Promoting community capacity through university-community engagement: the Deakin University / Department of Human Services (Barwon South West) Partnership

The formal Partnership between Deakin University and the Victorian Department of Human Services (Barwon-South Western Region), based in Geelong, aims to bring together the knowledge, experience and resources of the Department and Deakin University for the benefit of the people living in that region, as well as for the mutual benefit of both organisations. A recent review process featured stakeholder interviews and focus groups. A special workshop on university-community engagement was also held for interested stakeholders in late 2006. This was facilitated by Prof. Judith Ramaley, President of Winona State University, during her visit to Deakin University as a Fulbright Visiting Senior Specialist. Visioning and strategic planing have continued throughout 2007.

This paper will describe the efforts and achievements of the Partnership through the complementary lenses of Healthy Cities, health-promoting universities and community capacity. This framework will be used to describe how the Partnership coordinators have used Prof Ramaley’s insights to establish a draft Business Plan that espouses a more mature form of collaboration and embraces shared, transformative goals. The paper will describe how the notion of community capacity is being used to evaluate the Partnership’s overall contribution to community engagement.

Individual characteristics associated with community intergration of adults with intellectual disability

Background The purpose of this study was to identify individual characteristics associated with community integration of adults with an intellectual disability.

Method A group of 37 males with high support needs, and who had previously lived in a large institution, participated in the study. Using proxy respondents, data were collected on three measures of community integration, and on the participants' adaptive and maladaptive functioning. Chronological age and years of institutionalisation were also examined for their associations with community integration.

Results Level of daily living skills predicted life circumstances. There were no significant associations among the measures of community integration.

Conclusions The examination of the relationships between participant characteristics and community integration produced similar conclusions to previous research. Only daily living skills scores were uniquely associated with variations in life circumstances. Further research is required to determine whether these findings will be replicated with other cohorts of participants.

Cultural diversity and mental health : the relationship between leisure experiences and wellbeing in an ageing Italian community in Australia

One of the population health implications for Australia’s ageing population is that a larger proportion of the Australian community will be retired and have more time for leisure pursuits. Meaningful leisure activities for this group are thought to be a factor in promoting positive mental health. However, a search of health literature revealed a paucity of research on how older adults make use of their leisure time, what meaning these pursuits have to them, and whether their chosen leisure activities are health enhancing and promote wellbeing. Australia’s population is diverse with many cultures represented. As the population ages, mental health workers will be called upon to provide culturally-appropriate mental health services to clients from a range of ethnic groups. Literature on how people of culturally diverse backgrounds understand leisure activities is also limited. This paper reports on a study carried out in an Italian community in a large regional centre. The participants were selected based on the following criteria; aged 65 years and over, born in Italy, independently living in the community, ambulant, and retired from paid workforce. This study explored how a well-elderly group from an ethnic community derived meaning from their leisure activities and how this impacted on their mental health. Establishing the relationship between leisure and mental health in an ageing ethnic community is important because it sheds light on potential intervention strategies that can be used to maintain the mental health of people living independently in the community. Participants were interviewed using semi-structured questions about their perceptions of leisure, the meanings they derived from these activities, and their perceived impact of these activities on their health. Participant observation was also used to add trustworthiness to the data. Themes arising from the interviews and participant observation will be related to the participants’ sense of health. Results also revealed how older Italians engaged in leisure activities. Implications of the research findings will be directed towards mental health practice with older ethnic clients in community settings. The promotion of healthy lifestyles and positive mental health for Australia’s ageing population will also be discussed.

The Victorian living with possums policy : a review

Possums in urban areas can cause problems for residents when they live in the roof cavity of homes. The Victorian Living With Possums policy was implemented by the Department of Natural Resources and Environment (DNRE) in 1997 to address the ineffective, illegal and inhumane nature of possum management practices. Human-possum conflicts in urban areas can be difficult to resolve, and it is therefore important that the Living With Possums policy is effectively reaching the community and other stakeholders (e.g. vets, local councils).

This study represents Stage 1 of a two-part research project that aims to examine community awareness of and compliance with the policy and relevant legislation. A pilot questionnaire was designed and distributed to a sample of individuals who have recently hired possum traps from local councils or private organisations within metropolitan Melbourne. Preliminary findings indicate that although there is some level of awareness about the Living with Possums policy, there is evidence of non-compliance and a lack of understanding about the detailed policy guidelines. In Stage 2 of this project, questionnaires will be distributed to a larger sample of individuals who are experiencing conflicts with possums in order to examine just how widespread this lack of compliance and awareness is.

Assessment of indigenous older peoples ’ needs for home and community care in remote central Australia

The Home and Community Care (HACC) program in Australia provides services which supports older people to live at home. Individual HACC organisations are generally responsible for initial assessment of eligibility and need of clients presenting for services. This paper reports on a project which aimed to develop an understanding of the various approaches to assessment of client needs in Central Australia. The majority of clients in this geographical area are indigenous. The project was initiated in recognition of the primary importance of assessment in determining service access and service delivery and of the particular challenges faced by service providers in remote areas. This paper discusses key project findings including the client group and services provided, initial needs assessment and care planning processes. Evident inconsistencies in practice reflect a variety of complex contextual factors. Staff in remote areas have an inadequate knowledge base to draw upon to assist them with assessment and care planning decisions, and further research and professional development is required.

Associations of perceived community environmental attributes with walking in a population-based sample of adults with type 2 diabetes.

Background: No studies have yet examined the associations of physical environmental attributes specifically with walking in adults with type 2 diabetes.

Purpose: The purpose of this study was to examine associations of perceived community physical environmental attributes with walking for transport and for recreation among adults living with type 2 diabetes.

Methods: Participants were 771 adults with type 2 diabetes who completed a self-administered survey on perceived community physical environmental attributes and walking behaviors.

Results: Based on a criterion of a minimum of 120-min/week, some 29% were sufficiently active through walking for transport and 33% through walking for recreation. Significantly higher proportions of those actively walking for transport and for recreation had shops or places to buy things close by (67.8% and 60.9%); lived within a 15-min walk to a transit stop (70.6% and 71.0%); did not have dead-end streets close by (77.7% and 79.8%); reported interesting things to look at (84.8% and 84.4%); and lived close to low-cost recreation facilities (81.3% and 78.8%). In addition, those actively walking for transport reported living in a community with intersections close to each other (75.6%) and with sidewalks on their streets (88.1%). When these variables were entered simultaneously into logistic regression models, living close by to shops was positively related to walking for transport (OR= 1.92, 99% CI=1.11–3.32).

Conclusions: Consistent with findings from studies of healthy adult populations, positive perceptions of community environmental attributes are associated with walking for transport among adults with type 2 diabetes. The now-strong public health case for environmental innovations to promote more walking for transport is further reinforced by the potential to benefit those living with diabetes.

Negative beliefs about low back pain are associated with high pain intensity and high level disability in community-based women

Background Although previous studies have investigated beliefs about back pain in clinical and employed populations, there is a paucity of data examining the beliefs of the broader community. We aimed to characterize the beliefs that community-dwelling women have about back pain and its consequences, and to determine whether those with varying levels of pain intensity and disability differ in their beliefs. Methods 542 community-dwelling women, aged 24 to 80 years, were recruited from a research database. Participants completed a self-administered questionnaire that included detailed demographic information, the Chronic Pain Grade Questionnaire (CPG) and the Back Beliefs Questionnaire (BBQ). The CPG examined individuals' levels of pain intensity and disability, and the BBQ investigated their beliefs about back pain and its consequences. Results 506 (93.4%) women returned the study questionnaire. The mean (SD) BBQ score for the cohort was 30.7 (6.0), indicating generally positive beliefs about back pain. However, those women with high intensity pain and high level disability had a mean (SD) score of 28.5 (5.7) and 24.8 (5.7) respectively, which reflects greater negativity about back pain and its consequences. There was an association between negative beliefs and high pain intensity (OR = 0.94 (95% CI: 0.90, 0.99), p = 0.01) and high level disability (OR = 0.93 (95% CI: 0.89, 0.97), p = 0.001), after adjusting for confounders. Conclusion This study highlights that although women living in the community were generally positive about back pain, subgroups of women with high pain intensity and high level disability were identified who had more pessimistic views. While a causal relationship cannot be inferred from these cross-sectional data, the results suggest that negative beliefs individuals have about back pain may be predictive of chronic, disabling spinal pain.

Depression in people with intellectual disability : an evaluation of a staff-administered treatment program

The prevalence of co-morbid depression in people with intellectual disability (ID) provides a strong rationale for the early identification and treatment of individuals at risk. The aim of this study was to evaluate a staff-administered group CBT program for the treatment of depression in people with mild ID. A sample of 13 staff employed at two community-based disability agencies were trained to deliver the program to 47 individuals with mild ID and symptoms of depression. A wait list control group comprised of 27 individuals subsequently completed the program. Compared to the control group, individuals who had participated in the treatment program showed lower depression scores, and fewer automatic negative thoughts. Furthermore, these changes were maintained at a 3-month follow-up. The results indicate that staff can be trained to deliver a CBT program within community settings that is effective in the reduction of depression symptomatology in people with mild ID.

Academic staff take the lead : experimenting with social software at Deakin University

This paper reports on a two staged staff development exercise to help new academic staff to integrate Web 2.0 technologies including web-based communication and some digital technologies into their curricula. It involved professional development for the teaching staff in the first stage followed by these teachers providing professional development for the course participants. The teachers engaged in a blended community of inquiry with face-to-face sessions and online work while the professional development for the course participants included technical support, training and a peer group environment with formal allocation of time for the course, finally leading to an institutionally recognised qualification. Evaluations conducted through focus group interviews revealed that collegial networks and time were important for effective professional development. The paper reflects on the successes and limitations of the model and its potential for further development. It also highlights the importance of providing professional development in a safe environment for academics to adopt technologies for teaching and learning.

Developing recreation programs for disadvantaged sectors of the community

Physical activity participation can provide benefits for both the health and well-being of the community. Many people, however, are not active enough to achieve these health and well-being outcomes. The Victorian Health Promotion Foundation’s (VicHealth) 2001 Active Recreation Scheme funded 27 projects designed to provide recreation programs to address the active recreation needs of disadvantaged groups who are often the least physically active members of Victorian communities. This research aimed to identify themes and strategies of these projects that increased participation or reduced barriers to participation in active recreation. Site visit interviews were conducted with representatives of 11 projects to become familiar with successful program strategies and barriers to recreation program development. Following the site visits a focus group discussion with representatives from all 27 funded projects was conducted to explore ways in which barriers to recreation participation could be minimized and what strategies were effective in increasing recreation participation. Nine general dimensions that were identified as strategic approaches to increase the participation of disadvantaged groups in recreation programs were relationships, resources, community values/attitudes, communication (promotion and education), participant awareness/motivation, autonomy supportive, planning, program design, and mentors/role models. It was found that a focus on a community coalitions and complementary policy developments had positive effects on creating active communities. Four themes that guided the community and policy developments were i) community partnerships, ii) community support, iii) focus on the participants and iv) program design elements. The study also showed that the management and manipulation of these themes assisted agencies to develop programs that increased recreation participation.

Knowledge of late-life depression : an empirical investigation of aged care staff

Objectives: This study examined knowledge of late-life depression among staff working in residential and community aged care settings, as well as their previous training in caring for older people with depression.

Method: A sample of 320 aged care staff (mean age = 42 years) completed a survey questionnaire. Participants included direct care staff, registered nurses and Care Managers from nursing and residential homes and community aged care services.

Results: Less than half of the participating aged care staff had received any training in depression, with particularly low rates in residential care. Although aware of the importance of engaging with depressed care recipients and demonstrating moderate knowledge of the symptoms of depression, a substantial proportion of staff members saw depression as a natural consequence of bereavement, aging or relocation to aged care.

Conclusion: Experience in aged care appears to be insufficient for staff to develop high levels of knowledge of depression. Specific training in depression is recommended for staff working in aged care settings in order to improve the detection and management of late-life depression, particularly among direct carers, who demonstrated least knowledge of this common disorder.

Preventing falls among older people : current practice and attitudes among community pharmacists

Objective: Falls among older people are a major cause of injury and death in Australia Urgent action is required if we are to stem the .epidemic' increase in falls as our population ages. This paper describes current practice and attitudes of community pharmacists in Northern Rivers, New South Wales, in relation to preventing falls. .. Method: Comm~typhannacists in the Northern Rivers area ofNew South Wales were surveyed to detennine their current activities to reduce the risk of falls in older clients and to gauge awareness of the successful 1992-96 falls prevention program- 'Stay on Your Feet'. Results: Response rate was 79% (53/67). Seventy-two per cent reported that they urge 'most' or 'almost all' older clients to bring in out-of-date medications for disposal, 66% give them falls prevention advice at least 'sometimes', 57% refer at least 'some' older clients to allied health practitioners for assessment or treatment of falls risk. and 92% are interested in receiving more written information regarding falls prevention. Conclusion: The fmdings suggest that while community pharmacists are both ready and keen to play a role in future falls prevention initiatives. their current involvement varies considerably. Specific ways in which they might further help to reduce falls are: regularly checking the potential of client. medications to connibute to falls. giving more verbal or written advice, promoting 'falls safe' products, referring older clients to allied health practitioners for assessment or treatment of falls risk, and training staff [Q provide falls prevention advice

Lived experience of gay men caring for others with HIV/AIDS : living, loving and dying in the era of HIV/AIDS

This thesis explored gay male carers’ experience of caring for their partner, brother or friend who had HIV/AIDS. Through using phenomenological methodology (van Manen, 1990), the day-to-day caring experiences were uncovered. The data gathered were then analysed through a nursing ‘lens’, with the concept of stigma as an anchoring point. The dual stigmas of homophobia and AIDS phobia impacted on the daily lives of these men as they cared for their loved one. The research identified six themes. These were: 1) the relationship; 2) coping with HIV and AIDS; 3) the corporal impact of HIV/AIDS; 4) experiences of carers including the absence of others; 5) living daily with the virus: Demands of people living with HIV/AIDS (PLWHA); and 6) saying goodbye, but wanting to keep the memory alive. The caring these men undertook, for which they were frequently unprepared, was intensive and complex, but because of their commitment and love they battled on. Because of a sense of shame associated with AIDS phobia on the part of the PLWHA, the carer often had to undertake this care in isolation, without support from family, friends or home health care agencies. The carers struggled with not only the demands of day-to-day care, but also with non-acceptance from family, both of the nature of the relationship with their partner and of their homosexuality. Family members were forced, often with great difficulty, to acknowledge the close commitment the men had to each other. Recognition that one had a terminal disease, HIV/AIDS was also required. The fear of potential transmission was high among carers, friends and family members. Notably, there was an absence of blame on the part of the carer towards his partner for contracting HIV/AIDS. The physical decline and marking of the body further stigmatised the PLWHA, which added to carers’ burdens. They endeavoured to minimise the physical decline in their partner, so he could continue to pass as healthy, and attempted to make the day-to-day living as normal as possible. The methods of combating weight loss and opportunistic infections meant frequent medical appointments, complex intensive medical procedures and help with personal care, which was undertaken at home largely without support from health care staff. Carers frequently struggled also with their partner’s denial of being ill. One strategy all carers used was to escape with their partners from their everyday life in Melbourne and attempt metaphorically to leave the HIV/AIDS behind; this was a time when they could rekindle their life together as it was before HIV/AIDS came into their lives. Some carers chose to holiday without their partner, to give themselves a break from the day-to-day caring, while others planned and took holidays with their partner. The decline of the health in the PLWHA meant that family members had to recognise and accept both the nature of the relationship and the presence of the disease. This recognition and acceptance often came only when the partner was very ill, even at the point of dying. Carers and their partners discussed the potential use of euthanasia, as a means of ending the final phase of life with some dignity. One carer and his partner used euthanasia, despite its illegal status. The main concern for all carers was providing comfort and a reduction in the pain associated with HIV/AIDS for the partner. The widespread grief associated with HIV/AIDS was evident amongst these carers. All had known other gay men who had died, some carers own partner had died, or was about to die. There was an overwhelming sense of grief, which at times was repressed as a means of coping day-to-day. All carers felt it was important and necessary to remember those lost to HIV/AIDS through the various public memorials, as they did not want their partner to be just another faceless person lost to this disease. This phenomenological study of carers’ experience highlights the need for health care workers to be aware of the differing strategies that gay men use to cope with HIV/AIDS. While it may seem that the carers are coping with care of their partner, the outer façade is not always an accurate portrayal of the true situation. Health care workers should enquire as to the assistance these carers need from health care services in order to continue to care for their loved one. Such assistance can be the simple recognition of the partner and acceptance of them as part of the PLWHA’s network; this inclusion and acceptance is half the battle.

Belonging to a Victorian community choir : ageing, music and culture

Australia's ageing population created challenges for maintaining well-being and combating social isolation. Older Australians frequently rely on community arts organizations to enhance quality of life, specifically in health, happiness and community. Arts engagement takes place in many different contexts, from formal to informal and throughout the lifespan of the individual. Culture shapes the way in which we age and cultural identity is celebrated through the arts. This study will explore ageing and cultural diversity within Australian society through an examination of community arts engagement, specifically a community choir in Melbourne, Victoria, Australia. Much previous research concerning music engagement by older people has focused on its therapeutic applications, but there have been less attention given to healthy older people still living in communities. This paper reports on how music engagement can facilitate successful ageing be encouraging a sense of community, enhancing well-being and supporting cultural identity.

Defining and measuring the outcomes of inclusive community for people with disability, their families and the communities with whom they engage

This paper explores the meaning of ‘inclusive community’ as understood by a major disability service provider in Victoria, Australia. Scope is a major non government agency with 1300 staff, a $50M annual budget and over 4500 clients. The recent adoption of a new Strategic plan for the organisation has focused significant attention on the priority area of building welcoming and inclusive communities. Given this mandate, the organisation has begun research to define and measure outcomes for people with a disability, their families, and the communities with whom they engage, as a result of increased community inclusion. This paper reviews literature on outcomes definition relevant to this task and suggests that outcome measures to date, especially within the field of disability, have offered a set of outcomes that are too limited in their aspiration and breadth. It has been the experience within Scope that people with a disability, including people with intellectual, multiple and complex disabilities, aspire to and experience outcomes across a far broader range of life domains than is currently captured in either existing disability outcome measures or in government policies that frame service delivery. As a result, the paper introduces an emerging outcomes framework which seeks to define outcomes across a range of citizenship domains.