“Cutting a Track” REGIONAL PLAN 2020 – 2022 the Murrumbidgee Aboriginal Impact Co

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MURRUMBIDGEE ABORIGINAL HEALTH CONSORTIUM “Cutting a track” REGIONAL PLAN 2020 – 2022 The Murrumbidgee Aboriginal Impact Co. gratefully acknowledges Health Consortium would like the financial support from Murrumbidgee Primary Health Table of Contents to acknowledge the hard work Network, through the Australian from the committee members Government’s PHN Program, to and the local Aboriginal develop the 2020-2022 Regional Partnership Commitment 2 Appendix A – Health and Service data 28 communities for all their Plan of the Murrumbidgee Aboriginal Population spread 29 support and input into the Health Consortium. Introduction 3 Socio-economic status 30 development of the regional Impact Co. would like to The role and purpose of the Consortium 4 Mental health 32 Murrumbidgee Aboriginal acknowledge the traditional Alcohol and other drugs 36 health plan. Aboriginal custodians of country Principles 4 Chronic disease 40 throughout New South Wales and The Murrumbidgee Aboriginal Approach to developing the 2020-2022 regional plan 6 Maternal health and early childhood 46 pay our respect to them, their culture Health Consortium look Family violence 52 and their Elders past, present and Relevant Commonwealth/State plans and programs 9 forward to working with Bec-lee Creating dreams Wiradjuri artist future. We acknowledge and are List of tables local service providers and thankful to the many Aboriginal Foundational enablers 10 About the artwork Table 1: Spread of Aboriginal and Torres Strait Islander population Aboriginal communities to people who participated in this in the Murrumbidgee region according to IARE (ABS, 2016) 29 Aboriginal and Torres Strait Islander people in achieve good health outcomes Tree of life: This symbol signifies hope, strength goals, plans moving project and for the welcome they Table 2: Socio-economic status of IAREs according to most to least the Murrumbidgee region 12 for all Aboriginal families forward, triumphs and tribulations, challenges and opportunities. gave us as we visited their land and disadvantaged (PHIDU, 2016) 30 residing in the Murrumbidgee communities. To the Traditional Table 3: Age standardised rate (ASR) of mental health related This symbol relates to all areas of life, death and rebirth. It’s the cycle Health issues 15 Owners, Elders and community hospital admissions of Aboriginal and Torres Strait Islander people area. of life. members in each service/community Priority areas 20 (PHIDU, 2014/15-2016/17) 32 Table 4: ASR of potentially preventable chronic conditions per In Aboriginal culture we use the term Dreamtime to explain our we visited, we hope we respect your 100,000 hospital admissions by Aboriginal and Torres Strait Islander existence, our creation and our passing. The Tree is very sacred as it land and country and that we walked Measuring success – Evaluation and Monitoring people (PHIDU, 2014/15-2016/17) 40 holds the stories of our Elders and is home to our ancestors. Once lightly on it on the occasions that we Framework 24 Table 5: Proportion of children developmentally vulnerable in one we pass over, we go back to our old people and are transformed into were there. or more domain according to the AEDC (PHIDU, 2015) 47 country, the trees, rocks, mountains and cullies are our resting place, Table 6: Proportion of Aboriginal and Torres Strait Islander women our home, which is why we are so connected to country. that smoked during pregnancy (PHIDU, 2012-2014) 47

We belong to the land and we all stand on sacred ground. We also Table 7: No. of recorded domestic violence incidents per 100,000 population (NSW Bureau of Crime Statistics and Research, 2018-2019) 52 have many uses of the Tree. Birthing trees were used by our mothers to birth children, women’s business. And sorry business which means loss of our culture surrounding the tree in grief and burial ceremonies. The Tree is a very strong and sacred symbol for our culture. PartnershipPartnership CommitmentCommitment Introduction

AllAll signatoriessignatories toto thethe The Murrumbidgee Aboriginal Membership of the Consortium includes: MurrumbidgeeMurrumbidgee AboriginalAboriginal Health Consortium (The healthhealth planplan 2020-222020-20222020-22 are are are Consortium) was established committedcommitted toto ensuringensuring in 2015 to improve the Core membership: Associate membership: RiverinaRiverina Aboriginal Aboriginal Medical Medical and and Dental Dental LeetonLeeton District District Local Local Aboriginal Aboriginal Land Land that this represents a new Riverina Aboriginal Medical and Dental Leeton and District Local Aboriginal Land that this represents a new health and wellbeing of • Aboriginal community participants CorporationCorporation CouncilCouncil representativerepresentative • Department of Education stagestage inin thethe relationshipsrelationships Aboriginal people living • Riverina Aboriginal Medical and • Prime Minister and Cabinet betweenbetween GovernmentGovernment andand in the Murrumbidgee Dental Corporation • Justice NSW representative non-governmentnon-government agencies.agencies. ItIt region as defined by the • Griffith Aboriginal Medical Service recogniserecognisesrecognise the the the importance importance importance of of of Murrumbidgee Primary • Family and Community Services thethe strengthstrength ofof relationshipsrelationships Health Network (MPHN) • Viney Morgan Aboriginal Medical • Department of Premier and Cabinet Service toto ensuringensuring improvedimproved healthhealth boundaries by coordinating • Aboriginal Affairs representative GriffithGriffith AboriginalAboriginal MedicalMedical ServiceService MurrumbidgeeMurrumbidgee PrimaryPrimary HealthHealth NetworkNetwork outcomesoutcomes forfor locallocal AboriginalAboriginal and implementing targeted • Riverina Murray Regional Alliance andand TorresTorres StraitStrait IslanderIslander strategies and initiatives • Local Aboriginal Land Council communitiescommunities residingresiding withinwithin through key regional representatives the Murrumbidgee region. As This Regional Plan outlines the priorities the Murrumbidgee region. As stakeholders. • Murrumbidgee Local Health District a living document it will be of the Consortium that will be the areas of a living document it will be (MLHD) focus for the 2020-2022 period, including reviewedreviewed and,and, ifif necessarynecessary VineyViney MorganMorgan AboriginalAboriginal ServiceMedicalService MurrumbidgeeMurrumbidgee LocalLocal HealthHealth DistrictDistrict • MPHN the underpinning strategies and initiatives. amendedamended fromfrom timetime toto time.time. Services • Non-Government agencies In addition, this document outlines how the It’sIt’s notnot intendedintended toto bebe aa delivering Aboriginal wellbeing Consortium will work together, an overview legallylegally bindingbinding document.document. initiatives aligned with the of the health and population needs and the Aboriginal Health Consortium Plan state and national Government policies that currently influence the range of services that RiverinaRiverina MurrayMurray RegionalRegional AllianceAlliance MarathonMarathon HealthHealth are available to support the delivery of its Justine Summers priorities. Executive Manager Service Delivery

22 3 THE ROLE AND PURPOSE OF THE CONSORTIUM

The role and purpose of the Consortium as it forms the basis of this Regional Plan and underpins the work of the Consortium. WE AIM TO OUR PURPOSE • Support better outcomes for To work together to improve the health and wellbeing of local Aboriginal and Aboriginal and Torres Strait Islander Torres Strait Islander Australians to increase life expectancy. community in the Murrumbidgee region, focusing on prevention and PRINCIPLES early intervention; and • Ensure services in the region are The following principles underpin the way in which we work. coordinated and easy-to-access/ navigate Trust – The Consortium will ensure that it retains the trust of community and its initiatives are always in their best interests. Consortium members will also by actively build trust in one another, creating a solid foundation for an effective • Promoting greater collaboration and committed partnership with one another. between services providers in the Collaboration – Consortium members will work together with each other to region; improve the health and wellbeing of the local Aboriginal and Torres Strait • Leveraging and sharing existing Islander community. This will be done in a respectful and meaningful manner. resources; and

Accountability – Consortium members are collectively responsible for ensuring • Attracting additional resources to that the actions in the Regional Plan are implemented. meet the needs of our community.

Adaptable – The actions and initiatives of the Consortium will be informed by the needs and context of the local community. Where there is a change in need and/or context, the actions and initiatives of the Consortium will need to be adapted accordingly.

4 5 A summary of the research activities that were undertaken by Impact Co. to inform this Regional Plan are highlighted on this Approach to developing the page.

Project establishment 2020 – 2022 Regional Plan Two workshops with the Consortium

JULY Impact Co. facilitated two workshops with the Consortium (one in August and the other in December 2019). To support the development Review of previous Regional Plan of the Regional Plan, an Consultations with Community and Consortium members #1 external consultancy firm, Develop a structure / framework for the 2020 –2022 Regional Plan (22 July –26 July 2019). Impact Co., was engaged. The A desktop scan of relevant policies and programs approach to developing the AUGUST This involved identifying relevant policies and programs at the State and Commonwealth level that the Regional Plan comprised of 8 Consortium should be cognisant of when developing the 2020 – 2022 Regional Plan. Workshop 1: Confirmation of priority areas and desired outcomes (19 August 2019) key components or ‘sprints’, which are outlined below. SEPTEMBER An analysis of demographic and population health data

OCTOBER This involved analysing publicly available data sources according to Indigenous Areas (IARE) or Local Government Areas (LGAs) across the Murrumbidgee PHN catchment to understand the variation of health Consultations with Community and Consortium members #2: Obtain input for initiatives status of Aboriginal people and the spread of available health services. to operationalise the Regional Plan (21 October 2019 –25 October 2019) NOVEMBER Two rounds of consultations with consortium and community members In total, Impact Co. conducted 21 consultations (combination of face-to-face and phone interviews or Preparation of draft 2020 –2022 Regional Plan focus groups) with 16 service provider representatives and 46 community members across Wagga Wagga DECEMBER (including Tolland and Ashmont), Leeton, Griffith, Narrandera, Tumut and Albury-Wodonga.

Workshop 2: Obtain feedback on draft 2020 – 2022 Regional Plan (2 December 2019) Facilitation of an online survey for additional feedback JANUARY Following the second workshop with the Consortium, an online survey was created and shared with the Finalise 2020 –2022 Regional Plan Consortium to validate the findings. FEBRUARY

6 7 Relevant Commonwealth / State plans and programs

In relation to improving the overall health Relevant Commonwealth Policies and Programs Relevant State Policies and and wellbeing outcomes for Aboriginal Programs and Torres Strait Islander people, there are The National Aboriginal and Torres Strait Islander The NSW Aboriginal Health Plan two relevant Commonwealth/State plans. Health Plan 2013-2023 2013-2023 Supports the national effort led by the Council of This policy represents the NSW NSW’s response to the national policy is Australian Government to close the health and life Government’s commitment towards reflected in The NSW Aboriginal Health expectancy gap between Aboriginal and Torres Strait closing the gap in health outcomes Islander people and non-Indigenous people by 2031 for Aboriginal people. The 10 year Plan 2013-2023, which articulates NSW plan provides opportunities for NSW Health’s responsibility, through its service Health to re-examine the best ways The Indigenous Australians’ Health Program (IAHP) of working together. providers (e.g. local health districts), to In July 2014, the Australian Government established implement the plan and report on its IAHP, which consolidated four existing funding streams for primary health care, child and maternal progress. Rather than focusing on specific health, Stronger Futures in the Northern Territory; health conditions, this policy places a and programs covered by the Aboriginal and Torres focus on: Strait Islander Chronic Disease Fund

• Decreasing the disparity in health outcomes through partnerships; The Murrumbidgee Aboriginal Health Plan compliments both the State and National • Implementing evidence-based practice; Plans described above with a focus on ensuring improvement of the health of • Ensuring integrated planning and Aboriginal and Torres Straits Islander people in the Murrumbidgee region. service delivery; • Strengthening the Aboriginal workforce; • Providing culturally safe environments; and • Strengthening performance monitoring.

8 9 Foundation enablers To underpin the Regional Plan, there are 5 foundational enablers that are required for its effective implementation. These 5 enablers are: For each enabler, the Consortium has identified its objective, its measures of success and actions. This is outlined below.

Foundational Objective Success measures Actions enabler

Internal To increase the There is shared understanding of the value and purpose of the Consortium The role and expected contribution from Consortium 1. 5. accountability accountability of Consortium among members members is clarified through an agreement members towards the Commitment of Consortium members is obtained via an agreement INTERNAL BETTER Regional Plan ACCOUNTABILITY Agreed To refine, and agree, on the The structure and agenda of the Consortium is refined to allow for: Refine the structure and agenda of the Consortium 3. UNDERSTANDING processes internal processes of the • Contribution from Consortium members; meetings on how the Consortium • The sharing of information; SHARING OF THE COMMUNITY Consortium • Identification of opportunities for collaboration; engages • Developing clear action items; and OF DATA • Ensuring accountability of members on the action items Sharing of data To share and link data Availability of evidence-based data to demonstrate collective impact and Agreement on the types of data that will be collected to track and monitor the continuous improvement of services from Consortium members combined efforts of the There is transparency among Consortium members on the opportunities for Development of appropriate governance structures to Consortium services ensure the secure and appropriate use of information Development of clear processes to support the collection and coordination and data provided by Consortium members of data provided by Consortium members

2. Sharing of To leverage and share There is trust among Consortium members to collaborate with each other Develop an understanding of available resources that resources resources more effectively Shared information and resources are used for a purpose to inform future can be shared across the Consortium AGREED PROCESSES ON to meet the needs of the planning and delivery of services Proactively share information and resources across the community, improving New initiatives and activities are developed in collaboration or partnership, Consortium 4. health outcomes rather than in silos Identify opportunities to co-design and collaborate HOW THE CONSORTIUM with other Consortium members on existing programs ENGAGES SHARING OF or new opportunities e.g. government funding grants RESOURCES Better To develop a better Actions and initiatives that are developed, designed and implemented Rotate the location of Consortium meetings to understanding understanding of the diverse consider the diverse needs of communities across the Murrumbidgee region increase the proximity of the Consortium to various of the needs of communities communities located across the Murrumbidgee region community across the Murrumbidgee Identify opportunities for the Consortium to engage/ region interact with community members to gain a deeper understanding of their needs, including exploring the possibility of organising community forums across the Murrumbidgee region

10 11 The spread of the population by age groups and the composition of families in each Indigenous Area are shown below. Aboriginal and Torres Strait 35 15-19 years 30 Aboriginal population Lachlan 10-14 years Islander people in the 25 0-19 years (%) by IARE 5-9 years 20 0-4 years Murrumbidgee 15 10 5

region 0 Carathool- Griffith - Lachlan Tumut Young Carathool - DeniliquinMurray - LeetonGundagai - Narrandera Central Murray Cootamundra Upper MurrayWagga Wagga Murrumbidgee Murrumbidgee CoolamonWest - Wyalong Temora Junee - Harden Compared to Australia and New South Wales, the Coolamon - Temora - 30 West Wyalong 35-39 years Murrumbidgee region has a higher population of 25 Young Aboriginal population 30-34 years Aboriginal and Torres Strait Islander people (5.1% 20 20-39 years (%) by IARE 25-29 years compared to 2.8% Australia and 2.9% NSW). 15 20-24 years Cootamundra 10 Central TOTAL NUMBER OF ABORIGINAL Murray Narrandera 5 Gundagai - Junee - 0 Harden AND TORRES STRAIT ISLANDER Griffith - Lachlan Tumut Young Carathool - DeniliquinMurray - LeetonGundagai - Narrandera Central Murray Cootamundra Upper MurrayWagga Wagga Wagga Murrumbidgee CoolamonWest - Wyalong Temora Junee - Harden PEOPLE (2016) Wagga 20 Tumut 55-59 years Upper 50-54 years Murray 15 Aboriginal population Deniliquin- 45-49 years Murray 40-59 years (%) by IARE ABORIGINAL POPULATION BY IARE 10 40-44 years

0 Griffith - Lachlan Tumut Young Carathool - DeniliquinMurray - LeetonGundagai - Narrandera Central Murray Cootamundra Upper MurrayWagga Wagga Murrumbidgee CoolamonWest - Wyalong Temora Junee - Harden 0-853 853-1,706 1,706-2,559 2,559-3,412 3,412-4,265 (8) (3) (1) (0) (1) 12 13 10 65 years and over 8 Aboriginal population 60-64 years 60 years plus (%) by IARE 6

0 Griffith - Lachlan Tumut Young Carathool - DeniliquinMurray - LeetonGundagai - Narrandera Central Murray Cootamundra Upper MurrayWagga Wagga Murrumbidgee CoolamonWest - Wyalong Temora Junee - Harden Health issues Aboriginal FAMILIES by IARE Aboriginal people are more 60 likely to die from chronic Deaths by cause 2010 - 2014 ABS % children in Aboriginal jobless families diseases and from external 50 % Aboriginal low income families causes compared to people Deaths from cancer, Deaths from Deaths from Deaths from 40 % Aboriginal single parent families from New South Wales. Aboriginal persons circulatory system respiratory system external causes, 30 aged 0 to 64 years diseases, Aboriginal diseases, Aboriginal Aboriginal persons persons aged 0 to persons aged 0 to aged 0 to 64 years 20 64 years 64 years 10 Number ASR per Number ASR per Number ASR per Number ASR per 0 100,000 100,000 100,000 100,000 oung Griffith - Lachlan Tumut Y Carathool - DeniliquinMurray - Leeton Gundagai - Narrandera Central Murray Cootamundra Upper MurrayWagga Wagga Murrumbidgee CoolamonWest - Wyalong Temora Junee - Harden NSW 425 39.3 442 41.7 126 11.8 422 41.6

MPHN NR 33.9 28 61.7 NR NR NR 116.3

NR = not recorded

14 15 The consultations and workshops that were The five health issues on the first row were those considered In addition to identifying health issues, during conducted as part of the MENTAL most important by community members during the consultations a number of key themes relating to development of this Regional HEALTH consultations. For each of these priority health issues, the why there were health issues were identified. The Plan identified a number of ALCOHOL & following aspects were explored: basis of these key themes helped Consortium CHRONIC members to prioritise strategies that could health issues for the Aboriginal OTHER DRUGS 1. The experiences of community and Consortium members; and Torres Strait Islander DISEASE MATERNAL be applied to all of the health issues for the population residing within the HEALTH & 2. The variation of health and wellbeing outcomes; Regional Plan. Some examples of comments that emerged from the key themes included: Murrumbidgee region. EARLY 3. Relevant national and state government policies that CHILDHOOD FAMILY influence the range of service or initiatives currently VIOLENCE delivered through the Consortium; and PALLIATIVE 4. The current service availability, which has been informed CARE AGED through the consultations and a desktop scan of Consortium member agencies that provide Aboriginal wellbeing CARE initiatives aligned with the Regional Plan. This information DISABILITY can be found in Appendix A.

“The biggest issues around here are AOD and mental health. “Accept that people need to take more responsibility about their choices – but there should be more awareness of the “The average person – if they wanted help – you wouldn’t be able services or supports that are available.” to get it. Where do you look? Where do you go for help?”

“We could take a focus on chronic disease – it’s an opportunity where we can “There is an importance in forming partnerships, particularly to provide pick a project, see who’s working in the space, use existing resources and pull outreach services. We need to get a better understanding” of the organisation together an initiative that we can badge as the Consortium.” we are partnering with and vice-versa, including the programs provided so that we can encourage cross-referrals.”

16 17 18 19 Priority Areas

During the process of developing this Regional Plan, it was agreed by the Consortium that the priority areas of the 2020-2022 Regional Plan should be informed by the input provided by community members. These priority areas are identified below and have been structured around the key strategies required to enhance the health and wellbeing of Aboriginal and Torres Strait Islander people across the region. The specific health areas of focus for each priority area will vary between regions according to the needs and context of the local community.

Enhancing health literacy Strengthening service 1. of the community 3. delivery and the responsiveness of services Increasing the awareness of 2. heath needs and services in Improving coordination and the region 4. integration between service providers

20 21 PRIORITY AREA 1: ENHANCING HEALTH LITERACY OF THE COMMUNITY PRIORITY AREA 3: STRENGTHENING SERVICE DELIVERY AND THE RESPONSIVENESS OF SERVICES

OBJECTIVES ACTIONS OBJECTIVES ACTIONS To develop resources with simple We will share health information in a language that is accessible and easy to understand by the and relevant language community. This may include the use of Aboriginal languages or stories in resources, events, To focus on early intervention We will prioritise early intervention activities (including communication activities) that focus on, and program names and social media. activities for the younger target, the younger generation. generation To share resources more We will find and share resources developed by members of the Consortium so that they reach more effectively communities across the region. To ensure services continue We will monitor and evaluate services provided by the Consortium to ensure that the needs of the to meet the needs of the community are met. This can be done through both qualitative and quantitative methods. To directly engage the community We will hold local and targeted health promotion workshops or events to improve health literacy community in health promotion activities and increase awareness of available services. These workshops or events can focus on specific topics such as mental health, eating healthy etc. To build the cultural safety and We will design and deliver a range of capacity building activities to support other service providers To encourage and support We will empower Community Champions (e.g. Elders as influencers or inspirational speakers with competency of services across across the Murrumbidgee region to enhance the cultural competency of service delivery staff and Community Champions lived experiences) to support health promotion activities/messages in key communities across the the region cultural safety of services. Murrumbidgee region. The role of Community Champions may include facilitating referrals to local services. To engage the community in a We will actively engage the community to understand their needs and design programs/services to meaningful way to design and be delivered in the region. After doing so, the Consortium will be transparent in publishing feedback To enhance the profile of the We will share the achievements of the Consortium with the broader community through positive deliver services and in providing appropriate reimbursement for community involvement and participation. Consortium stories.

PRIORITY AREA 4: IMPROVING COORDINATION AND INTEGRATION BETWEEN SERVICE PROVIDERS PRIORITY AREA 2: INCrEASING THE AWARENESS OF HEALTH NEEDS AND SERVICES IN THE REGION OBJECTIVES ACTIONS OBJECTIVES ACTIONS To promote knowledge sharing We will share learnings and insights from service delivery among members of the Consortium to enable continuous improvement. To build the community’s We will proactively share the information on the health services offered by all members of the awareness of services offered by Consortium (where relevant) with the local community. We will seek to develop a website or an all Consortium members app as a central ‘go to’ point for all health and support service needs in the Murrumbidgee region. To seek new methods of service We will collaborate to identify new and innovative models of service delivery to meet the needs of delivery the community. This includes the use of telehealth and other adaptive new technologies. “Cutting a track” – To advocate We will actively advocate to local, State and Federal Government, and other government agencies on behalf of the Aboriginal and on the needs of the local community. To enhance integration and We will build on our awareness and understanding of the services provided across the Consortium, Torres Strait Islander population collaboration across the developing stronger referral pathways between Consortium members and service providers outside in the Murrumbidgee region Consortium of the Consortium. We will identify opportunities for Consortium members to co-locate services to enhance service integration. This will allow resources to be pooled more effectively to deliver more holistic services to the community. 22 23 Measuring success – Evaluation and monitoring framework Program logic to monitor and evaluate the Regional Plan

Input Activity INDICATORS SHORT-TERM OUTCOMES INDICATORS LONG-TERM OUTCOMES

Conduct Develop No. of health community Encourage Collection promotion events No. of Community Increased health literacy of the resources Share and support and health No. of resources Enhancing the health literacy with simple resources more conducted Champions Aboriginal and Torres Strait Islander promotion Community developed of the community sharing of and relevant effectively and registered supported community events or Champions data language participants workshops PRIORITY AREA 1

Increased The Consortium Increased access Increased funding Share the information Advocate on behalf knowledge and Existing makes an active of appropriate to support the To improve Develop a web- Increasing the awareness of on the health of the Aboriginal and Completion of Number of users of contribution to understanding of funding based service health services Aboriginal and the health and services offered by Torres Strait Islander web- based web-based service the development health needs and services in health services and/or directory by the Aboriginal Torres Strait all members of the population in the service directory directory of government the region by the Aboriginal wellbeing of resources and Torres Strait Islander community Consortium region programs or and Torres Strait Islander community in the region local Aboriginal

PRIORITY AREA 2 policies Islander community and Torres Strait Islanders and Reach and Community No. of Support service Adopt a No. of early increase their life Collaboration uptake of and other key consultations Health services are culturally Increased satisfaction of Early intervention providers in the place-based intervention and Share participants stakeholders No. of with the safe and competent as expectancy activities focus approach and initiatives/ Strengthening service delivery health services by the region to provide are aware community commitment positive in early evaluations and the responsiveness of perceived by the Aboriginal and on the younger culturally safe co-design programs Aboriginal and Torres Strait stories intervention of the role completed and of Consortium generation services/ undertaken services Torres Strait Islander community and competent initiatives/ and purpose community Islander community across the members services programs with programs of the events Consortium the community implemented Consortium conducted PRIORITY AREA 3

No. of joint Experience Share learnings Collaborate to form No. of referrals No. of co-located projects/ Improving coordination and Increased satisfaction of health and insights Enhance referral between and expertise new and innovative partnerships that services across the services by the Aboriginal and Torres links integration between service of Consortium for continuous models of service look at service Consortium Consortium providers Strait Islander community members improvement delivery design and members innovation PRIORITY AREA 4

24 25 The table below highlights the data source that could be employed to monitor or answer the performance indicators. PRIORITY PERFORMANCE INDICATOR DATA SOURCE AREA PRIORITY PERFORMANCE INDICATOR DATA SOURCE Consortium Consortium Website data Consultations Consultations with AREA meeting service (e.g. Google with community key stakeholders Consortium Consortium Website data Consultations Consultations with minutes provider Analytics, members (e.g. focus (e.g. Consortium meeting service (e.g. Google with community key stakeholders or activity event groups, surveys or members, minutes provider Analytics, members (e.g. focus (e.g. Consortium data registration) interviews) government) or activity event groups, surveys or members, data registration) interviews) government) 3 No. of early intervention initiatives/programs undertaken across the Consortium 1 No. of resources developed 3 Reach and uptake of participants in early 1 No. of health promotion events conducted and intervention initiatives/programs implemented registered participants 3 Community and other key stakeholders are aware of 1 No. of Community Champions supported the role and purpose of the Consortium

1 Increased health literacy of community members 3 No. of evaluations completed

2 Completion of web-based service directory 3 No. of consultations with the community and community events conducted by the Consortium 2 Number of users of web-based service directory 3 No. of capacity building activities conducted 2 The Consortium makes an active contribution to the development of government programs or policies 3 Health services are culturally safe and competent as perceived by the community 2 Increased access of appropriate health services by the Aboriginal and Torres Strait Islander community 3 Increased satisfaction of health services by the Aboriginal and Torres Strait Islander community

2 Increased knowledge and understanding of health 4 No. of joint projects/partnerships that look at service services by the Aboriginal and Torres Strait Islander design and innovation community 4 No. of referrals between Consortium members 2 Increased funding to support the Aboriginal and Tor- res Strait Islander community in the region 4 No. of co-located services across the Consortium

Short term Medium term Long term 4 Increased satisfaction of health services by the Ab- original and Torres Strait Islander community

26 27 Population spread

Appendix A – Table 1: Spread of Aboriginal and Torres Strait Islander population in the Murrumbidgee region according to IARE (ABS, 2016) In 2016, there was an estimated 15,232 individuals No. IARE No. of Aboriginal Aboriginal population residing in the Murrumbidgee and Torres Strait as a proportion of the Health and Islander people total population (%) region that identified as being of Aboriginal and Torres Strait 1 Lachlan 1441 21.2 Islander descent, which is 5.7% service data of the total NSW Aboriginal 2 Narrandera 706 12.3 population (estimated 265,685). The population 3 Carrathool – Murrumbidgee 640 11.8 spread of Aboriginal and 4 Gundagai – Junee – Harden 973 7.1 Torres Strait Islander people in 2016 according to IAREs 5 Wagga Wagga 4265 6.6 ranked from highest to lowest 6 Cootamundra 503 6.6 according to the proportion of the Aboriginal population 7 Griffith – Leeton 2295 6.1 to the total population in Table 1. In the Murrumbidgee 8 Tumut 589 5.3 region, there are 13 IARES. 9 Young 653 5.2 Although Wagga Wagga

had the highest number of 10 Deniliquin – Murray 742 4.8 Aboriginal and Torres Strait Islander people residing in the 11 Coolamon – Temora – West Wyalong 791 3.9 area, Lachlan, at 21%, had the 12 Central Murray 661 3.6 highest proportion of the total

population. 13 Upper Murray 972 3.4

NSW 265,685 3.4

28 29 Socio-economic status

Lachlan The Indigenous Relative Table 2: Socio-economic status No. IARE IRSEO score Socioeconomic Outcome of IAREs according to most to Index (IRSEO) is a measure 1 Lachlan 68.1 least disadvantaged to highlight the variation (PHIDU, 2016) INDIGENOUS RELATIVE in socio-economic status 2 Griffith – Leeton 55.4 SOCIOECONOMIC OUTCOMES across the region. IRSEO 3 Narrandera 50.7 scores range from one (most (IRSEO) INDEX (2016) Carathool- Murrumbidgee advantaged area) to 100 4 Tumut 49.3 (most disadvantaged area). As Coolamon - Temora - West Wyalong per Table 2, there were seven 5 Deniliquin – Murray 48.8 Young IARES within the region that 6 Young 48.5 had an IRSEO score higher than the state average, the 7 Gundagai – Junee – Harden 46.1 Cootamundra highest being Lachlan with a Central Narrandera score of 68. NSW 36.3 Murray Gundagai - Junee - 8 Wagga Wagga 35.5 Harden Wagga 9 Carrathool – Murrumbidgee 33.3 Wagga Tumut 10 Cootamundra 31.6 Upper Murray Deniliquin- 11 Upper Murray 28.2 IRSEO BY IARE Murray

12 Coolamon – Temora – West Wyalong 26.2

13 Central Murray 21.1

0.0-13.6 13.6-27.3 27.3-40.9 40.9-54.5 354.5-68.1 (0) (2) (4) (5) (2) 30 31 Mental health

Lachlan Mental health and suicide Table 3: Age standardised No. IARE ASR of mental health-related prevention, and the stigma hospital admissions rate (ASR) of mental health- or embarrassment associated related hospital admissions 1 Narrandera 3921.9 AVERAGE ANNUAL ASR OF with accessing support, was of Aboriginal and Torres by far the health issue most Strait Islander people 2 Carrathool – Murrumbidgee 3131.6 MENTAL HEALTH RELATED discussed by community (PHIDU, 2014/15-2016/17) members. The data in Table 3 Griffith - Leeton 3101.7 HOSPITAL ADMISSIONS Carathool- 3 suggests that six IAREs in Murrumbidgee 4 Cootamundra 2743.1 – ABORIGINAL PERSONS the Murrumbidgee region Coolamon - Temora - West Wyalong experience rates of mental (2014/15-2016/17) 5 Lachlan 2481.6 Young health-related hospital admissions higher than the 6 Deniliquin – Murray 2434.1 state average, with Narrandera Cootamundra NSW 2377.1 experiencing rates more Central than 1.5 times the average Murray Narrandera 7 Wagga Wagga 2313.7 Gundagai - Junee - (3921.9 vs. 2377.1 per 100,000 Harden admissions). 8 Gundagai – Junee – Harden 2296.1 Wagga Wagga 9 Tumut 1737.9 Tumut Upper 10 Young 1678.7 Murray Deniliquin- ABORIGINAL MH ADMISSIONS BY IARE Murray 11 Upper Murray 1621.6

12 Central Murray 1620.8

13 Coolamon – Temora – West 1590.6 Wyalong 0-784 784-1,569 1,569-2,353 2,353-3,137 3,137-3,922 (0) (0) (7) (5) (1) 32 33 COMMUNITY VOICES RELEVANT COMMONWEALTH/STATE POLICIES AND PROGRAMS Current service availability

Relevant Commonwealth Relevant State Of the policies listed, there PROGRAM LOCATION(S) DESCRIPTION Policies and Programs Policies and are two worth highlighting Programs given their direct influence in Outreach services funded Deniliquin Administered by MLHD: Psychiatry - General “[Mental ill-health is…] someone who through NSW Rural the range of services that are feels imbalanced and needs support” National Strategic Framework Living Well: A Doctors Network (RDN) Griffith Administered by MLHD: Psychiatry for Aboriginal and Torres Strait Strategic Plan for currently provided to address Administered by Firsthealth: Psychiatry Islander Peoples’ Mental Health Mental Health in mental health in the region. “The biggest issues around here are AOD and Social and Emotional NSW “ This includes: Leeton Administered by Firsthealth: Psychiatry and mental health. Accept that people Wellbeing A Strategic Plan Provides a strategic vision for that aims for the need to take more responsibility about The National Strategic Tumut Administered by MLHD: Psychiatry - Geriatric their choices – but there should be more Aboriginal and Torres Strait people of NSW Islander people, families and to have the best Framework for Aboriginal and awareness of the services or supports that Wagga Wagga Administered by MLHD: Psychiatry – Geriatric (x2) and General (x2) communities to achieve and opportunity for Torres Strait Islander Peoples’ are available.” sustain the highest attainable good mental health Mental Health and Social Psychological Services Griffith Administered through Griffith AMS and Riverina Medical and Dental Aboriginal standard of social and emotional and wellbeing, for People Accessing Wagga Wagga Corporation, this service provides face-to-face psychological interventions for Aboriginal and Emotional Wellbeing, “[Suicide prevention…] we need to be okay wellbeing and mental health. and to live well in Aboriginal Medical and Torres Strait Islander people aged 16 years and over. Requires referral from AMS GPs their community about talking about it…we need more The National Aboriginal and which complements the Services only via a mental health treatment plan. Torres Strait Islander and on their own information on what services are available to terms. This involves Fifth National Mental Health Suicide Prevention Strategy Social and Emotional Griffith, Leeton, Administered through Griffith AMS and Riverina Medical and Dental Aboriginal get help.” developing strong and Suicide Prevention Plan The overarching objective of this Wellbeing Darlington Point, Corporation, this program involves a dedicated Social and Emotional Wellbeing Worker partnerships strategy is to reduce the cause, – the national approach for Coleambally, Hay, Hillston, that Aboriginal and Torres Strait Islander clients can talk to and obtain assistance to with Aboriginal “There is a mental health nurse that prevalence and impact of suicide collaborative government Leeton, Narrandera and access other services or programs provided by AMS, or social support services provided communities. Wagga Wagga by Housing NSW, Centrelink, DCJ or Job Network providers. provides outreach services [from a on individuals, their families and effort between 2017 and 2022. communities. community centre] – it has taken her Deniliquin, Griffith, Provided by MLHD, the Specialist Community Mental Health Services provide mental This Framework is intended to MLHD Specialist 7 months to build a rapport with the Community Mental Temora, Wagga Wagga, health care for adults and children which is close to home, accessible, personalised, community and start providing care.” Medical Outreach Indigenous support the work that is being Health Services Young and Tumut and evidence based and focused on recovery. Chronic Disease (MOICD) undertaken by PHNs; and outreaching to whole of The Specialist Community Mental Health Service provides the following specialties: Program MLHD “The community is very tight knit. Everyone • Child and adolescent mental health and Got It (School based intervention for A medical outreach program The MOICD program, which is Kindergarten to Year Two) knows someone who works in one of funded by the Australian the main program providing • Youth mental health the medical services, so there’s some Government and auspiced by • Adult mental health embarrassment or fear of judgment…there is the NSW Rural Doctors Network outreach services delivered • Older persons mental health difficulty sharing personal thoughts with family to increase access to a range by psychiatrists and mental • Consumer peer worker of health services to manage • Aboriginal Mental Health traineeship program members.” chronic diseases, including health-related allied health mental health. professionals across the region. MLHD Mental Health Wagga Wagga 30 bed Acute Adult Unit, 20 bed Recovery Unit, 8 bed Older Persons Acute Mental Inpatient Services Health unit and 8 beds Transitional Behavioural Assessment and Intervention Service for people with severe behavioural disturbance associated with dementia. 34 ” 35 Alcohol and other drugs RELEVANT COMMONWEALTH/STATE POLICIES AND PROGRAMS The policies highlighted have Relevant Commonwealth Policies and Programs Relevant State Policies Currently, there is no local COMMUNITY VOICES and Programs led to a number of AOD data that could be identified services provided within The National Aboriginal and Torres Strait Islander Drug Strategy 2014- the region as listed in the to demonstrate the impact of 2019 alcohol and other drug (AOD) “Put it out on flyers, radio, newspapers. Keep Addresses the use of alcohol, tobacco and other drugs as part of a table to follow. For example, use by Aboriginal and Torres advertising where to get help!” comprehensive, holistic approach to health that includes physical, spiritual, the MOICD program has cultural, emotional and social wellbeing, community development and funded the provision of an Strait Islander population. capacity building. The policy places an emphasis on building the capacity However, national data “I found it pretty hard to get help with my AOD issues…when I and capability of the AOD system, particularly community-controlled AOD Addiction Medicine physician services, and the leadership position they should take in designing and in Wagga Wagga, and the suggests that although there needed help, I relied on my family…it took me 3 months to get help.” delivering programs to address harm. has been a significant decline PHN has commissioned “ The National Ice Action Strategy programs such as Work It in the proportion of Aboriginal ”Long waiting list to access AOD rehabilitation – some and Torres Strait Islander In 2015, the Council of Australian Governments (COAG) endorsed this Out, AOD Enhancement community members have to go to Melbourne. Would be strategy in response to the release of the Australian Government Response and the Women’s Wellness people who smoke, Aboriginal great to access rehab support that is just outside of Wagga so to the National Ice Task force’s Final Report. The Response involved establishing a role for PHNs in the planning and commissioning of AOD and Recovery Program as a and Torres Strait Islander that you can get support discreetly.” services, including Aboriginal and Torres Strait Islander-specific services. result of the funding provided people were more likely to Funding of up to $241.5 million was committed to assist PHNs to achieve have used an illicit drug in the “I did the COPE program…it taught me a lot about myself and my addiction, this objective. through the National Ice last 12 months. This was at a Action Strategy. understanding of reactions and feelings – I can’t praise them enough.” Medical Outreach Indigenous Chronic Disease (MOICD) Program rate 1.8 times higher than non- A medical outreach program funded by the Australian Government and Indigenous Australians. “The average person – if they wanted help – you wouldn’t be auspiced by the NSW Rural Doctors Network to increase access to a range of health services to manage chronic diseases, including AOD support As such, similarly to mental able to get it. Where do you look? Where do you go for help?” services. health, the impact of AOD in the local community was “Our AOD program has clients but we know that community members also an issue frequently raised don’t come to us voluntarily. How do we get people to engage? Some by community members, members will hit rock bottom before they look for help.” particularly the role the Consortium could play in “Kids are bored…they need something or programs to fill increasing the awareness and in the time such as social events, training or upskilling.” availability of support services. 36 ” 37 Current service availability

PROGRAM LOCATION(S) DESCRIPTION Women’s Deniliquin, Griffith, Delivered by Calvary Healthcare, Riverina. The service provides high intensity AOD services Wellness and Wagga Wagga and Young to pregnant women and women who have young children, who are struggling with substance Outreach Wagga Wagga Administered by MLHD: Recovery abuse. The service is non-residential, allowing mothers to maintain their bond with their family services funded • Physician – Addiction Medicine Program and support networks. through NSW Rural Doctors MLHD Deniliquin, Griffith, Temora, Provided by MLHD, the Community Drug and Alcohol service provides assessment, support and Network (RDN) Community Wagga Wagga, Young and counselling to people with harmful patterns of drug and alcohol use and substance dependence. AOD Services Tumut and outreaching to The following services are provided: Tackling Griffith, Lake Cargelligo/ Team consists of five TIS workers and a Coordinator that currently delivers community health whole of MLHD • specialist counselling Indigenous Murrin Bridge/Hay, Hillston, promotion programs and activities to inform and support people in their decision to not smoke • opioid treatment program Smoking Darlington Point, Leeton, or quit smoking. • drug and alcohol consultation liaison workers Program Narrandera, Tumut/ • assessment and referral to involuntary drug and alcohol treatment. Brungle, Wagga Wagga, The Magistrates Early Referral into Treatment program is also delivered in Wagga Wagga. Cootamundra, Young, Junee, Finley, Moama, Deniliquin and West Wyalong St Vincent’s Griffith (through GAMS), Delivered by St Vincent’s Addiction Medicine Specialist in conjunction with MLHD Community Addiction Deniliquin, Temora, Young AOD services. The service uses videoconferencing technology to provide access to Addiction Medicine and Tumut through Medicine Specialists with the aim of: Alcohol and Entire region Delivered through the Regional Drug and Alcohol support network comprising of Griffith’s AMS, Specialist Community AOD. • Improving access to various specialist addiction medicine services for individuals living in Drugs Network Rivmed, Albury & Wodonga Aboriginal Health Service and Viney Morgan AMS. rural and remote areas of New South Wales; and Services offered include: Clinics - • Delivering education for health professionals in the MLHD, building their capacity to support • Drug & Alcohol Detoxification admission & discharge support. Telehealth individuals affected by substance use disorder. • Drug & Alcohol Rehabilitation admission & discharge support. • Drug & Alcohol Counselling. • Drug & Alcohol Support Groups, both Women’s Group & Griffith Aboriginal Men’s Shed. Calvary Alcohol Wagga Wagga Delivered by Calvary Healthcare Riverina, Residential detoxification and rehabilitation program • Drug & Alcohol information and education to individuals, communities and high dchool and Other and day program. Open to people across MLHD. students. Drugs Service • Advocacy and referral to other services and agencies which may assist in the individual’s recovery.

Work It Out Wagga Wagga Provides AOD intervention services for Aboriginal and Torres Strait Islander people who are at risk of losing employment, or have difficulty gaining employment, or at risk of dropping out of education due to substance abuse problems.

AOD Wagga Wagga The program provides counselling and support services for people who are waiting to access Enhancement AOD treatment, and also for people who have recently been discharged from AOD services. (Pre and Post Treatment Service)

38 39 Table 4: ASR of potentially preventable chronic conditions per 100,000 Chronic disease hospital admissions by Aboriginal and Torres Strait Islander people (PHIDU, 2014/15-2016/17)

Chronic diseases, such as national government funding Lachlan No. IARE ASR of potentially heart/cardiovascular disease, and policies as described below), preventable admissions diabetes, asthma and kidney it was identified that an ‘easy related to chronic conditions win’ for the Consortium could AVERAGE ANNUAL ASR OF disease, were also validated 1 Carrathool - 2891.2 as a significant issue affecting be to build the community’s Murrumbidgee POTENTIALLY PREVENTABLE communities across the awareness of chronic disease 2 Griffith – Leeton 2844.4 Murrumbidgee region. and strengthen how members of CHRONIC CONDITIONS – Carathool- Murrumbidgee Community members residing the Consortium can collaborate 3 Lachlan 2374.1 ABORIGINAL PERSONS in Wagga Wagga had no together. Coolamon - Temora - West Wyalong issues with accessing support 4 Narrandera 2205.2 (2014/15-2015-17) The data presented in Table 4 Young services for a chronic illness, indicates that there are seven 5 Gundagai – Junee – 1991.8 including prompt access or IAREs within the region that Harden referrals to other services. Cootamundra have rates of hospital admissions 6 Wagga Wagga 1799.4 However, this was in contrast Central related to potentially preventable to towns outside of Wagga Murray Narrandera chronic conditions (i.e. those that 7 Coolamon – Temora 1515.6 Gundagai - Junee - Wagga where community – West Wyalong could be prevented by timely Harden members were more likely to and adequate health care in the NSW 1466.9 Wagga experience a lack of access community) higher than the Wagga to allied health and specialist 8 Cootamundra 1336.1 Tumut NSW average. The IARE with Upper services, particularly if there the highest rate in the region, POTENTIALLY PREVENTABLE Murray isn’t a local Aboriginal health 9 Deniliquin – Murray 1258.2 Deniliquin- Carrathool – Murrumbidgee, was CHRONIC CONDITIONS Murray service. almost double the state average 10 Tumut 1247.7 Given the various existing (2891.2 vs. 1023.3 per 100,000 11 Central Murray 1103.3 resources to address chronic admissions). illness (e.g. existing state and 12 Upper Murray 1023.3

13 Young 840.9 0-579 579-1,159 1,159-1,738 1,738-2,318 2,318-2,897 (0) (3) (4) (3) (3) 40 41 COMMUNITY VOICES RELEVANT COMMONWEALTH/STATE POLICIES AND PROGRAMS Current service availability

“No issues accessing services, Relevant Commonwealth Policies and Programs Relevant State PROGRAM LOCATION(S) DESCRIPTION the challenges are more faced or Policies and Programs experienced by individuals under Outreach Boorowa Administered by NSW RDN: National Aboriginal and Torres Strait Islander Cancer Integrated care services funded • Optometry the 40 year old group.” Framework (2015) for patients with through NSW Provides high-level guidance and direction to combine chronic conditions. Rural Doctors Aligned with the Network Deniliquin Administered by NSW RDN: “We could take a focus on chronic efforts to address disparities and improve cancer “ outcomes for Aboriginal and Torres Strait Islander NSW Integrated Care • Physician – Oncology disease – it’s an opportunity where we people. Strategy, this program Administered by Brian Holden Institute: can pick a project, see who’s working is designed to assist • Optometry Medical Outreach Indigenous Chronic Disease people with chronic in the space, use existing resources and Program disease manage their Hay Administered by Brian Holden Institute: care. Integrated care pull together an initiative that we can A medical outreach program funded by the Australian • Optometry interventions occur Government and auspiced by the NSW Rural Doctors Administered by NSW RDN: badge as the Consortium.” via three methods: Network to increase access to a range of health • Optometry health coaching, care services to manage chronic disease. • Podiatrist navigation and care • Ophthalmology – General “There is an importance in forming coordination. partnerships, particularly to provide outreach Integrated Team Care (ITC) Program A program to support Aboriginal and Torres Strait Hillston Administered by Brian Holden Institute: services. We need to get a better understanding Islander people with access to high quality and • Optometry of the organisation we are partnering with and culturally appropriate health care to manage complex chronic diseases. The program is funded by the vice-versa, including the programs provided so Australian Government and administered by the Harden Administered by NSW RDN: that we can encourage cross-referrals.” Primary Health Networks. • Optometry

“Need to have a role model – As a result of the policies outlined the ITC program (combined with Griffith Administered by MLHD: • Physician – Neurology, Geriatrics, Cardiology demonstrate that there is a reason above, there are a number of the Integrated Care Coordination • Nurse – Anaesthetist, Theatre, Recovery or rationale to adopt [a particular chronic disease-specific programs Program) delivered across behaviour].” currently being delivered across the the catchment through five Lake Cargelligo Administered by LiveBetter Services: • Registered nurse catchment. As listed in the table commissioned providers and the • Dietitian/nutritionist to follow, this includes outreach Aunty Jeans program, which is • Asthma educator “Culture appropriateness is an issue • Diabetes educator services delivered in 12 locations delivered in nine locations. in our town…. a number of Elders as a result of the MOICD program, are reluctant to go to the hospital.” 42 ” 43 Leeton Administered by NSW RDN: Aunty Jeans Cootamundra, Deniliquin, Griffith, A community orientated program to support Aboriginal people with/or at risk of • Surgery – Orthopaedic Program Lake Cargelligo, Leeton, Narrandera, chronic illness. The program combines: • Podiatrist Tumut, Darlington Point, Wagga • Health promotion and health assessments Wagga and Young • Information and education Narrandera Administered by Rivmed: • Exercise sessions • Physician – Endocrinology • Healthy eating • Diabetes educator • Fun activities • Podiatrist • Nurse – Registered nurse • Dietician/nutritionist

Tumbarumba Administered by NSW RDN: • Optometry

Wagga Wagga Administered by MLHD: • Physician – Genetics (x2) administered by Rivmed: • Podiatrist • Diabetes educator • Dietician/nutritionist • Exercise psychologist • Occupational Therapist Administered by Firsthealth: • Physician – Rheumatology (x4), pain Management (x2) administered by NSW RDN: • Physician – Neurology, Nephrology

Young Administered by MLHD: • Surgery – General • Physician – Oncology

Integrated Entire catchment To deliver this program through the catchment, MPHN has commissioned an Aboriginal Team Care Consortium of RivMed and GAMS and Marathon Health to provide mainstream access Program

Integrated Care Entire catchment Delivered through the MLHD and Marathon Health Coordination Program

44 45 Table 5: Proportion of children developmentally vulnerable in one or more Table 6: Proportion of Aboriginal and Torres Strait Islander women that smoked Maternal and early childhood domains according to the AEDC (PHIDU, 2015) during pregnancy (PHIDU, 2012-2014) No. IARE % of children No. IARE % of women The need for maternal in Australia by the time they development is in relation to The data in Table 6 developmentally smoking during vulnerable in one or pregnancy and early childhood commence school. The AEDC smoking during pregnancy. indicates that there more domains intervention services was examines five domains of early Literature suggests there is a are 10 IAREs in the 1 Narrandera 64.9 1 Carrathool - Murrumbidgee 62.5% raised by stakeholders childhood development: physical link between maternal smoking catchment that had 2 Tumut 64.7 and community members health and wellbeing, social during pregnancy and the risk of rates of smoking during 2 Upper Murray 43.8% outside of Wagga Wagga competence, emotional maturity, otitis media (i.e. an ear infection) pregnancy by Aboriginal 3 Lachlan 64.4 and Griffith, who commented language and cognitive skills, in children. There is also clear and Torres Strait Islander 3 Wagga Wagga 40.0% on the lack of access to local and communication skills and evidence that some patterns of women above the 4 Cootamundra 62.5 NSW 36.7% obstetricians, gynaecologists general knowledge. otitis media do predict long- state average. Of the 5 Coolamon – Temora - West Wyalong 59.2 and paediatricians and the term outcomes for speech and 10 IAREs, the highest AEDC results in 2015 were 4 Griffith – Leeton 30.4% difficulties in obtaining language and can contribute to rate was found in 6 Gundagai – Junee- Harden 57.8 only available for 5 out of transport to these major behavioural problems affecting Narrandera at 64.9% of 5 Lachlan 27.8% the catchment’s 13 IARES. As towns. emotional, social and educational all pregnancies between 7 Young 54.2 Table 5 demonstrates, there 6 Narrandera development. This warrants 2012 and 2014. In relation to early childhood were three IARES that had 8 Griffith – Leeton 52.6 consideration given that the development, assessments proportions of children that were Tumut rate of long-term ear or hearing 9 Deniliquin – Murray 50.0 identify opportunities to developmentally vulnerable in problems in Aboriginal and Gundagai – Junee – Harden nurture young children so that one or more domains higher than 10 Wagga Wagga 48.0 Torres Strait Islander children they do better in school and the NSW average. Of the three, Deniliquin – Murray aged 0-14 years is almost three develop the skills they need Carrathool-Murrumbidgee had NSW 47.2 times the rate of non-Indigenous Cootamundra to be responsible, productive the highest proportion at 62.5% children (8.4% vs. 2.9%) and yet 11 Carrathool – Murrumbidgee 43.5 adults. The Australian Early of children assessed, which is Coolamon – Temora – West Wyalong 60% of childhood hearing loss is Development Census (AEDC) more than 1.5 times the state 12 Central Murray N/A preventable. is a population-based measure average of 36.7%. Central Murray that is used to measure the 13 Upper Murray N/A The most extensive local Young development of children data related to childhood

46 47 COMMUNITY VOICES RELEVANT COMMONWEALTH/STATE POLICIES AND PROGRAMS

Relevant Commonwealth Policies and Programs Relevant State Policies and Programs Lachlan

Healthy Ears – Better Hearing, Better Listening Healthy Safe and Well: A Strategic PROPORTION OF ABORIGINAL A medical outreach program funded by the Australian Health Plan for Children, Young Government and auspiced by the NSW Rural Doctors People and Families 2014-24 MOTHERS WHO REPORTED “A visiting Network to provide multidisciplinary teams and/or Provides a comprehensive planning, paediatrician would health practitioners to support the prevention, early service and policy road map for SMOKING DURING PREGNANCY detection, diagnosis, treatment and management of NSW Health from preconception “ ear health and hearing conditions in Aboriginal and to 24 years of age, addressing the be very helpful.” Carathool- Torres Strait Islander children and youth (up to 21 health of women and their partners (2016) Murrumbidgee years). during pregnancy, babies, children Coolamon - Temora - and young people in the context of West Wyalong “There is a lack of Medical Outreach Indigenous Chronic Disease the families and communities. Young public transport to get Program A medical outreach program funded by the Australian to Wagga or Griffith. Government and auspiced by the NSW Rural Doctors Network to increase access to a range of health Cootamundra This cost is transferred services to manage chronic disease, which extend to SMOKING DURING PREGNANCY Central to the community. maternal and early childhood services. Murray Narrandera BY IARE Gundagai - Junee - It is also difficult to Harden transport kids.” As a result of the two national programs Practitioner (GP). A number of services Wagga listed above, outreach services for are also delivered by MLHD, the impact Wagga Tumut maternal and child health are currently of which are monitored under the Upper delivered in seven locations across the Healthy Safe and Well: A Strategic Murray No data 0.0%-12.2% 12.2%-25.3% Deniliquin- catchment by paediatricians, speech Health Plan for Children, Young People (2) (0) (0) Murray pathologists, midwives, Ear Nose and and Families 2014-24. The list of current Throat (ENT) physicians and a General services are outlined in the table to ” follow. 25.3%-38.5% 38.5%-51.7% 51.7%-64.9% (0) (3) (8) 48 49 Current service availability

PROGRAM LOCATION(S) DESCRIPTION Tackling Griffith, Lake Cargelligo/ Team consists of five TIS workers and a Coordinator that currently delivers community health Indigenous Murrin Bridge /Hay, Hillston, promotion programs and activities to inform and support people in their decision to not Outreach Deniliquin Administered by NSW RDN: Smoking Darlington Point, Leeton, smoke or quit smoking. services funded • Paediatrics - General Program Narrandera, Tumut/Brungle, through NSW Cootamundra, Young, Junee, Finley, Moama, Denliiquin and Rural Doctors Corowa Administered by NSW RDN: West Wyalong Network • Paediatrics - General Griffith, Darlington Point, Griffith AMS’ Child and Maternal team provides services to pregnant women and women with Hay Administered by Griffith’s AMS as part of Child & Maternal Health Outreach Team: Child & Leeton, Narrandera, Hay, Aboriginal partners. The team consists of 2 Aboriginal Health Workers and a nurse/midwife/ • Speech pathologist Maternal Outreach Team Hillston, Lake Cargelligo, Murrin early childhood worker. Bridge The team also conducts a mothers group called Marrabina Mum’s and Bub’s targeted at Hillston Administered by MLHD: Aboriginal families with children aged 0-4 years. • Midwife Administered by Griffith’s AMS as part of Child & Maternal Health Outreach Team: Aboriginal Griffith, Lake Cargelligo, Leeton Administered through the MLHD, this service is delivered by an Aboriginal and Health • Speech pathologist Maternal Infant and Narrandera. Worker and midwife working together to deliver care for Aboriginal women and women with Administered by RFDS – Broken Hill: Health Service **Wagga Wagga and Tumut Aboriginal children. • GP (female) have outreach once a week. The program aims to empower women through education, building skills and sharing knowledge to support women to have a healthy pregnancy and strong baby. Griffith Administered by MLHD: • Surgery – Paediatric Building Strong Griffith, Lake Cargelligo, Administered by the MLHD, this program provides free, culturally safe, early childhood health Administered by Griffith AMS: Foundations Narrandera services for Aboriginal children from birth through to school age and their families. • ENT for Aboriginal The service is provided by a Child and Family Health Nurse and an Aboriginal Health Worker, • ENT surgery Children, working together to support the health, growth and development of Aboriginal children. Families and Leeton Administered by Griffith’s AMS as part of Child & Maternal Health Outreach Team: Communities • Speech pathologist (BSF)

Wagga Wagga Administered by MLHD: Aboriginal Wagga Wagga Administered through the MLHD, this program provides intensive support to Aboriginal • Paediatrics – Rehabilitation, administered by NSW RDN: Sustained families who meet the criteria for families requiring support. • Paediatrics - Haemtology, Neurology, Neprhology (x2) Home Visiting Program

Otitis Media Entire catchment Administered through the MLHD, Aboriginal Health Staff will attend schools and preschools to (OM) screening perform OM screening and/or education.

50 51 Family violence COMMUNITY VOICES RELEVANT COMMONWEALTH/STATE POLICIES AND PROGRAMS Programs or policies in Services Program. However, The fifth most significant Rates of domestic or family Table 7: No. of recorded domestic violence incidents per 100,000 “We are aware of our duty relation to family or domestic none of the currently-funded issue highlighted by the violence at a local IARE level population (NSW Bureau of Crime Statistics and Research, 2018-2019) of care towards family violence in NSW are generally 11 sites of this program service Consortium and community could not be identified. As violence – but we don’t have released from the Department the Murrumbidgee catchment. members was family violence. such, the data on Table 7 No. IARE No. of domestic violence of Communities and Justice In addition, the consultations incidents per 100,000 a specific family violence However, rather than being indicates the top 10 local (previously known as the undertaken suggest that no population worker.” considered as a stand-alone government areas (LGAs) with “ Department of Family and specific funding is currently issue, Consortium members the highest rate of domestic 1 Lachlan 883.5 Community Services). This available to Aboriginal Medical indicated that addressing violence incidents (includes includes the Integrated Services to deliver family 2 Leeton 727.0 family violence should occur non-Indigenous population). Domestic and Family Violence violence services.

in conjunction with targeted The top 10 LGAs had rates 3 Wagga Wagga 711.1 initiatives that address other significantly higher than the identified health domains, state average, with Lachlan 4 Gundagai 640.3 such as AOD or mental health. having more than double the 5 Griffith 640.3 ” NSW average rate (883 vs.

387 per 100,000 population). 6 Edward River 614.6

7 Murrumbidgee 556.7

8 Junee 506.8

9 Narrandera 505.8

10 Hilltops 490.6

NSW 387.1

52 53 Current service availability

PROGRAM LOCATION(S) DESCRIPTION

Joint Wagga Wagga Delivered through the MLHD alongside agency partners NSW Police and the Investigation Department of Family and Community Services. Services provided include: Response Team • Crisis support following disclosure (JIRT) • Medical, psychological and emotional support to meet the needs of the children and non-offering members • Provision of long-term therapeutic services

Sexual Assault Deniliquin, Griffith, Wagga Wagga and Young Delivered through MLHD, provides 24 hour free and confidential counselling Service and ongoing support for sexual assault victims and their non-offending family and friends.

Counselling Corowa, Deniliquin, Finley, Griffith, Leeton, Delivered through MLHD, service includes the provision of counselling for those for Domestic Narrandera, Temora, Wagga Wagga and dealing with experiences of domestic violence, past and present. The service is Violence Young staffed by experienced psychologists, social workers and counsellors.

Women’s Adelong, Batlow, Boorowa, Cootamundra, Delivered through MLHD, the service is staffed by women who provide services Health Nurse Coolamon, Deniliquin, Griffith, Gundagai, for women, focusing on Aboriginal women, women from a non-English speaking Team Hay, Harden, Hillston, Junee, Lockhart, Lake background and women with a disability. Cargelligo, Leeton, Moulamein, Narrandera, Temora, Tumut, Tumbarumba, Wagga Wagga, West Wyalong and Young

Wagga Wagga Wagga Have developed a long-term project, the DVproject:2650, believe a whole Women’s of community approach is the only way to realise a community with a zero Health Centre tolerance for domestic violence. The project has completed phase one of the project (Research), and will be commencing the second phase (Strategic Planning) shortly.