BACKGROUND: A core goal of Healthy Homes and Neighbourhoods is sector-capacity building, engagement and identification of the needs of the communities served.

AIM: To endeavour to identify the needs and barriers in accessing and engaging with the health and social care system for ethnically Sudanese women living in a disadvantaged suburb of Sydney.

METHODS: Participants were recruited via direct and indirect community engagement strategies, and were invited to participate in a community consultation specifically for Sudanese women. The session was conducted in English with Arabic interpretation. Emerging key themes were recorded, summarised and analysed.

RESULTS: Fifteen women participated in the community consultation. Preliminary results suggest barriers to health and social care utilisation included accessibility of appropriate housing options, cost of physical therapies and local inaccessibility of culturally appropriate primary care physicians. A key theme identified was the alienation experienced by Sudanese women who have undergone female genital mutilation (FGM) and who are accessing perinatal care and childbirth services.
Other emerging themes identified ways in which the health sector could deliver improved care, including better coordination of acute and community-based services, ensuring services are advertised effectively and in Arabic and improved training of birth attendants in the effects of FGM on pregnancy and birthing.

CONCLUSION: Ethnically Sudanese women who have resettled in Australia experience a range of barriers to accessing and engaging in a complex health and social care system. Further alienation occurs when women access the healthcare system specifically for perinatal care and childbirth services.

LESSONS LEARNED Access to the local community relied on long-term, consistent relationship building, identification of key leaders and shared planning and goal development. Female Genital Mutilation and its consequent morbidity is a common issue for Sudanese women who have resettled in Australia.

SUGGESTIONS FOR FUTURE RESEARCH :Future research will focus on gaining information on the cultural, moral and social acceptability of FGM and the breadth of experiences of women exposed to FGM generationally and across the lifespan. Research should inform the implementation of the Sudanese community’s self-determined values and needs and the facilitation of supportive partnerships to guide responses from the health and social care sector.

AUTHORS: Rebecca Howard, Una McKeever

INTRODUCTION
Persons experiencing social disadvantage including homelessness, substance use and mental illness experience poor health outcomes, high rates of untreated chronic diseases and shorter life expectancy. Many are not linked to mainstream primary health care and cannot prioritise their health over daily survival needs. Consequently, health seeking is often delayed, resulting in high rates of late-stage presentation to Emergency Departments and more serious illness. In many instances these outcomes may have been prevented through proactive and timely primary care intervention. With funding from St Vincent’s Health Australia’s (SVHA) Inclusive Health Program, St Vincent’s Hospital Melbourne (SVHM) is piloting three novel, integrated models taking care outside traditional hospital walls, to places where disadvantaged persons congregate.

AIMS
These models broadly aim to:
-Establish partnerships with key community agencies to establish integrated and proactive health responses
-To engage with hard-to-reach consumers attending these community services
-To improve the health outcomes of these vulnerable consumers
-To reduce preventable, acute hospitalisations as a result of unmet health needs

METHOD
Models 1 and 2 are two years into their three-year pilot term and Model 3 is a two year pilot which commenced in 2019.

Model 1 is a Primary Health Hub at the Salvation Army (SA) 614 Precinct in Melbourne’s CBD. The SA provide meals and practical supports, whilst working with clients to create pathways out of marginalization. SVHM has embedded a 1.0FTE Registered Nurse and a 0.5FTE Mental Health Clinician on-site to engage with consumers, assess/treat acute health needs (e.g. wounds, infections), address chronic health needs and link people into appropriate primary or tertiary health services.

Model 2 is a partnership between SVHM, Jesuit Social Services (JSS), Bolton Clarke and The University of Melbourne, embedding a 0.8FTE Registered Nurse within JSS’s ReConnect prison release case management team. The nurse provides outreach 1:1 clinical care and secondary consultation/capacity building with ReConnect’s 18 case managers.

Model 3 is a partnership between SVHM and North Richmond Community Health’s Medically Supervised Injecting Room, embedding an Infectious Diseases Nurse and Mental Health Clinician to engage with consumers to address their complex physical health, mental health, substance issues and psychosocial needs.

RESULTS
Early results from all three projects have seen high rates of consumer engagement with the health professionals. The projects are being quantitatively and qualitatively evaluated by way of cohort demographics, identified health needs, service delivery provided, consumer outcomes and healthcare utilisation. Case studies are providing rich information about entwined, complex health and psychosocial needs that are validating the need for these flexible, outreach service models. Key learnings include the need for dedicated partnership planning to ensure well-aligned project implementation, appropriate clinical governance and support for staff working in these outreach environments and thorough evaluation frameworks to assess project effectiveness.

DISCUSSION
Across health, housing and welfare sectors there is increasing recognition of the need for integrated health and welfare service responses. SVHA is providing significant financial investment to pilot these models with comprehensive evaluation frameworks to contribute to best practice evidence to support sustainable funding.

1. Introduction

Background:
Building respectful relationships between Aboriginal people affected by cancer and health service providers is integral to the provision of culturally inclusive, responsive and safe care.

Problem statement:
The Parkville Precinct health partners, consisting of Peter MacCallum Cancer Centre, the Royal Melbourne Hospital and The Royal Women’s Hospital have identified a common goal of establishing an Aboriginal Health Directorate that is culturally safe and responsive to the healthcare needs of Indigenous people across the precinct.

2. Theory/Methods
This mixed methods scoping project examined current practices and barriers to the provision of culturally appropriate and responsive cancer care against literature and best practice.
• Quantitative data collection was based on a cultural safety self-assessment gap analysis tool
• Qualitative approaches included extensive literature review and a series of interviews with stakeholders to inform evidence-based recommendations for improvement against gap analysis for each health service.

3. Results
• Health services are in varying maturity of a whole of organisation approach to a cultural competency strategy
• Value of partnering with local Aboriginal and Torres Strait Islander communities to inform organisational policy and procedures
• Positive impact of sharing Aboriginal and Torres Strait Islander patient experience stories
• Improving Indigenous patient identification on admission/presentation to hospital and cultural safety with health care providers was identified as priority areas for improvement
• Comprehensive strategies and recommendations developed as informed by the gap analysis

4. Discussions
The project emphasizes on simple, cost effective ways for implementation with existing resources such as:
• Ensuring that the Aboriginal Health Liaison Officer role is hired in pairs to address social isolation in the workplace.
• Generating a report of all Aboriginal and Torres Strait Islander patients attending health services to better identify and respond to their needs.
• Visible cultural presence such as flags, artworks, murals, and commemoration plagues.

The recommendations above are short term goals for each health services to achieve, and they lay the vital foundation towards collaborative long terms goals.

5. Conclusions
The establishment of a Precinct Aboriginal Health Directorate should be an Indigenous-led model of care and this would ensure provision of comprehensive Aboriginal public health care with a holistic approach and flexible models of care with a diverse workforce that is culturally safe, responsive and accessible.

6. Lessons learned
• Executive engagement with whole of organisational commitment/approach is integral.
• Partnering with Aboriginal health agencies and local Aboriginal communities, bearing in mind the principle of self-determination.
• Cultural Awareness fosters respect towards Aboriginals; to build better relationships and work effectively without bias or prejudice.

7. Limitations
• Legal and financial constraints – Coordination with three major public health services would require intricate planning and sensitivity in regards to these issues.
• Sample size and selection criteria – scoping of stakeholders did not involve Indigenous patients directly.

8. Suggestions for future research
• Strategies to improve Indigenous patient identification on admission/presentation to hospital
• The impact of cultural safety training with healthcare providers

West Heidelberg Community Legal Service (‘WHCLS’) is a community legal centre that provides assistance to vulnerable and disadvantaged people in the Banyule region of Melbourne. For almost 40 years, WHCLS operated a unique integrated legal service delivery model through its co-location with Banyule Community Health. In 2014, the legal and health service merged, formalising the health justice partnership underpinning the long standing collaboration between the services.
Implementing an integrated practice model in a community health service which engages with a population ranked among Australia’s most disadvantaged has highlighted a range of unique challenges and opportunities for practitioners and clients.
In particular, this presentation explores how the benefits of a flexible, innovative and multi-disciplinary service response can be achieved while maintaining and protecting traditional and less malleable client protections that are created by the lawyer-client relationship, such as legal professional privilege.
For legal and health practitioners there is a need to reconceptualise established discipline-bound approaches to adapt to a context of integration. Ensuring open and effective communication between disciplines without risking clients’ rights and practitioners professional obligations can involve: joint team meetings; focusing on shared goals rather than shared clients; joint attendance at community events and outreach activities; sharing anonymous statistical data and collaborative efforts to align community services i.e. child care and legal appointment rosters. These approaches can improve the quality and accessibility of services available to the community while maintaining clients’ rights in their engagement with health, legal and social support services.
Increased communication between collaborating services and disciplines (i.e. legal and health) allows for a constant re-evaluation of potential discipline-bound assumptions, helping practitioners broaden their understanding to provide a service that enables clients with complex needs to feel better recognised and supported while improving health and legal outcomes.

Introduction
Gippsland Primary Health Network (PHN) enlisted the Health Issues Centre (HIC) to engage with people aged over 65 years experiencing ‘declining capacity’ and ‘dependency’, to better understand their barriers to accessing health and social care services. The findings were needed to inform the Gippsland PHN health needs assessment.

Methods
HIC applied its Social Listening© methodology incorporating self-directed social media conversations, on-line open response surveys and face-to-face intercept conversations©. Facebook engagement (via a mediated conversation linked to an optional survey) was supplemented by in person and telephone interviews with people aged over 65 years, their adult children and health, social care and community professionals working with them.

Results
64 older people and 38 adult children of older people completed online surveys. Interviews were conducted with 23 older people and nine professionals.
Survey results identified major concerns for older people as loss of independence (41%) and physical (41%) and mental (37%) capacity, while carers were most concerned about their parent’s pain and suffering (66%), loss of physical capacity (63%), loss of mental capacity (60%) and loneliness (60%).
Key barriers to service access across data sources included; the importance of empathy and validation when interacting with service providers, poor communication of clinical information and access logistics such as waiting times, cost of services, travel times and limited access to digital options.

Discussion
The methodology enabled participants to determine the direction of inquiry and six stages of decline were identified that can be reinforced by health services failing to empathise and validate experiences of ageing. This can create a Spiral of Decline and Withdrawal.
The research identified critical intervention points for health and social service providers to intercept the decline. An essential component is the need to help older people feel valued and understood.

Conclusions
Health and social care providers have a critical role to play in intercepting the spiralling effect of decline and withdrawal from accessing health and social care services. It is important to seize the opportunities to express empathy that can restore consumer self-esteem and trust in the health system. With a service system based on strengthening consumer identity and validating experiences of ageing, significant gains could be made to reduce severe physical and mental health decline.

Lessons learned
Empathy and validation of older peoples’ experiences is essential for clinicians and service providers to restore consumer self-esteem and sense of identity.
Access logistics including cost, travel and waiting times are significant barriers to services for older people in rural areas.
Effective communication of clinical information is a foundation for good quality care and can allow health and social service providers to intercept a spiral of decline and withdrawal.

Limitations
The sample was relatively small and does not adequately cover the experiences of vulnerable groups including Aboriginal and Torres Strait Islander people, consumers with dementia and marginalised groups.

Suggestions for future research
Further engagement with older people, particularly vulnerable groups and males, using consumer focussed methods, would be valuable to better understand how their barriers to service access can be addressed.

1. An introduction
People living with mental illness die 20 years prematurely¹ and much of this early death is attributed to cardiovascular disease, respiratory disease, diabetes and cancer.² Eighty percent of people with mental illness also have a chronic physical health condition³ and many of these illness are completely avoidable.⁴

2. Short description of practice change implemented
This paper describes a national model of implementation to support quality physical health care for people living with mental illness. It seeks to support an integrated approach across professions and services, and also support individual clinicians to take a holistic approach to care.

3. Aim and theory of change
To support local, regional, state and national action and innovation, Equally Well has adapted constellation model of collective impact to influence practice.⁵ across the Australian health and human services system. This approach is underpinned by a social and digital media strategy that builds awareness, provides resources and facilitates collaboration.

4. Targeted population and stakeholders
Ninety key organisations, including all Australian governments, 15 professional colleges, and key consumer and advocacy organisations have committed to make implementing Equally Well a priority. Equally Well also specifically supports clinicians, people living with mental illness and their carers.⁶

5. Timeline
Equally Well commenced in 2015 with a program of extensive stakeholder consultation.⁷ The project has a 10 year horizon, at which time the next steps will be considered.

6. Highlights
A recent national audit of activity revealed there are now hundreds of local services innovating and introducing new partnerships and processes to implement Equally Well. Examples include: 19 new, coordinated projects in one state to improve the physical health of older people living with mental illness, a GP network in another state running workshops to plan actions, and Victoria developing their own Equally Well implementation strategy.

7. Comments on sustainability
Embedding action within a multitude of committed partners helps make the program sustainable and not reliant on a central agency or policy. In addition, including the implementation of Equally Well as an action of The Fifth Mental Health and Suicide Prevention Plan, also supports sustainability.

8. Comments on transferability
With a wide ranging strategy that seeks to influence state and national policy, but also individual clinicians, consumers means this program is transferable to other policy areas.

9. Conclusions
• A collective action approach appears to be an effective way to implement national policy across a complex health system.
• With organisations at different stages of organisational readiness, a collective impact approach means lessons learned and resources can be shared as organisations mature and change.

10. Discussions
The presentation will discuss the challenges associated with sectors that have been hard to engage.
It will also discuss the role of social media and the importance of collective ownership of the movement and facilitating vibrant, respectful dialogue between clinicians, consumers and carers.

11. Lessons learned
In a human services environment with so many competing demands, the capacity to maintain continuous communication, link partners, share success and facilitate collaboration is critical.