The journey of Aboriginal children and their families throughout the NCHN
Ensuring the on-going provision of high quality, culturally appropriate services to Aboriginal children and their families as part of our core business is a high priority for the NCHN. This priority is supported by the Aboriginal Health Services Plans for both NC and HNE Health Services.
This project aims to facilitate the patient journey through primary, secondary and tertiary levels of care in order to prevent chronic and complex health issues.
The project targets Aboriginal children and their families/carers, traveling away from home to receive care from HNE and NC Area Health service (AHS). The scope is:
- from the point of a decision to care for locally or transfer into a higher level of care in the NCHN Health, through to
- the child is discharged, either directly into the community, or when the care is handed to another health or community care provider at the end of the episode of care.
The project will involve identifying a small number, possibly two receiving sites (higher levels of care) within each AHS (total of four). The sites chosen will reflect the points where the highest number of inflows of Aboriginal children to a secondary or tertiary facility occurs.
Site selection will occur after analysing current data during the first stage of the project. In addition, a number of sites with high numbers of Aboriginal children and families being referred for higher-level care will also be selected across the two AHS.
While the project will focus on the nominated sites, the successful solutions will be rolled out to cover the remaining parts of both Areas. This will come with the challenges arising from the differences in the complexity and the range and nature of issues arising from the diversity of the communities in the Area.
Aims and objectives
When the project commenced the objectives were reviewed and reworded as follows:
- Confirm what constitutes a culturally appropriate health service for Aboriginal children and their families.
- Explore communication between hospital staff and Aboriginal children and their families.
- Identify the level of involvement of Aboriginal children and their families have in health care and discharge planning.
- Identify what support and assistance is required for Aboriginal families when their child’s health care is transferred to a service outside their local community, in particular, travel, accommodation and social support arrangements.
- Build on existing initiatives so that the best possible and culturally appropriate supports are accessible to Aboriginal families when their child’s health care is transferred to a service outside their local community.
- Provide cultural knowledge to children’s health planning to ensure improved health experiences and outcomes for Aboriginal children.
In addition, the following Measurable Benefits were identified:
- Improved Aboriginal child and their families’ satisfaction with public hospital experiences. Explore the possibility of measuring this via the NSW Health Patient Survey, provided sample sizes are sufficient. Otherwise alternative measures will be explored.
- Increased percentage of Aboriginal families accessing the transport, accommodation and social support arrangements that are available when a child’s health care is transferred to a service outside their local community.
- All children’s health policy documents to include cultural aspects relevant to improved health outcomes for Aboriginal children.
Expected outcomes
Currently, after a decision is made to transfer from a smaller facility to a larger one, Aboriginal children often face isolation from family and friends, thereby compromising their cultural environment in a way that hampers the patient and family health experience and outcomes.This project aims to better understand the journey for the Aboriginal child and their family in this situation. The goal is to improve the patient and family experience by ensuring continued access to culturally appropriate health care for Aboriginal people, by redesigning the supporting infrastructure in a way that will lead to improvements in health outcomes.
Other expected outcomes include:
- A redesigned, more consistent child and their family/carer journey that recognises the difference in the geography, isolation, workforce and the range of service models across the NCHN.
- Better negotiation of the patient journey and support for children and their families who need specialist intervention in a health facility away from home and family/community.
- Better informed AHS policy and planning to better meet the needs of Aboriginal children and their families.
- Greater participation by the child and their family in the planning for all aspects of care prior to transfer to higher and lower levels of care
- Greater involvement by the mainstream discharge planners and the Aboriginal Liaison Officers and all other relevant care providers in the implementation of the care plan prior to and follow-up post discharge
- A re-orientation of mainstream health staff, leading to a greater understanding of how best to meet the needs of Aboriginal people
- An improved use of ‘prevention of relapse planning’ in the community setting, and
- Wider access to appropriate accommodation and social supports, and culturally appropriate care.
Progress against key performance indicators
The success of the project will be measured by:
- Evidence of review of health services for Aboriginal children.
- Building on the extensive consultation and existing initiatives from recent Aboriginal Health plans and projects.
- Interviews with 18 families who had their child transferred to a higher level of care in the last 12 months.
- Interviews, workshops and focus groups with staff from acute and community networks and Aboriginal Medical Services conducted.
- Completion of Diagnostic, Solution, and Implementation Report
- Evidence of planning and policy development within the AHS in direct
relationship with the results of the project.
- Identification of 22 recommended solutions that address the need to improve cultural competence of staff, collaboration within and across services, culturally appropriate support for travel, enhanced physical environment, data collection, and discharge planning.
- Regular Local Leadership/Implementation meetings continue for follow-up in the implementation process.
- Action Plans in both area health services have been developed to implement the solutions
- A Brief has been prepared and submitted to the Transport Review Committee in direct relation to the findings of this project.
- The findings of this project have been noted in the Aboriginal Hospital Liaison Officer HNE Health draft Review and Recommendations.
- North Coast Area Health Service has established an In-service Collaboration Meeting to build stronger collaborative relationships and communication protocol between paediatric health services, Aboriginal Health workers and key stakeholders including Aboriginal Medical Services. A major role of this meeting will be to continue implementing solutions from the North Coast Area Health Service action plan.
- North Coast Area Health Service has established the Aboriginal Hospital Liaison Officer network forum with first meeting held on 1 June 2009. AHLO's supported having their own network forum. Draft terms of reference are being developed. There is strong sponsorship for the initiative from the Executive Director of Population Health and Planning.
- NCAHS have made Aboriginality a mandatory field in the Electronic Medical Record.
- NCAHS in the process of developing “GP” field as mandatory [with flag] when not filled in to check with consent from family where they would like discharge summary sent e.g. Aboriginal Health worker or AMS, to ensure follow up of child patients.
- The need for two full time Implementation Officers, one Aboriginal or Torres Strait Islander and one non Aboriginal has been agreed upon by the HNE Steering committee to model the partnership concept while continuing to assist with implementation of the identified solutions.
- The position for an Aboriginal/Torres Strait Islander Implementation Officer has been advertised.
- Evidence of follow-up on health issues identified through the patient
journey.
- HNE IPTAAS trial commenced until the end of the financial year to allow Aboriginal families otherwise eligible for IPTAAS to have two escorts covered for travel & accommodation costs on cultural grounds rather than medical grounds.
- A flow chart is being developed by Transport for Health in NCAHS to provide clear information for staff on transport routes available around the Lismore area for patient discharge.
- NCAHS working group for Cultural Awareness training has been established. In-Service Collaboration meeting is following up to ensure training will be rolled out to all NCAH staff.
- All executive staff from CYP&F CN HNE Health & key clinicians have attended Cultural Respect training (June 2009).
- NCAHS brochure of information on contacts for Aboriginal families has been developed soon to be distributed.
- NCAHS Directory of Services for Aboriginal families developed and soon to be distributed.
- NCAHS have purchased Aboriginal art work and posters for Casino and Lismore Base Hospitals.
- “Speak UP” posters ordered and received in NCAHS, HNE Aboriginal Health designing HNE specific posters for display in health facilities to encourage reporting of Aboriginality to improve data collection.
- Culturally appropriate information included in the “Childrens Unplanned Admission Booklet” to improve discharge planning.
Discussion
- The project scope for the two AHS differed in the distance between project sites for each AHS. As a result some of the solutions for each area differ. One such solution is the IPTAAS trial for HNE Health which was not relevant for NCAHS due to the project sites being situated within the minimum range for IPTAAS eligibility. Whilst residents from NCAHS do need to travel for higher levels of health care many residents travel to Queensland rather than JHCH. The decision not to include any facility outside the AHS was made due to the inability to influence any change in such a site.
- In order to capture the impact that distance has on families needing to have their child transferred to a higher level of care HNE Health’s project sites were selected accordingly and as a result are four hours by road apart which while challenging for the project officer to maintain consistent momentum across the three sites has provided valuable information.
- Cultural change requires broad and ongoing consultation to build relationships and trust;
- Building cultural safety for Aboriginal communities in health facilities requires a high level of flexibility in timeframes and a clear process with strong collaboration in a partnership model;
- To ensure greater ease of communication and implementation of solutions of the project, two local teams, a leadership team to advise and an implementation team to follow through with solutions need to be established.
- Clinical Redesign methodology presented challenges particularly around timeframes when working with Aboriginal communities and across two area health services.