Abstract Presentations
1
Aboriginal Health in Aboriginal Hands: How an ACCHO is Optimising the Management of Hepatitis B
Lakhbinder Kang, Cameron Taylor and Jessamy Stirling, Derbarl Yerrigan Health Service
Background:
In 2019 DYHS embarked on a project to improve the management of Hepatitis C During the process of generating reports for Viral Hepatitis, it was noted that there were many patients with chronic hepatitis B (CHB). A process was started aimed at identifying, recalling and treating patients with hepatitis B.
Approach:
DYHS instigated the following initiatives to accurately identify, recall and offer treatment to patients:
- Creating clinical items to support accuracy of report generation.
- The appointment of Aboriginal Health Practitioners (AHPs) and a Sexual Health Nurse as ‘Hepatitis Champions’
- Development of reports from medical software to identify patients with CHB, Past hepatitis B infection, Isolated anti-HBc, non-immune to hepatitis B and close hepatitis B contacts.
- Reviewing and updating patient reminder and recall systems.
- Analysing recorded data for the patient status (Regular, Past or Transient)
- Classifying the correct chronic hepatitis B phase
- Partnership with a tertiary hepatology team and planning regular MDT meetings
Analysis/Argument:
Derbarl Yerrigan has identified 777 patient files that would benefit from review. A detailed review of the files has been started and aims to ensure each patient has the correct diagnosis and clinical items. We are prioritising the regular patients (51) with chronic hepatitis B and ensuring their management including regular monitoring blood tests and screening for hepatocellular carcinoma (HCC) is optimal as per the ashm decision making aid in Hepatitis B.
Outcome/Results:
47 of the 51 regular patients with CHB: 28 immune control (HBeAg-negative chronic infection), 2 immune tolerant (HBeAg-positive chronic infection),17 unknown .
We have identified more than 250 patients that are not immune to hepatitis B and would benefit from being immunised.
In 2022, DYHS requested 2056 Hepatitis B tests for clients of DYHS. DYHS has created a clinical item for Multidisciplinary Team Meetings (MDT) which will facilitate co-management of patients with a local tertiary hospital.
Conclusions/Applications:
Hepatitis champions, Hepatitis B registers and a proactive approach have enabled DYHS to provide an ongoing systematic approach to hepatitis B management.
Disclosure of Interest Statement:
“Derbarl Yerrigan Health services recognises the considerable contribution of the ASHM in facilitating the “Beyond the C” project. We also recognise the need for transparency of disclosure of potential conflicts of interest by acknowledging these relationships in publications and presentations.”
2
Innovating a simple score to predict Group A Streptococcus clinical outcome among First Nations Australians
Nguyen ADK, Davis TJ, Smith S and Hanson J
Background:
Group A Streptococcus (GAS) bacteraemia can have high case-fatality rates and disproportionately affects Aboriginal and Torres Strait Islander Australians, herein respectively referred to as First Nations Australians.1 Early recognition of high-risk patients facilitates prognostication, escalation to tertiary-level care from remote settings and assist clinical management by identifying factors associated with worse outcomes.2
Methodology/Principal Findings:
We examined 286 consecutive GAS bacteraemia patients between January 1, 2014, and December 31, 2020. Overall, 169/286 (59.1%) identified as First Nations Australian. These individuals were more likely to have severe comorbidity compared to non-First Nations Australians (85/169 (50.3%) versus 41/117 (35.0%), p=0.01). 50/286 (18%) had adverse outcomes (death or intensive care unit admission within 30 days of hospitalisation). We identified associations between demographic, clinical and laboratory indices at presentation and adverse outcomes. Multivariable analysis indicated systolic blood pressure (SBP) <100 mmHg, serum albumin <30 mmol/L, serum lactate >4 mmol/L, and lymphocyte count <0.5 x 109/L were independent predictors of adverse outcomes. The BALL prediction score was created using these variables, with one point for each criterion. Adverse outcomes in patients proportionately increased with rising BALL scores: 6/59 (10%), 17/50 (34%), 12/19 (63%), 3/4 (75%) and 3/3 (100%) for scores of 0, 1, 2, 3, and 4, respectively. The area-under-the-receivingoperator-characteristic curve of the BALL score in predicting adverse outcomes 0.77 (95% CI 0.69–0.85) was superior to NEWS2 (0.62 (95% CI 0.51-0.72), p=0.02) and APACHEII (0.53 (95% CI 0.41-0.65), p=0.001) scores and similar to the SOFA score (0.79 (95%CI: 0.69-0.88), p=0.75).
Conclusions:
Despite our cohort’s severe comorbidity amid the high burden First Nations Australians experience, the simple calculation of a 4-point score – SBP, serum albumin, serum lactate, lymphocyte count – in GAS bacteraemia patients can rapidly stratify those at risk of sequelae or death, and determine those in need of referral, potentially leading to improved outcomes.
3
Boodjari Yorga Program in the Great Southern
Tanya Reif and Joyce Ugle, Great Southern Aboriginal Health Service
The Boodjari Yorga Program is facilitated through the Great Southern Aboriginal Health Service in the Southwest of WA. It is a wrap-around antenatal service provided to Aboriginal women, or women of any ethnic origin partnered with an Aboriginal male.
The BYP team consists of a Clinical Midwife, who provides the culturally appropriate clinical side of pregnancy care, and the Maternal Aboriginal Liaison Officer who provides the social and emotional culturally appropriate side of care. These two major team players have a unique symbiotic relationship. The BYP is unable to perform effectively without significant input from both parties.
The West Australian Handheld Pregnancy Record is closely adhered to-following King Edward Memorial Hospital guidelines, which keeps pregnancy safe and accountable.
The aim of the Boodjari Yorga Program is to guide women and their families through their journey of pregnancy, which can be quite daunting - especially for first time mums. The never-ending blood tests, scans, foreign language, and constant check-ups can be quiet overwhelming.
Antenatal care is delivered in the client's home. We also provide transport and support to ultrasounds, pathology collections, Drs appointments and iron infusions. In addition to this, the Midwife provides individualised tours of the maternity unit, and childbirth education towards the end of the pregnancy.
The aim of the BYP is to ensure that the mother is in optimal condition for labour and birth, not only physically but emotionally. We have a wonderful Social Work team that the client can be referred to for social and emotional matters.
Once the baby is born, the Midwife closes off the relationship with a "close the loop" visit providing the mother and her partner a debrief session on the birth experience and have any outstanding questions answered.
The Maternal ALO continues to follow the family with the Child Health Nurse for the next 5 years.
4
Moorditj Koolangkas, Moorditij Moort (Strong Children, Strong Families)
Antonia Hendrick, Glenda Kickett, Ellie Moir and Rosemary Walley, University of Western Australia
Most research projects aiming to capture the needs of Aboriginal and Torres Strait Islander children and families in specific communities are often commissioned and carried out by non-Indigenous organisations and researchers. Capturing the voices of Aboriginal people tends to be significantly hindered by the researchers' lack of cultural capital and responsiveness.
This presentation reflects Aboriginal families from an urban perspective about their social emotional and overall health and wellbeing needs and aspirations for growing strong children in their community. The project was led and delivered by strong Noongar people from the community that comes with cultural knowledge and wisdom to ensure the research practices were conducted in a culturally appropriate manner that centred on cultural capital and relational ways of knowing, doing and being. Cultural governance and protocols became the guiding principles of the project.
The Moorditj Koolangkas Moorditij Moort research team would like to share their journey of truth and liberation, enabling the community to have control and ownership of the research. This project has impacted the researchers and the organisation to see more clearly the richness and importance of culture, resilience and the determination of families and the community to create strong pathways for community kids to have a quality of life.
5
Stronger You, Stronger Mob Campaign
Julie Spratt and Ky Ryan, Mental Health Commission
The Strong Spirit Strong Mind Youth Project (SSSMYP) is an alcohol and other drug (AOD) and social and emotional wellbeing (SEWB) prevention project, targeting young Aboriginal people, aged 12-25 years, across Western Australia (WA).
Funding of $9.27 million over a four-year period (July 2021 – June 2025), was received through the WA State Government Election Commitment.
The SSSMYP public education campaign is attached to other key strategies such as:
- Community Grants
- Scope of Service for Youth Community Outreach
- Culturally Secure Youth Resources
The Stronger You, Stronger Mob public education campaign was developed to provide strengths-based messaging and culturally appropriate strategies to support young Aboriginal people in WA.
The key focus areas of the culturally secure campaign are:
- Prevent the early uptake of AOD use for young Aboriginal people aged 12-25 years across WA;
- Increase their awareness of the harms associated with AOD use; and
- Maintain and improve optimal levels of social and emotional wellbeing.
The concepts are aligned to the SEWB model by Gee, Dudgeon, Schultz, Hart and Kelly, 2013.
The campaign media includes radio, out-of-home advertising, social media, digital advertising, and paid search.
6
Developing Understanding of Lateral Violence Contributes to Culturally Safe Practice in Health
Lindi Pelkowitz and Lenelle Papertalk, The University of Western Australia and Western Australian Centre for Rural Health
Background:
When allied health students come to the Midwest of Western Australia for field placements in regional towns, the Western Australian Centre of Rural Health (WACRH) includes training for culturally safe practices in the form of Miyarnuwimanha cultural orientation and Clinical Yarning training. Students' responses indicated a belief that feuding and conflict within Aboriginal communities was part of Aboriginal culture, and that students were unfamiliar with the concept of lateral violence. WACRH therefore developed a workshop to address student unconscious racism and develop their knowledge about lateral violence.
Objective:
To facilitate a workshop that assists students to understand how racism, oppression and relationships are constructed and embedded in history, politics, law, policies and social constructs that lead to the creation of lateral violence.
Methodology:
The workshop draws on practical and theoretical underpinnings of lateral violence and how this impacts Aboriginal society. Participants learn about local history prior to colonization, the impacts of colonization, resistance and includes a field trip on country to a site of conflict. Students examine oppression, policies, practices, autobiographical stories, evidence, struggles and success as part of a process in addressing attitudes towards lateral violence. The role of governments in creating conditions for lateral violence and contemporary acts of oppression is discussed. The workshop concludes with strength-based ways to address and heal the drivers of lateral violence.
Outcome:
This workshop offers reflective learning which enables students to think about their own attitudes and assists in developing strength-based discourses to improve their clinical practices. Students value learning about systemic oppression and its harmful outcomes. Students share that the workshop is transformative in how they view feuding, and that they integrate these insights into delivering health practice that is less judgmental.
7
Breaking New Ground; Using Continuous Quality Improvement (CQI) Audit to Improve the Management of Rheumatic Heart Disease.
Maddison Cooling and Daniel Hunt, Derbarl Yerrigan Health Service
Background:Over 5000 Aboriginal and Torres Strait Islander people in Australia have RHD1. Through addressing social determinants of health, benzylpenicillin prophylaxis and regular review, RHD is a largely preventable condition2. Audits assisted Derbarl staff to identify more than 340 patients with RHD, many of whom were not known to the RHD registry and not receiving optimal management. Derbarl staff have been able to identify, recall, and better manage patients with RHD through CQI. This presentation will focus on the development of clinical items in Communicare, improved recall and reminder procedures, establishment of an on-site echocardiography service and strong liaison with the RHD register to improve health outcomes of Aboriginal people living with RHD.
Results:
100% of Derbarl clients have an RHD Audit Clinical Item completed and 100% have been notified to the RHD register. 53.47% of regular clients have had an echocardiogram, of which 57.64% are up to date. 79.17% of regular clients have a recall for echocardiography. 33.33% of regular clients have seen a cardiologist, of which 51.39% are up to date. 59.02% of regular clients have a recall for cardiology. Of the 59 regular clients who remain on benzathine benzylpenicillin prophylaxis 14.58% are up to date and 84.75% have a recall in place. 86.85% of regular clients who are overdue for benzathine benzylpenicillin have a recall in place.
Conclusions:
Through creating the RHD Audit Clinical Item Derbarl has been able to implement and monitor a recall system for all RHD/ARF patients. The RHD Audit Clinical Item has enabled Derbarl to more accurately record data, ensure recalls and reminders are active, and ensure strong communication with the RHD registry particularly for transient patients. Derbarl is committed to continue to use CQI to improve management and outcomes of Aboriginal people living with RHD.
References:
1. Wyber R, Noonan K, Halkon C, Enkel S, Ralph A, Bowen A, Cannon J, Haynes E, Mitchell A, Harford K, Bessarab D, Katzenellenbogen J, Seth R, Bond-Smith D, Currie B, Maguire G, McAullay D, D’Antoine H, Steer A, de Klerk N, Krause V, Snelling T, Trust S, Slade R, Colquhoun S, Reid C, Brown A, Carapetis J. The RHD Endgame Strategy: A Snapshot. The blueprint to eliminate rheumatic heart disease in Australia by 2031. Perth (AU): The END RHD Centre of Research Excellence, Telethon Kids Institute; 2020 2. Wyber R, Noonan K, Halkon C, Enkel S, Cannon J, Haynes E, Mitchell A, Bessarab D, Katzenellenbogan J, Bond-Smith D, Seth R, D’Antoine H, Ralph A, Bowen A, Brown A, Carapetis J. Ending rheumatic heart disease in Australia: the evidence for a new approach. Perth (AU): The Medical Journal of Australia; 2020
8
Exploring Ways to Reduce Aboriginal Stillbirths in the Noongar Boodjar Region
Carrington Shepherd and Carolyn Lewis, Curtin University
Stillbirth disproportionately impacts Aboriginal and Torres Strait Islander peoples placing a profound burden on families. Yet, it remains an (almost) invisible public health problem, with a paucity of evidence-informed and Aboriginal-specific interventions addressing this distinctly higher stillbirth risk. Aboriginal-specific evidence is required to support the development of stillbirth education and awareness initiatives.
Methods:
Jinda Maawit Project is a large-scale multidimensional, mixed methods study of Aboriginal stillbirth. The approach includes: (1) a population-level epidemiological study to investigate the relationship between stillbirth and parental physical and mental health using routinely collected linked administrative health data; (2) a cross-sectional survey (N=450) of Aboriginal women (16-45 years) living in Noongar Boodja regions of Western Australia to develop a foundational understanding of knowledge about stillbirth risks among Aboriginal women; and (3) a qualitative examination, using indepth interviews (N=20), of the barriers to timely, high quality antenatal care.
Results:
The Jinda Maawit project is ongoing, although our extensive community engagement to-date has supported the establishment of a robust Aboriginal governance and the identification of key findings including: (i) the lack of models of care and support services for stillbirth in Aboriginal communities, (ii) the lack of cultural education in health care providers, and (iii) the lack of acknowledgement to the significance of birthing on country.
Conclusions:
The vision of the Jinda Maawit project is to provide a more nuanced understanding to the reasons for current stillbirth rates to guide preventative population health strategies for reducing stillbirth among Aboriginal populations
9
Binar Health Embassy Project
Corey Dalton, dalton Health Direct and Andrew Vlahov, Binar Futures
The Binar Health Embassy (Albany, January 2024) was a pilot project to ascertain the positive impact that Binar’s basketball activities could have on broader health objectives for the Aboriginal community. From planning and engagement with key stakeholders, the analysis of results became very clear that conducting a community health outreach adjacent to a popular basketball event was well received by the community and incredibly cost effective for the medical service providers.
This has culminated into the creation and roll out of a rural "Health Embassy" that encompasses sport as a vehicle to promote chronic disease management, health promotions and greater youth and community engagement to empower ownership of individuals health outcomes. The Inaugural event was in Albany WA with > 500 youth participants. The second was in Bunbury WA with >300 and the next is planned in Leanora WA.
At all times a culturally safe approach was maintained that was led from Binar and Dalton Health Direct focussing on Culture, Sport, Youth Leadership and Youth Development. A paradigm shift is required by everyone if we are to make practical and real progress towards Closing the Gap on key targets.
It is well documented that CTG strategies are underpinned by having Aboriginal and Torres Strait Islander people having a genuine say in health strategy, health promotions, policy and programs. This was the brokering message with our nonindigenous partners who were integral to the success. Engagement with local Aboriginal Controlled Health Organisations and partners provided direct access for health care.
We enabled eight health promotion stalls at the event with a focus on chronic disease and health across all facets such as Rheumatic Heart Disease, Skin Disease, Diabetes, Smoking/Vaping, Chronic Wet Cough, ENT, Heart Health, Asthma, Headspace Mental health.
10
Community Consultation for 2023 Carnarvon Aboriginal Community Tuberculosis (TB) Screening Program
Ashton Ryder, WA Country Health Service
Abstract backgroundWhat is the problem or issue you intend to address?
To complete a community consultation with the Aboriginal community of Carnarvon to inform the 2023 Carnarvon Aboriginal Community TB Screening Program.
What’s the rationale for this project?
To ensure the screening program is informed and culturally appropriate we needed to ensure we did extensive community consultation with the Aboriginal community.
Aims and Objectives
What were you trying to improve through this project?
- Encourage input and participation of Aboriginal people in planning the 2023 Aboriginal Community TB Screening program.
- Ensure health communication messaging was culturally informed.
- Identify and address gaps regarding knowledge of TB in the community.
Methods
What did you do to address the aims?
- Asked the community standardised questions to identify their current knowledge and awareness of TB, barriers to screening, use of incentives, key messaging, ways to improve participation and engagement, screening locations.
- Ensured the consultation was conducted over a suitable timeframe (occurring from September 2023 – October 2023).
- We consulted with 58 people. The coverage of the consultation allowed people from different Aboriginal language groups to participate.
Results
What did you find from this project?
- Community members had varying awareness, attitudes, and beliefs about TB.
- Fear was a common theme – fear of needles, fear of the unknown and feeling shame of a positive result.
- Incentives were suggested and supported by the community.
- We learned we should use specific, key messaging.
- We learned where to offer screening and how to improve testing rates of specific demographic groups.
How do the findings relate to your objectives?
Recommendations and advice taken from the community consultation guided the design and implementation of the 2023 community screening program for TB in Carnarvon. Based on this feedback, improvements were made compared to the 2022 TB screening program.
Conclusion and further outcomes
What will you do as a result of this project?
- The findings from this community consultation informed the 2023 Carnarvon Aboriginal Community Tuberculosis (TB) Screening Program.
- This consultation will inform future activities regarding TB.
What will you do differently?
One challenge we found was engaging with Aboriginal men. Engaging with this group should be our focus for next time and considered effort should be given.
11
Social and Emotional Wellbeing - An Aboriginal Service Model Approach
Rachel Radcliffe, Aboriginal Health Council of WA
WA Aboriginal Community Controlled Services (ACCHS) are well positioned to refine and expand the delivery of holistic health care. Through the SEWB Service Model, WA ACCHS can achieve and sustain health holistically for Aboriginal people in their communities.
Between 2018-2022 staff from 17 AHCWA Member Services identified that the term ‘mental health’ was challenging for many Aboriginal people as it was associated with the stigma of mental illness. Culturally secure awareness and de-stigmatisation were seen as priority activities for ACCHS. As a result, ACCHS implemented the four pillar approach to deliver culturally secure prevention and early intervention services to improve SEWB and mental health outcomes (Aboriginal Health Council of WA).
A four pillar approach is used to define a sector wide method of delivering SEWB services but is flexible in allowing individual ACCHS to determine the service or activity needs based on their community. The four pillars are:
- culturally secure community development
- psychosocial support
- targeted interventions, and
- supported coordinated care.
SEWB is broader than the confinements of clinical models and includes social support, practical support, brief intervention and professional psychological support. This model is intended to deliver optimal, culturally appropriate SEWB outcomes for Aboriginal people, their families, and communities (Aboriginal Health Council of WA).
The ACCHS SEWB Service Model Pilot, funded by the Mental Health Commission WA, began in June 2022 and is being delivered across five regions of WA. The presentation will share how these organisations have delivered services to their communities and will include:
- ACCHS SEWB Service Model four pillar approach
- Workforce: the importance of interdisciplinary teams
- Aboriginal ways of working: service and activities undertaken
- Coordinated care: coordination between SEWB, primary health, acute services and external community services.
Aboriginal Health Council of WA. (n.d.). ACCHS Social and Emotional Wellbeing Service Model. Retrieved from https://www.ahcwa.org.au/wp-content/uploads/2022/05/ACCHS-Social-_-Emotional-Wellbeing-Service-Model.pdf
12
A Co-Designed Qualitative Study on Yarning About Diabetic Foot Education Using Plantar Pressure Maps with Aboriginal People
Steven Gillingham, The University of Western Australia
Purpose:
This study aims to explore the experiences of Aboriginal people with diabetic foot disease (DFD) and their families in receiving podiatry foot care. It also seeks to identify the medical jargon encountered by Aboriginal individuals with DFD and their families during podiatry foot care. Additionally, the study aims to investigate Aboriginal peoples' perspectives on the value of foot pressure maps in DFD education. Finally, the study aims to co-design strategies for effectively communicating foot pressure maps, potentially using metaphors or narratives.
Study design/methodology/approach:
Co-designed strategies are developed under the guidance of an Aboriginal Chief investigator and through collaboration with Aboriginal Advisory Group. Qualitative methods will involve one-on-one research yarns to discuss DFD education and plantar pressure maps to gather data from Aboriginal individuals with DFD and their families. The data collected is analysed to identify common experiences, encounters with medical jargon, and perspectives on foot pressure maps.
Originality/Value:
This study addresses the gap in research regarding the use of foot pressure maps in DFD education within the Whadjuk Aboriginal community. Through combining the cultural practice of yarning with the visual representation of foot pressure maps, the study aims to create culturally safe DFD education tools for Aboriginal individuals. The research contributes to the development of culturally appropriate educational tools that respect Aboriginal culture and improve DFD prevention and treatment outcomes. The co-design strategies developed in this study have the potential to enhance communication and engagement between Aboriginal individuals and healthcare providers.