1. Bingji Bingji Booris
(Heavily pregnant to babies – Yuin Language)
Project Evaluation
Jackie Jackson
Aboriginal Health Manager
Amanda Gear
Clinical Midwifery and Maternity Risk
Management Consultant

2. Acknowledgement of Country
We would like to acknowledge and pay our respects to the first people,
the Gadigal people of the Eora nation, past, present and future and all
other Aboriginal people here today we recognise the continuing
connection of Aboriginal and Torres Strait Islander peoples to their
country, lands and family.

3. Background
Case for change
• The continuum of care for women accessing Aboriginal Maternal
Infant Health Service (AMIHS) was fragmented
• Only 14% of women were booking in before 14 weeks
• Near misses and adverse incidents highlighted the need for early
access and referrals for support
• Women’s and stakeholder’s stories demonstrated that Aboriginal
Cultural Awareness and Sensitivity could be strengthened.
• Makita’s journey

4. Mapping AMIHS Woman’s Journey
AMIHS
Women
and
Families
Collaboration
Communication
Trust
Culturally
appropriate
Respecting
differences
Pathways
Safe, evidence-
based care
Woman-
centred care

5. Objectives
1. By July 2016  50% AMIHS women will be booked in before
14 weeks
2. By December 2015  Implement the recommended standards
for Diabetes Screening, Renal Diseases and Quit Smoking
3. To increase the postnatal continuity of care capacity so that
100% AMIHS women will be followed up by the AMIHS Midwife
for two weeks after birth

6. Methods
• Women’s stories guided by
Indigenous Pie (10)
• Staff interviews (10)
• Tagalongs (3)
• Process Mapping
• Key Performance Indicators
• Brainstorming workshops
• One to one consultations (12)
• Consultation with external stakeholders
• Literature search
• Incident Information Management
System (IIMS) review
• Complaints review

7. Summary of Key Issues – The 3 Cs
• Continuity of Care
86% of women did not receive
early assessment & intervention
• Cultural Awareness
There was poor compliance to the
Respecting The Difference e-
learning
• Cultural Aesthetics
Some of the AMIHS women
identified that the maternity
service environment was not
culturally welcoming for them
Respecting
the
Difference
Training
AMIHS
Staff
Maternity
Staff
Dec 2014 0% 0%
April 2015 100% 15%
Dec 2015 100% 100%

8. The New Journey for AMIHS Women
My ideal Maternity Service would be…..
The home visits are convenient, the supports are amazing, the ability to
call with concerns when needed - great, as at times maternity at the
hospital is too busy or too clinical for me to understand
(Melissa, reflecting on things after one year)

9. Summary of Key Solutions
1. Raising Cultural
Awareness and
Aesthetics
• Managers - monitor
compliance with HETI
eLearning
• Cultural Inclusion Checklist
(Maternity Services) –
complete and implement
• Develop and facilitate the
Respecting the Difference
face-to-face training for all
Maternity staff

10. Summary of Key Solutions cont.
2. Standardized the
clinical pathways and
continuity of support
• Improve community awareness
about early access with the
use of approved social media
• Adapt clinical pathways to
include culturally appropriate
service delivery and educate
staff in VTE, diabetes and
renal screening
• Ensure continuity of care with
known Midwife and Aboriginal
Health Worker

11. Summary of solutions cont
3. Develop and support the local workforce
• Clinical Supervision
• New Directions Funding to enhance the Allied Health
support
• Providing leave relief for clinicians (backfilling)
• Implement Intake Meetings
• Include in Perinatal reviews
• Aboriginal Health Workforce
Strategy

12. Implementation Sequencing
We are
here

13. Results to Date
On Target In Progress
1. By July 2016  50% AMIHS women
will be booked in before 14 weeks
2. By December 2015  Implement the
recommended standards / assessments
for Quit Smoking, Diabetes, Renal
Diseases, VTE screening
• VTE screening draft tool in
progress
• Awaiting for CEC maternity
package
To increase the postnatal continuity of
care so that 100% AMIHS women will be
followed up by the AMIHS Midwife for
two weeks after birth
• Still a challenge due to
workload and workforce
constraints
• Need to seek additional
resources for clinical staff hours
for continuity of care
• Recruitment of AMIHS Manager
progressing – unable to recruit
for 7 months

14. Results to Date
Other benefits achieved:
• Information exchange from other Aboriginal
Health programs to assist to review
practices and models of care
• Successful applications to date:
New Directions (Commonwealth Dept
Health) for Allied Health enhancement to AMIHS
• Capital Works to enhance the workplace/clinic space for AMIHS
Women and staff - culturally appropriate and safe AMIHS
clinic and work spaces
• Trauma informed care training
• Smoking cessation workshops attended
• The Maternity Service is interested in Redesign Processes to
establish a Midwifery Group Practice!

15. The Next Steps
1. Continue with implementing Respecting the Difference face to face training
2. Improve pregnancy screening and clinical pathways
3. Continue and improve communication with clinicians
4. Continue learning from women’s stories
5. Recruit the AMIHS Team Leader
6. Continue to explore ways to fund and offer full of continuity of care
through pregnancy, labour, birth and postnatal care so that we can have
the first sustainable AMIHS continuity of care program in NSW
7. Share lessons learned with AMIHS services in SNSWLHDS and across the
State.
8. Inspire Eurobodalla Maternity Service to use Redesign Methodology to explore
Midwifery Group Practice models

16. Lessons learned during the Implementation Phase
• The importance of valuing and understanding women’s
stories and their individual journeys  This impacts
significantly on how our care may impact upon women’s
lives.
• That Respecting the Difference Training makes a
difference by increasing the awareness of complexities.
• Culturally sensitive and appropriate environments
 Aesthetics are important for women and also for
clinicians.
• Community development is an essential part of
engagement with women and their journey.
• Sharing lessons learned supports others when
developing and enhancing continuity of care paths

17. Acknowledgements
• Women and families who have generously shared their stories,
enabled tagalong experiences, assisted and donated photos for the
project. Coolamon made by Raw Kreations - Mary Moore for her
nephew baby Alfred Moore
• SNSWLHD Executive Sponsor - Executive DONM Julie Mooney &
Cherie Puckett, Nurse Manager Leadership and Practice
Development
• Steering Committee and Project Team members
• AMIHS/BSF Manager and Clinicians
• Eurobodalla Maternity Services Management, Clinicians and
SNSWLHD Clinical Midwifery Consultant
• SNSWLHD Manager Redesign & Innovation - Judith Hallam
• Support from everyone at the NSW Agency for Clinical Innovation

18. Thank you
Any Questions?