Page Contents

• Paediatric Outreach Clinic at the La Perouse ACHC
• Early Childhood Service
• Aboriginal Health Care Worker Liaison Service

The program aims to improve access for children living in Aboriginal communities to primary health and continuing care services. The strategies used to achieve this goal are based on actively reaching out to the community. Some of the strategies used include:

• A "drop in" Paediatric clinic where children can be seen with or without a pre-arranged appointment. Health care workers are flexible about timing and location of consultation and do their best to accommodate the family's individual needs.
• Visiting families in the home setting ( primarily through the Early Childhood service) and emphasising good health care as an important part of a child's upbringing.
• Transport service provided by the Aboriginal Health Education Officer to facilitate attendance at clinics and Community Health Activities.
• Child groups run at La Perouse Aboriginal Community Health Centre (ACHC) where families meet and enjoy social contact while receiving informal health advice.
• Creation of a child-friendly environment including construction of a new playground on the site of the ACHC, where children can play in a safe environment while their parents receive health care. This also facilitates strengthening of ties both within the community and to the Health Clinic.

In 2006, there were approximately 1,188,140 people resident in the South East Sydney Illawarra Health (SESIH) Area. Within this population there are 15,453 people who identify as Aboriginal and Torres Strait Islander (1.3%).  There are 5 244 Aboriginal children aged 0-14 years living in SESIH which makes up 34% of the total Aboriginal population. Within the northern network of SESIH, there are 1171 Aboriginal children 0-14 years (includes local government areas: Botany, Randwick, Sydney, Waverly and Woollahra).

In the Randwick local government area (Centennial Park to La Perouse), there 465 Aboriginal children 0-14 years which includes:

• 169 Aboriginal children 0-4 years
• 160 Aboriginal children 5-9 years
• 136 Aboriginal children 10-14 years

To remediate a lack of local health care for the La Perouse Aboriginal community following the closure of Prince Henry Hospital services in 1998.

• To improve access to local Health Services for the La Perouse Aboriginal Community.
• To improve access to Prince of Wales Hospital (POWH) tertiary Health Services for the La Perouse Aboriginal Community.
• To improve utilisation of Health services by the La Perouse Aboriginal Community.
• To improve the Health status of the La Perouse Aboriginal community.

• The provision of a local accessible Paediatric service in continuity with the Malabar Midwifery service to address health and developmental needs of Aboriginal children.  The service also aims to improve family and community connectedness through community education and liaison.
• The establishment of a paediatric clinic in a purpose-built building dedicated to the health and well being of the Aboriginal population and attendance by dedicated staff who provide health services, advocate for the community and encourage community development and connectedness.

The service aims to provide coverage of the local Aboriginal child community by maintaining multiple points of contact and entry for families.  These include links with:

• Maternity services - local tertiary maternity service through the Royal Hospital for Women (RHW) and Malabar.  The Early Childhood Nurse (ECN) has contact with every child born through the Malabar service and all women booked in at RHW have been given information about the Malabar service. (Proportion of population captured to be reported in formal service evaluation)
• Gujaga Child Care centre with health screening provided for all children attending and through informal networks of families and friends
• Community information on Paediatric clinic through leaflets, school newsletters, community paper and La Perouse community health service
• Sydney Children’s Hospital Emergency Department and medical teams have been informed with written and verbal information about referral pathways and clinic services

Through maintaining a consistent dedicated service that is accepted and utilised by the community, it is anticipated that over time, improvement in health indicators will result.  These include:

• Reduced hospital admissions and emergency department presentations (due to improved management and education of families for chronic conditions). A study to examine the relationship between ED presentations and the existence of the clinic will commence in 2008. Data regarding hospital admission for children attending the clinic as compared with those not attending will be compiled once Ethics approval has been obtained
• Improvements in neonatal outcomes (mortality, birth weight, prematurity) 
• Improved attendance and reductions in loss to follow-up at SCH specialist appointments 
• Improved compliance with chronic care management plans
• Reductions in child morbidity rates such as decreased injury rates, child protection notifications, teenage pregnancies, hearing loss, developmental delay and late presentation to hospital for acute conditions

From 2001, La Perouse Community Health Services for approximately 2000 local Aboriginal people were limited to the (2 room) Arrunga Clinic - until the La Perouse ACHC was opened in 2006. From 2007, Area Aboriginal Health (Gail Daylight) working initially with Geriatric Medicine and Community Health, set out to develop, within La Perouse ACHC, an integrated Aboriginal Community Health Service.

In response to longstanding requests for local, accessible health services from the La Perouse Aboriginal Community, the health centre opened. Monday October 9th 2006 saw the first clinic operate. The centre was purpose built on Aboriginal Lands Council land. It aims to be a culturally appropriate referral and drop-in centre operated through a collaboration of staff from Prince of Wales Hospital (POWH), Sydney Children’s Hospital (SCH), the Royal Hospital for Women (RHW), Sydney/Sydney Eye Hospital, and the Aboriginal Medical Service (AMS) at Redfern. Known as “Nuggong Ngura”, meaning “place of good health” in the Dharawal language, the centre offers outreach health services including medical, nursing and midwifery clinics, screening programs, support groups and education sessions for the La Perouse Aboriginal Community.  All clinics are run with an Aboriginal health worker in attendance. The focus is to decrease the impact of existing health problems, make health services more accessible to the community and develop early intervention strategies that improve health outcomes.

• Commenced in November 2006
• Thursday morning, fortnightly 
• Drop in service to enable flexibility and accessibility
• Any child in Northern network of South Eastern Sydney and Illawarra area welcome (GP referrals preferred) 
• Any medical, developmental or behavioural concern welcome 
• Staffed by consistent doctor and nurse with support of the Aboriginal Health Education Officer
• Numbers fluctuate but approximately 5-7 patients are seen per clinic
• Children range from 2 weeks to 15 years of age with the majority under 3 years of age
• Common presentations include general health checks, skin conditions, developmental and behavioural concerns, acute infections and sleep problems

• Ear Nose and Throat clinics and specialists involved in these clinics
• Speech Therapy
• Out of Home Care Clinics, specifically for children in kinship or foster care

Staffing is provided for the Paediatric service as follows.

• Early childhood services at weekly clinics or home visiting to provide continuity of care for routine infant blue book checks at Early Childhood clinics at La Perouse CHC.
• The ECHN and the Aboriginal Health Education Officer meet all women in the ante-natal period (36 weeks gestation) to explain the service and provide home visiting to all newborns and their parents seen at Malabar Midwifery service.
• Coordinating with midwives from Malabar in providing integrated home visiting to enable 6 week newborn check and maternal post natal check to occur in a single appointment.
• Available by mobile phone to be contacted by mothers to assist with any queries.
• Flexibility with appointment times and location.
• Coordinating with midwives from Malabar in providing integrated home visiting to enable 6 week newborn check and maternal post natal check to occur in a single appointment.
• Providing transport and support  for families to attend specialist medical or allied health appointments.
• Working in collaboration with Paediatric Fellow in Paediatric clinics.
• Ensuring all mothers are engaged in follow-up care, either with the service or with their own Family Doctor.
• Creating contact between local families in the community.

The AHEO's role involves a wide range of functions with primary focus on providing liaison between Aboriginal families and primary and continuing health care. The AHCW also aims to improve family and community connectedness through community education and liaison. The Aboriginal Health Education Officer facilitates access to health care services by:

• Liaising with the Early childhood nurse about families requiring medical care. The Aboriginal Health Education Officer with the ECHN meet all women in the ante-natal period (36 weeks gestation) to explain the service and provide home visiting to all newborns and their parents seen at Malabar Midwifery service.
• Contacting families and facilitating transport to services. This includes providing transport if required.
• Accompanying patients to appointments and supporting families through the process of accessing medical care.
• Assisting families with carrying out recommendations made.

The evaluation process consists of the following elements:

• Monthly: Aboriginal Health-Link Advisory Committee (AHLAC) sets projects.
• Community Consultation: through six community members on the AHLAC.
• Quarterly: ACHC Governance Committee Meetings.
• Clinic statistics and attendances kept by Paediatric service and ECHN.
• Presentations on the health of urban Aboriginal communities and Aboriginal Health and Ageing Research across Australia.

Initial data from the first 19 months of the Paediatric clinic is presented below.  Formal evaluation is currently underway.

* total consists of 86 from Paediatric Clinic (La Perouse CHC), 62 in health screening at Gujaga Child Care Centre, and 19 children seen at both sites.

A total of 178 occasions of service (including review appointments) have been delivered at the clinic in the first 19 months of operation.

Since commencement of this service in July 2007 (up to March 2008), 169 Aboriginal infants and children have been seen in over 200 clinic and home visits including 34 newborns. Since November 2006, 129 children have been seen in 178 medical consultations or in community based, paediatric screening clinics. This constitutes around 60% of all under 5 year-olds in the Aboriginal population in the target geographic area. 

Ongoing data collection systems have been reviewed and are currently being developed so they accurately represent the occasions of service and will contribute to the formal evaluation being conducted by the University of Technology.

Aboriginal Child and Family Health Service - Data collected from 01/07/20 07 to 31/03/2008

In the short term, the objective is to establish services that are widely accepted and trusted by the community.

• Purpose built ACHC for the local community
• Culturally respectful service
• Establish trust and reliability within the community including continuity of care 
• Work in partnership with the Aboriginal community
• Capacity building of community through community groups and common use of community health building as a meeting place and for education sessions
• Flexible, local (accessible) drop-in service accepted by community

Child Health, South Eastern Sydney Illawara Area Health Service
Phone: 02 9382 8189