Improving Allied Health Services for Indigenous people in a Regional WA

Town

Contributors

Amanda Jackson, senior speech pathologist, WA Country Health Services - Midwest Region

Juli Coffin, senior lecturer Aboriginal health, Combined

Universities Centre for Rural Health Ivan Lin, lecturer/senior physiotherapist, CUCRH &

WACHS – Midwest Region

“I’m not sure what makes it okay for the clients who come. I’m not sure why clients don’t come. I don’t really know why apart from it’s a cultural difference”

Speech Pathologist

• 2-3 times prevalence disability in Indigenous than non-Indigenous

• speech difficulties similar for Aboriginal and non Aboriginal families ~10%

• > prevalence arthritis and other musculoskeletal conditions

• 15% Indigenous people report sensory/speech difficulties impacting on activities of daily living

(AIHW 2005/2006 and ICHR 2005)

Issue # 1

What is the level of services accessed by the Aboriginal population of Geraldton?

Issue # 2

What are ways we can make allied health services more appropriate/better accessed by Aboriginal people in Geraldton?

Geraldton

• Regional centre Midwest Region

• Yamaji region • Population 19062

(approx 30 000 surrounds)

• ATSI 9.3% (WA average 3.5%)

The project

What allied health services

need to be more inviting

What Aboriginal

people need to want to

come

• Several projects

• Speech and physiotherapy focus

• 6-week Fellowship with CUCRH

• Mid-2005 to present and ongoing

Three methods

Statistical data from Dept of Health database Focus groups and interviews with Aboriginal professionals, community members, and allied health professionals (speech pathologists/audiologists) Recommendations, actions, evaluation

Access

• 6.9% Aboriginal people speech caseload • 5.9% Aboriginal individual outpatient physiotherapy

consults • No ATSI attendees at chronic disease programs

coordinated by physiotherapy (pulmonary rehab, cardiac rehab, diabetes)

• Significant differences in DNA rate Aboriginal vs non-Aboriginal population

“…(I would like) an understanding of how to provide services. How to get around the issues I keep getting told about. How to provide an appropriate service. Determine whether it actually is that people aren’t accessing the service because of the mode of delivery or because it is not a priority. Should we do education activities? There are lots of questions. I don’t know how to do things differently”

Speech Pathologist

“..it’s like when people go to the doctor, they don’t have a clue. They don’t understand the jargon. Work with the health workers. Ask them if they have the time to go out into the community with you. They can then introduce you”

Aboriginal Professional

“You need to get your service out in to the community a bit more. So that people know what you’re on about..”

Aboriginal Professional

“People don’t like coming to the hospital for two main reasons. They may have relatives who have died there and therefore have negative associations there. Little kids say are you going there to die. That is the biggest issue. The other reason is that the receptionist or the

therapist might have had a bad day..”

Aboriginal Professional

“I think too, when you did that ear testing, my son thought it was fun and it was enjoyable. Because it is an Aboriginal

person doing it. And they weren’t afraid and he could relate to someone. He can think, she looks like my Nan or my Auntie. And it wasn’t a traumatic thing. If you tell a kid why they are having their hearing tested, and what it’s for they will just freak right out. So I think it is really

important to have an Aboriginal liaison person..”

Aboriginal Professional

“Sometimes it’s good to have an Aboriginal person with them to go along with them……. and then you get into a conversation together.”

Aboriginal Professional

Barriers

• Lack of an Aboriginal presence in Allied Health • Transport • Provision of Services at the Hospital • Difficulties in cross cultural communication

Barriers identified only by Aboriginal Participants

• Shame • Perceptions that the service is costly • Perceived racism • Age limits on the service

Suggestions from Aboriginal Stakeholders

• Employment of Aboriginal staff • Community based (comfortable locations) • Promotion of services • Training for AHPs in providing culturally secure services:

communication, interpersonal skills, time to build relationships with Aboriginal clients, orientation to Aboriginal services in Geraldton

Suggestions Speech pathologists

• Undergraduate and work place training • Clinical resources • Time • Culture of providing culturally secure services including

the development of guidelines and policies to support practice

Outcomes

1. Partnerships with GRAMS 2. Allied health promotion 3. Cultural training for AHP 4. Guidelines

1. Partnerships with GRAMS

• MOU with GRAMS: – Only formal agreement between two health services – Delivery of allied health clinics at GRAMS – 2-way learning – support

• Working together and student placements

Working together

• Aboriginal Men’s Health

“More Than Medicine”

An exercise program for individuals with diabetes

Student projects based with GRAMS and CUCRH

Student projects based with GRAMS and CUCRH

“Good Tucker, Good Teeth”

2. Allied Health Promotion

• Employment of Aboriginal health promotion position

• Scholarship through Heathways and Aust Health promotion Association

• Speech target • Allied health support and

promotion within community

3. Cultural training

• Planned for October • Partnership of Aboriginal organizations in Geraldton

4. Guidelines

• Checklist for practitioners to circumvent obvious obstacles: transport, location for services etc..

What’s changed so far?

• Increase in individual physiotherapy outpatient occasions of service (8.5%)

• DNA rate similar

Challenges and Opportunities

• Development of productive working partnerships - need to continue to build relationships with the right people

• changes driven by clinicians - needs to be married with supportive Health Department policies

• Health service needs to remain proactive • There’s a lot more to do

What allied health

services need to be

more inviting

What Aboriginal

people need to want to

come

Acknowledgements

Staff of GRAMS Aboriginal and non-Aboriginal participants from community,

health, education and disability services Australian Government Department of Health and Ageing

PHCRED program