Capital Health Network

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CHN Annual Report 2020-21 Aboriginal and Torres Strait Islander health Integrated Team Care Program

To support local First Nations people with chronic disease, CHN partners with local organisations to provide care coordination services and funding for certain approved medical equipment to eligible First Nations people. The Integrated Team Care (ITC) Program assists First Nations people with chronic disease who require coordinated, multidisciplinary care to access timely and culturally appropriate health care and this is funded by the Australian Government’s Indigenous Australians’ Health Programme.

CHN, ACT’s PHN has partnered with Grand Pacific Health to support clients who have been referred to them through mainstream GPs and Winnunga Nimmityjah Aboriginal Health and Community Services to provide the program for their clients.

Over 9,190 care coordination and support services were provided to assist Aboriginal and Torres Strait Islander people through the ITC Program in the last year.

l-r Capital Health Network (CH) Indigenous Health Officer Sharon Storen, Grand Pacific Health (GPH) Care Coordinator Jessica Davis, GPH Aboriginal Outreach Worker Clyde (Cookie) Chatfield and CHN Indigenous Health GP Advisor Dr Naomi Luck (Houston).

Client story: “You helping me gave me the confidence to find my mob”

Bradley (pseudonym) engaged with his GP who referred him to Grand Pacific Health. The Integrated Team Care (ITC) Program Care Coordinator, Registered Nurse Jess, and the Aboriginal Outreach Worker, Darcy, met with Bradley to discuss how they may be able to help. Bradley expressed that he was having difficulty accessing medical specialists due to his financial position and inability to move around. Bradley was unable to clean his own home or do any yard work, his wheelchair was broken and he had no family or connections within the community.

Jess immediately referred Bradley to My Aged Care who were able to provide him with yard maintenance and a cleaner the following fortnight. Darcy discussed community connection with Bradley and found out that Bradley had only recently discovered his Aboriginal heritage and was desperate to understand where he had come from. “I never felt that I’ve truly belonged,” Bradley said.

Over the coming weeks, Jess and Darcy assisted Bradley to attend medical specialist appointments by providing taxi vouchers and funding the appointment costs. Jess also funded a new wheelchair for Bradley and organised some grocery vouchers, after discussing appropriate nutrition to assist with reducing his blood sugar levels.

Within a few months, Bradley’s pain was well managed, his Diabetes was under control and he was involved in local community groups. “I hadn’t felt that good in years and I finally had the ability to start looking into my heritage,” Bradley said smiling.

Darcy and Jess continue to assist Bradley through the ITC Program and recently caught up with Bradley to see how he was going. “I can’t thank you enough. Honestly, you helping me gave me the confidence to find my mob. I found out that I was a part of the stolen generation. I have been for a few trips to my country and I’ve finally found where I belong. I found home,” said Bradley.

Bradley is in the process of organising the move to his country.

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