2021 projects

Dementia Centre for Research Collaboration (DCRC) Implementing Research Evidence into Practice
2021 – 2022

Background

Talking Mats^TM, developed by speech and language pathologists at the University of Stirling in Scotland, are a visual tool to aide thinking and provide support for people with communication difficulties to express their views about things that matter to them. The mats can be physical or digital and use picture symbols to help people communicate. They can have a positive impact on the quality of life of people with dementia.

What we did

This project focuses on training and studying the use of Talking Mats within two aged care providers to promote greater engagement of people with dementia in the active planning of what supports they want from their ‘consumer directed’ care packages. Specifically, it will explore what barriers and enablers exist to make Talking Mats part of aged care providers everyday care planning practices – and what benefits are experienced from their use by people with dementia, their carers and the providers.

Associate Professor Lyn Phillipson, Professor Belinda Goodenough, Dr Kate Williams and Dr Louisa Smith (UOW), Dr Craig Sinclair (USNW), and Prof Lee-Fay Low (USyd) are investigators on the research team. Whiddon, Bluehaven Care and Talking Mats Ltd are also partners in the research project.

UOW Global Challenges Seed Funding
Partners: UOW SMART infrastructure, NSW Transport, Liverpool and Wollongong Muncipal Councils
December 2020 – December 2021

Background

Due to the pandemic, people’s way of life changed dramatically. Australian governments imposed tight restrictions to stop the coronavirus from spreading, which resulted in significantly reduced road traffic and people movement. However, essential travel demand to maintain daily life remained, like grocery shopping and healthcare visits. Thus, it is critical to develop a feasible and holistic solution to maintain people’s life, especially for seniors and people with impaired mobility, when similar crises occur again. To achieve that, existing transport services need adjustment to support people to adapt to the unexpected scenarios after crisis occurs.

What we did

This project is covering all groups of people, with special attention to seniors and people with impaired mobility. In 2021, a survey was developed and adminstered exploring how COVID-19 affected daily travel and quality of life for people in NSW, and how people adapted to the ‘new normal’ with eased restrictions from 11 October 2021 as part of the Reopening NSW roadmap. Qualitative research with transport vulnerable older people has also explored the impact of transport access during COVID lockdowns on health and quality of life. It is expected the project will make a significant contribution to understanding the mobility and social impacts and adjustment of transport services to tackle unexpected crises in the future.

National Health and Medical Research Council
Duration: 2017 – 2021

Background

Many Australians can currently, or will soon be able to access cannabinoids for medicinal purposes under the supervision of a doctor. However, currently there are difficulties in sourcing reliable, consistent and ‘clinically suitable’ products that are safe and effective for specific conditions. Doctors are also concerned about staying up-to-date with rapid changes to legislation, and the lack of access to sufficient information, including a reliable evidence base, to guide their prescribing.

ACRE incorporates over 20 Chief and Associate Investigators from multidisciplinary fields including pharmacology, clinical psychology, plant science, public health and health economics. They come from over 10 Australian universities and other research institutions to build capacity in medicinal cannabis research and provide a national response to current challenges.

What we did

ACRE is developing a well-governed collaborative strategy to generate world-class research in medicinal cannabis. This will be pivotal in establishing Australia as a world leader in appropriately balanced implementation of medicinal cannabinoid uptake into specialist and primary health care settings.

Professor Kathy Eagar continues to lead one of ACRE’s research themes focused on the development and dissemination of policy, guidelines and information into the health and lay community via websites and GP focus groups.

More information is available on the Centre’s website: https://www.australiancannabinoidresearch.com.au.

Australian Digital Health Agency
August 2019 – September 2021

Background

There is international evidence that training regarding rational prescribing and test ordering, along with system-based strategies, such as protocol-based test ordering and use of clinical guidelines, promotes health cost savings. The My Health Record (MHR), Australia’s online patient-controlled health record, provides an opportunity to combine training in the use of a centralised health record with evidence-based prescribing and test ordering for general practitioners (GPs).

The aim of the CHIME-GP study was to evaluate the effectiveness of the Medcast Pty Ltd multifaceted educational intervention in an Australian general practice setting, regarding use of the MHR system and rational use of medicines, pathology and imaging.

What we did

The study was undertaken in general practices across urban and regional Australia, using a mixed methods approach which incorporated a three-arm pragmatic cluster randomised parallel trial with a prospective qualitative inquiry. The effectiveness of the intervention in each arm was assessed, using the other two arms as controls. The primary outcome was the cost per 100 consultations of selected prescriptions, pathology and radiology test ordering in the six months following the intervention, compared with six months prior to the intervention.

In total, 106 GPs enrolled in the trial. Of those, nine participants withdrew and 44 completed all education sessions. On an intention to treat basis (i.e. including all participants with available data), the rates of increase in pathology and imaging costs were lower than in the control arms, though not statistically significant. In the per protocol analyses (i.e. GPs who completed all education modules), pathology costs were statistically significant lower than in the control arms. Among participants who completed the education modules, imaging and prescriptions costs were lower than controls, though not statistically significant. Based on the per-protocol findings, the savings in imaging amounted to 42%, in prescribing to 16%, and in pathology to 13% relative to the respective average costs across the sample.

Sixty participants completed baseline questionnaires and 37 completed post-education questionnaires. We found statistically significant overall improvements in confidence and self-reported use of MHR as well as a statistically significant increased confidence in deprescribing, self-assessed frequency of review of pathology test ordering and confidence in evidence-based imaging ordering for low back pain.

The findings from the CHIME-GP study suggest that quality improvement can be achieved, along with reduced growth in health system expenditure for low value pathology tests. The online nature of the intervention made it potentially highly scalable nationally.

Australian Government’s Medical Research Future Fund
Duration: April 2019 – June 20212

Background

Aboriginal children have higher rates of injury than non-Aboriginal children, particularly in remote areas. Serious childhood injury can have lifelong implications. Many of the risk factors that give rise to childhood injuries are the same as the risk factors for chronic disease. Aboriginal Community-led interventions are likely to be the most effective means of preventing child injuries, but there has been little research or evaluation show what works best. The highest risk of injury is during early childhood and adolescence. Targeting young parents aged 15 to 24 therefore offers a good opportunity for engagement and improving health literacy around injury prevention.

What we did

Conducted by the Australian Prevention Partnership Centre, this project involves a rigorous evaluation of a community-led child injury prevention program in partnership with Aboriginal community-controlled organisations in Walgett, NSW. It is the result of a partnership between the Walgett Aboriginal Medical Service Ltd (WAMS), the Dharriwaa Elders Group, Walgett (DEG), the University of New South Wales (UNSW), Kidsafe NSW and the University of Wollongong.

The work builds on a research partnership between UNSW and DEG called ‘Yuwaya Ngarra-li’, meaning ‘vision’, which aims to improve the wellbeing, social, built and physical environment and life pathways of Aboriginal people in Walgett through evidence-based programs, research projects and capacity building.

The project will establish trusted relationships with young parents and learn of the supports they need. Health promotion will then be delivered around childhood injury prevention to groups who are engaged through a variety of information sessions and vocationally focused programs on these topics of interested.

This is a mixed methods study with three phases:

1. Phase One: Led by experienced Aboriginal investigators, qualitative research will be undertaken with young parents and community stakeholders to understand the health literacy of the community and identify service providers who are engaging in child safety and parenting, educational and employment services, and the role of family, community and other providers to support them.
2. Phase Two: A community-led intervention will be developed, informed by a literature review of effective interventions and stakeholder and community interviews. The program will be delivered through the existing supported playgroup Goonimoo (run by WAMS), and WAMS’ Children’s Services.
3. Phase Three: Research staff working in partnership with the Yuwaya Ngarra-li team will work alongside the Aboriginal Health Worker to evaluate the program.

This project provides a unique opportunity to develop a robust evaluation framework around a community-led program. The project will enable the development of culturally safe co-produced program and provide evidence on its feasibility and acceptability. If the program is found to be successful, further funding will be sought to trial and evaluate implementation on a larger scale.

Partners: IRT Group, Playgroup NSW, Bluehaven Care, Illawarra Shoalhaven Local Health District
2019 – 2021

Background

Dementia is a global challenge that requires interdisciplinary thinking, collaboration and innovation to improve the lives of people living with dementia. With no effective medical treatments or cure in sight, there is increasing urgency to support the social health and wellbeing of people living with dementia and those at risk of developing it.

What we did

The project, led by A/Prof Lyn Phillipson (Principal Research Fellow, School of Health and Society, UOW), has built understanding and taken action to support and enhance the social health of people with dementia through reducing barriers and providing support for social, civic and care connections. It specifically explored how people with dementia can be supported to live connected lives that are manageable, meaningful and comprehensible, through: neighbourhood and home design (Design Connections); intergenerational play (Play Connections); and creative, personalised supports in aged care (Care Connections).

Despite challenges presented by the COVID-19 pandemic (particularly restrictions prohibiting face-to-face contact with many of our research participants and partners), each of our three complementary research streams have generated new knowledge, built new strategic national and international research partnerships, and contributed substantially to the development of innovative methodologies to promote the inclusion of people with dementia in research.

To find out more about the project please visit https://www.uow.edu.au/global-challenges/living-well-longer/pieces/.

University of Wollongong Faculty of Science, Medicine and Health – Small Project Grants Scheme
October 2019 – December 2021 

Background

This study investigated associations between the nursing practice environment, nurse staffing, nursing care processes and five patient outcomes (mortality, pressure injuries, falls, medication errors and infections). Donabedian’s conceptual model was used to link structural factors (such as the nursing practice environment) with nursing care processes and four key nursing-sensitive patient outcomes in a major teaching hospital in NSW. Natural variations between acute-care wards will enable analysis of the impact that the practice environment has on patient outcomes and identify strategies to support practice improvement and prevent adverse patient outcomes.

What we did

As part of a doctoral research project, we ran a survey between January and March 2021 collecting data on the nurse practice environment and nurse staffing at 17 surgical and medical wards at a major teaching hospital in NSW. Data was collected using a cross-sectional survey tool developed using PaperSurvey.iO, which enables the printing and scanning of surveys using optical character recognition. We collected information on nurses’ background, shifts, care provided, work environment, burnout and job satisfaction. This data was combined with information on nursing processes and patient outcomes, extracted from hospital information systems.

This project provided detailed, ward-level data to support improvements to the nursing practice environment, nursing care processes and patient outcomes. Understanding the linkages between the nursing practice environment, nurse staffing and patient outcomes provides local data to support nurse unit managers, nursing executive and health care managers to improve nursing care and prevent avoidable adverse events.

Community Services Illawarra Shoalhaven, NSW Department of Communities and Justice
May 2020 – November 2021

Background

The Aboriginal Cultural Support Program was developed by the Illawarra Shoalhaven District (ISD) of the NSW Department of Communities and Justice as a result of a restructure to the roles and responsibilities of staff engaged to undertake Aboriginal Cultural Casework and the repurposing of Birralee to an Aboriginal Service Hub. The restructure was in response to the increasing number of Aboriginal children reported at risk of significant harm and entering Out of Home Care. The program aimed to provide safe, culturally sensitive and responsive services that ensure that intervention, information and support is provided in a way which meets the needs of Aboriginal children, families and communities.

Researchers from Ngarruwan Ngadju were engaged to undertake a review of the Aboriginal Cultural Support Program. The scope of the evaluation included: development of a program logic and evaluation framework; conduct of a process and outcomes evaluation; and assessment of the cultural appropriateness and acceptability of the program, including the training provided to Aboriginal cultural support workers. Analysis of the program across the District included consultation with ISD staff around the operation of the new model, overall assessment of the strengths and limitations of the new model and recommendations for improved program delivery consistent with the policy frameworks.

What we did

Project governance and ethical oversight was provided by a steering committee, which comprised respected community elders and other key stakeholders. Ethical approval was obtained from the University of Wollongong’s Social Sciences Human Research Ethics Committee. Following completion of an initial literature and policy review, an evaluation framework (including program logic) was developed and data collection took place. This involved semi-structured interviews and focus groups with managers, cultural workers and case workers. Data collection was impacted by the COVID-19 pandemic, however consultation with Aboriginal community organisations and their clients was undertaken. These data were analysed and synthesised with 18 months of program data from the Aboriginal Cultural Support Program. A final report was delivered to Community Services Illawarra Shoalhaven in November 2021.

UOW Global Challenges Program
Duration: April 2018 – March 2021

Background

The clear and urgent need to address the educational disadvantage of Indigenous children and young people has been recognised in Commonwealth and State policy for more than a decade, with renewed attention under the most recent National Agreement on Closing the Gap. Current policy acknowledges that valuing and respecting culture underlies effort to support Indigenous young people to thrive and reach their potential. In 2018, researchers from Ngarruwan Ngadju were invited to evaluate the Ngaramura project (Supportive Pathways for Indigenous Children in Schooling and Employment), funded by the National Indigenous Australians Agency, which aimed to address the educational needs of disengaged youth in the Illawarra region. The program was developed by an experienced local Aboriginal educator, after extensive consultation with stakeholder groups across the region, including schools, community organisations and the Illawarra Aboriginal community. In collaboration with the Coomaditchie United Aboriginal Corporation and the project’s steering committee, the research team conducted an evaluation focused on the delivery of the program at the Coomaditchie Hall in Kemblawarra, over a three year period. The purpose of the evaluation was to describe how the program was implemented, provide insight into its effectiveness and make recommendations and feedback for program improvement.

What we did

The evaluation was conducted in a staged approach. In Stage 1 we developed a program logic model which clearly described the inputs, activities, participants and the short, medium and long term expected outcomes of the project, through a series of interviews with key stakeholders. The evaluation framework also developed in Stage 1 set out the key questions for the evaluation and identified data sources for the evaluation. Stages 2 and 3 involved conducting a mixed methods process and outcomes program evaluation.

Four key concepts were shown to underlie Ngaramura: Re-connecting with education though culture and identity; Elders as holders of Indigenous cultural knowledge and history; Culturally safe spaces for young people to learn and thrive; Culture continuity through young people. Ngaramura operationalises these key concepts through: learning through culture; adapting the community setting as a cultural learning place; Linking young people, families and schools; asserting Aboriginal identity in relationships with schools; connecting young people to services; providing supportive pathways to address educational and employment disadvantage.

From 2018 until early 2020 Ngaramura was successfully delivered onsite as intended, with young people at the Coomaditchie Hall. Despite various adversities during this period, including a fire and the COVID pandemic, over a three year period Ngaramura sustained engagement with the five schools designated by the funding body to provide referrals. Ngaramura received a total of 149 students from the five schools over the three year period from 2019-2020. Innovative programs such as Ngaramura are uniquely able to fill a much needed gap in place-based culturally based programs based on local Indigenous knowledge from respected elders who know local families, communities and services and are experts in local Indigenous history.

The final evaluation report was delivered in 2021.

Artwork by the youth engaged in the Ngaramura project, and included in the production of the local Dreaming story Birth of the Butterflies. This story and other local Dreaming stories are available to view online (https://www.coomaditchie.org.au/dreaming-stories) and printed picture books are available for sale.

Australian Government Department of Health
November 2018 – December 2021

Publication

Evaluation of the Improving Social Connectedness of Older Australians project pilot: Informing future policy considerations

Background

In late 2018, CHSD was engaged to undertake an evaluation of the Improving Social Connectedness of Older Australians project pilot, a ‘Better Ageing’ initiative of the ‘2018-19 More Choices for a Longer Life Budget Package’.

The pilot project implemented an intervention to improve social connectedness amongst older Australians and tested delivery of these methods through two Primary Health Networks (PHNs). The objective was to review and adapt existing models and frameworks (where relevant) that focus on processes and ‘connection’ interventions that increase the social connectedness of older Australians who are assessed by their primary health care professional or community based service providers as having, or being at high risk of, social isolation and / or loneliness. The pilot commenced in January 2019 and concluded in June 2021 however, during this period project activities were suspended for approximately six months due to the impact of COVID-19. The two pilot sites, Perth South PHN and Nepean Blue Mountains PHN, each implemented an individual-level strategy to directly assist lonely and socially isolated older people, supported by a complementary suite of asset-based community development strategies. The Australian College of Mental Health Nurses was funded as the project manager and was engaged in co-design and oversighting implementation of the pilots.

What we did

The evaluation aimed to contribute to the evidence base for interventions that improve social connectedness and reduce the risk of mental and physical health problems in older people. The COVID-19 pandemic presented major challenges and necessitated significant adaptations to both implementation and the evaluation approach. Nonetheless, the mixed methods evaluation was successfully completed using a range of quantitative and qualitative data sources, including site visits, interviews and surveys of stakeholders and consumers, and consumer health assessments.

In late 2021, the Department was provided final evaluation reports for each site as well as a report to inform future policy considerations. It summarised what worked in the context of the evaluation to help inform the Australian Government’s future models of care and interventions for lonely and socially isolated older Australians. For example, future interventions should view older people as important contributors to the social capital of their communities, engage them in co-design, use a strengths-based personalised response, and incorporate principles of reciprocity where older people are able to ‘give something back’. The evaluation concluded that primary care organisations, as well as the Australian Government’s national network of Regional Assessment Services (RAS) are well-positioned to identify lonely and socially isolated older adults particularly when integrated with existing local measures and service providers. For this to be effective many older people will require facilitated support to engage with these activities and services. Multi-component interventions that integrate community efforts with those of health and social service providers assist in the sustainability of program components. Further research is needed to quantify potential benefits, learn more about effective implementation and assess policy options.

Project team: Cristina Thompson, Darcy Morris, Sonia Bird

NSW Ministry of Health
Duration: February 2017 – October 2021

Publications

Evaluation Report 1

Stage One Summary Report

Stage One Implementation and Outcomes Report

Evaluation Report 6

Final Evaluation Report

Background

The Pathways to Community Living Initiative (PCLI) is a major mental health reform program led by the NSW Ministry of Health in collaboration with NSW Local Health Districts. It is a key component of the whole-of-government enhancement of mental health care under the NSW Mental Health Reform 2014-2024. The PCLI represents a transformational change in the care of people with severe and persistent mental illness and complex needs who are, or are at risk of becoming, long-stay inpatients in NSW hospitals. CHSD was commissioned in 2017 to conduct a formative and summative evaluation of the program.

What we did

The goal of the PCLI evaluation was to help consumers, carers, clinicians, managers and policymakers assess the impact of the PCLI and the extent to which it is meeting its objectives, identify opportunities to refine the program, and inform investment and practice change. There were four components: consumer outcomes, consumer and carer experiences, provider and system outcomes, and economic evaluation.

Three deliverables were submitted during 2021, including a revised version of the Stage One formative and summative evaluation (Evaluation Report 5). This report has since been published on the Ministry website with a foreword by Dr Nigel Lyons, Deputy Secretary, Health System Strategy & Planning.

Evaluation Report 6 presented the findings of a qualitative organisational case study of mental health service reform processes and resulting practice change at two Local Health Districts which were among the six PCLI primary implementation sites. This piece of work represented a ‘deep dive’ into the processes of the PCLI and examined the extent to which the observed practice change could be attributed to the reform program.

The final report of the independent evaluation was delivered in October 2021. The report presented the summative findings of the mixed methods evaluation activities and formative information to guide continuing reform within mental health services.

Project team: Kate Williams, Cristina Thompson, Anita Westera, Conrad Kobel, Sonia Bird and Darcy Morris

Collaborators: Tim Coombs and Peri O'Shea

Australian Government Department of Health
October 2020 – September 2021

Publication

Williams K and Fildes D (2021) Evaluation of the Trusted Advocates Network Trial (Farmers’ Trial) and the Seafood Industry Mental Health Supports Trial (Fishers’ Trial): Final Report. Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong.

Background

CHSD was engaged by the Mental Health Supports Branch of the Australian Government Department of Health to conduct an independent evaluation of a model of mental health promotion delivered by volunteers in rural and regional communities: the Trusted Advocates Farmers’ and Fishers’ Trials.

The Farmers’ Trial was an extension of the Empowering Our Communities initiative to provide additional mental health support for people in drought-affected rural areas. Under the Farmers’ Trial, nine Primary Health Networks (PHNs) were funded to recruit, train, and support up to 10 volunteers in target communities. These volunteers, known as Trusted Advocates, provided informal mental health support to peers and acquaintances. They were recruited from among established and respected members of the community, received reimbursement of expenses, and were linked with each other in local networks, with an emphasis on building capacity within communities to provide mutual support. The goal of the Trusted Advocates Network was to ensure these individuals had the skills and strategies to manage sensitive discussions. To this end, they were provided with training and support (including clinical debriefing as required) to assist them in their roles.

A similar Trusted Advocates program was delivered by Seafood Industry Australia (SIA) in three communities dependent on commercial fishing. Other components of the Fishers’ Trial were: training and community awareness for support coordinators, general practitioners, and other health professionals; communication activities aimed at enhancing access to existing services; and community resilience grants to fund networks and events which raise awareness and address issues of mental health stigma and social isolation.

What we did

The evaluation was designed to document the processes of implementation at each of the 12 implementation sites across five States and Territories. It also assessed outcomes in terms of help seeking behaviour, linkages to mental health services, and community resilience. In particular, it evaluated the extent to which Trusted Advocates could:

• feel confident and effective;
• identify people who may be struggling with mental health issues;
• encourage them to engage in self-help;
• recognise when professional help is required and facilitate reaching out for help;
• direct them towards mental health supports and other relevant services in their communities.

Evaluation activities commenced in late 2020 and continued to April 2021, including data collection via an online survey and interviews with ‘trial managers’ (individuals responsible for local implementation of the program) and Trusted Advocates volunteers across the participating PHNs and SIA. Findings were presented in an interim report (February 2021) and final report (May 2021), including recommendations to the Department to guide future implementation efforts.

Project team members: Kate Williams, Dave Fildes

National Health and Medical Research Council
2017 – 2021

Background

The Study of Environment on Aboriginal Resilience and Child Health (SEARCH) is Australia’s largest prospective longitudinal study of urban Aboriginal children and will provide, for the first time, comprehensive information on the causes of health and illness in a large group of urban Aboriginal children. SEARCH is a partnership with Aboriginal Community Controlled Health Organisations.

What we did

The project builds on the SEARCH cohort study of > 1,600 children and their families based on a long-standing Aboriginal Community Controlled health sector and research partnership. The project aims to improve urban Aboriginal child and adolescent health by using data from participants to identify opportunities for intervention and developing data-driven multicomponent interventions to improve health services.

Working as part of SEARCH are four Aboriginal Community Controlled Health Services: Tharawal Aboriginal Corporation; Western Sydney Aboriginal Health Service (interim services are being provided by WentWest); Awabakal Newcastle Aboriginal Cooperative Ltd; and Riverina Medical and Dental Aboriginal Corporation.

ACCHSs and government and non-government agencies are already using the information collected by SEARCH to understand the health needs of urban Aboriginal children in a wide range of areas such as ear health, mental health, nutrition, and overweight and obesity.

iCare
April 2019 – July 2021

Related publication

McRae P, Kobel C, Lukersmith S, Simpson G. What Does It Take to Get Somebody Back to Work after Severe Acquired Brain Injury? Service Actions within the Vocational Intervention Program (VIP 2.0). Int J Environ Res Public Health. 2022 Aug 3;19(15):9548.

Background

Returning to work following a traumatic brain injury is recognised as a key measure of community reintegration. The Vocational Intervention Program 2 (VIP2) is the second phase of an employment program that aimed to achieve successful employment outcomes for people following a traumatic brain injury. VIP was coordinated and implemented by the Agency for Clinical Innovation (ACI) and the Ingham Institute of Applied Medical Research. Its concept was based on an integrated service model where services were delivered by a team of providers working across organisations and levels of care.

iCare engaged CHSD to undertake a health economic evaluation of the VIP which utilised a cost-benefit analysis approach to assess the costs of the VIP2 relative to the outcomes and benefits achieved.

What we did

Funding provided to VIP2 was used to establish the cost base for the CBA and the benefits were derived based on the number of participants that achieved competitive employment and the type of their employment. A human capital approach was employed to assign a monetary value to these outcomes. Historical return to work rates were applied as a comparator to calculate the impact of the VIP2.

During the VIP2, 221 individuals were referred from a NSW Brain Injury Rehabilitation Program (BIRP) unit to a vocational provider. Of these, 173 individuals subsequently participated in the VIP2. Until June 2021, 135 had either completed or withdrawn from the program, 62 of those were in competitive employment which was 17.2 percentage points higher than historical rates for this population. Their occupations included labourers (23%), community and personal service workers (18%), technicians and trade workers (18%) and professionals (16%).

The cost of VIP2 included program management and coordination but excluded costs of vocational providers and BIRP unit staff.

We estimated that for every $1 invested in the program the return was $10.34 and therefore recommended VIP2 to continue as a model of vocational rehabilitation in NSW.

Project team members: Rob Gordon, Conrad Kobel

St Vincent’s Health Network Sydney
July – October 2021

Background

CHSD was commissioned by the St Vincent’s Health Network Sydney to deliver a Workforce Capacity Assessment of the Homeless Health Service (HHS). The Homeless Health Service (HHS) operates in the City of Sydney Local Government Area providing holistic, multidisciplinary healthcare and support to people experiencing primary homelessness. The HHS was experiencing increasing demand for its services and this had been exacerbated by the impact of the COVID-19 pandemic. St Vincent’s management were keen to identify opportunities for improving the scope of practice of nurses to better meet identifiable service gaps within the standards of practice, policies, regulations and legislation related to nursing roles. The HHS employs 50 staff, one third of whom are registered nurses. The vast majority of clients presenting have complex physical and mental health issues. Any changes to how care is delivered also needed to take into account potential impacts on other team members and work for the patient, practising nurse, team, HHS and broader hospital and health system.

What we did

We employed a cross-sectional survey to obtain the views of staff employed by the HHS in both nursing and non-nursing roles. The survey was distributed to all 50 team members of the HHS and 20 individuals responded (representing a response rate of 40%). In addition, 16 individuals participated in semi-structured interviews and six in focus groups.

The research elicited insights from the front line and a high proportion of both nurses and non-nursing staff perceived that service gaps existed that reduce access to care for clients and several barriers to improving access to care for clients, at the client, service and system level were identified. The results indicated that there was strong support amongst all team members to increase the scope of practice of nurses to improve opportunities for people experiencing homelessness to access services. A range of opportunities were identified where nurses’ contribution might be further developed for example, in assessment and referral, provision of physical and mental health care (including development of care plans) and education and support for clients.

The information gathered is contributing to a broader four phase study ‘Optimising scope of practice of the nursing workforce to increase access to care for people experiencing or at high risk of vulnerability’ being conducted by a St Vincent’s research team. A key output will be the design of a hospital-led learning pathway to better support nurses caring for vulnerable populations such as those experiencing homelessness.

Project team members: Cristina Thompson, Darcy Morris

The JO and JR Wicking Trust
January 2019 – January 2021

Background

More than 60,000 people die in residential aged care (RAC) in Australia annually, and with an ageing population the delivery of palliative and end of life care is an increasingly important issue. However, there is no national framework to systematically identify and measure the outcomes of RAC residents with palliative care needs or to routinely assess, respond to, and measure palliative or end of life needs of these residents. This means that palliative and end of life care is often ad-hoc and reactive rather than a planned response to identified needs. Further, there is no systematic approach to improving end of life care in this setting or for monitoring care at a service, organisation or national level.

This project comprised the pilot implementation of the PCOC model adapted and tailored for use in the RAC setting, and its evaluation. The aim of the ‘PCOC Wicking Model for RAC’ is to drive systematic improvements to palliative care outcomes for residents and their families. The evaluation sought to examine the feasibility of the pilot model by identifying how successfully it can be embedded into aged care homes (ACHs). In this way, the project ultimately aimed to articulate the pathway for a broader national rollout of the model to facilities, thereby affecting systemic improvement of palliative care outcomes within the aged care sector.

What we did

The project involved close collaboration between PCOC, CHRISP and AHSRI teams, as well as participating ACHs. It was organised into three phases:

1. Pre-implementation: A governance structure was established to provide strategic input around intervention development, project management, and research translation. ACHs interested in participating prepared for implementation by assessing their readiness, undertaking education and training of staff, modification of end of life care protocols to incorporate PCOC and installation of IT infrastructure for data collection. Evaluation components included analysis of the readiness assessments and pre- versus post-education and training evaluation.
2. Implementation: Participating ACHs used the standardised assessment and response protocol to identify and respond to residents’ palliative care needs and concerns. Routine PCOC assessment data we collected and submitted to PCOC every six months. Data were analysed and feedback reports provided to participating ACHs to inform their quality improvement activities. Compliance with the assessment and response protocol was evaluated using clinical audit data.
3. Post-implementation: 28 semi-structured interviews and two focus groups were conducted with RACF and PCOC staff to explore their experiences during the pre-implementation and implementation phases. These were thematically analysed as part of the summative evaluation to highlight valuable lessons learned.

A final report was delivered to the Wicking Trust in January 2021, and options for the national rollout of the PCOC Wicking Model for RAC were explored, informed by recommendations arising from the evaluation. This resulted in AHSRI being awarded $8.9 million funding from the Australian Government to establish the Palliative Aged Care Outcomes Program.

Resilience NSW
June – July 2021

Background

CHSD was engaged by Resilience NSW to undertake a peer review of the NSW Bushfires Mental Health Program Evaluation Plan. The program aims to recruit 30 bushfire recovery mental health clinicians to support disaster-affected individuals, carers and families, recovery support workers and emergency services staff and volunteers. This clinical workforce will provide post-disaster emotional wellbeing services and where necessary, referrals will be made to specialist mental health support services.

What we did

Methods for this peer review included documentary review of all program materials provided by Resilience NSW and other key resources. In addition we drew on the program evaluation expertise within Resilience NSW and the resources of qualitative, quantitative and mixed methods evaluation experts within our team.

Our review comprised a completed peer review template with supporting analysis. A strategically developed and fit for purpose data collection framework was included to address the program outcomes and objectives and overarching requirements to assess the contribution of the program to social recovery, sustainability and resilience. Program outcomes as per the program logic (immediate, intermediate and end of program) were clustered to reflect the focus of activities: activities primarily for individual community members, service providers, and/or the broader community and health system. Revisions were suggested to the key evaluation questions and recommendations were made concerning amendments to the overall evaluation plan.

Australian Government Department of Veterans’ Affairs
February – April 2020

Background

The demand for rehabilitation services in Australia is increasing and likely to continue doing so in coming years, largely due to the ageing population, increased survival from acute illness and trauma, and the impetus for people to remain independent for as long as possible. Thus, consistent with contemporary practice, the Department of Veterans’ Affairs is developing and implementing a new Rehabilitation in the Home program to provide rehabilitation services to a group of patients who are medically stable and have a home environment that is suitable for therapy, as an alternative to receiving these services in hospital, where clinically appropriate.

When the program has been implemented by the Department of Veterans’ Affairs, an external evaluation will be commissioned to assess the extent to which the program achieves its overall aims and delivers services in accordance with the agreed service delivery principles.

What we did

We were engaged to develop a framework that will underpin the evaluation. Our framework provides a comprehensive, fit-for-purpose approach to assessing the appropriateness, effectiveness and efficiency of the Rehabilitation in the Home model of care. The framework, based on an existing evaluation framework that has been refined over many years and applied across a range of settings and sectors, will facilitate an effective process and outcome evaluation of the program. It considers the impacts and outcomes at the individual, provider and system level. We detailed the key aims of the evaluation and the approach that will be adopted, as well as the evaluation questions and data reporting requirements.

COORDINARE – South Eastern NSW PHN
April 2020 – March 2021

Background

Primary care providers struggle to provide the complex, long-term care necessary for the increasing number of Aboriginal and Torres Strait Islander people living with chronic conditions. Integrated Team Care (ITC) provides care coordination and supplementary services to eligible people with chronic disease who require coordinated, multidisciplinary care. More than 2,870 Aboriginal people with chronic conditions received support from this program in 2018/19 in south-eastern NSW, with over 5,800 supplementary services funded.

Ngarruwan Ngadju were contracted by COORDINARE Primary Health Network (PHN) to conduct a review of the ITC program in south-eastern NSW. The objective of the review was to define an equitable funding and resource allocation model to suit regional requirements consistent with the Integrated Team Care National Guidelines. The scope of the review included: an analysis of service delivery across five sites; an overall assessment of the strengths and limitations of the current model of ITC in the PHN; co-design consultation to develop a regional collaborative model of coordinated care; recommendations for the best use of funding and resources to deliver against program guidelines; and suggestions for how the PHN will measure the effectiveness of any proposed recommendations if and once implemented.

What we did

Ethical approval for the project was received from the Aboriginal Health and Medical Research Council Ethics Committee of NSW in May 2020. The review was conducted in two phases. The first phase comprised a targeted literature review, qualitative data collection (including semi-structured interviews with ITC staff and clients and focus groups with ITC care coordinators), analysis of quantitative program data, and development of an equitable resource allocation model. The second phase of the project consisted of a co-design process where the preliminary results of the initial data collection and model development were presented to service providers. Two series of round table discussions were conducted with CEOs and staff at four ACCOs and one mainstream service, and a co-design workshop was also held. Following the co-design workshop, further engagement was held with all stakeholders regarding the initial recommendations of the review. The final report of the review was submitted in March 2021 and included recommendations to the PHN on the best use of ITC funding and resources.

Partners: Mental Health Children and Young People (MH-CYP) and Health Social Policy Branch (HSPB), NSW Ministry of Health; Western Sydney University, Parenting Research Centre
2020 – 2021

Background

The NSW Health SAFE START Strategic Policy and Guideline aim to improve the identification of vulnerable women and families through a comprehensive psychosocial assessment offered as a routine component of pregnancy and postnatal care. SAFE START includes clearly articulated service responses for women with low, moderate and complex psychosocial needs. However, since SAFE START was introduced in 2010, research has advanced, healthcare has reformed, and clinical practices and policy contexts have changed.

What we did

In November 2020, NSW Health engaged a multidisciplinary team – Dr Nicole Reilly (AHSRI), Prof Virginia Schmied, Prof Hannah Dahlen, Prof Lynn Kemp, A/Prof Ann Dadich (Western Sydney University) and Annette Michaux and Gina-Maree Sartore (Parenting Research Centre) – to undertake a state-wide review of SAFE START. This review is being undertaken in view of best evidence and in consultation with a wide range of key stakeholders across Australia.

In 2021, the team collaborated with the NSW Ministry of Health to develop a new policy guideline, recommendations for training and a state-wide implementation plan, due for release in 2022. This significant piece of work is a core activity under the NSW Health First 2000 Days Implementation Strategy 2020-2025. This strategy outlines the importance of the first 2000 days and the actions people within the NSW Health system need to take to ensure that all children have the best possible start in life.