Adam McEwen, Northern Sydney Central Coast Area Health Service & Stephanie Smith, Aboriginal Environmental Health Unit, NSW Health
Adam McEwen: Thank you everyone and welcome to this afternoon’s session. I will start off by acknowledging the Wongatha people, whose land we are gathered on here. Stephanie and I are going to present this afternoon about the review of the Aboriginal Environmental Health Training Program run by NSW Health. I will begin by giving you a background of the traineeship program.
In 1995 the NSW State Government convened an Aboriginal Environmental Health forum to address some of the problems of environmental health issues in Aboriginal communities. One of the key activities was the development of a training scheme for Aboriginal EHOs.
The trainees are employed full time and work within public health units alongside other public health professionals. The trainees undertake a degree through the University of Western Sydney by distance learning which usually takes between 5-6 years. Whilst studying the trainees are entitles to study leave up to a maximum of 2 days per week during study periods and are granted 4 weeks per semester to attend compulsory residential schools. The trainees are guaranteed 2 years employment in the public health unit post completion of the degree.
Now a background of the review and how it came about. The training program has been running for over 10 years whilst there has been quality improvements along the way there have been no formal review. The purpose of the review was to assess the effectiveness of the program and to identify strategies to maximize the benefits of the program and to ensure its long term sustainability. The review intended to examine workplace issues, program management and the tertiary education elements of the program. From there the review was divided into two stages.
Stage 1 focused on research and consultation with key stakeholders. These stakeholders being trainees, graduates, former trainees, program managers and directors of public health; basically anyone who has anything to do with the running of the program.
The consultation involved interview with these stakeholders to determine what was working well and where improvements could be made.
Stage 2 of the review focused on the long term sustainability of the program.
Within Environmental Health in NSW Health Aboriginal graduates and trainees now make up 17.6% of the workforce. NSW Health has a target of achieving a minimum of 2% Aboriginal/Torres Strait Islander representation across its work force. So 17.6% is something to be proud of. It is important to note that before this training program there was no Aboriginal people employed in NSW Health in the environmental health sector. A total of 24 trainees have participated in the program. The program has yielded 8 graduates. The program is the only one of its kind in Australia and possibly the world.
The stake holders interviewed were positive about the value of the program and saw the need for it to be continued and possible expanded. However, the review did find that the program was expensive to operate compared to other training programs and because of this NSW Health needs to find better ways of capitalizing on its investment by ensuring greater levels of permanency in employment for graduates within environmental health or within the health system.
The review identified there has been a degree of confusion about why the program operates and what it hopes to achieve. It recommended a program logic be developed. This will allow NSW Health and all the stakeholders to be absolutely clear about why the program exists; and it provides for a shared understanding that the ultimate aim of the training program is to achieve improved health outcomes and increase the lifespan of Aboriginal people. So how do we get there?
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The short term outcomes that are happening as a result of the program are that there is an increase in the number of Aboriginal people employed in the environmental health workforce. As a result of this we are getting increased engagement in the Aboriginal communities by environmental health and all sections of public health.
Medium term outcomes as a result of this engagement; an increase in workforce is that we are seeing improved environmental health condition in Aboriginal communities which hopefully will lead to the ultimate outcome of Aboriginal people having improved health and longer lives.
Stephanie: We asked the consultants to outline what they saw as the strengths of the program. Probably the most significant was that trainees have helped to focus or re-focus the work of the public health units on the environmental health needs of Aboriginal communities. Trainees have initiated dog programs, undertaken water sampling and have initiated the number a health promotion activities such as ‘Mr Germ’. However, one of the key things we need to be cautious about this is that the trainees should not be seen as the only link with communities. It is vital that we develop ways to ensure all environmental health officers feel confident in developing links with communities themselves.
The consultants also recognised that NSW Health had developed some good work supports for trainees and supervisors over the past ten years. These have included the competency assessment guide and process, that aims to ensure trainees develop all their workforce competencies. We have also developed a traineeship manual that outlines the funding responsibilities of the NSW Health Department and the Areas Health Services and the responsibilities of supervisors and trainees. The trainees have developed an orientation manual for new trainees coming into the program and there is also a very strong Aboriginal environmental health network that meets on a quarterly basis.
The review identified that the University retention rates are comparable with all other Indigenous people undertaking tertiary studies; which is around 42%. However, over the last two years we have had 100% retention rate in trainees which is really significant and all the trainees are passing their University subjects. We put this down to a range of reasons; including better recruitment processes, and improved arrangements with supervisors. However, one of the key things trainees have identified in the review is that strong peer support mechanisms exist, that continue to grow and develop. Currently there are 5 graduates working in the NSW Health system and we have 7 trainees. The trainees and graduates throughout the process have been able to provide new trainees with individualized orientation. This has included trainees and their families, recognizing that it is a long commitment to being involved in the program up to 6-8 years. Families need to be aware of this level of commitment and we need to look at ways that we can support them to support the trainees.
While we have a comprehensive competency assessment process it is really important that we look also at other broader work experience opportunities, including in other government departments and local government. We also need to look at developing a more structured mentoring program. At the moment there is quite a lot of good informal peer support networks but the review recommended that we tap into other programs such as those run by the Department of Premier and Cabinet. We also need to provide supervisor training. While we have got quite experienced senior environmental health officers we can’t assume that they are adequately skilled in managing trainees.
If the program is expanded it will be important that resources within the Aboriginal Environmental Health Unit (the unit that manages the program) are increase to ensure its effective administration.
Adam: Some of the employment or workforce issues that were identified within the review. NSW Health Aboriginal employment strategy is a State policy aimed at increasing the Aboriginal and Torres Strait Islander representation in the work place. Its goal as I have mentioned previously is 2%. At present the overall percentage of Aboriginal people in the NSW Health workforce is 1.6%. We are currently at 17.6% in the environmental health workforce. Again it is important to note that at the commencement of the program there was no Aboriginal people working in Environmental Health. So this is quite significant.
The issue of most concern for the trainees and graduates is that there is no guarantee of permanency of their position. While this is clear in the beginning it is extremely daunting toward the conclusion of the traineeship and a related weakness of the program is the failure by NSW Health to utilize the skills and expertise of the graduates.
There has also been discussion about how the success of the program is measured. Some stakeholders believe that a graduate employed within the heath system is a success; others believe that working with local government is a success. Generally it is believed that the graduates will take them their environmental health experience and it will contribute to improving health outcomes. The review supports the need to ensure trainees have planned career pathways. This could include rotations within other parts of the health system including working with other professionals working within the public health unit, stints in Aboriginal health and health promotion. This will expand the trainee’s ideas and potential career options within NSW Health meaning they are less likely to be lost from the system. So this program can contribute to achieving the overall targets within the health system and possibly have greater buy in from other areas of the health, which helps ensure its continuation.
Some educational components of the trainee program. At the moment the trainees complete their degree by distance education at the University of Western Sydney (UWS) usually taking 5-6 years. An option for future attainment of the degree could be enrol at The Batchelor Institute. There appears no reason why trainees within the program could not enrol at either Batchelor or UWS. Alternatively students could take some subjects at Batchelor and gain credit at UWS and vice versa.
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At the beginning of the program there was a dedicated research unit at UWS with a full time research officer. This officer had responsibility for coordinating delivery of the course to the Indigenous participants. After the Commonwealth funding was withdrawn that academic support provided by the research officer was no longer available. This had a marked effect on the trainees and the program. From 2004-2007 the program had no specific academic advisor for the trainees. After much negotiation a part time Academic Support position has been created. One of the limiting factors of the current UWS program is that there is little flexibility for the trainees around when courses are available externally. Most trainees reported that the length of the current program at 6 years was problematic. For some this has attributed to pressure on their families and personal relationships and others commented that maintaining enthusiasm for over 6 years was a real challenge.
The review also canvassed the possibility of introducing a VET qualification into the university degree pathway. Whist there is a strong need for a more flexible pathway to professional qualifications there was a concern about de-skilling the sector. VET trained environmental health workers that exist in other states and territories do not exist in the NSW Health system. As a result the VET pathway does not fit into the traineeship program objectives and would not be of benefit to NSW Health as these positions do not exist. However, in the future if the program expands to working with other partners, such as local government and local Aboriginal land councils, VET training may be a viable option.
Stephanie: We asked the reviewers to give us an assessment on the program costs. They concluded that it was an expensive program to operate in comparison to other cadetship programs. There was a need to examine how to make NSW Health funds go further. But at the same time ensure any changes to the program do not reduce retention rates of trainees in the program. As environmental health is the responsibility of both state and local government in NSW it will be important to focus on partnership opportunities.
So in terms of looking at how we maintain and grow the program we are currently looking at the potential of the Commonwealth National Indigenous Cadetship Program and what that might offer and how it might fuse that with our current funding program. We are going to examine working in partnership with Area Heath Services. Under the current program NSW Department of Health funds the program fully. However, we have just embarked on a partnership program with Hunter New England Area Health Service where we have a 50/50 in funding agreement. This actually allows us a double the program’s investment. There is a lot potential options for partnerships with local government.
Q. Is there a reason why there is no guarantee for employment?
A. Stephanie: There is a cap on employment within the public health units and there are only so many environmental health officer positions out there and they are unlikely to grow.
A. Adam: In the last couple of years that has only been 3-4 replacements of EHOs. Like other sectors environmental health staff is an aging workforce. In NSW Health there are only 51 EHO positions.
For more informationAdam McEwen
Environmental Health Officer
Northern Sydney Central Coast Health
PO Box 361, Gosford, NSW 2250
Ph: 02 4349 4824 Email: email@example.com