Anticipatory Care Project Newsletter - October 2019

Newsletter No. 3: October 2019

Printable PDF version (with images)

Welcome to our third newsletter!The Tasmanian Government wants to improve health in Tasmania, and has provided funding to four communities to try out new ways of delivering anticipatory are with the aim of improving health and wellbeing.  The communities are Flinders Island, Ulverstone, Northern suburbs of Launceston and Clarence.  More information about these communities is provided within the content of this webpage.  This image shows a partial image of Tasmania, showing where the communities are located.

The Anticipatory Care project is an action research project.  Our community partners are trialling many initiatives to test ‘what works and why’ for the prevention and management of chronic disease and improving the health and wellbeing of local communities.

This edition showcases just a few of the many anticipatory care activities happening across the state including:

  • The Health Connector in Clarence
  • Tackling Alcohol on Flinders
  • Playing for Health in the northern suburbs of Launceston
  • GPs improving systems to support people with chronic conditions

Also, in this edition:

  • System traps by Dr Riley
  • Research Update from UTas
  • Evaluation Update from Sax

Anticipatory care is a population approach to health care.
It identifies and supports people who are at risk of developing chronic conditions with the aim of preventing or slowing ill-health.


Community Snapshots

Clarence >>

Health Connectors

Through the Help to Health Project it has become clear that building and facilitating connections between and across the community and service providers is an important part of the work we do – we are Health Connectors!

We want to better understand if the health connector role contributes to improving access to health care for Clarence residents: how it improves service co-ordination and assists to improve the way our health and community systems work for and in the local community.

To do this we are developing a detailed description of the role, including naming up all aspects, actions and skills involved. We are collecting case studies and stories from community members, local services and health providers and listing up the range and diversity of organisations that have been connected.

The evidence we are gathering will be used to map the effect of having a health connector, how it is addressing community and structural needs and helping improve health access in Clarence. We will build on and track how the role progresses throughout the remainder of the project.

Like to know more?

Emily McKinnon
Phone: (03) 6282 0387
Email: emckinnon@ccc.tas.gov.au


The Clarence City Council Help to Health project recently linked with The Water Well project with the Rosny Library English Conversation Group to speak about basic health care in Tasmania. (see printable version, page 2 for image)

Northern Suburbs of Launceston >>

Playing for health in the northern suburbs of Launceston

Providing better supports and options, particularly for at risk young people, was identified as a priority in the northern suburbs early in the Anticipatory Care project.

Local project officers and support people have undertaken training in trauma-informed adventure play and there are now four Adventure Play groups up and running in the northern suburbs.

BOOM Adventure Play – Northern Suburbs Community Centre

The BOOM Adventure Play program has been running since April 2019. Already it’s showing its effectiveness in helping build resilience in young people between the ages of 10 and 16 years. Participants engaged in our adventure-based activities are working on improving self-regulation, developing leadership skills and forming new friendships. These lifelong skills are assisting participants to manage their stress, improve their relationships as well as improving their general health and wellbeing.


“…agencies have already begun to work together to address community concern around what could be described as ‘early surfacing adolescent risk behaviour’. According to WHO, this type of adolescent risk behaviour can have profound consequences for health and long-term well-being”
(Adventure Play Proposal, SPNH and NSCC, August 2018.


Starting Point Neighbourhood House (SPNH)

The Adventure Play program run by SPNH is also a trauma-based therapy program involving students between the ages of 10 and 12 years from Ravenswood Heights Primary School. Our adventures focus on fun and challenging experiences that help with self-regulation, personal-resilience and the creation of positive moments and memories.  Feedback about the program has ben extremely positive and we are seeing improved school attendance, attitudes and behaviours.


“We have already seen great improvements in self-confidence and resilience in all of the participants and continue to receive overwhelmingly positive reports from parents and schools”
(Fakington Wilde, Adventure Play Facilitator)


More information

Our Community Our Care Facebook page

Flinders Island >>

Tackling Alcohol on Flinders

Our Health Our Future (OHOF), is well underway. From the qualitative data that has been collected (interviews, focus groups, reflections, observations) it has become evident that alcohol consumption is prominent throughout the community, and is having an impact on people’s health and wellbeing.

The dominant themes that have emerged relate to alcohol use ‘being a social norm, part of the culture and almost an expected behaviour’. People have reported a stigma associated with not drinking alcohol, yet there is also a great deal of shame associated with the negative side of alcohol, such as drink driving convictions.

As part of the OHOF project, there has been a focus on the need to get some safe alcohol messages out into the community. Kat Bester from Anglicare is the visiting Community Services Social Worker (drug and alcohol support).  Kat has been instrumental in helping develop an alcohol awareness program with the Cape Barren School and Flinders Island District High School, together with the OHOF team.

Students are currently participating in a poster competition based around producing safe alcohol messages that will be shared throughout the community. The poster competition will be judged by the community at the upcoming Flinders Island Show, and an amazing prize package has been put together. The kids’ posters will be used in future education and promotional activities within the local communities.

More information is available on Our Health Our Future Facebook page or Our Health Our Future website

Patrick Street Clinic >>

Ulverstone’s GP led Anticipatory Care project

Proactive anticipatory care provided by GPs to people with chronic conditions improves the experience of care for the patient and can lead to better treatments and outcomes.

Both Victoria St and Patrick St Clinics have recently reviewed the systems they have in place for the care of people with chronic conditions. The aim of the Connecting Care GP audit was to get a clear picture of how care is currently being provided and whether there were opportunities for improvements.

The audit provided each Clinic with confidential, de-identified information about the characteristics of patients, the prevalence and nature of their chronic conditions, medications, health assessments and Medicare payments. These data were benchmarked against other national data on GP practices and performance.

The audit found that both clinics are demonstrating high levels of care for patients with chronic conditions. They are encouraging and supporting patients to see the same doctor for their ongoing care; ensuring patients have appropriate care plans in place, linking patients into free allied health sessions wherever possible and taking a team-based approach to the provision of care.

The GP audit again highlighted that there are increasing rates of chronic disease and an increasing need for co-ordinated, multidisciplinary approaches to their patient’s care.

However, the audit also revealed that there are no additional funds in the Medicare system to provide the co-ordinated care that complex high needs patients require.

The GP audit also demonstrated that people with chronic conditions have a broad range of health and social needs, so it is important to ensure they have easy access to information and to other community and health services.

Improving access and connecting up care is the focus of the Connecting Care Initiative.  Proof of Concept activities are being trialled for the future. Both Patrick St and Victoria Street Clinics will also continue to undertake regular audits to maintain and improve current levels of care for patients with chronic conditions.

Like more information?

Prof Judi Walker, Anticipatory Care Project Lead for Patrick St Clinic
Phone: (03) 6429 3158 or 0418 508 680
Email: wvipl@activ8.net.au


Our Research Partners

Sax Institute >>

The Evaluation team has recently finalised the interim evaluation report. Thank you again to all who participated, and for sharing your experiences.

Overall,

  • most interviewees are positive about the project and its focus on enhancing health in their community, with the relationships and connections that have been developed and strengthened through this project cited as important outcomes (acknowledging of course that these are building on the existing networks of those involved).
  • the professional, community engagement, project management and interpersonal skills of staff and local advisory group members working on the project is highly valued – as well as the motivation, pragmatism and problem-solving ability of project team members.
  • community control of the project and community ownership of the research is seen as critical, with the re-branding of ‘Anticipatory Care’ in each site evidence of this.

While timing is a concern and source of considerable stress across the board, on reflection there is a sense of achievement in relation to the progress so far.  There are also many suggestions provided on how things could be improved, especially in relation to the initial set-up phase, by providing longer lead times and greater clarity and guidance, while still maintaining flexibility.

This was a preliminary evaluation report, so there is a lot more to explore for the final evaluation, especially in relation to outcomes. We will keep you informed of next steps.

At the moment we are speaking to project support officers, so if you have not already been interviewed, could you please email hannah.tait@saxinstitute.org.au as soon as possible to set up at time to do a phone interview (and if you have already done an interview, thank you). We are keen to hear your perspective.

University of Tasmania >>

Using our research

All four communities, and our auspicing Chronic Conditions Working Group, have now used the causal loop diagram process. The process has been an opportunity for people to talk about their daily experiences of the anticipatory care system and for the groups to understand how system parts function and affect one another.

The causal loop workshops have shown us that each group’s capacity to affect the system is different - at individual, local, or government policy levels.

At the local level, for instance, we know that the skills of local front-line staff are important for making the system work effectively. Reception and other staff can be welcoming, ‘meet the person where they are’, listen to the person’s needs and help them find the right support, or they can act as gatekeepers and ‘system’ blockers.


Are there other relationships, networks, partnerships or places that are important to health and wellbeing?


Clarence’s The Right Place initiative is one model for supporting and skilling up reception staff; another is Our Community Our Care’s (Launceston) offer of Trust Based-Relational Intervention training to neighbourhood house staff, volunteers and community during November 2019.

We are now also at the stage of being able to provide ‘snapshots’ such as short reports to support or inform particular sub-projects. And we are working on a series of Research FAQs posters about key themes and learnings so far.

The Institute is also preparing for a series of Work-in-Progress local sessions.  These forums will bring researchers from across UTas together with community partners to share what we are learning with one another. The first of these will be in Launceston, later this year.

Dr Susan Banks
Senior Research Fellow
Anticipatory Care Project

Therese Riley Consulting >>

Dr Riley is providing systems thinking and mentoring support for the Tasmanian Anticipatory Care Project. In this article, Therese gets us thinking about system traps.

We're caught in a trap!

While Elvis Presley famously sang about being caught in a relationship trap (in the song Suspicious Minds), Donella Meadows (an eminent systems scholar) wrote about system traps. She created archetypes of this bad behaviour she called ‘traps’.

These reflect the “problematic behaviour” of systems that are organised in certain ways. They are traps because we try to fix them with changes in one part of the system when it is how the system is organised that’s the problem!

One trap is “policy resistance”. This is where systems of people or organisations (and other things) have their own goals and agendas that appear to be “…inconsistent with each other”.

Policy resistance happens when everyone is sticking to their own goals, “…pulling in different directions”. Under these conditions any small change will be met with more resistance, keeping the problem in place.

No doubt you have all experienced this trap! It is a trap because we keep trying to change the situation with small tweaks.

Donella Meadows wrote that the way to get out of this trap is to recognize what’s going on and ‘let go’ of the fixes. The opportunity here is to call in all the players to work out how to meet the various goals or identify an overarching goal/s “…that everyone can pull toward together”.

Next time your ideas or actions are met with resistance, step back and take time to consider whether you are in the trap of “policy resistance”. Knowing this may help you carve a path out of the trap and toward a more aligned system.

If you are interested in learning more about system traps check out Donella Meadows book - Thinking in Systems: A Primer.


More Information?

For more information about the Anticipatory Care Project:

Flora Dean

Principal Project Officer
Department of Health
phone: (03) 6777 4276
flora.dean@health.tas.gov.au