ACQ Vol 13 no 3 2011

Cultural diversity

Clinical insights Partnerships: A service delivery option for speech pathology in Indigenous communities Andrea Coleman, Tania Porter, Ursula Barber, Jillian Scholes, and Helen Sargison

The discrepancy between the growing demands for speech pathology services in Australia and the size of the skilled workforce calls for innovative solutions to meet population health needs. This is perhaps most apparent in rural and remote Aboriginal and Torres Strait Islander communities where the delivery of high-quality allied health services (necessary to close the gap in health inequality) is frequently challenged by an underinvestment in the workforce. In response, allied health clinicians are actively seeking alternative models of care that utilise a diverse range of resources to deliver the service. The purpose of this clinical insight is to share one such experience of service adoption from the perspective of the allied health team in the Deadly Ears program (Qld Health Aboriginal & Torres Strait Islander Ear Health Program). After outlining the background of the partnership, the paper highlights how the allied health team used this model of service delivery to reduce the impact of otitis media on communication development for Indigenous children in the context of the early childhood education setting. The insight then draws on reported benefits and areas for improvement with the intent of sharing how this model of care can effectively add to the scope of practice for speech pathologists working in resource- poor settings. T he prevalence of otitis media (OM), infection of the middle ear, exists in much higher rates in the Indigenous 1 population than the non-Indigenous population; it begins earlier and may extend into adolescence and beyond (Couzos, Metcalf, & Murray, 2001). A prevalence of 91% has been reported in Indigenous infants (Morris et al., 2005) compared with 30% among non-Aboriginal infants (Boswell & Nienhuys, 1995). OM often occurs with a fluctuating mild-moderate

conductive hearing loss that has the potential to adversely affect speech and language and educational outcomes (Williams & Jacobs, 2009). For this reason it is important that approaches to the management of OM in children from Indigenous communities encompass not only medical, but also developmental and educational considerations. Deadly Ears is a statewide (Queensland) Indigenous ear health program. It is the core component of Deadly Ears Deadly Kids Deadly Communities: 2009–2013 (Queensland Health, 2009), a comprehensive inter-agency strategic framework established to improve ear health in Indigenous children. Following community invitation, the Deadly Ears team works to develop sustainable solutions that improve ear health related population outcomes. This requires a diverse team that includes Community Engagement and Development, Health Promotion, Workforce development, Allied Health and an ENT outreach surgical team known as “Hospital Walkin’ Country”. This paper focuses on the allied health component of the program, which aims to reduce the impact of OM in Indigenous communities. Working closely with local service providers is essential to create the positive environments necessary to optimise communication and play development for all Indigenous children. Indeed, formation of partnerships with community- based organisations is considered essential for successful delivery of health promotion and capacity building activities in Indigenous communities (Pyett, Waples-Crow, & Sterren, 2008). While delivering sources to address the impacts of OM in Woorabinda community in early 2010, the Deadly Ears allied health team became aware that two other service providers shared the same aim: to reduce the impact of OM for 0- to 4-year-olds in a remote Indigenous community by building the capacity of key stakeholders in the early education setting. The first of these, Undoonoo Day Care, is a Multifunctional Aboriginal Children’s Service (MACS) long day-care in Woorabinda community, managed by the Woorabinda Shire Council. The second, the Child Services Skilling Plan (CSSP) (a Department of Education and Training program) was working with Undoonoo to deliver contextualised training to support the centre to meet legislative requirements and to provide quality early childhood services. Deciding that combining their efforts may prove more efficient than working separately, the three groups agreed to move forward in partnership to meet their shared goals. This paper describes how the shared journey evolved and offers a preliminary evaluation of its effectiveness to date.

Keywords COMMUNI- CATION DEVELOPMENT INDIGENOUS SERVICE DELIVERY OTITIS MEDIA

From top to bottom: Andrea Coleman, Tania Porter, Ursula Barber, Jillian Scholes

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ACQ Volume 13, Number 3 2011

www.speechpathologyaustralia.org.au