Qld Clinical Senate 4 November 2016 An Integrated Refugee Health Model of Care

Andrea Vancia, Brisbane South PHN Leeanne Schmidt Metro South Refugee Health Service

The problem - Increase in new arrivals

• Syria / Iraqi arrivals have increased settlement to Logan by 400% • Total referrals Jan – October 2016: 1178 people • Overwhelming current MSRHS capacity • No additional resources • Decision made not to accept referrals for Syrian/Iraqi clients • Manage risks Coordination of care and standard referral pathways Clients inappropriate presentation to emergency departments Delays in accessing health services Impact on GPs and general practice being overwhelmed Impact of settlement agency staff

What We Did

MSRHS • Flexible health assessment/ Immunisation clinic

appointment • Engagement of Logan City Council to immunise

clients most at risk of losing Centrelink payments - ‘No Jab No Pay’

• Ongoing evolving of oral health pathway

BSPHN and MSRHS • Settlement agency staff education • Practice nurse education to undertake refugee

health nursing assessment • Exploring other flexible models for building

sustainability of general practice • Continued capacity building in general practice

Benefits

• Stronger and sustainable partnerships between BSPHN, MSRHS and ACCESS Community Services

• Commitment of a shared vision for our clients/ patients

• Integration of services across the refugee health sector

• Flexibility to explore new models of care • Environment supporting clinician – led innovation “We really feel supported, even though you are no longer accepting Syrian referrals” (Team Leader ACCESS)

How Who Where

Resources / Contacts

Metro South Refugee Health Service P: 07 3290 8900 E: metrosouth_refugeehealth@health.qld.gov.au W: www.metrosouth.health.qld.gov.au/health-equity-and-

access/refugees-and-asylum-seekers

Refugee Health Connect P: 07 3864 7580 E: refugeehealth@bsphn.org.au W: www.bsphn.org.au/refugee-health

Refugee Health Resources W: www.materonline.org.au/refugeehealth

Other import things to contextualise this presentation

Who is a refugee/ asylum seeker?

The 1951 Convention Relating to the Status of Refugees (and its 1967 Protocol), to which Australia is a signatory, defines a refugee as:

“Any person who owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is

outside the country of his/her nationality and is unable, or owing to such fear, is unwilling to avail himself/herself of the protection of that country”

Source: United Nations High Commission for Refugees - UNHCR

Logan

Ipswich

Goodna

Gold Coast

Brisbane South

Brisbane North

Inala

Settlement areas

Yellow Stars: ACCESS Community Services - Logan Blue Stars: MDA - Woolloongabba

Client journey

• Coordinated care – individual focus • Clinical expertise – ‘refugee ready’

workforce and organisations

Supported by: South East Queensland Refugee Health

Partnership Advisory Group South East Queensland Refugee Primary

Health Care Clinical Advisory Group Refugee Health Connect

• Established in response to changes to Refugee Health Services in SEQ and the broader changes to the Australian Humanitarian Program and asylum seeker policy.

• Key stakeholders identify needs and develop a strategic response that meets the health needs of refugees and asylum seekers settling in SEQ.

• 21 organisations (primary care, refugee health, mental health, settlement services, PHN, HHS, DSS)

• Major achievements so far: Inception of Refugee Health Connect Development of state-wide framework supported by the Minister Refugee Health and Wellbeing: A strategic framework for Queensland

South East Queensland Refugee Health Partnership Advisory Group

• Established to facilitate a response to refugee health needs within the local community.

• Key stakeholders work collaboratively to build capacity among primary care providers including identifying gaps in knowledge and developing resources and education to address these gaps.

• Representatives from refugee health services, general practices, PHNs, pharmacy.

South East Qld Refugee Primary Health Care Clinical Advisory Group

Refugee Health Connect

One point of contact for all aspects of refugee health:

• builds capacity in primary care • links patients to primary care • navigates organisations to refugee

health services

Covers two different settlement areas: • Logan and ACCESS • Brisbane South/North and MDA

Metro South Refugee Health Service (MSRHS)

• Block funded for 550 people annually • Nurse led service • Staffing – 1 x CNC, 1 x CN and

0.8 Administration officer • Role: Nursing health assessment within

28 days of arrival Commence immunisation catch up Referral to a ‘refugee ready’ GP and

practice; TB referral Embedded child health and oral health

wellness program Case management and complex care support

Opportunities

• Referral pathways for gaining a timely diagnosis • Private allied health access to funded

interpreters • Engagement of interpreter services What enhancements are required

• Data on refugee sector emergency department presentations

• Audit the cultural sensitivity of our workforce • Stronger partnerships between PHNs and HHSs • Shared health record

How Who Where