NACCHO Aboriginal Health #Stroke #Heart #ClosetheGap Research : @ANUmedia New recommendations for cardiovascular disease risk assessment and management in Aboriginal and Torres Strait Islander adults aged under 35 years

This is a great step in reducing the burden of cardiovascular disease in Aboriginal and Torres Strait Islander people.”

Our people have greater rates of heart disease and screening from a younger age will contribute to longer healthier lives. NACCHO encourages all Aboriginal Community Controlled Health Organisations to implement these new guidelines in their practices.

The Chair of the National Aboriginal Community Controlled Health Organisation, Donnell Mills

The updated recommendations are for Aboriginal and Torres Strait Islander individuals to receive:

  • Combined early screening for diabetes, chronic kidney disease and other cardiovascular (CVD) risk factors from the age of 18 years at latest;
  • Assessment of absolute CVD risk using an Australian CVD risk calculator from the age of 30 years at the latest.

New recommendations for CVD risk assessment and management were published today in the Medical Journal of Australia.

See all Close the gap articles in the MJA Journal HERE

The recommendations were endorsed by the National Aboriginal Community Controlled Health Organisation, Royal Australian College of General Practitioners, Central Australian Rural Practitioners Association and the Australian Chronic Disease Prevention Alliance, led by the Heart Foundation.

The approach to early screening was developed in partnership with the Australian National University’s Aboriginal Reference Group (Thiitu Tharrmay) and other Aboriginal and Torres Strait Islander leaders in CVD prevention.

Take home messages

  1. Most heart attacks and strokes can be prevented, and in the last 20 years, the rate of deaths from CVD in Aboriginal and Torres Strait Islanders peoples has almost halved.
  2. High risk of cardiovascular disease begins early among Aboriginal and Torres Strait Islander peoples and is mainly due to diabetes and renal diseaseIt is recommended that there should be:
    1. Combined early screening for diabetes, chronic kidney disease and cardiovascular disease risk factors from the age of 18 years. This should include assessment of blood glucose level or glycated haemoglobin, estimated glomerular filtration rate, serum lipids, urine albumin to creatinine ratio, and other risk factors such as blood pressure, history of familial hypercholesterolaemia, and smoking status.
    2. Assessment of absolute CVD risk using an Australian CVD risk calculator from the age of 30 years. Outside of Communicare, the best CVD risk calculator to use is auscvdrisk.com.au/risk-calculator/
  3. What you can do: Assessment of CVD risk as part of a health check. The most important part of this check-up is working with your doctor to manage your risk factors to improve your heart health and help you live a healthier, longer life.

” Around 80% of heart attacks and strokes can be prevented with optimal care. Cardiovascular disease (CVD) remains a leading contributor to Aboriginal and Torres Strait Islander mortality despite a 40% decrease in deaths in the past two decades and significant decreases in smoking prevalence.

High risk of CVD begins early among Aboriginal and Torres Strait Islander peoples, mainly in people with diabetes and/or renal disease.

Our program of work, funded by the Australian Government Department of Health, is focused on improving prevention of cardiovascular disease for Aboriginal and Torres Strait Islander peoples through:

  • Revision and alignment of clinical practice guidelines ( see part 2 below )
  • Revision and enhanced Medicare Benefits Schedule items for prevention of chronic disease
  • Workforce education and engagement

See ANU program website

Read over 80 Aboriginal Heart health articles published by NACCHO over past 8 Years 

Read over 100 Aboriginal and Stroke articles published by NACCHO over past 8 years 

To combat high risk of heart attack and strokes, Aboriginal and Torres Strait Islander people should have had their heart checked by a GP by age 18 at the latest, according to new national recommendations.

As part of a regular health check with a GP, the recommendations launched today have moved the age Indigenous people should get screened for Cardiovascular Disease (CVD) down from 35 to 18.

Based on research from The Australian National University (ANU), a host of health professionals and Aboriginal and Torres Strait Islander CVD experts have agreed on the latest efforts to continue closing the gap on early heart attacks among Indigenous Australians.

“We have seen great improvements in CVD prevention and this was highlighted in this year’s Closing the Gap speech,” said ANU lead researcher, Dr Jason Agostino.

“However, it remains a leading cause of preventable death in Aboriginal and Torres Strait Islander peoples. We need to be doing all we can to prevent it.

“Just about every Aboriginal person I know has a family member or a community member who’s died young from a heart attack or stroke. We need to change that.

“We can improve things by picking up conditions like diabetes and kidney disease early and starting conversations about treatment.”

In the last 20 years, the rate of deaths from heart attacks and strokes among Aboriginal and Torres Strait Islanders peoples have almost halved.

However, three out of four Aboriginal and Torres Strait Islander adults under 35 have at least one CVD risk factor.

Rheumatic Heart Disease Australia’s Senior Cultural Advisor, Vicki Wade, is a 62-year-old cardiac nurse who has heart disease. She said it is important to remind community and health workers about the risks of CVD.

“Although rates have improved, the statistics are frightening. We have generations of Aboriginal people who are not seeing their grandchildren growing up because of heart attack and stroke,” Mrs Wade said.

“This is a chance for local solutions, community engagement and health workers to be educated.”

Fellow author, Heart Foundation Chief Medical Adviser, cardiologist Professor Garry Jennings, said: “Evidence shows that Indigenous Australians have CVD risk factors like diabetes, high blood pressure and high cholesterol at a young age. We need to prevent, identify and treat these.”

Aboriginal and Torres Strait Islanders should now undergo CVD risk factor screening from 18 years, at the latest, and use Australian CVD risk calculators from age 30.

“It’s easy to do. The assessment involves the normal parts of a health check with a blood and urine test. It is quick and can be done by your local GP,” said Dr Agostino.

“For the vast majority it will be bulk-billed and free.”

The move is backed by the Royal Australian College of General Practitioners, the National Aboriginal Community Controlled Health Organisation, The Australian Chronic Disease Prevention Alliance, and the Editorial Committee for Remote Primary Health Care Manuals.

“This is about getting consistency everywhere. This is what Aboriginal and Torres Strait Islander leaders and the evidence is telling us we should do,” Dr Agostino said.

“Many GPs are already screening as early as 15 but some GPs and nurses don’t know about the need to test early.

“This is about doing what we can to pick up risk factors early and close the gap on early heart attacks and strokes.”

RACGP Aboriginal and Torres Strait Islander Health Chair, Associate Professor Peter O’Mara welcomed the new recommendations, saying they could make a real difference in improving health outcomes for Aboriginal and Torres Strait Islander peoples.

“We cannot hope to close the gap without making evidence-based changes – these new recommendations are a positive step to improving early detection and treatment of CVD.

“The RACGP has over 40,000 members, including 10,000 members in the faculty of Aboriginal and Torres Strait Islander health. While many GPs know about early screening not all do. These new recommendations will help spread awareness among GPs, improving access to early screening and quality care.”

Under the new recommendations, young adults with type 2 diabetes and microalbuminuria, kidney disease, and very high blood pressure or high cholesterol will be identified as high- risk of CVD.

Want more information and resources?

A team at ANU is developing a toolkit on risk communication in CVD: Healing Heart Communities. Designed as a resource for all clinical staff in primary care, it aims to support conversations about CVD risk.

During development, the team has consulted the Australian National University’s Aboriginal Reference Group (Thiitu Tharrmay) and partnered with We are Saltwater People, an Indigenous-owned graphic design company based in QLD to create original artwork, design and layout.

You can find these initial resources here: [

NACCHO Aboriginal Mental Health News : Download @MenziesResearch and @orygen_aus A practice guide for ‘Improving the Social and Emotional Wellbeing of Young Aboriginal and Torres Strait Islander people

 ” Menzies Research and Orygen Australia have developed & just published a practice guide for ‘Improving the Social and Emotional Wellbeing of Young Aboriginal and Torres Strait Islander people’.

Little is known about how best to practically meet the social and emotional wellbeing (SEWB) needs of young Aboriginal and Torres Strait Islander people, particularly those with severe and complex mental health needs.

Yet, there is an urgent need for health programs and services to be more responsive to the mental health needs of this population.

Based on recent statistics, 67 per cent of Aboriginal and Torres Strait Islander young people aged 4-14 years have experienced one or more of the following stressors:

  • death of family/friend;
  • being scared or upset by an argument or someone’s behaviour; and
  • keeping up with school work. “

Download the Report HERE ( See PDF for all research references )

orygen-Practice-Guide-to-improve-the-social-and-emotional-wellbeing-of-young-Aboriginal-and-Torres-Strait-Islander-people

Read over 250 Aboriginal Mental Health articles published by NACCHO over past 8 Years

It is well documented that there are:

  • high rates of psychological distress, mental health conditions, and suicide noted among Aboriginal and Torres Strait Islander young people when compared to non-Aboriginal young people;
  • a lack of evidence-based and culturally informed resources to educate and assist health professionals to work with this population; and
  • notable gaps between knowledge and practice, which limits opportunities to improve the SEWB of young Aboriginal and Torres Strait Islander people.

This promising practice guide draws on an emerging, yet disparate, evidence-base about promising practices aimed at improving the SEWB of Aboriginal and Torres Strait Islander young people. It aims to support service providers, commissioners, and policy-makers to adopt strengths-based, equitable and culturally responsive approaches that better meet the SEWB needs of this high-risk population.

Rationale

The Australian Government appointed Orygen to provide Australia’s 31 Primary Health Networks (PHNs) with expert leadership and support in commissioning youth mental health initiatives.

Orygen has subsequently commissioned Menzies School of Health Research to identify and document promising practice service approaches in improving SEWB among young Aboriginal and Torres Strait Islander people with severe and complex mental health needs. This promising practice guide is an output of that work.

What do we know about the social and emotional wellbeing of Aboriginal and Torres Strait Islander young people?

It is recognised that Aboriginal and Torres Strait Islander societies provided the optimal condition for their community members’ mental health and social and emotional wellbeing before European settlement.

However, the Australian Psychological Society has acknowledged that these optimal conditions have been continuously eroded through colonisation in parallel with an increase in mental health concerns.2

There is clear evidence about the disproportionate burden of SEWB and mental health concerns experienced among Aboriginal and Torres Strait Islander people. The key contributors to the disease burden among Aboriginal and Torres Strait Islander young people aged 10-24 years are:1 suicide and self-inflicted injuries (13 per cent), anxiety disorder (eight per cent) and alcohol use disorders (seven per cent).3

Based on recent statistics, 67 per cent of Aboriginal and Torres Strait Islander young people aged 4-14 years have experienced one or more of the following stressors:

  • death of family/friend;
  • being scared or upset by an argument or someone’s behaviour; and
  • keeping up with school work.4

The stressors have a cumulative impact as these children transition into adolescence and early adulthood. Another study has shown that Aboriginal and Torres Strait Islander young people are at higher risk of emotional and behavioural difficulties.5

This is linked to major life stress events such as family dysfunction; being in the care of a sole parent or other carers; having lived in a lot of different homes; being subjected to racism; physical ill-health of young people and/or carers; carer access to mental health services; and substance use disorders. These factors are all closely intertwined.

Relevant national frameworks and action plans

The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (2015) was developed by the Australian Government Department of Health in close consultation with the National Health Leadership Forum. It has a strong emphasis on a whole-of-government approach to addressing the key priorities identified throughout the plan.

The overarching vision is to ensure that the strategies and actions of the plan respond to the health and wellbeing needs of Aboriginal and Torres Strait Islander people across their life course. This includes a focus on young people.6

The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023 provides more specific direction by highlighting the importance of preventive actions that focus on children and young people.7 This includes:

  • strengthening the foundation;
  • promoting wellness;
  • building capacity and resilience in people and groups at risk;
  • provide care for people who are mildly or moderately ill; and
  • care for people living with severe mental illness.

In addition, the National Action Plan for the Health of Children and Young People 2020-2030 identifies building health equity, including principles of proportionate universalism, as a key action area and identifies Aboriginal and Torres Strait Islander children and young people as a priority population.8

Social and emotional wellbeing frameworks relating to Aboriginal and Torres Strait Islander people

 

Over the past decades, multiple frameworks have been developed to support the SEWB of Aboriginal and Torres Strait Islander people in Australia.4-8 These have identified some common elements, domains, principles, action areas and methods.7, 9-12

One of the most comprehensive frameworks is the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023, which has a foundation of development over many years.13

It has nine guiding principles:

  1. Health as a holistic concept: Aboriginal and Torres Strait Islander health is viewed in a holistic context that encompasses mental health and physical, cultural and spiritual health. Land is central to wellbeing. Crucially, it must be understood that while the harmony of these interrelations is disrupted, Aboriginal and Torres Strait Islander ill-health will persist.
  2. The right to self-determination: Self-determination is central to the provision of Aboriginal and Torres Strait Islander health services and considered a fundamental human right.
  3. The need for cultural understanding: Culturally valid understandings must shape the provision of services and must guide assessment, care and management of Aboriginal and Torres Strait Islander peoples’ health problems generally and mental health concerns more specifically. This necessitates a culturally safe and responsive approach through health program and service delivery.
  4. The impact of history in trauma and loss: It must be recognised that the experiences of trauma and loss, a direct result of colonialism, are an outcome of the disruption to cultural wellbeing. Trauma and loss of this magnitude continue to have intergenerational impacts.
  5. Recognition of human rights: The human rights of Aboriginal and Torres Strait Islander peoples must be recognised and respected. Failure to respect these human rights constitutes continuous disruption to mental health (in contrast to mental illness/ill health). Human rights specifically relevant to mental illness must be addressed.
  6. The impact of racism and stigma: Racism, stigma, environmental adversity and social disadvantage constitute ongoing stressors and have negative impacts on Aboriginal and Torres Strait Islander peoples’ mental health and wellbeing.
  7. Recognition of the centrality of kinship: The centrality of Aboriginal and Torres Strait Islander family and kinship must be recognised as well as the broader concepts of family and the bonds of reciprocal affection, responsibility and sharing.
  8. Recognition of cultural diversity: There is no single Aboriginal or Torres Strait Islander culture or group, but numerous groupings, languages, kinship systems and tribes. Furthermore, Aboriginal and Torres Strait Islander people live in a range of urban, rural or remote settings where expressions of culture and identity may differ.
  9. Recognition of Aboriginal strengths: Aboriginal and Torres Strait Islander people have great strengths, creativity and endurance and a deep understanding of the relationships between human beings and their environment.13

While the principles outlined above are not specific to young Aboriginal and Torres Strait Islander people, they are considered to be appropriate within the context of adopting a holistic life-course approach.

What’s happening in practice?

This promising practice guide attempts to collate disparate strands of evidence that relate to enhancing youth mental health; improving Aboriginal and Torres Strait Islander SEWB; and strategies for addressing severe and complex mental health needs.

It has been well documented that there are significant limitations in the evaluation of Aboriginal and Torres Strait Islander health programs and services across Australia.22-24 The Australian Governments’ Productivity Commission Inquiry into

Mental Health and the Lowitja Institute are, at the time of producing this document, looking at ways to strengthen work in this space.24, 25

In the absence of high-quality evaluation reports, the term ‘promising practice’ is used throughout this guide.

This is consistent with the terminology used by the Australian Psychological Society through its project about SEWB and mental health services in Australia (http://www.sewbmh.org.au/).

It adopts a strengths-based approach26 which acknowledges and celebrates efforts made to advance work in this space in the absence of strong practice-based evidence.

This is achieved through the presentation of five active case studies.

These reflect organizational, systems and practice focused service model examples. The principles included in the National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing 2017-2023 have been mapped against each case study to illustrate how these privilege Aboriginal and Torres Strait Islander ways of knowing, doing and being.

Each case study includes generic background information to provide important contextual information; key messages or lessons learned, and reflections from staff involved in the project.

They have been developed in consultation with both the commissioning PHN and the service/organisation funded to develop and/or deliver the framework, program and service. Where possible, Aboriginal and Torres Strait Islander stakeholders were consulted during the development of the case studies.

Need help ?

Contact your nearest ACCHO or

If the situation is an emergency please call 000
If you wish to speak to someone immediately who can help call:

Kids Help Line

1800 55 1800
www.kidshelpline.com.au

Lifeline Australia

13 11 14
www.lifeline.org.au

NACCHO Aboriginal Health #AODConnect Resources Alert : Download an app to improve access to #alcohol and other #drugs AOD service information for Aboriginal and Torres Strait Islander communities

The AODconnect app has been developed by the Australian Indigenous HealthInfoNet Alcohol and Other Drugs Knowledge Centre to help alcohol and other drug (AOD) workers, community members and health professionals working in the AOD sector to locate culturally appropriate services.

The app aims to support efforts to reduce harmful substance use among Aboriginal and Torres Strait Islander people.

Read over 200 Aboriginal Health Alcohol and other Drugs articles published by NACCHO over past 8 years 

Aboriginal and Torres Strait Islander people are increasingly using online platforms to share and access information about different health topics.

The ownership and use of mobile phones in rural and remote Aboriginal and Torres Strait Islander communities is widespread and increasing, making apps a viable way to provide people living in these regions with access to health information.

AODconnect provides an Australia-wide directory of over 270 Aboriginal and Torres Strait Islander AOD treatment services.

It delivers a portable way to easily access information about service providers such as contact details and program descriptions, helping to facilitate initial contact and referral.

App

Once the app has been downloaded, users can search for AOD services even when their internet connection is unstable or not available.

This is especially useful in rural and remote areas of Australia where the Internet coverage is not always extensive or reliable.

The app enables users to search for services by state, territory, region and postcode via either an interactive map of Australia or by alphabetical listing.

Services can be filtered by the type of treatment they provide: counselling and referral, harm reduction and support groups, outreach, mobile patrols and sobering up shelters, residential rehab, withdrawal management and young people.

The services listed on the app are also available through the Alcohol and Other Drugs Knowledge Centre website.

The app is free to download on both iOS and Android devices.

If you would like to have your service added to the app or would like more information about the AODconnect app, please contact the Alcohol and Other Drugs Knowledge Centre email: aodknowledgecentre@healthinfonet.org.au or Ph: (08) 9370 6336.

Alcohol and other drugs GP education program


NACCHO Aboriginal Health Resources Alert : Download @HealthInfoNet Overview of Aboriginal and Torres Strait Islander health status 2019 : Continuing to show important positive developments for our mob

In the Overview we strive to provide an accurate and informative summary of the current health and well-being of Aboriginal and Torres Strait Islander people.

In doing so, we want to acknowledge the importance of adopting a strengths-based approach, and to recognise the increasingly important area of data sovereignty.

To this end, we have reduced our reliance on comparative data in favour of exploring the broad context of the lived experience of Aboriginal and Torres Strait islander people and how this may impact their health journey “

HealthInfoNet Director, Professor Neil Drew

The Overview of Aboriginal and Torres Strait Islander health status (Overview) aims to provide a comprehensive summary of the most recent indicators of the health and current health status of Australia’s Aboriginal and Torres Strait Islander people.

Download HERE 

Overview+of+Aboriginal+and+Torres+Strait+Islander+health+status+2019

The annual Overview contains updated information across many health conditions.

It shows there has been a range of positive signs including a decrease in death rates, infant mortality rates and a decline in death rates from avoidable causes as well as a reduction in the proportion of Aboriginal and Torres Strait Islander people who smoke.

It has also been found that fewer mothers are smoking and drinking alcohol during pregnancy meaning that babies have a better start to life.

The initial sections of the Overview provide information about:

  • the context of Aboriginal and Torres Strait Islander health
  • social determinants including education, employment and income
  • the Aboriginal and Torres Strait Islander population
  • measures of population health status including births, mortality and hospitalisation.

The remaining sections are about selected health conditions and risk and protective factors that contribute to the overall health of Aboriginal and Torres Strait Islander people.

These sections include an introduction and evidence of the extent of the condition or risk/protective factor. Information is provided for state and territories and for demographics such as sex and age when it is available and appropriate.

The Overview is a resource relevant for the health workforce, students and others requiring access to up-to-date information about the health of Aboriginal and Torres Strait Islander people.

This year, the focus will be mainly on the Aboriginal and Torres Strait Islander data and presentation is within the framework of the strength based approach and data sovereignty (where information is available).

As a data driven organisation, the HealthInfoNet has a publicly declared commitment to working with Aboriginal and Torres Strait Islander leaders to advance our understanding of data sovereignty and governance consistent with the principles and aspirations of the Maiam nayri Wingara Data Sovereignty Collective (https://www.maiamnayriwingara.org).

As we have done in previous years, we continue our strong commitment to developing strengths based approaches to assessing and reporting the health of Aboriginal and Torres Strait Islander people and communities.

It is difficult to make comparisons between Aboriginal and Torres Strait Islander people and non- Indigenous Australian populations without consideration of the cultural and social contexts within which people live their lives.

As in past versions, we still provide information on the cultural context and social determinants for the Aboriginal and Torres Strait Islander population.

However, for the selected health topics and risk/protective factors we have removed many of the comparisons between the two populations and focused on the analysis of the Aboriginal and Torres Strait Islander data only.

In an attempt to respond to the challenge issued by Professor Craig Ritchie at the 2019 AIATSIS conference to say more about the ‘how’ and the ‘why’ not just the ‘what’ where comparisons are made and if there is evidence available, we have provided a brief explanation for the differences observed.

Accompanying the Overview is a set of PowerPoint slides designed to help lecturers and others provide up-to-date information.

  • In 2019, the estimated Australian Aboriginal and Torres Strait Islander population was 847,190.
  • In 2019, NSW had the highest number of Aboriginal and Torres Strait Islander people (the estimated population was 281,107 people, 33% of the total Aboriginal and Torres Strait Islander population).
  • In 2019, NT had the highest proportion of Aboriginal and Torres Strait Islander people in its population, with 32% of the NT population identifying as Aboriginal and/or Torres Strait Islander.
  • In 2016, around 37% of Aboriginal and Torres Strait Islander people lived in major cities.
  • The Aboriginal and Torres Strait Islander population is much younger than the non-Indigenous population.

Download the PowerPoint HERE

Overview+of+Aboriginal+and+Torres+Strait+Islander+health+status+2019_+key+facts

NACCHO Aboriginal Health @DeadlyChoices News : The health importance of the #Indigenous mens and womens Rugby League #NRLAllStars : Plus both #Maori sides

 “ The game itself should be once again an exciting, fast-paced battle with an emphasis on attacking footy, which highlights the natural ability of the Indigenous and Maori talent.

At the end of the day, though, it doesn’t necessarily matter who wins.

Both sides will give it their all, but the immense respect that will be shown by the two cultures is what makes it worthwhile.

The coming together of Maori and First Nations Australia and the positivity that will be taken into the communities in the lead-up to game is a reason why it’s an important date on the calendar.

I’ll be tuning in on Saturday wearing my Deadly Choice Indigenous jersey, taking a moment to be thankful to the medical services that have helped me with my health.

I’ll take a moment to think about my great grandmother, an Indigenous elder that raised me as a child when nobody else would. I’ll think about my roots to Wiradjuri and my family and elders that have paved the way for me to be where I am now.

It’s more than a pre-season trial game for me. It’s a game that pays respect to a part of me that might seem little to some, but is a big part of my identity.” 

Jaydem Martin: Whose great grandmother Aunty Joyce Williams has contributed a lot to Aboriginal Health, she’s a Wiradjuri elder and was the founder of the Wellington Aboriginal Health Service in NSW.

Originally published in ROAR

Wiray Ngiyang Wiray Mayiny.” That’s the Wiradjuri translation of “no language, no people”.

This Saturday at Cbus Super Stadium on the Gold Coast, the NRL will feature another edition of the All Stars match when the Indigenous All Stars take on the Maori All Stars, returning to the ground where the modern concept began in 2010.

It’s the second year the two teams will be competing against each other, although they’ve met at various times in the past under different formats, with the Maori All Stars looking for revenge after losing to the Indigenous side last year in Melbourne 34-14.

Each year, unfortunately, a lot of people get caught up in the politics and debate of issues that the All Stars game bring up, but for those that think it’s nothing but a glorified trial game, it’s a lot more than that.

I was raised by my great grandmother, a Wiradjuri elder and Aboriginal activist, and grew up in Wellington, New South Wales, a town with a rich Indigenous history and a strong connection to the Wiradjuri nation.

What the All Stars game represents to me is a showcase of that tribe and the many different countries that make up Aboriginal Australia.

 

It’s an opportunity to celebrate the culture, the land, the language, the diversity of the traditional custodians, while also promoting positive initiatives such as Deadly Choices.

The Indigenous All Stars is a continuation of a legacy that dates back to 1973 when the first Australian Aboriginal team formed and won seven of nine matches in ten days, but it goes back even before that with the long history of the Redfern All Blacks.

Read about the Indigenous All Stars Team of the decade HERE

Wearing the Indigenous jersey is more than wearing a strip for a modern concept, it’s wearing a symbol of pride and acknowledging the history that Aboriginal men and women have contributed to rugby league throughout the decades.

It’s also representing one of the oldest continuous cultures.

NACCHO #WeStandwithQuadenBayles #saynotobullying

It’s celebrating the greats such as Arthur Beetson and Johnathan Thurston, players like Matty Bowen, John ‘Chicka’ Ferguson, David Peachey and Preston Campbell, the man responsible for the revival of the side, among many more. It’s also showing appreciation to the lesser known names.

Those that have dedicated their lives to country rugby league, like my great uncle, who was the chairman of the Wellington Cowboys up until his death.

It’s a thank you to all in administration that go out of their way to make the Koori Knockout and the Murri Carnival a success.

 

It’s a thank you to the nurses, the doctors and everyone involved in the Aboriginal medical centres that continue to work on improving the overall health of our people.

Most importantly it’s a game of hope.

For some of the players in the line-up this Saturday, their paths in life could’ve gone very differently.

Rugby league gave them a way to escape the negativity that can come from small town Australia and because of that, these players have become role models and examples to other Indigenous kids that aspire to play in the NRL.

I remember myself being a kid in Wellington with the dream of being like Preston Campbell, but the dream seemed too impossible, something I could never achieve.

Now there are kids growing up in the same town, and despite the issues that plague it, there’s a real sense of hope because they’ve seen people like Blake Ferguson, Brent Naden and Kotoni Staggs set their minds towards a goal and work hard to achieve it. They prove that the dream is possible.

Many people in Wellington will be tuning in and cheering on their hometown hero, Blake Ferguson, but also Tyrone Peachey, Josh Addo-Carr and Jack Wighton, three men that have strong ties to the town.

The game itself should be once again an exciting, fast-paced battle with an emphasis on attacking footy, which highlights the natural ability of the Indigenous and Maori talent.

At the end of the day, though, it doesn’t necessarily matter who wins. Both sides will give it their all, but the immense respect that will be shown by the two cultures is what makes it worthwhile. The coming together of Maori and First Nations Australia and the positivity that will be taken into the communities in the lead-up to game is a reason why it’s an important date on the calendar.

I’ll be tuning in on Saturday wearing my Deadly Choice Indigenous jersey, taking a moment to be thankful to the medical services that have helped me with my health.

I’ll take a moment to think about my great grandmother, an Indigenous elder that raised me as a child when nobody else would. I’ll think about my roots to Wiradjuri and my family and elders that have paved the way for me to be where I am now.

It’s more than a pre-season trial game for me. It’s a game that pays respect to a part of me that might seem little to some, but is a big part of my identity.

NACCHO Aboriginal Health and #Diabetes: This health professional survey is designed to assist Dr Michael Mosley and Ray Kelly with a 3 part SBS series Australia’s Health Revolution.

” Australia’s Health Revolution is a new three-part documentary series for SBS TV that’ll be hosted by popular UK presenter and journalist Dr Michael Mosley and Australian Indigenous diabetes educator and exercise physiologist, Ray Kelly.

The series will feature people all over Australia, from all backgrounds aged between 18 and 70 who have been diagnosed with diabetes or pre-diabetes and selected to be  part of a 12 week program, following a very low energy diet designed to achieve fast weight loss and help stabilise blood sugar levels.

The documentary will explore the big picture of type 2 diabetes in Australia, and the exciting new science behind diet and lifestyle programs that are reversing type 2 diabetes – previously considered incurable.”

Hear interview with Ray Kelly

We can turn blood sugar levels within seven days. It is really a matter of days and weeks to really transform someone form going toward the massive complications that come with type 2 diabetes and heart disease and turning them to becoming much healthier,”

Ray Kelly has been running a health program across Australia around the same principles as Dr Michal Mosley in the UK with great success covering some of the toughest areas and working closely with our ACCHO’s /Aboriginal Medical Services (AMS).

Read over 160 Aboriginal Health and Diabetes articles published by NACCHO over past 8 years 

How can you be involved ? Complete this diabetes survey.

 ” This GENERAL POPULATION and HEALTH PROFESSIONAL SURVEY designed to help inform some of the themes in the series.

The survey has been devised with help from The Charles Perkins Centre (Sydney Uni). The aim of the survey is to get an understanding of the experience of certain health conditions, including type 2 diabetes, from the perspective of (i) Australians and (ii) specifically, health professional’s (those involved in diabetes care and prevention as well as those who aren’t ).

Complete the survey HERE 

What we’ve known for many years is that type 2 diabetes is both preventable and reversible.

While the solution followed in the series is pretty simple-short term calorie restriction and using fresh, wholefoods as ‘medicine’- presenters want to highlight that low calorie diet programs aren’t routinely offered by most GPs or funded by Medicare.

Ray Kelly says that the TV series cannot come soon enough as Type 2 Diabetes is the fastest growing condition in the Western world yet it is both preventable and reversible.

“What we’ve known for many years is that type 2 diabetes is both preventable and reversible.”

Across 3 episodes, Ray Kelly and Dr Mosley will also shed a light on confronting health disparities and complexities of diabetes risk and prevalence in Australia.

At times they’ll explore confronting issues asking why diabetes death and hospitalisation rates are twice as high in remote areas than in major cities and why Australians are losing a staggering 4400 limbs to diabetes-related amputations every year.

Ray Kelly encouraged families and individual from all backgrounds, especially of Indigenous ancestry, to participate in the program.

.

 

Aboriginal Heath News : NACCHO supports #OchreRibbonWeek #saveFVPLS: 12th – 19th February and call for action to end the violence against Aboriginal and Torres Strait Islander people – particularly our women and children.

 

” This week is Ochre Ribbon Week. It’s a week to raise awareness of the devastating impacts of family violence against Aboriginal and Torres Strait Islander communities and call for action to end the violence against Aboriginal and Torres Strait Islander people – particularly our women and children.

Violence against Aboriginal and Torres Strait Islander women is a national emergency. Aboriginal and Torres Strait Islander women are 34 times more likely to be hospitalised because of family violence and 10 times more likely to die from a violent assault than other women.

Every single Aboriginal and Torres Strait Islander man, woman and child deserves to live a life free of violence and fear, and thrive in culture and identity. ‘

The National Convenor of the Forum is Antoinette Braybrook (CEO, FVPLS Victoria), and the Deputy Convenor is Phynea Clarke (CEO, CAAFLU).

 

Prevention is the key to ensuring safety for our children and mothers, keeping families connected and strong in culture. The holistic, wrap-around response that FVPLSs provide is essential to ending family violence against Aboriginal and Torres Strait Islander women and their children.

The goal of the Forum is to work in collaboration across Family Violence Prevention Legal Services (FVPLSs) and increase access to justice for Aboriginal and Torres Strait Islander victim/survivors of family violence. The Forum provides advice and input to Government and ensures a unified FVPLS response to addressing Aboriginal and Torres Strait Islander family violence.

The Forum has worked with members to develop tools for capacity building, good governance, professional development, training, data collection and evaluation.

The Forum is supported by a Secretariat, and Forum members are represented by their CEO/Co-ordinator (or delegate) at meetings and activities.

Family Violence Prevention Legal Services

FVPLSs are Aboriginal and Torres Strait Islander community controlled organisations – our communities know and trust our staff and services. We are unique, experienced and specialist service providers delivering culturally safe legal and non-legal services within which Aboriginal and Torres Strait Islander culture is acknowledged and celebrated.

FVPLSs provide legal assistance, casework, counselling and court support to Aboriginal and Torres Strait Islander adults and children who are victim/survivors of family violence. Legal services are provided to victim/survivors in matters related to:

  • Family violence (i.e. VRO, AVO different terminology across jurisdictions);
  • Victims of crime compensation;
  • Family law; and
  • Child protection.

FVPLSs also provide an important community legal education and early intervention and prevention function. FVPLSs have adopted a holistic, wrap-around service delivery model that prioritise legal service delivery while recognising and addressing the multitude of interrelated issues that our clients face. Nationally 90% of our clients are Aboriginal and Torres Strait Islander women and children.

FVPLSs are expected to ensure that the services offered are culturally inclusive and accessible to Aboriginal and Torres Strait Islander adults and children in the specified service region, regardless of gender, sexual preference, family relationship, location, disability, literacy or language.

Objectives of the National FVPLS Forum

The objectives of the Forum are to:

  1. Support and enhance the capacity of FVPLSs to provide high quality services that deliver results for clients and communities;
  2. Coordinate and facilitate communication, information sharing and relationship building between FVPLS units;
  3. Develop policy positions that identify areas of FVPLS work in need of reform and make recommendations for change;
  4. Provide advice and input to Government on issues relevant to the FVPLS program and its operation;
  5. Engage with key stakeholders including through participation in activities and national meetings that will benefit and promote National Forum positions;
  6. Promote the existence of the National Convenor/Secretariat role and FVPLSs in the appropriate forums and media; and
  7. Facilitate a co-ordinated approach to building a secure and sustainable resource base that meets the needs of FVPLSs and their clients.

Further information on some of our members’ services is available here.

This Ochre Ribbon Week, show your support in the following ways:

  1. Add the Ochre Ribbon Week 2020 frame to your Facebook profile picture here: https://www.facebook.com/profilepicframes
  2. Follow the National Family Violence Prevention and Legal Services Forum on Twitter and Facebook
  3. Donate to our Aboriginal and Torres Strait Islander controlled FVPLSs across the country
  4. Spread the word! Forward this email to your contacts

To find out more about Ochre Ribbon Week, head to https://www.nationalfvpls.org/

NACCHO Aboriginal Health News Alerts : Indigenous culture not to blame for alcohol abuse, violence says NT MP Yingiya Guyula

” To tackle the problems that (Jancita ) Price and myself and all of us want to see fixed requires a more mature conversation.

This should start with focusing on the behaviour and not pointing the finger at “culture “.

The idea that abandonment of culture is the great hope for Aboriginal people is false, offensive, and dangerous.

We must connect our past, present, and future as we look to address these ­issues.”

Yingiya Guyula is a senior leader for the Liya-Dhalinymirr clan of the Djambarrpungu people within the Yolngu Nation.

He is an independent member of the Northern Territory parliament.

Published in todays AUSTRALIAN

The efforts by Jacinta Price and others to blame Aboriginal culture for violence and abuse serve no one and achieve nothing positive.

The argument that Aboriginal culture is to blame for Aboriginal people being over-represented in cases of domestic and other forms of violence is wrong.

Our culture is who we are. We are inextricably part of our culture, our language, our customs, our spirituality, our worldview. Our law maintains our culture. To take these things away is to remove our identity.

It is a dangerous discussion because it is about the systematic dehumanisation of a group that might have catastrophic consequences.

Price wrote on this page about Yolngu law, but she is not a member of the Yolngu nation and she is not from Yolngu country. She has referred to an article titled Ngarra Law that has no authority.

It was written in English by one Yolngu elder and edited by a non-indigenous man who has no connection to, or authority, under Yolngu law, and was published in a journal no longer in print.

It was not supported by any other Yolngu leader or elder and was challenged by Yolngu leaders in meetings in Galiwin’ku, Ramingining and Maningrida in 2017 to dispute much of the content. We are disappointed about what has been written of our law.

I am not relying on anyone else for my understanding of my law. I am a djirrikaymirr (senior leader) and djungaya (manager) and djagamirr (caretaker) for many Yolngu law ceremonies, including a custodian of Ngarra rom (an institution of law). Our law is not merely a collection of crimes and punishments, it is a whole system of education, discipline and leadership that starts at a young age and continues for a lifetime.

I know this not from reading an article but because I have been trained in this all my life. I was taught by my elders to keep true to the law. When I went away to school I was warned there would be many outside temptations (like alcohol, drugs, greed) and that I must hear the sound of clapsticks and feel the painting on my skin, that signifies living by discipline and a pathway to leadership.

This law system has kept alive and made strong a society that has existed since time began. But these are modern-day issues, they are new to us, and just as Western law has adjusted, we need the opportunity for our elders — men and women — to apply a modern Yolngu response. It’s up to us to do that. It must come from us.

It is clear that foreign solutions are not working for our people. Billions of dollars are spent each year trying to solve what others call the “Aboriginal problem”, but as the Intervention continues to evidence, this pathway is failing everyone.

It is a very sad thing that these days visitors to our communities see all of the outward signs of poverty and disadvantage. These should never be confused with our system of law and culture. Alcohol and drugs are not our culture; overcrowding is not our culture; unemployment and bored kids are not our culture; high rates of imprisonment are not our culture; poor health and suicide are not our culture; and family violence is not our culture. These are not a product of our culture, they are all the side-effects found in every society around the world that is affected by poverty, disadvantage, and colonisation.

As a senior leader, I need to be clear: the family violence that we are seeing in our communities is not lawful — it is breaking the law.

But we are also facing issues of alcohol and drug addictions, gambling addictions, high levels of unemployment, high levels of welfare dependency, and low levels of self-worth, and we must solve these issues too if we are to be successful.

If a visitor to our communities is fortunate enough to attend our ceremonies or live with us, they will see elders leading and organising and educating. They will see young men, fit and confident, humble and dedicated. They will see young women proud and strong. They will see small children everywhere learning and observing. This is our culture, it is full of healthy and vibrant life. At one point not so long ago, this was our everyday — where our communities were governed without outside influence.

To tackle the problems that Price and myself and all of us want to see fixed requires a more mature conversation. This should start with focusing on the behaviour and not pointing the finger at “culture”. The idea that abandonment of culture is the great hope for Aboriginal people is false, offensive, and dangerous. We must connect our past, present, and future as we look to address these ­issues.

Yingiya Guyula is a senior leader for the Liya-Dhalinymirr clan of the Djambarrpungu people within the Yolngu Nation. He is an independent member of the Northern Territory parliament.

NACCHO Aboriginal Health and #Smoking : Download the @RACGP Supporting #smokingcessation Guide : Smoking daily is three times as high in the lowest socioeconomic areas of Australia compared to the highest.

“The likelihood of smoking daily is three times as high in the lowest socioeconomic areas of Australia compared to the highest.

What this means is that smoking-related health problems disproportionately affect those least able to afford the medicines that are essential to helping them quit.

We have made massive inroads, now it’s time for the final, decisive push to reduce daily smoking levels.

These medicines work, we just need to do more to help get them into the hands of people who need them most and removing restrictions on prescribing will do just that.”

RACGP President Dr Harry Nespolon said that the Government should act to assist those who struggle to afford the medicines that are proven to help people quit smoking.

Aboriginal and Torres Strait Islander people

 ” Indigenous Australians are still more than twice as likely as non-Indigenous Australians to be current daily smokers.2 However, there has been a progressive decrease in daily smoking rates for Aboriginal and Torres Strait Islander people, declining from 49% in 2002 to 45% in 2008, and then to 41% in 2012–13.3

People who identify as Aboriginal or Torres Strait Islander qualify for PBS authority listing that provides up to two courses per year of nicotine patches, each of a maximum of 12 weeks. Under this listing, participation in a support and counselling program is recommended but not mandatory. Access t nicotine patches for Aboriginal and Torres Strait Islander people can be facilitated through the Closing the Gap PBS co-payment measure (see page 45).”

Extracts from GUIDE

Download the RACGP Supporting smoking cessation: A guide for health professionals (2nd edition) smoking-cessation

Read over 130 Aboriginal Health and Smoking articles published by NACCHO over past 8 years

Read Aboriginal Health and our partnership with RACGP articles published by NACCHO over past 8 years

The Royal Australian College of General Practitioners (RACGP) has today recommended allowing greater flexibility in prescribing for smoking cessation pharmacotherapy.

The bold proposal, contained in the RACGP’s newly released Supporting smoking cessation: A guide for health professionals (2nd edition) (“the guide”), could prove a game-changer for reducing smoking rates.

Pharmacotherapy options available in Australia include nicotine replacement therapy (NRT, e.g. a transdermal patch or acute forms such as an oral spray, gum, inhaler or lozenge), varenicline (a drug that blocks the pleasure and reward response to smoking) and bupropion hydrochloride (which reduces the urge to smoke and helps with nicotine withdrawal).

Oral forms of NRT subsidised on the Pharmaceutical Benefits Scheme (PBS) are gum and lozenges for use as the sole PBS-subsidised therapy. This means that combination NRT (i.e. using two forms of NRT together such as a patch and gum) is not currently PBS-subsidised.

Under PBS rules, a maximum 12 weeks of PBS-subsidised NRT is available per 12-month period.

Australia has made commendable inroads in tobacco control and smoking rates with daily smoking nearly halved from 24% in 1991 to 12.8% in 2013. However, the job is not complete and there has been a slowing in the rate of decline with little change in prevalence from 2013 to 2016 (12.2%).

The latest National Tobacco Strategy aims to reduce the national adult daily smoking rate to 10% of the population and halve the Aboriginal and Torres Strait Islander adult daily smoking rate.

RACGP President Dr Harry Nespolon said that the Government should act to assist those who struggle to afford the medicines that are proven to help people quit smoking.

“Some people can quit unassisted; however, those who take advantage of behavioural support and vital medicines including combination NRT, varenicline and bupropion will substantially increase their chances of quitting.

“The science is in – a host of randomised clinical trials tell us that these medicines work. Varenicline or combination NRT almost triples the odds of quitting and bupropion and NRT alone almost double the odds of quitting versus a placebo at six months. The evidence is also clear that combination NRT is most effective.

“However, as things stand we have fixed PBS rules that don’t reflect best-practice medical assistance. As a result, people trying to quit smoking miss out on PBS subsidies that could make a real difference.

“We need to improve flexibility in prescribing to cut costs for patients using pharmacotherapy so that people who could really benefit from these medicines can access them.

“It’s vital to allow for PBS-subsidised combination NRT, which is proven to be the most effective form of NRT.

“We should also allow GPs to prescribe a second round of PBS-subsidised NRT within a 12-month period because it will help reduce relapse in people who have stopped smoking at the end of a standard course of NRT. This is a public health policy no-brainer, pure and simple.”

Dr Nespolon noted that the inflexibility in PBS prescribing was particularly troubling given that smoking rates are inverse to socioeconomic status.

Chair of the Expert Advisory Group behind the guide, Professor Nicholas Zwar, said that health professionals including GPs should also be encouraged to embrace the “brief intervention” approach to smoking cessation.

“One of the most often cited barriers to providing smoking cessation advice is that it can prove time consuming.

“Up until now health professionals have used a ‘5A’s approach’ which involves identifying patients who smoke, assessing nicotine dependence and barriers to quitting, advising patients to quit, offering assistance and arranging a follow up. It is sound practice but it does take time.”

Professor Zwar said that under the three-step model developed by Quit Victoria, advice and help for patients trying to quit smoking could be easier to provide and more frequently offered by a range of health professionals.

“This three-step model offers patients best practice smoking cessation treatment by linking into multi-session behavioural interventions such as Quitline and encouraging the use of pharmacotherapy.

“It can be summarised as ask, advise and help. Ask and record a patient’s smoking status, advise people who smoke to quit and on the most effective methods for doing so and help them by offering to arrange referral, encourage use of behavioural intervention and the use of evidence-based pharmacotherapy.”

The guide update was funded by VicHealth and the Australian Government Department of Health.

 

NACCHO Aboriginal Healthy Ageing News : The @georgeinstitute is looking to partner with ACCHO services in NSW, WA and SA to deliver a healthy ageing research project, called the #Ironbark project

The George Institute for Global Health is looking to work with Aboriginal communities on a healthy ageing research project, called the Ironbark project.

They are ready to partner with ACCHO services in NSW and SA to deliver either the Ironbark: Standing Strong and Tall program (weekly exercise group and yarning circle), and the Ironbark: Healthy Community program (a weekly social program).

Services are funded and trained to deliver one of the programs for 12 months with groups of Aboriginal men and women 45 years and older.” 

What is the study about?

The Ironbark Study is comparing two different programs aimed at improving health and wellbeing of older Aboriginal people. Both involve an ongoing program delivered weekly by a local person, in a community setting. The Ironbark: Standing Strong program is a weekly exercise and discussion program, and the Ironbark: Healthy Community program is a weekly program that involves discussions and social activities.

Who is conducting the research?

The study is being conducted by researchers from The George Institute for Global Health, The University of NSW, The University of Sydney, Flinders University, Wollongong University and Curtin University.

What does the study involve?

Services participating in the study are randomly assigned to either receiving the Ironbark: Standing Strong program or the Ironbark: Healthy Community program. Both programs aim to improve the health and wellbeing of older Aboriginal people.

At the end of the trial, sites that delivered the Ironbark: Healthy Community program will have the opportunity to deliver the Ironbark: Standing Strong program for a further 6 months, including all resources and equipment needed.

Being a site in the study involves recruiting 10 – 15 eligible Aboriginal people aged 45 years or older to participate in a weekly facilitated meetings at a culturally appropriate and accessible venue.

Participants

Participants must be: of Aboriginal and/or Torres Strait Islander descent; aged 45 years or older; living independently; prepared to attend the program weekly.

People cannot participate if: they have not gone outside without physical assistance from another person in the past month; they have been diagnosed with dementia; they have a medical condition precluding exercise (e.g., unstable cardiac disease).

People who do not fit the criteria, including non-Aboriginal family and community, will be able to attend classes but data collected will not be included in the trial.

What data will be collected?

A health assessment will be conducted with all participants by the study research assistants. This includes an interview where they will be asked about health and wellbeing, including questions about medication, sleep, physical activity and diet. Participants will also be asked to do some simple tests to measure their health, including strength and balance, and waist circumference. The interview and tests will take around one hour to complete.

Participants will be asked a few questions each week about their health, sleep, falls and physical activity.

These will take only 1-2 minutes to complete.

Every three months they will be asked some questions about their health, lifestyle and enjoyment of the program, and asked to complete some simple tests to measure strength and balance. These tests and questions will take about 30 minutes to complete.

At the end of the program participants will repeat the health assessment. This will include an interview where they will also be asked about quality of life and physical activity.

Ironbark: Standing Strong program

Sites allocated the Standing Strong program will be supported to deliver a weekly class that runs for around 1.5 hours – about 30 – 45 minutes is exercises, and 30 – 45 minutes will be a yarning circle facilitated by a trained worker. The program will run for the whole year, with additional weekly home exercise recommended.

Participants will be required to provide a form from their doctor indicating they are physically fit enough to do the class.

Ironbark: Healthy Community program

Sites allocated the Healthy Community program will be supported to deliver weekly yarning circles. The yarning circles will include discussions and activities that are important to community wellbeing and possibly social activities. Guest speakers may attend the program on request of the group.

How will the study benefit Aboriginal communities?

Being involved in the study will benefit participants directly by creating additional opportunities for them to meet with family and community, discuss topics important to older Aboriginal people, and have their experiences included in the findings.

The study will also contribute to employment opportunities for local Aboriginal people to participate as site managers and/or program facilitators.

It is also expected that the findings of the study will build on the evidence base around appropriate wellbeing programs for older Aboriginal people, and inform national policy development in this area.

What is needed from participating services?

We plan to recruit 60 Aboriginal community or health services in NSW, Western Australia and South Australia into the Ironbark Trial.

We are ready to work with services in NSW and SA : Services need to;

  • Be well established within their local Aboriginal community, and have existing relationships
  • Be able to offer programs or services specifically for older Aboriginal people, and can recruit 10 – 15 eligible participants. Groups should not already be doing a regular exercise

Ironbark – overview

  • Have existing Aboriginal staff working at the service who are willing to oversee program delivery on a weekly basis over the duration of the trial
  • Utilise a culturally appropriate venue that is accessible to participants
  • Be willing to actively participate in both the program delivery and research components of this

How will our service be supported to participate in the study?

The Study team will provide sites:

  • Funding to employ locally based staff on a casual basis
  • Weekly stipend to cover cost of morning/afternoon tea for group meetings
  • Ironbark: Standing Strong program sites will receive training and ongoing support on delivering the program, the Ironbark: Standing Strong and Tall Manual and handouts, all equipment needed to deliver the exercise program
  • Ironbark: Healthy Community program sites will receive training and ongoing support to deliver the program, resources to facilitate discussions and organise activities.
  • At the end of the trial, sites that delivered the Ironbark: Healthy Community program will have the opportunity to deliver the Ironbark: Standing Strong program, including all resources and equipment needed
  • All sites will receive site specific data from the study, as well as information about the results of the research

What will happen to the results?

All participating sites will receive copies of the findings of the study, in a format that is accessible to staff and community. Sites will also receive site specific information about the findings.

To inform program and policy development, we will also be disseminating the findings through peer review publications, reports to the funding body, presentations and reports to policy makers and to key stakeholders such as peak Aboriginal health and other organisations.

The findings will be presented in a non-identifying way, to maintain confidentiality of sites and individuals involved. Only the site managers will have access to non identifying information on participants, for emergency purposes and for accurate data collection.

Consent

Participation in this study is entirely voluntary – sites and services can stop at any time. All participants (sites and individuals), will be required to sign a consent form, prior to participation.

Contact check out their website:

www.ironbarkproject.org.au

The project is a collaboration between The George Institute for Global Health, University of NSW, Flinders University, University of Wollongong, Curtin University and University of Sydney.