Researchers: Dr Rhonda Marriott (Murdoch University), Professor Anne McMurray (Murdoch University), Assoc Prof Keryln Carville (Silver Chain and Curtin University), Jenny Prentiss (Nurses Board of WA), Veronica Strachan (Wounds West)

Funding: State Health Research Advisory Council

Project summary: This project aims to improve wound healing rates and access to best practice management of complex wounds in Indigenous communities across Western Australia through a culturally inclusive approach.

This will include: the incorporation of Indigenous beliefs and perspectives into patient management and treatment protocols; the implementation of education and health promotion programs; and interventions aimed at prevention, early detection and effective management of wounds. Expected outcomes of the project include increased awareness of wound assessment, wound complications and management; increased skill levels of health practitioners (particularly of the Indigenous health workforce); improved appropriateness of referrals to acute WA health centres; improved healing rates of wounds; a decrease in amputations (and other complications); and increased access to culturally appropriate best practice wound management by Indigenous patients. It is anticipated, based on a previous pilot conducted in the Kimberley region that significant cost savings will be realised within the duration of this project and will be sustained beyond the life of the project.

The project will be led by Aboriginal researchers supported by highly qualified senior clinicians and scientists. Funding was received in August 2007 and the project will end in July 2008. Provision will be made for a follow up evaluation to be conducted 12 months after the project has concluded to measure sustainability of the outcomes of this project.

---

Researchers: Pam Hunter (Derby Research Administration Officer, Department of Families, Community Services and Indigenous Affairs (FaCSIA)), Dr Melisah Feeney (Project director, FaCSIA), Graham Brice (Ethics and Research, FaCSIA)

Funding: Australian Government through FaCSIA

Project summary: Footprints intends to work with Aboriginal and Torres Strait Islander families in 11 regions across Australia, including Derby, Fitzroy Crossing and the surrounding communities to help better understand what impacts on children’s lives over time and explore how they can be better supported to grow up strong and resilient regardless of location. The study will concentrate on babies (6-18 months) and 3½-4½ year olds. It is overseen by a Steering Committee chaired by Professor Mick Dodson (ANU), and includes Adele Cox of the Kimberley region. The Committee has mandated that Footprints in Time must be designed and conducted so that it has the acceptance and support of Aboriginal and Torres Strait Islander communities and of participating families. The key research questions have been developed following consultation with Aboriginal and Torres Strait Islander communities around Australia, as well as Government departments and service providers, to identify areas where longitudinal research would provide useful information. The key questions are:

• What do Indigenous children need to have the best start in life to grow up strong?
  
• What helps Indigenous children to continue to grow healthy, positive and strong?
  
• What is the importance of family, extended family and community in the early years of life and when growing up.
  
• What differences are there between how Indigenous children are raised compared to non-Indigenous children.
  

Communities also have the opportunity to request additional questions be included at the local level. All requests for additional questions go to the LSIC steering committee. This is the first longitudinal study of Aboriginal and Torres Strait Islander children across Australia. This means that parents/carers will be asked for permission to be re-interviewed at least every year for four years or longer.

---

Researchers: Heather D’Antoine (Telethon Institute for Child Health Research), Nadine Henley (Edith Cowan University), Jan Payne (Telethon Institute for Child Health Research), Elizabeth Elliott (University of Sydney), Carol Bower (Telethon Institute for Child Health Research), Anne Bartu, (Drug and Alcohol Department)

Funding: Healthway Starter Grant

Project summary: The aim of this project is to collect qualitative data from Aboriginal women in the Kimberley (Fitzroy Crossing), Goldfields and the Metropolitan area on their knowledge, attitudes and practice regarding alcohol use in pregnancy. The data will be collected through focus groups. Data from non-Aboriginal women on this topic has already been collected through a computerised telephone survey. As anticipated, Aboriginal women were under-represented in this survey and it was planned that we would collect qualitative data from Aboriginal women on this topic. This information will be used to inform the development of an intervention aimed at informing women and the broader community about the effects of alcohol use in pregnancy. The data collection in the Kimberley and Goldfields is funded by a Healthways Starter Grant. The data collection for the Metropolitan area, which has commenced, is funded through the current NHMRC Program Grant.

---

Researchers: Deborah Lehmann, Anke Bergmann (Telethon Institute for Child Health Research), Paul van Buynder & Carolien Giele (Communicable Diseases Directorate, Western Australian Department of Health), David Smith & Jacinta Bowman (Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine), Amanda Leach & Kim Hare (Menzies School of Health Research, Darwin)

Funding: Department of Health WA

Project summary: The bacterium Streptococcus pneumoniae (pneumococcus) can cause middle ear infection and invasive pneumococcal disease (IPD) resulting in meningitis, pneumonia and blood poisoning. The Australian Aboriginal population has among the highest reported IPD rates worldwide. The existence of 90 different types (serotypes) of pneumococci increases the challenge of prevention, particularly vaccine development. A vaccine covering the 7 most common serotypes (Prevenar) and a booster with a vaccine covering 23 serotypes (Pneumovax) is offered to Aboriginal children. Pneumovax is also offered to Aboriginal adults. Following the introduction of Prevenar in 2001 incidence of IPD has fallen in children, though the serotypes causing disease are not entirely those not included in Prevenar. Further cause for concern is a marked increase of IPD in Aboriginal adults, also predominantly due to serotypes not included in the Prevenar vaccine. The likelihood of replacement diseases due to non-vaccine serotypes needs further investigation. Surveillance of IPD is hampered because antibiotics are often given before there is an opportunity for collecting blood cultures, particularly in remote parts of WA. However pneumococci are carried in the back of the nose of healthy individuals (up to 50% of Aboriginal children and more than 25% of Aboriginal adults). Carriers can transmit pneumococci to other members of the community. Surveillance of pneumococcal carriage can assist in predicting emerging serotypes causing IPD and susceptibility of pneumococci to antibiotics. Furthermore, carriage studies can assist in developing appropriate policies with regard to the next generation of pneumococcal vaccines, two of which are likely to be licensed in Australia soon.

---

Researchers:Trish Graham (Kimberley Public Health Unit (KPHU), Tracy Leon (Kimberley Division of General Practice), Hanneke Schoe (KPHU), Noelene Bending (KPHU), Margaret Williams (Ord Valley Aboriginal Health Service), Brenda Walters (Kununurra District Hospital)

Funding: Internal

Project summary: not provided

---

Researchers: Linda Klein (National Prescribing Service), Meg Stuart (National Prescribing Service), Michele Robinson (Aboriginal Health Council of South Australia)

Funding: National Prescribing Service

Project summary: There is a need for Aboriginal people to be better informed about how to use their medicines wisely and safely. Aboriginal Health Workers (AHWs) who work in Aboriginal Health Services are well placed to help their clients with medicine issues. The Good Medicines Better Health project provides training for AHWs about quality use of medicines (QUM), focusing on 3 chronic conditions where medicines use is common – hypertension, diabetes and asthma. The project uses a train-the-trainer strategy. Senior AHWs have become trainers and have begun to train local AHWs at KAMSC. This evaluation will focus on how QUM training has helped local AHWs function more effectively with clients in promoting QUM. A qualitative methodology is proposed with questions focusing on how AHWs respond to QUM training and use the information in their work with clients. A week of evaluation activities is planned at KAMSC, using observational methods to assess the practices of AHWs within the context of their daily work. Observation will be conducted by the AHW trainers or a local worker (to be identified) with which AHWs are comfortable. Only de-identified summary data will be collected for clients who have provided verbal permission for observation. An NPS evaluation staff member will be at KAMSC to discuss the observations, assist with record keeping, conduct discussion groups with AHWs, analyse findings and prepare a report for KAMSC and program stakeholders.

---

Researchers: Dr Roz Walker (Telethon Institute of Child Health Research)

Funding: Department of Health Office of Aboriginal Health

Project summary: This research is being conducted by the Telethon Institute for Child Health Research (the Institute) in collaboration with the WA Department of Health’s Women’s and Newborns Health Network (WNHN) and the Office of Aboriginal Health. This project explores the communication and decision-making processes surrounding prenatal, neonatal and end of life decisions between Aboriginal families, their communities and health care providers. It aims to develop more effective and culturally appropriate practices and procedures, to improve communication between health care professionals and Aboriginal women and their families in relation to prenatal diagnosis, neonatal intensive care, and end of life decisions. It also aims to develop resources for health care professionals and allied staff to increase their understanding of the cultural issues and complexities faced by Aboriginal families when prenatal, neonatal and end of life decisions are required; as well as identifying culturally appropriate resources to support Aboriginal families to make health care decisions when experiencing the death or dying of an infant/child.

---

Researchers: Vickie Hovane (Principle Researcher, Contracted to Notre Dame University Australia Broome), Joe Edgar (Research/ Community Facilitator, Nulungu Centre for Indigenous Studies, Notre Dame University Australia Broome), Steve Kinnane (Acting Assoc. Dean Arts and Sciences, Nulungu Centre for Indigenous Studies, Notre Dame University Australia Broome)

Funding: Caritas Australia

Project summary: The aim of the research project is to consult with Catholic Religious Congregations, Church personnel and school staffs in the Kimberley which have been associated with the Broome Diocese over a period of time on the issue of Child Protection. The project will seek feedback from these groups on the preventative, educative or healing responses, or lack thereof, currently in operation through the Diocese as a means of ensuring child protection for children engaged by these institutions. The research will be overseen by a reference group of Indigenous and non-Indigenous workers associated with the Broome Diocese. The results of the research will be utilised to guide the Broome Diocese in ensuring adequate and effective responses are actioned to prevent child abuse in any institutions or communities within the Diocese through educative, healing and program support.

---

Researchers: Prof Hugh Taylor (University of Melbourne), Prof Jill Keeffe, Sarah Fox & Anna-Lena Arnold (Centre for Eye Research Australia)

Funding: RANZCO Eye Foundation, Vision CRC

Project summary: The National Indigenous Eye Health Survey is designed to provide essential baseline evidence for future use in planning and prioritising the effective delivery of eye care to Indigenous Australians. The Survey is designed to assess the prevalence and main causes of vision impairment, the utilisation of eye care services, barriers to health and the impact of vision impairment on people. The survey utilises and relies upon a broad spectrum of expertise within the Indigenous health and eye health sectors. The structure of the project, with its state and national participating organisations, will produce meaningful information about the true extent of Indigenous eye health. This survey will provide definitive and quantitative data from which organisations around the country can advocate and plan service delivery to enhance existing services and develop new referral services. The implementation of effective eye health services will improve the health status of Indigenous people. The final report will provide the necessary information for the Government’s National Eye Health Framework. The ultimate goal is to provide the evidence base for the provision of eye care services so they will be available, accessible and appropriate for all Australians.

---

Researchers: Prof Fiona Stanley (Telethon Institute for Child Health Research), Prof Colleen Hayward, Dr Clair Scrine & Heather Monteiro (Kulunga Research Network, Telethon Institute for Child Health Research)

Funding: Rio Tinto Ltd

Project summary: This Project responds to a call from Aboriginal Health Workers for more training, development and support. It aims to build the capacity of Aboriginal Health Workers, Aboriginal community controlled health organisations and government agencies, and the Aboriginal community through the development and provision of practical tools and programs to bring about improvements in the area of Aboriginal child and maternal health. This will be achieved through the development of a toolkit which will provide ongoing assistance to individuals and organisations. Content of the toolkit will include the topics addressed through community consultation, as well as a range of other information and resources relevant to Aboriginal maternal and child health. The toolkit will also provide resources which aim to build the capacity of Aboriginal Health Workers by providing them with the skills and knowledge to conduct their own research.

---

Researchers: Dr Jason K Tan, (Paediatric registrar), Dr Andrew Martin (Supervisor, Gen. Paediatrician/Metabolic consultant), Dr Aris Siafarikas (Endocrinology consultant), Princess Margaret Hospital

Funding: Internal

Project summary: Vitamin D plays a key role in strengthening bones to help prevent fractures. Less well recognised, but possibly even more important are the roles vitamin D plays in supporting the immune system to help fight infections and in protecting against certain forms of cancer and diabetes. Humans produce vitamin D in their skin under the influence of sunlight. Lack of sun exposure and dark skin increase the risk of vitamin D deficiency.

At Princess Margaret Hospital, up to 80% of children seen at the Refugee Clinic (predominantly of African origin) are vitamin D deficient. These children require vitamin D supplementation, which can be given either in small doses each day or in a high dose at six-weekly intervals (“depot therapy”). Although there are no published studies examining the prevalence of vitamin D deficiency in Australian Aboriginal children, it seems highly likely that those children with darker skin who do not get regular sunlight exposure will also be at very high risk of vitamin D deficiency.

The aims of this study are to determine the prevalence of vitamin D deficiency in Aboriginal children from metropolitan and rural settings in Western Australia (WA); to examine the relationship between vitamin D levels and childhood infections; and to determine if depot and daily vitamin D therapy have the same therapeutic outcomes.

---

Researchers: Dr Roz Walker (Telethon Institute of Child Health Research), Valma Banks (Aboriginal Program Manager, HCMSI), Aboriginal community care workers (Halls Creek Mother’s Support Initiative)

Funding: Department of Health Western Australia

Project summary: The Halls Creek Mother’s Initiative –‘Yanan Ngurrangu Ngamayiu’ is a community-based maternal and child health prevention and education program for pregnant women and parents of young children in Halls Creek Halls Creek and the immediate surrounding communities which commenced in April 2008. This program aims to draw together the combined skills, knowledge and experience of local Aboriginal women and health professionals and other service providers to improve birth and developmental outcomes and mother’s wellbeing and capacity. This study is important to find out about the experiences of program participants and staff and whether the program is helping to change things positively for the women, children 0-3 years and the community.

---

Researchers: Dr Louise Maple-Brown (Menzies School of Health Research, Darwin), Dr Paul Lawton (Director, NT Renal Services), Prof Kerin O’Dea (Director, Sansom Institute, Uni SA), Prof Wendy Hoy (University of Queensland), Dr Alan Cass (The George Institute), Prof George Jerums (Austin Health, Melbourne), Dr Mark Thomas (Royal Perth Hospital), Dr Kevin Warr (Royal Perth Hospital), Dr Jaqui Hughes (Menzies School of Health Research), Dr Graham Jones (SydPath, St Vincents Hospital, Sydney)

Funding: NHMRC project grant 545202, 2009-2011

Project summary: There is an overwhelming burden of chronic kidney disease and end-stage renal failure in Indigenous Australians. It is vital that we are able to accurately measure kidney function in this high risk population. Glomerular filtration rate (GFR) is the best overall marker of kidney function. However, differences in body build and body composition between Indigenous and non-Indigenous Australians suggest that estimates of GFR derived for European populations may not be appropriate for Indigenous Australians. The burden of kidney disease is borne disproportionately by Indigenous Australians in central and northern Australia, with significant heterogeneity amongst these groups, thus differences in body build and body composition likely also affect the accuracy of GFR between different Indigenous groups.

By assessing kidney function in these high-risk Indigenous Australian populations from Northern Queensland, Northern Territory, and Western Australia, we aim to determine a validated and practical measure of GFR suitable for use in all Indigenous Australians. We will compare the accuracy of the following techniques to measure GFR to the reference GFR measured by the plasma disappearance rate of iohexol: Modification of Diet in Renal Disease 4 variable formula (MDRD-4), Cockcroft-Gault formula and cystatin C. Detailed assessment of body build and body composition will be performed using anthropometric measurements, skinfold thickneses and bioelectrical impedance and a sub-study in larger centres will use dual-energy absorptiometry (DXA). It is possible that these measures may enable a modification (derived from a simple measure of fat free mass in each participant) to be incorporated into the MDRD formula for estimating GFR. Alternatively, a biochemical measure of kidney function other than serum creatinine may be found to be the most reliable measure of kidney function in all Indigenous Australians. We do not believe that a single correction factor (similar to that for African Americans) is appropriate or practical for Indigenous Australians. Once eGFR methods are validated by this study it would lay the foundations for future interventional studies that aim to ameliorate the progression of kidney function to ESRF in Indigenous Australians.

---

Researchers: Anke van der Sterren, Viki Briggs, Terry James, Dallas Young, Nicole McMillan (Centre for Excellence in Indigenous Tobacco Control (CEITC), University of Melbourne)

Funding: Department of Health & Ageing

Project summary: Smoking is a major contributing factor to Indigenous poor life expectancy and remains comparatively high (Indigenous 51%, other Australians 19%). Indigenous Healthcare workers (IHWs) are key to improving Indigenous health through their multifaceted role as community members and trusted knowledgeable professionals. Their workload is high while their capacity to meet the demand is low, and they face particular challenges in providing tobacco control programs in their communities. The Department of Health & Ageing (DoHA) have funded the CEITC to undertake a national review and consultation across the country to assess the capacities and needs of the workforces in Indigenous health services to effectively deliver tobacco prevention and cessation activities and programs. The findings of the review and consultation process will result in recommendations to DoHA on the strategic directions for its Indigenous Tobacco Control Initiative.

---

Researchers: Victoria Hovane (nee Martin), Professor Alfred Allan, Dr M Allan (Edith Cowan University, Joondalup)

Funding: Internal

Project summary: The sexual abuse of children in Aboriginal communities continues to be a critical social problem in Western Australia. This research will investigate local Aboriginal understandings about child sexual abuse, what it looks like, how it is experienced, what are the barriers to addressing the issue and how those barriers can be overcome. A qualitative methodology utilizing a grounded theory approach and involving semi-structured interviews will be used. The interviews will be conducted with a minimum of 12 adult Aboriginal men and 12 Aboriginal women or until saturation is reached. Each interview will be audio-taped and transcribed. Thematic content analyses will be conducted on the transcribed data and the results used to develop a theoretical framework about child sexual abuse in the local Aboriginal community. This framework will be verified through two forums; one with a community group, and the other with a group of workers and professionals. The resultant framework may then be used to inform policy development and strategies for addressing the issue.

---

Researchers: Jan Saggers, Marie Finlay, Maxinne Sclanders, Jan Stuart, Caroline Adupa, Issihaka Toure, (Nexus Strategic Solutions), Mary Sankey (Sankey Associates), Dr Janet Fletcher (UWA Child Study Centre), Yarmintali (Rhonda) Murphy, (Yarmintali Consultancy)

Funding: Commissioner for Children and Young People

Project summary: The purpose is to conduct research with children and young people about their views on wellbeing. The specific objectives are to ensure research conducted obtains the views and perspectives of children and young people across Western Australia on what is important to their wellbeing and engages directly with a mix of children and young people across Western Australia, including Aboriginal and Torres Strait Islander and vulnerable or disadvantaged children and young people.

---

Researchers: Prof John Kaldor, Mr James Ward, Dr Rebecca Guy, Prof. Lisa Maher, Prof. Basil Donovan, A/Prof Matthew Law (National Centre in HIV Epidemiology and Clinical Research); Dr Alice Rumbold, Ms Bronwyn Silver, Ms Debbie Taylor-Thomson (Menzies School of Health Research); Dr Steven Skov (Northern Territory Department of Health and Families); Dr John Boffa, Ms Donna AhChee (Central Australian Aboriginal Congress); Prof Robyn McDermott (The University of South Australia); Professor Christopher Fairley (University of Melbourne)

Funding: National Health and Medical Research Council

Project summary: STRIVE is a collaborative research project between the National Centre in HIV Epidemiology Clinical Research and the Menzies School of Health Research in partnership with the Aboriginal Medical Services Alliance Northern Territory, the NT Department of Health and Families, Apunipima Cape York Aboriginal Health Council and the Kimberley Aboriginal Medical Services Council. STRIVE aims to reduce the short and long-term adverse consequences of sexually transmitted infections (STIs). It is being implemented in the Kimberley to address the recognised endemic rates of STIs occuring in Aboriginal communities in this region.

---

Researchers: Juan Fernando Larranaga, Nkandu Beltz (Save the Children); Richard Chenhall, Kate Senior (Menzies School of Health Research)

Funding: Department of Health - WA

Project summary: The proposed action research project will inform development of a program of activities for young people throughout the Shire of Wyndham, East Kimberley (SWEK) aimed at reducing harms arising from risky sexual activity. The program will be managed by the Department of Child Protection, and contracted to the recently developed Kununurra Youth Service. Save the Children already operates youth projects in both Wyndham and Kununurra, and have established solid relationships with a range of young people and their families in each area. Save the Children works closely with relevant stakeholders engaged in the delivery of sexual health services in the region. The current project will build on these established youth networks, and related community networks as a basis for further program design and development. Young people, stakeholders and other community members will be involved from early stages in determining and delivering relevant research strategies, which we anticipate will follow a peer-education model. The proposed project will link in with, and add value to, an existing youth led sexual health project being run by Save the Children in collaboration with the YBMAD youth group in Kununurra. It will also inform development of a large scale sexual health research project due to commence in 2010 which will employ similar participatory processes throughout three states of Australia.

---

Researchers: Ms Sue Peter, Nursing Director Ambulatory Care Services (Princess Margaret Hospital)

Funding: State Health Research Advisory Council

Project summary: At PMH in 2007 there were approximately 2,000 hospital admissions and 10,000 outpatient appointments for children residing in rural/remote areas. A large number of these (approximately one quarter) were from the Kimberley and Goldfield regions. Of the OPD appointments, approximately 1,600 were not attended. The average length of stay for these children was 4.6 days, compared with 2.9 days for children residing in the metropolitan area. In the current climate of increasing hospital demand and a shift towards Ambulatory Care Services it was deemed necessary to introduce an alternative, economically viable model of care coordination. The model of care trialled in this research study offers an integrated care coordination/case management program for children who live in the rural and remote regions. This partnership coordinated program, between the Kimberley and Goldfield health services and PMH, aims to reduce the need for unnecessary travel to PMH, reduce length of hospital stays, and increase the usage of local health services with the support of PMH. This research study is designed as an interventional study and the aim is to test the following hypotheses:

1. The Rural/Remote - Tertiary Paediatric Partnership Program will provide significant economic benefit to the WA health service through the reduction in hospital admissions, hospital length of stay and outpatient appointments within Princess Margaret Hospital, and reduction in the use of Patient Assisted Travel Scheme (PATS) by rural/remote health services.


2. The rural/remote care coordination program is a model of care that achieves improved health care utilitsation and is highly evaluated by families.

---

Researchers:

Funding: Internal

Project summary: The Commonwealth Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) is conducing an evaluation of the income management trials in Western Australia (WA). Voluntary Income Management (VIM) and the Child Protection Scheme of Income Management (CPSIM) are currently operating in the Kimberley, as well as in select metropolitan areas in Perth. The aim of this work is to evaluate an existing Australian government program and will focus on whether the income management trials have effected significant change towards the two main objectives:

• to promote socially responsible behaviour, particularly in relation to children; and
  
• to ensure that priority needs of the individual, children and their partners are met.
  

The evaluation gives people on or involved with income management the opportunity to provide feedback on their experiences. The feedback people provide will be used to inform future decisions about income management in WA. The evaluation will involve face to face and telephone interviews with individuals on income management, as well as online surveys with caseworkers from the Western Australian Department for Child Protection, and Centrelink. Focus groups will be held with and non-government organisations that provide money management and financial counselling services as well as peak body organisations. It will also involve an analysis of Centrelink and WA DCP administrative data.

---

Researchers: A/Prof Sandra Thompson Kate Taylor (Curtin University); Emeritus Prof Michael Hobbs, Dr Frank Sanfilippo, Prof Peter Thompson, Dr Tom Briffa, Dr Judy Katzenellenbogen, Kaylene Piercy (The University of WA)

Funding: National Health and Medical Research Council Grant

Project objectives: To describe the extent of and likely reasons for inequities in medical care of cardiovascular disease in Indigenous Western Australians compared with care received by the non-Indigenous population, using acute coronary heart disease as a model.

---

Researchers: Prof Elizabeth Elliott, A/Prof Jane Latimer, Dr James Fitzpatrick, Ms Barbara Lucas (The George Institute for Global Health); Ms Maureen Carter (Nindilingarri Cultural Health Services); Ms June Oscar Marninwarntikura Women's Resource Centre); Prof Carol Bower (Telethon Institute for Child Health Research), Prof John Boulton, Ms Robyn Doney (WA Country Health Services)

Funding: The Australian Government Departments of Health and Ageing and Families and Housing, Community Services and Indigenous Affairs.

Project summary: Indigenous leaders in the Fitzroy Valley (Kimberley, WA) initiated a partnership between Nindilingarri Cultural Health Services (Fitzroy Crossing), the George Institute for Global Health and the University of Sydney Medical School to conduct a FASD prevalence study (the Lililwan Project), including experts in local Aboriginal culture, Indigenous health, paediatrics, epidemiology and Human Rights. The prevalence study is part of a broader community strategy to overcome FASD and Early Life Trauma in the Fitzroy Valley. There is strong community support for leadership and collaboration in the Project. Stage 1 of the Project (data collection completed in August 2010) involved collection of demographic, prenatal, neonatal and early childhood data from 127 parents/carers of children born in 2002 or 2003 using a questionnaire (diagnostic checklist developed in consultation with the local community), as well as delivery of a community and service provider education program. There was a 95% participation rate within the target cohort of 134 children. This final stage of the prroject relates to the Interdisciplinary FASD Diagnostic Assessments in ~130 children born in 2002 or 2003 residing in the Fitzroy Valley. The interdisciplinary medical and neurodevelopmental assessment will be comprehensive, evidence-based, and tailored to the remote clinical context. It has been developed in consultation with Nindilingarri Cultural Health Services and the local health and education workforce and was trialled in 6 children at Fitzroy Crossing in November 2010. The clinical team consists of Aboriginal health workers, a paediatrician, school health nurse, physiotherapist, occupational therapist, speech pathologist, and psychologist. Aboriginal health workers have been employed and trained in research methods specific to this study (local community navigators) and they facilitate all interactions between the research team and participants.

---

Researchers: A/Prof Peter Morris, A/Prof Amanda Leach, Dr Heidi Smith-Vaughan, Prof Anne Chang, Dr Ruth Lennox(Menzies School of Health Research); Dr Patricia Valery (Queensland Institute of Medical Research); Prof Paul Torzillo (Royal Prince Alfred Hospital)

Funding: NHMRC

Project summary: Remote Aboriginal children have the highest rates of severe ear infection reported in the medical literature. At any time, large numbers of children have a bulging eardrum (acute otitis media) but most are completely asymptomatic. In a previous antibiotic study, acute otitis media (AOM) persisted in 50% of children after 1 week of treatment. In terms of clinical success, it didn't make any difference whether azithromycin or amoxicillin was used (although azithromycin seemed to be better at reducing the level of infection). Currently local clinicians are: i) uncertain whether antibiotics make any difference at all; and ii) reluctant to devote resources to case-finding without good evidence of substantial benefit. In this randomised controlled trial, we will determine the benefits of two doses of azithromycin given one week apart in children with asymptomatic acute otitis media. The results of the trial will become the best available evidence to guide the medical management of asymptomatic AOM in high-risk children. It is anticipated that this research will make an important contribution in the shift toward more effective prevention and management of otitis media in Australian Aboriginal children. It will also have implications for all disadvantaged populations where adverse outcomes are common and compliance with recommended treatment is poor.

---

Researchers: Margaret Williams (Flinders University / Ord Valley Aboriginal Health Service)

Funding: Internal

Project summary: The prevalence of vitamin D deficiency in antenatal clients in the Kimberley. This will be done through data collection from patient information systems and will not require the clients to have any extra testing done or to complete any surveys or questionnaires. The data will be collected and assessed according to the levels of vitamin d during pregnancy and all data will be de-identified. The final results will include only vitamin D level, indigenous status and health service attended. The data will be made available to KAMSC to include in the antenatal protocol if warrented.

---

Researchers: Asst/Prof Zaza Lyons, Prof Aleksandar Janca, Assoc/Prof Jon Laugharne, Dr Sophie Davison (The University of Western Australia)

Funding: Internal

Project summary: The concept of social and emotional wellbeing in an Aboriginal context describes an holistic view of health recognised by many Aboriginal people. Traditionally, health encompasses more than just the physical health of an individual – the social, emotional, spiritual and cultural wellbeing of the whole community is essential for the good health of individuals within the community. Conventional screening and assessment instruments, based on unfamiliar concepts and/or symptomatology; different use of language; and the use of numerous questions by strangers may lead to misdiagnosis of mental health problems or be unacceptable to Aboriginal people. While there are many screening instruments that are commonly used by clinicians and researchers to assess a range of psychological conditions, none have been validated in the Aboriginal population. In addition, there are few assessment tools that have been specifically developed and validated for use in the Aboriginal population. The development of a culturally appropriate, simple to use, screening tool would be of benefit in assessing the social and emotional wellbeing of Aboriginal people. The Here and Now Aboriginal Assessment (HANAA) has been developed by the School of Psychiatry and Clinical Neurosciences at the University of Western Australia as a means of screening for mental health problems among Aboriginal people. It focuses on the current mental and physical health of the individual. The following ten domains are assessed by conducting a semi-structured interview: general feeling; physical health; mood; suicide risk/self harm; substance use; memory; unusual experiences; functioning; contributing factors; and resilience. Each domain is rated jointly by the interviewer and respondent as being either not a problem; a small problem; or a big problem. A descriptive narrative can be recorded by the interviewer for each domain. Guidelines to assist the interviewer have also been developed. The purpose of this research project is to evaluate the feasibility, acceptability, reliability and validity of the HANAA in the adult Aboriginal population. On completion of the validation process the instrument could be a useful tool in assessing Aboriginal people presenting with possible mental health problems in a variety of settings, including remote communities, or regional and metropolitan centres.

---

Researchers: Prof Colleen Hayward, Prof Cobie Rudd, A/Prof Moira Sim, Ms Toni Wain (Edith Cowan University)

Funding: Australian Learning and Teaching Council

Project summary: This is a two-year project (commenced May 2010), funded by Australian Learning and Teaching Council Ltd, an initiative of the Australian Government Department of Education, Employment and Workplace Relations. The project has two primary aims:

• to positively influence the health and wellbeing of Australian Indigenous people by improving the education of health professionals;
  
• to engage students with authentic stories of Indigenous people's experience of healthcare, both positive and negative, which enhance the development of deep and lasting empathy.
  

---

Researchers: Dr Adam Mossenson, Dr Sharon Nowrojee (KPHU); Dr Sarah Larkins (JCU)

Funding: Internal

Project summary: Ear Nose and Throat conditions represent a significant health concern for Australia's Indigenous population, especially in rural and remote areas. Service provision of ENT specialists in the Kimberley region is a limited and every effort must be made to maximise on their time when available. Currently patients are referred to ENT outpatient clinics from GPs, remote area clinics and ACCHOs without any formal review of content/completeness of the referral prior to being seen in clinic by the specialist. This project aims to review the quality of the referral letters and clinical information provided to the visiting ENT surgeons. Further, case files will be reviewed in regards to management, follow up and adherence to clinical protocols.

---

Researchers: Dr Adam Mossenson, Dr Sharon Nowrojee (KPHU); Dr James Allen (Derby Hospital); Dr Sarah Larkins (JCU)

Funding: Internal

Project summary: Ear Nose and Throat conditions represent a significant health concern for Australia's Indigenous population, especially in rural and remote areas. Service provision of ENT specialists in the Kimberley region is a limited and every effort must be made to maximise on their time when available. Surgical visits to the Kimberley are limited and in the past have not been optimally taken advantage of due to a range of factors such as the process of notification of patients, non-attendance on surgical days and inability to gain consent. One month to the visiting ENT surgical week of August 2-6th a co-ordinated effort, supported financially from WACHS, was initiated between the Kimberley Population Health Unit, Derby Hospital, Derby Aboriginal Health Service, Community Health in Derby and remote area nurses to break down some of the barriers preventing efficient and maximal utilisation of ENT and anaesthetic services whilst in town. An economic analysis of this initiative will be made in this audit.

---

Researchers: Prof Hugh R Taylor, Prof David Dunt, Emma Stanford, Andrea Boudville, Colin Garlett, Robyn McNeil, Arthur Hseuh, Mitchell Anjou, Alex Ly Zhang, Helen Jordan (University of Melbourne)

Funding: Private Foundations and Donors

Project summary: Our overall aim is to "close the gap for vision" by developing evidence-based recommendations for policy change. The National Indigenous Eye Health Survey showed that although Indigenous children have better vision than mainstream children, Indigenous Australians aged 40 and above have six times the rate of blindness compared to mainstream. Ninety four per cent of their vision loss is preventable or treatable, but a third of adults have never had an eye exam. There is a significant shortfall in the provision of eye care services in outback Australia. Well co-ordinated and organised services provide a measurably better service and save money. Urban ophthalmologists and optometrists are prepared to provide these outreach services if the services are well organised.The overall aim of our current work is to develop a model of eye care for Indigenous Australians for presentation to Australian Governments. We are currently working on three key aims:

1. Identify the specific limitations and restrictions of the current funding mechanisms that support visiting eye care services to remote areas (Medical Specialist Outreach Assistance Program-MSOAP and Visiting Optometrist Scheme-VOS).

2. Identify key components in enhancing the pathway of care for the provision of eye services through Aboriginal Health Services.

3. Identify the economic implications of the proposed policy changes.

Our previous research has shown the very high unmet need for eye care services amongst Indigenous Australians. In more remote areas this is due inpart to a lack of eye care services. Eye care services used by Indigenous Australians are predominantly funded by the Federal or State Governments and evidence-based models are required to influence the development and implementation of new policy. This health services evaluation will assist in this process.

---

Researchers: Dr KA Senior, Dr RD Chenhall, Dr T Nagel (Menzies School of Health Research); Prof MK Pitts (La Trobe University); Prof S Saggers (Curtin University); A/Pro VK Burbank (The University of Western Australia); Ms W Armstrong (Charles Darwin University); Ms H Greville (WA Sexual Health); Mr M Wentzlaff-Eggebert (SA Sexual Health Program & Policy); Dr E Moore (AMSANT); Mr S Tatipata (Danila Dilba Health Service); Mr W Beaver (Central Australian Congress Health Service); Ms J Renfree, Ms D Bridges, Ms G Grady, Ms S Matthews, Mr J Smith, Ms M Howitt, Mr A Bergs, Ms B Kelly, Ms V Schulz, Mr M McAdie, Mr A van Zyl, Mr A Castro (Northern Territory Government); Ms A Hampshire (Mission Australia); Ms M Parker (Anglicare Youth Services)

Funding: Australian Research Council

Project summary: The health of Aboriginal and Torres Strait Islander young people is a national priority and it is clear in the area of sexual health that they suffer disproportionately when compared to the non- Indigenous population. Existing interventions are not achieving the desired changes in sexual health. This project explores sexuality in the context of everyday life of Aboriginal and Torres Strait Islander young people, in order to develop interventions that are appropriate and sustainable.

---

Researchers: A/Prof Lina Ricciardelli, Prof Marita McCabe, A/Prof David Mellor, A/Prof Alexander Mussap (Deakin University)

Funding: Australian Research Council

Project summary: The aim of this study is to gain a better understanding of the risk and protective sociocultural factors that shape Indigenous men's attitudes to health and their body, diet and physical activity, and their related behaviours . In collaboration with men from Indigenous communities the study will examine the importance of cultural identity, masculinity, intergenerational and interpersonal relationships, and sport for health. The research will be used to develop more effective strategies to promote fitness, healthy eating and positive patterns of physical activity. In order to achieve the aims of this research, the study will be undertaken in four stages, in four different locations. The first stage will involve running focus groups in each location; Stage 2 will involve semi-structured interviews; Stage 3 involves follow-up interviews; Stage 4 will involve organising and facilitating two community events in each location.

---

Researchers: Gail Cummins (Boab Health Services; formally Kimberley Division of General Practice)

Funding: Internal

Project summary: In 2001 the Kimberley Division of General practice, now Boab Health Services, conducted a Needs Assessment of Allied Health provision across the Kimberley region. As an outcome of this assessment More Allied Health Services (MAHS) funding was used to establish a Regional Dietetic Service and a visiting Podiatry service in the Kimberley. The demand on these individual Allied Health positions quickly indicated the need for a more comprehensive service and as additional funding opportunities became available the Primary Health Care Services auspiced by the Boab Health Services (BHS) expanded to include additional Dietetic and Podiatry positions as well as Diabetes Education and Counselling services. The Boab Health Services - Primary Health Care Team (BHS-PHCT) provides a chronic disease focused, multidisciplinary model of care to all towns in the Kimberly and to remote communities of significant size across the region. Opportunities to improve service delivery practices come from being reflective and recognising that there is science to changing behaviours, changing organisations and changing societies. The PHC professions included in the scope of this evaluation project are Counselling, Diabetes Education, Dietetics and Podiatry. The purpose of this evaluation project is to find out how aware people are of: What services are available from BHS; how the services are accessed; and once accessed, is a quality service provided and does the service meet the client's needs. The key evaluation questions are:

• What is the level of Community Awareness of our organisation's Primary Health Care Services?
  
• Are the Boab Health Services Primary Health Care Team's Referral Pathways understood and working well?
  
• Does the Boab Health Services Primary Health Care Team provide a Quality Service to the target population?
  

---

Researchers: Dr Adam Mossenson, Dizan Speers,Dr Carole Reeve (WACHS Kimberley)

Funding:

Project summary: Ear Nose and Throat conditions represent a significant health concern for Australia's Indigenous population, especially in rural and remote areas. The current framework for management of ear disease relies largely on community nurses and district medical officers for routine medical care of common ear conditions. However, there are many barriers to delivery of thorough primary care in ear health and there is much reliance on the input of specialist Ear Nose and Throat Surgeons. This project aims to establish the current state of ear health in a remote Indigenous community. Further, it hopes to evaluate the practicalities of the current Kimberley specific Ear Health Guidelines, which are due for review in the near future. It also aims to assess the outcomes of treatment when utilising the ear health protocols for acute ear conditions.

---

Researchers: Dr Sophie Davison, Prof Vera Morgan, Prof Daniel Rock, Prof Aleksandar Janca, A/Prof Frank Morgan, Prof Assen Jablensky (The University of Western Australia); Prof Tony Butler (University of New South Wales); Mr Michael Mitchell (Statewide Indigenous Mental Health Service); Dr Edward Petch (Statewide Forensic Mental Health Service)

Funding: WA Department of Corrective Services, WA Drug and Alcohol Office, Mental Health Commission

Project summary: Prisoner populations are characterised by disadvantage, stigmatisation, social exclusion and poor health. Studies from around the world have consistently shown that prisoners have higher rates of mental disorder than the general community, especially psychosis, major depression and antisocial personality disorder. They have high rates of substance misuse, self- harm, suicide, comorbidity of different disorders and high rates of mortality, morbidity and mental health service use after release. Their treatment needs are often not well met either in the health system or the prison system and they may revolve between the two. In the case of Indigenous offenders disadvantage is further compounded as Indigenous Australians suffer more ill-health, die at much younger ages, have lower levels of educational attainment and income, higher rates of unemployment and poorer housing conditions than the rest of the Australian populations (Grace 2010). Aboriginal people are incarcerated at alarming rates, despite the recommendations of the Royal Commission into Aboriginal Deaths in custody. WA has the highest rate of age standardised incarceration of Aboriginal people per head of population of any State with 40% of the prison population describing themselves as Aboriginal. There has been no comprehensive survey of prisoner mental health in WA to date.

The project aims to describe and quantify the nature and extent of mental disorders including alcohol and substance misuse disorders amongst all WA reception prisoners, as well as their met and unmet needs. The plan is to approach a consecutive sample of reception prisons throughout WA and interview those who consent using a standardised assessment interview that is internationally recognised and was used in the National Survey of Mental Health and Wellbeing. We will also look at their pathways into and out of prison. It is hoped that the project will provide high quality data that will assist in the planning and provision of mental health services to mentally disordered offenders both within the criminal justice system and the health system.

---

Researchers: Dr Cathy McAdam, Professor John Boulton (Kimberley Health WACHS), Ms Maureen Carter (Nindilingarri Cultural Health), Associate Professor Damien Jolley (The Alfred Centre)

Funding: Internal

Project summary: The senior women of Fitzroy Crossing achieved alcohol restrictions in October 2007 after a long and hard path of advocacy. The 12-month review undertaken by the Nulungu Centre for Indigenous Research for the WA Department of Health Office of Drug and Alcohol showed that the result of the intervention could be measured in substantial benefits to social well-being in the community, not least the amount of money spent on food. Since the alcohol restrictions were in part motivated by the high incidence of Fetal Alcohol Syndrome (now the focus of the community-wide Lilliwans survey), it is relevant to seek objectives measures of benefit for the unborn child. Birth size is the most robust measure of overall fetal growth; it is also readily available as every newborn baby is accurately measured and the results recorded in the hospital notes as well as in the WA Midwives perinatal data collection. This data also contains the maternal age and any medical complications of the pregnancy. It contains maternal smoking status but does not contain maternal intake of alcohol.

The proposal is to undertake a clinical audit of birth measures with the aim to make a comparison of birth size between babies born of mothers identifying as being from Fitzroy Crossing (postcode 6765) before and after the alcohol restrictions came into place in October 2007. The objective is to assess whether this intervention had any effect on birth weight, length and head circumference, and if there was any change in gestational age, maternal age at delivery or incidence of medical complications of pregnancy such as gestational diabetes. The audit will comprise an analysis of de-identified data from the Midwives Perinatal data collection over the period 2005-2009 to encompass the periods before and after the introduction of alcohol restrictions in October 2007.

---

Researchers: Dr Emma Griffiths, Dr Carole Reeve (Kimberley Population Health Unit)

Funding: Internal

Project summary: Hepatitis B is a vaccine preventable disease with the potential to cause significant morbidity and mortality in those chronically infected. The widespread introduction of hepatitis B vaccine has substantially reduced the impact of hepatitis B worldwide. Prior to the introduction of universal hepatitis B vaccination, the indigenous population of the Kimberley region was identified as a high risk group by international standards. Concerns have been raised, however, about the relative efficacy of the vaccine in remote Aboriginal and Torres Strait Islander communities, where the background risk remains much higher than the Australian average. Within the Kimberley region, case reports of chronic infection occurring despite full vaccination are known to the Kimberley Population Health Unit. Additionally, the epidemiology of hepatitis B in the Kimberley region has previously been inaccurately documented due to the inclusion of Christmas Island and Curtin detention centre detainees in summary statistics. This has led to spuriously low Aboriginal: non-Aboriginal rate ratios in published summary statistics, and impedes the evaluation of regional interventions. Surveillance of vaccine preventable diseases is an intrinsic role of the Kimberley Population Health Unit and is an essential public health service to the community. This project will aim to document the epidemiology of hepatitis B in the Kimberley region, with a focus on those fully vaccinated as children. The results will help to provide an epidemiological framework for program evaluation and identify any concerns relating to vaccine efficacy in the Kimberley region.

---

Researchers: Prof Diego De Leo, Dr Kathy McKay (Australian Institute for Suicide Research and Prevention); Mr Joe Tighe (Alive and Kicking Goals, Men’s Outreach Service Inc

Funding: WACH

Project summary: Alive and Kicking Goals! (AKG) is a positively-framed suicide prevention peer education project which takes an innovative approach in tackling the inadequate provision of mental health services available for youth at risk in the Kimberley. Operating under the auspices of Men’s Outreach Services (MOS), AKG aims to address the growing suicide epidemic amongst Indigenous youth in the Kimberley. Using the unique vehicle of a football club to engage and educate Indigenous youth, AKG centres on skill-building, confidence and esteem-building through peer education and leadership training. The Broome Saints Football Club (BSFC) was initially used as the vehicle with which to drive this change. Recently, the BSFC, MOS, AKG and AISRAP (Australian Institute for Suicide Research and Prevention) have joined together with the aim to further develop and evaluate the AKG suicide prevention training to be delivered in the West Kimberley. The AKG training will be delivered to primary- and secondary-schools, as well as other community arenas, as requested and required by the different communities. Two different workshops will be conducted: one for those aged 16+ years and those aged 10-15 years. A positively-framed DVD provides the foundation for both workshops.

---

Researchers: Elizabeth Sullivan, Juanita Sherwood, Tony Butler, Eileen Baldry (University of New South Wales); Jocelyn Jones, Mandy Wilson (National Drug Research Institute); Marisa Gilles (Western Australian Health Department), Michael Levy (Australian National University); Devon Indigenous, Jane Walker (Centre for Health Research in Criminal Justice

Funding: NHMRC

Project summary: Aboriginal and Torres Strait Islander adults are imprisoned 14-19 times more frequently than non-Indigenous people in Australia. This is one of the highest rates of Indigenous incarceration among the OECD countries. The number of Aboriginal women being imprisoned is also increasing each year, with a nine per cent rise between June 2009 and June 2010 alone; this is compared to three per cent among non-Indigenous women and two per cent among Indigenous men. This makes Aboriginal and Torres Strait Islander women the fastest growing sub-group among the prisoner population; particularly in Western Australia and New South Wales. Of these women approximately 80 percent are mothers.

SCREAM is funded through the National Health and Medical Research Council and aimed at understanding the health and treatment needs of Aboriginal mothers in prison in Western Australia and New South Wales. Taking a mixed methods approach and involving a broad range of stakeholders throughout the research process the project aims to:

• Describe the health of Aboriginal mothers in prison, with a focus on social and emotional wellbeing;
  
• Investigate availability and equity of access to culturally safe health care in prison for Aboriginal women;
  
• Identify the key attributes of culturally safe models of health care for Aboriginal women in prison;
  
• Identify pathways for the transition of culturally safe health care into the community so that health gains are maximised on release from prison; and,
  
• Build capacity among Aboriginal researchers, Aboriginal community controlled health services and relevant community organisations.
  

This research plan involves Aboriginal women and a broad range of other stakeholders in identifying practical steps to reduce health inequalities between incarcerated Aboriginal mothers and female carers and those in the community. The immediate outcomes of the completed study will include:

• Specific recommendations for models of care for Aboriginal women in prison;
  
• Increased capacity among Aboriginal female researchers in the field of public health and prison health; and,
  
• Recommendations for professional development and skills training among health and correctional workers in Australian prisons.
  

Opportunities for early intervention to prevent future offending behaviour in children will be identified, with the research providing a platform for policy and practice change.

---

Researchers: A/Prof Margaret Kelaher, Dr Mark Lock, Ms Hana Sabanovic (University of Melbourne)

Funding: Lowitja Institute and Australian Research Council

Project summary: A great deal of time and resources is devoted to planning processes in Aboriginal and Torres Strait Islander health but despite this very little is known about the relationship between planning processes and implementation. The importance of engaging Aboriginal and Torres Strait Islander people in the development of policy and planning has been recognised in the National Indigenous Reform Agreement (NIRA) and the Aboriginal and Torres Strait Islander Health National Partnership Agreements (HNPAs). Despite this there are no benchmarks that define appropriate participation or planning approaches within the agreements. Developing this area of knowledge is critical given that a lack of consideration of community values is both a major limitation in health policy analysis and a major contributor to failed policy reform both in Australia and internationally.

This project builds on work we have conducted examining the planning processes underlying the implementation of the first part of the HNPA. This work focussed on understanding the structure of and relationships between forums/committees involved in implementing the HNPA. It reviewed the plans and used social network analysis to understand the links between forums/committees in terms of membership and patterns of communication. In this project we aim to develop the evidence base defining best practice in the engagement of Aboriginal and Torres Strait Islander people in policy and practice. The project will build on the approaches of the first project by using social network analysis to understand the relationship between organisations involved in planning at different levels and the effects of this on program implementation. It will particularly focus on State and Territory planning committees at state/territory level and at regional level. These committees provide a critical link in the implementation of agreements with COAG and regional planning processes. This will enable a multilevel approach that ensures that the different ways that Aboriginal and Torres Strait Islander participation is actualised at different levels of government can be taken into account.

---

Researchers: Dr Sarah Woodland, Dr Carole Reeve (Kimberley Population Health Unit)

Funding: Internal

Project summary: Aim: to determine the causes of mortality in patients with RHD (Rheumatic heart Disease) in the Kimberley

The research project is based on the observation that many of the members of the Rheumatic Heart disease register known to have died have a young age of death. Other investigations have shown that ARF and RHD not only affects but kills Aboriginal people in their most productive years. The project will be conducted via systematic review of death certificates, medical records and public records to ascertain the cause of death of patients known to have Rheumatic Heart Disease who were on the RHD Register. This information will then be used to assess the impact of RHD on mortality in the Kimberley region.

---

Researchers: Dr Sally Banfield, Dr Carole Reeve (Kimberley Population Health Unit)
Funding: Internal
Project summary: Delivery of high-standard antenatal care to Indigenous Australians is essential to improving the health outcomes for both mother and newborn child. If service delivery is effective, it can strengthen positive bonds between the health care providers and the individual.

Unacceptably high rates of preterm births, low birthweight babies and perinatal mortality fall to the Australian Indigenous population. Research has shown poor obstetric outcomes are related to poor antenatal attendance, maternal malnutrition and high rates of tobacco and alcohol use.
Traditionally, the Kimberley region has provided antenatal care with community and hospital based midwives, GPs, and hospital based medical staff.

This project is considered to be an audit of antenatal care and its health outcomes prior to and during the intervention period of a case-based midwifery model of care. This intervention model involved a regionally-located midwife following women throughout the antenatal period, ensuring continuity of care in a culturally safe environment.

---

Researchers: Dr Paul Jelfs, Juanita Pettit (Australian Bureau of Statistics)

Funding:Commonwealth Department of Health and Ageing

Project summary: The Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) is a new Australian Bureau of Statistics information collection, funded by the ABS, Commonwealth Department of Health and Ageing (DoHA), and the National Heart Foundation of Australia. A significant component of the Australian Aboriginal and Torres Strait Islander Health Survey is the National Aboriginal and Torres Strait Islander Health Measures Survey (NATSIHMS) – a collection of biomedical information from Aboriginal and Torres Strait Islander respondents.

The NATSIHMS aims to measure markers for chronic disease and nutrition status derived from tests on blood and urine biospecimens (samples) from Aboriginal and Torres Strait Islander respondents from both remote and non-remote localities. It is important to note that participation in this component of the survey is voluntary and requires explicit consent by the respondent.

The resultant information from this survey will establish population benchmarks for these tests; provide information to assess health risks for population groups and to provide a platform for further research into health patterns. This will be achieved by combining the results of objective biomedical tests with self-reported survey-based results. With a number of these health risk factors being collectively responsible for shortening the lives of so many Aboriginal and Torres Strait Islander Australians, comparisons with the general population* will support assessment of progress in Closing the Gap in Aboriginal and Torres Strait Islander health outcomes.
There are no specific hypotheses established for testing in this survey, rather it is an establishment of a public health data base of objective measures of chronic disease and nutrition status indicators for descriptive purposes and creating an opportunity for a wide range of data users to access the data under controlled mechanisms to explore Aboriginal and Torres Strait Islander health issues. These further users of the data may have specific hypotheses that will be tested.

*ABS is currently conducting a biomedical survey in the general population as part of the Australian Health Survey. This biomedical component is known as the National Health Measures Survey (NHMS).

---

Researchers: A/Prof Amanda Leach, Prof Edward (Kim) Mulholland, Dr Heidi Smith-Vaughan, A/Prof Sue Skull, A/Prof Ross Andrews,Prof Jonathon Carapetis, Joseph McDonnell, Dr Vicki Krause, A/Prof Peter Morris (Menzies School of Health Research); Prof Mathu Santoshum (Johns Hopkins Bloomberg School of Population Health, USA); A/Prof Paul Torzillo (RPA Hospita); A/Prof Ngaire Brown (Poche Centre for Indigenous Health); Prof Peter McIntyre (Children’s Hospital Westmead, NSW; Anne Balloch (Murdoch Children’s Research Centre)

Funding: NHMRC

Project summary: A randomised controlled trial of pneumococcal conjugate vaccines Synflorix and Prevenar 13 in sequence or alone in high-risk Indigenous infants (PREV_IX_COMBO): immunogencity, carriage and otitis media outcomes. The combined schedule has the potential to provide protection from multiple bacterial pathogens of high significance. Internationally standardised correlates of vaccine protection, and clinical outcomes, will provide convincing evidence for vaccine policy here and worldwide.

---

Researchers: Dr Jonathan Laugharne, Susanne Stanley (The University of Western Australia)

Funding: Mental Health Commission WA

Project summary: In 2001, Lawrence, Holman and Jablensky released the Duty to Care report, revealing a range of physical disorders in people with a mental illness at markedly elevated rates when compared to the general population. The Who is Your GP report (HealthRight Advisory Group, WA Office of Mental Health, 2004) followed soon after recommending the development of clinical guidelines and monitoring protocols to improve the physical health of mental health consumers. In 2009, the Department of Health WA commissioned the Community, Culture and Mental Health Unit (UWA) to review the international literature and develop such guidelines. The Clinical Guidelines for the Physical Health Screening of Mental Health Consumers package was developed, and can be used and/or adapted for inpatient, outpatient, or community care situations. In essence, the Clinical Guidelines assessment package provides an overall, individualised, evidence-based evaluation of each consumer’s physical health status, where initial assessment results are used as a baseline from which to monitor ongoing health status. The integration of the Clinical Guidelines for the Physical Health Screening of Mental Health Consumers into Standard Mental Health Clinical Documentation places WA at the forefront of consumer physical health assessment.

In order to ease the introduction of these directives, the Mental Health Commission has provided funding to conduct a pilot service evaluation across the state to assess any issues that might arise during the implementation of mandatory physical health assessment and ongoing monitoring of mental health patients. The Clinical Guidelines physical assessment package will be provided to different services in different contexts (i.e. rural settings, inpatient, community outpatients, forensic psychiatry, and private practice) across WA. To evaluate the services, we will be conducting an audit of the patient screening forms and using a qualitative questionnaire to investigate potential difficulties for services. It is likely that a large number of participants in the evaluation of the Kimberley region of WA will be of Aboriginal or Torres Strait Islander decent. As poor physical health is a major issue for this population of people, we see enormous benefit in their inclusion in the evaluation. The data collected will also be analysed and possible publications will ensue to promote better physical health for mental health patients.

---

Researchers: Dr Carole Reeve, Tim O’Brien, Monica Frain, Dr Peta Williams, Dr David Reeve (Kimberley Population Health Unit); Ms Maureen Carter (Nindilingarri Cultural Health Services)

Funding: DoH

Project summary: This project aims to determine the effectiveness of moving from an acute focused hospital-based care system to a population based primary health service model of service delivery in small integrated hospitals in remote Aboriginal communities in the Kimberley.

Fitzroy Crossing is in the process of moving from being an acute hospital based model to community primary health based service provision. This has resulted in a demonstrated increase in occasions of service, improved chronic disease screening and outcome measures without a significant increase in staffing levels by using staffing more efficiently. We would like to examine this model of care in further detail and demonstrate additional savings and/or cost efficiencies in extending this primary health care model. A key enabler for this was the formal partnership developed with Nindilingarri Cultural Health Services.

---

Researchers: Prof Diego De Leo, Dr Kathy McKay Eeva-Katri Kumpula (Australian Institute for Suicide Research and Prevention, Griffith University

Funding: Commonwealth Department of Health and Ageing

Project summary: The Pathways to Care Project is conducted by the Australian Institute for Suicide Research and Prevention on behalf of the Commonwealth Department of Health and Ageing (DoHA) for the Australian Suicide Prevention Advisory Council (ASPAC). The project seeks to examine the mechanisms in place across Australia to respond to and provide care to people at imminent risk of suicide. The type of support a person at imminent risk of suicide receives can depend on how they come into contact with the support system but may also reflect differences in state- and territory-level legislation and the availability of resources in local areas. Consequently, ASPAC and DoHA are seeking to gain a better understanding of the ways in which people at imminent risk of suicide access these support systems.

---

Researchers: Dr Tony Mylius (WA Country Health); Dr Jamie Rankin (Royal Perth Hospital); Dr Michelle Ammerer (Sir Charles Gairdner Hospital); Dr Alan Whelan (Fremantle Hospital); Dr Siang Ung (Swan District Hospital); Dr Elizabeth Patterson (Rockingham District Hospital); Dr David Playford (Armadale Hospital); Dr Andrei Catanchin (Joondalup Health Campus); Dr Mark Hands (St John of God Subiaco)

Funding: Snapshot ACS has secured communication funds for teleconferencing from the Cardiac Society of Australia and New Zealand. High-level in kind project officer support has been provided by a majority of state Health and Clincial Networks, including the WA Department of Health.

Project summary: Snapshot ACS is a prospective registry which is designed to evaluate the existing patterns of care for patients who are admitted to hospital with an ACS in order to improve the quality of care. The project has recently received endorsement from the Australian Commission on Safety and Quality in Healthcare.

More than 400 centres that treat patients with ACS in Australia and New Zealand will be asked to participate and the researchers expect to enroll approximately 4,000 patients over a 2 week period. The main objective of the registry is to provide a greater understanding of the management and health outcomes of patients across the full breadth of hospitals in both countries.

Information on the clinical characteristics, the in-hospital investigations and management of patients will be collected. This will be compared to guidelines for recommended practice. This data will inform future strategies to improve ACS care in Australia and New Zealand.

---

Researchers: Prof Stephen O’Leary (Royal Victorian Eye & Ear Hospital); Prof Harvey Coates (PMH for Children); A/Prof Kelvin Kong (Newcastle); A/Prof Peter Morris (Royal Darwin Hospital); A/Prof Chris Perry (Royal Children’s Hospital Brisbane); Ms Adrienne Kirby (University of Sydney

Funding: NHMRC

Project summary: Ear infection (otitis media) is a major problem amongst children living in remote Australian communities. Medical treatment often fails, and ear nose and throat surgeons are called upon to provide surgical care. This clinical trial will provide surgeons with evidence so that they can recommend the best possible operation for children living in desert and tropical regions, most of whom are indigenous, to improve hearing and reduce the prevalence of ear infection and discharging ears.

This will be a multi-centre randomised trial across remote areas of NT & WA. It will assess the effects of two surgical interventions in the management of otitis media. Aboriginal and Torres Strait Islander children, between the ages of 3-10 years will be randomized into 3 groups:

1. adenoidectomy with ventilation tubes (VTA)

2. adenoidectomy with myringotomy only (MA)

3. medical treatment with the offer of surgery after 12 months if clinically indicated.

The children will be followed up for 12 months following surgery. This will be by monthly phone calls to the family to ask about the child’s ear health and a visit to the community after 12 months to test hearing and review ear and nasal swabs. It is expected that by the end of this period the ventilation tube will have dropped out (usually after 3-6 months), and that the otitis media will likely have recurred if were to do so.

The primary aim is to see a reduction in the prevalence of otitis media. Secondary aims include measuring hearing impairment, the prevalence of aural discharge, aural perforation, and the effect of treatment on nasal colonisation with pathogenic bacteria. The study will test whether there is an advantage of VTA or MA over medical therapy in controlling otitis media.

---