Country SA PHN Annual Report 19/20 1

Annual Report 19 / 20

Contents

Chair of the Board Report 2

Chief Executive Officer Report 3

Chair of Finance Report 6

Regional Health Priorities Statistics 8

Our Priority Areas 17

Reconciliation Action Plan 32

Local Health Clusters 36 2 Country SA PHN Annual Report 19/20

Chair of the Board Report

The 2019-20 year has been anything Additional funding was also provided but routine, but the Country SA PHN to enable the establishment of (CSAPHN) has stepped up to the plate specific Respiratory Clinics and and been a strong voice for the role enhanced Respiratory focus in smaller of primary health care at the forefront clinics across our patch. Our senior of bushfire recovery and pandemics. staff are to be congratulated on our positioning in this arena with a much The Board took pause last year and stronger presence than seen in undertook an external review to see other states. what areas of good governance required more attention and has As well as the specific challenges made some changes to internal and thrown at us in the past year, CSAPHN Board processes in response to this. has continued with business as usual We expected to swing into 2020 in commissioning, monitoring and “As well as the with a new found vigour only to reviewing the range of services we specific challenges be pushed back by the devastation commission across all of rural SA. It of the bushfires across our regions is a credit to all our staff and service thrown at us in the hotly followed by the need to modify providers that we have managed to past year, CSAPHN our business processes due to the maintain this despite the difficulties precautions put in place around presented. has continued with COVID-19. The organisation and the Thanks to our CEO Kim Hosking, Board have managed with a modified business as usual COO Mark Hartigan and all the meeting schedule with more in commissioning, CSAPHN staff for another teleconferences and video-meetings. monitoring and successful year. The PHNs were involved in providing reviewing the range immediate and longer term support of services we on the ground after the bushfires in commission across affected areas with some additional funding in this area. Dr Alison Edwards all of rural SA.” The SA COVID response built on Chair of the Board good relationships already in place between both of the SA PHNs and SA Health enabling us to be involved in the state-wide COVID response in the Command Centre and working with those in that space to ensure SA primary health was always in the mix with responses, information, testing etc. Country SA PHN Annual Report 19/20 3

Chief Executive Officer Report

It is clear that this past year has the first week of January, we were been an unprecedented challenge required to respond to the bushfire for Country SA PHN (CSAPHN). It emergencies in the Adelaide Hills, has been an unprecedented year of Kangaroo Island and the Upper challenge for all businesses and the South East. While we have been community, our partners, providers accustomed to a bushfire response of service and stakeholders. The in the summer of a number of the elephant that has blundered into and preceding years, the span of the consumed the ‘room’ has of course activity this year was greater. The been the advent of the COVID-19 Commonwealth directed funds and crisis. This crisis has dictated our required activities and principally activities this past year and will our mental health team, responded continue to do same throughout to planning and commissioning “As well as the the next period and almost certainly needs within barely a week to a beyond. The COVID-19 emergence fortnight time frame, recruiting specific challenges has created a public health event, a community project officer and thrown at us in the unparalleled in recent times, which directing funds to providers. Mental will impact public health and Health services were expanded into past year, CSAPHN community thinking for a generation. increased activities in each region and has continued with CSAPHN has responded to the crisis community forums led to grant funds throughout, aiming to be an exemplar being made available for community business as usual of good community practice and with support and resilience. in commissioning, the needs of our community at the As this activity played out it was front of our minds. monitoring and clear that a significant public health reviewing the range Our year commenced with event was approaching and ahead continuation and in some of the perceived demand and using of services we applications, the expansion of knowledge gained over time, we commission across activities in common with preceding began positioning ourselves for years. Our focus being to improve a response, the style and scope all of rural SA.” upon services commissioned for of which we had no real way of mental health and general health determining. activities and other activities aligned In March with the declarations of to our mission for improving system national and state emergencies and integration and coordination, as following an invitation to join with well as General Practice and other SA Health in their response to the provider support. Our 2019-2020 potential and early realities of the reporting and 2020-2021 annual COVID-19 crisis, the CSAPHN split planning deliverables were achieved, its organisation into two functional and the Christmas break taken. platforms; a COVID-19 response However immediately upon the and a Maintenance of planned commencement of the year, in activities team. 4 Country SA PHN Annual Report 19/20

Chief Executive Officer Report

The COVID-19 response part of the with the Board approved delegation It is not uncommon at this time, for organisation progressed activities of a CEO, undertook activities to comments to be made about staff to commission six Commonwealth support our Commissioned service of organisations not being at work funded Respiratory Clinics across providers in the emerging demands and now returning to work. This regional SA as well as fifteen nurse and changing needs and in managing is an unfortunate and unrealistic led activities in smaller and more their own challenges, as organisations appreciation of the realities of isolated communities, expanding the operating in a time of crisis. They this past year. It is also the case capacity of practices to support local supported increased demand for that comment is made reflecting need should they arise, and in some telehealth and remote service unrealistically, that employees areas, they did. General Practice was provision based on technology. All of the public sector and entities supported to respond and hundreds of the normal activities of the PHN such as the PHN associated with of thousands of items of personal continued, albeit with a reduced same had this past year easy. I am protective equipment were distributed workforce and increased demand uncertain as from where these to general practice and then wider to provide support and assistance. perceptions arise. The perceptions into allied health. The activities Throughout this period, the needs are not the realities of our staff, nor expanded into support to aged care of the Bushfire response were not the service providers with which we and flu activities were enhanced for forgotten, and our team continued to work. As an organisation we can be same. Staff were engaged in the State support the impacted communities. immensely proud of our workforce. Health Command Centre and were All of the necessary, planned and Our people responded to demand. leaders in initial community response scheduled activities were met and They shifted off site albeit that this activities. We engaged with SA Health delivered. was a challenge. Not all people in planning and command activities have dedicated studies or offices at Our staff, in common with the great including practical field response. home. Many live within limited space. bulk of the Australian workforce Regular community communications Many had to share family space with moved their work off site in March were progressed daily then as time children being home schooled by and work has progressed, consistent progressed weekly according to that worker, or shared space with with Commonwealth and State changing needs. We worked hand a partner also working from home. direction and advice. We were in hand with the Adelaide PHN Some had partners who lost their well positioned to shift off site in as the only State jurisdiction in jobs creating pressure within the terms of the safety and flexibility of Australia directly engaged in the State home environment. Yet we increased our systems and the capacity and Command and Control activities and our work product. We expanded capabilities of our information and both organisations supported each our capacity, and some officers of technology and finance teams. At other and presented to the state a the organisation managed their the end of the period our workforce seamless and consistent support normal role while adding new and remained off site, consistent with to SA Health and our communities, competing activities. Our productivity advice and direction and at time of adapted to varying demands and expanded. Some of our staff were this report we continue to work within needs. required to or volunteered to support that advice, with reduced numbers the distribution of the hundreds of While that team focussed on the of staff on site and expanded use of thousands of PPE to communities. emergency, the Maintenance Team telecommunications for engagement led by the Chief Operating Officer, and networking. Country SA PHN Annual Report 19/20 5

They unpacked bulk supplies and logical public health policy, planning repackaged the content into smaller and preparedness will be overtaken packaging for further distribution. and overruled by ill-conceived and Some became couriers. One of ill-considered alternative policy. our workers was directly impacted Effective management must always by engagement in what post the consider the consequence of actions. engagement, became identified as a Our organisation should hope for its risk environment and required testing communities and for its own safety, and isolation. Notwithstanding this security and surety, that appropriate response by our people, not a single well considered and constructed request has been made for home policy is maintained, developed and expenses or time in lieu of extra progressed. time worked. I could not be prouder Our next year will continue our of a workforce that I have had the good work and we will rise to the privilege of sharing my time with, in challenges as they arise. Our staff my forty six years in health in SA. have proved to be the equal to any Sadly, and lacking a commonality challenge as have those we engage with other significant public health as our Commissioned service initiatives in modern times, the providers and our partners. current crisis has become partisan I take this opportunity to express my and political and inflamed divisions. appreciation to all those engaged Confusion exists as community within and associated with our leaders and opinion makers debate enterprise throughout the past year. eradication verses containment and this creates difficulty for organisations for ongoing planning. We were fortunate that direct Governmental and expert leadership and inciteful decision making prevented Kim Hosking an emergency such as being Chief Executive Officer experienced elsewhere in the world. In the minds of many, the disease does not present the impact that they have been cautioned about and thus presents no significant danger. What’s the fuss? They have not experienced the real personal, system wide and community impact of the potential of this virus. There is danger now that what should be clear and 6 Country SA PHN Annual Report 19/20

Chair of Finance Report

Another year gone, another Financial As regards to our Auditors; last year Report to be circulated, but this year the AGM deferred the appointment has been a year of exceptions and of auditors to the Board of the PHN. activity like no other, and I will expand We the Board made no change, on that a little later. given new accounting standard requirements it was thought best that First though, our business this year, our current auditors were best placed as in previous years, showed growth to assist us through the process commensurate with funding received and need. While there is no issue in line with the additional health or concern with the current audit needs of country South Australia. company, it is important to ongoing Our funding increased a little over 6% evaluate the cost to the PHN to when compared to the previous year, ensure value in our audit. to $54.1 million an actual increase of “Our organisation, $3.2 million. The growth in income My role is as Chair of our Finance, like others deeply saw a growth in consulting and Audit and Risk Committee and it contractor expenditure in excess of is in the area of risk that we faced engaged in health, the actual funding increase when and effectively managed significant face the challenge combined with well managed challenges in the latter part of this controls and savings on operational financial year. The challenge has been of meeting the expenses. A fine result for the to respond to government directions need to be good communities we serve. impacting on our workplaces, but also to manage that same impact exemplars of safe The audit report shows no areas upon our service providers. As of concerns or risks which, while practice, while effective Commissioner of services, expected, is nevertheless pleasing there was a need to support service seeking to function in that all areas of operation are providers as their move to work compliant with business and effectively and off site impacted their service regulatory requirements. efficiently.” delivery approaches and resultant Meeting with principal audit partner spending. We were also in receipt Matt King, at the conclusion of the of emergency funds for bushfires audit, and discussions from that and COVID-19 activities, with meeting have not identified any demands for immediate activities to major concerns. Although some be undertaken by our organisation, modifications to our contracting the commissioning in short time of process have been suggested, these new services and facilitating support were all previously discussed by the to organisations funded by the Board and are under evaluation. Commonwealth for other activities. Country SA PHN Annual Report 19/20 7

As an organisation expected to be exemplars of safe practice, while an exemplar of good practice in seeking to function effectively and responding to the COVID-19 crisis, efficiently. Our organisation straddles we accomplished all of this with staff these needs and I look forward to that working away from offices, making point where we can be both a good use of the resources organised exemplar of safe COVID-19 practice, over time, to ensure we could in but also be out in the field again and an emergency do just that. The back in offices reaping the benefit of advent of most personnel no longer the personal interactions that support present in the offices, while it has not a vibrant and effective organisation impacted productivity as reported by such as ours. It’s a difficult time and our Executive Team, has meant the our PHN is just one of thousands in loss of the social and organisational this position. benefit of face to face meetings, Our business is sound, well managed relationships, and involvements. and run relative to needs and The face to face engagement adds reporting expectations as shown by value to the organisational thinking the Auditors Report. I commend the and relationships. This potentially report to you. creates issues from a governance and oversight perspective and from an employee and organisational view point. As we sit at the end of the Finance year we are now seeing from both ends of the business spectrum, that John Curnow organisations who’s enterprise is Chair of Finance reliant on face to face involvement with the community and consumers are actively returning to ‘normal’ work environments. Those who’s enterprise can be accomplished from behind the front offices continue to work from home and there is then a disparity between the two sectors. Our organisation, like others deeply engaged in health, face the challenge of meeting the need to be good 8 Country SA PHN Annual Report 19/20

Regional Health Priorities Statistics

Through the Needs Assessment Country SA PHN identifies health and service needs within Country SA regions and prioritise activities to address those needs through the commissioning of services. An overview of the principal data sources used is documented in the Needs Assessment Data Report - November 2018 which includes a holistic look at demographic, health, and health service patterns to identify locations and populations with particular health and service needs as well as country SA-wide priorities. Country SA PHN Annual Report 19/20 9

NORTH & WEST

YORKE & NORTH & WEST NORTH

NORTH & WEST CENTRAL SOUTH & CENTRAL Far West Barossa EAST CENTRAL Lower Eyre Adelaide Hills

Upper Eyre Fleurieu

Flinders & Port Augusta Kangaroo Island

Roxby Downs

YORKE & NORTH SOUTH & EAST

Mid North Riverland Regional Strategies Areas

Lower North Murray Mallee Adelaide PHN

Yorke Peninsula South East Outback 10 Country SA PHN Annual Report 19/20

Chronic Disease Cancer • Highest rates of Arthritis were • Prevalence of cancer is highest in in Gawler – Two Wells (31.1%), the Fleurieu Peninsula & Kangaroo followed by Outback - North and Island region followed by Murray East (26%), Yorke Peninsula (25.9%) & Mallee, Yorke Peninsula, and the and the Mid North (25%); all other Barossa regions; all other areas areas are close to SA rate or were equal to or below State and below (21.1%). CSAPHN rates. • Highest rates of Osteoporosis • Bowel Cancer screening rates were Population were in Gawler - Two Wells (11.9%) at 40.1% in the Outback - North followed by Yorke Peninsula (6.2%) & East. Only Yorke Peninsula and Health and the Mid North (5.6%); all other Fleurieu Peninsula & Kangaroo areas were below the State rate Island were above 50% participation (5.1%). across the CSAPHN region. • High rates of cardiovascular disease • Breast Cancer screening rates were were found in the Yorke Peninsula under 50% participation in Outback (11.3%) while the Adelaide Hills had - North & East region followed by the lowest with 2.7%. Lower North, Mid North, Fleurieu • While high rates of diabetes are Peninsula & Kangaroo Island, recorded across the CSAPHN Murray & Mallee, and Adelaide Hills region, the Barossa (5.2%), Adelaide regions which were all under 60%. Hills (6.2%) and Lower North (6.8%) • Cervical Cancer screening rates are well below CSAPHN overall were below 50% in Outback - rate (10.8%). North & East, followed by the Mid • The SA3 level area which had the North, Murray & Mallee, Yorke highest rate of Asthma above the Peninsula, Limestone Coast, state level (14.5%) was Mid North Fleurieu Peninsula & Kangaroo (23.4%), the Lower North had the Island, Eyre Peninsula and Gawler - lowest rate (11.3%), whereas other Two Wells regions which were rates areas are below CSAPHN (15.3%) under 60%. and SA (14.5%) rates. • SA3 level areas which had the highest rates of COPD included Outback - North & East (11.2%) which were over double the SA rate (4.9%), followed by Fleurieu Peninsula & Kangaroo Island (7.2%); all other areas were equal to or less than the SA rate (4.9%). • Rates of high blood pressure, high cholesterol, insufficient physical activity, and unhealthy weight are highest in the Yorke Peninsula and above SA averages for almost every region. Country SA PHN Annual Report 19/20 11

Immunisation • Barossa (97.2%), Gawler -Two Wells (96.2%), Murray & Mallee (95.7%) and Limestone Coast (95.8%) all achieved the national target of 95% for 1 year of age Immunisation. • No SA3 area achieved 95% coverage for 2 years of age immunisation, however all but two SA3s achieved 95% coverage for 5 years of age which were Adelaide Hills (92.8%) and Fleurieu Peninsula & Kangaroo Island (94.6%). • HPV vaccination for both girls (62.2%) and boys (65.7%) were lowest in the South Australian Outback (SA4) region.

After Hours • The highest number of after-hours sites are located within the Eyre Peninsula, however this region has a very large area and a high number of sites located within the regional cities of Whyalla (8) and Port Lincoln (4), meaning after hours service is sparsely distributed throughout the remainder of the region. • In the majority of hospitals in the CSAPHN region, emergency departments double as after-hours, serviced by on-call GPs from the local area. 12 Country SA PHN Annual Report 19/20

• 46% of general practices and 22% of allied health providers are employing secure messaging software to send information. • Allied health providers (61%) are less likely than general practice (99%) to use electronic patient records.

Digital Health

• The operational ratio for residential • There are no Residential Aged Care aged care places is highest in the Facilities places in the areas of Robe Flinders & Far North with 118.2 or Mallala and very low rate of RACF operational places per 1,000 dementia specific places in the persons aged over 70 years. Outback, Adelaide Hills and Gawler • Concentration of ageing population regions. in outer regional locations where • High number of ageing Culturally age-specific services are more and Linguistically Diverse (CALD) limited are in the Fleurieu Peninsula, populations located in the Yorke Peninsula and Mid North Riverland. Aged Care regions. • There is a projected increase in aged population throughout the region, particularly in the Riverland, Mallee, and South East.

• All of the CSAPHN region except • Rates per 1,000 population for Port Augusta, Whyalla, Gawler, GPs (3.5%), pharmacists (3.1%) and Mount Barker and Victor Harbor dentists (0.4%) are below state are considered GP distribution averages in nearly all CSAPHN priority areas. regions. • Rates per 1,000 population for • All of the CSAPHN region is podiatrists (0.7), psychologists considered a district of workforce (1.3%), registered nurses shortage for medical specialists. (63.5%), optometrists (0.4%) and physiotherapists (2.9%) are below Health state averages in all CSAPHN regions, despite higher rates of Workforce chronic disease and mental illness. Country SA PHN Annual Report 19/20 13

Chronic Disease Immunisations • Acute Rheumatic Fever and • Vaccination occurs at a higher Rheumatic Heart Disease register rate for Aboriginal and Torres Strait has a large proportion of the Islander children at age 5 years country SA cases in the far North (96.4%) then they do for other age West of the state from Coober groups 12 months (91.3%) and 2 year Pedy to Anangu Pitjantjatjara olds (87.1%). Yankunytjatjara (APY) Lands. • Vaccinations for HPV are also • Diabetes prevalence rate of 24.4% in occurring at a lower rate for Aboriginal country South Australia, increased Aboriginal and Torres Strait Islander to 40.2% for remote South Australia people in South Australia (girls 72.5% Health for all types of diabetes. Gestational and boys 69.1%). diabetes was highest in the remote Far West at 10.7% of all pregnancies. Early detection and treatment • Average annual age-standardised • In the 2016-17 financial year rate for hospitalised chronic in the CSAPHN region 5,884 diabetes complications is highest (35%) Aboriginal and Torres Strait in Eyre (Indigenous Area IARE) with Islander people had a 715 Health 25.2 per 1,000 followed by Port Assessment. The standout region Augusta (18.1) and Ceduna (13.4). in CSAPHN is Outback - North & East where 66.3% of the Aboriginal • The incidence of end stage kidney and Torres Strait Islander population disease in Aboriginal and Torres accessed a health assessment. Strait Islander people is occurring at a rate of 57.8 per 100,000 versus 8.5 Aboriginal Workforce per 100,000 in the non-Aboriginal population in South Australia. • Low numbers of Aboriginal and Torres Strait Islander health • Cancer is the second highest rate professionals in the CSAPHN for leading causes of mortality at region, General practitioners (0.7 232.1 per 100,000 compared to a per 100,000), Nurses and midwives rate of 171.6 per 100,000 for the (1.54 per 100,000) and Allied health non-Aboriginal population in professionals (1.7 per 100,000) in South Australia. CSAPHN is Outback - North & East • Breast, Cervical, Prostate and Bowel where 66.3% of the Aboriginal and cancer screening for Aboriginal Torres Strait Islander population and Torres Strait Islander people in accessed a health assessment. South Australia is low in comparison to the non-Aboriginal population. • Aboriginal and Torres Strait Islander populations have higher rates of blood borne virus and sexually transmissible infections, including HIV, Hepatitis C, Hepatitis B, gonorrhoea, chlamydia, and syphilis. 14 Country SA PHN Annual Report 19/20

• Psychological Distress • Access to mental health services Measurements revealed 13% by allied health professionals was of country South Australian’s lowest in both Eyre Peninsula & experienced high or very high levels South West and Outback - North & of distress, compared to the state East, equally providing at least one average of 11.9%. Furthermore, this session for 0.6% of the population. level increased for Aboriginal and Highest access for the CSAPHN Torres Strait Islander people with region was in the Limestone Coast, distress levels equating to 31.8%. Gawler -Two Wells, and Fleurieu • 1 in 7 young people aged 4-17 Peninsula & Kangaroo Island. Mental Health years were assessed as having had • The preparation of GP mental a mental health disorder(s) in the health care plans per 1,000 Alcohol & previous 12 months. population was highest in Gawler Other Drugs • The proportion of population – Two Wells, Adelaide Hills, and aged 12-24 years who accessed Fleurieu Peninsula & Kangaroo at least one service from a clinical Island with the lowest in Lower psychologist was highest in the Mid North, Eyre Peninsula & South West, North (2.9%), followed by the Lower and Mid North regions. North (1.9%) and Gawler - Two • Highest rates mental health Wells (1.8%). conditions were Lower North • For the 0-11 years cohort, the (26.4%), Mid North (22.2%), Barossa proportion of population accessing (20.6%), Gawler - Two Wells at least one service was highest in (20.4%), all of which were above the the Mid North (0.6%), followed by state average. the Yorke Peninsula (0.3%) and Eyre • Psychological distress was highest Peninsula & South West (0.3%). in the Mid North (19.7%) followed by • The number of young people Gawler - Two Wells (17.4%), Barossa serviced by a headspace centre (17%) and Adelaide Hills (13.3%). was highest in Murray Bridge (638), • The highest self-reported mental followed by Mount Gambier (506). health service utilisation was in • Access to mental health services the Fleurieu Peninsula & Kangaroo varied across the CSAPHN region, Island (8.0%) followed by Lower the lowest for each profession was North (7.6%), Limestone Coast consistently found in the Outback - (6.5%), and Murray & Mallee (5.6%) North & East (0.6%), Eyre Peninsula regions. & South West (1.0%). The highest access for the CSAPHN region was in the Mid North. • Access to clinical psychology was lowest in the Eyre Peninsula & South West where 0.4% of the population had at least one session, this was followed by Outback - North & East with 0.6%. Highest access was in the Adelaide Hills, Gawler – Two Wells, and Barossa. Country SA PHN Annual Report 19/20 15

Suicide Prevention Alcohol & Other Drugs • The highest rate of suicide was in • Country SA PHN SA4 area that had Eyre Peninsula & South West, Yorke the highest prevalence of monthly Peninsula, and Murray & Mallee risky drinking with Adelaide Hills regions, while the highest attempt (43%), Barossa (40%) and Outback - rates were found in the Limestone North & East (35%). Coast, Murray & Mallee, and Eyre • High prevalence of recent cannabis Peninsula & South West regions. use was in Gawler-Two Wells and • CSAPHN region had 1,041 Barossa (18%). hospitalisations for intentional self- • The level of prescribed opioids harm. The highest rates were in the dispensed in SA3 areas across Yorke Peninsula SA3 (3.6 per 1,000), Country SA PHN ranged from Limestone Coast (3.1 per 1,000), 53,757 (Adelaide Hills) to 94,892 and Fleurieu Peninsula & Kangaroo (Barossa). Island (2.9 per 1,000) regions. • Prevalence of lifetime illicit drug • Males in the country SA region use for school aged children (12-17) accounted for 79% of all deaths ranged from 8% in the South East to by suicide, a ratio of more than 18% in the Outback - North & East, 3:1. However females accounted while state prevalence was 14%. for the highest rates of suicide • Prevalence of recent attempts. methamphetamine use was highest • Aboriginal and Torres Strait Islander in South Outback South Australia South Australians suicide (25.5 per (4%) whilst state-wide prevalence 100,000) at a rate of more than was 2%. twice that of non-Aboriginal and • Treatment for alcohol as a principal Torres Strait Islander people in drug of concern was most South Australia (12.5 per 100,000) common in very remote areas respectively. Suicide was the (64% of all treatment episodes) second leading cause of death compared with 30% of treatment among Aboriginal and Torres Strait episodes in major cities (30%). Islander men at a rate of 39.2 per 100,000. • Aboriginal and Torres Strait Islander people, of whom 70% live in rural Australia, were 1.7 times more likely to have recently used illicit drugs compared to the non-Aboriginal population. • Mental and substance use disorders accounted for 19% of the total burden of disease for Aboriginal and Torres Strait Islander persons.

16 Country SA PHN Annual Report 19/20 Country SA PHN Annual Report 19/20 17

Our Priority Areas

The Federal Government has identified key priority areas for PHNs. The best way to demonstrate how we are bridging the gap in health access within these priority areas is to share program highlights that have been achieved across Country South Australia during 2019-2020.

Population Digital Aged Health Health Care

Health Aboriginal Mental Health, Workforce Health Alcohol & Other Drugs 18 Country SA PHN Annual Report 19/20

Population Health

Gender Connect Country SA

SHINE SA became increasingly aware implementation. The service’s dual “The service provides learning of an overwhelming need for a safe aim is to support the personal and opportunities for GPs and other and gender diverse friendly support professional development of a TGD health professionals within Country service for anyone living in rural and workforce. SA to increase their capacity to remote South Australia. Country SA safely support trans, gender diverse GCCSA also offers clients a wellbeing PHN recognised the importance of and gender questioning people to check whereby a peer support worker funding such a project and through improve their health and wellbeing,” will call to check in and see how a this collaboration in March 2020 said Kirsty Degabriele, GCCSA Team TGD person who has been using Gender Connect Country SA (GCCSA) Leader. the service is doing and offer further was launched. information and follow up calls as GCCSA provides two education The program is a free confidential required. sessions per year to upskill GPs and telephone peer support service for other allied health professionals Also available through the service is country South Australians of all ages with knowledge to assist in a more information about gender affirming who identify as trans, gender diverse positive experience for clients transition options and opportunities or gender questioning as well as their seeking assistance and establishing to connect with social and personal or professional supports - referral pathways for continuity community groups. The team has a after-hours four evenings a week. of care. GCCSA offers Workforce strong relationship which it continues Training Updates for organisations “It can be challenging for trans, to build with headspace’s Queer and professional groups working gender diverse and gender Youth Groups and is always eager within Country SA with the aim of questioning people to find safe and to support the development of new increasing knowledge around TGD supportive services. Access to safe community groups within country issues and confidence in working with supports can be more difficult to find South Australia. GCCSA is also able TGD communities. Four workforce for people living within Country SA. to provide referrals to emergency updates have been provided for 37 The GCCSA service provides a safe services and any other external professionals working in Country support option,” said Kirsty Degabriele, services where appropriate. SA including professionals from GCCSA Team Leader. Another unique element of the headspace centres in Whyalla, Victor One of the key factors crucial to the service is that it recognises the Harbor, Murray Bridge and from service’s success is that it is staffed importance of extending this Skylight. These updates have been by an entirely trans/gender diverse support and information beyond well received with a 100% satisfactory (TGD) team. Their lived experience the TGD person to their personal rating for overall experience from of gender diversity provides a vital and professional supports. This may the participants. point of connection for those seeking include partners, family members, information, support, advice and teachers, general practitioners understanding. TGD voices and (GPs), nurses as well as other health perspectives have also been front professionals and youth workers. and centre in GCCSA’s design and Country SA PHN Annual Report 19/20 19

A sample of participant feedback

“Engaging and passionate presenters!” SHINE SA has also received much positive feedback from both “Presenter delivered a lot of info in community members and other just an hour and it was great to be professionals who have utilised the able to ask questions and clarify info service. In addition, the TGD team in a non-judgmental way.” employed within the service has “Presenters were very kind, they were reflected increases in their skills, welcoming in receiving potentially knowledge, experience, confidence uncomfortable questions, made us all and sense of belonging and feel at ease and reassured us we were purpose within their community. doing well.” “The session had great information and was presented really well. It was informative and easy to understand Ollie, member of and promoted a space to further the GCCSA Team conversation.”

Overall, the GCCSA team has built a strong foundation to continue their work in supporting TGD people and their personal and professional supports living in Country South Australia. 20 Country SA PHN Annual Report 19/20

Digital Health

Telehealth, secure messaging and e-prescribing

Over the last year Country SA PHN Security approved platform with It is delivered by a set of technologies (CSAPHN) has worked hard to around 65 practices taking up the that enables the encryption (by consolidate our positive relationship offer in April and May. We also sender) and decryption (by receiver) with SA Health and to deliver deployed Healthdirect to Aboriginal of secure point-to-point messages telehealth to our country South Health services, some Mental Health that are stored on a secured network Australian rural and remote regions. service providers and domestic server and delivered to a single violence support services - linking a known intended receiving entity. Prior to the changes due to total of 80 central sites, with another COVID-19 restrictions, CSAPHN The service offers a technical solution 25 associated care sites. supported the access of public that supports SA Health’s broader health specialists and the Rural The challenges presented by digital health strategic priorities. It Mental Health Services team into COVID-19 also provided many replaces communication methods our country sites - with 140 general opportunities for rural and remote that have a risk of interference practices able to connect directly to communities to realise and including ShareFile, faxes and the SA Health systems. Our support experience the benefits of telehealth traditional posted mail – improving included direct training and activation services. A great example of this was the exchange of discharge and working with sites to maximise the use of Healthdirect at Nganampa summaries, referrals, pathology and room use and equipment access. Health in Alice Springs which services imaging reports. It allows practices Two key success stories include the the APY lands. It demonstrated the to receive messages and documents headspace service into schools in enormous value of provider to patient directly into their existing clinical the South East (a collaboration with direct service capacity with access software, improving efficiencies the Department of Education and to general practice, allied health and by removing the need for manual headspace Mount Gambier) and the integrated team care to their remote processes. The system will use the After Hours program for Residential regions. National Interoperability Framework, Aged Care Facilities in the Adelaide which means that most Secure This year has also been a busy and Hills to connect to the Mount Barker Messaging products will be able to exciting time for CSAPHN’s Digital Hospital. receive from and send to SA Health. Health team, more broadly, with the The changes required due to introduction of a range of significant This is particularly exciting for country COVID-19 provided both challenges digital health initiatives. CSAPHN has South Australian health professionals and opportunity for telehealth’s been working collaboratively with as it is the first time we are all sustainable use. Challenges already SA Health and the Australian Digital simultaneously working on a whole experienced and understood about Health Agency to introduce Secure of state solution. the use of insecure platforms, Messaging as a digital cornerstone to CSAPHN has been assisting SA Health hardware configuration and internet support implementation and better to implement Secure Messaging consistency surfaced in general clinical information flow of electronic across country South Australia. We practices’ response to the opportunity referrals and updates on the referral have ensured approximately 125 provided. triage status. general practices IT systems were To support general practices, as Secure Messaging is a key eHealth prepared to support this digital an existing PHN partner with the foundation, defining the protocols healthcare tool and supported more Healthdirect VideoCall service we for safe and efficient transmission of than 85 sites to have their pre- offered this free, secure and Cyber sensitive healthcare information. requisites in place, with remaining Country SA PHN Annual Report 19/20 21

The challenges presented by COVID-19 also provided many opportunities for rural and remote communities to realise and experience the benefits of telehealth services.

practices to be supported in the security of transmitted patient Digital Health strategic initiatives will new year. We have also conducted information it must comply with the continue to provide opportunities practice surveys to assess their national regulatory and technical for all Australians and for all primary readiness to adopt Secure Messaging frameworks developed by the health workers. As well as providing and to provide the appropriate level Commonwealth Department of many challenges, COVID-19 of support for this service to be fully Health and the Australian Digital restrictions have shown the way implemented across all country South Health Agency. e-Prescriptions telehealth and other digital health Australian Health sites and services. are helpful in overcoming lost services can be of particular benefit to prescriptions, minimising transcription those living and working in rural and This foundation work has also errors and saving printing costs remote communities. prepared country South Australian and time. Those patients without general practices and pharmacies the technological capacity for for the introduction of electronic e-prescriptions can either have the prescriptions (e-Prescriptions). On token sent to a carer or continue to June 18, 2019 the South Australian receive a printed paper prescription. parliament passed the required amendments to legislation to allow CSAPHN has also been working e-prescriptions as tender for writing with The Pharmaceutical Society and dispensing a script - bringing of Australia to ensure that we South Australia into line with other have consistent messaging and states. support and that country South Australian pharmacies are prepared An e-Prescription is electronically for e-prescriptions. This work has generated by prescribers and sent included remote support sessions, to the patient, as a token, by SMS follow up steps, resources and or email. To ensure the safety and training materials. 22 Country SA PHN Annual Report 19/20

Aged Care

Pharmacists in residential aged care facilities

The 2019 Aged Care Royal “It focuses on ensuring quality use medicines. We commend Country SA Commission highlighted the extent of medicines and achieves better PHN for initiating this program and of neglect of older Australians in outcomes for aged care residents working to incorporate pharmacists Residential Aged Care Facilities by reducing the use of high-risk more comprehensively into the (RACFs). In its Interim Report Federal medications, providing education and primary health care team.” and State health ministers made training to facility staff in the quality The positive impact of having medicine safety a national priority. use of medicines and supporting pharmacists on site at RACFs is them to provide more effective This was a welcome focus for the revealing the value a pharmacist’s medication delivery. Pharmaceutical Society of Australia medicines expertise brings to a (PSA) who shone a spotlight on the “The pharmacists also undertake facility. This is demonstrated in the prevalence of medication related medication reviews for residents identification and rectification of problems in RACFs in their January and support better transition into common medicine-use issues and as 2019 report Medicine Safety: Take residential aged care for residents the rates of errors reduces over time Care. It showed 98% of aged entering care from the community this role will be primarily preventative care residents had at least one and/or hospital and for those in nature. medication-related problem and returning to residential care from This has been the case at the more than half were exposed to at hospital,” said PSA State and Territory Strathalbyn and District Aged Care least one potentially inappropriate Manager SA and NT, Helen Stone. Facility where pharmacist Stacey medicine. Drug Use Evaluations and transitions Putland has been working one day The PSA stated that it strongly of care, including medication a week since the program began, believes “pharmacists must have a reconciliations, are contributing to providing a range of services greater role in the residential aged the prevention of medication errors including medication reviews, advice care sector to utilise their unique by providing an opportunity to to care staff, and liaising between the medicine expertise to ensure the safe review therapy and identify missing facility and community pharmacy. and optimal use of medicines for or unnecessary medicines prior to “Generally, pharmacists are able to older Australians.” developing an adverse outcome. provide a Residential Medication Funded by Country SA PHN and “On average, aged care residents have Management Review to an aged care delivered in partnership with the PSA, 76 prescriptions dispensed a year. resident every two years,” said Stacey. the Pharmacists in Residential Aged The number of medications a person “This is a comprehensive assessment Care Facilities Program integrates needs to treat their health can impact to identify, resolve and prevent pharmacists into the RACF care team medication adherence and increase medication-related problems. to reduce medication related harm the chance of medication errors,” When you consider the number of and significantly improve medication Helen said. medications aged care residents take safety and health outcomes and “(The) PSA believes supporting and how frequently their medication ultimately the quality of life for aged pharmacists to spend more time may change, two years can be a long care residents in country South in aged care is key to improving time between reviews.” Australia. medicine safety and quality use of Country SA PHN Annual Report 19/20 23

Stacey Putland, Pharmacist

“A resident was constantly pulling their Buprenorphine patch off, upon review I suggested changing to another brand, this has resolved the issue, there were many interventions trialled to this prior to a simple brand change.”

By being present at the RACF, Stacey Stacey’s time at the facility also Participant feedback can now undertake on the spot enables staff to utilise her medication medication reviews and follow up expertise. “One resident had been receiving a based on resident need. 2.5mg dose of warfarin when they “We recently had a resident start should have been receiving a The interim report of the Aged Care a new injectable medicine for 3mg dose.” Royal Commission also highlighted treatment of a chronic condition that concerns around the use of staff were unfamiliar with. I was able “First few weeks at the home, on psychotropic medications in aged to provide advice around its use and reviewing the resident’s current care. Stacey believes this is another because I spend regular time at the warfarin and INR monitoring, 2 health care challenge the program facility, I could catch-up with different residents had not had INRs monitored can help to address. staff on different shifts.” for 3 and 4 months. Once tested, both came back with significantly out “Our care team has already been able “The work I have been able to of range INRs (one was 8.4 which is to cooperatively assess a number of undertake through this program is nearly 3 times higher than ideal range) residents taking high-risk medicines incredibly rewarding,” Stacey said. these interventions could have been and either reduce or cease their “There’s been great support in this life saving for the residents as INRs in dose,” Stacey said. community, from the local pharmacy, this range can be acutely dangerous.“ “My experience suggests that general practitioners, facility staff, pharmacists can play a valuable role residents and their families, even in determining when and how the before the project, for a collaborative step down should occur, to ensure approach to care. the best outcomes for residents.” With this project funding we can By being on site, I can spend more increase the impact of the pharmacist time getting to know residents and on medication safety and resident their families, gaining a more in-depth health and well-being.” understanding of their individual The Pharmacists in Residential Aged circumstances and can tailor my Care project is currently scheduled to advice accordingly.” run until June 2021. 24 Country SA PHN Annual Report 19/20

Health Workforce

Pharmacists in general practice

The Pharmaceutical Society patient consultations, medication “I view my job as being a medication of Australia (PSA) and Country reconciliation and reviews, translator. By reconciling hospital SA PHN have collaborated on preventative health education, discharge summaries with general another innovative and highly prescribing audits, MBS billing practice health records and successful program – integrating contribution, preventative healthcare, conducting patient consultations, I pharmacists into general practices medicine information and staff reduce the possibility of medication in country South Australia. The education. problems such as treatment aim of the Pharmacists in General courses not being completed or a “Importantly, pharmacists also Practice program is to minimise person failing to restart taking a vital demonstrated flexibility within their the preventable harm caused by medication which they were taken off scope of practice in order to deliver medication-related problems and during their hospital stay.” value to general practices in ways enhance patient outcomes. that were not anticipated in the initial “Available medications and the PSA South Australia/Northern Territory project scoping and which we are guidelines for their use change Branch Manager, Helen Stone said continuing to explore as the program frequently. Pharmacists need to stay that every day in South Australia progresses,” said Helen. up to date with these changes and around 48 people or about 17,500 in this role I can ensure the clinic’s The Pharmacists in General Practice people a year are admitted to hospital general practitioners and registrars program has been operating in due to medication mistakes, at a cost can easily and quickly access this country South Australia since mid- of around $98 million annually. information, giving them more 2019 across eight locations in time to spend in patient care and Nationally, the PSA’s research Angaston, Kapunda, Jamestown, improving safe and quality use of found 250,000 Australians are Mount Gambier, Whyalla and Port medicines. hospitalised each year, with another Lincoln. At the Boston Bay Family 400,000 presenting to emergency Health Clinic experienced local The program has been equally departments, due to medication pharmacist, Kylie van Rooijen has successful for Barossa pharmacist errors. It found at least half of these been providing a range of services Tanya Tran. Tanya works across two could have been prevented. including medication reviews, advice general practices in Kapunda and and education, and liaison between Angaston providing the same range “PSA believes supporting pharmacists the general practice, hospitals and of services for the community. to spend more time in all health care community pharmacy and believes settings is key to improving medicine “Patients have found it very valuable the potential benefits are significant. safety and quality use of medicines,” to be able to spend as much time as said Helen. “A key point in the health care journey they need with a pharmacist in the where medication problems can general practice setting discussing Integrating pharmacists into regional arise is the transition from hospital in their medications and any questions general practices is proving very Adelaide back to the community,” they might have,” said Tanya. successful. Pharmacists are taking said Kylie. part in a range of activities including Country SA PHN Annual Report 19/20 25

As a trained Diabetes Educator, Tanya has found her involvement in they are often working extended Tanya’s engagement in general the project highly rewarding. hours providing services to local practice has expanded the support hospitals and providing emergency “Working closely with the doctors in available to patients with this complex services. the practice and caring for patients condition. has increased my clinical knowledge “Working as a General Practice “We have recently conducted a and ability,” Tanya said. Pharmacist relieves some of these trial designed to help people with pressures by supporting our doctors, “I feel like I learn something every diabetes manage their glucose and saving them time and enabling them day I am at work and have found this participants told me it has positively to focus on other tasks and allowing immensely satisfying.” impacted their health and given them them to spend more time with their a new lease on life,” Tanya said. Pharmacist Natasha Downing is patients. having an equally positive experience “Part of my work is to liaise closely I believe it is one answer to assisting working as part of the primary health with community pharmacies in with such shortages, and a solution to care team at the Goyder’s Line the region and keep up to date on help assist with improving rural health Medical Centre - providing care to the medication availability (…) I can ensure care services,” said Natasha. communities of Jamestown, Orroroo general practitioners are not only and Peterborough. The Pharmacist in General Practice kept informed of supply issues but project is currently scheduled to run can access my expertise in terms of Natasha has found that the project until June 2021. alternative treatments. I also provide also plays a much broader role in rural advice on available new medications primary health care providing much and medication guidelines. In this needed support to rural GPs who are role, I can provide another set of eyes under immense pressure. In addition when it comes to medicine safety.” to consulting within general practice, 26 Country SA PHN Annual Report 19/20

“We are looking at a program that takes in language, takes in culture, takes in a person’s environment…it’s a holistic package that is suited to the individual and the families, not just one client or individual.” Nukunu health worker Kym Thomas

“Aboriginal people feel good to see other Aboriginal people. We have the connection in the community, we know the people they are happy to come see us. “We’ve got about 27 different language groups here in Port Augusta, a lot of different cultures and differences. For us as Aboriginal people, we understand the different ways of the different groups of people,” Pika Wiya Mental Healthcare Worker Rick Dadleh Country SA PHN Annual Report 19/20 27

Aboriginal Health

Reducing suicide rates in Port Augusta: Aboriginal aftercare program proving an effective approach

Australia’s first Aboriginal specific What followed was the establishment From December 2018 to June aftercare model is having an impact of an Aboriginal working group 2019, around 120 people were in Port Augusta as it brings the in collaboration with the local supported with 13 to 20 referrals a community, clinical and cultural community, including people with month to the end of 2019. Three- workers together to reduce the rate lived experience, and representatives quarters of referrals were from the of suicide. from the Local Health Network and emergency department while the Aboriginal Community Controlled remainder came directly from the This project was initiated by Country Health Organisation (ACCHO). ACCHO – which demonstrates that SA PHN (CSAPHN) in 2017 under the the Aftercare Service is appropriately National Suicide Prevention Trial. Port “This group spent eight months supporting the most acute needs. Augusta had experienced a relatively documenting the co-design process high Aboriginal suicide rate and its and developing a model, followed In addition to providing appropriate population of 14,000 people which by four months of stakeholder support for people during a critical included 19.1% of Aboriginal people consultation,” Reg said. time in their care, one unanticipated from 27 language groups provided positive outcome from the project “Country SA PHN then commissioned the ‘critical mass’ needed to evaluate has been greater collaboration the Pika Wiya Health Service a new approach. between clinical and cultural workers Aboriginal Corporation to deliver the across the spectrum of mental health CSAPHN worked with the Black Dog Aboriginal Aftercare Service in what is services. Institute on a series of forums as part the country’s first Aboriginal specific of community consultation. Through aftercare model.” “To be able to achieve a positive this process, it was identified that impact for the wider community, The project has produced two sets of there was a gap in local services to alongside supporting individuals guidelines – for use in the emergency support Aboriginal people leaving when they need it most, has been a department at Port Augusta Hospital hospital after a suicide crisis. great outcome from this project,” and for the community mental health Reg said. “Research tells us that a previous team. Each offers a comprehensive suicide attempt is one of the staged approach to maintaining “We know the suicide rate fluctuates strongest predictors of a further contact through admission and after but the good news is that we are attempt,” CSAPHN Director Mental discharge with a mix of psychosocial, seeing a decline in Port Augusta since Health & AOD Reg Harris said. clinical and healing approaches the project started.” with a strong focus on family and “As a result, we knew there was community. immense value in delivering this service, but we also wanted to do it in the most effective way possible.” 28 Country SA PHN Annual Report 19/20

Aboriginal Health

715 Preventative Health Assessment: starting a journey to better health

More than 4,700 Aboriginal through early detection of chronic They have also supported efforts to and Torres Strait Islander peoples disease and further access to services encourage more people to access across country South Australia are or information they otherwise might the Health Check by handing out hopefully on a journey to better not receive. free shirts or caps to those who have health after completing the 715 completed their Health Check. “For example, if a person was Preventative Health Assessment (also identified as being pre-diabetic “The shirts and caps provide a great known as a Health Check) in 2019/20. through their Health Check, what visual stimulation for this program by The Health Check provides Aboriginal would then likely be initiated is creating a talking point – and that’s and Torres Strait Islander people with access to diabetes education or a exactly what we want,” Anthea said. the opportunity to have their health dietitian to assist them with looking at “The more people that talk about comprehensively assessed to identify individualised healthy living practices the Health Check, the more that risk factors for chronic disease. to avoid or to delay the onset of can hopefully be shared about how diabetes. The intent of this free, annual it’s patient-centred, that people can checkup is to set the patient on “In short, it’s the first step in linking take a support person with them if a pathway to better health by people with other health services and, they choose to and, importantly, providing access to preventative hopefully, a starting point for what that a good Health Check is about and early intervention management becomes a long-term health journey.” empowering people. strategies. Four Indigenous Health Project “It’s an important preventative “We are working towards a target of Officers from Moorundi Aboriginal measure that can make all the two in three people accessing the 715 Community Controlled Health Care difference for a person’s health – now Health Check by 2023 as part of the Service Inc, Port Lincoln Aboriginal and well into their future.” National Aboriginal and Torres Strait Health Service Inc, Country & Islander Health Plan,” Anthea Kemp, Outback Health and Sonder have Assistant Manager, Aboriginal Health been leading work in various ways to Policy, said. increase access to the Health Check – assisting general practices with “This Health Check can play such a support and advice, information for vital part in people’s long-term health follow-up care and much more. Country SA PHN Annual Report 19/20 29

Wayne Oldfield, wearing his 715 Health Check Shirt 30 Country SA PHN Annual Report 19/20

Mental Health

Supporting SA’s bushfire-affected communities

December 2019 and early January specialised services has remained connection and healing, specifically 2020 will be forever etched into our priority as we endeavour to give for women. Both programs were the memories of South Australians people the best chance of full mental fully subscribed with positive following devastating bushfires which health recovery from what were feedback from participants who were ravaged many parts of the state. highly traumatic bushfire events. appreciative of the opportunity to attend. In fact, the 2019-20 bushfire season “Our approach has been grounded was one of the worst South Australia in a long-term approach to support. Frontline distress and has endured with almost 300,000 We know there is so much to do of trauma counselling hectares of land burnt. Lives and a physical and practical nature in the CSAPHN commissioned local service homes were lost, wildlife and immediate aftermath of a bushfire but providers to provide counselling livestock were destroyed, and the often what’s required for emotional and other mental health services already immense recovery process wellbeing comes further down the to support the needs of people was subsequently impacted by track – when there is time and space experiencing distress or trauma. COVID-19. for people to get to this part of their These services were offered free of recovery journey.” It quickly became apparent that any charge, with individuals, families and response effort needed to match the While support for bushfire-affected emergency personnel able to access scale and complexity of challenges communities is continuing – and will up to ten mental health services and being faced by communities as for some time – CSAPHN’s activity in continue to support communities they set about recovering. Country 2019-20 included: across the state. On Kangaroo Island, SA PHN (CSAPHN) created a new this initiative included commissioning Bushfire Response Coordinator role Community grants the Island’s only current male to oversee the organisation’s funding Bushfire Community Recovery Grants mental health clinician to support and program delivery. were available for community groups community members. to apply for funding of up to $10,000 “CSAPHN’s role as part of the to deliver grassroots initiatives that Free suicide prevention training Australian Government’s bushfire strengthened social connectedness CSAPHN offered free suicide recovery program was to provide and supported mental health. prevention training to residents of immediate and short-term as well The funding grants provide the the Keilira region, Kangaroo Island, as medium-term mental health opportunity for communities to come the Adelaide Hills and the Yorke support for individuals, families and together to foster resilience, healing Peninsula. LivingWorks Start is a communities, including emergency and capacity building. 60-minute online program that trains services personnel,” CSAPHN Bushfire participants to recognise the signs Response Coordinator Sally Patten Women Learning Together received when a person might be having said. funding to provide activities on thoughts of suicide and then take Kangaroo Island and the Adelaide “Ensuring communities have access potentially life-saving action by Hills to promote the importance of to coordinated, tailored support and connecting them to help and support. Country SA PHN Annual Report 19/20 31

On Kangaroo Island, this initiative included commissioning the Island’s only current male mental health clinician to support Creating connections community members. A primary role of the CSAPHN Bushfire Response Coordinator has been to connect the large number of service providers working within the mental health and wellbeing space, particularly in the Adelaide Hills. This has also ensured that the Keilira and Yorke Peninsula communities have not been forgotten with services such as the Be You Bushfire Response Program and CRANA Plus now extending their services to ensure these communities are included. Linking in the Anglicare Suicide Prevention Service to the Lobethal Local Recovery Centre also provided their frontline staff with essential training and ongoing support.

Working collaboratively Alongside this, the CSAPHN Bushfire Coordinator has worked in collaboration with numerous other organisations and service providers within the recovery space – an approach designed to maximise access to services where they have been needed most. This includes mental health providers and clinicians, councils, the Red Cross, Wellbeing SA, Phoenix Australia, National Bushfire Recovery Agency (NBRA) as well as the Department of Premier and Cabinet and PIRSA among others. 32 Country SA PHN Annual Report 19/20

Reconciliation Action Plan

A significant number of the Aboriginal an organisation’s business plan. It training that is suitable for the and Torres Strait Islander population includes practical actions that will organisation particularly for the health in South Australia resides within the drive an organisation’s contribution to context; improving advertisements Country SA PHN (CSAPHN) service reconciliation both internally and in for recruitment; identifying Aboriginal area. Aboriginal and Torres Strait the communities in which it operates.” and Torres Strait Islander advertising Islander peoples are an important avenues; working towards the part of the communities of country Since this time, significant work creation of Aboriginal and Torres SA, each Aboriginal and Torres has been undertaken to progress Strait Islander traineeships; as well as Strait Islander community enriched the RAP. The RAP Working Group identifying further opportunities for and enriching in different histories, (RAPWG) was formed in August 2019, procurement and commissioning cultures, languages and experiences incorporating representatives from with Aboriginal organisations in that form part of our collective across the organisation with the country South Australia. perspectives. aim to progress the RAP by building a solid foundation together and COVID-19 restrictions impacted the CSAPHN recognises Aboriginal embed the reconciliation process organisation in several different ways, and Torres Strait Islander peoples at the heart of our organisation’s with RAP Actions affected, such as as the first Australians and we culture and decision making. It was participation in the Reconciliation celebrate Aboriginal diverse culture essential to establish the governance Week Events, which were cancelled. and heritage. We are committed to of the RAP through this time. By The RAPWG collaboratively were reconciliation and building respect, September 2019, the RAPWG using able to quickly identify online relationships and understanding Reconciliation Australia’s framework, solutions and created different ways between Australia’s First People drafted the organisations Reflect RAP the organisation could participate; and other Australians and a shared which was conditionally endorsed and despite the barriers, most of the commitment to empower Aboriginal by April 2020 and includes 14 main staff across the organisation, even in and Torres Strait Islander people to actions for the organisation to working from home arrangements, live healthy and prosperous lives. progress. were able to mobilise and participate in recognition of the traditional In July 2019, CSAPHN commenced These actions are progressive steps owners of the lands in country work to participate in Reconciliation aimed at improving relationships, South Australia. Subsequently, Australia’s Reconciliation Action Plan creating understanding and respect, demonstrating the overwhelming (RAP) Program. As Reconciliation and identifying and expanding on commitment across the organisation Australia provides, it’s a formal opportunities. From this, the PHN to reconciliation and the many and structure for organisations to has already undertaken actions such varied Aboriginal communities across actively contribute to the national as identifying and working with key country South Australia. reconciliation movement “(…) a partners on the RAP; investigating strategic document that supports and undertaking cultural competency Country SA PHN Annual Report 19/20 33

CSAPHN recognises Aboriginal and Torres Strait Islander peoples as the first Australians and we celebrate Aboriginal diverse culture and heritage.

NAIDOC Week Celebrations were Currently the RAP is in the process also postponed to November, of being visually designed by however the RAPWG felt it was OchreDawn including artwork by important to continue to observe emerging artist Shane Cook and the week on its original dates as once completed will be forwarded well. The RAPWG led celebrations to Reconciliation Australia for of the week internally with the staff full endorsement. Once officially across the organisation by sharing endorsed, a RAP Launch will need different online media from some to be undertaken, however, again of the Aboriginal communities with COVID-19 the format that this within our service area. Again, there launch takes may also require some was an overwhelming response creative imagination by the RAPWG and it created further opportunities with the support of the staff across to demonstrate our respect and the organisation. Once officially commitment, assisting in relationship endorsed, the CSAPHN RAPWG will building with colleagues and partners continue its formal reconciliation across our service area. journey, working together towards our RAP Actions and progress work for the next RAP – Innovate. 34 Country SA PHN Annual Report 19/20

Message from our RAP Champions

As Board Chair of Country SA Country SA PHN has a close working PHN, I am honoured to have a relationship with each of the role supporting and promoting the Aboriginal Community Controlled Reconciliation Action Plan (RAP) Health Organisations (ACCHOs) across the organisation and into our and commissions several programs communities. focussed on improving Aboriginal and There is much work to be done Torres Strait Islander health outcomes across all facets of health and its across the state. Our RAP will help us social determinants to improve maintain the focus and help embed Aboriginal and Torres Strait Islander inclusive thinking in all aspects of health outcomes. This needs buy-in our work. Dr Alison Edwards at all levels and as an organisation I look forward to watching the RAP Chair of the Board we have capacity to continue to raise process gain momentum and gain awareness and influence attitudes traction in all our activities. I am very as well as support the amazing pleased to share the role to champion work done by and in Aboriginal the RAP both internally and externally communities across rural South with my fellow Board Director Mr Australia. Wayne Oldfield who brings a wealth of lived experience and organisational involvement across the sector.

I’m pleased to be involved in The Reflect Plan provides us, as reconciliation across our organisation, an organisation, with a framework with our Chair of the Board, Dr Alison to identify and address inequity in Edwards and look forward to working our systems. It enables us to form with Dr Edwards as we advance close relationships and continually and promote the evolution of the evolve in our cultural awareness and Reconciliation Action Plan. understanding and how this impacts As the Aboriginal Consumer on our everyday actions. Representative on the Board of CSAPHN aspires to continually Directors, it is fantastic to be involved improve the opportunities for in a Reflect Plan that truly embraces employment, both within the Wayne Oldfield Aboriginal and Torres Strait Islander CSAPHN and influencing our services Board Director peoples and the role we can all play to improve, enabling opportunities for in reconciliation. Aboriginal and Torres Strait Islander peoples in country South Australia. I look forward to the journey. Country SA PHN Annual Report 19/20 35

Our RAP will help us maintain the focus and help embed inclusive thinking in all aspects of our work.

Dr Alison Edwards and Steve Scott 36 Country SA PHN Annual Report 19/20

Local Health Clusters

Local Health Clusters (LHCs) are at the Eyre, Upper Eyre, Barossa, Upper heart of Country SA PHN (CSAPHN). South East, Yorke Peninsula and Roxby The LHCs are a conduit between Downs. rural and remote communities and CSAPHN. LHCs engage with their The clusters and their communities communities to inform us about local have continued to embrace the online health priorities and to make sure feedback and engagement platform, commissioned services are locally Health Connections Community. The relevant, patient centred, cost effective online platform is continuing to prove and aligned to existing local care. very effective for driving membership and overall engagement between the As such, the clusters provide clusters, their respective communities communities with the opportunity and CSAPHN. to help shape local health services. Cluster members provide a broad Throughout 2019-2020 the LHCs have range of perspectives and experience been very active consolidating their to our PHN. This is vital to us as a role in local communities. CSAPHN regional and remote PHN – covering funded small Health Cluster Grants to 99.8% of the state geographically. the LHCs to undertake local activities in their communities of a primary The LHCs have a significant primary health nature. The LHCs created a health footprint right across country range of diverse projects based on South Australia covering the following local need. The following is a snapshot regions: Riverland, Limestone Coast, of that activity across the state. Fleurieu Peninsula, Mid North, Lower Country SA PHN Annual Report 19/20 37

ROXBY DOWNS

MID FAR WEST NORTH

UPPER EYRE LOWER EYRE RIVERLAND

BAROSSA YORKE PENINSULA

FLEURIEU LOCAL HEALTH CLUSTERS OPERATE IN THE FOLLOWING REGIONS UPPER SOUTH Far West Barossa EAST/LIMESTONE COAST Lower Eyre Fleurieu

Upper Eyre Riverland LIMESTONE Roxby Downs Upper South East/Limestone Coast COAST/LOWER SOUTH EAST Mid North Limestone Coast/Lower South East

Yorke Peninsula 38 Country SA PHN Annual Report 19/20

The Barossa LHC partnered with The expo was also a lot of fun local community groups to support with entertainment provide by the the Barossa Community Disability West Adelaide Bearcats Wheelchair Expo in February 2020. It was a Basketball Team and Jake Argent DJ great success with more than 60 on Wheels. exhibitors and more than 280 guests. Many participants expressed the benefit of networking with other families and carers and sharing their experiences. Service providers also found it beneficial to meet and speak Barossa with community members about the services they have available. Local Health Cluster

During Mental Health Week in The range of activities included a October 2019 the Lower Eyre Family Fun Day in Cowell, Matty Peninsula LHC collaborated with Curnow from ‘Mind the Noise’ local community groups to deliver talking at gatherings in Tumby Bay health literacy education through a and Cummins, a Mindfulness Mental diverse range of activities across the Health Morning in Kyancutta, a ‘Let’s Lower Eyre. The aim was to improve Chalk!’ event on the Port Lincoln health and wellness, encourage Foreshore for World Mental Health behavior change in communities to, Day, a ‘You are not Alone’ free men’s promote Question, Persuade Refer event and a roaming social media (QPR) training and promote the Lower frame at the Cummins Show. Lower Eyre Eyre LHC and CSAPHN. The activities included gatherings with lived Peninsula experience people talking about ways Local Health that we can keep well and providing tools for supporting out mental Cluster fitness and offering resources for help seeking. Country SA PHN Annual Report 19/20 39

The Upper Eyre LHC (UELHC) The following are examples of the partnered with Asthma Australia to feedback. deliver asthma education in areas “.. I learnt so much from these such as community, allied health sessions. I have even started using and general practice. The UELHC my spacer appropriately. The stats identified the need for asthma that were presented were pretty education – particularly childhood frightening…” UELHC member, asthma education was identified as webinar participant the highest priority. “…Just wanted to congratulate you The project aimed to raise community on organising last week’s asthma awareness of appropriate asthma webinars. Upper Eyre management, reduce avoidable Local Health hospital admissions, increase I found the one on the Tuesday knowledge of resources available to night in particular, very worthwhile, Cluster improve the understanding of asthma especially the changes in Asthma management and Asthma Australia’s Guidelines…” Primary Health Care COACH Program and increase Nurse referrals to the COACH program. “Thank you for helping to put Asthma Australia has been pleased together a terrific presentation. I have to be able to deliver this project on to admit I like Kingsley’s presentations time and budget under extraordinary as they are always summarised and circumstances. There have been relevant. Both presenters were great.” significant learnings due to the UE, GP Pharmacist innovation required to adapt and deliver this project in an on-line environment. 40 Country SA PHN Annual Report 19/20

The Riverland CSA in partnership intentions to provide appropriate with FocusOne Health, headspace support for others in challenging Berri and Riverland High Schools social contexts. contracted Encounter Youth to It was hoped the benefits of this facilitate an Alcohol and Other training go well beyond the current Drug (AOD) Program targeting cohort. The ripple effects of training senior school students and parents. a group of peers are far reaching and Custom modules were developed well evidenced. Young people look to with headspace Berri having key their peers for guidance far more than input into their development. The their parents, hence the peer group modules included: AOD and driving takes on a self-regulating function. with a country road focus, alcohol Riverland Young people look to their parents for and camping and alcohol and water boundaries, and with this education, Community (boating and water sports, swimming parents are more confident to and camping on the river, alcohol and Services implement these boundaries, drowning). The established outcomes knowing that their parenting peers Alliance included: increasing the use of are doing the same thing. This makes support networks and help seeking decision making around substance behaviour, decreasing student’s use for young people easier on intentions to engage in harmful several fronts. AOD use, and increasing students’

The Yorke Peninsula LHC partnered The third program run under the with Karen Keavy from ‘Into the Sun Health Cluster Grant was a Self- Counselling and Integrated Therapies’ Compassion/Mindfulness Group for to deliver a youth resilience program Indigenous Mothers of Moonta Area called ‘Empower Me’. The wellbeing School. Unfortunately, this group was meditation group was run at a unable to go ahead due to COVID-19 Wallaroo Café on a weekly basis. The restrictions at this time. program targeted adults and children who are feeling ‘stuck’. The second project is a Self- Compassion/Mindfulness Group for Yorke Year Two Boys aged from 7 to 8 years Peninsula and held at the Moonta Area School. All participants in the program had Local Health significant learning difficulties, some Cluster had family problems and all had non- attendance issues. Country SA PHN Annual Report 19/20 41

The Fleurieu RCSAC (local The feedback received included: governments of Victor Harbor and “This course was fantastic and very Yankalilla) offered Youth Mental informative” Health First Aid Training and mental health literacy for local adults to “At first I didn’t really think it was for better support young people. me but I’m glad I came” The sessions were very well attended “I would love to learn more” and the RCSA received some very “I gained a better understanding positive feedback about the training. of mental health and how to help Participants reported that it was easy others” to understand, well presented and The Fleurieu relevant and they stated that they “It was enjoyable and easy to Region would recommend Youth Mental understand” Health First Aid Training to others. “I enjoyed this course way more than Community I thought I was going to. I feel like it Services was really beneficial” Advisory Council

The Mid North LHC supported the The Mid North LHC was also involved creation of a Men’s Shed in Crystal in the Peer Support Asthma project Brook in partnership with Rotary and in the Mid North as local community Nystar. The planned rollout of the advisors. Safe Saw project was compromised by COVID-19 restrictions but is now back on track. The Mid North LHC also teamed up with the Orroroo-Carrieton Council, UniSA, and Local Health Networks to host student Occupational Therapists Mid North to undertake a community awareness Local Health project with great results in the local community. Cluster 42 Country SA PHN Annual Report 19/20

The Upper South East LHC Feedback from a 42 year-old farmer: commissioned Naracoorte “The one I’ve listened to was great psychologist Mandy Curnow from and the best part is it’s got blokes MC Coaching to create the ‘In the talking to blokes about deeper stuff head of a country bloke’ podcast and feeling comfortable to talk.” series focusing on primary health care in areas such as depression and Feedback from the wife of one of the anxiety. The 12 podcasts consisted participants: of interviews between qualified Kriena: “You should be very proud, psychologists and consenting you have created an incredible interviewees from a wide range of platform for men to share their story, Upper South backgrounds and locations with links in their own words (…) It’s amazing to the South East. what you have achieved just for East us, let alone every other podcast Mandy’s aim was to: “give men an you’ve done and will do! I know Matt opportunity to share their strengths Local Health especially can’t thank you enough, through vulnerability – by telling Cluster he’s really proud of where he’s at but personal stories, in whatever way I think he’s felt no one understood they choose – in the hope that other how hard it’s been for him, they do men may take some inspiration, now!!” motivation, and food for thought from them.” Listener feedback (via Health Connections Community): The aim was to use ‘laymans’ terms and avoid clinical terminology to Keenan: “Hi Mandy. Just had a listen lessen any potential stigma and reach to your podcasts with Wokka and a wider audience. Lach. Wanna say how much I enjoyed them. Inside the head of a country bloke is exactly the topic we need. Both blokes so down to earth and honest. Was good to listen to. Thank you.”

Matt Rowett

Country SA PHN 30 Tanunda Road, Nuriootpa SA 5355 PO Box 868 Nuriootpa SA 5355 Ph: 08 8565 8900 www.countrysaphn.com.au