Journal articles on the topic 'Community health services for children Victoria'

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1

Heilbrunn-Lang, Adina Y., Lauren M. Carpenter, Seona M. Powell, Susan L. Kearney, Deborah Cole, and Andrea M. de Silva. "Reviewing public policy for promoting population oral health in Victoria, Australia (2007–12)." Australian Health Review 40, no. 1 (2016): 19. http://dx.doi.org/10.1071/ah15013.

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Objective Government policy and planning set the direction for community decisions related to resource allocation, infrastructure, services, programs, workforce and social environments. The aim of the present study was to examine the policy and planning context for oral health promotion in Victoria, Australia, over the period 2007–12. Methods Key Victorian policies and plans related to oral health promotion in place during the 2007–12 planning cycle were identified through online searching, and content analysis was performed. Inclusion of oral health (and oral health-related) promotion initiatives was assessed within the goals, objectives and strategies sections of each plan. Results Six of the 223 public health plans analysed (3%) included oral health ‘goals’ (including one plan representing nine agencies). Oral health was an ‘objective’ in 10 documents. Fifty-six plan objectives, and 70 plan strategies related to oral health or healthy eating for young children. Oral health was included in municipal plans (44%) more frequently than the other plans examined. Conclusion There is a policy opportunity to address oral health at a community level, and to implement population approaches aligned with the Ottawa Charter that address the social determinants of health. What is known about the topic? Poor oral health is a significant global health concern and places a major burden on individuals and the healthcare system, affecting approximately 50% of all children and 75%–95% of adults in Australia. The Ottawa Charter acknowledges the key role of policy in improving the health of a population; however, little is known about the policy emphasis placed on oral health by local government, primary care partnerships and community health agencies in Victoria, Australia. What does this paper add? This is a review of oral health content within local government (municipal) and community health plans in Victoria, Australia. What are the implications for practitioners? The findings identify several opportunities for public health and community health practitioners and policy makers to place greater emphasis on prevention and improvement of the oral health of Victorians through policy development.
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Townsend, Michelle. "Educational outcomes of children on guardianship or custody orders: A pilot study: Australian Institute of Health and Welfare." Children Australia 32, no. 3 (2007): 4–5. http://dx.doi.org/10.1017/s1035077200011603.

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The Australian Institute of Health and Welfare (AIHW) has recently released a report on the educational outcomes for children and young people on guardianship or custody orders. This report, four years in the making, represents one of the first comprehensive Australian assessments based on educational performance data from multiple jurisdictions for children on guardianship or custody orders. Developed for the National Child Protection and Support Services data group, the study was funded by the Community and Disability Services Ministers’ Advisory Council (AIHW 2007).This pilot study examines how children on guardianship/custody orders are performing compared with all Australian children in education department-based testing for reading and numeracy in years 3, 5 and 7. Mean test scores were examined in addition to the achievement of national benchmarks for reading and numeracy. These nationally agreed benchmarks are designed to assess whether children have achieved the minimum standards for years 3, 5 and 7 (AIHW 2007). Data on 895 children on guardianship or custody orders were collected from five jurisdictions - Queensland, Victoria, South Australia, Tasmania and the Australian Capital Territory - for August 2003 (AIHW 2007). The data were linked through collaborative efforts by state and territory education and community services departments.
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Parkinson, Debra, Alyssa Duncan, Jaspreet Kaur, Frank Archer, and Caroline Spencer. "Gendered aspects of long-term disaster resilience in Victoria, Australia." January 2022 10.47389/37, no. 37.1 (January 2022): 59–64. http://dx.doi.org/10.47389/37.1.59.

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Research conducted in 2018 documented the disaster experiences of 56 women and men in Australia aged between 18 and 93 years. This paper draws out the gendered factors that affected their resilience, and in so doing, begins to address the dearth of research related to gendered aspects of long-term disaster resilience. It is unique in capturing the voices of survivors who spoke of events 9 years after the 2009 Black Saturday fires and of earlier fires and floods in Victoria more than 50 years ago, including the 1983 Ash Wednesday fires. Over decades, gendered expectations of men and women significantly hindered resilience. Men spoke of the long-term cost to them of demands to ‘be strong’ in the worst of disasters and reasons they were reluctant to seek help afterwards. Women spoke of their contributions holding a lesser value and of discrimination. Discussions of violence against women and children after disaster, and suicide ideation in anticipation of future disasters offered critical insights. Protective factors identified by informants were not wholly intrinsic to their character but were also physical, such as essential resources provided in the immediate aftermath, and psychological and community support offered in the long-term. Factors that helped resilience departed from the ‘masculine’ model of coping post-disaster by moving away from a refusal to admit trauma and suffering, to community-wide resilience bolstered by widespread emotional, social and psychological support. Genuine community planning for disasters before they strike builds trust and offers insights for emergency management planners.
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Western, Sally. "Preventing Childhood Injury: Developing a Home Safety Display in a Community Health Centre." Australian Journal of Primary Health 5, no. 1 (1999): 76. http://dx.doi.org/10.1071/py99009.

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Childhood injury is a major health issue, with approximately 20,000 children under five hospitalised each year in Australia. The home is a common site for childhood injuries, with some of the more frequent episodes including falls, poisoning, burns, cuts and crush injuries. A regional initiative to develop a coordinated approach towards minimising injuries sustained by children between 0-4 years, resulted in the development of 'Childsafe Now', a health promotion program which involved training of child care providers, and the establishment of several home safety displays in the Eastern metropolitan region of Victoria. One of the home safety displays was developed in a Community Health Centre, utilising a pre-existing child care facility and the multidisciplinary skills of the staff. Community Health Centres were established with a focus on health promotion - encouraging illness and injury prevention through a holistic combination of education, community involvement, behavioural and social modification and multi-disciplinary primary health care services - yet the opportunity to establish a permanent, functional display which combines all of these aspects of health promotion is becoming increasingly rare. However, the skills and knowledge which have traditionally been nurtured within the Community Health Program make Community Health Centres a particularly appropriate location for establishing a Home Safety Display.
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McLean, Karen, Harriet Hiscock, Dorothy Scott, and Sharon Goldfeld. "What is the timeliness and extent of health service use of Victorian (Australia) children in the year after entry to out-of-home care? Protocol for a retrospective cohort study using linked administrative data." BMJ Paediatrics Open 3, no. 1 (January 2019): e000400. http://dx.doi.org/10.1136/bmjpo-2018-000400.

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IntroductionChildren entering out-of-home care have high rates of health needs across all domains of health. To identify these needs early and optimise long-term outcomes, routine health assessment on entry to care is recommended by child health experts and included in policy in many jurisdictions. If effective, this ought to lead to high rates of health service use as needs are addressed. Victoria (Australia) has no state-wide approach to deliver routine health assessments and no data to describe the timing and use of health service visits for children in out-of-home care. This retrospective cohort data linkage study aims to describe the extent and timeliness of health service use by Victorian children (aged 0–12 years) who entered out-of-home care for the first time between 1 April 2010 and 31 December 2015, in the first 12 months of care.Methods and analysisThe sample will be identified in the Victorian Child Protection database. Child and placement variables will be extracted. Linked health databases will provide additional data: six state databases that collate data about hospital admissions, emergency department presentations and attendances at dental, mental and community health services and public hospital outpatients. The federal Medicare Benefits Schedule claims dataset will provide information on visits to general practitioners, specialist physicians (including paediatricians), optometrists, audiologists and dentists. The number, type and timing of visits to different health services will be determined and benchmarked to national standards. Multivariable logistic regression will examine the effects of child and system variables on the odds of timely health visits, and proportional-hazards regression will explore the effects on time to first health visits.Ethics and disseminationEthical and data custodian approval has been obtained for this study. Dissemination will include presentation of findings to policy and service stakeholders in addition to scientific papers.
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MWANGA, J. R., P. MAGNUSSEN, THE LATE C. L. MUGASHE, THE LATE R. M. GABONE, and J. AAGAARD-HANSEN. "SCHISTOSOMIASIS-RELATED PERCEPTIONS, ATTITUDES AND TREATMENT-SEEKING PRACTICES IN MAGU DISTRICT, TANZANIA: PUBLIC HEALTH IMPLICATIONS." Journal of Biosocial Science 36, no. 1 (January 2004): 63–81. http://dx.doi.org/10.1017/s0021932003006114.

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A study on perceptions, attitudes and treatment-seeking practices related to schistosomiasis was conducted among the Wasukuma in the rural Magu district of Tanzania at the shore of Lake Victoria where Schistosoma haematobium and mansoni infections are endemic. The study applied in-depth interviews, focus group discussions and a questionnaire survey among adults and primary school children. The perceived symptoms and causes were incongruous with the biomedical perspective and a number of respondents found schistosomiasis to be a shameful disease. Lack of diagnostic and curative services at the government health care facilities was common, but there was a willingness from the biomedical health care services to collaborate with the traditional healers. Recommendations to the District Health Management Team were: that collaboration between biomedical and traditional health care providers should be strengthened and that the government facilities’ diagnostic and curative capacity with regard to schistosomiasis should be upgraded. Culturally compatible health education programmes should be developed in collaboration with the local community.
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Rogers, J. G., G. G. Adams, F. A. C. Wright, K. Roberts-Thomson, and M. V. Morgan. "Reducing Potentially Preventable Dental Hospitalizations of Young Children: A Community-Level Analysis." JDR Clinical & Translational Research 3, no. 3 (March 15, 2018): 272–78. http://dx.doi.org/10.1177/2380084418764312.

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An increasing number of Australians are being admitted to hospitals and day procedure centers to have dental treatment under a dental general anesthetic (DGA). Children younger than 2 y are having DGAs. These operations are costly and, although there have been improvements in safety, are not without risk. Most DGAs in children are to treat dental caries and have been defined as potentially preventable dental hospitalizations (PPDHs). This article reports on an analysis of the impact of access to community water fluoridation (CWF), availability of oral health professionals (OHPs), and socioeconomic status (SES) on PPDHs of 0- to 4-y-olds in 2012–2013 in Victoria, Australia. Data on these variables were obtained at the community (postcode) level. From the negative binomial multivariate analysis, each of the 3 independent variables was independently significantly associated with PPDHs at the postcode level. Children residing in postcodes without CWF on average had 59% higher rates than those with access (incident rate ratio [IRR], 1.59; P < 0.0001), children in postcodes with the lowest level of availability of OHPs had 65% higher rates than those with the highest access (IRR, 1.65; P < 0.0001), and children living in the most disadvantaged SES quintiles had 57% higher rates than children in the most advantaged quintiles (IRR, 1.57; P < 0.0001). There was a stepwise social gradient by SES quintile. In analysis of access to CWF and SES status, children without access to CWF had 86% higher PPDH rates than children with access (IRR, 1.86; P < 0.0001). In summary, no access to CWF, poor availability of OHPs, and lower SES status were independently associated with higher PPDH rates among 0- to 4-y-olds in Victoria at the postcode level. The study highlights the importance of considering 3 interacting factors—access to CWF, access to OHPs, and SES—in efforts to reduce PPDH rates in young children. Knowledge Transfer Statement: Extending access to water fluoridation, increasing the availability of dental services, and raising disadvantaged families’ socioeconomic status are each likely to decrease the rate of dental general anesthetics in young children.
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Nolan, Andrea, Jennifer Cartmel, and Kym Macfarlane. "Thinking about Practice in Integrated Children's Services: Considering Transdisciplinarity." Children Australia 37, no. 3 (August 9, 2012): 94–99. http://dx.doi.org/10.1017/cha.2012.27.

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Integrated service delivery in the early childhood education and care sector is burgeoning as a direct result of government agendas in Australia that privilege services for young children and families, especially those considered most vulnerable and at risk. In many cases this means reviewing and revising current practice to work more collaboratively with other professionals. This paper reports the findings of one aspect of a larger Australian study entitled: ‘Developing and sustaining pedagogical leadership in early childhood education and care professionals’. The focus of this paper is the understandings and practices of professionals in both Queensland and Victoria working in integrated Children's Services across the education, care, community and health sectors. The notion of transdisciplinary practice is also explored as a way to sustain practice. Qualitative data collection methods, including the ‘Circles of Change’ process, the ‘Significant Change’ method and semi-structured interviews were used. The findings indicate concerns around professional identity, feeling valued, role confusion and the boundaries imposed by funding regulations. Working in a transdisciplinary way was generally considered a useful way to move practice forward in these settings, although the ramifications for leadership that this approach brings requires further consideration.
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Burgell, Bob. "A rejoinder: the real story of the H&CS Enterprise Competency Standards." Children Australia 18, no. 3 (1993): 31–34. http://dx.doi.org/10.1017/s1035077200003552.

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The article ‘A Word Salad - Enterprise Based Competencies in Child Protection’, Children Australia 18 (2) 1993 by Dr. Lesley Cooper, examines the Victorian Department of Health and Community Services (H&CS) Skills Enhancement Project (SEP). H&CS plainly rejects the negative criticisms of the skill analysis work which the article espouses.
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Szwarc, Barbara. "Give them a break: A study of families’ perceptions of the supports available in the community for families with a child with a life-threatening illness." Children Australia 23, no. 2 (1998): 21–27. http://dx.doi.org/10.1017/s1035077200008592.

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The effectiveness of current support services for families who have a child with a progressive life-threatening illness seems to be a frequently overlooked issue. This paper, which is based on the findings of a recently conducted study, attempts to elucidate the critical issues in supporting this unique group of families. The study examined the perceptions of families regarding the value and effectiveness of the social supports available in the community for families caring for a child with a life-threatening illness in Victoria. Attention has been drawn to perceived gaps in support for these families. Also considered is the effectiveness of supports available for bereaved families who have lost children with life-threatening illnesses. The study was based on information provided by families who had been involved with a family support agency known as Very Special Kids.
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Price, Anna M. H., Anna Zhu, Huu N. J. Nguyen, Diana Contreras-Suárez, Natalie Schreurs, Jade Burley, Kenny D. Lawson, et al. "Study protocol for the Healthier Wealthier Families (HWF) pilot randomised controlled trial: testing the feasibility of delivering financial counselling to families with young children who are identified as experiencing financial hardship by community-based nurses." BMJ Open 11, no. 5 (May 2021): e044488. http://dx.doi.org/10.1136/bmjopen-2020-044488.

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IntroductionPoverty and deprivation can harm children’s future health, learning, economic productivity and societal participation. The Australian Healthier Wealthier Families project seeks to reduce the childhood inequities caused by poverty and deprivation by creating a systematic referral pathway between two free, community-based services: universal, well-child nursing services, which provide health and development support to families with children from birth to school entry, and financial counselling. By adapting the successful Scottish ‘Healthier Wealthier Children’ model, the objectives of this Australian pilot are to test the (1) feasibility of systematising the referral pathway, and (2) short-term impacts on household finances, caregiver health, parenting efficacy and financial service use.Methods and analysisThis pilot randomised controlled trial will run in three sites across two Australian states (Victoria and New South Wales), recruiting a total of 180 participants. Nurses identify eligible caregivers with a 6-item, study-designed screening survey for financial hardship. Caregivers who report one or more risk factors and consent are randomised. The intervention is financial counselling. The comparator is usual care plus information from a government money advice website. Feasibility will be evaluated using the number/proportion of caregivers who complete screening, consent and research measures, and access financial counselling. Though powered to assess feasibility, impacts will be measured 6 months post-enrolment with qualitative interviews and questionnaires about caregiver-reported income, loans and costs (adapted from national surveys, for example, the Household, Income and Labour Dynamics in Australia Survey); health (General Health Questionnaire 1, EuroQol five-dimensional questionnaire, Depression, Anxiety, Stress Scale short-form); efficacy (from the Longitudinal Study of Australian Children); and financial service use (study-designed) compared between arms.Ethics and disseminationEthics committees of the Royal Children’s Hospital (HREC/57372/RCHM-2019) and South West Sydney Local Health District (2019/ETH13455) have approved the study. Participants and stakeholders will receive results through regular communication channels comprising meetings, presentations and publications.Trial registration numberACTRN12620000154909; prospectively registered. Pre-results.
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Sutcliffe, Simon B., Puneet Bains, Fraser Black, Sandra S. Broughton, Stuart Brown, Simon Colgan, Megan E. Doherty, et al. "The Two Worlds of Palliative Care: Bridging the Gap with Nepal." Nepal Journal of Science and Technology 20, no. 2 (December 31, 2021): 125–30. http://dx.doi.org/10.3126/njst.v20i2.45802.

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Despite past geo-political turbulence, Nepal has made significant progress in societal and economic initiatives, particularly in relation to social determinants of health. These improvements, however, belie the suffering of those with life-limiting disease due to pain, stigma, social and financial distress, consequent upon low patient, caregiver and health professional awareness of the need for, and availability of, appropriate care and support. Two Worlds Cancer Collaboration (INCTR-Canada) has been working with partners in Nepal to build capacity for palliative care by: (a) organizational and administrative support – establishing the Nepal Association of Palliative Care (NAPCare), and the creation of the Nepal Strategy for Palliative Care, approved by government in 2017; (b) “twinning” between 2 hospital palliative care units in Nepal and the Nanaimo Hospice and Victoria Hospice, BC, Canada; (c) sustainable growth of palliative care according to WHO foundational measures, implementing facility-based clinical programs, and home-based care aligned with the cultural, social, and economic environment of Nepal; (d) training of health professionals in adult and paediatricpalliative carethrough interactive on-line “distance learning” (Extension of Community Healthcare Outcomes, ECHO);(e) leveraging palliative care training and expertise across the government health system, and (f) local and international support to build a newfacility for Hospice Nepal to provide more support for more patients in a rural ambience on the outskirts of Kathmandu. Palliative care needs to become standard-of-care, providing peace, comfort and dignity for adults and children. Working collaboratively with partners in Nepal, the collective vision is a capable professional Nepali community leading palliative care services for all in need, wherever in need.
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Falk, Joern, Björn Globisch, Martin Angelmahr, Wolfgang Schade, and Heike Schenk-Mathes. "Drinking Water Supply in Rural Africa Based on a Mini-Grid Energy System—A Socio-Economic Case Study for Rural Development." Sustainability 14, no. 15 (August 2, 2022): 9458. http://dx.doi.org/10.3390/su14159458.

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Water is an essential resource required for various human activities such as drinking, cooking, growing food, and personal hygiene. As a key infrastructure of public services, access to clean and safe drinking water is an essential factor for local socio-economic development. Despite various national and international efforts, water supply is often not guaranteed, especially in rural areas of Africa. Although many water resources are theoretically available in these areas, bodies of water are often contaminated with dangerous pathogens and pollutants. As a result, people, often women and children, have to travel long distances to collect water from taps and are exposed to dangers such as physical violence and accidents on their way. In this article, we present a socio-economic case study for rural development. We describe a drinking water treatment plant with an annual capacity of 10,950 m3 on Kibumba Island in Lake Victoria (Tanzania). The plant is operated by a photovoltaic mini-grid system with second-life lithium-ion battery storage. We describe the planning, the installation, and the start of operation of the water treatment system. In addition, we estimate the water prices achievable with the proposed system and compare it to existing sources of drinking water on Kibumba Island. Assuming a useful life of 15 years, the installed drinking water system is cost-neutral for the community at a cost price of 0.70 EUR/m3, 22% less than any other source of clean water on Kibumba Island. Access to safe and clean drinking water is a major step forward for the local population. We investigate the socio-economic added value using social and economic key indicators like health, education, and income. Hence, this approach may serve as a role model for community-owned drinking water systems in sub-Saharan Africa.
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McCann, Warren. "Redeveloping Primary Health and Community Support Services in Victoria." Australian Journal of Primary Health 6, no. 4 (2000): 36. http://dx.doi.org/10.1071/py00032.

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Why Primary Care Reforms?: It gives me very great pleasure to have been asked to speak at this major international Conference about redeveloping primary health and community support services in Victoria. While opening the Conference, the Victorian Minister for Health, the Honourable John Thwaites, launched the Primary Care Partnership Strategy which is one of the most ambitious and far reaching primary health and community support reform agendas in Australia.
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M. Brown, Rhonda. "Community Health Within the Context of Health Reform." Australian Journal of Primary Health 6, no. 1 (2000): 85. http://dx.doi.org/10.1071/py00009.

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Recent health reforms in Victoria based on a market model characterised by competition and market control of health services, have radically changed the funding and management of community health organisations and the way health services are provided. Community health has sustained ongoing funding cuts, restructures, amalgamations, and corporatisation over the past decade. Within the context of reform community health has been forced to become competitive through improvement in the efficiency and effectiveness of services. At the same time organisations must collaborate to ensure a co-ordinated approach to health care and continue to provide services which are responsive to community needs. With diminishing government funding community health organisations must seek alternative funding sources through the tendering process. A 1998 study of one of the largest metropolitan community health organisations in Victoria gives some insights into the impact of these reforms. The findings of this study show that health reforms based on market principles are not compatible with the delivery of health care, and in particular with primary health care, the underlying philosophy of community health. Organisations are becoming more bureaucratic and hierarchical with decision making being driven by management rather than by consultation with community and staff. Resources are being diverted from health promotion and community development activities to direct services, that are individual and problem focused rather than community and prevention focused.
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Pettigrew, Kim. "The Light Ones–Victoria Police, Community Services Victoria, and the Children and Young Persons Bill 1987." Journal of Social Welfare Law 11, no. 4 (July 1989): 235–41. http://dx.doi.org/10.1080/09649068908415700.

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Renzaho, Andre. "Re-visioning cultural competence in community health services in Victoria." Australian Health Review 32, no. 2 (2008): 223. http://dx.doi.org/10.1071/ah080223.

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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 serviceled programs.
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Fabb, Linda. "Community Health and the Environment." Australian Journal of Primary Health 2, no. 3 (1996): 85. http://dx.doi.org/10.1071/py96045.

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Case Study One: The Lead Project: Public Health On The Ground: Doutta Galla Community Health Service (DGCHS) is located in Victoria, in Melbourne's inner West. It aims to provide health care services, and health education and promotion to a culturally diverse and changing community. It currently services two local council areas and a population of 146,000 people, with a further 249,000 coming into the area daily for work, study or shopping. It covers four of Melbourne's largest public housing estates and large groups of people from Non-English Speaking Background including South America, the Horn of Africa, Turkey, Vietnam and China.
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Mann, Leona. "Widening The Net: New Directions For Community Health." Australian Journal of Primary Health 3, no. 1 (1997): 72. http://dx.doi.org/10.1071/py97008.

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The Central Wellington Health Service, in Central Gippsland, Victoria, has been likened to an 'Area Health Board' or a 'Multi-Purpose Centre', because it has been structured into one organisation with an integrated range of services from acute to community.
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Wilson, Gai, Paul Butler, Tricia Szirom, and Jenny Cameron. "Indirect Services Funded by the National Women's Health Program in Victoria." Australian Journal of Primary Health 4, no. 2 (1998): 77. http://dx.doi.org/10.1071/py98023.

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Victoria's Women's Health Services and Centres Against Sexual Assault have implemented a range of indirect activities utilising various strategies and methods with a particular focus on information and resource provision, education and training, community development and promotional activity. They have increased women's access to existing services by working to make those services more appropriate and relevant. To achieve this they have involved women in the community in program management, design and implementation. Collaboration with other agencies in health and related services has also been a key strategy in achieving changes to mainstream services and fulfilling the aims of the dual strategy.
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Dedman, Paul. "Community Treatment Orders in Victoria, Australia." Psychiatric Bulletin 14, no. 8 (August 1990): 462–64. http://dx.doi.org/10.1192/pb.14.8.462.

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It is one of the failures of contemporary psychiatry that many patients who respond well to neuroleptic medication given to them when they are in-patients relapse after discharge due to not taking any further medication. Those working closely with the acute psychiatric patient in the community are often forced to stand by powerlessly as a patient deteriorates, causing damage to himself and his social milieu until such a point is reached when he is again ill enough to warrant compulsory admission and treatment. This process is, of course, devastating for a patient's family and also disheartening for professionals involved, and is perhaps partly responsible for the high turnover of staff involved in front line services. Even if assertive outreach methods are employed such as those involved in a number of comprehensive community-based programmes (Stein & Test, 1980; Borland et al, 1989) so that contact with the patient is not lost, it is not possible without the necessary legislation to enforce treatment in the community.
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Mitchell, Brian. "Preventative Child Welfare Services in Victoria." Children Australia 13, no. 1 (1988): 10–14. http://dx.doi.org/10.1017/s0312897000001752.

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The idea of prevention in child welfare is not new. The prevention of substitute placement of children whether on a temporary or long-term basis has been a fundamental principle of child welfare we have held to for many years in Victoria.However, it is only in the last decade that this principle is actually being carried out in practice by a number of voluntary agencies. For many children placement is still commonly used as a solution it is easier to place a child than to promote change within many multi-deficit families.
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Martin-Kerry, Jacqueline M., Martin Whelan, John Rogers, Anil Raichur, Deborah Cole, and Andrea M. de Silva. "Addressing disparities in oral disease in Aboriginal people in Victoria: where to focus preventive programs." Australian Journal of Primary Health 25, no. 4 (2019): 317. http://dx.doi.org/10.1071/py18100.

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The aim of this study is to determine where Aboriginal people living in Victoria attend public oral health services; whether they access Aboriginal-specific or mainstream services; and the gap between dental caries (tooth decay) experience in Aboriginal and non-Aboriginal people. Analysis was undertaken on routinely collected clinical data for Aboriginal patients attending Victorian public oral health services and the distribution of Aboriginal population across Victoria. Approximately 27% of Aboriginal people attended public oral health services in Victoria across a 2-year period, with approximately one in five of those accessing care at Aboriginal-specific clinics. In regional Victoria, 6-year-old Aboriginal children had significantly higher levels of dental caries than 6-year-old non-Aboriginal children. There was no significant difference in other age groups. This study is the first to report where Aboriginal people access public oral health care in Victoria and the disparity in disease between Aboriginal and non-Aboriginal users of the Victorian public oral healthcare system. Aboriginal people largely accessed mainstream public oral healthcare clinics highlighting the importance for culturally appropriate services and prevention programs to be provided across the entire public oral healthcare system. The findings will guide development of policy and models of care aimed at improving the oral health of Aboriginal people living in Victoria.
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Silburn, Kate, and Virginia Lewis. "Commissioning for health and community sector reform: perspectives on change from Victoria." Australian Journal of Primary Health 26, no. 4 (2020): 332. http://dx.doi.org/10.1071/py20011.

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Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.
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Guzys, Diana, Guinever Threlkeld, Virginia Dickson-Swift, and Amanda Kenny. "Rural and regional community health service boards: perceptions of community health – a Delphi study." Australian Journal of Primary Health 23, no. 6 (2017): 543. http://dx.doi.org/10.1071/py16123.

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Much has been written about the composition of health service boards and the importance of recruiting people with skills appropriate for effective and accountable governance of health services. Governance training aims to educate directors on their governance responsibilities; however, the way in which these responsibilities are discharged is informed by board members’ understanding of health within their communities. The aim of this study was to identify how those engaged in determining the strategic direction of local regional or rural community health services in Victoria, Australia, perceived the health and health improvement needs of their community. The Delphi technique was employed to facilitate communication between participants from difference geographic locations. The findings of the study highlight the different ways that participants view the health of their community. Participants prioritised indicators of community health that do not align with standard measures used by government to plan for, fund or report on health. Devolved governance of healthcare services aims to improve local healthcare responsiveness. Yet, if not accompanied with the redistribution of resources and power, policy claimed to promote localised decision-making is simply tokenistic.
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Leggat, Sandra G., Timothy Bartram, and Pauline Stanton. "People Management in Victorian Community Health Services: An Exploratory Study." Australian Journal of Primary Health 12, no. 3 (2006): 59. http://dx.doi.org/10.1071/py06046.

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Recent studies have identified the importance of a suitable workforce in achieving health care goals. This paper reports on a study investigating human resource management (HRM) in the public health sector in Victoria. Using survey methodology we found limited use of strategic human resource management, although the community health service respondents reported greater sophistication in HRM than the hospital respondents, particularly in relation to performance management. We explore possible reasons for these differences, such as the values of the community health sector, governance and experience with system reform.
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Castle, David J. "Letter from Australia: mental healthcare in Victoria." Advances in Psychiatric Treatment 17, no. 1 (January 2011): 2–4. http://dx.doi.org/10.1192/apt.bp.110.008375.

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SummaryMental health services in the state of Victoria, Australia, have undergone enormous change over the past 15 years, with the closure of all stand-alone psychiatric hospitals and a shift of resources and services into the community. Although successful overall, various areas cause concern, including pressure on acute beds, a paucity of alternative residential options, and suboptimal integration of government and non-government agencies concerned with the care of people with mental illnesses. Certain groups, notably those with complex symptom sets such as substance use and mental illness, intellectual disability and forensic problems, remain poorly catered for by the system. Finally, community stigma and lack of work inclusion for mentally ill individuals are ongoing challenges.
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Tobin, Margaret J. "Rural Psychiatric Services." Australian & New Zealand Journal of Psychiatry 30, no. 1 (February 1996): 114–23. http://dx.doi.org/10.3109/00048679609076079.

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Objective: The objective was to describe and evaluate a community mental health service developed during 1991–1992 in an attempt to meet the mental illness needs of an isolated rural community. The setting was the Grampians health region in Western Victoria: this region has an area of 45,000 square kilo-metres and a population of 182,000. Method: The method involved firstly describing the evolution of the service delivery model. This comprised a team of travelling psychiatrists and community psychiatric nurses which succeeded in providing a combined inpatient and outpatient service which was integrated with general practitioners. Secondly, diagnostic and case load descriptions of patients receiving service were compared for both the inpatient and outpatient settings. Results: The results were that reduced reliance on inpatient beds and increased consumer satisfaction were achieved. Conclusion: It was concluded that on initial evaluation of the service it was seen to be meeting its objective of treating the seriously mentally ill in an isolated rural community based setting.
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McCoppin, Brigid. "Guest Editorial: Community Participation in Community Health: A PHACS Information Resource." Australian Journal of Primary Health 5, no. 2 (1999): 6. http://dx.doi.org/10.1071/py99014.

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In his foreword to the recent Department of Human Services (DHS) publication Community participation in community health: A PHACS information resource 3 (1999), the Parliamentary Secretary to the Victorian Minister for Health says that the 'heart' of the current primary health and community support (PHACS) reforms is to ensure that the 'locally based alliances' which are to emerge from them will be responsive to client needs, and notes also that the proposed PHACS demonstration projects will have to include plans for community participation. The aim of this Information Resource in the series Towards a stronger primary health and community support system from the Department of Human Services Victoria, is to guide workers in community health agencies, and in the other PHACS services, in developing ways of encouraging community participation. As such, the document provides both a rationale and practical suggestions, and should be a useful resource for board members and staff of community agencies, as well as for those either teaching or studying in such fields as health promotion and health education, where engaging the interest of members of the public is a central purpose.
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Llewellyn-Jones, Lorraine, and David Harvey. "The development of a Health Promotion Community Participation Framework." Australian Journal of Primary Health 11, no. 2 (2005): 136. http://dx.doi.org/10.1071/py05032.

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This paper reports on research conducted through Monash University located in the state of Victoria, Australia. The outcome of the research was the development of a Health Promotion Community Participation Framework, providing guidelines for health professionals in community health centres and services to assist them with facilitating community participation in health promotion. A literature review was conducted and information collected from health professionals working in metropolitan and rural community health centres and services across the state of Victoria, Australia. The Framework does not emphasise levels of community participation as a hierarchy, but instead proposes using the levels or types of participation across a continuum. This has been done to encourage the use of appropriate transparent strategies that will enable both individual community members and different sections of communities to participate in health promotion activities. This is particularly important where government policies dictate the direction of health promotion, as this "top down" approach can lead to the community being excluded for health promotion processes. The use of a continuum promotes the concept that participation can be effective at different levels, even when the issue to be addressed has already been identified. The Framework also proposes that in order for community participation strategies to take place, there needs to be capacity building at both the organisational level and the community level.
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Klein, Harald. "Reforming Primary Care in Victoria: Will Primary Care Partnerships Do the Job?" Australian Journal of Primary Health 8, no. 1 (2002): 23. http://dx.doi.org/10.1071/py02004.

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Spiralling medical costs and escalating demand for health services are putting primary care reform firmly on the agenda for governments around the world. A more coordinated and prevention-oriented approach must be adopted now to avoid a looming crisis in health care. In Victoria, the Primary Care Partnership (PCP) Strategy aims to improve health outcomes and better manage the demand for services by functionally integrating health and community support services. This paper provides an overview of the key factors that have shaped primary care reform in the State of Victoria; the logic of the PCP Strategy; a summary of the results of the strategy after 18 months; and a critical assessment of the key challenges for the strategy in the future. The paper concludes that the strategy has already led to much stronger collaboration between agencies, more integrated service planning and emerging models for service coordination. For these achievements to translate to improved health outcomes, the systems changes being initiated by PCPs need to be translated into the way services are provided in the community. This cannot be achieved by collaboration between service providers alone. It is now time for all relevant parts of government to support PCP objectives and initiatives in the way they plan and fund services.
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Smith, Janine. "Community nursing and health care in the twenty-first century." Australian Health Review 23, no. 1 (2000): 114. http://dx.doi.org/10.1071/ah000114.

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This article reports on research into the changing role of generalist community nurses inVictoria during the 1990s. It provides an analysis of the implications of current policy trendsand presents an overview of current practice and trends in contemporary health care deliveryin the community. It discusses a vision for community nursing inspired by interviews withgeneralist community nurses throughout Victoria, and offers creative recommendations andstrategies that will facilitate planning for the personal and professional changes necessary totake community services into the twenty-first century.
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McLennan, Fiona, Kate Vickers, Kylie Mason, Karen Bloomberg, Victoria Leadbetter, and Meg Engel. "Capacity Building and Complex Communication Needs: A New Approach to Specialist Speech Pathology Services in Rural Victoria." Australian Journal of Primary Health 12, no. 2 (2006): 66. http://dx.doi.org/10.1071/py06024.

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The aim of this article is to provide a description of the establishment of an innovative approach to improving speech pathology services and community inclusion of people with complex communication needs in rural Victoria. The East Hume Regional Communication Service was established by Ovens and King Community Health Service in partnership with Wodonga Regional Health Service in 2004 as part of a "hub and spoke" network of services across Victoria for people with complex communication needs. Unlike traditional speech pathology services that historically have focused on clinical one-to-one intervention, the Regional Communication Service has a strong focus on community capacity building, enhancing inclusion of people with complex communication needs through improved knowledge, skills and attitudes. This paper will review the relevant literature and outline the Victorian Government policy context within which the service was established. Service highlights and successful initiatives will be described and key factors contributing to the success of the East Hume Regional Communication Service will be explored. Areas for process improvement during the initial two years of operation will also be discussed. This article will provide an insight into establishment of a service delivery model addressing both individual needs and community inclusion that has the potential to be extended across multiple disciplines and areas of practice within rural Australia.
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Ong, Kevin, Andrew Carroll, Shannon Reid, and Adam Deacon. "Community Outcomes of Mentally Disordered Homicide Offenders in Victoria." Australian & New Zealand Journal of Psychiatry 43, no. 8 (January 1, 2009): 775–80. http://dx.doi.org/10.1080/00048670903001976.

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Objective: The aim of the present study was to describe characteristics and post-release outcomes of Victorian homicide offenders under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (and/or its forerunner legislation) released from forensic inpatient psychiatric care since the development of specialist forensic services. Method: A legal database identified subjects meeting inclusion criteria: hospitalized in forensic psychiatric care due to finding of mental impairment or unfitness to stand trial for homicide in Victoria; released into the community; and released between 1 January 1991 and 30 April 2002. Using clinical records, demographics, index offence, progress in hospital, diagnosis, psychosocial and criminological data were obtained. Outcomes (offending or readmission into secure care) were obtained from the clinical records. Results: Of the 25 subjects, 19 (76%) were male. Primary diagnoses on admission to forensic hospital care were schizophrenia, n = 16 (64%); other psychotic disorder, n = 5 (20%); depression, n = 3 (12%); and personality disorder, n = 1 (4%). Mean time in custodial supervision was 11 years and 2 months, less for those whose offence occurred after the development of forensic rehabilitation services. In the first 3 years after release, there was a single episode of criminal recidivism, representing a recidivism rate of 1 in 25 (4%) over 3 years. Twelve subjects (48%) were readmitted at some point in the 3 year follow up. Conclusion: There was a very low rate of recidivism after discharge, but readmissions to hospital were common. Lengths of custodial care were reduced after the introduction of forensic rehabilitation facilities. Recidivism is low when there are well-designed and implemented forensic community treatment programmes, consistent with other data suggesting a reciprocal relationship between safe community care and a low threshold for readmission to hospital, lessening re-offending at times of crisis. Further research should be directed at timing of release decisions, based on reducing identified risk factors to acceptable levels.
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Mullen, P., and J. Ogloff. "Providing mental health services to adult offenders in Victoria, Australia: Overcoming barriers." European Psychiatry 24, no. 6 (September 2009): 395–400. http://dx.doi.org/10.1016/j.eurpsy.2009.07.003.

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AbstractPurposeTo illustrate the development of the interface between general and forensic mental health services in Victoria, Australia.MethodDeveloping effective cooperation between the general and forensic mental health services requires overcoming a number of barriers. The attitude of general services that antisocial behaviour was none of their business was tackled through ongoing workshops and education days over several years. The resistance to providing care to those disabled by severe personality disorders or substance abuse was reduced by presenting and promoting models of care developed in forensic community and inpatient services which prioritised these areas. The reluctance of general services to accept offenders was reduced by involving general services in court liaison clinics and in prisoner release plans. Cooperation was enhanced by the provision of risk assessments, the sharing of responsibility for troublesome patients, and a problem behaviours clinic to support general services in coping with stalkers, sex offenders and threateners.ConclusionsActive engagement with general services was promoted at the level of providing education, specialised assessments and a referral source for difficult patients. This generated a positive interface between forensic and general mental health services, which improved the quality of care delivered to mentally abnormal offenders.
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Clyde, Margaret. "Catering for the needs of pre-school age children in rural areas: A case study." Australian and International Journal of Rural Education 1, no. 1 (March 5, 2019): 13–20. http://dx.doi.org/10.47381/aijre.v1i1.242.

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In 1985 the then Minister for Community Services (Victoria), the Hon. Caroline Hogg, announced a change of policy in relation to preschool services in Victoria; all children were to have a year of "kindergarten type experiences" in the year before school, and existing playgroups for two year olds were to be phased out, while two years of kindergarten for some children was to become the exception. This policy came about for two reasons; firstly, as a way of implementing the Cain Labor Government's policy of social justice and equity, and secondly as an attempt to be more financially accountable. While both these objectives, in hindsight, may have a somewhat hollow ring today, they brought great changes to the preschool programs of Victoria which had been established nearly a century before by voluntary organisations in response to inner city poverty and need. It meant that an effort would be made to ensure that children in isolated and/or rural pockets of Victoria were to be included in the sessional kindergarten program and that the traditional "four sessions of two and a half hours per week at a place called a kindergarten" might not be seen to be appropriate in terms of travelling distance involved for parents or children, or affordable in terms of the best use of a rapidly declining budget.
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Morales, Juan, Elizabeth María Yovera-Sandoval, and Marlene Raquel Basilio-Rojas. "Community Health Services and Blood Lead Reduction in Children." Universal Journal of Public Health 10, no. 6 (December 2022): 590–95. http://dx.doi.org/10.13189/ujph.2022.100606.

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38

Gardner, Fiona. "Shared Action: Stronger communities, safer children." Children Australia 27, no. 2 (2002): 23–28. http://dx.doi.org/10.1017/s1035077200005034.

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This article explores the effectiveness of an innovative and exciting project called ‘Shared Action’, a community development approach to child protection in Bendigo, Victoria. Shared Action was a three-year project which started in January 1997. It began by encouraging a sense of community ownership. A shared vision was developed with key goals leading to a wide range of community activities. A sense of hope and cooperation grew along with social networks, the capacity to resolve conflict constructively and a shared sense of community responsibility.
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Kong, F., C. Kyle-Link, J. Hocking, and M. Hellard. "11. SEX AND SPORT: A COMMUNITY BASED PROJECT OF CHLAMYDIA TESTING AND TREATMENT IN RURAL AND REGIONAL VICTORIA." Sexual Health 4, no. 4 (2007): 288. http://dx.doi.org/10.1071/shv4n4ab11.

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Chlamydia is the most common notifiable infectious disease in Australia with the number of notifications increasing 92% over the past 5 years. The "Sex and Sport" Project is piloting a community based chlamydia testing and treatment program reaching young people in a specific community setting, sporting clubs. This multifaceted approach utilises health education, population screening and collection of data on risk taking behaviour as the first steps in enhancing health and shaping future service provisions. The project's primary aim is to assess the feasibility of an outreach testing and treatment program. Secondary aims are to measure the prevalence of chlamydia and assess sexual risk behaviour in this population. Strong community collaborations and integration into local health services through the Primary Care Partnerships is important in the project's sustainability; in particular key community members respected by sporting clubs needed to be identified, capacity developed to deliver effective health promotion messages and improve young people's access to sexual health services. Additionally, local knowledge has guided overall program implementation and provides opportunities for capacity building to regionally based services. For example, poor access to sexual health services is being addressed by the participants being able to access services via telephone consultation with Melbourne Sexual Health Centre. Approximately 1000 Victorians aged 16-25 years from the Loddon Mallee region of Victoria will be tested between June and September 2007. This paper will report on the feasibility, challenges and possible solutions in establishing a community based outreach testing and treatment program.
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40

Liang, Zhanming, Peter F. Howard, Lee C. Koh, and Sandra Leggat. "Competency requirements for middle and senior managers in community health services." Australian Journal of Primary Health 19, no. 3 (2013): 256. http://dx.doi.org/10.1071/py12041.

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The Australian health system has been subjected to rapid changes in the last 20 years to meet increasingly unmet health needs. Improvement of the efficiency and comprehensiveness of community-based services is one of the solutions to reducing the increasing demand for hospital care. Competent managers are one of the key contributors to effective and efficient health service delivery. However, the understanding of what makes a competent manager, especially in the community health services (CHS), is limited. Using an exploratory and mixed-methods approach, including focus group discussions and an online survey, this study identified five key competencies required by senior and mid-level CHS managers in metropolitan, regional and rural areas of Victoria: Interpersonal, communication qualities and relationship management; Operations, administration and resource management; Knowledge of the health care environment; Leading and managing change; and Evidence-informed decision-making. This study confirms that core competencies do exist across different management levels and improves our understanding of managerial competency requirements for middle to senior CHS managers, with implications for current and future health service management workforce development.
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Ansari, Z., MJ Ackland, NJ Carson, and BCK Choi. "Small Area Analysis of Diabetes Complications: Opportunities for Targeting Public Health and Health Services Interventions." Australian Journal of Primary Health 11, no. 3 (2005): 72. http://dx.doi.org/10.1071/py05045.

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The objective of this paper is to present small area analyses of diabetes complications in Victoria, Australia, and to illustrate their importance for targeting public health and health services interventions. Local government areas in Victoria were aggregated into 32 Primary Care Partnerships (PCP), which are voluntary alliances of primary care providers. The 32 PCP areas were used as the basic geographic units for small area analyses. Admission rates for diabetes complications were age and sex standardised using the direct method and the 1996 Victorian population as the reference. Admission rate ratios were calculated using the Victorian admission rates as the reference. The 95 per cent confidence intervals for the standardised admission rate ratios were based on the Poisson distribution. There was a wide variation (almost fivefold) in admission rates for diabetes complications across the PCP catchments, with the lowest standardised rate ratio of 0.37 and the highest of 1.75. There were 11 PCPs (seven metropolitan, four rural) with admission rate ratios significantly higher than the Victorian average. The seven metropolitan PCPs contributed more than 43% of all admissions and bed days for diabetes complications in Victoria. Small area analyses of diabetes complications are an exciting new development aimed at stimulating an evidence-based dialogue between local area health service providers, planners and policy-makers. The purpose is to provide opportunities to target public health and health services interventions at the local level to improve the management of diabetes complications in the community.
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Walker, Rae, Beverley Lewis, and Sally Mitchell. "Community Health Service Agreements 1992 to 1995: Changes in Practice and Purpose." Australian Journal of Primary Health 2, no. 4 (1996): 42. http://dx.doi.org/10.1071/py96054.

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In Victoria, community health centres are undergoing major changes. In this paper, a study of service and funding agreements, their changed purposes, and how the practices surrounding them have also changed, is reported. The study provides some insights into the dynamics of the contractual model of health system management. The information was obtained from the service and funding agreements of community health centres, interviews with staff of the Department of Human Services, and interviews with community health centre managers. At the end of 1995, community health centres were still in a transitional phase. They were changing from being locally focused, multi-disciplinary organisations that approached health as a social and technical issue to ones that were centrally focused, still multi-disciplinary but increasingly attending to the technical provision of services. There were, however, many ambiguities in the system that allowed services to resist the changes that were considered least desirable. To a degree they de-coupled internal operations from the external presentation of them.
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43

Furman, Rich, and Robert Jackson. "Wrap-Around Services: An Analysis of Community-Based Mental Health Services for Children." Journal of Child and Adolescent Psychiatric Nursing 15, no. 3 (July 2002): 124–31. http://dx.doi.org/10.1111/j.1744-6171.2002.tb00335.x.

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44

Bigby, Christine. "A demographic analysis of older people with intellectual disability registered with Community Services Victoria." Australia and New Zealand Journal of Developmental Disabilities 19, no. 1 (January 1994): 1–10. http://dx.doi.org/10.1080/07263869400035061.

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45

EZARD, NADINE, NICK LINTZERIS, PETA ODGERS, GLENDA KOUTROULIS, PETER MUHLEISEN, AARON STOWE, and AMANDA LANAGAN. "An evaluation of community methadone services in Victoria, Australia: results of a client survey." Drug and Alcohol Review 18, no. 4 (December 1999): 417–23. http://dx.doi.org/10.1080/09595239996284.

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46

Pillay, A. L., and M. R. Lockhat. "Developing community mental health services for children in South Africa." Social Science & Medicine 45, no. 10 (November 1997): 1493–501. http://dx.doi.org/10.1016/s0277-9536(97)00079-8.

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47

Sarmiento, Catalina, and Graham J. Reid. "Re-Accessing Community Mental Health Services for Children and Adolescents." Journal of Behavioral Health Services & Research 47, no. 1 (July 8, 2019): 21–37. http://dx.doi.org/10.1007/s11414-019-09668-2.

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48

Creswell, Cathy, and John Brereton. "Community Mental Health Services and the children of service users." Clinical Psychology Forum 1, no. 144 (October 2000): 4–6. http://dx.doi.org/10.53841/bpscpf.2000.1.144.4.

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49

Anderson, Philip. "Developing Preventive Services." Children Australia 13, no. 2 (1988): 16–19. http://dx.doi.org/10.1017/s0312897000001880.

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Before discussing the types of services that are required I would like to look, just briefly, at some of the recent history in the provision of services.Edith Bennett was the Director of the Family Welfare Division in what is now Community Services Victoria. Those of you who have been around for more than ten years will remember her. She once said that what we need is a range of flexible services. Being rather young and believing I knew it all I thought at the time that this was a load of simplistic rubbish. How could something so simple be true. The field likes to make these things complex. However, looking back I feel she had made a key point that is perfectly obvious now.
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Holbery, Eileen, and Marie Quinn. "Mealmakers Program: Linkages for Health." Australian Journal of Primary Health 2, no. 1 (1996): 138. http://dx.doi.org/10.1071/py96020.

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The Mealmakers Program is an initiative for the promotion of health through early intervention. Community members and three health agencies linked together to plan and implement a program aimed at improving the wellbeing of children attending a pre-school in a disadvantaged area of Victoria. The Program has four components: a food program providing nutritious meals daily; a dental health monitoring and treatment program; the provision of accessible information on healthy eating for the children and their families; and practical education on growing vegetables. The Program now has assured funding, and community ownership, which is responsible for the Program's functions, the employment of staff, and extensive networking with health care professionals.
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