Increasing Pap smear rates at an urban Aboriginal Community Controlled Health Service through translational research and continuous quality improvement.

This article describes translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS). Rapid Plan-Do-Study-Act (PDSA) cycles were conducted, informed by client surveys, a data collection tool, focus groups and internal research. There was a statistically significant increase in Pap smear numbers during PDSA cycles, continuing at 10 months follow up. The use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. Community and service collaboration should be at the core of research in Aboriginal and Torres Strait Islander health settings. This model is transferrable to other settings and other health issues.

Walan Girri: developing a culturally mediated case management model for problematic alcohol use among urban Indigenous people.

OBJECTIVE: To describe the design and implementation of a culturally mediated case management model at Winnunga Nimmityjah Aboriginal Health Service (Winnunga) for Indigenous clients who consume alcohol at problematic levels. METHODS: Our research took place from March 2008 to March 2010 in the Australian Capital Territory and built on previous research partnerships between Winnunga and The Australian National University's National Centre for Epidemiology and Population Health. We conducted a review of existing models to determine elements for consideration in the community controlled setting, and conducted staff surveys to assess current levels of skill and confidence around alcohol screening, brief intervention and care planning. Using the information from the review and staff surveys, we then undertook staff capacity building to build confidence and skills in conducting alcohol screening, brief intervention and care planning. This process was driven by Winnunga's social health team. To meet Medicare benefits schedule requirements, and frame the study within the Aboriginal and Torres Strait Islander Chronic Disease Package framework, we included team care arrangements, care planning and health checks. RESULTS: Elements of case management were suggested by staff and incorporated into the final model. Forty staff in the health service participated in identifying training needs for the development of the case management model and undertook a range of training before the model was implemented. Staff working within the social health team decided that the focus of the case management was to build a stronger future for their clients, hence the name of the case management model 'Walan Girri' (Wiradjuri language for strong future). The model included a package of screening instruments and brief intervention, related polices and discussion of 'mob' and 'country.' Changes in Winnunga management and staff, the composition of the research team and the way Walan Girri evolved led to protracted development and implementation. CONCLUSIONS: This project highlights considerations for implementing a case management model in a dynamic health service environment. Capacity building for Winnunga staff and for an Indigenous PhD scholar were part of the process and were integral in maintaining momentum in the project.

Starting a perinatal and infant mental health service at Winnunga Nimmityjah.

OBJECTIVE: This paper briefly describes how the contexts of social and emotional wellbeing in Aboriginal and Torres Strait Islander communities impacts on perinatal and infant mental health. In response to these issues, a perinatal and infant mental health service was started through Winnunga Nimmityjah, a community controlled Aboriginal health service. The process of starting the clinic and some clinical themes are described.

Positive impact of a long-running urban Aboriginal medical service midwifery program.

BACKGROUND: The Winnunga Nimmityjah Aboriginal Health Service Aboriginal Midwifery Access Program (AMAP) was established in 2001 to provide antenatal care, birth support and postnatal care to clients in the Australian Capital Territory (ACT). AIM: To describe the uptake and impact of AMAP services on access to antenatal care, behavioural risk factors and pregnancy outcomes and to compare the characteristics of AMAP clients with other women giving birth in the ACT. METHODS: A descriptive study of medical records for AMAP clients who gave birth in 2004-2008. OUTCOME MEASURES: maternal and baby characteristics, antenatal visits, behavioural risk factors and complications. Characteristics of AMAP clients were compared with the ACT Maternal and Perinatal Collection. RESULTS: Of 187 women, 11.2% were aged <20 years, 50.3% presented in the first trimester and 94.7% attended five or more antenatal visits. Of 193 babies, 17.1% were born preterm and 18.1% had low birthweight. Compared with the ACT Maternal and Perinatal Collection, Aboriginal and Torres Strait Islander AMAP clients had a higher smoking rate (63.8 vs 49.0%), a lower caesarean delivery rate (20.0 vs 27.6%), a slightly lower proportion of preterm babies (18.8 vs 21.6%) and a slightly lower proportion of low-birthweight babies (18.8 vs 21.0%). CONCLUSIONS: Aboriginal Midwifery Access Program provides high-quality antenatal care in a trusted environment. The high rate of smoking in pregnancy needs to be addressed.