Enhancing the implementation of the Aboriginal and Torres Strait Islander Child Placement Principle: policy and practice considerations

Overview The Aboriginal and Torres Strait Islander Child Placement Principle ("the Principle") was developed in recognition of the devastating effects of forced separation of Indigenous children from families, communities and culture. The Principle exists in legislation and policy in all Australian jurisdictions, and while its importance is recognised in many boards of inquiry and reviews into child protection and justice systems, there are significant concerns about the implementation of the Principle. Recent estimates suggest the Principle has been fully applied in as few as 13% of child protection cases involving Aboriginal and Torres Strait Islander children. The purpose of this paper is to explore the contemporary understanding of the Principle, and review the multiple and complex barriers at the policy and practice levels which are impeding its implementation. Promising approaches that might address these barriers are also examined. Key messages The Aboriginal and Torres Strait Islander Child Placement Principle was developed in response to the trauma experienced by individuals, families and communities from government policies that involved the widespread removal of Aboriginal and Torres Strait Islander children. „ The fundamental goal of the Principle is to enhance and preserve Aboriginal and Torres Strait Islander children’s connection to family and community, and sense of identity and culture. „ The Principle is often conceptualised as the “placement hierarchy”, in which placement choices for Aboriginal and Torres Strait Islander children start with family and kin networks, then Indigenous non-related carers in the child’s community, then carers in another Aboriginal or Torres Strait Islander community. If no other suitable placement with Aboriginal and/or Torres Strait Islander carers can be sought, children are placed with non-Indigenous carers as a last resort, provided they are able to maintain the child’s connections to their family, community and cultural identity

Gambling in a remote Aboriginal setting - the good, the bad and the ugly

In 2009 the Ceduna Koonibba Aboriginal Health Service, an Indigenous-specific service, and Statewide Gambling Therapy Service joined together to investigate the impact that gambling was having on the Aboriginal people living in this region. Both organisations were funded through the state-based Office for Problem Gambling to provide gambling intervention. A number of signs indicate that the community development approach has proven effective. Towards the end of the first year of the project six people signed up for one-on-one therapy to address gambling; a small group of women met regularly to learn more about how to overcome gambling and provide support to each other. In general, there has been a notable improvement in the level of engagement with the program amongst health and welfare workers in the town, with the Project Officers regularly meeting with staff across agencies

‘Imagine if I gave up smoking ...’: a qualitative exploration of Aboriginal participants’ perspectives of a self-management pilot training intervention

Author version made available in accordance with the publisher's policy.This paper reports on a pilot qualitative study investigating Aboriginal participants’ perspectives of the Flinders Living Well Smoke Free (LWSF) “training intervention”. Health workers nationally have been trained in this program, which offers a self-management approach to reducing smoking among Aboriginal clients. A component of the training involves Aboriginal clients volunteering their time in a mock care planning session providing the health workers with an opportunity to practise their newly acquired skills. During this simulation the volunteer clients receive one condensed session of the LWSF intervention imitating how the training will be implemented when the health workers have completed the training. For the purpose of this study ten Aboriginal clients who had been volunteers in the mock care planning process, underwent a semi-structured interview at seven sites in Australia, including mainstream health services, Aboriginal Medical Services and remote Aboriginal communities. The study aimed to gauge their perspectives of the training intervention they experienced. Early indications suggest that Aboriginal volunteer clients responded positively to the process, with many reporting substantial health behaviour change or plans to make changes since taking part in this mock care planning exercise. Enablers of the intervention are discussed along with factors to be considered in the training program

Ten principles relevant to health research among Indigenous Australian populations

Writing in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value.1 As committed Indigenous health researchers in Australia, we reflect Marmot’s ideal — to provide the answers to key questions relating to health that might enable Indigenous Australians to live the lives that they would choose to live.As a group, we have over 120 collective years’ experience in Indigenous health research. Over this time, particularly in recent years as ethical guidelines have come into play, there have been many examples of research done well. However, as the pool of researchers is constantly replenished, we hold persisting concerns that some emerging researchers may not be well versed in the principles of best practice regarding research among Indigenous Australian populations. Implementing any research methodology among Indigenous Australian groups will work best when the following 10 principles are met. These principles are reflected in the many documents related to working and researching with Indigenous Australians; for example, the National Health and Medical Research Council (NHMRC) ethical guidelines for research among Aboriginal and Torres Strait Islander people.2 In this article, we set out these principles in one short, accessible document

An oral health literacy intervention for Indigenous adults in a rural setting in Australia

BACKGROUND: Indigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy. METHODS/DESIGN: This is a randomised controlled trial (RCT) that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrolment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism. DISCUSSION: This study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities.Eleanor J. Parker, Gary Misan, Alwin Chong, Helen Mills, Kaye Roberts-Thomson, Alice M. Horowitz and Lisa M Jamieso

Reducing disease burden and health inequalities arising from chronic disease among Indigenous children: an early childhood caries intervention

Background: This study seeks to determine if implementing a culturally-appropriate early childhood caries (ECC) intervention reduces dental disease burden and oral health inequalities among Indigenous children living in South Australia, Australia. Methods/Design: This paper describes the study protocol for a randomised controlled trial conducted among Indigenous children living in South Australia with an anticipated sample of 400. The ECC intervention consists of four components: (1) provision of dental care; (2) fluoride varnish application to the teeth of children; (3) motivational interviewing and (4) anticipatory guidance. Participants are randomly assigned to two intervention groups, immediate (n = 200) or delayed (n = 200). Provision of dental care (1) occurs during pregnancy in the immediate intervention group or when children are 24-months in the delayed intervention group. Interventions (2), (3) and (4) occur when children are 6-, 12- and 18-months in the immediate intervention group or 24-, 30- and 36-months in the delayed intervention group. Hence, all participants receive the ECC intervention, though it is delayed 24 months for participants who are randomised to the control-delayed arm. In both groups, self-reported data will be collected at baseline (pregnancy) and when children are 24- and 36-months; and child clinical oral health status will be determined during standardised examinations conducted at 24- and 36-months by two calibrated dental professionals. Discussion: Expected outcomes will address whether exposure to a culturally-appropriate ECC intervention is effective in reducing dental disease burden and oral health inequalities among Indigenous children living in South Australia.Jessica Merrick, Alwin Chong, Eleanor Parker, Kaye Roberts-Thomson, Gary Misan, John Spencer, John Broughton, Herenia Lawrence and Lisa Jamieso

'I know it's bad for me and yet I do it': exploring the factors that perpetuate smoking in Aboriginal Health Workers - a qualitative study

Extent: 12p. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6963/12/102BACKGROUND Aboriginal Health Workers (AHWs) have a mandate to deliver smoking cessation support to Aboriginal people. However, a high proportion of AHWs are smokers and this undermines their delivery of smoking cessation programs. Smoking tobacco is the leading contributor to the burden of disease in Aboriginal Australians and must be prevented. Little is known about how to enable AHWs to quit smoking. An understanding of the factors that perpetuate smoking in AHWs is needed to inform the development of culturally relevant programs that enable AHWs to quit smoking. A reduction of smoking in AHWs is important to promote their health and also optimise the delivery of smoking cessation support to Aboriginal clients. METHODS We conducted a fundamental qualitative description study that was nested within a larger mixed method participatory research project. The individual and contextual factors that directly or indirectly promote (i.e. perpetuate) smoking behaviours in AHWs were explored in 34 interviews and 3 focus groups. AHWs, other health service staff and tobacco control personnel shared their perspectives. Data analysis was performed using a qualitative content analysis approach with collective member checking by AHW representatives. RESULTS AHWs were highly stressed, burdened by their responsibilities, felt powerless and undervalued, and used smoking to cope with and support a sense of social connectedness in their lives. Factors directly and indirectly associated with smoking were reported at six levels of behavioural influence: personal factors (e.g. stress, nicotine addiction), family (e.g. breakdown of family dynamics, grief and loss), interpersonal processes (e.g. socialisation and connection, domestic disputes), the health service (e.g. job insecurity and financial insecurity, demanding work), the community (e.g. racism, social disadvantage) and policy (e.g. short term and insecure funding). CONCLUSIONS An extensive array of factors perpetuated smoking in AHWs. The multitude of personal, social and environmental stressors faced by AHWs and the accepted use of communal smoking to facilitate socialisation and connection were primary drivers of smoking in AHWs in addition to nicotine dependence. Culturally sensitive multidimensional smoking cessation programs that address these factors and can be tailored to local needs are indicated.Anna P Dawson, Margaret Cargo, Harold Stewart, Alwin Chong and Mark Danie

Empowering Indigenous communities to prevent child abuse and neglect

In some jurisdictions of Australia, the rate of Indigenous children in foster, kinship and residential care on any one night has reached almost one in ten. This rate is almost ten times higher than non-Aboriginal children and has steadily increased over the past decade. Contrast this with rates of non-Indigenous children in out-of-home care, which have stabilised in most jurisdictions. For Aboriginal children and their families, significant spending on responses has yielded little, if any, benefit on the ground. This paradox is the result of long-standing mutual distrust between families and child protection services, a reliance on responses that are mobilised only after harm is suspected, and a failure to address the factors that drive abuse or neglect in Indigenous families. Mutual distrust The policies of removing children have had a profound and enduring effect on the emotional and social well-being of generations of Aboriginal and Torres Strait Islander people. As Aunt Sue Blacklock, Chair of Winangay Resources and the Australian Centre for Child Protection’s inaugural Ambassador for Children, explains: For many Aboriginal children, being removed from the family home also means loss and disconnection from their local community, from their culture and land. This sense of loss of identity and culture, dispossession and separation from local community is the same as those experienced by the Stolen Generations. Current child protection methods marginalise the most disadvantaged and may make them scared to identify problems or ask for help. For many families, the fear and distrust of “the welfare” has significant impacts on parenting, safety for children and opportunities to receive help. In recognition of this harm and suffering, Aboriginal community leaders developed the Aboriginal and Torres Strait Islander Child Placement Principle in the 1980s. The principle upholds the rights of the child’s family and community to have some control and influence over decisions about their children. It also prioritises options that should be explored when an Aboriginal or Torres Strait Islander child is placed in care. The principle has been adopted in legislation or policy in all Australian states and territories. However, recent reviews estimate it has been fully applied in only 15% of child protection cases involving Aboriginal children. Research has shown that where families have greater involvement in decision making in child protection, there is greater trust and less adversarial relationships between families and child protection services. Delayed response A number of inquiries and policymakers have recommended earlier intervention and prevention support for Indigenous families. But there remains little assistance for Aboriginal children and families to get help before parenting problems reach crisis point. In the Northern Territory (NT), around three-quarters of notifications to child protection services were deemed to require support other than a child protection response. Many of these children do not receive such a response, and the concerns about their well-being may go unaddressed. Problems that could have benefited from early support worsen until they reach a threshold for statutory intervention. Relying only on tertiary systems, which are designed to intervene once harm is suspected of occurring, is expensive, harmful and dehumanising for children and their families. Community members and policymakers liken this focus on responding to harm rather than preventing it as “the ambulance waiting at the bottom of the cliff”. Governments have failed to implement recommendations for earlier intervention and prevention services, or have implemented them poorly by providing services that are not based on evidence of best practice. At times authorities have failed to pay attention to the workforce and training needs of staff delivering programs for families, or have ignored the needs and strengths of communities. This has meant that significant investments have not yielded the anticipated results. It has also meant that children and families might never receive the programs and supports that could be of potential benefit for them. Towards innovative responses Innovation in child abuse prevention and child protection responses for Aboriginal children is growing. The evidence base to help inform what might prevent harm and reduce intergenerational trauma within Aboriginal families is also getting stronger. The strategies with the most promise have been developed by and with Aboriginal organisations and individuals. They focus on: family and community responsibility for raising children evidence-based approaches to early intervention and responding to child abuse and neglect engaging families in service design and delivery mobilising community and family resources for caring for children. Promising examples include the Let’s Start program, which has been running in the Tiwi Islands (and other NT sites) for several years. This program has been well evaluated and focuses on improving parenting skills and promoting parent–child attachment for children with behavioural problems. The Family Group Conferencing program has been trialled in Alice Springs. It brings together extended members of children’s families to share concerns about children, extend protective networks and link families to supports. It also makes plans for children’s protection and care.     For Aboriginal parents affected by poor social and emotional wellness, including mental health problems, the Family Wellbeing Program has been used and evaluated in a number of settings and been shown to have positive outcomes for participants. It has a specific focus on empowerment and personal development of Indigenous people through sharing stories, discussing relationships and identifying goals for the future. The Winangay Aboriginal Kinship Carer Assessment Tools have been developed out of concern about the number of Aboriginal children in out-of-home care and the lack of support for many kinship carers. These assessment and support planning tools are undergoing a large-scale evaluation in Queensland. These approaches represent a seismic shift in working with Aboriginal families and children – from a “power over” to a “power sharing” relationship, and hopefully to an empowering one. The approaches also include a clear focus on the professional development of Aboriginal and non-Aboriginal workers to undertake this work in a culturally safe and evidence-based way. There is often talk of Aboriginal communities taking “ownership” of the most challenging issues. Aboriginal communities are very capable of identifying clear, workable solutions to the problems they face in caring for their children. But they must be given the support and resources to do so and to operate within a system that focuses on preventing harm. • Fiona Arney, Chair and Director, Australian Centre for Child Protection, University of South Australia and Alwin Chong, Director Yaitya Purruna Indigenous Health This article was originally published on The Conversation. Read the original article