again in 2015, the latter as a baseline for a study of the cost-effectiveness of a professional-delivered triple preventive intervention: topical disinfectant, fissure sealants and fluoride varnish.
Results: Age-weighted overall caries prevalence and severity declined from 2004 to 2012 by 37.3%. The effect was most marked in younger children, dmft (decayed, missing,& filled deciduous teeth) decreasing by approximately 50% for ages 4–9 years; at age 6, mean number of decayed teeth decreased from 5.20 to 3.43. DMFT (decayed, missing & filled permanent teeth) levels also decreased by almost half in 6–9 year olds. We attributed this to water fluoridation. Nevertheless disease levels were still well above the national average, the overall mean dmft being 2.76 and the mean DMFT 1.32, with 64% of the children having decayed deciduous teeth, and 45% decayed permanent teeth.
In August 2015, 400 schoolchildren were examined. These are being rendered dentally fit, and the triple preventive intervention applied.
Discussion: There are many barriers to such research including long-distance logistical planning, high costs, the complexity of ethical permissions, research governance approvals, credentialing of clinicians, truancy and the multiple consents required from parents/guardians which reduce compliance. The effects on caries will be examined in further epidemiological surveys in 2016-2018 and the economics evaluated using Markov chain models.
Conclusion: Continued efforts are needed to promote healthy lifestyles in remote Indigenous communities, but these have limited success. There is clearly benefit in water fluoridation, and health economic aspects of this are currently being quantified, as are the cost-benefits and cost-effectiveness of individual preventative interventions by oral health professionals as part of an ongoing NHMRC grant.
Building the capacity of parents and children living in remote communities around nutritionAuthor/s
Selma has worked cross-culturally in Brazil for over five years as a nutritionist in primary health sector in both private and public settings. Selma lived in Brisbane for 4 years where she undertook her PhD research project and worked as a lecturer/subject coordinator at the Queensland University of Technology. She moved to Darwin in 2008 and worked as a remote public health nutritionist and a child health nutritionist in 2008 and 2009 and since 2010 she has been working in nutrition research projects at the Menzies School of Health Research. She was responsible for the nutrition education component of the SHOP@RIC, a randomized trial completed in 2015 assessing the impact of price reduction with and without an in store nutrition education strategy on purchasing fruit, vegetables and water in 20 remote NT communities. She is currently leading the Healthy Eating and Drinking Study (HEDS), a 4 years (2016-2019) project funded through National Medical and Research Council (NHMRC) aimed at assessing the impact and cost-effectiveness of a multi-component intervention to reduce sugar-sweetened beverage consumption and increase water, fruit and vegetable consumption among Indigenous Australian school-aged children living in remote communities.
Background: The diets of Indigenous children living in remote Australian communities are generally poor. Consumption of sugar-sweetened beverages among this target group is high (over 0.4L/day), and fruit/vegetable intakes are low, increasing the risk of obesity, type 2 diabetes and cardiovascular disease. There is little evidence of effective approaches to promoting healthier dietary intakes among children living in remote Indigenous communities. This trial aims to test the impact and cost-effectiveness of a multi-component intervention to reduce SSB consumption and increase water, fruit and vegetable consumption among Indigenous Australian school-aged children living in remote communities.
Method: Twelve remote communities will be included in the study. Training free of charge to all people with interest in nutrition will be provided in all communities. Two trained residents from each community will be recruited to work on the project to support participant recruitment, data collection and program implementation. The communities will be randomised to intervention or control (delayed intervention). Intervention will be delivered over 18 months and will include: i) a school-based nutrition education program delivered consisting of 10 1h-workshops; ii) parental involvement in community events including cooking demonstrations and taste testing, school workshops and data collection sessions; and iii) supportive environmental changes including 24hour-access to drinking water and good practices at the community store to encourage healthier eating and drinking. A total of 300 (150 control and 150 intervention) primary school children will be recruited through the schools. Anthropometric measurements and questionnaires to assess dietary intake and mediators of dietary behaviour change will be collected at baseline and at 6, 12 and 18 months post-baseline. The primary outcome is the difference between intervention and control participants in the change in sugar-sweetened beverage consumption from baseline to 18 months post-baseline.
Conclusions: This trial will provide evidence on the effectiveness and cost-effectiveness of a multi-component intervention to reduce sugar-sweetened beverage consumption among Indigenous Australian school-aged children living in remote communities. Building the capacity of community residents through training and supporting them to implement the project over 18 months and involving parents in the program activities will ensure sustainability of the strategies implemented to improve eating and drinking intake and lead to better health outcomes.
Growing child safety on Australian farmsAuthor/s
Tony is the Director of the Australian Centre for Agricultural Health & Safety, University of Sydney. He has over 20 years’ experience in agricultural health and safety, with his interests covering a range of public health issues. He has worked extensively across rural Australia and internationally in the areas of agricultural injury and chronic disease.
Children account for approximately 15% of all fatal incidents on farms in Australia. There is also a considerable injury burden which results from non-fatal injury. While there is consensus that this is unacceptable, the level of inputs to promote prevention approaches in farm safety for children has substantially reduced in recent years.
The aim of this presentation is to assess non-intentional farm injury deaths involving children (<15 years) for the period 2001-13 and to review the evidence for prevention of these incidents.
Data from the National Coroners Information System for the period were analysed. A total of 166 child-related cases were identified with leading causal agents/mechanisms in descending order being drowning (59), quads (25), car/ute (21), motorcycle (10), tractor (8) and horses (8).
Each of these cases has been reviewed to assess the potential for prevention using existing evidence-based approaches. Information on the most important areas for prevention of these incidents will be defined along with potential options for future initiatives.
Validity and acceptability of Kimberley Mum’s Mood Scale to screen for perinatal anxiety and depressionAuthor/s
Dr Julia Marley is a Senior Research Fellow (Rural Clinical School of WA (RCSWA)) and Principal Research Officer (Kimberley Aboriginal Medical Services (KAMS)). Since 2006 she has been conducting collaborative research into improving Aboriginal health and building research capacity in the Kimberley region. Dr Marley also Chairs the Kimberley Aboriginal Health Planning Forum Research Subcommittee.
In consultation with key Aboriginal people, senior management and staff involved in research at KAMS and RCSWA Dr Marley has led the development of a KAMS model of research. By embedding research into existing health services and including Aboriginal people, health service providers, administrators and policy makers as core members of the research team KAMS is better able to determine what information is required to help improve Kimberley primary health care services. The KAMS research model ensures that the process, interpretation, dissemination and implementation of results are culturally safe. It also prioritises translating the evidence from research into policy and practice as quickly as possible over academic publications. The research that Dr Marley has led has had significant outcomes at regional and national levels, including incorporating the use of glycated haemoglobin tests instead of glucose tests for screening for diabetes in the Kimberley.
Introduction: Perinatal mental health is important for the well-being of mother and infant. Unfortunately anxiety and depressive disorders affect 20% of Australian pregnant women and mothers within the first year post birth. Potential long-term health impacts include poorer birth outcomes, poorer bonding between mother and infant, and susceptibility to lifelong psychopathology. Early identification and appropriate support may improve outcomes, however most women do not seek and/or receive treatment. Community consultation with over 100 Kimberley Aboriginal women and key collaborators demonstrated the need for a culturally safe screening tool that included adequate ‘yarning time’. This led to the development of the Kimberley Mum’s Mood Scale (KMMS).
Aims: To determine if the KMMS is a valid and acceptable method of identifying Kimberley Aboriginal perinatal women at risk of anxiety or depressive disorders compared to a blinded semi-structured clinical interview.
Methods: KMMS consists of two parts. Part 1 covers the same areas as the EPDS using similar stems and scoring system. However it uses ‘Kimberley’ English, locally developed graphics and a visual Likert scale (focusing on feelings not numbers). Part 2 is a psychosocial tool that incorporates key elements identified by Kimberley Aboriginal women, enabling the score from Part 1 to be put into context. A cross-sectional design was used to determine the reliability and validity of the KMMS to identify women with anxiety and/or depressive disorders compared to a reference standard (using DSM IV criteria). A qualitative approach was used to determine KMMS’ acceptability. Ninety-seven Aboriginal women aged 16 years and older who intended to continue with their pregnancy or had a baby within the previous 12 months were enrolled in the study.
Results: Part 1 had good internal consistency reliability (Cronbach’s a, 0.89). Overall KMMS risk (combined Part 1 and 2) equivalence for screening for anxiety or depressive disorders was ≥ moderate (sensitivity, 82.6%; specificity, 86.8%; positive predictive value, 67.9%). Participants found the process easy and useful. Healthcare providers found KMMS more useful than the EPDS. Part 2 allowed healthcare providers to ask questions that gave participants an opportunity to express themselves, resulting in a deeper understanding between them.
Conclusions: KMMS is an effective tool for identifying Kimberley Aboriginal perinatal women at risk of anxiety and depressive disorders. Adoption of KMMS with culturally safe training and support is likely to improve screening processes, and with further validation may have broader applicability across remote Australia.
Minding their mouthsAuthor/s
Dr Rachel Martin graduated as a dentist from Melbourne University in 1991. She gained a Masters of Public Health in 1998. She has worked 25 years in public oral health, developing community programs, teaching and research. She works as a clinician in the Oral Health program at North Richmond Community Health and runs the Victorian research study on the Hall Technique. Rachel was on the committee that wrote the first National Oral Health Promotion Plan for Australia in 2013, and is an inaugural member of the Australian Chapter of the international Alliance for a Cavity Free Future. She also sits on the Dental Board of Australia, Registration and Notification committee (AHPRA).
Background: Dental decay (dental caries) is the most common chronic disease in young children. Up to 50% of children have experienced caries by five years of age. Childhood dental caries causes pain and infection, which adversely affects general health and sleep patterns of the child and family. This has lasting implications for social, educational and health outcomes including increased anxiety in children and their families in their interactions with oral health services.
Treatment of oral disease is the one of the most common reason for avoidable hospital admissions (AHA) in children. Each year for the last 15 years at least 1% of rural Victorian 5-9 year olds have been hospitalised for dental treatment. Current costs are $3153 per admission.
Aim: To present a current and innovative model for oral health care delivery by a Victorian oral health service to rural children.
Methods: As traditional surgical management of dental caries (fillings and extractions) does not address the multifactorial nature of caries, North Richmond Community Health Service Oral Health (NRCH_OH) has developed a model of care focusing on prevention and early intervention in oral disease. This health promoting model of care is client and family centred and is based on individual risk assessment.
Children are screened at primary schools, day care and maternal and child health centres; when identified as ‘at risk’ are invited to attend the clinic with their families.
In the clinics and some institutional settings, oral health professionals provide a range of educational, preventive and minimally invasive services tailored to child and family risk status. Using treatments such as the Hall Technique (sealing decay with preformed metal crowns) and silver fluoride, clinical experiences are provided without the unpleasant sharps, smells or noises traditionally associated with dental treatment.
Results: Young children receiving early treatment tell us, through validated scales, they are happy with their clinical visits. Staff and parents are also reporting improved satisfaction levels and the use of minimally invasive clinical interventions is increasing.
Conclusions: Children and their families can be provided with positive experiences of oral health care and the services that will ensure a lifetime of good oral health practices via the preventive measures of diet, effective daily oral hygiene practices and appropriate service utilisation. In applying preventive and early intervention methods, the need for costly and invasive management such as general anaesthesia for dental treatment can be greatly reduced.
A child development unit in regional New South Wales: activities, outcomes and experiencesAuthor/s
Associate Professor Tim McCrossin has been a consultant paediatrician in Bathurst for 20 years and Clinical Dean for Western Sydney University Bathurst Rural Clinical School since 2009. Whilst functioning primarily as a busy regional general paediatrician, interests have of necessity diversified to include service development, education, research and rural health issues. Research pursuits continue to include the broad scope of general paediatrics and rural health.
Aims: This study aims to (a) document the existing service model of a regional Child Development Unit in Bathurst, NSW (b) assess the activities and outcomes of the Child Development Unit over an 11 year period, and (c) explore the programs successes, barriers and enablers and areas for improvement.
Methods: To document the current service model the researchers consulted with staff working at the Child Development Unit and reviewed relevant documents stemming from the program. A retrospective analysis of all child development assessments completed at the Bathurst Child Development Unit between 1st January 2003 and 31st December 2014 identified 11 years of activities and outcomes. Program successes, barriers and enablers and areas for improvement were explored via two focus groups with: (a) health and education professionals involved in the child development assessment and/or ongoing care of the child, and (b) parents of children that have completed a child development assessment at the Bathurst Child Development Unit.
Relevance: The Bathurst Child Development Unit is one of only three clinics that are based outside of a metropolitan centre in NSW. To our knowledge, no studies to date have reviewed the activities and outcomes of a regionally based Child Development Unit or explored the effectiveness of such a service model from the perspective of clinicians, parents and relevant health and educational providers that are involved in the child’s future care.
Our findings have the potential to enhance the existing Bathurst Child Development Unit and to also inform the implementation of similar service models in other regional settings, potentially providing an important model for the provision of developmental services for children close to home in regional and rural centres.
Results: Data collection is ongoing. It is anticipated that the study’s findings will include: the number of assessments completed; the number and type of specific screening assessments completed, diagnoses made, recommendations made, and referrals made; and to whom the reports were distributed. Program successes, barriers to and enablers of the child development assessment and recommendations for improvement will also be documented.
Conclusion: It is anticipated that this project will demonstrate that regional sites have the capacity to implement a Child Development Assessment Unit via creative collaborations between the local health service and a locally based University. It is also anticipated that the study will demonstrate positive outcomes and experiences for rural/regional children that have accessed a child development assessment locally.
Reaching families by building partnershipsAuthor/s
Robert is a Registered Nurse and Midwife with over 30 years’ experience working in the speciality field of maternal and child health and holds a Masters of Public Health. He has been the CEO of Tresillian Family Care Centres, which is an early parenting service operating from four sites across metropolitan Sydney and more recently, an additional two sites in rural NSW and Victoria, since November 2013.
He was previously the CEO at Karitane for 10 years prior to commencing at Tresillian Family Care Centres. He is also the current President of the Australian Association of Parenting and Child Health and Treasurer of the NSW Health Services Association.
In addition, he is a Fellow of the Australian Institute of Company Directors and an accredited hospital surveyor with the Australian Council on Healthcare Standards.
Tresillian, the largest specialist child and family health organisation in Australia, has committed to extend the reach of early parenting support services for families in rural and regional areas. Tresillian has been providing support for families experiencing a range of difficulties in the early parenting period since 1918. These include infant sleep difficulties, feeding problems, parent-child relationship difficulties, toddler behaviour challenges and parents at risk of or experiencing perinatal mental health disorders.
Sleep problems are one of the most common presenting problems with studies showing up to 35% of children experiencing clinically significant sleep and settling difficulties in infancy and early childhood. The sleep deprivation and stress associated with infant sleep and settling difficulties can impact on the mood and coping ability of parents emphasizing the importance of being able to access help early.
Partnerships and collaboration are central to Tresillian’s rural service development. Through consultation and building a foundation of trust and respect for service expertise between organisations, Tresillian commenced the delivery of services in Lismore on the NSW North Coast and Albury Wodonga on the NSW-Victorian border. The secondary level Tresillian services provide a referral pathway for primary health providers to support families experiencing complex early parenting difficulties often complicated by psychosocial challenges requiring additional intensive support. The Day Stay and Outreach services at Lismore and Albury provide holistic care through a multidisciplinary team approach with a focus on early intervention and prevention.
The identification of need is not limited to individuals but the community as a whole with service system forums being held with partner health agencies and NGOs in the local areas. These forums have been integral to obtaining a clear picture of the services available to families and importantly identifying the service gaps and needs in the community, providing a platform for further collaboration.
The service development and delivery model will be presented, describing actions taken to adapt and tailor models from metropolitan services to rural settings. As Tresillian has moved forward with rural service development, two models of service collaboration have been implemented: (i) management of a service through a partnership agreement; (ii) formation of an alliance through a service level agreement enabling service enhancements to increase the capacity of an existing service. Both models include the provision of evidence-based clinical practice protocols and building the capacity of health professionals in the local area through professional development and networking.
Innovative approaches to adolescent transition in the remote Indigenous health settingAuthor/s
Alice Mitchell: currently completing a qualitative PhD study on Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD) among Aboriginal young people with Menzies School of Health Research. Alice’s expertise is in cross-cultural communication and health literacy. Alice has experience in mentoring Aboriginal Language Interpreters, creating health radio and DVD programs in an Aboriginal language, teaching germ theory of disease in the NT and Kenya (for people with HIV), as well as exploring the needs of pregnant refugee women in Darwin. The plight of Aboriginal young people with ARF has been a continual burden to Alice, hence the PhD study. Part of this study included producing a phone app to enable Aboriginal young people to track and self-manage their own injections. Alice is a midwife and holds a Master in Applied Linguistics.
The concept of Adolescent Transition encompasses a process of self-management, health literacy and support for both the emerging adult with a significant health condition and their parents, which goes far beyond the act of transfer from a paediatric to adult health care setting. In a tertiary hospital setting this process holds significant challenges. In a remote setting there are numerous further challenges and barriers such as distance, isolation, limited or in some cases non-existent technology & communication options and health resources already at capacity. The indigenous health setting has further complexities with cultural and linguistic considerations, trust and engagement, and differing notions to a Western construct of wellness, health, autonomy and the role of community. There is a paucity of evidence or expert opinion in the literature regarding which model of care may be effective in such unique settings.
Through the authors’ work in remote Aboriginal communities across two states, qualitative data and anecdotal evidence has been collected. This has been informed by years of work in the adolescent transition field including establishing a transition program in a major tertiary hospital setting, a global scope in the field involving travel to key programs internationally and anthropological field work in the NT.
This presentation will provide a brief overview of the underpinning philosophy and aims of an adolescent transition program and an overview of the unique challenges for an adolescent transition model of care in remote Indigenous health settings. A proposed model of care to support young people with complex health conditions, their families and communities as they transition from paediatric to adult health care in remote settings will be provided. A summary of resource and practice implications from this proposed model of care for health services working in the remote indigenous health settings will be included.
Meaningful consultation—a medical and a community perspectiveAuthor/s
Lorna is currently working as a research fellow with Flinders University on an ARC research project. Lorna is a Torres Strait Islander and has a background in health, adult education and research. Lorna has been working in Aboriginal health and education research for last fifteen years.
Dr Heggie currently is the Director of Medical Services, Primary Health Care Branch, Top End Health Service since July 2014. The DMS provides strategic leadership and advice to the other professional heads and general manager; represents Primary Health Care Branch in a range of forums and is a key participant in the area of clinical governance, workforce development, education, service delivery strategy, planning and delivery plus disaster responses. He delivers clinical services to the remote aboriginal community of Minjilang on Croker Island, West Arnhem Land. Hugh is responsible for and participates in the telephone decision support roster giving advice to remote practitioners and facilitating retrievals across the region.
He has been a Medial Practitioner since 1980 and has worked within a remote setting in the Northern Territory as a resident Rural Medical Practitioner since 2002 in both Central Australia and the Top End joining Remote Health in 2009 in the Chronic Disease portfolio. He was appointed as the Senior Rural Medical Practitioner - Operations for Top End Remote Health in May 2011, Acting Chief Rural Medical Practitioner for the NT in 2013 and currently is clinical and line manager to approximately 50 Rural Medical Practitioners who work within the Top End region.
Hugh holds a Bachelor of Science - Pharmacology (University of Melbourne), MBBS (University of Melbourne), Dip Ops RACGP; Graduate Certificate Health Professional Education and is a registered provider of radiology services (remote).
He enjoys running, remote bushwalking and camping, guitar and his family, children/grandchildren … of course colourful shirts/socks and dancing.
Melita’s career with the Menzies School of Health Research has been colourful and varied since she started in May 1998 as a trainee doing a Certificate II in Lab Skills (lab assistant). She has worked on projects on skin sores and scabies, ear health and heart health and everything in between including melioidosis and jellyfish research.
Melita’s current projects focus on better understanding acute rheumatic fever (ARF) and rheumatic heart disease (RHD), which could lead to better diagnosis, treatment and prevention.
Acute Rheumatic Fever (ARF) is caused by an immunological response to group A streptococcal (GAS) infection and can lead to permanent heart damage, a condition known as Rheumatic Heart Disease (RHD).
RHD is seen at very high rates in Indigenous Australians. The rates are among the highest in the world. Indigenous people are up to eight times more likely than other groups to be hospitalised and nearly 20 times as likely to die from this disease. In the Northern Territory (NT) 1 in 50 Aboriginal people suffer from this preventable disease.
Can meaningful consultation at the service provider level (practitioner/clinician level) and at the client/patient and family level to generate changes in thinking (current practices) and action?
The presenters have collaborated to describe what they’ve experienced and ask members of the audience—how different service providers, communities/families and researchers can work together to encourage and engage in meaningful consultations to decrease the prevalence of ARF and RHD.
The first speaker discusses strategies the Primary Health Care Branch, Top End Health Service have taken educating practitioners/clinicians unfamiliar with the NT context about community engagement and health literacy and what this means for remote Aboriginal and Torres Strait Islander children and their families.
The second speakers discuss learnings from a genetic research project conducted in NT with Aboriginal and Torres Strait Islander adults and what insights can be transferred to healthcare delivery.
Each presenter will provide case studies to illustrate the importance of communication and ongoing engagement with the community.
Can a prevention planning framework improve rural youth health outcomes?Author/s
Lisa Neville is a Health Promotion Officer at Alpine Health, North East Victoria, and has worked to improve health outcomes within the Alpine Shire communities since 2007. Since 2009 Lisa has been the Coordinator of Communities That Care Myrtleford, a prevention planning framework in the Myrtleford community that aims to promote healthy youth development and improve outcomes for young people and families.
Lisa is a strong advocate for equity in health. She champions opportunities to provide rural and regional communities with equitable access to services and support systems through positive partnership development, evidence based work and by increasing community capacity to undertake evidence-based prevention planning processes. Lisa is passionate about the promotion of healthy youth development and improving outcomes for young people and families, particularly in country Australia. Lisa has a strong interest in youth alcohol reduction and the role of gender equity in family violence prevention
Introduction: Communities that Care Myrtleford (CTCM) follows the evidence-based Communities that Care (CTC) process of community-change to promote healthy youth development and improve outcomes for children and adolescents. The process is a long-term, comprehensive, risk and protective-focused prevention strategy based on research of predictors of health and social problems. In 2009 the results of a Communities that Care Youth Survey undertaken in Myrtleford indicated that Myrtleford students were higher than Australian averages on a range of indicators relating to alcohol and other drug use, school problems and family conflict. Alpine Health, together with Communities That Care Limited and the Myrtleford Family Safe Group formed Communities that Care Myrtleford to increase protective factors and to target the following risk factors: family conflict; community laws and norms favourable to substance use; and low commitment to school.
Methods: CTC Myrtleford commenced in 2009 with a Youth Survey that was undertaken by all Year 5, 7 and 9 students in Myrtleford. Following the survey a Community Board and Key Leader Group were formed. The Communities That Care process was undertaken resulting in the creation and subsequent implementation of a Community Action Plan. Effectiveness and change were measured by repeating the Youth Survey in 2015.
Results: The initial Youth Survey in 2009 identified above average trends in concerning risk factors for young people in Myrtleford. In the repeat Youth Survey in 2015 many improvements were evident in the areas that were targeted in the CTC Myrtleford Action Plan and comparisons were predominantly similar to Australian averages. Key findings were:
- Reduction in binge drinking in Year 9 students from 2009 (54%) to 2015 (8%);
- Reduction in alcohol use within the past 30 days in Year 9 students from 2009 (56%) to 2015 (36%);
- Reduction in school suspension rates in Year 9 students from 2009 (21%) to 2015 (5%);
- Significant decline in Year 9 students ‘Low commitment to school’ from 2009 (88%) to 2015 (66%)
- Significant improvements in ‘community rewards’ showed in Year 7 (2009: 53%, 2015: 88%) and Year 9 (2009: 54%, 2015: 90%).
Discussion: The CTC framework can provide an integrated approach to the prevention of adolescent behaviours that impact negatively on health outcomes. By harnessing and working closely with communities, using evidence based programs and interventions and working in a collaborative fashion the risk factors that lead to poorer long-term health outcomes for young people in rural areas can be effectively addressed.
Maintaining the wellbeing of children’s carers through a national carer gatewayAuthor/s
Ann Nicholas is a Clinical Analyst on the Carer Gateway at Healthdirect. The Carer Gateway provides a central point for carers that provides practical information and advice and connects them with services in their local area.
After her mother was diagnosed with dementia in 2011, and one of her family was facing serious mental health issues, Ann took two years out of the workforce to provide care for them. Ann’s personal experience has created an awareness of the difficulties and rewards the role of a full time carer present, that only first-hand experience can provide.
With a background in nursing, Ann has spent over 20 years involved in the Health industry. Her passion for caring for others has led to her planning and producing education campaigns with Commonwealth Serum Laboratories, the NSW Cancer Council as well as working with an RTO on the Acute Management of Spinal Injuries.
Ann’s career also includes Medical Risk Management and Quality Assurance specialising in providing medical risk assessment and prevention at both national and international sporting, concert and entertainment events for both competitors and spectators.
An essential component in ensuring the wellbeing of country children is the health of the person looking after them. It is well known that carers can spend all their energy caring for their loved one with little time spent looking after themselves. Carers can find themselves feeling socially isolated, and emotionally exhausted from the experience of seeing their loved one in pain or difficulty. In order for carers to provide good care it is imperative we as a community support them in their roles. This is particularly applicable in rural locations where healthcare services can be more difficult to access.
In recognition of the work that carers do and as part of the Carer Recognition Act in 2010, the Department of Social Services engaged Healthdirect Australia to design and deliver Carer Gateway, which launched in December 2015 as a national service consisting of an Australian based helpline, a website, and a ‘find a service’ tool. Anyone who is looking after a child with a chronic illness or disability is considered a carer - Carer Gateway aims to help them feel more confident in their caring role by giving them information about the appropriate local services they can access, and by providing practical information and support to help them in their daily role. The website also has links to other sources of trusted information for carers that is appropriate for the Australian environment.
Often carers don’t access support because they don’t know what is available or may find the system too overwhelming. With the introduction of Carer Gateway there will be a central point for carers, directing them to the most relevant services in their region. This is particularly significant for improving the equitability of access to support across rural and remote areas as 36% of carers live outside of major cities*.
To inform the service design, a research study was conducted with peak bodies, service organisations and a representative sample of the Australian carer population including Aboriginal and Torres Strait Islander peoples, Culturally and Linguistically Diverse groups, and those in rural and remote areas. The information collected was then refined by a multidisciplinary team which included policy, health technology and telephony experts. The result is a service which recognises the broad influences on the health of carers and children being cared for, which can extend to financial, legal and social factors.
When we think or talk about carers we automatically think about adults but children can also be carers and all the issues that face adult carers also face child carers and are sometimes more pronounced. When we talk about Caring for Country Kids we should also think about caring for those Country Kids that are carers as well.
The presentation will:
- Explore the journey through service design to the delivery of a high quality service - Carer Gateway - which is an important resource for carers and health professionals.
- Demonstrate the practical information available to carers on the website which will help them in their daily role.
- Demonstrate how appropriate services can be located by carers using the ‘find a service’ tool.
- Examine some additional sources of information and support available to carers via the website, and through other services managed by Healthdirect Australia.
Carers are essential and often unrecognised by society. Carer Gateway is a crucial service providing support to all carers, including those caring for country kids.
Visit www.carergateway.gov.au for more information.
*AMR Carer Service Development Research 2015
Active lorikeets to little wrens: early intervention programs for preschool childrenAuthor/s
Lyn Nicol is the senior speech pathologist at Gippsland Lakes Community Health. She has over thirty years’ experience working in childhood development and learning, teaching, special education and speech pathology. Lyn holds a Diploma of Primary Teaching, Graduate Diploma of Special Education and a Master of Speech Pathology.
Lyn has worked in multiple rural settings throughout Victoria. In 2009 Lyn commenced with Gippsland Lakes Community Health in beautiful East Gippsland and leads the paediatric allied health team.
She works in close collaboration with co presenter Angela Ellis developing innovative and practical solutions to meet the needs of the Paediatric population of the area. Lyn is a firm believer in the use of evidence based practice and the use of multi -disciplinary and trans-disciplinary Allied Health practices.
The paediatric team at GLCH has grown over the last five years to include specialist Paediatric Speech Pathology, Occupational Therapy, Physiotherapy, and the use of group therapy. Lyn has participated in the development of training packages for Allied Health Assistants working in paediatrics and childcare workers.
As part of the paediatric allied health team she takes a lead role in the ongoing development and delivery of the Active Lorikeet and Little Wren programs.
Angela Ellis is the Executive Manger of Community Health Services at Gippsland Lakes Community Health in Victoria, she has over 10 years leadership experience and is passionate about rural health.
Angela commenced with the organisation as the sole physiotherapist in 1982 and has since been instrumental in developing a suite of quality allied health services; lifestyle and wellbeing programs; paediatric therapy groups; and a child care and early education centre. She currently manages a busy team of 48 multi-disciplinary health professionals who have been recognised on multiple occasions at both a state and national level for excellence in the areas of paediatrics, Aboriginal health and innovative service model design.
Angela believes service models need to be flexible and reactive to respond to the demand from community and staff shortages throughout rural Australia and has facilitated a multi-pronged service remodel to achieve this. She is heavily invested in the development of a skilled allied health assistant team that supports service delivery and reduces the demand for one-on-one intervention on health professionals; taking services out to remote communities; and establishing a private/public allied health service with ‘same for all’ access to services regardless of funding source.
Active Lorikeets is a program developed by Gippsland Lakes Community Health delivering speech pathology and occupational therapy to pre-school children assisting with their school readiness and improving access to allied health. School readiness is imperative to a child’s future and we have the evidence to support Active Lorikeets assists in this area of development.
The program delivers screening and intervention for speech, language and/or fine motor difficulties, via:
- Pre-school groups facilitated by Allied Health Assistants
- Home therapy programs
- Individual therapy with Allied Health Professionals for children identified developmentally vulnerable.
The program utilises Allied Health Assistants trained and supervised by Allied Health Professionals and has evidence to support it as an effective way to deliver services, reduce waiting lists, improve service accessibility for paediatric clients and improve clients’ school readiness.
From the evaluation of the Active Lorikeets program we had identified a group of children unable to access the program so the Little Wrens program has been developed to be delivered in childcare facilities to a younger cohort, 3-4 year old children.
The session outlines are structured and designed to demonstrate to childcare educator’s strategies and education on how to assist in furthering children’s development whilst in their care. Small group sessions are delivered weekly, with Allied Health Assistants facilitating the group and the childcare educator assisting. By attending and assisting in the delivery of the weekly sessions the childcare educators will be enabled to continue therapy goals during usual session throughout the week.
GLCH have developed a comprehensive Active Lorikeets and Little Wren resource kit. The kit consists of two CDs that include all resources required to deliver both programs anywhere including:
- AHA Training, AHA training documents, AHA Active Lorikeets training check list, Knowledge base for AHA’s in the Active Lorikeets program
- Marketing, Copyright terms and conditions, Active Lorikeets Logo, Example poster, Example brochure
- Letter Templates and Information Packages, Kindergarten expression of interest, Kindergarten acceptance acknowledgement, Parent invitation to participate, Parents’ consent, Active Lorikeets pre questionnaire, Parent/teacher comments pre therapy, Screen result, Active Lorikeets post questionnaire
- Home Programs, Occupational Therapy, Speech Pathology – articulation, Home program cover, Colour recognition, Listening to the sound, Fine motor skills, Minimal pairs, Gross motor skills, Sound on its own, Number concepts, Sound in short words, Upper and lower case letters, Sound in a word visual discrimination, Sound in sentences, Drawing a person, Sound in conversation, Follows verbal directions, Identifies body parts, Personal data response, Rote counting, Visual motor skills
- All required therapy plans
- Resources: How to use the Therapy Plans, Screening Tools, Session Skills Directory, Active Lorikeets Book List Therapy Template, Purchased Software and Games Useful Websites, Term 1 Therapy Plans, Term 2 Therapy Plans, Term 3 Therapy Plans, Term 4 Therapy Plans
- Program Manual
- Evaluation Report
Active Lorikeets and Little Wrens is an innovative way to deal with some common service delivery issues faced by rural health services throughout Australia. These programs have grown to become an example of excellence in service provision and workforce development. It has enabled GLCH to become a pioneer in creating quality resources and training opportunities for other health services throughout Australia.
These quality affordable early intervention programs can be delivered anywhere in Australia. By supporting paediatric healthcare services children will have greater access to the specialised healthcare they need.
The Song Room: engaging young people in creativity (remotely!)Author/s
Deborah Nicolson is the Director of Programs for The Song Room. She has had overall responsibility for the planning, creative content, co-ordination, evaluation and delivery of all programs nationally as well as the support, direction and management of the programs team including Teaching Artists since its inception.
The Song Room’s long-term tailored programs are designed to ensure access to quality arts experiences for those students who have the least opportunity for high participation. Independent research commissioned by The Song Room has demonstrated improved educational, personal and social outcomes for these children. Many wonderful Teaching Artists work with thousands of children and their classroom teachers each week in schools in the most marginalised communities across Australia. They bring their passion and expertise in their art form into the classroom, inspiring and ensuring engagement through creativity.
To complement the Teaching Artist programs our online platform, ARTS:LIVE (www.artslive.com.au) provides resources in 5 art forms for all teachers at all schools giving teachers access to creative ideas and tools to incorporate into their classrooms.
In 2014 The Song Room was a recipient of a WISE AWARD for Innovation in Education. This coincided with the tenth anniversary of its Teaching Artist programs.
The Song Room is a national not-for-profit organisation that brightens the futures of Australia’s most disadvantaged children with tailored, high-quality music and arts programs, delivered in partnership with schools across the country.
We now have a strong evidence base which has demonstrated that high participation in the arts levels the playing field for the disadvantaged and increases student attendance at school, enhances their education as well as their social-emotional wellbeing.
In order to meet our vision of all Australian children having the opportunity to participate in music and the arts we run Teaching Artist programs for a minimum of 6 months in a school. Teaching Artists are artists first and foremost with teaching experience. They bring the world of the arts, performance and inspiration into the classroom, mentoring generalist classroom teachers in new ways of incorporating more creativity in the classroom. We estimate around 2,000 schools in Australia need our help in this way. These are schools with in low socio-economic settings with high numbers of new arrivals and refugees, schools with high numbers of aboriginal children, students with behavioural issues and special needs.
For all other schools, The Song Room delivers Australian Arts Curriculum-aligned music and arts resources via its online platform, ARTS:LIVE. The site has hundreds of videos, resources, lesson plans for years F – 10 and is free for all teachers and at all Australian schools. Last year The Song Room won a global award for Innovation In Education at the WISE Summit.
Deborah Nicolson is the Director of Programs for The Song Room and has overall responsibility for the planning, creative content, co-ordination, evaluation and delivery of all programs nationally. In this presentation, Deborah will illustrate how music and the arts has helped children in rural and remote settings from wanting to come to school and staying at school; how the arts has helped teachers build strategies for learning for their disadvantaged cohort and how working with local health professionals has helped impart knowledge about healthy living practices through song-writing, singing and making music. Examples include excerpts from videos showing aboriginal children who have devised their own video clips from lyrics to performance.
Every contact counts: youth mental health services development in country South AustraliaAuthor/s
Judy is a Social Worker who has worked with young people all of this millennium. Her roles have included community health, welfare, local government and community organisations. Judy was the principal project officer responsible for the state-wide development of Youth Mental Health Services in South Australia and has now taken a clinical role in providing this service for young people in country South Australia. Judy is passionate about working alongside young people to ensure they have the support, connections and tools they need to lead a full and meaningful life.
David West is a community mental health nurse based in Victor Harbor, providing specialist mental health services for the David surrounding rural communities. He is the Regional Senior Mental Health Clinician for Barossa, Hills, Fleurieu and Kangaroo Island, and the Country Health SA portfolio holder for the Youth Mental Health Service (YMHS).
David’s nursing education began as a general nurse in the ACT in 1979 and he has postgraduate qualifications in perioperative and psychiatric nursing, traumatic stress and community mental health. He has worked in acute, aged care, forensic, rehabilitation, and community settings.
His current position is instrumental to supporting clinicians in local mental health teams, community health services and local hospital inpatient units. He has oversight of the YMHS, and ensures comprehensive, coordinated care for young people 16 to 24 years, in conjunction with non-government service providers.
He is also a mental health clinician with the Royal Australian Navy, holding the commissioned rank of Captain. As a Reservist, David brings a depth of clinical experience, strong clinical leadership, and health education for serving Defence personnel.
As a visiting lecturer at Flinders University Rural Clinical School, he facilitates mental health education for medical, nursing and allied health students placed in country SA.
The purpose of Youth Mental Health Services (YMHS) in South Australia is ‘every contact strengthens a young person’s wellbeing, mental fitness and engagement with life’. YMHS is being implemented in recognition that 75% of serious mental illness initiates within the 16 to 24 year age range and 70% of people don’t seek help. Country Health SA led this resource neutral state-wide programme with a ‘can do’ attitude and mindful of the importance of community collaboration.
Developing a Model of Service to flexibly adapt to the diversity of country mental health contexts across culture, landscape and community characteristics, it has been important to walk alongside clinicians in local communities. This involved systematic co-development, visiting each of 13 country locations four times in the space of a year; and more than 20 country clinicians participating in developing the model. Community and youth sector workers were consulted to guarantee the quality collaboration that predicts seamless services for young people.
CHSALHN’s state-wide leadership and partnering with clinicians, consumers and carers, has ensured that they were the first LHN to implement services, and that country kids’ needs are prominent in state-wide conversations.
The use of technology to better engage young people in care shows promise, however few examples embedded in clinical mental health practice exist. CHSALHN approached this challenge through the Young and Well Towns research project – a partnership with Flinders University and the Young and Well Cooperative Research Centre. YMHS clinicians were provided an internet-enabled iPad to trial a wellbeing measure via an electronic platform. The platform provided two-way asynchronous communication between consumer and clinician, along with mood tracking, wellbeing scores and health promoting behaviours. Whilst the research protocol was designed in consultation with YMHS clinicians, the capacity to recruit young people proved limited. Post-implementation semi-structured interviews with 13 clinicians indicated that frontline service change occurs as a function of team support. It is hypothesised that the role of team is the principal context for country mental health clinicians’ practice, providing feedback, reflection, and support; and sharing the inherent risks of a challenging job whilst understanding the ongoing connection to local community. It is frequently argued that executive and senior clinical leadership are the critical factor in service change, however even where this is evident, competing organisational imperatives may mean it is triaged out by individual teams.
Child doctors: an ancient paradigm for the 21st centuryAuthor/s
Don Palmer ThL, MA, Tjungurrayi, Founding CEO of The Malpa Project
Don a journalist, film maker who founded The Malpa Project to respond to un-met needs for health equity for Indigenous Australians. Malpa has run projects in communities in five states and the NT and has trained over 500 Young Doctors. Malpa has received multiple awards. Don is a member of the NSW Clinical Excellence Commission’s advisory board. He spent several years on the ABC’s NSW Advisory Board and as an academic training some of Australia’s most prominent media personalities and journalists and as adjunct professor at Macquarie University. He is a Winston Churchill Fellow and holds a Master of Arts in Mass Communication. As a documentary film maker he was winner of a United Nations Media Peace Prize and provides of media training to the Public Interest Advocacy Centre and organisations including the NSW Aboriginal Land Council.
Traditional Aboriginal health service delivery responds to a perceived direct connection between mental and physical health. The Ngangkari believe that healing the kurunpa (soul/spirit) was essential before healing the body.
The Malpa Project has developed an innovative, grass-roots, community capacity building program that emerges from lived experiences in communities and is making a significant difference in urban, regional and remote locations. The project is called Young Doctors, or according to location, Dhalayi Doctors, Ngargin Doctors, Boorai Doctors etc and uses the traditional Aboriginal paradigm of health service delivery. Those with the knowledge of health (including mental health) transfer that knowledge to children (9 and 10 year olds) with the expectation that they will engage in leadership behaviour that enhances the quality and longevity of their entire community. Students learn the traditional knowledge of medicine from traditional knowledge keepers and Elders and western medicine from a range of community health practitioners. They learn health leadership, hygiene, environmental health, nutrition and health literacy. There are currently over 300 Young Doctors and by the end of 2015 there will be more than 450 in SA, Vic, Qld, Vic and the Northern Territory. The results can be encapsulated in a single statistic: when the programs are run then school attendance is usually 100% and the attendance by the wider school community is elevated. This privately funded initiative addresses the need for resilience, is owned and run by local people who each devise their own agenda as they teach the traditional and contemporary understandings of health. The Young Doctor projects respond with a culturally appropriate methodology that helps communities build stronger families and communities. The approach is replicable, scale-able and adaptable. This year graduate Young Doctors will be taught to conduct hearing tests and make medical referrals (under clinical supervision). This is in response to high prevalence of ear problems and the dismantling of such tests by governments. The project creates career pathways for staff and students.
The lumps and bumps of establishing a rural multidisciplinary paediatric feeding clinicAuthor/s
Tammy is the Speech Pathology Manager at GV Health in Shepparton and is the coordinator for the Advanced Scope of Practice Project: Speech Pathology led Paediatric Feeding Clinic.
Tammy has worked within a range of rural and regional health services across the entire continuum including Community, Sub Acute, Acute and Private Practice. The diverse nature of clinical practice rurally has fostered a number of clinical specialties including rehabilitation and paediatric feeding.
Tammy has a passion for Paediatric feeding and is a strong advocate for the coordination of rural and regional services; and supporting families.
Background: Paediatric feeding is an area of clinical specialty for Speech Pathologists and Dietitians. Over the past three years, an increase in hospital referrals has identified the need for a complex multidisciplinary feeding clinic. Specialised assessment and management of infants and children with complex feeding needs in the 0-5 year age group, has emerged as an area where Speech Pathologists with expertise in paediatric feeding, can effectively contribute to improving patient outcomes and reducing hospital re-admissions. Historically, paediatric clients with complex feeding issues were provided with inpatient intervention by the Speech Pathology and Dietetics clinicians. Timely access to community based paediatric services for ongoing treatment was problematic due to long waiting lists. Delay in continuation of treatment places these children at nutritional and developmental risk. As a result children in this cohort are more likely to develop sensory and oral aversions to eating as well as defensiveness surrounding meal times.
Aim: To develop a Speech Pathology led multidisciplinary allied health feeding clinic to provide a clinical pathway for treatment of medically based feeding conditions whilst children wait for update into a community service.
Method: An area of emerging risk through increased identification and referral of complex paediatric feeding problems, prompted discussion between the paediatric and allied health teams to consider an appropriate management pathway. Several budget proposals were unsuccessful in securing funding for the clinic. External funding from Department of Health and Human Services was received in 2015 to conduct a pilot project under the Advanced Practitioner Model.
Results: Development and initial findings of the pilot project will be presented.
Discussion: Regional Victorian children have limited access to a non admitted specialised complex feeding service. Continued advocacy for this client group and service will be a high priority.
Seedlings in the desert … strong forest of the futureAuthor/s
Polly celebrated 50 years in nursing last year ,with a varied career from a military Nurse in United Kingdom, Remote area work in Pilbara ,Correctional service work in NSW and several positions in Queensland working in the Mental Health. She has worked in Alice Springs for almost 6 years in the Child and Youth Mental Health Team and enjoys her work with children and families, liaising with schools and local agencies.
Polly is passionate in her commitment to early intervention, positive practical support and encouraging parental bonding.
Sally Cleworth is a Child and Adolescent Psychiatrist working for the last 5 years in the Hunter New England Mental Health Service with the ‘Whole Family Team Project’ and the Aboriginal CAMHS team, ‘Wiyiliin ta Counselling Service’. Two years ago she commenced regular work with the Central Australian Child and Youth Mental Health Team in Alice Springs. She has a keen interest in family systems; working with families and carers to support the safety and wellbeing of children and young people; and working with Aboriginal colleagues and communities in NSW and the NT.
The ‘state of play’ of child and youth mental health services in Central Australia, and a look at therapeutic interventions used by the child and youth mental health team in Alice Springs
Background: Central Australia is home to around 40 000 people spread across a vast expanse of desert. Its geography, unique demographics, and the spread of population across many isolated communities, are some of the factors that have limited the ‘reach’ of child and youth mental health services to date. Alice Springs has a small but burgeoning child and youth mental health service (CYMHS). It is a multidisciplinary team that strives to be responsive and holistic in its approach to children and young people with significant and sometimes severe emotional and behavioural difficulties.
Objectives: A snapshot of the scope and operations of the CYMHS team is presented, and a vision of ‘what next’ that is practical and sensitive to existing systems and cultural needs. The therapeutic work of the team is highlighted with use of stories and metaphor to describe examples of child- and family-focused interventions.
Where are we now and the role parents will play in future advocacyAuthor/s
Vicki Russell is the current CEO of NOFASD Australia. She has a BBSc (Justice) and a MSSc (Police Studies) and is a current PhD candidate at the University of Tasmania. She is a Churchill Fellow 2001 and holds a Diploma in Project Management. Vicki has a background in trauma counselling and the alcohol and other drug sector. She trained in Narrative Practice and Professional Supervision in Narrative and has a Certificate of Mastery in the Fetal Alcohol-Neurobehavioural approach through FASCETS Inc in Portland, Oregon. Vicki has trained at the University of Washington in FASD assessment and diagnosis; community based risk assessment in North Dakota; and onsite training in the Parent-Child Assistance program in Seattle, Washington State, USA. She has acquired over a decade of specialist knowledge on fetal alcohol spectrum disorders and has presented Australian papers and facilitated training at national and international fora. For over 25 years, Vicki has developed and delivered education and training programs on sexual assault; vicarious trauma; Fetal Alcohol Spectrum Disorder; girls, women and alcohol to professional and non-professional groups across all levels of prevention. Vicki facilitated weekly group sessions for three years (2009 to 2011) to all residents in a Tasmanian youth detention facility aware that FASD is overrepresented among youth offenders. The program design was responsive to need and focused on improving communications skills.
The focus of the presentation is an exploration of some of the key influences which have progressed and suppressed FASD policy and practice over the past four decades.
This presentation begins with a brief overview of FASD, the complexity of the condition across the lifespan and introduces a neurobehavioural approach as an alternative to more typical interventions. Scientific evidence has informed of the toxicity of alcohol and the risk is very real. We have the diagnostic criteria for the complete fetal alcohol spectrum of conditions but clinicians need specialist training to recognise causation in a repertoire of possible conditions.
The ‘invisibility’ of fetal alcohol brain difference is made distinct from other physical brain injuries. FASD is on the Commonwealth policy agenda but not recognised as a disability. Prevention messages are inconsistent and sometime mythological; the child is the victim and therefore mothers who drink in pregnancy are to blame. Alcohol is recognised as a ‘consumable’ but producers resist labelling. Prevention contradicts notions of harm minimisation and calls for abstinence. These are some of the contextual factors, the tensions that define FASD as an intractable and incredibly complex problem. Post-diagnosis, FASD is a social problem and prevention requires changes in attitude and behaviour in a society that has a ‘love’ for alcohol.
As a social problem, parents know how tough it is. Human stories are the missing piece and empowering parents to speak out and to advocate is a welcomed challenge.
Virtual classroom for paediatric educationAuthor/s
Rob graduated with a Bachelor of Nursing and specialised in intensive care nursing. He worked for over ten years in clinical roles in Melbourne and the United Kingdom before moving to managerial, project and policy development positions in Specialist Outpatients Clinics, Service Redesign and the Victorian Department of Health.
He is interested in improving health outcomes through system design and initiatives to support the primary care - tertiary care interface.
Rob is currently employed at the Royal Children’s Hospital Melbourne in the role of Program Manager, Primary Care Liaison and implements projects to support the transition of care between the RCH and community based healthcare professionals, including the implementation of electronic transmission of discharge summaries, improving discharge summary completion (presented at the Australasian Lean Healthcare Network symposium 2015), and delivering a face to face and online practical paediatric education program for primary health care practitioners.
Dr Alexis Butler is the General Practitioner (GP) education consultant for The Royal Children’s Hospital (RCH) where she provides advice on how best to inform primary care. She developed and ran the RCH Practical Paediatrics Program (PPP), an annual series of face to face paediatric primary care education events held at the RCH, organised in partnership with Medicare locals. To further support paediatric education for rural GPs she created the Practical Paediatrics Program On-line (a series of on-line educational activities) from recordings of the PPP. Alexis is currently running a virtual classroom primary care education program in partnership with the Australian College of Rural and Remote Medicine. She is interested in and an advocate of providing support to primary care in rural communities.
Alexis has worked for many years in General Practice and Mother and Baby units in Australia and the United Kingdom, and previously worked as GP liaison at The Royal Victorian Eye and Ear Hospital. She is the GP Liaison representative at the Peter MacCallum Cancer Centre Melbourne (addressing projects that integrate primary care into cancer management and organising GP education) and GP Liaison Physician for the Victorian Cytology Service - visiting practices Victoria wide providing cervical cancer screening education for GPs.
Problem: Rural, regional and outer metropolitan General Practitioners (GPs) often have less access to peers, sub-specialists and specialists, and difficulty accessing high quality paediatric education.
Intervention: To address this issue The Royal Children’s Hospital (RCH) and the Australian College of Rural & Remote Medicine (ACRRM) commenced an innovative project using on-line technology to provide interactive clinical paediatric education to these GPs.
This project is part of a larger ACRRM – RCH collaboration making paediatric education sessions accessible to a larger GP and Rural Doctor audience; including the production of online modules.
Funded by the Victorian Department of Health Paediatric Clinical Network this project aimed to provide high quality paediatric up-skilling of high relevance to GPs from leading paediatric sub-specialists.
The ACRRM online learning platform Rural and Remote Medical Education Online (RRMEO) was used to deliver the education sessions with the RCH providing specialist speakers, CPD and registration coordination.
Sessions were ‘live’ with participants communicating via their internet connection using standard internet browsers, headset and microphone. Presenters displayed PowerPoint slides on an interactive whiteboard and engaged participants through chat messaging, online polling, breakout rooms, and recording of sessions.
The ACRRM – RCH collaboration has been strengthened through combining the RRMEO technology and RCH resources to deliver this targeted education.
Results: Four paediatric clinical education sessions have been delivered to audiences with many rural & remote GPs who would be otherwise unable to attend face to face education sessions, from locations as diverse as Euroa and Mildura in Victoria, Gladstone QLD, and Broken Hill, NSW.
Topics included: Dermatology, The Crying Baby, IgE and non-IgE Food Allergy, with one allergy session added to the ACRRM online program attracting a further 87 attendees.
Registered attendees for the four sessions totalled 291, with 131 attending and 88 completing evaluations.
A review of the Virtual Classroom project identified issues including a 50% attendance rate for people who had registered, poor sound quality for some presentations and a small number of participants had difficulties with internet connections.
Over 90% (n=88) of participants said the content was entirely relevant to their learning needs, between 24% and 50% of participants said they had further learning needs in relation to the presented topics and over 70% of participants said the online format was suitable and convenient.
Overall the project has been very successful and planned activities for the next year include childhood diabetes and respiratory conditions.
The ASQ-TRAK: a developmental screening tool for remote Australian Aboriginal childrenAuthor/s
Samantha Simpson is a registered psychologist and a PhD candidate with the Science of Learning Centre at the Melbourne Graduate School of Education. She completed a Bachelor of Science at Victoria University of Wellington and a Masters in clinical psychology at the University of Melbourne. She has a broad range of clinical and research experience, including in hospitals, private practice, early childhood centres, and youth mental health settings. She has also worked and volunteered in the community sector in both Australia and New Zealand, working with children and adults with disabilities, incarcerated men, and Maori and Pacific young people. As part of her PhD, she is working on the validation of a developmental screening tool adapted for Australian Aboriginal children living in remote areas.
Structured developmental screening instruments are an essential component of developmental monitoring to aid early detection of children with developmental difficulties and facilitate early intervention. While a recent cross-cultural adaptation of the Ages and Stages Questionnaire (ASQ-3) has been shown to have high face validity, there are no developmental screening instruments with proven validity for use with Australian Aboriginal children living in remote areas. Without the routine use of culturally appropriate and valid developmental screening instruments, the majority of children with developmental difficulties are not detected or are detected too late for effective intervention. This study aims to determine the concurrent validity of the adapted ASQ-3 (the ASQ-TRAK) when compared to a structured developmental assessment, the Bayley Scales of Infant Development 3rd Edition (Bayley-III).
The study aimed to recruit 120 Central Australian Aboriginal children aged 2, 6, 12, 18, 24 and 36 months. A total of 67 children and their caregivers participated in the study. Child health nurses were trained to administer the ASQ-TRAK during routine well-child checks. The Bayley-III was administered within one week by a practitioner blinded to ASQ-TRAK results. Developmental delay was defined by a score of ≥2 SD below age-specific norms on any ASQ-TRAK domain and/or a standard score of ≤75 on any Bayley-III domain.
Scores on the ASQ-TRAK communication, gross motor, fine motor, and problem-solving domains were moderately correlated with the corresponding domains on the Bayley-III (R = .67; R = .49; R = .46; and R = .60, respectively; all p < .001). Overall, percentage agreement for classification of developmental delay was 90%. The ASQ had a sensitivity of 71% and a specificity of 92% for detecting developmental delay.
Preliminary results suggest that the ASQ-TRAK holds promise as a developmental screening tool that can be used to improve detection of developmental difficulties in Australian Aboriginal children living in remote areas. Further studies can build on the current data set and include children from other areas, which will allow the ASQ-TRAK to be used with confidence in remote Aboriginal communities across Australia.
Goulburn Valley Homeless Youth Dual Diagnosis Initiative (HYDDI)Author/s
Kevindev Singh is a nurse currently in the role of the Homeless Youth Dual Diagnosis Initiative (HYDDI) at Goulburn Valley Health. Mr. Singh originally grew up in Melbourne, however now resides in the regional city of Greater Shepparton, Victoria. Mr. Singh has worked in mental health for over 10 years across multiple service programs within both metro and rural settings. Mr. Singh has developed a passion for working with the youth and has continued to expand his knowledge and skills within this field. He has completed a Postgraduate in Mental Health Nursing, Developmental Psychiatry Course, is Dual Diagnosis and Autism Diagnostic Observational Schedule (ADOS) trained. Mr. Singh is a strong advocate for positive physical and mental health, as he is a fully qualified personal trainer, and is completing his Masters in Mental Health Nursing (Nurse Practitioner). Mr. Singh wishes to help clinicians identify the youth who may be falling through the gaps within the homelessness sector, as this youth cohort maybe some of the most unsupported and transient in their lifestyle that services are unable to reach them. To be placed within this sector and providing appropriate education and support, has the potential to make positive change for all involved.
Strong sustainable communities depend on the wellbeing of their children and young people. Early Intervention with young people with emotional and behavioural difficulties has been proven to be most effective in improving social wellbeing outcomes.
HYDDI is a project funded by the Homelessness sector and introduced into the Goulburn Valley, where a sole clinician primarily supports the homelessness sector on all three tiers (primary, secondary and tertiary) to navigate and engage with appropriate services and prevent disengaged youth falling through service gaps due to their transient lifestyle. The role is serviced through the local Child & Youth mental health service (CYMHS), however based within the community and local youth homeless refuge network. A youth friendly pathway to service has been developed so the young person only needs to tell their story once to the HYDDI worker who then supports their access to appropriate services thus eliminating the barriers to service usually experienced by disengaged youth.
Feedback thus far has been positive in relations to access to psycho-education on mental health and AOD needs to the youth on an as needed basis, as well as linking the youth into appropriate support services in a timely manner. Access by community groups in relations to mental health and AOD education has been highly sort after from a number of different programs, such as; the homeless and youth sectors, ethnic community leaders for/to local families and youth, local schools and police.
The HYDDI role has the capacity and requirement to provide tertiary support to at least 16 young people through-out a year, however within the first 3 months the role had already picked up 6 clients needing close support with their mental health and alcohol & drug (AOD) use. This demonstrates there is a need for dual diagnosis support within the homelessness sector as these 6 would not have accessed traditional services due to their transient lifestyles if not picked up through the refuge until a crisis point later in their lives.
The HYDDI role has networked with youth and AOD services within the local community establishing a new secondary consultation process within the sector and streamlining referral pathway between programs ensuring improved access to service for this cohort. The role is currently funded until July 2017, our hope is that the data will support recurrent funding of the position.
Supporting families returning home after their child’s cancer treatmentAuthor/s
Penny Slater is Program Manager for the Queensland Paediatric Palliative Care, Haematology and Oncology Network, and the tertiary centre of that network at the Lady Cilento Children’s Hospital.
In that role she manages the statewide clinical network and the oncology program at the LCCH, including planning, evaluation, quality and safety, and consumer engagement.
Prior to this, Penny has been with Queensland Health since 1990 in various research, planning and evaluation positions relating to diabetes, aged care, suicide prevention and oral health services.
Treatment for children’s cancer in Queensland is provided through a shared care model between the tertiary centre in Brisbane (Lady Cilento Children’s Hospital (LCCH)), and ten nominated Shared Care Units throughout the state. LCCH determines the treatment plan and provides the majority of the treatment. Where possible, some chemotherapy and supportive and follow up care is received in the Shared Care Unit closer to the family’s home.
The Discovery Interview methodology was used to interview 17 families about their experience of cancer treatment. A recurring theme was the difficulty of the stage following the intensive phase of treatment at LCCH, when the patient and carer returned home.
Many parents identified that completing treatment was a particularly challenging time, coming to terms with everything that had happened. Their child’s treatment was very task orientated and they focused on their child. After treatment, when their child was doing well, they had time to reflect on their experience and they also lost the safety net of regularly attending the tertiary hospital and having that re-assurance.
The main aim for the family following treatment was to get back to a level of normality, including the child returning to school. Cancer treatment had an ongoing impact on the child, but also challenged relationships in the immediate family unit and their wider group of family and friends.
Many parents reported that having a child with cancer meant that their life had changed forever. Parents had various coping strategies to come to terms with this. However, every time their child seemed lethargic or sick, or when they had a scan or test, they were fearful of relapse. Many called for a role at the hospital that dealt with the emotional needs of families and an avenue to maintain contact with other oncology families.
When seeing health providers in their regional area, one parent who was experiencing difficulties said it was hard to explain how she felt, while another parent was concerned that they thought she was being over protective. Another parent was grateful when their local health provider was thorough in monitoring their child.
When the families return home from cancer treatment, they need support to adjust to changed circumstances with their family and friends, re-build relationships, get back to a level of normality, and overcome the continuing anxiety that the cancer could return. They need to be diligently supported and re-assured by their local health professionals.
Assessment of dental caries among young Aboriginal children in New South WalesAuthor/s
Leanne Smith is an Oral Health Therapist (Dually qualified Dental Hygienist and Dental Therapist). Leanne graduated from Newcastle University as a hygienist with distinction. She received the Deans Merit Award and recognition for her outstanding commitment to the dental profession. In 2012 she completed her Post Graduate Diploma in Dental Therapy. She has extensive clinical experience in private practice and joined the University of Newcastle (UON) as a Clinical Tutor for both Hygiene and Therapy courses in 2013.
Leanne is currently undertaking a PhD in Oral Health which is focused on improving the oral health of young Aboriginal children. She will evaluate the ‘Smiles not Tears’ dental education program. This program is of unique design as it involves training Aboriginal Health Workers to teach parents with young Aboriginal children how to prevent dental caries. Aboriginal Health Workers are also trained to check the child’s teeth for dental caries.
Leanne has had five papers published on Aboriginal Oral Health in the last 18 months and has presented her research at national conferences.
Leanne is a member of the Dental Hygiene Association Australia and the Australian Dental and Oral Health Therapists Association.
Introduction: Early Childhood Caries is a rapid form of dental decay that affects children under six years of age. Early Childhood Caries has a negative impact on a child’s quality of life, causing pain, infection, delayed development and increases the likelihood of caries in the permanent dentition. It is widely recognised that dental caries (dental decay) is preventable however Aboriginal children younger than five years of age are hospitalised for dental treatment nearly twice as often as non-Indigenous children. Limited research has been undertaken in Australia to assess the dental status of Aboriginal children of less than six years of age. This paper reports on the dental health status of Australian Aboriginal preschool children in seven different rural, remote and metropolitan areas of New South Wales, Australia, in order to provide information on whether targeted oral health promotion programs to control Early Childhood Caries are required.
Methods: A convenience sample of young children from seven Aboriginal communities in rural, remote and metropolitan areas of New South Wales, was recruited. Oral examinations were conducted in 21 childcare facilities including preschools and ‘Mums and Bubs’ groups. One calibrated examiner completed all of the examinations, recording the dmft/s of children with written parental consent.
Results: A total of 196 children were invited to participate and 173 children aged two to five years were ultimately examined, a response rate of 88.3 percent. The dmft and dmfs scores increased with remoteness. Children 4-5 years old living in remote NSW had a mean dmft of 3.5 and mean dmfs of 8.0 compared with children living in rural areas who had a dmft and dmfs of 1.5 and 4.2 respectively, with untreated dental caries being the primary contributor to the scores. The Significant Caries Index was highest for 4-5 year old children living in remote communities (SiC10 = 13.7), followed by those living in rural areas (SiC10 = 8.0). All of the children who had previously received dental treatment had active carious lesions at the time of examination.
Conclusion: There was a high prevalence of untreated dental caries among the Aboriginal children, particularly for those residing in remote locations. The findings from this study support the need for a culturally appropriate oral health promotion program to prevent dental caries in young Aboriginal children.
Revitalising child development outreach services for children in rural north QueenslandAuthor/s
Melissa Smith graduated from James Cook University, Townsville, with a Bachelor of Physiotherapy (2008). Since graduating, Melissa has worked with paediatric populations across multiple health settings and has been based at Child Development Service (CDS) Townsville since 2013. CDS Townsville is a community based early intervention service that provides family centred transdisciplinary care to children with chronic and complex developmental delays. Melissa’s substantive role at CDS Townsville also involves the provision of outreach services to families living within the Townsville Hospital and Health Service rural and remote communities. Melissa is currently employed in a project officer role to develop an evidence-based model of care aimed at enhancing child development services provided to families in an outreach setting.
Carly Hislop graduated from James Cook University, Townsville with a Bachelor of Sports and Exercise Science (2001), University of Queensland, Brisbane, with a Masters of Physiotherapy Studies (2005) and Griffith University, Gold Coast, with a Graduate Certificate in Health Professional Education (2012).
Carly has worked in both clinical and management roles at Child Development Service (CDS) Townsville since 2007. CDS Townsville is a community based early intervention service that provides family centred transdisciplinary care to children with chronic and complex developmental delays. As CDS Townsville Team Leader, Carly provides mentorship to the project officer developing the evidence-based model of care for the provision of child development outreach services to children and families living in rural and remote north Queensland.
Child Development Service (CDS) Townsville has been providing outreach to children with chronic and complex developmental concerns living in outer regional, rural and remote localities across the Townsville Hospital and Health Service (THHS) in an ad-hoc way since the 1990’s. A review of this service indicated that the model was inefficient, ineffective, dislocated from local providers, and delivered in a way that was not evidence based or family focused.
The Australian Early Developmental Census (AEDC) is a population measure of children’s development upon school entry. The AEDC enables services to better understand the developmental capabilities of children from communities across Australia and compare communities in terms of the prevalence of developmental vulnerability. The AEDC confirms that geographical isolation increases a child’s risk of developmental vulnerability. The 2012 data indicates that CDS outreach locations demonstrate levels of developmental vulnerability significantly higher than the state and national averages, yet service access rates from these communities is extremely low.
CDS is developing a new sustainable, evidence based model of care that will improve access to high quality, integrated, specialist child development services that is specific to the needs of children and families living in communities within THHS. The model of care is being developed following completion of a literature review, service mapping of local communities, analysis of needs, satisfaction feedback from consumers, clinicians and community stakeholders, and a three-month pilot. The model will be transdisciplinary in nature, family-centred, partner with local community service providers and paediatric medical services, and use telehealth to support care provision.
An interim model will commence in early 2016, with the final model rolled out from mid 2016. An evaluation phase will occur following a six-month trial period. It is hypothesised that the new model will result in increased community engagement (demonstrated by an increase in referrals), earlier identification of children with development delay (demonstrated by a decrease in child’s age at referral) and an increase in family engagement (demonstrated by increased attendance rates). Qualitatively, it is hypothesised that the new model will result in improved consumer and community satisfaction and improved partnerships between Health, Education and other agencies.
The evaluation of this model will allow ongoing collaboration between CDS and multidisciplinary allied health professionals providing local services within THHS rural and remote communities. It will add evidence to support and improve the value of outreach services provided to children and families accessing Queensland Health in the outer THHS.
Skin sores up north: influences on APSGN, rheumatic heart disease and sepsis in childrenAuthor/s
Scott Stokes is a Paediatric Nurse Practitioner (Acute Care), employed at Broome Hospital in the Kimberley region of Western Australia. He has worked in neonatal and paediatric care in WA, nationally and abroad for many years, and has post graduate and Masters level qualifications in these fields. Much of Scott’s career has been practiced in regional and remote areas.
Scott qualified as a PNP in 2012, and has since led reform and practice change in neonatal and paediatric care in the Kimberley region. Central to the ethos was to facilitate a model of ‘care closer to home’, whereby infants and children could receive treatment locally, as opposed to travelling vast distances to tertiary centres. This has been especially exemplified through the PNP-led non-invasive respiratory program (CPAP and high flow oxygen therapy), which has had proven outcome benefits for both the patient and their family, as well as the health system.
Scott continues to assume an active leadership, education, consultancy and clinical portfolio within and external to WA Country Health, and is looking forward to being involved with expansion projects at a local, state and national level into the future.
Skin sores as a portal of access for pathogenic organisms, with resulting systemic implications, is a recognised and well documented health concern in rural (particularly Aboriginal) children. This has been exemplified in the Kimberley region of Western Australia in recent years, with an epidemic of skin-sore derived APSGN (Acute Post Streptococcal Glomerulonephritis), preceded by a 2 year epidemic of RHD (Rheumatic Heart disease) and ongoing clusters of bacterial sepsis. The morbidity and mortality data associated with these (essentially third world) diseases in a developed country has attracted national and global attention.
This review provides a demographic account of the evolution, natural history, prevalence, health outcomes and targeted health policy (response) for APSGN, RHD and Sepsis in Kimberley children. Importantly, we present the implemented strategies, referenced using best practice evidence and local innovation, which demonstrates how a coordinated and synergistic public and acute health sector response can positively influence health outcomes. These responses have included the introduction of regional policies (Unwell Child Procedure, APSGN treatment guidelines), Public Health education, screening and monitoring (including community contact tracing), disease surveillance models and the re-orientation of health practitioner practices (ventrogluteal injection techniques, community engagement).
Adapting metro nutrition programs to successfully reach remote and regional communitiesAuthor/s
Nina Tan is an Accredited Practicing Dietitian who has been working in community and public health nutrition for the last 5 years. Nina currently works at Cancer Council NSW as the Eat It To Beat It Program Manager. Eat It To Beat It is a community based nutrition program aiming to increase fruit and vegetable consumption of families with primary school aged children. Prior to managing the state-wide implementation of the program Nina coordinated the program in Greater Western Sydney.
Prior to working at Cancer Council NSW Nina worked at the Healthy Kids Association helping schools implement the NSW Healthy School Canteen Strategy.
Nina has a strong interest in Aboriginal health and nutrition. From 2010 to 2012 she coordinated a self-initiated, Hip Hop nutrition project titled ‘Eat Every Colour’, funded by the East Arnhem Shire Council. Through this project Nina worked with children of the East Arnhem Land community Gunyangarra, to create a healthy eating Hip Hop music DVD and learning resource.
Background and aims: Cancer Council NSW’s (CCNSW) Eat It To Beat It program aims to increase fruit and vegetable consumption in families with primary school aged children. In NSW, 90% of adults not eating the recommended amount of vegetables and 50% not eating enough fruit.
A Randomised Controlled Trial of the Eat It To Beat It Fruit & Veg Sense Workshop demonstrated the program’s ability to increase actual daily fruit and vegetable intake by 0.51 serves.
Methods: Eat It To Beat It was developed in the Hunter NSW region where it has been successfully operating since 2008. In 2012 the program expanded to several areas across NSW including regional and remote areas of Western NSW. Eat It To Beat It utilizes a train-the-trainer model where volunteers are trained to deliver Eat It To Beat It sessions and workshop to groups of parents on behalf of CCNSW. The program has been adapted in order to reach families in rural and remote areas of Western NSW.
Relevance and challenges for regional, rural and remote communities: Western NSW CCNSW staff cover almost 75% of the state’s area, and some of the most disadvantaged communities in the nation. The geographical distances between communities which have small populations can be extremely prohibitive to program delivery.
Program content needs to be adapted for rural and remote populations where access to fresh fruit and vegetables is an issue and recruiting volunteers in this region can be challenging.
Results and recommendations: Western NSW has 15 mobile volunteer program facilitators in the Dubbo, Orange, Cowra & Bathurst area. Initial face-to-face training takes place in the local communities to lessen volunteer travel burden, and updates and engagement can be maintained via Skype, online e-learning modules, phone and email.
To increase capacity of Eat It To Beat It in more remote areas, including Broken Hill, Bourke, Walgett and Cowra; collaboration with local Aboriginal Medical Services and the Local Health District involves staff being trained either via Skype video-conferencing to then deliver the program locally and on a needs basis. This partnership has allowed health workers in isolated communities who have pre-existing relationships with local schools and expertise in nutrition to utilise EITBI program resources to deliver on their objectives, while increasing the reach of EITBI.
In Western NSW, 50 Eat It To Beat It workshops and sessions have been delivered reaching over 820 regional, rural and remote families.
Conclusions: The Eat It To Beat It delivery model has been successfully adapted, to overcome barriers in order to provide nutrition information to rural and remote families in Western NSW.
Foundations for the future: learnings from a National Disability Insurance Scheme trial siteAuthor/s
Wendy is an Occupational Therapist with nearly 25 years’ experience working in paediatrics and mental health within various roles across SA Health in metropolitan, rural and remote areas. Wendy currently manages the Child Health and Development Programs for Country Health SA Local Health Network.
Since starting with CHSALHN at the beginning of 2013, one of the most challenging parts of her role has been managing the implementation of the NDIS Trial for 0-14 year olds in South Australia for Country Health.
Wendy also has a background in working with Aboriginal people and clinically is part of a team setting up and providing NDIA services to a remote Aboriginal community on the West Coast of SA.
When she is not at work Wendy loves to connect with her family, her garden and her Art Quilting buddies.
The National Disability Insurance Scheme (NDIS) trial commenced in South Australia in 2013 until 30 June 2016 with a focus on services to Aboriginal children living in remote communities in Yalata and Oak Valley.
Tullawon Aboriginal Community Controlled Health Service, auspice the program on behalf of the National Disability Insurance Agency (NDIA) the organisation who administers the NDIS. Country Health SA Local Health Network (CHSALHN) as a registered NDIA Service Provider agreed to provide paediatric Allied Health therapy services to children in these communities for the period of Trial. The Local Area Coordinator (LAC) based at Yalata works with the local community, service providers and with CHSALHN staff about the needs of children and families who are participants of the NDIS.
Partnership at every level is key to the success of the program. Having the commitment of Community Controlled Aboriginal Health Services, the Local Area Coordinator, an NDIA Service Provider and NDIA staff has been essential to address the challenges associated with establishing NDIA services to children in remote Aboriginal communities.
The paper will present key learnings and outcomes of the trial for NDIA service provision. Future directions and the implications for NDIA services to Aboriginal children in remote communities will be discussed from the Community and NDIA Service Provider perspectives.
South West Hospital and Health Service: a new model of rural paediatric careAuthor/s
Dr Tucker has been working as a Consultant Paediatrician in Australia for 2 years. She is dual-trained in both general and community child health, completing her training in Glasgow, Scotland in 2007. Prior to the move to Australia Dr Tucker was lead Paediatrician in Stirling, central Scotland for vulnerable children and child protection. She has always held an interest in rural and community health and completed elective periods of study as an undergraduate in Ethiopia, and on a First Nation native Canadian reserve in Northern Manitoba. Prior to pursuing specialist training she also completed a neonatal fellowship in Vancouver, British Columbia. This gave a great insight into the challenges of providing specialist services to a diverse and sparse population across a vast and challenging environment.
Dr Tuckers first introduction to work in regional Australia was at Mackay where the value of Telehealth to support rural sites was recognised. More recently she has now taken up a part-time position as general paediatrician at LCCH, Brisbane with responsibility for outreach services to Southwest Queensland in a unique model supporting rural child health services.
When not working Dr Tucker enjoys walks on the beach with her Australian husband and 3 yr old son. Dr Tucker also enjoys gardening and reading but never seems to have the time!
It has long been recognised that a multi-disciplinary team-based approach to care is best practice, particularly in chronic and complex conditions. ‘Act now for a better tomorrow’ the Queensland health statewide handbook clearly describes this in the child development context. Although individual services across allied health and child health in SWHHS worked well individually, the existing service was largely a medical model with inconsistent paediatric input across rural sites. On review of referrals 80% were assessed likely to have benefited from another service prior to or in place of a paediatric review. This necessitated a review of paediatric service provision. AEDC data highlighted the significant burden of developmental difficulties across the Southwest and a new service model was required which would be responsive to the complex needs of these children and their families. A model was developed which provides a family centred team-based approach to assessment and early intervention. Paediatric input is one part of this with an emphasis on seeing the right person at the right time. This maximises value to families and supports local, state and national health objectives. A significant commitment to building relationships across the care continuum has been made to support local service provision with a number of professionals and other services actively participating in case conferencing. Paediatric services are provided through a paediatric outreach position based at LCCH, Brisbane which provides a unique opportunity to link with specialist services including the Connected Care program. Use of Telehealth services and videoconferencing as routine practice has helped develop our evolving child health and development team.
Melissa van Leeuwen
Teaching children about acute rheumatic fever and rheumatic heart disease in schoolsAuthor/s
Melissa van Leeuwen is the Central Australian (CA) Public Health Nurse Coordinator of the Rheumatic Heart Disease (RHD) Control Program and is located in the Alice Springs Centre for Disease Control (CDC). Currently Melissa works closely with health services and regional groups to raise the profile of rheumatic fever with children and adults across the health sector. Previously Melissa has worked with Aboriginal Medical Services working in remote Western Australia, where one of her portfolios was overseeing the provision of care for RHD patients. Melissa has worked in CA for many years as Remote Area Nurse and held other portfolios specific to quality assurance within the health sector. She is passionate about seeing an end to ARF and RHD amongst Aboriginal and Torres Strait Islander people of Australia.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are rare diseases and therefore very much forgotten in many parts of the world and even Australia, yet in the Indigenous population of the Northern Territory, Queensland, South Australia and Western Australia, they occur commonly and are therefore still a reality. This is particularly so for children, who bear the largest burden of acute presentations. Even so, many Indigenous people do not know about ARF or its potential severity if not diagnosed early and treated according to guidelines. The treatment of Acute Rheumatic Fever / RHD is for a minimum of ten years, often longer for children, depending on the severity of the illness. In Central Australia (CA) there has been a focus on actively seeking ways in which the awareness of ARF amongst Indigenous people, and the Health Professionals who care for them, can be increased and improved so as to facilitate early diagnosis and better adherence to treatment. One method that has been conducted has been through a school-based education program which focuses on raising the profile of ARF. The program is designed to introduce children to ARF and how the illness can affect the body, how to manage the illness and how it can be prevented. The program aims to broaden the students’ and health care providers’ understanding of ARF by incorporating anatomy and physiology of the heart. Tactile processes are employed to raise the awareness by the use of a real ox heart; talking of healthy living; eating well and the importance of exercise. The lesson uses a variety of different media from videos, puppets, an ox heart, games, worksheets and physical exercise. It is also an opportunity to provide teachers with vital education to help in the early identification of symptoms of ARF. The children love the interactive nature of the program, and enthusiastically get involved. The response from schools is also very positive, with many schools requesting the program return. The lesson can be adapted for any age group of children – from preschool through to year 12. The program has been successfully delivered to small and large groups of children in a number of schools across CA.
Connected care in regional Queensland: a journey in unpredictable oceansAuthor/s
Lea Vieth has over seven years’ experience in Paediatric Nursing. She is currently the Care Coordinator for Central Queensland Hospital and Health Service, as part of a state-wide program that targets the most medically fragile paediatric patients in Queensland - The Connected Care Program. Lea has a special interest in the experiences of regional families with children who have chronic and complex medical conditions, and how they can be supported to negotiate the health system. Lea has also collaborated with CQUniversity and the Rockhampton Paediatric Unit on a variety of research projects on innovations enabling regional nurses to better care for paediatric patients. This research recently received an Opal Award - a CQUniversity award which recognises projects that improve the wellbeing, learning and research capabilities of local communities.
Lea loves working in a regional area. She believes that rural and regional nursing has encouraged her to be creative and innovative in her approach to providing the best possible care to the paediatric population. Lea has seen firsthand the experiences of families who must travel long distances for specialist care, and this has reinforced her commitment to the patients of the Connected Care Program.
Lynne McKinlay is the Deputy Executive Director of Medical Services for Children’s Health Queensland and Medical Lead of the Queensland Connected Care Program. The purpose of the Connected Care Program is to improve care and care outcomes for children with complex and chronic medical health care needs through the establishment of a network of care coordinators in Hospital and Health Services across Queensland.
Dr McKinlay was Director of the Queensland Paediatric Rehabilitation Service from 2001 to 2014 before moving into medical administration and leadership in a full-time capacity. She holds the position of senior lecturer with the School of Medicine, University of Queensland and was the founding clinical director of the Queensland Cerebral Palsy and Rehabilitation Research Centre in the Faculty of Medicine and Biomedical Sciences at the University of Queensland.
She was a Churchill Fellow in 2002, investigating paediatric rehabilitation systems of care in North America, with this knowledge guiding ongoing development of the paediatric rehabilitation services in Queensland. She has published papers in the area of childhood brain injury and has a special interest in Clinical Informatics and provision of care for people with complex healthcare needs.
Lynne has recently taken on a part time role as a senior medical educator for the Cognitive Institute, an international provider of healthcare education.
Background: For a family with a child experiencing complex and chronic medical needs in regional Queensland, the journey can be lonely, isolating, frustrating, exhausting and at times desperate. The reality is that often these children are required to have management with multiple specialists at facilities many hundreds of kilometres away. Uprooting the child from routine and home to access these services is complex for all involved including siblings. In 2014 a new programme called Connected Care was initiated by Queensland Health. The central aim is to connect the teams involved in a child’s care in order to determine meaningful solutions for both the child and their family.
Aim: The aim of this paper is to present the journey experienced by practitioners in setting up the initiative in regional settings in Queensland. The analogy of this journey is likened to a ship’s pilot (the care coordinator with knowledge of the ocean) guiding the ship (the family) through the confusing oceans (the health care system) to arrive in port safely.
Discussion: The paper will firstly present the challenges of both the pilot and the ship. These include the tyranny of distance, communication between multiple teams, establishing something new, promoting a new concept within the district and finding ways to establish trust in families who have at times been previously lost in the turbulent waters of the health care system. Secondly, preliminary outcomes of this new innovation will be discussed. Finally, the rewards will presented, including the connections made, the enabling of families and the building of resilience. The voices of families will be central to the discussion.
Conclusion: Families with children experiencing complex and chronic medical conditions in regional Queensland face a life-time of challenges. Reducing their burden through initiatives such as the Connected Care Program is a move in the right direction. However, with any new initiative one can predict that the sailing may not always be smooth. The benefits to families and their children makes the journey worth pursuing.
Delivering online child oral health training for remote health personnelAuthor/s
Dr David Walker BDS, MHPEd, PhD is a honorary Research Fellow in Indigenous Oral Health at the University of Sydney and Oral Health Training Consultant with Queensland Health’s Torres and Cape Hospital and Health Service.
Dr Walker’s principle research interests are in improved Indigenous community oral health and the sustainable development of new health personnel roles. He will present lessons learned from his current focus on the development of appropriate tele-training of remote primary health personnel in oral health in far north Queensland using a blended learning approach.
Dr Walker would like to acknowledge the hospitality of the rural and remote Indigenous communities and health personnel who have guided and supported this research. He also acknowledges the funding support of the Department of Health through its RHCE2 program; and the support of the Torres and Cape Hospital and Health Service and the Brocher Foundation in Geneva of this research.
Aims: This presentation reports the development, implementation and evaluation of child oral health training for rural and remote primary health personnel. This training was undertaken with the support of the Rural Health Continuing Education Scheme and the Torres and Cape Hospital and Health Service to reduce the impact of early childhood caries in the remote Indigenous communities of Cape York and the Torres Strait.
Methods: This child oral health training program has been developed for delivery to primary health personnel through face-to-face workshops and more recently through online training using a blended leaning approach. Face-to-face workshops have been evaluated through the conduct of pre- and post-training questionnaires and through post-training semi-structured interviews with participants. Evaluation of the online blended learning approach to training delivery is ongoing. The evaluation research is undertaken to determine: participant characteristics; change in participant knowledge and attitudes; participant evaluation of the training program; and how to best improve the delivery of child oral health training to rural and remote primary health personnel.
Relevance: The development of this training responds to the need to develop child oral health training for rural and remote primary health personnel nationally. Oral disease has a widespread and severe impact on the health of rural children. This is highlighted by the numbers of infants and children requiring multiple dental extractions under general anaesthesia in distant regional hospitals due to early childhood caries. Primary health personnel, including Aboriginal and Torres Strait Islander Health Workers and nursing personnel, are well placed to reduce the impact of this disease - however these personnel often receive little training in oral health.
Results and conclusions: This presentation provides an outline of the lessons learned in developing appropriate approaches to delivering child oral health training which respond of the needs of rural and remote communities and primary health personnel.
Healthy ears: providing outreach ear health service across rural VictoriaAuthor/s
Sue Ward lives in the small rural community of Dimboola in Victoria. Being a parent of a deaf child living in such a rural community, Sue learnt first-hand the difficulties facing a person suffering a hearing loss accessing any support from a service understanding deafness and being able to support the family in coping with this disability.
Sue became involved with the Wimmera Hearing Service, a voluntary group supporting sufferers of deafness and hearing impairment. Becoming a volunteer herself for 14 years, in 2001 Sue then accepted the role of Manager of The Wimmera Hearing Society Inc as the service had grown and needed appropriate coordination. Sue has therefore been involved in the hearing impaired/deaf sector for 36 years.
Wimmera Hearing Society Inc is based in Horsham, Victoria, which is the City servicing the Wimmera Region which includes the small town of Dimboola.
With a nursing background, Sue shifted direction when she started volunteering with WHS and completed many deaf related qualifications so that she could more easily assist community members diagnosed with hearing loss and needing support with deaf related problems. Sue’s personal involvement, then her interest in the area, has given her a great understanding for people suffering deafness and the related issues.
Sue recognised the need for others in rural and remote towns to be able to access the services of WHS, and instigated and developed a unique mobile testing unit and program, which travels and provides free hearing assessments across country Victoria.
My background is Quality Management and Health Care Commissioning in the UK National Health Service, where I worked for Primary Care Trusts and Health Authorities in South East England.
I came to Australia in 2011 and took up the post of Regional Oral Health Plan Project Coordinator for the North and West Metropolitan Region of Victoria, coordinating implementation of the oral health plan, establishing key partnerships for service delivery and improving the oral health of the most disadvantaged sections of the community.
In 2014 I secured the post of Project Manager for the Mental Health program at Monash Health where I project managed implementation of the Mental Health Act 2014, improving nutrition risk screening and the development of an ipad app.
In 2015 I secured the role of Ear and Eye Health Services Program Officer in the outreach team at RWAV engaging with ACCHOs and other health organisations to support indigenous clients in attending surgical appointments. In late 2015, I was appointed A/Team Leader VIC outreach with responsibility for a number of outreach programs including, the Rural Health Outreach Fund, the Visiting Optometrists Scheme, the Indigenous Chronic Disease program, the Healthy Ears program and the Ear and Eye Surgical program.
The Rural Workforce Agency Victoria (RWAV) and Wimmera Hearing Society (WHS) Inc. have for the past 2 years been providing an ear health service to Aboriginal and Torres Strait Islander youth via Aboriginal Health Services across country Victoria.
Rural Workforce Agency Victoria (RWAV) is a not-for-profit organisation working with communities that have underserviced health needs. RWAV do this through a number of initiatives that recruit, support and advocate for the health workforce throughout rural and regional Victoria. This includes the administration and management of outreach programs across the state.
The Wimmera Hearing Society Inc. is a volunteer based hearing assessment referral, education and support service established in 1982. The service is based in Horsham, Victoria.
WHS has a custom built mobile hearing unit fitted with 4 testing booths.
The partnership with RWAV and WHS has evolved into a very sought after service within the Aboriginal Co-ops throughout Victoria. Currently 22 Aboriginal and Community Health Services are involved in this program.
This service includes visiting the sites twice a year, providing a full hearing assessment, referral, communication strategies and educational support for the Aboriginal Health Workers (who then provide practical assistance with service provision). Reports in the form of a ‘Healthy Ear’ Booklet are retained at each Health Service and when WHS revisits the results are added. This is giving the program, the Health Service, Education Department and families a great resource in relation to each young person’s hearing history.
With support from Aboriginal Health Services and Health Workers, we are now able to include Aboriginal Education Support workers in this project. This has enabled our service to visit schools. Positives from this include getting a much larger number of participants and with the support of the Health Service Aboriginal Health Workers and the Education Support Workers, we are all working together and providing a much better outcome for the students.
Our presentation will include information on how this program has developed and the benefits to Aboriginal youth, families and education facilities, and ideas on how this can be expanded to include partnerships with Ear Nose and Throat (ENT) specialists.
Going the distance in paediatric palliative careAuthor/s
Amy Wethered is the Paediatric Palliative Care Clinical Nurse Consultant for the John Hunter Children’s Hospital located in Newcastle NSW. She is actively involved with the NSW paediatric palliative care program and state-wide working parties developing new paediatric palliative care resources. She is currently seconded to a Nurse Educator position for the Paediatric Palliative Care National Education and Quality Improvement Collaborative Project. Which aims to improve palliative care education and training of the health and palliative care workforces. She has recently been appointed a position on the Human Ethics Research Committee at the University of Newcastle.
Paediatric Palliative Care (PPC) is the care provided to children with Life limiting conditions. The focus is on quality of life and care is tailored to each family’s unique and individual needs. The PPC service at the John Hunter Children’s Hospital (JHCH) is providing care to children, young people and their families within the Hunter New England Local Health District which covers an area of over 130,000 Km2. There are many obstacles and challenges involved in providing quality PPC over this distance. This has inspired the service to explore some innovative ways to improve the quality of service, the care provided and ultimately outcomes for patients and their families.
One of these innovations is the Telepad project. This project has seen the development of videoconferencing (via a secure network, usually with iPads) with the children, families and health care professionals linked with our service. Video conferencing may not seem at first to be well-suited to PPC because of the sensitivity of discussions and the obvious value of face to face communication. However we find families linked with our service are often in circumstances where the travel, inconvenience and costs of attending consultations at a tertiary hospital are a great burden.
Video conferencing has allowed patients, their families and carers to have access to expert health care without travelling to major health centres and without having the costs and inconvenience associated with this. It has also been of particular value for our rural patients and the local teams/clinicians providing care for these families. The Telepad Project has undergone independent evaluation which was based on the reports of parents of children receiving PPC and of health staff from the community and JHCH PPC service. The project reported providing more equitable access to expert PPC and has significantly improved the experience of patients and their families. The benefits included convenience, reduced travel, reduced costs, better local support for families and the opportunity to link-in all staff of the multidisciplinary team. Video conferencing is now embedded in our practice and is a sustainable program able to be easily replicated by other facilities.
Maxi kids: building capacities for rural and remote children and communitiesAuthor/s
Ms Elizabeth (Liz) Whale; Marathon Health Primary Health Service Early Intervention Team Leader, BPsycSc.
Born in rural Western NSW, Liz Whale has worked in the paediatric health, education and welfare domains for over 16 years. Her passion for working with young children saw her return to the area in 2010 with a goal to improve the significant challenges faced by rural Australians in accessing localised, quality, co-ordinated and sustainable health care.
Liz was the project lead for the Coonamble Desert Pea Media – Tin Town Trackers Projects 2013/2014, showcased at the 13th National Rural Health Alliance Conference in Darwin 2015. She has contributed significantly to the design and development of a multidisciplinary, multiagency whole of child health, development, assessment and pathway to care program recognised by the 2014 ACI NSW Rural Health and Congress Award for Innovation and the 2014 NSW Health Secretary Award for Integrated Care.
Currently Liz is enjoying the challenges of working as the Early Intervention Team Leader for Marathon Health (NGO) and leads a paediatric multidisciplinary early intervention team across seventeen rural and remote communities throughout Western NSW.
The future health and well-being of our population is dependent on the health and well being attained in the early years of life. The Australian Early Developmental Index (AEDI) 2012, identifies 1 in 10 Australian children, 10% are developmentally vulnerable on two or more domains. This national average increases significantly for rural and remotely located children, 13% and 14% respectively. The Maxi Kids Program has been designed in consultation with primary health clinicians and identified community needs to mitigate the health and developmental factors that place children at risk for poor outcomes in later life.
Maxi Kids is a six week health promotion and intervention program for children aged between 3 and 7 years of age. Maxi Kids assists parents and carers, early childhood educators, early childhood teachers and health staff discover each child’s strengths and areas needing intervention specific to their developmental ages and stages and associated health development using the medium of play and structured experiences.
Facilitated by an Allied Health Assistant under the remote supervision of an Occupational Therapist, children are screened in the domains of gross motor, fine motor, visual perceptual, auditory processing, body image, nutrition and social skills. The six week program is tailored to the individual and the identified needs of the child to be implemented at weekly intervals within school and preschool environments. Parents, carers, early childhood educators and teachers, and the child’s General Practitioner are informed on and included in the child’s direct and broader healthcare when and where appropriate and as required specific to their individual needs. These supports and intervention directly affect the child and indirectly affect parental and stakeholder capacity and caregiving environments.
Early findings for the Maxi Kids program have identified significant improvement on individual assessments pre and post program. Within 52 working days, the implementation of the Maxi Kids program January to June 2015 delivered 8 programs to 25 children with 83% of participants obtaining a score of 100% in their developmental and health screening indicators post program. Stakeholder and parent and carers customer satisfaction surveys have universally and overwhelmingly identified as ‘highly satisfied’ with the program content, outcome and service delivery. The program often identified as ‘brilliant’, ‘awesome’ and ‘wonderful’ when asked for further comments or feedback.
The immediate and significant success of the Maxi Kids program sees the potential for further expansion of service delivery throughout Western NSW including developing further efficiencies in telehealth consultations and intensive staff training.
CareTrack Kids: the appropriateness and safety of care provided to Australian childrenAuthor/s
Les White was appointed as the inaugural NSW Chief Paediatrician in September 2010. He was Executive Director of Sydney Children’s Hospital from 1995 to 2010, following a clinical and academic career, with emphasis on childhood cancer. Other positions have included President of Children’s Hospitals Australasia (1999-2004) and the John Beveridge Professor of Paediatrics (2005-2010). He has over 120 publications and many more abstracts, awards, grants and invited presentations in his CV. He serves on 9 not-for-profit boards relating to children’s health or medical research. He was awarded a Doctorate of Science for research contributions related to childhood cancer and holds a Master of Health Administration. In 2007 he received an Order of Australia award for service to medicine, medical administration and the community in the field of paediatrics. He has championed the rights of children and young people in healthcare in the Australian setting. His current interests include childhood injury, intellectual disability, health services research and state-wide networking of paediatric services.
Introduction: Australian and international clinical practice guidelines are available for common paediatric conditions. Yet there is evidence that there are substantial variations between the guidelines, recommendations and the care delivered. Our adult study, CareTrack Australia (CTA) demonstrated that appropriate care (care in line with level 1 evidence or guidelines) to patients is delivered on average only 57% of the time. This NHMRC Partnership Grant, CareTrack Kids, aims to determine the appropriateness of the healthcare delivered to Australian children for 16 common paediatric conditions in acute and primary healthcare settings. We also aim to measure the frequency and types of adverse events encountered in Australian paediatric care. This fills a knowledge gap as few large-scale adverse events studies have been undertaken internationally in children’s healthcare, and none in Australia.
Methods and analysis: There are two main phases to the research – identifying conditions and indicators and reviewing care against the indicators. We have identified 19 conditions amenable to population-level appropriateness of care research and have developed clinical indicators for each condition. Candidate conditions were identified from published research; burden of disease, prevalence and frequency of presentation data; and quality of care priority lists. Clinical indicators were developed through searches of national and international guidelines and extracting their recommendations. Experts reviewed the indicators using a wiki-based approach and modified Delphi process. A total of 540 clinical indicators were developed.
A random sample of 6,000 – 8,000 medical records representing a cross-section of the Australian paediatric population will be reviewed for appropriateness of care against the indicators within three Australian states (New South Wales, Queensland and South Australia) using multistage, stratified sampling. Records from hospitals, general practice, and paediatricians will be reviewed. The inclusion criteria are children aged <16 years who presented with at least one of the study conditions during 2012 and 2013. Suitably experienced nurses will be employed to act as surveyors for this study.
To collect adverse events, a mechanism for retrospective medical record review, the Institute of Healthcare Improvement’s Global Trigger Tool, will be used. GTTs use a series of ‘triggers’ to screen the record for a potential AE. The presence of a trigger signals the need for an in-depth review. AEs will then be coded according to incident type, and AE rates calculated.
Science walkin’ country: a journey of research in a remote Aboriginal CommunityAuthor/s
Amanda Wood is an Ear and Hearing Health Clinical Nurse Consultant with Deadly Ears, Children’s Health Queensland’s Aboriginal and Torres Strait Islander Ear Health Program.
Amanda first joined Deadly Ears in January 2013 as a Clinical Nurse in the ENT Outreach team. During the past three years, she has been instrumental in the development and delivery of various projects, most notably Deadly Ears’ database module on QChild, a state-wide hearing health database of all children in Queensland. The new database has led to significant service and outcome reviews, and continues to encourage and enable innovation.
As a result of her work on the QChild database, Amanda has also played a lead role in the development of a Deadly Ears teleotoscopy service.
She is also a member of the research team for the Aboriginal and Torres Strait Islander Bacterial Interference in Otitis Media Explorative Study. Exposure to this project has increased her interest in research, particularly with a focus on continuing to improve the health outcomes of Aboriginal and Torres Strait Islander children.
Prior to joining Deadly Ears, Amanda was a paediatric Registered Nurse at the Townsville Hospital. While in Townsville, she completed a Master of Public Health and Tropical Medicine, which is where her interest in Aboriginal and Torres Strait Islander child health developed. Previous to this, she was a Registered Nurse at Mater Children’s Hospital Brisbane.
Background: Aboriginal and Torres Strait Islander (A&TSI) children have some of the highest rates of otitis media (OM) in the world which impacts on communication development, education and employment outcomes. Despite a plethora of treatments, the burden of disease remains significant. Research to address this issue is a key priority, however conducting research in A&TSI communities comes with unique challenges that warrant consideration.
Objectives: To review the literature in relation to conducting research in A&TSI communities and share the journey of a research team and a remote community working together to conduct research aimed at improving OM in A&TSI children. This study, The Aboriginal and Torres Strait Islander Bacterial Interference in Otitis Media Explorative (BIOME) study, explores the microbiome of the upper airways of A&TSI children in the search for ‘good’ bacteria to formulate a probiotic to fight OM.
Methods: Keyword searches were conducted of Medline (Ebsco) and CINAHL. Relevant papers were reviewed to derive the major themes. The research team in collaboration with community stakeholders have used a participatory action research approach to plan and deliver the first stages of the project. Reflections of the journey to date in relation to the literature will be explored.
Results: Major themes include trust, partnerships, and communication. Trust is a challenge for any research team working in A&TSI communities. In the infancy of the project the scientific team partnered with a clinical team who had a long and reliable history of working in communities. This original partnership was invaluable in building initial trust and opening communication lines into the community allowing for the subsequent development of a further partnership with the community. There are ongoing challenges within the partnership, however with respect of each other’s expertise, in science and cultural and community respectively, we are starting to formulate a strong, productive relationship. Communication challenges arise through geographical, cultural/linguistic, and educational barriers. Perceptions of the scientific process, language used, expectations of outcomes and goals can differ and can be difficult to uncover and remediate. This is a key issues in the delivery of the project, with specific challenges including engagement of the wider community and collaborative reflections and problem solving.
Conclusions: Further research into A&TSI OM is required, however this is not without challenges, challenges that we have faced and continue to face in the delivery of The A&TSI BIOME project. However through partnerships, open communication and trust we are negotiating this difficult path to make Science Walkin’ Country a reality.