Anex Bulletin: Hi Felicity! What’s the scope and scale of your role today?
Felicity Sheaves: I manage the HIV and Related Services within Population Health for Nepean Blue Mountains Local Health District, NSW Health.
We are a small outer metropolitan sister/brother team comprised of NSP, hepatitis health promotion and sexual health promotion. The team has approximately 7.2 full time equivalent staff.
I am responsible for the coordination of hepatitis prevention services – inclusive of needle and syringe programs. The NSP is across four local government areas – Hawkesbury, Penrith, Blue Mountains and Lithgow.
I have very recently become responsible for managing the Sexual Health Promotion Team, promoting positive sexuality and preventing HIV and STIs.
AB: What career path brought you to your current position?
FS: I was a late studier – I finished an honours degree in health communications. I was interested in health promotion and had been working as a research assistant in a centre at Western Sydney University called the Centre for Research in Healthy Futures on a healthy food project. I saw the NSP casual position come up and applied for the outreach role. In 1998 I moved into the hepatitis project officer role, thinking of ways to engage people with hepatitis C. I worked with a part-time researcher and we rolled out the Safe Injecting Cwiz project [more of this later].
Then the NSP coordinator position came up at Nepean and I put my hand up for that role. I took on that position and it was a really great time. We’d been a mobile outreach program in Nepean Blue Mountains where I’d previously worked as a casual. It was a high methadone injecting area and we were still providing winged infusion sets and 10 and 20 ml syringes (which were all later banned in NSW to ‘prevent’ methadone injecting). I oversaw the move to a new location and we had a support nurse – we weren’t aware of any sites outside Redfern and Kirketon Road with a nurse. We handed our needles and syringes and were also able to build up a great level of trust with the clients through the nursing service.
AB: What sense of satisfaction do you get from your role?
FS: It’s a constantly changing environment. With the new direct acting anti-viral treatments we’ve been able to build upon our partnerships. Working with your partners – that’s the really satisfying part of it. What you can do with your scarce resources!
AB: What initiatives have you introduced in your work that NSPs in other jurisdictions could learn from?
FS: Our approach is to build trust and rapport through responsive service delivery and integrating health care through key partnerships. When you haven’t got many resources, look around to see who you can partner with to provide the best possible levels of care.
Listen to what the punters are saying about how best to work with them and meet their needs and work as closely with the peak consumer organisation. For us, this is the New South Wales Users and AIDs Association.
I’m lucky enough to work with a super experienced team of long-term staff who’ve worked 15 – 20 years in this field. We’ve continued to grow our work over the years, learn from many mistakes and laugh at ourselves and with each other.
Whilst our teams are small we have more than one discipline – health education officers, nurses, social workers and a contract part-time Aboriginal peer support worker employed through the NSW Users and AIDs Association since 2015.
The teams provide a wealth of experience and important complementary skill sets which enables a diversity of work to occur. The NSP for example has been providing nursing care to NSP clients since 2002, which was really unusual in NSW apart from the legendary Kirketon Rd Centre.
Collaboration, cooperation and shameless self-promotion of scalable projects has been our style, so when we think that we have good projects or ideas we actively engage the sector with them.
In 2003 the NSP won the Anex NSP Program Excellence Award for the Safe Injecting Cwiz, a hepatitis C prevention project for young people under 25. This incentivised project was based on the American Sociologists work of Bob Broadhead and Doug Heckathorn from the Eastern Connecticut Health Outreach (ECHO) project.
These projects were the forerunners of the Deadly Liver Mob, Positively Hep projects and other incentivised project models in NSW. Incentives and NSP were really controversial, due to fear of shock jocks and general risk aversion at the time, so it took another ten years to get this project work up and running and embedded in core business.
In 2016 the NSP partnered with Sexual Health and the Liver Clinic to enable NSP clients to receive hepatitis C treatment. The NSP used the two key multifaceted incentivised hep C projects to engage at risk clients, fostering interest and understanding about the direct acting antiviral treatments and demand for education, assessment and treatment on site in the NSP.
Through the Positively Hep project, South Court NSP has engaged over 330 NSP clients in education, screened 145, 63 were found to have chronic hepatitis C and treated 22 to date.
The Sexual Health Director/staff specialist provides medical oversight for hepatitis testing, assessment and treatment, as well as a performance and image enhancing drugs (PIEDs) clinic, and supporting a smoking cessation project within the NSP.
Rotations of medical registrars through the sexual health clinic have also provided the NSP with medical support and the opportunity to influence doctors along their medical journey.
AB: What is your most pleasing achievement?
FS: Working with colleagues in the sector to influence change is really fabulous.
The big ticket item has been the endorsement and roll out of the Deadly Liver Mob project across seven local health districts in NSW. This has been a significant collaborative effort with my hepatitis project partner Louise Maher and the Aboriginal NSP worker Kerri-Anne Smith. We worked hard to develop and propel the project as an up scalable model and great way to work with priority populations. This project is funded by a NH&MRC grant administered by the Centre for Social Research in Health. It’s endorsed by the NSW Ministry for Health and local health district partners. The uptake of the project in rural, regional and metropolitan sites is really exciting and it’s delivering encouraging results.
AB: If you could change one thing (practical or policy) in NSPs in Australia what would that be? Why?
FS: Provide free access for peer distribution of naloxone to save lives now.
All health facilities such as community health centres and emergency departments should be mandated as designated NSP access points with external free vending machines and internal access to a full range of equipment. We need to take away arbitrary site approvals and also fund primary health care and injecting centres in key locations with dedicated multidisciplinary teams and peer workers to address the range of health issues for people who use drugs.
AB: Thanks for your time Felicity.
– Sophie Marcard