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Professional practice in refugee health

What does advanced practice in refugee health nursing look like?

Merilyn Spratling, Refugee Health Nurse Coordinator and Nurse Practitioner at EACH Social and Community Health in Melbourne gives an overview of advanced practice in refugee health nursing. This presentation at the RNA Forum 2019 was the prelude to a workshop where attendees contributed to the development of a scope of practice for refugee health nurses in Australia, a body of work still currently in progress.

You can watch the video or listen as audio only via the button below.

The Humanitarian Settlement Program one year on

Each state and territory (except Northern Territory) reports on the challenges and opportunities in their region brought about by the change to the Humanitarian Settlement Program which commenced in November 2017.

Models of care

Overview Of Current Refugee Health Services In ACT:

ACT expects 300 Humanitarian arrivals in the 2017 year.  It is not known how many remain in ACT, however, once they initially resettle. From Jul to Dec 2016 there were 216 Humanitarian arrivals.

Most Humanitarian arrivals are seen by a regional GP clinic. Some are referred directly to Companion House, an NGO that assists survivors of Torture and Trauma, that has a dedicated medical service for refugee background clients. Companion House offers a wholistic service to survivors of torture and trauma, ostensibly those seeking asylum and also people who have been granted a humanitarian visa or are sponcered by their family.

Companion House  also offers torture and trauma counselling.  English teachers or other services, such as MACH nurses and also community members also refer to Companion House. Often these ad hoc referrals are when the care of the client becomes more complex than the usual GP clinic client. Catch up Immunisations are also provided by both Companion House and GP services.

Companion House also assists those seeking Asylum by providing pro bono medical care, some counselling, some community development activities and also with some government funded and some community funded, i.e via donations, migration assistance.

Companion House offers initial screening to people newly arrived in Australia.

There are 6 GP’s  and one paediatric registrar, who work one  to two session per week.

There is no fee for service, clients are bulk billed, or if they don’t have medicare they are not charged. Companion House provides an intensive, supported service and employs a patient logistician to keep a record of all external clients and reminds and prompts clients when they have an external appointment, arranging transport when possible.

ROLE OF REFUGEE HEALTH NURSES:

Companion House has a midwife, Women’s Health Nurse and a Nurse lead Liver Clinic. Nurses all work part time, with an equivalent of 1.2 nurse load FTE per week. I.E 6 and a half nurse days per week.The nurses in the service offer pap screening, nutrition education, midwifery, child health and immunisation services, as well as general primary health  care and education,and access to the public health dentist. There is also a nurse lead hepatitis clinic, co-ordinating  care of people living with chronic hepatitis. One of the nurses there is an NPC, studying at James Cook University ( via distance obviously)

Overview Of Current Refugee Health Services In New South Wales:

Average number of Humanitarian intakes per year

NSW receives 30- 40 % of the Australian Humanitarian intake each year. This equates to 4,000 – 6,000 people, with the exception of 2016-17, whereby NSW received over 10,000 of the Iraqi / Syrian cohort.

NSW has several different models of refugee health care.

Sydney: The NSW Refugee Health Service (RHS) is a state wide service located in Sydney. The RHS manages the Refugee Health Nurse Program (RHNP), which is responsible for on-arrival health assessments, triage, care planning and referral for newly arrived refugees under the Humanitarian Program (Visa 200 subclass). This is a nurse led model with 11 clinics operating across metropolitan Sydney and 12.0 FTE. Patients are linked to local GPs for ongoing primary health care. In 2017 the RHS introduced a Disability Support Team (1.0 FTE), and the Early Childhood Refugee Nurse Program (3.0FTE), which provides at home assessments for children 0-5 yrs. Finally, the NSW RHS employs senior registered nurses (3.0 FTE) to coordinate care for people seeking Asylum with no Medicare access. This care includes free medical GP clinics, coordination of specialist referrals, advocacy and health screening. There are 3 GP clinics in Sydney.

Optimising Health Program (School Screening).   There are a number of refugee nurses conducting school screening in schools across NSW. In Sydney, there are 4.5 FTE nurses deployed to eleven Intensive English Centres (IECs), and primary schools, one in the Mid North Coast at Coffs Harbour, and one in Warrawong IEC in the Illawarra region. These clinics offer vision, hearing and other health screening to all newly arrived refugee students.

The Asylum Seekers Centre is located in Newtown. It is a NGO, which offers free health care, dental care, psychological and other support to people seeking asylum. There are full and part time registered nurses, who conduct assessments, care coordination, advocacy and referral.  There is a free GP clinic, mental health counselling, oral health, physiotherapy and osteopathy. See https://asylumseekerscentre.org.au/

HARK (Health Assessment Refugee Kids), is a tertiary referral clinic located at the Children’s Hospital Westmead. This clinic sees children from both refugee and asylum seeking backgrounds, is pro bono and a gateway to the myriad of services available in the tertiary sector.

Illawarra:  Located between 50-100 kms south of Sydney, refugee nurses (3.05 FTE) are employed by the local health district. Utilising a case coordination management model of care, the refugee nurses conduct an initial home visit, needs assessment, and health orientation with linkage to local GPs, hospital based and public health services, NGOs including disability and aged care services and other health specialists. The service also provides case coordination, health education and support through a social worker (1.0fte) and multicultural health education officers who work closely with the nurses to link clients to community based supports. Health screening is conducted through linked GPs in the Illawarra Shoalhaven. Referrals have increased four-fold in 5 years with 685 refugee clients arriving in the area in 2016.  The service delivers a suite of professional development interventions to build the capacity of mainstream services to meet the needs of refugee clients with the hospital and public healthcare system. The service provides ongoing case coordination and referral management for complex clients in collaboration with GPs, hospital services and specialists in the Illawarra and in Sydney. A refugee paediatric clinic is conducted on a monthly basis at the Wollongong Hospital in collaboration with the Sydney Children’s Hospital Network. Health education sessions are conducted with refugee English language students and hospital tours are conducted annually. School screening for eyesight and hearing has been implemented in Warrawong IEC. The service also links with refugee specific community based programs to reach proposed (202) refugees who otherwise may not come to the attention of settlement services.

Hunter region: Located 100kms north of Sydney, the refugee nurses (1.6 FTE) are employed by the local health district. Two nurses are located at Newcastle, and the other nurse in Armidale, in the New England district. On arrival health assessments are conducted by the nurses in the client’s home in the Newcastle region. In addition, a “Refugee/CALD Outreach Clinic” at TAFE is conducted monthly to support and educate students with matters relating to their health issues. Referrals to dental, FPA, Sexual Health, STARTTS and Psychiatry are performed by the nurse. The Newcastle team see approximately 200 new arrivals each year. All clinics are nurse led and clients are seen by 1 of our 2 Paediatricians and our Honorary Medical Officers.

Mid North Coast: Located in Coffs Harbour, this service is provided by an experienced Clinical Nurse Consultant (CNC) and Registered Nurse, who are employed by the local health district.  The CNC and Registered Nurse conduct the initial nursing health assessments. They organise: referrals such as; dental, audiometry, early childhood clinic, women’s health, Physiotherapy, as well as orientation to the health system.   

GPs are employed on a permanent part- time basis to complete the medical assessment.

The CNC and Registered nurse case – manage the patients until all medical appointments are complete and then link them in with a local GP. This service can also supply ongoing case management for complex cases.    

This service also conducts outreach clinics to two local high schools, which offers enhanced health screening (vision and hearing etc.)

In February 2017 a weekly outreach clinic within the city CBD was established to make the clinic more accessible to new arrivals.

The CNC holds regular health education sessions for new arrivals; for example navigating the health system, women’s health days and hospital tours.

The Mid North Local Health District holds an annual Multicultural Health Expo on Harmony day in March each year.

Wagga Wagga: Located in the Riverina district of southern NSW, a part time (0.3) refugee nurse is employed by the Local Health District to support staff in both the government and non-government sector in providing holistic care to newly arrived refugees

All of the nurses employed across NSW are offered professional development and support by the NSW Refugee Health Service. A yearly Refugee Nurse Forum is held in Sydney, offering professional development topics and peer support.

ROLE OF REFUGEE HEALTH NURSES:

Roles vary depending on the model of care as described above. However, a generic role description for refugee nurses may include:

Provision of health assessments, case management and referrals for newly arrived refugees arriving in NSW. Work within a nurse-led model in various locations across NSW, including clinics located in hospitals, services, school settings, and home visits.
First point of health contact for newly arrived refugees with a role in initial assessment, community triage and referral to appropriate health services
Conduct health screening within a nurse-led model using standardised assessment
tools, and initiate diagnostic tests, in preparation for follow-up by GPs;

Coordinate care of certain high needs individuals/families in partnership with GPs and relevant agencies;
Liaison, assertive follow-up and advocacy for clients, in collaboration with designated Humanitarian Settlement Service providers
Supervision of undergraduate nursing students on placements
Contributions to education on refugee health issues for health service providers, students and key service partners

Provide assistance with sourcing up-to-date health information for refugees, and providing health education to patients as relevant
Provision of a reliable and responsive point of contact for local health workers and staff
from relevant external agencies, regarding refugee clients and refugee health issues

Collaboration in Public Health initiatives targeting refugees as required, such as catch-up immunisation

Promote social connection and integration through referrals to established support and orientation programs

 

Participate in professional development and networking opportunities.

 

Overview Of Current Refugee Health Services In The Northern Territory

The Department of Immigration and Border Protection currently has a quota to resettle 60 permanent Humanitarian Refugees in the Northern Territory per year (previously 200/year).

The Northern Territory Refugee Health Program (NT RHP) service model differs in some aspects of service design compared to other Australian states and the Territory. NT has a greater advantage in the sense that Settlement Services, Torture & Trauma services and counselling services are co-located at Melaleuca Refugee Centre (MRC).Melaleuca also employees the Refugee Health  Coordinator (RHC) funded by Northern Territory Primary Health  Network (NT PHN).

The Refugee Health Program aims to deliver appropriate care to vulnerable people and populations through the provision of coordinated health services for refugees during their first 12 months of settlement in the Darwin region. The Refugee Health Program also contributes to the strategic planning and development of refugee health services in the Northern Territory. The outcome is to maximise the health and wellbeing of refugees in Darwin by facilitating a smooth integration into mainstream primary health care services.

Context and historical background of the NT Refugee Health Program

In 2009, the Northern Territory Department of Health and families provided funding to establish the RHP which was administered by NT Medicare Local (Formerly the General Practice Network NT) now the Northern Territory Primary Health Network (NT PHN).
Under the umbrella of the program, NT PHN contracted clinical services to a single specialist refugee clinic located in a community private general practice setting known as the Darwin Refugee Clinic, trading as Northlakes Medical Centre (Johnston, et al, 2011).
The (NT RHP) was primarily contracted to provide comprehensive, appropriate, and sustainable bulk-billing primary health care services for newly arrived Refugees in Darwin for their first 12 months of arrival.
NT RHP also facilitated (to date) the NT Refugee Health Network (NT RHN) which brings together Key stakeholders in Refugee health with the main objective of improving service delivery models that support the integration of health services for Refugees (Menzies school of health research,2012)
CURRENT HEALTH CARE MODEL

In 2016 the NT RHP underwent a needs assessment as a response to Refugee dynamic policy cycles and keeping abreast with best practice in Refugee health. One of the key objectives was to redesign the NT RHP model to an evidence based model that is cost effective , sustainable and optimises health outcomes for Refugees (Human Capital Alliance ,2016)
From 1st July 2016, the current NT RHP came into effect. Under the current model two General Practice Groups (Arafura Medical Clinics and Top End Clinics). Contracted by Northern Territory PHN to render bulk-billing primary health care services for newly arrived Refugees in the NT for their first 12 months of arrival.
Arafura Medical Clinics has 5 clinics across Darwin and Palmerston city (http://www.arafuramedical.com.au).Top End Medical Centre has 3 clinics across the two cities (www.topendmedicalcentre.com.au).
Top End Medical Centre has 3 clinics across the two cities (www.topendmedicalcentre.com.au).
The two General Practice have co-visioned with Melaleuca Refugee Centre (MRC) and established strong links and working partnerships between Refugee Health Coordinator, settlement case coordinators, torture & trauma and counselling service providers.
Refugee Health Coordinator Key roles

MRC has a contract with Northern Territory Primary Health Network (NT PHN) to coordinate and integrate the provision of refugee health services through the engagement of a Refugee Health Coordinator who applies a social model of care:

Undertake triage (non- clinical) and referral of all clients to contracted General Practice, facilitating client orientation and navigation of the mainstream health system
Support client health literacy.
Facilitating primary health care workforce education and training.
Establish strong engagement and partnerships with General Practice staff, NTG health services and specialist clinics i.e. Centre for Disease Control and other key stakeholders in Refugee health and well-being.
Chair the Refugee Health Program Steering Committee.
Participate in the Northern Territory Refugee Health Network Meetings owned and chaired by NT PHN.
Undertakes advocacy and awareness of refugee health needs mainly in primary health care and other key specialized health services.
The Refugee health coordinator represents the NT Refugee health locally and nationally.
ROLE OF REFUGEE HEALTH NURSES:

The practice nurses working  from the two General Practices do not have formal  Refugee nursing qualifications but rather upskilled in Refugee nursing and supported by the Refugee Health  Coordinator refugee nursing speciality and experience in mental health nursing
OTHER REFUGEE SERVICES

Settlement Services are offered by Melaleuca Refugee Centre. www.melaleuca.org.au
Red Cross, Life Without Barriers and Anglicare offer migration support to asylum seekers, immigration detainees and population groups who are vulnerable as a result of migration.
Centre for Disease Control has a memorandum of understanding with refugee health service providers and prepares the NT immunisation catch-up schedule.
Royal Darwin Hospital offers health literacy support and promotes the use of interpreters to non-English speaking clients. However it does not offer refugee speciality fields.
‘Healthy Start Darwin’ was introduced in 2015 to offer healthy literacy services to refugees and asylum seekers, a collaborative initiative between NT Multicultural Council, Red Cross and Royal Darwin hospital medical students.
Adult Migration English Program is offered at Charles Darwin University.
International Health and Medical Services provides health services in detention centres.
COLLABORATION OF REFUGEE HEALTH SERVICES AND PROGRAMS

Collaboration of the Refugee Health Services is through the Northern Territory Refugee Network quarterly meetings facilitated by NT PHN
Refugee Health Steering Committee quarterly meetings (between MRC, the two contracted General Practice, NT PHN and occasional invited delegates)
MRC owns and chairs Refugee support network quarterly meetings (a network forum that brings together Refugee and Humanitarian service providers in governmental, non –governmental organisations and programs.
At National Level the senior refugee project officer (NT PHN) and the Refugee Health Coordinator (Melaleuca Refugee Centre) are representative members of RHeaNA.

Overview Of Current Refugee Health Services In Queensland

The Queensland Refugee Health and Wellbeing Policy and Action Plan 2017 – 2020 provides a shared vision and purpose for the delivery of health services and care. https://www.health.qld.gov.au/publications/publichealth/groups/multicultural/framework-refugee.pdf

Our vision is that all refugees settling in Queensland have access to the right care, at the right time and in the right place to ensure they have the best possible health and wellbeing.

The Refugee Health Network Queensland (The Network) aims to be a mechanism to build capacity, partnerships, and facilitate coordination of care across health, settlement agencies, communities, and government and non-government sectors. The long-term aim is to improve the health and wellbeing of people of refugee backgrounds throughout Queensland. The Queensland Refugee Health Partnership Advisory Group underpins these activities. Clinical expertise is provided by the South East Queensland Clinical Advisory Group.

The Network was established in 2016 to facilitate greater coordination and collaboration amongst health and community services to provide more accessible and appropriate health services for people of refugee backgrounds. The Network is funded by Queensland Health and supported by Mater Health.

The Network is a “network of networks” and includes regional networks and topic specific working groups, as well as other key policy stakeholders such as representatives of the government and the community. It provides a strategic platform to feed advice to government about key issues experienced at the community and service level, and advocate for and develop options for solutions for identified problems.

Service locations

There are five key settlement locations in Queensland. All share similarities in Model of Care delivery, however all are tailored to local community and workforce availabilities.

South Brisbane Metro South Refugee Health Service (MSRHS) located at Logan Central Community Health Centre provides care for people from refugee backgrounds settled in the Logan, Gold Coast and Ipswich areas. They work closely with the Brisbane South PHN, Gold Coast PHN and Darling Downs West Moreton PHN to support general practices to deliver primary care to refugee populations.
Mater Integrated Refugee Health Service (MIRHS) in partnership with Brisbane South PHN works closely with General Practitioners and practice nurses to deliver primary care to refugee populations in GP practices in areas of high settlement.
North Brisbane Mater Integrated Refugee Health Service (MIRHS) in partnership with Brisbane North PHN works closely with General Practitioners and practice nurses to deliver primary care to refugee populations in GP practices in areas of high settlement.
Toowoomba The refugee health service is located at Kobi House, Toowoomba Hospital.
Cairns Community Child Health provides refugee health nursing assessments and referral to general practices for completion of medical assessments and ongoing care.
Townsville The service works in partnership with PHN Northern Queensland.
ROLE OF REFUGEE HEALTH NURSES

Queensland’s refugee health nurse workforce is employed by both public and private health providers.  

The majority of refugee health nurses in Qld work part time; with only the Clinical Nurse Consultant   (MSRHS) and A/ Nurse Unit Manager (MIRHS) working full time.

The Model of Care in each service location is shaped by the many factors including the settlement provider, housing affordability, local workforce and workforce capacity, and, family need. It is consistently flexible and evolving; responding to changes and client/patient needs. The delivery of care can be co-located within general practice, in a community health setting, hospital campus, or in the family home.

Key shared aspects of their role include triage and coordination of care, nursing health assessment, referral to agencies including ‘refugee ready’ general practice, TB services, oral health, child health, midwifery, sexual health, diabetes nurse educator, optometry.

Refugee health nurses’ skills and qualification may include:

Public Health
Child Health
Primary Care
Immunisation Program Nurse
Midwifery
School Based Youth Health
Health Promotion
OTHER REFUGEE SERVICES:

The Mater Refugee Complex Care Clinic (MRCCC) provides health care to people from refugee backgrounds with complex health needs and a primary health service to asylum seekers without Medicare. The clinic offers specialised primary health care including, complex case management, treatment, specialist referral and secondary consultation service for general practices. When appropriate, patients will be assisted to reconnect with their community GP for all their ongoing primary health care needs.

 

The Mater Refugee Health Services’ website provides an outline of the services offered by the Mater Hospital and resources for general practice working with patients from refugee backgrounds.

Refugee Health Connect (RHC) is a single point of call for assistance with identifying appropriate primary health providers for refugee health needs including assessments and ongoing care for people from a refugee background.

Refugee Health Fellow – Mater Health Services and St Vincent’s Health Australia fund a Refugee Health Fellow position for a GP with knowledge and experience in refugee health to build capacity across Brisbane. The role includes:

Providing education to GPs, specialists, nurses, and other health professionals as required and in response to requests for assistance.
Providing advice and liaison regarding clinical issues relating to refugee health.
QPASTT – The Queensland Program of Assistance to Survivors of Torture and Trauma (QPASTT) provides flexible and culturally sensitive services to promote the health and wellbeing of people who have been tortured or who have suffered refugee related trauma prior to migrating to Australia. QPASTT provide counselling services to clients, but also are a major provider of mental health and wellbeing education and capacity building in Brisbane, Logan and regional areas of Queensland. QPASTT aims to provide services which address the range of physical, psychological and social needs that survivors of torture and trauma have.

Red Cross – Red Cross provide case management and help asylum seekers to apply for Status Resolution Support Services in Brisbane. They convened the Queensland Emergency Relief Practitioners’ Forum to foster better networks between agencies that provide emergency relief for asylum seekers and to develop a referral guide for practitioners supporting asylum seekers, especially those subject to return.    

Multicultural Development Australia (MDA)  – MDA is the settlement agency working with new humanitarian arrivals in Brisbane and Toowoomba. They also provide case management and SRSS support for asylum seekers in Brisbane, Toowoomba and Rockhampton.

Access Community Services – Access is the settlement agency working with new humanitarian arrivals in Logan and the Gold Coast. They also provide case management and SRSS support for asylum seekers.  

Townsville Multicultural Support Group – TMSG is the settlement agency working with new humanitarian arrivals in Townsville. They also provide case management and SRSS support for asylum seekers.

Centacare – Centacare is the settlement agency working with new humanitarian arrivals in Cairns. They also provide case management and SRSS support for asylum seekers.

Refugee Health Clinical Advisory Group (RH-CAG). The group comprises primary health care clinicians and other allied health professionals who come together on a monthly basis to discuss: clinical protocols, develop clinical resources, identify training needs and coordinate training events. The group provides direct feedback to the Refugee Health Partnership Advisory Group Queensland.

Overview Of Current Refugee Health Services In South Australia:

South Australia receives between 8 and 10% of the national humanitarian intake.  Every year the Humanitarian Settlement Services (HSS) provider in SA directly refer approximately 40% of all new clients to the Migrant Health Service (MHS), which is the state funded specialist Refugee Health Service. The remainder are referred to mainstream GPs.

The MHS target client group is families and individuals from a refugee or asylum seeker background with complex health and psycho social needs considered difficult to manage in a mainstream primary care setting.

Approximately 700 new clients are registered at the MHS per year. The average length of stay is 12 months after which clients are assisted to transition to mainstream GP care.

Several metropolitan based General Practice clinics and one other PHC service have refugee friendly services and routinely accept referrals from the HSS provider – for clients who are not considered to be complex.

The aim of the MHS service model is to ensure timely access to quality health care to individuals from refugee / asylum seeker back ground. Services are multidisciplinary and acknowledge the experience of forced migration and post migration challenges as barriers to equitable health care. The service model achieves positive health outcomes and promotes health and psycho social wellbeing as an integral step in successful resettlement.

 

There are two intake pathways; the New Arrival Pathway for newly arrived Humanitarian entrants and the Complex Case Pathway for asylum seeker clients – and clients in the post settlement period (up to 5 years) who are struggling to access mainstream primary care services (‘falling through the gaps’).

 

MHS clinical services include:

Multiple GP clinics per week, Bulk Billed for Medicare card holders and capacity for fee waiver.
Refugee Health Nurse led clinics
Counselling team for therapeutic management and psycho social support – 3 Social Workers and a Clinical Psychologist
Multi-cultural Primary Health Care Workers who provide health literacy support and education.
Visiting practitioners – Psychiatrist, Optometrist and 2 Paediatricians.

 

 

ROLE OF REFUGEE HEALTH NURSES:

SA Health currently funds 4.3 full time equivalent Refugee Health Nurse positions all based at the Migrant Health Service (MHS). This includes: one Nurse Unit Manager and 4 Level 2 Clinical Nurses.

The MHS Service Model is underpinned by Nurse Led Clinics delivered by the refugee health nurses – all with advanced practice skills and experience working with refugee and asylum seeker clients. Fragmentation of client care is minimised through nurse led coordination of MHS services and programs – from the initial health assessment to eventual Transition to mainstream service providers. Care coordination is achieved through a Client Centred Care Plan – which tracks each client’s clinical journey through the MHS. Within each of the Nurse Led Clinics nursing staff deliver care within clear scope of practice frameworks, underpinned by evidenced based and approved guidelines for assessment and care.

The MHS Refugee Health Nursing role includes;

New Arrival Nursing Clinic for Comprehensive Health Assessments
Immunisation Clinics  delivering ‘catch up’ immunisation
Daily Drop – In and Triage Clinic for all walk-in clients,
Women’s Health Program for well women’s screening, sexual and reproductive health advice and management
Child Health Clinics for developmental screening, follow-up and support of under 5 year olds.
Complex case management for clients experiencing complex health and psycho social issues.
Capacity building sessions with community and service provider groups

 

OTHER REFUGEE SERVICES AND PROGRAMS:

 

The Australian Migrant Resource Centre (AMRC) – Humanitarian Settlement Service Provider.  
Survivors of Torture Trauma and  Rehabilitation  Services (STTARS)
Red Cross
The Australian Refugee Association (ARA)

Adelaide has one Primary Health Network which supports a Refugee Health Project – which provides targeted support to GP clinics through education and resource development.
Child and Adolescent Mental Health – Multicultural Mental Health Nurse Practitioner.

 

Overview Of Current Refugee Health Services In Tasmania

Northern Tasmania receives between 200 and 250 humanitarian arrivals each year and  

Southern Tasmania receives around 300 refugee and humanitarian arrivals each year.

Primary Health Tasmania’s Refugee Health Program supports health professionals to provide the best possible care to refugees in Tasmania. Primary Health Tasmania maintains strong relationships with local refugee health and settlement services, provides a range of resources, and facilitates education sessions for health care providers.

Southern Tasmania

In Southern Tasmania, different models of refugee health services are provided by two separate organisations.  

RAHAC (Refugee & Humanitarian Arrival Clinic)

This clinic is operated by the Tasmanian Health Service, and is primarily aimed at screening of newly arrived refugee and humanitarian entrants.  Clients normally attend 2-3 weeks after arrival in Tasmania.  Following their initial screening appointment, clients are seen approximately one month later, by which time all results are back.  At this appointment any treatment for infectious diseases is commenced.  If any other (non-infectious disease) results are abnormal, these are managed/treated at the Southern Tasmania Refugee health Clinic.  RAHAC offer both an adult and paediatric service.  Clients generally have 2-3 appointments in this clinic.

STRHC (Southern Tasmania Refugee Health Clinic)

This clinic is operated by Primary Health Tasmania and is bulk-billing clinic run by general practitioners and registered nurses/authorised nurse immunisers.  It provides a comprehensive initial health assessment and primary health care, initial management/treatment of any acute or chronic conditions, and formulation and administration of a comprehensive immunisation catch-up program.  Where specialist services are required, STRHC refers clients to the appropriate specialist service (e.g. optometry, audiometry, child health, gynaecology, etc.).  Once health issues have been addressed and immunisation catch-up completed, then the clinic (in conjunction with the humanitarian settlement service) assists the client to enrol in and integrate into a mainstream community general practice.  Clients are seen in this clinic for up to 12 months for complex cases.  

 

 

 

Northern Tasmania

In Northern Tasmania, most refugee health services are provided by Primary Health Tasmania, with the exception of TB screening, which is provided by the Tasmanian Health Service.

Primary Health Tasmania operates the Refugee Health Clinic in Launceston.  It is a bulk-billing clinic run by general practitioners and registered nurses/authorised nurse immunisers.  This clinic provides a comprehensive initial health assessment, including all infectious disease.  The clinic provides primary health care, initial management/treatment of any acute or chronic conditions, and formulation and administration of a comprehensive immunisation catch-up program.  Where specialist services are required, the Northern Tasmania Refugee Health Clinic refers clients to the appropriate specialist service (e.g. optometry, audiometry, child health, gynaecology, etc.).  Once health issues have been addressed and immunisation catch-up completed, then the clinic (in conjunction with the humanitarian settlement service) assists the client to enrol in and integrate into a mainstream community general practice.  Clients are seen in this clinic for between 6-9 months.

ROLE OF REFUGEE HEALTH NURSES:

A full time Clinical Nurse Consultant commenced at the RAHAC in 2010 the providing screening and coordination of clinics

There is also a CNC position at the Refugee Health Clinic in Launceston.  

OTHER REFUGEE SERVICES AND PROGRAMS:

Community Detention (no valid visa therefore no Medicare, Centrelink or work rights) – all health services are provided by International Health and Medical Services (IHMS).  Clients are issued with an IHMS Health Care Card that ensures they have access to a network of agreed GPs and are able to access services on presentation of their Health Care Card.

Bridging Visa E (BE) Holders (eligible for Medicare) – must pay any medical service gap fees.  Dental, spectacle, and torture and trauma counselling costs are covered by the Department of Immigration and Border Protection (DIBP).  

Overview Of Current Refugee Health Services In Victoria

Victoria  receives between 29%-32%  of the national humanitarian intake.  Many clients also transfer interstate to Victoria  post arrival  to relocate with family members. The anticipated number of Humanitarian intake for 2017-2018 is approximately  8,000 clients. Currently  there are approximately 9000 people who are in the process of seeking asylum who are located in Victoria. All people who arrive under the humanitarian program and people seeking asylum are eligible for services in Victori including public hospital access.  

The Refugee Health  Nurses are employed under the State Department of Health  and Human Services (DHHS)V ictorian Refugee Health Program and are  located in 16 community health centres (CHCs)  in rural Victoria and metro Melbourne. There are currently 46 Refugee Health Nurses (23 EFT) and 22 Allied health staff (10 EFT) employed under the program . To access  refugee health  services based in Victorian  CHCs please go to this link   http://refugeehealthnetwork.org.au/refer .

The aim of the Refugee Health Program based in Community Health services is to provide a coordinated, evidence-based approach to healthcare delivery that improves health and wellbeing outcomes. The specific objectives of the Refugee Health Program in relation to refugee and asylum seekers are as follows.

Service delivery

The Refugee Health Nurses (RHN) provide direct services that address physical, social and mental health needs.
They support comprehensive assessment and intervention as soon as practical after the client’s arrival.
RHN’s aim to improve the capacity of refugees and asylum seekers to understand and access the healthcare and human services systems and to manage their own health and make informed decisions about their own healthcare.
Client care

RHN’s provide care that is culturally responsive, accessible and sensitive to needs that may arise out off from the refugee, asylum seeker and settlement experiences.
System support

The RHN’s support specialist case management, settlement and asylum seeker services to strengthen refugees’ and asylum seekers’ access to health services.
They support coordination and continuity of care between providers.
They support refugees and asylum seekers in their interactions with other services, and encourage policies and practices that promote health and wellbeing.
They contribute to a coordinated, collaborative approach across the service system.
ROLE OF REFUGEE HEALTH NURSES:

Undertake early health and social needs assessments of refugee clients using the nominated health assessment tools.
Facilitate and coordinate mainstream and specialist referrals to health and community service providers, eg: GPs, dental health, nutritionists, school nursing program, local Best Start programs, torture and trauma counselling and hospitals etc. This may also involve facilitating and advocating for other health care providers’ access to interpreters and transport.
Promote social connection and integration through referrals to established social support and orientation programs.
Enable individuals, families and refugee communities to improve their health and wellbeing.
Provide information and support regarding clients’ rights, entitlements and obligations under the Victorian health care system.
Work with Community Health Promotion programs that identify refugees as a population group to develop health promotion activities specific to refugees.
Actively engage local refugee community leaders in the planning and development of the RHN Initiative.
Collect refugee health data and community feedback.
Support the Community Health Centre’s in its role as a sentinel site for refugee settlement, early health care and assessment.
Actively participate in professional development and networking opportunities, in particular those provided by the Victorian Foundation for Survivors of Torture (VFST).
The RHNs based in community health services work in a flexile and responsive manner.The underlying policy which influences the different models across the State  is the

Refugee and Asylum Seeker Guidelines in Community Health:

https://www2.health.vic.gov.au/getfile?sc_itemid=%7b36EE4572-54FC-4469-8FEA-3FB85ADB5CB3%7d&title=Refugee%20and%20asylum%20seeker%20health%20services%20-%20Guidelines%20for%20the%20community%20health%20program

The RHNs  work in a  a comprehensive co-ordinated approach to refugee health. This co – ordinated approach involves many partners:

Settlement Health Co-ordinator’s (SHC): The SHC are experienced RHNS who are co-located with settlement services . The  SHCs  provide health and community services orientation, triage and referral for newly arrived clients . The nurses aim to improve the quality of referrals and assessments of refugees from settlement services to health services via training of AMES Australia settlement case managers and improved triage practices. In doing this, the nurses  provide an important link between refugee health programs delivered by community health services, AMES Australia settlement services and broader referral to health and human services.

Refugee Health Nurse Practitioner;The Refugee Health Nurse Practitioner (NP) is an independent and interdependent role which functions within a Primary Health Care Refugee Health nursing and medical team.  The Nurse Practitioner practises within a multidisciplinary framework to maximise optimum therapeutic, disease management and preventative health outcomes for clients which includes:

Identification and assessment of refugee or asylum seeker background specific health conditions requiring advanced practice knowledge and skill to identify and refer appropriately,
Ordering and interpretation of diagnostics,
Referrals to appropriate specialists or service providers and follow-up when indicated,  
Prescription, administration and monitoring of medication according to the Drugs, Poisons and Controlled Substances Act 1981, the Nurse Practitioner “Primary Care” category formula.
The Victorian Refugee Health Network; co ordinates the health responses in the State. http://refugeehealthnetwork.org.au/ The Network was established in June 2007 to facilitate greater coordination and collaboration amongst health and community services to provide more accessible and appropriate health services for people of refugee backgrounds
Refugee Health Fellows: are employed as part of the Victorian Co ordinated response Their specialities are infectious diseases, paediatrics and General Practice. http://refugeehealthnetwork.org.au/engage/refugee-health-fellows/
Specialist outreach services: are located across the State which include infectious disease clinics, Vitamin D clinic and paediatric clinics, http://refugeehealthnetwork.org.au/refer/specialist-services/
Ongoing free training; in Refugee Health issues is offered to all nurses and allied health at Foundation House  Online training is offered  http://refugeehealthnetwork.org.au/learn/
Specialist Torture and Trauma counselling Foundation House http://www.foundationhouse.org.au/
Asylum Seeker Resource Centre and the Cabrini Asylum Seeker and refugee health centre provide services to all clients who do not have access to Medicare. https://www.asrc.org.au/

Overview Of Current Refugee Health Services In Western Australia

The Humanitarian Entrant Health Service (HEHS) is a specialist public health program that provides a holistic health assessment service for all refugees and humanitarian entrants who are resettled in Western Australia under the Commonwealth Government’s Humanitarian Program and Special Humanitarian Program.

The Humanitarian Entrant Health Service provides an extensive post-arrival holistic health assessment. During the assessment the staff aim to detect and treat infectious diseases of public health importance. Included is a comprehensive vaccination program for both adults and children. As HEHS provides a holistic approach all avenues of health are explored and appropriate referrals are made to specialist services including but not limited to counselling for trauma and torture, obstetrics and chronic disease follow-up. The on-site HEHS medical officer develops a plan of care for each client to take to their General Practitioner; to ensure adequate follow-up records are also transferred to Refugee Community Health Nurses. HEHS is overseen by the WA Refugee Health Advisory Council.

The average number of Humanitarian intakes per year for WA is 600; although we did surpass this in 2016.

ROLE OF REFUGEE HEALTH NURSES:

Perform initial Nursing assessment approx. 2 weeks following arrival
Triage and refer as appropriate
Commence catch up vaccination plans
Further community nurse follow up of eligible clientele (Family groups with children aged less than 18 years of age and including those with children over 18 attending high school are seen by Community Refugee Health Nurses)
FTE: 2.3 Nursing and 0.7 Medical

Locations: Located in the Perth CBD- Anita Clayton Centre Suite 1/311 Wellington Street Perth WA 6000. Co-Located with the WA Tuberculosis Control Program

Primary Role

The Humanitarian Entrant Health Service assists in assessing the health status of humanitarian entrants (refugees) referred to the service to identify potential health problems, screen for communicable diseases and provide an appropriate plan of care. The nurses liaise with Primary Health Care to ensure ongoing health needs of the clients are met. Provide health education to clients and other health services around humanitarian entrant health issues.

OTHER REFUGEE SERVICES:

Health

 

Princess Margret Hospital Refugee Health Clinic

 

Supports the care requirements of refugee children and adolescents including their medical, social and psychological needs.

 

Community Refugee Health Nurses – Child and Adolescent Health Service

 

Community nursing support of newly arrived refugee families for up to 24 months post arrival.

 

ISHAR Multicultural Centre for Women’s Health

 

Womens health services caters to clientelle of all ages and from all cultural backgrounds includes medical, antenatal care, counselling, training and/or support.

Mental Health

 

Centrecare

 

Centrecare is a not-for-profit organisation delivering quality professional counselling, support, mediation and training services.

 

Association for services to Torture and Trauma Survivors (ASETTS)

 

ASeTTS is a non-profit, non-government organisation which provides treatment and support to people who have been tortured or traumatized by violent conflicts. Many clients are recent arrivals to Australia, although services are available to all survivors whatever the length of their residence in Australia has been.

Settlement Supports

 

Metropolitan Migrant Resource Centre – Settlement Agency  

 

A non-profit community organisation based in Mirrabooka which provides services across the metropolitan area. Covers general humanitarian entrant support such as health and wellbeing, interpreters and locating food.

 

Communicare – Settlement Agency

 

Communicare Settlement Grants Program  provides a range of services aimed at assisting new arrivals. Services include English program, renting and accommodation issues, family and domestic violence, alcohol and drug issues, children and youth issues, legal problems, health and mental health issues, counselling and financial help.

 

Multicultural Services Centre WA

 

Meet the settlement, welfare, education and training, cultural and related needs of culturally and linguistically diverse Western Australians;

 

Coalition for Asylum Seekers, Refugees and Detainees (CARAD)

 

Non Governmental Organisation supporting asylum seekers and refugees who are not eligible for any other assistance from government services because of their visa status.

 

Centrelink Multicultural Team Leader for Refugee and Asylum Seekers

 

References

Russell G, Harris M, Cheng I-H , Kay M, Vasi S, Joshi C, Chan B, Lo W, Wahidi S, Advocat J, Pottie K, Smith M, Furler J (2013)  Coordinated Primary Health Care for Refugees: A Best Practice Framework for Australia Refugee Health Plan 2011-2016 NSW Government – Policy Document Page 4.
Harris MF, Zwar NA (2007) Care of patients with chronic disease: the challenge for general practice. The Medical Journal of Australia 187(2), 105–107.
Victorian Refugee Health Program (2015 ) https://www2.health.vic.gov.au/primary-and-community-health/community-health/population-groups/refugee-health-program
Primary Health Branch Guidelines for the Refugee Health Nurse Program Updated October 2008 https://www2.health.vic.gov.au/primary-and-community-health/community-health/population-groups/refugee-health-program
NSW Refugee Health Service (2013) Refugee Health Nurse Program: Information for General Practitioners and Other health Professionals. http://www.swslhd.nsw.gov.au/refugee/pdf/refugee-health-nurse-program-gp-other-health-web.pdf
Government of Victoria (2008) Primary Health Branch Guidelines for the Refugee Health Nurse, http://www.health.vic.gov.au/pch/refugee/nurse_program.htm.
Jacqui Robson, (2011) ‘EACH’ – Refugee Health Nurse Program evaluation project 2011 Victoria www.health.nsw.gov.au.
Phillips C, Smith M, Kay M, Casey S (2011) The Refugee Health Network of Australia: towards national collaboration on health care for refugees  Medical Journal of Australia, August, 195(4) 185:186. 

Refugee Health Nurse Standards of Practice

August 2018

Refugee Health Nurse Standards of Practice workshopped by RNA members at the first RNA National Forum in November 2017, and further developed by the Steering Committee of RNA, with support and assistance from Professor Liz Halcomb.

Best practice guidelines for immunising a person of refugee background in a primary care setting.

RNA webinar – May 2017

South Australian immunisation calculator

The South Australian immunisation calculator has been developed and designed for Australian children < 10 years of age.

Vitamin B12 deficiency in refugees

This article outlines important information for those working with populations of refugee background regarding testing, clinical manifestations and management of vitamin B12 deficiency.