Building a Perinatal Service Model for a WA Aboriginal Community

1. Building a Perinatal Service Model for a WA Aboriginal Community Leanda Verrier State Coordinator WA Perinatal Mental Health Unit 14 November 2008 L. Verrier – WA Perinatal Mental Health Unit J. Brooks – WA Perinatal Mental Health Unit M. Mitchell – State Indigenous Mental Health Service

2. Background • Funding through WA Mental Health Division – Key initiative of State Mental Health Strategy • Development of State Perinatal Mental Health Reference Group • Establishment of WA Perinatal Mental Health Unit (WAPMHU) • Four principle areas identified: Coordination, Service Expansion, Education & Research • Priority to be given to women & their families from: • Aboriginal & Torres Strait Islander populations • Rural and remote communities • Culturally & Linguistically Diverse backgrounds

3. Service expansion - Indigenous Aims: • Raise awareness of perinatal mental health issues in the Indigenous community • Provide support for existing infrastructure • Establish support networks for Indigenous women • Provide education and training for service providers and wider community • Establish innovative and culturally appropriate approaches

4. Service expansion - Indigenous Framework • Staff mix – Indigenous and non-Indigenous • Service mix - primary health strategies and tertiary case management • Community education and promotion – culturally sensitive, strong visual messages • Incorporates school based education program • Ongoing consultation • Traditional and spiritual components

5. Indigenous Service Model - Carnarvon • Background literature • Identifying the gaps • Addressing the gaps • Base line evaluation report • Implementation • Evaluation

6. Indigenous Service Model - Carnarvon Background – from the literature • Perinatal mental health in Indigenous (& rural) communities - received little attention(Dowling, 1999) • Detection and management of post-partum depression requires attention(Swan & Raphael, 1995) • Success relies on community self management & ownership - capacity building involves the whole community(Westerman, 2002)

7. Indigenous Service Model - Carnarvon Background – from the literature • Existing frameworks for healing within Aboriginal communities(Minniecon et al, 2003; Vicary, 2002) • Support from extended family & friends central(Vicary & Andrews, 2001) • Trans-generational networks are crucial for information, practical & emotional support(Vicary & Andrews, 2001)

8. Indigenous Service Model - Carnarvon Identifying the gaps • Implementation steering committee – 13 stakeholders from metro area met regularly during initial development phase • Extensive local service provider consultation

9. Indigenous Service Model - Carnarvon Identifying the gaps • Local steering committee established • Evaluation framework: Baseline data collected and analysed • Mapping of local services • Focus groups (3) with Aboriginal women from the local communities • Postnatal Women’s Questionnaires • Health Professional Questionnaires • Statistical information (e.g. birth data)

10. Base line evaluation report Aboriginal participants • Qualitative (focus groups) and quantitative (questionnaires) information collected • Postnatal women’s questionnaire • Snapshot - Six Aboriginal women having given birth in the last 3 years completed questionnaires • Reported adequate levels of social support – family • Possibly significant % experiencing symptoms of depression and anxiety and not receiving professional help

11. Base line evaluation report • Three focus groups – total of 34 Aboriginal women • Thematic analysis – four core themes • 1. Trust – fear and mistrust seen as the most important issue “The workers need to go to the communities and town women to build their trust” “Visit the girls before they get pregnant – keep in contact” “May talk to someone outside the family, but the relationship is important” Solution: continuity of care, need to take time to get to know community before women get pregnant

12. Base line evaluation report • 2. Family support – Aunties and grandmas provide practical and emotional support often at a cost to their own well being. Family did not always have knowledge of psychological matters. Mothers did not seek professional support. • “If we have problems, we talk to our mums and nanas” • “Family gives a lot of support to mums, puts a lot of pressure on family, especially grandma” • Solution: include extended family in service provision

13. Base line evaluation report • 3.Lack of education – seen to be the cause of many problems for Aboriginal mothers • “Lack of information and resources on this stuff, girls just don’t know” • “The young girls here don’t know basic baby care. They also think they are the only one who is struggling” • “We need promotional material in the school that are culturally appropriate” • Solution: culturally appropriate health promotion strategies, targeting school girls may be beneficial

14. Base line evaluation report • 4. Young mothers – need the most practical and emotional support yet were the most distrustful of family and service providers – too afraid and ashamed to ask for help • “They are frightened and ashamed to go to a service” • “Where does she go? …wont go to mental health because they think she is loopy” • Outcome – clearly revealed a need for the service

15. WA Perinatal Mental Health Unit (State Coordinator) State Indigenous Mental Health (State Coordinator) Project Coordination Supervision Education/training Local community service – provision of line management Consultation/liaison officer & Aboriginal Health Worker • Small client caseload • Birthed at KEMH • High risk mums • Advocacy for client group • Health promotion • Support groups • Small client caseload • Service Consultation/liaison • Clinical pathways • Support groups • Teenage mums • At risk mums • Cross generational Health Promotion School & community PROPOSED SERVICE MODEL

16. Base line evaluation report February 2008 • Health professional participants • Health professional questionnaire • 14 health professionals completed questionnaires • Low levels of perinatal knowledge/awareness • Most would take appropriate and helpful action – but still room for improvement • Average score multi choice section was 50% • Many unable to differentiate between baby blues and PND • Lack of familiarity with EPDS

17. Base line evaluation report • Aboriginal births at Carnarvon Hospital – stable over last 6 years, averaging 35 births (KEMH birthing relatively low n = 8) • Improvements to service delivery encouraged and supported by local service providers • Newly renovated maternity unit keen to implement universal antenatal EPDS • Carnarvon AMS – most preferred place for those presenting with depressive symptoms • 116 occasions of service for depression in Aboriginal mothers over 1 year period • Source: Aboriginal Perinatal Service Expansion, Baseline evaluation – executive summary. Prepared by Janette Brooks, Research Officer, WAPMHU

18. Indigenous Service Model - Carnarvon Implementation • Key partners - WAPMHU, State Indigenous Mental Health, Carnarvon Mental Health Services, Carnarvon Medical Services Aboriginal Corporation, Gascoyne Primary Health • Development of service model - 2007 • Development of Memorandum of Understanding 2008 - to identify the roles/responsibilities of the main stakeholders • Locate service within Carnarvon Hospital

19. Indigenous Service Model - Carnarvon Implementation • Information resources/publications developed and now available • Boodjari Business DVD – for consumer and health professional, • Pamphlets – Mum’s guide / Dad’s guide, • Training booklet for AHWs – • Education and training package delivery- trialled with Marr Mooditj

20. Indigenous Service Model - Carnarvon • Development of promotional activities – PMH day Nov • Local project coordinator commenced in August • Recruitment of Indigenous Perinatal Mental Health Worker • Feedback to Carnarvon community from base line evaluation and new programs available in Carnarvon

21. Indigenous Service Model - Carnarvon Evaluation Evaluation framework • Once service commenced follow up data collected (EPDS, focus groups, questionnaires) and analysed after 6 months • at the end project period (18 months) to evaluate performance against expected outcomes (KPIs) • Baseline data will be used as a comparison

22. What we expect Key Performance Indicators (KPI): • Increase in level of social support by Indigenous mothers in the Carnarvon • Increased maternal mental health knowledge by local service providers and community members • Provision of perinatal health promotion strategies • Increase in use of maternity services during pregnancy and after baby is born • Increase in use of mental health services during pregnancy and after baby is born

23. DVDs and pamphlets Currently available from WA Perinatal Mental Health Unit 9340 1795

24. For more information Contact Nikki Phillips (Project Coordinator) Carnarvon Hospital Ph.99410323 nicole.phillips@health.wa.gov.au • Leanda Verrier (State Coordinator) • WA Perinatal Mental Health Unit Ph. 9340 1795 • Email: leanda.verrier@health.wa.gov.au Website www.yourzone.com.au/perinatalhealth