CRC for Aboriginal Health Annual Report 0809
Established and supported under the Australian Government’s Cooperative Research Centres Programme. The Cooperative Research Centre for Aboriginal Health (CRCAH) is a public good research Whale Dreaming centre funded through the Commonwealth Government’s Cooperative Research Centres © Y. Bundle 2007 Programme, its 12 core partners and external bodies. The CRCAH brings together eight universities or research institutions, four industry partners and six associated partners. The This work arose from a dream Yaraan received. Menzies School of Health Research (MSHR) is the Centre host. MSHR provides centre agent It is about the Whale Dreaming songline services and accommodation for the secretariat and executive of the CRCAH. connected to Keerray Woorroong Country along the coast near Warrnambool. Vision In her dream the Old People told Yaraan the Sustained improvements in Aboriginal health through strategic research and development. story of the Southern Right Whale and their journey to our waters to give birth to their young. They told her the secret of the whales and the Mission statement knowledge they bring. With strong and effective Aboriginal input and control, we will conduct high-quality strategic This work tells their story. Aboriginal health research, and we will engage in effective development activities with Aboriginal communities, service providers, policy formulators and decision-makers. Yaraan Bundle Yaraan Bundle is a Keerray Woorroong/ Objectives, principles and values Gunditjmara woman living in her homelands This Centre has a commitment to research which will lead to improved health outcomes in the Western Districts of Victoria, Gunditjmara for Indigenous Australians, and to stakeholder involvement and partnerships in research to Country. She also has family/kinship connections achieve that. with the Yuin/Monero from the South Coast of New South Wales and the Bidjera from central The poor health of Aboriginal people is due to poverty, social disadvantage, alienation, and Queensland. health care systems that have not sufficiently addressed Aboriginal people’s needs. Yaraan is mother to Keanu Lien. She is one of Aboriginal health problems may be improved by appropriate research and development, five daughters to her artist mother, Vicki Couzens, including research to discover new ways to apply existing knowledge. Aboriginal health and musician/singer/songwriter father, Robert would be improved through full participation of Aboriginal people in effective partnerships Bundle. which seek sustainable solutions. Yaraan is a dancer in our ‘peeneeyt thanambool’ Strengthening the capacity of Aboriginal people to achieve full participation in services (strong women) women’s dance and cultural and appropriate means of control of these services is of critical importance for addressing group. Along with her sisters, ‘peeneeyt Aboriginal health deficits. thanambool’ have performed at many festivals The partners take a holistic view of health which encompasses the existence of social and across Victoria and interstate. She is a prolific emotional wellbeing as well as the absence of disease. storyteller and writer with works published in newsletters, and an annual publication, Lewin, an anthology of Indigenous children’s writings from around the world, was published for With strong and effective Aboriginal input and control, we will conduct Photo courtesy of Jo Grant seven consecutive years as part of the Global high quality strategic Aboriginal health research, and we will engage in Indigenous Arts Project. effective development activities with Aboriginal communities, service Yaraan’s deep spiritual connection to culture and providers, policy formulators and decision-makers. Country is what inspires her writing, storytelling and artworks.
Front cover and internal artwork: Yaraan Bundle For further information on the artist or artwork, see the inside back cover. Layout, design and production: CRC for Aboriginal Health Communications Unit and Inprint Design: (08) 8201 3223 www.inprint.com.au CRC for Aboriginal Health Annual Report 0809
Building an Indigenous Health and Research Workforce For further information: Cooperative Research Centre for Aboriginal Health PO Box 41096 Casuarina NT 0811 T 08 8943 5000 F 08 8943 5010 E [email protected] www.crcah.org.au 22 Catterthun Street Winnellie NT 0820
Throughout this report the terms ‘Aboriginal’ and 'Indigenous' refer to Australian Aboriginal and Torres Strait Islander people. CONTENTS
1 Executive Summary Table 2
2 Chair’s Report 3
3 CEO’s Report 4
4 Governance, Structure and Management 5
5 Research 10 Overview 10 National Research Priorities 11 Comprehensive Primary Health Care, Health Systems and Workforce 12 Chronic Conditions 15 Healthy Skin 17 Social Determinants of Health 19 Social and Emotional Wellbeing 21 Research Collaborations 23 Commercialisation and Utilisation 24 6 Communications 26 Link Program 28 7 Education and Training 29
8 International Collaborations 31
9 Appendices 33
10 Glossary 54
1 1 EXECUTIVE SUMMARY TABLE
Achievements and Research activities of the Research transfer and knowledge exchange activities have increased in the past year as more projects are completed. CRC in relation This has resulted in the release of several new publications, and the development of a body of work that synthesises the to research, research fi ndings of all of our projects across our fi ve program areas. commercialisation/ The CRCAH was successful in its application for funding for a further fi ve-year program of activity, which will contribute to the expansion of emerging research and utilisation activities. utilisation and education outcomes Utilisation for the reporting Twelve South Australian Aboriginal students successfully graduated from a new pilot course developed and nationally period accredited by James Cook University and piloted by the Aboriginal Health Council of SA (AHCSA). The CRCAH provided in-kind and fi nancial support to AHCSA, also resulting in three publications and the development of a funding proposal to employ a Project Offi cer in knowledge translation and research support. A training program for East Arnhem community workers to deliver programs on skin health has now been expanded as an accredited training program for delivery in the Northern Territory community of Galiwinku. The CRCAH co-hosted with Flinders University the 2008 Australian–American Fulbright Symposium, ‘Healthy People, Healthy Country’, which attracted national and international guest speakers. The increasing demand for empowerment programs developed within the CRCAH’s social and emotional wellbeing suite of research has resulted in the research team, led by Dr Melissa Haswell and Professor Komla Tsey, developing a train-the- trainer course to help facilitators deliver the programs in Aboriginal and Torres Strait Islander communities in at least three States/Territories. The same program has been adapted for, and taken up by, schools in Cape York. Education The CRCAH supported 17 scholarship and in-kind students, who were supported through funding, professional development opportunities and involvement in program activities. Three students completed their studies in this period. The CRCAH was proud to announce that Lisa Whop was the fi rst student to complete her studies under the CRCAH Cadetship program. She has now commenced further studies through a Master of Epidemiology and has a work placement at the Queensland Institute of Medical Research. A new guide aimed at improving the supervision of Indigenous researchers, Supporting Indigenous Researchers: A Guide for Supervisors, was launched by the Deputy Prime Minister Julia Gillard and has been in strong demand. Twenty researchers have benefi ted from the successful Indigenous International Program that is supported by the Offi ce for Aboriginal and Torres Strait Islander Health (OATSIH).
Risks, opportunities Risks and responses to the The potential lack of available time for researchers towards the end of their projects to write up results was raised as a above risk to maximising knowledge exchange with end users. To address this, the CRCAH has established small writing bursary grants to increase the impact of research. Opportunities The CRCAH has been strengthening relationships and working collaboratively with affi liates of the National Aboriginal Community Controlled Health Organisation in the past year to support them with building their capacity in the fi eld of research through a number of activities. This has included working with the Victorian Aboriginal Community Controlled Health Organisation, the Aboriginal Health & Medical Research Council and AHCSA to support them to assist the Aboriginal community health sector in their States to build their research capacity, develop internal abilities and engage effectively with external researchers. The CRCAH has expanded its international research network through its involvement with the Teasdale Corti project on comprehensive primary health care. The CRCAH is also the Australian representative within the Healing our Spirit Worldwide movement for the 2010 gathering in Hawaii.
Impediments to A gap continually highlighted by the Indigenous health sector is the need to improve and increase the evaluation of achievement of Indigenous tobacco control programs to identify what is working, and to increase the capacity of health services to the CRC’s objectives deliver effective health programs. The CRCAH in partnership with the Centre for Excellence in Indigenous Tobacco Control has endeavoured to support Aboriginal organisations, such as Maari Ma and the Cape York Institute, to implement and experienced during evaluate best practice smoking interventions. the year and strategies to address these
Awards, special Ian Anderson, CRCAH Research Director, was appointed as the Chair of the new National Indigenous Health Equality commendations, CRC Council (NIHEC). Paula Arnol, a CRCAH Board Member, was also appointed to NIHEC. highlights CRCAH PhD student Sanchia Shibasaki, a Torres Strait Islander woman, was awarded a Doctorate of Philosophy in Epidemiology, Population Health and Health Services in June 2009. Sanchia chose to have her award presented to her by the Lord Mayor of Thursday Island, her local community, so that she could share this special occasion with family and community, and her PhD supervisor. A key in-kind project looking at improving the journey to hospital for remote cardiac patients was recognised in the recommendations to the Senate Inquiry into the Patient Assisted Travel Scheme. The fi ndings of this student research, undertaken by Monica Lawrence have also had a signifi cant impact in that it has since informed models of practice in SA and WA and promoted stronger links between NT and SA.
2 CRCAH Annual Report 2008−2009 2 CHAIR'S REPORT: Pat Anderson
projects came and went, health service opportunities for Aboriginal people. These delivery and health policy remained are now widely acknowledged as ‘best essentially the same. practice’ in Aboriginal health research. By the early 1990s, however, the Aboriginal I believe the CRCAH has been instrumental health sector began to think about ways in changing attitudes in the research world in which research could be made more to why, how, where, and by whom research useful and appropriate for Aboriginal is carried out. I also believe we have communities. New ethical and practical helped lead a shift in Aboriginal attitudes guidelines for research had begun to be to research. While some Aboriginal people, established, by both mainstream and organisations and communities retain Aboriginal organisations. an understandable scepticism about the With the establishment by the Australian benefi ts of research, the widespread Government in 1990 of the Cooperative hostility of the past is largely gone. Research Centres Programme—which Critical to our ability to lead change has had the aim of developing user-driven, been what I regard as our greatest success— cooperative research with a focus on the building of research capacity within practical outcomes—we were presented the Aboriginal community. Our CRC has This year has been a highly signifi cant with an opportunity. After much discussion supported, trained, educated and employed one for the Cooperative Research Centre and negotiation, a collaboration of six a myriad of Aboriginal and Torres Strait for Aboriginal Health, as well as for the partners—Flinders University, Northern Islander students and researchers and they future of research by and for Aboriginal Territory University, Northern Territory are, I believe, our most important and and Torres Strait Islander peoples. After Health Services, Central Australian enduring legacy. much work by CRCAH staff, partners and Aboriginal Congress, Danila Dilba This year’s work that has led to the Aboriginal Health Service, and Menzies supporters, our proposal for a further refunding of the CRCAH for a further fi ve School of Health Research—put together fi ve years of funding from the Australian years will allow us to continue along our a proposal for a CRC for Aboriginal and Government has been successful. This now successfully established pathway. Tropical Health. Professor John Mathews represents an endorsement of our unique It is also a signifi cant step towards the was instrumental in developing this approach to research that empowers establishment of a permanent body for consortium. Aboriginal researchers and communities, collaborative Aboriginal health research in and delivers results that make a difference In July 1997, the bid was successful the Australian research landscape. in the ‘real world’ of health service delivery. and the new CRCATH was established to The need for such a body is underlined It also provides a point from which we can undertake research and education activities by the commitment of all Australian look back at our past, to the beginnings of that would lead to better outcomes governments to addressing the health the CRCAH as we know it today. in Aboriginal and tropical health. As inequity between Aboriginal and Torres Aboriginal people and organisations, this In the 1980s, ‘research’ was still a dirty Strait Islander and other Australians. For was an area we entered cautiously. Many in word in the Aboriginal world. Many this commitment to be made real, we our own sector remained deeply suspicious, decades of research carried out by non- need to know what is needed, what works based on their own long experience of best, and how Aboriginal people and Aboriginal researchers for non-Aboriginal exclusion from the research fi eld. institutions had left many of us deeply communities can be involved in and control suspicious of the ‘R’ word. Although we had So it was a learning process for all their own health. concerned: for us, and for our partners won rights in many areas of our lives, and I look forward to working with the CRCAH and researchers. Like all learning processes had established a network of community partners and Board on these issues in the it had its diffi culties and its tensions, but controlled health services across the future, and would like to thank them for the model itself was sound. The sense country, when it came to research we were their support and hard work during 2008– of partnership and collaboration grew still continually being asked to participate 09. Once again, many thanks to our CEO alongside a new approach to research that in other people’s processes that apparently Mr Mick Gooda and our Research Director put issues of Aboriginal empowerment and served other people’s priorities. Professor Ian Anderson for their leadership, knowledge exchange at the centre of the and particularly for their success, in gaining The research agenda was set in forums research task. support for a further fi ve years of CRCAH to which few Aboriginal people had At the end of the fi rst funding cycle in operations. access. And research methodology was still 2003, an expanded partnership with a Finally, I would like to record my focused on Aboriginal people as subjects sharpened focus on Aboriginal health—the appreciation of the many researchers, of research: research was something current CRC for Aboriginal Health, in fact— students and staff of the CRCAH upon carried out ‘on’ Aboriginal people, not was funded by the Australian Government. ‘with’ Aboriginal people, and certainly not The CRCAH continued the principles of whose hard work all of our achievements ‘by’ Aboriginal people. Worse still, despite Aboriginal participation and control; are based. the large volumes of research to which inclusive approaches to health research; Pat Anderson we were subjected, very little seemed to the transfer of research into practice; and Chairperson CRCAH be translated into practice; as the research the provision of research and training July 2009
CHAIR'S REPORT 3 3 CEO'S REPORT: Mick Gooda
which is to be called the Cooperative ‘On Friday 7 August 2009 Research Centre for Aboriginal and Torres we were informed that our Strait Islander Health, or CRCATSIH. application for a fi ve-year While this process was long and sometimes funding extension through frustrating, I can safely say that every decision around the development of this the Australian Government’s ‘legacy’ organisation was fully informed and Cooperative Research understood because every minute detail Centre Program had been was dissected, tested and challenged. This long lead-in time has provided the most successful! ’ solid basis possible upon which to build an organisation, and together with the On Friday 7 August 2009 we were Unsurprisingly the 2008–09 year has commitment of our partners I now look informed that our application for a presented signifi cant challenges. Not least forward to seeing the new organisation fi ve-year funding extension through the was the somewhat limited time we were grow and meet the challenging demands Australian Government’s Cooperative given to prepare the CRCAH Extension that we have set for ourselves. Research Centre Program had been application. We were advised of the new Other challenges during the year included successful! guidelines in November 2008 and then the preparation of a wind-up plan for this had to put together an application by the The Ministerial announcement followed CRCAH and the relocation of our head due date of 20 March 2009. This meant 10 months of extremely hard work by offi ce from the Royal Darwin Hospital asking people who had already put in a CRCAH staff, our board, our partners and campus to a new offi ce in the Darwin tremendous amount of work over the year supporters from across the country, and is suburb of Winnellie. I must acknowledge to cut short their Christmas break to ensure the culmination of the work of the CRCAH the hard work of all the staff over the past that the application was of the highest over the past six years. year in ensuring we met these challenges, possible standard. in particular my Deputy, Wendy Ah Chin, The early years saw the development of While it is always fraught to single out and the Program Managers. They have our research processes that provided the individuals in such a tightly timed and worked tirelessly to ensure that the foundation upon which we have built our effort-intensive undertaking, I must take management of our research program user-driven research agenda, such as the this risk and mention several people. positioned us to move towards the end Programmatic and Facilitated Development Professor Ian Anderson worked tirelessly to of this CRCAH with our research agenda Approaches. The following years were ensure the research agenda was rigorous, complete and budgets on track to when these processes were put into relevant, feasible and achievable. Jenny achieve full expenditure. The relocation practice, when our research projects were Brands worked with dogged determination to Winnellie was carried out almost developed and the research got underway. to put together a new element of the seamlessly. For this I must thank the staff There were years of consolidation and application process, the Economic Impact of the Menzies School of Health Research. review, and the year just passed could be Projection, while also contributing described as the one in which we carried signifi cantly to the application itself. Nea With the research stage of our projects out a whole range of preparations for the Harrison project-managed the whole ending, our attention has turned to the future: preparation for the wind-up of this process and made sure the application business of knowledge exchange, where CRCAH, developing a plan for an enduring was submitted on time. I was extremely we advocate and promote the uptake of organisation to carry on the work of this happy to press the ‘send’ button to submit our fi ndings into changed practice and CRCAH, and, fi nally, the preparation of the the application a full two hours and 23 policy development. The CRCAH Board CRCAH Extension application that will now minutes before the deadline. has allocated signifi cant resources to see us continue until 30 June 2014. allow us to address this important part In conjunction with the application However, it is nearly impossible to break of our research program. We are not process, the CRCAH Board had to make only looking at how we can work with the years into neatly compartmentalised some tough decisions about the structure individual projects to achieve this goal, pieces of work as I have described above. of the organisation that would come but are also taking a program perspective Besides all the work in preparing for these after the CRCAH. This process began with by synthesising the fi ndings of projects events, the day-to-day work of managing a workshop back in October 2006 and within and across our fi ve programs. The the current workload, overseeing projects every subsequent board meeting included early work of this synthesis contributed and supporting research teams and a workshop where this matter was signifi cantly to the development of maintaining and strengthening relationships considered. It was decided to establish the research agenda included in the across the broad spectrum of organisations a company limited by guarantee to be Extension Application, and it will provide and people with whom we engage still called the National Institute for Aboriginal clear and well-evidenced direction in its has to go on. And we cannot discount and Torres Strait Islander Health Research implementation over the years ahead. the effort that goes into the ‘corporate’ (NIATSIHR). Not only is this company work of preparing annual reports and designed to carry on the legacy of the Mick Gooda audits, collecting in-kind contributions and CRCAH, it is also the organisation that will CEO CRCAH monitoring and managing budgets. host the operations of the CRCAH Extension, July 2009
4 CRCAH Annual Report 2008−2009 4 GOVERNANCE, STRUCTURE AND MANAGEMENT
The Board of the CRC for Aboriginal Health
Pat Anderson Paula Arnol Stephanie Bell Jonathan Carapetis Philip Davies Jill Gallagher Michael Good Shane Houston
Michael Kidd Vivian Lin Terry Nolan Lesley Podesta Janelle Stirling Russell Taylor Robert Wasson Ted Wilkes
Pat Anderson is the Chairperson of the and, just as importantly, the transfer of Philip Davies joined the University of CRCAH Board. She is an Alyawarre woman research fi ndings into practical day-to-day Queensland’s (UQ) School of Population known nationally and internationally as operations. Health as Professor in Health Systems and a powerful advocate for disadvantaged Policy in April 2009. He was previously Stephanie Bell, a Kulilla/Wakka Wakka people, with a particular focus on the a Deputy Secretary in the Australian woman and Stolen Generation heritage health of Indigenous peoples. Ms Anderson Government’s Department of Health & of Warramunga people, is Director of the has extensive experience in all aspects of Ageing (DoHA), and until this year was the Central Australian Aboriginal Congress, Aboriginal health, including community CRCAH Board member representing DoHA. one of the country’s largest and longest development, advocacy, policy formation Professor Davies has more than 30 years’ and research ethics. She has spoken established Aboriginal medical services. international experience of health care before the United Nations Working Group Ms Bell is also a founding member and policy and management. Before coming to on Indigenous People, and was formerly Chairperson of AMSANT, Chairperson of Australia in 2002 he worked as a Senior the CEO of Danila Dilba Health Service in the Northern Territory Aboriginal Health Health Economist with the World Health Darwin. She has also been Chair of the Forum and an executive board member Organization (WHO) in Geneva. Prior to National Aboriginal Community Controlled of NACCHO. Ms Bell convenes the Small-to- that he was a Deputy Director-General in Health Organisation (NACCHO), as well Medium-Sized Enterprise Forum within the New Zealand’s Ministry of Health where as Executive Offi cer of the Aboriginal CRCAH. he was responsible for sector-wide policy Medical Services Alliance Northern Territory Jonathan Carapetis is Director of the issues. (AMSANT). Ms Anderson has had many essays, papers and articles published, Menzies School of Health Research Professor Davies replaced Professor Alan including Little Children Are Sacred, the in Darwin. A medical practitioner, Lopez during the reporting period as report into abuse of Indigenous children paediatrician and specialist in infectious UQ’s representative on the CRCAH Board; in the Northern Territory. In 2007, she was diseases and public health, Professor Ms Lesley Podesta has replaced Professor awarded the Public Health Association of Carapetis’s research in group A Davies as the OATSIH representative on the Australia's Sidney Sax Public Health Medal streptococcal diseases in the Aboriginal Board. in recognition of her achievements. population led to the establishment of Jill Gallagher is a Gunditjmara woman Australia’s fi rst rheumatic heart disease Paula Arnol was born in Cairns but from western Victoria who has lived and has lived in Darwin for more than 20 control program in the Top End. He co- worked within the Victorian Aboriginal years. She is the CEO of Danila Dilba founded the Centre for International Child community all her life. Ms Gallagher Health Service, the principal Aboriginal Health at the University of Melbourne’s worked in Aboriginal heritage for 15 years comprehensive primary health care service Department of Paediatrics. More recently with the Museum of Victoria followed by for Darwin and surrounding areas. Ms Professor Carapetis has been encouraging an appointment to the Museum’s Board Arnol is a strong advocate for Aboriginal new directions for Menzies' research, of Directors where she served for nine community control of primary health including the link between education and years. Ms Gallagher also worked in the care services. As such, she places a strong health, and promoting child health, mental Victorian Government as Manager of the emphasis on evidence-based outcomes health and international health research. Aboriginal Heritage Services Branch at
GOVERNANCE, STRUCTURE AND MANAGEMENT 5 Aboriginal Affairs Victoria. During this Professor Kidd replaced Professor Roy Coordinator of the Indigenous Health time she studied archaeology at La Trobe Goldie during the reporting period as Research Program at the Queensland University. In 1998, Ms Gallagher started Flinders University’s representative on the Institute of Medical Research from working for the Victorian Aboriginal CRCAH Board. 2001 until 2006. A/Professor Stirling Community Controlled Health Organisation Vivian Lin is Chair of Public Health and, has also been the CEO of the Durri (VACCHO) as the Sexual Health Manager until January 2005, was Head of the Aboriginal Corporation Medical Service and developed and set up the Well Persons School of Public Health, at La Trobe in Kempsey NSW, and has experience in Health Check around Victoria. She is University. Prior to joining the university, education as well as in Aboriginal health currently CEO of the Victorian Aboriginal Professor Lin worked for State and research. Health Service (VAHS). Commonwealth health departments, Russell Taylor was born and raised in Michael Good, AO is the Director of the including most recently as Executive Millers Point, an inner-city waterfront Queensland Institute of Medical Research Offi cer of the National Public Health suburb of Sydney that today forms part of (QIMR), Chair of the NHMRC, Director Partnership. Professor Lin consults for the the tourist precinct more commonly known of the Griffi th Medical Research College, World Bank and WHO, is Vice-President as ‘The Rocks’. He proudly identifi es as a Professor in the School of Population for Scientifi c Affairs for the International Kamilaroi man with family connections Health at UQ, and Head of the Molecular Union of Health Promotion and Education, to La Perouse in Sydney and to traditional Immunology Laboratory at QIMR. He and President of the Chinese Medicine country in the New England area of is the immediate past President of the Registration Board of Victoria. She also NSW. Mr Taylor is currently Principal of Lancefi eld International Symposium on serves as Advisory Editor for health the Australian Institute of Aboriginal and Streptococci and Streptococcal Diseases, policy on the journal Social Science and Torres Strait Islander Studies in Canberra, a past President of the Association of Medicine. and prior to this was Chief Executive Australian Medical Research Institutes, Terry Nolan is Head of the School of and a past Director of the Cooperative Offi cer at the NSW Aboriginal Housing Population Health and Associate Dean Research Centre for Vaccine Technology. Offi ce. His career spans more than 15 in the Faculty of Medicine, Dentistry He was made an Honorary Member of the years in various senior executive positions and Health Sciences at the University of American Society for Tropical Medicine including terms with the Aboriginal and Melbourne. Professor Nolan is also Chair of and Hygiene in 2006. In 2008 he was Torres Strait Islander Commission, the the Australian Technical Advisory Group on awarded an Offi cer of the Order of Australian Development Commission and Immunisation and a Professorial Research Australia for service to medical research as Principal at AIATSIS from 1997 to Fellow at the Murdoch Childrens Research and education. 2003. Institute. Shane Houston is the Executive Director Mr Taylor replaced Mr Steve Larkin Lesley Podesta is the First Assistant Systems Performance and Aboriginal Policy during the reporting period as AIATSIS’s Secretary of OATSIH in the Commonwealth in the Northern Territory Government’s representative on the CRCAH Board. Department of Health and Ageing. Ms Department of Health and Family Services. Podesta has a particular interest in family- Robert Wasson is Deputy Vice-Chancellor A Gangulu man from Central Queensland, centred care of chronic disease, early (Research) at Charles Darwin University. Professor Houston has worked in childhood interventions, better population Previously Director of the Centre for Aboriginal affairs for more than 30 years, health interventions and improving clinical Resource and Environmental Studies at the mainly in the health and employment and management standards in primary Australian National University’s Institute areas. He has held a range of positions care. Her work in the health portfolio of Advanced Studies and Dean of Science at local, State, national and international spans nearly 10 years, with previous at the ANU, Professor Wasson is widely levels including 13 years in senior public roles that included Assistant Secretary recognised for his contribution to research sector management roles and a stint with of the Residential Programs Branch in in support of environmental and natural the World Council of Indigenous Peoples. Aged Care, and then Assistant Secretary, resource management. Michael Kidd, AM is the Executive Dean of Biosecurity and Disease Control in the Ted Wilkes is a Nyungar man from WA the Faculty of Health Sciences at Flinders Population Health Division. In this position who works at Curtin University’s National University in South Australia. Professor Kidd she was responsible for leading Australia’s Drug Research Institute. Associate Professor also works as a general practitioner with a emergency response to the Bali bombings, Wilkes has enjoyed a life-long involvement special interest in the care of people with South-East Asian tsunami, the development in Aboriginal affairs, with his early HIV. He is a past president of the Royal of a bio-terrorist health response and professional life spent in the Aboriginal Sites Australian College of General Practitioners, pandemic infl uenza planning. and is currently an Honorary Professor with Department with the Western Australian Ms Podesta replaced Professor Philip the Faculty of Medicine at the University Museum. Following that, he became Acting Davies during the reporting period as of Sydney and a member of the Advisory Inaugural Head of the Centre for Aboriginal Board of the Poche Centre in Indigenous OATSIH’s representative on the CRCAH Studies at Curtin University and then enjoyed Health. Professor Kidd also chairs the Board; he now represents the University of 16 years as the Director/CEO of the Derbarl Australian Government Ministerial Advisory Queensland on the Board. Yerrigan Health Service in Perth. Associate Committee on Blood Borne Viruses and Janelle Stirling is an Associate Professor Professor Wilkes serves on a wide range of Sexually Transmissible Infections, and is an in Aboriginal Health at the Northern State, national and international committees elected board member and Treasurer of Rivers University Department of Rural which are working towards improving the World Organisation of Family Doctors. Health in Lismore NSW. She was the fi rst health outcomes for Aboriginal people.
6 CRCAH Annual Report 2008−2009 Changes to Board membership Medical Association. He now works at Board meetings, proceedings Charles Darwin University. Departed: Roy Goldie and Steve Larkin and function Alan Lopez was replaced by Professor resigned from the CRCAH Board following The CRCAH held fi ve board meetings during Philip Davies as UQ’s representative on the the 13 November 2008 meeting. Alan the reporting period: on 4 September CRCAH Board during the reporting period. Lopez resigned following the 25 March 2008 in Brisbane; on 13 November 2009 meeting. Professor Lopez is Professor of Medical 2008 in Perth; on 12 February 2009 Statistics and Population Health, and Head Roy Goldie was replaced by Professor in Melbourne; on 25 March 2009 in of the School of Population Health, at the Michael Kidd, AM as Flinders University’s Canberra; and on 6 May 2009 in Darwin. University of Queensland. Before joining UQ representative on the CRCAH Board during in January 2003 he worked at the World The board’s function is to review the the reporting period. Professor Goldie is a Health Organization in Geneva for 22 years operations of the CRCAH and its research respiratory pharmacologist with a particular including as Chief Epidemiologist in WHO’s projects. The board had a heavy workload interest in respiratory diseases, including Tobacco Control Program (1992–95), in 2008–09 as it monitored the progress of asthma. He was Professor in Pharmacology Manager of WHO’s Program on Substance the CRCAH’s wind-up strategy, the conclusion at UWA from 1999–2003, and also Deputy Abuse (1996–98), Director of the of a signifi cant part of the CRCAH’s research Dean of Medicine and Dentistry during Epidemiology and Burden of Disease Unit agenda, and considered options for the this time. In 2004 Professor Goldie was future of the CRCAH beyond the expiry of (1999–2001), and Senior Adviser to the appointed the Executive Dean of Health its seven-year term on 30 June 2010. This Director-General (2002). Sciences at Flinders University but resigned was refl ected by the fi ve board meetings from this role during the reporting period. Joined: Michael Kidd joined the CRCAH compared with the three held in 2007–08. Board at the 25 March 2009 meeting; Steve Larkin was replaced by Mr Russell The board contributed substantially both to Russell Taylor and Lesley Podesta joined the Taylor as AIATSIS’s representative on the the development of the CRCAH’s (ultimately CRCAH Board at the 6 May 2009 meeting. CRCAH Board during the reporting period. successful) rebid for another fi ve-year A Kungarakany man, Mr Larkin has a long Changed representation: Philip Davies term under the CRC Program, and to the history in the Aboriginal health sector. He ceased being the DoHA representative establishment of a new company limited by has been Principal of AIATSIS, Assistant on the CRCAH Board following the 12 guarantee called the National Institute for Secretary in OATSIH in the Department of February 2009 meeting, and rejoined Aboriginal and Torres Strait Islander Health Health and Ageing, CEO of NACCHO, and as the UQ representative at the 6 May Research, which will host the operations of Aboriginal Health Adviser for the Australian 2009 meeting. the new CRCAH Extension organisation.
Core Partner Organisations
There were no changes to the Queensland Victoria CRCAH’s Partner Organisations Queensland Institute of Medical during the reporting period. La Trobe University Research The University of Melbourne Northern Territory The University of Queensland Central Australian Aboriginal South Australia Australian Capital Territory Congress Flinders University Australian Institute of Danila Dilba Health Service Darwin Aboriginal and Torres Strait Department of Health & Islander Studies Batchelor Community Services Commonwealth Department of Northern Menzies School of Health Health and Ageing Research Territory Charles Darwin University Western Alice Springs Queensland Australia South Brisbane Supporting Partner Organisations Australia New South Wales
Northern Territory Western Australia Sydney Perth ACT Batchelor Institute of Telethon Institute for Child Adelaide Canberra Indigenous Tertiary Education Health Research Victoria Department of Employment, Australian Capital Territory Melbourne Education and Training Commonwealth Department of Tasmania Families, Housing, Community Hobart Services and Indigenous Affairs
GOVERNANCE, STRUCTURE AND MANAGEMENT 7 CRCAH Program Leaders
Name Organisation CRCAH Program Area
Rosemary Knight DoHA Chronic Conditions Leisa McCarthy MSHR Chronic Conditions Brian Marshall Link UP Chronic Conditions Kevin Rowley UM Chronic Conditions Faye Acklin Consultant Comprehensive Primary Health Care Ross Bailie MSHR Comprehensive Primary Health Care Ben Bartlett Consultant Comprehensive Primary Health Care John Liddle CAAC Comprehensive Primary Health Care Ross Andrews MSHR Healthy Skin Christine Connors NT DHCS Healthy Skin Thomas Brideson Greater Western Area Health Service NSW Social & Emotional Wellbeing Stephen Castle OATSIH Social & Emotional Wellbeing Wendy Edmondson (née Clinch) Wirraka Maya Health Service Social & Emotional Wellbeing Melisah Feeney FaHCSIA Social & Emotional Wellbeing Gary Robinson CDU Social & Emotional Wellbeing Fran Baum FU Social Determinants of Health Michael Bentley SAHRU Social Determinants of Health Michaela Coleborne OATSIH Social Determinants of Health Colleen Hayward ECU Social Determinants of Health
Organisational Structure KEY: CRCAH position University of Melbourne position
Executive Offi cer CEO Research Director
Publications Manager Deputy CEO Research Development Offi cer
Research & Development Manager Communications Manager Research Project Offi cers External Projects Manager
Communications Offi cers
Capacity Research Administration Development Program Transfer Link Executive Contracts Offi cer/Research Offi cer Managers Coordinator Coordinator Support Offi cer Manager Assistant
8 CRCAH Annual Report 2008−2009 Staff Changes
After six years working for the CRCAH her position is shared between ourselves and its predecessor the CRCATH, Research and Menzies. With more than 30 years in and Development Manager Jenny Brands an administrative environment, Kathryn left at the end of June 2009 to take up has brought many valuable skills to this a role with the Menzies School of Health busy role. Research. In her new position, Jenny is Long-time CRCAH staffer Lindy Quall contributing research transfer support to returned to the Darwin offi ce from one of the CRCAH's most successful projects, maternity leave in April 2009 following the the ABCD project. Jenny has contributed birth of her daughter. enormously to the evolution of the CRCAH’s Jenny Brands research agenda, in particular its Facilitated Communications Unit welcomes Development Approach, and she will be new team members Cape York Development Corporation, sorely missed. Our long-serving graphic designer and Cape York Land Council, Cape York Digital In other staff changes, Maria Halkitis Communications Offi cer, Cassandra Preece, Network and the Health Interactive was appointed Contracts Manager left Darwin to take up a position with the Technologies Network (HITnet). Steve is at the CRCAH in August 2008, with Mibbinbah Men’s Places project based in descended from the Kaurareg people from additional responsibility for improving the Gold Coast. Cass was a key player in the Prince of Wales group of islands and the the organisation’s Intellectual Property the evolution of the CRCAH ‘brand’, and the Kuku Yalanji people from the Mossman/ management processes. Maria is currently Board acknowledges Cass’s hard work and Daintree/Laura area. based in the CRCAH’s Darwin offi ce. creativity and wishes her all the best for the We also appointed David Moodie as a Kathryn Ansell joined the team in March future. specialist writer and editor. Dave has 2009 as the Administrative Support Offi cer Replacing Cass is Steven Pelham, a Cairns- worked in media and communications for and Receptionist at the CRCAH’s new head based IT and graphic design consultant who more than 25 years, and been a consultant offi ce in the Darwin suburb of Winnellie; has previously worked with the Balkanu to the CRCAH since 2006.
Ian Anderson heads up National Indigenous Health Equality Council
CRCAH Research Director Professor Melbourne in November 2008, Ian said Ian Anderson’s leading role in tackling that developing and monitoring realistic Indigenous health disadvantage was national targets for Indigenous health recognised in July 2008 when Federal was critical in evaluating the impact of Minister for Health Nicola Roxon strategies that aim to close permanently appointed him the inaugural chair of the the health gap between Indigenous and Government’s new National Indigenous non-Indigenous Australians. Health Equality Council (NIHEC). ‘In monitoring progress towards targets NIHEC’s role is to advise the Government set by COAG, valid target setting will on how best to achieve a ‘closing of the require methods that are specifi c, health gap’ between Aboriginal and measurable, achievable, realistic and time Torres Strait Islander people and other bound,’ he said. Australians. The 11-strong council also Ian pointed out the main contributors includes Board member Paula Arnol in to the gap in life expectancy were its mix of leading Indigenous and non- now non-communicable diseases and Ian Anderson Indigenous health professionals. conditions such as respiratory diseases, Refl ecting Ian’s long-held emphasis on cardiovascular diseases and diabetes. health system in delivering targeted workforce development, Ms Roxon said ‘The health gap is not narrowing because, primary health care, especially primary one of NIHEC’s fi rst challenges would be over the past 20 years, the causes have preventative services and health to increase the numbers of Indigenous shifted from communicable diseases to promotion, to Indigenous Australians.’ health professionals. Having more non-communicable diseases,’ he said. Ian said that in order to lock in health Indigenous doctors, nurses and other ‘Signifi cant opportunities for health gains over the longer term there also health workers ‘may well hold the key to gain exist through tobacco control needs to be an emphasis on resolving the making a lasting difference long term,’ programs and health promotion initiatives social determinants underlying Indigenous she said. addressing obesity, but such programs ill-health, such as low employment, poor In his fi rst major speech as NIHEC need to be appropriately resourced. housing, lack of education, discrimination, chair, to the NatStats08 Conference in Increased capacity is required in the social dislocation and disempowerment.
GOVERNANCE, STRUCTURE AND MANAGEMENT 9 5 RESEARCH
Overview
With the CRCAH approaching the end of its • Teasdale Corti – Revitalising Health for the capacity of project team members seven-year lifespan, most of our remaining All: The successful implementation of in developing policy messages, media research projects have either disseminated three Australian project sites, exploring engagement and the like. These activities their fi ndings or will be doing so over the the value of comprehensive primary have included: next 12 months. A major focus of our work health care in Indigenous contexts is to increase the capacity of the Aboriginal in Utopia (Central Australia), at the • Providing writing bursaries for Project and Torres Strait Islander health and Central Australian Aboriginal Congress Leaders to enable them to write up the research workforce, and it is pleasing that in Alice Springs and at the Victorian results of their research in a variety of so many of our projects have witnessed a Aboriginal Health Service in Melbourne. forms. growing involvement by Indigenous people • Adult Literacy Mass Education • Continuing to expand the number of at all levels. Well over half of our funded Workshop: The workshop on adult project summaries and the amount of and in-kind research teams have one or information on our website. more Aboriginal or Torres Strait Islander literacy held in March 2009 supported team members. the need to identify agencies that have • Supporting projects to develop posters the resources and capacity to pilot an for conference presentations, and Throughout the year, ongoing support has adult literacy campaign. been provided for knowledge exchange attending conferences and events to activity as projects near completion, and • Empowerment research: A showcase share fi ndings and build relationships additional funding and support has gone to and workshop held in Cairns in April with others. 2009, and the launch of comprehensive selected projects to increase their impact. • Providing professional writing support to These efforts have resulted in substantial protocols governing research in this projects so they can produce community practical outcomes, including the following area, made a signifi cant contribution reports and other materials. highlights: to the important work being done on empowerment and on spirituality in • Establishing guidelines outlining • ABCD CQI Centre: The launch of the the Social and Emotional Wellbeing National Audit and Best Practice in the process we have developed to Program. Chronic Disease (ABCD) CQI Centre maximise the quality and usefulness (One21seventy) in Brisbane during the • Publications: Eight new reports and of publications from funded projects, annual ABCD meeting in August 2009, discussion papers with important including peer reviewing. fi ndings, analyses, reviews and tools. which will be the culmination of a body • Developing tools to assist research of work spanning a decade. Our focus on research transfer and teams with identifying key messages • Healthy Skin – Galiwin'ku Ivermectin knowledge exchange activities has and targeting audiences, and providing Study: The project team has expanded continued to increase as more research resources such as how to write policy on the successful training program projects release their fi ndings. The team briefs. implemented as part of the East Arnhem approach that we use to develop strategies Healthy Skin Project, training local and identify opportunities for the uptake • Funding multi-media projects, such Aboriginal people to deliver accredited of fi ndings and key messages from projects as DVDs and podcasts, which enable outreach programs on Elcho Island as has been benefi cial, not only in translating fi ndings to be disseminated to a much community workers. results into action but also in increasing wider audience.
Synthesis and bundling of research outputs
The synthesis and bundling of research been produced from programs relevant to Draft results at both program and outputs at both program and programmatic program goals and priorities, what has been programmatic levels will be subject to levels intensifi ed during the year under the learnt (key messages), where there may be ongoing refi nement and development leadership of Barbara Beacham and Dr Alice opportunities for action supporting change, over the coming months, through Program Roughley (consultant) in close collaboration and areas that have been recommended for Leader and stakeholder engagement with Program Managers. The synthesis and further research. workshops to be conducted late in 2009. bundling activity involved identifying and At the programmatic level our objective has Broader knowledge exchange to support drawing together program outputs – key been to synthesise learnings from across adoption of outputs will be promoted messages from research projects, products program areas. This has been achieved by through interactive stakeholder engagement with practical knowledge adoption potential mapping the key messages, those products workshops to support identifi ed optimal and recommendations for action. Broadly, with knowledge adoption potential and any users, customising messages for different the activity aims to support knowledge recommended actions emerging from each users and determining action plans for exchange. program against the framework provided subsequent activity. Program synthesis The objective of the work at the program by the major areas of activity and topics statements will be available on the CRCAH level has been to document what has articulated in the CRCAH Extension Program. website in early 2010.
10 CRCAH Annual Report 2008−2009 National Research Priorities: How we’ve contributed to the National Research Priorities
The CRCAH contributes primarily to the Ageing well, ageing productively Men’s Sheds/Spaces project (CD219) has ‘Promoting and Maintaining Good Health’ One of the biggest challenges in improving also continued to expand. goal of the National Research Priorities Indigenous health is addressing the lower Strengthening Australia’s social and through its work in promoting health and life expectancy of Aboriginal and Torres economic fabric preventing disease among Aboriginal and Strait Islanders and the earlier age at Torres Strait Islander people. The Social Determinants of Health program which they develop chronic conditions that draws together and emphasises the National research priorities relevant lead to poorer health. Health services and signifi cant impact that social and economic to the CRCAH systems that support healthy and productive conditions have on health. The program lives underpin this. The role of quality, thus covers research in areas as diverse as A healthy start to life culturally safe health services in promoting water access and equity, particularly in rural The CRCAH’s Healthy Skin and Chronic improvements in health outcomes, for areas, through to urban experiences of Conditions programs have many projects example, is explored in research such as racism and their impact on SEWB, and the relevant to a healthy start to life with their ‘Improving the Culture of Hospitals’ project effects on health outcomes of poor access focus on child and maternal health. In (CP178) that supports cultural reform in to services. hospitals. particular, research fi ndings show that The CRCAH’s work is also mapped against skin infections and infestations are among Preventive health care the NHMRC’s priorities for Aboriginal health, the most common reasons for children in Diabetes prevention, tobacco control and known as the ‘Road Map’, and the Closing remote communities to present to primary prevention of ear disease are examples the Gap targets developed in 2008. These health care centres, with 70–80% of of key areas of research from the Chronic are shown in Appendix 1. children diagnosed with scabies or skin Conditions program. As well as more than disease before their fi rst birthday. These 40 funded and in-kind Chronic Conditions National Research CRC Research skin infections are linked with serious projects, recognising the critical role of Priorities (%) diseases later in life such as kidney and spirituality in Aboriginal wellbeing has been heart diseases. PROMOTING AND MAINTAINING GOOD a strong message coming out of the SEWB HEALTH: Promoting good health and The ‘Let’s Start’ program (SE213) for program. Empowerment interventions as a preventing disease, particularly among young and older Australians children aged three to seven and their fi rst step in helping people to engage and families has continued to expand into benefi t from health and building capacity A healthy start to life 25% new communities, and received additional programs are also key messages. A number Ageing well, ageing 25% funding as part of the Northern Territory of interventions have been tested, evaluated productively Emergency Response. Many parents report or supported through the CRCAH, including Preventive health care 25% a high degree of satisfaction with the AIMhi (SE63), Family Wellbeing Program program and the resulting improvements in (SE103), Empowerment Measurement Strengthening Australia’s 15% social and economic fabric their children’s behaviour. Tools (SE257), and Let’s Start. Mibbinbah
Putting the Indigenous view on national health reform
When the Australian Government’s National also came out in support of community- signifi cant narrowing of the gap – measured Health and Hospitals Reform Commission controlled health centres and improving by life expectancy – over recent decades.’ (NHHRC) delivered its fi nal report in July primary health care services, which were The CRCAH submission also called for an 2009, its key recommendations in the area among the other main areas addressed increase in identifi cation of Indigenous of Aboriginal and Torres Strait Islander by the CRCAH in its submission entitled clients, culturally secure practice and health matched several of the main issues ‘Bridging the Health Equity Gap’. increased numbers of Indigenous people in raised by the CRCAH in its September 2008 Underpinning the CRCAH’s submission was its the health workforce. submission to the commission. call for recognition of the need to improve However, other CRCAH recommendations In proposing a National Aboriginal and health outcomes for Australia’s Indigenous were overlooked in the NHHRC’s fi nal report. Torres Strait Islander Health Authority to people in light of research fi ndings detailing Among these were the need for action pool government money to provide the their lower life expectancy and higher within the health system to be matched best possible health services for Indigenous burden of chronic conditions compared with by accompanying action on the social people, the NHHRC mirrored the CRCAH’s the rest of the Australian population. determinants of health, such as improving call for ‘health sector funding processes that ‘The ‘health gap’ between Australian education, income and housing for provide clear and measurable incentives Indigenous peoples and the rest of the Aboriginal and Torres Strait Islander people. for the reform of health service delivery Australian population is wider than that The CRCAH intends to continue lobbying for for Indigenous people, both at the primary between Indigenous and non-Indigenous reform in these areas, which are vital for health care and hospital levels’. populations elsewhere in the First World lasting improvements in Indigenous health. The NHHRC, established in February 2008 (Canada, New Zealand and the United To download the full CRCAH submission go to provide advice on practical reforms States),’ the submission stated. ‘Unlike in to:
RESEARCH 11 Comprehensive Primary Health Care, Health Systems and Workforce Program – Overview
The Comprehensive Primary Health Care, • The highlighting by the ‘Overburden’ Publications Health Systems and Workforce (CPHCHSW) project (‘Good Practice in Funding The CPHCHSW Program delivered three and Regulation of PHC services for Program consists of more than 50 projects, reports and a policy brief during the Aboriginal and Torres Strait Islander including eight courses. The 2008–09 year reporting period, including: saw this activity base expanded slightly with People’, CP203) of the undermining the instigation of three new funded projects effect of current overly complex and • Bailie, R., Shibasaki, S. & Sibthorpe, B. focusing on important aspects of system fragmented funding sources and systems 2008, Business Case Supporting the performance: on services’ efforts to reduce the gap in Development and Funding of Beyond Indigenous health and offer alternative 1:21:70 National Centre for Quality • Improving the Identifi cation of relationships. Improvement in Indigenous Primary Aboriginal and Torres Strait Islander Health Care, CRCAH, Darwin. People at Mainstream General Practice Synthesis of research across the (CP313) Margaret Kelaher and Ian program • Lawrence, M. with Dodd, Z., Mohor, S., de Crespigny, C., Power, C. & MacKean, Anderson (UM) In this program, the synthesis of key L. 2009, Improving the Patient Journey: • The Role of Agreements in Health messages from research and identifi cation Achieving Positive Outcomes for Remote Reform in Indigenous Health: of recommendations for action and Aboriginal Cardiac Patients, CRCAH, Understanding Processes and Evaluating products with practical knowledge Darwin. Effectiveness (CP329) Margaret adoption potential has been ongoing • Watson, C. & Harrison, N. 2009 Kelaher (UM) through the year. This synthesis focused on New South Wales Aboriginal Mental three key areas of desired change integral • Building Workforce Capacity to Address Health Worker Trainer Program: to system performance: Complex Health, Housing and Social Implementation Review, CRCAH, Darwin. Inclusion Issues through a Computer i. Improving the effectiveness of (external contract) practices/services. Application Designed to Support • Improving the Journey for Remote Area Decision Making Using Critical Systems ii. Reducing barriers and strengthening Aboriginal Cardiac Patients Travelling Thinking and Practice (CP 111) Janet facilitators to service access and Long Distances to Hospital: Policy Brief. McIntyre and Denise DeVries (FU) utilisation. New in-kind projects The major focus for program activity has iii. Reducing barriers and strengthening been supporting the completion of research facilitators to health system and service A further three new in-kind projects were project activity, knowledge synthesis, capacity and competency improvement, endorsed into the CPHCHSW program: brokerage and transfer. Program outcomes including funding arrangements. • Moving Forward Together in Aboriginal resulting from this activity have been many The results highlight the importance of Women’s Health: Participatory Action and varied, and include the following aspects of good governance, priority setting Research Exploring Knowledge Sharing, highlights: and systems of quality assessment and Working Together and Addressing Issues • Many of the major projects conducted improvement important to system and Collaboratively in Urban Primary Health stakeholder roundtables to review service effectiveness. They also underscore Care Settings (CP 323). Janet Kelly project results and inform further the centrality of better interactions with (FU) development. Aboriginal and Torres Strait Islander people • Developing Training Pathways to Meet to improved service access and utilisation, the Needs of Aboriginal People with • The establishment of the National leading to improved health outcomes. The disabilities (CP 306). Inge Kowanko Centre for Quality Improvement in results of this synthesis will further inform (FU) Primary Health Care (One21seventy) as activity around establishing the research • Stepping UP: Aboriginal and Torres a result of the ABCD project. agenda for the CRC Extension program. Strait Islander Professional Development • The implementation of three user-led Program (CP 316). Douglas Josif (NT research and capacity development Government) projects in Australia as part of the Teasdale Corti ‘Revitalising Health For Publications released in 2008–09 All’ international CPHCHSW project, and the establishment of an international advisory group to the project (see story p31). • The engagement, as a result of activity in the ‘Improving the Culture of Hospitals’ project, of stakeholders at all levels of the acute system (from health service executives to practitioners) in developing skills and understanding the need to support cultural reform in hospitals through continuous quality improvement (CQI) activity.
12 CRCAH Annual Report 2008−2009 Improving hospital culture and patient treatment
Although the main focus of CRCAH activity is the primary health care sector, it has supported two exciting related projects focusing on the acute sector. These projects are contributing to building institutional processes and relationships that support effective understanding, integration and communication through facilitating sustained relationships between hospitals, the Aboriginal and Torres Strait Islander people using the facility, and related services and agencies. The ‘Improving the Culture of Hospitals’ project (CP178) aims to develop a range John Willis, Project Manager for 'Improving the Culture of Hospitals' of resources, tools and guidelines within a quality improvement framework to assist hospitals across Australia implement vital being undertaken in up to 16 sites • Improved discharge planning cultural reforms (including improved across Australia. (transfer of care) and sharing of health information across geographical communication) that will improve the The ‘Improving the Patient Journey’ boundaries, especially in terms of way they provide services to Aboriginal project (CP138) focused on improving cardiac rehabilitation education and and Torres Strait Islander patients in their the journey from primary to acute the management of heart failure. care. Aboriginal and Torres Strait Islander care and home again for Aboriginal patients’ experience is being used as the people from remote locations who • Input into the development of a central reference point for these reforms. are required to travel vast distances to clinical model of care for a Stepdown Key outputs so far include: hospitals for surgery, often with life- facility in metropolitan Adelaide to provide Aboriginal people discharged • Publication of a comprehensive toolkit threatening conditions. The broad aims were to improve quality and safety of from hospital with a safe place for outlining a culturally appropriate CQI recovery. process with accompanying resources, care for remote area Aboriginal cardiac tools and guidelines patients; develop an alternative model of • Stronger linkages and partnerships care for this patient group, based on a between government health agencies • A formal education program for clinical/cultural approach and improved in South Australia and the Northern Aboriginal and Torres Strait Islander Territory, to foster coordination and staff in hospitals, to assist them in coordination and communication; and to accountability across jurisdictions and engaging effectively in conventional determine whether an alternative model the continuum of care. CQI activities. of care enhanced patient outcomes and overall hospital effi ciencies. • Input into the development of a • A national network of Aboriginal and Key outputs so far include: clinical model for the establishment Torres Strait Islander people working of a new Family Wellbeing Centre in in hospitals. • The development of a clinically/ southern Adelaide. culturally appropriate approach to the • A pilot training program for health The project has also drawn support patient journey. service executives, to assist them in from the Australian Nursing Federation, providing leadership around the use of • The establishment of a funded Remote which co-launched with the CRCAH the CQI processes for cultural reform. Nurse Liaison position within the project’s fi nal report at its annual health The project has been enthusiastically Cardiac Unit at Flinders Medical Centre, care forum at Federal Parliament in June received by the sector, with activity Adelaide, to implement the approach. 2009.
RESEARCH 13 Reliable health data is vital to ‘closing the gap’
This is an edited version of an editorial by collections; and inconsistencies in analysis, collect the information, and those about Associate Professor Jane Freemantle from interpretation and ownership of the data whom the data are being collected, as to the University of Melbourne’s Onemda in each jurisdiction. the importance of the accurate collection VicHealth Koori Health Unit, which Prior to 1976, no Australian jurisdiction of information about Indigenous status. appeared in the December 2008 edition separately identifi ed Indigenous people Until this occurs we will never really know Gwalwa Gai. of the CRCAH newsletter in vital statistics or in hospital-based if we have ‘closed the gap’ on Aboriginal A/Professor Freemantle is leading a fi ve- collections. In 1984, the Australian and Torres Strait Islander disadvantage. year project through Onemda, a CRCAH Government initiated moves to identify core partner, to examine the critical issue all Indigenous Australians in births The Australian Bureau of Statistics of health data on Aboriginal and Torres and deaths data collections. By the end has recently recalculated the life Strait Islander people. of 1997, all major vital statistics and expectancy at birth for Aboriginal The catch-cry ‘Close the Gap’ is being hospital-based collections included the and Torres Strait Islander peoples heard throughout the Australian Indigenous status of persons who are following the availability of new data community. Reliable health data about born, die or are admitted to hospital in from its Indigenous Mortality Quality Aboriginal and Torres Strait Islander every State and Territory. However, there Study conducted in 2006–07. This people is vital to this process, for is an acknowledged under-identifi cation suggests that the life expectancy of example, when evaluating policies aimed of Indigenous people in statutory and Australia’s Indigenous peoples is at improving service delivery and health administrative data collections. This 67.2 years for men and 72.9 years status, or in assessing the effectiveness of makes it near-impossible to provide a for women, with the life expectancy programs and interventions. complete and accurate profi le of the of Indigenous men on average 11.5 Currently, Indigenous people are relatively mortality of Australia’s Indigenous people, years lower than for non-Indigenous invisible in health statistics due to major which is of great concern as mortality men and the life expectancy of defi ciencies in the health data describing data is one of the most important ways of Indigenous women on average 9.7 them. These defi ciencies are in part measuring community health. years lower than for non-Indigenous due to: misclassifi cation of Indigenous Improving the accuracy of Indigenous women. This compares with previous people; inconsistencies in the collection, identifi cation in data collections must estimates of an average 17-year life sources, completeness, and classifi cations be achieved at the point of collection, expectancy gap. in statutory and administrative data through better informing both those who
Community controlled health sector crushed by compliance overburden
CRCAH-funded research into funding in the School of Medicine at Flinders primary health care, funding complexity arrangements for Aboriginal community University. is also ineffi cient for government. As a controlled health services (ACCHSs) has result, it does not deliver the control that Over two years Professor Dwyer’s found that the compliance burden is so the current system is designed for, as team has gathered information about high that it is undermining the efforts staff on both sides treat relationships as primary health care funding programs, of the community sector to close the long term despite the short-term funding policies and individual health services’ health inequity gap. In a report to be contracts. Moreover, the compliance performance based on fi nancial reports launched in August 2009, researchers regime is built around a ‘head count’ and interviews with key stakeholders. have found that ACCHSs ‘are funded in approach for each particular condition, more complex ways, and from more ‘In one case an Aboriginal health service rather than treating the whole person sources, than most other health care operating in a remote area was funded regardless of the conditions with which organisations of equivalent size’. from 42 different buckets of money they may present. and all of these required separate ‘The time that goes into preparing and The Overburden researchers applications and reporting requirements,’ processing reports is out of proportion have recommended that funding Professor Dwyer says. ‘Some of these with the funding levels,’ the researchers arrangements be single, main, long- grants were as low as $1000. It’s not say. The ‘Overburden Project – Funding term contracts, with simplifi ed but hard to imagine how accounting and and Regulation of Primary Health Care holistic data collection, monitoring reporting on this multitude of grants is for Aboriginal and Torres Strait Islander and reporting. For more information a waste of precious health resources.’ People’ (CP203) is led by Professor on the Overburden project and its Judith Dwyer, who heads up the As well as impacting on the ability of recommendations, visit:
14 CRCAH Annual Report 2008−2009 Chronic Conditions Program - Overview
The Chronic Conditions Program is the Professor Joan Cunningham and the the reasons why Aboriginal people stop CRCAH’s second largest research program, project team concluded that both primary and start smoking2. It found that family with 32 in-kind and 11 funded projects. prevention and better management of members were not only important in Approximately three-quarters of these known risk factors and existing disease are people’s decision to take up smoking, but projects have now completed the research urgently required. also important to why Aboriginal smokers component of their activity. Work continues Researchers have completed the research fi nally chose to stop smoking. For further to ensure that key fi ndings from all of component of the project and now have information visit:
1. Australian Bureau of Statistics (ABS) 2006, National Aboriginal and Torres Strait Islander Health Survey, Australia, 2004–05, ABS Catalogue No. 4715.0, ABS, Canberra. 2. Johnston, V. & Thomas, D. P. 2008, ‘Smoking Behaviors in a Remote Australian Indigenous Community: The infl uence of family and other factors’, Soc.Sci.Med., vol. 67, no. 11, pp. 1708–16. 3. Lehmann, D., Tennant, M., Silva, D., McAullay, D., Lanigan, F., Coates, H. & Stanley, F. 2003, ‘Benefi ts of Swimming Pools in Two Remote Aboriginal Communities in Western Australia: Intervention study’, British Medical Journal, vol. 327, 23 August, pp. 415–19.
RESEARCH 15 AHCSA partnership takes root and fl ourishes
One of the CRCAH’s core roles is to engage Convocation in Darwin,’ Alwin says. ‘AHCSA – Project Offi cer, Sector Translation and in effective development activities with thought it was an ideal opportunity to Research Support. The aim of this position Aboriginal communities and service source new research partners that could is to support AHCSA and the Aboriginal providers, and in South Australia we secure funding and work successfully with community controlled health sector in SA have been assisting the Aboriginal Health Aboriginal communities in SA.’ to build their research capacity, so they Council of South Australia Inc. (AHCSA) ‘An example of my involvement with can develop the internal ability to engage to engage more closely with the research the CRCAH was a funded project to effectively with external researchers. community. evaluate the Royal Adelaide Hospital ‘This arrangement will allow the AHCSA is the peak Aboriginal community (RAH) Aboriginal and Torres Strait Research Offi cer to gain invaluable access controlled body representing Aboriginal Islander Action Plan, which had been to CRCAH training opportunities and health, substance misuse services, and implemented two years earlier. ‘Mapping networks,’ Alwin says. ‘This partnership Aboriginal health advisory committees the Journey’ was a partnership between has the potential to connect community in SA. As with many other Aboriginal AHCSA, the RAH and the CRCAH. This priorities with highly qualifi ed and skilled organisations working in the health project represented a sub-project within researchers – the outcome being highly sector, AHCSA has made a decision to the broader scope of CRCAH work known creditable research that brings great become more directly involved with as ‘Improving the Culture of Hospitals’ benefi ts to the communities.’ research activities to ensure that research (CP178) overseen by Russell Renhard. priorities are aligned with Aboriginal This led to me being invited onto Russell’s Most recently Alwin was invited as an people’s needs. research team, which uses the CQI process industry partner to the recent CRCAH re- bid interview, which clearly spelt out the In 2003, AHCSA, in partnership with to encourage systemic changes within organisation’s 2009–14 research agenda. Flinders University, won a NHMRC fi ve- hospitals.’ year grant for the fi rst CCRE (Centre of The CCRE is now at the end of its ‘We successfully argued that the research Clinical Research Excellence) focusing lifespan and is currently transferring its agenda would address priorities identifi ed on Aboriginal and Torres Strait Islander learnings to a broader audience. With through an analysis of the Indigenous Australians. A main aim of the CCRE has the CRCAH’s backing, the CCRE has been burden of disease and injury and the been to build the research capacity of the able to support AHCSA with the delivery needs of end-users in the Aboriginal health sector, and translate learnings into of Certifi cate IV in Indigenous Research health sector,’ Alwin says. ‘Spending relevant policies and practices. The CRCAH Capacity Building, 2009 and 2010; two days with several key CRCAH staff has provided in-kind support to the CCRE in publishing and disseminating three and members was an amazing learning for these activities (Project No. CD99). publications – CCRE Achievements Report, experience for me. Alwin Chong is AHCSA’s Senior Research Mapping the Journey, CCRE Fact Sheet ‘Our growing partnership should result and Ethics Offi cer and has been a key (www.ahcsa.org.au/content/clinical- in a greater presence for the CRCAH in driver in the development of AHCSA’s research); and with media launches. SA through the Aboriginal community relationship with the CRCAH. The CRCAH has also recently provided controlled health sector. This is very ‘I fi rst got involved with the CRCAH in AHCSA with a writing bursary to develop exciting and I’m looking forward to doing 2003 when I was invited to a CRCAH a proposal for a new research position great things with the CRCAH in the future.’
Early momentum in budding nutrition research program
The CRCAH has identifi ed nutrition as of a Mainstream Childhood Obesity (ewba) community programs, which an area where targeted research should Prevention Program to Aboriginal promote the benefi ts of being a healthy yield signifi cant improvements in the People’ in-kind project (CD321) is led weight to children and their families, and health of Aboriginal and Torres Strait by Annabelle Wilson, a PhD student at whether the programs can be transferred Islander people, and as a result we plan Flinders University. and adapted for use by Aboriginal people. to increase our focus on this area during ‘There are only a few examples of obesity CRCAH in-kind support has provided the fi ve years of our Extension research prevention programs with children Annabelle with opportunities for agenda under our new Healthy Start, from Indigenous and different cultural networking and expert advice, and in Healthy Life program. groups around the world,’ she says. ‘This August 2009 supported her attendance at Already we have begun identifying is disappointing, considering that the the Nutrition Roundtable that the CRCAH nutrition-related research projects for prevalence of overweight and obesity in hosted in conjunction with the CSIRO. both fi nancial and in-kind assistance, with Aboriginal Australians is high, and that, ‘What I liked about the Roundtable was one of the fi rst such projects looking at as a single risk factor, high body mass is a that it gave some of the Aboriginal people the possibility of adapting mainstream leading cause of illness and injury.’ I have been working with a chance to childhood obesity programs to an The project is investigating the have a say and promote their work on a Aboriginal context. The ‘Transferability effectiveness of SA’s eat well be active much larger scale.’
16 CRCAH Annual Report 2008−2009 Healthy Skin Program – Overview
The World Health Organization has • Delivery of Certifi cate 2 in Indigenous estimated that there are in excess of 111 Child Health Research (HS331) million children worldwide who have skin • A Handbook of Skin Conditions in sores and that many of them will also have Aboriginal Populations of Australia scabies. These children generally live in (HS285) situations of socioeconomic disadvantage that result in overcrowding and poor access With the completion of seven projects, a to health hardware for both hygiene and strong body of work with clear and key health care. In such circumstances these messages has emerged from the Healthy infections are often under-recognised, and Skin program. Over the past few years certainly undertreated, and the potential considerable effort has been put into morbidity and mortality from their ensuring that lessons learnt from these sequelae are under-appreciated. projects will be used to guide changes in Along with children in the Pacifi c region, practice, and/or inform the development Aboriginal and Torres Strait Islander of policy to improve the health status children generally have the highest of Aboriginal and Torres Strait Islander reported prevalence of skin sores people. This is not a one-off process: (often 40–90 per cent within individual ongoing surveillance of current research communities) as well as the highest is required to ensure that clinical practice prevalence of scabies (often 50–80 per guidelines, such as the CARPA Manual and cent). Although these skin conditions are a information provided to inform policy, is part of everyday life for many Indigenous current and best practice. Flipchart: Recognising & Treating Skin Australian children living in remote Conditions communities, they are now rare in the Spreading the word on skin disease The fl ipchart contains photographs of skin broader Australian population. During 2008–09 Healthy Skin Project conditions and is a valuable resource for Too often, these common childhood skin Leaders and the CRCAH have updated AHWs, health practitioners and community disorders are considered to be merely of resources about the impact of skin workers to improve the recognition and nuisance value. In reality, they are among conditions on Aboriginal and Torres Strait treatment of skin conditions. It is designed the most common reasons for children in Islander communities throughout Australia, for a primary health care setting, where a remote communities to present to primary with the objective of supporting health community worker can sit with a patient health care centres. New research shows services and practitioners to recognise and or group of patients to assist with early this begins within the fi rst months of life, treat skin conditions. These resources went diagnosis. with 70–80 per cent of children diagnosed through a lengthy quality assurance process. with scabies or skin disease before they are one year old. In addition, skin infections The resulting Healthy Skin packages may lead to serious complications, – incorporating an up-to-date policy including sepsis, kidney disease and heart brief, the East Arnhem Regional Healthy disease. As a result, the rates of acute and Skin Project: Final Report 2008 and chronic kidney and heart diseases among the fl ipchart Recognising & Treating Indigenous Australian adults are the highest Skin Conditions to support the work of reported in the world. Aboriginal Health Workers (AHWs) and health practitioners – have recently been The Healthy Skin program is made up disseminated to the education sector, of eight research projects (in-kind and funded): government, the community controlled sector and other organisations providing • Filling the Gaps (HS164) health services to Aboriginal and Torres • East Arnhem Healthy Skin (HS41) Strait Islander people.
• Wuchopperen Skin Study (HS197) Policy brief • Research Toward Vaccines for Tropical The policy brief incorporates key fi ndings Health (HS140) from many years of work by researchers • Investigation of Immune Responses in and health practitioners within the Menzies Mice Administered a Vaccine Designed to School of Health Research, the Queensland Prevent Group A Streptococcal Infections Institute of Medical Research and the and Its Associated Diseases Rheumatic Murdoch Childrens Research Institute at the Fever and Heart Disease (HS124) University of Melbourne. Key messages from • Facilitated Development of a Research the research highlighted what worked, Project Proposal to Control Scabies and what didn’t work and recommendations Strongyloidiasis at Galiwinku (HS315) for action.
RESEARCH 17 Knowledge exchange Skin infections are a signifi cant cause of Galiwin’ku signs up for landmark scabies drug trial morbidity in disadvantaged settings around the world, and Healthy Skin researchers The CRCAH’s Healthy Skin program has the year by dedicated community have been working to transfer knowledge made impressive gains over the past workers, there was no discernible impact about their research at an international four years in reducing the incidence against scabies prevalence. level by holding preliminary discussions and severity of skin sores in remote with international collaborators on the Overseas research suggested that the Aboriginal communities in the NT’s East role of ivermectin in the control of scabies. drug ivermectin had the potential to Arnhem region. However, the rate of Four articles have also been published or be effective against both scabies and infestations by the scabies mite remains accepted for publication, and these can be unacceptably high, particularly in strongyloidiasis in remote communities, found at:
18 CRCAH Annual Report 2008−2009 Social Determinants of Health Program – Overview
Over the past year signifi cant work has ‘The SDOH plan has only really been in working in mainstream health delivery been undertaken to consolidate the Social operation for two years,’ Alice says. ‘The services were not suffered by those in Galiwin’ku signs up for landmark scabies drug trial Determinants of Health (SDOH) Program. outcomes and topics are many. Expectations ACCHOs. To alleviate the worst effects of A review of SDOH projects was undertaken are very great for a program with a small the stressors, the study recommended by Dr Alice Roughly, Visiting Fellow for budget.’ giving more autonomy to Aboriginal Health the National Centre for Epidemiology ‘Under the CRCAH there appears to have Workers and employing more Aboriginal and Populations Health at the Australian been a greater emphasis on practical workers in mainstream services. National University, with a view to research outcomes with projects such as Aboriginal and Torres Strait Islander consolidating the work undertaken by the the SDOH textbook and short course and CRCAH and its predecessor the CRCATH. the suite of empowerment projects. CRCAH Urban Location and Health Project (SD142 IK) Alice found that a key outcome of the SDOH projects have focused largely on CRCAH’s portfolio of SDOH research is the developing the theoretical underpinnings Gilbert Gallaher (Flinders University) collaboration now occurring between of the SDOH and bringing together a This project focused on Aboriginal and Aboriginal communities, many of community of practice around the social Torres Strait Islander people living in Australia’s leading scientists from across determinants of health.’ urban areas of Adelaide. With little known diverse disciplines, and State/Territory Many of the current SDOH projects have about Indigenous people’s experience of and national government departments. concluded during the reporting period, and urban life, social capital and racism, this This collaboration is leading to shared a number have moved into active research project aimed to contribute to the paucity understandings about social determinants transfer phase. Among these, the Aboriginal of the literature in this area. The study and integrated actions and solutions Voice and Vision Project and the Aboriginal found that Aboriginal and Torres Strait to health challenges in Aboriginal and Torres Strait Islander Urban Location Islander people living in urban Adelaide communities. and Health Project have been the main were active participants in community These understandings include how to highlights. groups, had strong connections to family work with Aboriginal communities, and friends, were keen to have a positive Aboriginal Voice and Vision: neighbourhood environment and were the health issues that confront them, Aboriginal Women’s Experience of generally well integrated in their local and their capacity for participation in Working in the Victorian Health communities. health planning, strategy setting, policy System (SD317IK) development and on-ground activities. However, levels of trust in institutions and Through investing, commissioning and Pranee Liamputong and Alice Wilkins (La Trobe University) people in Australia were substantially lower coordinating 34 social determinants of among study participants compared with There has been little information about health projects, Alice found that the CRCAH levels reported by non-Indigenous people the experience of Aboriginal women has: in a companion study. It is likely that the working in the Victorian health care system. • Brought together a research and This project aimed to uncover barriers lower levels of trust among Indigenous practice community around the social and enablers impacting on the work of people are strongly related to the high determinants of health. Aboriginal women in the Victorian health levels of racism reported, with 93 per cent • Generated a level of awareness on care system, and how they managed these of participants experiencing racism at least SDOH. barriers and enablers within themselves, sometimes and two-thirds experiencing with their colleagues, with their patients, it often. Experience of racism was also • Generated a body of SDOH knowledge within their community and as part of the associated with poorer health outcomes. and captured, communicated and or health system. published it to increase its accessibility This fi nding suggests that the signifi cant to target audiences. The study found that although all the study role of racism in the lives and health of participants suffered from stress related to urban-dwelling Indigenous people be • Achieved many intermediate level their working lives, participants’ levels of explicitly considered in health research program outcomes and is on a pathway stress depended on whether they worked on Aboriginal people. The project’s fi nal to achieving longer term program in a mainstream health delivery service or report has been widely disseminated to a outcomes. in an Aboriginal Community Controlled broad range of organisations and feedback • Covered many SDOH topics in line with Health Organisation (ACCHO). Many of the indicates that it is being used in project program outcome areas. stressors experienced by the participants planning and also university teaching.
RESEARCH 19 Adult literacy campaign ten years in the making
A workshop in Alice Springs hosted by Previous research undertaken by The workshop in April 2009 reviewed the the CRCAH in April 2009 has built on its the CRCAH and its predecessor in research done to date before looking at previous work in this area to set a clear collaboration with the NT community- the structure, coordination, methodology agenda for the development, research controlled Aboriginal health sector and impact of specifi c national literacy and evaluation of a pilot adult literacy used international studies of the campaigns conducted in a variety of campaign among Aboriginal and Torres linkages between adult literacy and countries, including Granada in the 1980s Strait Islander people. The workshop health development to argue for such and in Timor-Leste since 2007. The formed an Aboriginal steering committee an intervention. In 2004, the Central extent of illiteracy in the Aboriginal adult for the project – ‘Adult Education for Australian Aboriginal Congress presented population was also canvassed, as was Critical Literacy’ (SD309) – backed up by fi ndings from this earlier work at the the impact that this has on the capacity a technical sub-committee with expertise CRCAH's Social Determinants of Health of individuals and communities to take in specifi c areas to help plan and develop workshop, and put forward options for a control of their health development. A the next pre-campaign phase over the more detailed study of the role of adult report on the workshop proceedings is in next 12–18 months. literacy in health development. preparation for publication in early 2010.
Profi le – Gilbert Gallaher
I have always been interested in the way Torres Strait Islander people who worked Gilbert Gallaher social categories are constructed, how on the project – two research assistants these categories result in groups of people and one administration support person. who are oppressed or marginalised, and Although this study looked at many things, how this process impacts on individuals’ perhaps the most signifi cant fi ndings health. This interest stems from my own are those that relate to increasing our personal and professional experiences understanding of the impacts of racism both as an Aboriginal man and as a gay on Aboriginal people living in urban man growing up in rural Queensland. environments, and the need to create an When the opportunity to work on the Aboriginal environment for everyone. This ‘Aboriginal and Torres Strait Islander policy recommendation was originally Urban Location and Health Project’ came put forward by a community member along, it was one that I couldn’t resist – as ‘Aboriginal-eyes-ing spaces’ and I saw mainly because little research had been this as an essential step in recognising done on the experiences of Aboriginal and honouring Aboriginal approaches to people living in urban environments policy development. There are a couple of and how such experiences impact on reasons for this: it provides ownership of health. Another key drawcard for me policy recommendations to the Aboriginal was that the project also employed other people who live in Adelaide, and it allows Aboriginal and Torres Strait Islander for acknowledgment and recognition of researchers. the diversity of ways in which Aboriginality completed his Doctorate in Public Health is expressed in urban contexts. The fact that I was appointed as the at Flinders University where he studied project’s manager was a real honour and Gilbert Gallaher is a Murri who has the health impacts of internalised racism. I was very proud to represent my mob. I worked in a variety of clinical settings as a Gilbert currently lives in Toronto, Canada, would say that this would be a sentiment registered nurse. He has a Masters degree where he holds a post-doctoral fellowship shared by the other three Aboriginal and in Primary Health Care, and in 2008 in Inner-City Health Research.
20 CRCAH Annual Report 2008−2009 Social and Emotional Wellbeing Program – Overview
During the reporting period the Social and towards each other, towards themselves, to review, further explore and ensure Emotional Wellbeing (SEWB) program and towards those less powerful than that lateral violence issues within the focused heavily on knowledge exchange as themselves. Lateral violence occurs department are being addressed. it moves into the fi nal phase of research worldwide in all minorities and particularly activity associated with the current CRCAH. Indigenous peoples where its roots lie in VACCHO to produce local lateral The SEWB program has also started colonisation, oppression, intergenerational violence DVD planning its future into the Extension CRC trauma and ongoing experiences of racism Since 2006 the CRCAH has been program, which is due to run until 2014. and discrimination. distributing within Australia a DVD on The SEWB program is conducting a A pilot workshop was held in Adelaide lateral violence produced by Canada’s synthesis of its entire suite of research on 30 April–1 May 2009 to develop an Native Counseling Services of Alberta work to group its messages and Australian version of Canada’s Lateral (NCSA), as well as organising workshops recommendations into key themes. Violence program, including a ‘train to start a community discussion around This process has two main aims: fi rstly, the trainer’ program. The workshop dealing with the destructive results of outcomes from the synthesis will inform the was organised by the Lateral Violence lateral violence. This arrangement was put Community Feedback workshop scheduled subcommittee, which was established as a in place following a CRCAH-hosted visit for later in 2009; and secondly, synthesis result of the 2007 CRCAH-facilitated Lateral to Australia in February 2006 by two key outcomes will support the transfer of SEWB Violence Roundtable. Canadian Aboriginal health activists, Allen research fi ndings into the new program and Patti Benson of the NCSA. The pilot workshop was facilitated by areas within the Extension CRC program. Interest in the DVD has been overwhelming, CRCAH CEO Mick Gooda and Yvonne Clark, with Indigenous community leaders lecturer and psychologist at the University SEWB Workshop in Cairns: Strategic across the country asking for an Australian of Adelaide, with writer Valerie Cooms Support for Strengthening Research version of the DVD and a more structured (a Murri PhD student at AIATSIS) also (SE257) approach to the workshop. These in attendance as the reviewer and course suggestions are being acted on, with the In April 2009 those interested in the writer. All nine participants were South Victorian Department of Justice funding the substantial body of CRCAH-funded research Australian government employees from a Victorian Aboriginal Community Controlled work collectively called the ‘Empowerment single department, primarily in leadership Program’ gathered in Cairns to participate Health Organisation (VACCHO) to begin roles. in two workshops aimed at addressing two production of a local DVD. In an exciting specifi c challenges: The workshop’s main aims were to: development VACCHO has secured the services of award-winning Indigenous fi lm • To provide clearer articulation and • explain and demonstrate an maker Richard Frankland to direct the fi lm more rigorous demonstration of the understanding of lateral violence and here. benefi ts of the Family Wellbeing the surrounding issues; and Program, which needs to be measured • identify strategies to successfully deal Publications via a metasynthesis process to ‘harvest’ with lateral violence. key learnings and outcomes from the Two discussion papers developed within process across settings. Within the workshop, participants were the SEWB program have been launched able to come up with a number of their and are available on the CRCAH website, • To evaluate progress and provide advice own resolutions and strategies within with further publications currently with the for the next steps of the Empowerment the context of their work environment. editors. Both discussion papers are part of Program, including the development of The course was formally evaluated with a developing body of work that explores ‘tools’ to measure program outcomes. a favourable outcome. There will be a Aboriginal and Torres Strait Islander Approximately 200 people attended 'refresher day' with the initial participants notions of spirituality and wellbeing. ‘The Showcase – Linking Measures of Empowerment with Indicators of Health and Social Change, Progress, Critical Challenges and Opportunities in Empowerment Research’, which also included presentations from the AIMhi and Let’s Start projects. ‘The Measuring Empowerment – Progress and Critical Challenges and Opportunities’ (the tools workshop) brought together key stakeholders and specialists, and was facilitated by CRCAH CEO Mick Gooda and Project Leader Dr Melissa Haswell. Lateral Violence workshop Lateral violence describes the way people Mick Gooda and in positions of powerlessness, covertly or Yvonne Clark at the workshop overtly direct their dissatisfaction inward
RESEARCH 21 The Role of Spirituality in Social and partnerships between the researchers and in Developing Community Capacity in Emotional Wellbeing Initiatives: The the community, as well as the core values Indigenous Organisations (IK291SE) Family Wellbeing Program at Yarrabah of collaborative research. Scott Davis (MSHR) (CRCAH Discussion Paper No. 7) was developed and written as part of an in-kind New in-kind projects • Family Therapy Training for Aboriginal Child & Family Workers in Communities project. Research Dancing: Refl ections Several in-kind projects were accepted on the Relationships between University- within this program area and include: (IK333SE) Kerry Proctor (La Trobe) based Researchers and Community-based • Stories of Hope and Resilience: Using Researchers at Gurriny Yealamucka Health • Indigenous Community Capacity Services Aboriginal Corporation, Yarrabah Development for Better Health: New Media and Storytelling to Facilitate (CRCAH Discussion Paper No. 8) was The Role of Aboriginal Community ‘Wellness’ in Indigenous Communities funded as a way of highlighting both the Controlled Primary Health Care Services (IK305SE) Samia Goudie (UQ)
Workshop nets worldwide audience
An Aboriginal and Torres Strait Islander Aboriginal and Islander Health Council promotion practice. This report will soon health workshop co-hosted by the CRCAH (QAIHC) as part of the 2008 Population be made available on the websites of on 6 July 2008 in Brisbane has provided Health Congress. It aimed to consolidate IUHPE and AHPA, and a commentary the opportunity for the Social and recent success stories and innovations about the workshop published in the Emotional Wellbeing (SEWB) Program’s occurring in Indigenous health by IUHPE journal Global Health Promotion research to be shared with a wider identifying success factors critical to (http://ghp.sagepub.com) to call international audience. informing future health service delivery attention both to the issues and to the and policy. The workshop, entitled ‘Success Stories: online document. Environmental, Social, Emotional & A workshop report has since been Spiritual Health of Aboriginal and produced in draft form and contains Contributions to the workshop will also Torres Strait Islanders’, was organised detailed case studies and brief reports be at the heart of a more substantial in collaboration with the International that were presented, discussed and document (under preparation) that will Union of Health Promotion and Education documented. Additionally, the carefully be published as an Indigenous chapter in (IUHPE), the Australian Health Promotion planned workshop process is summarised the IUHPE monograph Global Program on Association (AHPA) and the Queensland as an example of successful quality health Health Promotion Effectiveness.
Mibbinbah comes of age
The ‘Mibbinbah Men’s Spaces’ project ‘We’ve had great support from the CRCAH, ‘We’re working with a local registered (CD219) crossed a signifi cant threshold which funded the establishment of our training organisation called SAILS Inc. to in March 2009 when it launched a new new corporate structure, and we are develop fully certifi ed training modules health promotion company, Mibbinbah confi dent of the continued backing of in Aboriginal Men’s Health, and we are Ltd, as the vehicle to take its work into our major supporters Beyondblue and La looking forward to holding a training the future beyond the expiry of CRCAH Trobe University,’ he says. workshop in November 2009 to identify funding in May 2010. how best to do this,’ Jack says. During the reporting period Mibbinbah The Gold Coast-based company has been also continued its evolution as a training For more information about Mibbinbah, set up as a charity and aims to secure organisation. A third round of training for visit:
22 CRCAH Annual Report 2008−2009 Research Collaborations – Overview
A key strength of the CRCAH continues to The CSIRO approached the CRCAH for Tobacco Control and the Cape York be its ability to develop strong collaborative support with community engagement Institute (see story below), to increase relationships with its partners and other around nutrition, and since then the CRCAH the implementation and evaluation of stakeholders throughout Australia and also has been working with the peak research best-practice smoking interventions in internationally. The value placed by our body in planning a national Indigenous Indigenous communities. stakeholders on the CRCAH’s impartiality roundtable on nutrition and preventative The CRCAH has also continued to assist is one of the contributing factors to our health for August 2009. researchers and non-partner organisations success, along with a genuine philosophy With tobacco being the leading factor with an interest in improving Indigenous of working together and creating contributing to disease and death among prisoner health, and our support for opportunities for new interactions. Indigenous Australians, the CRCAH is Associate Professor Tony Butler and his The CRCAH has continued to expand also engaged with, and supportive of, team is one such example where informal its collaborations with non-partner organisations such as Maari Ma, the assistance can lead to great rewards (see organisations during the reporting period. Centre for Excellence in Indigenous story below).
Prisoner Roundtable paves Helping Cape York smokers kick the habit way for $2.3m research grant The Cape York Institute (CYI), based in Following on from the CEITC and CRCAH- Cairns, has been working on the early facilitated National Indigenous Tobacco development of a series of innovative Control Research Roundtable, held in May The assistance of the CRCAH has strategies to reduce smoking rates in helped pave the way for the awarding 2008, the CYI identifi ed a need to build four Aboriginal communities located of a $2.3 million NHMRC Capacity its organisation’s capacity and knowledge in Far North Queensland’s Cape York Building Grant to Curtin University’s in the area of tobacco control. As a region. The strategies aim to change Associate Professor Tony Butler to result, the CRCAH organised a roundtable individual behaviour by offering 'near conduct research in the area of on 5 August 2008 to bring together staff term' rewards and building networks Aboriginal prisoner health. from CYI with key experts on Indigenous of non-smokers. The ultimate goal of tobacco control and Aboriginal health. Tony’s project, ‘From Broome to these strategies is to build a consensus Berrima: Building Australia-wide in communities that smoking is both Since the roundtable the CRCAH has Research Capacity in Indigenous damaging and a non-acceptable supported the CYI through providing Offender Health and Health Care behaviour – a social norm already a fi nancial grant to fund a researcher Delivery’, was developed as a result achieved in many other parts of to further develop the strategies into of the November 2007 Aboriginal Australia. a research proposal. The proposal Prisoner Health Roundtable co-hosted The CRCAH and the Centre for Excellence outlines three stages: fi rstly, to establish by the CRCAH, the Australian Institute in Indigenous Tobacco Control (CEITC) baseline data and commence community for Aboriginal and Torres Strait have been involved in the early education campaigns; secondly, to focus Islander Studies and the Public Health development of these strategies and have on teenagers and family members as Association of Australia. supported the development of these change agents; and, thirdly, to enforce From its inception, the impetus for ideas into a research proposal. This is the idea that smoking in homes around this project has come directly from driven by the fact that smoking is the children is unacceptable. The three Indigenous community members. single biggest contributing factor to the stages of the strategy will build on each Following the roundtable, it was life expectancy gap between Indigenous other and link together to form an agreed that the area of Indigenous and non-Indigenous Australians. Fifty-one integrated and comprehensive approach offender health had been neglected per cent of Indigenous people smoke to combat smoking. and a decision was made to develop compared to a 17 per cent rate across a proposal for an NHMRC grant the general Australian population, so The research proposal has been around an Australia-wide approach to clearly there is potential to achieve submitted to a funding body and the improving research outcomes in this signifi cant health gain through behaviour CYI is awaiting advice on whether the area. The grant, which was announced modifi cation. research will be funded. in December 2008, will develop much-needed capacity in Indigenous offender health research, building a team of Indigenous researchers and creating an Australia-wide network for sharing knowledge in this fi eld.
RESEARCH 23
Commercialisation and Utilisation – Overview
Utilisation highlights each project, and each of the fi ve program to all Area Health Services in NSW to areas. This process represents an important support the expansion of the Aboriginal The CRCAH’s approach to the development strategic mechanism in enabling systematic Mental Health Worker Training Program. of research, and the applied nature of and tactical identifi cation of outputs with The review supports the implementation much of our research, means that there major benefi ts for our commercialisation and management of the program by is often signifi cant uptake into policy and and utilisation activities, which are a key documenting sound practices, challenges practice well before the completion of focus for us now as we move into the fi nal and solutions experienced by Area a project. As reported last year, one of year of our current research program. In Health Services with regard to workplace the most impressive examples of this is particular, it will help us provide others preparation, recruitment, training and the Audit and Best Practice in Chronic with greatly improved access to our range support for Aboriginal Mental Health Conditions (ABCD) project (CP104). of products and outputs, such as research Worker Trainees. Over the past decade, the ABCD project has recommendations, frameworks and tools; worked with almost 100 primary health resources such as fl ipcharts, DVDs and Conduct of evaluation work in services across Australia to help them reports; and courses and consultancy partnership with MSHR research improve their management of chronic services. teams disease issues for Aboriginal and Torres The CRCAH evaluators teamed up with Strait Islander communities. Men’s Places on the move researchers at Menzies School of Health The CRCAH has also built up a successful The three-year ‘Mibbinbah – Men’s Places’ Research (MSHR) to undertake evaluation commercial consulting arm, whose project (CD219) has yet to fi nish but and planning activities including: evaluation expertise adds value to other already it has spawned a new health • development of a monitoring plan for organisations’ programs around Australia. promotion charity, Mibbinbah Ltd, which the Australian Nurse Family Partnership A separate report on this consulting work is was launched in March 2009 (see story Program; and contained within this section. p22). The project focuses on bringing Indigenous men together in a safe place to • evaluation of the Australian Red One21seventy – New spin-off company talk about ways of supporting each other Cross Breakfast Program in remote from ABCD project and to improve the health and wellbeing of communities throughout the Northern The National Centre for Quality their communities. Territory. Improvement in Indigenous Primary Care: Ultimately, the idea is to help make both This work is ongoing. One21seventy is the spin-off company Indigenous and non-Indigenous societies being developed to continue the success a healthier and more secure place for Support for the Bourke NSW Housing of the ABCD project beyond its life as a Indigenous men, women and children. and Supported Accommodation research project. This new CQI centre, to The project already runs programs at six Program be launched in August 2009, will give sites along the east coast and in Darwin, The CRCAH is documenting the comprehensive support for Aboriginal and and project leaders Jack Bulman and Rick development and implementation of an Torres Strait Islander health centres to Hayes see the new entity as ensuring these innovative model of service delivery and provide high-quality primary health care. programs continue to expand and attract coordination of housing and mental health One21seventy will be a non-profi t fresh funding beyond the life of the current and support services in Bourke, New South organisation set up with the support of project. Wales. The program involves the Greater the CRCAH and Menzies School of Health Western Area Health Service, Richmond Research, a CRCAH partner, providing External Projects - Overview Fellowship, NSW Housing Offi ce, and services on a cost-recovery basis. The In 2008–09 the CRCAH commercial government and non-government agencies name One21seventy refl ects the Centre’s arm operating as AHCIP Ltd undertook working in partnership to implement aspiration to increase life expectancy for and sponsored a range of contractual an innovative model that will provide Indigenous people beyond One in infancy, work that supported CRCAH research more effective and culturally relevant beyond 21 in children and young adults, and development activities. The CRCAH accommodation and community living and beyond seventy in the lifespan. external projects staff also helped the support to people with a mental health CRCAH develop its future planning activities. illness or disability. Bundling research outcomes for External contracts managed through the better utilisation AHCIP in 2008–09 are listed below. Evaluating the impact of, and The body of research arising from the outcomes from, CRCAH research and investment and effort of the CRCAH and Publication of NSW Aboriginal Mental development activity its partners provides a signifi cant legacy of Health Worker Training Program: The CRCAH external contract team is knowledge, approaches and tools for future Implementation Review managing the external evaluation of the generations of researchers and health In January 2009, the CRCAH funded and CRCAH’s research and development activity. professionals. As reported earlier in this published the New South Wales Aboriginal The evaluation is being undertaken by Annual Report (see story p10), the CRCAH Mental Health Worker Training Program: La Trobe University in Melbourne. The has been identifying and synthesising the Implementation Review in partnership evaluation commenced in March 2009 and key messages and research outputs from with NSW Health. It has been distributed will be completed by June 2010.
24 CRCAH Annual Report 2008−2009 CRCAH research program to yield $455m benefi t, forecaster fi nds
Over the next 15 years, the CRC for To cite just one example from the Healthy ‘If national smoking levels have fallen Aboriginal Health's research program is Start, Healthy Life Program, the CRCAH by 4.3 per cent in 14 years due to Quit likely to return more than $6 in benefi ts is proposing to fund the development of campaigns, then the National Indigenous for every $1 invested, resulting in a net a monitoring framework to look at the Tobacco Control Program should be able benefi t of $455 million. effectiveness of the National Indigenous to produce a 4.6 per cent [reduction in Tobacco Control Program. This would That’s the outcome of an economic Indigenous smoking] over the 15-year evaluate local programs to reduce benefi t timeframe,’ the report states. evaluation by respected forecaster smoking, record the evidence of what Access Economics of the CRCAH’s works, bring that evidence together from Access Economics then used a number proposed research program, which we sites around the country, and make sense of economic concepts to calculate the commissioned as part of our successful of it to inform future tobacco control dollar value of the health gains likely to bid for a further fi ve years of funding programs. Access Economics found that fl ow from this projected reduction. This from the Commonwealth’s Cooperative 25 per cent of the benefi t should be showed a $532.5 million benefi t from Research Centres Program through to the attributed to the work of the CRCAH. health gain alone, with a further $80.4 year 2014. The evaluation looked at what Access Economics then looked at what million in savings from productivity gains results could reasonably be expected if might be a realistic outcome of improved and other resources saved. Twenty-fi ve the tools and resources produced by each anti-smoking campaigns within the 15- per cent of this gain, or $153.2 million, of the CRCAH's three proposed research year timeframe set by the CRC Program could be attributed to the role played by programs were put into use. for the measurement of outcomes. the CRCAH.
Action research with Family Relationship Centres
During 2008–09 the CRCAH provided non-Indigenous community members. The • An improvement in the effectiveness of research support to the Darwin-based FRC Darwin sought specifi c support from the service pathway for clients. Family Relationship Centre (FRC) the CRCAH to establish an action research • An ongoing project to ensure that for its action research program. The process within its organisation to assist Australian Government established with service delivery. External Projects information, for what can be a Family Relationship Centres in all States Consultant Jeannie Devitt began working complex process, is as consumer to provide support, and particularly with the Darwin FRC in early 2008 and, friendly as possible. mediation services, for separating using a participatory action research Our emphasis in this is addressing families. The FRC Darwin is the only framework, has enabled FRC staff to the social diversity of the clients (and Northern Territory centre, but it runs an identify and prioritise a range of issues. outlet in Alice Springs and so is able to potential clients) of the Darwin Family The key issues dealt with through this provide services to many communities Relationship Centre. A highlight of the approach include: throughout the NT. work was the brief evaluation of an • The clarifi cation of roles of Indigenous All FRCs – and in particular the FRC introduction to (mainstream) confl ict advisers. Darwin – are committed to developing resolution presented at the request services that are accessible and • A plan for effective remote area of Miwatj Health in Nhulunbuy in appropriate for both Indigenous and services delivery. March 2009.
Intellectual property
As foreshadowed in the 2007–08 annual A new project management database 2009–10 the CRCAH intends to appoint a report the CRCAH appointed a Contracts (CENTRIC) has been successfully lawyer with experience in working with Manager during 2008–09, which has implemented, increasing our capacity CRCs to fi nalise policy and procedures helped us to streamline the way in which to make CRCAH research fi ndings both with regard to monitoring and managing our intellectual property is recorded. accessible and practicable. During intellectual property.
RESEARCH 25 6 COMMUNICATIONS
The 2008–09 year has been another the Governor General Ms Quentin Bryce To put this in perspective, stakeholders have year of high activity and growth for (see story on p27). downloaded more than 144,945 gigabytes the CRCAH Communications Unit as the of data from our website. To visualise this, imperative for effective knowledge Media that equates to around 14,600* electronic exchange increased with the approaching The CRCAH’s role in informing the publications being downloaded from completion of the CRCAH research program public debate around Aboriginal health our website in the past year (or 36,000 and the transition towards a new CRC for continued with effective media intervention memory sticks of data**). If you would Aboriginal & Torres Strait Islander Health. throughout the year. Nineteen media like to become a subscriber to our website, To achieve the necessary communications releases were distributed with all media please visit:
26 CRCAH Annual Report 2008−2009 • Bailie, R., Shibasaki, S. & Sibthorpe, B. • McEwan, A., Tsey, K. & the Posters 2008, Business Case Supporting the Empowerment Research Team 2008, • Northern Territory Department of Health Development and Funding of Beyond The Role of Spirituality in Social and and Families 2009, Handwashing 1:21:70 National Centre for Quality Emotional Wellbeing Initiatives: The Project: Key Messages and Themes. Improvement in Indigenous Primary Family Wellbeing Program at Yarrabah, The CRCAH Publications Unit is based at Health Care. DP 7. Onemda VicHealth Koori Health Unit at the Discussion papers • Mayo, K., Tsey, K. & the Empowerment University of Melbourne, and staffed by Jane Yule and Cristina Liley, with freelance • Davis, S. R. & Brands, J. 2008, Research Research Team 2009, Research Dancing: support from Cathy Edmonds and Peter Refl ections on the Relationships between Priorities in Aboriginal Prisoner Health: Russ. Jane and Cristina are also available Recommendations and Outcomes from University-based Researchers and for advice on writing and editing and on the CRCAH Aboriginal Prisoner Health Community-based Researchers at Gurriny publishing options, and can be contacted at Industry Roundtable, November 2007, Yealamucka Health Services Aboriginal [email protected] / cliley@unimelb. DP 6. Corporation, Yarrabah, DP 8. edu.au or on +61 3 8344 0829 / 3061.
Learning lessons from history – Beyond Sandy Blight National leaders’ group backs Indigenous research The work of the late Professor Fred Murray – is the fi rst time Aboriginal institute Hollows in taking cheap and accessible members of the original trachoma team treatment for trachoma and other eye have documented their experiences of In late May 2009 the Board’s health ailments to Aboriginal people is the groundbreaking health program. proposed National Institute for well known, and nearly 20 years after Sandy Blight was the term white people Aboriginal and Torres Strait Islander his passing Fred remains an Australian gave to trachoma – a disease that Health Research (NIATSIHR) icon. What is less well known and less remains endemic in many Aboriginal received a substantial boost with the communities. understood is the critical role of Fred’s establishment of a powerful advocacy Aboriginal colleagues in the success More than 30 years after the NTEHP group of leaders in science, health and of the early trachoma program in the commenced, the program still sets a politics. 1970s. benchmark for quality Aboriginal health The group was welcomed and interventions and provides strong lessons The role played by Gordon Briscoe, briefed at a reception held at for health agencies and planners on Jilpia Jones and Trevor Buzzacott, Canberra’s Government House by the among others, in the Aboriginal health how to engage with Aboriginal people and communities so that real health Governor-General, Her Excellency Ms intervention that was the National Quentin Bryce AC. At the reception Trachoma and Eye Health Program outcomes result. In deeply personal accounts, the NTEHP Aboriginal veterans Ms Bryce spoke on the importance (NTEHP) had been largely overlooked describe how the program, in a of Indigenous leadership in health until the joint publication by the CRCAH radical departure from previous health research, and highlighted the key and AIATSIS in December 2008 of a programs, was characterised by: respect nature of workforce development and book on the trachoma program. for Aboriginal people and culture; an improved educational opportunities Beyond Sandy Blight: Five Aboriginal assurance that there would be ‘no survey for Aboriginal and Torres Strait Experiences as Staff on the National without service’; equality within the team; Islander people in the challenge to Trachoma and Eye Health Program – by and a strong commitment to Aboriginal close the health gap. Jilpia Nappaljari Jones, Trevor Buzzacott, engagement and leadership within the The advocacy group includes Gordon Briscoe, Reg Murray and Rose program. four former Australians or Young Australians of the Year, a recipient of At the launch of Beyond Sandy Blight the Prime Minister’s Science Prize, a former head of the Australian Army and two former Federal Cabinet Ministers. The members are: Mr Aden Ridgeway, Professor Hugh Taylor AC, Mr Russell Taylor, Lieutenant General John Sanderson (rtd) AC, Dr Lowitja O’Donoghue AC, Dr Carmen Lawrence, Professor Michael Good, Professor Ian Frazer, Professor Fiona Stanley AC, Ms Tania Major, Mr Fred Chaney AO and Dr Mick Adams.
COMMUNICATIONS 27 Link Program – Overview
The 2008–09 year has been a mixture of partners and six associate partners, Link ‘My meetings with the various Link people great change and consolidation for the Link people do everything from assisting with in Darwin and Canberra assisted me in Program as the CRCAH focused on winding organising events, to linking appropriate better understanding their roles within down its current operations and preparing CRCAH staff to their own staff, right their separate organisations, and how the for the future. Among the key changes was through to the circulation of CRCAH CRCAH can assist them,’ Penelope says. ‘The that La Trobe University-based Penelope publications. meetings also meant that I was able to Smith took over as the Link Coordinator in During the early months of 2009 Penelope build a personal rapport, which is a great July 2008 from Johanna Monk, who had focused on strengthening the Link Program’s asset in the work we do.’ fi lled the role for three years. collaboration with our partners in Darwin Penelope’s meeting with Laurie Rivers As a Link person herself for more than and Canberra. In Darwin she was able to particularly stood out for her. ‘My meeting three years, Penelope had worked closely spend time meeting Link people including with Laurie in Darwin really assisted in with Johanna as the only Link people Braiden Abala (NT Department of Health bringing understanding to the importance based in Melbourne. While maintaining and Families), Cyril Oliver (Danila Dilba of having a government department which and continuing a lot of the processes set Health Service), Norm Grogan (Menzies up by Johanna, Penelope has also been is focused on training and employment School of Health Research), Peter involved with our organisation.’ able to bring fresh eyes to the role which is Stephenson (Batchelor Institute), Leon increasingly important as the CRCAH moves Zagorskis (NT Department of Education As a result of this meeting, Laurie became towards its next phase. and Training) and Laurie Rivers (NT involved with the Melbourne meetings held Link people play a signifi cant role in Department of Regional Development, in preparation for the CRCAH Extension both formal and informal networking, Primary Industries, Fisheries and Resources). interview process, and played a pivotal role communication and knowledge exchange, In Canberra she met up with with Mary in the Extension re-bid’s ultimate success – and as a result the Link person’s role Stutters (OATSIH), the Footprints in Time demonstrating yet again the Link Program’s within the extended CRCAH family is varied project team (FaHCSIA) and Nerelle Poroch ability to add value to all areas of the and dynamic. Representing our 12 core (previous AIATSIS Link person). CRCAH’s work.
New research agenda spurs Batchelor Link revival
The establishment of a new Division limited to low skill, low recognition p30) and features case studies provided of Research at the Northern Territory’s areas like community liaison, we are by Batchelor students and staff. Batchelor Institute of Indigenous Tertiary now ensuring our voice is heard at the ‘We now use that as a resource for our Education in 2007 has been the catalyst project conceptualisation stage so that postgrad students, which has been great,’ for a substantial reinvigoration of the our expertise and research capacity is Peter says. CRCAH Link program on campus. better utilised, which makes linkages to In June 2009 Peter handed over Batchelor’s Pro Vice-Chancellor of funding bodies like the CRCAH a far more the reins to two new Link people at Research, Professor Peter Stephenson, saw meaningful proposition.’ Batchelor, Ms Karrina Demasi (who has value in broadening and strengthening Peter says that as Batchelor’s postgraduate expertise in Indigenous health and health links to other agencies and organisations research area expands there will also with interests in Indigenous research. As be a much greater need for students to worker training) and Dr Emma Young a result, in November 2007 he travelled build on-the-job skills and experience in (whose expertise includes environmental to Melbourne to attend his fi rst Link research activities as they work towards health training, impact assessment and meeting. establishing research careers. community development). ‘As a supporting partner to the CRCAH, ‘Our postgrad students are involved ‘Whereas my role was really to re- Batchelor Institute had some involvement in a number of areas, such as mental establish the strategic connection, both in the Link program in the past, but health and wellbeing, cultural survival, Karrina and Emma bring skill sets to it would be fair to say the baton has language revival and multimedia,’ he the table that will allow us to get much changed hands a lot over the years and says. ‘We’re also building up expertise more involved in CRCAH-funded research we had only intermittent periods of strong in early childhood programs in remote activity,’ he says. ‘They will be strong engagement,’ he says. ‘But since we set communities and prisoner programs, representatives for us in the CRCAH up a Division of Research and established which will eventually feed through into family.’ a postgraduate studies program, we our postgraduate research area.’ ‘I am excited to be provided with the are working to make the most of our ‘So there are a lot of synergies for us now opportunity to be involved with so many research efforts.’ in our relationship with the CRCAH.’ national organisations aimed at achieving positive outcomes in Indigenous health,’ Batchelor now has 14 students enrolled To give one example of the growing Emma says. in its Masters program and a further six relationship, Batchelor Institute made a students enrolled in the PhD program, signifi cant contribution to the CRCAH’s Karrina says of her new Link role that she which started at the beginning of 2009. Supporting Indigenous Researchers: A ‘was overjoyed to be returning to work ‘Whereas previously our ability to Practical Guide for Supervisors, which with members of the CRCAH and looks get involved in research was largely was launched in March 2009 (see story, forward to future collaborations’.
28 CRCAH Annual Report 2008−2009 7 EDUCATION AND TRAINING
The CRCAH continues to provide education 1. Queensland Institute of Medical • Masters Remote Health Management and training support for Aboriginal and Research (QIMR) Health & Science (FU) Torres Strait Islander researchers. Our main Program • Graduate Diploma In Public Health achievement for the reporting period is the QIMR continues to introduce young (MSHR) completion and publication of Supporting Indigenous Queenslanders to health Indigenous Researchers: A Practical Guide research through its annual Spotlighting • Master of Public Health (MSHR) for Supervisors (see story, p30). The Careers in Indigenous Health & • Professional Doctorate (MSHR) development of the guide was refl ective of Science Program. The program is a • Graduate Certifi cate in Public Health the values of the CRCAH – user involvement, highly successful component of QIMR’s (MSHR) collaborative development, teamwork, commitment to improving Indigenous suffi cient time and fl exibility for quality health outcomes through capacity • Promoting Aboriginal & Torres Strait outcomes, rigour in acknowledgment, and building. Conducted over fi ve days, the Islander Health short course (MSHR) a proper consent and review process. program gives students a ‘hands-on’ • Community Development and Public Other capacity-building highlights funded experience in QIMR laboratories as well Health short course (MSHR) and supported by the CRCAH include: as visits to local universities, seminars on • Issues in Indigenous Health Research Indigenous health, and the experience 1. 2008 Fulbright Symposium – short course (MSHR) Supporting the Emerging Leaders of some Indigenous cultural activities. • A Practical Approach to Health Program Around 20 students and two teachers Research Methods short course The Capacity Development Offi cer attend the program each year. (MSHR) worked with Flinders University staff to 2. Onemda internships develop the Emerging Leaders Program Onemda VicHealth Koori Health Unit, the • Teaching into Bachelor of Health (see story, p32). This facilitation work CRCAH and the University of Melbourne's Sciences (UQ) ensured that the Emerging Leaders Indigenous Employment Strategy have Scholarships / cadetships / were able to receive the most benefi t developed a pilot internship program from the Symposium. The CRCAH also for Indigenous students from around traineeships provided funding to support Indigenous Australia. In its fi rst year, the program During 2008–09 the CRCAH supported researchers attending this event. gave three students studying Indigenous 17 scholarship and in-kind students 2. ASSA Summer School health and community development the through funding, professional development Funding was provided for seven opportunity to cultivate knowledge and opportunities and involvement in activities students and fi ve supervisors to attend experience of real-world Indigenous in the program areas. Three students the 7th Academy of the Social Sciences research. The internships, based at completed their studies during this period, of Australia Summer School for Onemda, ran over eight weeks between and no new scholarships were awarded Indigenous Postgraduate Students at December 2008 and February 2009. due to the winding down of the CRCAH. the University of Melbourne. This annual The program provides networking, However, following the success of our event provides the expert learning and mentoring and work opportunities, and re-bid for a fi ve-year extension to the development experience required for the interns are paid for their work. CRCAH, we will again offer scholarships to Indigenous postgraduate students. 3. In-kind courses Indigenous postgraduate students. 3. Student involvement in CRCAH research Our core partners are providing a Student Lisa Whop was the fi rst to programs range of courses from Certifi cate level complete her studies under the CRCAH CRCAH Program Managers have been to Professional Doctorate level that active in supporting researchers and Cadetship Program, which is a partnership prepare students for work in the fi eld of between QIMR, the National Indigenous students with projects that are aligned Indigenous health. Sixteen courses are to their program areas. Capacity Cadetship Program (NICP) and the CRCAH in-kind to the CRCAH with 411 students building is an important component of to provide support for undergraduate participating in these courses throughout Program Managers’ work to develop students. Lisa completed a Bachelor of the year. better research outcomes for Indigenous Applied Science (Medical Science) and people. Some of the support included • Aboriginal Health Past to Present was employed at QIMR for the on-the- knowledge exchange activities, (MU) job component of her cadetship. She has now gone on to further studies and publications, networking, writing • Graduate Certifi cate Remote Health bursaries and attending conferences. is enrolled in a Master in Epidemiology Practice (FU) at the Australian National University and Capacity development through • Graduate Diploma Remote Health has a work placement at QIMR. The core partners (in-kind projects/ Practice (FU) Professional Development Program is programs/courses) • Masters Remote Health Practice (FU) designed to support Aboriginal and Torres Our core partners contribute in many ways Strait Islander students and staff at core • Graduate Certifi cate Remote Health to building the knowledge and skills of partner organisations to develop their skills Management (FU) Aboriginal and Torres Strait Islander people and knowledge. Funding was provided to wishing to be part of the Indigenous health • Graduate Diploma Remote Health a number of people including Catherine workforce, including: Management (FU) Jacka (Project Offi cer, QIMR), who
COMMUNICATIONS 29 attended the Introduction to Qualitative Research Techniques course offered by the Australian Consortium for Social and A road map to lifting Indigenous research capacity Political Research Incorporated. Researcher Sanchia Shibasaki (see story below) was A new CRCAH guide aimed at improving also successful in gaining a place in the the supervision of Indigenous CRC Innovation and Leadership Training researchers, as well as increasing their in August 2008 at the University of recruitment and training, was launched Melbourne. The objective of the course is by Deputy Prime Minister Julia Gillard to help early career researchers become as part of the annual Science Meets the research leaders of the future. Three Parliament event in March 2009. other researchers were supported to attend Based on interviews with both conferences. Indigenous and non-Indigenous Indigenous International researchers, Supporting Indigenous Researchers: A Practical Guide for Program Supervisors offers ways of improving the The Indigenous International Program has capacity of Indigenous health researchers been a great success, with 20 Indigenous to identify, design, implement and researchers benefi ting so far. The program conduct high-quality health research. Deputy PM Julia Gillard at the launch has helped them to travel overseas to Researched and written over a number attend conferences, present papers, develop of years, the guide refl ects the CRCAH serious investment in developing a their skills and knowledge, and network view that sustainable improvements in strong Indigenous health workforce. A at international forums. Funding for this Aboriginal and Torres Strait Islander companion volume, is due out in the program has been provided by core partner health will only be possible with a 2009–10 reporting period. OATSIH.
Top of the class for Torres Strait Islander
Torres Strait Island woman Sanchia Born and raised on Thursday Island, Sanchia Shibasaki Shibasaki is the very latest Indigenous Sanchia started her tertiary studies with researcher to have used a CRCAH a Bachelor of Applied Health Sciences scholarship to boost her qualifi cations, (Physiotherapy). She worked at the receiving her doctorate in Epidemiology, Ingham Hospital and then for fi ve Population Health and Health Services on years was a resident physiotherapist 27 June 2009. at the Thursday Island Hospital before successfully completing a Masters degree CRCAH Capacity Development Offi cer in Epidemiology and Population Health. Diane Walker was on hand to congratulate Sanchia after she was Sanchia then worked in Darwin before taking up a CRCAH Research Fellowship presented with her PhD from the at the Aboriginal-controlled Central Australian National University (ANU) by Australian Aboriginal Congress Primary Torres Shire Mayor, Mr Pedro Stephen, at Health Care Service in Alice Springs. She a ceremony on Thursday Island. was granted a NHMRC scholarship to CEO Mick Gooda said Sanchia represented undertake her doctorate at the ANU’s a new generation of health professionals Australian Primary Health Care Research whose work was playing a critical role in Institute. closing the health gap between Aboriginal Sanchia said her PhD, the Information and Torres Strait Islander peoples and Atlas Project, identifi ed information other Australians. He said Sanchia’s management practices needed by doctorate was further evidence of the primary health care services to provide To complement her health expertise ongoing emergence of a highly educated chronic disease management, with a Sanchia is now studying for a Graduate and skilled Aboriginal and Torres Strait particular emphasis on diabetes patient Diploma in Professional Management at Islander health workforce. management. the Australian Institute of Management.
30 CRCAH Annual Report 2008−2009 8 INTERNATIONAL COLLABORATIONS
Teasdale Corti: Building CPHC across • CPHC in the Island Lake Communities: Borders What does it mean and how does it look? Healing Our Spirit As reported in previous annual reports, Worldwide – The Sixth the CRCAH is coordinating and co-funding • Wellbeing at Utopia: The role of the the Australian arm of an international Urapuntja Health Service Gathering study that aims to document and highlight • Case study of the Male Health Program the role of comprehensive primary health in Alice Springs The CRCAH is a proud supporter of, care (CPHC) in the 21st century and its and committed participant in, the • Historical analysis of CPHC at Victorian relationship with the Social Determinants Healing Our Spirit Worldwide (HOSW) Aboriginal Health Service, Fitzroy, of Health. movement, which is preparing for its Melbourne The project, ‘Revitalising Health For All: Sixth Gathering in Hawaii in 2010. Learning from CPHC Experiences’, has been As a key outcome of the workshop. the As the organiser for Australian funded by the Canada-based Teasdale Corti CRCAH has agreed to host an International participation in the event, the CRCAH grants program – hence the generic name Indigenous Reference Group that will assist has been publicising HOSW through its the CRCAH has given to the suite of three and guide the global project. networks, encouraging the submission Australian projects that it is coordinating Australian projects commence and co-funding. of abstracts and liaising with travel The three Australian projects developed groups to secure special HOSW International training program during the workshop were funded by packages. the CRCAH and commenced during the In March 2009 the CRCAH hosted a two- The Sixth Gathering will take place reporting period in the following locations: week training and capacity-development on 3–10 September and is being workshop on CPHC for six research teams • in Alice Springs under the project hosted by native Hawaiian healthcare from New Zealand (Maori), Canada management of the Central Australian organisation Papa Ola Lokahi. Its (Canadian First Nation and Métis) and Aboriginal Congress (SD326); focus will be on successes, best Australia (Aboriginal participants in the • in the Central Australian community of Community Controlled sector) as part of practices and common issues in Utopia under the management of the the Teasdale Corti developmental process. health, healing and addictions within Urapuntja Health Service (SD327); and Indigenous populations. It will also The course worked with each of the • in Melbourne under the management have a signifi cant cultural exchange research teams to build on their existing of the Victorian Aboriginal Community skills and knowledge, fi nalise their research program, with delegates encouraged Controlled Health Organisation designs and implement their CPHC research to experience and share aspects of (SD328). studies. The six projects that developed each other’s unique cultures. from the training process are: The CRCAH has committed $180,000 The CRCAH has set up its own HOSW to supporting these projects, which are • Initiatives to improve access to CPHC for webpage (www.crcah.org.au/hosw), due for completion during 2010. It Maori in Aotearoa New Zealand which contains key event information is anticipated that their fi ndings will • Infl uence of a Community Health reinforce the signifi cant role that Aboriginal as well as links through to the offi cial Indicators Toolkit and Database on the community-controlled health services play HOSW website (www.hosw.com) and development and evaluation of a CPHC both in improving health outcomes and the website of event hosts Papa Ola Strategy in the Athabasca Region of in addressing the social determinants of Lokahi (www.papaolalokahi.org). Saskatchewan Aboriginal and Torres Strait Islander health.
Tracking Indigenous children’s health across the globe
A CRCAH in-kind study released in April Inuit Health Branch of Health Canada, determinants of health of Indigenous found that Indigenous children in Canada, was a collaboration across the four children relative to non-Indigenous the United States, Australia and New countries. CRCAH partner, the University children. Zealand experience higher rates of infant of Melbourne’s Onemda VicHealth Koori Signifi cantly all four countries emphasised mortality, child injury, accidental death Health Unit, led the Australian research. that the data describing Indigenous and other health ailments than their non- The study provides insight into common children were compromised in quality Indigenous counterparts. issues affecting Indigenous children’s and completeness, highlighting again the Indigenous Children’s Health Report: health around the world, and is one need for urgent improvements in data Health Assessment in Action, released of the fi rst reports researched by a collection. by the Canadian-based Centre for consortium of international researchers To read the full report, visit:
EDUCATION AND TRAINING 31 Fulbright Symposium: Why socioeconomic inequality is lethal
Of all the events organised by the CRCAH in Michael Marmot, a leading international using as examples the Northern Territory 2008–09, without doubt the largest and researcher who chairs the World Health Emergency Intervention, and the lack of most important was the 2008 Fulbright Organization’s Commission on Social effective intervention by US authorities Symposium held in Adelaide’s National Determinants of Health. after Hurricane Katrina devastated parts Wine Centre on 10–11 July 2008. In a stark example of how social of Louisiana populated mainly by African Opened by Federal Health Minister Nicola determinants create huge disparities in Americans. Roxon, and headlined ‘Healthy People, health outcomes, Sir Michael told the Other CRCAH collaborators who had a Prosperous Country’, the Symposium was Symposium that more than a quarter of presence at the Symposium included co-hosted with Flinders University. It was the deaths from cardiovascular disease CRCAH PhD graduate Dr Yin Paradies, who one of Australia’s biggest-ever gatherings in Australia in 2002 were caused by presented evidence about the negative to examine ways in which health inequities socioeconomic inequality. He said action impacts of racism on health, and our and disparities can be reduced by was required on a broad front – from the Chairperson Pat Anderson, who took part concerted actions that cut across sectors circumstances in which children are born to in a forum entitled ‘Health, Hope and and act on the social determinants of the way in which they grow, work and age. Happiness: Creating Prosperous Societies’. health and wellbeing. One of the most topical parts of the The latter forum was recorded and More than 100 experts and activists from Symposium agenda was provided by subsequently broadcast on ABC Radio in all over Australia and around the world CRCAH Research Director Ian Anderson, August 2008. came to Adelaide to listen to the latest who together with Dr David Satcher – Also attending the Symposium were research around the social determinants Director of the Center of Excellence on more than 30 ‘Emerging Leaders’ in the of health and to workshop ways of Health Disparities at the Morehouse School areas of health, research and community improving policy and practice around these of Medicine in Atlanta, Georgia (and development. This is the fi rst time that such determinants. The Symposium program the 16th Surgeon General of the United an Emerging Leaders Program has been examined the effects of social determinants States) – delivered a forum entitled ‘Race, included in a Fulbright Symposium, and on the health of Indigenous and non- Health and Emergency: Social Determinants their presence was facilitated by CRCAH Indigenous people in Australia and in the under Crisis’. The session explored the Capacity Development Offi cer Diane Walker United States. Keynote speaker was Sir impact of race on health interventions, (see Education & Training Overview, p29).
Community Empowerment strategy trialled in PNG
Ground-breaking work around empowerment and family wellbeing by the CRCAH’s Far North Queensland research partners James Cook University and the Yarrabah community’s Gurriny Yealamucka Health Service has been taken up by public health researchers at the University of Papua New Guinea (UPNG). PNG men with their Australian brothers at an Indigenous men’s forum held in Cairns
Papua New Guinea (PNG) health and Change introduces the concept of form the basis for local HIV prevention professionals, led by UPNG’s Russell empowerment and its role in enabling and other strategies in PNG, and a Kitau (Acting Head of the School of change even in the most challenging one-week intensive Empowerment and Public Health), had heard about the and diffi cult situations. It provides skills Change pilot course to groups of students JCU/Yarrabah community research and strategies for mediation, confl ict enrolled in UPNG’s School of Public Health collaboration based on the Aboriginal- resolution, leadership development, team was delivered in May 2009. developed Family Wellbeing program and building, organisational change and According to JCU Professor Komla Tsey, other empowerment strategies. This had innovative teaching and learning across the response from the PNG students was been operating at Yarrabah’s community different cultures. overwhelming. As a result, JCU and UPNG controlled health service, Gurriny When Mr Kitau visited JCU and Gurriny are currently planning to implement a Yealamucka, since 2001. Yealamucka Health Services early in longer term empowerment research JCU had also developed a postgraduate 2009, he immediately saw the potential capacity-building initiative within UPNG subject, Empowerment and Change, based for the empowerment program to that focuses both on coursework teaching on its work at Yarrabah. Empowerment facilitate community mobilisation and and on research training.
32 CRCAH Annual Report 2008−2009 APPENDICES Appendix 1: Addressing Priorities in Aboriginal and Torres 9 Strait Islander Health Research
TABLE 1: Projects funded by the CRCAH that deliver on the National Health and Medical Research Council’s Road Map Priorities for Aboriginal and Torres Strait Islander Health Research
Road Map Theme: 1. Descriptive health research that outlines patterns of health risk, disease and death CRCAH-funded projects Project description The CRCAH has not funded research that only describes patterns of health risk, disease and death. However, there are components of this work contained within some projects (e.g. Filling the Gaps). Much of the work listed against Theme 4 on the social determinants of Aboriginal health is also descriptive.
Road Map Theme: 2. A research focus on the factors and processes that promote resilience and wellbeing CRCAH-funded projects Project description
Evaluating Antenatal Care Services in the Aims to develop an ongoing health information system to foster continuous improvement in antenatal care in Central Australian Region Central Australia, informed by the features of quality antenatal care for Aboriginal women in Central Australia. AATAAC AATAAC or Azithromycin versus Amoxycillin for Treatment of Acute otitis media in Aboriginal Children assesses the effectiveness of a new treatment option for acute otitis media. The CRCAH committed funds for research transfer and feedback to communities involved. Give Your Baby a Better Chance: Innovate A student project that aimed to optimise, evaluate, test and validate a GBS sensitive and specifi c PCR test based Testing Prior to Birth on a model developed by Robyn Marsh in 1999. It aimed to ensure that the test was simple to use and results could be quickly obtained at the point of care. Mibbinbah (Men’s Places) This research program is two distinct but related projects: Men’s Sheds/Spaces Pilot Project and Men’s Chronic Conditions Project. The fi rst seeks to evaluate existing Indigenous Men’s Sheds/Spaces through employing Local Indigenous Male Project Associates, who will be trained in the use of participatory action-research methods – leadership, communication, media, IT – to help develop and sustain these Sheds/Spaces. The second will look at if and why participation in chronic conditions programs by Indigenous males is improved through association with ‘safe’ and ‘well-facilitated’ Sheds/Spaces. Tiwi Life Promotion Evaluation Evaluation of a suicide prevention intervention. Australian Integrated Mental Health This project looks at the experiences of Aboriginal people in the NT, both remote and urban, with mental illness, Initiative (AIMhi) and their journey through mental health services. The project has explored strategies to facilitate the journey of clients and their carers from community to primary care to specialist mental health services and home again. Empowerment as a Strategy for Health Empowerment programs seek to encourage people to take control of their own lives. There is considerable and Wellbeing international and national evidence to demonstrate that interventions that empower socially excluded groups can improve health outcomes and quality of life. This is one of a number of components the CRCAH has funded within a 10-year study of empowerment. Kanyirninpa: Health, Masculinity This in-kind project looked at how men in a desert area view the concept of health. The CRCAH funded research transfer activities. Let’s Start Let’s Start works with Indigenous parents and children to ensure more effective parenting and address behavioural problems among children. The CRCAH has funded the project to be extended in the Darwin and Palmerston regions, and to produce high-quality resources to ensure its transferability. Spirituality and Social and Emotional Three discussion papers looking at Indigenous spirituality and its relationship to health and wellbeing have been Wellbeing funded by the CRCAH. Healthy Skin East Arnhem A project that aimed to trial regional mass treatment programs to control scabies and skin sores, particularly among Aboriginal children. Filling the Gaps A multi-part project that is, among other things, examining the potential for resistance among scabies to current treatments and the factors infl uencing the uptake or otherwise of standard treatments for scabies.
Road Map Theme: 3. A focus on health services research CRCAH-funded projects Project description
Sharing the True Stories Aimed to identify and address barriers to effective communication between Aboriginal client groups and health staff in renal and hospital services in the NT. All the Aboriginal clients involved in the research program were Yolngu speakers from north-east Arnhem Land. CARPA Manual Dissemination This project looked at potential intellectual copyright and other issues related to web-based dissemination of the Central Australian Remote Practitioners’ Association Manual.
34 CRCAH Annual Report 2008−2009 Appendix 1 – Addressing Priorities in Aboriginal and Torres Strait Islander Health Research
Learning from Action This project used an action learning and research approach to develop an understanding of management practices in Aboriginal health services and to support managers to share and improve their management strategies. Overseas Trained Doctors in Aboriginal Aimed to document the extent to which overseas trained doctors are employed in providing services to Health Services Aboriginal people, their experiences within these practice environments, and the experiences and impact of their employment on health services to Aboriginal Australians. Information Atlas Aims to identify the strategic information management practices needed by primary health care services to provide chronic disease management, with a particular emphasis on diabetes patient management. Feasibility of Transferring an Aboriginal This project aimed to explore the factors critical to success in transferring a health program from one location Health Program (community) to another. CRCAH funding supported completion of data collection. Improving the Culture of Hospitals for Aims to support a program of cultural reform to improve cultural sensitivity in hospitals by contributing to the Aboriginal People development of relevant quality assurance and improvement tools and processes. Overburden Project – Funding and The aim of this project is to improve the effectiveness of funding models and regulatory arrangements for Regulation of Primary Health Care for Aboriginal primary health care. Aboriginal and Torres Strait Islander People Support Systems for Aboriginal and Aims to identify the support needs (including that required to promote internal capacity) of Aboriginal Torres Strait Islander Health Care Services community controlled health organisations as corporate entities, and to describe effective external support systems/frameworks. ACE Prevention – Advisory Committee This project, as part of a larger NHMRC funded in-kind project, resources two project standing committees that provide stakeholder input into the larger NHMRC ACE Prevention project. The committees include an Indigenous Steering Committee and a Technical Advisory Panel. Quality and Standards in Aboriginal and A joint project between the CRCAH and the Offi ce of Aboriginal and Torres Strait Islander Health. The project Torres Strait Islander Health provided advice from the Aboriginal health sector about accreditation standards that could be applied to the sector. Revitalising Health for All – Teasdale Corti The CRCAH is supporting the Australian component of a major international project looking at the health and capacity benefi ts of comprehensive primary health care. Establishing the Prevalence of the HPV The Human Papilloma Virus (HPV) is the most common viral sexually transmitted infection. This pilot focused Infection in Indigenous and Non- on two communities, remote and urban, to test and refi ne information, training materials and data collection Indigenous Women in Australia processes with primary health care staff and community members. The Relevance of an Accredited ADEA An evaluation was completed on the impact of the fi rst accredited Australian Diabetes Educators Association Course to AHWs, Supervisors and course for Aboriginal Health Workers and their delivery of diabetes health services to Aboriginal people. CRCAH Aboriginal People in SA funds were used to publish and disseminate the report. EarInfoNet and InfoNetwork An Otitis Media Network was set up in early 2005 as an informal network of researchers, policy makers and service providers involved with ear and hearing health among Aboriginal children. The CRCAH funded the development of the Indigenous EarInfonet website and online community from this network, which provides current evidence and resources on ear health to health services and practitioners. The HPV Vaccine and the Indigenous This study highlighted the need for culturally diverse methodological approaches when mass population health Community interventions are implemented. Aboriginal participation in the project resulted in high levels of vaccine uptake and the development of culturally appropriate resources. IMPAKT – Improving Access to Kidney IMPAKT was a NHMRC-funded project that investigated the disparity in access to kidney transplants between Transplants - Research Transfer Indigenous and non-Indigenous Australians. It found that Indigenous patients are interested in transplants but are unclear about the processes. CRCAH funds are supporting the leveraging of additional funds to produce resource materials appropriate for Aboriginal patients and families, and a train-the-trainer model for delivery. Monitoring and Evaluating Aboriginal This project has: 1) Established a monitoring and feedback system using tobacco consumption data; Tobacco Control 2) Completed a quantitative research program using tobacco consumption data; 3) Completed a qualitative research program using interviews about quitting, smoking and tobacco control interventions. The NHMRC is funding a second phase of this project. A Structured Systems Approach to Aims to improve the implementation of comprehensive health promotion by using a CQI model to build system Improving Health Promotion Practice for capacity in remote Australian Aboriginal communities. The focus is on the community and organisational Chronic Conditions processes that are essential for effective health promotion. The NHMRC is funding a second phase of this project. Chronic Condition Management Strategies Aims to develop and demonstrate sustainable and effective chronic condition management (CCM) strategies for in Aboriginal Communities Aboriginal communities, by looking at CCM strategies that three participating services currently use, what works well for them and why, and what systems and supports are required. Then, according to their priorities and available resources, participating Aboriginal health services will be offered additional CCM strategies along with associated training for health service providers and organisational change. Coordinated Aboriginal Mental Health The aim of this project was to develop, implement and evaluate agreed pathways and protocols of care for Care Aboriginal people with mental health (including drug and alcohol) problems. ABCD CQI Centre Aims to support development of a national quality improvement centre in primary health care for Aboriginal and Torres Strait Islander people. Improving Identifi cation of ATSI People Aims to improve identifi cation practices and protocols by understanding the barriers and facilitators at point of in General Practice care which inhibit or promote identifi cation of Indigenous people in general practice within a quality of care culturally appropriate framework. The Role of Agreements in Health Aims to understand the impact of agreements on health and service delivery arrangements from a social networking framework.
APPENDICES 35 Appendix 1 – Addressing Priorities in Aboriginal and Torres Strait Islander Health Research
Road Map Theme: 4. A focus on the association between health status and health gain, and policies and programs outside the health sector CRCAH-funded projects Project description
Social Determinants of Aboriginal Health Sixteen papers were presented at the Social Determinants Workshop in Adelaide, July 2004, and published as Workshop and Published Papers Beyond Bandaids: Exploring the Underlying Social Determinants of Aboriginal Health. Social Determinants of Indigenous Health The CRCATH supported a series of workshops and their subsequent evolution into a short course. The CRCAH Short Course and Textbook later supported the publication of B. Carson et al. 2007, Social Determinants of Indigenous Health, Allen & Unwin, Sydney. Housing Improvement and Child Health CRCAH funding was to extend an NHMRC funded study to allow the completion of data collection, analysis and feedback to communities. Water Service Delivery and Changing This project has two parts: Household Water Use 1.To expand an existing project to a third community in an arid region in SA. This project used an action research approach to engage Aboriginal people in responding to the National Water Initiative with a focus on water conservation and the implications of a user pays systems for water service delivery. 2. Dissemination of the research fi ndings to share information on sustainable water supplies in Aboriginal communities in arid regions. Utilities and Equity To develop research partnerships and a research methodology to examine the impact of the rising cost of public utilities (water, electricity, etc.) on the socio-economic status, and subsequent health status, of Aboriginal people in urbanised locations across Australia. Commission on the Social Determinants The CRCAH convened the Commission on the Social Determinants of Health (CSDH) International Symposium on of Health International Symposium the Social Determinants of Indigenous Health, Adelaide, 29–30 April 2007. Racism and Indigenous Health: Setting This project convened a roundtable of national and international researchers and policy makers to develop an the Research Agenda agenda for research on racism and Indigenous health in Australia and NZ. Aboriginal Prisoner Health: Developing a The CRCAH convened an industry roundtable in Nov 2007 to identify research priorities in the areas of Research Agenda Aboriginal prisoner health and reducing recidivism. Perspectives on the Social Determinants Cross-sectoral collaboration and communication between researchers, policy makers and service providers is vital of Aboriginal Health to address the social determinants of Aboriginal health. This project examines why dialogue across these groups is so diffi cult and how it might be improved. The Fulbright Symposium on the Social The CRCAH and Flinders University co-convened the conduct of the 2008 Australian Fulbright Symposium in Determinants of Health Adelaide, entitled Healthy People: Prosperous Country. Stress and Chronic Disease: A Systematic International literature suggests that psychosocial stress is an important contributor to chronic diseases. This Review review demonstrated clear links between stress and a range of chronic diseases for Indigenous peoples in a number of fi rst world nations (including Australia), as well as for African-Americans. Aboriginal Health Council of South This aimed to improve understanding of systems, processes, structures and relationships critical in improving the Australia/Royal Adelaide Hospital culture of hospitals for Aboriginal and Torres Strait Islander people, based on experiences at the Royal Adelaide Protocols and Processes Project Hospital.
Road Map Theme: 5. A focus on previously under-researched Aboriginal and Torres Strait Islander populations and communities CRCAH-funded projects Project description
Health Services Utilisation and Linkage A developmental project to facilitate consultations with stakeholders and increase understanding of how to – Stage 1 approach research into patterns of service utilisation (or non-utilisation) by Aboriginal and Torres Strait Islander people in urban and fringe locations in ways that are effective and culturally safe. Supporting Best Practice Research in The aim of this project was to develop a guide for supervisors of emerging Indigenous researchers that will lead Indigenous Health to improved training and development of Indigenous researchers. Many of the projects listed above under Themes 3 and 4 also address previously under-researched populations such as urban Indigenous populations with broader projects that look at, for example, health service provision in a wide range of contexts.
Road Map Theme: 6. Development of the nation’s Aboriginal and Torres Strait Islander health research capacity (including training Aboriginal and Torres Strait Islander researchers) and health research practice in relation to Aboriginal and Torres Strait Islander communities CRCAH-funded projects Project description
CRCAH Education Programs, Scholarships, Ongoing support of Indigenous students and Core Partner staff in further studies and professional development. Cadetships and Professional Development Indigenous International Program Providing opportunities for Core Partner Indigenous researchers to attend overseas conferences and present at these conferences.
36 CRCAH Annual Report 2008−2009 Appendix 1 – Addressing Priorities in Aboriginal and Torres Strait Islander Health Research
Funding Support for Indigenous Providing funding support for postgraduate Indigenous students to attend the ASSA Summer School Program to Postgraduate Research Students further develop their research skills and projects. Revitalising Health for All – Learning Exploring Comprehensive Primary Health Care (CPHC) in service delivery in the Aboriginal health sector, and from CPHC Experiences in the Aboriginal developing the research capacity of Aboriginal people. and Torres Strait Islander Health Sector [Aboriginal and Torres Strait Islander] The project aims to develop an Internet-based network of Indigenous researchers, to enable people to provide Research Ethics Network peer support and build research capacity. Looking for Practical Solutions for Aimed to undertake a critical assessment of the CRCAH research assessment process, and investigate possible Quality Assessment Processes for Grant alternative pathways that would align with the principles of Indigenous leadership and collaboration in research. and Publication Review in Aboriginal Health Research VACCHO Social Determinants of To explore the role of the sector in addressing the social determinants of Aboriginal health. Aboriginal Health Roundtable Positive Stories of Aboriginal and Torres To fi nd out how Aboriginal and Islander people have coped since their release from prison, and what has Strait Islanders Lives Post-prison Release helped them to stay out of prison. and Design of Health-based Interventions CRCAH Collaborative Approach to Supporting development and implementation of the Facilitated Development Approach, which promotes Research Indigenous leadership and involvement in collaborative research activities. East Arnhem Regional Healthy Skin The CRCAH funded a training program for East Arnhem community workers to deliver programs on skin health. Project The program has now been expanded as an accredited training program for delivery in Galiwinku, NT. The Child Health Research Certifi cate will have a broader focus covering common areas of childhood illness and three important underlying factors: nutrition, hygiene and childhood immunisation. East Arnhem Regional Healthy Skin The CRCAH has been providing intensive in-kind and fi nancial support to the Aboriginal Health Council of South Project Australia (an in-kind project) resulting in the development of a funding proposal to employ a Project Offi cer in sector translation and research support. Funding has also been provided for a ground-breaking pilot course, Certifi cate 4 in Indigenous Research. Twelve South Australian Aboriginal students successfully graduated in 2008.
APPENDICES 37 Appendix 1 – Addressing Priorities in Aboriginal and Torres Strait Islander Health Research
TABLE 2: CRCAH research projects and the Closing the Gap targets1 The overall goal of the Close the Gap targets is to close the Aboriginal and Torres Strait Islander life expectancy gap within a generation and halve the mortality gap for Aboriginal and Torres Strait Islander children under fi ve within a decade. The table below sets out CRCAH projects that can help inform the work required to achieve the sub-goals that contribute to achieving that larger over-arching goal.
SUB GOAL: To achieve comparable rates in perinatal and infant SUB GOAL: To reduce the level of absolute risk of vascular mortality events among Aboriginal and Torres Strait Islander Australians by 2.5% within 10 years CRCAH Projects: Evaluating antenatal care services in the central Australian region CRCAH Projects: Preventing infant deaths among Aboriginal and teenage women in South Predicting heart attack and stroke for Aboriginal people in Central Australia Australia: Protective factors and risk factors Burden of infl uenza and other respiratory viruses among Aboriginal Reducing prevalence of non-communicable disease risk factors among children in the Top End Indigenous Australians Effectiveness of rotavirus vaccine for the prevention of gastroenteritis Sociocultural factors facilitating or inhibiting Indigenous health and health among hospitalised children in the NT delivery especially in relation to cardiovascular diseases and respiratory illness: An East Kimberley project PneuMum: A randomised controlled trial of pneumococcal polysaccharide immunisation for Aboriginal mothers to protect their babies from ear Improving the patient journey disease Centre for Excellence in Indigenous Tobacco Control Housing Improvement and Child Health (HICH) Monitoring and evaluating Aboriginal tobacco control A collaborative and international study of bronchiectasis in Indigenous Exploring resilience and coping in relation to smoking within ‘at risk’ children populations Assessment of hearing of school-aged children in the APY Lands of South Impact of tobacco management policies for Indigenous and non- Australia Indigenous populations: Is evidence informing Indigenous smoking Imagining childhood – Children, culture and community policy? Let’s Start Improving identifi cation of Aboriginal and Torres Strait Islander people in general practice Talking about maternity and postnatal care with Aboriginal families in Victoria and South Australia The transferability of a mainstream childhood obesity prevention program to Aboriginal people Understanding the social and emotional wellbeing of Aboriginal women after childbirth See also many projects listed in relation to goals addressing chronic diseases, men’s health, primary health care and mainstream health Indicators to improve children’s environmental health in remote services Indigenous communities – Stage 1 (Kids’ Environmental Health Study KEHS) The impact of Prevenar on the incidence of invasive pneumococcal disease SUB GOAL: To improve the management of and reduce adverse in Australia outcomes in chronic disease The impact of conjugated pneumococcal vaccine on pneumococcal carriage dynamics CRCAH Projects: Pneumonia in Indigenous Children Territory-wide Using Radiological DRUID: Diabetes and Related disorders in Urban Indigenous people in the Endpoints (PICTURE) Darwin region Healthy Skin East Arnhem ACE Prevention – Guiding intervention choices around avoidable disease burden and cost effectiveness Give your baby a better chance: Innovate testing prior to birth A structured systems approach to improving health promotion practice for Injury mortality of Indigenous Australians: An exploration of data quality chronic disease in Indigenous communities and ascertainment bias Chronic condition management strategies in Aboriginal communities Hospitalised injury of Australia’s Aboriginal and Torres Strait Islander people 2000–02 The Aboriginal and Torres Strait Islander Adult Health Check in a remote Aboriginal community Reported injury mortality of Aboriginal and Torres Strait Islander people in Australia, 1997–2000 Stress and chronic diseases: A systematic review Healthy Skin – Filling the Gaps Clinical management of Aboriginal people experiencing co-existing diabetes and alcohol-related health problems Wuchopperen skin study IMPAKT (Improving Indigenous Patient Access to Kidney Transplant) Measuring the SEWB of Indigenous children Cluster of chronic conditions self-management and related in-kind projects Can swimming pools improve Indigenous children’s hearing? Dissemination of 4th edition of the CARPA Manual The transferability of a mainstream childhood obesity prevention program to Aboriginal people The information atlas project
1. The Close the Gap Indigenous Health Equity Targets were developed by the Steering Committee for Indigenous Health Equality, founded by Social Justice Commissioner Tom Calma, NACCHO, the Australian Indigenous Doctors’ Association, the Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN), the Indigenous Dentists’ Association of Australia, and Oxfam Australia. The targets were presented to the Australian Government at the National Indigenous Health Equality Summit, held in Canberra in March 2008, and are to be integrated within a variety of monitoring frameworks and into the activity of the COAG Working Groups on Indigenous issues.
38 CRCAH Annual Report 2008−2009 Appendix 1 – Addressing Priorities in Aboriginal and Torres Strait Islander Health Research
Building capacity of local Aboriginal communities to develop population The Aboriginal and Torres Strait Islander Adult Health Check in a remote health initiatives Aboriginal community Improving identifi cation of Aboriginal and Torres Strait Islander people in Revitalising Health for All – Teasdale-Corti Australian activity general practice Learning from Action: Management of Aboriginal health services ABCDE (Audit and Best Practice for Chronic Disease Extension) project Indigenous community capacity development for better health ABCD CQI Centre Information atlas project Healthy Lung Study Feasibility of transferring an Aboriginal health program that is successful from one community to another SUB GOAL: To improve the mental health and SEWB of Aboriginal teams within community health services Indigenous Australians to the same standards enjoyed by the Building the capacity of local Aboriginal communities to develop majority of the Australian population and reduce the impact population health initiatives of mental disorders on patients and their families Aboriginal people travelling well CRCAH Projects: Quality standards in Aboriginal and Torres Strait Islander health Our Children – Stolen Futures: Evidence of intergenerational trauma from Developing training pathways to meet the needs of Aboriginal people with Indigenous historical out-of-home care disabilities Indigenous social and emotional wellbeing and what we can do to Improving the patient journey improve it: Muuji Regional Centre project Sharing the true stories Australian Integrated Mental Health Initiative (AIMhi) Building workforce capacity to address complex health, housing and social Coordinated Aboriginal Mental Health Care inclusion issues through a computerised decision support system Spirituality and social and emotional wellbeing – three discussion papers Putting cross-cultural policy into practice Understanding the social and emotional wellbeing of Aboriginal women after childbirth SUB GOAL: Improve the responsiveness of mainstream health Positive stories of Aboriginal and Torres Strait Islanders’ life post-prison services and programs to Aboriginal and Torres Strait Islander release, and design of health-based intervention peoples’ health needs Let’s Start CRCAH Projects: Researching the control factor and the concept of empowerment in addressing the social determinants of health Improving the culture of hospitals project Development of clinical practice guidelines for the management of Health service utilisation – Stage 1 alcohol problems in Aboriginal and Torres Strait Islander people A critical analysis of the quality and effectiveness of health care Measuring the SEWB of Indigenous children communications between English-speaking health staff and speakers of Indigenous languages in Central Australia Racism and Indigenous health: Setting the research agenda Building workforce capacity to address complex health, housing and social Evaluation of Lotus Glen Correctional Centre, Aboriginal and Torres Strait inclusion issues through critical systems thinking and practice Islander peer education project DRUID: Diabetes and related disorders in urban Indigenous people in the Critical assessment of I’m an Aboriginal Dad program Darwin region Evaluation of Central Northern Adelaide Health Service Family and Evaluating antenatal care services in the Central Australian region Community Healing program Audit and Best Practice for Chronic Disease Extension (ABCDE) Victorian Aboriginal and Torres Strait Islander emergency department SUB GOAL: Achieve specifi ed levels of completeness of presentations identifi cation in health records Sharing the true stories 2 CRCAH Projects: Aboriginal Health Council of South Australia, Royal Adelaide Hospital procedures and protocols project Health service utilisation – Stage 1 Aboriginal and Torres Strait Islander urban location and health project Aboriginal Health Council of South Australia, Royal Adelaide Hospital procedures and protocols project Coordinated Aboriginal Mental Health Care Improving the culture of hospitals project Australian Integrated Mental Health Initiative (AIMhi) Improving identifi cation of Aboriginal and Torres Strait Islander people in Improving identifi cation of Aboriginal people in general practice general practice Improving the patient journey IMPAKT (Improving Indigenous Patient Access to Kidney Transplant) SUB GOAL: Increase access to culturally appropriate primary health care to bridge the gap in health standards SUB GOAL: National coverage of child and maternal health CRCAH Projects: services is provided Audit and Best Practice for Chronic Disease Extension (ABCDE) CRCAH Projects: Health service utilisation – Stage 1 See projects listed in relation to perinatal and infant mortality Frameworks for best practice in funding and regulation Support systems for Indigenous health care A structured systems approach to improving health promotion practice for chronic disease in Indigenous communities
APPENDICES 39 Appendix 1 – Addressing Priorities in Aboriginal and Torres Strait Islander Health Research
SUB GOAL: Enhance Indigenous-specifi c population programs Effectiveness of rotavirus vaccine for the prevention of gastroenteritis for chronic and communicable disease among hospitalised children in the NT Indicators to improve children’s environmental health in remote CRCAH Projects: Indigenous communities – stage 1 (Kids’ Environmental Health Study KEHS) See projects listed in relation to chronic diseases and communicable diseases Melioidosis and pneumonia The impact of Prevenar on the incidence of invasive pneumococcal disease in Australia SUB GOAL: National nutrition plan developed, funded and The impact of conjugated pneumococcal vaccine on pneumococcal implemented carriage dynamics CRCAH Projects: Healthy Skin East Arnhem A structured systems approach to improving health promotion practice for Water supply and use in Aboriginal communities South Australia chronic disease in Indigenous communities Human Papilloma Virus (HPV) infection in Indigenous and non- The transferability of a mainstream childhood obesity prevention program Indigenous women in Australia to Aboriginal people HPV vaccine and the Indigenous community intentions to vaccinate their A national Indigenous roundtable on nutrition and preventative health, pre-adolescent children: What do Indigenous people think about giving a co-hosted by CSIRO and CRCAH vaccine to children to prevent cancer of the cervix? The National Trachoma and Eye Health Program (NTEHP) history project SUB GOAL: Comprehensive and culturally appropriate oral Healthy Skin – Filling the Gaps health care services organised and coordinated on a regional Hand washing campaign basis CRCAH Projects: SUB GOAL: Improve access to timely and appropriate mental Strong teeth for little kids – Improving dental health for remote health care in PHCS and specialised mental health care Aboriginal children; a cluster randomised trial services across the lifespan CRCAH Projects: SUB GOAL: Adolescent and youth health (goal yet to be See projects listed against improving mental health and SEWB developed) CRCAH Projects: SUB GOAL: Build community capacity in understanding, Victorian Aboriginal Health Service Young People’s project promoting wellbeing and responding to mental health issues Analysis of historical and contemporary reproductive health issues for Aboriginal and Torres Strait Islander adolescents CRCAH Projects: HPV vaccine and the Indigenous community intentions to vaccinate their Empowerment as a strategy for health and wellbeing pre-adolescent children: What do Indigenous people think about giving a Let’s Start vaccine to children to prevent cancer of the cervix? Understanding the social and emotional wellbeing of Aboriginal women after childbirth SUB GOAL: Men’s health (goal yet to be developed) Australian Integrated Mental Health Initiative (AIMhi) CRCAH Projects: Links between social networks, social capital and Aboriginal health outcomes Developing, sustaining and evaluating health programs for Aboriginal men Community development and the social determinants of health The Indigenous Men, Health and Indigenous Men’s Sheds/Spaces Research program Culture as a determinant of health Boys to Men: Garbutt Magpies 25 years on Researching the control factor and the concept of empowerment in addressing the social determinants of health Critical assessment of I’m an Aboriginal Dad program Evaluation of the Central Northern Adelaide Health Service Family and Community Healing program SUB GOAL: Communicable disease programs implemented CRCAH Projects: SUB GOAL: Promote mental health recovery across the lifespan Burden of infl uenza and other respiratory viruses among Aboriginal CRCAH Projects: children in the Top End See projects listed under improving mental health and SEWB Pneumonia in Indigenous Children Territory-wide Using Radiological Endpoints (PICTURE) PneuMum: A randomised controlled trial of pneumococcal polysaccharide immunisation for Aboriginal mothers to protect their babies from ear disease Investigation of immune responses in mice administered a vaccine designed to prevent group A streptococcal infections and its associated diseases rheumatic fever and rheumatic heart disease Research towards vaccines for tropical health Housing improvement and child health (HICH) project
40 CRCAH Annual Report 2008−2009 Appendix 1 – Addressing Priorities in Aboriginal and Torres Strait Islander Health Research
SUB GOAL: Provide an adequate workforce to meet Aboriginal Moving forward together in Aboriginal women’s health – Exploring knowledge sharing, working together and addressing issues collaboratively and Torres Strait Islander health needs by increasing the in urban primary health care settings recruitment, retention, effectiveness and training of health practitioners working within Aboriginal and Torres Strait Sharing the true stories Islander health settings and build the capacity of the Putting cross-cultural policy into practice Indigenous health workforce CRCAH Projects: SUB GOAL: Increase the quality of the health services and the Indigenous AOD workers’ wellbeing, stress and burnout workforce Audit and Best Practice for Chronic Disease Extension (ABCDE) CRCAH Projects: Improving the culture of hospitals project Audit and Best Practice for Chronic Disease Extension (ABCDE) Aboriginal and Torres Strait Islander apprenticeships with DHCS Frameworks for best practice in funding and regulation Safe medication management in community settings; Safe management of Support systems for Indigenous health care intoxicated people training; Mental health and AOD co-morbidity Quality standards in Aboriginal and Torres Strait Islander health Australian Indigenous EarInfoNet Building workforce capacity to address complex health, housing and social A critical analysis of the quality and effectiveness of health care inclusion issues through critical systems thinking and practice communications between English-speaking health staff and speakers of Indigenous languages in Central Australia Stepping up: Aboriginal and Torres Strait Islander professional development program Centre for Excellence in Indigenous Tobacco Control Cultivating a concern for cultural competency Health service utilisation – Stage 1 ABCD CQI Centre Frameworks for best practice in funding and regulation Improving the culture of hospitals Support systems for Indigenous health care Putting cross-cultural policy into practice Victorian Aboriginal Health Service young peoples’ project Access by Aboriginal and Torres Strait Islander students in Victoria to A structured systems approach to improving health promotion practice for nursing education chronic disease in Indigenous communities LIME Network – Leaders in Indigenous Medical Education Chronic condition management strategies in Aboriginal communities Sharing the true strories The Indigenous Men, Health and Indigenous Men’s Sheds/Spaces Research program Revitalising health for All: Teasdale-Corti Australian activity SUB GOAL: Build an effective mental health/SEWB workforce LIME Network – Leaders in Indigenous Medical Education CRCAH Projects: Sharing the true stories 2 Australian Integrated Mental Health Initiative (AIMhi) Dissemination of 4th Edition of the CARPA Manual Evaluation of the Central Northern Adelaide Health Service Family and Australian Integrated Mental Health Initiative (AIMhi) Community Healing program Learning from Action: Management of Aboriginal health services Safe medication management in community settings; Safe management of Governance and its role in Aboriginal health intoxicated people training; Mental health and AOD co-morbidity Community development and the social determinants of health Building workforce capacity to address complex health, housing and social inclusion issues through critical systems thinking and practice The Centre for Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health Let’s Start Overseas trained doctors in Aboriginal health services Indigenous alcohol and other drug workers’ wellbeing, stress and burnout Information atlas project Coordinated Aboriginal Mental Health Care To assess the impact of an accredited Australian Diabetes Educators Indigenous social and emotional wellbeing and what we can do to Association course on the diabetes health care of Aboriginal people in improve it: Muuji Regional Centre project South Australia Researching the control factor and the concept of empowerment in Aboriginal teams within community health services addressing the social determinants of health Improving the patient journey Critical assessment of I’m an Aboriginal Dad program Putting cross-cultural policy into practice AHCSA/RAH procedures and protocols project SUB GOAL: To immediately commence improvement of the Access by Indigenous students in Victoria to nursing education most basic facilities within all existing Indigenous Australians’ houses to ensure safety and access to critical health facilities Quality standards in Aboriginal and Torres Strait Islander health Building the capacity of local Aboriginal communities to develop CRCAH Projects: population health initiatives Housing Improvement and Child Health (HICH) project Critical assessment of I’m an Aboriginal Dad program Housing, the physical environment and Aboriginal health Developing training pathways to meet the needs of Aboriginal people with disabilities Evaluation of the CNAHS Family and Community Healing program Stepping up: Aboriginal and Torres Strait Islander professional development program Improving the patient journey
APPENDICES 41 Appendix 2: Current and Completed Research Projects in Year to June 2009
Administering Expected No. Project Title Project Leaders organisation completion date Status Program
3 Optimising Chronic Lung Disease Care for Indigenous Bart Currie MSHR August 2008 Completed CC Australians Graeme McGuire 13 Socioeconomic and Environmental Determinants of Health Matthew Stevens MSHR January 2009 Completed SDOH in Indigenous Communities in the NT 54 DRUID: Diabetes and Related Disorders in Urban Joan Cunningham MSHR December 2010 Active CC Indigenous People in the Darwin Region 65 Evaluating Antenatal Care Services in the Central Australian Lorraine Liddle CAAC December 2009 Active CPHC Region 82- Safe Medication Management in Community Settings; Safe Charlotte de Flinders University Ongoing Completed SEWB 84 Management of Intoxicated People Training; Mental Health Crespigny and AOD Co-morbidity 96 Predicting Heart Attack and Stroke for Aboriginal People in Kevin Rowley The University of December 2009 Active CC Central Australia: Protective Factors and Risk Factors Melbourne 103 Empowerment as a Strategy for Health and Wellbeing Melissa Haswell The University of September 2008 Completed SEWB Queensland 107 Audit and Best Practice for Chronic Disease Extension Ross Bailie MSHR December 2009 Active CPHC (ABCDE) 111 Building Workforce Capacity to Address Complex Health, Janet McIntyre Flinders University September 2009 Active CPHC Housing and Social Inclusion Issues through Critical Ann Roche Systems Thinking and Practice 112 Capacity Building in Indigenous Policy–Relevant Joan Cunningham MSHR July 2009 Active CPHC Health Research (CIPHER) 113 Can Swimming Pools Improve Indigenous Children’s Linnett Sanchez Flinders University December 2011 Active CC Hearing 124 Investigation of Immune Responses in Mice Administered Michael Batzloff MSHR December 2008 Completed HS A Vaccine Designed to Prevent Group a Streptococcal Infections and its Associated Diseases Rheumatic Fever and Rheumatic Heart Disease 125 Strong Teeth for Little Kids – Improving Dental Health for Peter Morris MSHR December 2008 Completed CPHC Remote Aboriginal Children; A Cluster Randomised Trial 127 PneuMum: A Randomised Controlled Trial of Pneumococcal Ross Andrews MSHR December 2010 Active CC Polysaccharide Immunisation for Aboriginal Mothers to Protect their Babies from Ear Disease 131 A Critical Analysis of the Quality and Effectiveness of Health Kerry Taylor Flinders University December 2009 Active CPHC Care Communications between English Speaking Health Staff and Speakers of Indigenous Languages in Central Australia 140 Research towards Vaccines for Tropical Health David Kemp QIMR Ongoing Active HS 142 Adelaide Urban Location and Health Fran Baum Flinders University April 2010 Active SDOH
149 ACE: Prevention – Guiding Intervention Choices around Rob Carter The University of December 2009 Active CPHC Avoidable Disease Burden and Cost Effectiveness Queensland 158 Developing Sustainable Aboriginal Health Research Practice Priscilla Pyett The University of April 2009 Active CPHC Melbourne 162 Housing Improvement and Child Health (HICH) Project Ross Bailie MSHR July 2009 Active SDOH
166 Australian Indigenous EarInfoNet Peter Morris MSHR Ongoing Active CC Felicity Ward 181 Imagining Childhood: Children Culture and Community Gary Robinson CDU September 2008 Completed SEWB
183 Aboriginal and Torres Strait Islander Apprenticeships with Douglas Josif DHCS August 2009 Active CPHC DHCS 185 Developing, Sustaining and Evaluating Health Programs for Brian McCoy La Trobe University February 2010 Active SEWB Aboriginal Men 188 A Collaborative and International Study of Bronchiectasis Peter Morris MSHR, QIMR, DHCS December 2010 Active CC in Indigenous Children Gabrielle McCallum
42 CRCAH Annual Report 2008−2009 Appendix 2 – Current and Completed Research Projects in Year to June 2009
Administering Expected No. Project Title Project Leaders organisation completion date Status Program
190 CEITC Centre for Excellence in Indigenous Tobacco Control Peter Morris The University of Ongoing Active CC Gabrielle McCallum Melbourne 194 Health Service Utilisation – Stage 1 Michael Rae Bentley Flinders University May 2009 Completed CPHC Browyn Walker La Trobe University Fredericks QAIHC 203 Frameworks for Best Practice in Funding and Regulation Judith Dwyer Flinders University December 2009 Active CPHC Project 204 Support Systems for Indigenous Health Care Ian Anderson La Trobe University December 2009 Active CPHC 206 VAHS Young People’s Project Reg Thorpe The University of October 2009 Active CPHC Melbourne 207 Ethics Network Paul Stewart The University of July 2009 Active CPHC Melbourne 208 ACE Prevention – Advisory Committee Rob Carter Deakin University January 2012 Active CPHC The University of Queensland 213 Let’s Start Gary Robinson CDU August 2009 Active SEWB 216 Monitoring & Evaluating Aboriginal Tobacco Control David Thomas MSHR February 2009 Completed CC 217 A Structured Systems Approach to Improving Health Ross Bailie MSHR 2010 Active CC Promotion Practice for Chronic Disease in Indigenous Communities 218 Chronic Condition Management Strategies in Aboriginal Inge Kowanko Flinders University 2010 Active CC Communities Malcom Battersby Peter Harvey 219 The Indigenous Men, Health and Indigenous Men’s Sheds/ Jack Bulman La Trobe University May 2010 Active CC Spaces Research Program 242 Aboriginal Families Study in South Australia Stephanie Brown The University of 2011 Active CC Melbourne 247 Boys to Men: Garbutt Magpies 25 Years on Brian McCoy La Trobe University December 2009 Active CC 257 Strategic Support for Strengthening the JCU/UQ Melissa Haswell The University of July 2009 Active SEWB Empowerment Research Komla Tsey Queensland 259 Revitalising Health for All – Teasdale Corti Australian Activity Mick Gooda CRCAH December 2010 Active CPHC 267 Strengthen our Voice: A Comparative Post-colonial Serene Fernando ANU March 2010 Active SDOH Narrative of the Kamillaroi People of North-west NSW and Canada 268 Prison Roundtable Scott Davis CRCAH December 2008 Completed SDOH 269 Perspectives of the SDoH Scott Davis CRCAH 2009 Completed SDOH 276 Spirituality Literature Review – Muuji Organisation Julie Tongs Winnunga October 2008 Completed SEWB Nimmityjah & AIATSIS 282 Understanding the Social and Emotional Wellbeing of Tanya Koolmatrie The University of June 2010 Active SEWB Aboriginal Women after Childbirth Melbourne 283 Indicators to Improve Children’s Environmental Health Liz McDonald MSHR December 2008 Completed SDOH in Remote Indigenous Communities – Stage 1 (Kids’ Environmental Health Study KEHS) 284 Exploring Resilience and Coping in Relation to Smoking George Tsourtos Flinders University January 2010 Active CC within ‘At Risk’ Populations 286 Effectiveness of Rotavirus Vaccine for the Prevention of Jonathan MSHR February 2010 Active CC Gastroenteritis among Hospitalised Children in the NT Carapetis 287 Indigenous AOD Workers Wellbeing, Stress and Burnout Ann Roche Flinders University June 2009 Completed SEWB 288 Preventing Infant Deaths among Aboriginal and Teenage Philippa Middleton Flinders University December 2008 Completed CC Women in South Australia 289 Victorian ATSI Emergency Department Presentations Nadia Costa La Trobe University October 2008 Completed CPHC 290 Differential Impact of Australian Tobacco Management Penelope Azzato La Trobe University June 2009 Completed CC Policies for Indigenous and Non-Indigenous Populations – Vivian Lin Is Research Evidence Informing Indigenous Smoking Policy
APPENDICES 43 Appendix 2 – Current and Completed Research Projects in Year to June 2009
Administering Expected No. Project Title Project Leaders organisation completion date Status Program
291 Indigenous Community Capacity Development for Better Scott Davis MSHR December 2009 Active SEWB Health 292 Our Children – Stolen Futures: Evidence of Kim Kilroy The University of March 2010 Active SEWB Intergenerational Trauma from Indigenous Historical Out- Queensland of-home Care 293 LIME – Leaders in Indigenous Medical Education Network Odette Mazel The University of Ongoing Active CPHC Melbourne 296 Burden of Infl uenza and other Respiratory Viruses among Jonathan MSHR January 2011 Active CC Aboriginal Children in the Top End of the Northern Carapetis Territory (FLUTE) Study 298 Positive Stories of Aboriginal and Torres Strait Islanders’ Megan Williams The University of September 2008 Completed SDOH Life Post-prison Release, and Design of Health-based Queensland Intervention 299 The Aboriginal and Torres Strait Islander Adult Health Paul Burgess MSHR June 2009 Active CPHC Check in a Remote Aboriginal Community 300 Revitalising Health for All – Teasdale Corti International Fran Baum Flinders University December 2010 Active CPHC Project 301 ABCD CQI Centre Ross Bailie MSHR December 2009 Active CPHC 309 Popular Education for Critical Literacy Workshop Ben Bartlett CRCAH May 2009 Active CPHC 311 Lateral Violence Mick Gooda CRCAH December 2009 Active SEWB 312 VACCHO – Social Determinants Research Forum Proposal Ray Mahoney VACCHO December 2009 Active SDOH 313 Improving Identifi cation of Aboriginal and Torres Strait Margaret Kelaher The University of December 2009 Active CPHC Islander People in Australian General Practice Melbourne 314 PhD study investigating Art-making as a Transformative Elizabeth Savage- La Trobe University March 2011 Active SEWB Process Contributing to Improved Feelings of Wellbeing for Kooroonya Urban Aboriginal Women 315 Facilitated Development of a Research Project Proposal to Ross Andrews MSHR December 2008 Completed HS Control Scabies and Strongyloides at Galiwin’ku 316 ‘Stepping Up’: Aboriginal and Torres Strait Islander Douglas Josif DHCS June 2009 Completed CPHC Professional Development Program 317 Aboriginal Voice and Vision: Aboriginal Women’s Alice Wilkin La Trobe University October 2010 Active SDOH Experience of Working in the Victorian Health System 321 Transferability of a Mainstream Community Based Annabelle Wilson Flinders University February 2011 Active CC Childhood Obesity Prevention Program of Aboriginal People 322 ‘Sort of Like Reading a Map’. A Community Report on the Fran Edmonds The University of June 2009 Completed SEWB Survival of South-east Australian Aboriginal Art since 1834 Melbourne 323 Moving Forward Together in Aboriginal Women’s Health: A Janet Kelly Flinders University December 2008 Completed CPHC Participatory Action Research Project Exploring Knowledge Sharing, Working Together and Addressing Issues Collaboratively in Urban Primary Health Care Settings 325 Lotus Glen Correctional Centre: Indigenous Peer Support Megan Williams The University of February 2010 Active SDOH Project Evaluation Research Queensland 325 Congress: Teasdale Corti Project Stephanie Bell CAAC December 2009 Active SDOH 326 Utopia: Teasdale Corti Project Sarah Doherty Urapuntja Health December 2009 Active SDOH Service 328 VACCHO / VAHS: Teasdale Corti Project Ray Mahoney VACCHO December 2009 Active SDOH 329 The Role of Agreements in Health Reform in Indigenous Serene Fernando ANU March 2010 Active SDOH Health: Understanding Process and Evaluating Effectiveness 330 QIC Interpretive Guide Development Jill Dixon La Trobe University February 2010 Active CPHC 331 Delivery of Certifi cate II in Child Health Research Ross Andrews MSHR December 2009 Active HS 333 Family Therapy Training for Aboriginal Child and Family Kerry Proctor La Trobe University June 2010 Active SEWB Workers in Community
44 CRCAH Annual Report 2008−2009 Appendix 3: Involvement of End-users in CRCAH Activities
Nature and scale of benefi ts Organisation Type/s of interaction, activity and location to end-users Anaiwan Aboriginal Land Council, NSW Collaborator in projects Knowledge sharing, networking Aboriginal & Islander Alcohol Relief Service Participation in roundtable Infl uence on research priorities Aboriginal Catholic Ministry Collaborator in projects Knowledge sharing, networking Aboriginal Health Council of SA Collaborator in several projects, participant in project Infl uence on research priorities, project grant development, roundtables, partner in in-kind projects Aboriginal Health and Medical Research Collaborator in projects Knowledge sharing, networking Council of NSW Aboriginal Medical Services Alliance of the Participant in project development, attendance at CRCAH Infl uence on research priorities, access to/use NT (AMSANT) Symposium, CRCAH staff member based there of CRCAH staff member Aboriginal Resource and Development Collaborator in projects Knowledge sharing, networking Service Abstarr Consultancy Collaborator in projects Knowledge sharing, networking Aboriginal Women’s Business Unit (Royal Collaborator in project Infl uence on research design Women’s Hospital, Vic.) ACT Government Collaborator in project Development of health system for Aboriginal prisoners in new ACT prison ACT Healthpact Collaborator in project Development of health system for Aboriginal prisoners in new ACT prison Adelaide River Health Service Collaborator in project Improvements in quality of care through CQI AIATSIS Core Partner Infl uence on research priorities Albany Health Service, WA Collaborator in project Improvements in quality of care through CQI Ali Curung Health Service, NT Collaborator in project Improvements in quality of care through CQI AMITY Community Services, NT Collaborator in project Research applied to local organisational needs Amoonguna Health Service, NT Collaborator in project Improvements in quality of care through CQI Anangu Education Offi ce / Collaborator in project Knowledge sharing, networking Dept of Education, SA Andrology Australia Collaborator in projects Knowledge sharing, networking Apunipima Cape York Health Council, Qld Participation in roundtable Infl uence on research priorities Arnhem Land Progress Association, NT Participant in project development Infl uence on research design Australian Bureau of Statistics Collaborator in project Knowledge sharing, networking Australian College of Rural and Remote Collaborator in project Knowledge sharing, networking Medicine Australian Indigenous Doctors Association Participant at roundtable Infl uence on research priorities Australian Indigenous HealthInfoNet Collaborator in project Infl uence on research design Australian Institute of Health and Welfare Collaborator in project Knowledge sharing, networking Australian Medical Association Collaborator in project Infl uence on research design Australian National University, ACT Collaborator in project Access to CRCAH networks Australian Nursing Federation Collaborator in project Infl uence on research design Bagot Community Clinic, NT Collaborator in project Knowledge sharing, networking Baker Institute, Vic. Collaborator in project Knowledge sharing, networking Balranald Health Service, NSW Collaborator in project Improvements in quality of care through CQI Balunu Development Aboriginal Participation in roundtable, CRCAH support in developing Infl uence on research priorities, in-kind support Corporation, NT evaluation plan, roundtable to communicate with NT from CRCAH staff government and NGO agencies Bamaga Health Service, Qld Collaborator in project Improvements in quality of care through CQI Barunga Health Service, NT Collaborator in project Improvements in quality of care through CQI Batchelor Health Service, NT Collaborator in project Improvements in quality of care through CQI Batchelor Institute of Indigenous Tertiary Supporting Partner Link person, Link induction, CRCAH Knowledge sharing, networking, research Education projects, help inform teaching e.g. Healthy Skin, ABCD, applied to local organisational needs participant in quality assurance processes
APPENDICES 45 Appendix 3: Involvement of End-users in CRCAH Activities
Nature and scale of benefi ts Organisation Type/s of interaction, activity and location to end-users Belyuen Health Service, NT Collaborator in project Improvements in quality of care through CQI Beswick Health Service, NT Collaborator in project Improvements in quality of care through CQI Beyondblue Participant in roundtable, participant/partner in several Knowledge sharing, networking, access to projects CRCAH networks Broken Hill Health Service, NSW Collaborator in project Improvements in quality of care through CQI Broome Health Service, WA Collaborator in project Improvements in quality of care through CQI Bulla Health Service, NT Collaborator in project Improvements in quality of care through CQI Bundidee Health Service, NT Collaborator in project Improvements in quality of care through CQI Cancer Council Collaborator in project Research applied to local organisational needs, access to CRCAH networks Cancer Council NSW Collaborator in project Infl uence on research design Cancer Council Victoria Collaborator in project Infl uence on research design CanDo4Kids / Townsend House, SA Collaborator in project Knowledge sharing, networking, research applied to local organisational needs, access to CRCAH networks Cape York Institute, Qld Participant at roundtable Infl uence on research priorities Catholic Education Collaborator in project Infl uence on research design CCRE Aboriginal Health Council of SA Participant at roundtables, quality assurance processes, Infl uence on research priorities, shared collaborator in funded and in-kind projects investment in research priorities Ceduna Koonibba Aboriginal Health Collaborator in project Research applied to local organisational needs Service, SA Centacare, NT Participant in workshop Knowledge sharing, networking Central Australian Aboriginal Congress, NT Core Partner, Board member, Chairperson of SME forum, Infl uence on research priorities, professional participation in roundtables, participant in quality assurance development support, funded project processes, participant in number of projects, contributor to several in-kind projects, host to two CRCAH trainees, three CRCAH – sponsored industry attendees at Chronic Diseases Network Conference, CRCAH-funded Research Fellow Central Australian Remote Health Collaborator in project Infl uence on research design Development Services, NT Central Australian Remote Practitioners Collaborator in project Research applied to local organisational needs Association, NT Central Northern Adelaide Health Service, Collaborator in project Knowledge sharing, networking, research SA applied to local organisational needs Central Northern Adelaide Health Service, Collaborator in project Knowledge sharing, networking, research SA applied to local organisational needs Centre for Remote Health, NT Collaborator in project Shared investment in research priorities Centre for Rural & Remote Mental Health, Participant at roundtable, CRCAH CEO is board member Knowledge sharing, networking Qld Charles Darwin University, NT Core Partner, collaborator in projects Infl uence on research priorities Children, Youth and Women’s Health Collaborator in project Research applied to local organisational needs Services, SA Children’s Hospital Westmead, NSW Partner in in-kind projects Knowledge sharing, networking Committee of Deans of Australian Medical Partner in major project promoting Aboriginal content/ Research applied to local organisational needs Schools cultural appropriateness of medical education, recipients of CRCAH publications Communication and Information Participation in roundtables and/or quality assurance Knowledge sharing, networking Strategies, Collaborative Centre for processes Aboriginal Health Promotion, NSW Council of Remote Area Nurses of Australia Collaborator in project Research applied to local organisational needs Country Health SA (HMS Area Aboriginal Participant at CRCAH Symposium Knowledge sharing, networking Health) Dajarra Health Service, Qld Participant in project Improvements in quality of care through CQI Daly River Health Service, NT Participant in project Improvements in quality of care through CQI
46 CRCAH Annual Report 2008−2009 Appendix 3: Involvement of End-users in CRCAH Activities
Nature and scale of benefi ts Organisation Type/s of interaction, activity and location to end-users Danila Dilba Health Service, NT Core Partner, Board member, Link person, participant in Infl uence on research priorities, professional quality assurance processes, CRCAH Symposium, participant development support in number of projects, two staff receiving scholarship and/or professional development support, CRCAH-funded Research Fellow Dareton Health Service, NSW Participant in project Improvements in quality of care through CQI Department of Emergency Services, Qld Participant at roundtable Knowledge sharing, networking Department of Employment and Participant at roundtable Knowledge sharing, networking Workplace Relations, Australian Government Department of Employment, Education and Supporting Partner, participant in roundtables, Link person, Research applied to local organisational needs, Training, NT collaborator in project knowledge sharing, networking Department of Families, Housing, Supporting Partner, Program Leader, Link person, Infl uence on research priorities Community Services and Indigenous collaborator in external project, partner in number of Affairs, Australian Government projects, participating in roundtables and quality assurance processes Department of Family and Community Supporting Partner Knowledge sharing, networking Services, ACT Department of Health and Ageing/OATSIH, Core Participant, Board member, Program Leaders, Infl uence on research priorities, infl uence on Australian Government Link person, funder of International Program, partner research design in a number of research projects, signifi cant number of participants in roundtables and quality assurance processes, CRCAH CEO and Research Director participation in various projects and committees Department of Health and Community Core Partner, Board member, Program Leader, Link person, Outcomes from ABCDE project applied to DHCS Services, NT participating in research priority setting, participation in policy and practice, Healthy Skin East Arnhem roundtables, participant in number of projects, contributor delivers skin treatment services to DHCS clients, of several in-kind projects individual professional development Department of Health and Human Collaborator in project Research applied to local organisational needs Services, Tas. Department of Health, SA Collaborator in projects, participant in roundtables, quality Infl uence on research priorities, research assurance process, participant at Fulbright Symposium applied to local organisational needs, knowledge sharing, networking Department of Health SA, Aboriginal Participant at Fulbright Symposium Knowledge sharing, networking Health Division Department of Health, WA Collaborator in project Research applied to local organisational needs Department of Human Services, SA Collaborator in project Research applied to local organisational needs Department of Human Services, Vic. Collaborator in project Research applied to local organisational needs Department of Natural Resources, Collaborator in project Research applied to local organisational needs Environment, the Arts and Sport, NT Derbal Yerrigan (DY) East Perth Health Participant in project Improvements in quality of care through CQI Service, WA DY Maddington Health Service, WA Participant in project Improvements in quality of care through CQI DY Mirrabooka Health Service, WA Participant in project Improvements in quality of care through CQI Diabetes Australia Collaborator in project Research applied to local organisational needs Dietitians Association of Australia Collaborator in project Research applied to local organisational needs Drug and Alcohol Services, SA Collaborator in project Research applied to local organisational needs Drug Prevention Council Collaborator in project Research applied to local organisational needs Eyre Peninsula Division of General Practice, Collaborator in project Research applied to local organisational needs SA
Family and Community Healing program Collaborator in project Infl uence on research design Fitzroy Crossing Health Service, WA Participant in project Improvements in quality of care through CQI Flinders Medical Centre, SA Participant in in-kind project Knowledge sharing, networking, research applied to local organisational needs
Flinders University, SA Core Partner Infl uence on research priorities Garden Point Clinic, NT Collaborator in project Research applied to local organisational needs
APPENDICES 47 Appendix 3: Involvement of End-users in CRCAH Activities
Nature and scale of benefi ts Organisation Type/s of interaction, activity and location to end-users Geraldton Health Service, WA Collaborator in project Improvements in quality of care through CQI Gold Coast Drug Council, Qld Collaborator in in-kind projects Knowledge sharing, networking Gold Coast Institute of TAFE, Qld Collaborator in in-kind projects Knowledge sharing, networking Gold Coast Native Title Group, Qld Collaborator in in-kind projects Knowledge sharing, networking Greater Western Area Health Service, NSW Collaborator in in-kind projects Knowledge sharing, networking Griffi th University, Qld Collaborator in in-kind projects Knowledge sharing, networking Gurriny Yealamucka Health Services, Qld Participant at roundtable Infl uence on research priorities Hopevale Health Service, Qld Participant in project Improvements in quality of care through CQI Human Rights and Equal Opportunity Participant at roundtable Knowledge sharing, networking Commission
Human Services Training & Advisory Council Collaborator in in-kind projects Knowledge sharing, networking Ivanhoe Health Service, NSW Participant in project Improvements in quality of care through CQI James Cook University, Qld Collaborator in major program of work around Infl uence on research priorities, project grant empowerment, attendance at roundtables and contribution to quality assurance, contributor to range of other projects Jilkminggan Health Service, NT Participant in project Improvements in quality of care through CQI
Kalkarindji Health Service, NT Participant in project Improvements in quality of care through CQI Katanning Health Service, WA Participant in project Improvements in quality of care through CQI Katungul Aboriginal Corporation and Collaborator in project Improvements in quality of care through CQI Community Medical Service, NSW Keeria Press Collaborator in in-kind projects Knowledge sharing, networking Kidney Health Australia Collaborator in project Research applied to local organisational needs Kimberley Population Health Unit, WA Collaborator in project Research applied to local organisational needs Koorie Heritage Trust Inc., Vic. Participant in a project Knowledge sharing, networking La Trobe University, Vic. Core Partner Infl uence on research priorities Lajamanu Community Council, NT Collaborator in project Research applied to local organisational needs Lajamanu Health Service, NT Participant in project Improvements in quality of care through CQI Laynahpuy Homelands, NT Participant in project Improvements in quality of care through CQI Ltyentye Apurte, Health Service, NT Participant in project Improvements in quality of care through CQI Maari Ma Health Aboriginal Corporation, Collaborator in number of projects Knowledge sharing, networking, research NSW applied to local organisational needs Malabam Health Board, NT Collaborator in project Research applied to local organisational needs Maori Smokefree Coalition, New Zealand Collaborator in project Research applied to local organisational needs Mapoon Health Service, Qld Participant in project Improvements in quality of care through CQI Marngarr Health Service, NT Participant in project Improvements in quality of care through CQI Marthakal Health Service, NT Participant in project Improvements in quality of care through CQI Marwarn-karra Health Service, WA Participant in project Improvements in quality of care through CQI Mary St Adolescent Program, SA Participant in roundtable Infl uence on research priorities Maya Healing Centre, Vic. Participant in roundtable Infl uence on research priorities Menindee Health Service, NSW Participant in project Improvements in quality of care through CQI Menzies School of Health Research, NT Core Partner, Board member, collaborator in projects Research applied to local organisational needs, infl uence on research priorities, knowledge sharing Milikapiti Women’s Centre, NT Collaborator in project Research applied to local organisational needs Milingimbi Health Service, NT Participant in project Improvements in quality of care through CQI Miwatj Health Service, NT Participant in project Improvements in quality of care through CQI Mookai Rosie B/Bayan, Qld Participant at roundtable Infl uence on research priorities
48 CRCAH Annual Report 2008−2009 Appendix 3: Involvement of End-users in CRCAH Activities
Nature and scale of benefi ts Organisation Type/s of interaction, activity and location to end-users Mornington Island Health Service, Qld Participant in project Improvements in quality of care through CQI Mt Liebig Health Service, NT Participant in project Improvements in quality of care through CQI Mulung Medical Centre Aboriginal Participant at roundtable Infl uence on research priorities Corporation, NSW Murdoch Childrens Research Institute, Vic. Collaborator in project Access to CRCAH networks Muru Marri Indigenous Health Unit, Participant in project Knowledge sharing, networking, research University of NSW applied to local organisational needs Muuji Regional Centre, ACT Participant in project Knowledge sharing, networking, research applied to local organisational needs Napranum Health Service, Qld Participant in project Improvements in quality of care through CQI Narrogin Health Service, WA Participant in project Improvements in quality of care through CQI National Cancer Control Initiative Collaborator in project Research applied to local organisational needs National Centre for Education and Training Partner in in-kind projects Knowledge sharing, networking on Addiction National Centre for Immunisation, Collaborator in project Access to CRCAH networks Research and Surveillance National Aboriginal Community Controlled Peak body for Aboriginal health sector, participation in Infl uence on research priorities Health Organisation (NACCHO) roundtables, collaborator in project National Heart Foundation Collaborator in project Research applied to local organisational needs National Stroke Research Institute Collaborator in project Research applied to local organisational needs Nguiu Clinic, NT Collaborator in project Research applied to local organisational needs Nightcliff Renal Unit, NT Collaborator in project Infl uence on research design Noarlunga Health Service, SA Collaborator in project Research applied to local organisational needs Northern Area Health Service, Queensland Participant at roundtable Knowledge sharing, networking Health, Northern Area Mental Health Northern Territory Human Services Training Collaborator in project Infl uence on research design Advisory Council NSW Department of Health Collaborator in project Research applied to local organisational needs NSW Justice Health Participant at roundtable Knowledge sharing, networking Ntaria Health Service, NT Participant in project Improvements in quality of care through CQI Nunkawarrin Yunti, SA Participant in a number of projects Knowledge sharing, networking, research applied to local organisational needs Oenpelli Health Service, NT Participant in project Improvements in quality of care through CQI Osteoporosis Australia Collaborator in project Research applied to local organisational needs Outback Stores / Indigenous Business Participant in project development Infl uence on research design Australia OXFAM Australia Participant at roundtable Knowledge sharing, networking, access to CRCAH networks Palumpa Health Service, NT Participant in project Improvements in quality of care through CQI Palyalatju Maparnpa Health Committee, WA Collaborator in project Research applied to local organisational needs Pika Wiya Health Service, SA Participant in in-kind projects Knowledge sharing, networking Pine Creek Health Service, NT Participant in project Improvements in quality of care through CQI Plan Health, NSW Collaborator in project, Program Leader Knowledge sharing, networking, research applied to local organisational needs, access to CRCAH networks Point Pearce Community, SA Participant in project Knowledge sharing, networking Pormpuraaw Council, Qld Participant at roundtable Knowledge sharing, networking Port Lincoln Aboriginal Health Service, SA Collaborator in project Professional development Primary Health Care Research and Participation in roundtables and quality assurance processes Knowledge sharing, networking, access to Evaluation Department CRCAH networks
APPENDICES 49 Appendix 3: Involvement of End-users in CRCAH Activities
Nature and scale of benefi ts Organisation Type/s of interaction, activity and location to end-users Queensland Aboriginal and Islander Health Collaborator in number of major projects, participant in Infl uence on research priorities, infl uence on Council roundtables, quality assurance processes, conducting related research design, shared investment in research research through its Centre for Clinical Research Excellence priorities Queensland Health Participant at roundtable, collaborator in projects Infl uence on research priorities Queensland Institute of Medical Research Core Partner Infl uence on research priorities Quit Victoria Collaborator in project Infl uence on research design Riverina Medical and Dental Aboriginal Collaborator in project Research applied to local organisational needs Corporation, NSW Royal Adelaide Hospital, SA Collaborator in project Research applied to local organisational needs Royal Children’s Hospital, Vic. Collaborator in project Research applied to local organisational needs Royal Darwin Hospital, NT Collaborator in project Research applied to local organisational needs Royal Flying Doctor Service, Qld Participant at roundtable Knowledge sharing, networking Royal Prince Alfred Hospital, NSW Collaborator in project Research applied to local organisational needs Royal Prince Alfred Hospital, NSW Collaborator in project Research applied to local organisational needs Rumbalara Aboriginal Cooperative, Vic. Collaborator in several projects Infl uence on research priorities Rural Workforce Agency of Victoria Collaborator in project Research applied to local organisational needs SAILS Inc (Anglican Sailing Adventures in Collaborator in project Provision of expertise in training program Life Skills) Services for Australian Rural and Remote Collaborator in project Research applied to local organisational needs Allied Health (SARRAH) Sexual Health Information Networking & Collaborator in in-kind projects Knowledge sharing, networking Education, SA Snake Bay Clinic, NT Collaborator in project Research applied to local organisational needs Social Inclusion Unit, Department of Participant at Fulbright Symposium Knowledge sharing, networking Premier and Cabinet, SA Southern Adelaide Health Service, SA Participation in roundtables, quality assurance processes, Infl uence on research priorities collaborator in project, participant in Fulbright Symposium Strong Women, Strong Babies, Strong Collaborator in project Research applied to local organisational needs Culture Program, NT Sydney South-West Area Health Service, Collaborator in project Research applied to local organisational needs NSW Take Two, Berry Street, Vic. Participant in roundtables, partner in in-kind projects Infl uence on research priorities Tasmanian Government Collaborator in project Infl uence on research design Telethon Institute of Child Health Research, Collaborator in project, Supporting Partner, Board member Knowledge sharing, networking WA (independent) involved in quality assurance processes The George Institute for International Collaborator in project Knowledge sharing, networking, access to Health, NSW CRCAH networks The Royal Women’s Hospital, Vic. Collaborator in project Research applied to local organisational needs The WA Centre for Pathology and Medical Collaborator in project Access to CRCAH networks Research Ti Tree Health Service, NT Participant in project Improvements in quality of care through CQI Timber Creek Health Service, NT Participant in project Improvements in quality of care through CQI Titjikala Health Service, NT Participant in project Improvements in quality of care through CQI Tiwi for Life, NT Collaborator in project Research applied to local organisational needs Tiwi Health Advisory Board, NT Collaborator in project Research applied to local organisational needs Top End Division of General Practice, NT Collaborator in project Research applied to local organisational needs Top End Mental Health, NT Participant in roundtable, linked to AIMHI project Infl uence on research priorities Townsville Aboriginal and Islander Health Collaborator in project Research applied to local organisational needs Service, Qld University of Adelaide (The), SA Partner in in-kind projects Knowledge sharing, networking University of Canberra, ACT Collaborator in project Access to CRCAH networks
50 CRCAH Annual Report 2008−2009 Appendix 3: Involvement of End-users in CRCAH Activities
Nature and scale of benefi ts Organisation Type/s of interaction, activity and location to end-users University of Melbourne (The), Vic. Core Partner, Board member, participant in roundtables Knowledge sharing, networking, access to CRCAH networks University of New South Wales (The), Collaborator in project Access to CRCAH networks, knowledge sharing, NSW networking University of Northern British Columbia, Collaborator in in-kind projects Knowledge sharing, networking Canada University of Otago, New Zealand Collaborator in in-kind projects Knowledge sharing, networking University of Papua New Guinea, School of Collaborator in project Research applied to local capacity development Public Health, PNG needs University of Queensland (The) Core Partner Infl uence on research priorities University of South Australia Collaborator in project Knowledge sharing, networking, access to CRCAH networks University of Sydney (The), NSW Collaborator in project Knowledge sharing, networking, access to CRCAH networks Urapuntja Health Service, NT Collaborator in project Research applied to local organisational needs Utju Health Service, NT Participant in project Improvements in quality of care through CQI Victorian Aboriginal Child Care Agency, Vic. Participant at roundtables, collaborator in project Infl uence on research priorities Victorian Aboriginal Community Controlled Board member (independent), involved in many Infl uence on research priorities, infl uence on Health Organisation (VACCHO) CRCAH projects, participating in research priority setting, research design participation in roundtables, participant in quality assurance processes, involvement in capacity development strategy planning Victoria University, Vic. Participant in roundtables Knowledge sharing, networking, access to CRCAH networks Victorian Aboriginal Health Service, Vic. Collaborator in project Research applied to local organisational needs Wadeye Community Health Centre, NT Collaborator in project Research applied to local organisational needs Western Desert Nganampa Walytja Participant in project Knowledge sharing, networking Palyantjaku Tjutaku, NT Wesley Mission, Lifeskills Program Participant in in-kind project Knowledge sharing, networking Westmead Hospital, NSW Collaborator in project Knowledge sharing, networking, research applied to local organisational needs Wilcannia Health Service, NSW Participant in project Improvements in quality of care through CQI Willowra Health Service, NT Participant in project Improvements in quality of care through CQI Winnunga Nimmityjah Aboriginal Health Collaborator in project Knowledge sharing, networking, research Service, ACT applied to local organisational needs Women’s Alcohol and Drug Service (Royal Collaborator in project Infl uence on research design Women’s Hospital) Vic. Women’s and Children’s Hospital, SA Collaborator in project Research applied to local organisational needs Wu Chopperen Health Service, Qld Participant at roundtables, collaborator in projects Infl uence on research priorities Wujai Wujai Health Service, Qld Participant in project Improvements in quality of care through CQI Wurli Wurlijang Health Service, NT Participant in project Improvements in quality of care through CQI Wyeth Vaccines Collaborator in project Infl uence on research design Yalu Marnggithinyaraw, NT Collaborator in project Infl uence on research priorities Yarralin Health Service, NT Participant in project Improvements in quality of care through CQI Yirrkala Health Service, NT Participant in project Improvements in quality of care through CQI Yolngu Consultants, NT Collaborator in project Infl uence on research design Youth Justice, Department of Communities, Collaborator in in-kind projects Knowledge sharing, networking Queensland Government
APPENDICES 51 Appendix 4: Third-Year Review Recommendations
Third-year review recommendation Progress That the Board review the timelines for program approval, project development and Done. Changes made to the Facilitated Development Approach and roll-out for the Social and Emotional Wellbeing and Social Determinants of Health all priority projects endorsed or close to fi nal endorsement by July Programs, and realistically set priorities on which potential projects can feasibly be 2007. delivered in the time remaining in the current CRC round. This may require a variation in the Agreement Schedule. That the Board give consideration to identifying an ‘operational’ Program Leader Done. Issue of Program Leader time was discussed with Program (from the existing PLs) for each program, who has responsibility for taking projects Leaders individually and at the Research Development Group. As forward (together with the Program Manager), and buying some of that person’s a result, additional mechanisms to support the involvement of time. program leaders were put in place – ranging from issues about time management to fi nancial support. That the CRCAH track and report on website hits as one measure of utilisation and Done. potential industry impact. That the Research Director expedite the SEWB Program Statement to the Board in Done. good time to allow speedy development of the program. That the CEO meets regularly with key partner researchers and the Board gives The CRCAH has continued to build on strategic opportunities consideration to explore ways to be able to take advantage of strategic opportunities throughout the year, including additional investments in projects when they arise. that will lead to a signifi cant increase in their impact, as agreed to by the Board; collaborative investments with new stakeholders; and assisting the ACCHO sector to build the capacity of their sector to use health research. That the CRCAH considers alternative but explicit measures of research quality from an Done. Facilitated Development Approach involves Aboriginal Indigenous perspective, and test those. researchers and research users and supports their active involvement in all quality assurance processes. That the CRCAH reviews its procedures for communicating these obligations to partner Project reporting forms and procedures reviewed and organisations and researchers, to enable and ensure accurate reporting of research communicated to all core partners and project leaders. outputs. The CRCAH considers expanding its reviewer pool by appointing international experts Ongoing. Quality assurance policy developed for CRCAH-funded to its review panels. publications. Proportion of recommendations implemented. 100% Strategies for implementing any remaining recommendations. There will be ongoing effort to ensure the CRCAH can take advantage of strategic opportunities and engage international researchers in quality assurance or other processes. Any diffi culties anticipated by the Board in relation to any of the recommendations. N/A
52 CRCAH Annual Report 2008−2009 Appendix 5: Performance Measures
1. QUALITY AND RELEVANCE OF RESEARCH
1.1. Undertake quality research on health systems, health determinants and health conditions. Number of peer-reviewed publications arising from CRCAH research (both funded and in-kind research) 11 Number of presentations at conferences arising from CRCAH research (both funded and in-kind 57 research) Amount of competitively funded research leveraged into CRCAH as in-kind $2,800,000 Amount of other external funding leveraged into CRCAH through external projects $201,000 Proportion of CRCAH research reports published following quality assurance processes 100% 1.2. Undertake relevant research with impact on Aboriginal health outcomes through research partnerships with stakeholders, Aboriginal control and participation, and high standards of ethical and methodological practice. Proportion of CRCAH-funded projects which have undergone quality assurance processes (merit and 94% technical review by scientifi c and industry reviewers) Number and proportion of programs developed and conducted in collaboration with industry partners 100% Number and proportion of CRCAH-funded projects initiated from industry priorities 80% Proportion of industry representation at CRCAH Symposium N/A Number and proportion of members of the Board, Executive, and Research Development Group who are Board: 8/16 (50%) Aboriginal Executive: 3/5 (60%) RDG: 9/23 (39%) Number and proportion of projects conducted with Aboriginal Project Leaders/team members 51% 2. UTILISATION AND APPLICATION OF RESEARCH OUTPUTS
Research programs will achieve improvements in health outcomes for Aboriginal people. Number and proportion of programs which include explicit research transfer goals and plans that aim to 100% achieve research impacts conceptually, symbolically, and/or instrumentally Number of identifi able conceptual, symbolic or instrumental impacts from each CRCAH research program Conceptual: 15 products (annual description and testimonials) Symbolic: 2 products Instrumental: 37 products Number and value of in-kind projects incorporated into CRCAH research programs 119 in-kind projects (10 new in-kind projects started in reporting period), value unable to calculate 3. EDUCATION AND TRAINING RESEARCH OUTPUTS
Strengthen the capacity of and develop career pathways for Aboriginal people in health research and related areas, and increase capacity of the Aboriginal health research workforce. Number of Aboriginal students undertaking and completing traineeships, cadetships, undergraduate and Traineeships: 9 started, 8 completed postgraduate degrees (both CRCAH funded and in-kind students) Cadetships: 2 started, 1 completed Undergraduate: 1 started, 0 completed Postgraduate: 30 started, 19 completed Postgraduate in-kind students: 3 started, 2 completed Number of non-Aboriginal researchers undertaking and completing research degrees relevant to the 29 started, 26 completed CRCAH objectives (both CRCAH funded and in-kind students) In-kind: 12 started, 6 completed Number of CRCAH-endorsed education and training activities conducted by the CRCAH and its partners 16 Number of students taking part in endorsed education and training activities conducted by the CRCAH and 411 its partners Number and proportion of research programs which include explicit capacity development plans All programs include capacity development goals; all have committed funds to specifi c capacity development activities Number of students involved in CRCAH research program’s activities 29 4. COLLABORATIVE ARRANGEMENTS OUTPUTS
To enhance collaboration among researchers, between researchers and industry or other users, and to improve effi ciency in the use of intellectual and other research resources. Number of Board meetings held 5 Number of Research Development Group and Link people meetings held RDG: 1 Link People: 6 Number of core partners, external partners, research and industry partners involved in CRCAH research. 275 Number of CRCAH newsletters produced Gwalwa-Gai (newsletter): 5 e-Bulletin: 24 Degree of satisfaction with CRCAH newsletters and other communications mechanisms (annual survey) •83.3% rated their satisfaction with Gwalwa-Gai (G-G) as high (58.3%) or very high (25%) •100% of respondents said they read G-G for ‘Concise news roundup for Aboriginal health sector’ •81.8% rated their satisfaction with the e-Bulletin as high (72.7%) or very high (9.1%) •81.8% rated CRCAH Communications activities as effective (54.5%) or very effective (27.3%) 5. MANAGEMENT Summary fi nancial statement Completed Proportion of total budget allocated to administration of the CRCAH 26% Quarterly and annual fi nancial statements, annual report, management data questionnaire and audit Completed submitted on time
APPENDICES 53 10 GLOSSARY
AATAAC Azithromycin versus Amoxycillin for Treatment of Acute otitis FaHCSIA Department of Families, Housing, Community Services and media in Aboriginal Children Indigenous Affairs (Australian Government) ABCD Audit and Best Practice in Chronic Disease FDA Facilitated Development Approach ABCDE Audit and Best Practice in Chronic Disease Extension FRC Family Relationship Centre ABS Australian Bureau of Statistics FU Flinders University ACCHO Aboriginal Community Controlled Health Organisation HICH Housing Improvement and Child Health ACRRM Australian College of Rural and Remote Medicine HIV Human Immunodefi ciency Virus ADEA Australian Diabetes Educators Association HOSW Healing Our Spirit Worldwide AHCSA Aboriginal Health Council of South Australia IMPAKT Improving Access to Kidney Transplant (study) AHMAC Australian Health Ministers Advisory Council IUHPE International Union of Health Promotion and Education AH&MRC Aboriginal Health and Medical Research Council KEHS Kids’ Environmental Health Study AHPA Australian Health Promotion Association MPH Master of Public Health AHW Aboriginal Health Worker MSHR Menzies School of Health Research AIATSIS Australian Institute of Aboriginal and Torres Strait Islander NACCHO National Aboriginal Community Controlled Health Studies Organisation AIDA Australian Indigenous Doctors’ Association NAGATSIHID National Advisory Group on Aboriginal and Torres Strait AIHW Australian Institute of Health and Welfare Islander Health Information and Data AIMHI Australian Integrated Mental Health Initiative NAIDOC National Aborigines and Islander Day Observance Committee AMA Australian Medical Association NCSA Native Counselling Services of Alberta AMSANT Aboriginal Medical Services Alliance of the NT NGO Non-Government Organisation ANF Australian Nursing Federation NHHRC National Health and Hospitals Reform Commission ANTAR Australians for Native Title and Reconciliation NHMRC National Health & Medical Research Council ANU Australian National University NIATSIHR National Institute for Aboriginal and Torres Strait Islander Health Research AOD Alcohol and Other Drugs NICP National Indigenous Cadetship Program ASSA Academy of the Social Sciences Australia NIHEC National Indigenous Health Equality Council ATSIC Aboriginal and Torres Strait Islander Commission NSPS National Suicide Prevention Strategy CAAC Central Australian Aboriginal Congress NSW New South Wales CARPA Central Australian Rural Practitioners Association NT Northern Territory CATSIN Congress of Aboriginal and Torres Strait Islander Nurses NTEHP National Trachoma and Eye Health Program CC Chronic Conditions OATSIH Offi ce of Aboriginal & Torres Strait Islander Health CCM Chronic Condition Management OECD Organisation for Economic Cooperation and Development CCRE Centre of Clinical Research Excellence PHAA Public Health Association of Australia CDAMS Committee of Deans of Australian Medical Schools PNG Papua New Guinea CDU Charles Darwin University CEITC Centre for Excellence in Indigenous Tobacco Control QAIHC Queensland Aboriginal & Islander Health Council CEO Chief Executive Offi cer QIMR Queensland Institute of Medical Research CIPHER Capacity Building in Indigenous Policy Relevant Health RAH Royal Adelaide Hospital Research (CRCAH project) SA South Australia CNAHS Central Northern Adelaide Health Service SACHRU South Australian Community Health Research Unit COAG Council of Australian Governments SAILS Anglican Sailing Adventures in Life Skills Inc CPHC Comprehensive Primary Health Care SARRAH Services for Australian Rural and Remote Allied Health CPHCHSW Comprehensive Primary Health Care, Health Systems and SDOH Social Determinants of Health Workforce SEWB Social and Emotional Wellbeing CQI Continuous Quality Improvement TAFE Technical and Further Education CRCAH Cooperative Research Centre for Aboriginal Health UM The University of Melbourne CRCATH Cooperative Research Centre for Aboriginal and Tropical UN United Nations Health UPNG University of Papua New Guinea CSDH Commission on the Social Determinants of Health (WHO) UQ University of Queensland CSIRO (Australian) Commonwealth Scientifi c and Industrial Research Organisation UWA University of Western Australia CVD Cardiovascular Disease VACCHO Victorian Aboriginal Community Controlled Health Organisation DoHA Department of Health and Ageing DHCS Department of Health and Community Services (NT) VAHS Victorian Aboriginal Health Service DRUID Diabetes and Related Disorders in Urban Indigenous People WA Western Australia in the Darwin Region (study) WHO World Health Organization
54 CRCAH Annual Report 2008−2009 Whale Dreaming © Y. Bundle 2007 This work arose from a dream Yaraan received. It is about the Whale Dreaming songline connected to Keerray Woorroong Country along the coast near Warrnambool. In her dream the Old People told Yaraan the story of the Southern Right Whale and their journey to our waters to give birth to their young. They told her the secret of the whales and the knowledge they bring. This work tells their story.
Yaraan Bundle Yaraan Bundle is a Keerray Woorroong/ Gunditjmara woman living in her homelands in the Western Districts of Victoria, Gunditjmara Country. She also has family/kinship connections with the Yuin/Monero from the South Coast of New South Wales and the Bidjera from central Queensland. Yaraan is mother to Keanu Lien. She is one of five daughters to her artist mother, Vicki Couzens, and musician/singer/songwriter father, Robert Bundle. Yaraan is a dancer in our ‘peeneeyt thanambool’ (strong women) women’s dance and cultural group. Along with her sisters, ‘peeneeyt thanambool’ have performed at many festivals across Victoria and interstate. She is a prolific storyteller and writer with works published in newsletters, and an annual publication, Lewin, an anthology of Indigenous children’s writings from around the world, was published for Photo courtesy of Jo Grant seven consecutive years as part of the Global Indigenous Arts Project. Yaraan’s deep spiritual connection to culture and Country is what inspires her writing, storytelling and artworks. For further information: Cooperative Research Centre for Aboriginal Health PO Box 41096 Casuarina NT 0811 T 08 8943 5000 F 08 8943 5010 E [email protected] www.crcah.org.au 22 Catterthun Street Winnellie NT 0820