Service Coordination for Aboriginal Clients Graeme Fletcher – Team Leader, Supporting Primary Health Public Health & Research Unit VACCHO Victorian Aboriginal Community Controlled Health Organisation

VACCHO Who are we? VACCHO represents a collective of 24 Aboriginal Community Controlled Health Organisations (ACCHOs) around Victoria. ACCHOs Multi-functional community organisations with health as a key part of their responsibility; some members are groups that offer full health services. National representation Every state and territory has a similar representative and advocacy organisation; and together we form the National Aboriginal Community Controlled Health Organisation (NACCHO).

What we do for our Members: Develop policy Provide support and advice Education & training Assist with strategic planning

Identify state wide health needs Advocacy Auspice state wide health projects Initiate approaches to government and mainstream agencies around Aboriginal health issues Negotiate with the State and Federal governments Put together responses to issues and write submissions What we do on behalf of our Members:

Myths about VACCHO VACCHO is a funding body VACCHO runs health services VACCHO gets involved in internal politics

Some current initiatives designed to improve or enhance service coordination: Aboriginal Health Promotion & Chronic Conditions Program (AHPACC) – DoH Strengthening Primary Health Care (SPHC) – DoH Improving Care for Aboriginal Patients (ICAP) – DoH Other initiatives aimed at improving linkages: AHWs, IOWs, etc (State and Federal funding)

AHPACC Program Aboriginal Health Promotion & Chronic Care AHPACC involves Aboriginal Community Controlled Health Organisations & Community Health Services working in partnership to: Strengthen relationships between ACCHO's & CHS’s Increase access to health promotion and chronic disease management services Increase capacity of the Aboriginal workforce Improve health outcomes and prevent hospital admissions

AHPACC in Yarra North Yarra Community Health Service (from report presented at VACCHO AHPACC Forum in April 2010: NYCH AHPACC activities include: A drop in clinic (9-12 am on Monday morning except public holidays) Programs related to homelessness, drug and alcohol and working in with the Department of Justice The Billabong BBQ every Tuesday morning provides an opportunity to offer a range of outreach services and a large proportion of the attendees have chronic illness (e.g. VAHS GP attends to give flu shots, optometrist) Dental service at NYCH Theatre performances with health promotion messages Acknowledgement signs have been installed at NYCH sites A memorial breakfast is held each 2nd Tuesday in November, commemorating “Parkies” who have passed away Successful Cultural Awareness training completed at North Yarra Completed the entire cultural audit – invited Team Leaders and CEO to lead the process (currently doing a review) Close links have been established with MAYSAR (Melbourne Aboriginal Youth Sport and Recreation), Maya Healing Centre, Collingwood Football Club. Dental van goes to Swan Hill

AHPACC Challenges Accountability Workforce issues Community engagement Integration Measuring Outcomes  AHPACC program review

Strengthening Primary Health Care (VAHS pilot) Objectives Increase the use of Medicare items for health assessments and chronic disease management Increase the use of standardised chronic disease management best practice guidelines for Aboriginal clients Increase integrated care across services and providers, through increased use of coordinated care plans Increase recalls/reminders for Aboriginal clients for health assessments, screening, and ongoing care Increase appropriate referral of Aboriginal clients across primary and specialist health care services Increase processes to support coordinated discharge planning for Aboriginal clients Increase access to culturally safe primary and specialist health care services for Aboriginal client

ICAP Why AHLOs? - The role of AHLOs “Aboriginal health workers are so important because a blackfella will go to a blackfella when they won’t go to a whitefella” NHHRC, 2009 Cultural interface Social and cultural support Cultural education Relationship building Links to resources, networks and events Over 70% of Aboriginal patient admissions occur at hospitals with AHLOs

ICAP Improving identification (signage, posters, brochures) Discharge planning tool(s) Environment and access – artwork etc Establishing Aboriginal Advisory Committees Community engagement

ICAP Challenges Accountability Workforce issues Community engagement Integration Measuring Outcomes  ICAP/KMHLO program review

Closing the Health Gap Regional Advisory Committees established Regional Closing the Gap Implementation Plans PRIORITIES: Tackling smoking Primary health care services that can deliver Fixing the gaps and improving the patient journey Healthy transition to adulthood Making Indigenous health everyone’s business Close the Gap

Closing the Gap Healthy Lifestyle Workers will be trained and employed to reinforce local community campaigns and provide targeted education, support and guidance for families and individuals with or at risk of chronic illness to adopt healthier lifestyles eg healthy diets and exercise and added support to quit smoking.

Closing the Gap Improving chronic disease management and follow-up care A key focus of the package is on improving the detection and management of chronic disease and addressing known barriers to accessing health care. This will be achieved through an integrated suite of reforms to existing programs, supported by new initiatives, as outlined below. New financial incentives -via the Practice Incentives Program (PIP) -will support accredited general practices and Aboriginal Medical Services to provide better health care for Indigenous Australians, including best practice management of chronic disease.

Closing the Gap The PIP Indigenous Health Incentive will include: -A one-off payment to practices that agree to undertake certain activities to improve the provision of care to their Indigenous patients; -An annual payment to practices for each Indigenous patient registered with the practice for chronic disease management for a 12 month period; and -An annual payment to practices for each registered patient for whom a target level of care is provided by the practice in a 12 month period. -Practices participating in this incentive will be able to refer those Indigenous patients identified as needing more complex chronic disease management for care coordination. They will also be able to access Pharmaceutical Benefit Scheme (PBS) co-payment relief for their Indigenous patients through the package.

Aboriginal Outreach Workers The Government is funding local Indigenous people to work as Aboriginal and Torres Strait Islander Outreach Workers in Indigenous health organisations. Aboriginal and Torres Strait Islander Outreach Workers will encourage and support Indigenous people to access primary healthcare services and to ensure follow-up treatment is accessed. This may include assisting people to travel to and from appointments. Aboriginal and Torres Strait Islander Outreach Workers will be employed through selected Indigenous health organisations to help Aboriginal and Torres Strait Islander Australians who do not currently access health care, to do so. Aboriginal and Torres Strait Islander Outreach Workers will also help with access to follow-up treatment.