Yarning Circle Workshop

Session 5: Yarning Circle

The primary objective of the Yarning Circle was to identify how the A-TRAC program can support the existing workforce to contribute to reduced smoking rates for Aboriginal people in NSW.

Part A:

In Part A of the session, the AH&MRC sought delegates’ input into future planning for the A-TRAC Program and other Aboriginal tobacco resistance and control initiatives. Delegates were asked to complete a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis of training they had received in their current roles. Ten tables of 6-8 delegates discussed their responses as a group and identified the following factors.

Strengths

The following strengths were identified in training courses delivered to the workforce: Culturally appropriate Accessible and flexible mode of delivery Options of webinars, online, and in-house or local training need to be considered because releasing staff for training is more problematic when travel is involved Tailored to the audience i.e. clinical or non-clinical Training that can be applied to, and inform other programs has clear benefits.

Weaknesses

The following weaknesses were identified in training courses delivered to the workforce: Misalignment between clinical content of training and non-clinical nature of workers’ roles. Training needs to be better tailored to fit needs and context of workers roles Not culturally appropriate which includes not reflecting a holistic Aboriginal interpretation of health and wellbeing Training that is delivered online can be less effective and less popular with the workforce There is a lack of training focused on nutrition Some courses overlap and repeat the same material

Opportunities

Training was seen to create the following opportunities: Employment opportunities/career progression Increased knowledge and skills Keeping up to date with the latest information and research Networking/inspiration and new ideas Sharing resources/information/programs Promoting program successes Creating a focus on grassroots programs Self empowerment and confidence Besides training, other opportunities were also identified that could contribute to a stronger workforce and successful programs: Role models in the community Greater community engagement Regional shadowing Symposiums and conferences are a great way to learn Give out Free NRT/Hospitals to give out NRT/Train nurses and GPs in NRT The Review of the Tackling Smoking and Healthy Lifestyle program (The Review) was seen as an opportunity to showcase strengths of the workforce and success of programs delivered

Threats

Threats to effective training delivery and implementation were created by: Changing governments and changes to the structure of programs results in a lack of clarity and direction around workers’ roles and areas they should target for training Lack of clear direction in funding agreements also inhibits services ability to provide evidence and effectively evaluate the impact of training and programs delivered Funding uncertainty and cuts threaten budget capacity to fund workforce development which impacts on staff retention- loss of knowledge and skill base and the cost of training new staff Misalignment between clinical training and non-clinical roles Lack of capacity of services to apply and incorporate training in every day service delivery. This may be due to: o Lack of staff capacity (to continue to service community needs while in training) o Lack of funding o Lack of understanding of the value of skills gained, which can limit support to undertake training o Lack of applicability of training across other programs Other factors were also identified that could threaten the workforce and the success of programs: The Review of the TS&HL program- in particular the recruitment freeze that has been imposed for the duration of the review Lack of time to engage with community, due to wide geographical coverage of TS&HL teams Lack of trust when referrals are made by non-clinical staff Gaps in continuity of care- no structure or refer process in place to support patients to quit when they leave hospitals Lack of resources to collect data and evaluate programs.

Part B:

The Commonwealth funded Tackling Smoking and Healthy Lifestyle (TS&HL) teams that are situated in Aboriginal Community Controlled Health Services and other organisations nationally, are currently under review and the future of the program is uncertain.  The AH&MRC intended to prepare a submission to promote the views and perspectives of the Aboriginal Community Controlled Health Sector in NSW. Dr Jenny Hunt (AH&MRC Public Health Medical Officer) explained to delegates that the purpose of this part of the Yarning Circle was for the AH&MRC to better understand their views about the program in order to incorporate them in the submission and to assist the AH&MRC to advocate for Aboriginal tobacco resistance and control initiatives in NSW. The AH&MRC submission that was developed as part of this workshop can be viewed HERE Delegates were seated at 10 tables with 6-8 people on each table. They were given 20 minutes to discuss and respond to the following questions. Responses were then fed back to the room. 1. What has Regional Health Lifestyle and Tobacco Control funding made possible and achieved on the ground? 2. If you had the power to redesign the program, what changes would you make? 3. What other comments do you have about the program or review? Below is a summary of the key themes that emerged from these discussions: 1. What has Regional Health Lifestyle and Tobacco Control funding made possible and achieved on the ground? Made smoking cessation a priority in Aboriginal Communities The ability to deliver culturally appropriate resources and programs according to community needs including the ability to embrace local knowledge and increase community empowerment Greater reach to isolated communities Seeing a decrease in smoking rate and uptake rates Decreasing the social acceptability and ‘coolness’ of smoking in Aboriginal communities Increased education and community awareness through o Social marketing campaigns o Events- schools/sports o Providing role models/champions Partnerships with other community groups and organisations Increased resources (media and program resources) and the ability to use these for health promotion (spreading the message) Having a dedicated position has enabled services to focus on tackling smoking Development of smoke free policies and frameworks Stronger referral pathways between GPs/nurses/Quitline/dietitians Supported staff to quit Linked more community members into the ACCHSs Transfer of knowledge to other programs Saved lives 2. If you had the power to redesign the program, what changes would you make? Change the program to “Tackling Chronic Illness” to encompass broader aspects of health and design a more holistic program looking beyond just smoking cessation Create clearer job descriptions and directions for the programs by having an structure and framework in place outlining KPIs/deliverables/outcomes and Design a clear evaluation strategy and provide adequate guidance, resources, training and support to conduct evaluations of programs including ethically approved data templates and a standard evaluation tool Better coordination, referral pathways and continuity of care between GPs, nurses and TS&HL Teams AHWs should be trained in tobacco Workers who are clinically trained should be able to apply their skills in their TS&HL roles Clear NRT referral More sharing of resources Extend program to all remote areas of the state Change position title to “Health Action Workers” with a tobacco focus Change term “Brief Intervention” to “Tobacco Check” Longer term funding contract Greater accountability of how funds are spent Design a clear workforce strategy including training, educated supervisors/mentors to provide better support to on the ground workers Encourage managers/supervisors to attend training and engage with the program Greater support for staff in maintaining healthy lifestyles themselves 3. What other comments do you have about the program or review? Frontline workers from ACCHSs need to be consulted as part of the review Short timeframes and proposed outcomes don’t align, are unrealistic and set up to fail The Review is too quick and the framework for reporting is unclear Uncertainty of funding has created a scramble to survive Recruitment freeze during review has limited productivity of programs Clinical quit programs should be encouraged in order to ensure follow up and provide evidence of outcomes TAW should be based in ACCHS (and combined with HLW positions) so quit programs can be developed and clients supported Client - ACCHS GP - TAW (Tobacco Action Worker) - Follow up and support groups Federal government needs to support preventive health programs The program is unevenly distributed due to regional delineation and populations Include more of a cultural approach to kinship and connecting in terms of family/area/region Create a separate smoking status Medicare item number Provision of iPads would be ideal for data collection and interaction with youth United we stand, divided we fall- it’s the AH&MRC’s role to advocate for us a sector, keep us working together Methodology should be “most significant change”- a mixed method approach with multi-level stories.