Social and Emotional Wellbeing Screening for Aboriginal and Torres Strait Islanders within Primary Health Care: A Series of Missed Opportunities?

Erika Langham,Barbara Nattabi,Ross Bailie,Irina Kinchin,Roxanne Gwendalyn Bainbridge,Janya Mccalman,Veronica Matthews

doi:10.3389/fpubh.2017.00159

Abstract

Social and emotional wellbeing (SEWB) is a critical determinant of health outcomes for Indigenous Australians. This study examined the extent to which primary healthcare services (PHSs) undertake SEWB screening and management of Aboriginal and Torres Strait Islander clients, and the variation in SEWB screening and management across Indigenous PHS. Cross-sectional analysis between 2012 and 2014 of 3,407 Indigenous client records from a non-representative sample of 100 PHSs in 4 Australian states/territory was undertaken to examine variation in the documentation of: (1) SEWB screening using identified measurement instruments, (2) concern regarding SEWB, (3) actions in response to concern, and (4) follow up actions. Binary logistic regression was used to determine the factors associated with screening. The largest variation in SEWB screening occurred at the state/territory level. The mean rate of screening across the sample was 26.6%, ranging from 13.7 to 37.1%. Variation was also related to PHS characteristics. A mean prevalence of identified SEWB concern was 13% across the sample, ranging from 9 to 45.1%. For the clients where SEWB concern was noted, 25.4% had no referral or PHS action recorded. Subsequent internal PHS follow up after 1 month occurred in 54.7% of cases; and six-monthly follow up of referrals to external services occurred in 50.9% of cases. Our findings suggest that the lack of a clear model or set of guidelines on best practice for screening for SEWB in Indigenous health may contribute to the wide variation in SEWB service provision. The results tell a story of missed opportunities: 73.4% of clients were not screened and no further action was taken for 25.4% for whom an SEWB concern was identified. There was no follow up for just under half of those for whom action was taken. There is a need for the development of national best practice guidelines for SEWB screening and management, accompanied by dedicated SEWB funding, and training for health service providers as well as ongoing monitoring of adherence with the guidelines. Further research on barriers to screening and follow up actions is also warranted.

Highlights

The need for screening and management of social and emotional wellbeing (SEWB) concerns is highlighted by evidence that Australian Aboriginal and Torres Strait Islander adults are three times more likely than non-Indigenous adults to experience very high levels of psychological distress [1, 2]
The root cause of SEWB and effects of its absence were explained by Pat Anderson, Chairperson of Australia’s national Indigenous health research institute, the Lowitja Institute: Those of us who have worked on the frontline of Aboriginal health for any length of time know that beneath the surface reality of Aboriginal people’s poor health outcomes sits a deeper truth
The findings of the present study suggest that there is a lack of clarity regarding best practice pathways for SEWB screening and management, and there are a number of opportunities to improve key aspects

Summary

Introduction

The need for screening and management of social and emotional wellbeing (SEWB) concerns is highlighted by evidence that Australian Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) adults are three times more likely than non-Indigenous adults to experience very high levels of psychological distress [1, 2]. The root cause of SEWB and effects of its absence were explained by Pat Anderson, Chairperson of Australia’s national Indigenous health research institute, the Lowitja Institute: Those of us who have worked on the frontline of Aboriginal health for any length of time know that beneath the surface reality of Aboriginal people’s poor health outcomes sits a deeper truth. It is about the importance of social and emotional wellbeing, and how this flows from a sense of control over one’s own life. This study examined the extent to which primary healthcare services (PHSs) undertake SEWB screening and management of Aboriginal and Torres Strait Islander clients, and the variation in SEWB screening and management across Indigenous PHS

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Discussion

Conclusion