About This Programme
Coordinated care, culturally led
ITC was established to empower Aboriginal and Torres Strait Islander people facing complex chronic diseases and health decisions by facilitating access to personalised one-on-one assistance through Care Coordination and Supplementary Services funding.
The objectives of this program are to contribute to improving health outcomes for Aboriginal and Torres Strait Islander people with chronic health conditions and improving equitable access to culturally safe primary health care services (including, but not limited to general practice, allied health and specialist services) through community-controlled organisations, while also maintaining client choice with mainstream options.
Care Coordination
Who Delivers It & Who It's For
At Torres Health Indigenous Corporation, we employ Care Coordinators (who have a clinical background as a Health Worker and/or Nurse) with a Senior Team Project Officer and support from our Clinical Lead to tailor Care Coordination to meet the needs of the communities that we service. With the exception of Badu Island (who are serviced through NPAWS in Bamaga), we have clients referred to us from all the Torres Strait Islands.
Eligible clients must identify as Aboriginal and/or Torres Strait Islander people and must have a chronic condition diagnosed that has been or is likely to be present for six months or more. Care Coordination is working collaboratively with our clients, their GPs, and other service providers so that the clients can understand their chronic health condition and how to manage it appropriately, as well as advocating for the client to navigate the mainstream and specialist services.
Supplementary Services
Additional Support Funding
Supplementary Services funding provides assistance to clients to access medical specialist and allied health services where other services are not available in a clinically acceptable timeframe, and other sources of funding are not available.
Examples of Supplementary Services include providing Cab Charges for clients to attend specialist medical appointments when travelling to Cairns/Townsville/Brisbane; payment for gap fees for accommodation (for the client only) where Queensland Health has a daily capped fee; purchase of medical aids such as assisted breathing devices (CPAP machines and accessories, nebulisers); medical grade footwear that is prescribed and fitted by a podiatrist; mobility aids (e.g. walking frames, non-electric wheelchairs, shower stools); and spectacles (for eyesight issues related to chronic disease).
Referral Information
How to access ITC
Referrals to the ITC program are predominantly from mainstream GP services, and clients must have a current GP Chronic Condition Medical Plan (GPCCMP) and a Torres Health ITC referral completed. If clients self-refer, they are assisted through care coordination to obtain a current GPCCMP. On the Outer Islands, a Remote Area Nurse (RAN) can also refer to ITC, but the client must see the GP on the next visit to the island. We also can take referrals from allied health clinicians as long as the client has a current GPCCMP.
Clients who are able to self-manage, or who do not have contact with the ITC team after 3 months are “exited” from the program; however, they can be re-enrolled at any time where they require further care and support.
Referrals are accepted via email to itc@torreshealth.com or referrals@torreshealth.com