Identified as a priority by Bridging the Gap partners in Melbourne’s southeast, a multidisciplinary working group designed the Language in Labour project at Dandenong Hospital.

The group comprising representatives from maternity, language services and the Murdoch Institute adopted the Plan-Do-Study-Act (PDSA) framework to try out new ways to enable staff to be supported in offering all women with low English proficiency an accredited interpreter early in labour.

Four PDSA cycles over nine months in 2015 resulted in many learnings and achievements, including:

• The value of bringing together a group comprising managers and front-line staff from different hospital departments and working together to co-design options to address a service gap.
• The benefit of using PDSA to build system and workforce capacity for change; strengthen the intervention; and support reflective practice.
• Identifying the need for professional development to enhance best practice in caring for women with low English proficiency and their families, and working with interpreters.
• A significant increase in the proportion of women who required an interpreter having one in labour.

Members of the working group and researchers have written a paper together reporting the Language in Labour project has been published in the Australian Health Review. The Policy and Practice Brief summarises the learnings and achievements from the project 

More information

• Engaging professional interpreters during labour - Policy Practice Brief424.50 KB
• Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women during labour.

Oh Su Tha Pwee Ah Dah Sah Taw Tha (Karen translation)

The overall aim of Healthy Happy Beginnings is to improve the engagement of families of refugee background in pregnancy and early childhood care, improve health literacy and reduce social isolation.

Healthy Happy Beginnings is a community-based group pregnancy care model for refugee background women. The program has been underway for two years with over 90 women attending to date.

It is a unique model delivered by a multi-disciplinary team including a midwife, maternal and child health nurse, a community-matched bicultural worker and a professional interpreter, to provide clinical pregnancy care and improve health literacy in a community setting.

Community consultation with the Karen mothers and fathers informed the planning of the model of holistic pregnancy care and provided input for the name ‘Healthy Happy Beginnings’.

Women find out about the program from the bicultural worker, GPs, Mercy Hospital, word of mouth from family and friends and other local agencies such as ISIS Primary Care. City of Wyndham, VicSEG New Futures, and Mercy Hospitals Victoria have formed a local partnership to deliver the program. 

The objectives are to:

• Provide culturally appropriate care, centred on the woman and what she wants to know.
• Provide community based care, close to home, enhancing access.
• Be welcoming of women and her family and her community.
• Identify complex obstetric and/or psychosocial needs earlier and respond appropriately with referral as necessary and follow up
• Promote continuity of provider/s and consistency of information; ensure women are fully informed of choices and options.
• Provide integrated pregnancy care that introduces and transitions women to the maternal and child health service and ongoing primary health care.
• Build the capacity of all staff to work with and care for families of refugee background in a collaborative and multi-disciplinary team.
• Evaluate the program, including women’s and staff experiences and assess the financial sustainability of the model.

An evaluation with participants found the program made women feel prepared, confident and reassured, with the greatest benefits coming from storytelling with peers, and developing trusting relationships with a team of professionals with whom women could communicate in their own language. The role of the bicultural worker was considered pivotal in the multidisciplinary care team.

One mother reported:

"I was a first-time mum, so I would come here to speak to the facilitators, and they gave me advice and just made me feel better…very reassuring and encouraging."

The program has recently been awarded funding to expand the program to other sites and communities over the next 4 years. Funding was awarded by the Office for Multicultural Affairs and Citizenship through a Capacity Building and Participation Program - Strategic Partnerships grant. 

Gaps in the collection of demographic information, such as country of birth and language spoken, were identified during a day of professional development for Maternal and Child Health (MCH) staff (City of Greater Dandenong).

This hampers identification of women of refugee background for administrative purposes and may limit the tailoring of care to individual families, the understanding a woman’s needs for interpreting services and their preferred language is an example here.

Using the Plan-Do-Study-Act (PDSA) approach and starting small with just two MCH nurses at one centre, demographic information was checked for completeness and updated.

We monitored results over time with learnings showing that:

• It didn’t take any extra time in the appointment to ask women where they were born, when they arrived in Australia and their preferred language.
• Asking was straightforward and considered part of standard practice.
• The questioning did not offend family members; in fact, this led to more open conversations.
• Sometimes it was difficult to remember to ask; electronic prompts weren’t mandatory.

To replicate success and upscale learnings to another MCH centre, one participating MCH nurse was identified as a refugee ‘data champion’ and shared learnings, achievements, and to help others.

Women of refugee background, people seeking asylum and other vulnerable populations presenting for pregnancy care have been under-identified in health service administrative data and in clinical settings.

This hampers the ability to inform care and enhance referral pathways that best meets the needs of these women. The Bridging the Gap partnership group in Melbourne’s west prioritised improving the identification of women who may be of refugee background by testing ways to improve administrative data sets and by improving the quality of general practitioner (GP) referrals to maternity.

A working group formed to undertake service mapping of the current patient registration system, to identify the issues and complexities (e.g. multiple system interfaces) to streamline and enhance the patient registration processes and timely triage for the prioritisation to caseload midwifery care. More questions arose and several inter-related projects to improve identification occurred at the same time:

• Inclusion of four data items - Country of birth, Year of Arrival, Language spoken and Interpreter required – to provide a proxy measure for identifying people of refugee background in administrative data; this included understanding which data was captured in systems such as IPM (inpatient management) and the Birthing Outcome System.
• Because of service mapping, the patient registration and referral pathways and initial auditing of data in maternity referral forms at Sunshine Hospital, gaps in information provided via GP referral to the health service were found.
• Collaboration with a parallel project to improve the quality of referrals provided an opportunity for the four data items (listed above) to be included.
• Internal and external consultation undertaken by GP Liaison at Western Health, along with professional development and newsletters, supported general practice managers and GPs to improve referrals.
• Using the Plan Do Study Act (PDSA) framework proved invaluable in the various phases of improving the quality of referral data.
• A new position, triage midwife, enabled early identification of vulnerable women, including those of refugee background, for triage to Midwifery Group Practice or Caseload midwifery. The model offers continuity of care from pregnancy, including birth and in the early days after birth, and transition to maternal and child health.
• Maternity booking clerks (who receive and enter referral data) attended a professional development session on identification of asylum seeker and refugee background families, and continue to play an important role in enabling patient identification.