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We evaluate a method to describe changing substance use patterns in northern Australia's remote Aboriginal communities (Arnhem Land, Northern Territory). Substance use was assessed in random samples in two communities A (n = 194) and B (n = 176). Five Aboriginal health workers made assessments independently of each other in community A. A different group of three health workers made independent assessments in community B. Sub-samples were opportunistically recruited for interview (community A, n = 77; community B, n = 55). In community C, 101 people were interviewed and were also assessed by four local health workers working together. Proportional agreements (kappa-? statistic) among health workers for a history of substance use and current use, varied from ? = 0.207 for petrol sniffing (P = 0.006) up to ? = 0.749 for cannabis use (P<0.001), all better than would be expected by chance. In communities A and B, agreement between health workers? consensus and self-reported substance use was weaker (0.103<?<0.482) probably because of under-reporting in interviews. In community C, where interviews were conducted in a confidential clinic setting, agreement between health workers? concensus and self-report varied from ? = 0.273 for petrol sniffing (P<0.001) up to 0.819 for tobacco use (P<0.001). Aboriginal health worker consensus classification clarified equivocal self-report data.

The Universal Service Obligation (USO) scheme we have in place in Australia in 2015 was put in place over 25 years ago when the world was very different than what it is today. The paper documents how the current USO entrenches an annual subsidy of some $300 to Telstra to provide a standard telephone service over an aging copper infrastructure to regional and remote premises across Australia. The current expensive USO scheme is inadequate for people in remote and regional Australia and in the light of the NBN roll out and the demand for mobile services is in urgent need of review. The paper reviews the approach taken to providing high cost telecommunications services in rural areas both developed and developing economies across the world and draws lessons for devising a basis for a way forward. Given the now bipartisan acceptance of the rural and remote component of the NBN roll out and drawing on these lessons, now is the opportunity to scrap the current USO scheme and establish a Universal Service Fund (USF) where the NBN is the Universal Infrastructure wholesale provider with alternative retailers. The paper supports five practical interrelated recommendations that diverts current USO funding to ensure broadband and mobile services extension in rural and remote Australia as well as reimagining future payphones around public WiFi and rural community innovation.

The goal of these guidelines is to provide broad statements with examples of activities, which can be implemented by employers, service providers, communities, clinicians, and other stakeholders to establish and maintain safe and effective operating systems in remote health services. The guidelines identify seven safety and security priority areas, each of which is to be considered through the lense of the individual, the team, the employer, the infrastructure, the environment and the culture and community

The LGBTI community has many challenges that they face above and beyond the everyday health issues that we confront in the general sexual and reproductive health stream. The statistics for the LGBTI population demonstrate that they have the one of the highest rate of suicide of any population in Australia. Research with the transgender population is even higher with some UK statistics of up to 50% of Trans people having attempted suicide. As a health executive leading a sexual and reproductive health organisation there are many challenges in meeting the population needs for the diverse LGBTI population and specifically the transgender population. On establishing a small response to the transgender population, the organisation soon realised that the service demand was quickly outstripping the services available. This paper explores the service planning from a health administration perspective as well as the clinical needs of this population group and the challenges that are faced in establishing such a service in cons trained financial environments. As a state organisation, the challenges become how we extend our services to rural communities where LGBTI services are limited or non- existent. Rurality is a barrier to accessing health services generally, but when it comes to highly specialised services for the transgender population, this challenge is heightened. A population service planning approach highlighted the need for 3 key services that would assist rural T rans people to be supported. Firstly: general practitioners require clinical support and education to meet the needs of the transgender person. Targeted education webinars and telephone support are acceptable approaches for rural doctor s. Secondly: providing counselling support through telemedicine so that people do not wish to leave their homes or cannot make the journey to a clinic, can gain assistance through teleconferencing sessions with a clinical psychologist. Thirdly: peer -to-peer telemedicine support services where a T rans person in a small country can speak with someone from the trans community who understands the personal challenges.

The purpose of this review was to assess the effectiveness of current guidelines and how they are operationalised in practice for ensuring safety for remote primary health care staff working in Northern Territory (NT) government primary health care centres, when providing after hours on-call services in remote NT communities. In particular, the review was designed to assess the effectiveness of the Remote Health Atlas on-call safety and security procedures in ensuring a safe work environment by auditing on the ground practices. The report did not include any assessment of staff travel, medical evacuations or visiting health services to remote centres. Also out of scope were NT Health urban primary health care services and remote Primary Health Care (PHC) services administered by other organisations. Notwithstanding the non-inclusion of this latter group of services, it is hoped that Aboriginal Community Controlled Health Organisations that are responsible for operating remote primary care clinics may find this report and the recommendations both relevant and useful. The report recommendations aim to strengthen the effectiveness of existing arrangements for promoting and ensuring staff safety and security in remote health facilities.

Background: Cardiovascular disease remains the leading cause of morbidity in Aboriginal Australians, however only around 5% of eligible Aboriginal people at tend cardiac rehabilitation (CR) heart health programs. Through community consultation and strong collaboration between Heart Foundation, Karratha Central Healthcare (formerly Pilbara Health Network) and key stakeholder organisations in the West Pilbara a need was determined to provide culturally specific heart health programs for local communities in the region. These communities are Roebourne, Karratha and Onlsow. Method: Consultation with local Aboriginal communities using snowball methodology, was followed by consulting with key community organisations/stakeholders. Oral interviews, were transcribed and fed back to all participating persons. Discussions included establishing community understanding and needs in relation to heart health logistics for program setup, recruitment of staff and aspects of implementation and sustainability. Yarning is an important part of Aboriginal culture, it was used throughout to discuss health messaging and support positive behaviour change through the diverse program activities and meetings. Results: Since program commenced in September 2015, many changes have occurred including success in breaking down working in silos and establishing a more collaborative and partnership approach with stakeholder service providers the program can work alongside. Each town is different in size and access to service providers. Significantly through our program ’s processes, participants have experienced empowerment over their own health. Outcomes include improved self -esteem, increase knowledge of the benefits of healthy eating, physical activity and mostly cardiovascular health knowledge. Cross cultural learning between staff and community people has been beneficial and the program continues to evolve.

Technology is advancing at an incredible rate with new devices, wearables, gadgets and gizmos coming on to the market every week. Technology provides rural health services with new ways of connecting with country consumers and innovative opportunities in the way we provide health services. Our thinking is changing from everyone who needs a health service coming into a hospital, health centre or clinic and describing our capacity in term s of hospital bed numbers, to considering every person in every household across our rural areas as a potential ‘hospital bed’ —the vision held by the late Dr Peter Chapman, Chief Medical Advisor Country Health SA Local Health Network (CHSA). This paper will describe the key factors necessary for the successful implementation of technology - enabled health services implemented by CHSA in rural South Australia. Examples of technology - based initiatives will be described, highlighting the key impacts, elements necessary for successful implementation and the challenges faced.

Background/aim: Few studies have examined graphomotor skills in children with prenatal alcohol exposure (PAE) or fetal alcohol spectrum disorder (FASD). Methods: Graphomotor skills were assessed in 108 predominantly Australian Aboriginal children aged 7.5–9.6 years in remote Western Australia using clinical observations (pencil grasp; writing pressure) and standardised assessment tools (the Evaluation Tool of Children's Handwriting; and the Miller Function and Participation Scales – The Draw-a-Kid Game). Skills were compared between children (i) without PAE, (ii) PAE but not FASD and (iii) FASD. Results: Most children used a transitional pencil grasp and exerted heavy handwriting pressure (83.3% and 30.6% of the cohort). The percentage of letters (M = 62.9%) and words (M = 73.3%) written legibly was low. Children with FASD were more likely than children without PAE to use a cross-thumb grasp (P = 0.027), apply heavy writing pressure (P = 0.036), be unable to write a sentence (P = 0.041) and show poorer word legibility (P = 0.041). There were no significant differences between groups for drawing outcomes, although some children with FASD drew pictures that appeared delayed for their age. There were no significant differences between children without PAE and those with PAE but who were not diagnosed with FASD. Conclusions: Overall, graphomotor skills were poor in this cohort, but children with FASD performed significantly worse than children without PAE. Findings suggest the need for improved occupational therapy services for children in remote regions and evaluation of graphomotor skills in children with PAE.

To increase by 50% the confidence and skills of Broken Hill clinicians to identify, diagnose and treat Eating Disorders by January 2017. Methods /interventions An online survey was disseminated to as many local health clinicians and relevant other professions (high school teachers and social services workers) to gauge baseline and post -intervention data around levels of skill and confidence in identifying, diagnosing and treating eating disorders. Rural health clinicians should be empowered and supported to take on the ‘specialist generalist’ role. In rural health we ’re often the only one of our profession in our region so we need to be able to provide care to the patients in our area. Refusing to provide a service because you ’re not specialised in a certain area isn’t an option when the only other option is that the patient /client doesn’t receive a service at all. The role of the specialist generalist is well known and often quite revered in Rural health but requires extra professional development and multi -disciplinary support. Financial and system support for these to occur is vital to ensuring rural clinicians can be specialist generalists. • Be wary of overdoing the Obesity, healthy eating and weight loss messages. Whilst it is important and expected that as health workers we look to address the levels of obesity in Australia, we need to make sure that public messages about health remain safe and appropriate for all ages and avoid any implication of fat -shaming or diet shaming.

In February 2016 the Kimberley Aboriginal Medical Service (KAMS) successfully rolled out a pioneering initiative in collaboration with ISA Healthcare Solution, the software developer and vendors of MMEx , to ensure the continuity of care for our patients across the Kimberley region. This presentation outlines the obstacles in delivering healthcare in remote indigenous Australia and gives a voice to the unspoken thoughts behind provocative innovation, in a somewhat frustrating political environment where “rocket science” was definitely not a prerequisite however innovation and collaboration were vital in ensuring its success.

Introduction: An international systematic literature review found that few publications evaluate the preference or understanding of an individual or group when seeking consent for research with Indigenous communities. Research with Indigenous communities has not always done in a way that address the priorities of the community, even if they are conducted in line with protocols such as the NHMRC guidelines. The Lililwan Project is an example of a study that was well received by the Aboriginal communities of Fitzroy Crossing receiving a 95% participation rate. In response, the community initiated the Picture Talk Project, to examine what had been learned about community engagement and consent process. In this paper we will discuss how findings inform current research policies and ethical guidelines. Methods: Invited by Aboriginal leaders of the Fitzroy Valley, researchers with the Picture Talk Project interview Aboriginal community leaders and focus group discussions were held with Aboriginal community members about research experiences and the consent process including the methodology used by the Lililwan Project. These are analysed using NVivo10 software with an integrated method of inductive and deductive coding and grounded theory. Local Aboriginal research team members, employed as Community Navigators to interpret language and provide cultural guidance, also validate the coding of data. Themes are synthesised and supporting quotes from participants were identified. This paper will explore three themes in the light of how they inform policy change. Results: Interviews with Aboriginal leaders (n=20) and focus groups (n=6) with Aboriginal community members (with 3 to 10 participants) were conducted in the presence of a local Aboriginal Community Navi gator to interpret language and provide cultural guidance. Participants were from different age groups, both males and females and from all major local language groups of the Fitzroy Valley. Themes include: • Research—finding knowledge • working together with good communication • being flexible with time. Insightful statements from individual participants exemplify these themes. Recommendations for research policy change are put forward based on these findings. Conclusion: Research policies and guidelines need to change so that researchers rethink the ways in which Aboriginal people are approached to engage in research. Respect for cultural differences needs to be better understood so that it can be embedded in every step of a research process. Aboriginal research partners should be engaged from the start to the end of any project. There needs 2 to be flexible timelines provided by funding bodies if a project is delayed for cultural reasons. Projects should specify how they aim to provide benefits to the community.

Introduction and Aims:Aboriginal leaders in remote Western Australian communities, concerned about the impact of high levels of alcohol consumption in pregnancy, invited researchers to collaborate in The Lililwan Project with the objective to determine prevalence of fetal alcohol spectrum disorders (FASD). Design and Methods:Using active ascertainment, children born in 2002/2003, living in the Fitzroy Valley in 2010/2011, were identified (n = 134). In interviews, 127 (95%) consenting caregivers provided social, biomedical and antenatal data including alcohol use, with birth outcomes derived from medical records. Interdisciplinary assessments were conducted for 108 (81%) children. Prenatal alcohol exposure was objectively quantified. Conditions on the FASD spectrum (fetal alcohol syndrome (FAS), partial FAS, and neurodevelopmental disorder – alcohol exposed) were diagnosed using Canadian FASD Diagnostic guidelines with slight modification. Management plans were prepared for each child. Results:Alcohol was used in 55% of 127 index pregnancies. Of women who drank, 87% drank at high-risk levels and 88% drank in the first trimester. In 108 children assessed, FAS or partial FAS was diagnosed in 13 [120 per 1000 (95% confidence interval 70–196)], all with confirmed prenatal alcohol exposure. Of these, 69% had microcephaly, 85% had growth deficiency, and all had facial dysmorphology and central nervous system impairment in 3–8 domains. Using conservative diagnostic criteria, eight more children were diagnosed with neurodevelopmental disorder – alcohol exposed. Overall FASD prevalence was 194 per 1000 (95% confidence interval 130–280). Additional children considered at high risk for neurodevelopmental difficulties were referred for future evaluation. Discussion and Conclusions:FASD prevalence was higher than reported previously in Australia and amongst the highest worldwide. Alcohol use in pregnancy remains a major public health challenge throughout Australia, particularly in remote communities with high rates of alcohol consumption. Aboriginal community-led initiatives for FASD prevention and FASD intervention must be supported. Disclosure of Interest Statement:This project was funded through the Commonwealth Department of Health and philanthropic foundations. No pharmaceutical grants were received in the development of this study. Data on The Lililwan Project FASD prevalence is not yet published in the scientific literature. The community consultation process requires that these data not be communicated outside the abstract review panel prior to the 2015 Conference.

Introduction Anecdotal reports suggest that high-risk drinking in pregnancy is common in some remote Australian communities. Alcohol is teratogenic and may cause a range of lifelong conditions termed ‘fetal alcohol spectrum disorders’ (FASD). Australia has few diagnostic services for FASD, and prevalence of these neurodevelopmental disorders remains unknown. In 2009, Aboriginal leaders in the remote Fitzroy Valley in North Western Australia identified FASD as a community priority and initiated the Lililwani Project in partnership with leading research organisations. This project will establish the prevalence of FASD and other health and developmental problems in school-aged children residing in the Fitzroy Valley, providing data to inform FASD prevention and management.Methods and analysis This is a population-based active case ascertainment study of all children born in 2002 and 2003 and residing in the Fitzroy Valley. Participants will be identified from the Fitzroy Valley Population Project and Communicare databases. Parents/carers will be interviewed using a standardised diagnostic questionnaire modified for local language and cultural requirements to determine the demographics, antenatal exposures, birth outcomes, education and psychosocial status of each child. A comprehensive interdisciplinary health and neurodevelopmental assessment will be performed using tests and operational definitions adapted for the local context. Internationally recognised diagnostic criteria will be applied to determine FASD prevalence. Relationships between pregnancy exposures and early life trauma, neurodevelopmental, health and education outcomes will be evaluated using regression analysis. Results will be reported according to STROBE guidelines for observational studies.Ethics and dissemination Ethics approval has been granted by the University of Sydney Human Research Ethics Committee, the Western Australian Aboriginal Health Information and Ethics Committee, the Western Australian Country Health Service Board Research Ethics Committee and the Kimberley Aboriginal Health Planning Forum Research Sub-committee. Results will be disseminated widely through peer-reviewed manuscripts, reports, conference presentations and the media.

Introduction and Aims: Alcohol use in pregnancy is thought to be common in remote Australian communities, but no population-based data are available. Aboriginal leaders in remote Western Australia invited researchers to determine the prevalence and patterns of alcohol use in pregnancy within their communities. Design and Methods: A population-based survey of caregivers of all children born in 2002/2003 and living in the Fitzroy Valley in 2010/2011 (n = 134). Alcohol use risk was categorised using the Alcohol Use Disorders Identification Test consumption subset (AUDIT-C) tool. Birth and child outcomes were determined by interview, medical record review and physical examination. Results: 127/134 (95%) eligible caregivers participated: 78% were birth mothers, 95% were Aboriginal and 55% reported alcohol use in index pregnancies; 88% reported first trimester drinking and 53% drinking in all trimesters. AUDIT-C scores were calculated for 115/127 women, of whom 60 (52%) reported alcohol use in pregnancy. Of the 60 women who drank (AUDIT-C score ≥ 1), 12% drank daily/almost daily, 33% drank 2–3 times per week; 71% drank ≥ 10 standard drinks on a typical occasion; 95% drank at risky or high-risk levels (AUDIT-C score ≥ 4). Mean AUDIT-C score was 8.5 ± 2.3 (range 2–12). The most common drinking pattern was consumption of ≥10 standard drinks either 2–4 times per month (27%) or 2–3 times per week (27%). Discussion and Conclusions: High-risk alcohol use in pregnancy is common in remote, predominantly Aboriginal communities in north western Australia. Prevention strategies to reduce prenatal alcohol use are urgently needed. [Fitzpatrick JP, Latimer J, Ferreira ML, Carter M, Oscar J, Martiniuk ALC, Watkins RE, Elliott EJ. Prevalence and patterns of alcohol use in pregnancy in remote Western Australian communities: The Lililwan Project. Drug Alcohol Rev 2015]

In this article, grounded theory was used to develop models of Corporate Social Responsibility (CSR) that can generate benefits for communities impacted by the Australian resource sector. Interviews were conducted with community representatives who interacted with a range of resource companies located in three Australian jurisdictions. Separate conceptual models were developed for Indigenous communities with legislated land rights as opposed to local communities nearby resource development. This was because they had different priorities in terms of model elements. Indigenous people sought to maintain cultural and environmental values through CSR whilst accepting a need for some social change. These values were expressed in cases where legislative frameworks enabled their protection and sufficient resources were available, such as financial capital, policy commitments and stakeholder support. Local communities were seeking to maintain their viability and to ensure companies were accountable for their impacts. CSR in this context relied on company policy and the formation of voluntary partnerships which differed according to the organisation’s culture. In this paper, it is argued that participatory CSR provided a mechanism to express community values linking it to perceptions of empowerment and capacity to provide long-term value to communities. The study also helps identify where improvements can be made to the Australian resource sector.

In 1986 the Aboriginal community in Western Australia was identified as a high-risk group for hepatitis B virus infection. An immunization programme was commenced in 1988 but concerns were expressed about horizontal transmission, especially in schools, to the low-risk Caucasian group and whether they should also be included in the vaccination programme. To estimate the extent of this occurrence, a survey of schoolchildren from two district high schools in Broome and Derby in the Kimberley Region of Western Australia was carried out in March 1989. A total of 607 students aged 4 to 19 years were included in the study. None of the 300 Caucasian students had any serological markers of hepatitis B virus infection (95% confidence interval (CI) upper limit, 1.3%). Eighteen children were found to be seropositive for hepatitis B surface antigen (HBsAg); 17 were Aboriginal and one Asian. In addition, 61 Aboriginal students and one Asian had hepatitis B surface antibody (antiHBs). The hepatitis B virus infection rate in these Aboriginal children is 28.2% (95% CI, 23.2%-33.7%) with a carrier rate of 6.1% (95% CI, 3.9%-9.6%). This study demonstrates that Caucasian students have a very low risk of infection with hepatitis B virus in this community, and there is therefore no need to extend the hepatitis B vaccination programme beyond the already identified high-risk groups.

Background : Medication misadventure is a serious issue with two to three % of all hospital admissions being medication- related. The federally funded Home Medicine Reviews (HMRs) have provided an avenue for pharmacists to undertake medication reviews to reduce medication misadventure and they have been shown to be beneficial in improving quality use of medicines and overall health outcomes. The HMR program does not give reasonable access to medication reviews in Cape York due to accessibility and funding restrictions. A service model was required to address the challenge of providing medication reviews and to reduce the incidence of medication misadventure within the funding parameters. Methods: A service model using telepharmacy was trialled in ten primary health care clinics throughout Cape York. The solution supported individualised, culturally appropriate medicine education/counselling via telehealth to outpatients who had complex or extensive medication regimes or were recently discharged from hospital. Resources were developed to support the service model. A comparative analysis evaluated the outcomes of the state- funded telepharmacy service model to the HMRs using a cost analysis, clinical variables, patient safety factors and patient satisfaction. Results: Telepharmacy delivery is a more cost effective way to deliver medication management reviews to remote communities than the current HMR funding model, which is not financially viable for remote communities. The safety evaluations indicated an improvement in service quality, safer use of medications and reduced hospitalisation due to medication misadventure. The comparative analysis has informed business model planning and provided a better understanding of cost difference for remote pharmacy medication review methods. Discussion: The telepharmacy trial has increased access t o services, developed clear process and increased the capacity to provide treatments closer to home. Phase two of the implementation will embed the service model within the rural and remote facilities.

Background: Delivery of malignancy related lymphoedema services including provision of compression garments in rural and remote Queensland has been difficult due to staff and skill shortages. Consumers have undertaken lengthy, expensive travel to metropolitan centres to access services. The service barriers and access issues have prompted Queensland Health stakeholders to examine the scope of compression garment selection, fitting and supply that can be safely and effectively delivered by generalist occupational therapist and physiotherapists in smaller regional, rural and remote locations to improve local access to this service for community members. Methods: A new service model involved an evaluated trial of compression garment selection, fitting and monitoring provided by generalist occupational therapists and physiotherapists (i.e. physiotherapist or occupational therapist who had not completed a formal lymphoedema training program (e.g. Level 1 or 2 course), but had undertaken, an on-line education program with support of lymphoedema therapists, supported by telehealth, implementation resources and governance processes. The service model included a training model that paired generalist occupational therapists and physiotherapists in rural areas with a lymphoedema therapist The online education program covering pathophysiology, assessment and management of lymphoedema, compression garment prescription, monitoring and care accompanied one-on-one telehealth delivered coaching sessions. Telehealth was used to support the supervised practice stage of the training program and was used if required in the post-training phase if generalist clinicians required support from their lymphoedema therapist coach. Results: Seven rural and remote health facilities have implemented the telehealth supported compression garment selection, fitting and monitoring service model. There were 69 referrals and 58 garments provided during a 12 month trial period. Evaluation demonstrated that the delivery of compression garment selection, fitting and monitoring by generalist occupational therapists and physiotherapists supported by defined training, supervision and governance processes is safe, effective and positively evaluated by consumers and health professionals. Discussion: The service model has provided sustainable workforce and service solutions and improved access to care for consumers in rural and remote Queensland. Phase two of the service model implementation is underway and will promote and expand the model for the provision of compression garments for the treatment of lymphoedema.

Cardiovascular disease (CVD), a leading cause of morbidity and mortality, has similar incidence in metropolitan and rural areas but poorer cardiovascular outcomes for residents living in rural and remote Australia. Cardiac Rehabilitation (CR) is an evidence-based intervention that helps reduce subsequent cardiovascular events and rehospitalisation. Unfortunately CR attendance rates are as low as 10–30% with rural/remote populations under-represented. This in-depth assessment investigated the provision of CR and secondary prevention services in Western Australia (WA) with a focus on rural and remote populations.

Objective: To describe the detailed associations of albuminuria among a contemporary cohort of Aboriginal and Torres Strait Islander people to inform strategies for chronic kidney disease prevention and management. Methods: A cross-sectional analysis of Indigenous participants of the eGFR Study. Measures: Clinical, biochemical and anthropometric measures were collected (including body-circumferences, blood pressure (BP); triglycerides, HbA1c, liver function tests, creatinine; urine- microscopic-haem, albumin: creatinine ratio (ACR), prescriptions- angiotensin converting enzyme inhibitor or angiotensin receptor II antagonist (ACEI/ARB). Albuminuria and diabetes were defined by an ACR>3.0 mg/mmol, and HbA1c≥48 mmol/mol or prior history respectively. Waist: hip ratio (WHR), and estimated glomerular filtration rate (eGFR) were calculated. ACR was non-normally distributed; a logarithmic transformation was applied (in base 2), with each unit increase in log2-albuminuria representing a doubling of ACR. Results: 591 participants were assessed (71% Aboriginal, 61.6% female, mean age 45.1 years, BMI 30.2 kg/m2, WHR 0.94, eGFR 99.2 ml/min/1.73m2). The overall prevalence of albuminuria, diabetes, microscopic-haem and ACEI/ARB use was 41.5%, 41.5%, 17.8% and 34.7% respectively; 69.3% of adults with albuminuria and diabetes received an ACEI/ARB. Using multivariable linear regression modelling, the potentially modifiable factors independently associated with log2-albuminuria were microscopic-haem, diabetes, WHR, systolic BP, alkaline phosphatase (all positive) and eGFR (inverse). Conclusion: Albuminuria is associated with diabetes, central obesity and haematuria. High ACEI/ARB prescribing for adults with diabetes and albuminuria was observed. Further understanding of the links between fat deposition, haematuria and albuminuria is required.

Objectives It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle. Technology provides a possible solution not only for increasing access to these opportunities, but also in building community capacity to support children with autism. The aim of the present study was to investigate the current learning and support needs within rural and remote professionals prior to setting up a model of support.Methods An online survey was used to gather information from service providers in rural and remote communities on their demographics, current skills and confidence in working with clients on the autism spectrum, current supervision and professional development, identified learning and support needs, and the availability and uptake of technology for accessing professional development.Results Respondents reported below average levels of perceived confidence and skills when working with children with autism, most notably children with challenging behaviour. Half the respondents do not currently attend supervision sessions, with only 15% receiving regular supervision (fortnightly or more often), and 66% of respondents had travelled more than 3 h to access professional development workshops. The majority of participants had access to technology and over half had already used this for online training.Conclusion Overall, service providers in rural and remote areas are generally not currently meeting their needs in terms of frequency of supervision and professional development. The present needs analysis identifies key areas for learning, the ideal frequency of support and the acceptability of using technology to deliver this support. This information will guide future researchers in the development of an evidence-based model that will be accessible and meaningful to its participants.What is known about the topic? It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle, which may be triggered by geographical isolation. Technology-delivered intervention and support, also known as eHealth or Telehealth, has been used successfully in the disability sector for medical rehabilitation, direct intervention, employment support and support groups, but there is little evidence as to how technology is received by and implemented with disability and mainstream service providers supporting children with autism living in remote regions.What does this paper add? This paper provides an insight into the current skills and confidence of a broad range of service providers, including educators, allied health therapists and therapy and community support workers, in working with children with autism. This paper also investigates the experience, feasibility and potential uptake of a technology-driven program of support and professional development in rural and remote Australia. Finally, this paper provides an insight into the desired frequency of training and support, as well as identified learning support needs.What are the implications for practitioners? These findings have and will continue to guide practitioners in the development of an evidence-based, technology-driven model of supporting rural and remote staff working with children with autism. Technology has the potential to provide practitioners in geographically isolated areas with access to more responsive, collaborative and individualised professional support and training. Such practice may improve the skills of practitioners and the level of support they can provide their clients with autism, with the added potential of increasing staff retention in rural and remote areas of Australia.

There has been substantial research into trends in maintenance and shift of community languages among Australian migrants; however, similar studies for Indigenous language usage in Australia are scarce. Studies of language maintenance and shift have tended to focus on language shift across specific languages. In this paper, we report on a study based on census data to identify reports of Indigenous language usage across three census periods; 2001, 2006 and 2011. The study examines the linguistic distribution of Indigenous language groups and identifies changes in numbers of speakers of specific Indigenous languages over the last inter-censal period. It then investigates language use on the basis of the age and gender distribution of Indigenous language speakers. We conclude with a discussion of the motivations for some of the changes observed in the language landscapes of Indigenous languages in Australia.

Among the strategies employed by colonial authorities to 'manage' Indigenous people, forced removal and centralisation to townships was a deliberate attempt to fragment relationships to home territories. For Yanyuwa, an Indigenous group in northern Australia, this meant being removed from their saltwater country in the Gulf of Carpentaria and resettled 60 km inland. Despite this violent act Yanyuwa saltwater identity has remained strong. Whilst enduring, it has however undergone changes in the way relationships to place are established and maintained. Travelling through saltwater country with younger and middle generation Yanyuwa has revealed that sometimes relationships to place are marked by conditions of fear, nervousness and uncertainty. Not classically held to be dispositions of a 'proper' Indigenous person, these reveal that states of intimacy require time and certain conditions to flourish. So too, distance, signalled by fear and uncertainty, is a relational state that defines a vitally important relationship with country.

Knowledge translation (KT) is a process that includes the synthesis, dissemination, exchange and application of knowledge to improve health (including services and the health system), with education being one key mechanism. The program ‘Recognising and Responding to Dementia in Indigenous Communities (RRDIC)’ offered by the Centre for Remote Health aims to develop remote and primary health care workers’ skills and knowledge in Indigenous dementia care and management, including appropriate dementia assessment. This ‘knowledge- to-action’ program translates relevant recent research findings into a comprehensive resource document, and an interactive two-day workshop, with conceptual frameworks and practical materials designed to be used by participants in their practice contexts. Dementia care and management is an area that has experienced accelerated research in response to the growing disease burden in Australia. An increased awareness of the higher prevalence of dementia in Australian remote Aboriginal communities has led to a need for up-to-date and contextually relevant learning materials for health professionals working with these groups. This paper reports on development, delivery and evaluation phases of the education program. Particular KT strategies will be highlighted such as participatory processes involving practitioners, clients, carers and community members; and use of frameworks that accommodate cultural and environmental considerations (including cultural safety; and the International Classification of Functioning, Disability and Health (ICF). Particular learning strategies used in the program will also be highlighted such as: • Reflective questions designed to foster deeper learning and promote reflective practice • Case studies designed to highlight areas requiring particular knowledge and skills • Comments and quotations from individuals experienced in the area to ensure relevance to aged care in remote and Indigenous contexts • Frequently asked questions, and answers provided by key experts in the area of Indigenous dementia • Carer communication strategies to encourage skill development in determining what, when and how practitioners need to communicate with carers and family members. The program is underpinned by the principles of effective KT, including using best available knowledge, attention to context, end user involvement and participatory processes in the program’s development and implementation, and use of educational strategies that lead to change in practice

Access to Home and Community Care services in Australia is based on the assessed needs of individual clients, with individual Home and Community Care organisations generally being responsible for initial assessment of eligibility and need. Home and Community Care funded services are expected to operate within the agency's program guidelines and to adhere to minimum service standards. However, service delivery contexts in remote areas of Australia present particular challenges for staff in the practice of assessment and care planning. This paper discusses the findings of a project which investigated approaches to assessment of client needs in remote Home and Community Care services. Some of the challenges of providing care in remote/Indigenous contexts are discussed. The research project highlighted that there was an inadequate knowledge base to assist staff with assessment and care planning in these cross-cultural contexts; a greater focus on developing the assessment skills of staff was needed. Subsequently, an education program incorporating the International Classification of Functioning, Disability and Health was developed for Home and Community Care assessment staff in remote communities. Rather than focusing on process skills and procedures, the program was designed to equip staff with a solid and consistent conceptual framework to assist with assessment and care planning.