Career summary

I have thirty years’ experience in the design, implementation and evaluation of health and human services for vulnerable Australians. I have held senior leadership roles in service delivery, program development, system reform, research and public policy.

Most of my career has been in the public sector in large-scale health and human services program design and delivery, funding and public policy. My roles have included leading Aged and Disability services for the NT Government, out of home care policy and funding for the NSW Government and shaping disability policy in NSW. I have also worked in the not-for-profit sector in senior leadership and operational roles and spent a year at Deloitte in their Economics practice. In addition, I have run my own micro-business for more than a decade.

I initiated the Poche Centre for Indigenous Health (USyd) program of high impact translational research in 2013 which included Aboriginal academics and community members as Investigators on all research. When I left in 2019, the Poche Centre had eleven research projects across 78 sites producing high impact translational co-designed research in oral health, children’s health, genomics, cardiovascular disease, lung disease and health systems reform. I have since transferred that research to Djurali at Macquarie University.

Research Impact:

Since joining the team at Macquarie University in late 2019, I have been an Investigator on grants totalling $11.05m to co-design, deliver and evaluate services with priority populations including new approaches to oral health, allied health, hearing, workforce and cardiovascular disease. All of my research includes multidisciplinary researchers, students and community members. 

1. Remote Indigenous oral health project

Our study established a remote, comprehensive dental program with Aboriginal people. Where interventions to prevent common oral diseases like tooth decay have become available to most Australian children in recent decades, Aboriginal children in rural Australia have historically had limited access to public dental services. The disparity is compounded by the cost of basic supplies like toothpaste and toothbrushes, which may be unattainable for some families, and poor availability of cool filtered drinking water in remote communities. We began our research in 2013 and sought to reduce consumption of sugary drinks by installing refrigerated and filtered water fountains in schools and communities. We also engaged teachers to encourage students to fill up their water bottles and drink from them throughout the school day. We also sought to increase fluoride intake by establishing daily in-school tooth brushing programs, supplying toothbrushes and toothpaste for school and home, and applying fluoride varnish to the children’s teeth once each term. We also provided treatment for existing tooth decay and gum disease.

Impact

In just four years we found a reduction in tooth decay, plaque and gingivitis (gum disease). The average number of teeth with tooth decay per child in 2014 was 5.31, compared to 4.13 in 2018. The proportion of children with no tooth decay increased from 12.5% in 2014 to 20.3% in 2018.There was also a dramatic reduction in the proportion of children with severe gingivitis from 43% in 2014 to 3% in 2018. We also saw an increase in positive oral hygiene behaviour including tooth brushing, consumption of drinking water and reduced consumption of sugar-sweetened beverages. In 2014, 13% of children reported brushing their teeth on the morning they took the survey. This increased to 36% in 2018.

This study resulted in funding changes in NSW with funding transferred from Fly in Fly out to Aboriginal Community Controlled Health Services. This remote dental service is now nationally accredited. We compared the cost using two years of Dental Weighted Activity Units (DWAUs) between a Fly in-Fly out program and the community co-design model. The co-design model delivered 47% more treatment at 25% of the cost.

2. School-based fluoride varnish project

Aboriginal children have double the rate of caries of non-Aboriginal children. Fluoride varnish is proven to be safe and effective in the prevention of tooth decay if applied 2-4 times per year. Increasing access to fluoride is part of the NSW Oral Health Plan 2020. Previously, only dental professionals and doctors could apply fluoride varnish. Our study developed and evaluated an effective, systematic and sustainable way to provide fluoride varnish for children at risk of caries.

Our method was based on a co-design process and has been implemented in five stages:

1. Policy development (2014)
2. Rural/remote School based setting (2015/16)
3. Aboriginal Workforce (2017/18)
4. Urban scale up (2018-20)
5. National Scale-up Assessment (2020/21)

Impact

Our research team has hosted three national meeting seeking to harmonise regulation and policy with respect to fluoride varnish nationally. We have been able to shape the fluoride varnish guidelines for vulnerable populations. We have advised on the implementation of the mobile children’s dental program in NSW, Queensland and Tasmania. We have initiated the Initiative Scale Up Assessment Tool along with colleagues nationally to scale the project across Australia. This project has received funding and in-kind assistance from the NSW Government, Colgate and the MRFF.

3. Vocational education project

Aboriginal people typically have poor completion rates for vocational education (~30%). Employment of Aboriginal people in healthcare services improves the cultural competence of those services. Our study designed, implemented and evaluated a seven step model of delivery of vocation education for Aboriginal students.

Impact
More than 500 vocational education qualifications have been awarded to Aboriginal scholars using the seven step approach with a 93% completion rate. Qualifications have been awarded in a range of healthcare para-professions including: Dental Assisting, Aboriginal Health Worker, Cancer care, Counselling, Health Service Assistance, hearing health.