ABORIGINAL HEALTH RESEARCH EXPO Showcase of work from Flinders University and

Cooperative Research Centre for Aboriginal Health

24 November 2005, Function Centre, Flinders University

Painting:Takanna Wadu © Shialee Brodie. Kaurna Artist SA Ph: 0407 727 728 This painting is called Takanna Wadu, meaning ‘many partnerships’ to make Aboriginal health good. The tree represents strength of family and health; the spirit represents wellbeing; the hands are for reconciliation - 7 hands to represent each state; the ibis is representitive of the Tjilbruke dreaming trail in SA and the importance of remembering culture and stories; large centre circle is Kaurna country where people are coming together to share their knowledge; other small circles represent other groups of people connecting up with each other to find the best ways forward to make a difference to Aboriginal health and wellbeing.

ABORIGINAL HEALTH RESEARCH EXPO

SHOWCASE OF WORK

8.30 am – 6.00 pm, Thursday 24th November Function Centre, Flinders University

Linkages with the Cooperative Research Centre for Aboriginal Health will be a prominent feature of the Expo - with CRCAH CEO, Mick Gooda, presenting an overview of the CRCAH's approach to research including the Indigenous Research Reform Agenda. This is a great opportunity for Aboriginal health researchers to share work and ideas, network, and engage with stakeholders.

Supported by

Flinders Aboriginal Health Research Unit and

Cooperative Research Centre for Aboriginal Health

Further information and R.S.V.P. by 21.11.05 to Anne Amos Email: anne.amos@flinders.edu.au Phone: 08 8201 5890

ABORIGINAL HEALTH RESEARCH EXPO Flinders University – 24th November 2005

Program

8.30- 9.00 Registration. Coffee/tea available all day. Posters and other displays from CRCAH and

Flinders researchers on view all day 9.00- 9.20 Welcome from traditional owners (Kaurna elders – Leonie Brodie, and Lewis O’Brien),

Kurruru dancers 9.20- 9.30 Welcome and introduction to the day and to our guests (Prof Roy Goldie, Flinders

University) 9.30- 9.40 Minister for Aboriginal Affairs and Corrections (Terry Roberts) 9.40- 9.50 Outline of Flinders Aboriginal Health Research, an area of strategic investment for

Flinders University (Inge Kowanko and FAHRU staff) 9.50- 10.30 Outline of the Cooperative Research Centre for Aboriginal Health, a national

collaboration, and its relationship to Flinders (Mick Gooda and CRCAH staff) 10.30-11.00 Morning tea 11.00-12.30 Oral presentations and discussion

• 11.00 Evaluation of the AFL Central Australia Living with Alcohol program (Ricky Mentha) • 11.15 Coordinated Aboriginal mental health care (Charlotte de Crespigny, Jackie Ah Kit) • 11.30 Water service delivery and State and Commonwealth water reform objectives – a

response from Aboriginal communities in South Australia (Eileen Willis, Denise Wilton) • 11.45 Aboriginal people travelling well (Kim O’Donnell, Yvonne Helps) • 12.00 Compositional and contextual determinants of urban health inequities: an

Indigenous perspective (Gilbert Gallaher) • 12.15 Discussion

12.30-1.30 Lunch and poster viewing 1.30-3.00 Oral presentations and discussion

• 1.30 Bridging the gap: Coordinating transition of care for Indigenous cardiac surgery patients from remote areas (Monica Lawrence)

• 1.45 Characteristics of successful primary health services for Aboriginal women (Janet Kelly)

• 2.00 Strong teeth for healthy kids (Iris Raye) • 2.15 Perspectives on ear health and hearing in school-aged Indigenous children in South

Australia (Linnet Sanchez) • 2.30 Systemic Governance to enhance social justice (Janet McIntyre, Doug Morgan) • 2.45 Discussion

3.00-3.30 Afternoon tea 3.30- 4.45 Oral presentations and discussion

• 3.30 Centre for Clinical Research Excellence in Aboriginal Health – overview (Peter Harvey)

• 3.45 Development of Living Improvements For Everyone (LIFE) program for Indigenous Australians (Fiona Coulthard, Kate Warren)

• 4.00 Improving diabetes management for Aboriginal people through the national 'QAAMS' program for point of care HbA1c and urine ACR testing (Mark Shephard, Kay Mundraby)

• 4.15 Diabetes education and Aboriginal health workers (Meri King, Leonie Melbourne) • 4.30 Discussion

4.45- 5.00 Wrap up (FAHRU) 5.00 – 6.00 Drinks

Flinders Aboriginal Health Research: Working together through research to improve Aboriginal health and wellbeing Flinders Aboriginal Health Research is one of eleven Areas of Strategic Research Investment selected by Flinders University. It brings together a large multidisciplinary network of Flinders University researchers and their colleagues with a strong track record and long term commitment to improving Aboriginal health and wellbeing through research. Flinders University is a leading provider of quality research that improves Aboriginal health, builds capacity and meets the needs of Aboriginal people and other stakeholders. In recent years Flinders University has steadily built a reputation in Aboriginal health research, developing respectful partnerships with Aboriginal communities and key organizations, gaining significant grant income, and achieving major roles in national research collaborations including the Cooperative Research Centre for Aboriginal Health (http://www.crcah.org.au/), and the Centre for Clinical Research Excellence in Aboriginal Health, in partnership with Aboriginal Health Council of SA (http://www.ahcsa.org.au/07/07_1.htm). This research spans the health and social sciences and the humanities, in keeping with holistic Aboriginal understandings of health as encompassing physical, social, emotional, spiritual, environmental, cultural and community wellbeing. Some of the focus areas include: social and emotional well-being, complex chronic conditions, health services and systems, workforce development, social determinants of health, safety and preventable injury, infectious disease and consequences, appropriate research methodologies, health indicators and trends. The granting of ASRI status and funding, along with significant co-investment from the Faculty of Health Sciences, has enabled the establishment of the Flinders Aboriginal Health Research Unit (FAHRU) to develop the necessary leadership and supports to build on early successes and achieve its vision. FAHRU is led by Dr Inge Kowanko, with Kim O'Donnell and Helen Liddle (research associates) and Anne Amos (admin assistant). Together they comprise a team with complementary skills and experiences. FAHRU is co-located with the Faculty of Health Sciences office in the Sturt Building at Bedford Park, except for Helen Liddle who is based at the Centre for Remote Health in Alice Springs. The role of FAHRU is to - coordinate, conduct, support and grow Aboriginal health research across all Flinders University

campuses (SA and NT) - build relationships and enhance collaborations with Aboriginal communities and organisations,

government agencies and other stakeholders In this way the needs of research users (Aboriginal people and the organizations that serve them) can be matched with the skills of research providers (research teams based at Flinders University). FAHRU promotes, and tries to model, the principles of Indigenous research reform, which are espoused internationally and nationally e.g. through the CRCAH and NHMRC and Aboriginal research ethics committees. Key elements include meaningful partnership with Aboriginal participants in all stages of the research from planning through conduct to reporting, ensuring that research findings translate to better policies and practices that improve health outcomes, and providing opportunities for capacity development of Aboriginal people and others with an interest in Aboriginal health and research. It follows that a major role of FAHRU is to develop and maintain relationships with Aboriginal communities and groups. This reflects the reality of Indigenous research today, i.e. Aboriginal communities set the research agenda according to their needs and priorities. It means spending time, sitting down with Aboriginal people, listening, being flexible, responding to needs as they arise, thinking beyond the project, and demonstrating long term commitment. Aboriginal people are interested in practical research programs that address problems and lead to sustainable solutions, research that builds on previous studies, and takes into account prior knowledge of what works and what doesn’t and in what context. Therefore networking, extensive consultation and making connections with related activities are key roles for FAHRU.

Cooperative Research Centre for Aboriginal Health Mick Gooda, CEO CRCAH The Cooperative Research Centre for Aboriginal Health (CRCAH) is a body established by twelve organisations either representing the health industry or research bodies. Over the least eighteen months the CRCAH has embraced a new direction of a Programmatic approach to the establishment and implementation of the research agenda. An intricate part of this approach involves the strong participation of representatives from the Aboriginal Community Controlled Health sector in a Facilitated Development process which brings together researchers and users of research as a means of ensuring the research the CRCAH conducts will be of practical use, rigorous and will work towards the CRCAH’s vision of ‘sustained improvements in Aboriginal Health through strategic research and development’. The Facilitated Development process includes the CRCAH Board setting specific priorities for research, the development of the research proposal through to the conduct of the research itself.

ORAL PRESENTATIONS

Evaluation of the AFL Central Australia Living with Alcohol program Ricky Mentha (Centre for Remote Health) Objective: This study evaluates the impact of the Living With Alcohol Program and if alcohol reduction, education and transport strategies. The Centre for Remote Health, in conjunction with the National Drug and Research Institute and Tangentyere council have designed an evaluation for the proposed program which entails analysis of mainly routine collected data from AFL Central Australia, it’s security company, police and the Alice Springs hospital over the course of the proposed program. Methods: The Centre for Remote Health, in conjunction with the National Drug Research Institute and Tangentyere Council have designed an evaluation for the proposed program which entails analysis of mainly routinely collected data from AFL Central Australia, it’s security company, police and the Alice Springs hospital over the course of the program. In addition, these will be direct observations at all AFL Central Australian games and events for the duration of the evaluation. With the application of a questionnaire to the umpires, administrators, club representatives and security staff. Results: The study is in progress. To date, we have completed direct observations over the past 12 months and are currently extracting data from AFL Central Australia, hospital, police, Tangentyere council and the security company.

Coordinated Aboriginal Mental Health Care - A Model for Best Practice for Rural and Metropolitan Service Delivery Jackie Ah Kit, Charlotte de Crespigny Coordinated Aboriginal Mental Health Care is the both the title and the goal of an ongoing project by a collaborative research team from Flinders University and Aboriginal health service providers in the Eyre Peninsula region of South Australia. The investigators are Inge Kowanko, Charlotte de Crespigny and Helen Murray (Flinders University), Jackie Ah Kit (Port Lincoln Aboriginal Health Service), Colleen Prideaux (Ceduna-Koonibba Aboriginal Health Service), and David Mills (Eyre Peninsula Division of General Practice). This project builds on their previous work on medication management for Aboriginal people with mental health problems, conducted in Port Lincoln and across SA, which consulted widely with Aboriginal people and recommended better integration of services. That research highlighted the problems faced by clients and their families in navigating the multiple services they require, and the need for holistic and culturally appropriate systems of care (final report is available online at http://nursing.flinders.edu.au/research/index.php?id+108#aboriginalhealth ). In the current project the team is working with the wide range of health, social and human service providers that are involved in the care or support of Aboriginal people from the Eyre Peninsula region who have mental health problems (including alcohol and other drug use problems). Together with the research team these key stakeholders are identifying strategies that enhance coordination of services, and developing agreed pathways and protocols that are client-focused and holistic, and embedded in systems rather than personality-dependent. Some strategies that promote inter-agency collaboration or communication that have already been identified and implemented by the research team during the project include: bringing together workers from different agencies for training in response to shared needs, advocating for Aboriginal community input into the Review of Mental Health Legislation in SA, providing health promotion resources, lobbying for improved out of hours telephone help. Members of the team have worked together over several years, and have put much effort into building trust, nurturing professional and personal relationships, and demonstrating long term commitment to improving wellbeing of Aboriginal people. They have developed the action-oriented partnership approach to research based on principles of respect, collaboration, meeting needs and participation. As well as linking with its previous studies, the team ensures that its research articulates with related work. The Coordinated Aboriginal Mental Health Care project is supported by grants from Flinders University and the Cooperative Research Centre for Aboriginal Health. It is also a foundation project of the Centre of Clinical Research Excellence in Aboriginal Health Research, a joint project of Flinders University and The Aboriginal Health Council of SA, focusing on chronic condition management in the Eyre region.

Water service delivery and State and Commonwealth water reform objectives – a response from Aboriginal communities in South Australia

Presenters: Eileen Willis and Denise Wilton, Chairperson Nepabunna Council Researcher team: Meryl Pearce, Eileen Willis, Maria Wilson, Tom Jenkin, Ben Wadham, Udoy Saikia, Carmel McCarthy, Fiona Ryan and the members of the Nepabunna and Yarilena communities. This is a participatory, action research project aimed at engaging discrete Aboriginal communities and homelands in South Australia in discussions on strategies to reduce potential adverse impacts of the Commonwealth Water Reform Initiatives on their well-being, i.e. to identify strategies that are economically feasible and environmentally sustainable to reduce the potential water costs to individual households. Specific objectives include: • To conduct an economic appraisal of water costs to households. • Identify appropriate low-cost strategies aimed at reducing service delivery costs to

individual households while simultaneously promoting water conservation, greater water use efficiency, and sustainability of water resources.

• Where Aboriginal communities/homelands currently have no formal water service provider, to engage the community in discussions around the levels of water service delivery that they would be willing to pay for.

Work in development: Aboriginal People Travelling Well; a model of action for change

Presenter: Kim O’Donnell Research team: Yvonne Helps1, Kim O’Donnell2, Charlotte de Crespigny3, Inge Kowanko2, James Harrison1

1Research Centre for Injury Studies; 2 Flinders Aboriginal Health Research Unit, 3 School of Nursing and Midwifery, Flinders University

Background: Although most Australians expect and enjoy access to a range of safe transport options, some segments of the population do not. Safety and wellbeing suffers seriously due to preventable deaths and disabilities and restricted access to employment, education and essential health and community services [4]. Aboriginal people are particularly affected [1], with impacts present in remote, rural and urban settings [2, 3]. Objectives: Identify barriers preventing Aboriginal people from travelling safely in South Australia. Identify solutions and key organisations in positions to facilitate action for change. Methods: Conduct a series of forums, involving government agencies and non-government organisations and community leaders. Identify gaps within and between services in relation to safe travel. Conduct a literature review based on themes drawn from the forums. Subject to funding and ethics approvals, conduct focus groups in Aboriginal communities in urban and remote locations to explore needs, priorities and solutions regarding transport. Collect case studies describing experiences representative of the problems associated with not being able to travel well. Describe positive examples of community problem solving. Results to date: Agencies and non-government organisations are committed to the provision of services to Aboriginal people, but lack integration and co-ordination of resources. Engagement with Aboriginal communities is complicated by difficulties that are not easily addressed. Practical, relatively simple solutions using existing resources and supplementary resources have been identified. Conclusions: Lack of safe, sufficient transport has negative effects on the health and wellbeing of Aboriginal people in many settings. Collaboration between communities and organisations in positions to effect change facilitates positive action. Research and evaluation is limited in this area. References 1. Western Sydney Area Health Service Centre for Public Health, Blacktown Aboriginal injury surveillance and prevention project report. 2003, Western Sydney Area Health Service Centre for Public Health,: Sydney. 2. ABS, National Aboriginal and Torres Strait Islander Social Survey 2002. 2004, Australian Bureau of Statistics: Canberra. 3. Helps YLM and Harrison JE, Injury Mortality of Aboriginal and Torres Strait Islander peoples in Australia, 1997-2000. 2004, Australian Institute of Health and Welfare: Canberra. 4. Kowanko, I, de Crespigny, C and Murray, H. 2003. Better medication management for Aboriginal people with mental health disorders, and their carers. Final Report. Flinders University Bedford Park. http://nursing.flinders.edu.au/research/index.php?id=286

Compositional and contextual determinants of urban health inequities: an Indigenous Perspective. Presented by Gilbert Gallaher - Research Fellow, Department of Public Health Flinders University. Abstract: This research will explore the factors that contribute to Indigenous people in metropolitan Adelaide having poorer health, and identify those facilities and resources that may help reduce health inequities among urban Indigenous communities. To do this, the project is concerned to understand in more detail the compositional factors (relating to the types of people living in a location) and contextual factors (relating to the location itself) of areas that may account for locational differences in health as they relate to urban populations. The research will particularly examine the role of social capital in contributing to and ameliorating poor health outcomes for Indigenous people. The research also aims to document what experiences Indigenous people have had of racism, and the extent to which this has an impact on their social, emotional and physical health status. Similarly, the perspectives of local Indigenous people on the concept of “whiteness” and the impact this has on health, also hope to be determined. By focussing specifically on those contextual factors that are health damaging or health enhancing for Indigenous people, the proposed research will serve as an important adjunct to an already funded NH&MRC project grant which is examining the links between location, social capital and health, specifically the compositional and contextual determinants of locational differences in health that contribute to the dynamics of the production of health inequities among broader population groups.

Bridging the gap: Coordinating care for Indigenous cardiac surgery patients from remote areas. Monica Lawrence Flinders Medical Centre Aboriginal people are twice as likely to die from cardiovascular disease than non-

Aboriginal people. Alarmingly, this gap is widening. Rheumatic heart disease is reported

to be in epidemic proportions in many Aboriginal communities at the Top End. The

incidence of acute rheumatic fever among Aboriginal and Torres Strait Islander children

aged 5-14 years in the Top End of the Northern Territory is about 250 per 100,000 and in

Central Australia is about 350 per 100,000.

Many of these remote area Aboriginal people have never left their families or

communities are transferred to FMC for major cardiac surgery that includes coronary

artery bypass grafting or valve surgery. My nursing research in conjunction with my

nursing practice has highlighted the traumatizing experience many of the remote area

Aboriginal people are confronted with when referred for major cardiac surgery.

The “Bridging the Gap” project has been implemented over the last four months and has

enabled me to identify many of the cultural and administrative gaps in the transition of

cardiac care from remote communities of the Top End to Flinders Medical Centre.

Characteristics of successful primary health services for Aboriginal women Janet Kelly Janet Kelly is a community health nurse who works with Aboriginal women in women’s and sexual health. Her work with Shine SA (formerly family planning) is based at Gilles Plains, a north eastern suburb of Adelaide. She also co-provides women’s health services in Ceduna through a specifically funded women’s health visiting program. Janet is currently studying a PhD in nursing research at Flinders University, researching how urban primary health care can better meet the health needs of Aboriginal women. This follows on from previous research focusing on young Aboriginal women and sexual health. The aim of this presentation is to discuss how Aboriginal research can inform and improve primary health care practices. Janet shares her learning through her previous research with young urban Aboriginal women, Aboriginal Elders, Aboriginal health workers and sexual health nurses. Through this presentation, she poses the question of how Aboriginal knowledge and Aboriginal research ethics can help guide health services to meet local Aboriginal women’s needs and preferences.

Strong Teeth for Little Kids: A randomised controlled trial. Presenter: Iris Raye Aim: To compare dental carries in children living in remote communities of the NT which have received either standard oral health services or assistance in incorporating oral health programs (including application of fluoride varnish) into primary health care of children. Background: Dental decay and poor oral hygiene is a serious health problem for all preschool children in Australia. Good oral hygiene is important for eating, speaking and smiling, but there are serious health effects if not maintained. Untreated dental caries not only lead to pain and infection, affecting children’s learning and behaviour / playing but can lead to life threatening complications in children who are already sick. Methods: All communities will receive baseline oral health surveillance with referral intervention, combination of health education, training, community oral health promotion activities and concentrated fluoride application (6 monthly over 2 years).Final assessments in all communities will occur in 2008. If the intervention is shown to be effective it could be widely introduced into primary health care programs. This would reduce the number of emergency and general dental treatments throughout childhood and potentially, substantially improve the overall health of Aboriginal children. Acknowledgments: This project is a collaboration between Menzies School of Health Research, the Dental School of Health at University of Adelaide, the Northern Territory Dept. Health and Community Services, and the Australian Research Centre for Population Oral Health (ARCPOH). Funding for this project is through the NHMRC.

Perspectives on Ear Health and Hearing in School-aged Indigenous Children in South Australia Assoc. Professor Linnett Sanchez 1 , Ms. Karen Sparrow1, Ms. Helen Smith2

1Dept. of Speech Pathology and Audiology, School of Medicine, Flinders University 2Senior Speech Pathologist, Vodafone World of Difference 2005 Awardee in association with CanDo4Kids/Townsend House Foundation “Can’t hear: Can’t Learn” This clear bold statement holds for any child with impaired hearing in any school system, but it continues to have particular relevance to indigenous Australian children. This talk presents data about the hearing and ear health status of school-aged children (N=400) living on the APY Lands of north –western South Australia collected on three occasions between 2003 and 2005 with the Commonwealth Government’s NIELNS funds (National Indigenous Education in Literacy and Numeracy Scheme) and for 100 indigenous school-aged children living in the southern suburbs of Adelaide, in association with DECS. What do we learn from these data and what purposes does this work serve? How can the data and the activities themselves support the recent policy advances in Aboriginal Ear Health and Hearing of the Federal Government, the Northern Territory and emerging developments in South Australia?

Systemic governance to enhance social justice : Addressing Indigenous complex health, housing and social inclusion issues through systemic approaches to build workforce capacity Janet McIntyre1, Doug Morgan2, 3, John Roddick4, Denise de Vries4, Ann Roche5, Bevin Wilson1 1. Flinders Institute of Public Policy and Management, Flinders University 2. University of South Australia 3. Neporendi Forum 4. Dept of Informatics and Engineering, Flinders University 5. National Centre for Education and Training on Addictions, Flinders University The participatory action research project is about developing the capacity of the SA Health department to understand what enhances wellbeing and social inclusion, why and how by listening to and learning from the experiences of the service users based at Neporendi. The service users will be the capacity builders - not the other way around. A holistic approach to wellbeing and social inclusion is understood as a central value of Neporendi Forum Inc. Confidentiality and respect for the rights of the participants is central. A computer design will be created by Neporendi service users and the Health Department. service providers. It will be designed by Neporendi service users to address Aboriginality, their perceptions of well-being and their concerns about meeting well-being and social inclusion in a holistic manner. Descriptions and drawings will be converted to typologies and then into general scenarios to help guide the decision making process as to what works, why and how. The Neporendi service users will tell stories that will be the basis for the generic design of a computer program to help manage complex decision-making. We will research the following hypotheses: • The greater the use of a) participatory design processes, b) cross cultural knowledge management

systems and c) Indigenous – non Indigenous capacity building partnerships to address complex problems (such as homelessness, family violence, drug use, unemployment and social inclusion issues) the better the problem solving outcomes for both human service users and providers.

• The greater the use of participatory design to build capacity to articulate partnerships, the more effective the management of complex problems.

This project recognizes that the chances for a healthy start in life are embedded within a complex cycle of a) socio-economic status, b) employment, c) housing, and d) education opportunities and that unless these issues are addressed the well-being objectives cannot be met. Potential outcomes and outputs • Provide a computer model of knowledge management that places Indigenous knowledge at the

forefront and that could be applied in a range of human service settings. • Enhance workforce capacity building and problem solving to span organizations and based on working

with, rather than within knowledge areas (see Van Gigch 2002). • Demonstrate systemic collaboration. • Create communication and management links across areas of knowledge relevant to achieving better

outcomes • Identify the extent to which collaborations can meet current needs. • Map expressed need, normative need and perceived need, the referral traffic and the refusals in a

dynamic evaluation and management model. • Share the findings and its relevance to policy through workshops with a range of stakeholders. The resulting flow-on effects of adopting an holistic and systemic approach (Roche & McDonald, 2001) for promoting intergenerational health and well-being will: a) achieve better role modelling across men and women of all age groups and b) lead to greater control over employment opportunities, socio-economic status, and improved health (Warren, 2004).

Centre for Clinical Research Excellence in Aboriginal Health A collaboration of Flinders University and Aboriginal Health Council (SA) Presenter: Peter Harvey

The Centre of Clinical Research Excellence in Aboriginal Health was established in 2003 through a successful NH&MRC tender involving the Aboriginal Health Council of South Australia (AHCSA) and Flinders University. Our foundation research communities in the Spencer Gulf region are Pika Wiya Health Service, Port Lincoln Aboriginal Health Service and Ceduna Koonibba Aboriginal Health Service. In recent years a number of collaborative research programmes involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work forms the basis of the initial CCRE activities.

The CCRE aims to expand chronic illness research in indigenous communities, refine models of care and apply, in other communities in South Australia and interstate, some of the successful processes and strategies that are currently being developed and documented in our partner communities.

The key objectives of the Centre are to improve the health status of indigenous people through conducting relevant and meaningful clinical research, providing formal training for indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. It is anticipated that the successful implementation of these key principles will serve to encourage Aboriginal people to lead and manage their health research agenda and to have increasing influence over health research and health systems development in the future.

Development of Living Improvements For Everyone (LIFE) program for Indigenous Australians Fiona Coulthard and Kate Warren The Commonwealth Government Sharing Health Care chronic disease self-management (CDSM) initiative was established in 2001 across all states of Australia. This demonstration and research program has resulted in the testing and refining of a range of new approaches to chronic illness self-management including the application of patient centred care planning, use of Enhanced Primary Care (EPC) Medical Benefits Scheme (MBS) item numbers to fund care planning and the introduction of peer-led chronic disease self-management training program. The South Australian Sharing Health Care project (SHC SA) focused on rural and remote communities in Whyalla, Port Lincoln and Port Augusta, including Pika Wiya Aboriginal Health Service where modified forms of the Stanford University CDSM course were introduced. Following the conclusion of the Sharing Health Care project local CDSM course leaders have continued to apply and expand self-management principles in Aboriginal Communities. All of these activities have been integrated to form the LIFE (Living Improvements For Everyone) model of chronic disease management. In South Australia it is estimated that 450,000 people over the age of 20 have at least one preventable chronic disease and the burden is growing. In Indigenous Australian communities, there are higher levels of chronic disease which occur much earlier in life. (1) This paper outlines the processes involved in the introduction and acceptance of self-management as a key component of chronic illness management at the Pika Wiya Health Service and highlights some of the successes of this program to date. Data from the National Evaluation and Local Evaluation programs of the SHC SA project are also presented in relation to achievements in health outcomes and organizational change in the communities involved and an outline of continuing research is provided. Throughout this paper, the term ‘Indigenous’ is used to describe Aboriginal and Torres Strait Islander people of Australia, but more specifically, the Aboriginal community of Port Augusta and surrounding areas. It is acknowledged that some of the methods used in the development of the LIFE model may not suit all indigenous groups across Australia but may be easily modified.

Improving diabetes management for Aboriginal people through the national 'QAAMS' program for point of care HbA1c and urine ACR testing. Mark Shephard# and Kay Mundraby* #QAAMS Program Manager, Community Point-of-Care Services, Flinders University Rural Clinical School, Adelaide, South Australia. *Senior Aboriginal Health Worker, Kambu Medical Centre, Ipswich, Queensland. As part of an Australian Government-funded, national program called QAAMS (Quality Assurance for Aboriginal Medical Services) which began in 1999, Aboriginal Health Workers from 63 Aboriginal medical services across Australia have been conducting on-site HbA1c tests on the DCA 2000 point-of-care (POC) analyser (Bayer Australia) for monitoring glycaemic control in Aboriginal people with diabetes. 75% of the participating services are located in rural and remote Australia. In 2003 the QAAMS program expanded to include urine albumin:creatinine ratio (ACR) testing on the DCA 2000 to further support diabetes management. Urine ACR is a biochemical marker for early stages of renal disease, which is a major complication of diabetes particularly in Aboriginal people. The ability to perform both these tests on-site by POC provides a powerful and culturally effective platform to improve diabetes management in Australia’s Aboriginal people. The QAAMS program aims to empower Aboriginal Health Workers and their health services to provide a more timely, efficient, and practical diabetes monitoring service using a sound quality assured framework. The QAAMS program comprises four common elements: production of culturally appropriate education resources, formal on-site training and competency assessment for Aboriginal Health Workers conducting POC HbA1c and urine ACR testing, on-going management services including a help hotline and an annual Training Workshop, and a unique quality assurance program (developed in partnership with the RCPA Quality Assurance Programs Pty Ltd) which constantly monitors the analytical performance of the DCA 2000 instruments at all participating sites and ensures the instruments are producing results that are acceptable for patient care. There is now a strong evidence base to show that the QAAMS model provides a health service delivery system for Indigenous Australian clients with diabetes which is robust, sustainable, analytically sound in Indigenous hands and culturally and clinically effective. It provides a convenient and accessible service for Aboriginal clients with diabetes and, in many services, significant improvements in diabetes control have been observed. The program can work equally well across services with small, medium or large infrastructures and is particularly suited to rural and remote Aboriginal medical services. This unique Australian initiative sets an international precedent and has significant potential for use in rural and remote Indigenous medical services in other countries where diabetes is a major health problem or where services have limited access to laboratory services due to geographic isolation. The Diagnostics and Technology Branch, Australian Government Department of Health and Ageing, Canberra funds QAAMS.

Diabetes Education & Aboriginal Health Workers Meri King (Senior Lecturer, School of Nursing & Midwifery, Flinders University) Leonie Melbourne (Aboriginal Student, Graduate Certificate in Health: Diabetes Management and Education) Type 2 diabetes is a major health problem in the Aboriginal community and as such it is a national (Colagiuri, Colagiuri & Ward 1998) and state (DHS 2002) health priority. Research has indicated that the ideal health professional most likely to encourage Aboriginal people with this chronic disease to make the necessary lifestyle changes and comply with medical regimes is the Aboriginal health worker. However, to undertake this role effectively, the Aboriginal health workers needs to undertake specialised diabetes training in this area (King 2001). With this in mind, since 1998 the School of Nursing and Midwifery has enable over 40 Aboriginal health workers to undertake the nationally accredited Australian Diabetes Educators Association course. This is the first time in Australia that large numbers of Aboriginal health workers have undertaken an accredited ADEA course. These professionals are now available to care for Aboriginal people with diabetes in the community and they have come from South Australia, Northern Territory and NSW to undertake the course. As an Aboriginal health professional, Leonie represents her people from Northern Territory and this is her story. References Colagiuri, S, Colagiuri, R & Ward, J 1998, National diabetes strategy and implementation plan, Commonwealth Department of Health and Family Services, Canberra, ACT. DHS 2002, 'Strategic plan for diabetes in South Australia 2003-2006', revised edn working document, Government of South Australia, Adelaide, SA, pp. 1-3. King, M 2001, 'The diabetes health care of Aboriginal people in South Australia: part 1 & part 2', Contemporary Nurse, vol. 10, no. 3-4, pp. 147-162.

POSTER PRESENTATIONS

Sadness and Heart Disease – Assessing the suitability of a depression screening tool for use with Aboriginal and Torres Strait Islander patients with ischaemic heart disease.

Danielle Esler 1,2,3 and 5, Bruce Davis 1, Fay Johnson 2 and 4, David Thomas 4 (1) Danila Dilba Health Service Darwin, (2) Flinders University, (3) Monash University, (4) Menzies School of Health Research, (5) Northern Territory General Practice Education and Training The high burden of disease placed on the Aboriginal and Torres Strait Islander population by ischaemic heart disease (IHD) has been well documented. Emphasis both in mainstream health services and Aboriginal Medical Services (AMS) has focused on risk factor modification as a method of reducing this burden of disease. Depression has recently joined traditional risk factors as a risk of similar magnitude to smoking and hyperlipidaemia.

This project, examines the acceptability of a depression screening tool (the PHQ-9) for use with Aboriginal and Torres Strait Islander people. In addition it will assess the validity of a modified PHQ-9 for screening for depression in Aboriginal and Torres Strait Islander patients with IHD. The proposal involves opportunistic screening for depression of clients with IHD as they attend Danila Dilba Health Service. Subsequent diagnostic psychiatric interview by an interviewer blinded to screening results will provide the gold standard to which the screening test is compared. Utilisation of the gold standard for depression diagnosis in a sample of Aboriginal and Torres Strait Islander people with IHD will give a concurrent measure of depression prevalence.

This project has significant implications in light of current public health policy driven screening in Indigenous Health (eg Adult health Checks).

Better medication management for aboriginal people with mental health problems Inge Kowanko1, Charlotte deCrespigny1, Helen Murray1, Scott Wilson2 1 Flinders University, 2 Aboriginal Drug and Alcohol Council (SA) Inc This study explored medication use issues among South Australian Aboriginal people with mental health disorders, including drug and alcohol problems, and their carers and other family members. Most participants were managing complex and chronic physical health problems in addition to mental health disorders. The project team was a partnership of researchers from Flinders University and the Aboriginal Drug and Alcohol Council (SA) in collaboration with all Aboriginal communities involved. We used multiple methods, including interviews with clients and workers; survey of service providers; review of hospital separation data and key documents. Recommendations for improving medication management, safety and related issues, and implementation and evaluation of targeted strategies, were developed collaboratively by the team and local project committees. The research highlights the complex needs of Aboriginal people, lack of medication education, inadequate and uncoordinated services, and unsafe practices. The project has led to effective collaborations between Aboriginal communities, service providers and researchers to provide staff training, community workshops, practice guidelines, further research into coordinated Aboriginal mental health care, and other strategies to improve safe use of medicines, reduce harms associated with substance use, and enhance emotional and social wellbeing. This research informs culturally appropriate policies and practices to enhance quality use of medication for Aboriginal people with mental health and other disorders, and offers a partnership model for ethical research that can produce tangible benefits for participating communities. The full report is available online at http://nursing.flinders.edu.au/research/index.php?id=108#aboriginalhealth

PneuMum: A randomised controlled vaccine trial that aims to find out if pneumococcal immunisation of mothers in the last few months of pregnancy or at delivery can prevent ear disease in Aboriginal and Torres Strait Islander children. Presenter: Simone Raye Australian Indigenous children experience the highest rates of acute and chronic ear infections in the world, with resultant permanent ear damage, hearing and educational disadvantage. These infections are mainly bacterial, and Streptococcus pneumoniae is the predominant pathogen. The current childhood vaccination schedule at 2, 4 and 6 months does not appear to reduce nasopharyngeal colonisation within days of birth and near universal rates of ear disease in Indigenous children of the Northern Territory. PneuMum is a randomised controlled trial, assessing the impact of vaccinating Indigenous women with the 23 valent pneumococcal polysaccharide vaccine either during pregnancy or shortly after delivery on infant nasopharyngeal carriage and ear disease. The study is a collaborative effort between Menzies School of Health Research and the Centre for International Child Health, the University of Melbourne. In addition to funding support from the National Health and Medical Research Council, the PneuMum study has been endorsed as an in-kind project for the Cooperative Research Centre for Aboriginal Health and has received in-principle support from the World Health Organization and the Centre for Disease Control of the Northern Territory Department of Health and Community Services.

Out of Sight Out of Mind Jill Mitchell & Charlotte de Crespigny School of Nursing & Midwifery Flinders University Aim To raise nurses’ awareness of the urgent need for a holistic approach to Aboriginal women’s health care to address their complex health needs, particularly in remote communities. The need Current statistics show that the life expectancy of Aboriginal Australians is 20-25 years less than non-Aboriginal people (ABS 2004). Serious illnesses among Aboriginal people develop, and are compounded by, concurrent psychosocial and mental health issues, from an early age. Unrelenting poverty, poor nutrition and living conditions, and generational grief all contribute to this situation, which remains largely invisible to mainstream Australia, and many health professionals. A holistic approach to screening, assessment and early interventions is urgently needed to address the complex health needs of Aboriginal women, inclusive of women’s sexual health, injuries from violence, acute and chronic disease, mental health and alcohol, tobacco and other drug (ATOD) problems. At present holistic health care services are at best limited and often non-existent in remote communities, being limited by under-funding and limited professional resources ‘on the ground’ (Ring 2002). Currently a ‘silo’ approach continues to be used by Aboriginal and mainstream services by focusing their time, resources and expertise on particular issues e.g. sexual health or diabetes screening and intervention, and often omitting ATOD use. This lack of interconnectedness between nurses and other key workers delivering health services, fails to identify or address Aboriginal women’s diverse needs. Research in progress: ‘Transferring a successful Aboriginal Well Women’s health program’ A qualitative naturalistic inquiry is currently being undertaken to evaluate the transferability of a successful Aboriginal Well Women's Health (AWWH) program from Central Australia to a similar SA remote community. This program aims to link relevant existing Aboriginal and non-Aboriginal services in directly contributing to the program from a primary health care perspective, and identify and bridge gaps in key services needed by the women including ATOD. The AWWH program has been piloted using a community empowerment model of collaboration to enable a merger of local expertise and resources, and a holistic approach to women’s health in this recipient community. Outcomes Early results indicate that the program is transferable, and that women are attracted to this well health program, revealing a number of sexually transmitted infections, uncontrolled diabetes, early renal disease and ATOD problems. It is anticipated that once fully implemented and evaluated, through the community consultative process, the outcomes will be brought to the attention of local Aboriginal women, community leaders, health service providers, key decision makers, funding bodies and policy makers, with the aim of informing and influencing future resourcing, programming and practices that can more effectively promote and improve Aboriginal women’s health. Importantly, drug and alcohol nurses and others will be better informed about Aboriginal women’s health so that this significant population does not remain "out of sight and out of mind".

Muna Paiendi – Forefront Runners: An Aboriginal health team in a mainstream community health setting Muna Paiendi Aboriginal Health team (Central Northern Primary Health Care Services, North/North-East, Adelaide) with the assistance of Michael Bentley from the South Australian Community Health Research Unit (Department of Public Health, Flinders University, Adelaide) Contact Details: Deb Walker, Muna Paiendi Community Health Centre Telephone: 08-8182 9206; Fax 08-8182 9384, Email: Deborah.Walker@health.sa.gov.au Muna Paiendi – its name coming from the Kaurna language, meaning first seek knowledge/ information – is an example of an Aboriginal health service that successfully operates within the mainstream of the State-funded public health sector. Muna Paiendi is a team of dedicated professionals working together to raise the community’s awareness of illnesses that are hurting Aboriginal people. Located at Elizabeth in Adelaide’s northern suburbs, Muna Paiendi Community Health Centre is one of the sites of Central Northern Primary Health Care Services. Muna Paiendi offers a variety of primary health services for Aboriginal people, as well as liaison with, and training sessions for, a large number of related agencies working with Aboriginal people. This poster illustrates the development of Muna Paiendi, through looking back, looking around, and looking forward. Looking back explores the growth of Muna Paiendi from a single Aboriginal Health worker in 1994 to a staff of around 30 in 2005. Looking around places Muna Paiendi in the current South Australian climate of health reform and observes it working with mainstream and Aboriginal Community-controlled agencies, using its influence in the current South Australian climate of health reform, and working with its community. Looking forward acknowledges that the rapid growth of Muna Paiendi means using action-reflection to reposition itself in the ever-changing health environment.

A Haemodialysis Nutritional Screening Tool for Nurses – Phase 2 Multi-Centre Study Paul N Bennett 2 Leo Breugelman3 Anthony Meade1 Dee Parkhurst1

2Flinders University of South Australia 1The Queen Elizabeth Hospital 3Royal Adelaide Hospital Paul N Bennett is a Lecturer in Nursing at Flinders University of South Australia. He is the current Renal Research Coordinator for the Renal Society of Australasia (SA Branch) and Editor of the Renal Society of Australasia Journal. Leo Breugelmans is the Nurse Unit Manager of Hampstead Dialysis Centre, Adelaide, South Australia. Anthony Meade is the Senior Renal Dietician at The Queen Elizabeth Hospital, Woodville, South Australia. Dee Parkhurst is the Clinical Nurse Manager of Wayville Dialysis Centre, Wayville, South Australia. Study Purpose: To validate a nurse-performed nutritional screening tool (NST) for haemodialysis (HD) patients in order to identify nutritionally at-risk patients. Background: HD patients are at risk of nutritional-related problems. Nutritional screening by nurses may assist in the early recognition of and response to these problems. Nutritional screening is a simple and rapid process to identify those at risk so that the dietitian can perform a comprehensive nutritional assessment. Method: Following analysis of the data from a pilot study of an NST using 9 screening parameters (Bennett et al., 2003; Meade et al., 2004) the tool was refined to 4 parameters (weight change, poor appetite, serum potassium and phosphate). Standard Dietitian Assessment (SDA) was performed by dietitians within one month of NST. Results: 112 HD patients (m=65, f=47) from 9 satellite HD units in SA, NT and QLD (7 metropolitan and 2 rural) were screened with the NST and then compared with SDA. Mean age of patients was 57.6 years. Overall, the NST showed sensitivity of 0.84 (95% CI +/- 0.1) and a specificity of 0.9 (95%CI +/-0.08). The NST was more sensitive (sensitivity 0.93 95% CI +/- .09) and more specific for males (specificity 0.92 95% CI +/- 0.1, LR+ve 8.7, LR-ve 0.18). Specificity was very strong in metropolitan patients (specificity 0.94 95% CI +/- .07). Conclusion: The study showed an improved sensitivity and specificity than the previously reported NST. The tool is particularly specific in that it screens those patients NOT requiring dietitian intervention. The NST identified at-risk males in HD satellite units and at-risk HD patients from metropolitan HD satellite units. This has implications for Aborigines and Torres Strait Islanders who have a high incidence of renal disease and a proportionally higher representation in the HD population.

ISN (Indigenous Staff Network) Helen Liddle, Ricky Mentha, Anita Curtis, Tahnia Edwards. Centre for Remote Health The ISN is made up of Indigenous Researchers who work in Indigenous Health Research at University Departments of Rural Health. The Indigenous Staff Network [ISN] has a role in the Australian Rural Health Education Network [ARHEN] and the University Departments of Rural Health [UDRH]. The ISN have identified key protocols for UDRH to undertake research and educational activities in and with Indigenous communities. The ISN acts as an advisory, advocacy and action group, to enhance respect, credibility, transfer of knowledge, resources and support that will raise the profile of the UDRH Aboriginal staff, Aboriginal health research with Aboriginal Communities. The ISN has:

• Assisted and supported Indigenous communities toward self-determination of local health priorities in remote and rural settings.

• Provided support and encouragement to Indigenous health workforce, researchers, educators and students, working within and for rural and remote communities.

• Ensures that non-Indigenous health workers, professionals and academics are equipped with cultural safety and protocols when dealing with Indigenous health issues.

• Developed guidelines and processes to ensure Indigenous communities and UDRHs work together in providing education and research initiatives.

• Strived to ensure Indigenous issues are acknowledged and acted upon in the forefront of the national and state health agendas.

• Provided mechanisms for partnership and alliance with peak Indigenous health bodies ensuring representation on Indigenous health issues is presented as a collaborative voice.

Indigenous Alcohol Clinical Practice Guidelines Amanda Tovell, Charlotte de Crespigny The Commonwealth Department of Heath and Ageing have funded an Adelaide-based Consortium for an 8 month contract to develop evidence-based clinical practice guidelines that are suitable for the management of alcohol problems experienced by Aboriginal and Torres Strait Islander peoples. The Consortium comprises Aboriginal Drug and Alcohol Council Inc. (SA), Drug and Alcohol Services of South Australia, and the Flinders University School of Nursing and Midwifery. The consortium is led by Flinders Consulting Pty. Ltd. All consortia partners have a strong track record in collaborative projects and developing clinical practice guidelines in this field. Key personnel in the project include Professor Charlotte de Crespigny (Project Director), Dr Lynette Cusack and Mr Scott Wilson (Key Advisors), Ms Amanda Tovell (Project Coordinator) and Dr John O’Connor (Professional Writer). The new guidelines will be based on the National Recommendations for the Clinical Management of Alcohol Related Problems in Indigenous Primary Care Settings

1 and the

Australian Guidelines for the Treatment of Alcohol Problems2. The new guidelines will

acknowledge the importance of taking a holistic perspective of Indigenous people’s health and well being, and provide an updated literature review and resources published after 2003. A national Clinical Reference Group will oversee the clinical and cultural content of the new guidelines and provide guidance to the project team in the development of effective implementation and dissemination strategies and a comprehensive evaluation plan. The Clinical Reference Group membership represents a multidisciplinary team of Indigenous and non-Indigenous specialists in the fields of Alcohol and Other Drugs (AOD) and Indigenous health. Consultations and forums will be held with key stakeholders, including Aboriginal and community health workers, general practitioners, nurses, AOD and mental health clinicians and Indigenous community members, to develop a user-friendly resource. Consultations are being held in diverse geographical locations throughout Australia, including regional and remote areas of South Australia, the Tiwi Islands, and Sydney. For further information on this project, please contact Ms Amanda Tovell, Project Coordinator, email amanda.tovell@flinders.edu.au, telephone 08 8201 7569. 1

Hunter, E., Brady, M., & Hall, W. (2000). National Recommendations for the Clinical Management of Alcohol-Related Problems in Indigenous Primary Care Settings. Canberra: Commonwealth Department of Health and Aged Care. 2

Shand, F., Gates, J., Fawcett, J., & Mattick, R. (2003). Guidelines for the Treatment of Alcohol Problems. Canberra: National Drug and Alcohol Research Centre, Commonwealth Department of Health and Ageing.