WestBay Alliance & Brimbank Melton PCP Care Planning for Refugee Health An Evolving Model

Care Planning and Refugee Health Refugee health care is complex and involved. Its success is dependant upon an integral understanding of the ‘whole’ picture of what is going on in a refugee’s life. Refugee Care Planning must be done within the framework of the service coordination pathway. It must involve consideration of the other issues going on for the refugee.

Background to Primary Care Partnership (PCP) Refugee Health Projects One-off statewide initiative to support the integration of newly arrived refugee entrants. Facilitated by Primary Health Branch of the Department of Human Services (DHS). Funds allocated to each of the 8 PCPs where Refugee Health Nurses (RHNs) are situated. Projects complimented the RHN Initiative.

Aim of the Refugee Projects To develop stronger, more integrated, and community-based, health and community services for refugees by: –Reducing duplicative practices. –Increasing understanding of referral and care pathways. –Improving service coordination and care planning. –Delivering integrated health promotion practice.

This PCP Project A joint Refugee Health Project for the 2 Primary Care Partnerships (PCPs): WestBay Alliance (PCP) – Wyndham – Hobsons Bay – Maribyrnong Brimbank / Melton PCP

Project Objectives To progress work on developing care pathways for refugees across a range of service providers. In partnership and cooperation with GP Divisions: –Improve care coordination between GP practices and health providers. –Support new GPs willing to work with refugees.

Objectives cont. To identify and link with other appropriate services such as Infectious Disease Units. To encourage the use of the Service Coordination Tool Template and the Statewide GP Referral Template. Identify and prioritise service gaps and workforce development needs. To identify opportunities for further funding / support.

Steps involved in the Project 1.Established an advisory group with 2 key service providers – WRHC & ISIS 2.Held discussions with Refugee Service Providers in the 5 LGAs. 3.Mapped Current Care Pathway. 4.Documented Enablers and Barriers to Refugee’s access to and experiences with the health system.

Discussions with Service Providers Western Region Health Centre AMES – Adult Multicultural Eduction Services Migrant Resource Centre GP Divisions – Western Melbourne and Westgate Royal Melbourne Hospital ISIS Deer Park Royal Children’s Hospital - Immigrant Clinic Victorian Foundation for Survivors of Torture Western Hospital

Discussions with Service Providers cont. Maribyrnong City Council Brimbank City Council Maribyrnong & Brimbank Family Services Other Metropolitan PCPs Melbourne City Mission Royal Women’s Hospital Dinka & Karen Refugee Representatives New Hope Foundation Local Churches

Mapping Current Care Pathway according to Service Coordination Principles The documentation of current care pathways occurred after discussions with many settlement and health service providers. These pathways attempt to map how a refugee negotiates the settlement and health system, after they arrive in the country.

Current Care Pathway

Barriers experienced by Refugees during Pathway Negotiation The complexities and duplication in the process. Misunderstanding about Pre-Departure Medical Screen results. Different allocations of support for different Visa holders. Health system illiteracy and ignorance about health system negotiation ‘Falling through the cracks’ before establishing a connection with health system.

Barriers experienced by Refugee cont. Initial TB screening only conducted at Western Hospital for the whole state. Gaining access to an Interpreter when unable to speak or understand English. Waiting lists for appointments and services. High health demands due to years spent in refugee camps with poor diet, limited resources, and limited access to essential medical care. Public transport access and a different concept of time-keeping for appointments. Confusion and misunderstanding about tests / medication / therapy / follow-up.

Steps involved in the Project cont. 5. Developed a Proposed Care Pathway, with incorporated enablers. 6. Developed a Complexity Screen 7. Presented results to service providers at a forum (up to 50 providers). 8.Established a working group of selected service providers (18 members) to refine pathway and complexity screen. 9.Developed a protocol to guide implementation. 10.Provided feedback to larger group at a second forum.

Developed a new Proposed Care Pathway Based on Service Coordination principles. More efficient and unified. Facilitating health access that is more: –streamlined –structured –supportive of the newly arrived refugee. Uses ‘intake’ and ‘access’ roles or personnel to assist the refugee along the Care Pathway suited to the complexity of their situation

Proposed Care Pathway

Enablers of Proposed Care Pathway An ‘ideal’ pathway – something to aim for? May not be achievable immediately, but some aspects can be put in place now. Has the goal of improved service coordination and care planning. Based on the Social Model of Health. Outlines the roles and responsibilities of those involved in the Care Pathway. Outlines the Principles underlying the implementation of the Care Pathway.

Enablers of Proposed Care Pathway cont. Indicates different pathways, depending on the complexity of the refugee. Allows for additional support to be provided (eg. by community guides, access workers or volunteers) for refugees and their families, who have more complex needs. Accounts for all visa holders and their various entitlements. Indicates the relevant assessment, communication and care planning tools to be used (SCTT and others).

Enablers of Proposed Care Pathway cont. Attempts to reduce number of appointments for refugees. Utilises the MBS item number for GPs who do a comprehensive Refugee Health Assessment. Involves referral to specialist services for specific assessment and ongoing treatment. Incorporates regular, informative discussion between GP, Nurse & AMES Case Coordinator, to ensure effective case management and care planning.

Developed a Complexity Screen To measure the level of complexity and urgency in a refugee situation. To ensure appropriate levels of support are provided for refugees to enable access and efficiency of further assessment. To encourage communication between service providers regarding the specific needs of each refugee.

Contents of Complexity Screen Purpose of Tool / Screen General Information ‘Alert’ Health Information Education Level Pre-Arrival Experience Family Composition Living Situation Health Situation Complexity and Urgency Score and Action Professional Judgement

So how does all this relate to Care Planning? Refugee Care Planning could not be done well, if this process had not occurred. The steps in this project have established a solid foundation for care planning. Key Principles: –Interagency collaboration and useful discussion –Willingness to change if it makes access easier for the client –Keeping the client and their circumstances at the centre of the planning

Essential ingredients for good Care Planning Outlined in the Principles underlying the success of the Refugee Care Pathway: Client focused and empowering Informed consent and privacy Culturally sensitive and respectful Information provision and sharing Partnership – including refugee Collaboration between agencies and client

Essential ingredients for good Care Planning cont. Shared responsibility Strengths based Proactive approach Reduced duplication Effective communication and feedback Appropriate training and education

Thank You! Questions? WestBay Alliance & Brimbank Melton PCP