Social and Emotional Wellbeing Screening for Aboriginal and Torres Strait Islanders within Primary Health Care: A Series of Missed Opportunities?

Abstract

BackgroundSocial and emotional wellbeing (SEWB) is a critical determinant of health outcomes for Indigenous Australians. This study examined the extent to which primary healthcare services (PHSs) undertake SEWB screening and management of Aboriginal and Torres Strait Islander clients, and the variation in SEWB screening and management across Indigenous PHS.MethodsCross-sectional analysis between 2012 and 2014 of 3,407 Indigenous client records from a non-representative sample of 100 PHSs in 4 Australian states/territory was undertaken to examine variation in the documentation of: (1) SEWB screening using identified measurement instruments, (2) concern regarding SEWB, (3) actions in response to concern, and (4) follow up actions. Binary logistic regression was used to determine the factors associated with screening.ResultsThe largest variation in SEWB screening occurred at the state/territory level. The mean rate of screening across the sample was 26.6%, ranging from 13.7 to 37.1%. Variation was also related to PHS characteristics. A mean prevalence of identified SEWB concern was 13% across the sample, ranging from 9 to 45.1%. For the clients where SEWB concern was noted, 25.4% had no referral or PHS action recorded. Subsequent internal PHS follow up after 1 month occurred in 54.7% of cases; and six-monthly follow up of referrals to external services occurred in 50.9% of cases.ConclusionOur findings suggest that the lack of a clear model or set of guidelines on best practice for screening for SEWB in Indigenous health may contribute to the wide variation in SEWB service provision. The results tell a story of missed opportunities: 73.4% of clients were not screened and no further action was taken for 25.4% for whom an SEWB concern was identified. There was no follow up for just under half of those for whom action was taken. There is a need for the development of national best practice guidelines for SEWB screening and management, accompanied by dedicated SEWB funding, and training for health service providers as well as ongoing monitoring of adherence with the guidelines. Further research on barriers to screening and follow up actions is also warranted.

Integrating Healthcare Services for Indigenous Australian Students at Boarding Schools: A Mixed-Methods Sequential Explanatory Study

“…In particular, the finding that despite 27% of secondary students reporting a high Kessler score, only 12% reported use of a service for mental health, alcohol, drugs or violence raises concerns about whether appropriate youth friendly and after hours services are sufficiently available, and whether students are sufficiently engaged in health-promoting activities such as sports and recreation, arts, music and other after-school activities that can improve social and emotional wellbeing [53]. This finding may be related to evidence of a dearth of pathways developed for, or modified to specifically meet the mental healthcare needs of, Indigenous adolescents [20] and/or poor integration between primary healthcare and mental healthcare services [36].…”

“…Additionally, the Department of Education, with a contribution from the Commonwealth Department of Health, funds allied health therapy services to six state schools in Cape York under the Be well Learn well program. For the Indigenous consumer, this variety of public and nongovernment providers, funding arrangements and regulatory mechanisms can result in ineffective, non-existent or confusing referral pathways, lower screening rates and limited access [35,36]. There are primary schools in each Cape York community, but there is limited access to secondary education programs.…”

Understanding the structure and processes of primary health care for young indigenous children

“…26 in contrast, there has been little focus on the more complex processes of care needed for social and emotional wellbeing and child neurodevelopment, and this is reflected in the lower PoCis that we reported for these two conditions. 27 The delivery of child neurodevelopment assessments has been shown to vary across primary healthcare services, and researchers have recently called for a more system-wide approach to improve delivery, recording and monitoring. 28 There has been a recent emphasis on the importance of child neurodevelopment and the delivery of social and emotional services in family-centred care practice.…”

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

“…Yet there is little data available to guide their efforts as to which students might need enhanced support [e.g., Ref. ( 51 )], how such support might be provided, or how linkages with primary health-care services might best be facilitated. Further, research is thus needed to determine how CQI can support best practice more generally across sectors.…”