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Session H5: Addressing health needs: identifying community role and developing community partnerships

1. Raelene Lesniowska: Improving health care for Aboriginal and Torres Strait Islander patients (ICAP Program)

Full paper | Audio | Video | Slideshow pdf 621KB

Abstract

Despite widespread availability of mainstream urban health services, these are grossly underutilised by Aboriginal people. Additionally, urban Aboriginal dwellers, like their remote neighbours, continue to experience poorer health and lower life expectancy than non-Indigenous Australians. The lower ‘visibility’ of Aboriginal people in some urban health settings falsely negates the existence of an Aboriginal community there. For this and other reasons, under-identification of Aboriginal and Torres Strait Islander patients continues to hamper the provision of culturally appropriate health care.When Aboriginal people do access mainstream services, it’s often not until their health is in crisis. There may also be a range of factors specific to urban settings contributing to their ill health. Health service provision can contribute up to 70 per cent to Closing the Gap between Indigenous and non-Indigenous life expectancy. Yet, the health system is not geared to the needs of Aboriginal people. What’s more, Aboriginal people don’t systematically receive the levels of care that clinical pathways recommend.In 2004, the Victorian Government introduced the Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program to improve identification of and culturally appropriate care for Aboriginal patients in Victorian health services. ICAP encourages:
• Whole of health service responsibility for Aboriginal health care
• Relationships with Aboriginal people and organisations
• Staff cultural awareness
• Culturally appropriate discharge planning and referrals

The ICAP reform has achieved a number of inspiring outcomes. This presentation captures some of these successes and demonstrates how, against a backdrop of colonisation, dispossession, racism and socio-economic disadvantage, substantial in-roads can be made towards improving mainstream healthcare for Aboriginal and Torres Strait Islander patients in urban (and rural) settings.

Author bio:

My background includes 18 years working in health promotion, policy and projects; in the UK, local government (Melbourne) and the Victorian Department of Human Services (DHS).  My strong passion about Aboriginal health began in 2004, while managing the development of a state-wide residential Alcohol and Drug Healing Service for Koori young people.  I was appointed to the ICAP Program in 2008.  My position is auspiced by St Vincent’s Hospital, Melbourne and involves supporting 15 Melbourne hospitals to implement the DHS funded Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program.  I also work in partnership with two other ICAP Project Officers to implement ICAP across Victoria; one based at DHS and one at the Victorian Aboriginal Community Controlled Health Organisation (VACCHO).  Together we participate in a wide range of ICAP initiatives that encourage whole of health service responsibility for and culturally appropriate responses to Aboriginal health care needs. 

2. M. Kilcullen, A. Swinbourne & Y.  Cadet-James:  Factors affecting resilience of Aboriginal and Torres Strait Islander grandmothers raising their grandchildren

Full paper pdf (104Kb) | Audio | Video | Slideshow pdf 34KB

Abstract

The poorer health of Aboriginal and Torres Strait Islanders is well documented across physical, social, and mental health. In amongst the heath statistics however, there is an almost invisible yet resilient group. A grandparent raising their grandchildren is not a new phenomenon in this community. However the factors contributing to the children coming to their care has changed over the past decades. Historically, the parents continued to be a part of their children’s lives when children were in grandparental care. Currently this is less likely to be the case, leaving grandmothers to raise the children without parental support. Grandmothers in rural and remote areas have reported negative social pressures that have affected their psychological and social functioning in their roles as primary carer. The grandmothers who are raising their grandchildren are in effect addressing and interrupting the intergenerational transfer of trauma and distress. It is therefore critical to support the grannies who take up this important role. As the majority of research is conducted in rural or remote areas it is also important to describe the experiences of urban grandmothers. The current study aimed to identify urban grandmothers who had found a way to successfully navigate through the reported negative experiences and continue to functioning positively. The current study utilised a positive psychology framework in order to identify the strengths that promote resilience of urban Indigenous grandmothers who are raising, or have raised their grandchildren. Seven grandmothers who identified as Aboriginal and/or Torres Strait Islander participated in qualitative interviews of approximately one-hour duration. Analysis was conducted using a grounded theory method. Grandmothers described several psychosocial factors providing strength and enhancing their resilience while raising their grandchildren. Sociocultural factors included developing and maintaining social networks, maintaining traditional kinship structure, participating in traditional adoption, employment, and religion. Psychological factors included acceptance of life situations, self-reliance, being facilitators of family healing, implementing problem-solving skills, and flexibility of responses. As these older Indigenous women provide a link between generations through their connectedness to traditional knowledge and support mechanisms, supporting these women is crucial to the improvement of the health and well-being of the Indigenous community by the growing up of ‘healthier’ children.

Author bios

Meegan Kilcullen: I am a PhD student at James Cook University in Townsville, Australia where I completed my undergraduate degree in Psychology. In my Honours year I completed a research project in conjunction with the supervisors of the PhD research, Dr Anne Swinbourne and Professor Yvonne Cadet-James, a Gugu-Badhun woman. The Honours project qualitatively explored factors affecting resilience of Australian Aboriginal and Torres Strait Islander grandmothers who were raising their grandchildren. These projects have been conducted within a positive psychology framework that retains a holistic view of mental health. My PhD extends my interest in Indigenous understandings of mental health and their relationship to everyday functioning.

3. Karen Adams: Urban Indigenous people and Type II diabetes prevention – a case study

Full paper | Audio | Video | Slideshow pdf 3MB

Abstract

This paper will discuss novel and creative ways in which urban Indigenous communities, in partnership with researchers, have intervened to prevent Type II diabetes. How these findings can be applied in Victoria, Australia with the western metropolitan Melbourne Aboriginal and Torres Strait Islander context will be explored.

Type II diabetes has become a leading cause of morbidity and mortality for Indigenous people worldwide. Complications from the chronic condition occur at a higher rate for Indigenous people resulting in significant disability and reduced life expectancy. Type II diabetes is largely preventable. Modest weight reductions from changes to nutrition and physical activity practices can delay markedly the onset of Type II diabetes or prevent it completely. Internationally around 50% of Indigenous people live in urban settings. These settings have impact on exposure to diabetes risk factors and accessibility to preventative services. Implementing and evaluating preventative diabetes interventions with this population has proven to be a challenge internationally. This is because remote and rural populations often have an easier to identify group of people within a geographic area. In urban settings the population is more likely to be scattered across a broader mass with occasional densities occurring. In western metropolitan Melbourne the population has a particular pattern.

An international systematic review was conducted on Type II diabetes prevention. Interventions with urban populations were isolated and analysed for participant recruitment, intervention and evaluation methods. A profile of the western metropolitan Aboriginal and Torres Strait Islander population was collated using census data, Victorian Government data and client usage patterns at the Western Suburbs Indigenous Gathering Place (Aboriginal Community Controlled Health Organisation). Population patterns and implications for diabetes prevention were described. An exploration is offered of the types of preventative interventions relevant for the western metropolitan Melbourne Aboriginal and Torres Strait Islander population.