Paediatric Aboriginal Health at Southern Health: the 'Reaching Out' team
Knowledge Circle Practice Profiles

Overview

Practice focus

The focus of this service is on the outreach method of service delivery as a way to provide a soft entry point for clients who require access to hospital care.

Delivered by

Southern Health: A public hospital in Clayton, VIC.

www.southernhealth.org.au

The information provided for this Promising Practice Profile was supplied by the Nursing Co-ordinator at Paediatric Aboriginal Health.

Service type

The Reaching Out team at Southern Health delivers paediatric services exclusively for Aboriginal and Torres Strait Islanders to provide cultural connections and intensive support for children aged 0-18 and pregnant women who require access to hospital treatment.

The service is based on an outreach model of nursing care so the women and children are assisted in accessing the hospital's health services. The aim of the service is to encourage a healthier generation of children in the south-east Melbourne Aboriginal community.

Location(s)

Services are provided through more than 40 locations across south-east Melbourne, Victoria.

Description

When the Reaching Out service was first developed, the primary objective was to provide assistance to Aboriginal children who required in-hospital care. However, hospital data showed that the majority of children being serviced were under five years of age. In light of this, and because Aboriginal women usually have more than one child, it was evident that there was a need to extend the service to pregnant women and their subsequent children. Therefore, the service now offers assistance to children AND pregnant women.

Service objectives for Aboriginal families include:

  • supporting children and families to access services within Southern Health;
  • assisting families to access other community services;
  • assisting with transport;
  • assisting with filling out paperwork;
  • liaising with the medical team and other service providers on their behalf;
  • building rapport to gain their confidence in the utilisation of healthcare services; and
  • establishing links with Aboriginal Community Controlled Healthcare Organisations.

The Reaching Out paediatric service is based upon an outreach model that addresses a gap as reported in the current literature that identified a need for a nursing-led service to assist Aboriginal children and their families to access the acute hospital setting. The two registered nurses of the service are able to build rapport with these families who experience a welcoming and culturally respectful contact within the hospital setting. With a view to enhancing the autonomy of the service's clients, the service continues to build upon its partnerships with Southern Health and other community organisations including Aboriginal Controlled Health Organisations and mainstream health services.

Resourcing

The initial project was funded with $96,000 from the Aboriginal Health Branch of the Victorian Department of Health with Closing the Gap funds over a six month period. Southern Health has since committed to ongoing funding to provide the service with a Registered Nursing position.

Practice

MOST promising aspect

The most promising aspect of this service is the link that has been established between the nurses and the Aboriginal families in community who require hospital care. Having two familiar faces to contact is important for these Aboriginal families as they are more likely to attend outpatient appointments and share in healthcare decisions that affect them. In turn, better health outcomes are more likely to result for these Aboriginal families.

Evidence base and opportunities

The Reaching Out team adopts an outreach approach to delivering health services and thus provides a soft entry point for its clients to access more intensive hospital treatment and care. The approach also encourages clients to keep outpatient appointments and to share in the decisions that affect them.

One of the two nurses includes an Aboriginal nurse and both undertake cultural awareness training to ensure their services remain relevant to their clients. This supplements the engagement strategies that reflect a range of Aboriginal cultural concepts and practices, and the service objectives of Southern Health are also supportive and inclusive of Aboriginal culture. Such culturally appropriate responses are known to increase the likelihood that clients needs are adequately met, while the provision of appropriately trained and committed staff offers a greater likelihood that program objectives can be achieved.

By employing an Aboriginal nurse that shares a similar cultural background to the target clients, the service is able to build trusting relationships with its clients. This trust is a key ingredient to service effectiveness for Aboriginal and Torres Strait Islanders.

Only two nurses carry out this service, yet feedback from other services in the community indicate the service has gained traction with the local Aboriginal and Torres Straight Islander community by providing positive outcomes for their children and families. A formal exploration about how this has been achieved and whether it is sustainable in the longer term is warranted to help build the evidence base around what works in building the health of Aboriginal families. Opportunities may also exist in other metropolitan locations that have a demonstrated need to provide Aboriginal groups with better access to hospital care in other areas.

Cultural relevance

Involvement of Aboriginal and Torres Strait Islanders

This service provides an Aboriginal paediatric registered nurse who helped in developing the program to be culturally appropriate.

Cultural practices and materials

The Aboriginal paediatric registered nurse works alongside a non-Aboriginal registered nurse to provide culturally competent services, and both have undertaken up to three cultural awareness training programs.

The service adopts engagement strategies that reflect a range of Aboriginal cultural concepts and practices. These include:

  • understanding past history and its impact on accessing health care for Aboriginal people;
  • being mindful of dates in the calendar that are significant to the Aboriginal community;
  • accepting that a person's appearance may not indicate their Aboriginality;
  • acknowledging the role of the family's 'community'; and,
  • accepting that each family is unique with individualised cultural needs and beliefs.

The following service objectives of Southern Health are also inclusive of Aboriginal culture:

  • recognising staff's interest in Aboriginal cultural awareness and developing education;
  • integrating Clinical Care Guidelines into Southern Health's Aboriginal Policy to assist clinical staff in culturally caring for the Aboriginal Child and Family;
  • membership in the Aboriginal Working Party Group at Southern Health;
  • writing for publications to substantiate Southern Health's commitment to Aboriginal Health and presenting relevant material at professional health conferences.
Adaptability

The service demonstrates its ability to be adapted by extending the program in its early stages of implementation from a children-only service to servicing antenatal women. This, along with the focus on providing outreach services, provides a flexible approach to service delivery that can accommodate a range of different service environments and other potential target groups.

Evaluation

Evaluation status

The service has not been evaluated and an evaluation is not planned or underway.

Effectiveness

Demonstrated outcomes

Since the inception of this program in November 2011, approximately 24 Aboriginal children and /or antenatal women have been assisted in attending in-hospital care via this service. The Reaching Out team has also positively impacted on Paediatric Aboriginal Health, who have received a number of referrals from Bunurong Aboriginal Health Services and also from within Southern Health. More importantly, the service is receiving referrals by 'word of mouth' from within Aboriginal Communities. This exemplifies the trust that the community has in the Reaching Out services at Southern Health. Aboriginal families now have a dedicated team of registered nurses to help facilitate hospital care for vulnerable children and families in their Aboriginal community.

 

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