llustrating the importance of building strong partnerships with community, the Aboriginal Health Unit at Nepean Blue Mountains LHD successfully developed an initiative called Sharing and Learning Circles in collaboration with Aboriginal community members in each of the local government areas (LGAs) within the catchment of the LHD.
Conversations identified local health needs, the level of access to healthcare services and how priorities for local people could be progressed.
Each LGA ‘Learning Circle’ also developed recommendations for further consideration by the LHD Chief Executive and Aboriginal Health Governance Committee.
Penrith Council also supports partnerships with local health and community service providers through its Village Café community website and monthly meetings at Kingswood, North St Marys and Llandilo, where people come together to share ideas on wellbeing and strengthening community connections over a cup of coffee.
The Waminda Aboriginal Corporation’s Birthing on Country model offers wrap-around maternity support in the community and in hospital settings by providing intrapartum birth care and postnatal care for up to six weeks.
The first stand-alone Aboriginal midwifery model in Australia, the program has been running at Waminda, a women’s health and welfare service on the NSW South Coast on Yuin Country, since 2018. It is an example of the “continuation of thousands of years of knowledge and practice, which provides holistic maternal, child and family health care that embeds cultural integrity and safety during pregnancy, labour, birth and postnatal care”170.
Co-designed by Waminda, Illawarra Shoalhaven Local Health District (ISLHD) and local community members, the strong relationships were critical to ensure the model was sustainable and met safety and quality standards.
The NSW Government has provided complementary funding, while the Australian Federal Government committed to support Waminda to build the Gudjaga Gunyahlamai Birth Centre and Community Hub in Nowra, and for employment of six midwives in the start-up years. Waminda applied through the Indigenous Land and Sea Corporation for a grant to acquire land for the Birth Centre.
Recognising cultural safety plays a key role in Aboriginal peoples’ decision-making around mental health care and treatment, the Ministry of Health’s Mental Health Branch developed a video and discussion guide to assist service providers working with Aboriginal people better support their mental health and wellbeing needs.
These resources were created with assistance from a statewide advisory committee made up of approximately 20 Aboriginal and non-Aboriginal professionals, local Elders, cultural ambassadors, youth and Aboriginal service providers. The resources provide a strong visual presentation combined with a structured approach to guide staff in considering the value of cultural identity in emotional and social wellbeing, as well as providing practical tips to improve engagement with Aboriginal people.
The resources complement the Respecting the Difference training and provide a further opportunity for services and staff to review and improve the quality of service delivery, reflect on clinical practices, and increase knowledge and skills in working with Aboriginal people and their families. The resources are also relevant to many government and non-government services who work with Aboriginal people.
The NSW government has committed to sharing more data, including health data, with Aboriginal communities in a streamlined way. NSW Health has implemented a number of key data-sharing projects: HealthStats NSW is the publicly accessible website which includes an Aboriginal Health topic page, featuring almost 100 indicators disaggregated by Aboriginality.
HealthStats NSW is a tool for exploring changes in data based on demographic and geographic characteristics in an interactive way. Users can view and download data and select indicators to produce tailored reports that provide insights into a wide range of health determinants and outcomes.
The NSW Health Aboriginal Dashboard for Local Health Districts and Specialty Health Networks (LHDs/SHNs) provides a snapshot of measures that reflect the response of LHDs/SHNs to the needs of local Aboriginal communities. Areas of progress and suggested areas of improvement for twenty measures are presented, based on a comparison of the two most recent years of data for Aboriginal and non-Aboriginal populations for each LHD and statewide, with selected measures presented in time series charts over 7 years. The Dashboard is shared with the AH&MRC of NSW, and individual ACCHSs to drive improved performance on measures of access and equity, as well as collaborative efforts to improve Aboriginal health outcomes.
NSW Health has a strong commitment to working with and supporting Aboriginal people and communities. This includes working with Aboriginal owned businesses to grow the First Economy of NSW.
The NSW Health Aboriginal Procurement Participation Strategy was published in March 2022. The Strategy sets priorities for NSW Health to support the objectives of the NSW Aboriginal Procurement Policy, as well as a focus on specific Aboriginal health improvement targets, the NSW State Health Plan, and the Aboriginal Workforce Strategy.
The NSW Health Aboriginal Procurement Participation Strategy sets three key priorities:
These efforts will continue to support Aboriginal people and communities to enhance their economic prosperity now and into the future.
In recent years, the Mid North Coast LHD has implemented a number of strategies to increase employment of Aboriginal staff.
Key actions have included implementing employment strategies and frameworks to accelerate appointment of Aboriginal people. These have included:
Numerous engagement and retention strategies have also been used to create a sense of belonging and community for Aboriginal employees. These have included:
The LHD has also developed an Aboriginal Health Worker/Practitioner Framework to support greater clinical employment opportunities for Aboriginal people, with an equal focus on clinical and cultural supervision.
Having met their Aboriginal workforce stretch-target in 2019, the LHD’s Aboriginal workforce has consistently been higher than the statewide average171.
The LHD attribute their successful scale-up of Aboriginal recruitment to the early establishment of ambitious Aboriginal employment KPIs, continuous messaging about the importance of recruiting and retaining Aboriginal employees, and strong support from Executive Champions.
The Towards Zero Suicides in Custody program supports the statewide suicide prevention health initiative. The program is tailored to be effective and accessible for people in adult correctional settings.
The Aboriginal adult prison population experiences higher rates of self-harm and attempted suicide. One in four deaths in custody are unnatural (suicide or self- inflicted causes). In addition, patients generally have little contact with health services in the community.
The program was created to address this need, and features layered interventions to create a suicide prevention safety net.
Implementation began in the middle of 2022 and is underpinned by five key themes. These themes are then broken down into 14 separate interventions that targets patients, staff, and stakeholders.
One intervention, the Suicide Prevention Outreach Team, has received over 100 referrals since February 2023. This supports safety planning with at-risk patients.
In collaboration with Healing Works, they have developed a video series called, ‘Supporting Mob in Custody’, which targets families and carers who have an incarcerated loved one by providing support for their mental health needs.
This sophisticated approach to suicide prevention increases the accessibility of health services and effectively targets at-risk patients.
The BreastScreen services delivered by the Mid North Coast Local Health District work with local ACCHSs and the Primary Health Network (PHN) to identify and implement strategies to increase the number of Aboriginal women aged 50 -74 years access the screening program.
Training and education are provided to staff who work with ACCHSs and PHNs, focussing primarily on the importance of regular screening. This ensures Aboriginal women can access timely and accurate information about the program to make informed decisions about screening.
The effective strategies to support improved participation in the program include:
These efforts have proven to be successful in increasing participation rates.
Approximately 18% of Aboriginal people residing in the South Western Sydney Local Health District (SWSLHD) catchment live in social housing, with many having complex health needs exacerbated by their sub-optimal living conditions.
The LHD’s Aboriginal Health Service, and the Department of Communities and Justice (DCJ) Housing Team established the Aboriginal Health Escalated Housing Pathway to address this.
The pathway initiative is a coordinated approach to support clients, whose social housing issues were making their health, safety or social and emotional wellbeing worse.
Once clients have been identified, the LHD staff work with the DCJ Housing Team, to ensure clients receive expedited interventions to resolve their housing issues.
Some of the more common issues addressed through the pathway initiative have included:
The initiative is also able to make priority referrals for clients to complementary services as needed.
Staff from the Aboriginal Health Service and DCJ meet regularly to review progress of their clients with complex needs and determine coordinated responses to address health and housing concerns.
Executive sponsorship of the Pathway program is provided by the District Director for Housing, while the Director, Aboriginal Health at the LHD ensures timely interventions are actioned through to completion.
The pathway has been a great success, enabling more than 100 clients with complex needs to have their housing issues resolved, supporting improved health outcomes.
The Aboriginal Patient Experience Survey Program Advisory Committee, established to oversee the program of work which oversampled all adult admitted and maternity patients in 2019, highlighted the limitations of survey quantitative data for describing Aboriginal patients’ experiences of care and requested a nested interview study be conducted to explore experience and cultural safety in more depth.
The Aboriginal Patient Experience Survey explores the experiences and cultural safety of admitted and maternity patients in depth. CAH and CEE collaborated with the Sax Institute to manage and implement the project, and the Advisory Committee, which included broad representation from the Aboriginal community, was involved in all aspects of the study design.
The study investigated patients’ perceptions of the quality and safety of their care and how it impacts their health, including help-seeking and self-management behaviours. It also looked at experiences of reporting discrimination and receiving support, as well as views on the facility’s response to the issue.
The study involved 20–25 general admitted patients and 20–25 maternity patients from three LHDs and four ACCHSs, who were interviewed by Aboriginal Hospital Liaison Officers and Aboriginal Health Workers using yarning guides to conduct semi-structured interviews. ACCHS staff also participated in focus groups.
The findings will be analysed alongside the NSW Adult Admitted Patient Survey and a literature review to inform improvements in hospital services to better meet the needs of Aboriginal patients.