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ASSI Linker Model
​Empowering induvial change, family and community change

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The The ASSI Linker Model has been designed to be used by Link Workers in preventative and primary health care; however, The ASSI Linker Model it can also be used to maintain and support Cultural Identity, Education and Employment, Access to Social Services, Transport and Mobility and Justice.

While the ASSI Linker can effectively (as reported in the Pilot Program) provide support to a person in Tertiary Health Services or Government Service, it is the responsibility of the service to provide Culturally safe access to services to all.

An ASSI Linker can effetely support relationships, community support, Communication and access to information

Without this separation of responsibilities the ability to built trust is compromised.

Aboriginal and Torres Strait Islander Communities are supported through the Aboriginal and Torres Strait Islander Cultural Capability Framework: Queensland Health has implemented the Aboriginal and Torres Strait Islander Cultural Capability Framework 2010-2033. This framework aims to ensure that health services are culturally respectful and competent, addressing the specific needs of Aboriginal and Torres Strait Islander peoples [1]. The framework focuses on increasing the knowledge and skills of healthcare staff to deliver culturally safe services.

The ASSI Linker Model has been designed to support people who are Australian South Sea Islanders.

In the Queensland Context, 
  1. the Australian South Sea Islander Recognition Statement [4]
  2. Queensland Multicultural Health Policy and Action Plan: This plan guides the vision that all people from multicultural backgrounds in Queensland can access safe, equitable, and culturally appropriate public healthcare. It addresses challenges [such as language and cultural barriers, health literacy, and discrimination [2]
    .. The plan represents a significant milestone in improving health outcomes for multicultural communities in Queensland.
  3. Multicultural Policy and Action Plan: The Queensland Government's Multicultural Policy and Action Plan sets out a vision for cultural diversity and inclusion by 2032. It focuses on delivering culturally responsive services, promoting social cohesion, and driving diversity and inclusion across the public sector [3] 

1: Cultural Capability. Queensland Health. 
2: Queensland Multicultural Health Policy and Action Plan. Queensland Health. 
3: Multicultural Policy and Action Plan. Department of Women, Aboriginal and Torres Strait Islander Partnerships, and Multicultural Affairs.
4: The Australian South Sea Islander Recognition Statement

The Northern Queensland Primary Health Network funded the proof of concept project.

The ASSI Linker model ​
  • Provides direct client support for South Sea Islander people with mental illness and chronic disease to provide linkages to the relevant services.
  • Maintain and update information on specified platforms to create a local system that supports consumers and providers to navigate care, social and community services in the Region to both prevent and manage chronic health conditions.

The ASSI Linker Model requires
  • a Community Reference Group to maintain cultural safety and provide appropriate services and support
  • the uses Linksocial.com.au to monitor and demonstrate impact

The ASSI Linker Model is based on the 2014 and 2024 Australian South Sea Islander Community (and Health) Survey

Summary of Findings
The Role of Link Workers in supporting Strong Relationships Community Support and Clear Communication in Managing Chronic Disease. Managing chronic diseases such as diabetes, heart disease, and arthritis often requires more than just medical interventions. Active involvement, community support, strong relationships, and clear communication play crucial roles in helping individuals manage these conditions effectively. This article explores the evidence-based benefits of these factors in chronic disease management, drawing on recent Australian research and studies.

1. Active Involvement in Self-Management
Active involvement in self-management is essential for individuals with chronic diseases. This includes participating in decision-making, setting personal health goals, and adhering to treatment plans. A study by the Australian Government Department of Health and Aged Care found that active involvement in self-management leads to better health outcomes and more sustainable behaviour changes[1]. Patients who are actively engaged in their care are more likely to adhere to their treatment plans and make healthier lifestyle choices.

2. Community Support and Shared Experiences
Community support can significantly impact the well-being of individuals with chronic diseases. Emotional support from community groups can reduce stress and anxiety, which are often exacerbated by chronic illness. The Australian Institute of Health and Welfare (AIHW) highlights that community support can lead to better mental health outcomes for individuals with chronic illnesses[2]. Peer support groups provide a platform for individuals with similar conditions to share their experiences and coping strategies, improving self-efficacy and quality of life[3].

3. Community-Based Self-Management Programs
Community-based self-management programs are essential in helping individuals manage their chronic conditions. These programs provide education and resources to help patients take control of their health. Research indicates that community-based programs can lead to better health outcomes and more sustainable behaviour changes. A study by the Australian Government Department of Health and Aged Care emphasises the importance of community involvement in self-management programs[4]. This collaborative effort can lead to more effective disease management and improved health outcomes.

4. Strong Relationships and Emotional Support
Strong relationships with family and friends play a pivotal role in managing chronic diseases. Emotional support from loved ones can reduce stress and improve mental health. The AIHW reports that close relationships can lead to better mental health outcomes for individuals with chronic illnesses[2]. The presence of a supportive partner or family member can help patients cope with the emotional burden of their condition, leading to improved overall well-being.

5. Clear Communication and Health Outcomes
Clear communication between patients and healthcare providers is crucial for effective chronic disease management. Good communication ensures that patients understand their treatment plans and are more likely to adhere to them. A study by Charles Darwin University identified barriers and enablers to good communication in chronic condition management, emphasising the importance of open, two-way communication[5]. Effective communication can lead to better health outcomes and improved patient satisfaction.

6. Integrated Care and Social Networks
Integrated care interventions that strengthen primary care relationships have been shown to improve chronic disease management by fostering better communication and support networks[6]. Social networks, including friends and community members, influence health behaviours and lifestyle choices. Positive social interactions can encourage healthy behaviours such as regular physical activity and adherence to treatment plans.
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7. Reducing Social Isolation
Chronic diseases often lead to social isolation, which can worsen health outcomes. Community support helps mitigate this isolation by providing companionship and a sense of belonging. The AIHW reports that social support can reduce feelings of loneliness and improve mental health in individuals with chronic illnesses[2]. By maintaining strong social connections, patients are more likely to engage in positive health behaviours and adhere to their treatment plans.

Conclusion
The management of chronic diseases is a multifaceted process that benefits significantly from active involvement, community support, strong relationships, and clear communication. Emotional support, peer groups, community-based self-management programs, and reducing isolation all contribute to better health outcomes. As research continues to evolve, it becomes increasingly clear that fostering active involvement and strong community support is a vital component of effective chronic disease management.

[1]: Review of the National Strategic Framework for Chronic Conditions. Australian Government Department of Health and Aged Care. [2]: The ongoing challenge of chronic conditions in Australia. Australian Institute of Health and Welfare. [3]: Implementing chronic disease self-management in community settings. Australian Government Department of Health and Aged Care. [4]: The effectiveness of chronic disease management planning on self-management. BMC Primary Care. [5]: Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management. Charles Darwin University. [6]: Can integrated care interventions strengthen primary care and improve chronic disease management? Health Policy and Systems.

References
[1] Review of the National Strategic Framework for chronic conditions
[2] The ongoing challenge of chronic conditions in Australia
[3] Implementing chronic disease self-management in community settings ...
[4] The effectiveness of chronic disease management planning on self ...
[5] Barriers and enablers to good communication and information-sharing ...
[6] CSIRO PUBLISHING | Australian Journal of Primary Health
[7] Communicating with patients and colleagues | Australian Commission on ...
[8] https://doi.org/10.1071/PY13087


A resource for community

To use this this model please contact the Queensland United Australian South Sea Islander Association.

Access to Link Social is through Community Information Support Services

Contact QUASSIC

Queensland United Australian South Sea Islander Council​
Level 1, 5 Green Square Close,  FORTITUDE VALLEY QLD 4006 
PO Box 5444 MACKAY MAIL CENTRE QLD 4741
[email protected]

Community Information Support Services
Level 1, 5 Green Square Close,  FORTITUDE VALLEY QLD 4006
PO Box 222, FORTITUDE VALLEY QLD 4006
[email protected] 

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