Re-visioning cultural competence in community health services in Victoria

There are few studies exploring the need to develop and manage culturally competent health services for refugees and migrants from diverse backgrounds. Using data from 50 interviews with service providers from 26 agencies, and focus group discussion with nine different ethnic groups, this paper examines how the Victorian state government funding and service agreements negatively impact on the quest to achieve cultural competence. The study found that service providers have adopted 'one approach fits all' models of service delivery. The pressure and competition for resources to address culturally and linguistically diverse communities' needs allows little opportunity for partnership and collaboration between providers, leading to insufficient sharing of information and duplication of services, poor referrals, incomplete assessment of needs, poor compliance with medical treatment, underutilisation of available services and poor continuity of care. This paper outlines a model for cultural consultation and developing needs-led rather than service-led programs.

Community engagement and working with government

Community engagement in health care can occur from policy to local community levels. It is consistent with democracy. A systems perspective can see consumers engaged to legitimise government agendas. Often community participation is via consultation instead of partnership or delegation. A community development approach to engagement can empower communities to take responsibility for their own health care. Understanding rural place facilitates alignment between health programs and community, assists incorporate community resources into health care and provides information about health needs. Rural communities, health services and other community organisations need skills in working together to develop effective partnerships that transfer some power from health systems. Rural engagement with national/state agendas is a challenge. Community engagement takes time and resources, but can be expected to lead to better health outcomes for rural residents.

Building capacity for rural health : the role of boundary crosser and the impact of their behaviours on community readiness partnerships

The concept of partnership has entered policy rhetoric and is urged as good practice in a variety of domains including health. Rural communities tend to have fewer resources available for the provision of services such as health than their metropolitan counterparts, and so could be expected to benefit from partnerships with external agencies. Indicators of coalition maturity for working in partnership with external agents in order to build stronger communities are distilled from the group development and partnership research literature and considered in the light of the experiences of the University Department of Rural Health in community engagement. The chapter draws on experiences of two rural community coalitions working to plan and negotiate health service provision. The coalitions were analysed against the indicators. A key indicator of maturity and readiness for working in partnership with external agents is related to the behaviour of ‘boundary crossers’. Boundary crossers are defined as people who move freely between two or more domains and who understand the values, cultures and language, and have the trust, of both. Domains can be within a community or be the community and an external sector. Community health professionals, especially those in senior positions, often act as boundary crossers between the community and broader domains such as regional/state health services or policy, although other community members can fill the role. Other key indicators of coalition maturity for working in partnership with external agents include local leadership that empowers the community, a willingness of community coalitions to take risks and mould opportunities to meet their vision, and a culture of critical reflection and evaluation of past actions.

This chapter analyses the impact of boundary crossing behaviour on community readiness and partnerships with external agents that are intended to build rural community capacity to plan and negotiate health service provision. It is argued that the characteristics and modus operandi of boundary crossers who are members of rural community coalitions affect the level of maturity of the coalitions and community readiness to work with external agents. An understanding of the characteristics and modus operandi of boundary crossers provides valuable insights for external agents in designing their approach to partnerships that build rural community capacity for health.

Our health in our hands : building effective community partnerships for rural health service provision

This paper reports findings from a study in two small Tasmanian rural communities that examined the process of developing and sustaining partnerships between health services and their communities. It identifies a generic framework for partnership development that appears to be common to partnerships, regardless of their purpose or of partners involved. The framework comprises ten predictors or indicators of effectiveness, and a sequential nine-stage partnership development process. Integral to the framework are social capital, and the leadership practices of health service and community leaders. The influence of context on the partnership development process is also examined, with reference to historical precedent, age or maturity of the partnership, and community readiness.

Multi-level rural community engagement in health

Community participation in health is consistent with notions of democracy. A systems perspective of engagement can see consumers engaged to legitimise government agendas. Often community participation is via consultation instead of partnership or delegation. A community development approach to engagement can empower communities to take responsibility for their own health care. Understanding rural place facilitates alignment between health programs and community, assists in incorporating community resources into health care and provides information about health needs. Rural communities, health services and other community organisations need skills in working together to develop effective partnerships that transfer some power from health systems. Rural engagement with national/state agendas is a challenge. Community engagement takes time and resources, but can be expected to lead to better health outcomes for rural residents.

Community led regeneration - experiences from London

The Community Health Project (CHP) is a community development project based in a multicultural deprived area of London, set up to tackle health inequalities. It is a partnership with the local Housing Action Trust, Health Authority and local residents and was established in 1994. The paper describes the work of the project, identifying the influences the project has been able to exert at a number of different levels: local, regional, national and international. The CHP provides a case study of how local people can act together to take part in development opportunities, with considerable and far-reaching effects. The experience of the CHP and other similar initiatives are analysed to identify elements of a framework for supporting the involvement of local communities in social and economic regeneration programs in ways that are empowering, giving local communities greater control over their lives and local resources and enabling the development of community capacity.

Scaling up community-based obesity prevention in Australia : background and evaluation design of the health promoting communities : being active eating well initiative

Background : There is only limited evidence available on how best to prevent childhood obesity and community-based interventions hold promise, as several successful interventions have now been published. The Victorian Government has recently funded six disadvantaged communities across Victoria, Australia for three years to promote healthy eating and physical activity for children, families, and adults in a community-based participatory manner. Five of these intervention communities are situated in Primary Care Partnerships and are the subject of this paper. The interventions will comprise a mixture of capacity-building, environmental, and whole-of-community approaches with targeted and population-level interventions. The specific intervention activities will be determined locally within each community through stakeholder and community consultation. Implementation of the interventions will occur through funded positions in primary care and local government. This paper describes the design of the evaluation of the five primary care partnership-based initiatives in the 'Go for your life' Health Promoting Communities: Being Active Eating Well (HPC:BAEW) initiative.

Methods/Design : A mixed method and multi-level evaluation of the HPC:BAEW initiative will capture process, impact and outcome data and involve both local and state-wide evaluators. There will be a combined analysis across the five community intervention projects with outcomes compared to a comparison group using a cross-sectional, quasi-experimental design. The evaluation will capture process, weight status, socio-demographic, obesity-related behavioral and environmental data in intervention and comparison areas. This will be achieved using document analysis, paper-based questionnaires, interviews and direct measures of weight, height and waist circumference from participants (children, adolescents and adults).

Discussion : This study will add significant evidence on how to prevent obesity at a population level in disadvantaged and ethnically diverse communities. The outcomes will have direct influence on policy and practice and guide the development and implementation of future obesity prevention efforts in Australia and internationally.

The efficacy of partnership evaluation and its impact on alliance transformation : a case study 12 months post evaluation

Partnerships involving higher education, governments, and industry have been recognised as important vehicles for engaging community, leveraging knowledge, and sharing potential resources. The critical need for these partnerships in rural and regional locations has been of particular note. Partnership evaluation can serve a critical function of informing continuous improvement and may therefore assist the evaluated agencies to work towards responsive transformational change. The ability for a partnership to adapt and change may aid in their sustainability. Despite the potentially important role of partnership evaluation, the development of tools that measure partnership are at an early stage. Partnership evaluation is rarely reflected upon in the published literature. Moreover, benefits and reflections of the efficacy of evaluations 12 months post analysis is rare in the published literature. Therefore, a brief review of partnership approaches and measurement tools are presented. The purpose of this paper is to reflect upon the efficacy of an evaluation conducted 12 months previously of a partnership between Deakin University, the Department of Health and Department of Human Services (Barwon South West Region), known as the Deakin/DH/DHS Strategic Alliance. This case study reviews several tools/metrics utilised. The efficacy of the evaluation tools is discussed. Those metrics, underlying the tools which contributed to positive change in partnerships are discussed.

Building capacity in sexuality education : The Northern Bay College experience : Report of the first phase of the sexuality education and community support (SECS) project

The Sexuality Education and Community Support (SECS) project aims to introduce a P-12 approach to sexuality education at Northern Bay P-12 College (NBC) through a collaborative partnership process between the schools within the College and local, regional, and state health and education agencies and has set out to change current sexual health education practice in the College and assist other schools in the region to do the same. The Project’s goal is a ‘sustainable, responsive, whole school, regionally consistent, best practice sexuality education’. During this first or establishment phase of the SECS project strategies have been implemented to begin the process of building capacity in sexuality education at NBC. These strategies are aimed at developing a sustainable approach during the next three and a half years.