The 2016 NSW Rural Health & Research Congress includes six themed Concurrent Streams:

1. Aboriginal Health: improved outcomes – respectful partnerships
This stream will showcase programs and initiatives that are working towards meeting the health needs of Aboriginal people in rural and remote communities.

2. Innovation in health care: the lived experience
This stream will demonstrate innovation, resourcefulness and creativity in design. The presentations will:
- describe the initiative
- outline the process of stakeholder engagement
- indicate how the initiative has been / could be embedded in the system
- outline the potential for it to be taken up by other health settings

3. Mental Health/ Drug and Alcohol: addressing the complexity
All sessions within this stream will focus on mental health and drug and alcohol related issues in rural communities.

4. Palliative/end of life care: meeting the need
These presentations will address aspects of/approaches to end of life care that assist in meeting the physical, emotional, spiritual or social needs of rural Australians.

5. Technology in healthcare: innovation in action
This stream will highlight the effective use of technology in health care, particularly in addressing the challenges of service delivery across rural and remote areas.

6. Integrated care and partnerships: rethinking relationships
Presentations will provide examples of initiatives and programs that have improved how rural health related services work together.

Below are the presentation summaries for the sessions held in each theme:
Please email for more information.

1. Aboriginal Health: improved outcomes – respectful partnerships

Session Title:
Integrated Aboriginal Chronic Care (IACC)
Speaker: Emma Walke, Manager, Aboriginal Health and Robert Monaghan, IACC Project Officer, North Coast Primary Health Network

Presentation Summary: A model of care was developed suitable for all organisations, which involves a central point to assess clients’ chronic care needs. Referrals are received through the usual mechanisms, forwarded to a central unit, clients are contacted, and their needs assessed using a consistent process which allows access to any/all services. A case lead is identified from the most suitable service and ongoing review of clients’ needs is assessed through regular case conferencing. This allows clients’ access to services that they need without being hindered by which program they are enrolled/referred into.

Session Title: Written by the mob for the mob: stroke education resources for the Gomeroi/Gamilaraay Aboriginal Community
Speaker: Rachel Peake and Mary-Anne Dieckman, Peel and Mehi Sector Stroke Service, Tamworth Rural Referral Hospital, HNE LHD

Presentation Summary: To contribute to Closing the Gap, the Gomeroi/Gamilaraay community members were assisted to develop culturally appropriate localised stroke resources (booklet/digital stories). The community then evaluated the processes used to develop stroke resources with Participatory Action Research. This project demonstrates an innovative approach to the development of health resources. Consequently, this resource has generated great pride within their community that has led to the development of further community developed health resources and education.

Session Title: Aboriginal chronic care in custody: a unique holistic care model linking custodial care from reception, custody, release and beyond
Speaker: Sonya Edenden, Registered Nurse and Michelle Wellington, Aboriginal Health Worker, Justice and Forensic Mental Health Network, South Coast Correctional Centre, Nowra

Presentation Summary: The Aboriginal Chronic Care program delivers prevention, chronic care management, education and discharge planning to indigenous patients with a chronic condition. The program is a unique program tailored to each patient’s individual chronic care needs whilst incorporating cultural appropriate practice and sensitivity. The program focuses around holistic discharging planning, linking each patient to appropriate community services, organising medications, substance abuse support and most importantly a chronic case manager to ensure compliance and follow up with multiple organisations in the community. The overall success that this program has achieved is attributed to the close working relationship and cohesiveness that the Aboriginal Chronic Care Clinician, Aboriginal Health Worker and Medical Officer possess as a united team. Each team member brings their own experience, knowledge, dedication and enthusiasm which directly benefits each indigenous patient and ultimately provides the best healthcare outcomes possible.

Session Title: The Journey: expressing the patient journey through art
Speaker: Samantha Lewis, Wendy Brown, Courtney Vaccari and Leonie James, Shoalhaven Cancer Care Centre, IS LHD

Presentation Summary: Wendy Brown, an Aboriginal patient who was receiving treatment for breastcancer, decided to paint her cancer journey in a beautiful Aboriginal artwork and donated this artwork to the centre with a beautiful plaque with an explanation of her cancer journey. All staff members of the Shoalhaven Cancer Care Centre then came together and decided on a set of Shared Values, which is a promise all staff members are making to the patients, family and friends. Wendy Brown then kindly painted these shared values through the means of an Aboriginal artwork along with a beautiful plaque. These artworks are now proudly displayed in the Shoalhaven Cancer Care Centre front foyer for all to view and read. This encourages all patients to express their feelings and emotions in any positive way they feel comfortable with, whether it be a painting, a journal, wood work, etc. New patients who are scared, emotional and unsure are now able to view the artworks and feel comfortable that the staff are going to give them the best quality care possible; and through Wendy’s Cancer Journey artwork, patients are able to relate to Wendy and her feelings and emotions she was going through at the time, which may put patients at ease and let them know they aren’t in this alone. The patient story is positively powerful and can be expressed in many different ways. Patients should be encouraged to express their journey as a way of helping them deal with their emotions in a positive outlet. This is also an amazing way of reaching the Aboriginal Community in regards to cancer treatments and education surrounding treatments.

Session Title: Every women every time: Moree integrated care antenatal patient journey
Speaker: Jennifer Gallagher, Project Manager, Moree Integrated Care Team, HNE LHD

Presentation Summary: Moree Integrated Care team is working in collaboration with many services to provide antenatal services to women in two isolated rural communities of Collarenebri and Mungindi. Geographic and structural boundaries have been set aside in the interests of delivering integrated, person-centred care.

Session Title: Mobile oral health centre – closing the gap
Speaker: Cassandra O’Connor, Senior Dental Assistant and Maria Pana, Oral Health Therapist, Dubbo, WNSW LHD

Presentation Summary: The Mobile Oral Health Centre achieves high participation by Aboriginal people in small rural communities. The highly visible semi-trailer clinic, funded under Closing the Gap, provides care to Aboriginal and non-Aboriginal patients. Through community engagement, 39% of appointments are attended by Aboriginal clients and their feedback is very positive.



2. Innovation in health care: the lived experience

Session Title: Real life transformation
Speaker: Brian Burke and Jocelyn Collie, Nurse Managers, Essentials of Care, Wagga Wagga, M LHD

Presentation Summary: The past twelve months has seen a new and invigorated approach to the Essentials of Care program within the Murrumbidgee Local Health District. A renewed focus, staff engagement and processes to support clinical staff have seen an increased uptake of initiatives focused on person centred care. We aim to share with you our approaches and outcomes.

Session Title: Local birthing services for rural women: adaptation of a rural New South Wales maternity service
Speaker: Margaret Rolfe, Biostatistician, University Centre for Rural Health North Coast, The University of Sydney

Presentation Summary: This study reports the transitioning of maternity services at a small rural hospital in NSW from an obstetrician and general practitioner-obstetrician (GPO) service to a caseload midwifery (MGP) model, and compares maternal characteristics, labour and delivery details, and neonatal outcomes.

Session Title: Good to go
Speaker: Karen Winkler, Nurse Manager, Casino Hospital Emergency Department, NNSW LHD

Presentation Summary: Multidisciplinary clinical staff explored ways to improve care to emergency department (ED) patients and ways to improve the referral process in order to minimise unnecessary re-presentations to Casino Hospital ED without compromising patient safety.

Session Title: An angio delay won't keep the doctor away
Speaker: Shirley Walker, Whole of Health Project Officer and Ryan Armstrong, NUM, The Tweed Hospital, NNSW LHD

Presentation Summary: Long delays for patients requiring interventional cardiology at a tertiary facility were identified due to patients needing to be transferred by the ambulance service. By redesigning a service that we already provided we were able to substantially reduce delays, reduce length of stay and significantly reduces costs associated with using the ambulance service.

Session Title: Translating Q-Fever prevention strategies into practice with general and hospital practitioners
Speaker: Jane Jelfs, John Turahui, Paul Corbin, Mid North Coast Public Health Unit, MNC LHD

Presentation Summary: Q-Fever is caused by a bacterium, Coxiella burnetii and can be spread from infected animals to humans. Despite the availability of a safe and effective vaccine, residents of the NSW north coast are 48 times more likely to be diagnosed with Q-Fever than residents in metropolitan Sydney, with a new case notified on average every week and nearly half of all notified cases hospitalised. Limited studies indicate that Q-Fever remains underdiagnosed and that multiple visits are made by patients to hospitals and medical centres before diagnosis. Educational sessions will target larger, rural regional medical practices and all hospitals across the Mid North Coast Local Health District as well as developing an on line e-health presentation. A Q-Fever HealthPathway will also be developed to raise awareness and skills of both GPs and hospital clinicians. A Q-Fever educational session was delivered to eleven medical practices representing a total of 46 general practitioners and 22 ancillary staff. The majority were unaware that animals other than cattle could transmit Q-Fever to humans and raised concerns about the skills required to undertake Q-Fever pre-vaccination screening and immunisation. Expanding the audience will provide evidence of the effectiveness of the provision of these targeted clinical education sessions and will have the potential to be translated across the entire NSW Health network.

Session Title: Rolling-group model for early years stuttering treatment: half the clinical time and twice the fun
Speaker: Nicole Rappell, Speech Pathologist, Byron Bay, NNSW LHD

Presentation Summary: Stuttering treatment for children proves problematic for speech pathologists due to monopolizing extensive clinical hours and potential inequity of service across our caseload. This community-based study demonstrates that an innovative rolling-group model is not only effective and perceived as viable but importantly requires approximately half the usual clinical hours.

3. Mental Health/ Drug and Alcohol: addressing the complexity

Session Title:
Psychoeducation for mental health inpatients
Speaker: Leah Sparke, Prue Kevans and Gabrielle Hansen, Pharmacy Department, Orange Health Service, WNSW LHD

Presentation Summary: Between 25-50% of psychiatric patients are non-compliant with their pharmacological treatment which is influenced by patient’s beliefs and feelings about medications and their illness. Poor health literacy in mental health drug and alcohol (MHDA) patients may also be a factor. Two interventions were implemented to provide patient-focused psychoeducation to MHDA inpatients, patient groups and consumer friendly medication information leaflets.

Session Title: Resolving homelessness in Goulburn Mental Health Inpatient Unit (Chisholm Ross Centre) through Community partnerships
Speaker: Jeby Jose and Melissa Keith, Social Workers, Goulburn Mental Health Unit, SNSW LHD

Presentation Summary: A partnership approach was used to address referral pathways for homeless mental health consumers in the Goulburn Mental Health Inpatient Unit. Quarterly consultation meetings occurred with housing partners including Housing NSW, Richmond Psychiatric Rehabilitation Australia (PRA) and specialist homeless services. Social Workers from the Mental Health Inpatient Unit attended local homelessness service forums. Outcomes included both short and long term accommodation options for complex mental health consumers.

Session Title: Mental health emergency transport: the lived experience in regional Australia
Speaker: Dr Joanne Bradbury, Southern Cross University, Gold Coast Campus

Presentation Summary: Police are frequently the first point of contact for people experiencing mental health challenges in the Australian community. Police contact is amplified in rural and remote regions, particularly after-hours, where mental health services are limited. This research reports on the lived experience of emergency transport from the perspective of those who have been transported under mental health legislation, carers, caseworkers, paramedics and police.

Session Title: A good family life: improving engagement with families that have experienced trauma and child protection involvement 
Speaker: Martina Rich, Senior Social Worker, and Anthony Madden, Psychologist - Keep them Safe - Whole of Family Team, Newcastle, HNE LHD

Presentation Summary: Families that come under the attention of child protection services often have extensive experiences of involvement with multiple agencies and long histories of minimal engagement or “non-compliance”. These experiences usually sit alongside extensive intergenerational trauma. The impact of this frequently elicits strong negative effects such as anger, grief and loss as well as overwhelming feelings of shame. This in turn can promote a defensive position that sabotages any subsequent therapeutic work designed to reduce risk of harm to the children.

Session Title: Yinaar Yarning: improving outcomes one woman at a time
Speaker: Jessica Morrison, Midwife, Aneata Hickey and Kelly Lawson, Aboriginal Health Workers, Aboriginal Maternal and Infant Health Service, Moree, HNE LHD

Presentation Summary: Our presentation will explore the journey women and their families go on when their pregnancy is complicated by opiate use. More specifically we will be looking at the challenges faced by these women living in rural NSW and strategies and partnerships the Moree Aboriginal Maternal and Infant Health Service has developed.

Session Title: Exploring the treatment of eating disorders in rural health settings: towards an effective model of service delivery
Speaker: Deanna Bowen, Doctor of Social Work Candidate, Charles Sturt University, Wagga Wagga

Presentation Summary: The current study is conducting research on Eating Disorder (ED) service delivery in rural Australian health settings.  Using this knowledge, combined with knowledge of successful ED treatments in metropolitan settings, an effective model for service delivery in rural settings will be developed.  The research is currently in the data analysis stage, and therefore existing literature in the subject area and preliminary results of the research will be explored.

4. Palliative/end of life care: meeting the need

Session Title:
EMU: the End-of-life Minimum Universal clinical quality and outcomes reporting tool
Speaker: Inca Hutchinson, Junior Medical Officer, IS LHD, Emily Saurman, Research Fellow, Broken Hill UDRH, The University of Sydney and Sarah Wenham, Specialist Palliative Care Physician, FW LHD

Presentation Summary: There is little evidence for the quality and outcomes of care for those patients that receive palliative care from non-specialist providers. EMU is designed for universal application and embedment within current clinical documentation to demonstrate a quality palliative approach to care for all patients, from any provider, in any setting.

Session Title: Mind the gap: addressing the mental health treatment gap in advanced chronic and terminal illness
Speaker: Julianne Whyte, Research Fellow - Listen, Acknowledge Respond Project, Corowa

Presentation Summary: Mental illness in the terminally ill is underdiagnosed and undertreated – it’s a “Treatment Gap”. Responding to the complex mental health needs of these people requires specialist skills and knowledge. Trans-disciplinary teams that routinely screen and treat mental illness, as opposed to traditional multi-disciplinary teams, are the answer for rural communities.

Session Title: Transforming the palliative approach in rural residential aged care facilities
Speaker: Rebecca Dalwood, Clinical Nurse Consultant and Sarah Wenham, Specialist Palliative Care Physician, Broken Hill Health Service, FW LHD

Presentation Summary: The method and outcomes of a Decision Assist funded project will be presented to demonstrate  the sustainable improvements in palliative and end-of-life care provision that can be achieved in rural residential aged care facilities through embedding a systematic clinical approach, education, mentoring and enhancing linkages with Specialist Palliative Care services.

Session Title: The Supportive and Palliative Care Indicators Tool (SPICT): can it be used to trigger transition to a palliative approach and improve care for patients with a non-malignant life-limiting disease in a remote care setting?
Speaker: Jeffery Duncan, Medical Student, University of Wollongong, Sarah Wenham, Specialist Palliative Care Physician, FW LHD, and Emily Saurman, Research Fellow, Broken Hill UDRH, The University of Sydney

Presentation Summary: The results of a retrospective cross-sectional case note audit will be presented to demonstrate how the validated Supportive and Palliative Care Indicators Tool (SPICT) can effectively identify patients with non-malignant life-limiting disease in a remote care setting, facilitate the transition to a palliative approach and improve end-of-life care provision.

Session Title: Experiences of informal caregivers in managing the care and the death in the rural palliative care home setting
Speaker: Caroline Short, Clinical Nurse Consultant Palliative Care, HNE LHD

Presentation Summary: This presentation reports the qualitative research results regarding the expanded role of caregivers in administering medications, managing symptoms and the death in the rural palliative care home setting. Face to face interviews were conducted to investigate the lived experience of caregivers in the palliative care home setting who participated in the Cessnock Kurri Kurri Singleton Palliative Care’s (CKKSPC) program ‘Improving Medication Safety in the Rural Palliative Care Home Setting’. The CKKSPC claim that this program provides a safe, legal and ethical framework supporting caregivers in the management of care in the last days of life, and death in the home setting. Concerns regarding this program were identified, discussed and debated through the palliative care clinical leadership stream with most notable concern being for caregiver well-being for the future. The research was conducted to improve understanding of caregiver needs and challenges; caregiver capacity and wellbeing; impact on bereavement; and the possibility of an emerging culture around care of the dying and death in the community. In consideration that the medication safety program was designed for use in rural areas, enabling a home death, the results of this study has the potential to contribute to future palliative care model development across Australia.

Session Title: A mapping study of palliative and end of life care in Far West NSW
Speaker: Emily Saurman, Research Fellow, Broken Hill UDRH, The University of Sydney

Presentation Summary: A new integrated needs-based model of care was developed in the FW LHD to support the provision of a quality and consistent palliative approach to care for all patients regardless of their age, diagnosis, provider, or setting. This mapping study describes the process of care provision and will inform model implementation.

5. Technology in healthcare: innovation in action

Session Title: Online learning - does it click with rural nurses?
Speaker: Kim Riley, Clinical Nurse Consultant, Scone, HNE LHD

Presentation Summary: For many rural nurses, continuing professional development opportunities can be limited. Online learning is seen as the way to overcome many of the identified barriers (cost, distance, staffing) but how well are rural nurses’ needs being met by the online learning environment? Research undertaken in 2013 provides an insight into the issues that increase or decrease engagement and satisfaction with online learning for one group of rural nurses.

Session Title: Rural Innovations Changing Healthcare (RICH): a virtual forum
Speaker: Jenny Preece, Rural Health Network Manager, NSW Agency for Clinical Innovation

Presentation Summary: A needs assessment conducted by the NSW Agency for Clinical Innovation (ACI) Rural Health Network recognised the need for local health districts and other rural health service providers to share projects, resources and lessons that inspire health improvement across rural NSW. It also showed that geographically-isolated clinicians needed a better way of accessing CPD opportunities. It uses a blend of Telehealth, live webstreaming and social media technologies to connect 18 rural health sites across NSW for a day showcasing health innovations and sharing clinical and workforce redesign projects that improve patient care. On average over the last four years, the RICH Forum is attended by 200 delegates across a range of health services and with the addition of live webstreaming for Organisations external to NSW Health in 2016; Western Australia, South Australia and Queensland Health staff joined the RICH Forum, spreading the value of the forum nationally. The RICH Forum is a model that can be replicated across many sectors where geographic and professional isolation are factors that impact recruitment, retention and skills acquisition.

Session Title: Virtual health service
Speaker: Sharyn Cowie, Telehealth Manager, Broken Hill, FWNSW and WNSW LHD

Presentation Summary: Western/Far Western NSW Local Health Districts have developed a 2015-18 Telehealth Strategy. In the District’s Strategic Health Services Plan, Telehealth is seen as a primary enabler to support delivery of care for the health priorities. The Telehealth vision is to build a "Telehealth Platform" that will support truly integrated service models and build effective provider networks with Primary Care, Aboriginal Medical Services and our partners to improve consumer experience and reduce the costs of delivery services.

Session Title: Rural young people’s healthcare journeys in the digital age
Speaker: Fiona Robards, Department of General Practice, The University of Sydney, Westmead

Presentation Summary: Many young people face barriers accessing healthcare, particularly in rural areas, leading to poorer health outcomes. The Access 3 study, funded by the Office of Kids and Families to shape the next NSW Youth Health Policy will describe the experiences of marginalised young navigating the health system in NSW.

Session Title: Using telehealth to support students with language and phonological awareness needs
Speaker: Ellen Stolp, Jessica McGrath and Louise Davies, Royal Far West, Sydney

Presentation Summary: Group therapy via telehealth is a successful intervention approach for targeting students’ expressive language and phonological awareness skills. Training school staff increases confidence and competence in identifying and supporting children with communication difficulties in the school context.

Session Title: Support my spine ASAP! A rural telehealth model of care for patients who have suffered a spinal fracture
Speaker: Ryan Gallagher, Senior Physiotherapist, Neurosciences, Newcastle, HNE LHD

Presentation Summary: A telehealth based model of care redesign to facilitate management of patients with spinal fractures deemed suitable for conservative management in a Thoracic Lumbar Sacral Orthosis (TLSO) to eliminate transport to metropolitan hospitals for management. Significant reductions in patient length of stay have occurred resulting in significant efficiency savings.

6. Integrated care and partnerships: rethinking relationships

Session Title:
Northern NSW integrated care
Speaker: Vicki Rose, Sharyn White and Dr Tony Lembke, North Coast Primary Health Network

Presentation Summary: Northern NSW Local Health District, North Coast Primary Health Network, local Aboriginal Medical Services and NSW Ambulance are partners in the North Coast Integrated Care Strategy, funded by NSW Health under the Planning and Innovation Fund. The partnership has been involved in conducting an Integrated Care Collaborative with the support of the Improvement Foundation. This quality improvement approach has been effective in engaging clinicians to test and adopt changes to provide better integrated care.

Session Title: The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) project: a collaborative approach to understanding and preventing unplanned hospital admissions for chronic conditions
Speaker: Jennifer Johnston, Research Fellow, University Centre for Rural Health North Coast, The University of Sydney

Presentation Summary: The identification and understanding of unplanned admissions for chronic conditions are critical issues for health service policy, design and delivery. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) is a collaborative project which aims to identify modifiable factors driving unplanned admissions for chronic conditions and to develop interventions to reduce such admissions.

Session Title: Pharmacists in regional hospital leading the way to improve patient safety in transitions of care
Speaker: Ged Hawthorn, Acting Deputy Director of Pharmacy, Orange Health Service, WNSW LHD

Presentation Summary: This project looked at improving the documentation of medications in the discharge summary and providing greater education to patients on their medicines on transfer of care. Fifty per cent of medication errors happen on transition of care and thirty per cent of these have the potential to do harm. By implementing a range of solutions, significant improvements were seen ensuring a safer and smoother transition from hospital to the primary care setting.

Session Title: Paramedic Connect – community health
Speaker: Haley Estreich, Station Officer, Coolah Ambulance Station, Ambulance Service of NSW

Presentation Summary: Paramedic Connect is a collaborative initiative between NSW Health and NSW Ambulance. Its goal is to increase paramedic engagement and increase access to health services in rural communities. It does this through the utilisation of paramedics to provide community education and heath activities in collaboration with local health professionals.

Session Title: Making it real: using research to improve autism diagnosis in a rural Ccmmunity
Speaker: Catherine Bourke, Social Worker, Mudgee, WNSW LHD

Presentation Summary: Mudgee Autism Working Party have a shared vision of improving the process of autism diagnosis in their rural community. Informed by recent research, they have collaborated across public, private and community agencies to improve local referral pathways and knowledge. They have achieved improvements with limited additional funding.

Session Title: Accessible renal care through a network
Speaker: Linda McCorriston, Clinical Nurse Consultant’ Renal and Cherie Puckett, Nurse Unit Manager Leadership and Development, Queanbeyan, SNSW LHD

Presentation Summary: Southern NSW Local Health District and the Canberra Hospital executives collaboratively recognised the need to develop a strong working partnership, to deliver safe and equitable services to renal patients in ACT and SNSW LHD. The establishment of a Renal Network has created strong governance, staff capability, improved collaboration and continuity of care for patients.