2021 research projects

Australian Research Council Discovery Indigenous Grant
May 2019 – June 2022

Background

This project involves the Aboriginal led investigator team working in partnership with ACCOs across south eastern NSW. Few of the innovative models that operate within ACCOs have been theoretically considered, documented or evaluated. This study addresses this knowledge gap and consequently optimises the long term and sustainable impacts of ACCOs on Aboriginal health and wellbeing. We apply a decolonising lens to better understand how Aboriginal organisations successfully operate within, and enable, key networks across social and community contexts; and investigate how, why and under what circumstances, community led programs are effective.

The main aim of the project is to develop an Aboriginal place based model of service delivery, and to share and transfer learnings to other locations within Australia. Phase one of the project will describe the policy environment; phase two will use regional case studies to understand and contextualise Aboriginal community controlled approaches; phase three will co-design a strategy to support the ACCO model, and; phase four will translate the learnings from south-eastern NSW to locations in Western Australia and Queensland.

What we did

During 2019 we conducted three literature reviews. A scoping review of the literature on ACCOs was undertaken determine the number, nature and scope of exiting peer-reviewed literature on ACCOs. In a separate review we identified literature around Aboriginal conceptions of place in relation to health and are conducting a narrative analysis of the results. Additionally we have reviewed how ‘place-based’ is understood and applied by government in their policies, planning and programs of activity.

Ethical approval was obtained from the Aboriginal Health and Medical Research Council of NSW to conduct phases one and two of the project. For phase one we have identified and have commenced a series of semi-structured interviews with key policy stakeholders from regional, state and Commonwealth Government.

Phase two of the project, ethnographic regional case studies, planned for 2020, was altered due to the COVID-19 pandemic. Over the past year we focused on two sites in the Illawarra region, with virtual data collection occurring across both sites. The broader regional ethnographic study is planned for recommencement in 2021.

NSW Health COVID-19 Research Grants
July 2020 – June 2022 

Background

Aboriginal Community Controlled Organisations (ACCOs) in NSW are currently at the frontline of the COVID-19 pandemic response, with their already stretched resources, delivering health and social services to vulnerable Aboriginal communities, including those in south-eastern NSW still traumatised by the catastrophic bushfires of summer 2019-20.

This project addresses a gap in knowledge of how urban and regional ACCOs are responding to the complex health and social challenges confronting local Aboriginal communities in the context of the COVID-19 pandemic. The project aims to document their rapid and agile response to the pandemic in continuing service provision, and explore challenges including effective communication with Aboriginal communities. This project builds on an existing ARC Indigenous Discovery project and using a Community Based Participatory Research (CBPR) approach, and existing networks and partnerships, we address the key research question – what should a place-based COVID-19 response for NSW Aboriginal communities look like?

The co-developed Aboriginal-led qualitative study leverages existing Indigenous chronic disease related research in south-eastern NSW to develop strategies, and produce evidence, to support a de-centralised place-based response to COVID-19; one that is culturally safe and responsive to local Aboriginal community needs, which will produce outcomes that are transferable to other settings.

What we did

Phase 1 of the study was conducted over six months (July-December 2020). It had three component parts: a rapid review of literature; stakeholder consultation; and a review of communications and social media. An application to amend the existing ethics protocol was approved by the AH&MRC in February 2021 and an expanded Steering Committee was established for governance oversight of the project. During the first six months of this project research and data collection focused on extending the ethnographic phase that contextualises Aboriginal responses to COVID-19. This phase is not primarily aimed at site recruitment or recruitment of individual participants to the study, but is oriented to collecting and analysing social media and published information about the pandemic through social media communications and messaging and available literature. It is also focused on consulting with ACCOs and their government stakeholders about the impacts of COVID-19 prevention measures on their services and the challenges they face in continued service provision.

The initial rapid review of literature captured practice literature and peer reviewed literature on pandemics and Indigenous communities; a further scoping review of emerging literature is currently being undertaken. Consultation with regional stakeholders is underway with planned meetings ongoing into 2021. An additional survey instrument to capture the impact of COVID-19 on staff wellbeing has been developed, with participant recruitment expected to begin in 2021. Finally, a communications briefing paper has been produced based on social media data collection.

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

Background

Talking MatsTM, 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 Community Engagement Grants Scheme
October 2021 – October 2022 

Background

In collaboration with the Illawarra Aboriginal Corporation, Ngarruwan Ngadju applied to the UOW Community Engagement Grant Scheme for a small grant to develop and evaluate a project that addressed the isolation of Aboriginal women occurring as a result of the COVID-19 pandemic. The project aimed to strengthen and support local Aboriginal women living in the Illawarra region during difficult times, to restore networks, and nurture the exchange of Aboriginal knowledge and traditional practices. The project is structured around a 10-week program of cultural activities including: traditional weaving with an Aboriginal elder, bush tucker and exploring Country, excursions to the Australian Institute of Aboriginal and Torres Strait Islander Studies, and short films. At the end of the project participants are expected to have: increased knowledge in their culture which equates to an increase in confidence; improved networking skills through meeting other Aboriginal women in the group; and access to respected Aboriginal Elders and Aboriginal facilitators and organisations.

What we did

Ngarruwan Ngadju is collaborating with the Illawarra Aboriginal Corporation on the implementation and evaluation of the project. Our role is also to continue to enhance their capacity to work with Aboriginal women in the community by demonstrating the outcomes of their work. Another aim of the collaboration is for Ngarruwan Ngadju researchers to work with the Illawarra Aboriginal Corporation to further refine the evaluation plan and develop clear indicators and culturally appropriate data collection methods to measure its success both qualitatively and quantitatively. The results of the project will be written up in a report and disseminated widely, including to the program participants, the local Aboriginal community and through the Ngarruwan Ngadju website, and in a publication.

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 can be found on the Australian Centre for Cannabinoid Clinical and Research Excellence's website.

Dietitians Australia
September 2020 – January 2023

Background

In Australia, 4.4 million people (one in six) have a disability and there is increasing emphasis on the need for all health professionals to better understand and respond to the needs of people with disability.  However currently, there are few educational opportunities or resources to support dietitians to work safely and effectively with people with disability in contemporary dietetic practice.

The purpose of the Capacity Building for Dietitians in Disability project is to enhance dietitians’ knowledge and capacity to meet the needs of people with disability and improve access to timely, inclusive, relevant and high‐quality dietitian services. The project will capture the perspective of dietitians, people with disability, carers and other relevant stakeholders, to inform the development of an educational program and resources. An advisory group will inform program development and implementation.

What we did

Dietitians Australia has engaged CHSD to provide support in the development and implementation of the Capacity Building for Dietitians in Disability monitoring and evaluation framework. Working collaboratively with CBDD, we have provided advice on the ethics application and on data collection strategies that are being used to inform program design and implementation. The findings will be critical to the development of a program logic, evaluation questions, and data collection protocol. We will provide ongoing support and advice to Dietitians Australia throughout the course of the project and conduct a series of targeted stakeholder interviews during the third year of the project, the results of which will be synthesised and analysed, and submitted with our final report.

Australian Digital Health Agency
August 2019 – September 2021

Background

There is international evidence that training regarding rational prescribing and test ordering, along with systembased 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 is to evaluate the effectiveness of Medcast Pty Ltd’s multifaceted educational intervention in an Australian general practice setting, regarding use of the MHR system and rational use of medicines, pathology and imaging. The study is being undertaken in general practices across urban and regional Australia, using a mixed methods approach which incorporates a three-arm pragmatic cluster randomised parallel trial with a prospective qualitative inquiry.

The effectiveness of the intervention in each arm will be assessed, using the other two arms as controls. The primary outcome will be an economic analysis of 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.

What we did

One hundred and six GPs were enrolled in the trial and twenty-six GPs participated in pre-intervention interviews.

The preliminary findings of the pre-intervention interview data showed that participant engagement with MHR prior to the intervention was varied, with only a few being regular and opportunistic users. Main motivators to participate in the study were to learn how to use or to improve use of MHR and to improve clinical practice. The majority of participants perceived that the intervention could have a positive impact on their work efficiency and clinical practice, while a few perceived it could impact their prescribing and test ordering. All participants perceived the education format to be both acceptable and useful. Webinars and online learning modules were mostly thought to be flexible, convenient and accessible. Time and functionality were the main perceived barriers to the format.

At this time, all GP participants have completed all components of the education intervention. Over the coming months, data will continue to be collected and analysed. The final evaluation report (due in October 2021) will present the full analyses and findings of the project: the qualitative data collection and analysis and the quantitative data collection and health economic analysis.

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

‘Connections for Life with Dementia’ was funded to generate new knowledge and take action to promote the social health of people with dementia – with a focus on social, health, civic and care connections. Our three complementary research streams are:

  • Design Connections – building evidence around enabling neighbourhood and home design
  • Play Connections – building evidence for how intergenerational playgroups can be used to support wellbeing
  • Care Connections – supporting people with complex care needs in residential care who were transitioning from one living environment to another.

Each have contributed substantially to the development of innovative methodologies to promote the inclusion of people with dementia in research.

The team faced some major obstacles with COVID-19 restrictions prohibiting face-to-face contact with many of our research participants and partners. This has posed particular challenges when working with people with dementia using methods that aim to support their social connections.

Nonetheless, the team has successfully managed to generate new knowledge and build new strategic national and international research partnerships, analyse data, write publications and obtain additional funding to further the research.

The project, led by Associate Professor Lyn Phillipson, brings together a strong group of interdisciplinary researchers from the Faculties of: Social Sciences; Science, Medicine and Health, Business and Engineering; and Information Sciences. The project has active partnerships with the Illawarra Shoalhaven Local Health District, Kiama Municipal Council/ Blue Haven Care, Playgroup NSW and the IRT Foundation. Finally, the project also draws on the expertise of people with dementia and their care partners.

Access more information about the Connections for Life with Dementia project

UOW Global Challenges Seed Funding
December 2020 – December 2021 

Background

Disability can add complexity during emergencies. This is not just because of disability related factors but because emergencies magnify how society positions people with disabilities as, at best, marginal and inessential and, at worst, expendable.

What we did

This project will work with people with disabilities in the Illawarra-Shoalhaven to understand how their experiences during the global COVID-19 pandemic and the local 2019/2020 bushfire emergencies can be placed at the heart of community preparedness and recovery, and improve disaster responses.

Co-researchers with disabilities will work with an interdisciplinary team to build long-term partnerships with disability service providers in the Illawarra-Shoalhaven. These partnerships aim to understand and promote the perspectives of people with disabilities and their capacities and support needs during emergencies.

Community Services Illawarra Shoalhaven, NSW Department of Communities and Justice
May 2020 – March 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 is in response to the increasing number of Aboriginal children reported at risk of significant harm and entering Out of Home Care. The aim of the Aboriginal Cultural Support Program is 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.

Community Services Illawarra Shoalhaven (Department of Family and Community) invited researchers at the Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre to submit a proposal to undertake a review of the Aboriginal Cultural Support Program. The scope of the evaluation includes: develop a program logic and evaluation framework; describe the activities and scope of the program; conduct a process evaluation that describes how the program is being implemented; conduct an outcomes evaluation that assesses the program’s achievements over the short and medium term; assess the cultural appropriateness and acceptability of the program to stakeholders; and provide an assessment of the training provided to Aboriginal cultural support workers. Analysis of the program across the District includes: 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

The project commenced in May 2020 with an application for ethical approval to the UOW Human Research Ethics Committee. A Steering Committee, which includes respected community elders, was established for project governance and ethical oversight. There has been ongoing communication between the Department and the research team. Research activities include an initial literature and policy review, development of a program logic and evaluation framework, program data collection from monthly activity reports, and qualitative data collection.

Data collection was impacted by the COVID-19 pandemic in the early months of the project and much of the planned face-to-face data collection was done by telephone interview. We received ethical and Work Health and Safety approval to resume face-to-face data collection in October 2020, and to date have conducted semi-structured interviews with eight managers and six cultural workers, as well as three focus groups with eight cultural workers and another two focus groups with 12 case workers. Community consultation is ongoing and further qualitative data collection is planned with Aboriginal community organisations and their clients in 2021.

Global Challenges Program
Duration: April 2018 – March 2021

Background

In 2018 the Coomaditchie United Aboriginal Corporation invited researchers from the Ngarruwan Ngadju research team to evaluate the Ngaramura (Supportive Pathways for Indigenous children in Schooling and Employment) program. This project pilot addresses the educational needs of disengaged youth in the Illawarra region. In collaboration with the Coomaditchie United Aboriginal Corporation and the project’s steering committee, the research team conducted an evaluation which focused on the delivery of the program at the Coomaditchie Hall in Kemblawarra, over a three year period.

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 program evaluation over a 12 month period utilising the following sources of program and qualitative data:

  • De-identified routinely collected program data
  • Individual interviews with parents / carers of past and present students
  • Group and individual interviews with Ngaramura staff
  • Group and individual yarns with current and past program participants (secondary school students)
  • Onsite observation of the Ngaramura program
  • Interviews with school staff from the five participating schools.

With additional funding the Ngaramura pilot program was extended; we therefore extended the data collection period and reported on the evaluation early 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.

NSW Ministry of Health
July 2020 – June 2021

Download the interim report now

Background

Carers have a critical role to play in providing support for people with mental health illness. The Family and Carer Mental Health Program is a state-wide program funded by the NSW Ministry of Health, delivered since 2006 in partnership between local health districts, the Justice Health and Forensic Mental Health Network and five specialist community managed organisations. Its purpose is to improve the wellbeing of families and carers of people with mental health conditions and the people they support. The program acknowledges the critical role that families and carers play in promoting and sustaining positive mental health and recovery, together with consumers, practitioners and relevant professionals.

The program focuses on the delivery of family friendly mental health services by supporting carers directly and training staff of relevant service providers to include families and carers in the service system and to be responsive to their needs. The core objectives of the program are to: improve family and carer coping; increase carers’ knowledge of mental illness; enhance carers’ wellbeing, resilience and relationships; assist carers in finding services to meet their needs and circumstances, and; provide individual emotional support to carers.

CHSD was engaged by the NSW Ministry of Health in mid-2020 to evaluate the program.

What we did

In evaluating the program, a key evaluation objective is to assess the extent to which the model of care is effective, efficient and appropriate, and what, if any, changes could enhance its outcomes.

In 2020, after the evaluation methodology and approach was finalised, we undertook a rapid literature review relevant to delivery and provision of services to families and carers of people with a mental illness, and commenced quantitative and qualitative data collection activities and stakeholder engagement.

Australian Government Department of Health
November 2018 – December 2021

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 is implementing an intervention to improve social connectedness amongst older Australians and is testing delivery of these methods through two Primary Health Networks (PHNs). The objective is 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 and / or community based service providers as having, or being at high risk of, social isolation and / or loneliness. Implementation of these models commenced mid-2019. The two pilot sites are Perth South PHN and Nepean Blue Mountains PHN. The Australian College of Mental Health Nurses is funded as the project manager and is engaged in co-design and oversighting implementation of the pilots.

What we did

The evaluation aims 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. However, the project pilot was significantly disrupted in 2020, first by natural disasters (bushfires and flooding) and then the advent of the COVID-19 pandemic. Implementation by project teams unavoidably slowed for much of the year, with activities within general practices and those in the community aimed at bringing people together particularly affected. Consequently, a six-month extension of the project (and evaluation) timeframes was granted to accommodate changes in implementation necessitated by the COVID-19 pandemic. From September 2020 most project activities gradually resumed, however, implementation has continued to be affected as COVID-19 case locations and alerts emerge.

Notwithstanding these challenges, the evaluation remained on track this year, with adaptations to the evaluation approach allowing data collection and (virtual) site visits to continue with implementation sites.

Project team: Cristina Thompson, Darcy Morris, Sonia Bird

NSW Ministry of Health
June 2020 – February 2022

Background

CHSD was commissioned by the then Mental Health, Drug and Alcohol Branch of the NSW Ministry of Health in 2015 to conduct an independent evaluation of the LikeMind pilot. The LikeMind initiative’s service model can be characterised as a NGO-led and managed service-hub approach to the integrated provision of care and support, which is readily accessible in a community setting, for adults aged between 25 and 65 years old who experience moderate to severe mental illness.

The Phase 1 evaluation, conducted over three years and completed in February 2019, found it had largely achieved its primary objectives and identified key challenges and opportunities for the initiative moving forward. At that time, LikeMind services had funding arrangements in place until 30 June 2019. The Ministry has subsequently approved additional funding to these four services for the period 1 July 2019 to 30 June 2022. In line with the decision to extend the delivery of LikeMind services, the Ministry also engaged CHSD to extend the LikeMind evaluation.

What we did

After finalising our approach to the evaluation, implementation commenced in the second half of the year. The methodology builds on the previous evaluation. Specifically, we will use the same evaluation framework (modified as appropriate), and a broadly similar approach to stakeholder engagement, data collection and data analysis activities. At the same time, we will be introducing several enhancements to the evaluation to improve the extent to which we can evaluate the LikeMind initiative’s overall effectiveness.

NSW Ministry of Health
Duration: February 2017 – September 2021

Background

The Pathways to Community Living Initiative (PCLI) commenced in 2015 to support the transition of long-stay mental health patients into appropriate community-based services as a key component of the NSW Mental Health Reform 2014-2024. Underpinned by substantial investment from the NSW Government, the PCLI is led, funded and coordinated by the NSW Ministry of Health in collaboration with Local Health Districts. CHSD was commissioned in 2017 to conduct a formative and summative evaluation of the program.

What we did

The goal of the PCLI evaluation is 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 are four components: consumer outcomes, consumer and carer experiences, provider and system outcomes, and economic evaluation.

Evaluation Report 4: Strengthening partnerships through collaboration was submitted in December 2019 and finalised in 2020. In addition, Evaluation Report 5: Stage One implementation and outcomes was submitted in September this year. This report provided formative and summative findings for PCLI Stage One, which at the time of reporting had been operating for approximately five years. Major data sources were 30 interviews with key informants and routine administrative data drawn from the Health Information Exchange.

The evaluation team has also participated frequently in governance and communication activities, including regular attendance at online PCLI Steering Committee meetings. This close engagement continues to provide opportunities to deepen our understanding of the program and monitor developments as they happen.

A proposal to extend the timeline and scope of the evaluation was accepted by the Ministry of Health in 2020. The extension allows the evaluation to encompass the planning and commissioning of the Stage Two Specialist Living Services (SLSs) under the PCLI to serve consumers with the most complex needs and without significant ageing‐related issues.

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

Collaborators: Tim Coombs and Peri O'Shea

NSW Ministry of Health
October 2020 – September 2021

Background

CHSD was engaged by the Mental Health Supports Branch of the Australian Government Department of Health to conduct an independent evaluation of the Farmers’ and Fishers’ Trials.

The Farmers’ Trial is 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 PHNs have been funded to recruit, train, and support up to 10 volunteers in target communities. These volunteers, known as Trusted Advocates, provide informal mental health support to peers and acquaintances. They are recruited from among established and respected members of the community, receive reimbursement of expenses, and are 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 is to ensure these individuals have the skills and strategies to manage sensitive discussions. To this end, they are provided with training and support (including clinical debriefing as required) to assist them in their roles.

A modified Trusted Advocates program is being delivered by Seafood Industry Australia (SIA). The Fishers’ Trial will involve: (1) appointment of paid Fishers’ Mental Health Support Coordinators in three target communities; (2) training and community awareness for support coordinators, general practitioners, and other health professionals; (3) communication activities aimed at enhancing access to existing services; and (4) 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 has been designed to document the processes of implementation at each of the 12 implementation sites across five States and Territories. It will also assess outcomes in terms of help seeking behaviour, linkages to mental health services, and community resilience. In particular, it will evaluate the extent to which Trusted Advocates:

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

Evaluation activities commenced in late 2020 with the preparation of a protocol, ethics approval, and data collection via interviews with key informants across the participating PHNs and SIA. Interviews were also conducted with Trusted Advocates volunteers at four implementation sites. Preliminary findings were presented in an interim report in February 2021, with the final report submitted in April 2021.

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.

Australian Research Council Linkage Projects Scheme
Duration: 2018 - 2021

Background

Workforce participation of people with a disability remains low. This project aims to develop a model of successful employment for people with a disability, identify sources of employer diversity that explain willingness to hire, and develop social marketing messages that improve employer attitudes and achieve greater inclusion in Australian workplaces.

What we did

This project consists of two sub-studies:

  1. Developing a theoretical model of successful employment for people with a disability: This study will conduct interviews with people with a disability and their employers to identify the factors that contribute to sustained employment of people with a disability, with a view to developing a theoretical model of success. It will then test the validity of this theoretical model through a quantitative survey of people with a disability.
  2. Using social marketing to improve employer attitudes toward hiring people with a disability: This study will identify differences in employer attitudes toward hiring people with a disability. It will involve interviewing and conducting a quantitative survey with employers. Segmentation analysis will be performed on the quantitative data to identify groups of employers that have common attitudes toward hiring people with a disability. Advertising messages will be developed (with undergraduate UOW students) and tested through an online survey with employers to assess the advertisements’ effectiveness in improving employer attitudes toward hiring people with a disability.

The outcome of this study will be more people with a disability and their carers gaining meaningful employment, with benefits including improved physical and mental health, social connections and economic security. It will benefit employers by creating more diverse workplaces and a broader talent pool, resulting in greater innovation and productivity.

PhD candidates Mr Paul Ikutegbe and Ms Rola Mahasneh commenced work on the project in 2019 and 2020 respectively. Both have made excellent progress to date.

Project team: A/Prof Melanie Randle, A/Prof Rob Gordon, Prof Kathy Eagar, Prof Sara Dolnicar, Mr Simon Watts.

iCare
April 2019 – July 2021

Background

iCare engaged CHSD to undertake a health economics analysis examining key elements of the Vocational Intervention Program (VIP), a program being coordinated and implemented by the Agency for Clinical Innovation (ACI) out of the Ingham Institute of Applied Medical Research.

VIP aims to achieve placements in competitive employment through two specific interventions:

  • Fast-track: early intervention model, targeting clients who were working at the time of their injury, identified to have good return to work (RTW) potential and whose employers have agreed to trialling a return to their preinjury place of employment.
  • New-track: targeting clients with no option to resume their pre-injury employment and require a work training placement to gain new skills and improve work readiness.

What we did

Work commenced on this evaluation in 2019 with potential approaches to the health economic evaluation being developed. In order to obtain feedback about progress to date, a series of four focus groups with VIP service providers and clinicians from Brain Injury Rehabilitation Program units were conducted in late 2019.

The key finding from these focus groups was a strong sense that implementation of the VIP has occurred seamlessly following its initial establishment phase. Both Brain Injury Rehabilitation Program clinicians and service providers identified several factors that have contributed to its success to date that were outlined in a report to iCare in March 2020.

Work on the health economic analysis continues in 2021 with the aim of contributing to decision-making processes regarding future investment in the program.

Project team members: Rob Gordon, Conrad Kobel

NSW Ministry of Health Translational Research Grant Scheme
May 2019 – November 2021

Background

Aboriginal Australians are twice as likely to have a heart attack as other Australians and more than 10 times as likely to die from coronary heart disease. Cardiovascular disease also strikes Indigenous Australians much earlier, with more than 20% of 35 to 44-year-olds already afflicted, figures show. There is a particularly high incidence around the Shoalhaven region of NSW.

This feasibility study is developing and evaluating a family-centred outreach model for cardiac rehabilitation in the Aboriginal community. The study aims to increase participation in evidence based cardiac rehabilitation and culturally inclusive care, and identify and manage family members at risk of a cardiovascular event. Aboriginal Health Workers from the Illawarra Shoalhaven Local Health District’s Aboriginal Chronic Disease Program will deliver the program to consenting participants who have suffered a cardiac event, together with members of their family, in a community setting.

What we did

Working in partnership with the Illawarra Shoalhaven Local Health District, Ngarruwan Ngadju are providing academic leadership and project support, including undertaking qualitative data collection, analysis and report writing. Assistance is also being provided in the preparation of intervention materials and the administration of questionnaires.

The two-year feasibility study based in the Illawarra and Shoalhaven region may be rolled out state-wide if it proves to be a success in reducing hospital readmissions and saving lives.

The project commenced in May 2019, with successful applications to the UOW/ISLHD and AHMRC ethics committees, governance committees established, staff training, and the development of the project manual. Cardiac client recruitment and baseline data collection commenced in September 2019. One focus group and 10 face-to-face in-depth interviews were conducted with service providers in the early stages of the project. The data indicated strong support for the model, which was considered culturally appropriate and positive feedback was obtained around opportunities for improved skills (e.g. clinical, relationship building, engagement, cultural understanding). Areas for improvement were identified.

The study was directly impacted by unprecedented natural disasters including the 2019/2020 bushfires, floods in early 2020, and then the COVID-19 pandemic. Due to the latter, the project was suspended in April 2020. The study resumed in October 2020, with recruitment planned to re-commence early in 2021.

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’ was to scaffold and drive systematic improvements to palliative care outcomes for residents and their families. The evaluation examined the feasibility of the pilot model by identifying how successfully it can be embedded into residential aged care facilities (RACFs). In this way, the project ultimately sought 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 RACFs. It was organised into three phases:

  • Pre-implementation: A governance structure was established to provide strategic input around intervention development, project management, and research translation, including a steering committee involving experts in the field from a broad range of disciplines across Australia that met three times a year. Activities were also undertaken that assessed and prepared participating sites for implementation, including the conduct of readiness assessments, delivery of education and training, and the development of IT infrastructure. Evaluation components included analysis of the readiness assessments and pre- versus post-education and training evaluation.
  • Implementation: A range of activities were undertaken once RACF sites started using the model (‘go-live’). Namely, RACFs use of the standardised assessment and response protocol, as well as data collection and entry of the routine PCOC assessments. Compliance with the assessment and response protocol was evaluated using clinical audit data.
  • 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 are being explored, informed by recommendations arising from the evaluation.

NBNCo, Vita Foundation, Australian Government’s Be Connected Initiative
Duration: August 2016 – present

Background

Living Connected has created a service to improve the digital literacy of older citizens who live in the Illawarra Shoalhaven. This service applies the results of four years of research into why and how older people use digital devices and on the benefits to social wellbeing from this use.

As developed countries struggle to find suitable living arrangements for their ageing populations, many elderly citizens are becoming increasingly marginalised and isolated. Isolation is known to lead to severe problems such as depression. There is a large body of evidence that remaining active and engaged with others contributes to the health and wellbeing of the elderly. With age, the physical capability to get out and about diminishes. Meanwhile, digital technology continues to improve, providing new ways to connect with others and engage in exciting new activities.

The most recent Telstra report on digital inclusion in Australia reveals that older citizens are missing out on the benefits of the Internet; something that the rest of us take for granted. Government agencies, businesses and community services expect everyone to interact with them online and are making it difficult to access services in person. This is a real challenge for the digitally excluded made even more acute in 202 with COVID 19 restrictions.

What we did

The mission of Living Connected is to be a not-for profit community enterprise providing services for the social wellbeing of elders assisting them to set up and use a computer whereby they remain independent, connected and engaged. Research into the outcomes of social services has identified eight domains of wellbeing, three of which are on a higher level than the others: maintaining independence, staying connected and being able to engage in meaningful activities. The Living Connected team of contract and volunteer mentors has spent three years translating this service into practice, helping seniors to use digital technology in small groups and on an individual basis throughout the Illawarra and NSW South Coast.

In 2020 we received an additional $77,000 in grants, enabling us to pivot under COVID restrictions to deliver services online. When all face-to-face services stopped in March this year, we setup five weekly Zoom sessions. We have run digital mentor training on Zoom and taught seniors how to join and run Zoom sessions. Being online has allowed us to extend our services into more outer regional areas.

View the Living Connected website

Project leader: Professor Helen Hasan

National Health and Medical Research Council
Duration: March 2018 – February 2022 

Background

Australia’s Aboriginal and Torres Strait Islander population is ageing: in 1991, Aboriginal people aged 55 years and over accounted for only 6% of Australia’s total Aboriginal population and this proportion is predicted to double to 12% by 2021, with resulting increases in ageing conditions such as falls. This large-scale trial in NSW, SA and WA will test the effectiveness of a community-based program in reducing falls and improving function in older Aboriginal people.

The project was named after the Ironbark tree because it is native to Australia, evokes images of old, strong, trees standing tall and that is what we want to see our old people doing. Standing tall and strong as they age. The Ironbark Study is comparing two different programs aimed at improving health and wellbeing of older Aboriginal people. Both involve an ongoing program delivered weekly by a local person, in a community setting. The Ironbark: Standing Strong program is a weekly exercise and discussion program, and the Ironbark: Healthy Community program is a weekly program that involves discussions and social activities.

The study plans to recruit 60 Aboriginal community or health services in NSW, SA and WA into the Ironbark Trial. Services participating in the study are randomly assigned to receiving one fo the two programs. Both programs aim to improve the health and wellbeing of older Aboriginal people. At the end of the trial, sites that delivered the Ironbark: Healthy Community program will have the opportunity to deliver the Ironbark: Standing Strong program for a further six months, including all resources and equipment needed.

The study is being conducted by researchers from The George Institute for Global Health, the University of NSW, the University of Sydney, Flinders University, the University of Wollongong and Curtin University.

What we did

Ngarruwan Ngadju researchers participate in the Ironbark study on the chief investigator team, the Aboriginal governance committee and in the engagement and recruitment of sites in south-eastern NSW. From late 2019 members of the team commenced discussions with Aboriginal organisations in the region to inform them of the study, its benefits for community, and to ascertain their interest and capacity to be involved as study sites for the trial.

The Ironbark project was directly impacted by the COVID-19 pandemic due to its reliance on face-to-face intervention with elderly Aboriginal people across Australia. The research was suspended during 2020 and is due to re-commence in 2021. Program outcomes have been adjusted to address the reduced timeframe and scope of the project.

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. The 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.

Ngaurrwan Ngadju were contracted by Coordinare South Eastern NSW 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. The review was conducted in two phase. In the first phase of the project we conducted a targeted literature review; collected qualitative data including conducting semi-structured interviews with Integrated Team Care staff (n=15) and clients (n=7) and one focus group with ITC Care Coordinators (n=7 participants); analysed quantitative program data; and developed 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 the CEOs and staff at four ACCOs and one mainstream service and a co-design workshop with 13 participants was held. The final report of the review was submitted in March 2021 and included recommendations to the PHN.

UOW Global Challenges Seed Funding
December 2020 – December 2021 

Background

Chronic health conditions, loneliness and social isolation are predictors of functional decline and premature death in older persons. This mixed-method scoping study will seek to address the “Living Well, Longer” challenge by exploring the self-care, and General Practice Nurse (GPN) support of older persons affected by disaster.

While GPNs are well-positioned within community settings to support older persons to remain independent and healthy, little is known about how older persons maintain self-care and connection with GPNs during periods of natural disaster and pandemic. Older residents in Eurobodalla have lived experience of the 2018 and 2019/2020 bushfires, and more recently, they have been subject to public health measures restricting movement associated with COVID-19.

What we did

This study will bring together an interdisciplinary team of health professionals and researchers to answer the following research questions:

  • What factors impact the self-care of older persons living with chronic health conditions during a disaster or pandemic?
  • How can GPNs contribute to identifying and supporting the self-care of socially isolated older people in their local community?

Findings from this study will enable interventions to be developed that support older persons to remain independent and live longer in their local community.

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