• Strengthening Aboriginal families and children
• Rationale for the program
• Development of the program
• Implementation
• Evaluation
• Impact of the program on the target group
• Contact

The Mums and Dads with Koori Bubs Clinic is relevant to the award category "Strengthening Aboriginal Families and Children" as the clinics have contributed to an increase in access for antenatal and postnatal care for Koori women and also for early childhood assessments. By providing the clinic there has been a strengthening of Aboriginal families and children in the south coast by improving access to a range of health providers. The clinic has been held fortnightly in Moruya but is about to be relocated to Bateman's Bay.

The program was developed in response to feedback from community members and health professionals that there was not a solid continuum of care once a Koori women had birthed for ongoing child health assessments and postnatal care. It was agreed to create a multidisciplinary clinic to close some of these known gaps in care.

Clinic commenced in Moruya on a fortnightly basis in April 2008. Moved to Bateman's Bay in May 2009.

18 clinics have been held. Clinics are not held in the school holidays.

Number of clients accessing service in six months from July – December 2008:

• 25 different families have accessed service.
• There were 66 adults, 97 children and 18 antenates attending the service, some of these are repeat visits.
• 19 child and family health nurse assessments were completed at the clinic.

Our service is an exciting partnership which brings together all the key providers that a young Koori mother is likely to interact with during her pregnancy and early parenting years. The partnership between Healthy for Life, Koori Maternal Access Program (KMAP) and Greater Southern Area Health Service (GSAHS) Community Health aims to provide a comprehensive service to Koori women (and women with Koori babies) and closes some of the known "gaps" in care and outcomes. Research has demonstrated the importance of trusting relationships in working with Aboriginal Australians and our partnership has been designed to allow the development of these relationships and ensure a continuum of care.

We believe we will be able to improve the quality of pregnancy care, improve birth outcomes, impact on positive parenting and family planning; and develop strategies to support early childhood development. We are also in a position to identify issues relating to the broader social determinants of health and make appropriate referrals to other service providers as needed.

The Mothers and Koori Babies clinic is run every fortnight in Moruya and plays an important role in both building trusting relationships with and getting improved follow up for mothers and Koori babies.

The clinic is staffed by the KMAP midwife and Aboriginal health worker (AHW) who provide routine pregnancy care in collaboration with the maternity unit and the local obstetrician. This support continues throughout the birthing process and for six weeks after the birth.

A Child and Family Health nurse also attends the clinic and becomes involved in care from two weeks post partum. After the birth, a woman returns to this familiar environment to continue her involvement with the child and family health nurse for her babies / toddlers routine growth and development checks, feeding advice and other information.

The Healthy for Life nurse and Aboriginal health worker are facilitating the clinic and pick up where the child and family health nurse finishes, building the link back to the regular GP. The nurse and health worker facilitate age appropriate family health checks, ongoing health literacy education and liaison with the woman's regular GP for contraception and other women's health issues.

There is a strong health promotion agenda which provides a fortnightly education session in an informal environment with topics that target known problems including drinking in pregnancy, smoking, nutrition and breast feeding, parenting skills and social isolation.

Negotiations are underway to link with an Aboriginal playgroup who will visit monthly. The social networking inherent in this model will be valuable for young mothers.

Women and children can drop-in or have an organised time and transport is available.

The evaluation schedule has a number of layers including ongoing discussions with attendees and those that do not access service.

1. Families that attended clinic were consulted about the clinic and there was extremely positive feedback given by families:
   • "It is great it gets me out of the house and I am able to see all of the health services in one place"
   • "More transport would be good"
   • "Easy to access health care"
   • "Tuesday is my day to meet with other Mums"

2. There are a number of process indicators around the implementation and attendance.

   18 clinics have been held in the period from April – December 2008. Clinics are not held in the school holidays.

   Number of clients accessing service between April and December 2008:

   • 25 different families have accessed service.
   • There were 66 adults, 97 children and 18 antenates attending the service, some of these are repeat visits.
   • 19 child and family health nurse assessments were completed at the clinic.

3. In addition, we are developing a framework to measure clinical outcomes. To measure the effectiveness of our antenatal, postnatal and early childhood program activities and to highlight areas of opportunity to strengthen our program activities we are seeking access to prospectively audit Healthy for Life Program files using a validated audit tool designed by Menzies School of Health Research.

   The clinical audit is a process of comparing information in the medical record and information systems against the standard protocols or criteria for the delivery of a given item of care. The data collected through this process can be used to identify what is needed to improve patient care, and assess changes over time. It is not feasible to audit all patient records so a representative sample is taken. Menzies School of Health indicate that a random sample of thirty files is a representative sample.

   It is proposed that a clinical audit be conducted once per year. The audit would be prospective, starting with all consenting clients from the date approval might be granted. The audit would be undertaken on a random sample of thirty files.

   All Koori mums (and/or women with Koori babies) that have been involved in the Healthy for Life / Koori Maternal Access Program (KMAP) partnership, AND that have given their consent, would be eligible for inclusion in the sample. Clients, who decline to consent, would not be included in the audit.

   The clinical auditing team would include a member from the Healthy for Life Program, Midwife from KMAP and Aboriginal Health Worker from KMAP.

   An audit tool that meets our needs has been identified. The Maternal Health Clinical Audit Protocol has been developed to meet the needs of the Healthy for Life Program of the Office for Aboriginal and Torres Strait Islander Health in the Australian Government Department of Health and Aging. The data generated from the audit process can be presented in the form of performance measures. The information can be useful in helping our team set specific goals for improvement in delivery of services.

Aboriginal families are attending the clinics and this has created increased access to ongoing health services. There have been an increasing number of fathers attending the clinic with children. There has been an emphasis on strengthening family.

Southern General Practice Network
Phone: 02 44745100