Cah35-2015 Journal Footprint 01
Cah35-2015 Journal Footprint 01
Journal Footprint
1
Snapshots in Primary Care
Connecting health in the Central
Adelaide and Hills region
INTRODUCTION
MEMBERSHIP
BOARD MEMBERS
ADVISORY AND WORKING GROUP
MEMBERSHIP
Introduction
Our Aim
Our Purpose
in October 2011.
Our Values
Leadership: We will lead health reform to provide
integrated and effective primary health solutions
Integrity: We will be accountable, honest and ensure
professional and ethical conduct
and providers will benefit from our experiences and learnings. Our
aim for this document is to share with you our successes and
Central LGAs.
The Socio Economic Indicators for Areas (SEIFA Index) for SLAs within
CAHML shows significant areas of disadvantage in Western Adelaide,
the Campbelltown area and Mount Barker regions. Within the CBD
of Adelaide there is a concentration of people who are homeless or
sleeping rough.
The population of CAHML is expected to increase to 545,000 people
Within the CAHML region, there are a range of acute and primary care
settings. The region has a number of public hospitals including the
Royal Adelaide Hospital, the Womens and Childrens Hospital, The
Queen Elizabeth Hospital, Hampstead Rehabilitation Centre and St
Margarets Rehabilitation Hospital. In the Adelaide Hills region, there
is Mount Barker Public Hospital, Gumeracha Public Hospital and
Stirling Community Hospital. Private hospitals within the CAHML
region include Ashford, Calvary North Adelaide, Calvary Wakefield, St
Andrews, North Eastern Community and a number of others.
From a primary care perspective, there are 220 general practices, with
over 830 GPs, 45 GP registrars and 205 Practice Nurses working
within the region. There are also over 1500 allied health professionals
and 156 pharmacies across the region. There are a range of Aged
The snapshots are grouped around the key priority areas for
CAHML including;
and many other primary, secondary and tertiary level health services.
Mental Health
Positive Ageing
and Evaluation
eHealth
Stakeholder Engagement
Community engagement
They outline the approaches and the challenges, the learnings and
region has the highest proportion of older adults (> 85 years) nationally,
that CAHML has achieved. For more comprehensive list of the work
Publications section.
Membership
CAHML ADVISORY, WORKING AND
REFERENCE GROUPS
Robert Penhall
GP Partners Adelaide
Dr Nigel Stocks
Healthfirst Network
Andrew Stanley
SANT Datalink
David Ng
Dr Stephen Christley
Donna Page
Mike Barienic
Mr Chris Seiboth
CAHML CEO
Ms Kirsty Rawlings
CAHML
Ms Jackie Sincock
CAHML
Incorporated
Summit Health
Previous Members:
Dr Rod Pearce
Dr Danny Byrne
GP Liaison, CAHML
Dr Bronwyn Knight
GP Liaison, CAHML
CAHML BOARD
Justin Beilby, Chair
Anne Skipper AM
Juliet Brown
Assoc. Prof Robert Penhall
Dr Michael Taylor
Klaus Zimmerman AM
Yvonne Sneddon
Dr Pasquale Cocchiaro
Stephanie Miller
Previous Board Member: Dr Rod Pearce
Jackie Lance
Lisa Edmonds
Medical HQ
Bronwyn Jones
Moira Noonan
SA Health
Jane Barrow
Karen Lewis
Donna Page
Dr Kay Price
Alex Stevens
CAHML
Cathy Zesers
CAHML
Janeen Lallard
CAHML
Dr Roly Vinci
Dr Michael Taylor
Mt Barker Clinic
Angela Nasone
Dr Michael Wozniak
Angela Baker
ProHealth Care
Jackie Lance
Donna Page
Dr Kathryn Materne
Karen Royals
TQEH
Dr Jose Abadia
Mary Young
RAH
Dr Peter Donohoe
Midwest Health
Alicia Watson
RAH
Dr Briony Andrew
Adam Phillips
Chemplus
Dr Jennifer Wilton
Dr Harry Macris
Sophie Piron
Meryl Horsell
CAHML
Dr Danny Byrne
CAHML
Kirsty Rawlings
CAHML
Chris Seiboth
CAHML
Jo Teakle
CAHML
Cathy Zesers
CAHML
Donna Harrison
CAHML
Debra Rowett
DATIS
Kyp Boucher
Sharon Goldsworthy
QEH
Natasha Miliotis
Michael Bakker
Mary Barbaro
Mind Australia
Simon Dawe
Carol Hampton
Mission Australia
Heidi White
Mary Allstrom
Neami National
Helen Gilbert
Tania Sharp
Salvation Army
Laurie Broomhead
Stirling Chemmart
Kylie Hutchinson-McGowan
Marcia Hills
Paul Creedon
Cathy Zesers
CAHML
Jennie Charlton
Cathy Caird
CAHML
Chris Seiboth
CAHML
Bill Miliotis
CAHML
Membership
HEADSPACE CONSORTIUM
Kathy Mickan
CAHML
Carol Hampton
Mission Australia
Chris Chalubeck
Centacare
Mia Vincent
Workskil
Kathy Robinson
Gayle Goodman
Neville Phillips
Sean Miller
headspace
Mark Hinton
headspace
Meredith Perry
Paul Creedon
Helen Shaw
Sonja Walmsley
Dan Cox
CAHML
CAHMLww
Yvonne Sneddon
Alison King
Courtney Bartosak
John Glover
Julie Patterson
Leah Trotta
Mary Buckskin
Stephanie Miller
Penny Worland
Chris Seiboth
CAHML
Kirsty Rawlings
CAHML
Danielle Grant-Cross
CAHML
Community Member
Nicola Rankine
Community Member
Telika Heron
Community Member
Kaeshan Khan
Community Member
Angela Newbound
CAHML
Nancy Bates
CAHML
Lorelle Hunter
CAHML
CAHML
Meryl Horsell
CAHML
Kirsty Rawlings
CAHML
Vanessa Gaston-Gardner
CAHML
Lorelle Hunter
CAHML
Nancy Bates
CAHML
Janeen Lallard
CAHML
Alice Windle
CAHML
Fred Graham
CAHML
Bill Miliotis
CAHML
Barbara Figueroa
CAHML
Jackie Sincock
CAHML
2
Priority Areas
YOUTH MENTAL HEALTH
INCLUDING HEADSPACE
PIR
NEWACCESS
ATAPS
COPD
CTG
END OF LIFE CARE
HEALTHY AGEING, DEMENTIA
AND FALLS PREVENTION
IMMUNISATION
2014-14
62% of clients were women
PROGRAM STAFF
Kathy Mickan, headspace Woodville team
Managers - Lead Meryl Horsell, Mark Hinton
KEYWORDS
BACKGROUND
OBJECTIVES
APPROACH
Youth Mental Health outcomes have been achieved through a
number of strategies.
Networking and working collaboratively has enhanced sector
awareness of CAHML services and also gives CAHML insight into the
needs of the young people and service providers.
CAHML has participated in regional youth sector networks in the
west, central, east and hills regions of Adelaide.
CAHML is also a member of the Adelaide Hills Child and Youth
Mental Health Working Group and the Mental Health for Learning
Reference Group supporting the KidsMatter and MindMatters
programs in schools.
headspace Woodville is represented at Western Workers with Youth
Network, The Port Adelaide Suicide Prevention Network, Inner West
Community Partnership (DECD) and Weaving the Nets.
Education has enhanced the capacity of service providers to engage
with and support young people who have mental health needs.
10
KEY LEARNINGS
Consulting and collaborating with young people, contractors and
other service providers has ensured that our service delivery is youth
available resources
IMPACT
A key impact of CAHMLs involvement in youth mental health has
tenders rather than competing against each other for the funding.
health care in SA: for example: the introduction of the Primary Health
Summit Health.
Psychosis Program.
The changes will impact on youth mental health service delivery and
the relationships across service providers.
Continuing efforts to maintain strong relationships will be critical to
the future of youth mental health planning and program development.
KEY DOCUMENTS
http://cahml.org.au/images/RFP-AFTER-HOURS.pdf
http://cahml.org.au/images/AHs_MBSItemsCheatsheetOct13_V2.pdf
http://www.healthdirect.gov.au/after-hours-gp-helpline
REFERENCES
RESULTS
11
PROGRAM STAFF
Claire Fleckner, Justyna Rosa, Darren Hunt, CAH PIR Support
Facilitators, Operational and Management Group.
Managers- Bill Miliotis, Dan Cox, Chris Seiboth
KEY WORDS
Recovery, Coordinated Care, Mental Illness/Health
BACKGROUND
Addressing the needs of people with severe and persistent mental
illness requires a complex system of treatment, care and support,
often requiring the engagement of multiple areas of service delivery,
including health, housing, income support, disability, education and
employment.
Central Adelaide and Hills (CAH) PIR commenced on 18 November
2013 with Central Adelaide and Hills Medicare Local (CAHML) as the
lead organisation in the Consortium CAH PIR.
APPROACH
The CAH PIR model is recognised as consistent with a "collective
impact" approach which is designed to address complex social
OBJECTIVES
PIR aims to deliver wrap around support to meet a range of
12
Days
Average time from referral to exit
180
OUTCOMES
The CAH PIR Consortium set a key performance indicator of five days
their needs.
CAH PIR is funded over the life of the program to provide services
to 520 clients, therefore the 263 accepted onto the program to date
reflects 46.8% of this total.
Table 1: Total client summary for CAH PIR (18/11/14 to
31/12/2014)
Pending
Ineligible
Cancelled
Active
Closed
Total
Refferal
51
11
69
Assessing
19
11
30
51
20
71
99
18
117
32
11
43
26
51
22
182
49
330
Action
Planning
Case
Coordination
Monitoring
Only
Total
13
KEY LEARNINGS
CAH PIR has made significant progress in enabling a health system
to better coordinate care and support people with severe and
persistent mental illness. Key program learnings include:
To date, CAH PIR is achieving this at individual client level, and our
focus in the third year is to consolidate these gains, reform and
develop pathways at a broader systems level.
KEY DOCUMENTS
Australian Government, Department of Health,
Operational Guidelines for PiR Organisations, May 2013;
Central and Adelaide Hills Partners in Recovery (CAH PIR)
Local Practical Guidelines V10, December 2014
REFERENCES
1.
14
PROGRAM STAFF
Melissa Corbett, Corrie van der Keyl, Matthew Ragless,
Natalie Zesers, Robert Merrett
MANAGER/S
Tracey Sloan, Simone Thrippleton, Mary-Jane Honner, Dan
Cox, Danielle Grant-Cross
KEY WORDS
beyondblue, NewAccess, Low Intensity Cognitive Behavioral
Therapy, anxiety, depression
BACKGROUND
CAHML has five NewAccess Coaches who have been trained and
the region as part of the beyondblue Roadshow (big blue bus) that
This beyondblue initiative was made possible with funds from the
Movember Foundation. The program has provided support for over
260 people since the commencement in late February 2014 until
November 2014, when the program was transferred to Uniting Care
OBJECTIVES
Nearly 3 million Australians currently live with anxiety and/or
depression.
Only 46% of Australians with anxiety and depression access support.
Research in Australia indicated that the NewAccess model would
APPROACH
flyers, wallet size fold outs) aimed at two audiences: GPs and other
15
171
Clients recieved
treatment after being
referred to the CAHML
NewAccess program
OUTCOMES
14/10/2014)
Referral Summary
Number of refferals
264
Number of completed
75
episodes
Figure 1 Age distribution of clients accessing CAHML NewAccess
Not suitable
11
173
deactivated
Number of clients
60
50
15
declined treatment
assessments
40
Number of clients
30
20
209
assessments
treatment
171
over 65 years
56-65 years
46-55 years
36-45 years
28-35 years
18-25 years
0-17 years
Number of clients
10
0
241
offered initial
13
have deceased
initial assessment
16
GAD-7
Initial PHQ-9
12.98
Initial GAD-7
11.92
Final PHQ-9
6.19
Final GAD-7
5.54
KEY LEARNINGS
NewAccess is complementing other mental health services but
also filling a gap in the market, by providing a free service which
is targeted towards people with mild to moderate depression and
anxiety.
71%
recovery
rate
17
PROGRAM STAFF
Natalie Worth ATAPS Program Manager, Simone Thrippleton
ATAPS Program Manager, Meryl Horsell, Manager Health
Programs
BACKGROUND
6. Homeless
Referrals were directed to the contracted providers who have
well established internal processes and appropriately trained staff
receiving and triaging referrals. Referrals were received via secure
fax or phone and were assessed for ATAPS eligibility, and prioritised
OBJECTIVES
The ATAPS program enables GPs to refer consumers to ATAPS
mental health professionals who deliver focussed psychological
(i.e. suicide prevention clients were given priority along with people
identified as being affected by past forced adoption 2013/14).
Clients were matched to the most appropriate ATAPS program and
clinician based on diagnosis and location.
utilised.
deliverables.
APPROACH
all clients.
18
OUTCOMES
In 2012/13, across all ATAPS programs 1442 people received
2. Suicide prevention
required.
KEY LEARNINGS
contract terms:
here
Staff within the ATAPS team shared the motivation and enthusiasm
for the ATAPS journey at CAHML and were personally and
professionally committed to primary health care for priority groups
occurs quarterly.
19
Over the 2-3 year period that CAHML managed ATAPS, these
programs have moved successfully from development phases to
steady and solid continuous delivery of quality programs.
There has been enhanced clarity of referral pathways and an increase
in the collaboration between CAHMLs key organisations and networks.
Expansion has naturally followed this success and demand
management has become a focus, whereas promotion and
awareness raising were more the focus in the previous year.
Any promotional and stakeholder liaison/relationship building
activities were strategically targeted for maximum benefit to the
relevant program, and this led to strong increases in programs that
had previously had lower than anticipated uptake.
Examples of successful collaborations between the CAHML ATAPS
team, stakeholders & ATAPS providers are described below:
KEY DOCUMENTS
20
PROGRAM STAFF
Joanne Teakle, Donna Harrison, Michele Herriot, Emma Jervis,
Cathy Caird
Managers Lead Meryl Horsell, Kirsty Rawlings
KEYWORDS
COPD, Respiratory disease, Chronic Obstructive Pulmonary
BACKGROUND
Chronic Obstructive Pulmonary Disease (COPD) is a debilitating
irreversible disease which can be treated and managed to both
support patients to improve their quality of life and to improve their
APPROACH
Project.
COPD prevalence.
OBJECTIVES
partnerships
21
ment for people with COPD within the pharmacy setting. CAHMLs
Pharmacy Liaison Officer was a core project member and worked
closely with participating pharmacies to develop their COPD education capacity.
A practical General Practice COPD Guide that describes the processes for developing COPD management systems within general
practice is soon to be released.
DEVELOPMENT OF A COPD
EVALUATION FRAMEWORK
CAHML and CALHN have worked together to improve outcomes for
people with COPD. The underpinning premise of the collaborative
will help achieve the best care, first time and every time, in the right
place.
This collaborative arrangement has culminated in the development
of a COPD Evaluation Framework. The Evaluation Framework is
number of spirometrys
22
OUTCOMES
1. The MLQIP COPD Quality Improvement Project key
achievements include:
100% retention of involved practices and pharmacies
throughout the project.
All practices achieved improvements in recording data
quality measures: increased accuracy of the COPD
registers and increased numbers of spirometry recorded,
and smoking status recorded.
care topics. Six education events have been held and attended by
services.
STAKEHOLDER COLLABORATIONS
The project involved linking with UniSA and the Royal Adelaide Hos-
CAHML also facilitated interested stakeholders from the South Australian Ambulance Service and CALHN in exploring opportunities for
trialing different care models to minimise the number of Emergency
Department attendances for people with Chronic Obstructive Pulmonary Disease (COPD) when it is appropriate and safe to do so.
23
KEY LEARNINGS
Successful work programs need to have champion who is skilled
and knowledgeable in the topic. On the ground support personnel,
who have the skills, time and motivation to support any General
Practice in key activities has been found to be crucial.
The COPD program has been successful as a result of have a driver.
annual
prevalence
of COPD
in the region
The
It was generally agreed across the project that the Care Facilitator,
is estimated
who was leading and driving the project across all practices and
pharmacies, was the main reason that the MLQIP was a success.
Without the key personal to motivate, encourage and support, along
with providing time to General Practice to physically help with what
is required to fulfill the project, then it would have been far less
successful.
at
12,292
cases, or
2.3%
of the total
population.
KEY DOCUMENTS
CAHML COPD Population Health Monograph, 2014
CAHML COPD Infographic, 2014
Lung Foundations COPDx Guidelines
Australian Primary Care Collaborative program is available
from the APCC website. http://apcc.org.au/
CAHML COPD Evaluation Framework, 2015
GP COPD Management Guidelines, 2015
24
PROGRAM STAFF
Alexandra Stevens, Karen Atkinson, Donna Harrison (Care
Coordinators); Annette Miller, Warwick Wallace, (Outreach
Workers); Kahlia Miller-Koncz (CTG Program Support); Nancy
Bates (Aboriginal Community Engagement).
Past team members: Penny Angus, Fred Graham, Ros Miles,
Snowy Day, Lorelle Hunter, Manager Lead Meryl Horsell
KEYWORDS
Closing the Gap, care coordination, outreach worker,
supplementary services, chronic disease
CAHML has managed the CTG program since July 2012. The
program is comprised of 3 elements: care coordination and supplementary services, Indigenous health project officer, and Aboriginal
outreach workers. The program structure has enabled the formation
of a unified CTG team that works collaboratively to support CTG
clients and mainstream services that provide primary health care to
Aboriginal and Torres Strait Islander people.
The CTG program works with many of the most disadvantaged people in the region, particularly those residing in areas of disadvantage
BACKGROUND
OBJECTIVES
years shorter life expectancy and a younger age profile than the
racism/judgement.
25
APPROACH
CAHML is the provider of the CTG program and works within the
Australian Government Department of Health CTG program operating
guidelines.
The Closing the Gap team comprises three care coordinators, two
Aboriginal outreach workers, a program support officer and an
Aboriginal community development officer.
The CTG team is supported by other CAHML staff, particularly the
OUTCOMES
The program and service delivery model has been very successful.
The impact of activities to increase awareness of the CTG program
is demonstrated by the increasing number of referrals. Since CAHML
assumed management, the CTG program has directly supported 234
clients.
Effective community links have been developed, particularly since the
move to Port Adelaide.
Collaborative relationships with other service providers are enabling
more integrated care approaches to client management. Effective
working relationships, which have streamlined referral pathways,
exist with other local health care agencies including Port Adelaide
Community Health Care Service, Nunkuwarrin Yunti, RAH Aboriginal
Cancer Care team, as well as CTG teams in other regions.
Client outcomes that have been achieved include:
26
the range of medical aids and allied health services needed to assist
them manage their health care needs. Having access to a flexible
As well as working with clients individually, the CTG program has also
The ongoing need for the Closing the Gap program is significant if the
people is to be achieved.
medical supports that give them the best chance of improving their
health status.
There are no alternative community-based CCSS options available
for Aboriginal people with chronic disease. Many CTG clients operate
KEY LEARNINGS
from a very low health literacy base and require significant investment
chronic disease requires all three elements of the CTG program: care
their condition.
CTG activity is a model that works very well. Team members provide
each other with collegial support, provide leave cover and offer team
approach to care. Having a male outreach worker is an important
aspect of engaging with men and supporting them on their health
care pathway.
Establishing a culturally safe and friendly workplace for the CTG
team, particularly for the Aboriginal members of the team, has been
an important part of the CTG program. Having a designated office
in Port Adelaide has been a major achievement in establishing a
culturally friendly workspace. The office displays Aboriginal and
Torres Strait Islander flags and Aboriginal artwork is on display in the
work area.
Being very proactive in engaging with clients is a feature of the
program. Communication with clients is often difficult due to limited
Age ranges of
clients varied from
8 to 77 years.
KEY DOCUMENTS
CTG program resources include artwork designed by local KaurnaNgarrindjeri man Allan Sumner.
27
PROGRAM STAFF
KEYWORDS
End of life, palliative, quality of life
disease.
Meeting the health care needs of an older aged
population includes improving access to end of life
care options.
BACKGROUND
17% of people living in the CAHML region are over 65 years of age.
95% of people over 65 years live in a private dwelling and over 25%
live alone.
Many older people are supported by home and community care
(HACC) programs and for many, the desire to remain at home for as
long as possible extends into the end of life period.
Supporting people at home during their end of life period, and to die
at home if that is their preference, requires an integrated approach
from primary care providers and palliative care specialists.
for the primary care sector in end of life care. This has included
promoting the South Australias Advance Care Directives Act 2013
and Advance Care Directive form.
An End of Life Care monograph has been developed to identify areas
within the CAHML region with highest prevalence of COPD or highest
risk factors.
The monograph builds on the CAHML Comprehensive
Needs Assessment (2014) and the CAHML Population Health
Commissioning Atlas which identified an ageing population with
associated high levels of chronic disease and multi-morbidity.
The monograph provides an overview of end of life care across the
CAHML region and is designed to assist service planners and health
OBJECTIVES
held in May 2014 to provide opportunity for GPs to connect with the
APPROACH
28
OUTCOMES
long as possible.
75
KEY LEARNINGS
65
process. Many GPs may only have one or two patients a year
26%
RS
45
64
YE A
AGE
RANGE IN
CAHML*
28%
-4
4Y
E AR
of older
people live
alone
25
25.2%
16
%
RS
YE AR
EA
14%
9%
4Y
- 24
0-1
15
ARS
8%
-7
4
A
YE
RS
+ YE
KEY DOCUMENTS
CAHML Health Profile: A population health needs
assessment of the Central and Adelaide Hills region 2015
CAHML Population Health Commissioning Atlas 2011
CAHML End of Life Monograph 2015
SA Health Palliative Care Services Plan 2009-2016
South Australia Advanced Care Directives Act 2013
29
PROGRAM STAFF
Nathanael Brown, Janeen Lallard, Health Provider Team
Manager- Cathy Zesers
KEYWORDS
Healthy ageing, Dementia, Falls prevention,
Hospital avoidance.
BACKGROUND
Healthy ageing is one of CAHMLs key priority areas and includes
enhancing older peoples access to services that support them
to lead healthy lives, remain active and connected to their
communities. The CAHML region has one of the largest populations
APPROACH
Various engagement options were implemented and included the
following:
care systems.
injurious fall.
OBJECTIVES
care.
region.
30
and aged care organisations, often they are not aware of each
others involvement. It will be crucial for the PHN to establish
OUTCOMES
Positive outcomes were achieved across the various healthy ageing
engagement processes and included:
KEY DOCUMENTS
Older People Clinical Network Information, structure,
governance, objectives. http://www.sahealth.
sa.gov.au/wps/wcm/connect/public+content/
sa+health+internet/health+reform/clinical+networks/
older+people+clinical+network
Better Health Care Connections, CAHML website: http://
www.cahml.org.au/articles/-stay---home----a-newinitiative-across-metro-adelaide.html
Falls Prevention SA website: http://www.fallssa.com.au
REFERENCES
Bradley, 2013 Hospitalisations due to falls by older
people, Australia 2009 10, online, accessed 8-01-15
http://www.aihw.gov.au/WorkArea/DownloadAsset.
aspx?id=60129542822
31
Immunisation Program
The CAHML Immunisation Program has supported
providers to implement strategies to increase childhood
immunisation rates across the region.
PROGRAM STAFF
Angela Newbound: Immunisation Program Coordinator, Lorelle
Hunter, Nancy Bates,
Managers Lead Meryl Horsell, Danielle Grant-Cross
KEYWORDS
Immunisation, Vaccination
BACKGROUND
The CAHML region has had the lowest immunisation rates for children
< 7 years of age in South Australia, and the lowest for Aboriginal and
Torres Strait Islander children at 2 years of age, according to the National
Health Performance Authority (NHPA) report and reports generated
through the Australian Childhood Immunisation Register (ACIR).
Approximately 6,000 children <7 years who resided in the CAHML
region were not fully vaccinated. The greatest majority of these
children live in the western suburbs of Adelaide.
Under vaccinated children are at risk of acquiring vaccine preventable
diseases which could lead to severe illness, hospitalisation, disability
or death.
The cessation of the designated immunisation incentive for GPs
and incorporation of this resource into the Practice Nurse payment
has reduced the focus within some GP practices on maintaining an
active vaccination program in the face of many competing needs.
Many GP practices under-prioritise immunisation in relation to other
health care services required.
APPROACH
The CAHML Immunisation program team has the objective of
maximising access to expert immunisation advice to the primary
care sector and providers across the region. To lead the program,
CAHML employed an experienced Immunisation Coordinator,
who utilised support from the Stakeholder Engagement and
Communications, Provider Support, Closing the Gap, and Planning
and Research teams. This has ensured that a strong promotional
capability has been maintained.
OBJECTIVES
CAHMLs aim has been to advocate for and promote the benefits
of immunisation to reduce the prevalence of vaccine preventable
Activities undertaken:
32
KEY LEARNINGS
means:
information.
and acceptance.
education sessions.
child.
Resources such as Immunisation Reminder fridge magnets
were developed for the Aboriginal and non-Aboriginal
Childhood Development.
The ability to track and map rates across the region and
maintain an accurate and up-to-date database of relevant
ACIR data is difficult. As CAHML is not a Registered Provider,
only limited data is available and this impacts on the ability to
OUTCOMES
engagement.
outcomes.
33
KEY DOCUMENTS
health.gov.au/
Services: http://www.humanservices.gov.au/health-
professionals/
9%
APPROXIMATELY
6,000
CAHML has
reduced the
number of
children not fully
immunised by
34
PROGRAM STAFF
Lead Vanessa Gaston-Gardner, Senior Project Officer
Healthy Weight (Program Lead), Stakeholder and community
Engagement Team
Manager Danielle Grant-Cross
BACKGROUND
Overweight and obesity are major issues in Australia with 63% of the
adult population either overweight or obese.
ENGAGEMENT STRATEGIES
Citizen's Jury on Obesity
Citizens Jury on Obesity was held in May 2013. This process explored
community viewpoints in relation to bariatric surgery access, treatment
OBJECTIVES
1. To clarify and document care pathways to aid general practice
in the management of overweight and obesity.
2. To complete a document designed to inform future direction
and management of overweight and obesity across the CAHML
region through primary health care.
APPROACH
CAHMLs approach to developing the Healthy Weight Strategy was
based in the IAP2 principles captured in the CAHML Community
Relations Policy. This included identifying best practice, knowing
the issue, knowing the community and building collaborative
partnerships.
In developing the Healthy Weight Strategy key stakeholders were
identified as:
35
Aboriginal Health
A number of strategies were used to engage with the Aboriginal
KEY LEARNINGS
community:
Sharing information.
Communication
PHC nurses.
OUTCOMES
Identify gaps
Identify needs
This document is a guide based on what has been learnt from May
KEY DOCUMENTS
36
PROGRAM STAFF
Vanessa Gaston-Gardner, Flinders University SA, Griffith
University NSW, Kings College London and the UK National
Institute for Health and Clinical Excellence.
Managers - Chris Seiboth, Danielle Grant Cross
KEYWORDS
Citizen's jury, obesity, bariatric surgery
BACKGROUND
OBJECTIVES
understandings.
Each juror completed a questionnaire to gather a base line on
surgery?
3. What about patients who dont meet the above criteria?
4. Should surgery for obesity be given a lower priority for
resourcing/ funding than other elective surgeries?
APPROACH
The Citizen's Jury on Obesity was conducted as part of a larger
research project. CAHML Citizen's Jury was the second conducted
by Griffith University having delivered a similar event in NSW.
Professional facilitators with broad experience in Citizen's Jury were
engaged to conduct the CAHML event.
The Jury
Twelve jury members were selected. The selection process involved
The Verdict
As with a legal jury, the Citizen's Jury
clarified information
37
OUTCOMES
KEY LEARNINGS
The process of planning and implementing a Citizen's Jury is time
consuming. Ideally a Citizen's Jury would run for 1 to 2 days to
allow time to gather enough information to deliberate and reach
consensus.
Key learnings from the jurors were:
38
3
Key Areas
HEALTH PLANNING AND ANALYSIS
COMPREHENSIVE NEEDS
ASSESSMENT-(CNA): QUANTITATIVE
COMPREHENSIVE NEEDS
ASSESSMENT-(CNA): QUALITATIVE
IMPACT
CLINICAL GOVERNANCE
ACCREDITATION
RECONCILIATION ACTION PLAN (RAP) /
ABORIGINAL WELLNESS GROUP (AWG)
AFTER HOURS
PROGRAM STAFF
Alice Windle, Kelly Quinlan, Simone Champion, Kylie Cocks,
Managers: Kirsty Rawlings, Chris Seiboth
KEYWORDS
population health planning, population health analysis, health
needs, social determinants of health, comprehensive needs
assessment, evaluation, primary care
BACKGROUND
A key part of CAHMLs work has been to better understand the
health and service system needs of our community so that CAHMLs
key priorities, strategies and activities address these identified needs.
This has been undertaken by utilising population health needs analysis
and planning methods, and has been conducted in conjunction with
consumers, health providers and key stakeholders to develop locally
focused and responsive primary health care services.
OBJECTIVES
CAHML has a commitment to understanding the health needs of its
region through a rigorous population health analysis process.
This includes:
APPROACH
To understand the health needs of the region and assist in
developing appropriate solutions, CAHML has:
Identified the health needs and gaps in services within the region.
and aged care sectors, and other services in the primary health
care sector.
40
OUTCOMES
Mental health
data for the region at the Statistical Local Area (SLA) and CAHML
Aboriginal health
Childhood I\immunisation
Obesity
After hours
eHealth
The CNA supported further the key priorities identified and provided
more detail regarding the key issues and areas, and highlighted an
appropriate response.
representatives.
The key health issues and contributing factors identified in the CNA
One of the key outcomes from the CNA process has been
disseminating the information learned from this process for the many
health providers, organisations and stakeholders that each play a role
in keeping people well. They have subsequently used this information
to plan and reorient service provision.
Norwood Payneham and St Peters LGAs, and this is also evident for
prioritised in consultation with the CNA SLG, the CAHML Board and
older adults, youth and early childhood age groups. There is a high
staff. Priority needs were used to inform the CAHML Strategic Plan
for 2014-17 and the Annual Plan for 2014-15, including key activities,
back indicating this is also an issue in the Mount Barker and Adelaide
Hills regions.
Immunisation rates across the CAHML region are very low for
children aged 1 to 5 years, and particularly within the Aboriginal and
Torres Strait Islander community. Within the CALD and Aboriginal and
Torres Strait Islander population groups in the western region, there is
41
KEY LEARNINGS
Using an evidence base to determine an appropriate response in
primary care is essential. This allows for detailed planning regarding
key activities for specific populations or sub-regions within the region.
It also allows for the planning and monitoring of key outcomes and
key stakeholders within the region that also had a vested interest in
the region.
There are issues for older adults around access to transport, social
isolation, coordination of health and social services, capacity to
navigate the health system, and coordination of end of life and
palliative care.
Culturally and Linguistically Diverse populations
Analysis of the data has demonstrated the CALD communities also
tend to demonstrate higher rates of social disadvantage, chronic
Youth Health
Given the high prevalence of younger people aged 15 to 29 years
within parts of the CAHML region, there is a corresponding need to
address the correlating health needs of youth mental health, sexual
KEY DOCUMENTS
CAHML CAHML Health Profile: A population health needs as-
The key focus areas for CAHML that have been shaped by the
42
KEYWORDS
Quantitative data analysis, demography, needs assessment,
health services research, health planning
PROGRAM STAFF
Alice Windle, Kelly Quinlan, Simone Champion, Kylie Cocks,
Justin Reeves, Bronwyn Knight
Manager- Lead Kirsty Rawlings
BACKGROUND
APPROACH
needs assessment.
OBJECTIVES
Assess the health status of the population and identify the key
health issues/needs for the region, including the prevalence of
Identify health inequities that exist between geographic
areas and population groups and gain understanding of the
contributing social determinants.
A large range of data was only available at Medicare Local level (eg
Medicare Item data), did not align with ML boundaries, or was only
available at state or national level. This could not be meaningfully
compared using the matrix method described above, however it
whether any health needs of the CAHML region could be identified.
Where available, data of disease/risk factor prevalence for specific
further contextualise the data on each indicator, each SLA was given
a rating based on its comparison against Australian and Adelaide
43
KEY DOCUMENTS
44
PROGRAM STAFF
Alice Windle, Kelly Quinlan, Simone Champion, Kylie Cocks,
Manager- Lead Kirsty Rawlings
KEYWORDS
qualitative data collection, needs assessment, survey, focus
groups, thematic analysis
BACKGROUND
Engagement was undertaken with community members, health
needs within the CAHML region to provide a full range of views and
perspectives. The qualitative data collected was used to support
and inform the overall CNA process. Utilising both quantitative
and qualitative data provides an in-depth picture of the health
OBJECTIVES
about the felt need of people within the CAHML community and
ideas.
The qualitative data collection was a way to get behind the numbers
of the quantitative analysis, to provide insights that could not be
obtained from data alone.
Data Analysis
The dataset developed from surveys, focus groups and stakeholder interview responses was reviewed, coded and then collated to
identify important themes within the data. The coded and collated
APPROACH
Data Collection
time against the main dataset to check that the story of the data
45
OUTCOMES
Number of
mechanism
sponses
re-
Total Responses
Online survey
169
Face to face
87
335
76
ticipation
Key stakeholder
interviews
Environmental
process and allowed the project team and the organisation to hear
the voices of the community and build a story around the data. The
short timeframe available to undertake the consultation for the CNA
did not allow for planned follow-up consultations to delve further in to
survey
Focus group par-
KEY LEARNINGS
32
scan documents
reviewed
the key needs that were identified. This would have allowed a greater
level of detail and validation of the existing findings.
A snapshot of the key primary health care needs that were identified
across the CAHML region include:
Health priorities
Access issues
System issues
KEY DOCUMENTS
46
PROGRAM STAFF
SA LIP IMPACT Core Team: Principal Investigator: Professor
Nigel Stocks (University of Adelaide), LIP Lead: Kirsty Rawlings
(CAHML), LIP Coordinator: Simone Champion (CAHML)
KEYWORDS
IMPACT, primary health care, vulnerable populations, access
to health care, service design, health care intervention,
innovation, program evaluation
BACKGROUND
GOVERNANCE
The SA LIP IMPACT Team comprises the IMPACT Principal
OBJECTIVES
vulnerable populations.
47
APPROACH
The program is based on a mixed methods approach in which
qualitative and quantitative methods are combined in order to achieve
the various objectives of the program.
The IMPACT program of research involves four interconnected
projects over five years:
OUTCOMES
1. To produce a set of innovations that can be tailored,
implemented and robustly evaluated for effectiveness and
feasibility;
2. Facilitated dialogues which engage local community and
decision makers across sectors in designing organisational
innovations to improve access to PHC for vulnerable
populations;
3. Connection with colleagues across provincial, national and
international contexts. Sharing of lessons learned across
contexts will further inform future practice innovations for
vulnerable populations;
The IMPACT Advisory Group has discussed and selected an intervention: Transitional Discharge Model from hospital to primary care.
Project 2 Syntheses of effectiveness and implementation
Project 3 Mixed method analysis of surveys
Project 4 Implementation and evaluation of organisational
innovations
To build a local picture of access to health care and vulnerability, a
detailed analysis of local data was conducted using both quantitative
and qualitative data sources.
Engagement with the SA LIP Network was then activated through a
series of Deliberative Forums.
KEY DOCUMENTS
http://www.med.monash.edu.au/sphc/impact/
IMPACT Central Adelaide and Hills Data Story Sheets
48
PROGRAM STAFF
Jackie Sincock, Chris Seiboth, Associate Professor Robert
Penhall,
Manager Lead Kirsty Rawlings
KEYWORDS
clinical governance, clinical improvement, quality, safety, root
BACKGROUND
As defined by Scally and Donaldson (1998), clinical governance is:
Client
Clinical
Staff
Quality,
Corporate
experience
effectiveness
development
evaluation
support
and
and
and
and
and
participation
performance
management
research
environment
OBJECTIVES
To establish accountability and responsibility for the safety, quality
APPROACH
(HPROD) team.
49
OUTCOMES
Achievements in clinical governance are:
KEY LEARNINGS
The process of developing and implementing a framework for clinical
quality, safety and improvement assisted CAHML with understanding:
KEY DOCUMENTS
CAHML Clinical Governance Framework November 2013
CAHML headspace Clinical Governance Framework
December 2014
Medicare Local Accreditation Standards 2013
National Mental Health Standards 2010
National Quality and Safety in HealthCare Standards 2012
50
Achieving Accreditation:
A Worthy Pursuit
PROGRAM STAFF
Jackie Sincock, Kelly Quinlan, Simone Champion, Kaylene
Johns, Simone Good, ALL CAHML Staff, Manager- Lead Kirsty
Rawlings
KEYWORDS
accreditation, safety, quality, improvement
APPROACH
BACKGROUND
Accreditation is a process of review that organisations participate
in to demonstrate the ability to meet predetermined standards. It is
implemented with a focus on safe, high quality care and continuous
quality improvement.
OBJECTIVES
Accreditation required achievement against 12 mandatory standards,
across a spectrum of best practice organisational management and
service delivery processes. The standards were developed as part of
a quality framework to assist MLs to meet their strategic objectives.
The Accreditation team used humour to sell the message of accreditation and equip people with the tools they needed, providing
Accreditation gift boxes and badges.
Visual tools were located around the office to display the mandatory
standards.
To achieve accreditation CAHML was required to submit an online
self-assessment (January 2014) and undergo a three day on-site
assessment with two surveyors (3-5 March 2014).
Preparation for the on-site assessment included setting the days
agendas, allocating staff for interview and developing the evidence
base to demonstrate achievement against the standards.
OUTCOMES
Following the on-site assessment CAHML was found fully compliant
and was recommended for and awarded accreditation by the
Department of Health for the period 1st April 2014 to 17th April 2017.
Words CAHML staff used to describe accreditation
51
KEY LEARNINGS
The path to accreditation higlighted for CAHML that:
KEY DOCUMENTS
Department of Health Medicare Local Accreditation
Standards 2013
Department of Health National Mental Health Standards
2010
52
PROGRAM STAFF
Nancy Bates, Jackie Sincock, Bill Miliotis, Vanessa GastonGardner, Barbara Figueroa, Janeen Lallard, Alice Windle, Fred
Graham, Lorelle Hunter, Brenton Graham,
Managers Lead Danielle Grant-Cross, Kirsty Rawlings, Chris
Seiboth
KEYWORDS
Reconciliation, action plan, Aboriginal wellness
BACKGROUND
APPROACH
From the outset, the pursuit of a RAP was driven from the CAHML
CAHML staff.
sustainable opportunities.
http://www.reconciliation.org.au/raphub/about/
In February 2014, CAHML embarked on the process of building and
implementing a RAP, through Reconciliation Australia.
OBJECTIVES
53
OUTCOMES
website.
http://www.reconciliation.org.au/raphub/wp-content/
2015-RAP.pdf
Of the 23 actions outlined in the RAP, all will be achieved by the end
uploads/2015/01/Central-Adelaide-and-Hills-Medicare-Local-2014-
Photography
KEY LEARNINGS
Developing a RAP has been a worthy pursuit for CAHML and is
recommended for other primary health care organisations to capture
and demonstrate their work and commitment to Aboriginal and
Torres Strait Islander health and wellness.
54
KEY DOCUMENTS
Central Adelaide and Hills Medicare Local Reconciliation
Action Plan 2014-2015
After-Hours Program
The CAHML After-hours Program provides Australian
Government funding for the provision of after-hours
primary health services within the CAHML region and
replaced the General Practice After Hours Program and
the Practice Incentive Program (PIP) After Hours Incentive
from June 2013.
PROGRAM STAFF
Alice Windle, Emma Caddy, Kelly Quinlan and Litza Myers,
Manager (s) - Lead Cathy Zesers, Kirsty Rawlings
KEYWORDS
After-Hours, after-hours care, after-hours period
BACKGROUND
APPROACH
whose health condition is urgent and cannot wait for treatment until
regular services are next available. CAHML administers funding for
after-hours (AH) primary health services to further improve access
to AH care so that communities across the region have suitable AH
services in place.
During this time it is difficult for people to access AH primary care, for
Other initiatives:
OBJECTIVES
55
RESULTS
IMPACT
staff.
include:
5. Recent migrants.
The 2013-2014 funding year practice reports indicate an increase
the program.
DISCUSSION
The increase since the commencement of the project and further
results show that the AH Program is delivering out of hours care
to an increasing number of providers and consumers across the
CAMHL region.
KEY DOCUMENTS
http://cahml.org.au/images/RFP-AFTER-HOURS.pdf
http://cahml.org.au/images/AHs_MBSItemsCheatsheetOct13_V2.pdf
http://www.healthdirect.gov.au/after-hours-gp-helpline
56
4
Engagement
STAKEHOLDER ENGAGEMENT
STRATEGY
GP ENGAGEMENT
PRACTICE MAPPING
CONTINUING PROFESSIONAL
DEVELOPMENT
PRACTICE MANAGER
ENGAGEMENT
NURSE NETWORK
ALLIED HEALTH ENGAGEMENT
NURSE MENTOR PANEL
PHARMACY ENGAGEMENT
COMMUNITY ENGAGEMENT
STRATEGY
ABORIGINAL COMMUNITY
ENGAGEMENT STRATEGY
Stakeholder Engagement
- A Critical Element
CAHML identified engagement as a critical element in
ensuring we adopt inclusive participation strategies in
shaping the health service delivery that improves health
outcomes across our health priority areas.
PROGRAM STAFF
Vanessa Gaston-Gardner, Nancy Bates, Tom Ootes, Barbara
Figueroa and Lorelle Hunter
Manager/s: Lead Danielle Grant-Cross, Chris Seiboth, Cathy
Zesers, Kirsty Rawlings
KEYWORDS
Stakeholder Engagement, Collaboration, Inclusion,
Communication, Partnerships/Relationships, Community
Engagement
BACKGROUND
APPROACH
into the development of our key strategic priorities and our program
and service development. Our initial engagement work was guided
by the initial Population Health Commissioning Atlas, and recognised
the valuable process of ensuring inclusive participation in shaping
service delivery and health outcomes. Our 13 Foundation members
provided a base initially to roll out our engagement plan that focused
on improving the communitys healthcare literacy as well as their
understanding and ability to navigate the health system, especially
within Aboriginal, Culturally and Linguistically Diverse (CALD) and new
migrant populations.
The 2013-2014 Comprehensive Needs Assessment (CNA), which
provided more detailed data on our key focus areas enabled
OBJECTIVES
1. Ensure stakeholder engagement is embedded in the culture
and core function of CAHML.
2. Inform planning, service provision and program development
through a bottom up approach to service improvement.
3. Enhance collaboration, strengthen partnerships and increase
linkages across CAHMLs region.
4. Identify opportunities to improve the organisations
communication and linkages within local communities.
It was identified early that engagement was a two way process that
needed to be responsive and reciprocal. Inclusivity was crucial for
all CAHML activity especially those harder to reach due to language,
culture, age and mobility. It was important that information was
accessible, transparent, impartial and objective. Participation and
communication needed to be meaningful with a culture of sharing
ideas encouraged. Lastly, Stakeholders were valued and respected
and their input was used to improve policy and outcomes.
CAHML was committed to improving the health of people living in our
region and we acknowledged that we could not do it alone. CAHML
recognised and understood that a lot of good work was already
being done by external organisations in our region. We therefore
partnered with our stakeholders and further advanced and enhanced
this good work. We recognised the importance of approaching
stakeholder engagement in a unique manner. Being a true start up
organisation we created our initial strategies listed below.
Pivotal to this success has been the relationships with members,
58
lead agencies.
Mental Health Think Tank
One major highlight of our work was this event facilitated by Dr
ENGAGEMENT STRATEGIES
First of all thank you for the opportunity to be invited it was a privilege
to be part of a dynamic and forward thinking group. The workshop
was excellent and I will be reporting this to our Board." Rosetta Rosa
General Manager, COTA SA.
CALD Engagement
The aim of this strategy was to increase health literacy and engage
in health education and promotion with women from Hispanic, Italian
and Vietnamese origin. Underpinning our success in this area was the
effective engagement and partnerships developed with peak bodies
and lead agencies, including Multicultural Communities Council of
South Australia and Multicultural Aged Care (MCCSA), MAC, Migrant
information about the state of their health, their health needs and
59
Identify gaps
Identify needs
KEY LEARNINGS
CAHML being successful with its bid to trial the NewAccess mental
the transition into the new Primary Health Networks. There is joint
KEY DOCUMENTS
Communication Plan
2015
OUTCOMES
60
GP Engagement -
Cornerstone of Primary Care
Often referred to as the cornerstone of primary
care, general practice includes general practitioners,
primary care nurses, practice/ business managers and
administrative staff. Of these identified roles, general
practitioners are a critical component in supporting
capacity building, system change and improvement, and
yet for a range of reasons they can be difficult to engage
in any comprehensive way.
PROGRAM STAFF
Dr Bronwyn Knight, Dr Danny Byrne, Dr Peter Del Fante,
CAHML Provider Support Team, CAHML GP Advisory Group,
CAHML Clinical Governance Committee, CAHML Board
Manager Lead Cathy Zesers
KEYWORDS
general practice, primary care, engagement, clinical, advice,
liaison, representation
BACKGROUND
Engaging with GPs provided the mechanism to build on existing
general practice;
APPROACH
OBJECTIVES
organisations by:
Practice visits;
Education events;
61
OUTCOMES
CAHML achieved a great deal:
Gaining support from GPs can be hard when this the work is often
invisible, behind-the-scenes work, with slow progress.
There are many areas of mutual interest to GPs and primary health
organisations.
newsletters or GP bulletins.
KEY LEARNINGS
The three most important lessons from CAHMLs GP engagement
experience are:
1. Change agendas can be a lengthy process to implement. It
takes time to generate support and leverage that support for
system improvement.
2. General practitioners wish to be represented but are difficult
to persuade to be involved directly. Financial incentives are
Education events
attracted more
1000
than
attendees in
2013/2014 with
strong positive
feedback.
62
BACKGROUND
PROGRAM STAFF
Madeline Collins, All CAHML staff
Manager Lead Cathy Zesers
KEYWORDS
general practice, database, planning, communication,
connections
region.
OBJECTIVES
relevant resources.
OUTCOMES
The following outcomes were identified:
APPROACH
Yellow Pages.
63
GPs recorded in
our stakeholder
database grew
from 400 to 650,
an increase of
63%
800
Practice Nurses
recorded in our
stakeholder database
grew from 55 to 77, an
increase of 29%
600
400
200
0
GPs
Practice Nurses
Practice Staff
DISCUSSION
64
Practice staff
recorded in our
stakeholder
database grew
from 71 to 114,
which is an
increase of
61%
Building Capacity in
Primary Health Care
A large part of the health provider capacity building
work undertaken by CAHML has been to provide access
to quality education for health professionals across
the region. Continuing professional development (CPD)
opportunities support quality care and ensure health
providers are up to date, informed and are meeting the
PROGRAM STAFF
Litza Myers, Cathy Zesers, Janeen Lallard, Emma Jervis,
Madeline Collins, Dr Bronwyn Knight, Dr Danny Byrne,
Nathanael Brown, Cathy Caird.
Manager - Cathy Zesers
KEYWORDS
Education, Quality, CPD
BACKGROUND
CAHML offers education to support CPD for allied health
OBJECTIVES
CAHML CPD activities are provided in a planned and systematic way
and aim to update or extend knowledge, skill or assessment in a
health area. Key objectives are to enable providers to:
APPROACH
1550 attendees
to education events
as providing Good/Excellent
learning experience
65
OUTCOMES
KEY LEARNINGS
attendance rates.
The value of networking and communication opportunities between
providers shouldnt be underestimated.
Invest in coordination and administration support for events, as
administration and documentation can be time consuming and
requires a team effort, especially for large scale events. Knowing who
needs to do what and when including budget considerations, staff
capacity, planning and timing makes all the difference.
66
KEY DOCUMENTS
RACGP QI&CPD program 2014-2016 Triennium.
http://www.racgp.org.au/education/qicpd-program/
PROGRAM STAFF
Emma Jervis, Health Provider Liaison Officer,
Manager Lead Cathy Zesers
KEYWORDS
Practice Manager (PM), network (PMN), engage, educate,
opportunity, quality, improvement
BACKGROUND
APPROACH
2013 that guided planning for essential Practice support for local
were asked what they felt was lacking in service provision in the
OBJECTIVES
The PMN was established in order to meet organisational objectives
around engagement, innovation and collaboration. The objectives of
need
67
KEY LEARNINGS
With the growth of the PMN came a number of key learnings:
OUTCOMES
The PMN grew exponentially through 2013 and 2014, culminating
the Network
Another significant outcome of the PMN was the roll out of a package
of support for general practices requiring help in gaining accreditation.
The provision of accreditation support was a successful undertaking.
Over the course of 2013 and 2014, the reputation of the
accreditation support package grew. Comments from PMs who have
received accreditation support include:
68
KEY DOCUMENTS
For more information about the role of the Practice
Manager, please visit the Australian Association of
Practice Management website. http://www.aapm.org.au/
PROGRAM STAFF
Janeen Lallard
Manager Lead Cathy Zesers
KEYWORDS
Primary Health Care Nurse Network, profession practice,
database, engagement, support
BACKGROUND
OUTCOMES
nurses.
According to CAHML data, there were 205 PNs working in the region
in August 2013. CAHML is connecting with 168 nurses in February
2015!
(refer to Connecting with PHC Nurses graph)
OBJECTIVES
To collaborate, provide a CAHML PHC Nurse and multidisciplinary professional development program
200
150
100
50
0
Sep-13
Nov-14
Feb-15
69
KEY LEARNINGS
Listen to the nurses, their needs, what are the gaps they will
inform you! Plan ways to obtain feedback from the network and
use the information in any planning.
70
PROGRAM STAFF
Janeen Lallard, Nathanael Brown, Litza Myers, Madeleine
Collins, Cathy Caird, Dr Bronwyn Knight, Dr Danny Byrne and
Emma Jervis (Health Provider Team)
Manager Lead Cathy Zesers
KEYWORDS
Allied Health, Allied Health Providers (AHPs)
BACKGROUND
programs.
APPROACH
OBJECTIVES
The key objectives of connecting with allied health were to:
of Practice (CoP). The CoP brings together AHPs from both public
Share evidence and information,
71
OUTCOMES
KEY LEARNINGS
AHPs are keen to collaborate with general practice to provide better
connected care. Improved and more viable business models for
AHPs are continually sought with providers keen to support clients
and further integration with general practice, yet funding models have
been a common challenge. Specific learnings include:
process and were also linked into the feedback sessions at the
needs and support them to utilise local level information in their own
planning activities.
Two allied forums were run in consecutive years (2013 and 2014) and
opportunities.
professional input and skills that each member of the team can
bring.
Communities of practice:
health and ageing programs and included a multi-disciplinary group
involved more than 150 allied health and pharmacy providers. The
first forum in 2013 focused on ehealth and the second on building a
Program collaboration:
AHPs have also contributed to programs including
ATAPs, COPD, Healthy Weight, and Closing the Gap. Liaison
and shared work group opportunities with CALHN have also
involved multi-disciplinary and multi-sector collaboration to address
improvements and redesign of services such as falls prevention,
memory clinics and outpatient services.
KEY DOCUMENTS
Six grants for allied health projects were also provided, addressing
COPD, diabetes, social integration, falls and chronic pain.
72
PROGRAM STAFF
Janeen Lallard, Litza Myers
Manager Lead Cathy Zesers
KEYWORDS
Nurse Mentor, Primary Health Care Nurse Network
BACKGROUND
APPROACH
CAHML recognized that there are primary health care nurses with
a wealth of knowledge, enthusiasm and who show leadership and
innovation, and therefore the idea of a PHC Nurse Mentor Panel was
born!
OBJECTIVES
73
OUTCOMES
Practice Nurses/Nurse Manager role; Associate Professor Lecturer in Nursing; Nurse Practitioner Candidate; Nurse
Liaison GP Training Organisation; Nurse/Practice Manager;
KEY LEARNINGS
Regular communication with a network supports continued
engagement.
KEY DOCUMENTS
74
https://www.youtube.com/watch?v=wi7oAR5HnZo
PROGRAM STAFF
Nancy Bates, Cathy Caird
Manager Lead Cathy Zesers, Danielle Grant-Cross, Meryl
Horsell
KEYWORDS
Connecting, Aboriginal and Torres Strait Islander health,
Pharmacies
BACKGROUND
APPROACH
facilitator would be present to aid and steer the discussion, with this
and Torres Strait Islander people living within the CAHML area.
Reconciliation.
the training with the aim is for these to be displayed at the pharmacy
as a visual message to Aboriginal and Torres Strait Islander people
that this pharmacy is a welcoming and safe place.
The Training Package was launched at a major Allied Health and
Pharmacy event in November 2014.Expressions of Interest were
sought from business to be pilot sites, in order for the delivery of the
OBJECTIVES
75
OUTCOMES
KEY DOCUMENTS
..\..\..\..\STAKEHOLDER RELATIONSHIPS\ACE-
Development\pharmacy\Training Package\Connecting
KEY LEARNINGS
Package
http://www.psa.org.au/wp-content/uploads/Guide-toproviding-pharmacy-services-to-Aboriginal-and-TorresStrait-Islander-people-2014.pdf
http://iaha.com.au/wp-content/
uploads/2013/06/20130429-CTG-positionpaper_436824_2.pdf
The funding for the filming of the videos was limited as well as
having time constraints. Ideally some of the videos would be
filmed again after training at the pilot sites was undertaken.
76
PROGRAM STAFF
Barbara Figueroa, Nancy Bates, Lorelle Hunter, Vanessa
Gaston-Gardner, Tom Ootes, Elena DiBez, Nathanael Brown
Manager: Danielle Grant-Cross
KEYWORDS
Community engagement, stakeholder relationships, public
participation, community relationship, Comprehensive Needs
Assessment
BACKGROUND
OBJECTIVES
These were:
Youth.
APPROACH
identified as:
77
Citizen's Jury
stakeholders;
78
Local Councils
Closing the loop with participants to let them know how their
care, learning from what has occurred previously and creating new
This event reflected true engagement fomr the grass roots up. With
OUTCOMES
programs and teams. All staff are responsible for this enagagement
which is part of their daily work. Through effective community
engagement, CAHML has been successful in being part of over 70
Identified gaps
Identified needs
KEY LEARNINGS
The process of community engagement has provided many
opportunities to learn and improve the way subsequent activities
have been developed.
The main learnings have been:
Carers Association of SA
79
PROGRAM STAFF
Nancy Bates, Lorelle Hunter, Angela Newbound, Tom Ootes
Manager Lead Danielle Grant-Cross, Meryl Horsell
KEYWORDS
Aboriginal Community Engagement, Immunisation, Publication,
Resources
BACKGROUND
There are approximately 4830 Aboriginal and Torres Strait Islander
people living in the CAHML region who carry a high burden of
disease compared with the rest of the population. Without effective
engagement, for the purpose of building trust and integrity, identifying
OUTCOMES
Aboriginal employment
CAHML has achieved a high rate of recruitment and retention of
Aboriginal staff.
health outcomes.
OBJECTIVES
Coordination CTG)
Gap Program.
APPROACH
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service provision:
strategies.
4,828
ABORIGINAL
AND/ OR
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KEY LEARNINGS
Connecting with the Aboriginal and Torres Strait Islander people
for the purpose of responding to health needs requires genuine
engagement underpinned by the following principles:
KEY DOCUMENTS
http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/
Content/Publications/2013/ctgc-rs23.pdf
http://www.un.org/esa/socdev/unpfii/documents/DRIPS_
en.pdf
http://www.wchn.sa.gov.au/library/sah_aboriginal_cultural_
respect_framework.pdf
http://www.naccho.org.au/aboriginal-health/healthpromotion-and-prevention/
http://www.lowitja.org.au/sites/default/files/docs/Health_
Promotion_Tools_Scoping-Study.pdf
http://www.aigi.com.au/toolkit-resources/
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Resources /
Publications
Monographs:
HEALTHY AGEING
MENTAL HEALTH
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Commissioning, an Overview
HEADSPACE
Quick Jab to Close The Gap, Its never too late. Immunise your
Mob - poster
IMMUNISATION
Posters
Infographics
Booklets
Forum Worksheets
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