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Coomealla Health Aboriginal Corporation (CHAC) is an Aboriginal Community Controlled Health Services (ACCHS) in western New South Wales, providing health services and GP services to the Wentworth Shire.

The Aboriginal Child Health Check Program was developed in response to the poor attendance rate of young people at the doctors and was a joint venture between Coomealla Health Aboriginal Corporation, Coomealla High School, and Dareton Primary School. The school reported high numbers of children with health problems including scabies, head lice, hearing and eyesight problems, and boils.

To provide comprehensive health assessments/screening of all primary school aged children in Dareton.

• To increase the knowledge of teachers in identifying health issues in students.
• To work proactively with schools to address a range of school health problems including scabies, lice, boils, hearing infections and conjunctivitis. 
• To conduct comprehensive Preventative Health Checks on all 5-11 year old children at Dareton Primary School.

• Provide Preventative Health Screening to all 5-11 year old children at Dareton Primary School.
• To conduct head lice medications to the entire school to eradicate head lice at the school.
• To provide information to parents and teachers in regards to treatment and prevention of infections leading to boils.
• To provide hearing and eyesight testing to all students and make referrals as necessary to specialist services.

• Number/percentage of children completing Child Health Checks.
• Complete 2 Lice Treatment days.
• Produce home information leaflets on boil prevention. Swab all boils to test for infection type to provide best information and treatment for eradication of boils.
• Provide hearing screening to all students.
• Provide eyesight testing to all students.

In early 2007 CHAC was approached by the local Primary School (Dareton PS) and High School (Coomealla HS) in relation to the number of students presenting with boils, lice and/or scabies at the school. The initial contact was in relation to wanting assistance with treatment (e.g. lice shampoo and scabies cream) and medical dressings for boils. After 6 months no noticeable difference in the number of students presenting with lice, scabies or boils was noted.

After an initial period of providing treatments on demand (shampoo, creams and dressings) it was agreed that we trial some preventative treatments. These included holding a lice eradication day where all families in the school were asked to treat all children on a given day. CHAC provided families with shampoo where needed.

Children who presented (at school) with boils had them dressed/covered by the classroom teacher or first aid person and were referred to the health centre. Very few children presented at the health centre for further treatment until the boils had increased significantly in size/pain and had spread.

When children did present at CHAC it was noted that treatment/medications where often ineffective or had little effect on the boils. The CHAC doctor (GP) undertook a small research project where all patient boils where swabbed and sent for testing. Over 80% of boils where found to be MRSA resistant and required a different regime of treatment. This information was given to the local hospitals and other medical Centres for their Information. A marked decrease in prevalence of boils was noted (no exact numbers are available).

Keeping with our focus of Primary Health care we then looked at trying to access children earlier, before the boils, etc got to a very painful state. It was decided that by increasing the number of children undertaking Child Health Checks we could prevent many of the school health issues from occurring.

A review of our patient files showed very few children undertook/completed Child Health Checks. In 2008 we used our Patient Information System (FERRET) to produce client lists in an attempt to target specific age groups. We found that we expended a lot of time and effort trying to entice young people to come and have a health check.

We developed a program where we operate a specific Child Health Check Day on the last Thursday of each school holidays (4 times per year). By doing set days we have been able to utilise a range of services to assist with testing. These include the school dental technician; and Greater Wester Area Health nursing staff. The schools also attended to remind students that school started on the following Monday.

The Health Check Days involve conducting a Community event including jumping castle and BBQ. Health Workers undertook opportunistic health checks but also used the lists generated from the Patient Information system to target children that have not attended. This ensures that a larger number and range of children are accessed rather than repeat the testing on the same children each term. As an added incentive for children to complete the comprehensive Health Checks (which take over 1 hour per child) we offer gifts to each child who participates.

The list of children who undertook the health checks was compared to the list of students at the school which allowed further targeting of all children who may not attend CHAC as a medical centre.

In 2008, their where 108 students at the Primary School (98 aboriginal students). By utilising Child Health Check days (3) we conducted/completed 45 Health Checks. In 2009 we have conducted one (1) Child Health Check Day which was forced to be extended over three (3) days due to the large number of participants. We have completed 36 Child Health Checks already (20 Primary and 16 Secondary) with a further14 to be completed.

This Child Health Check Program has worked exceptionally well. Even more pleasing is the number of young children that have had other health issues identified and treated. Though most of these where hearing problems one child was identified as having a heart murmur and has been operated on in Adelaide.

A further development to the project has been the commencement of a school fruit program where fresh fruit is available to all students in their classroom (each classroom has a fridge). Research around boils and their treatment uncovered research in Queensland that identified fresh fruit and a lack of vitamin C as being directly linked to the prevalence of boils. This program has been running since mid 2008 and continues in 2009.

The Child Health Check Program using ‘lists’ was an initiative of CHAC through its Aboriginal Health workers who identified that a large number of our clients/patients where repeat clients, and wandered if some of the health issues regarding children (particularly at the school) where related to the fact that we where not seeing all the children.

A comparison of patient/client lists and school lists showed many children did not access the health centre regularly for treatment.

Using the lists, Health workers identified children that they knew or where related too. Having had little success in getting parents to bring children in for Health Checks it was decided to offer prizes/incentives to entice children to come. This worked quite well but we found that we could regularly not get the children in to see the GP due to the other patient demands/needs.

As a result we trialled Health Check Days which proved successful, but again had difficulties around the GP seeing urgent cases that rose during the day. In mid 2008 we employed a GP (locum) to see patients for two (2) days to release the GP to be able to only do Health Checks. This worked exceptionally well and has now become our model. This model has been extended in 2009 to include keeping the locum for 2-3 weeks to ensure follow-up of patients not completed or missed is possible.

With the extension of our prizes/incentives we have extended the Health Checks targeted program to include the High School. We are currently in partnership with the High School to complete the same project aiming at 70% of all aboriginal students at the High School undertaking health Checks. The local community has been very supportive with them offering significant discounts on prizes (often at cost).

Much debate about the project has revolved around the pros and cons of offering incentives. We have concluded that the results have vindicated the process with CHAC being on target to complete more than 2/3 of all primary school and high school students in Dareton/Coomealla.

The results of the intervention have included:

• 46 % of Primary School children completed health checks in 2008 with a further 20 students completing in April 2009 bring the number of children having had Child Health Checks to 65/98 or 66%. With Child Health Checks being valid for only 12 months CHAC will now aim to maintain and improve on this number.
• With the Child Health Check program now targeting secondary students specifically, CHAC has completed 16 Health Checks out of 97 or 17% at the High School.
• Anecdotal evidence from both the Primary School and High School shows a marked decrease in student lice and scabies incidences. No numbers are recorded.
• 4 Aboriginal Health Workers completed Venapuncture course to allow for bloods to be taken.
• 2 Aboriginal Health Workers completed Hearing training (Cert IV) with Australian Hearing.
• 1 High risk (Child with Heart condition) identified.
• Over 70% of children referred for further dental follow-up.
• 10% of children referred for further eye examination.

The response by the community has been very positive.

• In addition to holding Child Health Check days we included Community meals and information sessions on healthy eating and diet by our nutritionist and Diabetes Educator.
• In response to the dental checks by the school dental van technician she has been able to prioritise patients and see the urgent cases more quickly. With children being checked it prompted over 50% of the parents to also be checked. As a result CHAC now runs a bus to Balranald (180km) on a fortnightly basis to allow people to access free dental services.
• We have made a very timely impact on a small child’s life by picking up the heart condition early.
• Children have spread the word in relation to health checks and we are now having parents bring their children in voluntarily to have checks undertaken.

Coomealla Health Aboriginal Corporation
Phone: 03 50274824