Aboriginal Community Controlled Health Organisation Research Articles

"Listen with your ears and eyes and heart and your minds and your soul": Implications for decolonising consultation and occupational therapy from case studies on "Closing the Gap" policy implementation.

Including Aboriginal and Torres Strait Islander people and communities through consultation has been a key feature of policy implementation throughout the Australian Government's "Closing the Gap" (CTG) strategy. However, consultation often reinforces power imbalances between government and local community and can undervalue or marginalise Indigenous knowledge and leadership. Occupational therapy has a short history of examining colonial power structures within the profession, but there has been limited progress to decolonise consultation and practice. Drawing on decolonising research methodology and positioned at the interface of knowledge, comparative case studies were used to understand policy implementation in two regions. In Shepparton, Victoria, CTG policy was implemented predominately through an Aboriginal Community Controlled Health Organisation, and in Southern Adelaide, South Australia, CTG policy was implemented through mainstream state government and non-government providers in the absence of a local Aboriginal-controlled organisation. Findings were examined critically to identify implications for occupational therapy. Our case studies showed that policy stakeholders perceived consultation to be tokenistic and partnerships were viewed differently by Aboriginal and non-Indigenous participants. Participants identified the need to move beyond a rhetoric of "working with" Aboriginal and Torres Strait Islander people, to promote Aboriginal leadership and really listen to community so that policy can respond to local need. The findings of this research show that Aboriginal-controlled services are best positioned to conduct and respond to community consultation. A decolonising approach to consultation would shift the status quo in policy implementation in ways that realign power away from colonial structures towards collaboration with Indigenous leadership and the promotion of Aboriginal-controlled services. There are lessons for occupational therapy from this research on policy implementation on authentic, decolonised consultation as a key feature of policy implementation. Shifting power imbalances through prioritising Indigenous leadership and honouring what is shared can drive change in CTG policy implementation processes and outcomes.

Capacity building to address antimicrobial resistance in remote Australia: The inaugural HOT NORTH Antimicrobial Academy

BackgroundRates of antimicrobial resistance (AMR) for some pathogens in Australia are considerably higher in rural and remote compared to urban regions. The inaugural Hot North Antimicrobial Academy was a 9-month educational programme aimed to build workforce knowledge and capacity in antimicrobial use, audit, stewardship, surveillance and drug resistance in remote primary health care. MethodsThe Academy was advertised to Aboriginal and Torres Strait Islander, regional and remote healthcare workers. Participants were Aboriginal health practitioners, nurses, pharmacists and doctors from Queensland, Northern Territory, South Australia and Western Australia working in remote primary health care with a focus on Indigenous health. Due to COVID-19 restrictions, the Academy ran virtually from February–November 2021 using Microsoft Teams. The Academy was evaluated using surveys and yarning circles to assess impact and knowledge gain. ResultsParticipants and faculty from across Australia attended 19 lectures and mentorship sessions. Eleven participants commenced and eight (73%) completed the Academy. The Academy raised participants awareness of AMR guidelines, governance and generating change; built confidence in advocacy; grew knowledge about drug resistant infections; and created a community of AMR champions in Indigenous health. ConclusionThe evaluation confirmed the Academy met the needs of participants, provided opportunities to move stewardship from tertiary hospitals into Indigenous and remote clinics and developed skills in research, audit, stewardship and advocacy for all involved. All sessions were recorded for future use, with facilitation by the National Aboriginal Community Controlled Health Organisation (NACCHO) in future years.

Strong Born-A First of Its Kind National FASD Prevention Campaign in Australia Led by the National Aboriginal Community Controlled Health Organisation (NACCHO) in Collaboration with the Aboriginal Community Controlled Health Organisations (ACCHOs).

The Strong Born Campaign (2022-2025) was launched by the National Aboriginal Community Controlled Health Organisation (NACCHO) in 2023. Strong Born is the first of its kind national Aboriginal and Torres Strait Islander health promotion campaign to address Fetal Alcohol Spectrum Disorder (FASD) within Australia. Strong Born was developed to address a longstanding, significant gap in health promotion and sector knowledge on FASD, a lifelong disability that can result from alcohol use during pregnancy. Utilizing a strengths-based and culturally sound approach, NACCHO worked closely with the Aboriginal Community Controlled Health Organisations (ACCHOs) to develop the campaign through co-design, as described in this paper. Since its inception, the ACCHOs have continually invested in driving change towards improvements in Aboriginal health determinants and health promotion. The Strong Born Campaign developed culturally safe health promotion tool kits designed for the community and health sector staff and also offered communities the opportunity to apply for FASD Communications and Engagement Grants to engage in local campaign promotion. The tool kits have been disseminated to 92 ACCHOs across Australia. This paper describes the development of the Strong Born Campaign and activities following its launch in February 2023 from an Indigenous context within Australia, as described by NACCHO.

Describing skin health and disease in urban-living Aboriginal children: co-design, development and feasibility testing of the Koolungar Moorditj Healthy Skin pilot project

BackgroundIndigenous children in colonised nations experience high rates of health disparities linked to historical trauma resulting from displacement and dispossession, as well as ongoing systemic racism. Skin infections and their complications are one such health inequity, with the highest global burden described in remote-living Australian Aboriginal and/or Torres Strait Islander (hereafter respectfully referred to as Aboriginal) children. Yet despite increasing urbanisation, little is known about the skin infection burden for urban-living Aboriginal children. More knowledge is needed to inform service provision, treatment guidelines and community-wide healthy skin strategies. In this pilot study, we aimed to test the feasibility and design of larger multi-site observational studies, provide initial descriptions of skin disease frequency and generate preliminary hypotheses of association.MethodsThis project has been co-designed with local (Noongar) Elders to provide an Australian-first description of skin health and disease in urban-living Aboriginal children. In collaboration with an urban Aboriginal Community Controlled Health Organisation (Derbarl Yerrigan Health Service), we conducted a week-long cross-sectional observational cohort study of Aboriginal children (0–18 years) recruited from the waiting room. Participants completed a questionnaire, skin examination, clinical photos, and swabs and received appropriate treatment. We assessed the feasibility and impact of the pilot study.ResultsFrom 4 to 8 October 2021, we recruited 84 Aboriginal children of whom 80 (95%) were urban-living. With a trusted Aboriginal Health Practitioner leading recruitment, most parents (or caregivers) who were approached consented to participate. Among urban-living children, over half (45/80, 56%) of parents described a current concern with their child’s skin, hair and/or nails; and one-third (26/80, 33%) reported current itchy skin. Using a research-service model, 27% (21/79) of examined urban-living participants received opportunistic same-day treatment and 18% (14/79) were referred for later review.ConclusionsThis co-designed pilot study to understand skin health in urban-living Aboriginal children was feasible and acceptable, with high study participation and subsequent engagement in clinical care observed. Co-design and the strong involvement of Aboriginal people to lead and deliver the project was crucial. The successful pilot has informed larger, multi-site observational studies to more accurately answer questions of disease burden and inform the development of healthy skin messages for urban-living Aboriginal children.

Responsiveness of a rural Aboriginal community controlled health organisation: A qualitative study.

Responsiveness of health care systems is a global concept defined as the ability of systems to function in a manner that meets the expectations of individuals, and is under-studied. In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are valued by Aboriginal and Torres Strait Islander Peoples for the provision of holistic culturally safe primary health care and are well positioned to be responsive to community needs. To develop a conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal and Torres Strait Islander Peoples in their service region. A qualitative interview study using abductive reasoning was conducted. Interviews conducted with Aboriginal clients, key informants, and ACCHO health personnel from two evaluations undertaken in partnership with a rural ACCHO located in Victoria, Australia, were analysed through an iterative process of identifying key concepts from the data and evidence. Key concepts were used to develop a conceptual framework. Across the two evaluations, 22 participants were involved in data collection and 28 interviews were undertaken. A conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal Peoples within their service region was developed and encompassed three concepts: operating within a complex adaptive system, mechanisms of responsiveness used by the ACCHO, and challenges experienced by the ACCHO when being responsive. The developed conceptual framework expands on research supporting the value of ACCHOs in providing holistic culturally safe health care to their communities, particularly in rural settings. A key finding is the importance for ACCHOs to meet the health care needs of their community whilst navigating needs in the context of the broader health care system. When dissonance is encountered between external system components and community needs, challenges can be experienced such as adequately resourcing models of service delivery and maintaining the provision of services. Conceptualising the health care system as a complex adaptive system in which an ACCHO operates and is responsive, highlights the competing demands experienced. Findings expand on mechanisms of responsiveness used at the service-user interface. Future research should examine how the broader health care system can support the role and functions of ACCHOs in being responsive to the health care needs of their communities.

Implementation of telehealth primary health care services in a rural Aboriginal Community-Controlled Health Organisation during the COVID-19 pandemic: a mixed-methods study.

Globally, primary care organisations responded rapidly to COVID-19 physical distancing requirements through the adoption of telehealth to maintain the delivery of health care to communities. In Australia, temporary Medicare Benefits Schedule (MBS) telehealth items were introduced in March 2020 to enable the provision of telehealth services in the primary care setting. These changes included funding for two modes of telehealth delivery: videoconferencing and telephone consultations. As primary care organisations, Aboriginal Community Controlled Health Organisations (ACCHOs) rapidly adopted telehealth consultations to maintain the delivery of primary care services to Aboriginal and Torres Strait Islander clients. The aim of the present study was to evaluate the implementation (specifically the uptake, acceptability and requirements for delivery) of telehealth primary healthcare services for Aboriginal and/or Torres Strait Islander peoples by a rural ACCHO during COVID-19. A single-site convergent-parallel mixed-methods study was undertaken in the context of an ongoing research partnership established between a rural ACCHO and a university department of rural health. De-identified health service data from March 2020 to March 2021 was extracted, including MBS telehealth consultations and client demographics (eg age, gender and postcode). Variables were analysed using descriptive statistics to examine the uptake of telehealth by Aboriginal and Torres Strait Islander clients. A geographical analysis of postcode data was also undertaken. Semi-structured interviews were undertaken concurrently with a purposive sample of health service personnel (including health professionals) involved in the implementation or delivery of telehealth, and Aboriginal and/or Torres Strait Islander clients who had accessed telehealth, to explore the acceptability of telehealth and requirements for delivery. Thematic analysis using an inductive approach was undertaken. The analyses of quantitative and qualitative findings were merged to identify key concepts pertaining to the uptake, acceptability and requirements for telehealth delivery. During the first year of implementation, 435 telehealth primary healthcare consultations were delivered to Aboriginal and/or Torres Strait Islander clients. Seven health personnel and six Aboriginal and/or Torres Strait Islander clients participated in interviews. Merged findings from an analysis of quantitative and qualitative data were grouped under three concepts: uptake of telehealth consultations by Aboriginal and Torres Strait Islander clients, maintaining the delivery of ACCHO services during COVID-19, and implications for sustaining telehealth in an ACCHO. Findings identified that telehealth maintained the delivery of ACCHO services to Aboriginal and/or Torres Strait Islander clients across the lifespan during COVID-19, despite a preference for face-to-face consultations. A greater uptake of telephone consultations compared to videoconferencing was identified. Barriers to the utilisation of videoconferencing were largely technology related, highlighting the need for additional support for clients. Telehealth was a useful addition to face-to-face consultations when used in the appropriate context such as the administration of long-term medication prescriptions by a GP. Engaging the ACCHO sector in the policy discourse around telehealth is imperative for identifying requirements for ongoing implementation.

Cervical Screening Reminders for Aboriginal and Torres Strait Islander Women in Primary Care-Randomised Controlled Trial of Letter vs. Phone/SMS Reminders.

(1) Background: Aboriginal women have a higher mortality from cervical cancer, yet cervical screening rates are lower than for other Australian women. (2) Methods: A randomised controlled trial of reminder letter vs. phone call/SMS for routine cervical screening testing in an Aboriginal Community Controlled Health Organisation in NSW. (3) Results: 256 women aged between 25 and 74 who were due for cervical screening were randomised to receive a reminder letter (and up to two further letters for non-responders) or a phone call (followed by up to two SMS) to attend the screening. A total of 15 women (12.5%) attended for cervical screening test within 3 months following a letter, and 24 women (17.6%) after a phone call/SMS reminder; this difference was not significant (p = 0.252). Time spent on sending letters vs. phone calls/SMS was similar; the cost was lowest for SMS. (4) Conclusion: Response to reminders was lower than expected. While there was no significant difference in effectiveness in letter vs. phone call/SMS for cervical screening recalls, reminder systems, including opportunistic reminders, can play a role in encouraging women to participate in screening programs in conjunction with national screening registers. The choice of reminder type should be left to service and consumer preference.

Provision of Dental Care to Indigenous South Australians and Impacts on Improved General Health: Study Protocol.

Indigenous South Australians carry a disproportionate burden of dental diseases, with approximately 80 percent of Indigenous adults having both periodontal disease and dental caries. The chronic inflammatory nature of many dental conditions means there are widespread systemic impacts, particularly on type 2 diabetes, chronic kidney disease and cardiovascular disease. Evidence suggests there are barriers experienced by Indigenous South Australians in accessing timely and culturally safe dental care. This study aims to: (1) elicit the views of Indigenous South Australians regarding their perspectives of what comprises culturally safe dental care; (2) provide such dental care and; (3) assess any changes in both oral and general health using point-of-care testing following receipt of timely, comprehensive and culturally safe dental care. This mixed-methods study will involve qualitative interviews and an intervention without randomisation. The qualitative component will comprise seeking perspectives of Indigenous South Australians regarding what culturally safe dental care means for them. For the intervention component, participants will take part in oral epidemiological examinations at baseline and 12-month follow-up (after receipt of dental care), which will include collection of saliva, plaque and calculus, as well as completion of a self-report questionnaire. The primary outcome measures-changes in type 2 diabetes (HbA1c), cardiovascular disease (CRP) and chronic kidney disease (ACR)-will be obtained by blood/urine spot from a finger prick/urine collection at baseline and 12-month follow-up via point-of-care testing. Participant recruitment will commence in July 2022. The first results are expected to be submitted for publication one year after recruitment begins. The project will have a number of important outcomes, including increased understanding of what culturally safe dental care means for Indigenous South Australians, the delivery of such care, and empirical evidence of how culturally safe dental care leads to better prognosis for chronic diseases linked with poor oral health. This will be important for health services planning, especially in the Aboriginal Community Controlled Health Organisation sector, where the management of dental diseases in a culturally safe manner for better chronic disease outcomes is currently insufficiently understood, planned and budgeted for.

Communities Setting the Direction for Their Right to Nutritious, Affordable Food: Co-Design of the Remote Food Security Project in Australian Indigenous Communities

Despite long histories of traditional food security, Indigenous peoples globally are disproportionately exposed to food insecurity. Addressing this imbalance must be a partnership led by Indigenous peoples in accordance with the UN Declaration of the Rights of Indigenous Peoples. We report the co-design process and resulting design of a food security research project in remote Australia and examine how the co-design process considered Indigenous peoples' ways of knowing, being, and doing using the CREATE Tool. Informed by the Research for Impact Tool, together Aboriginal Community Controlled Health Organisation staff, Indigenous and non-Indigenous public health researchers designed the project from 2018-2019, over a series of workshops and through the establishment of research advisory groups. The resulting Remote Food Security Project includes two phases. Phase 1 determines the impact of a healthy food price discount strategy on the diet quality of women and children, and the experience of food (in)security in remote communities in Australia. In Phase 2, community members propose solutions to improve food security and develop a translation plan. Examination with the CREATE Tool showed that employing a co-design process guided by a best practice tool has resulted in a research design that responds to calls for food security in remote Indigenous communities in Australia. The design takes a strengths-based approach consistent with a human rights, social justice, and broader empowerment agenda. Trial registration: The trial included in Phase 1 of this project has been registered with Australian New Zealand Clinical Trials Registry: ACTRN12621000640808.

Murru Minya–informing the development of practical recommendations to support ethical conduct in Aboriginal and Torres Strait Islander health research: a protocol for a national mixed-methods study

IntroductionConducting ethical and high-quality health research is crucial for informing public health policy and service delivery to reduce the high and inequitable burden of disease experienced by Aboriginal and Torres...

An Aboriginal Community-Controlled Health Organization model of service delivery: qualitative process evaluation of the Tulku wan Wininn mobile clinic

BackgroundMobile clinics have been implemented in diverse clinical and geographical settings to provide proximal health care for specific populations. Primary health care mobile clinics have been implemented widely for Indigenous populations, with a paucity of research evaluations around service delivery models internationally. To redress factors impeding service accessibility for Aboriginal and Torres Strait Islander Peoples, Budja Budja Aboriginal Cooperative (Aboriginal Community Controlled Health Organisation located in a small rural town in Victoria, Australia), developed and implemented the Tulku wan Wininn primary health mobile clinic.MethodsA qualitative process evaluation methodology was used to explore contextual factors mediating the implementation of the mobile clinic, including the acceptability of the service to health service personnel, external key informants, and Aboriginal and/or Torres Strait Islander clients. A synthesis of international ethical guidelines, (Consolidated Criteria for strengthening reporting of health research involving Indigenous peoples (CONSIDER statement), was prospectively applied to shape the study design and research process. Semi-structured interviews were conducted with participants. Data collection occurred from July 2019 to October 2021. Inductive thematic data analysis was undertaken concurrently with data collection.ResultsData was collected from 19 participants which included 12 health service personnel and key informants, and 7 Aboriginal clients. In total, data from 22 interviews were included as interviews with three clients were undertaken twice. Four themes were developed: considerations for early implementation, maintaining face-to-face services during COVID-19, acceptability as a model of service delivery, and maintaining the mobile clinic as a service delivery model.ConclusionEvidence supporting the acceptability of a primary health care mobile clinic for Aboriginal Peoples residing in rural Victoria is provided. Despite the experience of early implementation challenges and adaptations, the mobile clinic addressed known transport and cultural barriers to accessing primary health care services. In the context of COVID-19 lockdowns, the mobile clinic was valued for the provision of face-to-face care for Aboriginal clients. Key issues for maintaining the mobile clinic include health workforce and funding. Findings are of value to other organizations seeking to implement a primary health mobile clinic service delivery model to redress barriers to accessibility experienced by the communities they serve.

The short term safety of COVID-19 vaccines in Australia: AusVaxSafety active surveillance, February - August 2021.

Objective:To assess the short term safety of the COVID‐19 vaccines Comirnaty (Pfizer–BioNTech BNT162b2) and Vaxzevria (AstraZeneca ChAdOx1) in Australia.Design:Prospective observational cohort study; online surveys by AusVaxSafety, a national active vaccine safety surveillance system, three and eight days after vaccination.Setting, participants:People aged 16 years or more who received COVID‐19 vaccines at sentinel vaccination hubs, general practices, or Aboriginal Community Controlled Health Organisation clinics, 22 February – 30 August 2021.Main outcome measures:Primary outcome: proportion of respondents who reported any adverse event following immunisation (AEFI) 0–3 days after vaccination. Secondary outcomes: proportions of respondents who reported specific adverse events or medical review for AEFI within seven days of vaccination; impact on usual daily activities; recovery.Results:4 851 480 people received COVID‐19 vaccines at participating sentinel sites during the study period (25% of all COVID‐19 vaccine doses administered in Australia to 30 August 2021). 3 035 983 people responded to both surveys (response rate, 62.6%); 35.9% of respondents reported one or more AEFI 0–3 days after Comirnaty dose 1, 54.7% after Comirnaty dose 2, 52.8% after Vaxzevria dose 1, and 22.0% after Vaxzevria dose 2. Local pain, fatigue, headache, and myalgia were the most frequently reported symptoms. After adjusting for demographic characteristics, vaccination site type, jurisdiction, and self‐reported medical conditions, the odds of reporting any AEFI were higher for women than men (range of adjusted odd ratios [aORs], by vaccine and dose, 1.53–1.84), for people with a history of anaphylaxis (aOR range, 1.28–1.45), and for people reporting certain underlying conditions, including obesity (aOR range, 1.15–1.75), immunodeficiency (aOR range, 1.04–2.24), or chronic inflammatory disease (aOR range, 1.05–1.75). 0.9% of respondents sought medical advice in the three days following vaccination, most frequently after Comirnaty dose 2 (1.4%) and Vaxzevria dose 1 (1.2%).Conclusion:AusVaxSafety active surveillance affirms the short term safety profile of Comirnaty and Vaxzevria vaccines in a large population sample during the first six months of the Australian COVID‐19 vaccination program.

Consulting a Victorian Aboriginal community about their oral health.

The legacy of colonisation, assimilation, racism and victim blaming has created inequality in health for Aboriginal people, reflected in their oral health status. Despite the existence of community dental services, oral disease levels continue to be of concern. This study, initiated by a rural Victorian ACCHO (Aboriginal Community Controlled Health Organisation), aimed to consult their community about the barriers to and enablers of oral health and understand their lived experiences with dental services. Using an Aboriginal knowledge framework and collaborative approach involving an Aboriginal researcher and Community Mentor, this study consulted an ACCHO community about their oral health. Following community engagement, 21 community members participated in digitally recorded yarning circles and semi-structured interviews. Themes emerging from the data included dental care history and past experiences involving pain and shame, the value of having community-centred services and engagement with patients and the community. Experiences of dental care are often related to pain driving attendance resulting in experiences that multiply fear and anxiety. While community-based care was considered a strength, approaches to individual dental care often resulted in increasing shame and diminishing trust. Increasing cultural safety and participatory approaches to designing and delivering dental care may increase engagement and trust. Important gaps in cultural and clinical understanding between the community and dental service providers have been identified. These findings will be used to inform the delivery of dental services and to develop oral health promotion programs at the ACCHO, and cultural safety preparation for student dental practitioners.

Translating evidence into practice: Implementing culturally safe continuity of midwifery care for First Nations women in three maternity services in Victoria, Australia

SummaryBackgroundStrategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service.MethodsA prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020.FindingsThe model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model.InterpretationKey enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas.FundingPartnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.

Burden of the Beast

Burden of the Beast

Participatory research with a rural Aboriginal Community Controlled Health Organisation: lessons learned using the CONSIDER statement.

In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are geographically proximal to where Aboriginal and Torres Strait Islander People reside and are valued for providing holistic and culturally safe primary health care. Partnering with ACCHOs in research is appropriate for redressing health inequities experienced by Aboriginal and Torres Strait Islander People, which includes a high burden of chronic disease. Historically, some approaches to Aboriginal and Torres Strait Islander health research have been unethical. Greater accountability in the research process, transparency in reporting, and use of culturally appropriate research methodologies are key recommendations to improving the ethical integrity of research. The need for strengthening the reporting of health research involving Aboriginal and Torres Strait Islander People and Indigenous peoples globally led to the development of the CONSolIDated critERia for strengthening the reporting of health research involving Indigenous peoples (CONSIDER statement), which is a synthesis of international ethical guidelines. This project report uses the CONSIDER statement to critically reflect on participatory research undertaken in partnership with an ACCHO in the rural context and to identify lessons of value for future research. By using the CONSIDER statement as a tool for critical reflection, it was identified that processes used to establish a research partnership with an ACCHO were key to setting the research agenda, including identifying ethical issues, the needs of local Aboriginal and Torres Strait Islander People, and expectations from the research. The participation of Aboriginal community members throughout the entire research process was not only methodologically important but was also ethically appropriate. Research activities in this project included opportunities for Aboriginal community members to directly share their perspectives and experiences and develop local solutions to issues affecting them. Outcomes included evidence to support future funding applications, community-derived priorities that assisted with government reporting, and locally identified methods for addressing chronic disease management. Key to this was building the research capacity and capability of local Aboriginal community members, which also reflected the ethical principles of reciprocity and equity. This also provided opportunities for non-Indigenous researchers to learn from local Aboriginal community members and develop skills in culturally appropriate research. Using the CONSIDER statement was beneficial in enabling researchers to critically reflect on a participatory research project undertaken in partnership with a rural ACCHO. Researchers identified that participatory approaches can be used to generate research of relevance to local Aboriginal community members and their ACCHOs, and to support health service reporting, and future funding applications. Research timelines and activities needed to be flexible and adaptable, to allow for staff turnover and unforeseen events of cultural significance. Similarly, it is important for researchers to be receptive to change and open to learning. Although research partnerships are established on trust and mutual respect, it is recommended that greater formal provisions are required to protect the intellectual property of Aboriginal and Torres Strait Islander communities involved in research. These lessons are likely to be transferrable to other settings and are of value to researchers seeking to partner with ACCHOs in research.

Integrating cultural considerations and developmental screening into an Australian First Nations child health check.

The aim of the present study was to integrate cultural considerations and developmental screening into a First Nations child health check. The 'Share and Care Check,' an optimised child health check, was co-designed with a remote Aboriginal Community Controlled Health Organisation and led by Aboriginal Health Practitioners/Workers. Of 55 families who completed the Share and Care Check, the majority of participants indicated that their family/child was connected with their tribe and country. However, half of the caregivers reported that they or their child would like to know more about their tribe. The most common developmental screening outcome was no functional concerns (32.7%), followed by having one area identified as a functional concern (24.5%) and two functional concerns (16.3%). All caregivers reported that the Share and Care Check was culturally appropriate, and the majority also reported that it was helpful. Data obtained from questions regarding cultural and developmental aspects of health can assist health providers regarding the best pathway of support for a child and their family. This could ultimately contribute to closing the gap through the provision of holistic culturally appropriate services.

Evaluating Patient Experience at a Novel Health Service for Aboriginal and Torres Strait Islander Prisoners: A Pilot Study

Background The Winnunga Alexander Maconochie Centre Health and Wellbeing Service (AMCHWS) is the first prison health service operated by an Aboriginal Community Controlled Health Organisation in Australia. This pilot study developed and implemented a patient experience survey to evaluate the novel model of healthcare delivered by the Winnunga AMCHWS to Aboriginal and Torres Strait Islander prisoners. Methods Patients accessing the Winnunga AMCHWS between February and May 2020 were invited to participate in the study. Descriptive data were analysed and compiled for demographics, patient satisfaction, patient perception of care quality, cultural safety, and patient thoughts on the Winnunga AMCHWS. Findings Sixteen of 26 eligible patients participated in the survey (62% response rate). At least 75% of patients were satisfied with the waiting time to see staff at the Winnunga AMCHWS most or all of the time. All 16 patients reported that Winnunga AMCHWS staff always treated them with dignity and respect. Of 14 patients who identified as Aboriginal, nine felt that they were treated better by staff because of their Aboriginal identity while the other five felt their Aboriginal identity made no difference to their treatment by the staff. Interpretation This patient experience survey of the Winnunga AMCHWS found that it has provided highly satisfactory, timely, respectful, and culturally safe care to patients. Due to the limitations of this study, continual evaluation of the Winnunga AMCHWS and future studies to evaluate the continuity of care, health, and re-offending rates of released patients are needed to fully evaluate the Winnunga AMCHWS model.

Enhancing interprofessional practice through the co-design of a holistic culturally and developmentally informed First Nations child health assessment.

This qualitative study explored staff experiences of co-designing and implementing a novel interprofessional (IP) First Nations child health assessment (the helpful check), developed in partnership with a remote North-Queensland Aboriginal CommunityControlled Health Organisation. Eleven staff across two teams (family health and allied health) were involved in co-designing and implementing the child health assessment and associated IP practices. Interviews were undertaken using a semi-structured interview template and were audio recorded and transcribed verbatim. Data were analysed using thematic analysis. Three overarching themes were developed: (1) connect teams by building strong relationships; (2) leave space for helpful check processes to evolve; and (3) integrate helpful check processes into routine practice to sustain change. Results demonstrate how the incorporation of IP practices into a remote primary healthcare setting led to perceived benefits for both the health service staff and clients.

The impact of telehealth on patient attendance and revenue within an Aboriginal Community Controlled Health Organisation during COVID-19.

Aboriginal Community Controlled HealthOrganisations (ACCHOs) provide culturally appropriate medical services to Aboriginal and/or Torres Strait Islander people. The aim of this study was to examine the impact of telehealth on patient attendance and revenue within anACCHO during COVID-19. This is a time-series study of general practitioner attendances at a regional Victorian ACCHO in two periods: March-June 2019 (pre-COVID-19) andMarch-June 2020 (during COVID-19). After adjusting for the number of available appointments, there was a 27%increased rate of attendances per appointment slot during the COVID-19 period when compared with the pre-COVID-19 period, and a 59% increase inMedicare Benefits Schedule items claimed during the COVID-19 period, compared with the pre-COVID-19 period. The findings indicate that the provision of services via telehealth increased the number of people able to access the medical clinic, and that this had a positive financial impact for the organisation.