ACCESS: Aboriginal Community Controlled Ear-health Support System: developing, embedding and evaluating best practice models of care

ACCESS will investigate a novel Aboriginal Child Health Navigator. Stream 1. Community consultation: We will determine what is needed from the Aboriginal Child Health Navigator model of care and how it can be integrated into enhanced service models through community yarning sessions and health worker semi-structured interviews with key informants such as parents, healthcare staff and service managers. The community consultation period will occur pre-, during and post intervention. The expected duration of the yarning circles will be approximately 60 minutes, although will not be limited if participants wish to continue with further discussion. The yarning topics will be developed by the research team and informed by the literature and relevant theoretical frameworks. The questions will then be reviewed by ACCHS staff and the local research team member, and amendments will be made following feedback. The interview guide for the health worker interviews will be developed by the investigators and informed by empirical evidence and theoretical frameworks. The interview guide will be reviewed by ACCHS staff, including the local research team member and amendments will be made following their feedback. The expected duration of the interview is 30-60 minutes. Stream 2. Evaluation and comparison: The second stream of ACCESS involves evaluating the Child Health Navigator, comparing a 12-month period prior to the Child Health Navigator and 12-months with the Child Health Navigator. From the 12-month Child Health Navigator period and the 12-month pre-Child Health Navigator period a 6-month analysis period will be determined. ACCESS will track appointment information of children to compare attendance to ear health-related services. The Child Health Navigator will use Aboriginal co-designed screening tools such as the Parent-evaluated Listening & Understanding Measure (PLUM) and the Talking and Listening Scale (HATS), in conjunction with the 715-health check to identify children who require the support of health and other relevant services. We will evaluate these tools during the follow-up consultations mentioned above (Stream 1). The PLUM and HATS are basic checklists. They assist early childhood workers to ask families the right questions in order to find out how a child’s listening skills are developing. Parents/carers will be asked about their child’s day-to-day hearing and speech. Examples include, can the child hear people calling them, talking or singing? Can they communicate, like pointing, cooing, babbling, copying sounds or saying words. The response options include ‘not yet or a little’, ‘sometimes’ or ‘a lot’. The responses are tallied and will indicate whether the child is ‘on track’ with their listening and talking skills. The 715 is a specific health check that is available for Aboriginal and Torres Strait Islander people. It helps to identify risk factors for chronic disease to manage the good health of the patient. The health check will include an assessment of the patient’s physical, psychological and social wellbeing. A Practice Nurse, Aboriginal Health Worker or Aboriginal Health Practitioner may assist with initial tests and medical history. A General Practitioner delivers the final assessment and recommends appropriate follow up care. The Aboriginal Child Health Navigator commencement will be staggered across Tharawal Aboriginal Corporation, Riverina Medical and Dental Aboriginal Corporation and Orange Aboriginal Medical Service ACCHS. We plan a four-month wash-in phase where we work with Navigators and the local ACCHSs to develop the role to be locally relevant and to specifically address the determinants and consequences of ear health and hearing problems. The Aboriginal Child Health Navigator will not replace the General Practitioner or other medical appointments rather coordinate, including supporting family identified priorities, the reason for any referrals, helping them to make the appointments, if needed, and assisting actual attendance by addressing any barriers (systems and social determinants) faced and promotion of family strengths and resilience. The Child Health Navigator will collaborate with ACCHS staff to ensure local processes are applied to invite participation to the Aboriginal Child Health Checks, ensure the conduct of these checks and the management plans arising from these checks. The Navigator will also be responsible for the education of families and services (including schools) to understand Otitis Media and hearing loss and the impact of these conditions. The anticipated duration of a Child Health Navigator session is dependent on the family’s needs and priorities. Appointments could vary from 30 to 60 minutes and session attendance will be documented on the study’s reporting system.