Aboriginal Services Research Articles

Searching for John Knox: Heritage Entanglements in Gamilaroi Country

ABSTRACT This essay discusses a road trip through Gamilaroi Country in regional New South Wales, “in search of” Pte. John Knox, an Aboriginal serviceman who is buried at Singapore’s Kranji War Cemetery. It shares insights into Australia’s multilayered heritage “entanglements” learned while travelling with his grandson, Les Knox, to their hometown, the Toomelah Aboriginal Community on the border of Queensland and New South Wales. Written collaboratively as an account of places encountered episodically during this shared journey, the essay describes the many suppressed layers of First Peoples’ memory and memorialisation that are drawn to the surface by storytelling. They are obscured by the more visible and prominent settler heritage of war memorials and ex-military migrant camps. The first part of this article traces John Knox’s training in Australia and service in Malaya through maps conjectured using various sources. The second part of the essay focuses on three key physical sites: The Toomelah War Memorial, the Myall Creek Massacre Memorial Site and the 1965 Freedom Ride, where this heritage manifests. It raises deeper questions on the “politics of sharing:” how we define and commemorate “conflict,” how and when we acknowledge Aboriginal service people and whether we connect to the Asia Pacific region.

Knowledge interface co-design of a diabetes and metabolic syndrome initiative with and for Aboriginal people living on Ngarrindjeri country

ObjectivesThis research program involves two phases to identify enablers and barriers to diabetes care for Aboriginal people on Ngarrindjeri country; and co-design a strength-based metabolic syndrome and Type 2 Diabetes (T2D) remission program with the Ngarrindjeri community. Study designA study protocol on qualitative research. MethodsThe study will recruit Aboriginal people living on Ngarrindjeri country above 18 years of age with a diagnosis of metabolic syndrome or T2D. Recruitment for phases one and two will occur through the Aboriginal Health Team at the Riverland Mallee Coorong Local Health Network. The lived experiences of T2D will be explored with 10–15 Aboriginal participants, through an Aboriginal conversational technique called ‘yarning’ (60–90 min) in phase 1. Elders and senior community representatives (n = 20–30) will participate in four co-design workshops (2–4 h) in phase 2. Qualitative data will be transcribed and thematically analysed (NVivo version 12). The analysis will focus on protective factors for the Cultural Determinants of Health. Ethics approval was obtained from Aboriginal Health Research Ethics Committee in South Australia (04-22-1009), and Flinders University Human Research Ethics Committee (5847). ResultsThis work will be used to pilot the co-designed diabetes remission trial. Outcomes will be published in peer-reviewed journals, presented at conferences, focusing on following best practice guidelines from the Australian Institute of Aboriginal and Torres Strait Islander Studies and National Health and Medical Research Council. Research translation will occur through digital posters, manuals, and infographics. ConclusionsThe findings will be summarised to all Aboriginal organisations involved in this study, along with peak bodies, stakeholders, Aboriginal Services, and interested participants.

Strengthening assessment and response to mental health needs for Aboriginal and Torres Strait Islander children and adolescents in primary care settings: study protocol for the Ngalaiya Boorai Gabara Budbut implementation project

IntroductionOpportunities for improved mental health and wellbeing of Aboriginal and Torres Strait Islander children and young people lie in improving the capability of primary healthcare services to identify mental healthcare...

Aboriginal Cultural Safety: A Case Study of Collaborative Practice at the Intersection of Family Violence and Child Protection

ABSTRACT There has been little research into what enables culturally safe collaboration between Aboriginal services and statutory child protection organisations, particularly when family violence is a concern. This article reports on a qualitative study that analysed working group data from practice between KWY Family Safety Services and the Department for Child Protection, South Australia, who came together to build culturally safe collaboration when working with Aboriginal families. The study found that when methods are put into place to deliberately make visible the power dynamics within this context, space for the development of meaningful collaboration with Aboriginal services become possible. However, open and regular communication to raise and work through issues of power as they arose was continually needed to ensure both agencies had the same information and decision making was shared. The implication for practice is that openness to work differently by statutory child protection was reinforced through respect for Aboriginal practice and strengths. IMPLICATIONS Collaboration between Aboriginal services and child protection organisations can be complex and challenging, especially due to the historical and continued discrimination experienced by Aboriginal people. Culturally safe collaboration is enabled through building sustainable relationships; shared understandings and accountability between agencies; redressing of unequal relationships, structures, and outcomes; and respect for Aboriginal ways of working.

Burden of the Beast

Burden of the Beast

Exploring differences in perceptions of child feeding practices between parents and health care professionals: a qualitative study

BackgroundEvidence on child feeding practice is often based on the perspectives and experiences of parents and less that of health practitioners. In this study, we explored child feeding practice in Aboriginal communities in northern Australia from both the parents and health practitioners’ perspectives with the aim of informing nutrition improvement programs.MethodsQualitative research methods were employed. Using semi-structured interviews, parents (n = 30) of children aged 2–5 years, and 29 service providers who were involved in the delivery of child health and nutrition programs in the same communities, were asked about child feeding attitudes and practices. Responses were analyzed through inductive and deductive analysis, recognizing that worldviews influence child feeding practices.ResultsSharing food was a central practice within families. Parents highly valued development of child independence in food behavior but were conflicted with the easy access to unhealthy food in their communities. This easy access to unhealthy food and inadequate food storage and kitchen facilities for some families were major challenges to achieving optimal diets for children identified by Aboriginal families and service providers. The responsive style of parenting described by parents was often misunderstood by service providers as sub-optimal parenting when viewed through a dominant western lens.ConclusionsApproaches to support healthy feeding practices and optimal child nutrition require health-enabling food environments. Along with a community-based Aboriginal health workforce, it is paramount that the non-Aboriginal workforce be supported to be reflective of the impact of worldview on their practice, to ensure a culturally safe environment for families where parenting styles are understood and appropriately supported.

\u201cThis is my boy\u2019s health! Talk straight to me!\u201d perspectives on accessible and culturally safe care among Aboriginal and Torres Strait Islander patients of clinical genetics services

BackgroundAboriginal and Torres Strait Islander people do not enjoy equal access to specialist health services that adequately meet their needs. Clinical genetics services are at the vanguard of realising the health benefits of genomic medicine. As the field continues to expand in clinical utility and implementation, it is critical that Aboriginal and Torres Strait Islander people are able to participate and benefit equally to avoid further widening of the existing health gap. This is the first study to explore barriers to accessing clinical genetics services among Aboriginal and Torres Strait Islander people, which has been acknowledged as a key strategic priority in Australian genomic health policy.MethodsA participatory design process engaged a majority-Aboriginal Project Reference Group and Aboriginal End-User Group. 63 semi-structured interviews were conducted with Aboriginal and/or Torres Strait Islander people who had accessed the government-funded clinical genetics service in Western Australia, Queensland or the Northern Territory between 2014 and 2018. The sample included patients, parents and carers. Participants were asked to recount their ‘patient journey’, from referral through to post-appointment and reflect on their perceptions of genetics and its implications for the health of themselves and their families. Analysis tracked chronological service engagement, followed by an inductive thematic approach.ResultsBarriers to access and engagement were present at each stage of the patient journey. These included challenges in obtaining a referral, long waiting periods, limited genetic literacy, absence of Aboriginal support services, communication challenges and lack of adequate psychosocial support and follow-up after attendance. Participants’ overall experiences of attending a genetic health service were varied, with positive perceptions tied closely to a diagnosis being achieved. The experience of (and expectation for) recognition of cultural identity and provision of culturally safe care was low among participants. Unaddressed concerns continued to cause significant distress in some people years after their appointment took place.ConclusionsThere is significant scope for improving the care provided to Aboriginal and Torres Strait Islander people at clinical genetics services. Immediate attention to minimising logistical barriers, developing relationships with Aboriginal Community Controlled Health Services and providing practical and specific cultural safety training for practitioners is required at the service-level. Our findings strongly support the development of guidelines or policies recognising the collective cultural needs of Aboriginal and Torres Strait Islander people in relation to genomic health care.

Patterns and preferences for accessing health and aged care services in older Aboriginal and Torres Strait Islander Australians.

To determine preferences for health and aged care services in Aboriginal and Torres Strait Islander Australians and explore related factors. Mixed-method, cross-sectional study including 336 Aboriginal and Torres Strait Islander people aged 60years and older from regional and urban areas. Exclusive preference for Aboriginal Community Controlled services was most common. This preference significantly increased when preferences for, and use of, aged care and disability services were considered. The likelihood of holding an exclusive preference for Aboriginal Community Controlled services was higher in regional settings compared to urban and in those reporting lower engagement in traditional activities during childhood. These findings suggest that the majority of older Australian Aboriginal and Torres Strait Islander people prefer aged and disability care provided by Aboriginal services. Given the anticipated increase in service demand in this population, there is a growing need for culturally safe services, particularly in regional settings.

The contribution of group work to the goals of comprehensive primary health care.

Group work, such as peer support and health promotion is an important strategy available to comprehensive primary health care. However, group work and how it contributes to the goals of comprehensive primary health care has been under-researched and under-theorised. In this 5-year study, we partnered with seven Australian primary health care services, and drew on service reports, two rounds of staff interviews (2009-2010 and 2013, N=68 and 55), 10 community assessment workshops (N=65), a client survey (N=315) and case tracking of clients with diabetes (N=184, plus interviews with 35 clients, and five practitioners) and clients with depression (N=95, plus interviews with 21 clients, and 11 practitioners). We conducted a rapid literature review of existing research on group work, and developed a model showing a group work reinforcing cycle. We examined the nature of the groups run, and the benefits staff and clients perceived. Benefits were grouped into four main themes: (a) social support, including for clients of the Aboriginal services, opportunities to celebrate their cultural identity, (b) improving skills and knowledge, (c) increasing access to services and (d) empowerment and solidarity. The perceived collective and individual benefits aligned with a comprehensive primary health care vision. However, the individualism stressed by neoliberal-driven health policy threatened the provision of group work and its potential collectivist benefits. There are multiple benefits of group work in primary health care that cannot be achieved through individual work, highlighting the importance of policy and organisational support for group work.

A Moving Female Frontier: Aboriginal Exemption and Domestic Service in Queensland, 1897–1914

Inspired by new histories of Indigenous mobility that emphasise how movement was an important feature of Aboriginal and Torres Strait Islander experience, this article examines how mobility enables us to better understand the legal status of exemption. It shows the way non-Indigenous families seized on exemption in Queensland between 1897 and 1914 as a way to maintain control over the movement of the women and girls who worked for them as domestic servants. It also examines how those women and girls negotiated, refused and embraced the policy of exemption and used it to gain freedom to move around Queensland, driven by their family connections, ambitions and cultural and community ties. These two different uses of exemption show that even though the 1897 Aboriginals Protection and Restriction of the Sale of Opium Act made the movement of Indigenous people fraught, Aboriginal and Torres Strait Islander people continued their efforts to be mobile.

Developing Culturally Responsive Supervision Through Yarn Up Time and the CASE Supervision Model

ABSTRACTThis article explores a culturally focused supervision training program supporting Aboriginal and non-Aboriginal supervisors to provide cross-cultural supervision for Aboriginal staff within mainstream and Aboriginal community and human service organisations. The key features of the training program, Yarn Up Time and the CASE supervision model are a culturally respectful approach to cross-cultural professional supervision practice with the purpose of contributing to the development of culturally responsive supervision with Aboriginal staff and their clients. The article concludes with feedback from participants who attended the training and supports the future advancement of cross-cultural supervision practice and models in Australia.IMPLICATIONSThere continues to be a need for more culturally responsive supervision for Aboriginal staff and for non-Aboriginal social work practice with Aboriginal people.Yarn Up Time and the CASE model is a culturally appropriate approach for supervising Aboriginal staff and non-Aboriginal social workers’ supervision of social workers’ practice with Aboriginal communities.Social work supervisors need to be able to use an effective cultural supervision model to support Aboriginal staff in Yarn Up Time.

The effectiveness of a sustained nurse home visiting intervention for Aboriginal infants compared with non-Aboriginal infants and with Aboriginal infants receiving usual child health care: a quasi-experimental trial - the Bulundidi Gudaga study

BackgroundIn Australia there is commitment to developing interventions that will ‘Close the Gap’ between the health and welfare of Indigenous and non-Indigenous Australians and recognition that early childhood interventions offer the greatest potential for long term change. Nurse led sustained home visiting programs are considered an effective way to deliver a health and parenting service, however there is little international or Australian evidence that demonstrates the effectiveness of these programs for Aboriginal infants. This protocol describes the Bulundidi Gudaga Study, a quasi-experimental design, comparing three cohorts of families from the Macarthur region in south western Sydney to explore the effectiveness of the Maternal Early Childhood Sustained Home-visiting (MECSH) program for Aboriginal families.MethodsMothers were recruited when booking into the local hospital for perinatal care and families are followed up until child is age 4 years. Participants are from three distinct cohorts: Aboriginal MECSH intervention cohort (Group A), Non-Aboriginal MECSH intervention cohort (Group B) and Aboriginal non-intervention cohort (Group C). Eligible mothers were those identified as at risk during the Safe Start assessment conducted by antenatal clinic midwives. Mothers in Group A were eligible if they were pregnant with an Aboriginal infant. Mothers in Group B were eligible if they were pregnant with a non-Aboriginal infant. Mothers in Group C are part of the Gudaga descriptive cohort study and were recruited between October 2005 and May 2007. The difference in duration of breastfeeding, child body mass index, and child development outcomes at 18 months and 4 years of age will be measured as primary outcomes. We will also evaluate the intervention effect on secondary measures including: child dental health; the way the program is received; patterns of child health and illness; patterns of maternal health, health knowledge and behaviours; family and environmental conditions; and service usage for mothers and families.DiscussionInvolving local Aboriginal research and intervention staff and investing in established relationships between the research team and the local Aboriginal community is enabling this study to generate evidence regarding the effectiveness of interventions that are feasible to implement and sustainable in the context of Aboriginal communities and local service systems.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12616001721493 Registered 14 Dec 2016. Retrospectively registered.

Ancient Australian goes home.

Researchers still hope for access to “Mungo Man” bones

Low uptake of Aboriginal interpreters in healthcare: exploration of current use in Australia\u2019s Northern Territory

BackgroundIn Australia’s Northern Territory, most Aboriginal people primarily speak an Aboriginal language. Poor communication between healthcare providers and Aboriginal people results in adverse outcomes including death. This study aimed to identify remediable barriers to utilisation of Aboriginal Interpreter services at the Northern Territory’s tertiary hospital, which currently manages over 25,000 Aboriginal inpatients annually.MethodsThis is a multi-method study using key stakeholder discussions, medical file audit, bookings data from the Aboriginal Interpreter Service 2000–2015 and an online cross-sectional staff survey. The Donabedian framework was used to categorise findings into structure, process and outcome.ResultsSix key stakeholder meetings each with approximately 15 participants were conducted. A key structural barrier identified was lack of onsite interpreters. Interpreter bookings data revealed that only 7603 requests were made during the 15-year period, with completion of requests decreasing from 337/362 (93.1%) in 2003–4 to 649/831 (78.1%) in 2014–15 (p < 0.001). Non-completion was more common for minority languages (p < 0.001). Medical files of 103 Aboriginal inpatients were audited. Language was documented for 13/103 (12.6%). Up to 60/103 (58.3%) spoke an Aboriginal language primarily. Of 422 staff who participated in the survey, 18.0% had not received ‘cultural competency’ training; of those who did, 58/222 (26.2%) indicated it was insufficient. The Aboriginal Interpreter Service effectiveness was reported to be good by 209/368 (56.8%), but only 101/367 (27.5%) found it timely. Key process barriers identified by staff included booking complexities, time constraints, inadequate delivery of tools and training, and greater convenience of unofficial interpreters.ConclusionWe identified multiple structural and process barriers resulting in the outcomes of poor language documentation and low rates of interpreter bookings. Findings are now informing interventions to improve communication.

Chronological narratives from smoking initiation through to pregnancy of Indigenous Australian women: A qualitative study

ObjectiveOne in two Indigenous Australian pregnant women smoke, yet little is known about their trajectory of smoking. This study aimed to explore Aboriginal women's narratives from starting smoking through to pregnancy. MethodsA female Aboriginal Researcher conducted individual face-to-face interviews with 20 Aboriginal women from New South Wales, Australia. Recruitment, through Aboriginal services and community networks, continued until saturation was reached. Audio-recorded transcripts were independently open coded by two researchers, inductively analysed and reported using a three-dimensional structure of looking backwards, forwards, inwards, outwards and a sense of place, to elucidate the chronology of events, life stages, characters, environments, and turning points of the stories. ResultsA chronology emerged from smoking initiation in childhood, coming of age, becoming pregnant, through to attempts at quitting, and relapse post-partum. Several new themes emerged: the role mothers play in women's smoking and quitting; the contribution of nausea to spontaneous quitting; depression as a barrier to quitting; and the hopes of women for their own and their children's future. The epiphany of pregnancy was a key turning point for many – including the interplay of successive pregnancies; and the intensity of expressed regret. ConclusionsAboriginal women report multiple influences in the progression of early smoking to pregnancy and beyond. Potential opportunities to intervene include: a) childhood, coming of age, pregnancy, post-natal, in-between births; b) key influencers; c) environments, and d) targeting concurrent substance use. Morning sickness appears to be a natural deterrent to continued smoking. Depression, and its relationship to smoking and quitting in Australian Indigenous pregnant women, requires further research.

Have we significantly underestimated the capacity in the Australian health system to treat chronic hepatitis C infection in an interferon-free era?

New antiviral therapies for hepatitis C infection may lead to an increase in capacity to treat because of their simplicity and safety. To determine the likely current capacity of accredited treatment centres in treating hepatitis C (HCV) patients with interferon (IFN)-free direct acting antiviral (DAA) agents in Australia. Data were collected from 22 centres before the introduction of DAA therapy - 11 sites from the Study 1 survey and an additional 11 sites from the Study 2 survey. The sites were selected based on consensus by viral hepatitis experts, in consultation with the NSW Agency for Clinical Innovation. The services were selected as they were experienced in the delivery of IFN-based treatments and/or had knowledge about IFN-free regimens. The sites selected offered a mix of metropolitan and regional clinics, opioid substitution clinics, Aboriginal services, general practitioner-initiated, criminal justice and nurse-led services. Following the survey, the first 3 months of actual treatment uptake, since listing in March and May 2016, became available for a comparison and were subsequently analysed. The survey indicated that an average of 27 h would be required to treat patients with IFN-based regimens. This was reduced to an average of 9 h if IFN-free regimens were used. The average number of patients on IFN-based treatment regimens per site was 87 per year compared to 493 per site if IFN-free therapy was freely available. There is capacity in the current health system to treat five times the numbers of patients with chronic HCV in Australia. When applying a weighted ratio; the results for all centres show a 3.6-fold increase in the capacity to treat with IFN-free regimens. However, these numbers may be an underestimate based on the first 3 months of actual treatment uptake since Pharmaceutical Benefits Scheme listing in March and May 2016. Although current sites have a significant capacity to increase rapidly HCV treatment numbers, expansion of treatment settings and new models of care and training may be required to deliver HCV treatment to all HCV-infected individuals.

Defending Country: Aboriginal and Torres Strait Islander Military Service since 1945

Defending Country: Aboriginal and Torres Strait Islander Military Service since 1945. By Noah Riseman and Richard Trembath (St. Lucia: University of Queensland Press, 2016), pp. xi + 243, photographs, bibliography, AU$34.95 (pb).

Effectiveness of the Koorliny Moort out-of-hospital health care program for Aboriginal and Torres Strait Islander children in Western Australia.

To determine whether the Koorliny Moort program could reduce emergency department presentations, hospital admissions and length of stay, and improve attendance at out-of-hospital appointments for Aboriginal and Torres Strait Islander children in Western Australia. Children were enrolled in the program from 1 August 2012. Each child acted as their own control. Evaluation data were collected from 1 August 2010 to 31 July 2014. Occasions of service and person-time in days were compared for each child before and after referral to the program. Aboriginal children aged 0-16 years residing in three WA regions (Kimberley, Pilbara, Perth metropolitan) who were referred to the Koorliny Moort program. Partnerships with primary care providers; nurse-led care coordination; and outreach care by paediatricians, nurses and social workers closer to the home of the child. Emergency department presentations; hospital admissions; length of hospital stay; non-attended appointments. A total of 942 children were referred to the program. There were significant decreases after referral to the program in the incidence of emergency department presentations (incident rate ratio [IRR], 0.47; 95% CI, 0.43-0.53; P <0.001), of hospitalisation (IRR, 0.70; 95% CI, 0.62-0.79; P <0.001), and of non-attended appointments (IRR, 0.83; 95% CI, 0.74-0.94; P <0.001), as well as in the mean length of hospital stay (IRR, 0.23; 95% CI, 0.21-0.25; P <0.001). Health-seeking behaviour and health outcomes for Aboriginal children can be improved by engaging Aboriginal families in their health care, providing effective communication between health service providers, and delivering a coordinated program of Aboriginal service provider-led care.

Elite Indigenous Masculinity in Textual Representations of Aboriginal Service in the Vietnam War

ABSTRACTThis article analyses three texts that feature Aboriginal soldiers or veterans of the Vietnam War as protagonists: the novel Not Quite Men, No Longer Boys (1999), the play Seems Like Yesterday (2001) and the Redfern Now television episode “The Dogs of War” (2013). In all three texts, military service in Vietnam inculcates among the protagonists sentiments constitutive of what Brendan Hokowhitu refers to as elite Indigenous masculinity—the mimicry and appropriation of white hegemonic masculinity. Constructing themselves as elite Indigenous males allows the Aboriginal soldiers/veterans to position themselves as superior to “other” Aboriginal males. Through the course of the texts, though, the protagonists come to realise that elite Indigenous masculinity is a myth because civilian (white) Australia will continue to judge them the same as other Aboriginal men. Through encounters with other Aboriginal men, the Aboriginal soldiers/veterans are able to reconceptualise their own masculinities and to accept the legitimacy of multiple Aboriginal masculinities.

Aboriginal service in the First World War: Identity, recognition and the problem of mateship

The popular construction of unconditional mateship, said to make the Australian Imperial Force (AIF) the band of brothers it never was, today overshadows the existence of racism in the AIF, and the fact that the negative treatment Aboriginal servicemen received post-war was often at the hands of those now said to have been their mates. This mateship myth also obscures the failure of white Australia to recognise the service of Aboriginal men. Before examining these intersecting phenomena, I first consider the diversity of the men who comprised the Aboriginal soldiers of the First World War to counter the oversimplification of this group. This masks individual stories and denies identities, including cultural identity, and in doing so reinforces generalisations about Aboriginal mateship. I then examine the contradictions in the observance of the 'Defence Act 1903' (amended 1909) and draw attention to the pragmatism and racism that underpinned the enlistment of Aboriginal men and their relationships within the AIF. Following this, an examination of the post-war treatment and recognition of Aboriginal servicemen exposes the transient reality of the wartime 'mateship' now prominent in discussion of Aboriginal war service.