Purro Birik - 39

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Purro Birik - (Healthy Spirit)





There is a recognised need for the presence of a Koori advocate at all interviews, assessments, and treatment related decision points during a Koori client's clinical journey through the Mental Health Services. Implicit within this recognition is the acknowledgment that whilst it is possible, (and in fact imperative), to train Koori people to be health professionals. It is impossible to train health professionals to be Koori people. It is the Koori people who are the experts in their culture and it is only the Koori people who can truly identify, understand, and create solutions for mental health issues.

The clinical journey of a Koori client can be clearly separated into three main components.

The Triage/Assessment Process

The first issue is the identification of an Aboriginal person. As it is already appropriate practice to register all new clients on PR1, the identification issue would be resol;ced by completing this form appropriately.

The client then needs to indicate as to whether they wish to have a Koori advocate present and whether they wish to have family present. This must include extended family.

Assessment interview not to proceed until every effort has been made to facilitate the attendance of a Koori Advocate. If unsuccessful, the mental health worker responsible is to document action taken.

A Koori advocate to be involved in all clinical discussion during the assessment process including consultation with other clinical staff and their input is to be given clinical and cultural value.

Risk assessment process to be developed specifically for Koori clients. There are specific cultural considerations, which must be taken into account (see Appendix 4)

Should admission occur, the Koori advocate to be invited to accompany the client into the in-patient unit and facilitate the client settling into the unit environment. The advocate is to be permitted to stay on the unit as long as required, by the advocate, to be certain that the client is comfortable and safe. Triage staff are responsible for providing introductions to appropriate acute staff and to ensuring that the Koori advocate has access to infrastructure and services as required.

In-patient Process

In all in-patients interviews and care related meetings there is to be every effort made to facilitate the presence of a Koori advocate. Any treatment changes or medication changes, any changes to the level of staff interaction, any changes of legal status are to be discussed with the client in the presence of a Koori advocate and family members (family at discretion of the client.)

Family sensitive practice to be a priority when working with a Koori client and there is to be recognition of the importance, role, and rights of the Koori extended family. Appropriate space will need to be allocated for family meetings.

Protocols of preferred therapy and drugs of choice to be developed and Tele-conferencing services to be utilised as appropriate.

Discharge Planning

A Koori Advocate, family members (extended) and client must be present before this meeting can proceed. Full open and frank discussion to occur during this meeting. All discharge planning including follow up times to be arranged. Discharge only to occur once all parties are satisfied with plans. Safety issues to be discussed openly and contingency plans to be finalised. Support in the community to be confirmed.

Community Process

A Koori advocate is to be included in the on-going care and planning by the community mental health worker. The Koori advocate is to be consulted on a community level prior to a team review, is to be involved in the development of an Individual Service Plan, and to be involved in any case closure or discharge planning meeting.

It would seem appropriate that in the initial stages of community follow-up that the Koori advocate be present during all clinic and/or home visits. This would conclude when the client and the advocate concur. If at any stage the client or the advocate felt it was appropriate, the Koori advocate could re-commence involvement. In the case closure process the Koori advocate, extended family and significant others are to be included in the discussion process. Should there be concerns about this process, the discussion process is to proceed until all parties are content. Discharge is not to proceed until all concerns have been answered.



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