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Northern Territory Emergency Response (NTER)
Monitoring Report

1. Improving Child and Family Health

A healthy start in life is clearly an essential building block for achieving successful early childhood development. Child health checks identify and treat conditions to help children thrive and learn.  If any issues are identified, follow-up service delivery ensures that the child is referred to a specialist for treatment.

1.1 Overview

This section provides summary indicator data on the Health components of NTER:

The CHCs, Child Special Services and Alcohol and other Drugs response commenced in July 2007 and are continuing in 2008-09.  EHSDI commenced on 1 July 2008.

Data Development

During the period July to December 2008, the health components of the NTER transitioned from the initial rapid implementation phase to sustained delivery of new and increased levels of health services for remote Indigenous communities in the Northern Territory.

Data for the Health indicators are sourced from systems developed to monitor the initial rapid implementation phase. Data collections for monitoring the long-term commitments are in development and data are not available for reporting at this time. Data on follow up services has become available.

Quantitative data collection relating to the Child Special Services element is still in development. Quantitative data on the Drug and Alcohol response has required more extensive development because the measure has involved a number of new service arrangements which required new data collections to be developed, agreed and established. There is also a long lead time in processing hospital data.

Context and Achievements

CHCs were progressively rolled out from July 2007 to 31 December 2008 and by the end of that period at total of 10,292 valid Child Health Checks had been provided across every region of the Northern Territory (NT). Follow-up service delivery has now commenced in all regions through existing service providers.

The main focus of the CHC Initiative since June 2008 has been the provision of follow-up care to children who had referrals from other checks in earlier time periods.  Preliminary data suggest that follow-up in primary health care has reached over 8,500 of children who have received CHCs. 

The major impediments to the roll-out of the CHCs and follow-up services were local infrastructure to support an increased workforce, particularly accommodation for clinical work and staff housing, and workforce availability. These were targeted for action in 2008-09 and will continue to be a focus of attention for the next two years under the Expanding Health Service Delivery measure.

Child Health Check Initiative

The main focus of the Child Health Check Initiative during the period 1 July to 31 December 2008 was the provision of follow-up care to children who had referrals from checks conducted previously. While preliminary data suggest that follow-up in primary health care has reached over 80% of children, follow-up in more specialised areas, which require the deployment of special facilities and staff, are progressing more slowly.

During this period, over two thousand audiology checks were provided to 1,825 children and over 1,800 dental services have been provided to 1,365 children. While 1,150 CHCs were provided during this period, the number was less than in the two previous reporting periods as the bulk of children and communities had had access to checks during those earlier times.  In total, 10,292 valid Child Health Checks have been provided in the period from July 2007 to 31 December 2008

Child Special Services

The Child Special Services implementation to respond to child abuse-related trauma proceeded following analysis of existing service delivery, and extensive consultation with the Northern Territory Government and the Community Controlled Health sector. The delivery of the new Sexual Assault Referral Centre Mobile Outreach Service (MOS) commenced in April 2008.

During the period 1 July to 31 December 2008, service delivery continued at the same time as new policy, planning and infrastructure was established to support the implementation of the service with four years of funding across all remote areas of the Northern Territory. In addition, the Central Australian Aboriginal Congress (Congress) were funded to undertake the scoping phase of a Healing Model for Adolescent Sex Offenders and to facilitate the Male Health Summit ‘Taking Care of Our Children’, held in Central Australia in July 2008.

Alcohol and other Drugs Response

The Alcohol and other Drugs (AOD) Response commenced in September 2007 with the provision of two dedicated hospital beds for detoxification at both Katherine District and Tennant Creek Hospitals.  This included the rapid deployment of specialist AOD teams to support these beds in the initial six weeks, as well as increased support for selected residential rehabilitation services in the five regional centres of the NT.

The second phase of the response, January to June 2008, included a wide range of measures to support expanded service delivery and workforce capacity including the deployment of 28 outreach workers in primary care and substance use services in the NT, the engagement of an AOD Clinical Director, workforce training and community education initiatives.

Key elements of the AOD Response introduced in 2007-08 are being continued in 2008-09 under the Closing the Gap – NT – Follow Up Care measure.  This includes increasing the AOD workforce in the primary health care setting, increasing the capacity for substance use treatment and rehabilitation services, workforce support and development, and an independent evaluation.

Expanding Health Service Delivery Initiative (EHSDI)

From 1 July 2008, implementation of the $99.7m EHSDI commenced. These funds are available in 2008-09 and 2009-10 and aim to:

During the period 1 July to 31 December 2008, governance under the NT Aboriginal Health Forum was established and an investment plan was agreed for the $38.9m in 2008-09 funds. An agreed list of core primary health care services was developed and plans for regional reform of health services established. The RAHC commenced operation following the engagement of Aspen Medical and the first seven health professionals were deployed in December 2008.

The most significant impediments to implementation of programs during this period were the lack of local infrastructure to support an increased workforce, particularly accommodation for clinical work and staff housing, and workforce availability. The EHSDI, MOS and AOD programs were involved in considerable planning, consultation and program infrastructure development during this period.

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1.2 Child Health Check Initiative (CHCI)

Participation in CHCI

The main focus of the Child Health Check Initiative during the period 1 July to 31 December 2008 was the provision of follow-up care to children who had referrals from checks in earlier time periods. While preliminary data suggest that follow-up in primary health care has reached over 80% of children, follow-up in more specialised areas which requires the deployment of special facilities and staff is progressing more slowly. During this period, over two thousand audiology checks were provided to 1,825 children and 1,894 dental services have been provided to 1,365 children. While 1,150 CHCs were provided during this period, the number was less than in the two previous reporting periods as the bulk of children and communities had had access to checks during those earlier times.  In total, 10,292 valid Child Health Checks have been provided in the period from July 2007 to 31 December 2008.

The CHC are based on existing health checks available to Aboriginal and Torres Strait Islander children aged 15 years or less through Medicare (i.e. Medical Benefits Scheme (MBS) item number 708). The data derived from these checks includes the child’s medical history, relevant family medical history, and their health status at the time of their health check. Information is also recorded on whether vaccinations, treatment and referrals were provided during the CHC.

As of 31 January 2009, an estimated total of 13,178 valid CHCs have been performed through the NTER and MBS Item 708 since 1 July 2007. The number of checks provided between 1 July 2008 to 31 December 2008 was 1,150. The estimated CHC coverage as at 31 December 2008 is 60%.  The coverage figure counts only one CHC per child and excludes checks more than 15 months old due to declining clinical relevance.  The coverage rate has a two month lag due to data availability. The peak CHC coverage was 74% which was reached in the period ending 31 October 2008.

Targets/Milestones

There is no target set for the proportion of children that should receive a CHC and nor is it expected that a child should receive a CHC every year.  The CHC is a tool to support clinicians in the exercise of their judgement and responsibilities with respect to the health of individual children and the population of children within their service area. Participation in the NTER CHCs during 2007 and 2008 compares favourably with other voluntary screening programs.

Health Conditions

The purpose of the CHCs is to identify and treat health problems or refer children to other primary, specialist or allied health services for treatment. It is important to note that data have been collected as a by-product of a clinical process and they are not a substitute for rigorous, scientific research on the prevalence of disease.  Detailed comparisons of the findings from the NTER CHCs and other data sources on disease prevalence can be found in the Progress Report published on the Department of Health and Ageing and the Australian Institute of Health and Welfare websites in May 2008 1

Since the CHC data collection commenced in July 2007, there has been little change in the proportions of children identified with various health conditions. A detailed analysis of 8,997 children (as at 17 October 2008) who had received at least one valid CHC reported the following:

Referrals

Just over two-thirds (69%) of children who received a CHC were referred for further services. The most common service need was for additional primary health care (39% of all referrals) and dental services (34%).

During 1 July 2008 to 31 December 2008 a further 449 children were referred for Primary Health Care follow-up while 487 children were referred for dental care, 238 for tympanometry and audiology, 143 for specialist Paediatrician follow-up and 138 for specialist Ear Nose and Throat follow-up.

Follow-Up Health Service Delivery

Follow-up of CHC referrals through existing Primary Health Care (PHC) or specialist services available in the NT often commenced soon after the checks were completed. The Australian Government provided additional follow-up funding to both Aboriginal Community Controlled Health Organisations and the Northern Territory Department of Health and Families.

Data on follow-up service delivery is currently available from three sources:

Follow-up Services - Progress

The figures in the Performance Indicator table show that the CHC figures for the current reporting period are lower than in the last reporting period.  This is due to the bulk of children and communities having had access to a CHC in the previous reporting periods and to the fact that the focus of attention has moved to the delivery of follow-up services. 

Data on follow-up service delivery was published on the Department of Health and Ageing and Australian Institute of Health and Welfare websites in December 2008 and was based on activities up until the 17 October 2008.  These data have now been updated and this report provides data available to the Australian Institute of Health and Welfare up until 8 May 2009.  Preliminary analysis of this data for 7,711 2 children who have had a CHC followed by a Chart Review shows the following proportions of children with specific referrals for follow-up had been seen:

It is not possible to disaggregate these Chart Review data into follow-up that occurred during the reporting period versus follow-up that occurred in early reporting periods.

While these figures and those in the Performance Indicator table demonstrate that services are reaching those who require follow-up, they also show the extent to which further follow-up services are required. Many children have yet to be seen for referrals and for those who have been seen, there is a continuing need for follow-up care, particularly for more specialised services.

The fact that many of the children who have received some follow-up care require further action is due to the chronic nature of many of the conditions being treated. Fundamentally, many ear, skin, physical growth and oral health problems are the result of poor living conditions, poverty, overcrowding and lack of adequate nutrition.  While these conditions can be ameliorated through health interventions, their prevention requires change to these broader determinants of health.

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1.3  Child Special Services

The Child Special Services implementation to respond to child abuse-related trauma proceeded following analysis of existing service delivery, and extensive consultation with the Northern Territory Government and the Community Controlled Health sector. The delivery of the new Sexual Assault Referral Centre Mobile Outreach Service (MOS) commenced in April 2008. During the period 1 July to 31 December 2008, service delivery continued at the same time as new policy, planning and infrastructure was established to support the implementation of the service with four years of funding across all remote areas of the Northern Territory. In addition, the Central Australian Aboriginal Congress (Congress) were funded to undertake the scoping phase of a Healing Model for Adolescent Sex Offenders and to facilitate the Male Health Summit ‘Taking Care of Our Children’, held in Central Australia in July 2008.

A four year funding agreement for $5.7 million was signed with NT DHF on 19 September 2008 for the implementation of the Sexual Assault Mobile Outreach Service (MOS) following its development phase in 2007–08 funded under the NTER.  The establishment of the MOS was to extend the reach of services to respond to child sexual assault and related trauma in remote communities not previously serviced by the NT’s Sexual Assault Referral Centre.  MOS services commenced operation in April 2008. Teams of sexual assault counsellors and Aboriginal sexual assault workers are now operational in all NT regions, and provide casework services, community education and professional development.

In the period from 1 July to 31 December 2008 MOS made a total of 38 visits to 11 communities and town camps across the NT and provided casework to children and families, as well as professional development and community education to service providers and community members.

Most recent case-related and non case related service data available 4 from DHF for this period indicates that in:

The Central Australian Aboriginal Congress (Congress) has completed the scoping phase of a Healing Model for Adolescent Sex Offenders.  The initial community engagement activities have occurred and have been well received by the community. 

The Male Health Summit ‘Taking Care of Our Children’ was facilitated by the Congress in Central Australia from 30 June – 3 July 2008. The Summit was attended by over 400 Aboriginal men who gathered to discuss the health of themselves, their children, families and communities. 

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1.4  Drug and Alcohol Treatment and Rehabilitation Services

The Alcohol and other Drugs Response commenced with the provision of two dedicated hospital beds for detoxification at both Katherine District and Tennant Creek Hospitals from September 2007, the rapid deployment of specialist Alcohol and Other Drug (AOD) teams to support these beds for an initial six weeks, as well as increased support for selected residential rehabilitation services in the five regional centres of the NT.

The second phase of the response from January to June 2008 has included a wide range of measures to support expanded service delivery and workforce capacity including the deployment of 28 outreach workers in primary care and substance use services in the NT, the engagement of an AOD Clinical Director, workforce training and community education initiatives.

Key elements of the Alcohol and other Drugs Response introduced in 2007-08 are being continued in 2008-09 under the Closing the Gap – NT – Follow Up Care measure.  This includes increasing the AOD workforce in the primary health care setting, increasing the capacity for substance use treatment and rehabilitation services, workforce support and development, and an independent evaluation of the measure.

Funding of $2.6 million was allocated under the Closing the Gap - Northern Territory - Follow Up Care: Drug and Alcohol Component to continue key elements of the alcohol and other drug (AOD) response in 2008-09.

The funding priorities approved under this measure are:

Two AOD registered nurses and 12 Indigenous Community Support Worker positions have been funded in six Aboriginal Community Controlled Health Organisations across the NT.  These positions continue from those funded under the NTER in 2007-08.  This workforce is complemented by an additional eight ongoing AOD positions, in four Aboriginal Medical Services and four NT Department of Health and Families health centres across the NT, funded through the 2006 Council of Australian Governments Substance Use measure. 

Additional funding has been provided in 2008-09 to five AOD treatment and rehabilitation services across the NT to enhance capacity and continue services provided under the NTER in 2007-08.

Funding has been provided to the NT Government to implement a range of workforce support and training activities targeted at the AOD workforce in the primary health care setting. 

A quantitative data collection relating to the Alcohol and other Drugs response commenced in April 2008 and the Northern Territory Department of Health and Families has been engaged to analyse the data. This will be available for the next NTER Monitoring report.

Evaluation of the Alcohol and Other Drugs (AOD) Response Measure

On 1 August 2008, Origin Consulting and Bowchung Consulting were engaged to conduct an independent evaluation of the NTER AOD Response Measure.  The consultants will report regularly on their progress and findings throughout 2008-09, with the final report due in June 2009.

The overall evaluation objective is to assess how well the Measure has been implemented and the extent to which it has achieved its goals.  In order to answer the overall evaluation objective, the consultants are to:

During the period 1 July to 31 December 2008, consultations commenced with key stakeholders involved in the implementation of the Measure. This included the Northern Territory Department of Health and Families and non-government organisations such as Aboriginal community controlled health organisations.  Consultations with Aboriginal and Torres Strait Islander communities in the NT will occur in 2009.

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1.5  Expanding Health Service Delivery Initiative (EHSDI)

From 1 July 2008, implementation of the $99.7m EHSDI commenced. These funds are available in 2008-09 and 2009-10 and aim to increase primary health care service delivery in remote locations; deliver more regionally-based primary health care services in remote NT communities and recruit and deploy health professionals through the Remote Area Health Corp (RAHC). During the period July to December 2008, governance under the NT Aboriginal Health Forum was established and an investment plan was agreed for the $38.9m in 2008-09 funds. An agreed list of core primary health care services was developed and plans for regional reform of health services established. The RAHC commenced operation following the engagement of Aspen Medical and the first seven health professionals were deployed in December 2008.

The EHSDI aims to enable a sustained focus on the delivery of CHCs and primary health care follow-up services during 2008-09 through significant additional resources to expand health service delivery in remote NT Indigenous communities.  Australian Government funding of $99.7 million has been committed towards this initiative over two years from July 2008. The Department of Health and Ageing has undertaken extensive planning for the implementation of the EHSDI with the Northern Territory Department of Health and Families and the Aboriginal Medical Services Alliance of the Northern Territory under the NT Aboriginal Health Framework Agreement.

The EHSDI aims to deliver long term, sustainable improvements in the NT primary health care system and provides for:

Significant progress has been made in the period July to December 2008, including:

Aspen Medical was successful through a competitive tender process to establish and operate the Remote Area Health Corp (RAHC). The RAHC’s focus is on the recruitment of urban-based health professionals for short term placement in NT remote Indigenous communities.  Marketing activities commenced in December 2008 with advertisements in industry appropriate journals.

On 4 December 2008 the RAHC’s first deployment to the NT occurred with two registered nurses being deployed to Ampilatwatja. By 31 December 2008 the RAHC had deployed seven health professionals and all were registered nurses.
Work is continuing to establish hub based outreach services to be delivered, initially from Alice Springs and Darwin.

Evaluation of the CHCI and the EHSDI

An independent evaluation of the CHCI and EHSDI is being conducted during 2008-09 and 2009-10. The objective of the evaluation is to address the performance of these initiatives in relation to their appropriateness, effectiveness and efficiency and to contribute to the refinement of policy and practice. The evaluation of the CHCI component will build on the data collections developed to monitor the implementation of the Child Health Checks and follow-up services. The evaluation of the EHSDI will draw on and foster the continuing development of the Northern Territory Key Performance Indicators for primary health care.

Northern Territory Hospitalisation Data

Unfortunately the hospitalisation data received from the Northern Territory Government was too late to be validated and included for this monitoring report.  For the next report, June 2009 we will be able to provide three full financial years of hospitalisation data for consideration.

  1. http://www.health.gov.au/internet/main/publishing.nsf/Content/nterchciProgressReport
  2. Note this data does not match the data presented in the Performance Indicator table due to differing time periods and a different subset of children being analysed.
  3. There have been more children who have received audiology checks than had an audiology referral.  This is because children are not required to have an audiology referral to have an audiology check.  The eligibility is that the children are less than 16 years old and live in an NTER prescribed area.
  4. *Note: Q1 and Q2 data cannot necessarily be added, as double counting may occur.  YTD Cumulative case-related data to 31 December 2008 is not yet available.  ..
  5. The RAHC is supplementing the recruitment efforts of the NT DHF and Aboriginal Medical Services.

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