PHAA National Social Inclusion and Complex Needs Conference

Working together to achieve better outcomes for people and communities

Program & Abstract Book

Hotel Realm, Canberra, 15-16 April 2013

Public Health Association AUSTRALIA © 2013 Public Health Association of Australia Inc.

PO Box 319 Curtin ACT 2605 Ph (02) 6285 2373 Fax (02) 6282 5438 Email: [email protected] Website: http://www.phaa.net.au

ISBN: 978-0-9871816-2-6

ABN 41 062 894 473 Content

Conference Welcome...... 5

About PHAA...... 7

Sponsors...... 8

Exhibitors...... 8

Program Information...... 8

Conference Floor Plan...... 9

Conference Program...... 11

Invited Speakers...... 18

Abstracts in Program Order...... 21

Poster Abstracts...... 76

Index of Presenters...... 84

Due to circumstances beyond our control changes may occur to this program

This conference received funding from the Australian Government

Welcome

The Public Health Association of Australia (PHAA) welcomes you to the first Australian conference to showcase successful programs/approaches in addressing complex needs and social determinants of health - with the broader purpose of identifying what works and how.

It has long been acknowledged that people with complex needs often fall through the cracks in service delivery – between national and jurisdictional service delivery, between government and non-government services, and between services delivered by different portfolio agencies. This conference seeks to identify and showcase successful collaborative efforts in service delivery, with a view to informing whole-of-government approaches to policy and program development.

We note that the Australian Government’s Social Inclusion Agenda has acknowledged this as an area of need and is working toward reforming the delivery of Government services to improve outcomes for people with complex needs.

The conference will be an excellent opportunity to hear the most recent research and practitioner wisdom with a view to breaking down structural and systemic barriers to achieving better health and social outcomes for people with complex needs. With noted national experts from both government and non-government sectors showcasing their work, the conference aims to shed new light and consider current evidence about issues relevant to, and the challenges in seeking to, achieve better outcomes for people with complex needs in the Australian community.

Plenary speakers at the conference include: The Hon Mark Butler MP, Minister for Social Inclusion, Mental Health, Housing & Homelessness Lin Hatfield Dodds, Chair, Australian Social Inclusion Board Robert Tickner, CEO, Australian Red Cross Dr Christine Boyce RACGP, National Faculty of Special Interests Board, Refugee Health Network Dr Tom Calma AO, ACT Australian of the Year 2013 Robyn Kruk AM, CEO, National Mental Health Commission

A panel session will round off the speaker program with noted national identities participating in a moderated discussion with other panellists and the audience on Breaking down structural and systemic barriers to achieving better outcomes for people with complex needs.

A draft Conference Declaration has been circulated to attendees with a view to using the conference as a springboard to progress a collaborative and ongoing agenda/program of engagement and advocacy to break down structural and systemic barriers to the development and implementation of comprehensive, multifaceted, cross- sectoral approaches to achieving better health and social outcomes for people with complex needs. It is envisaged that the Conference Declaration will provide a platform for future advocacy and action by participants and their respective organisations.

Welcome to the conference which we hope you will find both informative and stimulating. We are confident that the wide range of attendees with expertise in matters pertinent to improving outcomes for people with complex needs will lay the groundwork for a successful event and provide a strong framework for continued action on these important issues.

Conference Committee

Melanie Walker (Deputy CEO, Public Health Association of Australia) David Templeman (CEO, Alcohol and other Drugs Council of Australia) Dr Mark Wenitong (Aboriginal Public Health Medical Officer, National Aboriginal Community Controlled Health Organisation) Jennifer Evans (National Coordinator Families, Children & Food Security, Australian Red Cross)

5 Register at the conference!

There’s a new way for you to connect all of the doctors and nurses involved in your healthcare – wherever you are in Australia.

It’s called the eHealth record system.

Up until now every clinic or hospital you have visited has maintained a separate record of your health.

Now, with an eHealth record, you can supplement these fi les by linking key information about you.

So no matter where you are in Australia – or which doctor How to register or specialist you visit – a secure online summary of your • Online at www.ehealth.gov.au healthcare information will be available 24/7 to assist in • By calling the national eHealth your diagnosis and treatment. Helpline on 1800 723 471 Best of all it’s free and it’s available now. • In person at Medicare Australia About PHAA

Our Association forms multiple roles in capacity building, as a forum for the promotion of the public health and as a professional resource for public health personnel. The PHAA provides opportunities for the exchange of ideas, knowledge and information on public health and actively undertakes advocacy for public health policy, development, research and training. The PHAA is a non-party political organisation.

The PHAA has a national and multi-disciplinary perspective on public health issues. In addition to the advocacy and capacity building role, makes a major contribution to the public health debate in Australia through representation on government boards, committees and other decision-making bodies such as the National Health and Medical Research Council and the Australian Preventative Heath Taskforce. PHAA members are also representatives on many State and Territory committees contributing to a broad spectrum of public health issues.

Membership forms can be downloaded from the PHAA website at www.phaa.net.au, or are available on request from the PHAA Secretariat, email: [email protected] Phone: (02) 6285 2373, Fax: (02) 6282 5438, Post: PO Box 319 CURTIN ACT 2605

Conference Secretariat

Michael Moore - Chief Executive Officer Melanie Walker - Deputy Chief Executive Officer Eve Brighty - Memberhip Coordinator Julie Woollacott - National Conference Manager Janine Turnbull - Conference & Marketing Coordinator Vicki Thompson - Publications Coordinator

Audio Visual Producer - Frank Meany, One Vision PTY LTD

Abstract Reviewers

The following reviewers generously gave their time and expertise in reviewing the abstracts submitted for presentation at the Conference.

Tessa Boyd-Cain Fiona Clay Meredythe Crane Anna Greenwood Stella Conroy John Didlick Annette Dobson Michael Doyle Jaya Earnest Jennifer Evans Marisa Gilles Jill Guthrie Gwyn Jolley Nicole Lawder Angela Lawless Thomas McMahon Kyoko Miura Christine Morris Elisha Riggs Rosalie Schultz Michael Smith Heather Volk Scholarship Assessment Panel

The following people generously gave their time and expertise in assessing the scholarship applications for the Conference.

Patsy Bourke Meredythe Crane John Didlick Colin MacDougall Russell McGowan Bruce Simmons David Templeman Rachel Tham Heather Volk Ian White

7 Sponsors

Exhibitors ACT Government Australian Institute of Health and Welfare Calvary eHealth Public Health Association of Australia Ruah Community Services

Program Information

Poster Session and Networking function with Refreshments (Monday 5.30-6.30 pm) The Poster session and Networking function will be held in the Gallery

Sessions Please note the bell will ring 5 minutes prior to the beginning of a session

Meals Your conference registration includes morning tea, lunch and afternoon tea. These refreshments will be served in The Gallery. If you have requested a special meal, please make yourself know to the Catering Staff.

Copies of conference papers No conference proceedings will be produced. Conference papers are availble at the discretion of presenters and delegates are asked to contact speakers directly in order to obtain copies.

Parking Parking is available under the Realm Hotel for $15 per day.

8 Hotel Realm Floor Map

HIGH COuRT ya RD

14350

SOUTH NORTH HIGH COURT YARD COVERED HIGH COURT YARD OUTDOOR AREA

2075 LENGTH 11050 MM 2075 2075 LENGTH 14700 MM 2075 2025 8700 WIDTH 5600 MM CEILING HEIGHT 3000 MM WIDTH 5600 MM HEIGHT 5000 MM HEIGHT 5000 MM

NaTIONal BallROOM

46660

7215 16085 16085 7215

NATIONAL NATIONAL NATIONAL NATIONAL 17175 BALLROOM BALLROOM BALLROOM BALLROOM 17175 ONE TWO THREE FOUR

1590 1590 1590 1590

ENTRY ENTRY

2320 2320

THE GALLERY

SYDNEY MELBOURNE ROOM ROOM PRE-FUNCTION AREA PRE-FUNCTION AREA

BAR BAR

9 The ACT Government is commi� ed to a Social Inclusion agenda and suppor� ng individuals and families with complex needs. Mul� ple ini� a� ves from across the ACT Government Directorates have been designed to address the social determinants of health and wellbeing. Some of the ini� a� ves include; • A model of Throughcare has been introduced to case management services at the Alexander Maconochie Centre. An extended Throughcare model is cri� cal to suppor� ng the successful reintegra� on of off enders a� er release from prison, thereby seeking to reduce re-off ending. • The ACT Government provides funding for the award-winning Open Art Program operated by the Belconnen Community Services at several loca� ons across the ACT. The Program is inclusive and is open to people who have good mental health as well as those experiencing mental health issues. Running integrated classes helps to educate the community, reduce isola� on and break down s� gmas around mental health. • The ACT Mental Health Consumer Scholarship Scheme is designed to support mental health consumers to study in the human services area, and to increase employment opportuni� es. There is an immense value off ered by persons with an experience of mental illness. The ACT Government Health Directorate provides funding to the Canberra Ins� tute of Technology to deliver the course in a suppor� ve environment. • The ACT Government has a Social Procurement Policy for the purchasing of goods and services across the territory. The policy encourages purchasing of goods and services from organisa� ons who are able to demonstrate social value in their service provision. • The ACT Government Territory and Municipal Services Directorate demonstrates an ongoing commitment to improving the health and wellbeing of the Canberra community by addressing social determinants and social inclusion. The Directorate reports annually on its implementa� on of the Territory’s mental health promo� on, preven� on and early interven� on framework Building a Strong Founda� on: A Framework for Promo� ng Mental Health and Wellbeing in the ACT 2009-2014.

For further informa� on visit the ACT Government website www.act.gov.au Conference Program Day 1 Monday

7.30 - 8.30 Registration (The Gallery)

8.30 - 10.30 Welcome by Michael Moore, Public Health Association of Australia CEO and Welcome to Country by Aunty Agnes Shea (Ballroom 2)

Plenary 1 - Chair: Michael Moore, Public Health Association of Australia CEO

Speaker 1 Update on the work of the Australian Social Inclusion Board - Lin Hatfield Dodds, Chair of the Australian Social Inclusion Board Speaker 2 From Little Things Big Things Grow - Robert Tickner, CEO Australian Red Cross

Address by The Hon Mark Butler MP, Minister for Social Inclusion, Mental Health, Housing & Homelessness

10.30 - 11.00 Morning tea (The Gallery)

11.00 - 12.30 Concurrent Sessions 1

Justice and Complex Needs (Ballroom 1) Chair: Alison Churchill 11.00 – 11.15 A managed alcohol program for Sydney’s homeless - Carolyn Day 11.15 - 11.30 Why mental impairment legislation leads to indefinite detention - Patrick McGee 11.30 – 11.45 Patterns of injecting drug use among adult prisoners with intellectual disability - Kate van Dooren 11.45 – 12.00 Criminalising disability: pathways into the criminal justice system for people with complex needs - Eileen Baldry 12.00 – 12.15 The legal contours of community forensic disability service provision - Linda Steele 12.15 – 12.30 Innovation in Addressing Social Disadvantage through Medicare Locals - Jennie Roe

Breaking down structural and systemic barriers 1 (Ballroom 2) Chair: Michael Moore 11.00 - 11.15 Women with Cognitive Impairment and Unplanned Pregnancy – Opening the Door to Access, Options and Rights - Annarella Hardiman 11.15 - 11.30 The Ask Project: a health intervention for adolescents with intellectual disability - Lyn McPherson 11.30 – 11.45 Supporting ageing-in-place for people with intellectual disability: A rural and metropolitan comparison - Rafat Hussain 11.45 – 12.00 Views of a walking and social support program for people with intellectual disability - Katie Brooker 12.00 – 12.15 Ethical, policy and legal challenges in supporting people on Community Treatment Orders - Lisa Brophy 12.15 – 12.30 Communication is still the key – When mental health service providers achieve an appropriate system of care for Deaf clients - Francine Hanley

Collaborative Mental Health and Alcohol and Other Drug service delivery 1 (Ballroom 3) Chair: David Templeman 11.00 - 11.15 Enhancing inclusive practice in a specialised setting through Dual Diagnosis - Andrew O’Sullivan 11.15 - 11.30 Collaborative approaches to addressing the complex needs of women with post traumatic stress disorder and substance use disorder - Angela Dawson 11.30 - 11.45 Drug and alcohol management for pregnant incarcerated women - Jill Roberts 11.45 - 12.00 Smoke-free Policy in a Mental Health Inpatient Facility: patient and staff experience - Angela Hehir 12.00 - 12.15 Continuity of care for young people leaving custody - Julie Carter & Jeanette Toole 12.15 - 12.30 Connections: removing obstacles to achieve positive outcomes - Sandra Sunjic & Stephen Ward

11 Conference Program

Aboriginal and Torres Strait Islander services 1 (Ballroom 4) Chair: Vanessa Lee 11.00 - 11.15 Antenatal Emotional Wellbeing Screening in Aboriginal and Torres Strait Islander PHC Services in Australia - Kaniz Gausia 11.15 - 11.30 Sistergirls – an Ethical Challenge for Health Professionals - Crystal Tierney 11.30 - 11.45 Passageway to better health for Aboriginal children from birth to 2 years - Vanessa Clift & Jeanette King 11.45 - 12.00 Aboriginal Youth no longer forgotten – the “Y Health – Staying Deadly” Project Annapurna Nori & Rebecca Piovesan 12.00 - 12.15 ‘Yarning about hepatitis C’ DVD – A collaborative community based approach - Peter Waples-Crowe & Ronald Briggs 12.15 - 12.30 Improving sexual health education for Aboriginal young offenders - Kerri Masters

Family, Housing and Community Services (High Courtyard North) Chair: Clint Ferndale 11.00 - 11.15 ARC in Partnership: strengthening support to families - Donna Ribton-Turner & Heather Pickard 11.15 - 11.30 Children, Policy and Cultural shifts in homelessness services in South Australia - Yvonne Parry & Lynette Burke 11.30 - 11.45 Coming Home Program; Social Inclusion Calender and other activities - Sheila Ligo & Kirsty McIntyre-Smith 11.45 - 12.00 Social housing relocation and chronic disease in South Western Sydney: A Health Impact Assessment - Belinda Crawford 12.00 - 12.15 “We make our voyage better”: an organization-wide approach to inclusive service development - Sarah Pollock & Ann Taket 12.15 – 12.30 Prison is different: Innovative approaches to disease awareness and prevention education - Joanne Smith

12.30 - 2.00 Lunch (The Gallery)

2.00 - 3.30 Concurrent Sessions 2

Prevention and social determinants of health 1 (Ballroom 1) Chair: Warren Lindberg 2.00 - 2.15 Everyone, Everyday Disability Awareness Program - Megan Campbell & Maureen Howe 2.15 - 2.30 Piloting a community kitchen initiative for residents of unlicensed boarding houses in Sydney - Brooke Dailey 2.30 - 2.45 Predicting social exclusion and housing instability in women over 45 - Erin Whittle 2.45 - 3.00 EFHIA to assess impact of HealthStreet on social determinants of health - Kay Wilhelm 3.00 - 3.15 Supporting Smoking Cessation in High Priority Populations - David Lester 3.15 - 3.30 Improving the physical Health of people with a mental illness is Sunbury - Bernadette Hetherington

Breaking down structural and systemic barriers 2 (Ballroom 2) Chair: John Didlick 2.00 - 2.15 Improving communication and coordination in Aboriginal patient journeys; co-developing effective mapping tools - Janet Kelly & Sharon Perkins 2.15 - 2.30 The Kanyini’ Qualitative Study: Unpacking the structural and systemic health care barriers - Ricky Mentha 2.30 - 2.45 Breaking down barriers: A partnership to improve ear health for Aboriginal children - Sue Hedges & Stella Artuso 2.45 - 3.00 Reducing intergenerational disadvantage through a life-first employment program: Individual and systems approaches - Katy Osborne 3.00 - 3.15 Breaking the barriers to providing hepatitis C treatment in prison - Denise Monkley 3.15 - 3.30 Post-Release Support with high risk, complex needs ex-prisoner populations: What works? - Mindy Sotiri

12 CONFERENCE PROGRAM

Collaborative Mental Health and Alcohol and Other Drug service delivery 2 (Ballroom 3) Chair: Michael Smith 2.00 – 2.15 Blood, Sweat and Tears: Building interagency and intersectoral relationships in mental health - Elizabeth Jewson 2.15 - 2.30 Creating an integrated primary mental health platform - Melissa O’Shea & Kate Barlow 2.30 - 2.45 S-Check: a new early intervention for stimulant use - Nadine Ezard 2.45 - 3.00 Wrong way, go back: diverting young people from custody - Anna Curtis 3.00 - 3.15 The Sydney Medically Supervised Injecting Centre (MSIC) Mental Health Nurse Co-ordinator project - Mark Goodhew & Jennifer Holmes 3.15 - 3.30 Is there any more complex need than being an illicit drug-using mother? - Stephanie Taplin

Aboriginal and Torres Strait Islander services 2 (Ballroom 4) Chair: Peter Waples-Crowe 2.00 - 2.15 Walking in the Worlds of the Aboriginal Maternal Infant Care Workers - Renae Kirkham & Caroline Dalgetty 2.15 - 2.30 Driver licensing is a health issue: the Young Health Program - Maydina Penrith & Jake Byrne 2.30 - 2.45 Assessing Partnerships to Address Aboriginal Disadvantage - Sandra Thompson 2.45 - 3.00 Clinical engagement as a tool for improving outcomes for Aboriginal patients - Jane Cussen 3.00 - 3.15 Chronic Care Coordination by Indigenous Health Workers - A solution for better care? - Barbara Schmidt & Frank Hollingsworth 3.15 - 3.30 Winnunga Nimmityjah Aboriginal Health Service Holistic Model of Healthcare - Julie Tongs

Health Promotion (High Courtyard North) Chair: Heather Yeatman 2.00 - 2.15 Using social enterprise to address food security - Benjamin Chahola 2.15 - 2.30 Improving the quality and nutrition of community food programs: a needs assessment - Leanna Helquist 2.30 - 2.45 Building stronger linkages between Emergency Food Relief providers to improve current services - Rebecca Ramsey 2.45 - 3.00 From theory to practical action: building capacity for food security - Alice Wood & Sue Gordon 3.00 - 3.15 Partnership Development - Key Success Ingredient to Promote Healthy Lifestyles in Disadvantaged Populations - Lynne Prentice 3.15 - 3.30 Building young people’s mental health literacy through online spaces - Shane Cucow & Ali Hodson

3.30 - 4.00 Afternoon tea (The Gallery)

4.00 - 5.30 Concurrent Sessions 3

Prevention and social determinants of Health 2 (Ballroom 1) Chair: Leanne Wells 4.00 - 4.15 Strength in Diversity: Building a healthy sex and gender diverse community - Peter Hyndal 4.15 - 4.30 Sex Worker Awareness Training: Myth-busting with role play - Lexxie Jury 4.30 - 4.45 Supporting good reproductive health outcomes for women who use drugs Anna Olsen 4.45 - 5.00 A gendered view in focus: Addressing complex needs through a gender lens - Pam Rugkhla 5.00 - 5.15 HIV and Mental Health - Why all the complexity? - Michael Smith 5.15 - 5.30 “A tale of two states”- Breaking down structural and systemic barriers to abortion access - Brooke Calo & Rhonda Cale

13 CONFERENCE PROGRAM

Breaking down structural and systemic barriers 3 (Ballroom 2) Chair: Stella Conroy 4.00 - 4.15 Exploring service gaps and development options for people ageing with psychosocial disability - Sarah Pollock 4.15 - 4.30 Forgotten Australians, Still Forgotten: distant encounters with the service system Caroline Carroll & Simon Gardiner 4.30 - 4.45 Impacts of past adoption practices: Implications for collaborative responses to service delivery - Pauline Kenny 4.45 - 5.00 Housing First and Health: The example of Elizabeth Street Common Ground - Heather Holst 5.00 - 5.15 When will they ever learn: The Forgotten Australians experience of exclusion - Caroline Carroll & Wilma Robb 5.15 - 5.30 People with severe and enduring mental illness and their carers - Pat Sutton

Comprehensive case management – service providers working together 1 (Ballroom 3) Chair: Jennifer Evans 4.00 - 4.15 Beyond Referral – Building partnerships and knowledge in the context of increasing complexity for culturally and linguistically diverse clients - Effie Katsaros 4.15 - 4.30 Health Care for the Homeless and Innovative Approach through Reach - Joanne Hawkins & Clare Askew 4.30 - 4.45 Inanna Inc. Special Programs – Improving the social determinants of health for people with complex needs - Katy Haigh 4.45 - 5.00 Promoting social inclusion through a strengths-based program for vulnerable inner city population - Peter McGeorge 5.00 - 5.15 STAY: collaboration, consistency and not least client motivation and engagement - Dean Sullivan 5.15 - 5.30 Advocacy-Health Alliances: Better Health Through Medical Legal Partnership - Peter Noble

Aboriginal and Torres Strait Islander services 3 (Ballroom 4) Chair: Vanessa Lee 4.00 - 4.15 Applicability of Evaluative Tools in Assessing Aboriginal-Mainstream Partnerships – a literature review - Christina Tsou 4.15 - 4.30 Reflection on Contemporary Health Promotion Success in Indigenous Communities - Nicky Newley-Guivarra 4.30 - 4.45 An innovative paediatric service supporting Aboriginal children in accessing equitable in-hospital care - Sarah Ong 4.45 - 5.00 Continuous quality improvement for Aboriginal Health - Marianna Pisani 5.00 - 5.15 Get Healthy Service – Aboriginal Strategy - Scott Winch 5.15 - 5.30 Improving connections and building capacity: Supporting Better Diabetes Care in the Centre - Sharon Johnson

Social inclusion and linkages in service delivery (High Courtyard North) Chair: Christine Boyce 4.00 - 4.15 Supporting social inclusion for recently-arrived refugee-background youth: Ucan2 program evaluation - Karen Block 4.15 - 4.30 Enhancing refugees’ resettlement and social inclusion: service provider perspectives of service delivery - Greer Lamaro 4.30 - 4.45 Collaborative approaches: benefits for humanitarian entrants and refugees - Nancy Matina 4.45 - 5.00 ‘Stopping the run around’ Comorbidity Action in the North (CAN) Research - Imelda Cairney 5.00 - 5.15 Anchors – Building stable foundations for social participation - Martina Taliano 5.15 - 5.30 The Challinor Project: Deinstitutionalisation revisited - Cindy Nicollet

5.30 - 6.30 Poster Session and Networking function with Refreshments (The Gallery)

14 CONFERENCE PROGRAM Day 2 Tuesday

8.30 - 9.00 Registration (The Gallery)

9.00 - 10.30 Plenary 2 – Chair: David Templeman, CEO, Alcohol and Other Drugs Council of Australia (Ballroom 2)

Speaker 1 Connections, boundaries and borders - cross sectoral considerations in refugee healthcare - Dr Christine Boyce, RACGP, National Faculty of Special Interests Board, Refugee Health Network Speaker 2 The nexus between smoking and social inclusion in Aboriginal and Torres Strait Islander communities - Dr Tom Calma AO, ACT Australian of the Year 2013 Speaker 3 Australia’s first National Report Card on Mental Health and Suicide Prevention - Robyn Kruk AM, CEO National Mental Health Commission

10.30 - 11.00 Morning tea (The Gallery)

11.00 - 12.30 Concurrent sessions 4

Breaking down structural and systemic barriers 4 (Ballroom 1) Chair: Gino Vumbaca 11.00 - 11.15 South Australia’s Exceptional Needs Unit Management Assessment Program: Insights into Exceptionality - Richard O’Loughlin 11.15 - 11.30 Meeting the complex health needs of people who inject drugs: The role of targeted primary healthcare - Carolyn Day 11.30 - 11.45 Understanding the transfer of opioid substitution clients from public clinic dosing to community pharmacy dosing in NSW: Senior nurses’ perspectives - Carolyn Day 11.45 - 12.00 Discrimination Survey: Injecting drug users and repeated discrimination from service providers - Laura Santana 12.00 - 12.15 Shared Care or Shared Scare? A different approach to substance management - Lisale Hakerian 12.15 - 12.30 Coachstop Caravan Park - a decade of successes and challenges - Loretta Baker

Breaking down structural and systemic barriers 5 (Ballroom 2) Chair: Léan O’Brien 11.00 - 11.15 Harnessing cultural perspectives in alcohol and other drug counselling - Rachel Rowe 11.15 - 11.30 Improving access to health services by Refugees and CALD patients in Central Queensland - Roxanne Hodda 11.30 - 11.45 Use of Communication Technologies in Vulnerable, Hard to Reach and Marginalised Populations - Elizabeth Merrilees 11.45 - 12.00 TruckiesHelp: A 24/7 Alcohol and Other Drug Counselling Service for Long Haul Truck Drivers in NSW - Elizabeth Merrilees 12.00 - 12.15 Workplace Violence: A review of a community based health setting - Alison Derrett 12.15 - 12.30 Complex trauma and its impacts – a substantial public health issue - Cathy Kezelman

Comprehensive case management – service providers working together 2 (Ballroom 3) Chair: Mark Bartlett 11.00 - 11.15 Breaking the Barriers from Custody to Community - Rowena Bellwood 11.15 - 11.30 Exploring Integrated Service Responses to the Link between Legal and Health Needs - Mary Anne Noone 11.30 - 11.45 Haemodialysis behind bars: addressing complex needs collaboratively - Shirley O’Keeffe 11.45 - 12.00 Home for Good –Integrated Case Management for Post Release - Helen Fielder-Gill 12.00 - 12.15 Coming Home Program: Case Management Partnerships for women exiting prison - Kirsty McIntyre-Smith 12.15 - 12.30 Creating windows of change: the Vietnamese Transitions Program - Rachel Rowe

15 Cross-sectoral and cross-porfolio approaches (Ballroom 4) Chair: Ian Webster 11.00 - 11.15 Reflections on establishment of a cross sectoral health and social support service - Nanette Mitchell & Russ Sevior 11.15 - 11.30 Collaboration and homelessness: How ‘joined up’ are health and welfare services? - Natalie Rinehart 11.30 - 11.45 Non-government community services are promising settings to tackle smoking amongst the disadvantaged - Jon O’Brien 11.45 - 12.00 We’re in it together: a new approach to suicide prevention - Sue Murray 12.00 - 12.15 Acting on the Warning Signs - Linda Gyorki 12.15 - 12.30 Opening Doors – the role of Community Leadership in fostering Social Inclusion - Gregg Nicholls & Ronda Held

12.30 - 1.30 Lunch (The Gallery)

1.30 - 3.00 Panel discussion: Breaking down structural and systemic barriers to achieving better outcomes for people with complex needs (Ballroom 2) Chair: David Templeman, Alcohol and Other Drugs Council of Australia, CEO

Speakers: Ian W Webster, Gino Vumbaca, Julie Tongs OAM, David Morton (TBC), Léan O’Brien & Andrew Laming MP

3.00 - 3.30 Afternoon tea (The Gallery)

3.30 - 4.30 Closing Session with Development of Conference Declaration and Recognitions (Ballroom 2)

16 ANZJPH AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH

About the ANZJPH

The Australian and New Zealand Journal of Public Health is the Journal of the Public Health Association of Australia and is published six times a year, in February, April, June, August, October and December. Its contents are subject to normal refereeing processes. Finished discussions of research projects are the staple diet of the Journal, but there is space for reviews, views and historical pieces from time to time.

The Journal is indexed by Australian Public Affairs Information Service, Current Contents, Excerpta Medica, Index Medicus, the Cumulative Index to Nursing & Allied Health Literature and Social Sciences Citation Index and is available on microfiche from University Microfilms International.

Most of the disciplines embraced by PHAA publish journals that carry articles about facets of health, HAVE illness and health care. However, there is no other Australian Journal that gives an overview of research across the broad range of PHAA interests, YOU nor does any other journal aim to attract more than one or two of the many levels of workers in READ health care assessment and delivery. The Australian and New Zealand Journal of Public Health invites contributions which will add to THE knowledge in fields of interest. It will give priority, after normal refereeing processes, to papers whose focus and content is specifically related to ANZJPH public health issues.

To subscribe to the journal visit: http://www. phaa.net.au/journalSubscriptions.php INVITED SPEAKERS Lin Hatfield Dodds

Lin Hatfield Dodds is the National Director of UnitingCare Australia, and one of Australia’s leading social justice advocates. A recognised expert on social policy and community services, she has served on a wide range of boards and government advisory bodies, and is a frequent media commentator and conference speaker.

UnitingCare is Australia’s largest non-government provider of community services, with 1500 community service delivery sites located across every State and Territory, providing services to over 2 million Australians each year. UnitingCare employs 35,000 staff and 24,000 volunteers nationally and provides services to children, young people and families, people with disabilities, and older Australians, in urban, rural and remote communities. Its annual turnover is in excess of $2.3 billion. Lin has contributed to numerous government advisory bodies over the last decade, including as chair of the Australian Social Inclusion Board and a member of the current National Place Based Advisory Group and the National Youth Advisory and Consultative Forum which advised the then Federal Minister for Children and Youth Affairs. Lin was a leading participant in the Prime Minister’s Economic Forum (2012), the Australian Government Tax Forum (2011) and the Prime Minister’s 2020 Summit (2007). She was a member of the national Community Response Task Force advising the Deputy Prime Minister and Minister for Families, Housing, Community Services and Indigenous Affairs during the global financial crisis. Lin chaired the ACT Community Inclusion Board from 2006 – 2009, and is a past President of the Australian Council of Social Service (2007 – 2010). Lin’s background includes working as a counselling psychologist, including in drug rehabilitation and with young people at risk, with a particular interest in trauma and abuse. She has worked as a public policy advisor on health and community services within federal and state governments. Lin’s achievements have been recognised by being named ACT Australian of the Year (2008), receiving a Churchill Fellowship to study anti-poverty strategies (2003), and being awarded a Chief Minister’s International Women’s Day Award (2002).

Robert Tickner

Robert Tickner was appointed as Secretary General – Chief Executive Officer, Australian Red Cross in February 2005. During his tenure, Robert has overseen historic reforms to modernise and harmonise the work of Australian Red Cross to increase the organisation’s capacity to work for vulnerable people. Now operating under a cohesive national framework underpinned by a five-year strategy, Australian Red Cross has clearly defined its seven priority areas of service and ways of working.

In 2012, Robert was seconded to the International Federation of Red Cross and Red Crescent Societies in Geneva to act as Under Secretary General for Humanitarian Values and Diplomacy. Robert is focused on building a collaborative and innovative organisation to increase the impact and effectiveness of Australian Red Cross in addressing disadvantage among the most vulnerable people.

Prior to taking up his Red Cross appointment, Robert was the CEO of Job Futures Ltd, a large national network of community-based employment service providers.

Robert served as Federal Minister for Aboriginal and Torres Strait Islander Affairs from 1990-1996 and is Australia’s longest serving Minister for Aboriginal and Torres Strait Islander Affairs. Before being elected to the Federal parliament, he was a lecturer in the Faculty of Law at the Institute of Technology as well as the Faculty of Business Studies. He later served as Principal Solicitor to the NSW Aboriginal Legal Service. Between 1977 and 1984 he served as a Councillor on the Sydney City Council including a very brief period as Acting Lord Mayor.

Robert holds Bachelor of Laws, Master of Laws (Hons) and Bachelor of Economics degrees and has undertaken the first stage of an Executive MBA.

18 INVITED SPEAKERS Christine Boyce

Christine Boyce is a general practitioner who has been working in mainstream practice and refugee health for over ten years in Hobart, Tasmania. She chairs the RACGP’s specific interest group in refugee health, teaches at University of Tasmania’s clinical school, and has strong interests in social justice and equitable health care. In 2008 she was awarded the RACGP “GP of the Year’ in recognition of her work with refugees and in education.

Tom Calma AO

Dr Calma is an Aboriginal elder from the Kungarakan tribal group and a member of the Iwaidja tribal group in the NT. He has been involved in Indigenous affairs at a local, community, state, national and international level and worked in the public sector for 40 years and is currently on a number of boards and committees focussing on rural and remote Australia, health, education, justice reinvestment and economic development. Dr Calma, a consultant, is the National Coordinator, Tackling Indigenous Smoking where he leads the establishment and mentoring of 57 teams nationally to fight tobacco use by Aboriginal and Torres Strait Islander peoples. Dr Calma’s most recent previous position was that of Aboriginal and Torres Strait Islander Social Justice Commissioner at the Australian Human Rights Commission from 2004 to 2010. He also served as Race Discrimination Commissioner from 2004 until 2009. Through his 2005 Social Justice Report, Dr Calma called for the life expectancy gap between Indigenous and non-Indigenous people to be closed within a generation and laid the groundwork for the Close the Gap campaign. The Close the Gap campaign has effectively brought national attention to achieving health equality for Indigenous people by 2030. Dr Calma is a strong advocate for Indigenous rights and empowerment and has spearheaded initiatives including the establishment of the National Congress of Australia’s First Peoples and Justice Reinvestment. In 2010, Dr Calma was awarded an honorary doctor of letters from Charles Darwin University and in 2011, an honorary doctor of science from Curtin University. In the Queen’s Birthday 2012 Honours Awards Dr Calma was awarded an Order of Australia; Officer of the General Division (AO) and in December 2012 he was announced as theACT Australian of the Year 2013.

Robyn Kruk AM

Ms Kruk has led complex and diverse organisations at the Chief Executive level in both the national and state government including Director General of the NSW Department of Premier and Cabinet, NSW Health and the NSW National Parks and Wildlife Service. Robyn was former Secretary of the Australian Government’s Department of Environment, Water, Heritage and the Arts prior to taking up her current role of Chief Executive and Commissioner of the newly formed National Mental Health Commission. She serves on statutory and advisory boards both nationally and internationally including the Clinical Excellence Commission, Agency for Clinical Innovation and Co-Chair of the Reforming States Group for the US based Milbank Fund (Philanthropic Health Trust). She is currently Co-chair of the China Council for International Cooperation on Environment and Development Task Force on Environment and Development in Western China. Robyn was appointed a Member of the Order of Australia for service to public administration in a range of areas including Commonwealth-state reform initiatives in health and natural resources.

19 PHAA 42nd Annual Conference

A “fair go” for health: tackling physical, social and psychological inequality

16 - 18 September 2013 Hilton on the Park, Melbourne

For more information visit: www.phaa.net.au

14THNATIONAL IMMUNISATION CONFERENCE

17 - 19 June, 2014 Melbourne

For more information visit: www.phaa.net.au

20 Opening & Plenary 1: Monday 8.30 am - 10.30 am Day 1 Monday

7.30 - 8.30 Registration (The Gallery)

8.30 - 10.30 Welcome by Michael Moore, Public Health Association of Australia CEO and Welcome to Country by Aunty Agnes Shea (Ballroom 2)

Plenary 1 - Chair: Michael Moore, Public Health Association of Australia CEO

Update on the work of the Australian Social Inclusion Board - Lin Hatfield Dodds, Chair of the Australian Social Inclusion Board It has long been acknowledged that people with complex needs often fall through the cracks in service delivery – between national and jurisdictional service delivery, between government and non-government services, and between services delivered by different portfolio agencies. The Australian Government’s Social Inclusion Agenda has acknowledged this as an area of need and is working toward reforming the delivery of Government services to improve health and social outcomes for people with complex needs. Given the Government’s Social Inclusion Agenda and the related work currently being undertaken by the Australian Social Inclusion Board, Lin Hatfield Dodds will address the conference to update attendees on current activities of the Board.

From Little Things Big Things Grow - Robert Tickner, CEO Australian Red Cross The International Red Cross and Red Crescent Movement is the world’s largest humanitarian network. The Movement is made up of nearly 100 million members, volunteers and supporters in 187 National Societies. The Movement is neutral and impartial, and provides protection and assistance to people affected by disasters and conflicts.

The vision of Australian Red Cross is to ‘Improve the lives of vulnerable people in Australia and internationally by mobilising the power of humanity’. Through pursuing a nationally cohesive “One Red Cross” structure, the organisation has secured International, National and Local partnerships to ensure both immediate and long-term action in assisting those most vulnerable.

Over the past few years, Red Cross has focused not only on re-alignment of what we do, ensuring that we are better targeting our programs to those who are most in need, and where we do it, but also how we do it. “Ways of Working” guidelines assist Red Cross staff and volunteers in both immediate and long term action to assist those most vulnerable, with emphasis on the need to build genuine relationships based on respect and trust.

The leadership’s commitment to breaking down silos and creating a national organisation by inviting a local and global workforce to push for socially just change will be explored through International, National and Local partnerships.

Address by The Hon Mark Butler MP, Minister for Social Inclusion, Mental Health, Housing & Homelessness

10.30 - 11.00 Morning tea (The Gallery)

21 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

11.00 - 12.30 Concurrent Sessions 1

Justice and Complex Needs (Ballroom 1) Chair: Alison Churchill

11.00 - 11.15 A Managed alcohol program for Sydney’s Homeless Presenter: Carolyn Day, Addictions Medicine, University of Sydney Authors: K Dolan, E Baldry, N Ezard, S Hodge, A Rodas & B Crosby

An estimated 50% of homeless people are alcohol dependent. More than a third of homeless people admitted to St Vincent’s Hospital in Sydney present with alcohol and/or drug related problems. The needs of homeless alcohol dependent people cannot be adequately addressed by Sydney’s abstinence-based accommodation services. Consequently, they may be forced into unplanned alcohol withdrawal, increasing the risk of seizures and alcohol- related brain injury. Others may engage in risk taking behaviour including increased drinking immediately prior to entering shelters to avoid “wasting” alcohol or staying on the streets risking violence rather than enter abstinence- oriented services.

Managed Alcohol Programs (MAP) are a novel approach to assist homeless people with chronic and severe alcohol dependence, they dispense a regulated amount of alcohol at set times. MAPs operate in other countries, where improvements include reduced alcohol consumption, binge drinking, convulsions, visits to emergency departments and encounters with police.

Sydney has a minimum of around 350 alcohol dependent homeless persons, but no managed alcohol programs. Attempts to introduce MAPs have been rejected by Government who cite a lack of rigorous evidence as a barrier to implementation.

This paper will review the evidence for MAPs and consider whether Sydney might benefit from having a MAP.

11.15 - 11.30 Why Mental Impairment Legislation Leads to Indefinite Detention Presenter & Author: Patrick McGee, NSW Council For Intellectual Disability, NSW

The Aboriginal Disability Justice Campaign (ADJC) had its origins in longstanding concerns held by guardians (both paid and voluntary guardians) in the Northern Territory, particularly in the central desert region of Alice Springs. These concerns focussed on Indigenous people with cognitive impairments being detained indefinitely in theAlice Springs Correctional Centre (a maximum security prison located twenty five kilometres outside ofAlice Springs) as a result of being assessed as mentally impaired and then being found unfit to plead.

This poster outlines the experience of people with a cognitive impairment who are subject to mental impairment legislation and found unfit to be tried. People with cognitive impairment having been found unfit to be tried are being detained in prisons around the country. In the Northern Territory, detention occurs in maximum security prisons.

Many people with a cognitive impairment have multiple and complex care issues that are often left unaddressed until their contact with the criminal justice system. This is particularly so for Indigenous Australians with a cognitive impairment exhibiting at risk behaviours.

People with a cognitive impairment and associated risk behaviours are often vulnerable to indefinite detention in prisons as a result of a lack of non-custodial accommodation options that provide treatment of significant benefit. This practice disproportionately affects Indigenous Australians with a cognitive impairment.

22 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

11.30 - 11.45 Patterns of injecting drug use among adult prisoners with intellectual disability Presenter: Kate van Dooren, Queensland Centre for Intellectual and Developmental Disability, University of Queensland Authors: A Bhandari, K van Dooren, G Eastgate, N Lennox & S Kinner

Background: People transitioning out of prison experience a multitude of health-related challenges. This transition may be particularly risky for injecting drug users, not least due to their greatly elevated risk of death from overdose. Despite being a particularly vulnerable group among soon-to-be released prisoners, little is known about injecting drug use among prisoners with intellectual disability.

Methods: Using cross-sectional data from Australia’s largest randomised controlled trial involving soon-to-be released prisoners, we (i) compare drug use and injecting drug use patterns of adult prisoners with and without intellectual disability; and (ii) describe overlapping health-related experiences of prisoners with intellectual disability who report injecting drug use.

Results: Compared with other soon-to-be released adults, prisoners with intellectual disability report similar drug and injecting drug use. Physical health, mental health, polydrug use and sociodemographic variables (such as pre- incarceration homelessness) will be described.

Conclusion: Soon-to-be released prisoners with intellectual disability are likely to face many challenges during the transition out of prison. A substantial proportion will experience issues related to overlapping injecting drug use, poor health and social circumstances. Further research is urgently needed to guide the development of targeted interventions aiming to improve outcomes for this too often overlooked group.

11.45 - 12.00 Criminalising disability: pathways into the criminal justice system for people with complex needs Presenter: Eileen Baldry, University of NSW Authors: E Baldry & L Dowse

There is evidence that people with mental health disorders are over-represented in criminal justice systems (CJS) nationally and internationally as both offenders and victims, and that their imprisonment rates are increasing.

There is less but convincing evidence that people with cognitive impairment are over-represented in CJSs. There is though very little known about the presence and over-representation of people with both mental and cognitive impairment who have complex needs (other diagnoses e.g. problematic alcohol or other drug use and social disadvantages) in CJSs. In Australia Indigenous persons experiencing complex needs are significantly more over- represented than non-Indigenous persons in the CJS. That these vulnerable persons are so concentrated in a system primarily created for punishment when Australia has such sophisticated health and social support systems is a gross social injustice. This paper discusses findings from a linked and merged data set of 2,731 people who have been in prison in NSW and whose mental and cognitive diagnoses are known. New understandings and information about the systemic funnelling of these groups of people into the CJS and their social exclusion are revealed. Effective prevention and support approaches are also discussed using quantitative analyses and case studies.

23 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

12.00 – 12.15 The Legal Contours of Community Forensic Disability Service Provision Presenter & Author Linda Steele, Lecturer, Faculty of Law, University of Wollongong

Community forensic disability service provision to people with cognitive disability and complex needs in the criminal justice system is overwhelmingly considered to provide to extremely marginalised individuals an alternative to imprisonment and a pathway to disability services, as well as having the added benefit of enhanced social inclusion.

I argue that the criminal law helps to shape the spaces and relationships that structure community forensic disability service provision. These legal contours of service provision inadvertently provide additional possibilities for criminalisation and social marginalisation of people with cognitive disability in the criminal justice system. These legal contours might serve to limit the realisation by services of social inclusion objectives for their clients.

I will support my arguments with data on individuals with cognitive disabilities and ‘complex needs’ in the criminal justice system which is drawn from a large dataset created in an ARC Linkage Project: ‘People with mental health disorders and cognitive disabilities in the NSW criminal justice system’ led by researchers at UNSW. I will discuss the role of reporting obligations relating to bail, probation and diversion, the use of AVOs in group home settings and the significance of civil mental health laws and guardianship laws.

12.15 - 12.30 Innovation in Addressing Social Disadvantage through Medicare Locals Presenter & Author: Jennie Roe, Australian National Preventive Health Agency, Canberra

The Australian National Preventive Health Agency aims to support Medicare Locals in their formative stages to embed an evidence-based focus on population health and prevention as part of their core organisational ethos. Fundamental in this approach is for Medicare Locals to forge solid partnerships and true community engagement to identify local health needs and design and deliver preventive programs that focus on improving outcomes and reducing inequalities.

The Agency’s new Disease Prevention and Health Promotion in Medicare Locals program provides stimulus funding for Medicare Locals to collaborate with Local Hospital Networks, local councils, industry, NGOs and others to promote health in their local communities. Importantly the program is premised on local needs and reducing differentials by actively targeting social disadvantage.

Where evidence is currently lacking, the program seeks to generate new evidence through robust data collection and evaluation, and actively promoting the uptake of effective preventive activities within Medicare Locals. The program’s first funding round closed late in 2012, with successful applicants to be announced early in 2013. This presentation will showcase the initial Medicare Local projects funded, including their approaches to addressing social disadvantage in their particular communities, and the evaluation frameworks to contribute new evidence regarding effective prevention.

24 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

Breaking down structural and systemic barriers 1 (Ballroom 2) Chair: Michael Moore

11.00 - 11.15 Women with Cognitive Impairment and Unplanned Pregnancy – Opening the Door to Access, Options and Rights. Presenter: Annarella Hardiman, Pregnancy Advisory Service, Royal Women’s Hospital (The Women’s), Melbourne Authors: A Hardiman & S Dee

Background: Experiencing an unplanned pregnancy can be daunting for women, and women with a cognitive impairment (CI) may face additional complexities that affect their decision making. The Women’s Pregnancy Advisory Service (PAS) undertook two audits to develop an understanding of women with CI and their contact with PAS to improve service delivery for women with complex needs.

Methods: The medical records of 91 women with a CI who accessed the PAS between 2005-2007 and 2009- 2012 were audited. Data collected included: demographics, decision making processes, knowledge of pregnancy options, prevalence of violence, support, pregnancy outcomes and capacity to consent. Results between time periods were then compared.

Results: Women with a CI rely on support, information and advocacy from their health professionals. The second audit found more women with a CI had accessed the PAS in a timely manner. Access barriers were consistent between audits including conflict between women’s choices and those of their supports, higher ambivalence and support needs and some women unable to obtain an abortion in a public hospital due to their gestation.

Conclusion: These results are significant given the dearth of literature in this field. Further research, timely access to abortion, ongoing training for, and resources accessible to, health care professionals are key recommendations based on these results. Findings have informed the development of pregnancy options information for women with a CI.

11.15 - 11.30 The Ask Project: a health intervention for adolescents with intellectual disability Presenter: Lyn McPherson, QCIDD, University of Queensland Authors: N Lennox, C Bain, S Carrington, G Williams, M O’Callaghan, & L McPherson

Background: Adolescents with intellectual disability have been shown to have high levels of unrecognised disease and inadequate health screening and health promotion relative to the general population. Barriers to good health care for this group include communication difficulties and poor recall of health information.This presentation will report on a combined health and educational intervention that aims to improve the health of these adolescents.

Methods: The education component of this randomized controlled trial was based on the Ask Health Diary and delivered in special education schools and special education units in mainstream schools in Queensland. The health component consisted of a comprehensive health review (CHAP) performed on each adolescent by his/her general practitioner.

Results: Carers reported an improved means of keeping medical records, knowledge and ability to support the young person. Compared to the control group they reported the adolescent was significantly more likely to go to the doctor without them and explain their health problems to the doctor without help.

Conclusion: This program highlighted the need for teaching skills for going to the doctor and communicating with health professionals to successfully prepare adolescents with intellectual disability for the transition to adult health services and a life of good health.

25 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

11.30 – 11.45 Supporting ageing-in-place for people with intellectual disability: A rural and metropolitan comparison Presenter: Rafat Hussain, University of New England Authors: R Hussain, T Parmenter, M Knox, M Janicki, C Leggatt-Cook, S Wark & The Ascent Group

Dramatic improvements in life expectancy have led to a large cohort of people with an intellectual disability who are ageing. This emerging phenomenon presents a considerable challenge for carers and service providers as they have not previously had to manage a substantial number of individuals with the concurrent issues of ageing and intellectual disability. To date, there is limited comparative research across metropolitan and rural regions with respect to understanding issues faced by individuals and their carers in coping with health and well-being issues.

The purpose of the current study was to explore key dimensions that enable or impede community-based independent ageing-in-place options, and specifically how they differ in metropolitan and rural regions. These dimensions include understanding complex range of issues in healthy ageing and interplay of health, social and support factors from onset of ageing through to end-of-life care. This project utilised a mixed-methods study design aligned with principles of inclusive research. The preliminary findings of the research will be presented, with a focus upon the identification of factors that facilitates or hinder successful ageing in place for people with intellectual disabilities. The key similarities and differences for individuals residing in rural and metropolitan areas will be discussed.

11.45 – 12.00 Views of a walking and social support program for people with intellectual disability Presenter: Katie Brooker, Queensland Centre for Intellectual and Developmental Disability, University of Queensland Authors: K Brooker, K van Dooren, L McPherson, N Lennox & R Ware

People with intellectual disability report low levels of physical activity and community participation. Walk and Talk is a walking and social support intervention for people with intellectual disability that is currently being piloted in Brisbane, Australia. The program involves a person with intellectual disability walking with a walking partner (a community volunteer), once a week, around their local neighbourhood. To inform development and future evaluation of Walk and Talk, semi-structured interviews were conducted with 11 potential participants. Transcripts were analysed thematically and the major themes identified were: avoiding discomfort and stress, walking for health, walking for emotional benefits, walking with different partners and walking with purpose. Based on these themes, we identified recommendations for designing effective interventions to improve the likelihood of participation in walking programs such as Walk and Talk. Key recommendations made were to support participants to overcome or avoid uncomfortable walking situations, promote the importance of keeping healthy, complement current physical activities and make the most of emotional benefits of walking with someone new.

12.00 – 12.15 Ethical, policy and legal challenges in supporting people on Community Treatment Orders Presenter & Author: Lisa Brophy, The University of Melbourne and Mind Australia

Community Treatment Orders (CTOs) are a feature of all mental health legislation in Australia. CTOs enable involuntary treatment of people with mental illness in the community. CTOs present many ethical and practice dilemmas and currently new legislation proposed in Victoria is attempting to address the problems and unintended consequences attributed to the implementation of CTOs. Many people on CTOs have complex needs and while CTOs may be one method of ensuring they do not fall through the cracks in service delivery, the author will argue that CTOs are a very limited intervention in ensuring access to mental health care and treatment, and may represent a barrier to obtaining recovery focused service delivery in the community managed mental health support sector. People on CTOs deserve greater recognition of their needs and improved innovation in service delivery to enable a shift to less reliance on coercive interventions. The author will draw on various research projects she has undertaken focused on the experience of people on CTOs and other key stakeholders and her work on identifying principles for good practice.

26 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

12.15 – 12.30 Communication is still the key – When mental health service providers achieve an appropriate system of care for Deaf clients Presenters & Authors: Francine Hanley, AIPCA, La Trobe University

In 2002 a Deaf counselling student in the United States - Janet De Vinney - published a paper describing her struggle to obtain access to services for a period of depression (De Vinney & Murphy, 2002). Her paper presented many barriers starting with the ED intake and assessment procedures, inaccessibility of health team meetings and group treatments, and her frustration with what should have been standard practices in communication. Her publication did not reach its audience without both collegial and communication support.

Our paper will give a brief account of Janet De Vinney’s story before describing strategies applied within the mainstream mental health system and reported by Vicdeaf client services staff that have shown to lend appropriate and timely support to the mental health needs of Vicdeaf clients. Our paper will present examples where best practices in communication have fostered smooth transitions and positive outcomes for Deaf clients seeking access to mental health services. We will highlight also the importance of a framework built around a continuum of care and how Vicdeaf client services have a range of resources to support a framework of continuity between signing Deaf clients and service providers in the wider mainstream system.

Collaborative Mental Health and Alcohol and Other Drug service delivery 1 (Ballroom 3) Chair: David Templeman

11.00 - 11.15 Enhancing inclusive practice in a specialised setting through Dual Diagnosis Presenter & Author: Andrew O’Sullivan, Substance Use Mental Illness Treatment Team (SUMITT), Victoria.

Background: The objective of this project was to critically reflect on building the capacity of an adolescent mental health inpatient unit (IPU) to respond to the needs of young people and their families when they have co-occurring substance use.

Methods: All activities and strategies used to build capacity by the Dual Diagnosis Consultant (DDC) were documented. Then their outcomes were documented. Explanations for the outcomes were suggested. Finally, hypotheses were made about which strategies would bring about the desired outcomes in the future.

Results: Over a two year period, the IPU’s screening rates for young people dramatically improved. Also, a proportion of staff felt confident undertaking substance use assessments and referring and consulting with other services when needed.

Conclusion: Multiple strategies are required to increase skills and change work practices. Capacity-building should always allow staff to do as much of the work within their capability. Using specific work as a learning opportunity and providing feedback to staff about their assessments and treatment-planning appeared to be a very effective way to enhance inclusive practice.

27 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

11.15 - 11.30 Collaborative approaches to addressing the complex needs of women with post traumatic stress disorder and substance use disorder Presenter: Angela Dawson, University of Technology, Sydney Authors: C Pritchard, S Dean, J Robertson, D Jackson & A Dawson

In Australia, the health, social and economic burden of alcohol and drug dependence is profound. Women’s substance use problems are highly stigmatized and often not acknowledged. Pregnant and parenting women face particular societal condemnation and encounter multiple systemic barriers that delay treatment seeking with women fearing consequences for them and their children. Rates of comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are higher for women than men and are associated with trauma related to sexual abuse and family violence.

Little research has been undertaken internationally or in Australia to determine the most effective treatment for women with PTSD and SUD. Given the high incidence of PTSD comorbidity, it is critical that treatment models accommodate the complex needs of these women and draw upon integrated services requiring multiple service providers and professionals.

This paper reports on the trial of a unique integrated program for women with SUD and PTSD at Jarrah House, a residential medical detoxification and rehabilitation NGO program for women and their children. Early findings show encouraging increases in client quality of life scores and insight into how the program has empowered women to make life changes and plan their recovery supported by various providers.

11.30 - 11.45 Drug and alcohol management for pregnant incarcerated women Presenter & Author: Jill Roberts, Justice and Forensic Mental Health Network, NSW

Background: Women entering custody in NSW have a very high incidence of drug and alcohol use with 40% women drinking at harmful/hazardous levels and 78% using illicit drugs.

Methods: Clinical audits were undertaken on pregnant adult women entering custody. Patient histories and their clinical management were examined.

Results: The audit showed that almost all pregnant women had identifiable drug and alcohol issues and few had received any antenatal care prior to incarceration. Most had polysubstance use. Audits now confirm a high consistent rate of engaging women.

Conclusion: This project developed clinical pathways to ensure patient management plans commenced and were implemented promptly. Whilst prison health care is provided in a challenging environment, it also provides a unique opportunity to improve the health status of these women and their unborn children. Engaging this high risk patient group into treatment early opportunistically decreases the risk of adverse pregnancy outcomes by better managing drug withdrawal, decreasing risk lapsing back into drug use (and hence in utero substance exposure) and engaging patients in antenatal care.

28 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

11.45 - 12.00 Smoke-free Policy in a Mental Health Inpatient Facility: patient and staff experience Presenter: Angela Hehir, Justice and Forensic Mental Health Network Authors: A Hehir, D Indig, S Prosser & V Archer

Background: This presentation describes the experience of patients and staff in a high security forensic mental health inpatient facility and discusses the implications of smoke-free policies for people with severe mental illness.

Methods: Surveys and semi-structured focus groups and interviews were conducted with patients and staff. Data was collected on smoking history, patients’ experience of living in the hospital, and the experience of staff particularly in relation to their own smoking practice and patient management.

Results: Nearly all (80%) patients smoked prior to admission; while 39% were angry at being forced to stop smoking, 42% had wanted to give up. Most (75%) felt that living in a smoke-free environment had a positive effect on their health, a result reflected in staff surveys, although weight gain was an issue for some patients. Many intended remaining smoke-free on discharge and believed they could not have quit in an environment where smoking was possible. Most staff agreed that patient care was easier, however smokers were less likely to agree (64% vs 21%).

Conclusion: Smoke-free policies, incorporating strategies addressing withdrawal, smoking cessation and staff training and support, can have positive impacts on the health of patients with complex physical and mental health needs.

12.00 - 12.15 Continuity of care for young people leaving custody Presenters & Authors: Julie Carter & Jeanette Toole, Justice and Forensic Mental Health Network, NSW

Young offenders have a high prevalence of untreated mental health and/or drug and alcohol problems which often contributes to offending behaviour. Whilst young people in custody undertake a comprehensive health assessment and an appropriate treatment plan is implemented to address identified health needs, this care is often not continued once the young person returns to the community. This often results in the young person relapsing and resuming illegal activities to fund their substance use.

In response to this identified need, the NSW Community IntegrationTeam (CIT) commenced in 2008 to develop a more integrated approach to health service provision between custody and the community. Extensive collaboration was undertaken with partner agencies including Juvenile Justice and community health agencies, including Aboriginal Medical Service providers.

This presentation will describe the development, implementation and evaluation of CIT, including describing improved health and offending outcomes for participants and discussing strategies for improving collaborative partnerships. The CIT is a successful program that supports young offenders, over half of whom are of Aboriginal origin, with complex needs to improve their continuity of care in the community and strengthen community-based programs.

29 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

12.15 - 12.30 Connections: removing obstacles to achieve positive outcomes Presenters & Authors: Sandra Sunjic & Stephen Ward, Justice and Forensic Mental Health, Network, NSW

There is an over-representation of mental illness and drug and alcohol problems among people in custody. These problems result in an increased likelihood of re-incarceration as many people leave custody with very limited supports or assistance in place.

To address this issue, the Connections program was established in 2007 across the NSW prison system and has helped over 4000 patients with illicit drug problems to date. Patients are engaged pre release to commence release planning and are provided with assertive follow up in the community. The assistance provided ranges from very practical assistance such as transport to appointments, to advocacy with accessing community services, to helping to obtain affordable housing. The Connections program has developed strong collaborative partnerships across health and support services (both government and non-government) which assists patients to break down the barriers to obtain the help they need.

In 2009, an external evaluation found completing Connections was associated with improved general health, mental health, social functioning and remaining in the community for longer periods of time following release. This data was updated in 2012 to show completion of Connections reduced the recidivism rate by 20%. This presentation will discuss the strengths and limitations of the Connections program.

Aboriginal and Torres Strait Islander services 1 (Ballroom 4) Chair: Vanessa Lee

11.00 - 11.15 Antenatal Emotional Wellbeing Screening in Aboriginal and Torres Strait Islander PHC Services in Australia Presenter: Kaniz Gausia, Combined Universities Centre for Rural Health, Western Australia Authors: K Gausia, S Thompson, N Tricia, A Rumbold, C Connors, V Matthews & R Bailie

Background: Despite the recommendations for antenatal emotional wellbeing (EW) assessment in Australia, the extent to which EW assessments are undertaken among Aboriginal women attending in primary health care (PHC) centres is not known.

Methods: Medical records of 797 women from 36 centres providing services to Aboriginal communities in five states (NSW, QLD, SA, WA and NT) were audited as part of a quality improvement program. Information was collected on EW screening, tobacco and alcohol consumption, exposure to brief interventions on preventive maternal health behaviours, and counselling for social, financial or housing support.

Results: Overall, 85% of the women were Aboriginal, and half aged less than 25 years. The proportion of women with documented screening for EW varied from 5% to 38% between states (mean 17%). After adjustment for confounders, non- Aboriginal women were 4 times more likely to be screened for EW compared with Aboriginal women (OR=4.13, CI=2.46-6.92). Aboriginality, fewer than 4 antenatal visits, absence of an antenatal and birth care plan, and lack of counselling on financial support were independently linked with no screening of EW.

Conclusion: The significantly lower provision of antenatal EW screening among Aboriginal women in PHC services requires attention from health service providers and policy makers. Provision of training for midwives and further research on appropriate screening tools for Aboriginal women is needed to redress the gap.

30 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

11.15 - 11.30 Sistergirls – an Ethical Challenge for Health Professionals Presenter: Crystal Tierney, Charles Darwin University, Northern Territory Authors: C Tierney & R Williams

This paper is about a small research study which focused on issues specific to the Indigenous transgender group called the ‘Sistergirls’, who are a minority group of Indigenous males who live as women. They are mostly located on the Tiwi Islands or Darwin region. The Sistergirls are faced with a number of issues, some of which are related to health care. These issues are primarily a product of the group’s remote location and cultural differences, not only from non-Indigenous society but also within their own Indigenous communities.

Interviews were conducted with health professionals to explore the issues which are often faced when working with Sistergirls. The four key issues identified are problems surrounding the lack of culturally safe health care services, lack of service provider awareness in regards to complexities associated with Indigenous ‘men’s business and women’s business’, confidentiality, and provision of appropriate treatment.

The main recommendation from the study was for further research into appropriate strategies for increasing awareness and understanding of health care professionals when dealing with Sistergirls.

11.30 - 11.45 Passageway to better health for Aboriginal children from birth to 2 years Presenter: Vanessa Clift, & Jeanette King, Sydney Local Health District, New South Wales Authors: J King, A Bargon & L Hagstrom

Background: A new model of care for Sydney Local Health District was implemented in October 2011 connecting women who are pregnant with an Aboriginal or Torres Strait Islander baby by delivering an integrated primary health model of sustained health home visiting, with the aim to reduce the morbidity and mortality rate for Indigenous children.

Method: The program aims to increase access for Aboriginal and Torres Strait Islander families, including antenatal care; practical advice and assistance with breastfeeding, nutrition, parenting: monitoring of developmental milestones, health information and support for immunisation. A minimum of 20 home visits are offered including: an antenatal visit, weekly home visits during the postpartum period, monthly home visits until 15 months of age and bi- monthly visits to 2 years. A paediatric health assessment is offered at birth, then 6 monthly until 2 years of age with a developmental assessment attended at 12 months, 3 years and prior to starting school.

Result: There have been 70 families who have participated in the program, with 58 families currently engaged.

Conclusion: The paper will discuss how priorities to increase women using antenatal services, reducing tobacco use during pregnancy, reducing low birth weight and increasing children having age-appropriate health checks and vaccinations have been met.

11.45 – 12.00 Aboriginal Youth no longer forgotten – the “Y Health – Staying Deadly” Project Presenter: Annapurna Nori & Rebecca Piovesan, Watto Purrunna Aboriginal Health Service, Adelaide Authors: N Brown, R Piovesan, J O’Connor, S Shah, M McMillan, J Newham, C Larkin & A Nori

Aboriginal youth are particularly vulnerable health consumers; over-represented in social and health disadvantage, under-represented as seekers of health care. Prevention and early detection of risk factors are important but there is no Youth Health Check in the Medicare rebated Aboriginal Health Checks.

Supported by an Australian Primary Health Care Research Institute grant, “Y Health – Staying Deadly” is led by Primary Care researchers working in Aboriginal Health Services in Adelaide and NSW. Using a Community Based Participatory Action Research approach, the project informs Translational research. There is Aboriginal involvement in all aspects of the project – investigators, project support, clinical staff, youth and other community participants. We have developed an evidence-based culturally valid Youth Health Check: and collaborated with the Menzies’ ABCD National Research Partnership in the development and piloting of a Youth Health Audit tool. We are informally partnering with other youth health providers (NT Health, SA Health Second Story, SHine SA) to implement the Health Check. Other outcomes include the establishment of research capacity within an Aboriginal Health Service, and the production of a “comic book” to promote the health check. We will present the Youth Health Check screening tool, and discuss factors for ensuring social inclusion within research.

31 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

12.00 - 12.15 ‘Yarning about hepatitis C’ DVD – A collaborative community based approach Presenters: Peter Waples-Crowe, Victorian Aboriginal Community Controlled Health Organisation & Ronald Briggs, Childrens Protection Society, Victoria Authors: P Waples-Crowe, P Moro, G Irving & S Gregson

Hepatitis C infection rates in the Victorian Aboriginal community are up to six times greater than in the general community and the uptake of treatments are at much lower rates. There is considerable stigma and shame associated with hepatitis C in both the general and Aboriginal community.

During 2012, Hepatitis Victoria worked in collaboration with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and the Victorian Aboriginal Health Service (VAHS) to develop a short DVD on living with hepatitis C and treatment options. The DVD featured Aboriginal people telling their stories and experiences of hepatitis C, in their own words, for their own communities. The partnership between the three organisations ensured that the messages and information contained in the resource was both accurate and relevant to the community.

A surprise result of the project was one of participants becoming a ‘champion’ of hepatitis C. The participant moved from feeling shame and being filmed ‘in the dark’ to publicly championing the need for hepatitis C education and treatment for the Victorian Aboriginal community.

This presentation will outline the development of the DVD and reflect on the processes that have contributed to the success of the project and the individuals involved.

12.15 - 12.30 Improving sexual health education for Aboriginal young offenders Presenter: Kerri Masters, Justice and Forensic Mental Health Network, NSW Author: D Gardiner & J Carter

Aboriginal young people are disproportionately represented in juvenile detention and are 28 times more likely to be in custody than their non-Aboriginal peers. According to the 2009 NSW Young People in Custody Health Survey, Aboriginal young people in custody were significantly more likely to have engaged in risky sexual behaviours including younger age of first having sex, a higher likelihood sexually transmissible infections and more risky alcohol and drug use.

To respond to these issues an Aboriginal Sexual Health Education Program was developed for young Aboriginal men across five NSW juvenile detention centres. The program ensures ongoing cultural appropriateness through consultation with local Aboriginal Medical Services, Aboriginal Health Workers and onsite clinical staff. Referral and support to access other health services is also provided.

In the past two years, this program had over 2500 contacts with young people. Anecdotal evidence suggests that the sexual health education program provided in custody improves safe sexual practices once released. Further, the program has been shown to improve resilience amongst young people in custody that will benefit families and communities once released. This presentation will discuss the development and implementation of this program including reflecting on its strengths and limitations.

32 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

Family, Housing and Community Services (High Courtyard North) Chair: Clint Ferndale

11.00 - 11.15 ARC in Partnership: strengthening support to families Presenters: Donna Ribton-Turner, UnitingCare ReGen & Heather Pickard, Family Drug Help at sharc Authors: UnitingCare ReGen, Family Drug Help at sharc

Developed in 2005 by Family Drug Help at sharc, the six-week Action for Recovery Course (ARC) educational program offers family members of a person with problematic alcohol and other drug use the chance to learn more about their role in the person’s recovery. Family Drug Help at sharc has delivered the ARC program in partnership with ReGen since 2008.

Under the partnership model, the ARC sessions are held at ReGen and facilitated by Family Drug Help at sharc with support from ReGen staff. While the program is focussed on the specific needs of parents/carers/partners, ReGen staff are able to respond to regular questions about AOD use and support people’s engagement with the agency’s treatment and support services.

The evaluation (undertaken by ReGen’s Evaluation & Communications Unit) found that program participation was associated with significant improvements in measures of stress, anxiety and depression. Follow-up at three months identified marked improvements in program participants’ quality of life and engagement with treatment services by individual family members.

Evaluation findings also demonstrated the benefits of integrated service responses in improving the accessibility of alcohol and other drug treatment and support services for affected families.

11.15 - 11.30 Children, Policy and Cultural shifts in homelessness services in South Australia Presenters: Yvonne Parry & Lynette Burke, Flinders University, South Australia Authors: Y Parry, L Burke & J Grant

In 2008, with the aid of increased State and Commonwealth funds, Housing SA led the strategic reform of the homelessness sector in South Australia. Sector reforms were implemented in 2010. Reforms included the establishment of 75 specialist homelessness services across the state.

A fundamental principle of the South Australian Implementation Plan is that children who attend homelessness services will be recognised as clients in their own right. This requires assessment and case management for every child presenting with an adult at a homelessness service or domestic/Aboriginal family violence service in the state. There is a wealth of literature that identifies poor physical and mental health, limited educational engagement and criminality at high rates in this population of children. These children and their families are often described as “point-end” or “complex” are often disengaged from mainstream services including health and education; they fall through the gaps.

This presentation provides an outline of research and educational interventions aimed at addressing the policy changes and sector reforms through an internal cultural practice shift in frontline homelessness services to overcome structural and systemic barriers and promote opportunities for children in homeless families.

33 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

11.30 - 11.45 Coming Home Program; Social Inclusion Calender and other activities Presenters & Authors: Sheila Ligo & Kirsty McIntyre-Smith, Coming Home Program, Toora Women Inc.

The Coming Home Program supports women leaving prison. The aim is to prevent homelessness and reduce recidivism. Case management tailored to the individual needs of the women we serve is used. Support for family reconciliation, tenancy, health, employment, education and social and emotional well-being is available.

The Program includes a calendar of planned monthly ‘social inclusion’ events. All women, their families and friends are invited to participate. Outings are enjoyed by women service users and workers. Uptake is sporadic and unpredictable. Women with stronger relationships with workers trust that the aim is to have fun.

Often effective social integration happens during daily chores. Driving to Centrelink picking up women on the way and debriefing over coffee at the shops seems to overcome many obstacles women perceive about community participation. Grocery shopping with a couple of women can break down social barriers. Handling a wayward supermarket trolley is a great equaliser.

The Coming Home Program interacts with most women most days in the first 6 months of participation.There is an element of social inclusion in every interaction. This assists in facilitating an effective transition from incarceration to life in the community for this diverse range of women with complex needs.

11.45 - 12.00 Social housing relocation and chronic disease in South Western Sydney: A Health Impact Assessment Presenter: Belinda Crawford, Population Health Directorate, South Western Sydney Local Health District and Sydney Local Health District and Centre for Epidemiology and Evidence, NSW Ministry of Health Authors: B Crawford, R Byun, S Peters & P Sainsbury

Very little is known about the health and chronic disease impacts of relocating social housing tenants in the context of area renewal and regeneration. As the link between housing and health has been well established, housing renewal activities provide a key opportunity to target health improvement and reduce social inequality.

A health impact assessment (HIA) was completed to investigate the impacts of housing relocation on the health and chronic disease risk factors of social housing tenants, a group that often contains many disadvantaged people. The policies, practices and local guidelines that support the housing relocation process were considered as were the mechanisms by which different interventions and supports may lead to positive health outcomes, particularly for chronic disease. A public housing estate undergoing comprehensive renewal and regeneration in South Western Sydney was used as a case study example.

This HIA included a literature review, population profile and in-depth interviews with stakeholders and social housing residents. Qualitative and quantitative measures were used to analyse the information obtained.

The results of the HIA and recommendations for health and housing providers will be discussed. Opportunities for advocacy as well as the challenges of cross-sector research and service delivery will be identified.

34 Concurrent Sessions 1: Monday 11.00 am - 12.30 pm

12.00 - 12.15 “We make our voyage better”: an organization-wide approach to inclusive service development Presenters & Authors: Sarah Pollock, Mind Australia & Ann Taket, Deakin University, VIC

This presentation is concerned with the service delivery organisation as a site for social inclusion. It presents findings of a study on the implementation of a participatory approach to service development in three different service settings in a multi-sector community services organisation. Each service provided support to people with complex needs: children whose families had experienced homelessness; older people with a history of homelessness; and, people with disability. In each setting, service users and family members, staff, managers and government funders were facilitated to work together as equal participants.

The study identified the importance of: 1) creating ongoing and sustainable opportunities for service users and families to get together and discuss things that mattered to them, as well as opportunities for the different groups of participants to work together; 2) critical reflection on the broader situation and discussion of alternate ways of understanding the ‘problem’ ; and, 3) ensuring that service users had control over the language that was used to describe their experiences.

We conclude that a whole-of-organisation commitment, flexible, responsive and transformative leadership and willingness to address the ways in which professional discourses exclude service users from decision-making are all critical to becoming a socially inclusive organisation.

12.15 – 12.30 Prison is different: Innovative approaches to disease awareness and prevention education Presenter: Joanne Smith, ACT Hepatitis Resource Centre Authors: J Smith, J Didlick & K McIntyre-Smith

The ACT Hepatitis Resource Centre delivers a comprehensive range of hepatitis information, prevention, education and support services to raise community awareness, prevent transmission, and minimise the impacts for people living with viral hepatitis infection.

Detainees in Australia’s prisons are some of our most disadvantaged and vulnerable. Compared with the general community, detainees have poorer health, higher rates of risky behaviours, and limited access to health services and resources necessary to prevent infection. Detainees are a priority population for the provision of hepatitis information and prevention education At 92%, ACT prison entrants have the country’s highest rates of illicit drug use in the twelve months prior to incarceration. Many are incarcerated due to the impacts of drugs (including alcohol) on their lives. Hepatitis C is prevalent and multiple cases of in-prison transmission have been observed at the Alexander Maconochie Centre.

As detainees in Australia generally return to the community after relatively short periods of incarceration, prisons function as incubators of hepatitis C infection negatively affecting public health and the health budget.

Didactic approaches to health education in prisons have limited benefits. Instead, theACT Hepatitis Resource Centre has developed some innovative techniques to maximise engagement and benefits for participants.

12.30 - 2.00 Lunch (The Gallery)

35 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

2.00 - 3.30 Concurrent Sessions 2

Prevention and social determinants of health 1 (Ballroom 1) Chair: Warren Lindberg

2.00 - 2.15 Everyone, Everyday Disability Awareness Program Presenters: Megan Campbell & Maureen Howe, Disability ACT Author: M Campbell

The ‘Everyone Everyday’ program is being developed to promote awareness throughout the Canberra community about people with disability and their capabilities and contributions, and to foster respect for their rights and dignity.

A key element of the program is a teaching resource for ACT teachers to equip school age students with the knowledge, skills and confidence to take personal and collective action to enhance the inclusion of people with disability in everyday life. It is our aim that the program will positively influence attitudes and behaviours of the next generation of decision-makers who will be our future employers, service providers, business owners, advocates, policy makers, teachers, colleagues, neighbours and friends.

The resource includes sequenced lesson plans with classroom activities that are linked to the Australian Curriculum, and the resource will be available in electronic format.

The strong collaboration between the disability, education and community sectors in developing the program has been fundamental to ensure it meets the needs of the Canberra community, is sustainable and achieves educational buy in. ‘Everyone, Everyday’ is currently being trialed in the primary school setting and is being rigorously evaluated by the University of Canberra.

2.15 - 2.30 Piloting a community kitchen initiative for residents of unlicensed boarding houses in Sydney Presenter: Brooke Dailey, Health Promotion Service: South Western & Sydney Local Health District, New South Wales Authors: M Hua, R Khan & B Dailey

Background: Unlicensed boarding house residents are more inclined to experience problems around mental health, drug and alcohol use, social isolation, and poorer physical health. They are also prone to receive crisis- based interventions.

Methods: A pilot community kitchen project was developed to improve knowledge, skills, confidence in healthy food preparation, promote social cohesion and support referral pathways. The project partners included the health promotion service from the local health districts, Medicare Local, Newtown Neighbourhood Centre and the local church. Participants were recruited through the Boarding House Outreach program. The intervention strategy was 2 hours per week over 10 weeks and grounded on peer education. The pre and post intervention evaluation tools included a brief questionnaire and informal focus group with open ended questions.

Results: The retention proved to be challenging; the remaining four participants’ confidence in preparing healthy meals independently was increased; more fruits, vegetables and healthy snacks were consumed and expressed interest in tobacco cessation.

Conclusion: This pilot project highlighted areas to be improved: retention rate, development of a cook book, budgeting, adopting a passive facilitator’s style and inclusion of tobacco cessation.

36 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

2.30 - 2.45 Predicting social exclusion and housing instability in women over 45 Presenter: Erin Whittle, Faces in the Street, St Vincent’s Hospital, Sydney, New South Wales Authors: E Whittle, K Wilhelm, S McDermott, M Bramwell, L Collins, T Fletcher & P McGeorge

The Brotherhood of St Laurence and the Melbourne Institute of Applied Economic and Social Research have developed the Social Exclusion Monitor (SEM), a multidimensional framework measuring social exclusion/ disadvantage using economic and social indicators. Building on this research, Faces in the Street is currently undertaking a study to develop a brief measure translating domains drawn from the SEM into a format for use as a screening tool with individuals. The study is being undertaken in collaboration with the St Vincent’s Hospital Social Work Department.

The measure is being administered to women over 45 years old who access the social work services, as this group has been identified as a socially and economically vulnerable population, often with complex needs.They are susceptible to social exclusion and often not identified until a catastrophic change in circumstances has occurred – most frequently homelessness.

We propose that if the social exclusion measure is effective, it will identify vulnerable women prior to a transition into homelessness, effectively facilitating early intervention from a range of services. We anticipate it will allow services to identify the particular domains in which individuals need assistance and assist in providing them with targeted services.

2.45 - 3.00 EFHIA to assess impact of HealthStreet on social determinants of health Presenter: Kay Wilhelm, Faces in the Street, St Vincent’s Hospital, Sydney, New South Wales Authors: K Wilhelm, M Wise, L Collins, F Haigh, P McGeorge, S Bernardi, A Kohn & L Cottler

Introduction: HealthStreet, a community-based program, combining outreach, healthcare, information and a portal for community-based participatory research targeting populations at social disadvantage is being proposed for the Inner City Health Program at St Vincent’s Hospital, Sydney.

Methods: An Equity-Focussed Health Impact Assessment (EFHIA) was conducted to identify (i) areas of need in the inner city and (ii) impact of the proposed service and (iii) provide the EFHIA framework as a guide to service provision and research.

Results: Populations most likely to benefit were low economic resource households, young people 16-25 years. involved in high risk behaviour, people who were socially isolated and those with multiple morbidities.

Conclusion: The EFHIA demonstrated how the HealthStreet program can provide opportunities to link health and other services impacting on social determinants of health for those who are socially disadvantaged and lack opportunity and resources to manage their health.

3.00 - 3.15 Supporting Smoking Cessation in High Priority Populations Pre senter: David Lester, NSW and ACT Quitlines, St Vincent’s Hospital, New South Wales Authors: K Malera-Bandjalan, N Ezard, B Crosby, D Lester & G Curry

Tobacco smoking remains the most significant cause of preventable mortality and morbidity in Australia. Despite reduction of smoking rates in the overall population to about 15%, smoking rates remain as high as 30% to 80% among high priority populations with complex needs. The NSW and ACT Quitlines telephone smoking cessation services have developed innovative strategies to increase accessibility for and more effective engagement with these populations. Strategies include ongoing collaboration with the Aboriginal Health and Medical Research Council, Cancer Institute, Cancer Council, NSW and ACT Health, and NSW Multicultural Health Communication Services. Aboriginal and Torres Strait Islander Quitline enhancement includes employment of an Aboriginal Quitline Coordinator and Advisor and site visits with Aboriginal Medical Services workers and Aboriginal Health College students. Quit Prison includes consultation with Justice Health and Smoke-Free Prisons working group. Multilingual Quitlines employ Arabic, Chinese and Vietnamese speaking Advisors. Mental health capacity building includes Mental Health First Aid training for all staff. These projects are designed to address creatively and systematically the needs of particularly vulnerable and marginalized populations. Some indicators of success are already apparent but much more needs to be learned and to be put into action to prevent disease and promote health more equitably.

37 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

3.15 - 3.30 Improving the physical Health of people with a mental illness in Sunbury Presenter: Bernadette Hetherington, Sunbury Community Health Centre, Victoria Authors: B Heaney & B Hetherington

This joint project of Sunbury Community Health Centre (SCHC) and the Western Region Health Centre’s (WRHC) Sunbury community mental health program aims to ensure the physical health of people with a mental illness are a priority.

The Physical Health Assessment Program (PHAP) provides a comprehensive physical health check for people with a mental illness referred directly by WRHC Sunbury Community Mental Health program. The assessments are conducted by SCHC community health nurses who commence a pathway for the client in to a multi-disciplinary team of clinicians including dental services. A WRHC staff member or advocate are present to assist the client with any concerns and to assist with his/her health literacy.

At the end of each assessment the team in consultation with the client and/or carer/advocate will receive a comprehensive care plan outlining actions to be taken from this first visit including individual goals which are set by the client. The program reviews and evaluates the effects that this has on individuals and their experience of the process.

Breaking down structural and systemic barriers 2 (Ballroom 2) Chair: John Didlick

2.00 - 2.15 Improving communication and coordination in Aboriginal patient journeys; co-developing effective mapping tools Presenter: Janet Kelly & Sharon Perkins, Flinders University, South Australia Authors: J Dwyer, B Pekarsky, S Perkins & J Kelly

Background: Aboriginal people in rural and remote areas face particular challenges in accessing and navigating the health and support services required to meet their complex health needs. The Managing Two Worlds Together Project studied barriers and enablers to effective patient journeys as perceived by Aboriginal patients, carers and staff.

Methods: Patient journey mapping tools are being developed in collaboration with country and city Aboriginal and mainstream primary, hospital and support staff in SA and NT focusing on which specific communication and system gaps exist, and how best they can be overcome.

Results: Staff work hard to overcome gaps, but identifying the exact causes of complexity is often difficult. While clinical complexity is often anticipated, complexity of the patient journey itself, and of care and support systems as a whole, are often difficult to ‘see’ and anticipate. Patient journey mapping tools are proving useful in identifying both system wide and site specific gaps and the most effective strategies.

Conclusion: Health and education staff and managers are using these tools to help plan, coordinate and review Aboriginal patients journeys through and across their own and other services, to orientate and train new staff, for continuing education and as audit tools linked to existing CQI models.

38 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

2.15 - 2.30 The Kanyini’ Qualitative Study: Unpacking the structural and systemic health care barriers Presenter: Ricky Mentha, Baker IDI, Alice Springs Authors: A Brown, A Cass, B Rickards, S Togni, R Mentha, J DeVries, J Brady, B Fewquandie, H Liu, D Peiris, S Ingram & P Simon.

Background: Disproportionately high rates of chronic disease are experienced by many Indigenous Australians. Research designed to explore the major structural and systemic barriers impeding engagement with health care services is essential to improve outcomes for disadvantaged people. This is especially important for populations with complex needs, such as rural and remote and Indigenous communities and patients with chronic disease.

Methods: The Kanyini Qualitative Study involved the conduct of 205 semi-structured interviews across multiple sites with Indigenous patients, their families and healthcare providers to improve understanding of the primary barriers and enablers that influence Indigenous Australians’ engagement with chronic disease care. Thematic analysis of data was undertaken using within-site and across-site approaches.

Results: Significant tensions between patients and the health system were identified across the continuum of care. Indigenous participants’ engagement with often complex primary-through-tertiary care was impeded by their myriad competing demands. At the provider level, a pressured health system struggled to resource the ‘relational’ contexts integral to Indigenous understandings and expectations of ‘care’ which in turn undermined effective engagement.

Conclusion: For the Indigenous participants in our study, healthcare engagement for chronic disease was contingent upon contexts of sustained and therapeutic relationships with providers. Specifically, barriers derived from a pressured health system materially impaired patients’ capacity to engage effectively with health services.

2.30 - 2.45 Breaking down barriers: A partnership to improve ear health for Aboriginal children Presenters: Sue Hedges, Victorian Aboriginal Health Service & Stella Artuso, Royal Victorian Eye and Ear Hospital, VIC Authors: S Hedges, S Artuso & R Thorpe

Higher rates of ear conditions among Aboriginal children have highlighted the need for increased screening, earlier detection and improved access to specialist services, management and follow-up care. Despite higher levels of need among Aboriginal children, uptake to specialist services is generally low.

A project between an Aboriginal Community Controlled Health Organisation (ACCHO) and a Melbourne metropolitan specialist hospital was developed seeking to improve Aboriginal paediatric ear health by facilitating access to specialist services, streamlining surgical pathways, and increasing ear health awareness for patients, families and health workers.

Monthly specialist audiology and ENT services were provided for Aboriginal and Torres Strait Islander children in a culturally appropriate setting. Since April 2012, 70 children have been seen by a specialist, 18 children require surgery, 14 (78%) of which have already undergone surgery. Attendance (including drop-in appointments) and Did Not Attend rates were 71% and 46.5%, respectively, with drop-in appointments accounting for 19% of the total attendance.

The project facilitated access to specialist care for Aboriginal children by providing parents/carers with access to same day audiology and ENT specialist services, cultural and socially appropriate services, consistent staff to build relationships with families, reduced surgical waiting times and a comprehensive continuum of care.

39 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

2.45 - 3.00 Reducing intergenerational disadvantage through a life-first employment program: Individual and systems approaches Presenter: Katy Osborne, Flinders University, South Australia Authors: K Osborne, K Patel, R Walker, D King & M Moskos

Programs which aim to increase social inclusion view participation in employment as a pathway to reducing disadvantage. This paper draws on qualitative data from an evaluation of the South Australian Building Family Opportunities (BFO) Program (a Social Inclusion demonstration project delivered by the Department of Further Education, Employment, Science and Technology (DFEEST)). BFO is designed to enable long-term unemployed individuals living in family households in three areas of South Australia to enter employment. It uses a ‘life-first’ approach involving holistic strengths-based case management, alongside processes which aim to address systems-level barriers to reducing intergenerational disadvantage. In-depth interviews with 34 BFO clients, and 5 focus groups with BFO case managers were conducted. Participants described how being involved in BFO was empowering and positive for their health, and reported employment outcomes. While it was evident that the BFO model works well with a client group that experiences high levels of disadvantage, case manager and client findings also illustrated structural barriers to sustainable employment, including insecure and inadequate housing, and limited and precarious job opportunities. We conclude that there are challenges for such programs to reduce intergenerational disadvantage in the absence of broader measures to reduce structural inequalities.

3.00 – 3.15 Breaking the barriers to providing hepatitis C treatment in prison Presenter & Author: Denise Monkley, Justice and Forensic Mental Health Network, NSW

Prisoners in Australia have high rates of hepatitis C virus (HCV) infection (over 30%) arising from high rates of injecting drug use. Effective treatment for hepatitis C is available but access is limited due to the structural barriers in the prison setting and the need for physician-led treatment regimes.

In 2009, a two-year pilot study was undertaken in three NSW prisons of an innovative model for inmates with chronic HCV delivered by nurses, the Nurse-led Model of Care (NLMC). The key features of the model were provision of care for the patients within their correctional centre made feasible by protocol-driven structured assessment and management of antiviral therapy by skilled Clinical Nurse Consultants (CNCs), with limited involvement by specialist physicians.

The pilot provided strong evidence for the efficacy and safety of this model in the correctional setting with 391 patients enrolled, 144 clinically assessed and 108 initiating treatment. The treatment outcomes were consistent with community standards. This successful pilot study identified that the NLMC is an effective model of care and breaks the barriers to providing this important treatment to this highly disadvantaged population.

3.15 - 3.30 Post-Release Support with high risk, complex needs ex-prisoner populations: What works? Presenter & Author: Mindy Sotiri, Community Restorative Centre (CRC), NSW

CRC has over 60 years experience providing services to prisoners, ex-prisoners and their families. Over the last decade, CRC has developed a post-release support model that is specifically targeted to people with complex needs. 42% of all prisoners in NSW return to prison within two years of their release. Although there is currently an absence of specific data in NSW to draw on in regard to recidivism rates amongst complex needs populations, the research that does exist indicates that the groups CRC work with – if unsupported-would have a return to prison rate of well over 70%. The recidivism rate for CRC clients has over the last decade been exceptionally low. For instance last year, of the 60 clients assisted by the transitional project in Sydney, only 4 (6.7%) returned to prison.

This presentation will overview the key features of the CRC post-release model including: the necessity of ongoing intensive outreach support; the use of the ‘housing first’ model (acknowledging the centrality of safe, secure and permanent accommodation in allowing people from chronically disadvantaged backgrounds to make changes in their lives); and the importance of hopeful, pragmatic, non-judgemental and genuinely caring relationships between workers and clients

40 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

Collaborative Mental Health and Alcohol and Other Drug service delivery 2 (Ballroom 3) Chair: Michael Smith

2.00 – 2.15 Blood, Sweat and Tears: Building interagency and intersectoral relationships in mental health Presenter: Elizabeth Jewson, HealthWest Partnership, Melbourne, Victoria Authors: E Jewson & A Kleparska

Building sustainable interagency and intersectoral relationships is not easy. This presentation reflects on the successes and challenges of a mental health project implemented in Melbourne’s west. The project provided an opportunity for agencies working with young people with complex mental health needs (a group at high risk of social isolation) to develop a collaborative strategy to address service system barriers. The project included consulting with young people and facilitated the building of trust, positive relationships and improved communication.

Forty agencies identified in a forum the following priority issues: access to services, clear service pathways, collaboration between and awareness of available services. Working groups were formed to address these challenges and a suite of tools for clinicians and managers, a common interagency consent form and a shared care plan based on complex case studies were developed.

Those working with young people with complex needs are now more supported to: identify the most appropriate services for referrals, communicate effectively across agencies and sectors and improve young people’s journey through the service system.

Importantly, because mental health issues are often stigmatized, this project supported young people to access services early therefore reducing the risk of social isolation and enhancing their wellbeing.

2.15 - 2.30 Creating an integrated primary mental health platform Presenters & Authors: Melissa O’Shea, Barwon Health, Victoria & Kate Barlow, Barwon Medicare Local, Victoria

Barwon Medicare Local has a strong emphasis on service system development, cross sector communication and building capacity to address identified gaps within primary health care. In particular Barwon Medicare Local has promoted the establishment of primary mental health partnerships across the Barwon Region, with a focus on bridging the gaps between primary and tertiary mental health services. Barwon Health is the public mental health service provider and provides the full range of acute and community mental health services to 260,000 residents in the region.

This presentation will describe a unique and exciting collaboration whereby primary care and public service provision aimed at people with high prevalence disorders are integrated into a new co-located primary mental health platform.

Features include interdisciplinary work practice, functional integration, teaching and learning via academic partnership with Deakin University therapy, training and research clinic and a single point of access streamlining entry to an otherwise complex system for individuals and their families. The model is reliant on multiple program and funding sources and underpinned by a shared commitment to service system reform and shared strategic intent.

41 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

2.30 - 2.45 S-Check: a new early intervention for stimulant use Presenter: Nadine Ezard, University of New South Wales & St Vincent’s Hospital, NSW Authors: N Ezard, B Francis, M Magee, B Crosby & E Crouch

Stimulants have been used for many decades in Australia and their use and associated harm is rapidly rising in many countries across the region. Stimulant drugs include the amphetamine-type stimulants (amphetamine, methamphetamine) and cocaine. The majority of recent stimulant use is recreational and intermittent, risking mental and physical health problems, social problems, sexual and injecting risk behaviours and dependence. In New South Wales, stimulant use is prevalent among some groups who are treatment naïve and who may not otherwise attend services for drug treatment, including members of the gay, lesbian, bisexual, and transgender communities.

In 2013, St Vincent’s Hospital, Sydney, is establishing a low-threshold early Stimulant Check-up intervention, the S-Check, to provide a means for recreational and occasional stimulant users to bridge the gap between treatment and no treatment. Through interagency and inter-sectoral collaboration, a social marketing campaign introduces ‘Stimulant Check-ups’ into the language and mindset of people who use stimulants and their associates. Brief person-to-person interventions, based on bio-psycho-social assessment, are followed by referral as indicated.

The program aims to provide leadership and generate lessons learned on social inclusion in health care delivery for sub-populations of stimulant users.

2.45 - 3.00 Wrong way, go back: diverting young people from custody Presenter: Anna Curtis, Justice and Forensic Mental Health Network, NSW Authors: M Owen & J Carter

There is a significant association between mental illness, drug and alcohol problems and offending among young people. The 2009 NSW Young People in Custody Health Survey identified that nearly all 87% participants had a psychological disorder and 64% had a substance disorder.

The recognition of the link between health concerns and offending behaviour has driven the expansion of programs aimed primarily at diverting young people from custody to more appropriate services in the community. In NSW, the Adolescent Court and Community Team was developed to assess and divert young people with a mental illness and/or drug and alcohol issues away from the criminal justice system to appropriate community-based care. The program also provides support and advice to other agencies such as Juvenile Justice, Child and Adolescent Mental Health Services and Family and Community Services who provide services to these high risk young people.

Since the service commenced in 2006, there have been over 3000 assessments and 70% of all young people assessed were diverted away from custody into appropriate treatment. This presentation will discuss the strengths and limitations of the diversion program including a focus on building strong collaborations with partner agencies.

3.00 - 3.15 The Sydney Medically Supervised Injecting Centre (MSIC) Mental Health Nurse Co- ordinator project Presenter: Mark Goodhew & Jennifer Holmes, Sydney Medically Supervised Injecting Centre Authors: M Goodhew, J Holmes & I Flaherty

Sydney MSIC, through its unique low threshold harm reduction operating model, has contact with drug-using people who would not otherwise access health services. The demographics of clients attending the MSIC show they are a particularly marginalised group of long term drug users. On average clients have been injecting drugs for more than 13 years when first seen at MSIC. At the time of registration, 70% were unemployed, approximately 35% had completed only some secondary education, and 23% had been imprisoned in the previous 12 months. An increasing proportion of clients are in unstable accommodation with the latest figures showing this is currently at 30%. Further data shows that nearly 70% of clients had not accessed the local health services in the area, and 40% had never previously accessed drug treatment.

This project addresses the unmet mental health needs of the MSIC clients. Mental health issues are highly prevalent especially among the most frequent attendees of MSIC, as high as 65% according to a survey conducted onsite in July 2011, yet only 15% of all clients ever reported having had a referral or admission for mental health issues. We explore the facilitation of mental health referrals by this project using social network analysis.

42 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

3.15 - 3.30 Is there any more complex need than being an illicit drug-using mother? Presenter: Stephanie Taplin, Institute of Child Protection Studies, Australian Catholic University, ACT Authors: S Taplin & R P Mattick

Arguably there is no group of women with more complex needs than mothers who use illicit drugs. A recent NSW study of 171 mothers in opioid pharmacological treatment found high rates of mental health problems, more than half had been sexually abused as children, and all had substantial substance use histories. Most were also highly disadvantaged, single and struggling to care for their children. A substantial number had had one or more children removed by the child protection system. Logistic regression analyses found that being on psychiatric medication and having less parental support (along with greater numbers of children) were significantly associated with child protection system involvement.

To reduce the need for child protection system involvement, these mothers need better and targeted interventions aimed at treating their mental health problems and the trauma associated with their own abuse histories, along with support to remain in treatment for their substance use problems. But they also need help to address their other disadvantages and particular help with increasing their social and parenting supports.

This paper will discuss some of the study’s findings and provide directions for improving outcomes in families with substance-use problems.

Aboriginal and Torres Strait Islander services 2 (Ballroom 4) Chair: Peter Waples-Crowe

2.00 - 2.15 Walking in the Worlds of the Aboriginal Maternal Infant Care Workers Presenters & Authors: Renae Kirkham & Caroline Dalgetty, The University of Adelaide, SA

Marked inequalities in maternal and child health exist between Australia’s Aboriginal and non-Aboriginal populations. Improving the care of Aboriginal women before and during pregnancy has been identified as a key strategy to closing the gap in health outcomes. In 2004 a new birthing model of care was introduced in Port Augusta which includes Aboriginal Maternal Infant Care (AMIC) workers working in partnership with midwives and other care providers to deliver antenatal and postnatal care. This project broadly aims to increase understanding of the role of the AMIC worker and explore ways in which they manage the interface between the biomedical model of maternity care and Aboriginal knowledge and beliefs about reproductive health. Analyses of depth with AMIC workers, hospital staff and program clients has identified a number of complexities facing AMIC workers that are often invisible to the systems and institutions they are working in. Strategies that support the development of positive relationships between health professionals will help to ensure the sustainability of this model of care. These include training in cultural safety, and promoting awareness of systemic issues that create challenges for AMIC workers. Essential resources that will improve the working environment for AMIC workers will also be discussed.

2.15 - 2.30 Driver licensing is a health issue: the Young Health Program Presenters: Maydina Penrith & Jake Byrne, The George Institute for Global Health, The University of Sydney Authors: R Ivers, J Byrne, K Hunter & K Clapham

Driver licensing is an important part of life for many Australians, especially those who live in outer urban areas or regional and remote parts of the country where public transport is not accessible. Barriers to licensure may exacerbate the geographical and social exclusion of Aboriginal communities, and place a heavy burden on those few licensed drivers to service the rest of the community. It is likely that lack of a driver licence impacts significantly on access of Aboriginal people to services such as health, education and training, as well as on their opportunities for employment. Regulatory driving offences are important contributors to the high incarceration rates of Aboriginal people. The Young Health Program is aimed at reducing barriers to driver licensing. This community based program involves Aboriginal youth workers in community organisations coordinating access to various associated licensing services, case managing young people and promoting road safety and licensing via locally targeted, locally developed social marketing campaigns. The program has been established in three sites in NSW, and will be evaluated via interrupted time series analyses and detailed process evaluation.

43 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

2.30 - 2.45 Assessing Partnerships to Address Aboriginal Disadvantage Presenter: Sandra Thompson, Combined Universities Centre for Rural Health, UWA Authors: S Thompson, C Tsou, E Haynes & C Green

The National Apology to the Stolen Generations and commitment of funds to address Aboriginal disadvantage has focussed attention on the need for better partnerships between Aboriginal people and organisations and mainstream providers of services. Yet issues of history, power, trust, organisational culture and resources are major challenges to be overcome in effective intercultural organisational partnerships.

This presentation includes results and background on research underway in Geraldton WA, where a university centre is partnering with the Midwest Aboriginal Organisations Alliance to address the key Aboriginal identified priority areas of housing, inclusion in civic life with opportunities for Aboriginal people to have leadership positions, racism and cultural safety, and youth. All of these areas impact upon health and the circumstances are favourable for multi-organisational partnerships working to address them.

Major issues identified to date for the partnership include resourcing, the time consumed in partnership activity particularly for key Aboriginal leaders, timelines imposed by funding bodies, inter-personal and inter- organisational relationships and tensions, and the ability or lack of commitment of government agencies to act upon recommendations. Despite respectful efforts, intensive partnerships between Aboriginal and mainstream organisations can be overwhelming and there are risks from partnership research findings and recommendations not being implemented.

2.45 - 3.00 Clinical engagement as a tool for improving outcomes for Aboriginal patients. Presenter: Jane Cussen, Department of Health, Victoria Authors: L Parsons & J Cussen

The Victorian Aboriginal health reform priority area – fixing the gaps and improving the patient journey has focused effort on improving Aboriginal people’s satisfaction with care provided by hospitals and the transition between hospital and other care settings.

Eight Aboriginal Health Clinical Engagement projects are working to improve health outcomes and the patient experience in Victorian hospitals through system change and high level clinical engagement. The projects are located in various major health services and each have a different clinical focus - cancer, cardiac, renal, mental health, oral health, paediatric, emergency care and maternity. Projects respond to the needs of the Aboriginal communities they serve and the particular characteristics of the clinical area and the health services they work with.

Projects have developed models of care coordination, guidelines, respectful practice principles and resources to overcome structural and systemic barriers facing Aboriginal patients and to make Aboriginal health everyone’s responsibility.

Clinical engagement has repeatedly been shown to be an essential strategy for achieving sustainable change in healthcare. This presentation will reflect on clinical engagement as a strategy to achieve system change that contributes to improved outcomes for Aboriginal patients in mainstream health services.

44 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

3.00 - 3.15 Chronic Care Coordination by Indigenous Health Workers – A solution for better care? Presenters: Barbara Schmidt & Frank Hollingsworth, University of South Australia Authors: B Schmidt, A Sticpewich, V Owens, C Preece & R McDermott

“Getting Better at Chronic Care in North Queensland” is a cluster randomised controlled trial that aims to evaluate a new strategy for integrated community-based, intensive chronic condition management in rural and remote Indigenous primary care services in north Queensland. Indigenous adults with poorly controlled diabetes (HbA1c ≥8.5) and at least one other chronic condition were recruited from 12 communities in 2010/11. The communities were randomly allocated to receive either the intervention or ’usual care’. Participants in the intervention group began receiving care coordination from an Indigenous Health Worker (IHW) in January 2012. The primary outcome is reduction in HbA1c at 18 months. Secondary outcomes include quality of life, avoidable hospitalisations, mortality and intermediate clinical outcomes such as blood pressure and renal function.

The IHWs received intensive chronic disease and case management training to ensure they have the skills to coordinate chronic disease care according to best practice guidelines. Ongoing support is provided by an Indigenous Clinical Support Team. In this presentation we will discuss the professional and organisational issues faced by IHWs in establishing their roles as care coordinators for people with complex care needs and share some of their early success stories.

This study has ethics approval and participating research partners and communities to share learnings from the research.

3.15 - 3.30 Winnunga Nimmityjah Aboriginal Health Service Holistic Model of Healthcare Presenter & Author: Julie Tongs, Winnungna Nimmityjah, Aboriginal Health Service, ACT

Winnunga Nimmityjah Aboriginal Health Service in Narrabundah is the only Aboriginal Community Controlled Health Service delivering holistic health services for Aboriginal and Torres Strait Islander people in the ACT and region. It is operated by the Aboriginal community of the ACT, and was established in 1988 on a part-time basis and began full time operations in 1990. Winnunga Nimmityjah Aboriginal Health Service employs a wide range of health practitioners and offers numerous clinical services and programs tailored to suit the needs of the local Community.

Winnunga is a bulk billing service. This facility encourages members of our Community who would not normally be able to afford medical, psychiatry, psychology, opiate, audiology, midwifery and dental treatment to use Winnunga services. Our holistic approach to health and wellbeing means that all of these services work in partnership with the social and emotional wellbeing programs delivered by our Aboriginal Health Workers in the Social Health Team.

Winnunga’s strength lies in its holistic approach to delivering services which address the social determinants that impact on achieving health equality. It reaches under-served Aboriginal and Torres Strait Islander patients, the key intent in closing the gap in Aboriginal and Torres Strait Islander disadvantage.

45 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

Health Promotion (High Courtyard North) Chair: Heather Yeatman

2.00 - 2.15 Using social enterprise to address food security Presenter & Author: Benjamin Chahola South West Sydney Local Health District

Background: Studies show extreme food insecurity among some newly arrived refugees from arrival to post settlement periods. Over 80% African refugees are food insecure compared to 8% in general population nationally. Social exclusion limits their opportunities to participate in education, skills development and employment, access to services, social connection and advocacy.

Methods: A partnership project was developed between health, education, local community organisations to improve local community food security, employment opportunities and social connection in a Sydney west high school. Initiatives included: a Parents Café, horticulture training, catering social enterprises and community kitchens. The Parents Café provides a one-stop-shop to access information, resources, services, pathways to employment and further education and to socialise.

Results: Two catering social enterprises were established and 43 catering orders were delivered, 21 jobs were filled by refugees from African and other community groups. 28 and 22 participants completed Safe Food Handling and Barista courses respectively. 144 people have taken horticulture courses, out of 144, 56 are employed in nurseries and 3 have enrolled in further studies. A school ‘mini-farm’ will provide training for 18 participants in small scale, self-employed food production businesses.

Conclusion: This project has successfully increased social inclusion, training and employment opportunities for a local community.

2.15 - 2.30 Improving the quality and nutrition of community food programs: a needs assessment Presenter: Leanna Helquist, Doutta Galla Community Health Service, Melbourne Authors: L Helquist, K Cirone, A Leggat, S Nolan & D Platt

Background: The cities of Moonee Valley and Melbourne have a large proportion of disadvantaged groups including those experiencing homelessness. Marginalised communities are four times more likely to experience food insecurity and this is linked to poor health outcomes. Past projects have shown that clients are unable to meet their nutrition requirements when eating only at community food programs (CFPs). The aim of this project was to understand the needs of CFPs, their suppliers and clients, providing strategies to improve the quality and nutrition of meals.

Methods: Semi structured interviews were conducted with eleven CFPs, three CFP suppliers and ten CFP clients. Convenience and snowball sampling was used to collect data. Data was analysed using iterative thematic analysis.

Results: While CFPs are considered to provide a quality service, improvements to nutrition are important to suppliers and food providers. Suppliers and CFPs identify that collaborating with council, community health services and funders to improve resources and infrastructure are key areas in improving the quality and nutrition of food.

Conclusion: Council food policies need to better support food relief suppliers and providers. Community health needs to have an increased role in providing nutrition education and expertise to clients, providers and suppliers of CFPs.

46 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

2.30 - 2.45 Building stronger linkages between Emergency Food Relief providers to improve current services Presenter: Rebecca Ramsey, Queensland University of Technology, Queensland Authors: B Searle, R Ramsey & D Gallegos

Australia boasts a comprehensive social welfare safety net; however food insecurity is a persistent threat to vulnerable population sub-groups. The predominant strategy to alleviate food insecurity is emergency food relief (EFR), however EFR does not necessarily align with the definition of food security or the concept of human dignity. This research investigated potential strategies for the improvement of current EFR services to address food insecurity while maximising human dignity. Data was collected via semi-structured interviews from 29 staff members of Brisbane providers of EFR and analysed using thematic analysis.

Demand for EFR was increasing, with increases as high as two- to three-fold reported. Those on social welfare, or the ‘working poor’ were common recipients of EFR, and a high proportion of clients with mental illness or a disability was reported almost unanimously. Increased funding and strengthened collaborations between EFR organisations were identified as having the potential to improve coordination of services and allow for pooling of resources to meet the needs of clients and provide services to treat more than just hunger. Nutrition education and budgeting assistance combined with community co-ops or discount supermarkets were identified as strategies to improve food acquisition and encourage self-sufficiency and a sense of community.

2.45 - 3.00 From theory to practical action: building capacity for food security Presenters: Alice Wood & Sue Gordon, Narellan Community Health Centre, NSW Authors: S Gordon, A Wood & N Deane

Addressing food insecurity from a number of angles is key to finding practical community solutions. The commencement of Macarthur Future Food Forum enabled partnerships between NGO’s, Government services and community to find solutions to the complex factors contributing to food insecurity. This has resulted in stronger linkages between agencies to support food security projects.

The MFFF Food Security Capacity Building Project commenced in December 2011, providing support, raising awareness and building capacity within local NGOs. By providing food security training to 55 participants detailing a range of practical, achievable options, NGOs could develop a project best suited to their client needs. Small funding grants of up to $2000 have helped establish ten programs.

The lessons learned include: the importance of being practical, being out there doing the networking that enables the linkages; nurturing and mentoring the project leaders and empowering facilitators; guiding the way while knowing when to step back.

This presentation showcases the range of food security projects, including: involving men from diverse backgrounds in a Men’s Shed garden; vulnerable families getting support in a Community Kitchen; young offenders creating their own vegetable garden; church volunteers setting up a low cost food pantry; and a Tropical Pacific Island Garden.

47 Concurrent Sessions 2: Monday 2.00 pm - 3.30 pm

3.00 - 3.15 Partnership Development - Key Success Ingredient to Promote Healthy Lifestyles in Disadvantaged Populations Presenter: Lynne Prentice, ACT Health Directorate, ACT Authors: L Prentice, P Spence, M Ransome & S Sherwood

Background: Partnerships have been essential for the successful implementation of the Healthy Communities Initiative (HCI) in the ACT. The HCI is an obesity prevention intervention in a disadvantaged area and is “A joint Australian and Territory Government initiative under the National Partnership Agreement on Preventive Health.”

Methods: Partnership development was identified as a key project output, including partnerships with consumers. Qualitative and quantitative data have been collected over the two years of the project.

Results: The ACT Health Directorate and two non government organisations, Reclink Australia and Australian Red Cross ACT/SE NSW have achieved significant engagement with a disadvantaged community in Canberra. Community members have participated in a range of activities including the creation and maintenance of a community garden and nutrition program at a public housing site, and a ‘Run, Roll or Walk’ activity where a healthy lunch and ‘Tap into Water’ messages are promoted.

Conclusion: Professionalism, compassion, reliability and dedication were some of the attributes identified in feedback about the successful partnership which will be discussed. This has led to improved participation through an increased ability to: provide high quality services and support to participants; promote activities; enhance promotion of health messages; and to share workload and resources with the range of activities.

3.15 - 3.30 Building young people’s mental health literacy through online spaces Presenters & Authors: Shane Cucow & Ali Hodson, Inspire Foundation, NSW

Mental health is a big concern for young people, with 75% of all of mental disorders emerging before the age of 25. We also know that mental illness is the leading burden of disease for young people in Australia, while suicide is the leading cause of death amongst those aged 15-24. However, more than 70% of young people with signs and symptoms of a mental health condition do not seek professional help. The 2007 National Survey of Mental Health and Wellbeing found that 86% of those who don’t seek help simply didn’t think they needed it.

ReachOut.com bridges the gap between young people and face-to-face or online counselling services. ReachOut.com assists young people to link experiences with possible causes, and supports them in the development of factors that protect against emerging mental health difficulties - with actionable, self-directed help on everything from depression to wellbeing. It reaches young people in the spaces where they do seek help, connecting them with people their age that are going through similar experiences.

This session will introduce participants to the mental health framework behind ReachOut.com, and provides guidance in the use of e-mental health services to support young people.

3.30 - 4.00 Afternoon tea (The Gallery)

48 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

4.00 - 5.30 Concurrent Sessions 3

Prevention and social determinants of Health 2 (Ballroom 1) Chair: Leanne Wells

4.00 - 4.15 Strength in Diversity: Building a healthy sex and gender diverse community Presenter & Author: Peter Hyndal, A Gender Agenda, ACT

Transgender and Intersex people are one of the most socially isolated and marginalised population groups in Australia. Despite evidence of substantially poorer mental health and well-being outcomes, very few programs have been able to effectively engage with this community.

In 2011, A Gender Agenda ran a pilot “Social Inclusion Project” with funds from the ACT Health Promotion Grants Program - the first time a health promotion project targeting transgender and intersex people has ever been funded in Australia.

The project aimed to improve the mental health and well-being of participants by facilitating opportunities for social connection between otherwise isolated individuals. The project was designed within the framework of respectfully engaging with people – delivery models were adapted throughout the project in order to meet the emerging needs of participants.

The project successfully met its planned objectives – it engaged more people than originally planned, increased the frequency of social interactions, and also improved quantitative measures of mental health and wellbeing of participants. The real power of the project though, was the degree to which it started to build a cohesive, united, and diverse community of sex and gender diverse people, their partners and family.

This presentation will give a brief overview of the structure and outcomes of the project with the aim of sharing knowledge that could be used by others to run similar projects.

4.15 - 4.30 Sex Worker Awareness Training: Myth-busting with role play Presenter: Lexxie Jury, Sex Worker Outreach Program, AIDS Action Council of the ACT Authors: L Jury & S Marion-Landais

Back ground: Sex Workers Outreach Project (SWOP) is a peer-based community program whose primary purpose is HIV & STI prevention, education and referral for sex workers (SW) in the ACT. SWOP developed a peer-based training program to equip SW with the necessary skills sets and knowledge including health and safety awareness. Feedback was positive but highlighted a theme of SW’s frustration at perceived stigma and discrimination from local service providers.

Methods: The SWOP Project Officer incorporated SW feedback and expanded the existing SW training into a one- day training course, Sex Workers Awareness Training (SWAT). SWAT aims to engage the extended community, including police and medical providers, to address myths, reduce stigma and promote awareness of sex work.

Results: Police officers, physicians, medical residents training in forensic science and nurses completed the SWAT training and evaluations show a positive shift in knowledge and understanding of the issues facing SW. SW report a positive change in SWAT-trained service providers’ attitudes and report feeling less stigmatisation at the time of service.

Conclusion: Program benefits include SW’s improved perceptions of service providers, an increased number of SW accessing community services and an increased number of SW willing to disclose their occupation. Local health services have improved intake processes to ensure respectful service. SWAT has been successfully showcased in both Queensland and NSW and is encouraged for all professionals who work with SW.

49 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

4.30 - 4.45 Supporting good reproductive health outcomes for women who use drugs Presenter: Anna Olsen, The Kirby Institute, UNSW Authors: A Olsen & C Banwell

In light of recent debates on the use of financial incentives to promote long-acting contraception and sterilisation use among women who use drugs we discuss attitudes to contraception, pregnancy and parenting among Australian women who inject drugs. Interview data with women shows that despite common assumptions about their attitudes to health they aspired to control their fertility, expressed individual contraceptive preferences and concerns for their children (both born and unborn). Most had tried a number of contraceptive methods interspersed by periods of non-use related to experiences of side-effects, being single or abstinent, believing that they were infertile and trying to conceive. Attitudes varied from woman to woman and in the same individual over their life course. Although some believed that they were not capable mothers, most aspired to be successful parents. Evidence suggests that women who use drugs do not need to be paid to limit their fertility or, in the case of sterilisation, end their fertility. Rather, programs that aim to reduce barriers to obtaining free, non-discriminating reproductive advice and parenting assistance would better utilise women’s agency to improve their own reproductive health.

4.45 - 5.00 A gendered view in focus: Addressing complex needs through a gender lens Presenter & Author: Pam Rugkhla, Women’s Health Victoria, Melbourne

A systematic application of a gender lens in the design of policy and programs is essential in assisting people with complex needs. There are simple steps that can be incorporated into existing design structures - starting from the need to collect sex-disaggregated data, to appropriate consultation, and ensuring that the responses meet the needs of women and men they have been designed to cater for.

A one-size-fits-all approach can result in people with complex needs falling through the cracks. A gender sensitive approach takes into account the social and economic context of women’s and men’s lives. It allows for a systematic unpacking of power relations between individuals and groups, as well as protective factors for health outcomes.

This presentation will cover the steps for designing gender sensitive strategies along with examples of data and responses that are gender blind and those which are gender sensitive. By gaining increased understanding of gender analysis, professionals will be better equipped to improve health outcomes of women and men with complex needs.

5.00 - 5.15 HIV and Mental Health - Why all the complexity? Presenter & Author: Michael Smith, HIV Outreach Team - South Eastern Sydney Local Health District, NSW

People living with HIV and mental illness are at risk of being socially excluded and labelled as complex and challenging. It is acknowledged that the co-existence of medical and psychiatric illnesses can produce poor medical outcomes and psychiatric comorbidity can influence people with HIV because of risk behaviours and poor adherence (Andersson-Noorgard, 2010). The challenge for a person to receive care can be compounded by multiple health care agencies and non-government organisations with differing views on treatment and support and openly admitting that they struggle to manage people with mental health issues. The term complex is frequently used in the context of a person with HIV and mental health issues. Using a consumer study we can question where complexity exists and how it can exclude people that require treatment and support. The patient study will explore an approach that has been successful despite many challenges that were encountered in an attempt to get treatment and the promising results that have followed. This paper will question the use of the term “complex in health” and the impact on social inclusion and health care in a specialised health service inner city Sydney.

50 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

5.15 - 5.30 “A tale of two states”- Breaking down structural and systemic barriers to abortion access Presenters & Authors: Brooke Calo, Senior Social Worker, Pregnancy Advisory Centre, SA & Rhonda Cale, Counsellor & Trainer, Children by Choice, QLD

This presentation compares the inequity of abortion access between SA and QLD, focusing on the experiences of women with complex needs. Half of the 200,000 unplanned pregnancies in Australia each year will result in an abortion. However the legal status of abortion and affordability of abortion services differ markedly between the states. Whilst abortion remains within the criminal code in both SA and QLD accessibility of abortion depends on the state in which the woman resides, resulting in severe inequity for disadvantaged women.

With public provision of abortion in Queensland accounting for 1% of all procedures, Queensland women rely on expensive private clinics. Disadvantaged women with complex needs experience significant barriers to access particularly young women, ATSI women and those in rural or remote regions. Through advocacy Children by Choice supports women to navigate barriers, including financial burdens, geographic isolation, time constraints and compromised confidentiality. In 2011-2012 the average distance traveled for regional and remote women supported by Children by Choice to access an abortion was 857km each way.

Women living in SA have a very different experience with greater equity of access to abortion services. Public provision accounts for 99% of all terminations. The Pregnancy Advisory Centre, set up in 1992 by the South Australian Health Commission, is a publicly funded clinic. The centre provides a quality service for women in South Australia in relation to unplanned pregnancy and abortion.

This comparison presentation highlights the need for abortion access and care to be a national public health priority to address inequality and identifies key features of best practice services.

Breaking down structural and systemic barriers 3 (Ballroom 2) Chair: Stella Conroy

4.00 - 4.15 Exploring service gaps and development options for people ageing with psychosocial disability Presenter & Author: Sarah Pollock, Mind Australia, Victoria

This presentation concerns the extent to which current service configurations meet the needs of people ageing with psychosocial disability. Based on a project recently completed for the Victorian Department of Health, it identifies structural and systemic barriers and proposes service development options for this group of older Australians.

People who have experienced the effects of severe, enduring mental ill-health over their lifetime enter older age, often prematurely, with complex support needs across diverse life domains, including health, mental health, daily living and social support. This complexity is compounded by the social and behavioural impacts of enduring mental ill-health which often result in social isolation and lack of amenability to receiving services from mainstream providers.

There are funded supports from diverse sectors appropriate to the needs of this group. Age-related eligibility criteria, lack of coordination of services and insufficient duration and intensity, however, act as barriers. Mainstream providers often lack skills to work with this group. The costs of inadequate provision are considerable, both to the system in terms of higher levels of care and to individuals’ quality of life outcomes.

The presentation discusses options for development and strategies to give greater leverage off existing services and supports.

51 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

4.15 - 4.30 Forgotten Australians, Still Forgotten: distant encounters with the service system Presenters: Caroline Carroll, Open Place, Victoria and Alliance for Forgotten Australians & Simon Gardiner, Open Place, Victoria Author: S Gardiner

This presentation will outline the structural and systemic barriers that Forgotten Australians face when they seek services designed specifically to ameliorate the adverse impact of a childhood spent in institutional care.

The 2004 Senate Report estimated there are 500,000 Forgotten Australians. Now an ageing adult population, they are the product of an institutional ‘care’ system which at best was benignly neglectful and at worst physically and sexually abusive. Many Forgotten Australians carry for life the consequences of this childhood experience: many continue an institutional life in jails and mental health services while others provide the case loads of alcohol and drug services and homeless services; and there is also a hidden population of Forgotten Australians who live lonely lives estranged from family and whose social contacts come from service providers.

This paper argues that currently our service system - split between multiple sectors and specialities, is ill equipped to deal with the consequences of childhood institutionalization. The presentation will outline a strategy involving a range of interventions, at a micro, meta and macro level which aim to overcome some of these residual barriers that currently deny Forgotten Australians access to both universal and specialist services.

4.30 - 4.45 Impacts of past adoption practices: Implications for collaborative responses to service delivery Presenter: Pauline Kenny, Australian Institute of Family Studies, Melbourne Authors: P Kenny, D Higgins, C Soloff & R Sweid

The National Research Study on the Service Response to Past Adoption Practices examined the extent and effects of closed adoptions in Australia, to strengthen the evidence available to both governments and service providers to address the current needs of those affected. With over 1500 participants representing mothers and fathers separated from children by adoption, adopted individuals, adoptive parents and wider family members, as well as professionals working in post adoption support roles and broader health and welfare sectors, the study results provide in sight into the grief, loss and ongoing trauma associated with past practices, as well as information to assist in framing appropriate best practice models to meet the needs of those affected.

With a focus on primary health providers, general health and welfare professionals, right through to specialists in this niche field of expertise, the presentation provides insight into the very real, and in many cases, urgent public health needs for those affected by closed adoptions. The presentation will also highlight the characteristics of practice models that study participants deemed necessary to adequately respond to affected individuals, and discuss the workforce development implications including the need for more informed and collaborative responses across and within health and welfare sectors.

4.45 - 5.00 Housing First and Health: The example of Elizabeth Street Common Ground Presenter & Author: Heather Holst, HomeGround Services, VIC

Elizabeth Street Common Ground opened in inner city Melbourne in October 2010. Other Common Ground projects have recently launched in most Australian capital cities, all based on a US model of homelessness service delivery that local providers felt could be readily adapted to Australian conditions. The service offers housing and a range of on-site supports to highly marginalised single people who have been homeless over a long term and whose physical and mental health are very poor. Half the tenants in each Common Ground project are formerly homeless and half are lower income single people who work or study nearby, thereby offering a social mix as well as making each project more economically viable.

There is now over two years of evidence of the outcomes from this particular Housing First approach in which housing acts as the basic precursor for people to achieve stability and improve their health and wellbeing. This paper will reflect on what is working so far and what we have learnt not to do as the agency running the support services at Elizabeth Street Common Ground.

52 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

5.00 - 5.15 When will they ever learn: the Forgotten Australians experience of exclusion Presenters & Authors: Caroline Carroll & Wilma Robb, Alliance for Forgotten Australians, ACT

This presentation will outline a ‘blindness’ on the part of the health and social service systems of the lifelong impacts of a traumatic childhood in institutional ‘care’ and the difficulties Forgotten Australians face in obtaining recognition, respect and understanding. The speakers will outline systemic barriers that Forgotten Australians confront when seeking services, whether specifically designed for them or as mainstream clients of the health and welfare sectors.

The 2004 Senate Report estimated that around 500,000 Australians lived in institutions during the twentieth century (1920s – 1980s). Now an ageing adult population, they are the product of an institutional ‘care’ system that was largely without protections and where many experienced systematic abuse by staff and visitors to the institutions including: complex trauma, poor physical and mental health and restricted educational and economic outcomes.

The presenters will provide personal experiences as they argue for a national identity card that will provide priority access to health and allied health care along with priority access to aged care and secure housing.

5.15 - 5.30 People with severe and enduring mental illness and their carers Presenter & Author: Pat Sutton, Carers Australia, SA

It has been estimated that in Australia there are at least 60,000 people with severe and enduring mental illness with psychosocial disabilities.

They are amongst the most socially and medically marginalised people in our community, despite national and state mental health reforms taking place across the country, and many still do not receive the community supports they so desperately need.

Despite the fact that many are monitored and treated by qualified health professionals for their mental health problems, their physical health issues are often not being addressed. The life expectancy of people with schizophrenia, for example, is at least 25 years less than that of the general population.

This appalling situation is substantiated in many recent reports, including the Report Card presented to the Prime Minister by the National Mental Health Commission in September last year.

This presentation is by a carer, a mother of two sons with schizophrenia who have complex needs, who was featured in that Report Card.

Carers have serious concerns about the lack of appropriately supported accommodation and this is impacting significantly on their own health and wellbeing.

Carers who support people with severe and enduring mental illness and psychosocial disabilities know their loved ones well and this presentation will outline some of the barriers which exist and offer comment on approaches which could assist.

53 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

Comprehensive case management – service providers working together 1 (Ballroom 3) Chair: Jennifer Evans

4.00 - 4.15 Beyond Referral – Building partnerships and knowledge in the context of increasing complexity for culturally and linguistically diverse clients Presenter: Effie Katsaros, Multicultural HIV and Hepatitis Service, NSW Authors: E Katsaros, D Gray & J Klein

The Multicultural HIV and Hepatitis Service (MHAHS) of NSW has 21 years of experience in working with culturally and linguistically diverse (CALD) persons living with HIV. The service works with a model of using bi-lingual and bi- cultural co-workers to provide client support, community development and advocacy.

While treatment for HIV in Australia means that HIV has predominantly become a chronic manageable illness the complexity of issues for the clients MHAHS work with has actually increased. Mental health, late diagnosis, immigration issues, religious and cultural beliefs and persistent patterns of isolation are some of the common complexities that emerge.

In looking at the breadth of client experience we can see that good client outcome is strongly related to the working relationship between referring agencies. Comprehensive case management that goes beyond simple referral is essential in expanding the support base of clients and building the capacity of mainstream services to support CALD persons living with HIV.

This paper will present the unique partnership and case management that MHAHS, Parramatta Sexual Health Service and other referring agencies have developed.

4.15 - 430 Health Care for the Homeless and Innovative Approach through Reach Presenters: Joanne Hawkins, St Bartholomew’s House Inc, Western Australia & Clare Askew, Central Institute of Technology Authors: J Fereday, N Crossland & C Askew

Reach is a partnership between Central Institute of Technology, Curtin University and the Department of Health. Reach provides an innovative option for the delivery of Primary Health Care (PHC) services to groups within the community including the homeless, vulnerable and socially disadvantaged whilst providing student nurse clinical training places. The model of care has been established in line with the National PHC strategy, recognising key factors impacting on the current status of health care for these populations including limited access to GPs, over utilisation of hospital emergency departments and often negative experiences with mainstream health services.

Through the strong partnership established with St Bartholomew’s House PHC services are delivered to clients with the key focus of care centred on the building of relationships to ensure the service delivery is flexible, adaptable and reflective of the client groups needs. The building of relationships enables and supports the management of social and emotional wellbeing, mental health and chronic disease. In collaboration with GPs the registered nurses and nurse practitioners treat and manage acute and chronic conditions, promote health and refer for specialised care through both mobile and fixed clinics. The presentation will highlight the benefits of partnerships and collaboration across agencies.

54 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

4.30 - 4.45 Inanna Inc. Special Programs – Improving the social determinants of health for people with complex needs Presenter: Katy Haigh, Inanna Inc., ACT Authors: M Taliano, D Thompson & K Haigh

Inanna Inc. Special Programs area supports people living with the effects of a mental health issue and/or intellectual disability, and does this in collaboration with a range of services including Mental Health ACT, Disability ACT, the Public Trustee and the Public Advocate.

Inanna’s practices are informed by a feminist/narrative framework that recognizes that people live their lives in a social context, and require us to take account of the social and historical factors that have shaped each individual’s life. Having this understanding helps to broaden the territory in which solutions can be found to move their lives closer to their hopes and dreams.

The supports Inanna provides are tailored to each individual’s needs. Examples of supports put in place have included education, advocacy and assistance with understanding your rights and responsibilities around property and tenancy management, support in attending medical and/or legal appointments and activities to promote social inclusion.

This program is a response to the experience of those people that ongoing support enables them to have a higher quality of life and less disruptions to that lift caused by their mental health issues or disability. Inanna has been providing this model of service delivery for 4 years and has seen many positive outcomes for all clients involved.

4.45 - 5.00 Promoting social inclusion through a strengths-based program for vulnerable inner city population Presenter: Peter McGeorge, Inner City Health Program, St Vincent’s Hospital Sydney, New South Wales Authors: V Malone, P McGeorge, P Beckett, C Brady, R Ellis, S Bernardi, K Wilhelm

Inner City Health Program (ICHP) at St Vincent’s Sydney was established in 2011 by combining the Mental Health, Alcohol and Drug, Homeless Health and some General Health Services into a comprehensive healthcare service for vulnerable populations living in inner city Sydney. The Mental Health Program includes teams covering Inpatient, Community Mental Health, The Homeless Health Team, Rehabilitation and Early Intervention services.

ICHP is integrating a strengths and recovery-based approach across these services to improve the health of its vulnerable populations. The ICHP has begun working collaboratively with consumers to identify their individual strengths and resources, as well as consumer identified goals. This has resulted in improved outcomes from a system, clinical and consumer perspective. This model looks at the strengths people can take from their environment and resources available to them and moves away from the use of formal mental health services towards the use of natural community resources to stay well.

This presentation reports on the evaluation of, and the progress with, implementing an individualised recovery- focused, strengths assessment within the ICHP at St Vincent’s Hospital, Sydney.

55 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

5.00 - 5.15 STAY: collaboration, consistency and not least client motivation and engagement. Presenter: Dean Sullivan, Centacare Tasmania Authors: K Preen & D Sullivan

STAY a Commonwealth NPAH initiative is a partnership of Centacare Tasmania & Australian Red Cross in collaboration with Colony 47’s KEYS program that manages Housing Tasmania properties. Targeted specifically for clients who exhibit high and complex needs, aged 16-57, and who have a history of homelessness, it has been in operation for over two years during which workers, senior practitioners and the state coordinator have liaised, referred to and worked in collaboration with many main stream and specialist agencies.

STAY have found a consistent and persistent approach to home visit engagement with targeted casework is crucial to the long-term progression of clients to independent living. STAY maintains this client focus when working with all the mainstream agencies the diverse client group requires. Facilitating case management strategies with these agencies has been challenging, there has been little demonstrated consistency between regions, agencies or offices especially in referring the more ‘difficult’ complex clients for services.

Consistent and transparent engagement strategies with both the clients and agencies seem to have been the answer in achieving the positive long-term outcomes for STAY clients. Over 70% of the first client intake will transfer tenancies to the public or community housing sectors in the coming months.

5.15 - 5.30 Advocacy-Health Alliances: Better Health Through Medical Legal Partnership Presenter & Author: Peter Noble, Loddon Campaspe Community Legal Centre, Victoria

Advocacy-Health Alliances involve collaborations between advocates and health workers to achieve improved health and social outcomes for clients/patients. While AHAs are still in their infancy in Australia (with some notable exceptions to be profiled), they are best exemplified in the long-standing Medical-Legal Partnership movement in the US. These partnerships have not only broken down the barriers to accessible legal services to people experiencing health issues, they have demonstrated the socio-legal impacts on health and the associated health benefits of effective legal advocacy on behalf of patients. Expanding from a single attorney service at the Medical-Legal Partnership for Children at the Boston Medical Center, there are now some 300 MLPs at hospitals and health care centers across the US with lawyers (including legal aid agencies, law schools and pro bono attorneys) and front-line health care providers (including doctors, nurses and social workers), serving a range of disadvantaged and vulnerable cohorts including the elderly, cancer patients, pregnant women, the formerly incarcerated re-entering the community, children and other vulnerable populations.

This burgeoning model of service delivery promises to be one of the greatest innovations in the Australian legal assistance landscape, delivering advocacy services within health settings to improve wellbeing.

56 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

Aboriginal and Torres Strait Islander services 3 (Ballroom 4) Chair: Vanessa Lee

4.00 - 4.15 Applicability of Evaluative Tools in Assessing Aboriginal-Mainstream Partnerships – a literature review Presenter: Christina Tsou, Combined Universities Centre for Rural Health, UWA Authors: C Tsou & S Thompson

The recent attention on the need for better partnerships between Aboriginal organisations and Mainstream agencies has raised the need to assess the process, outcome and impacts of these partnerships, and to improve partnership functioning through transformative or iterative evaluation procedures. This presentation is on the findings of a literature review which examines the applicability of partnership tools toAboriginal-Mainstream Partnership evaluation recognising the cross-cultural context.

Principles identified from this literature review include: addressing power and knowledge differentials by recognising expertise in community knowledge through a strength-based approach; ensuring validity of evaluation findings by reinforcing cultural competence through inbuilt learning processes; and improving interconnectivity of evaluation to the broader community by including adequate problem solving strategies. Important considerations are formulating meaningful outcome indicators applicable to the community’s way of knowing, living and operation. These also translate to more specific principles when applying partnership assessment tools to assessAboriginal-Mainstream Partnerships.

Finally, the beginning stage of operationalizing one of the existing partnership assessment tools in an Aboriginal- Mainstream Partnership context will be presented to illustrate the potential for existing partnership assessment frameworks to accommodate cross cultural evaluation considerations.

4.15 - 4.30 Reflection on Contemporary Health Promotion Success in Indigenous Communities Presenter & Author: Nicky Newley-Guivarra, Hepatitis Queensland

It is not a simple matter to engage remote and other Indigenous communities in meaningful communication on internal organs and viruses. But it has been achieved by Hepatitis Queensland, a mainstream health NGO.

This paper reflects on the factors and circumstances that enabled this health promotion program to work at grass-roots level with people most at risk of viral hepatitis. Estimates are that 16,000 Indigenous people have chronic hepatitis C and 27,200 have chronic hepatitis B–three times the rates for non-Indigenous Australians. Hepatitis Queensland has identified the twin cultural pillars of art and story as critical components in facilitating communication and acceptance in Indigenous communities. A series of art workshops has been delivered by an experienced and acknowledged Indigenous artist with formal qualifications, creating successful health promotion.

Combining art and story to deliver health promotion in Indigenous communities requires a high degree of cultural sensitivity, an in-depth appreciation of the value of art and of story, time, persistence, and the passion to improve liver health. It requires integrity and sensitive delivery of relevant information in surroundings that focus on the participant, rather than the topic. This program won a Queensland ‘Innovation in Practice’ health promotion award in 2010.

57 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

4.30 - 4.45 An innovative paediatric service supporting Aboriginal children in accessing equitable in-hospital care Presenter: Sarah Ong, Southern Health, Victoria Authors: S Ong & H Cripps

Inequality between Indigenous and non-indigenous Australians is well documented. Indigenous Australians are susceptible to key social determinants that affect Indigenous health. Furthermore, mortality and hospitalisation rates are both significantly higher in this population. Past governmental actions have resulted in a genuine fear of accessing hospital care within the Indigenous population which remains evident in today’s generation. Therefore, to overcome these inequalities Southern Health developed and implemented an outreach model of supportive care in order to move toward closing the gap in Aboriginal health. The service aims to facilitate a process by which Indigenous children and their families feel culturally safe when accessing the acute care setting. Two paediatric registered nurses, one of whom is Aboriginal, are the key points of contact between the Aboriginal community and the hospital. The culturally respectful relationship that is built ensures these nurses provide equal access and quality health care for Aboriginal children and their families. Findings have indicated that by having nurses advocating and supporting this cohort, there is better compliance with accessing in-hospital care. This innovative clinical service has demonstrated advancement and improvement to the access of health care for Aboriginal children thus supporting better patient outcomes in a culturally safe manner for this vulnerable population.

4.45 - 5.00 Continuous quality improvement for Aboriginal Health Presenter: Marianna Pisani, Department of Health, Victoria Authors: R Lesniowska & M Pisani

The continuous quality improvement (CQI) tool: Aboriginal health in acute health services including area mental health services provides a process for Victorian health services to reflect on and improve the provision of culturally responsive healthcare and health outcomes for Aboriginal Victorians. The tool is a response to the Victorian Health Priorities Framework 2012-2022 and Koolin Balit: the Victorian Government strategic directions for Aboriginal health 2012-2022.

The CQI tool encourages a whole-of-health service approach to identifying progress and achievements, service gaps, and priorities for improvement, under four key result areas. The four areas are: engagement and partnerships, organisational development, workforce development and systems of care. The tool can also support organisational accreditation processes, as its indicators are consistent with the National Safety and Quality Health Service (NSQHS) Standards (2013), and the National standards for mental health services (2010).

The learnings, opportunities and challenges of using the CQI tool are also informing state-wide initiatives for improving acute and mental health services for Aboriginal patients. This presentation will describe how the development and implementation of the tool is acting as a catalyst for change within Victorian health services.

58 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

5.00 - 5.15 Get Healthy Service – Aboriginal Strategy Presenter: Scott Winch, NSW Office of Preventive Health Authors: S Winch, C Rissel & E Quinn

In February 2009, the Ministry of Health launched the Get Healthy Information and Coaching Service (GHS) as part of New South Wales’ response to the Australian Better Health Initiative.

Participants are recruited through self referral, proactive marketing or through health care providers and can choose either to have information only or a six month coaching program. Ten individually tailored coaching sessions are offered which are based on behaviour change and self regulation principles designed to assist people with making and maintaining sustainable healthy lifestyle choices.

Between February 2009 and June 2012, 4.2% of GHS participants were Aboriginal, with 76.2% female and 23.8% male. There were 23.8% of Aboriginal participants that lived in major cities compared to 41.4% inner regional and 35.8% outer regional. The GHS demonstrated significant improvement in weight (-1.8kg), waist circumference (-4.3cm) and reduction in obesity amongst participants from 83.9% to 61.4%.

An Aboriginal Strategy for the GHS has been designed based on a needs-assessment and implemented in order to improve access and participation rates by Aboriginal people within NSW. This Service will be launched in 2013 and includes: (i) three additional coaching sessions focusing on diabetes prevention; (ii) Aboriginal specific resources; and (iii) a two phase graduation.

5.15 - 5.30 Improving connections and building capacity: Supporting Better Diabetes Care in the Centre Presenter: Sharon Johnson, Baker IDI Heart & Diabetes Institute Central Australia Authors: S Johnson, S Wren, J Shaw, G Fedyszyn, N Cohen & A Brown

Background: Rates of diabetes amongst Indigenous people in Central Australia are significantly higher than in other parts of the Northern Territory and are four times higher than national data. Access to effective chronic disease care in this context is challenging, with rapid staff turnover a particular impediment to provision of quality care and program sustainability.

Methods : ‘Supporting Better Diabetes Care in the Centre’ (SBDCC) is an initiative commenced in 2010 by Baker IDI Heart & Diabetes Institute which aims to support and enhance best practice diabetes care in Central Australian Indigenous communities by providing specialist outreach services to participating Aboriginal Medical Services and Government health services in the region.

Results: SBDCC currently visits and supports 10 remote communities; 600 patient contacts have occurred over 24 months since the program commenced. Key outcomes include improved capacity for best practice diabetes care amongst patients and providers and enhanced linkages across the NGO/Government Sector. Importantly, health practitioners have identified the priority system of follow-up as increasing the effectiveness of patient management amidst competing clinical demands.

Conclusion: In resource-poor health settings within Indigenous communities experiencing a high burden of chronic disease, SBDCC has improved both patient and provider access to best practice diabetes care.

59 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

Social inclusion and linkages in service delivery (High Courtyard North) Chair: Christine Boyce

4.00 - 4.15 Supporting social inclusion for recently-arrived refugee-background youth: Ucan2 program evaluation Presenter: Karen Block, University of Melbourne Authors: K Block, L Gibbs, D Warr & E Riggs

In recent years, refugees settling in Australia have come predominantly from countries experiencing protracted conflict and consequent displacement of populations. Ensuing disruption to education and to family and social networks results in particular barriers to social inclusion for refugee youth and a corresponding need for evidence- based policies and practices to support their complex needs.

Ucan2 is an innovative cross-sectoral partnership program based on an integrated strategy that mutually supports learning, social wellbeing, emotional health and employment preparation. It provides work skills development, work experience, connections to members of the Australian community, experiential learning and psychosocial support. The program runs within standard on-arrival English language courses and provides support to refugee- background students prior to and during transition to mainstream secondary schools or tertiary institutions.

The paper presents findings from mixed methods evaluation research conducted by the authors in collaboration with program partners. Findings indicate that refugee-background youth are generally resilient but face threats to wellbeing and inclusion associated with poverty, separation from family and difficulties negotiating unfamiliar education systems. The findings demonstrate a compelling rationale for providing targeted and intensive support such as that offered by the Ucan2 program to young people during the early years of resettlement.

4.15 - 4.30 Enhancing refugees’ resettlement and social inclusion: service provider perspectives of service delivery Presenter: Greer Lamaro, Deakin University, Australia Authors: G Lamaro, A Jewson, B Crisp,A Taket, L Hanna & A Jewson

Refugees resettling in Australia often have complex health and social support needs. Many are resettled in regional areas where these needs are compounded. Adequate and appropriate support during resettlement can enhance refugees’ health, wellbeing and social inclusion. Refugees receive limited services during the initial six months of resettlement, but little is known about provision beyond this period, particularly in regional contexts. This study explored the current context of longer-term service delivery to refugees in regional Victoria, focussing on practitioners’ experiences, barriers and facilitators to service delivery.

The study was conducted in partnership with a regional multi-cultural resource centre (MRC). Twenty two semi- structured interviews were conducted with practitioners across five areas of health and social support: health, housing, education and language, welfare, and employment and income. Participants included refugee-specific and mainstream service providers. Data were analysed thematically.

Results reveal multiple challenges in providing support, including resourcing, and contested views regarding partnerships, service coordination and responsibility for service provision. Similar findings have been reported in other Australian contexts, despite differing state-based models of refugee service provision. Thus, the findings could inform service delivery reformat state and national levels to meet the complex needs of refugees for their long-term wellbeing and social inclusion.

60 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

4.30 - 4.45 Collaborative approaches: benefits for humanitarian entrants and refugees Presenter & Author: Nancy Matina, North West Metropolitan Region, Care Connect, VIC

Humanitarian entrants and refugees from all backgrounds have complex needs on arrival in Australia, including the need to become familiar with a new culture, learn English, find appropriate housing, enrol children in school, navigate new technologies and systems, as well as address complex physical and mental health issues. Owing to the complexity of these issues it is important that Care Connect staff, who work with recently arrived humanitarian entrants and refugees are sensitive to concerns and issues, and are able to address them in a culturally acceptable framework, with access to appropriate tools and resources.

It is widely accepted that multi‐agency responses and collaboration are key requirements to improve access to services and promote social inclusion however, achieving this across professional and agency boundaries often remains challenging. Individualised assessment, planning and service coordination for humanitarian entrants and refugees has been recommended as being important in improving communication, leading to more flexible and creative services.

Care Connect will present a case study from the Complex Case Support program to illustrate this approach in action and the outcomes for clients.

4.45 - 5.00 ‘Stopping the run around’ Comorbidity Action in the North (CAN) Research Presenter: Imelda Cairney, University of Adelaide, SA Authors: C de Crespigny, I Cairney & C Galletly

Co-existing mental health (MH) and alcohol/other drug (AOD) disorders are found in about 70% of consumers of MH or AOD services. Common comorbidities include alcohol abuse and depression, and cannabis use and psychosis. Despite years of research, policies, and guidelines, many people with comorbidity are treated for only one of these conditions, or excluded from treatment, depending on the service they approach for help.

Comorbidity Action in the North (CAN) is led by the University of Adelaide and funded by an Australian Research Council Linkage Grant and SA Health. CAN has identified barriers and facilitators for the delivery of effective, timely, culturally appropriate comorbidity services for people aged 12 years and over in a socio-economically disadvantaged region of South Australia.

Based on Critical Theory and using Participatory Action Research, CAN has scoped all local government and non-government MH and AOD services in this region, collecting quantitative and qualitative data by surveying and interviewing managers, staff, community/consumer advocacy groups and NGOs regarding their knowledge and experiences of local comorbidity services.

Based on the findings, CAN will work collaboratively with community leaders includingAboriginal and refugee groups, consumer advocates and service providers to find more effective ways of delivering comorbidity services.

61 Concurrent Sessions 3: Monday 4.00 pm - 5.30 pm

5.00 - 5.15 Anchors – Building stable foundations for social participation Presenter: Martina Taliano, Inanna Inc., ACT Authors: M Taliano & S Howard

It is estimated that 1 in 3 women will experience domestic violence in their lifetime, and the effects of this can be widespread through the community. A family’s situation affected by domestic violence can result in many other issues such as homelessness, poverty, poor physical and mental health or drug and alcohol addiction.

In response to the National Social Inclusion Agenda Inanna Inc. and Train4Life have partnered to pilot a project called Anchors. Using education as an empowering tool this project aims to “anchor” women, creating stability and increasing involvement within the community. The nine-course unit consists of formal classes comprising of units of competency from the Certificate II in Community Services qualification, during which women set clear goals for their lives and define pathways to achieve these goals. Upon completion of theAnchors course participants will have stronger social networks, recognized and built upon their skills and knowledge base and have a clearer understanding of their life goals, which will create opportunities for employment or further education.

Anchors courses are currently underway and conclude in March 2013. Participants have reported positively on the course content, with most already identifying plans to participate in further education or employment opportunities upon completion.

5.15 - 5.30 The Challinor Project: Deinstitutionalisation revisited Presenter: Cindy Nicollet, Queensland Centre for Intellectual and Developmental Disability (QCIDD), School of Medicine, University of Queensland Authors: L Young & C Nicollet

In Queensland, a shift in the provision of services for people with an intellectual disability resulted in the closure of its largest residential institution and the relocation of its remaining 165 residents into community-based accommodation.

In 2001, Young investigated the effects that this large scale relocation had on the life quality, choice-making and adaptive and maladaptive behaviours of a cohort of 104 adults with intellectual disability. Each individual was assessed six months prior to relocation and then again at intervals of 1, 6, 12, 18, and 24 months of residing in community-based accommodation. The AAMR Adaptive Behaviour Scale – Residential and Community 2nd Edition (ABS:RC2) (Nihira et al., 1993), Resident Choice Assessment Scale (Kearney et al., 1995) and the Life Circumstances Questionnaire (Young et al., 2000) were used to assess adaptive and maladaptive behaviour, choice making, and life quality, respectively.

The current project is revisiting the cohort from the 2001 study and investigating whether life quality, choice making and adaptive and maladaptive behaviours have remained stable or changed over the intervening time. The current project will explore the effects of ageing on this cohort, particularly in relation to life quality, choice-making and adaptive and maladaptive behaviour.

5.30 - 6.30 Poster Session and Networking function with Refreshments (The Gallery)

62 Plenary 2: Tuesday 9.00 am - 10.30 am Day 2 Tuesday

8.30 - 9.00 Registration (The Gallery)

9.00 - 10.30 Plenary 2 – Chair: David Templeman, Alcohol and Other Drugs Council of Australia CEO (Ballroom 2)

Connections, boundaries and borders - cross sectoral considerations in refugee healthcare - Dr Christine Boyce, RACGP National Faculty of Special Interests Board, Refugee Health Network The challenges facing our health system in providing relevant care for people from a refugee background are recognised. The social determinants of health status are particularly important for this population, whose needs are typically complex and resource intensive. We have a limited evidence base for effective interventions in this area, and care models have remained fragmented across acute and primary care, as well as state, federal and NGO sectors. Demands on individual professionals are high, and have impacts on morale and sustainability.

As a GP who has been working in this area for a decade, and current chair of the RACGP’s specific interest group in refugee health, Dr. Christine Boyce will present a blend of personal comment and shared learnings.

Successes will be showcased, and important challenges highlighted, providing a platform for further discussion during the conference.

The nexus between smoking and social inclusion in Aboriginal and Torres Strait Islander communities - Dr Tom Calma AO, ACT Australian of the Year 2013 Market research indicates that mainstream smoking cessation social marketing efforts are not reaching Indigenous peoples to the same extent as they do with the general population. Dr Calma will explore the research and talk about the relationship between smoking and social inclusion and discuss the Tackling Indigenous Smoking and Healthy Lifestyle Program that he leads and mentors. The Program comprises the national placement of 300 educators and trainers to inform the Indigenous community about the benefits of not smoking and a range of other support measures aimed to halve the smoking incidence by 2018.

Australia’s first National Report Card on Mental Health and Suicide Prevention - Robyn Kruk AM, CEO National Mental Health Commission The National Mental Health Commission was created on 1 January, 2012 and in November that same year, delivered Australia’s first National Report Card on Mental Health and Suicide Prevention. CEO, Robyn Kruk, will provide an overview of the work of the Commission to date, including the key findings, recommendations and outcomes from the National Report Card. The presentation will also touch on how the Commission’s underpinning ethos of ‘A Contributing Life’ links to broader themes of social inclusion, social justice and connectedness. In doing so, the presentation will highlight some of the structural and systemic barriers facing people with mental health difficulty in achieving better health and social outcomes, particularly in areas such as workforce participation, and how some of these issues can be better addressed.

10.30 - 11.00 Morning tea (The Gallery)

63 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

11.00 - 12.30 Concurrent sessions 4

Breaking down structural and systemic barriers 4 (Ballroom 1) Chair: Gino Vumbaca

11.00 - 11.15 South Australia’s Exceptional Needs Unit Management Assessment Program: Insights into Exceptionality Presenter & Author: Richard O’Loughlin, Exceptional Needs Unit, Department for Communities and Social Inclusion, SA

The Management Assessment Service is a program area within the Exceptional Needs Unit. The program was established in 1987 in response to recommendations in Dame Roma Mitchell’s Report on the South Australian Government’s response to behaviourally disordered persons.

In 2013, the program now incorporates a three tiered approach to developing person centred responses for individuals who have exceptional, high and complex needs. This approach is designed to break down structural and systemic barriers through the development of and support for collaborative partnerships that inform, influence and support sustainable systemic change.

Analysis of demographic and clinical features of individuals referred to the program over time reveals that determining that a person has exceptional, high and complex needs is as much related to the functions and capacity of services systems as the individual’s presenting behaviours and social impairments.

How to develop individualised, person centred responses for people with exceptional, high and complex needs whilst actively focusing on effecting systems change has become a key focus of the program in recent years. The strategy, its implementation and reflection of the effectiveness of this approach on systems change will be discussed.

11.15 - 11.30 Meeting the complex health needs of people who inject drugs: The role of targeted primary healthcare Presenter: Carolyn Day, Central Clinical School, University of Sydney Authors: C A Day, M M Islam, A White, S E Reid & P S Haber

People who inject drugs (PWID) typically experience complex and comorbid health and social problems. Despite this, their use of primary healthcare is poor, with high levels of emergency care often interpreted as drug seeking. This issue is compounded in NSW by a lack of GPs willing to prescribe opioid substitution treatment (OST), the most effective treatment for heroin dependence, and subsequently many public drug and alcohol clinics are at capacity with lengthy waiting lists and limited capacity to address comorbid problems. We propose a new model of primary healthcare for this group. Despite limited evaluation, primary healthcare facilities targeting PWID have been implemented in some settings in NSW with positive client outcomes. In this paper we describe a model of primary care for PWID enrolled in OST. We present findings from our experience of developing a successful nurse-led primary healthcare service operating out of a needle and syringe program and other research we have conducted with the target population demonstrating a need and willingness to utilise such a service, we describe a proposed model of care for public OST clinics which may increase healthcare utilisation and outcomes among this marginalised group.

64 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

11.30 - 11.45 Understanding the transfer of opioid substitution clients from public clinic dosing to community pharmacy dosing in NSW: Senior nurses’ perspectives Presenter: Carolyn Day, Central Clinical School, University of Sydney Authors: CA Day, J Bui, J Hanrahan, AWinstock, R Fois & B Chaar

Opioid substitution treatment (OST) is the most effective treatment for heroin and opioid dependence; however there is a chronic shortage of places in NSW. This study explored the perspectives of senior nurses in public drug and alcohol clinics in NSW on the transfer of stable OST clients from clinics to community pharmacy using qualitative exploratory semi-structured interviews. Nine interviews were conducted with nurses from eight public clinics. Many clinics reported being at or over full capacity. The main barriers to transfer identified by nurses were: difficulty motivating reluctant clients, negative perceptions of transferring, unwillingness to pay for pharmacy dosing, lack of convenient pharmacy providers and unstable clients. Most respondents recognised the significance of maintaining working relationships with pharmacy but felt collaboration could be improved. This study highlights the multifaceted barriers encountered by nursing staff in the transfer of OST clients from clinics to pharmacies.

Implementing strategies such as subsidised or standardised dispensing fees, improving collaboration with pharmacies and increasing promotion of pharmacy services may enhance the number of clients transferred to pharmacy. Pharmacy induction, where clients commence treatment at a community pharmacy, may help bypass the clinic bottleneck and increase treatment access for this marginalised group is discussed.

11.45 - 12.00 Discrimination Survey: Injecting drug users and repeated discrimination from service providers Presenter & Author: Laura Santana, Australian Injecting & Illicit Drug Users League, Australian Capital Territory

The Australian Injecting & Illicit Drug Users League (AIVL) have been conducting an online survey with people who inject drugs (PWID), those with hepatitis and/or HIV, and also people on Opioid Replacement Pharmacotherapies (ORP) who have experienced discrimination from service providers.

In six months over 120 surveys were completed. The data received further informed AIVL of what we already know to be many of the leading problems and issues that our community face. Both unrelenting and iniquitous, 90% of people reported the discrimination to be ongoing (that is, “happened on more than one occasion”). Hospitals and prescribers were the most highly reported health services where discrimination was experienced.

Furthermore, qualitative data indicated many of the perceived ‘offences’ or ‘actions’ taken against people were very serious with severe consequences or impacts. When asked why people had not made complaints to services the majority stated they would not do so as it would make things a lot worse for them, and equally so, was the belief that they simply wouldn’t be listened to.

This presentation will focus on the overall results of the survey to date (both qualitative and quantitative), the implications, and the need for extensive promotion.

12.00 - 12.15 Shared Care or Shared Scare? A different approach to substance management Presenter & Author: Lisale Hakerian, The Langton Centre, Surry Hills, Sydney, NSW

Accessing effective treatment can be a difficult journey for the substance dependent client partly due to a lack of treatment vacancies at Specialist Public Drug & Alcohol services in NSW. Public Clinics also encounter difficulties moving stable opiate and alcohol dependent clients on to the relatively low number of community GPs prescribing pharmacotherapy. General practitioners may be reluctant to take on “stable” opiate pharmacotherapy and alcohol dependence management for reasons including time constraints, lack of clinical practice or support, dual diagnosis challenges and concerns over client behavior or a self-perceived lack of skill. Clients engaging services essential for progress towards stability and better health such as mental health options, accommodation and appropriate early or crisis interventions may face barriers for multiple reasons including a misunderstanding of client needs. Combined these factors may result in a lost treatment opportunity. Could a Shared Care arrangement between a Specialist Public provider and a Community General Practice offer a better client journey and clinician experience? This paper describes the experience of a Shared Care Pilot program between a Public Drug & Alcohol service and General Practice and the developing relationships with other specialist service providers within the next phase of this program.

65 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

12.15 - 12.30 Coachstop Caravan Park - a decade of successes and challenges Presenter: Loretta Baker, Hunter New England Local Health District, NSW Authors: L Baker & T Merritt

We describe a health intervention in an urban caravan park that commenced in 2000.

The park provides housing of last resort for over 200 residents, including families and single mothers, most living on Centrelink benefits. Additional risk factors include substance abuse, mental health problems, limited literacy, poor oral health, Hepatitis C and violent lifestyles. Children’s school attendance was sporadic. Barriers to accessing mainstream health services included a shortage of GP’s, fee for service practice, lack of Medicare cards and limited access to the internet, telephones and transport.

The service is delivered on site in a building provided by St. Vincent De Paul. Access to key partners including St. Vincent De Paul, Centrelink, TAFE, Housing NSW, a private dentist and an on-site GP clinic each fortnight is provided. A needle and syringe programme is available and food security improved through provision of fresh fruit and vegetables.

Building trust and providing improved access to child care, assistance with transport and telephone cards for the public phone have helped residents access literacy and TAFE courses, which for some has been life changing.

The sustained intervention has seen the cycle of disadvantage broken for many residents with improved housing, employment and school attendance.

Breaking down structural and systemic barriers 5 (Ballroom 2) Chair: Léan O’Brien

11.00 - 11.15 Harnessing cultural perspectives in alcohol and other drug counselling Presenter & Author: Rachel Rowe, Drug And Alcohol Multicultural Education Centre, NSW

It is widely recognised that understanding and engaging with cultural perspectives is likely to enhance treatment for substance use issues and co-occurring mental health issues among culturally and linguistically diverse (CALD) communities. Despite this, not many services document the way they provide services to CALD clients. This presentation will explore the findings from the recent evaluation of the Drug andAlcohol Multicultural Education Centre’s Counselling Service in South-Western Sydney, NSW. For this study, in-depth interviews were conducted with half of the clients who attended the service between April and September 2011 (n=24) and all counsellors (n=6). The findings identify nine core strategies for culturally appropriate treatment. These include offering counselling in key languages, learning about the importance of cultural identity to each client without making assumptions, thoughtfully employing a mix of psychosocial interventions that reflects the interpretability of certain concepts; and recording data on culture to allow the service to respond to changing needs across the population who access the service.

66 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

11.15-11.30 Improving access to health services by Refugees and CALD patients in Central Queensland Presenter & Author: Roxanne Hodda, Central Queensland Medicare Local

Refugees and asylum seekers are among the most vulnerable people in Australia. Since 2010, Central Queensland has welcomed an increasing number of refugees, asylum seekers and people from other culturally and linguistically diverse (CALD) backgrounds. These groups experience disadvantage in accessing health services due to language and cultural barriers.

The Rockhampton Refugee and CALD Health Reference Group is a successful collaborative effort which aims to improve access to health services by refugees and people from CALD backgrounds. The group concentrates on developing initiatives directed at removing structural and systemic barriers to achieving better health and social outcomes.

This presentation describes new evidence from a general practice survey undertaken by Central Queensland Medicare Local in 2012. Findings show that even though GPs in CQ see patients from these groups, the number of GPs registered with the Translating Information Service (TIS) is very low. Many general practices would like additional resources to assist them in provision of appropriate care to these patients and resources in other languages. There is also an identified need to improve understanding among these patient groups about the process of accessing health services in Australia. The implications for policy and practice will be discussed.

11.30 - 11.45 Use of Communication Technologies in Vulnerable, Hard to Reach and Marginalised Populations Presenter: Elizabeth Merrilees, Alcohol and Drug Information Service, St Vincent’s Hospital, NSW Authors: E Merrilees, N Ezard, B Crosby & D Lester

Australian and international literature describes the extraordinary uptake of new communication technologies. Smartphone and internet uptake breaches gender, age and socioeconomic boundaries. In 2011 more than 60% of homeless people in USA had a mobile phone. Australia has the fastest uptake of communications technologies. Access is a key social determinant to health. Australia has significant regional and remote populations, increasing populations experiencing significant socioeconomic disadvantage, and with multiple and complex needs, while governments seek more cost-effective healthcare provision. Finding alternative pathways to client engagement is critical to equity of access.

ADIS services urban, regional and remote populations, offering Twitter, website, email, while TruckiesHelp uses Twitter, SMS, email, and website to support telephone contact. DASAS supports regional and remote healthcare via telephony and email. ADIS and Quitline collaborate with NSW Ministry of Health, AHMRC, TWU, Justice Health and others to meet the needs of complex clients where they are.

Nevertheless, technologies uptake by the health sector is slow, and more can be done to exploit this opportunity. While serious cost, privacy and efficacy considerations exist, are anxiety and conservative thinking obstructing effective evaluation? What is the evidence for these approaches? Can existing interventions be tailored to these opportunities?

67 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

11.45 - 12.00 TruckiesHelp: A 24/7 Alcohol and Other Drug Counselling Service for Long Haul Truck Drivers in NSW Presenter: Elizabeth Merrilees, Alcohol and Drug Information Service, St Vincent’s Hospital, NSW Authors: E Merrilees, D Lester, B Crosby, N Ezard, E Rauwendaal

Australian and international literature describes the broad range of vocational issues experienced by long haul truck drivers (Truckies). These include substance use primarily stimulants, cannabis, alcohol, sedatives and nicotine; mental health issues, primarily anxiety and depression); and general health issues, particularly sleep apnoea, cardiac and respiratory issues. These health issues present significant health, safety and financial risks to Truckies and the community.

Lack of engagement with health services is common and often related to confounding factors of the population - largely male, financially vulnerable, erratic work hours, high mobility and often in remote locations.

TruckiesHelp is an innovative pilot program designed to break down systemic barriers that prevent service access, funded by Department of Health and Ageing (DoHA). TruckiesHelp offers a 24/7 service, providing holistic support for Truckies. Centred on substance use and mental health issues, TruckiesHelp incorporates broader health and lifestyle issues, acknowledging their cyclic nature, and the influence of vocational factors.

TruckiesHelp is telephone based, supported by SMS, Twitter, email and website, and staffed by a multi-disciplinary AOD team using a client-centred, strengths based approach. Strategies include ongoing collaboration with Transport Workers’ Union and Stimulant Treatment Program, revised data collection, social media training, and new promotional activity.

12.00 - 12.15 Workplace Violence: A review of a community based health setting Presenter & Author: Alison Derrett, South Western Sydney Local Health District, NSW

Violence in the workplace is a significant occupational health and safety issue for health care providers both internationally and in Australia (de Martino, 2003; Farrell, Bobrowski & Bobrowski, 2006). In order to provide accessible services for people with complex needs health care is being provided more frequently in community based settings. There is minimal literature available that considers the ways in which violence towards staff should be addressed in non acute health settings.

A project was undertaken that reviewed the ways in which client related violence was addressed in two community health settings. These centres are managed by Community Health Services as part of the South Western Sydney Local Health District. This local government area was targeted for specific interventions by human services agencies approximately 10 years ago due to the high level of community violence and disintegration. The corresponding health needs of the community are high. Health services contributed to this agreement by establishing two adjacent community health centres; one concentrating on the provision of health services to the Indigenous community, and the other to provide easy access for the community to a range of health and welfare programs.

The project was able to make a number of key findings in relation to the strategies used to address client related violence and the definition of violence in these community based health settings. Furthermore this project was able to evaluate the strategies currently in place to improve staff and client safety and consider how effective the strategies were at addressing violence.

68 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

12.15 - 12.30 Complex trauma and its impacts – a substantial public health issue Presenter & Author: Cathy Kezelman, Adults Surviving Child Abuse, NSW

Trauma is not simply an individual misfortune. It is a public health problem of major proportions. The majority of people treated by public mental health and substance abuse services have trauma histories.

Repeated extreme interpersonal trauma resulting from adverse childhood events (`complex’ trauma) is not only more common than single incident trauma, but far more prevalent than currently acknowledged.

The effects of complex (cumulative, underlying) trauma are pervasive, and if unresolved, negatively impact mental and physical health across the lifespan. Currently in Australia, complex trauma and its effects are often unrecognised, misdiagnosed and unaddressed. A `merry go round’ of unintegrated care risks re-traumatisation and compounding of unrecognised trauma and escalation and entrenchment of symptoms is psychologically, financially and systemically costly.

Research shows that the impacts of even severe early trauma can be resolved, and its negative intergenerational effects can be intercepted. People can and do recover. It is time to put this research into practice.

This paper will present ASCA’s widely endorsed Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Practice to help establish strategies and pathways to respond to the public health challenge of complex trauma.

Comprehensive case management – service providers working together 2 (Ballroom 3) Chair: Mark Bartlett

11.00 - 11.15 Breaking the Barriers from Custody to Community Presenter & Author: Rowena Bellwood, Justice and Forensic Mental Health Network, NSW

Prisoners have significant complex needs including a high burden of chronic diseases, poor social determinants of health and are less likely to access health care in the community. Aboriginal people are over-represented in prison and are more likely to have a number of chronic diseases and risk factors for poor health. Comprehensive care coordination is critical for at risk patients given the large number of patient movements across correctional centres and turnover rates.

The Care Navigation Support Program (CNSP) (also known as Connecting Care) was developed in response to these needs to improve care coordination in custody and comprehensive case management post-release into the community. In custody, this entails increased medical appointment monitoring to ensure appropriate health care follow up. In preparation for release, the CNSP has improved patient self management skills, discharge plans, referral procedures and linkages and collaborative partnerships with external care providers.

This presentation will showcase the CNSP Program including describing a range of initiatives within the program such as chronic disease patient brochures, care coordination, release planning and shared care planning combine to improve patients’ health outcomes. Suggestions will be made for further improvements and collaborations to address the complex health and social needs of prisoners.

69 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

11.15 - 11.30 Exploring Integrated Service Responses to the Link between Legal and Health Needs Presenter & Author: Mary Anne Noone, School of Law, La Trobe University, VIC

Australian and international research has established links between legal, health and social need. Within the legal arena, these studies have generated a renewed focus on holistic/integrated approaches to service delivery particularly for communities facing significant levels of social exclusion. However, effective integrated service delivery is a dynamic and complex process. Many factors can facilitate or impede integrated service delivery. Using established frameworks on integration (drawn from health literature), a research project in Melbourne, sought to uncover “what is going on” at a Community Legal Service colocated with a Community Health Centre. This paper reports on data collected via online staff surveys, staff diaries, interviews with lawyers and their clients, interviews with health and welfare staff and a workshop. The data identifies if, and when, the agencies work together, in a formal and informal capacity, at a worker and organisational level, to best meet the needs of the people to whom they provide a service.

It identifies the importance of a focus on the needs of the client/community; holistic service delivery approach; organisational partnership and collaboration; and whole of government and service system approach to complex community need. The paper identifies factors that inhibit integrated services including external factors and concludes with recommendations on what facilitates integrated service delivery between legal, health, dental and welfare services.

11.30 - 11.45 Haemodialysis behind bars: addressing complex needs collaboratively Presenter & Author: Shirley O’Keeffe, Justice and Forensic Mental Health Network, NSW

The provision of health care in custody is predominantly based on a community health service model of care. Any prisoner who needs surgery or other complicated treatment must be provided with a security team to escort them to hospital and kept in a secure wing. The costs of escorts and stress associated with the process are substantial.

One area where this issue is highlighted is among prisoners who need regular haemodialysis. Justice & Forensic Mental Health Network undertook a partnership approach to addressing this problem with Corrective Services NSW (CSNSW) and South Eastern Sydney Local Health District (SESLHD) by installing a single haemodialysis chair at Long Bay Hospital in March 2011. This new service allowed four patients to receive treatment in prison each week rather than being transferred to SESLHD under the previous service model.

An evaluation of the service was undertaken after the first year and demonstrated 94% occupancy with no adverse events and a cost savings of $493,173 to CSNSW for escort services and $295,472 savings to SESLHD for community haemodialysis chairs. This presentation will discuss how this successful collaboration was achieved to improve the health of this disadvantaged population.

11.45 - 12.00 Home for Good –Integrated Case Management for Post Release Presenter: Helen Fielder-Gill, Samaritans Foundation, NSW Authors: H Fielder-Gill & J Woods

The good news story and the benefits in engaging with people with complex needs upon exiting correctional and rehabilitation centres using Integrated Case Management alongside a social determinants of health approach. The innovative approach utilised by Home for Good has achieved positive outcomes with partners inclusive of Social Housing providers, Health (including AOD, methadone providers including doctors, mental health), Centrelink, legal providers, job network providers , emergency relief services, TAFE and education providers, gyms and clubs providing recreational activities, alternative health services and non-government agencies. The Integrated Model has enabled the program to provide clients with positive opportunities to reintegrate into the community. This presentation will share how by considering the social determinants of health and utilising Integrated Case Management have assisted in a holistic provision of service to post-release clients, even by those who come from different perspectives and backgrounds, in particular tackling the lack of services in the Hunter Region for clients needing to access pharmacological services. This has including bringing services on-site and advocating within the region for more appropriate services.

70 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

12.00 - 12.15 Coming Home Program; Case Management Partnerships for women exiting prison Presenter & Author: Kirsty McIntyre-Smith, Coming Home Program, Toora Women Inc

The Coming Home Program supports women with community reintegration on leaving prison.

Our aim is to prevent homelessness and reduce recidivism. We provide comprehensive Case Management tailored to individual needs. This includes support with tenancy, health, family reconciliation, employment, education and social and emotional well-being. Flexibility is a program hallmark.

Governance is by an alliance of three established ACT Women’s Community Services. The services are united by feminist philosophy and trauma centred recovery expertise. This expertise is utilised in addressing challenges faced by ATSI and CALD women and issues of institutionalisation, substance use, mental health, sexual assault and violence against women.

We work closely with The Department of Justice and Corrections to access women currently incarcerated to establish working relationships prior to release. We liaise with ACT Housing to provide furnished accommodation for women and families to move into on release, and to live in indefinitely. Outreach support continues as long as women want.

Our holistic, partnership approach addresses individual complex needs of women and facilitates a smooth transition to life in the community.

12.15 - 12.30 Creating windows of change: the Vietnamese Transitions Program Presenter: Rachel Rowe, Drug And Alcohol Multicultural Education Centre, NSW & Authors: T Nguyen & R Rowe

“Otherwise they’re going straight back… to that spiral, it doesn’t change. What Transitions is doing is creating a window of change.” - Probation and Parole Officer

The Vietnamese Transitions Project seeks to address the structural barriers faced by Vietnamese men and women who have substance use issues and are completing prison sentences for illicit drug related offences. In the context of the over-representation of Vietnamese-born people in NSW prisons, this presentation will explore how a comprehensive case management program has achieved the impressive outcomes reported in its recent evaluation.

Over an 18-month period from 2011 to 2012, no Transitions participants returned to prison; and alcohol and other drug (AOD) and mental health treatment entry and retention rates among participants significantly increased. Eighty percent of participants reported improved relationships with their families; and participants who had access to suitable housing went from 33% at release from prison to 95% at discharge from the program. Evaluation findings also suggest that workers in prisons and transitional support services in the community are better placed to understand, treat and refer Vietnamese inmates, ex-inmates and their families as a direct result of the program.

71 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

Cross-sectoral and cross-portfolio approaches (Ballroom 4) Chair: Ian Webster

11.00 - 11.15 Reflections on establishment of a cross sectoral health and social support service. Presenters & Authors: Nanette Mitchell , City of Melbourne & Russ Sevior, Doutta Galla Community Health

Research undertaken by the City of Melbourne identified that for people with complex needs, homelessness is exacerbated by systemic and service coordination failings.

In 2011 Council conducted a round table that identified health services as a platform to address homelessness issues for people with complex needs. Central City Community Health Service opened in May 2012 managed by Doutta Galla Community Health and with resources from ten partner agencies providing both on-site and outreach services. Services include a gendered response for women.

This innovative collaborative project is in the early stages of implementation and is the only known service of this type in Australia. The presentation will include information on effective collaborative approaches for diverse, outreach and site based health service delivery; new approaches for HACC funded program activity groups, improved outcomes for vulnerable people and success in attracting additional State and Federal funding for new cross sectoral service models.

11.15 - 11.30 Collaboration and homelessness: How ‘joined up’ are health and welfare services? Presenter: Natalie Rinehart, Inner North West Melbourne Medicare Local, Victoria Authors: N Rinehart & J Borninkhof

Findings from a National Homelessness Research Agenda 2009-2013 study conducted by Melbourne General Practice Network (now Inner North West Melbourne Medicare Local). The research explored health and welfare experiences, beliefs and practices for those affected by chronic homelessness, GPs, pharmacists and services that support those affected by homelessness. Results suggest communication frequency and quality between service providers was lower than is likely needed to deliver the ‘joined up’ approach thought to produce the most beneficial outcomes for clients. Health and welfare service provider communication preferences indicated that collaborating for client wellbeing may take different forms for different providers.

Services that support those experiencing homelessness also identified a variety of actions on behalf of health and welfare providers that could enhance collaboration between the sectors. Themes of information sharing, relationship building and reducing barriers were evident. The outcomes offer a useful starting point in developing local ‘joined up’ approaches rather than the often fragmented service provision currently provided to this vulnerable population.

72 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm

11.30 - 11.45 Non-government community services are promising settings to tackle smoking amongst the disadvantaged Presenter: Jon O’Brien, Cancer Council NSW Authors: P Hull, J Bryant, B Bonevski, J O’Brien & S Salmon

Background: Smoking rates among highly disadvantaged population groups are three to five times higher than the general population. Non-government social and community service organisations (SCSOs) provide a potential setting to extend the reach of tobacco control efforts amongst disadvantaged people with complex needs. Since 2006, Cancer Council NSW’s Tackling Tobacco Program has collaborated with SCSOs to build services’ capacity to address smoking. Program activities have included grants, training, research, advocacy, resource development and social marketing.

Methods: Quantitative and qualitative methods were used to evaluate program activities from phase one of Tackling Tobacco (2006-2012).

Results: Most SCSO clients reported being smokers, and most indicated interest in quitting. Clients spent approximately 14-16% of weekly income on tobacco. SCSO staff were generally positive about addressing tobacco, although little previous activity was reported and several barriers identified. Brief intervention training improved self-reported staff skills and confidence. Clients frequently responded positively to smoking cessation support. Evaluations reported some evidence of improved policy implementation and positive staff attitude and behaviour change. Amongst clients, there was some evidence of improved finances and quality-of-life for those who quit. Few adverse outcomes were reported.

Conclusions: SCSOs are a promising setting for tobacco control activities targeting disadvantaged smokers.

11.45 - 12.00 We’re in it together: a new approach to suicide prevention Presenter & Author: Sue Murray, Suicide Prevention Australia, NSW

Suicide places inordinate strains on our community’s well-being, cohesiveness and productivity. Over recent decades many organisations and governments have sought to decrease the annual rates of suicide. Significant investment has been made financially and socially and yet the results have been limited with suicide rates remaining relatively unchanged across most age groups.

It is time to change the approach. Suicide Prevention Australia (SPA) is advocating for the adoption of collective impact approach. This will require organisations within the diverse suicide prevention and mental health sectors, as well as business and government (cross-portfolio), to commit to a common agenda, shared goals and measures and a reporting framework under which all participants operate. Importantly the programs of participating organizations will align to this agenda giving their group contributions a greater voice and ensuring accelerated progress towards the agreed goals and resolutions.

The collective impact approach has achieved success in addressing complex community-wide problems in the USA. Implementation of the innovative collective impact framework at a national level to reduce suicide in Australia will be a world first. Success will be reflected by a significant change in the number Australian’sof tragically lost by suicide each year.

12.00 - 12.15 Acting on the Warning Signs Presenter & Author: Linda Gyorki, Project Manager and Solicitor, North Melbourne Legal Service, Victoria

Violence against women is a major health, legal, social and economic issue for the community. For Victorian women aged between 15-44 years of age, intimate partner violence has been found to be the leading preventable contributor to death, disability and illness and to contribute 8% to the total disease burden. A partnership between North Melbourne Legal Service, a not-for-profit community legal centre and the Royal Women’s Hospital, Australia’s largest specialist hospital dedicated to improving the health of women of all ages and newborn babies, has the capacity to empower and protect a significant number of Victorian women by integrating legal assistance and training within the hospital context and promoting a coordinated health-legal response to violence. This health-legal partnership seeks to address fundamental barriers to accessing support and is based on the social model of health. A high-level, multi-disciplinary team from the University of Melbourne is evaluating the project.

73 Concurrent Sessions 4: Tuesday 11.00 am - 12.30 pm & Panel discussion: 1.30 pm - 3.00 pm

12.15 - 12.30 Opening Doors – the role of Community Leadership in fostering Social Inclusion Presenters & Authors: Gregg Nicholls & Ronda Held, MonashLink Community Health Service, Victoria

A partnership of health and community agencies working in the inner east area of Melbourne identified the health impacts of social isolation on our community. This included vulnerable groups such as older people, people with disabilities, and people from diverse cultural backgrounds. It was clear that agencies were struggling to engage with isolated people and connect them with resources that could make a difference. Instead of looking to “service” solutions, the partnership used a capacity building approach, identifying grass roots community leaders who are passionate about everyone having the opportunity to participate in their community.

The Opening Doors community leadership program commenced in 2009 and is now entering its fifth year with a new program starting in the south east area of Melbourne in 2011.

The core approach of the program is to build on the strengths of the participants and their local communities. Asset Based Community Development approaches are shared with participants and are utilised in developing local projects that are worked up during the program and continue to foster social inclusion in local communities.

The program has been formally evaluated and we can demonstrate that for every dollar invested there is at least five dollars produced as additional community benefit.

12.30 - 1.30 Lunch (The Gallery)

1.30 - 3.00 Panel discussion: Breaking down structural and systemic barriers to achieving better outcomes for people with complex needs (Ballroom 2) Chair: David Templeman, Alcohol and Other Drugs Council of Australia, CEO

It has long been acknowledged that people with complex needs often fall through the cracks in service delivery – between national and jurisdictional service delivery, between government and non-government services, and between services delivered by different portfolio agencies. This session will explore different perspectives with a view to shedding new light on ways to overcome challenges in seeking to achieve better outcomes for people with complex needs in the Australian community. The panellists will be asked to provide insights based on their own perspectives and then engage in a broader discussion with the audience.

Panel members will address the following areas within the context of the session theme of Breaking down structural and systemic barriers to achieving better outcomes for people with complex needs:

Ian W Webster, Emeritus Professor of Public Health and Community Medicine, University of New South Wales - The interface between the mental health and Alcohol and Other Drug sectors

Gino Vumbaca, Executive Director, Australian National Council on Drugs – The recent report “An Economic Analysis for Aboriginal and Torres Strait Islander Offenders: Prisons vs. Residential Treatment”

Julie Tongs OAM, Chief Executive Officer of Winnunga Nimmityjah Aboriginal Health Service - Challenges for Indigenous health workers working in both mainstream and community controlled settings

David Morton, Director General, Mental Health, Psychology and Rehabilitation, Department of Defence - Mental health and Post Traumatic Stress Disorder issues for Defence personnel post-deployment - implications for families, communities and future service delivery in terms of management of complex needs in the community (TBC)

Léan O’Brien, Senior Research Fellow, Centre for Research and Action in Population Health, Faculty of Health University of Canberra – The results from CeRAPH’s recent studies on social inclusion and complex needs with respect to health and wellbeing.

Andrew Laming MP, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health

74 Closing Session: Tuesday 3.30 pm - 4.30 pm

3.00 - 3.30 Afternoon tea (The Gallery)

3.30 - 4.30 Closing Session with Development of Conference Declaration and Recognitions (Ballroom 2)

Australasian Fetal Alcohol 19–20 Spectrum Disorders November 2013 Education Centre Conference Royal Brisbane and Women’s Hospital Butterfield St, Herston Brisbane QLD

Abstract submission closes 21 June 2013

For more information visit www.phaa.net.au

75 Poster Abstracts: Monday 5.30 pm - 6.30 pm POSTERS

Posters will be displayed in the Gallery Foyer and presenters of the posters will be available to discuss their posters on Monday 15 April, between 5.30 pm - 6.30 pm

1. Inanna Inc. Indigenous Families Support Program – Improving Indigenous family relationships Presenter: Martina Taliano, Inanna Inc., ACT Authors: M Taliano & J Kelly

Inanna Inc. Indigenous Family Support Program supports Indigenous families that are impacted by multiple stressors shaping the outcomes of their lives. Inanna works in collaboration with Care and Protection (ACT and NSW), Justice, Health and other supportive networks with these families to achieve the best outcomes for their lives.

Inanna’s practices are informed by a feminist/narrative framework that recognizes that people live their lives in a social context and within the Australian context that is not a level playing field for Aboriginal people. Having this understanding helps to broaden the territory in which solutions can be found to move their lives closer to their hopes. Research tells us that Indigenous families experience greater disadvantage in our society resulting in poorer health outcomes, over representation in the legal system, and living with the effects of intergenerational poverty.

Inanna provides intensive family support packages that can include 24/7 in home supports for new mothers, Indigenous women exiting correctional facilities and for families that have come under the Care and Protection system. Additional supports could include education, advocacy and assistance with understanding your rights and responsibilities around property and tenancy management, support in attending medical and/or legal appointments, and counselling to assist in managing previous traumas. The ability to provide individualised, dynamic and flexible services to many Indigenous families has resulted in increasing the opportunities for positive health and social outcomes, in particular for the adults and children involved with the individual support packages.

Inanna is proud of the excellent reputation the Indigenous Families Support Program has gained within the Community Sector, with Government agencies and within the local Indigenous community.

2. Yhunger presents.... food and physical activity living skills in youth homelessness services Presenter: Belinda Crawford, Sydney Local Health District, New South Wales Authors: R Yamazaki, E Franke, B Crawford & S Amanatidis

The YHUNGER#2 (Younger Hunger) project uses a setting based approach in youth homelessness and youth health services that is designed on evidence, inter-sectoral collaboration and youth participation. Yhunger workers present a reflection from their ten years working with youth homelessness services on a living skills package and research findings with 16 services and fifty homeless young people.The process behind the revamped Yhunger kit will be shared. The new kit features two cookbooks, a youth workers toolkit of forty activities, policy and practice ideas and Q&A sheets to promote food and physical activity. Professional development opportunities are planned to enhance services’ capacity.

On any given night in Australia, 105,000 people are homeless and nearly half of these are under the age of 25 years (ABS, 2006). Young people experiencing homelessness are diverse, including Aboriginal young people, young people from a refugee background, young people from out of home care and exiting correctional facilities, sexuality and gender diverse young people and young parents. A quarter of NSW youth homelessness services are in our two health districts, all run by NGOs and represented by the peak body, Yfoundations. The diversity of young people and service delivery types need insight, flexibility and creativity.

76 Poster Abstracts: Monday 5.30 pm - 6.30 pm

3. Translating research into practice: Academia and disability services working together Presenter: Rafat Hussain, University of New England and The Ascent Group, Armidale (2). Authors: R Hussain, T Parmenter & S Wark

The University of New England (UNE) in Armidale was confirmed as a fully independent university in 1954; a timeframe which coincided with the development of many non-government community based disability support organisations across Australia. However, for many years there was minimal interaction on a coordinated level between UNE and disability services in rural areas to oversee the translation of research into effective and efficient daily practice for individuals who may require assistance in social integration and inclusion.

In 2002, The Ascent Group and UNE signed a formal Memorandum of Understanding to work together on issues of mutual and wider community benefit. In the ten years since that time, a number of joint projects have been undertaken with respect to staff training, family and carer education, specialised clinical interventions and daily support practices. This paper outlines the successes, the difficulties and the ongoing benefits that have been derived from this relationship for both the service provider and the academic partner. It has particular relevance for both smaller organisations and rural providers which may struggle to access relevant information or resources from the tertiary education sector regarding complex care issues for individuals with intellectual disability and multi- morbidities.

4. Inner City Youth At Risk Project – Partnering to Improve Client Outcomes Presenters & Authors: Cindi Petersen & Tracey Brown, South Eastern Sydney Local Health District

The Inner City Youth at Risk (ICYAR) Project is part of the National Partnership on Homelessness NSW Implementation Plan (IP) and the Homelessness Action Plan and builds upon the successful Kings Cross Youth at Risk Project. The project is a partnership project which draws together 21 government and non-government agencies to target and respond to young people who are homeless and or at risk in the inner city.

The project involves three key strategies: (1) Coordination by a project coordinator based in a health service who works with partner agencies. (2) Quarterly Outreach sweeps to collect data on the profile of young people (3) Brokerage funds to support at risk young people in emergency situations and to support long term case plans and supported housing.

Key issues addressed include: health, accommodation, pregnancy and parenting, and transport out of area.

Data compiled from the project suggests that by intervening early young people and their dependants can be protected from the development of long term health issues and dependence on services. Innovative service delivery has resulted for clients.

The development and maintenance of effective partnerships with stakeholders has had a sustainable impact on the relationships between health services, community based and other government service providers. Data from the latest report covering the last two years will be presented highlighting the outcomes of the project.

77 Poster Abstracts: Monday 5.30 pm - 6.30 pm

5. A multi-site collaborative project supporting patients with severe burns trauma Presenter: Janelle Tolley, NSW Agency for Clinical Innovation, NSW Authors: J Tolley & A Darton

Treating someone with a severe burn injury is intensive and complex. A myriad of issues add to this complexity including the depth, coverage, etiology and site of the burn injury. Other factors impacting patient care include the presence of comorbidities, management of infection, pain and impact to mental health. To promote best treatment, collaboration across all health, social and familial networks involved in the patients care is essential. Peer support is an adjunct to the care team that promotes some of the values of social inclusion including the importance of social connections. Patients who suffer a trauma like a severe burn injury can become geographically and socially isolated from their community and support networks, particularly during times of inpatient treatment. Having the opportunity to speak with a burns survivor who is further down the path of recovery can help to reduce isolation and provide hope. Sharing Hope, Acceptance, Resilience and Experience (S.H.A.R.E.) is a peer support program established in March 2012 in New South Wales and is unlike anything offered nationally in burn care. This presentation will describe the program structure and early results, with focus on the collaborative effort which supported the development of this promising program.

6. Where there’s a will there’s a way! Integrating housing, healthcare and social support for homeless populations Presenters: Eva Bruce, Micah Projects Inc., Brisbane, QLD & Erin Ebert, Mater Health Services Brisbane, QLD Authors: J De Couto, K Rayner & E Ebert

How can we address the complex needs of our homeless and vulnerably housed populations? In a time of economic constraint, where the most disadvantaged struggle to be high on the list of community priorities, organisational partnerships that share a vision, values, resources and a real commitment to work together will become essential if we are to address the complex needs of disadvantaged populations. Brisbane’s Homeless to Home Healthcare Program was established out of the 50 Lives 50 Homes campaign launched in June 2010 by Micah Projects, Mater Health Services and partners aimed at housing and supporting Brisbane’s homeless population. Introduced to Australia at this time was the application of the Vulnerability Index (VI) Survey, a tool designed to identify and prioritise the housing and healthcare needs of the street homeless population according to their mortality risk. VI data collected reinforced the critical need for broad healthcare options to be well integrated into any successful model of housing and social support. This presentation will discuss the development of the Homeless to Home Healthcare program through its partnerships approach and practitioner experience. It will also detail the benefits thus far while highlighting the challenges to successfully achieving an integrated model of support and the ongoing advocacy and collaborative efforts still required.

7. Recruitment to an electronic health record network: the views of people with intellectual disability and their families and carers Presenter: Kate van Dooren, Queensland Centre for Intellectual and Developmental Disability, University of Queensland Authors: K van Dooren, M Stewart & N Lennox

Stark health inequalities experienced by people with intellectual disability are compounded by overlapping challenges and barriers to health system accessibility and appropriateness. Changes to the Australian health system will allow individuals to have an electronic health record (eHealth record) that can be shared between their doctor and other healthcare providers. The aim of this study was to identify the facilitators and barriers to registering for the eHealth network for people with intellectual disability and their families and carers. We interviewed six people with intellectual disability, three family members and two residential support workers. Our findings suggest that decision makers involved in the roll out of the eHealth Network should incorporate ‘reasonable accommodations’ for people with intellectual disability, including identifying and eliminating the barriers to accessibility of eHealth records and taking appropriate measures to promote access to individuals with intellectual disability. People with intellectual disability and their carers are a diverse group with a range of abilities. The translation of their views into practice will help to improve the eHealth system for this and other vulnerable population groups.

78 Poster Abstracts: Monday 5.30 pm - 6.30 pm

8. The People with Exceptionally Complex Needs Project - breaking down barriers in WA Presenter & Author: Amanda Perlinski, Disability Services Commission, Western Australia

The People with Exceptionally Complex Needs Project (PECN) is an inter-agency project between the Disability Services Commission, Mental Health Commission, Mental Health Services, Department of Corrective Services, Department of Housing, Drug and Alcohol Authority and the Office of the Public Advocate. It provides a co- ordinated service for 20 people who have two or more of the following conditions: intellectual disability; cognitive disability; a significant mental illness; drug and alcohol problems and who require a co-ordinated service and the existing services are not meeting their needs as well as they should. The project has two co-ordinators who report regularly to a high level Inter-agency Executive Committee which assists in unblocking blockages in the system for those people most vulnerable to falling between the cracks in service delivery. The project commenced in 2009.

This paper provides an overview of the project and the PECN population. It considers some of the health and social issues emerging from this small but complex sample which underline the need for collaboration to address their needs.

9. A Magic Wand? How Realist Evaluation Addresses Consumers’ Care Coordination Expectations Presenters: Heather Burton, Flinders University, South Australia & Lucy Atkinson, Flinders University, South Australia Authors: H Burton, L Atkinson, L Walters, J Tracy, R McDonald, R Davis & L Sweet

Preliminary data and theories from stage 1 of the PEACHI project will illustrate how local knowledge and the lived experience of consumers can inform tailored care coordination (CC) for people with intellectual disability (ID) taking account of specific contextual factors using Realist Evaluation (RE).

CC encompasses many possible strategies. RE assumes that in the real world there is no ‘one size’ solution to complex social issues and seeks to understand what key mechanisms work to generate desired outcomes in particular contexts.

In stage 1, qualitative interviews and focus groups with health and disability professionals were conducted following a CC trial in Ararat and thematically analysed to distill key outcomes and the mechanisms that generated them. The data informed development of CC interventions in stage 2. Further interviews with people with ID and their carers – consumers - in proposed intervention sites, the Riverland and Millicent, provided rich contextual data and identified existing local structural and systemic barriers to health care in response to the question “If you had a magic wand, what would you change?” Stakeholder meetings contributed local expertise. Findings will be presented to illustrate how RE helps to evaluate how the tailored CC interventions address the identified barriers.

10. Engaging disadvantaged populations in chronic disease risk factor reduction – the NSW Get Healthy Information and Coaching Service Presenter: Michelle Maxwell, NSW Office of Preventive Health, NSW Authors: S Winch & C Rissel

In February 2009, the Ministry of Health launched the Get Healthy Information and Coaching Service (GHS), a telephone-based service aimed at assisting adults make changes to their lifestyle chronic disease risk factors.

Participants are recruited through self-referral (primarily through mass media), proactive marketing or through health care provider referrals and can elect to receive an information package or enrol in the six month coaching program (involving 10 individually tailored sessions). Prior to beginning the coaching program, participants undertake a health assessment and are referred to their General Practitioner for medical clearance before entering the program if found to be at higher risk.

Between February 2009 to August 2012, 19,559 participants joined GHS; 6,474 (33.1%) requesting information; 13,085 (66.9%) requested coaching. There were 8147 (45.3%) participants from the 4th and 5th SEIFA quintile, 17.1% were from outer regional areas and 34.1% had a year 10 or lower education. On enrolment in the GHS, 32.1% were overweight while a further 53.3% were obese. The GHS has demonstrated significant reduction in weight (3.8 kg), waist circumference (4.9 cm) and an accepted Body Mass Index from 11.6% to 20.2% of participants. The GHS is an effective lifestyle modification program which engages well with disadvantaged populations.

79 Poster Abstracts: Monday 5.30 pm - 6.30 pm

11. How digital technology assists people to live independently at home and in the community Presenter & Author: Nancy Matina, Client Services Manager, North West Metropolitan Region, Care Connect, VIC

At Care Connect we recognise that a rapidly increasing ageing population with limited access to government funds continues to place pressure on the health system. This may result in poorer health outcomes and higher rates of social isolation for many.

Care Connect is committed to supporting people to live independent lives at home and in the community. To that end we have responded by developing iCareConnect®, a digital case management service. iCareConnect® has enormous potential in both a traditional community care and a consumer-directed care environment to: • increase the frequency of face-to-face contact between clients and their client advisers • increase the proportion of package funds allocated to brokered services • increase a person’s capacity to remain living independently • decrease a person’s social isolation • improve the productivity of client advisers • extend the reach and range of services available. iCareConnect® can also provide: • virtual visiting through volunteers, family, the community and cultural groups • e-learning, online shopping, banking • planned activity for multiple individuals simultaneously. iCareConnect® represents an innovative step in providing Australians access to greater service choices through the leveraging of technology.

12. Social Inclusion through a Health Coaching Approach to Promoting Healthy Lifestyles Presenter: Maree Sullivan, ACT Health Directorate, Canberra ACT Authors: M Sullivan, K O’Brien & L Prentice

Community consultation in the ACT Healthy Communities Initiative (HCI) identified the need for a community health outreach program provided by trusted community health professionals. The HCI is “A joint Australian and Territory Government initiative under the National Partnership Agreement on Preventive Health” and targets adults who are not in the paid workforce.

Mini health checks conducted by nursing and allied health staff were used as an engagement strategy and screening tool to identify people who wished to address any lifestyle related health risk factors. Staff who were trained in health coaching principles, assisted participants to prioritise their health goals, offered them educational resources and referral to appropriate services.

Fifty four health checks found extremely low fruit and vegetable intake; overweight or obesity in 65% of participants; and a high blood pressure rate in 52% of participants. Sixty three percent of participants identified as smokers.A Smokelyser machine was used to measure carbon monoxide levels, these readings gave positive reinforcement to participants smoking reduction. Podiatry and dental service staff as well as local general practitioners became involved in the smoking cessation strategy in response to the number and nature of referrals they received. Ongoing outreach sessions provided individuals with positive reinforcement of their lifestyle changes in a non threatening, accessible and familiar environment.

80 Poster Abstracts: Monday 5.30 pm - 6.30 pm

13. Collaborating to uncover undetected blood borne viruses and sexually transmitted infections in hard to reach populations in the ACT Presenter: Debbie Morgan, The Canberra Hospital, ACT Authors: R Del Rosario, M J Currie, A Tyson, D Morgan, D Fairall, P Habel, K Rossteuscher, T Bavinton & S J Martin.

Background: Staff from four health care agencies collaborate to provide outreach clinics incorporating sexual health education and screening for at-risk populations.

Methods: Between 2005 and 2012 data were collected from attendees (men who have sex with men (MSM), sex workers, vulnerable youth and female clinic attendees) at clinics conducted in sex-on-premises venues, brothels, youth centres, an AIDS support organisation. Rates of sexually transmissible infections (STI) and blood borne viruses (BBV) were determined.

Results: 92 clinics in 14 different venues, providing 1780 occasions of service to 624 people. STI and/or BBV screening was conducted on 988 occasions. There were 42 cases of chlamydia: 28, 5, 3 and 6 cases among MSM, youth identifying as queer, sex workers and vulnerable youth respectively. Rectal screening identified the majority of chlamydia among MSM. Per test infection rates were 5.8%, 5.3%, 1.4%, 7.3% for MSM, youth identifying as queer, sex workers and vulnerable youth respectively. 10 new cases of gonorrhoea, 3 new cases of HIV, 11 new cases of hepatitis C and 2 new cases of hepatitis B were detected.

Conclusions: This interagency collaboration found cases of STI and BBV which may otherwise have gone undetected demonstrating the public health value of outreach activities targeting hard-to-reach populations.

14. Get that away from me! Discussing sexuality and its complexities Presenter: Cindy Nicollet, Queensland Centre for Intellectual and Developmental Disability, School of Medicine, University of Queensland Authors: C Nicollet & M Taylor Gomez

Background: People with intellectual disability do not learn the social cues to support making healthy friendships which may lead to more intimate relationships, as in the general population. In addition, they do not receive adequate education about relationships and sexuality. People with mild to borderline intellectual disability often live in accommodation arrangements which offer limited support. They experience abuse and subsequent difficulties in forming relationships and negotiating friendships.

Methods: A pilot program was developed based on an existing resource. Topics included feelings, how to protect yourself, sexuality and sexual identity, intimacy and being connected, how to make friends and maintain relationships, and staying healthy. Presenters with and without prior experience of working with people with intellectual disability were approached.

A Brisbane-based community organisation showed interest in the proposal and selected eight participants for the group (four men and four women). The group ran weekly sessions for eight weeks.

Results: Outcomes were measured qualitatively through weekly evaluation forms and discussions with organisational support staff.

Conclusions: Feedback indicated that participants found the sessions useful. There is interest for this program to be repeated and for more formal evaluation to be undertaken.

81 Poster Abstracts: Monday 5.30 pm - 6.30 pm

15. Putting together the pieces: Responding to trauma and substance use Presenters: Brandon Jones, UnitingCare ReGen, VIC Authors: UnitingCare ReGen

Post-traumatic stress disorder and other trauma related mental health disorders often go unrecognised by AOD clinicians, despite being a common co-occurring issue amongst individuals presenting for AOD treatment. The Putting Together the Pieces program was produced by ReGen primarily as a guide for clinicians in the AOD sector and allied professions. Recognising that there is a lack of resourcing for clinicians working with clients with a co-morbid presentation involving trauma-related mental health disorders, the key resource seeks to build capacity in the sector and give clinicians an introductory resource that will increase their confidence around complex presentations involving trauma.

16. Empowering Consumers Through Self-directed Funding Presenter: Brett Collins, Justice Action Author: W Tian

By treating consumers with dignity and respect and encouraging participation in decision-making, self-directed disability funding services encourage independence, empowerment and a sense of social inclusion.

The Productivity Commission describes the current system as “unfair”, for reasons such as dependence of services on inequitable factors such as where consumers live, inability to choose and manage their own funds and limited engagement with the community. For example, the narrow selection criteria and opaque administration processes under the Housing and Accommodation Support Initiative reveal that power lies solely with accommodation support providers, rather than the consumers themselves.

The Commission recommends the implementation of a program that allows individuals to choose their own service providers. Self-directed funding systems have shown to be three times more efficient than traditional systems. The government has developed the National Disability Insurance Scheme (NDIS), which has received widespread support. However, concern has arisen over the inadequacy of funding allocated for it and the lack of detail concerning decision-making bodies and selection criteria. Furthermore, the NDIS may become an unrealistic political stunt that fails to reach the people who need it most. Nevertheless, its implementation should be the final step towards a system where the voices of consumers are heard.

82 83 PRESENTER INDEX

Poster numbers are located in the right column next to the page numbers of the abstracts. Page # for Poster # Page # for Poster # abstract abstract

Artuso, S 39 Gardiner, S 52 Askew, C 54 Gausia, K 30 Atkinson, L 79 #9 Goodhew, M 42 Baker, L 66 Gordon, S 47 Baldry, E 23 Gyorki, L 73 Barlow, K 41 Haigh, K 55 Bellwood, R 69 Hakerian, L 65 Block, K 60 Hanley, F 27 Boyce, C 19, 63 Hardiman, A 25 Briggs, R 32 Hatfield Dodds, L 18, 21 Brooker, K 26 Hawkins, J 54 Brophy, L 26 Hedges, S 39 Brown, T 77 #4 Hehir, A 29 Bruce, E 78 #6 Held, R 74 Burke, L 33 Helquist, L 46 Burton, H 79 #9 Hetherington, B 38 Byrne, J 43 Hodda, R 67 Cairney, I 61 Hodson, A 48 Cale, R 51 Hollingsworth, F 45 Calma, T 19, 63 Holmes, J 42 Calo,B 51 Holst, H 52 Campbell, M 36 Howe, M 36 Carroll, C 52, 53 Hussain, R 26, 77 #3 Carter, J 29 Hyndal, P 49 Chahola, B 46 Jewson, E 41 Clift, V 31 Johnson, S 59 Collins, B 82 #16 Jones, B 82 #15 Colliver, D 50 Jury,L 49 Crawford, B 34, 76 #2 Katsaros, E 54 Cucow, S 48 Kelly, J 38 Curtis, A 42 Kenny, P 52 Cussen, J 44 Kezelman, C 69 Dailey, B 36 King, J 31 Dalgetty, C 43 Kirkham, R 43 Dawson, A 28 Kruk, R 19, 63 Day, C 22, 64, 65 Lamaro, G 60 Derrett, A 68 Laming, A 74 Ebert, E 78 #6 Lester, D 37 Ezard, N 42 Ligo, S 34 Fielder-Gill, H 70 Masters, K 32 Matina, N 61, 80 #11

84 PRESENTER INDEX

Poster numbers are located in the right column next to the page numbers of the abstracts. Page # for Poster # Page # for Poster # abstract abstract Maxwell, M 79 #10 Roberts, J 28 McGee, P 22 Roe, J 24 McGeorge, P 55 Rowe, R 66, 71 McIntyre-Smith, K 34, 71 Rugkhla, P 50 McPherson, L 25 Santana, L 65 Mentha, R 39 Schmidt, B 45 Merrilees, E 67, 68 Sevior, R 72 Mitchell, N 72 Smith, J 35 Monkley, D 40 Sotiri, M 40 Morgan, D 74, 81 #13 Steele, L 24 Morton 74 Sullivan, D 56 Murray, S 73 Sullivan, M 80 #12 Newley-Guivarra, N 57 Sunjic, S 30 Nicholls, G 74 Sutton, P 53 Nicollet, C 62, 81 #14 Taket, A 35 Noble, P 56 Taliano, M 62, 76 #1 Noone, M A 70 Taplin, S 43 Nori, A 31 Thompson, S 44 O’Brien,L 74 Tickner, R 18, 21 O’Brien, J 73 Tierney, C 31 O’Keeffe, S 70 Tolley, J 78 #5 O’Loughlin, 64 Tongs, J 45, 74 O’Shea, M 41 Toole, J 29 O’Sullivan, A 27 Tsou, C 57 Olsen, A 50 Van Dooren, K 23, 78 #7 Ong, S 58 Vumbaca, G 74 Osborne, K 40 Waples-Crowe, P 32 Parry, Y 33 Ward, S 30 Penrith, M 43 Webster, I 74 Perkins, S 38 Whittle, E 37 Perlinski, A 79 #8 Wilhelm, K 37 Petersen, C 77 #4 Winch, S 59 Pickard, H 33 Wood, A 47 Piovesan, R 31 Pisani, M 58 Pollock, S 35, 51 Prentice, L 48 Ramsey, R 47 Ribton-Turner, D 33 Rinehart, 72 Robb, W 53

85 NOTES

86