Unit of competency details

Unit Descriptor 

This unit deals with the skills and knowledge required to develop and implement strategies to address social determinants that underpin and contribute to Aboriginal and Torres Strait Islander health issues in the context of delivering primary health care services

Application 

This unit underpins the delivery of primary health care services to Aboriginal or Torres Strait Islander communities and applies to those working independently and as part of a team to deliver services through visits to the community, in Aboriginal or Torres Strait Islander community clinics or in mainstream health services

Employability Skills 

This unit contains Employability Skills

Elements define the essential outcomes of a unit of competency.

The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement.

ELEMENT 

PERFORMANCE CRITERIA 

1. Support strategic initiatives in health service delivery

1.1 Identify current strategies  to improve health of Aboriginal and/or Torres Strait Islander clients

1.2 Clarify specific impacts of strategic initiatives on health of Aboriginal and/or Torres Strait Islander clients through investigation

1.3 Support strategic initiatives in line with organisation policies and practices, community requirements and Aboriginal and/or Torres Strait Islander health work role

2. Promote awareness of health strategies 

2.1 Explain strategic initiatives relating to Aboriginal and/or Torres Strait Islander health as part of primary health care service role

2.2 Inform clients and communities about strategic initiatives and encouraged to take advantage of associated benefits

2.3 Demonstrate commitment to achieving positive strategic outcomes for Aboriginal and/or Torres Strait Islander communities

2.4 Articulate potential negative aspects of current strategies on behalf of Aboriginal and/or Torres Strait Islander clients and communities

3. Contribute to strategic issues in health care delivery

3.1 Contribute knowledge of Aboriginal and/or Torres Strait Islander communities and related health issues to inform strategic development on primary health care services

3.2 Raise strategic issues at organisational, regional, state and/or national level in line with health work role and function

3.3 Suggest potential improvements to health system, infrastructure, services and resources to address perceived needs

3.4 Discuss strategic approaches to resolution of issues related to social determinants of health  and community control with clients, community representatives, service providers and related organisation representatives

4. Evaluate implementation of strategic initiatives

4.1 Evaluate outcomes of health care strategies against criteria that reflect identified community health objectives

4.2 Identify appropriate evaluation processes and criteria to assess effectiveness of strategic initiatives

4.3 Seek to identify strategic strengths as well areas for improvement as a basis for continual enhancement of health outcomes

4.4 Seek feedback on effectiveness of strategic initiatives from and provided to community and organisation(s) involved in health service delivery

4.5 Communicate outcomes of the evaluation to relevant stakeholders to guide future activities in the delivery of health services to the community

REQUIRED SKILLS AND KNOWLEDGE 

This describes the essential skills and knowledge and their level required for this unit.

Essential knowledge :

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes knowledge of:

• Social, cultural and environmental determinants of Aboriginal and/or Torres Strait Islander health, including:

• traditional Aboriginal and/or Torres Strait Islander cultural practices and lifestyle and their impact on Aboriginal and/or Torres Strait Islander health
• importance of land, tradition and cultural practice to aboriginal and/or torres strait islander health
• impact of socio-economic factors on health
• social and political factors that perpetuate disadvantage
• importance of personal achievement, education and supportive family /social networks
• impact of environmental factors on health
• barriers to improving environmental determinants of ill-health

• Means to address access and equity issues, such as:

• strategies Aboriginal and/or Torres Strait Islander families may employ to maintain strong culture and supportive social networks and maximise educational, employment and social opportunities for their children
• understanding the political context of the health care system and availability and access to Medicare benefits
• community development initiatives

• Aspects of Aboriginal and/or Torres Strait Islander health, including:

• relevant definitions of 'health' (such as those of the World Health Organisation, NACCHO)
• Aboriginal and/or Torres Strait Islander community perceptions of major health issues affecting them and underlying causes
• perceptions of non-Aboriginal and/or Torres Strait Islander people relating to major Aboriginal and/or Torres Strait Islander health issues and underlying causes

• Key health statistics (national, state and/or local) for Aboriginal and/or Torres Strait Islander people compared to those of non-Aboriginal and/or Torres Strait Islander population, such as:

• expectation of life at birth
• infant mortality rate
• age standardised mortality ratios for selected health conditions
• incidence of selected health conditions such as diabetes, rheumatic fever and dental caries

continued  ...

Essential knowledge  (continued ):

• Aboriginal and/or Torres Strait Islander history, including:

• history, social structures, beliefs and values of traditional and contemporary Aboriginal and/or Torres Strait Islander communities in Australia
• effects of colonisation as experienced by Aboriginal and/or Torres Strait Islander people
• historical dilemmas faced by Aboriginal and/or Torres Strait Islander people (acknowledge or deny Aboriginality)

• Impacts of government policies and legislation and their impact on Aboriginal and/or Torres Strait Islander communities, families and individuals
• Lifestyle and behavioural determinants Aboriginal and/or Torres Strait Islander health and strategies to address them, including:

• nutrition, physical activity, rest and sleep in relation to holistic health
• known behaviours that pose a significant risk to Aboriginal and/or Torres Strait Islander people
• Aboriginal and/or Torres Strait Islander lifestyle practices and the effects on health
• education and promotion of healthy lifestyle practices
• principles of well being applied to work and study practices

• Primary health care model, including:

• WHO Primary Health Care model and Ottawa Charter principles
• comparison of primary health care model and conventional Western 'medical' model
• development of Aboriginal and/or Torres Strait Islander health services in Australia
• community control in relation to health service delivery to Aboriginal and/or Torres Strait Islander people
• issues in implementation of health services at local, state/territory and national levels

Essential skills :

It is critical that the candidate demonstrate the ability to:

• Support, promote and implement strategies to improve the health of Aboriginal and/or Torres Strait Islander people
• Contribute to the development of strategic initiatives to address Aboriginal and/or Torres Strait Islander health issues
• Contribute to the evaluation of strategic initiatives undertaken

In addition, the candidate must be able to effectively do the task outlined in elements and performance criteria of this unit, manage the task and manage contingencies in the context of the identified work role

This includes the ability to:

• Identify and interpret strategic initiatives relating to Aboriginal and/or Torres Strait Islander primary health care
• Explain strategies, policies and practices that apply to own area of primary health care work
• Explain how social determinants impact health and how their impact may be reduced
• Support strategic initiatives relevant to improving the health of Aboriginal and/or Torres Strait Islander communities
• Contribute to development and evaluation of strategies related social, political, economic and environmental factors impacting on the health of Aboriginal and/or Torres Strait Islander clients and communities
• Build and maintain relationships with community groups, agencies and organisations involved in developing and implementing strategic initiatives impacting on the health of Aboriginal and/or Torres Strait Islander clients and communities
• Reflect on and improve own level and application of skills and knowledge to achieve desirable outcomes and maintain own capabilities

EVIDENCE GUIDE 

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects of assessment :

• The individual being assessed must provide evidence of specified essential knowledge as well as skills
• Consistency of performance should be demonstrated over the required range of situations relevant to the workplace
• Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible

Conditions of assessment :

This unit includes skills and knowledge specific to Aboriginal and/or Torres Strait Islander culture

Assessment must therefore be undertaken by a workplace assessor who has expertise in the unit of competency or who has the current qualification being assessed and who is:

• Aboriginal or Torres Strait Islander him/herself

or:

• accompanied and advised by an Aboriginal or Torres Strait Islander person who is a recognised member of the community with experience in primary health care

It is critical that in assessing this unit, consideration is given to the sensitive nature of some aspects of the unit, particularly as they apply to Aboriginal and/or Torres Strait Islander history and culture

Assessment methods should be sensitive to emotional reactions of individuals being assessed, and it is highly recommended that access be made available as required to support, such as counselling in social and emotional well being

Context of assessment :

Competence should be demonstrated working individually, under supervision or as part of a primary health care team working with Aboriginal and/or Torres Strait Islander clients

Assessment should replicate workplace conditions as far as possible

Related units :

This unit may be assessed independently or in conjunction with other units with associated workplace application

RANGE STATEMENT 

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Cultural respect 

This competency standard supports the recognition, protection and continued advancement of the inherent rights, cultures and traditions of Aboriginal and Torres Strait Islander peoples

It recognises that the improvement of the health status of Aboriginal and Torres Strait Islander people must include attention to physical, spiritual, cultural, emotional and social well being, community capacity and governance

Its application must be culturally sensitive and supportive of traditional healing and health, knowledge and practices

Community control 

Community participation and control in decision-making is essential to all aspects of health work, and the role of the health worker is to support the community in this process

Supervision 

Supervision must be conducted in accordance with prevailing state/territory and organisation legislative and regulatory requirements

References to supervision may include either direct or indirect supervision of work by more experienced workers, supervisors, managers or other health professionals

A person at this level should only  be required to make decisions about clients within the organisation's standard treatment protocols and associated guidelines

Legislative requirements 

Federal, state or territory legislation may impact on workers' practices and responsibilities. Implementation of the competency standards should reflect the legislative framework in which a health worker operates. It is recognised that this may sometimes reduce the application of the Range of Variables in practice. However, assessment in the workplace or through simulation should address all essential skills and knowledge across the Range of Variables

Aboriginal and/or Torres Strait Islander health workers may be required to operate in situations that do not constitute 'usual practice' due to lack of resources, remote locations and community needs. As a result, they may need to possess more competencies than described by 'usual practice circumstances'

Under all circumstances, the employer must enable the worker to function within the prevailing legislative framework

Social determinants of health may include :

• Socio-economic factors, including:

• income inequality
• employment, job availability/security
• working conditions
• education
• housing, overcrowding and access to food

• Social inclusion and exclusion, including:

• level of poverty and unemployment relative to the whole society
• isolation of communities located remotely from centres of high employment, education and services
• exacerbation by factors such as gender, age, ability, sexual orientation, culture and religion

• Contribution to the social economy
• Early childhood care and education
• Specific risk factors, including:

• rates of substance misuse and abuse
• poorer nutrition
• incidence of family violence

• Legacy of past (and current) practices:

• removal from land
• cultural dislocation
• family separation
• discrimination

Strategies to address social determinants of health may include :

• Policies of social inclusion to reduce social, economic and environmental inequities and barriers to access and equity
• Promotion of full employment, job security and healthy working conditions
• Facilitation of access to a high quality health system that recognises and addresses mental, social and spiritual health, including health promotion, disease prevention and health protection
• Facilitation of access to quality education, with early childhood education and care, and opportunities for meaningful experiences in lifelong learning and employment training
• Facilitation of access to adequate housing and food.
• Reduction of income disparities to allow access to the basic necessities for healthy living

Agencies and organisations involved in community development initiatives may include :

• Community controlled health providers
• Women's/men's centres
• Government health services
• Welfare agencies
• Emergency services
• Police
• Education and training organisations
• Non-government and private enterprise
• Community government councils
• Elected community organisations
• Homeland/outstation service providers

Aboriginal and /or Torres Strait Islander health bodies , strategies , policies and resources may include :

• National, state/territory and regional Aboriginal and/or Torres Strait Islander health strategies, policies, joint planning bodies
• The National Aboriginal and Torres Strait Islander Health Council
• The National Aboriginal Community Controlled Health Organisation (NACCHO) and its state/territory affiliates
• Resources available nationally, locally and at the state/territory level
• National Aboriginal Health Strategy (1989)
• ABS publications