aboriginal and torres strait islander health workforce capacity … · acquisition of knowledge and...

Aboriginal and Torres Strait Islander Health Workforce Capacity Building Perinatal Social and Emotional Wellbeing Project

Phase 1 report

2011-13

Statewide Maternity and Neonatal Clinical Network Northern Maternity and Neonatal Clinical Network

Acknowledgements I would like to acknowledge the traditional owners of country and their continuing connection to land and community and pay my respect to them and their cultures, and to the Elders both past and present. This report was written in 2013 with the assistance of Helen Holzwart-Jones (Clinical Network Coordinator – Northern family Health Clinical Networks). I would like to thank Helen, Rymer Tabulo (Project Manager and Clinical Chair – Northern Maternity and Neonatal Clinical Network), Jacqui Thomson (Clinical Network Coordinator – Statewide Maternity and Neonatal Clinical Network), and Associate Professor Rebecca Kimble (Project Sponsor and Clinical Chair – Statewide Maternity and Neonatal Clinical Network) for their support and encouragement during this phase of the project. I would also like to thank project reference group members for their active participation and for making themselves available to respond to questions, source and provide the copious amounts of feedback required. Additionally, I would like to acknowledge the support of the members of the Statewide Aboriginal and Torres Strait Islander Maternity and Neonatal Advisory Group; Northern Maternity and Neonatal Clinical Network, Northern Child and Youth Clinical Network, the Statewide Maternity and Neonatal Clinical Network and the Aboriginal and Torres Strait Islander Health Unit. Support and input from these members was greatly appreciated. Belinda Rule Project Officer Aboriginal and Torres Strait Islander Health Workforce Capacity Building Perinatal Social and Emotional Wellbeing Project


Phase 1 Report of 17.

Contents Acknowledgements................................................................................................................................................. 2 Contents ................................................................................................................................................................. 3 Executive summary ................................................................................................................................................ 4 Background............................................................................................................................................................. 5 Aim.......................................................................................................................................................................... 6 Objectives ............................................................................................................................................................... 6 Methodology ........................................................................................................................................................... 6

Summary activities undertaken .......................................................................................................................... 6 Assumptions....................................................................................................................................................... 8 Constraints ......................................................................................................................................................... 8 Exclusions .......................................................................................................................................................... 9

Risk analysis........................................................................................................................................................... 9 Identification of stakeholders and consultation..................................................................................................... 10 Outcomes ............................................................................................................................................................. 10

Survey results................................................................................................................................................... 10 Learning package............................................................................................................................................. 11 Expected Benefits ............................................................................................................................................ 12

Next step............................................................................................................................................................... 12 Phase 2 ............................................................................................................................................................ 12

Proposed summary of activities for Phase 2......................................................................................... 12 Barriers to Phase 2................................................................................................................................ 13

Budgetary Information .......................................................................................................................................... 13 Recommendations................................................................................................................................................ 14 Conclusion ............................................................................................................................................................ 14 Appendices ........................................................................................................................................................... 16



Executive summary In 2011, clinicians from the Northern Maternity and Neonatal Clinical Network (NMNCN) raised concerns about the effectiveness of perinatal psychosocial screening of Aboriginal and Torres Strait Islander women to accurately identify and refer social and emotional wellbeing issues. A working party investigated this and concluded that improved outcomes may be gained by building capacity in the health workers and the clinical staff supporting the health worker. Anecdotal evidence at the time suggested that it may be a statewide problem. After discussions at a statewide level, the Aboriginal and Torres Strait Islander Health Workforce Capacity Building Perinatal Social and Emotional Wellbeing Project (the project) was proposed and the Statewide Maternity and Neonatal Clinical Network (SMNCN) sponsored the project. Commonwealth funding for the project was obtained from the Aboriginal and Torres Strait Islander Early Childhood Development National Partnership Agreement managed by the Aboriginal and Torres Strait Islander Health Unit. A statewide pre-survey was conducted. The survey validated the initial concerns raised by NMNCN members. The survey revealed 50 per cent of respondents did not feel confident or comfortable undertaking perinatal psychosocial screening with Aboriginal and Torres Strait Islander women. Only 37 per cent believe Edinburgh Postnatal Depression Scale (EPDS) score gave an accurate representation of the social and emotional wellbeing of Aboriginal Torres Strait Islander women. Widespread gaps were revealed in the areas of referral knowledge, pathways, policies and work practices. Additionally, respondents also identified insufficient education and training on perinatal psychosocial screening, in particular with Aboriginal and Torres Strait Islander women Initially, a learning framework was designed using the National Perinatal Depression Initiative Training Matrix Framework of Perinatal Depression and Related Disorders. This was expanded to become a learning package to meet the identified educational needs and define a way that Aboriginal and Torres Strait Islander health worker and their supporting clinician could work effectively together in a partnership arrangement. In the relationship, the clinician provides clinical supervision for the health worker and the health worker provides cultural supervision for the clinician. This arrangement recognises both the clinical and cultural expertise available. It utilises both parties’ skills to their full potential. In this way, together they are able to provide the necessary service to support Aboriginal and Torres Strait Islander women and their families during the perinatal period. Widespread consultation and collaboration enabled the Perinatal Social and Emotional Wellbeing Screening: A Learning Framework for Perinatal Psychosocial Screening with Aboriginal and Torres Strait Islander peoples (the package) to be tailored to meet the identified needs of all stakeholders. It is expected that as a result of using the learning package, the knowledge, skills and understanding of the perinatal psychosocial screening tools by health workers and clinicians will be enhanced. It is anticipated that effective use of identified tools and referral pathways will lead to improved social and emotional wellbeing outcomes for Aboriginal and Torres Strait Islander women in the perinatal period. To measure the effectiveness of this learning package and the proposed best practice model of delivery, a pilot study needs to be undertaken. A pilot study will allow the refinement and improvement of the learning package, and its implementation. Groundwork for launching the learning package and showcasing it, and other similar strategies, will also be scoped during this phase. A concept brief has been drafted and funding sourced for this next phase (Phase 2). However, further work needs to be undertaken to locate an organisation to support a project officer into the future. The fiscal austerity measures and establishment management program delayed the employment of a project officer dedicated to this project in 2011/2012. To compensate, extended time in the 2012/13 financial year for the project officer has resulted in a funding shortfall that will require management. This will be compounded with the 2012/2013 funding shortfall for Phase 2 allocation. It is recommended that: 1. the NMNCN and SMNCN partner with a suitable organisation to progress implementation, evaluation and

review of the package using a pilot group (Phase 2) 2. the NMNCN and SMNCN undertakes to source additional funding (or otherwise problem-solve), to

overcome expected funding shortfall in 2012-2013 financial year for Phase 2.



Background Clinicians brought to the attention of the NMNCN that the Edinburgh Postnatal Depression Scale (EPDS) produced high scores that often did not accurately reflect the social and emotional wellbeing status of Aboriginal and Torres Strait Islander women in North Queensland. A small working party was formed. Initial thoughts were to adapt the language in the EPDS. Investigation of the research already completed in this area concluded that the tool was valid and, while some preferred an adapted tool, the evidence did not support that adaptation improved its functionality. Further investigation identified problems with the administration and use of the perinatal psychosocial (social and emotional wellbeing) screening tools with Aboriginal and Torres Strait Islander women in North Queensland. Anecdotal evidence, supported by selected data collection, demonstrated that the results obtained and resultant referrals were not matching the needs of the population. Investigation for possible cause and solution suggested that it may be a statewide issue. The NMNCN brought it to the attention of the Statewide Maternity and Neonatal Clinical Network suggesting that a solution be developed in a partnership arrangement. Following consultation, it was concluded that improved outcomes may be gained by building capacity in the health workers and clinical staff supporting the health worker. The solution may include methods to effectively support each other to use the available tools. This was consistent with the Queensland Health Aboriginal and Torres Strait Islander Maternity Care Conference and Workshop Report, Theme 3 (May 2011) recommendations. Further investigation revealed that there were multiple education resources available. It was considered that a learning framework that facilitates capacity building for health workers and their supporting clinicians may enable and empower staff to better support Aboriginal and Torres Strait Islander women and their families in the perinatal period. The project is the result of the Statewide Aboriginal and Torres Strait Islander Maternity and Neonatal Advisory Group clearly defining a problem in statewide terms and progressing to a statewide solution. It was undertaken on behalf of the Statewide Maternity and Neonatal Clinical Network in partnership with the Northern Family Health Clinical Networks as part of the Aboriginal and Torres Strait Islander Health Workforce Capacity Building – Perinatal Social and Emotional Wellbeing Project. Commonwealth funding for the project was obtained from the Aboriginal and Torres Strait Islander Early Childhood Development National Partnership Agreement. This was initially managed by the Queensland Health Primary, Community and Extended Care Branch and subsequently the Aboriginal and Torres Strait Islander Health Unit. This project is aligned to many strategic documents including, but not limited to: Queensland Health 2010: Making Tracks towards closing the gap in health outcomes for Aboriginal and

Torres Strait Islander Queenslanders by 2033- Policy and Accountability Framework, Brisbane 2010. Queensland Health 2010: Making Tracks towards closing the gap in health outcomes for Aboriginal and

Torres Strait Islander Queenslanders by 2033- Implementation Plan 2009-2010 to 2011-2012, Brisbane 2010.

Queensland Health 2010: Aboriginal and Torres Strait Islander Cultural Capability Framework 2010 - 2033, Brisbane 2010.

beyondblue Clinical Guidelines: http://www.beyondblue.org.au/index.aspx?link_id=6.1246 Framework for the National Perinatal Depression Initiative 2008-09 to 2012-13.

http://www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/perinatal-depression-1 . Commonwealth of Australia: Fourth National Mental Health Plan—An agenda for collaborative government

action in mental health 2009–2014, Canberra 2009 (Priority 2: Prevention and Early Intervention. Commonwealth of Australia: The Australian Health Ministers Conference: National Maternity Service Plan

2010, Canberra 2010 - http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesplan (See Action 2.3; Action 3.2.)

Australian Government Department of Health and Ageing: National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013-Australian Government Implementation Plan 2007-2013, Canberra 2007. (Key Result Area 4 - Social and Emotional Wellbeing)

Australian Government Department of Health and Ageing: Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice –Canberra 2010 http://apo.org.au/research/working-together-aboriginal-and-torres-strait-islander-mental-health-and-



http://www.beyondblue.org.au/index.aspx?link_id=6.1246

http://www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/perinatal-depression-1

http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesplan

http://apo.org.au/research/working-together-aboriginal-and-torres-strait-islander-mental-health-and-wellbeing-principal

wellbeing-principal (See Ch 16 - Promoting Perinatal Mental Health Wellness in Aboriginal and Torres Strait Islander Communities).

Additionally, the 2011 Queensland Maternal and Perinatal Quality Council Review of Pregnancies, Births and Newborns in Queensland Report: Queensland Maternal and Perinatal Quality Council 2011 (section 1.2.3 p 12) identified that suicide was the most common cause of indirect maternal death.

Aim The aim of the project was to develop a learning framework for the clinician/health worker dyad to facilitate the acquisition of knowledge and develop skill (consistent with scope of practice) to effectively use resources including, but not limited to: Edinburgh Postnatal Depression Scale (EPDS) Safe Start Psychosocial Assessment (Safe Start) community education resources identified local referral pathways.

Objectives By the end of the project we expected the following outcomes: 1. Health workers who work in the maternal and child health environment to have a learning framework to

facilitate the acquisition of knowledge and develop skills to become comfortable and confident within their scope of practice to: understand and support the use of EPDS and Safe Start tools understand and support the use of social and emotional wellbeing promotion resources engage community members in conversation about social and emotional wellbeing in the perinatal

period understand the choice of referral pathways available for women identified through EPDS and perinatal

psychosocial screening engage identified community members in conversation about the benefits of available referral

pathways. 2. Registered clinicians working in partnership with their health worker to have a learning framework that will

enable them to: use the EPDS and Safe Start tools in collaboration with the health worker support the health worker in the use of social and emotional wellbeing promotional resources support the health worker to engage community members in conversation about social and emotional

wellbeing in the perinatal period identify and use local referral pathways inclusive of specialised clinical services, allied health and social

support services.

3. Resources identified in the learning framework to be readily available and accessible. 4. Resources identified in the learning framework to meet the educational needs of the health worker and their

supporting clinicians working in the maternal and child health area. 5. A plan for the learning framework and resources to be communicated to all participating sites and other

stakeholders (including services where pregnant women seek care).

Methodology

Summary activities undertaken Health worker positions and their supporting clinicians working in the maternal and child health field with

Queensland Health and non-government organisations were identified as stakeholders. The knowledge acquisition and skill development needs of the health worker and supporting clinical staff

were assessed in collaboration with: o nurse educators and the Statewide Aboriginal and Torres Strait Islander Maternal, Child and Youth

Workforce Development Program



o health workers employed in maternal and child health services in Queensland

http://apo.org.au/research/working-together-aboriginal-and-torres-strait-islander-mental-health-and-wellbeing-principal

o clinical staff supporting the health worker working in maternal and child health services in Queensland o Queensland Centre for Perinatal and Infant Mental Health. o clinical nurse consultant, Perinatal Mental Health, Cairns and Hinterland Hospital and Health Service o Aboriginal and Torres Strait Islander Mental Health o Cert IV Maternal and Child Health training providers (Cunningham Centre) o Cultural Capability Unit o providers of Pathways to Rural and Remote Orientation and Training (PaRROT).

A needs assessment was conducted and included the requirement of:

o skill acquisition by health workers and supporting clinicians in the area of cultural capability and effective cross cultural communication

o identification of the best practice learning processes to facilitate optimum learning and skills development

o knowledge and skill development specific to supporting the social and emotional wellbeing of Aboriginal and Torres Strait Islander women and their families in the perinatal period.

Tools were sourced that may contribute to improving the social and emotional wellbeing of Aboriginal and

Torres Strait Islander women and their families in the perinatal period including, but not limited to: o EPDS o Safe Start tool o Stay Connected, Stay Strong DVD and associated printed resources o locally constructed referral pathway documents.

The scope and educational capacity of resources and education systems currently available were identified

including, but not limited to: o Perinatal Infant Mental Health Training – Universal Psychosocial Screening Module o Perinatal Infant Mental Health Training – Universal Psychosocial Screening Skill Development

Workshop o Aboriginal and Torres Strait Islander Mental Health First Aid Course o Cert IV in Maternal and Child Health o Stay Connected, Stay Strong DVD o Perinatal Mental Health Workshop o EPDS workshops o Resources identified on Beyond Blue website o Cultural Capability Education o PaRROT.

Gaps in the educational capacity of resources were identified and, where possible, ways to resolve these

gaps were negotiated. A learning framework for health workers and their support clinicians working in the maternal and child health

environment in both government and participating non-government organisations was developed and expanded into a learning package. The package directs the knowledge and skill acquisition required for health workers and supporting clinicians to become comfortable and confident to collaboratively support universal psychosocial screening, community education resources and relevant referral pathways.

The package includes direction for: o best practice learning processes to facilitate optimum learning experiences and skills development o learning objectives of courses/workshops o course schedule sources o relevance to various levels of clinicians/health workers o options for accessing course o contact details of organiser of courses/training o pathway for clinicians to support health workers in maternal and child health practice environments to

consolidate the knowledge acquired from courses/learnings o creating and maintaining relevant local referral pathways.

Assurance that health workers and their support clinicians would be able to effectively use resources and

learnings contained within the package in their clinical practice settings and in the wider community setting was established by: o identifying sites with health workers who wished to participate or be kept informed of the project

progress



o consulting with participating health workers and their support clinicians to ensure that the program met their educational and support requirements

o designing a pre and post-implementation survey for health workers and their support clinicians who are interested in using the package to evaluate their satisfaction

o the ability of the package to advance participating health workers and their support clinicians acquisition of knowledge and skill development

o the suitability of the learning direction to better enable health workers and support clinicians to support the social and emotional wellbeing of Aboriginal and Torres Strait Islander women and their families in the perinatal period

o conducting the pre-implementation survey and analysing the results. A concept brief was designed to trial, evaluate and review the learning package through a pilot group and

then communicate the final product to all participating sites and other interested stakeholders through: o health workers, supporting clinicians, managers and chief executive of participating sites o other Aboriginal and Torres Strait Islander maternal and child health workers o District/Local Health and Hospital Services Chief Executives o Primary Community and Extended Care Branch o Cultural Capability Team o Statewide Maternity and Neonatal Clinical Network for wider dissemination o Northern Maternity and Neonatal Clinical Network for wider dissemination o Southern Maternity and Neonatal Clinical Network for wider dissemination o Central Maternity and Neonatal Clinical Network for wider dissemination o non-government organisation stakeholders o Queensland Aboriginal and Islander Health Council o Queensland Centre for Mothers and Babies o Aboriginal and Torres Strait Islander Mental Health Branch.

Assumptions The following assumptions were made prior to the commencement of the project: Stakeholders will engage with the project to provide direction and guidance to the project officer. The use of the available screening tools is in the scope of practice for health workers employed in the

maternal and child health environment. Health workers in this environment require a sound understanding of basic mental health, perinatal infant

mental health and cross cultural communication skills to provide an effective support role. Clinicians supporting health workers require a sound understanding and assessment skills in basic mental

health, perinatal infant mental health and cross cultural communication skills to effectively support capacity building in the health worker.

Client assessment will remain the responsibility of the registered clinician. Effective screening of Aboriginal and Torres Strait Islander women will contribute to better health outcomes. The project is aligned with the priorities of Hospital and Health Services, state and national strategic plans. Hospital and Health Services will support capacity building in their workforce using the project deliverables. The project is aligned with the priorities of health worker and clinicians working in the maternal and child

health environment. The project is aligned with the priorities of the various stakeholders who are the custodians of the existing

resources. Funding can be identified and secured to progress this project.

Constraints The following constraints were identified prior to the commencement of the project: The timeframe does not allow for a pilot project to enable result evaluation. A pilot project or post project will be required to measure actual clinician satisfaction with deliverables. Currently available perinatal psychosocial screening education/training may not be suitable to provide

optimal learning in health workers and clinicians. The degree of health worker and clinician involvement in project activities will influence the accuracy and

project outcomes. Statewide austerity measures will influence the project’s ability to use allocated funding. Adequate data collection facilities to monitor EPDS key performance indicators are still to be developed,

including the development of the perinatal data system to enable capture of data for the key performance indicators proposed by Queensland Clinical Senate.



Exclusions The following exclusions were articulated prior to the commencement of the Project: Direct delivery of health worker education was not included in the project. Measurement of the Aboriginal and Torres Strait Islander women with high EPDS scores (>12) will be

dependant on the development of adequate collection methodologies and databases and will not be actioned by this project.

A reduction in the high EPDS scores or appropriate referral to mental health or other support services could not be measured until post project and is subject to development of data collection capacity.

Risk analysis The following risks were identified and managed with results as indicated below: Major Risk 1 Insufficient engagement and support from key stakeholders, health workers and clinicians

Likelihood: Moderate

Consequence: Delay in the progress of project

Management strategies: Early enlistment of influential key persons who are supportive of the initiative and able to clearly articulate

and communicate the benefits of the project Engage with key stakeholders in regular meetings Keep key stakeholders informed at all stages of project development Early engagement with clinicians to gain commitment Establish consistent operating and communicating processes Use multiple communication strategies Ensure issues and concerns are addressed in a speedy and timely manner Acknowledge and respond to feedback Identify key persons at each site who can become local champions

Outcomes: Good engagement and support from key stakeholders, health workers and clinicians as a result of

implementation of management strategies.

Major Risk 2 Inadequate or unsuitable perinatal mental health training available

Likelihood: Moderate to high

Consequence: Delay in the progress of project

Management strategies: Establish learning needs of health workers and clinicians Investigate training available Consult with training providers about the possibility of altering/adapting training to meet the needs of health

workers and clinicians

Outcomes Gaps were found between the training available and the learning needs of health workers and clinicians. Discussions with several training providers revealed they were open to the need to fill this gap. However,

due to time and staffing constraints, they were not able to at this time. As a result, additional information was added to the learning framework transforming it into a learning

package.

Major Risk 3 Inadequate time due to delay in starting project officer and austerity measures and not allowing project to be run part-time as envisaged.

Likelihood: High

Consequence: Project not completed

Management strategies: Timeline as tightly as possible Attend to key features first Reduce consultation and



Use resources as available without consideration for adaptation

Outcomes Project officer commencement was delayed, initial project tasks started by Helen Holzwart-Jones to

mitigate risk. Pilot project deferred to Phase 2 which has funding allocated but is dependent on attaining further

sponsor/employer support.

Identification of stakeholders and consultation Statewide consultation occurred through stakeholder involvement and collaboration. A small project working party was formed as the reference group. Stakeholders and the nature of their involvement are listed below: Internal partners/clients/stakeholders Nature of

involvement Management strategy (as per Clinician Engagement Framework)

Statewide Maternity and Neonatal Clinical Network Steering Committee

Decision makers Inform, Consult, Involve, Collaborate, Empower

Primary Community and Extended Care Branch

Project sponsor Inform, Consult, Involve

Statewide Aboriginal and Torres Strait Islander Maternity Advisory Group

Stakeholder Inform, Consult, Involve

Northern Maternity and Neonatal Clinical Network

Sponsor Inform, Consult, Involve

Project working party Active participants Inform, Consult, Involve, Collaborate

Project Wider Reference Group Stakeholders Inform, Consult

Health Workers and Clinicians (Lead role: Lyndell Gibson)

Stakeholders Inform, Consult, Involve

Maternity/child health clinical educators Stakeholder Inform, Consult

Queensland Centre for Perinatal and Infant Mental Health

Stakeholder Inform, Consult

Office of Rural and Remote Health - PaRROT


Aboriginal and Torres Strait Islander Workforce Unit


Aboriginal and Torres Strait Islander Health Branch/Unit


External partners/clients/stakeholders Nature of involvement

Management strategy (as per Clinician Engagement Framework)

Non-government organisations Stakeholder Inform, Consult

Other stakeholders Stakeholder Inform

Further requests for input and dissemination of information occurred through electronic and physical mailout of pamphlets to: Perinatal Infant Mental Health Nurse Network Australian College of Midwives Queensland Branch Aboriginal and Torres Strait Islander Staff Network (Queensland Health) All Queensland Health hospitals All Aboriginal and Torres Strait Islander health/medical services in Queensland

Outcomes

Survey results A 25 question pre-survey was created on Survey Monkey using multiple choice and short answer questions. A pamphlet and PowerPoint presentation were developed and circulated widely.



The survey was completed by 43 respondents, with 11 identifying as being an Aboriginal or Torres Strait Islander Health Worker and 26 identifying as being a registered nurse and/or midwife. There were 33 respondents who indicated they would like to be involved in a further pilot project When investigating staff involvement with perinatal psychosocial screening: 12 per cent listed lack of involvement due to no opportunity or lack of skills 49 per cent felt confident using these screening tools with Aboriginal and Torres Strait Islander women 51 per cent felt comfortable using these screening tools with Aboriginal and Torres Strait Islander women 42 per cent of respondents thought Aboriginal and Torres Strait Islander women understand most of the

questions only 37 per cent of respondents thought the EPDS score usually gave an accurate representation of the

social and emotional wellbeing of Aboriginal and Torres Strait Islander women. When investigating reasons why the EPDS was not seen as accurate: 30 per cent responded that it doesn’t use easy to understand English 58 per cent felt that it was culturally inappropriate 42 per cent felt it was due to the screener lacking cultural expertise 47 per cent said it doesn’t ask right questions Only 52 per cent of participants usually referred Aboriginal Torres Strait Islander women with EPDS scores of 13 and above and 39 percent of respondents stated they were unsure of local referral pathways or did not have any in their area. When asked about their participation in perinatal psychosocial screening education, 53 per cent indicated they had not received enough training and 21% felt there was a clearly identified pathway to obtain training in perinatal psychosocial screening. Overall, clinicians were more likely than health workers to be involved in perinatal psychosocial screening of Aboriginal Torres Strait Islander women and were more likely to feel confident and comfortable using the screening tools. Clinicians also felt that Aboriginal and Torres Strait Islander women were more likely to understand the questions in the screening tools. Clinicians and health workers both identified the need for increased access to perinatal psychosocial screening education that was more culturally appropriate, used language that was easier to understand and was available in different formats to suit the various learning styles. They also identified the need for increased health worker involvement with Aboriginal and Torres Strait Islander women. Health workers indicated they preferred “on-the-job”, “face-to-face” and supported styles of education and training rather than computer based and self-directed styles. Other popular suggestions to improve training included: face-to-face interactive sessions practical examples, scenarios and “how to respond to…” culturally appropriate training and examples making it more accessible and advertised more widely making a variety of learning modes available improving consistency and standardisation Queensland wide.

Learning package The major deliverable from this project was the development of a learning package. Initially a learning framework was designed using the National Perinatal Depression Initiative Training Matrix Framework of Perinatal Depression and Related Disorders. Various gaps in available training were discovered over the course of the project. As a result the content of the learning framework became more detailed. A decision was made by consensus that a learning package would be a more appropriate deliverable to meet the project objectives. A learning package is available for health workers and their support clinicians in the maternal and child health environment. This package will facilitate knowledge acquisition and skill development to enable collaborative use of the EPDS, Safe Start tool, relevant mental health promotion materials and available referral pathways.



The package contains reference to a suite of education resources. These have been identified as being able to meet workforce need and are readily available. The Package contains a measurement tool that will evaluate if clinicians using the material referred to in the learning framework report that they are more comfortable and confident in using the tools in their clinical practice. This tool will enable measurement to see if an 80 per cent effectiveness rate can be achieved after implementation. A project plan has been developed to trial the package and funding has been sourced.

Expected Benefits We expect that the package will:

articulate a best practice model where health workers and clinicians work effectively together by the health workers culturally supervising the clinicians and the clinicians clinically supervising the health workers

enhance knowledge, skills and understanding by health workers and clinicians with the perinatal psychosocial screening tools

improve health worker and clinician comfort and confidence working together to achieve effective perinatal psychosocial screening with Aboriginal and Torres Strait Islander women

increase accuracy of perinatal psychosocial screening of Aboriginal and Torres Strait Islander women with appropriate referral to other services as required

improve social and emotional wellbeing outcomes for Aboriginal and Torres Strait Islander women in the perinatal period

meet the 2012 Queensland Clinical Senate indicator that recommends: o Women with an Edinburgh Postnatal Depression Score (EPDS) of greater than or equal to 12 in

pregnancy and at least once within six weeks postnataly are referred for further mental health assessment.

Next step - Phase 2 A concept brief for Phase 2 of this project has been developed and funding tentatively sourced. In this phase, the learning package (developed in Phase 1 of the project) will be trialled by a pilot group, evaluated, reviewed and prepared for widespread implementation.

Proposed summary of activities for Phase 2 Recruit a small cohort to undertake the Package developed in initial project including: health worker/clinician dyads other interested persons. Provide support to participants undertaking the package including, but not limited to: the degree necessary to ensure sufficient completion rates to enable evaluation and review problem solve where required, access to information that uses external education or web based

resources/information Facilitate the resolution of problems with external or web based education, resources and information.

providing support to understand and work within a mentorship role. Evaluate and report participants experience, knowledge and skill acquisition in the areas of: perinatal psychosocial screening knowledge. confidence and comfort undertaking perinatal psychosocial screening with Aboriginal and Torres Strait

Islander women effectiveness of clinician/health worker partnerships psychosocial screening results and referral pathways for Aboriginal and Torres Strait Islander women. Review and adapt the package as required based on feedback from: participants stakeholders research.



Investigate and begin preparations for Phase 3, which will be to showcase this initiative and other maternity and neonatal examples of best practice health care delivery to Aboriginal and Torres Strait Islander women and children using clinician/health worker partnerships including, but not limited to: identification of, and negotiation with, potential partners to deliver Phase 3 of the project identification of, and negotiation with, other best practice examples that potentially could be showcased identification of required resources and relative costs to deliver Phase 3 of the project assistance with Phase 3 project scoping to attract the required resources. Develop a plan to implement the package at a wider level including: identifying a web base location to house the package identifying an authority to keep the package updated developing a plan to disseminate information about package availability.

Barriers to Phase 2 At the time of this report, it was unclear whether Townsville Hospital and Health Service would be able to continue with employment and management of the project officer position to enable Phase 2 of the project to commence. A brief for decision was progressed to the Executive Management Team and a decision is pending. Preliminary discussions with a non-government organisation to take over the employment and management of the project officer position to enable the project to continue, if the decision by Townsville Hospital and Health Service is unfavourable, have produced some encouraging initial results.

Budgetary Information

Phase 1 of the project was completed on 20 January 2013. A budget of $39 680 was allocated for 2011/2012 and $62 800 for 2012/2013. It was anticipated that a project officer would be employed for three months in the 2011/2012 financial year and five months in the 2012/2013 financial year. The total expenditure calculated to 20 January 2013 at the conclusion of the project officer’s contract was $74 153. This represented an overspend of $11 338.50 on the budgeted amount for this financial year. The budget overspend this financial year is a direct result of the delay in starting the employment of the project officer. The delay in starting the project officer was due to the introduction of fiscal austerity measures (including the Employment Management Program) across Queensland Health. This delay created an unbudgeted employment period for the project officer this financial year, with a reduced employment period last financial year. The expenditures for this financial year are detailed below. Description Cost Unit Month/

OccasionsOriginal Budget for Non Labour

Calculated cost by 20/1/13

Expected Overspend

Mobile phone calls 10 Per month 5 50 60

Desk phone levies 20 Per month 5 100 120

QH RAS 31.75 Per month 5 158.75 190.5

Computer levies 153 Per month 5 765 918

Rent to Cairns 378.04 Per month 6 2268.24 2268.24

Printing/postage to Cairns

24 Per month 6 144 144

Travel flights 400 Return flight 2 800 1094.7

Taxi/train 50 Return trip 2 100 50

Travel- accom and meals

314.1 Per day 2 628.2 329.25

Total Non Labour 5014.19 5174.69

Labour 57,800 68,978

Total $62, 814.19 $74, 152.69 -$11,338.50



The budget required and the budget available for Phase 2 of the project for the remainder of the 2012/2013 financial year indicates that a shortfall will exist if the project phases are run seamlessly without additional funding. Details are outlined in Appendix 6 (Phase 2 Concept Brief).

Recommendations It is recommended that: 1. the NMNCN and SMNCN partner with a suitable organisation to progress implementation, evaluation and

review of the package using a pilot group (Phase 2) 2. the NMNCN and SMNCN undertakes to source additional funding (or otherwise problem-solve), to

overcome expected funding shortfall in 2012-2013 financial year for Phase 2.

Conclusion The project was initiated after clinicians from the NMNCN raised concerns about the effectiveness of the perinatal psychosocial screening with Aboriginal and Torres Strait Islander women. A working party investigated this and concluded that improved outcomes may be gained by building the capacity of health workers and clinical staff supporting the health worker, and a concept brief was developed. The project was accepted and sponsored by the SMNCN and Commonwealth funding was obtained. The aim of the project was to develop a learning framework for the clinician/health worker dyad to facilitate the acquisition of knowledge and develop skill (consistent with scope of practice) to effectively use resources including, but not limited to, the current perinatal psychosocial screening tools. The objectives were to improve the ability of clinicians and health workers to develop the knowledge, skills and confidence to accurately provide perinatal psychosocial screening and support to Aboriginal and Torres Strait Islander women and their families. This was to be achieved through the development of a learning package that specifically meets the identified educational needs of the health workers and their supporting clinicians working in the maternal and child health area. A pre-survey was used to elicit the learning needs and gaps in service provision and available education sources. The survey revealed 50 per cent of respondents did not feel confident or comfortable undertaking perinatal psychosocial screening with Aboriginal and Torres Strait Islander women. Only 37 per cent believe EPDS score usually gave an accurate representation of the social and emotional wellbeing of Aboriginal Torres Strait Islander women. Widespread gaps were revealed in the areas of referral knowledge, pathways and policies/work practices. Respondents also identified insufficient education/training on perinatal psychosocial screening, in particular with Aboriginal and Torres Strait Islander women. This was consistent with the original paradigm that initiated the project. Stakeholders were engaged statewide and consulted repeatedly throughout the project, ensuring thorough collaboration and deliverables that met the identified needs. The package meets these needs, as well as providing a system where the Aboriginal and Torres Strait Islander Health Workers and their supporting clinician can work effectively in a partnership. In this relationship the clinician provides clinical supervision for the health worker and the health worker provides cultural supervision for the clinician. This recognises both the clinical and cultural expertise available and uses both parties’ skills to their full potential. In this way, together they are able to provide the service to support and improve the health outcomes of Aboriginal and Torres Strait Islander women and their families during the perinatal period. An evaluation of the effectiveness of this package and the proposed best practise model is needed. A pilot study will enable supported implementation, evaluation and review of the package and incorporated best practice model. A concept brief has been drafted and funding sourced for Phase 2. Due to the current fiscal austerity measures and change management processes in place in Queensland Health, further work needs to be undertaken to secure the support of an organisation willing to progress this initiative in partnership with the Statewide Maternity and Neonatal Clinical Network. It is recommended that the SMNCN partner with a suitable organisation to progress Phase 2, namely the implementation, evaluation and review of the package using a pilot group. A further recommendation is that the



SMNCN source additional funding to overcome the expected funding shortfall in the 2012-2013 financial year for Phase 2.



Appendices Appendix 1 – Concept Brief Appendix 2 – Implementation Plan Appendix 3 – Working Group Terms of Reference Appendix 4 – Survey Questions and Results Appendix 5 – Learning Package Appendix 6 – Concept Brief Aboriginal and Torres Strait Islander Perinatal Social and Emotional Wellbeing

Project Phase Two



Queensland Health Concept Brief

Date: 21st January 2013

Proposed Project Title*: Build workforce capacity that will enable Aboriginal and Torres Strait Islander Health Workers (HWs) to support the social and emotional wellbeing of Aboriginal and Torres Strait Islander women and their families in the perinatal period- Trial, Evaluation & Implementation (Phase two).

Project Statement*:

This project will trial, evaluate and prepare for the widespread implementation of a learning package developed in the initial project. The learning package will facilitate acquisition of knowledge and skill (consistent with scope of practice) for Health Workers and Clinicians in a model where they work in partnership to support the social and emotional wellbeing of Aboriginal and Torres Strait Islander women in the perinatal period using resources that include, but are not limited to the:

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Statewide Aboriginal and Torres Strait Islander Maternity and Neonatal Advisory Group (SATIMNAG) of the Statewide Maternity and Neonatal Clinical Network (SMNCN).

Outcome area*:

Patient Safety and Quality

PMPlus – Concept Brief Template Final Ver 1.1 (2009)

Project Scope

By the end of the project we expect to have:

Supported a small cohort of Health Workers and Clinicians to trial the learning package (developed in phase one of the project) to:

o Ensure resources identified in the learning package are readily available, accessible and suited for their purpose

o Facilitate mentoring relationships between Health Workers and Clinicians and o Ensure that the trial is kept to a predetermined timeframe to enable timely analysis.

Evaluated the experience, knowledge and skill development of the trial cohort and collected evidence to support or dispute that the developed model represents best practice to:

o Enable an effective working partnership to be developed between the Health Worker and Clinician

o Promote effective use of EPDS and Safe Start tools utilising a Health Worker / Clinician partnership

o Support the HW and Clinician to comfortably use Mental Health promotional resources. o Support the HW and Clinician to engage community members in conversation about social and

emotional wellbeing in the perinatal period. o Identify and use local referral pathways inclusive of specialised clinical services, allied health

and social support services.

Reviewed and adapted the learning package to incorporate the learnings from the trial.

Negotiated a web base location to store the revised learning package and a custodian to keep it updated.

Created a plan to widely disseminate the model as a Best Practice initiative to encourage use. This plan will explore but not be limited to the following:

o Identify and partner with another organisation to create a forum whereby this initiative and other best practice initiatives can be showcased.

o A plan to widely disseminate the information.

Objectives

Key Performance Indicator

The learning framework developed in the initial project has undergone a trial and evaluation and is available on the web for general use as a best practice model.

80% of clinicians utilising the material referred to in the learning package report that they are more comfortable and confident in using the tools in their clinical practice.

As a result of this project, we expect :

Improved and effective use of identified tools and referral pathways to support the social and emotional wellbeing outcomes for Aboriginal and Torres Strait Islander women in the perinatal period.

Purpose


Women will be screened at least once in pregnancy and within 6 weeks postnatally. Those with an EPDS of greater than or equal to 12 will be referred for a Mental Health assessment, as routine practice within Health Services.

Evidence that EPDS of Aboriginal and Torres Strait Islander Women is more reflective of their Social and Emotional well being status and resulting in relevant referrals to available services.

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Summary Activities

(High Level Work Breakdown Structure)

Recruit a small cohort to undertake the learning package developed in initial project including:

o Health Worker / Clinician Dyads and o Other interested persons.

Provide support to participants undertaking the learning package including but not limited to: o Development of an education strategy. o The degree necessary to ensure sufficient completion rates to enable evaluation and review. o Problem solve where required, access to information that uses external education or web based

resources/ information. o Providing support to understand and work within a mentorship role.

Evaluate and report participants experience, knowledge and skill acquisition in the areas of: o Perinatal Psychosocial Screening knowledge. o Confidence & comfort undertaking Perinatal Psychosocial Screening with Aboriginal and Torres

Strait Islander women. o Effectiveness of Clinician/ Health Worker Partnerships. o Psychosocial screening results and referral pathways for Aboriginal and Torres Strait Islander

women.

Review and adapt the learning package as required based on feedback from: o Participants o Stakeholders and o Research.

Investigate and begin preparations to showcase this initiative and other examples of Best Practice health care delivery to Aboriginal and Torres Strait Islander women and children using Clinician / Health Worker partnerships. This preparation will include but not be limited to: o Identification of and negotiations with partners to deliver Phase three of the project. o Identification of other best practice examples of Aboriginal and Torres Strait Islander Maternity and

Neonatal care that could be showcased. o Identification of required resources and relative costs to deliver Phase three the project. o Assist with the Phase three project scoping to attract the required resources.

Develop a plan to implement learning package at a wider level including: o Identify a web base location to house the package. o Identify an authority to keep the learning package updated. o Plan to disseminate package availability information.

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tionale & Background

tionale/ Background

Clinicians brought to the attention of the Northern Maternity and Neonatal Clinical Network (NMNCN) that the EPDS produced high scores that often did not accurately reflect the services required by the Aboriginal and Torres Strait Islander women in North Queensland. Anecdotal evidence identified similar issues in other parts of the State. Initial thoughts were to adapt the language used in the EPDS. Research already completed in this area concluded that the EPDS tool was valid. Whilst some preferred an adapted tool, the evidence did not support that adaptation improved its functionality with Aboriginal and Torres Strait Islander women. It was concluded that improved outcomes may be gained by building capacity in the HW and clinical staff supporting the HW. This was consistent with theme three recommendations in the Queensland Health Aboriginal & Torres Strait Islander Maternity Care Conference and Workshop Report. The initial project identified a Training Matrix Framework for Perinatal Depression and Related Disorders (developed as a National initiative by Beyond Blue). A learning package for elements of this framework was developed incorporating many of the education resources available. The package articulated a working partnership model for Clinicians and Health Workers. The model supported Clinicians to clinically supervise Health Workers and Health Workers to culturally supervise Clinicians. This phase of the project will seek to trial and evaluate the learning package and its ability to facilitate a “Best Practice” working partnership for Clinicians and Health workers. It will also begin the preparations required for more widespread implementation. This project is aligned to many strategic documents including but not limited to :

Queensland Health 2010: Making Tracks towards closing the gap in health outcomes for indigenous Queenslanders by 2033- Policy and accountability Framework, Brisbane 2010.

Queensland Health 2010: Making Tracks towards closing the gap in health outcomes for indigenous Queenslanders by 2033- Implementation Plan 2009-2010 to 2011-2012, Brisbane 2010.

Queensland Health 2010: Aboriginal and Torres Strait Islander Cultural capability Framework 2010 - 2033, Brisbane 2010.

Beyondblue Clinical guidelines: http://www.beyondblue.org.au/index.aspx?link_id=6.1246 Framework for the National Perinatal Depression Initiative 2008-09 to 2012-13;

http://www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/perinatal-depression-1 . Commonwealth of Australia: Fourth National Mental Health Plan—An agenda for collaborative

government action in mental health 2009–2014, Canberra 2009 (Priority 2: Prevention and Early Intervention.

Commonwealth of Australia: The Australian Health Ministers Conference: National Maternity Service Plan 2010, Canberra 2010 - http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesplan (See Action 2.3; Action 3.2.)

Australian Government Department of Health & Ageing: National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013-Australian Government Implementation Plan 2007-2013, Canberra 2007. (Key Result Area 4 - Social and Emotional Wellbeing)

Australian Government Department of Health & Ageing: Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice –Canberra 2010 http://apo.org.au/research/working-together-aboriginal-and-torres-strait-islander-mental-health-and-wellbeing-principl (See Ch 16 - Promoting Perinatal Mental Health Wellness in Aboriginal and Torres Strait Islander Communities).

The 2011 Queensland Maternal and Perinatal Quality Council, Review of Pregnancies, Births and Newborns in Queensland Report: Queensland Maternal and Perinatal Quality Council 2011 (section 1.2.3 p 12) identified that suicide was the most common cause of indirect maternal death.

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http://apo.org.au/research/working-together-aboriginal-and-torres-strait-islander-mental-health-and-wellbeing-principl


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Partners/Clients/Stakeholders

Partners/Clients/Stakeholders Interest/Expectations

Statewide Maternity and Neonatal Clinical Network Steering Committee (SMNCN)

Provide support and direction.

Endorsement of the final report of this project.

The project manager will report to the SMNCN steering committee each month.

Aboriginal and Torres Strait Islander Health Unit Funding provider

Consultation.

SMNSN Aboriginal and Torres Strait Islander Maternity Advisory Group

Lead Role- Active participants.

Northern Maternity & Neonatal Clinical Network Lead Role- Project Management

Active participants.

Maternal & Child Health Workers and their supporting Clinicians Lead Role: Lyndell Gibson – Advanced Health Worker Maternal & Child Health Cape York Health Service – Maternal & Child Health Team (Weipa Family Health)



Maternity / Child Health Clinical Educators Active participants.

Assumptions

Assumptions Funding can be identified and secured to progress this project.

A suitable Project Officer can be found and employed to progress the project

Stakeholders will engage with the project to provide direction and guidance to the project officer.

A suitable cohort of Clinicians and Health Workers will be identified, willing and supported by their Health Service to trial the learning package.

The use of the available screening tools is in the scope of practice for Health Workers employed in the Maternal & Child Health environment.

Health Workers in this environment require a sound understanding of basic mental health, peri-natal infant mental health and cross cultural communication skills to provide an effective support role.

Clinicians supporting Health Workers require a sound understanding and assessment skills in basic mental health, peri-natal infant mental health and cross cultural communication skills to effectively support capacity building in the HW.

Client assessment will remain the responsibility of the registered clinician.

Effective screening of Aboriginal and Torres Strait Islander women will contribute to better health outcomes.

The project is aligned with the priorities of Health Services, State and National Strategic plans.

Health Services will support capacity building in their workforce using the project deliverables.

The project is aligned with the priorities of Health Workers and clinicians working in the Maternal & Child Health environment.

The project is aligned with the priorities of the various stakeholders who are the custodians of the existing resources.

Qualitative evidence, (often anecdotal) is an acceptable measurement of achievement.


Queensland Centre for Perinatal & Infant Mental Health Active participants.

Office of Rural & Remote Health- PaRROT Active participants.

Indigenous Workforce Unit Consultation.

Aboriginal and Torres Strait Islander Hub for Mental Health (The Hub)

Consultation.

Queensland Aboriginal and Islander Health Council Consultation.

Mental Health First Aid Consultation.

NGOs Consultation.

Other stakeholders Consultation.

Likely Project Costs

Financial Year Non Labour Costs ($)

Temp FTE ($) Total $ Perm FTE %

2012/13 $6,083 1 NG7, Level 3 (From 21/1/13 to 30/6/13)

$59,730

2013/14 $6,083 1 x 1.0 FTE NG7, level 3 from 1/7/13 to 20/1/14).

$76,935

Project Costs

TOTAL For 2012/2013 = $ 69,730 ($50,600 assigned to date leaving shortfall $15,213) For 2013/2014 = $ 83,018 (leaving $ 55,541 to complete phase 3) See Appendix 1 for details

Potential Resource Contribution from Stakeholders

Townsville Hospital and Health Service will provide management for the Project Officer in association with RFDS or other NGO.

High Level of Confidence in Likely Project Costs

Comments: Project Officer wages are reasonably fixed. Travel requirements may increase non labour costs if not sufficiently managed.

Post-project Cost Implications

To be determined by the project for phase three of project.

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Project Timeframes Likely Milestones Description Commencement Date Completion Date Recruit a cohort of participants. 20/1/13 14/2/13

Participants complete learning package. 14/2/13 30/7/13

Experience, knowledge & skill of participants evaluated.

1/8/13 1/9/13

Learning package reviewed. 1/8/13 1/10/13

Arrangements for future access to package. 1/2/13 10/9/13

Workshop negotiated, arrangements made, budget secured.

20/1/13 14/11/13

Reports written & project completed. 14/11/13 20/1/13

Major Risk Analysis

Major Risks Likelihood Consequence Management Strategy

Secure a Project Officer in a timely fashion.

Moderate Delay in project start.

Commence negotiations to extend the tenure of the current Project Officer position to undertake this next project phase.

Submit a brief for decision to the Townsville Hospital and Health Service to extend the current Project Officer’s employment term.

Insufficient engagement with Clinicians and Health Workers.

Moderate Delay in a cohort of Health Workers and Clinicians starting and/ or finishing the learning package.

Identify and contact potential participants.

Project Officer to provide support to participants and problem solve issues identified with package structure and resources.

Project Officer to hold regular sessions with participants to ensure learning package is undertaken in a timely manner.

Insufficient engagement and support from HHS, Managers, key stake holders and clinicians

Moderate Delay in a cohort of Health Workers and Clinicians starting and/ or finishing the learning package.

SMNCN to seek support from HHS and managers for interested people to participate.

Project Manager to assist with the problem solving of access issues to the package resources.

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Recommendations & Decisions

Recommendations (Concept Proposer)

Progress to planning and definition phase Undertake preliminary project planning Undertake options analysis Cease

Comments:

Requirements for Next Step (if applicable)

Resources $ Costs

1. 2012/2013 Financial Year 1 x 1.0 FTE NG7, Level 3 for 5 months including on costs and rec leave.

2. 2013/2014 Financial Year 1 x 1.0 FTE NG7, level 3 for 7 months including on costs and rec leave.

$ 59,730 $76,935

3. Non Labour Costs (if applicable) $12,166

(Total) 2012/2013 Financial Year $ 65,813

(Total) 2013/2014 Financial Year $ 83,018

Next Step

Anticipated Timeframe 23 weeks 2012/2013 Financial Year 29 weeks 2013/2014 Financial Year

Name*: Helen Holzwart-Jones (on behalf of)

Work Unit/ Site: Statewide Aboriginal and Torres Strait Islander Maternity and Neonatal Advisory Group (SATIMNAG) of the Statewide Maternity and Neonatal Clinical Network (SMNCN).

Prepared By

Date*: 5th December 2013

Name*: Ms Rymer Tabulo

Position*: Chair, Northern Maternity and Neonatal Clinical Network

Signed:

Date*: 25th January 2013

Cleared By (Project Manager)

Comments: Approved

Authorised By (Project Sponsor)

Name*: Associate Professor Rebecca Kimble

Position*: Chair, Statewide Maternity and Neonatal Clinical Network

Signed:

Date*:

Comments: Approved

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Approval/Decision (Higher Authority)

Next Step* Progress to Planning and Definition phase Undertake preliminary project planning Undertake options analysis Revise concept brief and present again Cease

Comments:

Interim Project Manager (if applicable)

Ms Rymer Tabulo Chair, Northern Maternity and Neonatal Clinical Network

Governance

Project Sponsor Associate Professor Rebecca Kimble Chair, Statewide Maternity and Neonatal Clinical Network

Approved Not approved N/A

Resources for Next Step

Amount $ 152,748.00 Temporary FTE: One (1) x 12 months Ending 20-01-2014.

Higher Authority

Name*:

Position*:

Signed:

Approved By

Date*:

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*Indicates a mandatory field to be entered into PM PlusIS



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Appendix 1.

Non Labour Costs for Project Officer based at Cairns

Unit cost Unit Measurement Occasions Total $

Mobile Phone Calls $ 15 Per Month 6 $ 90

Desk Phone levies $ 30 Per Month 6 $ 180

QH RAS $ 31.75 Per Month 6 $ 190.5

Computer levies $ 153 Per Month 6 $ 918

Rent to Cairns $ 378.04 Per Month 6 $ 2268.24

Printing/ Postage to Cairns $ 24 Per Month 6 $ 144 $ 3790.74 Office costs

Travel Flights $ 400 Return Flight 3 $ 1200

Taxi/ Train $ 50 Return trip 3 $ 150

Travel Accommodation & Meals $ 314.1 Per Day 3 $ 942.3 $ 2292.3

Travel x 3 trips of 1 day

Total for Six Months $ 6,083

Labour Costs if Employed by Queensland Health

No. 2012/13 No. 2013/14 Account Code FTE's $ FTE's $

21/1/13-30/6/13 1/7/13-20/1/14

Nurses 500030 0.44 $ 44,241 0.56 $ 57,437

Total Base Salary Costs 0.44 $ 44,241 0.56 $ 57,437

On Costs

Superannuation 504100 $ 5,556 $ 7,216

Leave Accrual 503030 $ 5,291 $ 6,253

Leave Loading 503200 $ 588 $ 64

Long Service Leave 503300 $ 915 $ 1,189

Work Cover 511210 $ 805 $ 1,045

Payroll Tax 505000 $ 2,334 $ 3,031

Total On-Costs $ 15,489 $ 19,498

Total Salary Costs 0.44 $ 59,730 0.56 $ 76,935

Phase Two Total Project Costs

FTE's 2012/13 FTE's 2013/14

Non Labour Costs $6,083 $6,083

Labour Costs 0.44 $ 59,730 0.56 $ 76,935

Total $ 65,813 $ 83,018

Queensland Health Implementation Project Plan

PMPlusIS ID No:

Date Entered in PMPlusIS:

Project Title*: Build workforce capacity that will enable Aboriginal and Torres Strait Islander Health Workers (HWs) to support the social and emotional wellbeing of Indigenous women and their families in the perinatal period.

Project Statement*: This project will develop a learning framework that facilitates the acquisition of knowledge and skill development (consistent with scope of practice) to use resources that include, but are not limited to the:

Edinburgh Postnatal Depression Scale (EDPS)

Safe Start tool

Community education resources and

Identified local referral pathways.

Work Unit*:

Statewide Aboriginal and Torres Strait Islander Maternity and Neonatal Care Group (SATIMNCG) of the Statewide Maternity and Neonatal Clinical Network (SMNCN).

Outcome area*:

Patient Safety and Quality

Implementation Plan Aboriginal and Torres Strait Islander Emotional Wellbeing Project page 1 of 16.

Project Scope

By the end of the project we expect:

HWs who work in the maternal and child health environment will have a learning framework that facilitates the acquisition of knowledge and skill development to become comfortable and confident within their scope of practice to:

o Understand and support the use of EDPS and Safe Start tools. o Understand and support the use Mental Health promotion resources. o Engage community members in conversation about social and emotional

wellbeing in the perinatal period. o Understand the choice of referral pathways available for women identified

through EDPS and Universal Psychosocial Screening. o Engage identified community members in conversation about the benefits of

available referral pathways.

Registered clinicians working in partnership with HWs will have a learning framework that will enable them to:

o Use the EDPS and Safe Start tools in collaboration with the HW. o Support the HW in the use of Mental Health promotional resources. o Support the HW to engage community members in conversation about social

and emotional wellbeing in the perinatal period. o Identify and use local referral pathways inclusive of specialised clinical services,

allied health and social support services.

Resources identified in the learning framework are readily available and accessible.

Resources identified in the learning framework meet the educational needs of the HW and their supporting clinicians that work in the Maternal & Child Health area.

That the learning framework and resources are communicated to all participating sites and other stakeholders (including services where pregnant women seek care).

Objectives

Key Performance Indicator For the HW and their support clinicians in the Maternal & Child Health environment:

A suite of readily available education resources meeting workforce need have been identified and are available.

A learning framework is available that facilitates education and consolidation of knowledge to enable collaborative use of the EDPS, Safe Start tool, relevant mental health promotion materials and available referral pathways.

80% of clinicians utilising the material referred to in the learning framework report that they are more comfortable and confident in using the tools in their clinical practice.

As a result of this project, we expect to see:

Effective use of identified tools and referral pathways that will improve the social and emotional wellbeing outcomes for Aboriginal and Torres Strait Islander women in the perinatal period.

Purpose


Women with an Edinburgh Postnatal Depression Score (EPDS) of greater than or equal to 12 in pregnancy are seen by a Mental Health Service (MHS) during pregnancy and at least once within 6 weeks post-nataly. (KPI accepted by the QH Clinical Senate)

Referrals to mental health and support services will be promoted relative to the EDPS.



Benefits

Achievement of the project purpose will create the following benefits: To support the social and emotional wellbeing of Indigenous women during the perinatal period by: Creating a model where HWs and Clinicians work effectively together by the HWs

Culturally Supervising the Clinicians and the Clinicians Clinically Supervising the HWs Enhanced knowledge, skills and understanding by HWs and Clinicians with the

Perinatal Mental Health Screening Tools Improved HW and Clinician comfort and confidence working together to achieve

effective Perinatal Mental Health Screening with Indigenous women. Increased accuracy of Perinatal Mental Health Screening of Indigenous women with

appropriate referral to other services as required.


Rationale & Background Rationale/ Background

Clinicians brought to the attention of the NMNCN that the EDPS was resulting in high scores that were often not reflective of the services required by the Aboriginal and Torres Strait Islander women. An informal survey identified similar issues in other parts of the State. Initial thoughts were to adapt the language in the EDPS. Investigation of the research already completed in this area concluded that, the tool was valid and whilst some preferred an adapted tool, the evidence did not support that adaptation improved its functionality. It was concluded that improved outcomes may be gained by building capacity in the HW and clinical staff supporting the HW to effectively support each other to use the available tools. This was consistent with theme 3 recommendations in the Queensland Health Aboriginal & Torres Strait Islander Maternity Care Conference and Workshop Report. Further investigation revealed that there are multiple education resources available. It was considered that a learning framework that facilitates capacity building for HWs and the clinician workforce would enable and empower staff to better support Indigenous women and their families in the perinatal period. This project is aligned to many strategic documents including but not limited to : Queensland Health 2010: Making Tracks towards closing the gap in health outcomes

for indigenous Queenslanders by 2033- Policy and accountability Framework, Brisbane 2010.

Queensland Health 2010: Making Tracks towards closing the gap in health outcomes for indigenous Queenslanders by 2033- Implementation Plan 2009-2010 to 2011-2012, Brisbane 2010.

Queensland Health 2010: Aboriginal and Torres Strait Islander Cultural capability Framework 2010 - 2033, Brisbane 2010.

Beyondblue Clinical guidelines: http://www.beyondblue.org.au/index.aspx?link_id=6.1246

Framework for the National Perinatal Depression Initiative 2008-09 to 2012-13; http://www.health.gov.au/internet/mentalhealth/publishing.nsf/Content/perinatal-depression-1 .

Commonwealth of Australia: Fourth National Mental Health Plan—An agenda for collaborative government action in mental health 2009–2014, Canberra 2009 (Priority 2: Prevention and Early Intervention.

Commonwealth of Australia: The Australian Health Ministers Conference: National Maternity Service Plan 2010, Canberra 2010 - http://www.health.gov.au/internet/main/publishing.nsf/Content/maternityservicesplan (See Action 2.3; Action 3.2.)

Australian Government Department of Health & Ageing: National Strategic Framework for Aboriginal and Torres Strait Islander Health 2003-2013-Australian Government Implementation Plan 2007-2013, Canberra 2007. (Key Result Area 4 - Social and Emotional Wellbeing)

Australian Government Department of Health & Ageing: Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice –Canberra 2010 http://apo.org.au/research/working-together-aboriginal-and-torres-strait-islander-mental-health-and-wellbeing-principl (See Ch 16 - Promoting Perinatal








Mental Health Wellness in Aboriginal and Torres Strait Islander Communities). The 2011 Queensland Maternal and Perinatal Quality Council, Review of Pregnancies,

Births and Newborns in Queensland Report: Queensland Maternal and Perinatal Quality Council 2011 (section 1.2.3 p 12) identified that suicide was the most common cause of indirect maternal death.

Assumptions Stakeholders will engage with the project to provide direction and guidance to the Project Officer.

The use of the available screening tools is in the scope of practice for HW‘s employed in the Maternal & Child Health environment.

HWs in this environment require a sound understanding of basic mental health, peri-natal infant mental health and cross cultural communication skills to provide an effective support role.

Clinicians supporting HWs require a sound understanding and assessment skills in basic mental health, peri-natal infant mental health and cross cultural communication skills to effectively support capacity building in the HW.

Client assessment will remain the responsibility of the registered clinician.

Effective screening of Aboriginal and Torres Strait Islander women will contribute to better health outcomes.

The project is aligned with the priorities of Local Hospital and Health Services, State and National Strategic plans.

Local Hospital and Health Services will support capacity building in their workforce using the project deliverables.

The project is aligned with the priorities of HW and clinicians working in the Maternal & Child Health environment.

The project is aligned with the priorities of the various stakeholders who are the custodians of the existing resources.

Funding can be identified and secured to progress this project.

Constraints Timeframe does not allow for a pilot project to enable result evaluation. A pilot project post project will be required to measure clinician satisfaction with

deliverables. Currently available Perinatal Mental Health Screening Education/Training may not be

suitable to provide optimal learning in HWs and Clinicians. The degree of HW and Clinician involvement in project activities will influence the

accuracy and project outcomes. State wide austerity measures will influence the project’s ability to utilize allocated

funding. Adequate data collection facilities to monitor EDPS KPI’s are still to be developed

including the development of the perinatal data system to enable capture of data for the KPI accepted by Queensland Clinical Senate.


Exclusions Direct delivery of HW education. Measurement of the Indigenous women with high Edinburgh Postnatal Depression

Scale (EDPS) scores (>12) will be dependant on the development of adequate collection methodologies and databases.

A reduction in the high EDPS scores or appropriate referral to Mental Health services or other support services could not be measured until post project and subject to development of data collection capacity.


Summary Activities (High Level Work Breakdown Structure)

Identify stakeholders inclusive of HW positions with supporting clinicians working in the Maternal and Child Health field with Queensland Health and NGOs. Ascertain knowledge acquisition and skill development needs of the HW and supporting Clinical Staff in collaboration with: Nurse Educator positions and the Statewide Aboriginal and Torres Strait Islander

Maternal, Child and Youth Workforce Development Program. HWs employed in Maternal & Child Health services in Queensland. Clinical Staff supporting the HW working in Maternal & Child Health services in

Queensland. Queensland Centre for Peri-natal and Infant Mental Health. Aboriginal & Torres Strait Islander Mental Health. Cert IV Maternal and Child Health training providers (Cunningham Centre). Cultural Capability Unit. Providers of Pathways to Rural and Remote Orientation & Training (PaRROT). Needs assessment to include: Skill acquisition by HW and supporting clinicians in the area of cultural capability and

effective cross cultural communication. Identification of the best practice learning processes to facilitate optimum learning and

skills development. Knowledge and skill development requirements specific to supporting the social and

emotional wellbeing of Indigenous women and their families in the peri-natal period. Source tools that will contribute to improving the social and emotional wellbeing of Indigenous women and their families in the perinatal period including, but not limited to: EDPS Safe Start tool Stay Connected, Stay Strong DVD and associated printed resources and Locally constructed referral pathway documents. Identify the scope and educational capacity of resources and education systems currently available including, but not limited to: Perinatal Infant Mental Health Training – Universal Psychosocial Screening Module Perinatal Infant Mental Health Training – Universal Psychosocial Screening Skill

Development Workshop ASTI Mental Health First Aid course www.mhfa.com.au Cert IV in Maternal and Child Health Stay Connected , Stay Strong DVD EDPS workshops Resources identified on Beyond Blue website Cultural Capability Education PaRROT. Identify gaps in the educational capacity of resources and where possible negotiate ways to resolve these.

http://www.mhfa.com.au/


Document a learning framework for HW and their support clinicians working in the Maternal and Child Health environment in both Government & participating Non Government Organisations, that directs knowledge and skill acquisition required to become comfortable and confident to collaboratively support universal psychosocial screening, community education resources and relevant referral pathways. The learning framework to include in brief, direction for: Best practice learning processes to facilitate optimum learning experiences and skills

development. Learning objectives of courses/ workshops etc. Course schedule sources. Relevance to various levels of clinicians/ HWs. Options for accessing course. Contact details of organiser. Pathway for clinicians to support HWs in Maternal & Child Health practice

environments to consolidate the knowledge acquired from courses/ learnings. Creating and maintaining relevant local referral pathways. Ensure HWs and their support clinicians are able to effectively utilise the learning framework, resources and learnings contained within the framework in their clinical practice settings and in the wider community setting through: Identification of sites with HWs who wish to participate or be kept informed of the

project progress. Consultation from the participating HWs and their support clinicians to ensure that the

program meets their educational and support requirements. Survey HWs and their support clinicians using the learning framework post

implementation to evaluate their satisfaction with : The ability of the framework to advance their acquisition of knowledge and skill

development and The suitability of the learning direction to better enable HWs and support clinicians

to support the social and emotional wellbeing of Indigenous women and their families in the perinatal period.

Communication of the completed learning framework to all participating sites and other interested stakeholders through: HWs, supporting clinicians, manager and CEO of participating sites. Other Aboriginal and Torres Strait Islander Maternal & Child Health Workers. District/ Local Health and Hospital Services (LHHS) CEO’s. Primary Community and Extended Care Branch. Cultural Capability Team. Statewide Maternity & Neonatal Clinical Network (SMNCN) for wider dissemination. Northern Maternity & Neonatal Clinical Network (NMNCN) for wider dissemination. Southern Maternity & Neonatal Clinical Network (SMNCN) for wider dissemination. Central Maternity & Neonatal Clinical Network (CMNCN) for wider dissemination. Non-government organisation stakeholders. Queensland Aboriginal and Islander Health Council Queensland Centre for Mothers and Babies. Aboriginal & Torres Strait Islander Mental Health Branch.


Partners/Clients/Stakeholders

Internal Partners/Clients/ Stakeholders

Nature of Involvement

Management Strategy (as per QH Clinician Engagement Framework)

Statewide Maternity and Neonatal Clinical Network Steering Committee (SMNCN)

Decision Makers Inform, Consult, Involve, Collaborate, Empower

Primary Community and Extended Care Branch

Project Sponsor Inform, Consult, Involve

SMNSN Aboriginal and Torres Strait Islander Maternity Care Group

Stakeholder Inform, Consult, Involve

Northern Maternity & Neonatal Clinical Network

Sponsor Inform, Consult, Involve

Project Working Party Active Participants Inform, Consult, Involve, Collaborate

Project wider Reference Group Stakeholders Inform, Consult

Health Workers and Clinicians Lead Role: Lyndell Gibson

Stakeholders Inform, Consult, Involve

Maternity / Child Health Clinical Educators


Queensland Centre for Perinatal & Infant Mental Health


Office of Rural & Remote Health- PaRROT


Indigenous Workforce Unit Stakeholder Inform, Consult

Aboriginal & Torres Strait Islander Health Branch


Queensland Aboriginal and Islander Health Council


Mental Health First Aid Stakeholder Inform, Consult

External Partners/Clients/ Stakeholders

Nature of Involvement Management Strategy

NGOs Stakeholder Inform, Consult

Other stakeholders Stakeholder Inform


Project Key Dates & Milestones

Timeframe Commencement Date

Completion Date*

Overall* 01-04-2012 20-01-2013

Concept Phase 23-11-2011 29-03-2012

Planning & Definition Phase

Identify Stakeholders 12-06-2012 13-07-2012

Create Working Party and broader Reference Group 29-06-2012 01-08-2012

Develop project plan 01-04-2012 25-7-2012

Submit Report 1 to PCEC 01-04-2012 30-7-2012

Implementation Phase*

Identify stakeholders including HWs and supporting clinicians working in Queensland Health and NGOs.

12-06-2012 25-07-2012

Ascertain knowledge acquisition and skill development Needs Assessment of the HW and supporting Clinical Staff.

12-06-2012 13-08-2012

Source tools that will contribute to improving the social and emotional wellbeing of Indigenous women and their families in the perinatal period.

12-06-2012 13-08-2012

Identify the scope and educational capacity of resources and education systems currently available.

12-06-2012 17-09-2012

Report to Primary, Community and Extended Care Branch 12-06-2012 30-07-2012

Identify gaps in the educational capacity of resources and where possible negotiate ways to resolve these deficiencies.

12-06-2012 17-09-2012

Develop and administer pre survey 12-06-2012 17-09-2012

Document a learning framework for HWs and Clinicians. 30-07-2012 17-09-2012

Ensure HWs and their support clinicians are able to effectively utilise the learning framework, resources and learnings.

17-09-2012 01-10-2012

Communication of the completed learning framework to all participating sites and other interested stakeholders through

01-10-2012 12-11-2012


Finalisation Phase

Administer post survey and evaluate results 20-12-2012 07-12-2012

Executive Summary with a copy of deliverables to SMNCN 17-09-2012 28-11-2012

Report to Primary, Community and Extended Care Branch (PCECB) 28-11-2012 14-12-2012

Final Project Report and Recommendations 14-12-2012 20-01-2013


?Post Implementation review (PIR)

At the discretion of the SMNCN and dependent on additional funding.


Overall Project Budget & Cost Management

Financial Year*

Non Labour Costs*

Temp FTE ($)* Total $* Perm FTE*

%*

2011/12 $5000 1 NG7, Level 3 for 3 months including on costs and rec leave.

$34,680 0

2012/13 $5000 1 x 1.0 FTE NG7, level 3 for 5 months including on costs and rec leave.

$57,800 0

Project Costs

Total* For 2011/2012 = $ 39,680

For 2012/2013 = $62,800

Potential Resource Contribution from Stakeholders

Nil.

High Level of Confidence in Likely Project Costs Comments: Resources that will be utilised in the learning framework are readily

available and accessible.

Post-project Cost Implications

A pilot project to utilise the learning framework developed in this project will be necessary. The pilot project and evaluation will require additional funding.

Wider implementation post pilot project will require additional funding.

Estimated Margin of Error

Up to 10%

Major Risk Analysis

Major Risks Likelihood Consequence Management Strategy

Insufficient engagement and support from key stakeholders, HWs and clinicians

Moderate Delay in the progress of project

Early enlistment of influential key persons who are supportive of the initiative and able to clearly articulate and communicate the benefits of the project.

Engage with key stake holders with regular meetings. Keep key stake holders informed at all key stages of

project development.


Early engagement with clinicians to gain commitment. Establish consistent operating and communicating

processes. Utilise multiple communication strategies. Ensure issues and concerns are addressed in a speedy

and timely manner. Acknowledge and respond to feedback. Identify key persons at each site who can become local

champions.

Inadequate or unsuitable Perinatal Mental Health training

Moderate to High

Delay in the progress of project

Establish learning needs of HWs and Clinicians Investigate training available Consult with training providers about the possibility of

altering/adapting training to meet the needs of HWs and Clinicians

Inadequate time due to delay in starting project officer and austerity measures. Not allowing project to be run part-time as envisaged.

High Project not completed

Timeline as tightly as possible. Attend to key features first. Reduce consultation. Use resources as available without consideration for

adaptation.

Project Governance

Structure Direct reporting Structure as outlined below.

Role Name(s) Responsibilities Project Manager Rymer Tabulo Ensure project on time and deliverables

are met. Project Sponsor Rebecca Kimble Deliver project deliverables on time and

in budget

Project Management Roles & Responsibilities

Key Project Phases/Documents

Higher Authority for Approval/Sign-off

(Planned) Dates

Concept initiated July 2011 Concept phase completed

John Wakefield 29-03 2012

Approval of project plan

Maternity Care Group Next Meeting 2012

Release of project funds

Corelle Davies A/Exec Director PCEC

09-05-2012

Key Decision Points & Dates (ie. higher authority)

Pre-implementation N/A N/A

review (if relevant) Status Report 1* PCEC Branch 30-07-2012 Status Report 2* PCEC Branch 14-12-2012

Issue/change request

Implementation phase completed

Rymer Tabulo 28-11-12

Project completion report

Rymer Tabulo 27-02-2013

Finalisation phase completed

Rebecca Kimble 27-02-2013

* Project Manager to report project status to project Sponsor on a monthly basis


Human Resource Management

Accountable Officer Work Days/Weeks Required

Temp FTE

Perm FTE

Skill Development Requirements

Project Manager Rymer Tabulo 1 Nil

Project Officer Belinda Rule 1 Nil

TOTAL 1 1 Nil

Communication Management

Project Communication What How With/To Whom When/How Often Formal Meetings In person/ Telehealth Statewide Maternity and

Neonatal Clinical Bi-monthly

Time and Cost Management

Internal Budget Source Non- Labour Costs*

Planned Temp FTE ($)* Total ($)* Perm FTE*

Base* 2011/2012

$5,000 1 NG7, Level 3 for 3 months including on costs and rec leave.

$34,680 0

2012/2013 $5,000 1 x 1.0 FTE NG7, level 3 for 5 months including on costs and rec leave.

$57,800

Strategic Initiatives / Operational Imperative*

Nil Nil} Nil 0

Other* Nil Nil 0

Total $10,000 $92,480 0


Network Steering Committee (SMNCN)

Formal Meetings In person / Telehealth Northern Maternity & Neonatal Clinical Network

Bi-monthly

Working Party In person/ telephone /email

Project Working Party Monthly and as required

Collaboration Email Project Reference Group

As required

Consultation/ Collaboration/ Progress information

In person/ email/ telephone

Other stakeholders As required

Records Management Document Type/Name Electronic Location Hardcopy Record Location Project management documents C drive PIMH Project Officer

Computer Filing Cabinet PIMH Project Officer office

Project reference documents C drive PIMH Project Officer Computer

Filing Cabinet PIMH Project Officer office

Evaluation

Achievement of objectives will be determined by the following performance indicators: The following Key Deliverables will be physically available:

A suite of readily available education resources meeting workforce need have been identified and are available.

A learning framework is available that facilitates education and consolidation of knowledge to enable collaborative use of the EDPS, Safe Start tool, relevant mental health promotion materials and available referral pathways.

80% of clinicians utilising the material referred to in the learning framework report that they are more comfortable and confident in using the tools in their clinical practice (This evaluation is only possible after completion of a Pilot phase).

Data capture processes that need to be developed/implemented for the performance indicators are:

A pre and post survey learning package completion survey.

Project Evaluation Methodology (Process and Impact Evaluation)

Project management effectiveness will be reviewed through: Review through deliverables tabled with the SMNCN on 27-02-2013

Post Implementation Review (PIR)

(Outcome Evaluation)

The likely post implementation review strategy will be:

At the discretion of the SMNCN to run a pilot project and measure against project outcomes.


Recommendations (Project Manager)

Progress to Implementation*

Cease

Comments:

Progress to planning and definition phase

Undertake preliminary project planning

Undertake options analysis

Cease

Comments:

Requirements for Next Step (if applicable)

Resources Resources

Non Labour Costs (if applicable) Non Labour Costs (if applicable)

Anticipated Timeframe Anticipated Timeframe

Name*: Belinda Rule

Title*: Project Officer

Work Unit / Site*:

Womens & Childrens Health Institute The Townsville Hospital.

Date*: 15-07-2012

Phone Number*:

0477328576

Prepared By

Email*: [email protected]

Name*: Rymer Tabulo

Title*: Chairperson Northern Maternity & Neonatal Clinical Network

Work Unit/Site*:

Mackay Base Hospital

Phone Number*:

(07) 4885 6852

Email*: [email protected]

Signed*:

Date*:

Next Step

Cleared By

(if applicable)

Comments:


Approval/Decision (Higher Authority)

Next Step Progress to implementation phase

Revise project plan and resubmit

Cease

Comments:

Project Manager Ms Rymer Tabulo

Chair, Northern Maternity and Neonatal Clinical Network

Governance

Project Sponsor Associate Professor Rebecca Kimble

Chair, Statewide Maternity and Neonatal Clinical Network

Approved

Not approved

N/A

Amount $ As described

Time: As Described

Cost: As described

Quality: As described

Parameters of Project Manager Authority

Other:

Name: Rebecca Kimble

Title: Chair Statewide Maternity & Neonatal Clinical Network

Work Unit / Site:

Clinical Director Obstetric and Gynaecology Services RBWH

Phone Number:

(07) 3636 8252

Email: [email protected]

Signed:

Date:

Resources

Approved By

Comments:

Aboriginal and Torres Strait Islander Emotional Wellbeing Project Working Party

Terms of Reference

Purpose

To work with project officer to produce the deliverables on a project that has a goal to “Build workforce capacity to enable Aboriginal and Torres Strait Islander Health Workers (HWs) to support the social and emotional wellbeing of Indigenous women and their families in the perinatal period”.

Roles

The Project Officer’s role is to: Convene meetings and arrange secretariat functions. Bring project elements and progress to meeting for discussion. Seek direction and clarity to achieve project deliverables. Adapt project elements etc according to working party feedback.

The members of the Working Party will work with the project officer to produce the deliverables by: Identify Aboriginal and Torres Strait Islander Health Workers and supporting clinicians

working in the Maternal and Child Health field with Queensland Health and NGOs who work with Indigenous women during the perinatal period.

Engage with clinicians, education providers and consumers to: promote the project, disseminate information about the project to colleagues, consumers and workers from

other services and, facilitate feedback about various aspect of project and deliverables within established

timeframes. Evaluate educational tools and resources within established timeframes and provide

feedback. Assist with implementation at project completion. Read all meeting material prior to meeting and nominate a proxy if unable to attend the

meetings.

Meetings and Consultation

Meetings will be held by teleconference monthly or as deemed required. Other consultation will be predominantly undertaken via email. The Agenda and associated papers for consideration will be distributed one week prior to

the meeting. Quorum will be 50% of members + 1 will be required for critical decisions. Minutes will be distributed in a timely fashion post meeting.

Evaluation of Performance

Actions arising from previous minutes will be enacted on in the time specified by the person accepting the responsibility for that action

Terms of Reference Control History:

Version Date Prepared by Comments 1.1 August 2012 B. Rule Draft after initial group meeting. Initial endorsement

Aboriginal and Torres Strait Islander Emotional Wellbeing Project Working Terms of Reference Page 1 of 1

Aboriginal and Torres Strait Islander Perinatal Emotional Wellbeing Project Pre-Survey Questions and Results

Question Response Percent Count 1. What geographical area do you work in? Brisbane North 8.9% 4 Brisbane South 8.9% 4 Cairns and Hinterland 8.9% 4 Cape York 11.1% 5 Central Queensland 6.7% 3 Darling Downs 11.1% 5 North West Queensland 8.9% 4 South West Queensland 2.2% 1 Sunshine Coast 4.4% 2 Torres Strait and Northern Peninsula 2.2% 1 Townsville and Hinterland 6.7% 3 West Morton 4.4% 2 Wide Bay 0.0% 0 Other 0.0% 0 2. Who do you work for? Queensland Health 91.1% 41 AMS or Indigenous controlled community 2.2% 1 General Practice 0.0% 0 Other Non-government Organisation 6.7% 3 3. What is your job type Nurse or Midwife 91.1% 41 Aboriginal Torres Strait Islander Liaison Officer/ other 2.2% 1 Medical Officer 0.0% 0 Other clinician 6.7% 3 Other non-clinician 91.1% 41 4. How long have you been in this or a similar position/job? 0-6 months 2.2% 1 6-12 months 11.1% 5 1-2 years 8.9% 4 2-5 years 15.6% 7 Over 5 years 62.2% 28 5. Have you used/assisted with the Edinburgh Postnatal Depression Scale (EDPS)? Help women with EDPS and assess/evaluate results 55.6% 25 Help women with EDPS only (Refer to clinician to evaluate results) 13.3% 6 Involvement limited due to lack of skill/knowledge 2.2% 1 Involvement limited due to lack of opportunity 8.9% 4 No involvement 20.0% 9 6. Have you used/assisted with the Safe Start Tools Help women with tool and assess/evaluate results 55.6% 25 Help women with tool only (Refer to clinician to evaluate results) 13.3% 6 Involvement limited due to lack of skill/knowledge 2.2% 1 Involvement limited due to lack of opportunity 8.9% 4 No involvement 20.0% 9

Percent Count 7. How comfortable are you using these screening tools with Aboriginal Torres Strait Islander women? Very comfortable 22.2% 10 Reasonably comfortable 31.1% 14 Neutral/ not sure 20.0% 9 Mildly uncomfortable 8.9% 4 Very uncomfortable 4.4% 2 Not applicable 13.3% 6 8. How confident are you using these screening tools with Aboriginal Torres Strait Islander women? Very confident 24.4% 11 Reasonably confident 24.4% 11 Neutral/ not sure 24.4% 11 Mildly unconfident 8.9% 4 Very unconfident 4.4% 2 Not applicable 13.3% 6 9. In your experience, what percentage (%) of the screening in your area is done with Aboriginal Torres Strait Islander women? 0-1% 15.6% 7 5-10% 4.4% 2 10-20% 11.1% 5 20-50% 15.6% 7 50–75% 15.6% 7 75-100% 37.8% 17 10. Do your Aboriginal Torres Strait Islander women easily understand the questions in the screening tools? (Note: This includes the questions being read out to them if they have difficulty reading) Understand all the questions 6.7% 3 Understand most of the questions 35.6% 16 Neutral/ not sure 15.6% 7 Understand some of the questions 28.9% 13 Do not understand any of the questions 0.0% 0 Not applicable 13.3% 6 11. Does the EDPS give a score that reflects (equals) your Aboriginal Torres Strait Islander women's social and emotional health? E.g. low score for someone with no social and emotional problems and a higher score for someone with social and emotional problems Always 0.0% 0 Usually 37.8% 17 Sometimes 24.4% 11 Rarely 13.3% 6 Not sure 24.4% 11 12. What do you think may be the reason the EDPS gives a score that is not accurate? Tick more than one if necessary. Screening tool does not use easy to understand English 28.9% 13 Screening tool is not culturally sensitive/appropriate 60.0% 27 Persons administering/assisting with the tools lack cultural understanding 40.0% 18 Persons administering/assisting with the tools lack knowledge/skill in Perinatal Psychosocial Screening

26.7% 12

Screening tools do not ask “the right questions” to get an accurate picture of the women’s social and emotional wellbeing.

48.9% 22

N/A Screening tool produces accurate results 8.9% 4 Other 6

Percent Count 13. At your work do you have a policy/referral pathway/workplace instruction that says women with an EDPS score of >12 are to be referred to Mental Health Services? Yes 60.0% 27 No 13.3% 6 Unsure 26.7% 12 14. At your work are women with an EDPS score of >12 automatically referred to Mental Health Services? Always 11.1% 5 Usually 40.0% 18 Sometimes 22.2% 10 Rarely 4.4% 2 Never 2.2% 1 Unsure 20.0% 9 15. What do you think can be done to improve the way we use screening tools with Aboriginal Torres Strait Islander women? Basic Themes of Responses: Cultural appropriateness 17 Language 7 HW involvement 12 Education 10 Unsure 5 16. Please pick the amount of training you have had on Perinatal Psychosocial Screening? More than enough 13.3% 6 Reasonable 17.8% 8 Adequate 15.6% 7 Not enough 33.3% 15 Nil 20.0% 9 17. In general how do you rate the training you have had on Perinatal Psychosocial Screening? First class 2.2% 1 Good 20.0% 9 Adequate 28.9% 13 Poor 20.0% 9 Extremely poor 2.2% 1 Not applicable 26.7% 12 18. Please pick how useful in general this Perinatal Psychosocial Screening was? Very useful 6.7% 3 Useful 51.1% 23 Limited use 15.6% 7 Not useful 2.2% 1 Not applicable 24.4% 11 19. How easy was it for you to access training for Perinatal Psychosocial Screening? Very easy to access 8.9% 4 Easy to access 22.2% 10 Not sure 26.7% 12 Hard to access 20.0% 9 Could not access any training 20.0% 9

Percent Count 20. At your work is it clear what you need to read and do so you can learn about EDPS and Safe Start tools? Very clear pathway 20.0% 9 Not so clear pathway 24.4% 11 Not sure 20.0% 9 Unclear pathway 11.1% 5 No identified pathway 24.4% 11 20.0% 9 21. What Perinatal Psychosocial Screening Training did you find the most helpful/ worthwhile? Basic Themes of Responses: Workshop 6 Face-to -ace 8 Online training 3 Nil training received 5 Unsure 5 N/A 12 22. What Perinatal Psychosocial Screening Training did you find the least helpful/ worthwhile? Basic Themes of Responses: Original short training with rollout of screening 4 Self directed learning package 3 Online 5 All training was useful 6 Nil training received 3 Unsure 12 N/A 7 23. How could the training be improved? Basic Themes of Responses: Face-to-face interactive 9 Practical examples, scenarios and how to respond 15 Culturally appropriate training and examples 12 Refreshers available 4 Make training more accessible and advertised widely 8 Variety of learning modes available 4 Any training- none/little received 5 Consistency, standardised Queensland wide 3 Unsure 5 N/A 7 24. See next page. 25. Are you willing to be involved in a pilot educational project on Perinatal Psychosocial Screening? Yes 85.0% 34 No 15.0% 6

24. Please rate how do the these types of training suit you (meet your learning needs)? Starting at 1 = best and going down, with 12 = worst. Rating Response 1 2 3 4 5 6 7 8 9 10 11 12 Average Count

On the job training 28.9% (13)

24.4% (11)

13.3% (6)

6.7% (3)

4.4% (2)

11.1% (5)

2.2% (1)

4.4% (2)

0.0% (0)

2.2% (1)

0.0% (0)

2.2% (1)

3.33 45

Short face-to-face lecture (1hr) 17.8%

(8) 13.3%

(6) 15.6%

(7) 15.6%

(7) 11.1%

(5) 8.9% (4)

4.4% (2)

4.4% (2)

0.0% (0)

4.4% (2)

2.2% (1)

2.2% (1)

4.24 45

Power point presentation 0.0% (0)

2.2% (1)

17.8% (8)

13.3% (6)

13.3% (6)

6.7% (3)

6.7% (3)

13.3% (6)

11.1% (5)

2.2% (1)

6.7% (3)

6.7% (3)

6.47 45

Skill development workshop (interactive ½ to 1 day) 20.0%

(9) 26.7% (12)

15.6% (7)

17.8% (8)

8.9% (4)

2.2% (1)

2.2% (1)

2.2% (1)

0.0% (0)

4.4% (2)

0.0% (0)

0.0% (0)

3.27 45

Information forum/conference (non-interactive ½ to 1 day)

8.9% (4)

0.0% (0)

4.4% (2)

11.1% (5)

24.4% (11)

13.3% (6)

6.7% (3)

4.4% (2)

8.9% (4)

11.1% (5)

2.2% (1)

4.4% (2)

6.20 45

Videoconference- lecture (non-interactive 1-2hrs) 2.2% (1)

2.2% (1)

2.2% (1)

2.2% (1)

0.0% (0)

24.4% (11)

13.3% (6)

6.7% (3)

11.1% (5)

8.9% (4)

11.1% (5)

15.6% (7) 8.13 45

Interactive videoconference sessions (1-2hrs) 0.0% (0)

4.4% (2)

6.7% (3)

8.9% (4)

11.1% (5)

4.4% (2)

22.2% (10)

8.9% (4)

8.9% (4)

0.0% (0)

22.2% (10)

2.2% (1)

7.24 45

Computer based information program (no work required)

0.0% (0)

0.0% (0)

2.2% (1)

4.4% (2)

0.0% (0)

6.7% (3)

6.7% (3)

24.4% (11)

13.3% (6)

15.6% (7)

8.9% (4)

17.8% (8) 8.93 45

Computer based- self directed learning package (you need to do all activities by yourself)

0.0% (0)

2.2% (1)

4.4% (2)

6.7% (3)

17.8% (8)

6.7% (3)

6.7% (3)

4.4% (2)

24.4% (11)

6.7% (3)

11.1% (5)

8.9% (4)

7.71 45

Self paced learning package (with links to DVD & other training/information) (you need to do all activities by yourself)

4.4% (2)

6.7% (3)

6.7% (3)

4.4% (2)

4.4% (2)

8.9% (4)

11.1% (5)

13.3% (6)

6.7% (3)

26.7% (12)

4.4% (2)

2.2% (1)

7.18 45

Learning package with support and guidance provided by a mentor/ supervisor with links to other training sources.

11.1% (5)

15.6% (7)

8.9% (4)

4.4% (2)

4.4% (2)

4.4% (2)

8.9% (4)

8.9% (4)

6.7% (3)

2.2% (1)

22.2% (10)

2.2% (1)

6.22 45

Learning package- self directed & self contained (you need to do all activities by yourself & has no links other sources)

6.7% (3)

2.2% (1)

2.2% (1)

4.4% (2)

0.0% (0)

2.2% (1)

8.9% (4)

4.4% (2)

8.9% (4)

15.6% (7)

8.9% (4)

35.6% (16) 9.07 45


Phase 1 Report Page 17 of 17.

Appendix 6 – Concept Brief Aboriginal and Torres Strait Islander Perinatal Social and Emotional Wellbeing Project Phase Two